Compliance Newsletter

  Guiding Healthcare Providers in Designing, Managing, and Maintaining Regulatory Compliance  

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Lincare pays $5.25M to resolve False Claims Act allegations

On August 17, 2018, the Department of Justice announced that Lincare, Inc., has paid $5.25 million to resolve allegations that it violated the federal False Claims Act and the Anti-Kickback Statute by offering illegal price reductions to Medicare beneficiaries.  Lincare is one of the largest providers of oxygen and other respiratory therapy services to patients in the home with over 1,000 locations in the United States.

Read more here: https://www.hcca-info.org/Resources/View/tabid/451/ArticleId/10789/OIG-excludes-company-and-owner-from-federal-health-care-programs-Local-doctor-admits-to-falsely-prescribing-opioids-to-girlfriends-Doctor-wife-plead-n.aspx#ACEF0C64A-A07A-1342-347A-21F9CC0A5569. 

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Home Health Firm To Pay $1.5 Million In Kickback Scheme

On July 17, 2018,  federal officials announced that the owners of a Palm Beach Gardens home-health agency have agreed to pay $1.5 million to settle allegations that the company illegally paid kickbacks to marketers to lead to patient referrals. 

Read more here: http://wlrn.org/post/home-health-firm-pay-15-million-kickback-scheme

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Kentucky SNF Chain Preferred Care Settles $540,000 Upcoding Case

Nursing home chain Preferred Care agreed to settle False Claims Act charges for $540,000, the Department of Justice has announced.

Federal officials accused the company of upcoding Medicare beneficiaries between July 2012 and October 2017, and of providing “worthless services” at Kentucky's Stanton Nursing and Rehabilitation Center for three years.

Read more here: https://www.mcknights.com/news/preferred-care-settles-for-540000-in-whistleblower-upcoding-case/article/778714/

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Federal Appeals Court Holds Medical Judgment Not Valid False Claims Defense

The 10th Circuit Court of Appeals found that a doctor’s certification that a procedure was “reasonable and necessary” is false if the procedure doesn’t meet the government’s definition of what is reasonable and necessary, as determined by the Medicare Program Integrity Manual. Among the requirements is that the procedure is safe and effective; not experimental or investigational; and appropriate, including in duration and frequency.  A doctor's subjective judgment as to "reasonable and necessary" was irrelevant.  

Read more here: https://www.bna.com/medical-judgment-not-n73014477299/

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Physicians Indicted in $580 Million Kickback Scheme at Pacific Hospital of Long Beach

According to the Department of Justice, the matter relates to the payment of kickbacks in return for referrals of patients to Pacific Hospital for spinal surgeries and other services, which were paid for primarily through the California workers' compensation system. 

Read more here: http://www.healthcarefinancenews.com/news/more-doctors-indicted-15-year-long-580-million-kickback-scheme-pacific-hospital-long-beach. 

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More Than 600 Individuals Charged - Including 76 Doctors, 23 Pharmacists, and 19 Nurses -  in $2 Billion Fraud Scheme

On June 28, 2018, the DOJ and HHA announced the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.  Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

Read more here: https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-601-individuals-responsible-over. 

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Private Equity Firms Become DOJ Health-Care Fraud Targets

In a recent False Claims Act intervenor complaint, the Department of Justice (DOJ) alleged that Riordan, Lewis & Haden (RLH), a private equity firm based in Los Angeles, participated in a scheme with Diabetic Care Rx to defraud the federal government's TRICARE program.  RLH bought a controlling stake in Diabetic Care Rx in July 2012.

The case underscores the DOJ's willingness to hold private equity and other investment firms accountable for the compliance infractions of the organizations in which they invest.  

Red more here: https://www.bna.com/private-equity-firms-n73014476196/ 

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Federal Judge Dismisses therapy whistleblower case involving 80 SNFs

A federal judge has dismissed a False Claims Act case against Midwest-based Trilogy Health Systems involving allegations that Trilogy routinely administered unnecessary therapy to residents. 

Read more here: https://www.mcknights.com/news/federal-judge-dismisses-therapy-whistleblower-case-allows-wrongful-firing-claim-to-continue/article/769600/ 

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Addiction Treatment Center Owner Indicted for Fraudulent Claims by DOJ

The owner of Redirections Treatment Advocates, LLC, an opioid addiction treatment organization with locations in Pennsylvania and West Virginia, has been indicted on charges of unlawfully dispensing controlled substances and health care fraud.  

Read the DOJ's press release here: https://www.justice.gov/usao-wdpa/pr/redirections-treatment-owner-charged-unlawfully-distributing-buprenorphine-and.

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Compliagent's CEO, Nick Merkin, Cited in Article About Contingency Planning Obligations Under the HIPAA Rules

Read the Full Article Here:

 https://www.ahcmedia.com/articles/142754-ocr-concerned-about-hipaa-contingency-plans

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Substance Abuse Treatment Facility Settles $1.37 Million Fraud Case

On May 2, 2018, a Connecticut-based substance abuse treatment facility agreed to pay $1.37 million to settle claims of Medicaid fraud.  The New Era Rehabilitation Center was accused of fraudulently billing Medicaid for services relating to methadone addiction.  

Read more here: 

https://www.law.com/ctlawtribune/2018/05/02/connecticut-drug-rehab-center-pays-1-3m-to-settle-claims-it-fraudulently-billed-medicaid-for-work-with-meth-addicts/?slreturn=20180404110337

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Healthcare Fraud Enforcement Activities Result in $2.6 Billion Recovery

The Department of Justice (DOJ) and the Department of Health and Human Services announced the recovery of $2.6 billion in taxpayer dollars in 2017. According to the DOJ's recent report, many of these recoveries arose from false claims, fraudulent billing for ambulance transportation services, misrepresentations by EHR providers, and fraudulent billing for physical and occupational therapy services.

Read more here: https://www.justice.gov/opa/pr/department-justice-and-health-and-human-services-return-26-billion-taxpayer-savings-efforts.

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Southern California Ambulance Company Employee Sentenced to Prison for Involvement in Medicare Fraud Scheme

Aharon Aron Krkasharyan, a former employee of a Southern California ambulance company, pleaded guilty to one count of conspiracy to commit healthcare fraud related to $1.1 million in fraudulent Medicaire claims to Medicare. 

Read more here: https://www.justice.gov/opa/pr/former-employee-southern-california-ambulance-company-sentenced-prison-role-medicare-fraud

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Ambulance Company to Pay $9 Million to Settle False Claims Act Allegations

On March 28, 2018, Medical Transport LLC, a Virginia Beach-based provider of ambulance services, agreed to pay $9 million to resolve allegations that it violated the False Claims Act by submitting false claims for ambulance transports, the Justice Department announced.  

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Former Business Manager of Assisted Living Facility Indicted for Stealing Hundreds of Thousands of Dollars from Elderly Victim

The business manager of a Morristown, New Jersey, assisted living facility has been charged with exploiting her position to steal approximately $237,000 from an elderly victim under her care, U.S. Attorney Craig Carpenito announced.

Read more here: https://www.justice.gov/usao-nj/pr/former-business-manager-assisted-living-facility-indicted-stealing-hundreds-thousands