A pain medicine specialist and his medical corporation agreed to pay $835,000 to resolve FCA allegations that they participated in an illegal kickback arrangement causing false claims to be submitted to federal healthcare programs, in violation of the AKS.
A podiatrist and his medical corporation agreed to collectively pay nearly $1.6 million to resolve FCA allegations that they participated in an illegal kickback arrangement causing false claims to be submitted to federal healthcare programs, in violation of the AKS.
A pharmaceutical company its CEO/co-owner agreed to pay $47 million to resolve FCA allegations that they caused the submission of false claims to federal healthcare programs by offering kickbacks to induce claims for one of the company’s drugs.
A hospital system agreed to pay over $2.3 million to resolve self-disclosed FCA allegations that it submitted improperly modified claims to Medicaid resulting in falsified information.
An ophthalmology practice agreed to pay $1.3 million to resolve FCA allegations that it knowingly submitted false claims for medically unnecessary trans-cranial doppler ultrasounds (TCDs) which were tainted by a kickback arrangement with a third party, in violation of the AKS. The company agreed to cooperate with further DOJ investigations in the related scheme.
A university health system agreed to pay $23 million to resolve FCA allegations that it sought and received payment for ER visits by incorrectly coding E&M claims to federal healthcare programs.
A laboratory agreed to pay $6.5 million to resolve FCA allegations that it submitted false claims to federal healthcare programs for concurrent presumptive and definitive urine drug testing when performing both were medically unnecessary. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
An online mental health company entered into a non-prosecution agreement (NPA) and agreed to pay $3.652 million to resolve CSA allegations that it engaged in company practices that encouraged the unlawful distribution of a variety of controlled substances including: (1) incentives to providers who issued stimulant medication for ADHD patients; and (2) not maintaining operational controls against drug diversion. The company agreed to pay an additional fine of $2.922 million that it cannot currently pay and will be deferred for the length of the NPA.
A doctor, pharmacist and office complex owner agreed to collectively pay over $700,000 to resolve FCA allegations that: (1) they accepted above FMV rent to induce patient referrals; and (2) the doctor prescribed multiple medically unnecessary drugs, including opioids, which were filled at a pharmacy onsite. As part of the resolution, the doctor agreed to void his DEA registration and cease prescribing, dispensing, or administering controlled substances.
A medical center agreed to pay $14.2 million to resolve self-disclosed FCA allegations that it failed to include “PN” modifiers and site locations to classify services delivered at its off-campus outpatient facilities that are not eligible. The center also revealed the presence of Hospital Department Management Agreements and Operating Lease Agreements at each facility which created financial relationships between Horizon and the physician-owners, in violation of the Stark Law.
A compound ingredient supplier agreed to pay $21.75 million to resolve FCA allegations that it knowingly overstated the Average Wholesale Prices (AWPs) of two ingredients used in compound prescriptions causing false claims to be submitted to the Defense Health Agency. The high prices also created an increased potential in customer profit and an inducement to purchase their ingredients.
A physician group that focuses on substance abuse treatment agreed to pay $650,000 to resolve FCA allegations that it submitted false claims to MassHealth and MassHealth managed care entities for services that were not provided and billed for higher levels of service than were actually provided. As part of the resolution, the company entered into a three-year independent compliance monitoring program.
A veterinary medical supplier agreed to pay $1.125 million to settle CSA allegations that it failed to: (1) provide adequate documentation to DEA for 35 flagged opioid orders; (2) notify DEA of lost controlled substances; and (3) appropriately review the current information made available in ARCOS as requisite by the CSA. As part of the resolution, the company entered into a one-year MOA with DEA. An employee of the related veterinary office was charged, convicted, and sentenced after admitting she diverted drugs from the orders for her own personal use.
A medical transportation company agreed to pay $380,000 to resolve FCA allegations that it billed MassHealth for services that were not actually provided. As part of the resolution, the company implemented a three-year independent compliance monitoring program.
A doctor agreed to pay nearly $200,000 to resolve FCA allegations that he billed federal healthcare programs for medically unnecessary procedures, and for procedures that were more complex than were actually performed. The settlement amount was based on the doctor’s ability to pay. In February 2021, the doctor pled guilty to one count of making a false statement related to a similar healthcare matter while practicing in Michigan. The doctor willingly surrendered his South Dakota medical license in 2019 and his Iowa medical license in 2021.
A healthcare company and a former therapist agreed to collectively pay over $320,000 to resolve FCA allegations that they knowledgeably submitted or initiated the submission of false claims to Medicaid for services that were not provided or not provided by a qualified professional.
A doctor agreed to pay $65,680 to resolve FCA allegations that he submitted false claims to Medicare for DME and genetic testing that were medically unnecessary or reasonable.
A mobile phlebotomy laboratory and its owners agreed to pay a minimum of $135,000 to resolve FCA allegations that they: (1) submitted false claims to federal healthcare programs for services not performed and travel mileage related to these services that is not reimbursable; and (2) paid illegal kickbacks to a third-party marketer, in violation of the AKS. The settlement amount is based on the parties' ability to pay and may increase due to the sale of company property.
A primary care provider agreed to pay over $1.1 million to resolve FCA allegations that it improperly and knowingly billed Medicare for the surgical implantation of neurostimulator devices when the patients received electro-acupuncture devices that were not surgically implanted.
A physician assistant and his medical practice, along with a doctor agreed to pay $300,000 to resolve CSA allegations that they prescribed controlled substances to patients who exhibited signs of diversion and abuse via inconsistent urine drug tests. As part of the resolution, the doctor and physician assistant voluntarily surrendered their DEA registrations and will not re-apply for five years.
A laboratory company agreed to pay $27 million to resolve FCA allegations that it billed government healthcare programs for medically unnecessary urine drug tests tainted by physician kickbacks, in violation of the AKS. As part of the resolution, the company entered into a five-year CID with HHS-OIG).
A government services contractor providing Medicare support services agreed to pay $306,722 to resolve self-disclosed FCA allegations that it insecurely stored Medicare beneficiary identifiable information, in violation of CMS’s cybersecurity requirements.
A laboratory and its owner agreed to pay $235,000 to resolve FCA allegations that they billed North Carolina Medicaid for medically unnecessary drug tests tainted by illegal kickbacks, in violation of the AKS.
A home health agency and its owner agreed to pay nearly $400,000 to resolve FCA allegations that they knowingly received and kept more than one Paycheck Protection Program (PPP) loan.
A generic pharmaceutical manufacturer agreed to pay $425 million to resolve FCA allegations that it paid kickbacks using two co-pay assistance foundations, in violation of the AKS.
A generic pharmaceutical manufacturer agreed to pay $25 million to resolve FCA allegations that it paid and received payments to fix prices and allocate markets for two generic drugs, in violation of the AKS.
A doctor and his medical practice agreed to pay a total of $625,000 to the United States and the State of North Carolina to resolve FCA allegations that they participated in a laboratory kickback scheme, in violation of the AKS.
A doctor and her former medical practice agreed to pay $3.8 million to resolve FCA allegations that they billed Medicare and TRICARE for non-covered services. As part of the resolution, the doctor will be excluded from participating in all federal healthcare programs for five years.
A chiropractor and his clinic agreed to pay $170,000 to resolve FCA allegations that they submitted false claims to federal healthcare programs for the use of Sanexas treatment, TM Flow testing, vitamin injections and ENFD testing, which were either medically unncessary or non-reimbursable.
A Medicaid call center agreed to pay over $11.3 million to resolve self-disclosed FCA allegations that it reported falsified performance metrics and false claims for payment to the South Carolina Department of Health and Human Services.
