Friday, May 19, 2017

Criminal and Civil Enforcement - Healthcare Fraud

May 17, 2017; U.S. Attorney; Northern District of Ohio
Cleveland Heights woman sentenced to 10 years in prison, son to seven years for $8 million home healthcare fraud
A Cleveland Heights woman was sentenced to 10 years in prison for leading a $8 million healthcare fraud conspiracy in which participants provided forged documents and fraudulent forms to bill for services that were not provided, law enforcement officials said.
May 16, 2017; U.S. Department of Justice
United States Intervenes in Second False Claims Act Lawsuit Alleging that UnitedHealth Group Inc. Mischarged the Medicare Advantage and Prescription Drug Programs
For the second time in two weeks, the United States has filed a complaint against UnitedHealth Group Inc. (UHG) that alleges UHG knowingly obtained inflated risk adjustment payments based on untruthful and inaccurate information about the health status of beneficiaries enrolled in UHG's Medicare Advantage Plans throughout the United States, the Justice Department announced today. Today's action follows the government's filing of a complaint earlier this month in United States ex rel. Swoben v. Secure Horizons, a related action that also alleges that UHG submitted false claims for payment to the Medicare Program. 
May 16, 2017; U.S. Attorney; District of New Jersey
Omnicare Inc. Agrees To $8 Million Settlement In False Claims Act Case
NEWARK, N.J. - The U.S. Attorney's Office of the District of New Jersey, the U.S. Department of Justice and 28 states have reached an $8 million settlement with Omnicare Inc. resolving allegations arising from a whistle-blower suit filed under the False Claims Act. The agreement was announced today by Acting U.S. Attorney William E. Fitzpatrick.
May 12, 2017; U.S. Department of Justice
Former Administrative Law Judge Pleads Guilty for Role in $550 Million Social Security Disability Fraud Scheme
A former administrative law judge for the Social Security Administration (SSA) pleaded guilty in federal court today for his role in a scheme to fraudulently obtain more than $550 million in federal disability payments from the SSA for thousands of claimants.
May 11, 2017; U.S. Attorney; Middle District of Louisiana
Patient Marketer For All-Star Medical Supply Sentenced To Prison For Health Care Fraud
BATON ROUGE, LA - Acting United States Attorney Corey R. Amundson announced that U.S. District Judge Shelly D. Dick sentenced DEMETRIAS TEMPLE, age 56, of New Orleans, Louisiana, to serve ten (10) months in federal prison following her conviction for health care fraud. TEMPLE was ordered to make restitution to the Medicare program totaling $100,000 and pay a $100 special assessment. TEMPLE was ordered to forfeit an additional $100,000 as the proceeds of her criminal activity. Finally, following her release from prison, TEMPLE will be required to serve a two-year term of supervised release.
May 11, 2017; U.S. Attorney; Southern District of New York
Acting U.S. Attorney Announces $54 Million Settlement Of Civil Fraud Lawsuit Against Benefits Management Company For Improper Authorization Of Medical Procedures
Joon H. Kim, the Acting United States Attorney for the Southern District of New York, and Scott Lampert, Special Agent in Charge of the New York Regional Office for the Office of Inspector General for the Department of Health and Human Services ("HHS-OIG"), announced today that the United States simultaneously filed and settled a civil fraud lawsuit against benefits management company CaRECORE NATIONAL LLC ("CARECORE"), now part of eviCore healthcare, for authorizing medical diagnostic procedures paid for with Medicare and Medicaid funds over a period of at least eight years without properly assessing whether the procedures were necessary or reasonable. The settlement, approved in Manhattan federal court by U.S. District Judge Richard J. Sullivan, resolves CARECORE's civil liabilities to the United States under the federal False Claims Act. Under the settlement, CARECORE must pay a total of $54 million, of which $45 million will be paid to the United States and $9 million will be paid to the states that are named as plaintiffs in the suit. CARECORE also admitted and accepted responsibility for, among other things, improperly approving prior authorizations requests for hundreds of thousands of diagnostic procedures paid for with Medicare Part C and Medicaid funds.
May 11, 2017; U.S. Attorney; Northern District of Illinois
Chicago Dermatologist Convicted on Federal Fraud Charges for Billing Health Insurance Programs for Medically Unnecessary Treatments
CHICAGO - A federal jury has convicted a Chicago dermatologist on fraud charges for billing health-insurance programs for purported pre-cancerous treatments that were not medically necessary.
May 10, 2017; U.S. Attorney; Eastern District of Louisiana
Six Individuals Found Guilty of Health Care Fraud
Acting U.S. Attorney Duane A. Evans announced that on May 9th, after over four weeks of trial, a federal jury returned guilty verdicts against six individuals charged with committing approximately $13,655,094 in Medicare fraud.
May 10, 2017; U.S. Attorney; District of Oregon
Mary Holden Ayala Charged with Theft of Over $800,000 From Oregon Foster Care Agency Give Us This Day
PORTLAND, Ore. -A federal grand jury in Portland has charged Mary Holden Ayala, 56, a longtime resident of Portland, with theft of over $800,000, money laundering and filing false personal tax returns. Ayala served as the President and Executive Director of Give Us This Day (GUTD), an Oregon state-licensed private foster care agency and residential program for hard-to-place foster youth, until its closing in September of 2015. 
May 9, 2017; U.S. Attorney; Central District of California
