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Provider Fraud

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Seventh Circuit Gives Broad Read To What Constitutes A "Referral" Under Anti-Kickback Statute

Posted  02/26/15
By Gordon Schnell
Under the Anti-Kickback Statute, physicians may not solicit or receive kickbacks for referring Medicare patients to a particular healthcare provider. The question before the Seventh Circuit in United States v. Patel was the scope of what constitutes a referral under the statute. According to the Court, the scope is quite broad, even extending to situations where the physician plays no role in selecting the healthcare...

January 16, 2015

Washington Attorney General Bob Ferguson announced Sea Mar Community Health Centers agreed to pay $3.35M to settle charges of improperly billing Medicaid for thousands of dental appointments. According to the government, Sea Mar billed fluoride treatments as stand-alone appointments with a dentist or hygienist when they could have been performed much more cheaply by dental assistants as part of a patient’s regular six-month checkups. WA

DOJ Catch Of The Week -- Institute For Cardiovascular Excellence

Posted  01/9/15
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to Florida cardiologist, Dr. Asad Qamar, and his physician group, the Institute for Cardiovascular Excellence.  On Monday, the DOJ intervened in two whistleblower lawsuits alleging Qamar and his group billed Medicare for medically unnecessary peripheral artery interventions and paid kickbacks to patients by waiving...

January 7, 2015

Florida Attorney General Pam Bondi announced that Florida, along with California, Colorado, Kentucky, and Ohio and the federal government, entered a $22 million national settlement with DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the US. The settlement resolves allegations originating in a whistleblower lawsuit that DaVita paid illegal kickbacks to induce the referral of patients to its dialysis clinics, causing false claims to be submitted to the Medicaid program. DaVita will pay Florida $5.6 million in restitution and other recoveries. FL

October 31, 2014

Oklahoma-based dental company, Ocean Dental PC, which operates 28 clinics in seven states, agreed to pay more than $5M to settle charges it violated the False Claims Act by submitting false claims to the Oklahoma Medicaid program for dental work never performed or billed at a higher rate than allowed. The charges apparently stem from dental restorations by former employee Robin Lockwood who was sentenced to 18 months in federal prison in a separate case. NewsOK

DaVita — Medicare Fraud/Kickbacks ($400 million).

Two of our whistleblower attorneys led the representation of David Barbetta, a former financial analyst for DaVita HealthCare Partners, one of the largest providers of dialysis services in the United States. Mr. Barbetta brought a qui tam action under the False Claims Act against DaVita alleging the company violated the Anti-Kickback Statute by paying physicians to refer their patients to DaVita clinics for dialysis. According to the complaint, DaVita sold doctors shares of DaVita clinics at below fair market value, and purchased doctors’ interests in other clinics at above fair market value. The government joined the case, and alleged that DaVita had entered into these sweetheart deals with doctors, which gave the doctors returns of over 100%, and the doctors then steered their patients to DaVita clinics. In 2014, DaVita paid $400 million to settle the case, the largest stand-alone kickback settlement ever, and Mr. Barbetta received a whistleblower award of over $65 million. See Denver Post and Modern Healthcare for more.

October 22, 2014

DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the United States, agreed to pay $400 million to resolve claims it violated the False Claims Act by paying kickbacks for patient referrals to its dialysis clinics through its use of a sophisticated three-part joint venture business model to induce patient referrals to its clinics..  David Barbetta, former Senior Financial Analyst for DaVita, will receive an undisclosed whistleblower award. DOJ

Rose Cancer Center — Medicare Fraud ($5.7 million).

Two of our whistleblower attorneys co-led the representation of Kristi Beeson who reported Medicare fraud violations at her former employer Rose Cancer Center in Mississippi. Ms. Beeson, who was a laboratory technician for the clinic, brought a qui tam action under the False Claims Act against the clinic alleging, among other things, unqualified technicians performing bone marrow biopsies, diluting chemotherapy drugs, and doctoring patient records to conceal the clinic’s fraudulent Medicare billings. The physician who owned and ran the practice, Dr. Meera Sachdeva, plead guilty to various Medicare fraud violations, forfeited $5.7 million, and is now serving a 20 year prison sentence for her crimes. Ms. Beeson, along with three other whistleblowers, collectively received a whistleblower award of $525,000 for their efforts in exposing the fraud. See Clarion Ledger for more.

April 16, 2014

CRC Health Corp., a nationwide provider of substance abuse and mental health treatment services, agreed to pay $9.25 million to settle allegations that CRC violated the False Claims Act by providing substandard treatment in its Tennessee facility to adult and adolescent Medicaid patients suffering from alcohol and drug addiction.  The allegations were first raised in a qui tam lawsuit filed by Angie Cederoth, a former billing clerk in the CRC facility, under the whistleblower provisions of the False Claims Act.  She will receive a whistleblower award of$1.5 million.  DOJ

April 14, 2014

Hope Cancer Institute, a cancer treatment facility in Kansas, and its owner Dr. Raj Sadasivan, agreed to pay $2.9M to resolve allegations they violated the False Claims Act by submitting claims to Medicare, Medicaid and the Federal Employee Health Benefits Program for chemotherapy drugs and services not actually provided.  The allegations were first raised in a qui tam lawsuit filed by former employees of the facility Krisha Turner, Crystal Dercher and Amanda Reynolds under the whistleblower provisions of the False Claims Act.  DOJ
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