A former hospital CEO agreed to pay over $5.3 million to resolve FCA allegations related to kickback payments to physicians for the referral of laboratory testing, in violation of the AKS.
A laboratory agreed to pay $27 million to resolve FCA allegations that it: (1) billed federal healthcare programs for medically unnecessary urine drug tests; and (2) provided free urine test cups to physicians who agreed to refer laboratory testing, in violation of the AKS. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
A behavioral health organization agreed to pay a minimum of $5.5 million and up to $6.5 million to resolve FCA allegations that they violated the federal and Massachusetts False Claims Acts by encouraging patient participation in sober homes and then further inducing them to participate in the hospital’s partial hospitalization program, in violation of the AKS.
A bariatric and general surgeon agreed to pay $45,000 to resolve FCA allegations that he caused the submission of false claims to Medicaid and Medicare by improperly billing esophagogastroduodenoscopies (EGD) procedures.
Two home healthcare companies agreed to pay $9.75 million to resolve FCA allegations that they falsely claimed paying the minimum wage required by New York State to their home care aides. The companies also agreed to pay an additional $7.5 million to current and former aides under the Wage Parity Act.
A durable medical equipment supplier and its founder and chairman agreed to collectively pay $20 million to resolve FCA allegations that they billed federal healthcare programs for medically unnecessary and excessive supplies. The settlement was based on their ability to pay.
A hospital, laboratory, three lab employees, and a referring physician and his office manager have agreed to collectively pay more than $7.3 million dollars to resolve FCA allegations that they submitted false claims to Medicare, Kentucky Medicaid and TRICARE for services that were not medically necessary or were tainted by kickbacks, in violation of the AKS. The physician's settlement also resolved CSA allegations that he unlawfully prescribed controlled substances. As part of the resolution, the physician agreed to: (1) be excluded from federal healthcare programs for 15 years; and (2) surrender his DEA registration and not reapply for a new registration.
A behavioral health and addiction treatment services network, alongside its president and chief executive officer, and medical director, agreed to pay $1 million to resolve CSA allegations that they violated certain recordkeeping and dispensing requirements. As part of the resolution, the parties agreed to monitoring and compliance obligations.
A healthcare company agreed to pay $19.85 million to resolve FCA allegations that it knowingly: (1) billed for medically unnecessary inpatient services; (2) billed for services and failed to provide acute care following Medicare, Medicaid and TRICARE regulations; (3) failed to discharge beneficiaries at proper times; and (4) failed to provide acceptable staffing, training and/or supervision of staff.
A medical device company agreed to pay up to $28 million to resolve FCA allegations that it: (1) marketed its DABRA Laser product used in atherectomy procedures that were not FDA approved; (2) marketed the DABRA Laser in spite of performance issues prompting a recall; and (3) knowingly offered and paid remuneration to physicians to induce use of the DABRA Laser, in violation of the AKS. The settlement is according to DOJ’s inability to pay settlement guidelines.
A pharmacy and its owner agreed to pay $1.4 million to resolve FCA allegations that they submitted or caused the submission of false claims to Medicare and Medicaid for prescription drugs.
A pharmacy and its owner agreed to pay over $725,000 to resolve FCA allegations that they submitted or caused the submission of false claims to Medicare and Medicaid for prescription drugs.
A pain clinic agreed to pay $750,000 to resolve FCA allegations that it knowingly submitted or caused the submission of false claims to Medicare by using amniotic fluid injections for pain management.
A primary care provider agreed to pay $60 million to resolve FCA allegations that it paid kickbacks to third-party insurance agents in exchange for patient recruitment, in violation of the AKS.
A group of surgery centers agreed to pay nearly $12.76 million to resolve self-disclosed FCA allegations that they had improper financial relationships with two physician groups, in violation of the AKS and Stark Law.
A national pharmacy chain agreed to pay $106.8 million to resolve FCA allegations that it submitted claims to federal healthcare programs for prescriptions that were never dispensed to beneficiaries.
A physician agreed to pay $100,000 to resolve CSA allegations that he failed to keep and maintain proper records for prescription weight-loss drugs. As part of the resolution, the physician entered into a two-year MOA with DEA allowing him to maintain his registration with increased oversight by DEA.
A physician agreed to pay $1.08 million to resolve FCA allegations that he ordered medically unnecessary DME for Medicare and the Federal Employees Health Benefits Program patients.
A physician agreed to pay $25,000 to resolve CSA allegations that he prescribed opioids outside the usual course of professional practice. As part of the resolution, the doctor entered into an MOA with DEA, requiring him to work with an independent compliance monitor for three years.
A medical device manufacturer and its corporate parent agreed to pay $700,000 to resolve FCA allegations that they knowingly caused physicians to use improper billing codes to obtain exaggerated reimbursements from federal healthcare programs for a hemorrhoid removal system.
A urologist agreed to pay $65,000 to resolve CSA allegations that he failed to: (1) maintain proper records for certain purchases of a Schedule III controlled substance; (2) report his workplace as a practice location; and (3) properly document an instance of the destruction of a controlled substance.
A generic pharmaceutical manufacturer agreed to pay $25 million to resolve FCA allegations that it conspired to fix the price of a generic drug used to treat high cholesterol and triglyceride levels, in violation of the AKS. The resolution was based on the company’s ability to pay.
Two dentists and their three businesses agreed to pay $1.7 million to resolve FCA allegations that they submitted claims to the Connecticut Medical Assistance Program (CTMAP) for patients that had been referred by a patient recruiting company, in violation of their agreement with CTMAP and the federal AKS.
A nonprofit healthcare system agreed to pay over $10.8 million to resolve self-disclosed FCA allegations that it submitted false claims to federal healthcare programs for services by an oncologist at its cancer treatment center that were coded at a higher level than was performed and did not meet the requirements of a distinctly classifiable service when performed on the same day as chemotherapy. The healthcare system compensated the oncologist based on the false claims, making his salary inconsistent with fair market value.
A certified physician assistant paid $96,000 to resolve FCA allegations that he caused the submission or submitted claims to Medicare by performing medically unnecessary ultrasound procedures.
A medical clinic, its chiropractor and a partial owner paid $150,000 to resolve FCA allegations that they caused the submission or submitted claims to Medicare for medically unnecessary ultrasound procedures.
A physician agreed to pay $165,000 to settle CSA allegations that he dispensed prescriptions for Schedule III Controlled Substances without the required registration from the state’s Bureau of Narcotics.
A durable medical equipment provider agreed to pay $13.5 million to resolve FCA allegations that it submitted false claims to several federal healthcare programs for custom wheelchairs and wheelchair parts based on patient evaluations that were not properly authored, completed, or signed by qualified medical professionals.
An acupuncturist agreed to pay $850,000 to resolve FCA allegations that he billed the U.S. Department of Veterans Affairs for healthcare services that were not actually provided.
A pharmacy agreed to pay over $141,000 to resolve CSA allegations that it failed to maintain proper records related to controlled substances and billed federal healthcare programs for medications that were never dispensed.
A radiology practice and its founder/CEO agreed to pay over $8.8 million to resolve FCA allegations that they illegally paid investor physician kickbacks for referrals to its clinic, in violation of the AKS.
A home healthcare and hospice provider agreed to pay $3.85 million to resolve FCA allegations that it knowingly submitted false claims to Medicare for (1) patients who did not qualify or were not accurately certified for the benefit; (2) services not reasonable or considered medically necessary; and (3) services not provided or provided by untrained staff. The settlement is based on the provider’s ability to pay.
