Provider Fraud

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)

November 7, 2017

Detroit-area doctor Johnny Trotter was sentenced to 180 months in prison and to pay roughly $9 million in restitution for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided and efforts to circumvent Medicare’s investigation of the fraudulent scheme.  DOJ

October 13, 2017

First Coast Cardiovascular Institute, P.A. agreed to pay roughly $450,000 to settle charges of violating the False Claims Act by knowingly delaying repayment of more than $175,000 in overpayments owed to Medicare, Medicaid, TRICARE, and the Department of Veterans Affairs.  Specifically, the government alleged the company accrued credit balances or overpayments owed to federal health care programs and despite repeated warning failed to pay back the money it owed.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former First Coast employee Douglas Malie.  He will receive a whistleblower award of $90,000 from the proceeds of the government's recovery.  DOJ (MDFL)

October 3, 2017

Michigan physician Abdul Haq pleaded guilty to conspiracy to commit health care fraud for his role in an approximately $19 million Medicare fraud scheme involving three Detroit area providers.  Haq admitted he conspired with the owner of the Tri-County Network and others to prescribe medically unnecessary controlled substances, including Oxycodone, Hydrocodone and Opana, to Medicare beneficiaries, many of whom were addicted to narcotics. DOJ

October 3, 2017

New York Anesthesiology Medical Specialties, P.C. (d/b/a New York Spine and Wellness Center) agreed to pay roughly $2 million to resolve claims it violated the False Claims Act by improperly billing the government for moderate sedation services.  DOJ (NDNY)

September 27, 2017

Edison Adult Medical Daycare, its former owner Dinesh Patel and current owners Daxa Patel and Satish Mehtani agreed to pay $2.72 million to resolve allegations they violated the False Claims Act through Edison's improper billing and receiving payments from Medicaid despite Dinesh Patel having been excluded from participating in Medicaid following his 2012 conviction for accepting kickbacks. DOJ (DNJ)

September 22, 2017

Former Kentucky clinical psychologist Alfred Bradley Adkins was sentenced to 25 years in prison for his role in a scheme to fraudulently obtain more than $550 million in federal disability payments from the Social Security Administration for thousands of claimants.

September 20, 2017

Miami physician Roberto A. Fernandez was sentenced to 97 months in prison and to pay $4.8 million in restitution for his role in a $4.8 million health care fraud scheme that involved the submission of false and fraudulent claims to Medicare and the illegal prescribing of controlled substances, including oxycodone and hydrocodone. DOJ

September 15, 2017

Valentina Kovalienko, the owner of Brooklyn medical clinics Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. was sentenced to 84 months in prison and ordered to forfeit roughly $29 million for her role in a $55 million health care fraud scheme.  As part of her guilty plea, Kovalienko acknowledged that her co-conspirators paid cash kickbacks to patients to induce them to attend her two clinics.  She also admitted submitting false and fraudulent claims to Medicare and Medicaid for services that were induced by prohibited kickback payments to patients or that were unlawfully rendered by unlicensed staff. DOJ

September 11, 2017

Family Medicine Centers of South Carolina LLC agreed to pay $1.56 million, and the company's principal owner and former CEO Dr. Stephen F. Serbin and its former Laboratory Director Victoria Serbin, agreed to pay $443,000 to settle charges they violated the False Claims Act and Stark Law.  Specifically, the government alleged FMC’s incentive compensation plan improperly paid FMC’s physicians a percentage of the value of laboratory and other diagnostic tests that they personally ordered through FMC.  Dr. Serbin allegedly initiated this program and reminded FMC’s physicians that they needed to order tests and other services through FMC in order to increase FMC’s profits and to ensure that their take-home pay remained in the upper level nationwide for family practice doctors.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former FMC physician Dr. Catherine A. Schaefer.  She will receive a whistleblower award of $340,510 from the proceeds of the government's recovery. DOJ