Medicaid or Medicare Fraud

A settlement has been reached in a whistleblower class action lawsuit brought against Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. (Southern Crescent).  They are accused of submitting false claims to Medicare.

The whistleblower will receive $2,160,000 of the government's recovery.

In June 2009, the whistleblower filed the first lawsuit.  The government's case alleges that between 2003 and 2009, Dubuis Health System and Southern Crescent knowingly kept patients hospitalized beyond the time considered to be medically necessary, to increase their Medicare reimbursement and to maintain Southern Crescent’s classification as a long-term acute care facility.

A settlement has been reached in a whistleblower class action lawsuit brought against Shands Teaching Hospital & Clinics Inc, Shands Jacksonville Medical Center Inc, and Shands Jacksonville Healthcare Inc (Shands Healthcare). They are accused of submitting false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services by six of its health care facilities.

Of the $26 million settlement, $25,170,400 will go to Medicare and other federal health care payors.  The settlement also resolved allegations under the Florida False Claims Act; the state of Florida will receive $829,600. The whistleblower's portion of the recovery has not been determined.

A settlement has been reached in a whistleblower class action lawsuit brought against Gulf Region Radiation Oncology Centers Inc. (GRROC), Gulf Region Radiation Oncology MSO LLC, Sacred Heart Health System Inc., West Florida Medical Center Clinic P.A., Emerald Coast Radiation Oncology Center LLC (ECROC), Dr. Gerald Lowrey and Dr. Rod Krentel.

The whistleblower will receive $609,796 from the federal share of the settlement amount.

The original whistleblower suit was filed in September 2012,  The government alleged that between 2007 and 2011, the defendants regularly billed for radiation oncology services that were not supervised by a physician, as required by Medicare, Medicaid and TRICARE, and that, in fact, these services were often performed while the defendant doctors were on vacation or were working at another radiation oncology clinic. The government also alleged that the defendants billed for other treatment services even when patients’ medical records provided no evidence that the services were rendered. The defendants also allegedly billed twice for the same services and misrepresented the level of a service provided to increase their reimbursement from the federal health care programs.

A settlement has been reached in a whistleblower class action lawsuit brought against Kan-Di-Ki LLC, formerly known as Kan-Di-Ki Inc., doing business as Diagnostic Laboratories and Radiology (Diagnostic Labs).  They are accused of paying kickbacks for referral of mobile lab and radiology services subsequently billed to Medicare and Medi-Cal (the state of California’s Medicaid program).

The whistleblowers in this case will receive $3,755,500 as their share of the federal government’s recovery.

The initial case, filed by two whistleblowers, was filed in 2010.  The government's alleged that Diagnostic Labs was charging Skilled Nursing Facilities (SNFs) in California discounted rates for inpatient services paid by Medicare in exchange for the facilities’ referral of outpatient business to Diagnostic Labs.  For inpatient services, Medicare pays a fixed rate based on the patient’s diagnosis, regardless of specific services provided.  For outpatients, Medicare pays for each service separately.  Diagnostic Labs’ scheme enabled the SNFs to maximize profit earned for providing inpatient services by decreasing SNFs’ costs of providing these services.  It also allegedly allowed Diagnostic Labs to obtain a steady stream of lucrative outpatient referrals that it could directly bill to Medicare and Medi-Cal.  The provision of inducements, including discounted rates, to generate referrals is prohibited by federal and state law.

A settlement has been reached in a whistleblower class action lawsuit brought against Hospice of the Comforter Inc (HOTCI) who is accused of submitting false claims to the Medicare program for hospice services provided to patients who were not eligible for the Medicare hospice benefit.

The whistleblower's share of the government's settlement recovery has not been determined.

The whistleblower case was filed in August 2012.  The government's allegations were that between December 2005 and December 2010, HOTCI engaged in practices that resulted in billing Medicare for patients who were not terminally ill.  Specifically, HOTCI allegedly directed its staff to admit all referred patients without regard to whether they were eligible for the Medicare hospice benefit, falsified medical records to make it appear that certain patients were eligible for the benefit when they were not, employed field nurses without hospice training, established procedures to limit physicians’ roles in assessing patients’ terminal status and delayed discharging patients when they became ineligible for the benefit.

A settlement has been reached in a whistleblower class action lawsuit brought against The Ensign Group Inc who is accused of knowingly submitting to Medicare false claims for medically unnecessary rehabilitation therapy services. The Ensign Group Inc operates nursing homes across the western U.S. Six of Ensign’s skilled nursing facilities in California allegedly submitted the false claims:  Atlantic Memorial Healthcare Center, located in Long Beach; Panorama Gardens, located in Panorama City; The Orchard Post-Acute Care (a.k.a. Royal Court), located in Whittier; Sea Cliff Healthcare Center, located in Huntington Beach; Southland, located in Norwalk; and Victoria Care Center, located in Ventura.  