Two physicians and their family medical practice agreed to pay $600,000 to resolve FCA allegations that they submitted claims for services that were: (1) not provided; (2) supervised by the physician stated in the claim and had been rendered by a non-credentialed provider. They also altered patient records to falsely reflect that patients were seen by one of the physicians when the patient had actually been seen by a different provider. All parties executed a Consent Judgment totaling $1,646,835, which may be enforced if the Defendants do not make the required payments under their settlement agreement.
A non-profit physician group agreed to pay $3.15 million to resolve FCA allegations that it accepted a Paycheck Protection Program loan for which it was unqualified, and then sought and received forgiveness.
A pharmacy and its owner agreed to pay $115,000 to resolve CSA allegations they: (1) used a rubber stamp of a doctor’s signature to prescribe drugs without knowledge or approval from the doctor; (2) issued controlled substances to members of the owner’s family; and (3) ordered office inventory impermissibly.
A doctor agreed to pay nearly $620,000 to resolve FCA allegations that he submitted claims to multiple federal healthcare programs for services rendered when he was actually out of the office.
A dental office and its founders and former owners agreed to pay $6.3 million to resolve FCA allegations that they knowingly received multiple improper loans under the Paycheck Protection Program.
The owner of a DME supplier agreed to pay nearly $225,000 to resolve FCA allegations that he submitted claims for DME to Medicare that were medically unnecessary and tainted by kickbacks, in violation of the AKS.
A county in Florida agreed to pay $3.5 to resolve FCA allegations that it billed government healthcare programs for emergency medical services and transportation by technicians who did not have the necessary certifications.
An ophthalmology practice and its owner and ophthalmologist agreed to pay $469,232 to resolve FCA allegations that they: (1) submitted or caused the submission of false claims to Medicare and the Federal Employee Health Benefit for payment of transcranial doppler tests that were considered medically unnecessary; (2) billed for services that were not performed; and (3) accepted remuneration from billing and retaining payments, in violation of the AKS.
A cataract lens supplier and the estate of its former principal agreed to pay $12 million to resolve FCA allegations that they paid kickbacks to ophthalmic surgeons to encourage the use of their product in procedures, in violation of the AKS.
A group of substance treatment clinics agreed to pay $863,934 to resolve FCA allegations that they submitted false claims to Virginia Medicaid for services that did not fulfill the criteria with the billing code used.
A biopharmaceutical and clinical laboratory services company agreed to pay over $5.3 million to resolve FCA allegations that they paid commissions to third-party independent contractor marketers, in exchange for recommendations of genetic testing services, in violation of the AKS.
Two mental healthcare providers agreed to pay $1.083 to resolve FCA allegations that they submitted claims to federal healthcare programs for services rendered by non-physician personnel, resulting in higher reimbursement rates.
A chiropractor agreed to pay $180,000 to resolve FCA allegations that he submitted false claims to Medicare for surgically implanted neurostimulators when surgery or implantation was not performed. As part of the resolution, he agreed to a five-year exclusion from all federal healthcare programs.
An osteopathic doctor agreed to pay $72,000 to resolve CSA allegations that he improperly prescribed opioids. The doctor also entered into an administrative agreement with the DEA which prevents him from prescribing almost all controlled substances in the future.
A dialysis clinic provider agreed to pay over $34 million to resolve FCA allegations that it paid kickbacks to multiple entities to induce referrals to their clinics for numerous services, in violation of the AKS.
An acupuncturist and his clinic agreed to pay $2.3 million to resolve FCA allegations that they submitted upcoded claims to the VA for services provided to veterans.
A current home health provider agreed to pay $19.428 million to resolve FCA allegations that its successor and related entities: (1) knowingly retained overpayments from federal healthcare programs for services provided to ineligible patients and improperly concealed or avoided duties to repay the claims; and (2) violated the AKS by paying renumeration to a consulting physician in an effort to induce hospice referrals.
A pharmacy agreed to pay $150,000 to resolve CSA allegations that it improperly dispensed controlled substances, including opioids. As part of the resolution, the pharmacy surrendered it's DEA registration.
A pharmacy agreed to pay $150,000 to resolve CSA allegations that it improperly dispensed controlled substances, including opioids. As part of the resolution, the pharmacy surrendered its DEA registration.
An oncology company agreed to pay over $900,000 to resolve FCA allegations that it knowingly submitted claims to federal healthcare programs tainted by the referral of a physician's employment of a family member, in violation of the Stark Law.
A maintenance and detoxification facility agreed to pay $300,000 to resolve CSA allegations that it: (1) failed to maintain precise records; (2) did not perform required inventory checks; and (3) co-minged controlled substances between different registrants. As part of the resolution, the company entered into a MOA with DEA.
A maintenance and detoxification facility agreed to pay $300,000 to resolve CSA allegations that it: (1) failed to maintain precise records; (2) did not perform required inventory checks; and (3) co-mingled controlled substances between different registrants. As part of the resolution, the company entered into a MOA with DEA.
Three laboratory companies agreed to pay $2.45 million to resolve FCA allegations that they submitted claims with manipulated diagnosis codes to Medicare and Medicaid. As part of the resolution, the companies entered into a five-year CIA with HHS-OIG. One of the companies filed for relief under Chapter 11 and the agreement has been approved by the bankruptcy court.
A healthcare system and 12 affiliated skilled nursing facilities agreed to pay $21.3 million to resolve FCA allegations that they knowingly billed therapy services that were unnecessary, unreasonable, unskilled or that did not occur to federal healthcare programs. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
A pharmacy and several subsidiaries agreed to pay $101 million and have an additional $20 million allowed in its bankruptcy case to resolve FCA allegations that they inaccurately reported drug rebates to Medicare. The settlement is based on the companies’ ability to pay and the bankruptcy court has approved the settlement as part of the company's plan of reorganization.
A pharmacy corporation and 10 of its subsidiaries and affiliates agreed to pay $7.5 million and have an additional $401.8 million allowed in its bankruptcy case to resolve FCA and CSA allegations that they knowingly distributed prescriptions for controlled substances that: (1) lacked legitimate medical need; (2) were not issued in the usual course of professional practice; (3) were not valid prescriptions for a medically accepted symptom; or (4) were medically unnecessary. The company entered a MOA with DEA and a CIA with HHS-OIG. The bankruptcy court has approved the settlement as part of the company's plan of reorganization.
A group of home health agencies and their owner agreed to collectively pay nearly $4.5 million to resolve self-disclosed FCA allegations that they provided illegal kickbacks in exchange for Medicare referrals, in violation of the AKS.
A dermatology practice, its dermatologist and CEO have agreed to collectively pay $1.63 million to resolve FCA allegations that they submitted false claims for dermatology services to Medicare and other government payors, including: (1) claims billed for services as if they were performed under the supervision of the dermatologist when she was not physically in the clinic; (2) office visits where the practice inappropriately waived beneficiary co-pays; and (3) the use of specific skin grafts in situations their usage was not justified as billed.
A prescription drug benefit provider agreed to pay $20 million to resolve CSA allegations that it improperly filled certain opioid prescriptions in dangerous combinations including the “Holy Trinity” consisting of an opioid, a benzodiazepine, and a muscle relaxant. The prescriptions raised red flags, but the provider filled many of them without first resolving the issues. The provider closed its mail-order pharmacy operations in the area during the government’s investigation.
A group of non-profit home and community-based healthcare companies agreed to pay nearly $1 million to resolve FCA allegations that they submitted claims to Medicaid for services that failed to provide or document persons with serious mental illness at one location, as required by program guidelines.
A neurologist and pain management physician entered into a consent judgment and agreed to pay $550,000 to resolve FCA allegations that he lived outside of the U.S. while: (1) billing Medicare and Medicaid for sleep studies and other services provided; and (2) issuing prescriptions, in violation of the CSA. To resolve the entire case, the doctor also agreed to sell his real property in Panama City and to not reapply for a DEA registration.
