Provider Fraud

August 2, 2017

Atlanta-based pain management clinic Atlanta Medical Clinic and its owner Dr. Timothy Dembowski agreed to pay $250,000 to resolve charges they violated the False Claims Act by billing for services performed by a physician suspended from the Medicare program and administering foreign, non-FDA approved drugs, which are not eligible for reimbursement under the Medicare program.  DOJ (NDGA)

July 24, 2017

Dr. James Norman, the owner and operator of Norman Parathyroid Center, agreed to pay $4 million to resolve allegations he violated the False Claims Act by billing Medicare for pre-operative examination services for which he had already received payment from the government.  These extra fees ranged from $150 to $750 for Florida residents, to $1,750 or more for patients who lived out-of-state, adding up to hundreds of thousands of dollars in illicit billing.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former patient of Dr. Norman, Myra Gross, and her husband, Dr. David Gross.  They will receive a whistleblower award of roughly $600,000 from the proceeds of the government's recovery.  DOJ (MDFL)

July 24, 2017

Tennessee-based Pain Management Group P.C. agreed to pay $312,000 to settle charges it violated the False Claims Act by billing for medically unnecessary urine drug tests and non-FDA approved pharmaceuticals Botox, Supartz, and Eufflexa, which the company purchased from foreign-based suppliers.  DOJ (MDTN)

July 14, 2017

Narco Freedom, Inc., a former operator of outpatient chemical dependency clinics, Joining Hands Management Inc., an operator of short-term residences known as “three-quarter houses,” and Joining Hands co-owner Devorah Haigler, settled claims of violating the False Claims Act.  The government will receive a $50.5 million allowed claim in the Narco Freedom bankruptcy proceeding, and Joining Hands and Haigler will pay $300,000.  The government alleged the defendants engaged in a kickback scheme whereby Narco made monthly cash payments to Joining Hands in exchange for Haigler and others referring residents of Joining Hands three-quarter houses to NARCO outpatient programs.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act.  An unidentified whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)

July 13, 2017

New York podiatrist Perrin D. Edwards pled guilty to health care fraud for illegally charging Medicare and private insurance companies for podiatry services he never provided and agreed to pay $410,000 to resolve charges of violating the False Claims Act.  DOJ (NDNY)

June 27, 2017

Dr. Anindya Sen, owner of Tennessee-based East Tennessee Cancer & Blood Center and East Tennessee Hematology Oncology and Internal Medicine, and his wife Patricia Posey Sen, agreed to pay $1.2 million to resolve charges they violated the False Claims Act by billing Medicare and Tennessee Medicaid for non-FDA approved anticancer and infusion drugs manufactured in foreign countries.  DOJ

June 26, 2017

Dr. Miguel Burgos, the medical director of four Florida infusion clinics, and Yosbel Marimon, the owner of the clinics, were sentenced respectively to 64 months and 90 months in prison for their roles in a $13.7 million Medicare fraud conspiracy that involved submitting claims for expensive infusion-therapy drugs that were never purchased, never provided and not medically necessary.  DOJ

June 26, 2017

AMI Monitoring Inc. (aka Spectocor), its owner Joseph Bogdan, Medi-Lynx Cardiac Monitoring LLC, and Medicalgorithmics SA, the current majority owner of Medi-Lynx, agreed to pay roughly $13.5 million to resolve allegations they violated the False Claims Act by billing Medicare for higher and more expensive levels of cardiac monitoring services than requested by the ordering physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Spectocor sales manager Eben Steele.  He will receive a whistleblower award of roughly $2.4 million from the proceeds of the government's recovery.  DOJ