The whisltleblowers' share of the government's recovery has not been determined. 

The first of two whistleblower cases was filed in 2006.  The government's case alleged that between January 1, 1999, and August 31, 2011, six Ensign skilled nursing facilities submitted false claims to the government for physical, occupational and speech therapy services provided to Medicare beneficiaries that were not medically necessary.  Specifically, Ensign provided therapy to patients whose conditions and diagnoses did not warrant it, solely to increase its reimbursement from Medicare.  The government further alleged that Ensign created a corporate culture that improperly incentivized therapists and others to increase the amount of therapy provided to patients to meet planned targets for Medicare revenue.  These targets were set without regard to patients’ individual therapy needs and could only be achieved by billing at the highest reimbursement levels.  The government also alleged that Ensign billed for inflated amounts of therapy it had not provided and that certain patients were kept in these facilities for periods of time exceeding what was medically necessary for treatment of their conditions.

A settlement has been reached in a whistleblower class action lawsuit brought against a Tennessee cardiologist, Dr. Elie H. Korban, who is accused of billing Medicare and Medicaid for medically unnecessary cardiac stent placements.

The whistleblower's share of the recovery has not been determined. 

The initial lawsuit was filed in June 2007.  The governments allegations against Korban included that, from January 1, 2005, through December 31, 2008, Korban placed cardiac stents in Medicare and Medicaid patients when the stents were not medically necessary .  The government also claims that Korban improperly billed Medicare for work performed by substitute doctors when he was available to perform the services himself.

A settlement has been reached in a whistleblower class action lawsuit brought against Saint Joseph Health System Inc who is accused of submitting false claims to the Medicare and Kentucky Medicaid programs for a variety of medically unnecessary cardiac procedures.

The originally filing whistleblowers will receive a $2.46 million share of the government's recovery.

The initial whistleblower case was filed in March of 2011. The government's lawsuit alleges that doctors working at Saint Joseph Hospital performed numerous invasive cardiac procedures, including coronary stents, pacemakers, coronary artery bypass graft surgeries and diagnostic catheterizations, on Medicare and Medicaid patients who did not need them, and that the hospital was aware of these unnecessary procedures.  These doctors were affiliated with Cumberland Clinic which is a physician group that entered an exclusive arrangement with Saint Joseph Hospital in 2008 to provide cardiology services to the hospital’s patients.  Cumberland Clinic is owned by two London-based cardiologists, Satyabrata Chatterjee and Ashwini Anand. The government complaint makes further allegations that Saint Joseph Hospital violated the federal Stark Law and Anti-Kickback Statute by entering into sham management agreements that financially benefitted Chatterjee and Anand as an inducement for Chatterjee and Anand to direct more Cumberland Clinic patients to the hospital. 

A settlement has been reached to resolve False Claims Act allegations against SelfRefind, PremierTox LLC,  and the owners of SelfRefind and PremierTox.  They are accused of submitting claims to Medicare and Kentucky’s Medicaid program for tests that were medically unnecessary, more expensive than those performed or billed in violation of the Stark Law.

The government alleged that, after Wood and Peavler became owners of PremierTox, SelfRefind began referring comprehensive urine drug screening tests to PremierTox that were unnecessary and many times more expensive than other suitable alternative tests.  The government also alleged that PremierTox submitted to Medicare and Medicaid inflated claims that misidentified the class of drug being tested and billed for tests that were referred by SelfRefind in violation of the Stark law.

A settlement has been reached in a whistleblower class action lawsuit brought against Diagnostic Imaging Group (DIG) who is accused of falsely billing federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians. DIG previously operated chains in New Jersey and Florida through subsidiaries Doshi Diagnostic Imaging Services of New Jersey and Signet Diagnostic Imaging Services.  

The DIG agreed to pay $13.65 million to the federal government and an additional total of $1.85 million to New York and New Jersey. The three whistleblowers that initially filed lawsuits will receive the following amounts; $ 1.5 million , $ 1.07 million and $ 209,250.

The first of all the lawsuits was filed in September 2009.  The government alleged that hat DIG submitted claims to Medicare, as well as the New Jersey and New York Medicaid Programs, for 3D reconstructions of CT scans that were never performed or interpreted.  Additionally, DIG allegedly bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary.  Today’s settlement also resolves allegations that DIG paid kickbacks to physicians for the referral of diagnostic tests.  According to the government, the kickbacks were in the form of payments that DIG made to physicians ostensibly to supervise patients who underwent nuclear stress testing.  These payments allegedly exceeded fair market value and were, in fact, intended to reward physicians for their referrals.