Articles Posted in Health Care Fraud

A teenager who died after receiving mental healthcare services from unlicensed and underqualified professionals is the impetus behind a False Claims Act lawsuit handled by Greene, LLP on behalf of the late Yarushka Rivera. The case is now before the U.S. Supreme Court. The United States Office of the Solicitor General and the Department of Justice argued before the Supreme Court on April 19, 2016 with assistance from Greene, LLP.

Yarushka Rivera was a teenage enrollee of MassHealth benefits (Massachusetts’s state equivalent of Medicare) and began seeing Arbour counselor Maria Pereyra in 2007 after experiencing various behavioral problems at school. Pereyra, an Arbour staff member, lacked a professional license to provide mental-health therapy. Rivera’s parents met with Pereyra’s supervisor, clinical director Edward Keohan, after Yarushka complained that she was not benefiting from counseling. During the meeting, they became worried that Keohan was not properly supervising Pereyra and was unfamiliar with Yarushka’s treatment.

Yarushka was eventually transferred to another staff member, Diana Casado, who was also supervised by Keohan. Casado too, was unlicensed. Yarushka’s parents quickly became dissatisfied with her treatment and believed that Casado too, was not properly supervised.

md_tmgOn October 19, 2015, Greene LLP announced the resolution of False Claims Act claims against Millennium Health, LLC in a settlement reached with the United States. The settlement, likely to exceed $231 million once interest is calculated, brought to an end the whistleblower suit initiated by Greene LLP and client Mark McGuire in January 2012 under the qui tam provisions of the False Claims Act.

The settlement resolved allegations that Millennium encouraged physicians to order drug testing performed by the company without an individualized assessment of patient need. The Greene LLP suit and the United States’s complaint in intervention alleged that Millennium caused physicians to order such tests by promoting the use of standing orders termed “custom profiles,” which included a default panel of tests for Millennium to run on each specimen physicians sent to its San Diego, California facility for testing. Also resolved by the settlement were the complaints’ claims that Millennium billed the federal and state governments for testing it was referred in exchange for providing physicians with free point-of-care testing supplies, cups containing test strips that also served as specimen containers. Continue reading ›

Yellow-and-Red-Pills-300x224PharMerica Corporation has settled False Claims Act (FCA) allegations agreeing to pay the United States $9.25 million. The allegations had accused PharMerica of taking kickbacks from Abbott Laboratories Inc. in order to increase the use of the seizure prevention drug Depakote with the patients in their nursing homes. The presence of kickbacks is a violation of the Stark law and in this instance could place the elderly at risk. Kickbacks can create bias in the judgment of the nursing home staff, and nursing home staff must be uniquely objective in their decisions as nursing home patients may suffer from dementia. This settlement stems from a 2012 resolution between Abbott and the United States for FCA violations, resolving PharMerica’s role in that settlement. Continue reading ›

Pill-Capsule-150x150Adventist Health System has agreed to pay the government $115 million in order to settle allegations that it violated the False Claims Act and the Stark Law. The suit alleged that fraud was committed against the government when Adventist paid its doctors excessive sums in compensation for patient referrals. It was also alleged that fraud was committed through the miscoding of Medicaid and Medicare claims, which resulted in higher reimbursement rates than were deserved. This settlement is the highest amount ever paid in a case of fraudulent patient referrals and it nearly doubles the previous record. That past record was set just last week when North Broward Hospital District agreed to pay $69.5 million to settle allegations of kickback payments for patient referrals.   Continue reading ›

100-dollar-bill-and-drugs 2Retail Giant Kmart Corporation has agreed to settle, at a cost of $1.4 million, allegations that it violated the False Claims Act (FCA) by knowingly and illegally inducing Medicare beneficiaries to fill their prescriptions at pharmacies within their retail stores. Kmart, a unit of Sears Holdings Corp, is a major player in both the US department store and pharmacy market, operating some 780 retail stores that contain pharmacies. The Department of Justice announced the settlement on Tuesday. The settlement of the case U.S. ex rel. Leight v. Sears Holdings Corp et al. made no determination of liability on the part of Kmart. Continue reading ›

A pair ofStethoscope1 Missouri health care providers have agreed to pay the United States $5.5 million to settle a False Claims Act (FCA) suit. The Department of Justice (DOJ) had alleged that Mercy Health Springfield Communities and Mercy Clinic Springfield Communities violated the FCA by offering bonuses to doctors who had referred patients to the Mercy health care facilities. Such referrals are improper as they often result in the overuse of medical services, creating higher health care costs, which is ultimately paid for by the federal government through Medicare and Medicaid. Continue reading ›

The first Lady-Justice-150x150False Claims Act decision regarding the “60-day rule” created by the Affordable Care Act (ACA), was recently decided by the United States District Court for the Southern District of New York. The Department of Justice (DOJ) intervened in the False Claims Act (FCA) lawsuit which was pursued by whistleblower Robert Kane against his former employer Healthfirst MCO. The DOJ alleges that Healthfirst committed fraud against the government when they attempted to retain over $1 million dollars in overpayments made by Medicare and Medicaid to the healthcare provider. In U.S. ex rel Kane v. Healthfirst, Inc., NO. 11-2325 (S.D.N.Y), the district court denied Healthfirst’s motion to dismiss and clarified what constituted “identification” under the “60-day rule”.    Continue reading ›

Govt-Health-Insurance-Policy-150x150 2The first settlement involving a healthcare provider’s failure to investigate credit balances on its books has been reached. The Pediatric Services of America (PSA) has settled with the US government and several US states for $6.88 million to resolve all False Claims Act allegations made against the company. PSA, based in Norcross, Georgia, provides home nursing services to medically fragile children. Two whistleblowers, who had previously worked for the facility, came forward with extensive information demonstrating that PSA was knowingly being overpaid by the government and was not returning the excess funds. The case alleged that PSA violated federal and state law, affecting both the federal government and seventeen states. Continue reading ›

Talking-to-Patient-300x186The Department of Justice (DOJ) has recently resolved a case involving the largest settlement of alleged violations of the Anti-Kickback Statute by a skilled nursing facilities company in the United States. The skilled nursing company, Plaza Health Network, and its former president and executive director have agreed to pay $17 million to resolve allegations that the company violated the False Claims Act (FCA) by submitting claims to Medicare and Medicaid for patients that were referred to the company through illegal kickbacks. The whistleblower, who brought the case under the qui tam provisions of the FCA, will receive $4.25 million as his share of the recovery. Continue reading ›

This weeYellow-and-Red-Pills-150x150k the US Court of Appeals for the Fourth Circuit affirmed a South Carolina District Court judgment against Tuomey Healthcare System. The damages and penalties against Tuomey totaled $237,454,195 as decided in United States ex rel. Drakeford v. Tuomey Health Care System, Inc. A jury had found the defendant liable under the False Claims Act for their reporting of false claims to Medicare. The decision ends a case which has been under litigation for nearly ten years. Continue reading ›

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