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Aug 4, 2021
The U.S. Attorney’s Office in Nashville, Tennessee announced a call center employee will receive over $28 million for blowing the whistle on a mail order diabetic testing supply scheme. Prosecutors say that that Arriva Medical violated the False Claims Act by paying kickbacks to Medicare and Medicaid beneficiaries. Some of the patients who “qualified” for testing supplies weren’t even alive!
The case began in February 2013 when Gregory Goodman started working as a...
May 14, 2021
There are millions of Americans receiving counseling services and mental health care. Many of the patients receiving these services are on Medicare or Medicaid. Doctors’ offices and clinics that provide these services have an obligation to ensure those that provide these important services are properly trained and qualified.
In this post we discuss a recent case where the government claimed a Delaware provider accused of billing for unqualified Licensed Clinical Social Workers....
Apr 8, 2021
South Carolina-based Doctors Care and UCI Medical Affiliates of South Carolina will pay $22.5 million to resolve Medicare fraud allegations. The alleged misconduct was exposed in a False Claims Act lawsuit filed by two whistleblowers who used to work at UCI, a medical biller and a health care management specialist. The whistleblowers will share a $5.4 million award for their efforts in uncovering fraud.
UCI manages Doctors Care, an urgent-care chain headquartered in Columbia. The two...
Mar 5, 2021
Cambridge Behavioral Hospital, Ridgeview Behavioral Hospital, The Woods at Parkside, and their parent company Oglethorpe Inc. (collectively Oglethorpe) have agreed to pay $10.25 million to resolve allegations that they violated the Anti-Kickback Statute.
Oglethorpe operates medical facilities throughout Florida, Texas, Louisiana, and Ohio. Its alleged misconduct came to the attention of the Justice Department through a False Claims Act (FCA) complaint filed by a former Cambridge...
Mar 4, 2021
Three men were just sentenced in connection with a healthcare fraud scheme involving unnecessary pain cream prescriptions. Nationwide, the alleged misconduct cost government healthcare programs $1.5 billion. In Mississippi alone, the illegal billings amounted to $515 million.
In 2016, law enforcement raided several pharmacies and doctor’s offices in Mississippi, the epicenter of the scheme. Five years later, Dempsey Levi, 51, and Jeffrey Rollins, 44, were sentenced to seven years in...
Feb 4, 2021
Massachusetts-based Athenahealth, aka Athena, will pay $18.25 million to settle claims that it violated the False Claims Act (FCA) and the Anti-Kickback Statute (AKS) in the promotion of its electronic health records (EHR) product AthenaClinicals.
For years, prosecutors claim, Athena ran three marketing programs that violated both the FCA and the AKS. Under one of these illegal programs, Athena allegedly paid as much as $3,000 to each doctor who signed up for its services.
The...
Jan 9, 2021
A Tallahassee Florida surgeon is behind bars after being convicted of performing medically unnecessary cardiac angioplasties. On December 18, Moses deGraft-Johnson pled guilty to 55 counts of healthcare fraud and criminal conspiracy. He also pled to a count of aggravated identity theft.
Prosecutors and regulators are still trying to sort out how many patients were harmed by deGraft-Johnson. Over a several year period he performed hundreds of angioplasties and even billed for some that...
Dec 30, 2020
The owner of a Texas-based hospice chain has been sentenced to 20 years in prison and to pay $120 million in restitution for enrolling ineligible Medicare beneficiaries in hospice programs.
Rodney Mesquias deceived thousands of patients, telling them they only had a few months to live in order to enroll them in hospice programs and secure Medicare reimbursements. The vulnerable patients he targeted suffered from Alzheimer’s, dementia, and other chronic conditions.
After a...
Dec 28, 2020
Texas Heart Hospital of the Southwest dba Heart Hospital Baylor Plano will pay $48 million to resolve Medicare fraud allegations raised in a whistleblower lawsuit. Two former Heart Hospital doctors filed the complaint.
According to Mitchell Magee and Todd Dewey, Heart Hospital set unreasonably high patient quotas for physician owners, inducing illegal Medicare beneficiary referrals in violation of the Physician Self-Referral Law (aka Stark law) and the Anti-Kickback Statute (AKS). The...
Dec 21, 2020
Cambridge-headquartered Biogen, Inc. will pay $22 million to settle fraud allegations involving illegal Medicare copays for its drugs Avonex and Tysabri.
Copays for prescription drugs covered by Medicare are important to keep drug prices in check. When Medicare beneficiaries are required to make a partial payment, drugmakers have to charge a price they can afford. Pharmaceutical companies, however, often circumvent this requirement by illegally paying copays to boost Medicare...