A medical center, medical college and surgical group agreed to collectively pay $15 million to resolve FCA allegations that they billed for concurrent heart surgeries and regularly delegated complicated and dangerous heart surgeries to unqualified medical residents.
A doctor has agreed to pay over $629,000 to resolve FCA allegations that he prescribed medically unnecessary orthotic braces to individuals with whom he did not have a valid patient relationship.
A hospice provider, its owners and managers agreed to collectively pay $1.4 million to resolve FCA allegations that they entered into kickback arrangements, including monthly stipends and signing bonuses, with medical directors in exchange for patient referrals, in violation of the AKS.
A forensic drug testing company agreed to pay over $1.3 million to settle FCA allegations that it submitted false claims for drug tests to the Michigan Department of Health and Human Services.
An independent nurse practitioner group and its former owners agreed to pay almost $2 million to resolve FCA allegations that they required staff to use its proprietary patient charting software knowing it caused upcoded claims to be submitted to Medicare and Medicaid.
A chiropractor and his company agreed to pay $52,000 to resolve FCA allegations that they submitted false claims to federal healthcare programs for epidermal nerve fiber density testing and for the use of the Sanexas device. The chiropractor declared Chapter 7 bankruptcy.
Two chiropractors and their co-owned company agreed to pay $1.9 million to resolve FCA allegations that they improperly billed federal healthcare programs for use of the Sanexas and TM Flow devices, in addition to epidermal nerve fiber density testing.
A behavioral health company, its related healthcare companies and its CEO agreed to collectively pay over $4.5 million to resolve FCA allegations that they submitted false claims to Medicare and Connecticut Medicaid for telehealth psychological services to beneficiaries who were not residing in the nursing homes.
A doctor and his pain management practice agreed to pay $1.2 million to resolve FCA allegations that they: (1) submitted false claims that did not meet billing requirements including using ultrasound for pain management injections; and (2) upcoded claims in order to receive additional reimbursement funds.
A company that operates and manages multiple urgent care practices agreed to pay over $12 million to resolve FCA allegations that they submitted or caused the submission of false claims for COVID-19 testing for uninsured patients to the Health Resources and Services Administration (HRSA) program.
A public healthcare district agreed to pay $250,000 to resolve self-disclosed CSA allegations that it diverted fentanyl from a facility and failed to keep proper records for the controlled substance. As part of the resolution, the company entered into a MOA with DEA.
An ophthalmologist, his ophthalmology practice and other related entities agreed to pay a total of $2.5 million to resolve FCA allegations that they submitted false claims to Medicare and Medicaid for services that were not medically necessary or could not have been performed due to the doctor being out of the country or out of the office when services were stated as rendered.
A group of chronic disease management providers agreed to pay over $14.9 to resolve FCA allegations that they submitted false claims to Medicaid, Medicare and TRICARE for E&M services that did not conform to the federal healthcare program’s requirements. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
An ambulatory surgical center agreed to pay $125,000 to resolve CSA allegations that it did not: (1) maintain accurate and complete controlled substances records; and (2) provide effective controls and measures to protect against controlled substance theft and diversion.
A doctor agreed to pay $200,000 to resolve FCA allegations that he participated in a kickback scheme from a medical device company, in violation of the AKS. The doctor in turn used the free products involved in the scheme for surgeries performed in the Kingdom of Saudi Arabia, Qatar and Lebanon. The medical device company settled its own allegations with DOJ in January 2023.
A spinal device manufacturer and two senior executives agreed to collectively pay $12 million to resolve FCA allegations that they paid kickbacks to seventeen surgeons to induce the use of the company’s spinal devices, in violation of the AKS. The kickbacks included consulting fees, IP acquisition and licensing fees, company performance shares, registry payments, extravagant dinners and holiday parties for office staff and family, and travel to a luxury ski resort.
A non-profit corporation that operates a hospital system agreed to pay $735,000 to resolve FCA allegations that it submitted claims to Medicaid and Medicare in connection to violations of the Stark Law.
An owner and his variety of health and diagnostic companies agreed to collectively pay over $27 million to resolve FCA allegations that they submitted false claims to Medicare for cancer genomic tests procured via illegal kickbacks and considered medically unnecessary, in violation of the AKS. All parties agreed to be excluded by HHS-OIG from all Federal healthcare programs and the civil settlement is based on the owner's ability to pay. The owner previously pleaded guilty to criminal healthcare fraud for the same offenses.
A non-profit corporation that administers a Managed Long Term Care Plan agreed to pay over $10.1 million to resolve FCA allegations that it submitted false claims to Medicaid that failed to provide or adequately document specific certain long-term care services to patients in order to receive Capitation Payments.
A foundation agreed to pay $7.6 million to resolve FCA allegations that it submitted three federal grant applications and progress reports to the National Institutes of Health (NIH) that did not disclose an employee involved with the grants had active and/or pending financial research support from sources outside NIH. The foundation also permitted password sharing by employees during the application process, in violation of NIH policies. As part of the settlement, NIH has enacted Specific Award Conditions on all of the foundation’s grants for one year.
A hospital agreed to pay $24.3 million to resolve FCA allegations that it knowingly submitted false claims for transcatheter aortic valve replacement procedures to Medicare that did not comply with the program’s rules. As part of the settlement, the hospital entered into a five-year CIA with HHS-OIG.
A medical equipment company and one of its owners agreed to pay $352,800 to resolve FCA allegations that they submitted false claims for compression stockings to the Federal Employees Health Benefit Program.
A pharmacy and its pharmacist-in-charge agreed to pay $215,000 to resolve CSA allegations that they filled controlled substances prescriptions without a valid medical purpose. As part of the resolution, the pharmacy entered into a four-year Memorandum of Agreement with DEA.
A doctor and his practice agreed to pay over $2 million to resolve FCA allegations that they submitted claims to Medicare and Medicaid for services provided by the doctor but were actually provided by physician assistants who were not properly supervised.
An orthopedic surgeon and two hospital groups agreed to collectively pay $942,708 to resolve FCA allegations that they billed Veterans Affairs, Medicare and TRICARE for spinal surgeries that were medically unnecessary and at a higher spinal level than needed. The surgeon retired in 2018 and surrendered his physician license in 2019.
Two dentists and their dental practices agreed to pay over $498,000 to resolve FCA allegations that they paid a patient recruiting company for referrals of Connecticut Medical Assistance Program (CTMAP) patients and then submitted claims for those patient services above routine preventative care to CTMAP for reimbursement.
A health system agreed to pay $1.5 million to resolve self-disclosed FCA allegations that it knowingly offered discounts to patients to induce the purchase or referral of the health system’s services, in violation of the AKS.
A healthcare company and its owner agreed to pay $1 million to resolve FCA allegations that they submitted false claims to Medicare for care plan oversight services that the company did not physically perform. The owner pleaded guilty in 2023 to a criminal federal healthcare fraud charge and was sentenced to three years of probation.
A pharmacy chain agreed to pay $350,000 to resolve CSA allegations that it: (1) diverted controlled substances; (2) improperly sold pseudoephedrine chemical products; and (3) failed to maintain proper accounting records for controlled substances. As part of the resolution, the pharmacy entered into a Memorandum of Agreement with the DEA.
A specialty medical group agreed to pay $200,000 to resolve CSA allegations that it failed to keep and produce records relating to the transfer, acquisition, dispension and loss of Schedule III and Schedule IV controlled substances.
A group of hospice providers agreed to pay $4.2 million to resolve FCA allegations that they knowingly submitted false claims and retained the overpayments related to the care of hospice patients who were not eligible for the benefit because they were not terminally ill. The parties also improperly concealed the overpayments of these claims.
