Whistleblower Case Archives - Page 6 of 111

Catch of the Week: Detroit Medical Center

Posted 06/2/23

Handshake in room with dark window blinds

This week's Department of Justice (DOJ) "Catch of the Week" goes to Detroit Medical Center, Vanguard Health Systems, and Tenet Healthcare. On Wednesday, they agreed to pay roughly $30 million to settle government and whistleblower charges of violating the False Claims Act by providing kickbacks to certain referring physicians. It is just the latest in a string of False Claims Act settlements concerning kickbacks...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

May 31, 2023

VHS of Michigan Inc., d/b/a, The Detroit Medical Center, Vanguard Health Systems Inc., and Tenet Healthcare Corporation will pay nearly $30 million for causing the submission of false or fraudulent claims to Medicare. From January 1, 2014 through December 31, 2017, DMC, Vanguard, and Tenet violated the Anti-Kickback Statute when they provided the services of mid-level practitioners to 13 physicians at no cost or below fair market value. The physicians were selected for their high number of referrals, which DMC hoped would cause an increase in referrals to their facilities. Whistleblower Dr. Jay Meythaler will receive $5.2 million as part of the settlement. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicare, Provider Fraud, Whistleblower Case,

Catch of the Week: Vascular Surgeon Pays Over $60 Million for Defrauding Health Care Programs

Posted 05/26/23

This week's Department of Justice (DOJ) "Catch of the Week" goes to Michigan vascular surgeon Vasso Godiali. Yesterday, DOJ announced he was sentenced to 80 months in prison "for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of vascular stents and for thrombectomies that he did not perform." In addition to the jail time, Dr. Godiali also has to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

May 25, 2023

Vascular surgeon Vasso Godiali of Michigan has been ordered to pay $19.5 million in restitution and serve over 6 years in prison to resolve criminal allegations of defrauding Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. Godiali also agreed to pay up to $43.4 million to resolve civil allegations of violating the False Claims Act. Although Godiali allegedly began submitting false claims in 2009, his misconduct did not come to light until a 2015 qui tam suit by Innovative Solutions Consulting LLC, which alleged Godiali billed government programs for arterial thrombectomies and stent placements that were not medically necessary and not actually performed. Additionally, Godiali allegedly falsified medical records to justify the procedures, and improperly used a modifier code to increase his reimbursements. DOJ

Tagged in: Criminal Proceedings, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 11, 2023

GCI Communications Corp. has agreed to pay $40 million to resolve a whistleblower case by its former Director of Business Administration, which alleged the company violated the False Claims Act by failing to comply with competitive bidding regulations for the FCC’s Rural Health Care Program. In order to participate in the program—which awards $570 million in subsidies annually to bring critical telecommunications services to rural healthcare providers—GCI was subject to regulations governing the prices it could charge these providers. However, GCI charged inflated rates to a provider in Alaska, thereby receiving higher subsidy payments than it was entitled to. For launching a successful enforcement action, whistleblower Robert Taylor will receive a $6.4 million share of the settlement. DOJ

Tagged in: FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

April 20, 2023

Dr. Paul S. Koch, Koch Eye Associates, and Claris Vision violated the False Claims Act by paying kickbacks to optometrists who referred their patients to Koch and his companies for laser-assisted cataract surgery. Over a five-year period, from 2013 to 2017, Koch and his practices submitted false claims to Medicare based on those kickbacks. Koch will pay nearly $1.2 million to resolve the qui tam whistleblowers’ claims, and the two whistleblowers will receive $256,534.84 from the settlement. USAO RI

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 13, 2023

Adobe Inc. will pay $3 million to resolve false claims allegations it paid kickbacks under its Solution Partner program to companies that had a relationship with the government, potentially influencing federal purchases of Adobe software. Over a ten-year period, Adobe allegedly paid companies a percentage of the purchase price, running afoul of the anti-kickback provisions, and causing false claims to be submitted to federal agencies. The three whistleblowers—all former Adobe managers—will receive $555,000 for exposing the fraud. DOJ

Tagged in: FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

April 4, 2023

From 2014 to 2022, medical testing company Genotox Laboratories Ltd. paid kickbacks to their “1099” representatives, calculated as a percentage of the revenue Genotox received from Medicare, the Railroad Retirement Board, and TRICARE billings for testing orders facilitated or arranged for by these representatives. In addition to the kickbacks, Genotox also allowed providers to create “custom profiles” to pre-select the tests to order for their patients, often resulting in medically unnecessary testing, such as definitive drug testing for 22 or more drug classes. Genotox will pay $5.9 million, and Genotox’s former billing manager—the whistleblower in this qui tam action—will receive approximately $1 million. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 29, 2023

Michigan-based Covenant Healthcare System and two physicians, neurosurgeon Dr. Mark Adams and electrophysiologist Dr. Asim Yunus, have agreed to pay $69 million and about $406,500 and $346,000 respectively to resolve allegations of violating the Anti-Kickback Statute, Stark Law, and False Claims Act. Covenant allegedly provided Dr. Yunus and five other physicians medical directorship roles, employed Dr. Adams, forgave rent payments from another physician, and permitted a physician group to secure a lease on advantageous terms in exchange for referrals. Covenant then submitted false claims based on those referrals to Medicare, Medicaid, and TRICARE. The claims were first raised by Dr. Stacy Goldsholl in a qui tam suit; Goldsholl will receive over $12 million from the three settlements. USAO EDMI

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

March 27, 2023

Laboratory Corporation of America (“Labcorp”) has agreed to pay $2.1 million to settle a lawsuit by former employee Donna Hecker-Gross, who alleged that Labcorp overbilled the Department of Defense for genetic tests performed by a third party. Under a 2012 contract, Labcorp was to perform laboratory testing for military treatment facilities worldwide, but certain specialized tests would be performed by subcontractor GeneDx. However, when billing the Department of Defense for tests performed by GeneDx, LabCorp allegedly overcharged for them, double or triple billed for them, or billed for them even in the absence of evidence the tests were ever performed. For initiating a successful enforcement action, Hecker-Gross will receive a $357,000 relator’s share. USAO MD

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

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