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Provider Fraud

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DOJ Ramps Up Enforcement Against COVID-19 Fraud

Posted  04/25/22
COVID-19-Fraud-Whistleblower-Lawyers
Even as mask restrictions are being relaxed in most parts of the country, the U.S. Department of Justice is ramping up its oversight of federal funds spent to fight the COVID-19 pandemic.  Just last week, DOJ announced criminal charges against 21 defendants in nine federal districts for their alleged participation in COVID-19 fraud schemes that resulted in over $149 million in false billings to federal programs. 

April 13, 2022

A number of anesthesia entities owned and operated by Care Plus Management, LLC (Care Plus), which itself is owned and operated by doctors Paul D. Weir and John R. Morgan, have agreed to pay $7.2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  A qui tam suit by whistleblower Robert Douglas had alleged that between 2012 and 2016, Care Plus entered into illegal revenue-sharing arrangements with physicians in exchange for patient referrals.  For his contributions to a successful enforcement action, Douglas will receive a $1.3 million share of the settlement.  USAO NDGA

April 12, 2022

Providence Health & Services Washington has agreed to pay $22.7 million to settle allegations of submitting false claims to Medicare, Medicaid, and TRICARE.  According to an unnamed whistleblower, who will receive a $4.2 million relator’s share, the hospital allegedly gave their neurosurgeons volume-based financial incentives to perform complex surgeries, thereby incentivizing two neurosurgeons to perform an excessive number of complex surgeries on inappropriate candidates without regard to medical necessity or patient safety, and ultimately causing an excessive level of complications.  USAO EDWA

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

March 22, 2022

Ten doctors in Texas and a healthcare executive have agreed to pay nearly $1.7 million to resolve allegations of violating the False Claims Act, Anti-Kickback Statute, and Stark Law.  In exchange for ordering laboratory tests from Rockdale Hospital d/b/a A little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation, the doctors allegedly received thousands of dollars in kickbacks disguised as investment returns.  USAO EDTX

March 21, 2022

Jonathan and Daniel Markovich, two brothers who operate addiction treatment facilities in Florida, have been sentenced to over 15 years and 8 years in prison respectively after being convicted of running a $112 million fraud scheme.  Through patient recruiters, the defendants paid illegal kickbacks to patients in the form of airline tickets, cash payments, and illegal drugs to entice them to visit their inpatient detox and residential facility, Second Chance Detox LLC d/b/a Compass Detox, as well as their outpatient treatment program, WAR Network LLC.  The defendants then billed for therapy sessions that were not regularly provided to or attended by patients, and urine drug tests that were not medically necessary.  DOJ

Catch of the Week: Feds Shut The Door on an Uncommon Fraud Scheme involving New York Indigent Care Pool

Posted  02/3/22
The Southern District of New York announced a $12.9 million settlement with healthcare provider The Door, which provided services to uninsured youth for which it received reimbursement from New York State’s Indigent Care Pool.  The settlement demonstrates the importance of whistleblowers, including the two that brought this case and stand to share in up to 25% of what the government collected, in helping to shut...

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

February 1, 2022

Two North Carolina medical providers will pay nearly $1.5 million combined for submitting false claims to the Medicaid program. Knowles, Smith, & Associates LLP will pay $1,150,000 to resolve allegations spanning five years of failure to monitor their anesthesia billing by not providing services billed, administering medically unnecessary procedures, or failing to maintain sufficient supporting documentation. Stacy Benton Lewis, M.D., and the Center for Women’s Health, P.A. will pay $340,000 to resolve false billing allegations covering a four-year period for submitting claims for complex visits that did not occur. NC DOJ

January 20, 2022

A three-year-long kickback scheme effectuated by a hospital executive and seven doctors will net the DOJ a $1.1 million settlement and their continued cooperation in the investigation of and litigation against other parties. The Stark Law and Anti-Kickback Statute violations occurred over a three-year period, wherein management service organizations (MSOs) paid volume-based commissions kickbacks for ordering laboratory tests from Rockdale Hospital d/b/a Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation. Jaspaul Bhangoo, M.D., Robert Megna, D.O., Baxter Montgomery, M.D., Murtaza Mussaji, D.O., David Sneed, D.O., Kevin Lewis, D.O., and Angela Mosley-Nunnery, M.D. will all contribute to the settlement. Additionally, Richard Defoore, former CEO of Jones County Regional Healthcare d/b/a Stamford Memorial Hospital, also agreed to pay into the settlement fund for his contribution to the scheme. USAO EDTX
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