A staffing company agreed to pay $2.7 million to resolve FCA allegations that it failed to implement proper cybersecurity processes to protect patient health data gathered during COVID-19 contact tracing.
A laboratory marketer, his marketing company, three physicians and their medical practices have agreed to collectively pay over $1.3 million to resolve FCA allegations that they were involved in a kickback scheme that resulted in false testing claims being submitted to Medicare and TRICARE, in violation of the AKS. All parties have agreed to cooperate with DOJ investigations of additional participants in the alleged schemes.
A health group, health consulting provider and two corporate executives agreed to pay $7.084 million to settle FCA allegations that they knowingly submitted false claims for nursing home residents to Medicare Part A.
A doctor agreed to pay $60,000 to resolve CSA allegations that he failed to maintain: (1) invoices for purchases of certain controlled substances; (2) documentation of the date of receipt on specific receiving invoices; and (3) the initial inventory and new inventory biennially of all stocks of readily available controlled substances.
A physician agreed to pay $200,000 to resolve CSA allegations that he failed to maintain proper records of DEA Forms 222 for the purchase of Schedule II controlled substances.
A nurse practitioner has agreed to pay $52,560 to resolve FCA allegations that she received kickback payments in exchange for hundreds of medically unnecessary prescriptions for costly orthotic braces.
A pharmacy and its owner agreed to pay $120,000 to resolve CSA allegations that they filled prescriptions for controlled substances that: (1) were issued without a legitimate medical purpose; (2) displayed red flags of addiction and abuse; (3) were in dangerous combinations including the “Holy Trinity” consisting of an opioid, a benzodiazepine, and a muscle relaxant; and (4) were in unsafe or excessive amounts. The owner voluntarily agreed to surrender the DEA license in 2021 for the pharmacy which is no longer operating.
A family medicine doctor agreed to pay $96,000 to resolve allegations that he: (1) prescribed unsafe combinations of drugs; (2) wrote unlawful prescriptions; and (3) submitted claims to Medicare and Medicaid for services that were not performed. The settlement also restricts the doctor’s DEA registration for five years.
An oncology practice and its affiliated physicians, along with a reference laboratory have agreed to collectively pay over $4 million, plus accrued interest, to resolve FCA allegations that they entered into a kickback scheme where the laboratory paid for each biopsy referred by the oncology practice, in violation of the AKS. The settlement also resolves allegations of medically unnecessary services, treatments and tests being billed to federal healthcare programs from a specific doctor in the oncology practice, as well as her own practice entity. The doctor and her practice entered a three-year IA with HHS-OIG.
A chiropractic, medical, and DME provider and a group of doctors agreed to collectively pay $465,000 to resolve FCA allegations that they: (1) paid physicians to induce referrals of DME; or (2) accepted remuneration funds. Both actions resulted in false claims being submitted to the federal Medicare program, in violation of the AKS and Stark Law.
Two doctors and their family trust agreed to pay $342,466 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The parties agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A doctor and his pain management clinic agreed to pay $100,632 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The parties agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A doctor agreed to pay $217,430 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The doctor agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A doctor agreed to pay $120,634 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The doctor agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
The owner of a nonprofit that secures and administers grants agreed to pay $500,000 to resolve FCA allegations that she and another company official forged signatures on federal grant applications and then used the received funds for personal use.
Two laboratory marketers and their marketing companies agreed to collectively pay $720,000 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. All parties agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A laboratory agreed to pay $2.1 million to resolve FCA allegations that it submitted false claims to North Carolina’s Medicaid program for both presumptive and definitive urine drug tests which were performed at the same time and often on the same sample, resulting in reimbursements being paid for confirmatory tests which were not medically necessary.
A teleradiology company and its owner agreed to pay $3.1 million to resolve FCA allegations that they submitted false claims to federal healthcare programs that: (1) misrepresented who performed the radiology services; (2) included services performed by non-U.S.-based contractors; and (3) were not properly reviewed by the correct U.S.-based provider.
A laboratory and three of its owners agreed to pay over $13.6 million to resolve FCA allegations that they submitted medically unnecessary laboratory tests that were not ordered by the patients’ treating physician. The parties also agreed to be excluded from participating in federal healthcare programs for 15 years.
A chemical importer and distributor agreed to pay $300,000 to resolve CSA allegations that it: (1) violated recordkeeping requirements; (2) repackaged and relabeled a List I chemical without being a registered manufacturer; and (3) drop shipped a List I chemical to a customer without first importing it through its registered location.
A doctor and his diagnostic centers agreed to pay $1.8 million to resolve FCA allegations that they submitted claims that were: (1) unreasonable; (2) medically unnecessary; (3) not supported by patients’ records and/or diagnoses; or (4) performed by untrained and unlicensed technicians. The doctor also referred patients to his personally owned diagnostic centers, in violation of the Stark Law.
A doctor and healthcare staffing company agreed to pay $700,000 to resolve allegations of their participation in a scheme to bill Medicare for diagnostic laboratory testing and DME which was medically unnecessary, in voilation of the AKS.
A home healthcare agency and its owner agreed to collectively pay $600,000 to resolve FCA allegations that they submitted false claims to federal and North Carolina healthcare programs for services that were: (1) never performed; (2) billed by staff who were not present in the facility; and (3) provided by family members and then billed as if they were performed by other staff, including the forging of documents. The settlement amount was based on the parties’ ability to pay.
A hospital agreed to pay $17.3 million to resolve self-disclosed FCA allegations that it paid kickbacks to physicians at its chemotherapy infusion center based on the volume of their referrals sent to the hospital, in violation of the AKS. The settlement also resolves allegations that the chemotherapy services billed to federal healthcare programs were provided by non-physicians and not properly supervised.
A company that develops and sells hemp-derived products agreed to pay $989,438 to resolve FCA allegations that it improperly acquired a Paycheck Protection Loan from the U.S. Small Business Administration. The company was not eligible for the loan program due to its participation with cannabis businesses, which remain illegal under federal law.
A drug manufacturer agreed to pay $2 million to resolve allegations that it did not implement proper controls as required by current good manufacturing practice regulations, causing the company to introduce adulterated drugs into interstate commerce. Those drugs were then used in claims submitted to multiple federal healthcare programs, in violation of the FCA. The company pleaded guilty to criminal charges that it introduced tainted drugs into interstate commerce, in violation of the Federal Food, Drug and Cosmetic Act (FDCA). It agreed to pay an additional penalty and forfeiture amount of $1.5 million.
A doctor agreed to pay $60,000 to resolve FCA allegations that he prescribed an opioid to patients without a cancer diagnosis and without reasonable medical purpose. The doctor then billed federal healthcare programs for the associated visits.
A drug manufacturer, currently in bankruptcy and that has ceased operations, agreed to a civil settlement of $475.6 million to resolve FCA allegations related to its marketing schemes and sales of the opioid drug Opana ER with INTAC which targeted providers the company knew it was prescribing for non-accepted uses. The payments will be made as claims in the company’s bankruptcy proceedings. Criminally, the company pleaded guilty to a one-count misdemeanor information charging it with violation of the Federal Food, Drug and Cosmetic Act (FDCA) by introducing misbranded drugs into interstate commerce.
A therapy provider and its current and former owners agreed to pay $1.5 million to resolve FCA allegations that they submitted false claims to Medicare for: (1) therapy services when the provider was not in the United States; (2) therapy services performed by massage therapists rather than licensed professionals; (3) services performed by an assistant-level professional and not properly supervised; (4) services improperly coded to avoid caps; and (5) services when there were no licensed professionals on site.
