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Whistleblower Rewards

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Page 93 of 102

June 5, 2015

Atlanta-based dental practice Dennis B. Jaffe D.M.D., P.C. and its principal Dennis Jaffe agreed to pay $324,327.05 to settle charges they violated the False Claims Act by fraudulently billing Medicaid for tooth extraction procedures and for fraudulently billing for services rendered by a dental assistant when Jaffe was not present in the office. According to the government, Jaffe fraudulently sought payment from Medicaid for higher and more expensive levels of service than were actually performed, a practice commonly referred to as “upcoding.”  The allegations first arose in a whistleblower lawsuit filed by Michelle Smith under the qui tam provisions of the False Claims Act.  DOJ

Tagged in: FCA Federal, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme.  Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit.  Clearview is now owned by Community Health Systems which purchased HMA in January 2014.  According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute.  As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act.  The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $119,031.  DOJ, GA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services.  Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing.  The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC.  The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be determined whistleblower award. DOJ

Tagged in: FCA Federal, FCA State, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 28, 2015

Garden State Cardiovascular Specialists P.C., a New Jersey-based cardiology practice which owns and operates several facilities in New Jersey under the name NJ MedCare/NJ Heart, agreed to pay more than $3.6 million to resolve allegations the company and its principals, Dr. Jasjit Walia and Dr. Preet Randhawa, submitted claims to Medicare for various cardiology diagnostic tests and procedures, including stress tests, cardiac catheterizations and external counterpulsation, which were not medically necessary. The allegations were first raised in a whistleblower lawsuit filed by Cheryl Mazurek under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of more than $648,000.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 27, 2015

Durable medical equipment suppliers Orbit Medical Inc. and its partial successor, Rehab Medical Inc., agreed to pay $7.5 million to settle False Claims Act charges that Orbit submitted false claims to federal health care programs for power wheelchairs and accessories.  According to the government, Orbit sales representatives knowingly altered physician prescriptions and supporting documentation to get Orbit’s power wheelchair and accessory claims paid by Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency.  The allegations were first raised in a whistleblower lawsuit filed by former Orbit employees Dustin Clyde and Tyler Jackson under the qui tam provisions of the False Claims Act.  They collectively will receive a whistleblower award of approximately $1.5 million.  Whistleblower Insider

Tagged in: FCA Federal, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

May 20, 2015

Pharmacy benefits manager Medco Health Solutions Inc., a wholly-owned subsidiary of the pharmacy benefit manager Express Scripts Holding Company, agreed to pay $7.9 million to settle allegations it engaged in a kickback scheme in violation of the False Claims Act.  According to the government, Medco solicited remuneration from AstraZeneca in exchange for identifying Nexium as the “sole and exclusive” proton pump inhibitor on certain of Medco’s prescription drug lists known as formularies.  AstraZeneca allegedly compensated Medco in the form of reduced prices on the following AstraZeneca drugs: Prilosec, Toprol XL and Plendil.  In January 2015, the government reached a $7.9 million settlement with AstraZeneca to resolve kickback allegations arising out of the same conduct.  The allegations first arose in a whistleblower lawsuit filed by former AstraZeneca employees Paul DiMattia and F. Folger Tuggle under the qui tam provisions of the False Claims Act.  They will receive a whistleblower reward from the recovery that has yet to be determined.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

May 20, 2015

Florida-based neurologist Dr. Sean Orr agreed to pay $150,000 to settle allegations he violated the False Claims Act by providing medically unnecessary services and drugs to federal health care program beneficiaries.  According to the government, from September 2009 to April 2012 Orr knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal health care programs to be billed for medically unnecessary services and drugs.  In 2014, the government settled related allegations against Baptist Health System Inc. – Orr’s former employer and the parent company for Baptist Neurology Inc. and Baptist Medical Center-Jacksonville – for $2.5 million.  The allegations first arose in a whistleblower lawsuit filed by former Baptist Neurology employee Verchetta Wells under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $26,250.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 19, 2015

Atlanta-based world-wide package delivery service United Parcel Service agreed to pay $25 million to resolve allegations it violated the False Claims Act by submitting false claims to the federal government in connection with its delivery of Next Day Air overnight packages.  According to the government, UPS engaged in multiple practices to conceal its failure to comply with its delivery guarantees, thereby depriving federal customers of the ability to request refunds for late deliveries.  The government’s allegations arose out of whistleblower lawsuit filed by former UPS employee Robert K. Fulk under the qui tam provisions of the False Claims Act.  Mr. Fulk will receive a whistleblower award of $3.75 million.  DOJ

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

May 14, 2015

PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country, agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs.  The government’s allegations against PharMerica arose out of whistleblower lawsuit brought by Jennifer Denk, a pharmacist formerly employed by PharMerica, under the qui tam provisions of the False Claims Act.  Ms. Denk will receive a whistleblower award of $4.3 million.  Whistleblower Insider

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

May 7, 2015

Health Management Associates Inc. (and 14 hospitals it previously owned), along with Community Health Systems and North Texas Medical Center, agreed to collectively pay $15.69 million to settle whistleblower charges they violated the False Claims Act by seeking and receiving Medicare reimbursement for Intensive Outpatient Psychotherapy (IOP) services that were not medically reasonable or necessary.  The IOP services in question were typically performed on the providers’ behalf by Louisiana-based Allegiance Health Management.  The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The unidentified whistleblower will receive a whistleblower award of $2,667,300.  Whistleblower Insider

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

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