Articles Posted in Health Care Fraud

Govt-Health-Insurance-Policy-300x200 3Century Ambulance Service Inc. (“Century Ambulance”) of Jacksonville, Florida allegedly defrauded Medicare and Medicaid out of $5 million by submitting claims for ambulance services that were unnecessary or inflated. With the help of local hospitals, Century Ambulance allegedly falsified documents and records on a daily basis regarding patients transported either to or from hospitals owned by Southern Baptist Hospital of Florida Inc., Memorial Medical Care Group Inc., Orange Park Medical Center Inc., and Shands Jacksonville Medical Center Inc. (now UF Health Jacksonville). Relator Shawn Pelletier, a former emergency medical technician (“EMT”) employed by Century Ambulance, claims that the conduct has occurred since at least 2005 in his amended complaint filed today under the federal False Claims Act and the Florida False Claims Act. Pelletier has been an EMT since 1998 and worked for Century Ambulance from 2004 through 2006. Century Ambulance is a provider of both emergency and non-emergency medical transport services. Continue reading ›

Stethoscope1On Wednesday, the U.S. Department of Justice announced that AstraZeneca LP, a Delaware-based pharmaceutical manufacturer, has agreed to pay the federal government $7.9 million to settle allegations that it engaged in a kickback scheme in violation of the Anti-Kickback statute and the False Claims Act. AstraZeneca markets and sells pharmaceutical products in the United States, including a drug sold under the trade name Nexium. The settlement specifically resolves the allegations made by two relators that AstraZeneca agreed to provide remuneration to Medco Health Solutions, a pharmacy benefit manager, in exchange for Medco maintaining Nexium’s “sole and exclusive” status on certain Medco formularies and through other marketing activities related to those Medco formularies. AstraZeneca allegedly provided some or all of the remuneration to Medco through price concessions on drugs other than Nexium, namely on Prilosec, Toprol XL and Plendil. Such remuneration amounted to approximately $40 million. Continue reading ›

WhistleThe U.S. Department of Justice announced today that medical device manufacturer Medtronic Inc. has agreed to pay the federal government $2.8 million to settle a relator’s allegations of fraud brought under the False Claims Act against the Minnesota-based company. Medtronic allegedly caused a number of physicians, located throughout twenty states, to submit false claims to federal health care programs for a medical procedure known as “SubQ stimulation” between 2007 and 2011. As an investigational procedure, it was not eligible for reimbursement. United States ex rel. Nickel v. Medtronic, Inc. was filed in federal court in New York by Jason Nickell, a former Medtronic sales representative. The government subsequently elected to intervene in the case, leading to this settlement. For his role in helping to uncover the fraud, Nickell will receive $602,000.  Continue reading ›

Stethoscope1The U.S. Department of Justice announced yesterday that Tennessee-based Community Health Systems Professional Services Corporation and three affiliated New Mexico hospitals (collectively “Community Health”) have agreed to pay the federal government $75 million to settle a relator’s allegations that they violated the False Claims Act by making illegal donations to county governments which were then used to fund the state share of Medicaid payments to the hospitals. The corporation manages more than 200 affiliated hospitals across 29 states. Community Health is one of the largest hospital organizations in the nation and employs 135,000 people, including 22,000 physicians. In September, the publicly traded company reported to its investors that it had set aside a reserve of $75 million to cover the claims involved in this case. Every aspect of the case, from discovery to dispositive motions, had been fiercely litigated with nearly 650 docket entries filed. Continue reading ›

Hospital_billing-300x200On Monday, the U.S. Attorney’s Office for the Eastern District of Kentucky announced that Lafferty Enterprises, LLC, doing business as Trans-Star Ambulance Services (“Trans-Star”), has agreed to pay $948,000 to settle a relator’s allegations that it violated the False Claims Act by billing federal health care programs for medically unnecessary services over the course of several years. Between February 1, 2006 and December 31, 2012, the company transported Medicare patients to and from dialysis clinics by ambulance when an ambulance transport was not medically necessary. Medicare only covers non-emergency ambulance transports when all other forms of patient transportation are considered to pose a medical risk. The former owner of a different ambulance company operating in eastern Kentucky filed the complaint in this case. The relator, Kevin Fairlie, will receive $189,600 for his role in helping to uncover the fraud. Continue reading ›

