A dermatopathology laboratory agreed to pay $207,500 to resolve allegations that it submitted false claims to Medicare, Medicaid, and other government payors MammaPrint genomic tests that were: (1) medically unnecessary; and/or (2) tainted by illegal remuneration, in violation of the AKS.
A breast care center agreed to pay $322,500 to resolve allegations that it submitted false claims to Medicare, Medicaid, and other government payors MammaPrint genomic tests that were: (1) medically unnecessary; and/or (2) tainted by illegal remuneration, in violation of the AKS.
A global molecular diagnostics company agreed to pay a minimum of $3.25 million to resolve allegations that it submitted false claims to Medicare, Medicaid, and other government payors MammaPrint genomic tests that were: (1) medically unnecessary; and/or (2) tainted by illegal remuneration, in violation of the AKS.
An ophthalmology practice agreed to pay $615,000 to resolve FCA allegations that it submitted false claims for transcranial doppler ultrasounds (TCDs) that were: (1) medically unnecessary; (2) premised on false diagnoses; and (3) tainted by an arrangement with a third-party TCD provider, in violation of the AKS and Stark Law.
A pain management practice and its psychiatrist owner agreed to pay over $427,000 to resolve FCA allegations that they submitted claims to Medicare which included improper billing for E&M office visits.
A pharmacy agreed to pay over $1 million to resolve FCA allegations related to Evzio, a naloxone product that often requires prior authorization, including: (1) staff completing prior authorization forms instead of them being handled by a prescribing physician; (2) personnel signing prior authorization forms without authorization; and (3) submitting information to insurers that made it appear as though a physician was submitting the information. As part of the resolution, the company entered into an IA with HHS-OIG. The company also pled guilty to one count of healthcare fraud and was sentenced to one year of probation and ordered to pay restitution of $82,000.
A health system and its affiliate agreed to pay $31.5 million to resolve FCA allegations that they: (1) provided multiple forms of excessive benefits to induce physicians to refer patients to its facilities; (2) offered financial subsidies for EHR technology and equipment in exchange for federal healthcare program beneficiary referrals; and (3) paid bonuses to physicians for supposed participation in clinical integration activities, when they were actual bonuses to reward referrals, in violation of the AKS and Stark Law. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
Two dentists and their practice agreed to pay nearly $500,000 to resolve FCA allegations that they submitted false claims to federal and state healthcare programs associated with beneficiaries obtained by a third-party patient recruiting company, in violation of the AKS.
A pharmaceutical company agreed to pay $3.6 million to resolve FCA allegations that it caused false claims to be submitted for its drug Lazanda, a transmucosal immediate-release fentanyl, for individuals who did not have breakthrough cancer pain.
A clinic owner agreed to a consent judgment of over $4.7 million to resolve FCA allegations that he submitted claims to Medicaid for physician home visits that never actually occurred.
A drug and alcohol rehabilitation facility agreed to pay $19.75 million to resolve FCA allegations that it submitted claims to New Jersey’s Medicaid program and the Community Care Program of Veterans Health Administration (VHA) for partial hospitalization care and short-term residential treatment it was not properly licensed or contracted for.
A pharmaceutical manufacturer agreed to pay $202 million to resolve FCA allegations that it offered and paid kickbacks to healthcare practitioners who spoke at or attended events to induce prescriptions of the company’s HIV drugs resulting in false claims being submitted to federal healthcare programs, in violation of the AKS.
A home health agency agreed to pay $100,000 to resolve FCA allegations that it did not keep sufficient documentation of records. The company was previously ordered to repay $28,269.50 as part of an audit by New Hampshire Healthy Families.
A retail pharmacy agreed to pay $192,000 to resolve CSA allegations that it failed to keep and maintain complete and accurate records related to the receipt and dispensing of controlled substances including: (1) failure to perform a biennial inventory; (2) failure to execute a valid power of attorney; and (3) allowing an unauthorized individual to sign DEA Form 222s. As part of the resolution, the company agreed to enter into a three-year MOA with DEA.
A genetic and pharmacogenetic profiling company, its parent company, its CEO and COO agreed to pay $6 million to resolve FCA allegations that they participated in kickback schemes meant to cause fraudulent claims to Medicare which were medically unnecessary. Both companies are no longer operating.
