Provider Fraud

January 10, 2018

Dental management company Benevis LLC (formerly known as NCDR LLC), and more than 130 of its affiliated Kool Smiles dental clinics for which Benevis provides business management and administrative services, agreed to pay $23.9 million to settle allegations of violating the False Claims Act by submitting false claims for payment to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid.  According to the government, Benevis and Kool Smiles clinics located throughout 17 states submitted false claims to state Medicaid programs for medically unnecessary pulpotomies (baby root canals), tooth extractions, and stainless steel crowns, in addition to seeking payment for pulpotomies that were never performed.  The government further alleged that Kool Smiles clinics routinely pressured and incentivized dentists to meet production goals through a system that disciplined “unproductive” dentists and awarded “productive” dentists with substantial cash bonuses based on the revenue generated by the procedures they performed.  The allegations originated in five whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Three of the whistleblowers -- former Kool Smiles employees Adam Abendano, Poonam Rai, and Robin Fitzgerald -- will receive a whistleblower award of more than $2.4 million from the proceeds of the government's recovery. DOJ

December 29, 2017

Maryland physician Nwaehihie H. Onyeaghala of Krystal Medical Associates, LLC agreed to pay $1 million to settle allegations he violated the False Claims Act by submitting false claims to Medicare for medically unnecessary autonomic nervous function tests and peripheral vascular tests.  According to the government, the tests were not medically necessary because Dr. Onyeaghala lacked the necessary equipment to conduct the tests, the patients did not have an autonomic nervous function disorder before the test was conducted, Dr. Onyeaghala lacked the specific training to conduct such tests and he only used the tests to monitor patient symptoms, not make any clinical decisions about future patient care.  DOJ (DMD)

December 28, 2017

Maryland physician Jui Chih Hsu agreed to pay roughly $1.2 million to settle claims of violating the False Claim Act by submitting false claims to Medicare for medically unnecessary vitamin injections and evaluation and management services that were not documented.  DOJ (DMD)

December 14, 2017

Mississippi-based Region 8 Mental Health Services agreed to pay roughly $7 million resolve charges of violating the False Claims Act allegations by submitting claims for services not provided or not provided by qualified individuals as part of its preschool Day Treatment program. It is believed to be the largest False Claims Act healthcare settlement in the history of the State of Mississippi. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Region 8 employee. The whistleblower will receive an award of more than $1 million from the proceeds of the government's settlement. DOJ (SDMS)

December 12, 2017

Florida-based 21st Century Oncology Inc. agreed to pay $26 million to settle charges of violating the False Claims Act and the Stark Law through the company’s false attestation to the use of electronic health records software and through referrals from physicians with whom the company had improper financial relationships. DOJ

December 1, 2017

Skin Care Doctors, P.A. and its founder and CEO Michael J. Ebertz, M.D., agreed to pay $850,000 to resolve allegations of violating the False Claims Act by submitting false claims to Medicare in connection with certain dermatology products and procedures.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a doctor who formerly worked with Ebertz.  The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery.  DOJ (DMN)

December 1, 2017

Dr. Arthur S. Portnow, the owner and operator of Arthur S. Portnow, P.A. (d/b/a Apple Medical and Cardiovascular Group) agreed to pay $1.95 million to resolve allegations that he and his practice violated the False Claims Act by knowingly seeking reimbursement for medically unnecessary ultrasound tests that were performed on Medicare beneficiaries.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act Kathleen Siwicki, a former employee of Dr. Portnow’s practice.  She will receive a whistleblower award of roughly $350,000 from the proceeds of the government's recovery.  DOJ (MDFL)

November 28, 2017

California-based Cardiovascular Consultants Heart Center and its shareholder physicians -- Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory, and Dr. William Hanks -- agreed to pay $1.2 million to settle allegations of violating the False Claims Act by billing Medicare and Medicaid for medically unnecessary cardiovascular diagnostic procedures.  According to the government, company physicians automatically scheduled patients for nuclear stress tests on an annual basis without seeing the patients beforehand to confirm the procedure was necessary.  These test are expensive and expose patients to a significant amount of radiation as well as to the risk of invasive procedures based on false positive results.  This risk is only justified if the nuclear stress test is medically necessary.  DOJ (EDCA)