Criminal and Civil Enforcement - May 2017 - Inspector General - Medical
May 31, 2017; U.S. Department of Justice
Electronic Health Records Vendor to Pay $155 Million to Settle False Claims Act Allegations One of the nation's largest vendors of electronic health records software, eClinicalWorks (ECW), and certain of its employees will pay a total of $155 million to resolve a False Claims Act lawsuit alleging that ECW misrepresented the capabilities of its software, the Justice Department announced. The settlement also resolves allegations that ECW paid kickbacks to certain customers in exchange for promoting its product. ECW is headquartered in Westborough, Massachusetts.
May 31, 2017; U.S. Attorney; District of New Jersey
Medicare Advantage Organization and Former Chief Operating Officer to Pay $32.5 Million to Settle False Claims Act Allegations Freedom Health Inc., a Tampa, Florida-based provider of managed care services, and its related corporate entities (collectively "Freedom Health"), agreed to pay $31,695,593 to resolve allegations that they violated the False Claims Act by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans, the Justice Department announced today. In addition, the former Chief Operating Officer (COO) of Freedom Health Siddhartha Pagidipati, has agreed to pay $750,000 to resolve his alleged role in one of these schemes.
May 30, 2017; U.S. Attorney; District of Connecticut
Bristol Woman Convicted of Defrauding Medicaid Program Deirdre M. Daly, United States Attorney for the District of Connecticut, Phillip Coyne, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of Inspector General, and Chief State's Attorney Kevin T. Kane today announced that on May 26, a jury in Bridgeport convicted RONNETTE BROWN, 44, of Bristol, on 23 counts of health care fraud and one count of conspiracy to commit health care fraud. The trial before U.S. District Judge Victor A. Bolden began on May 22 and the jury returned a verdict of guilty on all counts of the indictment on Friday afternoon.
May 30, 2017; U.S. Attorney; District of Minnesota
Minnesota Mental Health Nonprofit And Its Leaders To Pay $4.5 Million To Resolve Fraud Allegations Acting United States Attorney Gregory G. Brooker and Minnesota Attorney General Lori Swanson today announced that Complementary Support Services and its related entities (collectively "CSS"), TERI DIMOND and HERBERT STOCKLEY have agreed to pay a total of $4.52 million to resolve allegations that they violated the False Claims Act (FCA) and Minnesota False Claims Act by defrauding Medicaid, a program jointly funded by the federal government and State of Minnesota to provide health care to low-income Minnesotans. CSS will pay the government $4 million, DIMOND agreed to pay $400,000, and STOCKLEY agreed to pay $120,000.
May 23, 2017; U.S. Attorney; Northern District of New York
Albany Physician Pays $100,000 And Agrees To 15-Year Period Of Exclusion From Medicare For Submitting False Claims ALBANY, NEW YORK - Dr. Michael Esposito has agreed to pay $100,000 for billing Medicare despite his exclusion from all federal health care programs, announced United States Attorney Richard S. Hartunian. Dr. Esposito is an endocrinologist who treated patients in the Capital Region until earlier this year, when the New York State Board of Professional Medical Conduct ordered him to stop practicing medicine because he had engaged in professional misconduct.
May 22, 2017; U.S. Attorney; Eastern District of Missouri
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 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
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
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. 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 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
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.