Provider Fraud
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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. DOJDecember 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. DOJTwo Physician Groups Pay Over $33M to Resolve Whistleblower Claims Involving HMA Hospitals
Posted 12/20/17
By the C|C Whistleblower Lawyer Team
Two physician groups, Dallas-based EmCare Inc. and Pennsylvania-based Physician’s Alliance Ltd (PAL), agreed to settlements that resolve claims the groups received illegal kickbacks in exchange for referring patients to hospitals owned by Health Management Associates (HMA). The settlements, announced by the Justice Department yesterday, resolve two separate whistleblower...
Oncology Clinic Settles FCA Suit for $26M
Posted 12/13/17
By the C|C Whistleblower Lawyer Team
Florida-based 21st Century Oncology Inc. and several of its subsidiaries have settled allegations regarding the practice’s use of Electronic Health Records (EHR) software. The settlement is a result of a self-disclosure of violations made under Medicare’s EHR incentive program. The incentive program allows healthcare providers that attest to meaningful use of their EHR...