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Other Government Health Programs

This archive displays posts tagged as relevant to government healthcare programs other than Medicare and Medicaid, and fraud in those programs. You may also be interested in our pages:

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August 2, 2019

A Georgia man accused of masterminding a fraud scheme against TRICARE has been sentenced to 8 years in prison and ordered to pay a combined $8 million in restitution and forfeiture.  Coordinated by Michael Burton, the scheme ran from 2014 to 2015 and involved multiple co-defendants and a Florida-based pharmacy.  Together, their cumulative actions caused TRICARE to spent millions of dollars on medically unnecessary compounded prescription drugs, and earned Burton over $1.4 million in commissions.  USAO NDFL

August 1, 2019

Tennessee-based telemarketer Scott Roix and his companies have agreed to pay $2.5 million to settle two whistleblowers’ False Claims suit alleging the submission of false claims to Medicare, TRICARE, and other federal health benefit programs.  Roix and his companies allegedly procured fraudulent insurance information from patients around the country in order to arrange prescriptions for medically unnecessary pain creams; they then sold these prescriptions to pharmacies, labeling proceeds as earned through marketing services.  The whistleblowers in this case, Jennifer Silva and Jessica Robertson, will receive $287,500 for revealing the fraudulent scheme.  USAO MDFL

July 24, 2019

Pennsylvania-based Eagleville Hospital has agreed to pay $2.85 million to settle allegations of defrauding Medicare, Medicaid, and the Federal Employees Health Benefits Program.  According to an anonymous relator, Eagleville violated the False Claims Act between 2011 and 2018 by submitting claims for substance abuse patients improperly admitted for high paying, hospital-level detoxification treatments.  The whistleblower will receive $500,000 of the recovery.  USAO EDPA

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted  07/12/19
Pill container spilled over with pills fallen out.
On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

June 27, 2019

Anne Arundel Medical Center (AAMC) has settled with the United States for alleged submissions of false claims to Medicare, TRICARE, and the Federal Employees Health Benefits Program.  In a whistleblower suit by former AAMC employee Barbara McHenry, the Maryland-based hospital was accused of billing for medically unnecessary Evaluation and Management (E/M) services from 2010 to 2013, and doubled billing for E/M services from 2014 to 2017 despite a 2014 update from CMS.  As part of the settlement, AAMC will pay $3 million and comply with a five-year Corporate Integrity Agreement, and McHenry will receive $473,100.  USAO MD

June 3, 2019

A former physician’s assistant in New Hampshire has been sentenced to 4 years in prison for writing prescriptions of a fentanyl spray in exchange for over $49,000 in kickbacks masked as speaker honorariums.  After being approached by a drug manufacturer in 2013, Christopher Clough wrote upwards of 750 prescriptions for the spray, which was intended for management of breakthrough cancer pain (BTCP).  Over 215 of those prescriptions were for Medicare and TRICARE patients and led to payments of over $2.1 million by Medicare and almost $600,000 by TRICARE.  On top of the kickback charges, Clough was accused of causing patient harm for prescribing the drug, in high doses, to patients who didn’t have BTCP, and then rebuffing patient and family requests to get off the drug.  USAO NH

May 30, 2019

HyperHeal Hyperbarics, an oxygen therapy facility in Maryland, has agreed to pay over $400,000 to settle whistleblower allegations filed under the False Claims Act.  In their 2016 qui tam suit, former employees Lesa Schrum and Juliette Skelton alleged that from 2013 to 2014, HyperHeal and its part-owner Eric Shapiro billed TRICARE for medically unnecessary services, services performed without physician supervision, or services that weren't ever performed.  As part of the settlement, Schrum and Skelton will receive $74,635.25.  USAO MD

May 29, 2019

Almirall, LLC, f/k/a Aqua Pharmaceuticals, LLC , will pay $3.5 million to settle kickback allegations exposed by a former Aqua sales representative.  According to the whistleblower, the pharmaceutical company paid kickbacks in the form of free meals, trips, gift cards, and gifts, to dermatology providers in exchange for prescriptions of their drugs to Medicare and TRICARE patients.  It also paid kickbacks by compensating healthcare providers for speaking engagements and consulting services. For coming forward with details of the fraud, the unnamed whistleblower will receive a $735,000 share of the recovery.  USAO EDPA

May 29, 2019

A doctor in South Carolina has agreed to pay $92,506.30 to settle allegations of accepting illegal payments from OK Compounding, LLC, in exchange for prescribing their pain creams to TRICARE patients.  The False Claims Act violations allegedly occurred between February and May 2013, and involved “medical director fees” paid to Dr. Jerry Back that were in reality, kickbacks.  This was the eighth kickback settlement in the Northern District of Oklahoma since the beginning of the year.  USAO NDOK

March 26, 2019

The owner and managing member of a Mississippi-based pharmacy has plead guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering and tax evasion in connection with a massive $200 million compounding pharmacy scheme involving at least 12 individuals over four years. Glenn Doyle Beach, Jr. of Advantage Pharmacy admitted to marketing and formulating compounded medications for TRICARE patients without regard to medical necessity, falsifying paperwork to mislead auditors, and engaging in money laundering and tax evasion to conceal proceeds. He is scheduled to be sentenced in July. DOJ; USAO SDMS
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