Other Government Health Programs Archives - Page 9 of 18

November 7, 2019

Compound drug ingredient supplier Fagron Holding USA LLC has agreed to pay over $22 million to resolve two qui tam suits involving three of Fagron’s wholly-owned subsidiaries. According to whistleblowers, Freedom Pharmaceuticals Inc. grossly inflated the price of active pharmaceutical ingredients used in compound prescriptions, causing pharmacy customers to submit false claims to TRICARE. Other allegations involved subsidiaries Pharmacy Services Inc. and B&B Pharmaceuticals Inc., which were accused of submitting false claims to federal healthcare programs, manipulating prescription drug pricing, paying kickbacks to physicians, and illegally waiving patient copays. DOJ

Tagged in: Compounding Pharmacy Fraud, Drug and DME Pricing, FCA Federal, Other Government Health Programs, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

October 31, 2019

In the largest healthcare fraud case ever to come out of Mississippi, pharmacy owner Thomas Spell has been sentenced to 10 years in prison and ordered to pay over $243 million in restitution for knowingly defrauding TRICARE. Between 2014 and 2016, Spell and his co-conspirators had deviously marketed compounded medications based on their rate of reimbursement from TRICARE, paid illegal kickbacks to marketers in order to obtain prescriptions from TRICARE beneficiaries, and improperly waived mandatory copayments for TRICARE beneficiaries. USAO SDMS

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

October 29, 2019

A former resident of Atlanta has been sentenced to 1.5 years in prison and ordered to pay $306,179 in restitution for defrauding PERACare, the Colorado Public Employees Retirement Association’s health insurance plan. For more than two years, Michael Bang allegedly submitted fraudulent reimbursement claims involving three Atlanta-area pharmacies to Express Scripts, which administers PERACare’s prescription benefits. Altogether, his scheme netted him over $300,000. USAO NDGA

Tagged in: Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Pharma Fraud,

Catch of the Week: Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M

Posted 10/11/19

Our latest Catch of the Week highlights the successful resolution of a whistleblower lawsuit against a Southern California eye doctor group and several individuals allegedly embroiled in a decade-long scheme to bill publicly funded healthcare programs for unnecessary eye exams. Ophthalmology provider group Retina Institute of California Medical Group (RIC), its former CEO, several of its doctors, and other involved...

Tagged in: Catch of the Week, FCA Federal, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

September 26, 2019

Physician Philippe R. Chain will pay $300,000 to resolve allegations that he caused the submission of false claims to Tricare while working for telemedicine company CallMD. Chain allegedly issued and approved prescriptions for compounded medications, many of which were not medically necessary, without speaking to, examining, or otherwise having a physician-patient relationship with the patients. USAO CT

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Lack of Medical Necessity, Other Government Health Programs, Provider Fraud,

September 18, 2019

Florida-based compounding pharmacy Diabetic Care Rx LLC, also known as Patient Care America, together with two of its executives, CEO Patrick Smith and VP of Operations Matthew Smith, and the private equity firm Riordan, Lewis & Haden Inc., will pay $21.36 million to resolve a case brought by two whistleblowers under the False Claims Act alleging that they paid unlawful kickbacks to secure referrals for patients covered by TRICARE, the federal healthcare program that covers military members and their families. The pharmacy paid patient recruiters to target military members and their families for the prescription of compounded creams and vitamins formulated to ensure the highest possible reimbursement from TRICARE. The marketers in turn paid doctors who issued the prescriptions, often without seeing or even speaking to the purported patients. In addition, the pharmacy and marketing company often covered patient copayments through a sham charitable organization affiliated with the marketing company. Private equity investor RLH was alleged to have known about and agreed to the kickback scheme. Whistleblowers Marisela Medrano and Ada Lopez were, respectively, the former Director of Marketing and the Reimbursement Services Manager of PCA. They will receive a yet-to-be-determined share of the U.S. recovery. DOJ; SD FL

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

August 29, 2019

International SOS Assistance, Inc. and related entities and individuals have agreed to pay $940,000 to resolve claims that they overbilled TRICARE for air medical evacuation services provided to military service members and their families. International SOS was alleged to have negotiated discounts from third-party air ambulance services, but failed to pass those discounts on to TRICARE. The case was brought by a whistleblower who used to be a flight desk manager for International SOS; he will receive an award of $165,000. USAO EDPA

Tagged in: Ambulance, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Other Government Health Programs, Pricing Fraud, Whistleblower Case, Whistleblower Rewards,

August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million. According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals. As part of the settlement, Seddon will receive a $200,000 relator’s share. USAO SDAL

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

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

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

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

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

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