Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing
Posted 10/22/21
Provider Fraud
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October 20, 2021
South Carolina provider Colonial Family Practice, LLC, has agreed to pay $1.25 million to resolve claims that they submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary nuclear stress tests and Cystatin-C tests, the latter of which were routinely submitted as part of a panel run on most patients, despite being payable for only a narrow set of patients. The settlements resolve two qui tam actions brought by a former clinical manager and by a former physician assistant. USAO SCCatch of the Week: Private Equity Firm and Former Executives of a Mental Health Center Reach $25 Million Medicaid Settlement
Posted 10/15/21
October 14, 2021
Owners and executives of Massachusetts mental health provider South Bay Mental Health Center, Inc. have agreed to pay $25 million to resolve claims that they caused the submission of false claims to the state’s Medicaid program, MassHealth, by billing for services provided by unlicensed, unqualified, and improperly supervised staff members in violation of MassHealth regulations. Defendants H.I.G. Growth Partners, LLC and H.I.G. Capital, LLC will pay $19.95 million and defendants Peter J. Scanlon and Kevin P. Sheehan, who held executive and board positions at relevant entities, will pay $5.05 million. The case was initiated by the filing of a whistleblower complaint under the Massachusetts False Claims Act. SBMHC previously agreed to pay $4 million to resolve related charges. MassOctober 8, 2021
U.S. Medical Management, LLC (USMM) and VPA, P.C. (VPA) have agreed to pay $8.5 million to resolve claims raised in five separate qui tam lawsuits that USMM and VPA billed Medicare for medically unnecessary laboratory and diagnostic testing services between 2010 and 2015. Although the government did not join any of the lawsuits, the whistleblower who filed first will receive $1.53 million under the alternate remedy provision of the False Claims Act. USAO EDMISeptember 15, 2021
A cardiologist in Florida who allegedly billed Medicare and Medicaid for medically unnecessary procedures has agreed to pay $6.75 million to resolve claims under the False Claims Act. Between 2013 and 2019, Dr. Ashish Pal allegedly made misrepresentations in patient medical records to justify ablations and vein stent procedures that were not reimbursable under program rules. Additionally, some of the procedures were later found to have been performed primarily by unqualified ultrasound technicians. As part of the settlement, Pal and Interventional Cardiology & Vascular Consultants, PLC, will enter in a multiyear integrity agreement and comply with training and reporting requirements, as well as a quarterly claims review by an independent organization. USAO MDFLConstantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference
Posted 09/10/21
September 3, 2021
A number of South Carolina pain management clinics, drug testing laboratories and other entities associated with chiropractor Daniel McCollum have had default judgments entered against them ordering the payment of $140 million. The defendant entities, Oaktree Medical Centre P.C., FirstChoice Healthcare P.C., Labsource LLC, Pain Management Associates entities, ProLab LLC, and ProCare Counseling Center LLC, were alleged to have provided illegal financial incentives to providers to induce their referrals of urine drug tests in violation of the Stark Law and the Anti-Kickback Statute, and to have submitted false claims to federal healthcare programs for medically unnecessary urine drug testing, steroid injections, opioid prescriptions, and lidocaine ointment prescriptions. The settlement resolves claims against the entities brought in three separate qui tam actions Donna Rauch, Muriel Calhoun, Brandy Knight, Karen Mathewson and Tracy Hawkins, former employees of pain management clinics owned or operated by McCollum. The government continues to pursue claims against McCollum. DOJ; USAO SC; November, 2021 judgment against McCollumCatch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme
Posted 09/3/21
