Other Government Health Programs Archives - Page 3 of 18

March 30, 2022

Multiple sales representatives of Delaware-based pharmacy, Heritage Therapeutics, LLC have been ordered to forfeit and/or pay fines totaling over $8.7 million after they were found to have paid kickbacks to physicians in exchange for prescribing expensive compounded medications to TRICARE beneficiaries. Additionally, Heritage and various executives have entered into a settlement agreement to resolve claims under the Anti-Kickback Statute and False Claims Act. USAO EDPA

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Other Government Health Programs,

March 28, 2022

A Pennsylvania-based psychiatrist and his wife have agreed to pay $3 million in the largest recovery against a single psychiatrist ever in the history of the U.S. Department of Labor – Office of Worker’s Compensation Programs (OWCP). From 2013 to 2021, Dr. Harry Doyle and his wife and sole employee, Sonya, allegedly billed OWCP for services that weren’t rendered, submitted double-billed and upcoded patient claims, and falsified patient records to reflect their false billing. As part of the settlement, they will be excluded from participating in federal healthcare programs for 25 years. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Upcoding,

February 2, 2022

New York healthcare provider The Door - A Center for Alternatives has agreed to pay $12.9 million to resolve claims that it submitted false claims for reimbursement to New York's Indigent Care Pool, which is funded by Medicaid. The Door was required to submit annual cost reports to New York reporting figures including the number of "threshold visits" to its ambulatory diagnostic and treatment center. A qui tam case initiated by two whistleblowers alleged that defendant knowingly inflated the number of threshold visits to increase payments. SDNY

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Other Government Health Programs, Provider Fraud, Whistleblower Case,

January 12, 2022

Six medical practices affiliated with Interventional Pain Management Center P.C. (IPMC), as well as physician-owner Dr. Amit Poonia, have agreed to pay nearly $7.5 million to resolve allegations of defrauding Medicare and the Federal Employees Health Benefit Program. In a qui tam suit by Anu Doddapaneni and Christian Reyes, the whistleblowers alleged that Poonia and IPMC violated the False Claims Act by using a billing code that mischaracterized P-Stim and NeuroStim treatments—which transmit electrical pulses through needles placed just under the skin of a patient’s ear—as surgical implantation requiring anesthesia. USAO EDNY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Misrepresentations, Other Government Health Programs, Provider Fraud, Whistleblower Case,

December 2, 2021

Texas-based Flower Mound Hospital Partners LLC has agreed to pay $18 million and enter into a five-year Corporate Integrity Agreement to resolve fraud allegations. According to Leslie Jennings, M.D., one of many physician-owners, when Flower Mound repurchased shares from physician-owners nearing retirement age and resold them to younger physicians, the company allegedly improperly took into account the value of each physician’s referrals in selecting to whom and how many shares would be resold. Claims arising from these referrals were then knowingly submitted to Medicare, Medicaid, and TRICARE, in violation of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act. For initiating a lawsuit that resulted in a successful enforcement action, Jennings will receive a $3 million share of the settlement. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

November 9, 2021

Kaléo, Inc., a pharmaceutical manufacturer in Virginia, has agreed to pay $12.7 million to resolve a whistleblower’s allegations that it violated the Anti-Kickback Statute and False Claims Act in claims submitted to Medicare, TRICARE, and the Federal Employees Health Benefits Program. Between 2017 and 2020, kaléo allegedly provided kickbacks to physicians and their staff to induce and reward them for prescribing Evzio, a higher-priced version of a drug used to reverse opioid overdoses and which often requires prior authorization. Kaléo also allegedly directed pharmacies to submit false prior authorizations and dispense Evzio without collecting required co-pays. USAO MA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Pharma Fraud, Whistleblower Case,

November 5, 2021

Two men who pleaded guilty to causing $134 million in false claims to be submitted to Medicare and CHAMPVA have been sentenced to federal prison and ordered to pay restitution of over $29 million. Michael Nolan of Florida was sentenced to 6.5 years, while Richard Epstein of Colorado was sentenced to about 5 years. Using a telemarketing company called REMN Management LLC, as well as a telemedicine company called Comprehensive Telcare LLC, Nolan and Epstein had bribed physicians to sign medically unnecessary orders for durable medical equipment, which they then sold to co-conspirators as support for the false claims. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Other Government Health Programs,

October 28, 2021

Rehab Authority, LLC, a physical therapy provider in Minnesota, has agreed to pay $4 million to resolve allegations by whistleblower Cami Lane that it violated the False Claims Act. RehabAuthority clinics had allegedly submitted false claims to Medicare, Medicaid, TRICARE, and the Veterans Health Administration for one-on-one outpatient physical therapy that was not provided. USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

October 25, 2021

Curant, Inc., which owns pharmacies in Florida and Georgia, has agreed to pay $4.6 million to resolve allegations of paying kickbacks to a third-party marketer, waiving mandatory copays from patients, and overbilling TRICARE for compound pain and scar creams. The alleged misconduct occurred between 2013 and 2015. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

October 20, 2021

MD Spine Solutions LLC, d/b/a MD Labs Inc., and its owners, co-founders Denis Grizelj and Matthew Rutledge, have agreed to pay up to $16 million to settle fraud allegations raised by an unnamed whistleblower. MD Labs had allegedly billed Medicare, Medicaid, and other federal healthcare programs for presumptive urine drug testing as well as confirmatory urine drug testing run on the same samples, which is frequently baseless or useless. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

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