A clinical laboratory and its owner agreed to pay $14.3 million to resolve allegations that they paid volume-based commissions to contract sales representatives in exchange for their recommendations for medically unnecessary respiratory pathogen panels (RPPs) and urine drug tests, in violation of the AKS. The two parties agreed to cooperate with DOJ investigations of other participants in these alleged schemes. The owner has also pleaded guilty to criminal charges, along with four others in connection to the scheme.
A doctor agreed to pay $60,000 to resolve CSA allegations that she wrote controlled substance prescriptions and did not maintain the required patient files. The doctor surrendered her DEA Registration voluntarily in October 2023.
A doctor and his medical practice agreed to pay almost $700,000 to resolve FCA allegations that they: (1) upcoded CPT codes; (2) billed for more services than could possibly be provided in one day; and (3) billed for services when the doctor was not physically in the United States.
A toxicology lab, its owner, and its compliance officer agreed to collectively pay $10,458,933 for the submission of medically unnecessary urine drug tests to Medicare and the Kentucky Medicaid programs. The owner and compliance officer were also convicted criminally in December 2023 for their actions.
A specialty pharmaceutical company agreed to pay $750,000 to resolve allegations that it improperly hired and employed a physician’s girlfriend to induce prescriptions written for two specific medications the company sold, in violation of the AKS.
A DME supplier agreed to pay $25.5 million to resolve FCA allegations that it: (1) waived, in full or partially, co-insurance payments to induce federal healthcare beneficiaries, in violation of the AKS; and (2) billed for the rental of non-invasive ventilators when the beneficiary did not use or no longer needed the device. As part of the settlement, the company made truthful admissions regarding its conduct.
A pharmacy and its owner consented to pay $110,000 to resolve CSA violations that they did not keep accurate, complete, and timely inventories related to Schedule II controlled substances. The pharmacy has ceased operations.
A pharmaceutical distributor agreed to pay $19 million to resolve CSA allegations of failing to report thousands of unusually large orders of oxycodone and hydrocodone to DEA. The company agreed to the wrongdoing and will maintain a new compliance program for five years and will surrender one of its DEA registrations.
A multi-hospital health system agreed to pay $11,712,336 to resolve self-disclosed allegations that they submitted false claims to Medicare for Annual Wellness Visit services that were not supported by patients’ medical records.
Two healthcare transportation providers and their owner agreed to pay $1.6 million to resolve allegations that the companies submitted medically unnecessary and upcoded claims to state and federal healthcare programs. The two companies also agreed to retain an independent compliance monitor, which also includes implementation of future training and auditing.
Two pharmacies agreed to collectively pay $1.3 million to settle CSA violations that they filled invalid prescriptions for controlled substances which were prescribed outside the scope of a specific physician’s current practice.
A medical center agreed to pay almost $2.1 million to resolve voluntarily disclosed allegations that it overbilled Medi-Cal for prescription medication by charging the higher U&C rate versus the lower actual acquisition cost required by the 340B Drug Pricing Program.
An e-commerce company agreed to pay $59 million to resolve allegations that it violated the CSA by selling encapsulating machines and pill presses through its website, without the proper record-keeping required by DEA. The company has also agreed to enhance and maintain its compliance program concerning the prohibited and restricted items policy.
A laboratory and drug rehabilitation facility agreed to collectively pay over $7.1 million to resolve allegations that they submitted false claims to the Medicare and Kentucky Medicaid programs for urine drug testing services that were medically unnecessary or not used for diagnosis.
A physician agreed to pay $95,000 to resolve FCA allegations that he ordered medically unnecessary DME while participating in a kickback scheme, resulting in false claims being billed to Medicaid, Medicare, and other federal healthcare programs, in violation of the AKS.
A group of DME companies agreed to pay $2.1 million to resolve FCA allegations that they submitted false claims to multiple federal healthcare programs for billing of: (1) used beds as if the product was new; (2) certain products under a miscellaneous code, resulting in a higher reimbursement; and (3) travel time as repair time for it to become a reimbursable expense. After these allegations were identified, the DME companies were purchased by Baxter International. The group involved in the alleged violations are no longer operating.
A hospital agreed to pay $801,000 to resolve allegations that two radiology practices, which formerly operated under a predecessor’s contract and are currently not operational, billed Medicaid, Medicare and TRICARE for imaging used in radiation therapy that were either not reviewed or reviewed on time, making them unreasonable and unnecessary. One of the radiology practices also billed consultation services at a higher rate than allowed.
A pharmacy, its current owner, former owner, and pharmacist agreed to collectively pay over $4.6 million to resolve FCA allegations that they: (1) billed Medicare and Medicaid for prescriptions that were not dispensed; and (2) billed Medicare for high-cost formulations of specific medications when they actually dispensed a lower-cost formulation to program beneficiaries. As part of the resolution, the current owner and the pharmacist entered an IA with HHS-OIG. The former owner of the pharmacy is responsible for $700,530 of the total settlement to resolve FCA allegations that it and its principal benefited from prescription medications that were not actually dispensed.
A health clinic and its owners consented to pay $2 million to resolve admitted FCA allegations that they used inexperienced staff and pressured them to submit false claims to federal healthcare programs including Medicare, Medicaid, and TRICARE. The agreement also resolves unadmitted allegations to the CSA, AKS and PPP loan program.
The owners of a wellness clinic agreed to pay a total of up to $108,000 to settle allegations they submitted false claims to Medicare for the surgical implantation of neurostimulator devices when the patients received electro-acupuncture devices that were not surgically implanted. In addition to the settlement, the clinic agreed to a five-year exclusion from all federal healthcare programs.
A healthcare company and one of its cardiothoracic surgeons agreed to pay $430,000 to settle FCA allegations that they submitted false claims to Medicare, Medicaid, and TRICARE for procedures they knew did not meet reimbursement criteria.
A long-term care hospital agreed to pay over $18.6 million, plus interest, to resolve FCA allegations that it made false claims related to cost outlier payments from Medicare. The settlement was negotiated based on the hospital’s lack of ability to pay.
A behavioral health provider agreed to pay $61,000 to resolve FCA allegations that he billed psychiatric and psychotherapy diagnostic evaluation claims to the North Carolina Medicaid program without properly maintaining required documentation, to prove the services were medically necessary or provided.
A clinical laboratory and its owner/CEO agreed to pay a total of $13.25 million to resolve FCA allegations related to multiple forms of illegal kickbacks and testing which was medically unnecessary for several reasons. The parties agreed to cooperate with DOJ in its further investigations against other participants in the alleged schemes.
A home healthcare agency agreed to pay over $9.9 million to resolve FCA allegations that it submitted false claims to the Energy Employees Occupational Illness Compensation Program (EEOICP) for services when the provider was not present in the homes of patients. The settlement also resolves allegations of paid kickbacks via the company’s “friends and family program,” in violation of the AKS. The settlement is based on the company’s financial condition.
A nonprofit cancer treatment and research center agreed to pay over $19.5 million resolve self-disclosed FCA allegations that it submitted false claims for services and items provided during its clinical research studies which were not eligible under federal healthcare programs.
A hospital system agreed to pay $42.5 million to resolve federal FCA and Delaware False Claims and Reporting Act allegations that it provided remuneration in the form of ancillary support providers to surgeons and neonatologists not employed by the system to induce referrals, in violation of the AKS and Stark Law.
A hospital system agreed to pay $7.25 million to resolve FCA allegations that it engaged in an improper financial arrangement which resulted in the submission of false claims to Medicare, in violation of the Anti-Kickback Statute.
A DME manufacturer agreed to pay over $2.4 million to resolve FCA allegations that it gave kickbacks to sleep laboratories in exchange for referrals which were billed to federal healthcare programs.