A national pharmacy chain and its various subsidiaries agreed to pay up to $350 million to resolve FCA and CSA allegations that they: (1) illegally filled invalid prescriptions for opioids and other controlled substances including the combination known as the “holy trinity,” (2) pursued payment for many of those illegal prescriptions from federal health care programs; and (3) pressured pharmacists to quickly fill prescriptions without taking the required time to confirm prescriptions were actually valid and legal. The settlement is based on the company’s ability to pay. If the company is sold, merged or transferred before FY 2032, the company will owe an additional $50 million. As part of the resolution, the company entered into a MOA with DEA and a five-year CIA with HHS-OIG.
A medical communication and education company, its subsidiary and several affiliates agreed to pay over $2 million to resolve FCA allegations that they knowingly certified their eligibility to obtain a lower postage rate for their shipping needs.
A former nurse practitioner agreed to pay $50,000 to resolve FCA allegations that she ordered medically unnecessary orthotic braces for Medicare beneficiaries. The settlement is based on the individual’s ability to pay.
Two physicians agreed to collectively pay $375,000 to resolve FCA allegations that they participated in a fraud scheme related to electroacupuncture devices, causing false claims to be submitted to Medicare, in violation of the AKS.
A pharmacy agreed to pay over $1 million to resolve FCA allegations that it: (1) completed required prior authorization forms in place of prescribing physicians; (2) signed prior authorization forms without physician authorization; (3) submitted information to federal healthcare programs which appeared as though a physician was submitting and not the pharmacy; and (4) submitted prior authorization requests with false information. The company also pleaded guilty to one count of healthcare fraud and pay restitution of $82,000. As part of the resolution, the company entered into an IA with HHS-OIG.
A nursing and rehabilitation center agreed to pay nearly $1.3 million to resolve allegations that they provided substandard care to residents in violation of the Maryland False Health Claims Act including: (1) understaffing; (2) wound care deficiencies; (3) regulatory violations which compromised patient care; (4) preventable falls; (5) avoidable nutritional and hydration deficits; and (6) failures to respond to residents’ change in condition.
A hospital, medical imaging company, and several individuals collectively paid over $3.1 million to resolve FCA allegations that they engaged in an illegal kickback and pass-through billing scheme for medical imaging services, in violation of the AKS. The total amount paid consists of a settlement, forfeiture, and consent judgment.
A physician group and its owner agreed to pay over $150,000 to resolve FCA allegationshat they improperly billed Medicare and Medicaid for telehealth visits by charging a facility fee intended only for in-person visits at approved medical sites, and falsely certified that they were meeting required program standards.
A medical group agreed to pay over $2.8 million to resolve FCA allegations that it wrongly reported payroll costs to receive full forgiveness of a $6.7 million Paycheck Protection Program (PPP) loan.
A medical device company agreed to pay up to $14.25 million to resolve FCA allegations that it submitted or caused others to submit false claims to Medicare and Medicaid for payment of vision tests using its NOVA electrophysiological device when it was medically unnecessary. The settlement is based on the company’s ability to pay.
A national pharmacy agreed to pay over $2.8 million, plus interest, to resolve allegations that it violated the Massachusetts, Georgia, and federal FCA by submitting claims for generic medications at an inflated price.
A nonprofit that operates a network of residential and non-residential facilities and programs for adults with developmental or intellectual disabilities agreed to pay over $5 million to resolve FCA allegations that it submitted claims to the New York Medicaid Program that did not meet requirements. The organization also avoided returning overpayments it received. As part of the resolution, the parties entered into a CIA with HHS-OIG.
A medical device manufacturer and its president and sole owner agreed to collectively pay $550,000 to resolve FCA allegations that they billed federal healthcare programs for services where providers improperly re-used single-use rectal sensors and catheters on multiple patients.
A Medicare Advantage provider, its subsidiary, former president and majority owner, and affiliated radiology group agreed to pay over $62 million to resolve FCA allegations that they submitted claims for severe spinal condition diagnosis codes for patients who did not suffer from the conditions.
Two physicians agreed to collectively pay $375,000 to resolve FCA allegations that they both solicited and accepted kickbacks in exchange for referring patients to a chiropractor, in violation of the AKS. The chiropractor resolved a separate settlement in 2024 related to this activity.
