Provider Fraud

July 29, 2016

Syed Imran Ahmed, a New York surgeon who practiced at hospitals in Brooklyn and Long Island, was convicted of submitting millions of dollars in fraudulent claims to Medicare.  According to the evidence, Ahmed submitted more than $25 million in false claims to Medicare for incision-and-drainage and wound debridement surgeries he did not perform.  DOJ

July 5, 2016

Drayer Physical Therapy Institute, LLC , with locations in in South Carolina and 14 other states, agreed to pay $7 million to settle charges of violating the False Claims Act by providing services to multiple patients simultaneously as though the services were being provided by a physical therapist or physical therapist assistant to one patient at a time.  The allegations originated in a whistleblower lawsuit filed by two former employees of Drayer under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $1.7 million from the proceeds of the government's recovery.  DOJ (DSC)

June 30, 2016

California-based Marshall Medical Center agreed to pay $5.5 million to settle allegations that it, along with Marshall Foundation for Community Health, El Dorado Hematology & Medical Oncology II, Inc., Dr. Lin H. Soe and Dr. Tsuong Tsai, violated the federal False Claims Act and California False Claims Act through a variety of Medicare and Medicaid billing improprieties.  The allegations originated in a whistleblower lawsuit filed by oncology nurse Colleen Herren under the qui tam provisions of the False Claims Act. She will receive a whistleblower reward of roughly $1,430,000 from the proceeds of the government's recovery.  DOJ (EDCA)

May 18, 2016

Missouri physician Randall E. Meyer pleaded guilty to (and agreed to pay roughly $75,000) violating the False Claims Act.  Meyer, a surgeon with Central Missouri Cardiology, P.C., admitted claiming the percentage of patients’ lesions and stenosis in their arteries was 70 percent or greater when it was substantially less.  The health care benefit programs would not have reimbursed claims if the programs had known Meyer was inflating the percentage of patient lesion and stenosis.  DOJ (W.D.MO)

March 15, 2016

Tennessee-based Southern Tennessee Medical Center agreed to pay roughly $2.5 million to settle charges it violated the False Claims Act by submitting Medicare claims for medically unnecessary days of in-patient geriatric psychiatric services and in-patient geriatric psychiatric services for which a Physician Certification or Recertification was not obtained.  DOJ (MDTN)

March 8, 2016

21st Century Oncology Inc., the nation’s largest physician led integrated cancer care provider, and its wholly owned subsidiary South Florida Radiation Oncology agreed to pay $34.7 million to settle charges they violated the False Claims Act by performing and billing for cancer care procedures that were not medically necessary or properly provided. According to the government, the companies improperly billed for Gamma function procedures — which measure radiation doses — under circumstances where there was no medically appropriate purpose for the treatment.  The allegations leading to the settlement originated in a whistleblower lawsuit filed by Joseph Ting, a former physicist at South Florida Radiation Oncology, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of more than $7 million from the proceeds of the government’s recovery.  This settlement follows on the heels of the $19.75 million settlement 21st Century Oncology Inc. subsidiary 21st Century Oncology LLC agreed to pay in December to settle charges of billing for medically unnecessary laboratory urine tests and for paying kickbacks to encourage physicians to order the tests.  Whistleblower Insider

March 7, 2016

Florida businessman David Brock Lovelace was sentenced to 174 months in prison and to pay $2,512,460 in restitution for his role in a multimillion-dollar health care fraud and money laundering scheme.  According to evidence presented at trial, Lovelace and co-conspirators used Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists, three purported medical clinics in Florida, to submit to Medicare more than $12 million in fraudulent claims for radiology, audiology, cardiology and neurology services not rendered by physicians, secured by kickbacks or the subject of forged or falsified documents.  DOJ

March 8, 2016

A Connecticut psychiatrist will pay $404,798 to settle a civil False Claims Act lawsuit alleging that she submitted false claims for payments to Connecticut’s Medicaid program. The state alleged that, from March 2010 to September 2013, while operating a private practice in Mansfield, Dr. Panoor submitted upcoded claims indicating that she provided Medicaid patients with both group counseling and either individual psychotherapy or a detailed examination on the same dates of service when, in fact, she did not provide psychotherapy or detailed examination sessions but instead provided medication management services or a brief meeting with the patient for the purpose of monitoring or changing a patient’s drug prescription – services that are coded, and thus reimbursed, at lower payment rates.

February 19, 2016

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $2.09 million to resolve allegations that patients were administered portions of single-dose vials of chemotherapy drugs that were left over from administrations to prior patients.  The settlement also resolves allegations that some platinum based drugs were administered inappropriately and that certain infusion services were upcoded.  The allegations originated in a whistleblower lawsuit filed by former Adventist employee Heather Huddleston under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $376,452 from the proceeds of the government's recovery.  DOJ (MDFL)