An urgent care practice agreed to pay $9,150,794 to settle FCA allegations that it submitted false claims for COVID-19 testing and other medical services to three federal healthcare programs including: (1) office visits performed by a physician when a non-physician practitioner had actually performed them; (2) upcoded office visits; and (3) COVID-19 office visit claims that were upcoded. The settlement also resolves the company’s self-disclosure to CMS for bonuses paid to certain physicians based on referral volume or value.
A pharmaceutical company agreed to pay $6 million to resolve FCA allegations that it participated in kickbacks and caused false claims to be submitted to Medicare and Medicaid. The company paid for genetic tests, including an additional fee to receive test results for marketing purposes. As part of the settlement, the company admitted and accepted responsibility for some facts of the settlement.
A company that formerly operated hospitals agreed to pay $2 million, along with extra contingent payments, to resolve FCA allegations for: (1) double-billing the government for COVID-19 tests which were also billed to other federal programs within the state; and (2) claiming cost outlier payments considered excessive and avoiding reimbursement of these outlier overpayments it received.
A doctor and his practice agreed to pay $115,000 to resolve FCA allegations that they submitted false claims to Medicare, TRICARE, and VHA for E&M services when other services not covered by these programs were actually performed.
A healthcare network agreed to pay $345 million to resolve FCA allegations that it submitted claims to Medicare for services unlawfully referred to the company in violation of the Stark Law including: (1) above FMV compensation to physicians; and (2) granting bonuses to physicians based on the number of referrals issued. As part of the resolution, the company will enter into a five-year CIA with HHS-OIG.
A medical device company agreed to pay over $14.7 million to resolve FCA allegations that they submitted false claims to federal health care programs for remote cardiac monitoring at a higher level than physicians intended or which was medically necessary, thus maximizing the reimbursement paid.
A pharmacy agreed to pay $165,000 to resolve CSA allegations that it (1) failed to maintain complete and accurate records required for controlled substances; and (2) did not take a biennial inventory as required. As part of the resolution, the pharmacy will be subject to several monitoring requirements related to reporting, dispensing and prescribing.
A medical practice agreed to pay $1,450,000 to resolve FCA allegations that: (1) one of its clinics had been operating as a pill mill; (2) it submitted false claims to Medicare and Medicaid for presumptive and definitive urine drug testing, which were medically unnecessary; and (3) it billed for E&M services at a higher level than was actually provided.
A hospital executive and three physicians agreed to pay $880,199 collectively to resolve FCA allegations that they were involved in an illegal remuneration scheme, in violation of the AKS. As part of the settlement, all parties have agreed to cooperate with DOJ investigations and litigation against others in the alleged schemes.
Two sleep centers agreed to pay $644,562 to resolve FCA allegations that they submitted claims for services billed under a physician’s name when they were actually performed by lower-level providers and technicians.
A hospital system and one of its cardiologists agreed to collectively pay $3,033,861.92 to resolve FCA allegations that they submitted improper claims to Medicare and Kentucky Medicaid for: (1) medically unnecessary appointments; (2) hospital admissions that did not meet requirements; (3) procedures that did not include sufficient documentation to support their medical necessity; and (4) ambulance transfers for improper hospital admissions. The allegations were self-disclosed by the hospital system.
A pharmacy agreed to pay $800,000 to resolve FCA allegations that it falsely billed the U.S. Department of Labor for a compound supplement that was never delivered to the beneficiary or was not ordered by a licensed healthcare provider.
An owner, her management company and six SNFs owned and/or operated by the company agreed to pay over $45.6 million to resolve allegations that they submitted or paid kickbacks to physicians in an effort to induce patient referrals, in violation of the AKS. As part of the resolution, the parties entered into a five-year CIA with HHS-OIG.
A pharmaceutical distributor agreed to pay $12 million to resolve CSA allegations that it failed to: (1) report hundreds of suspicious orders to DEA for controlled substances; (2) properly record controlled substances orders pertaining to defectives, shipping and delivery; and (3) submit required reports to DEA via an automated system. The settlement is based on the company’s ability to pay, forfeiture, and exposure to other civil fines. The agreement also requires the company to implement widespread improvements in its compliance program.
A medical practice, physician and practice employee agreed to pay $225,000 to resolve FCA allegations that they billed federal healthcare programs for office visits that were not: (1) medically necessary; (2) provided as the submitted claim stated; and (3) supported by the patient’s medical record.
A clinical laboratory agreed to pay over $1.1 million to resolve FCA allegations that they paid illegal kickbacks in exchange for testing referrals from providers, in violation of the AKS. The laboratory used marketing companies that utilized MSOs to disguise the kickbacks to providers.
A laboratory and its founder and CEO agreed to pay a minimum of $3,825,000, and up to $50 million, based on financial contingencies met, to resolve FCA allegations that they knowledgeably underpaid Medicaid rebates due to issues with: (1) FDA approvals after a reformulation; (2) price increases; and (3) acquisition of a drug from another manufacturer while continuing to market under old FDA approvals. The settlement is based on the parties' financial circumstances.
A pain management physician agreed to pay $1.5 million to resolve FCA allegations that he caused over 400 false claims to be submitted to Medicare and TRICARE fentanyl prescriptions in exchange for kickbacks. The prescriptions were also medically unnecessary.
A medical center agreed to pay $1 million to resolve allegations that it violated the FCA by submitting claims to Medicare and TRICARE for services provided without the required level of physician supervision.
A medical supply company agreed to pay $932,000 to resolve allegations that it violated the Maryland FCA by submitting false claims for supplies that were not requested or used by beneficiaries.
An acupuncture provider agreed to pay $250,000 to resolve allegations that it submitted false claims to the U.S. Department of Veterans Affairs for procedures that were: (1) not authorized; (2) lacked supporting documentation; or (3) not allowed as originally coded.
Several parties that provide dialysis services and treatments agreed to pay over $9.5 million to resolve FCA and New York State FCA allegations that they double-billed Medicaid for injectable medications administered during the treatment of end-stage renal disease.
A medical group, its principals and physician agreed to pay $1,724,986.08 to resolve FCA allegations that they submitted claims to TRICARE and Medicare for procedures that were not medically necessary and/or performed by an unqualified technician. The medical group also washed and allowed the re-use of single-use catheters.
Several applied behavioral analysis providers and their owners agreed to collectively pay more than $2.5 million to resolve allegations that they submitted false claims to MassHealth for: (1) services that were not rendered; (2) services that were not properly documented; (3) failing to provide acceptable supervision of paraprofessionals; and/or (4) services provided by uncredentialed individuals. As part of the resolution, all parties have agreed to a three-year independent compliance monitoring program.
A hospitalist group agreed to pay $4,384,618 to resolve FCA allegations that they: (1) upcoded specific CPT codes which usually report complex services of E&M; (2) allowed hospitalists to bill for an impossible amount of procedures and services in a single day; and (3) submitted claims for procedures and services rendered on the same day and by the same provider for beneficiaries in Michigan and Indiana, in violation of Michigan federal healthcare programs.
A life sciences company that creates diagnostic tests agreed to pay $653,143 to resolve FCA allegations that it billed federal healthcare programs for orders it received from referred physicians, in violation of the AKS.
A DME provider agreed to pay $200,000 to resolve FCA allegations that it billed Medicare and Kentucky Medicaid over 300 times for non-invasive ventilators that the patient did not use or need as the program’s reimbursement rules require.
A doctor agreed to pay an undisclosed amount to settle FCA allegations that he received kickbacks from a therapeutics company in the form of sham speaker programs, which resulted in the doctor being the number one prescriber of the company’s fentanyl spray. The settlement occurred after the doctor filed Chapter 11 bankruptcy and four days before going to trial.
