Provider Fraud

February 6, 2018

Kentucky ENT physician Phillip B. Klapper, M.D., Patricia Klapper, and Phillip B. Klapper, P.S.C. agreed to pay roughly $2.8 million to settle claims they violated the False Claims Act by submitting claims under the Federal Employees’ Compensation Act which falsely indicated that audiological tests were performed by licensed and certified personnel  and/or the testing results were altered to enable some claimants to appear to have hearing losses. DOJ (WDKY)

January 24, 2018

Tennessee chiropractor Matthew Anderson agreed to pay $1.45 million to resolve allegations he violated the False Claims Act. Specifically, the government alleged that Anderson and his management company, PMC LLC, caused pharmacies to submit requests for Medicare and TennCare payments for pain killers dispensed based upon prescriptions written at the Cookeville Center for Pain Management, one of the pain clinics Anderson managed, which had no legitimate medical purpose. The government further alleged that Anderson caused four pain clinics he managed to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. The allegations originated in a whistleblower lawsuit filed by a former office manager for the Cookeville Center for Pain Management under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $246,500 from the proceeds of the government's recovery. DOJ

January 23, 2018

Drs. Aytac Apaydin and Stephen Worsham, urologists based in Northern California who own Salinas Valley Urology Associates and formerly owned Advance Radiation Oncology Center, will pay roughly $1 million to settle claims they violated the False Claims Act by submitting claims to Medicare for image guided radiation therapy (IGRT) that was referred and billed in violation of the physician self-referral law (the “Stark Law”) and the Anti-Kickback Statute. DOJ

April 27, 2018

A behavioral health and substance abuse treatment provider with locations in Connecticut and its owners have agreed to pay $1,378,533 to resolve a joint state-federal investigation into allegations that they submitted false claims for payment to Connecticut’s Medicaid program. New Era Rehabilitation Center and its co-founders and owners – Dr. Ebenezer Kolade and Dr. Christina Kolade – are enrolled as providers in the Connecticut Medical Assistance Program (CMAP), which includes the state’s Medicaid program. As part of their practice, they provide methadone treatment services for patients dealing with opioid addiction. Most of their patients are CMAP beneficiaries. CT

January 19, 2018

San Diego-based health care system Scripps Health agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by charging federal health care programs for physical therapy services that were rendered by therapists who did not have billing privileges for these programs and were not supervised by an authorized provider. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Scripps employee Suzanne Forrest. She will receive a whistleblower award of $225,000 from the proceeds of the government's recovery. DOJ

January 18, 2018

Detroit-area doctor Gerald Daneshvar was sentenced to 24 months in prison for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulted in inappropriately high payments. DOJ