Oncology Therapy Center in High Desert Pays $3 Million to Resolve Allegations of Providing Radiation Treatments without Doctor Present
LOS ANGELES - A Lancaster-based radiation therapy center has paid $3 million to resolve allegations that it submitted fraudulent bills over a nearly 10-year period to three government-run healthcare programs for unsupervised radiation oncology services.
May 9. 2017; U.S. Attorney; Northern District of Alabama
Sales Rep for North Alabama Compounding Pharmacy Charged in $13 M Insurance Conspiracy
BIRMINGHAM - Federal prosecutors today charged a sales representative for a Haleyville, Ala.,-based compounding pharmacy with conspiracy in a multi-faceted scheme to generate prescriptions and defraud Blue Cross Blue Shield of Alabama and one of its prescription drug administrators out of over $13 million in one year. Acting U.S. Attorney Robert O. Posey, Federal Bureau of Investigation Special Agent in Charge Roger Stanton, United States Postal Inspector in Charge, Houston Division Adrian Gonzalez, U.S. Department of Health and Human Services, Office of Inspector General, Special Agent in Charge Derrick L. Jackson, and Defense Criminal Investigative Service Special Agent in Charge John F. Khin announced the charges.
May 8, 2017; U.S. Department of Justice Medicare Fraud Strike Force Case
Third Detroit-Area Physician Convicted in $17.1 Million Health Care Fraud Scheme
A third Detroit-area physician was convicted today for his role in a $17 million Medicare fraud scheme involving medically unnecessary physician visits.
May 8, 2017; U.S. Attorney; District of Connecticut
Morris Woman Sentenced to 10 Months in Federal Prison for Health Care Fraud
Deirdre M. Daly, United States Attorney for the District of Connecticut, announced that ANNE CHARLOTTE SILVER, 63, of Morris, was sentenced today by U.S. District Judge Victor A. Bolden in Bridgeport to 10 months of imprisonment, followed by three years of supervised release, for committing health care fraud. Judge Bolden also ordered SILVER to provide 100 hours of community service upon her release from prison, and to pay restitution of $1.6 million.
May 8, 2017; U.S. Attorney; District of Kansas
Kansas Medical Supplier to Pay $1 Million To Settle False Claim Allegations
KANSAS CITY, KAN. - A Dodge City medical equipment supplier has agreed to pay $1 million to settle allegations it submitted false claims to the Medicare program, U.S. Attorney Tom Beall said today.
May 4, 2017; U.S. Attorney; Eastern District of Texas
Smith County Husband and Wife Sentenced in Health Care Fraud Conspiracy
TYLER, Texas - A Smith County couple has been sentenced for health care fraud violations in the Eastern District of Texas announced Acting U.S. Attorney Brit Featherston today.
May 4, 2017; U.S. Attorney; Western District of Virginia
Third Member of Healthcare Conspiracy Pleads Guilty
Abingdon, VIRGINIA - A Bristol woman, who along with a husband and wife were accused of healthcare fraud, pled guilty today to related charges, Acting United States Attorney Rick A. Mountcastle, Virginia Attorney General Mark R. Herring and Nick DiGiulio, Special Agent in Charge, Philadelphia Regional Office for U.S. Health and Human Services - Office of Inspector General announced today.
May 2, 2017; U.S. Department of Justice
United States Intervenes in False Claims Act lawsuit Against UnitedHealth Group Inc. for Mischarging the Medicare Advantage and Prescription Drug Programs
The United States has intervened and filed a complaint in a lawsuit against UnitedHealth Group Inc. (UHG) that alleges UHG obtained inflated risk adjustment payments based on untruthful and inaccurate information about the health status of beneficiaries enrolled in UHG's largest Medicare Advantage Plan, UHC of California, the Justice Department announced today. Yesterday's action follows the government's intervention in February of this year in United State ex rel. Poehling v. UnitedHealth Group. Inc., a related lawsuit in the Central District of California that also alleges that UHG defrauded the Medicare Program. government is scheduled to file a complaint in that matter no later than May 16. 
May 2, 2017; U.S. Attorney; Western District of North Carolina
Hickory Pathology Lab Agrees To Pay The United States $601,000 To Settle False Claims Act Allegation
CHARLOTTE, N.C. - U.S. Attorney Jill Westmoreland Rose announced today that Piedmont Pathology in Hickory, N.C., has agreed to pay the United States $601,000 to settle allegations that it violated the False Claims Act by submitting false claims to Medicare and Medicaid for medically unnecessary procedures. 
May 1, 2017; U.S. Attorney; District of Kansas
Kansas Chiropractor to Pay $1 Million-plus To Settle False Claim Allegations
KANSAS CITY, KAN. - A Kansas City area chiropractor has agreed to pay more than $1 million to settle allegations his offices submitted false claims to Medicare for treating patients with peripheral neuropathy, U.S. Attorney Tom Beall said today.
May 1, 2017; U.S. Attorney; District of Rhode Island
Poplar Healthcare to Pay Nearly $900,000 to Resolve A False Claims Act Allegations
PROVIDENCE, RI - Acting United States Attorney Stephen G. Dambruch and Philip Coyne, Special Agent-in-Charge of the Boston Office of Inspector General for the Department of Health and Human Services (HHS-OIG), today announced that Poplar Healthcare PLLC, and Poplar Healthcare Management, LLC ("Poplar"), of Memphis, TN, have entered into a civil settlement agreement with the United States, under which Poplar will pay $897,640 to resolve allegations under the federal False Claims Act. The government alleges that Poplar, directly and through a subsidiary known as GI Pathology, promoted and billed the government for diagnostic tests that the government contends were not medically necessary.

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