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TRICARE 9 articles

Health Care Fraud Scheme Targeting TRICARE Ends in $7.6 Million Settlement

A California medical device company will pay the U.S. government $7.62 million to settle allegations it engaged in a health care fraud scheme targeting beneficiaries of TRICARE, the federal health care program for active-duty servicemembers and their families. The U.S. Justice Department lodged a False Claims Act (FCA) complaint against Vista, California-based DJO Global and its subsidiary Empi Inc. of Shoreview, Minnesota, alleging that the medical device manufacturers carried out a health care fraud plan involving the sale of special electrodes used for pain. According to the Justice Department, the medical device companies billed TRICARE for excessive and unnecessary transcutaneous ... 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

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

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

Whistleblowers Help U.S. Recover $7.5 Million From Dallas Hospital

A Dallas-based hospital will pay the U.S. $7.5 million to settle a False Claims Act lawsuit brought by two whistleblowers who accused the hospital of engaging in an illegal kickback scheme. According to the U.S. Department of Justice, whistleblowers Suzanne Scott and Savannah Sogar claimed that Pine Creek Medical Center, a physician-owned hospital serving the Dallas/Fort Worth area, provided physicians with valuable kickbacks in exchange for surgical referrals. Both women were formerly employed in Pine Creek’s marketing department. Supporting the whistleblowers’ allegations, federal prosecutors alleged that Pine Creek would pay for advertisements and other promotional materials benefitting the physicians with ... Read More

Florida Pain Clinics Pay $7.4 Million To Settle Billing Fraud Case

Coastal Spine and Pain, an operator of 10 pain-management clinics in the Jacksonville, Fla., area, has agreed to pay the U.S. government $7.4 million to settle a False Claims Act lawsuit alleging its clinics performed medically unnecessary and costly drug screening procedures to boost its reimbursements from Medicare and other federal health care programs. The settlement relates to Coastal’s routine use of “quantitative drug tests,” which identify and count particles of illicit drugs in a patient’s urine. The use of these very specific and extremely costly tests is appropriate only when there is reason to doubt the results of more general ... Read More

Johnson & Johnson’s Acclarent Settles Whistleblower Lawsuit With U.S. for $18 Million

Johnson & Johnson’s California-based medical device manufacturer Acclarent will pay the U.S. government $18 million plus interest to resolve allegations that it caused health care providers to submit false claims to Medicare and other federal health care programs by marketing and distributing its Stratus sinus spacer devices without U.S. Food and Drug Administration (FDA) approval. “The FDA approval process serves an important role in ensuring that federal health care participants receive devices that are safe, effective and medically appropriate,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.  “We will not permit companies ... Read More

Florida Radiology Chain Settles whistleblower Medicare Fraud Case For $8.71 Million

TAMPA, FLA — Rose Radiology Centers Inc. will pay $8.71 million to the government to settle allegations that it violated the False Claims Act by billing federal health care programs for radiology procedures that patients didn’t need or were rendered in an “unconscionable” way that violated federal rules for reimbursement. Rose Radiology operates about a dozen offices in the Tampa area and provides all of the radiology services for the Tampa Bay Rays baseball team and Tampa Bay Lightning hockey team, according to the Tampa Bay Times. The settlement resolves allegations originally brought in a lawsuit filed by two whistleblowers ... Read More

The Fraud List: Adventist Health System demonstrates a history of health care fraud

The Fraud List

Adventist Health System is a non-profit health care organization run by the Seventh-day Adventist Church. The Altamonte Springs, Fla.-based organization network encompasses about 45 hospital campuses in 10 Southern and Midwestern states in addition to a number of urgent care centers, home health care and hospice centers, and nursing homes, making it the largest Protestant-affiliated non-profit health care provider in the U.S. Adventist Health says its organization “incorporates Christian values at every level of service” and conducts its business “with integrity, honesty and fairness,” yet somehow these values have led it into numerous multimillion-dollar settlements to resolve allegations of fraud, most ... Read More