internal-auditOn Monday, the U.S. Department of Justice announced that the Research Foundation for the State University of New York (“SUNY”) has agreed to pay $3.75 million to settle allegations made by a number of relators that its Center for Development of Human Services (“CDHS”) violated the False Claims Act by manipulating the audits that it performed of federally funded health care programs in the state. The Research Foundation is a nonprofit educational corporation that administers grants and contracts that are awarded to university research projects by federal, state, and private entities. CDHS is a Research Foundation program headquartered at Buffalo State College, with offices in Albany, Buffalo, Syracuse, Rochester, and New York City. The complaint against the Research Foundation was filed in April 2010 by five of its former employees. The federal government then elected to intervene in the case. The relators will collectively receive $825,000, or 22%, of the total settlement for their role in uncovering the fraud. Continue reading ›

Doctor-with-ChecklistThe U.S. Department of Justice announced today that North Atlantic Medical Services Inc. (“NAMS”), doing business as Regional Home Care Inc., has agreed to pay $852,378 to settle the allegations of two relators realtor’s that it had violated the federal False Claims Act and the Massachusetts False Claims Act by submitting claims to Medicare and Medicaid for respiratory therapy services provided by unlicensed personnel. From September 2010 through January 2013, NAMS had allegedly used unlicensed employees to set up and provide instructions for sleep apnea masks and oxygen therapy equipment for patients in Massachusetts, even after the state’s Department of Public Health informed the company that the practice was illegal. NAMS is a Massachusetts-based medical device company that provides equipment and services for the treatment of respiratory ailments, such as oxygen deficiency and sleep apnea. Continue reading ›

Hospital_billingOn Tuesday, the state of Nevada and the federal government announced that they had elected to intervene in a complaint filed by two relators under the False Claims Act against Creekside Hospice II LLC (“Creekside”) that alleges that it aggressively lured non-terminally ill patients into its care in order to fraudulently seek reimbursement from Medicare and Medicaid since at least 2010. Creekside allegedly paid bonuses to employees who sold its inpatient services to people who did not have the requisite prognoses of six months or less to live and falsified patient medical records accordingly. The hospice received $66.56 million in payments from Medicare between April 2010 and March 2013, and an additional $4.73 million from the Nevada Medicaid program throughout the same period. Creekside’s hospice operations are primarily financed through the receipt of Medicare and Medicaid dollars, with approximately 90% of its revenue is derived from government health care programs. Continue reading ›

Hospital_billingA federal judge in California denied Prime Healthcare Services, Inc.’s (“Prime”) motion to dismiss a relator’s False Claims Act case alleging that the hospital group overcharged Medicare and Medicaid by more than $50 million. Prime was founded in 2001 by Dr. Prem Reddy. Thereafter, Prime engaged in a strategy of acquiring hospitals in financial distress and transforming them into financially stable businesses. Prime claims to have “saved” 29 hospitals. It operates 14 hospitals throughout California. In order to achieve some of these successes, Prime allegedly required hospital personnel to charge government health care programs the highest possible rates for patient admissions by falsely including comorbidities and complications including encephalopathy, septicemia, and malnutrition. Additionally, Prime allegedly eliminated less costly observation stays and refused to discharge patients to post-acute care centers in order to fraudulently increase its payments. Continue reading ›

Govt-Health-Insurance-Policy 3The U.S. Department of Justice announced today that CareAll Management LLC and its affiliated entities (“CareAll”) have agreed to pay $25 million, plus interest, to the United States and the state of Tennessee to settle a relator’s allegations that the home health provider violated the False Claims Act by submitting fraudulent and upcoded home health care billings to the Medicare and Medicaid programs. The settlement resolves conduct that allegedly occurred between 2006 and 2013 where CareAll overstated the severity of its patients’ conditions in order to increase the billing of, and in turn the reimbursement for, services that were not medically necessary and were rendered to patients who were not in fact homebound. The company had allegedly predetermined its desired profit margins and billed government health care programs accordingly to hit those targets. The wrongdoing was claimed to have permeated all branches of the CareAll system throughout Tennessee. Continue reading ›

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