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health care fraud 35 articles

Nevada Cardiologist Pleads Guilty to Opioid Prescription Fraud

A Nevada cardiologist charged with widespread opioid and health care fraud pleaded guilty on Nov. 26 to one charge of illegal distribution of a controlled substance, federal authorities announced. Dr. Devendra Patel, 59, was the first physician in the state to face criminal drug distribution charges under a federal push to clamp down on opioid “pill mill” clinics and the doctors who run them. The government has stepped up efforts to beat back the rising tide of opioid addiction and death, which former U.S. Attorney General Jeff Sessions called the “worst drug crisis in American history.” Dr. Patel, who ran ... Read More

Whistleblower Helps Recover $5.1 Million In Medicaid Funds From Indiana Dental Chain

A whistleblower who sued an Indiana-based dental chain and its Kansas-based management company has helped the U.S. and Indiana recover $5.1 million in Medicaid funds. The whistleblower lawsuit named ImmediaDent of Indianapolis and Samson Dental Partners, LLC, which provided administrative services to the dental chain, as defendants. The complaint alleged that the companies submitted false claims to Medicaid by improperly billing tooth extractions as more costly surgical extractions, the U.S. Attorney’s Office for the Western District of Kentucky said in an announcement of the settlement. The whistleblower’s complaint also accused ImmediaDent and Samson of billing Medicaid for “deep cleanings” that ... Read More

Hospice Whistleblowers Ask Appeals Court to Hear Medicare Fraud Case

A group of whistleblowers is asking the Third Circuit Court of Appeals to revive their False Claims Act lawsuit accusing a New Jersey hospice provider of falsifying patient records to make them appear eligible for end-of-life care. Four former employees of Care Alternatives Inc. of Cranford, New Jersey, now known as Ascend Hospice, filed the whistleblower lawsuit in 2008, alleging the company pressured them and others to alter patients’ medical records to satisfy Medicare’s criteria for hospice eligibility. The whistleblowers claimed that the company rewarded employees who complied with the alleged activity with bonuses. Several False Claims Act lawsuits have ... Read More

Whistleblowers Help U.S. Recover $3.8 Million From Vascular Care Company

Two whistleblowers who alleged that a Philadelphia-based vascular health company and several of its subsidiaries were cheating Medicare and engaging in illegal kickback schemes have helped the U.S. recover more than $3.8 million. The whistleblowers filed separate lawsuits alleging Vascular Access Centers LP and 23 of its subsidiary companies violated the federal False Claims Act and Anti-Kickback Statute, both of which are intended to protect U.S. taxpayer money from being squandered and misspent. The U.S. Department of Justice investigated the whistleblowers’ claims and chose to intervene, thereby taking over their litigation. ‘ According to the Justice Department, Vascular Access Centers ... Read More

Whistleblower Case Accusing Bayer of Baycol Fraud Moves Forward

A longstanding whistleblower lawsuit alleging Bayer AG cheated the U.S. Department of Defense by fraudulently representing its cholesterol drug Baycol as safe and effective will move forward after previously being dismissed. U.S. District Judge Michael J. Davis in Minnesota, who dismissed the case in 2015, found on Oct. 16 that whistleblower Laurie Simpson had presented sufficient proof that she had direct and original knowledge of the health risks associated with Baycol and Bayer’s downplaying of those risks. The Eighth Circuit sent the whistleblower lawsuit back to Judge Davis after finding on appeal that Ms. Simpson’s allegations satisfied the “who, what, ... Read More

Thousands of Illegal Opioid Prescriptions Dispensed by Houston Clinic

After a Houston clinic owner and physician went to prison for writing thousands of fraudulent prescriptions for opioid painkillers and other prescription drugs, Drug Enforcement Administration (DEA) agents shared with the press some of the clinic’s inner workings to demonstrate how insidious the opioid epidemic has become. Houston’s KPRC-TV featured the case of Gulfton Community Health Center, which ran an illegal opioid distribution operation that dispensed about 34,000 illegal prescriptions (about 2.1 million units of hydrocodone alone) to opioid addicts and dealers. DEA agent Wendell Campbell told KPRC that agents usually saw lines of 30-40 people at the doors of ... Read More

AmerisourceBergen Pays U.S. $625 Million, Resolving Illegal Drug Repackaging Scheme

AmerisourceBergen Corp. and four subsidiary companies will pay $625 million to settle allegations that they ran a profiteering scheme that involved buying sterile vials of drugs from manufacturers, breaking them open, pooling the contents, and then repackaging them into pre-filled syringes. AmerisourceBergen, a drug wholesaler that ranks number 11 on the Fortune 500 list, provided the illegally repackaged drugs to physicians treating cancer patients, the U.S. Department of Justice said in its announcement of the settlement. Federal prosecutors alleged that AmerisourceBergen profited by skimming drug overfill from the FDA-approved sterile vials and repacking them into pre-filled syringes. They said the ... Read More

DaVita’s HealthCare Partners Pays $270 Million to Settle Medicare Fraud Allegations

HealthCare Partners Holdings, a unit of DaVita Medical Holdings, has agreed to pay $270 million to settle allegations stemming partly from a whistleblower lawsuit alleging the companies caused Medicare to overpay on insurance claims submitted by Medicare Advantage plan providers. According to the U.S. Department of Justice, HealthCare Partners, an independent physicians association based in California, contracted with insurance companies to provide medical services to Medicare Advantage patients. Unlike traditional Medicare, which pays health providers for patient services they provide to beneficiaries, Medicare Advantage Plans are paid a fixed, monthly amount to provide health care to Medicare recipients who enroll ... Read More

Florida Opioid Pill Mill Doctor, Staff Go to Prison

A South Florida doctor busted for illegally dispensing prescription opioid painkillers to cash-paying “patients” has been sentenced to six-and-a-half years in prison. Dr. Andres Mecia, 64, of Fort Lauderdale, ran an opioid pill mill in his Oakland Park, Florida clinic, Adult & Geriatric Institute of Florida Inc., which operated under the name AGI Medical & Dental. According to the government’s allegations, Dr. Mencia and office personnel — Oscar Luis Ventura-Rodriguez, 41, of Ft. Lauderdale; Nadira Sampath-Grant, 51, of Margate, and John Mensah, 50, of Miami, performed sham consultations with patients seeking opioid drugs. In these consultations, Dr. Mencia and his co-conspirators ... Read More

Whistleblower Case Leads to $1.7M Recovery From Florida Urogynecology Group

A Florida network of urogynecologists has agreed to pay $1.7 million to settle a whistleblower’s False Claims Act lawsuit alleging the company billed Medicare for patient services that were never provided. The settlement resolves a whistleblower lawsuit filed by Holly Loebl, a former employee of FWC Urogynecology LLC, who accused the same company of knowingly misusing a certain Medicare billing code called “modifier 25,” which adds fees for extra services to Medicare billings, the U.S. Attorney in Orlando said. Orlando-based FWC Urogynecology operates more than a dozen clinics throughout Florida. Ms. Loebi filed her lawsuit under the whistleblower provisions of ... Read More