A pharmacy and its pharmacist-owner agreed to pay $275,000 to resolve allegations of improper dispensing of controlled substances including opioids, in violation of the CSA. The settlement includes: (1) future restrictions on the parties’ ability to dispense particular opioid prescriptions and those in combination prescriptions; and (2) intermittent comprehensive reviews to certify compliance with the CSA.
An imaging company and its owner/CEO agreed to collectively pay $85,480,000 to resolve FCA allegations that they violated the AKS and Stark Law by: (1) paying excessive fees above FMV to referring cardiologists to supervise PET scans; and (2) compensating cardiologists for services not provided. The settlements are based on the parties' ability to pay. As part of the settlement, both parties entered into a five-year CIA with HHS-OIG.
A mental health provider agreed to pay $700,000 to resolve FCA allegations that it billed MassHealth: (1) for services at a higher rate than actually provided; and (2) using an extra code that was not related to the service provided. As part of the settlement, the company agreed to participate in a three-year independent compliance monitoring program.
A professional services firm agreed to pay $465,293 to resolve FCA allegations that it submitted false claims to several government agencies by: (1) inflating billing rates; (2) invoicing for services that were not performed; and (3) moving recorded hours to other government projects to avoid going over budget.
A pharmacy and its owner agreed to pay $60,000 to resolve CSA allegations that they filled controlled substance prescriptions that: (1) were in high dosages and quantities; and (2) were prescribed from providers over 300 miles away from the pharmacy’s location without supplied documentation. As part of the settlement, the pharmacy agreed to enter a two-year compliance monitoring agreement with DEA.
A university agreed to pay $1.9 million to resolve allegations that it submitted proposals for federal research grants in which it failed to reveal existing and pending support from foreign sources.
A dental group and its doctor have agreed to pay $985,541 to resolve FCA and Tennessee Medicaid FCA allegations that they submitted false claims: (1) for dental services to TennCare; and (2) which included uncredentialed providers ineligible to bill the program.
A clinical diagnostic company that diagnoses and treats cancer patients agreed to pay $32.5 million to resolve FCA allegations that it violated Medicare’s 14-Day Rule by manipulating its billing practices in multiple ways including writing off unpaid fees, in violation of the AKS.
A health insurance company and its subsidiary MAO agreed to pay $37 million to resolve allegations that they submitted false and invalid diagnosis codes through their 360 comprehensive assessment program to increase payments received to their Medicare Advantage plan members. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
A health insurance program that owns and operates a MA Plan agreed to pay $172,294,350 to resolve FCA allegations that it submitted false diagnosis codes for MA enrollees in an effort to increase payments received from Medicare. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A specialty pharmacy and its CEO agreed to pay $20 million to resolve allegations that they paid kickbacks to: (1) patients in the form of waived copayments; and (2) physicians in exchange for patient referrals, in violation of the AKS. The settlement also resolves allegations of a specific doctor who received remuneration from the pharmacy and separately paid $480,000. The settlements were based on all parties’ ability to pay.
A behavioral healthcare provider agreed to pay $1.25 million to resolve allegations they billed the Indiana Medicaid program for care that did not include a signed and approved Individualized Integrated Care Plan, which is required by the state’s program for mental health sessions.
A behavioral health services provider and its owner agreed to pay $918,000 to resolve allegations that they submitted claims to Medicaid and TRICARE for services that were not provided. As part of the settlement, the company entered into a three-year IA with HHS-OIG.
A doctor and his medical practice agreed to pay over $585,000 to resolve FCA allegations that they received kickbacks for referring patients for laboratory testing, in violation of the AKS. The parties agreed to cooperate with DOJ’s further investigations of other participants in the alleged schemes.
A hospital district agreed to pay a $15,000 CSA penalty for improperly prescribing opioids at a drug store it owned. The company has entered into a MOA with the DEA as part of the resolution.
A company that provides at-home colon cancer-screening tests agreed to pay $13.75 million to resolve FCA allegations that they offered gift cards to prescribed patients in exchange for their samples for testing, in violation of the AKS.
A durable medical equipment provider was ordered to pay over $12 million for submitting almost 1,000 false claims to Medicare for medical braces which were filed using illegally purchased prescriptions from marketing companies. The owner agreed to separately pay $10,000 to resolve allegations of these charges and his role. As part of the owner’s agreement, he accepted a three-year exclusion from federal healthcare plans. The owner also agreed to relinquish $57,690.12 held in escrow held by HHS due to the suspension of payments.
A doctor agreed to pay $1.3 million to resolve allegations that he billed Medicare for critical care services when he actually provided routine care. The doctor also entered into a separate IA with HHS-OIG.
Three doctors and their pain management practices agreed to pay $653,796 to resolve FCA allegations that they accepted illegal kickbacks for referrals of patients’ laboratory testing, in violation of the AKS.
A community living care company agreed to pay $576,000 to settle allegations it submitted false claims to Medicaid for services which were: (1) not supported by medical records; (2) not allowed; (3) more than allowed; or (4) submitted without the required documentation. As part of the settlement, the company will begin a new EHR system for West Virginia locations.
A pharmacy agreed to pay $925,000 to resolve California FCA allegations it submitted claims and received reimbursement from Medi-Cal for drugs it dispensed and over-dispensed without the proper prescription.
A cardiologist and his practice agreed to pay over $6.5 million to resolve allegations of kickbacks being paid to physicians for patient referrals, in violation of the Stark Law and the AKS. The settlement amount is based on the doctor and practice’s ability to pay and the doctor has also agreed to surrender his ownership of the practice by Dec. 31, 2023. The doctor is barred from working for any company that bills federal healthcare programs and entered into a five-year Voluntary Exclusion Agreement with HHS-OIG.
A healthcare consultant agreed to pay $30,000 to settle allegations that she assisted in causing false claim submissions to Medicare for the surgical implantation of neurostimulator devices when the patients received acupuncture devices that were not surgically implanted. The consultant agreed to a three-year exclusion from participating in any federal healthcare programs.
A dermatology management company involved with a number of entities across the U.S. agreed to pay nearly $8.9 million to resolve self-reported allegations of the Stark Law and the AKS.
A former medical practice agreed to pay $850,949 to resolve allegations that it improperly submitted false claims for (1) evaluation and management services; and (2) billing patients under physician codes versus the non-physician provider who actually treated the patients.
A psychiatry practice and its owner agreed to pay $1.9 million to resolve allegations that they knowingly violated the FCA by double-billing evaluation and management services and psychotherapy services in the same patient visit resulting in increased payments from Medicaid and Medicare.
A senior living community operator agreed to pay $4.25 million to resolve allegations that it solicited and received kickbacks in exchange for referrals from its retirement facilities, in violation of the AKS.
A naturopathic physician agreed to pay $65,000 to resolve allegations she wrote prescriptions without a DEA registration in the state she was practicing and outside the limitation of a naturopathic physician. The physician also entered into a four-year Memorandum of Agreement (MOA) which will limit the doctor to prescribing only two controlled substances approved by state law along with other requirements.
A former physician and his medical practice agreed to pay $135,000 in civil penalties for supplying prescriptions outside the usual course of the practice, for non-legitimate purposes and in combinations which were dangerous to patients, including the “Holy Trinity.” As part of the settlement, the doctor surrendered his DEA registration and will not be able to seek renewal for a minimum of 15 years.
A healthcare provider agreed to pay $5 million to resolve FCA allegations that they submitted or caused the submission of false claims for "additional services" to Adult Expansion Medi-Cal members that were: (1) contractually not allowed; (2) duplicative of other required services; and/or (3) did not reflect the FMV of the services provided.
