Operators of the Lymphedema & Wound Care Institute Inc. in Houston have agreed to pay $4.3 million to settle a whistleblower’s allegations that they improperly billed Medicare for physical therapy treatments provided by unqualified therapists.
According to the whistleblower, a physician who treats patients with lymphedema, the defendants billed Medicare for lymphatic drainage therapy that was performed by massage therapists. Under Medicare rules, the subject therapy must be conducted by physical therapists in order to qualify for Medicare reimbursement.
As a reward for exposing this fraud by filing a False Claims Act lawsuit, the whistleblower will receive 19% of the settlement proceeds.
For more information on this case, click here:
Caremark LLC (“Caremark”) agreed to pay $4.25 million to resolve a False Claims Act lawsuit alleging that it failed to reimburse Medicaid for prescription drug costs that should have been paid by private health insurance plans. Caremark is a pharmacy benefit management company operated by CVS Caremark Corp.
“Dual eligible” individuals are covered by Medicaid as well as private health insurance, but federal law requires that private insurers assume their health care costs. Medicaid is entitled to reimbursement of any prescription claims it pays for dual eligibles.
Using a computer claims processing program, Caremark allegedly cancelled claims for reimbursement submitted by Medicaid for dual eligibles, thereby shifting prescription drug costs to the government.
This False Claims Act lawsuit was filed by a former Caremark quality assurance representative, who will receive $505,680 from the federal government’s share of the settlement proceeds.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/December/13-civ-1267.html
A Tennessee doctor will share in the government’s recovery after filing a whistleblower lawsuit against a cardiologist who allegedly performed medically unnecessary cardiac stent placements.
Under the settlement, cardiologist Dr. Elie H. Korban will pay $1.15 million to resolve allegations that he placed unnecessary stents in Medicare and Medicaid patients.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/December/13-civ-1333.html
Vantage Oncology LLC, an owner and operator of radiation oncology centers, has agreed to pay more than $2.08 million to resolve a whistleblower’s allegations that it over-billed Medicare for radiation oncology services.
The government in this False Claims Act lawsuit accused Vantage of double billing for certain procedures, billing for services without proper supporting documentation, and billing for radiation treatment provided without required doctor supervision.
The whistleblower in this case, a former Vantage employee, will receive $354,450 as his share of the settlement proceeds pursuant to the qui tam provisions of the False Claims Act.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1243.html
Basco Manufacturing Co. (“Basco”) has agreed to pay $1.1 million to resolve a whistleblower’s allegations that it made false customs declarations to avoid paying duties on products imported from China. The products involved were aluminum extrusions, which are used in the manufacture of shower enclosures.
As alleged by the whistleblower, Basco represented to the government that aluminum extrusions were imported from Malaysia, rather than China. By routing the products through Malaysia and misrepresenting their true origin, Basco avoided having to pay antidumping and countervailing duties applicable to Chinese products. The government claimed that Basco knew that the products were simply repackaged in Malaysia and were not substantially transformed to the extent that the country of origin could change from China to Malaysia.
By exposing this scheme through the filing of a False Claims Act lawsuit, the whistleblower is entitled to receive a share of the settlement proceeds. The amount of this share has not been determined.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1221.html
Baptist Health Systems has agreed to pay $3,675,000 to resolve a whistleblower’s allegations that it violated the False Claims Act by failing to disclose insurance coverage applicable to treatment it provided to Medicare beneficiaries.
Under Medicare rules, providers are required to disclose the fact that a patient has other insurance when the provider submits claims to Medicare. In these instances, the claims are processed through the applicable insurance policy, with Medicare sometimes paying for the patient’s deductible or other out of pocket costs. By failing to disclose the existence of applicable insurance coverage, Baptist Health Systems caused the government to overpay Medicare claims from 2003 through 2007.
The whistleblower who exposed this practice through the filing of a False Claims Act lawsuit will receive $661,500 from the settlement proceeds.
For more information on this case, click here: http://www.justice.gov/usao/txw/news/2013/Baptist_Hospital_SA_civil_settlement.html
Nursing home operator Ensign Group, Inc. has agreed to pay $48 million to resolve allegations that it billed Medicare for unnecessary rehabilitation therapy services.
These False Claims Act lawsuits involved billing for services provided at six skilled nursing facilities operated by Ensign in California. According to the whistleblowers’ allegations, Ensign provided medically unnecessary therapy to patients, and billed Medicare for services it had not provided. The government also contended that Ensign improperly incentivized its employees to increase the amount of therapy provided to Medicare patients regardless of the patients’ individual therapy needs.
The whistleblowers who filed these lawsuits, two therapists formerly employed with Ensign, will share in the settlement proceeds pursuant to the qui tam provisions of the False Claims Act. The amount of the whistleblowers’ share has not been announced.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/12-civ-1235.html
FreshPoint, Inc., a Houston-based subsidiary of Sysco Corp., has agreed to pay $4.2 million to resolve a False Claims Act lawsuit relating to the prices it charged the government for fresh fruit and vegetables.
According to the whistleblower’s allegations, FreshPoint improperly inflated its prices to reflect its view of the prevailing market price of the goods at the time of sale. Pursuant to its contracts with the government, FreshPoint was required to supply the produce at cost, plus a pre-established markup as its profit, and was forbidden from making further price adjustments based upon its perception of changes in market prices.
The whistleblower, a former employee of FreshPoint, will receive $798,000 from the settlement proceeds as his award for exposing FreshPoint’s pricing practices by filing a False Claims Act lawsuit.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1233.html
CA, Inc., formerly known as Computer Associates, has agreed to pay $11 million to resolve a False Claims Act lawsuit accusing it of overcharging the government for computer software maintenance services.
According to the whistleblower’s allegations, CA charged its customers for renewal plans immediately, even though they often had months remaining under their current plans. Through this practice, government customers who renewed their maintenance plans were double billed for the months remaining in their existing plans.
This whistleblower case was brought on behalf of the federal government, as well as New York, California, Florida, Hawaii, Illinois, Massachusetts, Nevada, Virginia and the District of Columbia. The federal portion of the settlement amounts to $8 million, and the states will divide the rest based on the number of renewal plans purchased.
For more information on this case, click here: http://www.ag.ny.gov/press-release/ag-schneiderman-announces-11-million-multi-state-settlement-over-fraud-claims-against.
The Department of Justice recently announced that Hospice of the Comforter, Inc. (HOTCI) has agreed to pay $3 million to settle a whistleblower lawsuit filed by one of its former employees.
According the allegations raised in this False Claims Act lawsuit, HOTCI submitted false claims to Medicare for hospice services. These claims violated the Medicare rules which provide for benefits for hospice services rendered to terminally ill patients with less than six months to live. The whistleblower exposed practices that included falsifying medical records to give the appearance that patients were eligible for benefits, admitting patients who did not qualify for the Medicare hospice benefit, and limiting physicians’ ability to assess the patients’ terminal status.
Pursuant to the False Claims Act qui tam provisions, the whistleblower who filed this lawsuit will share in the government’s recovery. The amount of the whistleblower’s share in this case has not been announced.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/November/13-civ-1179.html