Healthcare Fraud

A settlement has been reached to resolve False Claims Act allegations against Tenet Healthcare Corporation.

The allegations arose from a lawsuit, claiming Tenet Healthcare Corporation paid kickbacks to obstetric clinics serving primarily undocumented Hispanic women in return for referral of those patients for labor and delivery at the hospitals.  The hospitals then billed the Medicaid programs for the services provided to the referred patients and, in some instances, also obtained additional Medicare reimbursement based on the influx of low-income patients. 

Tenet Healthcare Corporation offered to pay $238 million to settle the matters.

According to the Department of Justice, four Tenet hospitals — Atlanta Medical Center, North Fulton Hospital in Roswell, Ga., Spalding Regional Medical Center in Griffin, Ga., and Hilton Head Hospital in Hilton Head Island, S.C. took part in the scheme with Hispanic Medical Management Inc, a prenatal services company that does business as Clinica de la Mama.

A settlement has been reached to resolve False Claims Act allegations against Dignity Health.

Dignity Health and its 18 affiliated hospitals were among the most recent group of 51 hospitals nationwide to settle with the United States Justice Department for $5.9 million.

On February 17, 2016, the United States Department of Justice announced that has reached settlements with 51 hospitals in 15 states for more than $23 million related to cardiac devices that were implanted in Medicare patients in violation of Medicare coverage requirements. 

A settlement has been reached to resolve False Claims Act allegations against 51 hospitals nationwide.

The whistleblowers' share of the settlement will be more than $3.5 million.

On February 17, 2016, the United States Department of Justice announced that has reached settlements with 51 hospitals in 15 states for more than $23 million related to cardiac devices that were implanted in Medicare patients in violation of Medicare coverage requirements.

These settlements are part of a nationwide investigation into the practices of hundreds of hospitals improperly billing Medicare for these cardiac devices. 

The United States Justice Department previously settled with 457 hospitals for more than $250 million in October.

A settlement has been reached to resolve allegations over heart procedures against Cleveland Clinic.

The Cleveland Clinic has agreed to pay $1.6 million to the United States Justice Department to settle allegations that it implanted cardiac devices into patients too soon after a heart attack or surgery.

Federal guidelines state that a patient can only have a device implanted 40 days after a heart attack and 90 days after surgery.

The Cleveland Clinic stated that doctors were aware of the imposed waiting periods but claim the treatments were “life-saving and life extending”.

The Cleveland Clinic is one of 11 hospital systems that have reached an agreement with the federal government over the procedures.

A settlement has been reached to resolve Stark Law and False Claims Act allegations against Tri-City Medical Center.

The allegations arose from a lawsuit that claimed Tri-City Medical Center entered into 97 financial arrangements with physicians and physician groups that did not comply with Stark Law. Five of the arrangements were with the hospital's former chief of staff and were entered into between 2008 until 2011 and 92 of the arrangements were entered into from 2009 until 2010, which were with community-based physicians and practice groups.

Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division stated: " The settlement of this matter reflects not only our commitment to protect the integrity of the healthcare system through enforcement of the Stark Law, but also our willingness to work with providers who disclose their own misconduct”.

A settlement has been reached to resolve False Claims Act allegations against Qualitest Pharmaceuticals Inc.

The allegations arose from a lawsuit that claimed Qualitest Pharmaceuticals, a generic drug maker, owned by Endo International Plc, illegally labeled multivitamins that contained fluoride.

New York Attorney General disclosed that Qualitest's false labeling caused healthcare professionals to submit false reimbursement claims to Medicaid and federal health care plans and that it also put patients in higher risk of cavities.

The multivitamins contained only half of the fluoride amount recommended by the United States Food and Drug Administration. 

Under terms of the settlement, Alabama-based Qualitest will pay 47 participating states and the federal government a total of $39 million to resolve the unlawful mislabeling allegations.

A settlement has been reached to resolve False Claims Act allegations against Dr. David G. Bostwick the former owner of Bostwick Laboratories.

The whistleblowers' share of the settlement will be approximately $2.5 million.

The allegations arose from a lawsuit that claimed Dr. David G. Bostwick directed Bostwick Laboratories to bill Medicare and Medicaid for medically unnecessary cancer detection tests and offering incentives to physicians to obtain Medicare and Medicaid business. 

A settlement has been reached to resolve False Claims Act allegations against Coloplast Corp and Liberator Medical Inc.

According to the Department of Justice, the allegations arose from a lawsuit claiming Coloplast Corp paid kickbacks to Byram Healthcare Centers, Inc.; CCS Medical, Inc.; Liberator; Liberty Medical, Inc. and Handi Medical, Inc., in return for marketing promotions and conversion campaigns.  In the case of Byram, Liberty and Handi, Coloplast’s promotional campaigns allegedly included kickbacks in the form of funding for cash incentives sometimes known as “spiffs” paid to the suppliers’ sales personnel to induce them to refer patients to Coloplast products.

Also, allegations arose claiming Liberator Medical received kickbacks from Coloplast in the form of price concessions, in return for Liberator’s agreement to conduct two campaigns promoting Coloplast ostomy products to Liberator’s customers.

These allegations were brought forward by two former employees of Coloplast Corp. 

A settlement has been reached to resolve False Claims Act allegations against Nashville Pharmacy Services LLC.

The allegations arose from a lawsuit that claimed Nashville Pharmacy Services overbilled Medicare and TennCare for pharmacy services.

On January 5, 2016, the Department of Justice disclosed that the settlement resolves allegations that Nashville Pharmacy Services automatically refilled medications without a request from the beneficiary, their physician, or a person acting as the beneficiary’s agent, in violation of TennCare’s contractual requirements; routinely and improperly waived TennCare and Medicare co-payments without an individualized assessment of those beneficiaries’ inability to pay; improperly used pharmaceutical manufacturers’ co-payment cards to pay the co-payments of certain Medicare recipients for thirteen Medicare beneficiaries; billed Medicare and TennCare for certain medications that were dispensed after the dates of death of 15 beneficiaries with either Medicare or TennCare coverage; and billed Medicare or TennCare for medications that lacked a valid prescription from a licensed provider for 22 beneficiaries with either Medicare or TennCare coverage.

The whistleblowers' share of the settlement will be approximately $1.4 million.

A settlement has been reached to resolve False Claims Act allegations against five southern California ambulance companies.

The allegations arose from a lawsuit that claimed five southern California ambulance companies (Pacific Ambulance, Inc., Bowers Companies, Inc., Care Ambulance Service, Inc., Balboa Ambulance Service, Inc., and E.R. Ambulance, Inc.), engaged in a so-called “swapping” kickback schemes by providing discounted and often below cost ambulance services to hospitals and/or skilled nursing facilities in exchange for exclusive rights to the facilities’ more lucrative Medicare patient referrals.

The whistleblowers' share of the settlement will be approximately $1.7 million.