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Medicare 312 articles

Tennessee Chiropractor Settles Whistleblower’s Opioid Allegations

A Tennessee chiropractor who allegedly prescribed opioids with no legitimate medical purpose through his four pain clinics and then billed Medicare and Medicaid for them will pay the U.S. more than $1.45 million plus interest to settle the accusations, which were initiated by a whistleblower under the False Claims Act. The U.S. Department of Justice said that from 2011 through 2014, Lenior City chiropractor Matthew Anderson and his management company PMC LLC, which managed four now-defunct pain clinics, wrote opioid prescriptions for patients who had no legitimate need for them. The patients, many of them Medicare and Medicaid beneficiaries, had ... Read More

California Urologists Pay U.S. $1 Million to Settle False Claims Allegations

Two California urologists accused of submitting false claims to Medicare and causing other doctors to submit false claims to Medicare have agreed to pay the U.S. government more than $1 million to resolve the allegations. The U.S. Justice Department (DOJ) said that Dr. Aytac Apaydin and Dr. Stephen Worsham, who own and operate Salinas Valley Urology Associates in Salinas, California, “knowingly caused eight urologists in Monterey and Salinas, California … to violate the Anti-Kickback Statute and the Stark Law” through improper financial arrangements. The defendants also owned Salinas-based Advance Radiation Oncology Center, California, which dissolved in 2016. According to the False ... Read More

Scripps Health Settles Whistleblower Complaint for $1.5 Million

A whistleblower who sued San Diego health care system Scripps Health alleging it improperly charged Medicare and another government health care program for physical therapy services has helped the U.S. government recover $1.5 million. The U.S. Justice Department (DOJ) and the whistleblower complaint alleged that Scripps Health submitted false claims to the Medicare and TRICARE programs for physical therapy services provided by therapists who lacked the proper credentials and billing privileges and were not supervised by a physician or other qualified health care provider. According to the DOJ, Medicare and TRICARE – the health care program for active servicemembers and their ... Read More

Three Convicted in $4.3 Million Kickback Scheme Targeting TRICARE

The owner of a Florida pharmacy, a physician, and a patient recruiter have been convicted of criminal charges for their involvement in an illegal kickback scheme that cheated a taxpayer-funded health care program for active military members out of $4.3 million. According to the U.S. Department of Justice (DOJ), Larry Howard, 53, the owner of Fertility Pharmacy in Oviedo, Florida, paid illegal health care kickbacks to patient recruiter Raymond Stone, 57, of Orlando. Mr. Stone in return referred patients to doctors selected by Mr. Howard. Those doctors then prescribed expensive pain and scar creams to Tricare patients. The prescriptions were ... Read More

Utah Doctor Faces False Claims Act Allegations

A physician slated to oversee medical studies of cannabidiol (CBD) oil, a cannabis compound that could be beneficial in treating epileptic seizures and other health problems, is facing a federal False Claims Act complaint accusing him of overbilling Medicare. Ogden, Utah’s Standard-Examiner reports that the False Claims Act lawsuit accuses Dr. Steven Warren of Bountiful, Utah, of improperly billing Medicare 80 times between February 2012 and July 2014 for visits to nursing home patients outside of Utah and receiving overpayments as a result. Under the False Claims Act, health care providers that improperly bill Medicare and other government health care ... Read More

Kmart Settles Whistleblower Drug Pricing Suit For $32.3 Million

Kmart Corporation will pay the United States $32.3 million to settle False Claims Act allegations brought by a whistleblower who alleged the retailer failed to report discounted prescription drug prices to government health care programs, resulting in the U.S. paying more for drugs than it should have. The U.S. Department of Justice said that James Garbe, a pharmacist at a Kmart store in Ohio, sued Kmart in 2008 under the whistleblower provisions of the False Claims Act, which allow private parties to sue on behalf of the U.S. government in cases of suspected fraud. The whistleblower lawsuit alleged that Kmart ... Read More

Judge Upholds Whistleblower Complaint Against Boston Scientific Subsidiary

A whistleblower complaint against Boston Scientific Corp. will move forward after a New Jersey federal judge dismissed a motion to dismiss the suit by subsidiary company Boston Scientific Neuromodulation Corp. The whistleblower lawsuit was filed in 2011 by Wendy Bahnsen and Carolina Fuentes, two former billing department employees, under the federal False Claims Act. According to the New Jersey Law Journal, the whistleblower lawsuit concerns a spinal cord stimulator that Boston Scientific Neuromodulation Corp. makes for the treatment of back pain: The plaintiffs claimed that Boston Scientific knowingly submitted false bills to Medicare from 2006 to 2010 for the stimulators ... Read More

Whistleblower Lawsuit Leads to $63.7 Million Recovery From DaVita Rx

A pair of whistleblowers has helped the U.S. government recover $63.7 million from DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with kidney disease. The U.S. Department of Justice (DOJ) said that Patsy Gallian and Monique Jones, both former DaVita employees, filed the lawsuit under the whistleblower provisions of the False Claims Act, alleging that the company was improperly billing Medicare and Medicaid and engaging in illegal kickback arrangements to boost its profits. DaVita settled the whistleblower complaint ahead of trial, paying the U.S $63.7 million to resolve allegations that it billed the federal health care programs for ... Read More

Nevada Cardiologist Arrested For Peddling Opioids, Health care Fraud

Federal authorities arrested a Nevada cardiologist Dec. 12 on dozens of charges related to the unlawful distribution of prescription opioids and health care fraud. Dr. Devendrakumar I. Patel, 58, faces 36 counts of distribution of controlled substances, including fentanyl, hydrocodone, and oxycodone, and three counts of health care fraud for allegedly billing Medicare and Medicaid for costly tests that he never provided. Dr. Patel is a cardiologist at Northeastern Nevada Cardiology in Elko, a practice that he owns. Dr. Patel is the first person in Nevada to be charged for illegal distribution of opioid drugs since the U.S. Department of ... Read More

Whistleblower Helps U.S. Recover $26 Million From Florida Oncology Group

A whistleblower proved to be instrumental in exposing illegal practices within 21st Century Oncology Inc. of Fort Myers, Florida, and several of the company’s subsidiaries and affiliates, and the defendant companies have agreed to pay $26 million to resolve accusations of False Claims Act and Stark Law violations, the U.S. Department of Justice announced. According to the Fort Myers News-Press, Matthew Moore, a health care executive who briefly served as the interim vice president of financial planning at 21st Century Oncology, filed a whistleblower lawsuit against 21st Century in February 2016. Mr. Moore’s whistleblower lawsuit triggered a federal probe of 21st Century’s ... Read More