Other Government Health Programs Archives - Page 7 of 18

July 8, 2020

An orthopedic hospital, its management company, a physician’s group, and two physicians have agreed to pay $72.3 million to resolve whistleblower-brought allegations under the Anti-Kickback Statute, federal False Claims Act, and Oklahoma Medicaid False Claims Act of defrauding Medicare, Medicaid, and TRICARE. Between 2006 and 2018, the Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM) and its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), allegedly provided free or below-fair market rate services and compensation to Southwest Orthopaedic Specialists, PLLC (SOS), including SOS physicians Anthony Cruse, D.O., and R.J. Langerman, Jr., D.O., in exchange for patient referrals. USP also allegedly offered preferential investment opportunities to physicians in Texas. As part of the settlement, USP will pay $60.86 million to the United States, $5 million to the State of Oklahoma, and $206,000 to the State of Texas, while SOS and its physician defendants will pay $5.7 million to the United States and $495,619 to the State of Oklahoma. DOJ

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

July 7, 2020

Florida Cancer Specialists & Research Institute, LLC (FCS) has agreed to return more than $2.3 million in overcharges to the VA after a successful qui tam action by a former Claims Resolution Specialist with FCS, Marianne Parker. Parker’s complaint instigated a government investigation that found that an error in the VA’s billing system had led the agency to pay the full amount billed by FCS for certain physician-administered drugs provided to veterans, rather than at the Medicare rate mandated by the Code of Federal Regulations. For alerting the government to the discrepancies, Parker will receive a 20% share of the funds. USAO MDFL

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

June 25, 2020

George Philip Tompkins of Houston, Texas, the former owner of Piney Point Pharmacy, was sentenced to ten years in prison following his conviction on charges of healthcare fraud, unlawful kickbacks, money laundering, and wire fraud. Tompkins billed $21.8 million to federal and state worker’s compensation programs for medically unnecessary compound gels and creams, paying kickbacks to generate prescriptions while claiming that the kickbacks were legitimate marketing expenses. Thompson was also ordered to pay restitution of $12.3 million. DOJ

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Criminal Proceedings, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

June 16, 2020

A doctor in Mississippi has been sentenced to four years in prison and ordered to pay nearly $5 million in restitution and judgment for committing healthcare fraud against multiple insurers, including TRICARE. In exchange for a 35% cut of reimbursements, Dr. Shahjahan Sultan had agreed to enter into a contract with a local pharmacy to prescribe expensive compound medications to insured patients, which he did without regard to medical necessity, and which resulted in over $8 million in losses to insurers. USAO SDMS

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

June 5, 2020

Alaska Neurology Center LLC and its owner, Franklin Ellenson, M.D., have agreed to pay $2 million and enter into a three-year Integrity Agreement to resolve allegations of submitting false claims to federal healthcare programs between 2013 to 2018. A whistleblower complaint revealed the defendants had engaged in a bevy of fraudulent billing schemes, including using false dates to bypass caps in reimbursement, billing for services provided by unqualified personnel, billing for non-reimbursable services, using multiple billing codes for procedures covered by a single code, using false names for providers, and resubmitting already rejected claims using false service or diagnosis information. The whistleblower in this case will receive a relator’s share of $380,000. USAO AK

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

April 15, 2020

A Florida-based reference laboratory, pain clinic, and two former executives have agreed to pay $41 million to settle claims of defrauding Medicaid, Medicare, TRICARE, and other government health programs by billing for medically unnecessary urine drug tests between 2010 to 2017. Led by Michael T. Doyle and Christopher Utz Toepke, the defendants allegedly had a policy of automatically ordering both presumptive and definitive urine drug tests for all patients at every visit regardless of need, with Toepke’s Tampa Pain Relief Centers Inc. performing all presumptive tests, and Doyle’s Logan Laboratories Inc. performing all definitive tests. The alleged False Claims Act violations were eventually brought to light in two qui tam cases; the whistleblowers of those cases will split a relator’s share of approximately $7.79 million. DOJ; EDPA; MDFL; FL

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

April 2, 2020

FPR Specialty Pharmacy LLC and Mead Square Pharmacy, Inc., along with owners Christopher Casey and William Rue, have agreed to pay $426,000 to settle a whistleblower-brought case alleging violations of the Anti-Kickback Statute and False Claims Act in connection with a compounded prescription analgesic cream called Focused Pain Relief. As part of the settlement, the defendants admitted that from 2011 to 2015, they sold prescription drugs to patients in states they were not licensed to sell in, failed to charge mandatory co-pays to beneficiaries of various federal healthcare programs, and paid sales agents to solicit physicians to prescribe the cream. USAO SDNY

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

April 1, 2020

A physician’s assistant in Louisiana, Stephen Honeycutt, has agreed to pay $620,500 for accepting illegal kickbacks from OK Compounding, LLC, which has been involved in multiple enforcement actions of a similar nature across the country. Over a period of about six months in 2013, Honeycutt prescribed expensive compounded pain creams to patients, many of whom were Medicare and TRICARE beneficiaries, in exchange for kickbacks disguised as medical director fees. USAO NDOK

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

March 20, 2020

A doctor in Florida has paid the United States $850,000 to settle claims of violating the Anti-Kickback and False Claims Acts. In exchange for prescribing a powerful but highly addictive fentanyl spray, Subsys, to her patients, Dr. Parveen Khanna allegedly took illegal kickbacks from manufacturer Insys Pharmaceuticals, Inc that were disguised as speaker fees, then submitted claims for reimbursement to Medicare and TRICARE in violation of program rules prohibiting payment for kickback-induced services. USAO MDFL

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

March 2, 2020

The owners and operators of Middlesex Rheumatology in Connecticut, Dr. Crispin Abarientos and his wife Dr. Antonieta Abarientos, have agreed to pay $4.9 million to settle allegations of violating federal and state False Claims Act. Between 2013 to 2017, the Abarientos allegedly billed Medicaid for an injectable prescription drug called Remicade, which is used to treat rheumatoid arthritis, but then failed to administer the drugs on Medicaid patients. Instead, they administered them on patients covered by Medicare or the Connecticut State Employees Health Plan, then billed the two providers for the drugs again even though the cost had already been covered by Medicaid. USAO CT

Tagged in: Criminal Proceedings, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

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