Provider Fraud
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March 29, 2019
Acacia Mental Health Clinic and its owner, Abraham Freud, have agreed to pay $4.1 million to the United States and the State of Wisconsin for submitting false claims to Medicaid in violation of the False Claims Act. According to a qui tam complaint filed by whistleblower Rose Presser, Acacia billed for urine drug screens in simple "cup" tests as if a more sophisticated test had been performed. Acacia also billed for medically unnecessary and duplicative urine drug tests and telemedicine services performed by foreign-based psychiatrists in violation of Medicaid regulations. USAO EDWIMarch 21, 2019
Nonprofit healthcare organization MedStar Health Inc. has agreed to pay $35 million to the United States to settle two qui tam lawsuits alleging violations of the False Claims Act at two of its hospitals in Baltimore. According to the first complaint, filed by three cardiac surgeons, MedStar paid illegal remuneration to MidAtlantic Cardiovascular Associates (MACVA) to induce referrals of Medicare patients. The second complaint, filed by former patients, alleged that while employed by MedStar, former MACVA employee Dr. John Wang engaged in a pattern of performing and billing for medically unnecessary cardiac stent procedures. DOJ
March 15, 2019
Long Island chiropractor Raymond R. Pellegrino pleaded guilty to charges arising from his fraudulent billing of private insurance companies. Pellegrino falsely billed Anthem Empire Blue Cross/Blue Shield over $2 million for services claimed to have been provided by doctors employed by him, when knew those services had not, in fact, been provided. USAO EDNYMarch 15, 2019
Connecticut Behavioral Health Associates, P.C. and its principal, psychiatrist Bassam Awwa, who treat patients for substance abuse, will pay $3.3 million in a settlement with the federal government and Connecticut. Defendants allegedly billed Medicare and Medicaid for multiple drug screening tests per patient visit, instead of the single test authorized. In addition, defendants submitted bills for urine alcohol screening that were already a component of the single test, and for definitive urine drug tests that were not actually performed. USAO CTMarch 14, 2019
The former owner and former COO of Atlanta-based Primera Medical Group, Shailesh Kothari and Timothy McMenamin, were sentenced to prison terms of 6.75 and 7.75 years, respectively, for their roles in submitting more than $8.5 million in fraudulent invoices to private insurance companies for allergy testing and allergy immunotherapy services that were never provided and were not medically necessary. Defendants submitted bills using the NPIs of doctors who had not performed the tests and, in fact, had no knowledge of the services. To cover up the fact that the services were not provided, defendants would create false laboratory reports for insurers and patients who requested them. USAO ND GAMarch 11, 2019
Medical device manufacturer Covidien LP will pay $20 million to resolve False Claims Act cases initiated by three whistleblowers alleging that Covidien violated the Anti-Kickback Statute by providing remuneration to healthcare providers in California and Florida. Covidien markets radiofrequency ablation catheters to providers including vein surgery practices for use in procedures for the treatment of varicose veins and underlying conditions, and allegedly provided its customers with substantial assistance in connection with marketing vein screening and related services in order to increase demand for such services and therefore induce purchases of Covidien's vein ablation products. Covidien will pay $17.5 million to the United States; $1.5 million to California; and $1 million to Florida. Two whistleblowers who were sales managers for Covidien, Erin Hayes and Richard Ponder, will share a $3.1 million whistleblower reward. The settlement also resolves claims by whistleblower Shawnea Howerton, a former employee of one of Covidien's customers. DOJ; USAO NDCal; FL$2.1 Million Whistleblower Settlement with Skyline Urology Resolves Allegations of Improper Unbundling Fraud
Posted 03/1/19
This week, the Department of Justice and Constantine Cannon LLP announced a $2.1 million settlement against Skyline Urology, at one time the largest urology practice in California. The settlement, which includes $1.85 million to the United States and $250,000 to the State of California, resolved allegations by our whistleblower client that Skyline had engaged in a systematic coding scheme to defraud Medicare and...
Constantine Cannon LLP Announces $2.1 Million Whistleblower Settlement with Skyline Urology
Posted 02/28/19
Settlement resolves whistleblower client’s allegations of systematic coding scheme to improperly increase reimbursement.
WASHINGTON, D.C. February 28, 2019 -- Constantine Cannon LLP is pleased to announce that its whistleblower client’s claims resulted in a $2.1 million settlement against Skyline Urology, a major medical practice in California. The whistleblower exposed an alleged systematic coding scheme to...
February 27, 2019
A Florida-based home health agency owner, Alexander Ros Lazo, has been sentenced to over 7 years in prison and ordered to pay $8.6 million in restitution for defrauding Medicare. In exchange for the referral of Medicare beneficiaries to his company, T.L.C. Health Services, Dos Lazo paid kickbacks to co-conspirators and caused his co-conspirators to submit billing for physical therapy services performed by an unlicensed practitioner, Misleady Ibarra. Along with Ros Lazo. Ibarra has been sentenced to 2 years in prison; the amount she will pay in restitution is still to be determined. DOJ