A pain clinic agreed to pay $240,000 to resolve FCA allegations that it wrongly listed a physician as the provider rendering services when a non-physician practitioner provided the services with no physician present in the office. The clinic also pled guilty to a similar charge of using a provider's National Provider Identifier (NPI) number to bill federal and private plans for services and procedures requiring an in-person consultation or direct supervision when this specific provider was out of the office and traveling. The clinic agreed to pay $58,365.26 in criminal restitution and $81,711.36 in criminal fines.
An optometrist agreed to pay $143,336 to resolve Maryland FCA allegations that they submitted false claims for vision services that were not actually provided.
A doctor and his practice agreed to pay $700,000 that they submitted false claims to Medicare for medically unnecessary chelation therapy to patients who were not suffering from lead poisoning and lead encephalopathy.
A physician agreed to pay $468,626 to resolve FCA allegations that he received kickbacks from a hospice care center to verify patients as eligible for hospice services when the patients were not actually eligible, leading to false claims being submitted to federal healthcare programs. The doctor received cooperation credit under DOJ’s Guidelines for Taking Voluntary Disclosure, Cooperation, and Remediation into Account in False Claims Act Matters.
A doctor, his wife and co-founder and their medical clinic agreed to pay $450,000 to resolve FCA allegations that they improperly billed for P-Stim devices to Medicare.
Three physicians, along with their respective practices, agreed to collectively pay nearly $2 million to resolve FCA allegations that they participated in an illegal scheme to receive kickbacks in exchange for their referrals to a specific laboratory, in violation of the AKS.
A skilled nursing facility and an acute care hospital agreed to pay over $6.5 million to resolve Federal FCA and Texas Health Care Program Fraud Prevention Act allegations that they submitted: (1) medically unnecessary claims for Ultra-High Resource Utilization Group therapy; (2) claims for individual outpatient therapy services when group therapy was actually provided; and (3) claims for therapy services when no plan of care was signed by a physician. The companies received cooperation credit under the Department of Justice’s Guidelines for Taking Voluntary Disclosure, Cooperation, and Remediation into Account in False Claims Act Matters.
A pharmacy agreed to pay $204,000 to resolve CSA allegations that it violated the recordkeeping requirements and did not sufficiently monitor the conduct of its staff pharmacist enabling the illegal distribution of oxycodone and alprazolam. As part of the resolution, the company entered into a Memorandum of Agreement with DEA.
A counseling provider and the estate of its deceased owner/operator agreed to pay $4.6 million to resolve FCA allegations that they submitted claims to Medicaid for services that were not actually rendered. Employees were directed to create generic notes that could be cut and pasted into patient files to bill for crisis intervention, which offered the highest reimbursement.
A hospice company agreed to pay $3 million to resolve FCA allegations that it knowingly submitted claims for hospice care for patients who were not eligible for the benefit because they were not terminally ill.
A medical practice agreed to pay over $250,000 to resolve FCA allegations that it submitted claims for chronic care management services to federal healthcare programs for less than the required 20 minutes of clinical staff time per month.
A healthcare administration company and its corporate parent agreed to pay over $11.25 million to resolve FCA allegations that the administration company falsely certified compliance with cybersecurity requirements in a contract with the Department of Defense to administer the Agency’s TRICARE benefits program. The parent company acquired the company in 2016 and assumed the liabilities of the administration company.
A medical center that participated in the Uniformed Services Family Health Plan (USFHP) program agreed to pay $29 million to resolve FCA allegations that it knowingly retained and concealed the existence of mistakenly inflated payments for healthcare services received from the Department of Defense for retired military members and their families.
An individual agreed to pay $2 million to resolve FCA allegations that he submitted claims for compounded medicated pain and scar creams prescriptions tainted by kickbacks, in violation of the AKS.
A company providing remote patient monitoring services agreed to pay up to $4.9 million to resolve FCA allegations that it paid a marketing service for Medicare beneficiary referrals, in violation of the AKS.
A diagnostic company agreed to pay over $219,000 to resolve FCA allegations that it submitted claims to the Idaho Medicaid Program for medically unnecessary drug analysis tests tainted by kickbacks, in violation of state and federal AKS laws. The state settlement was part of a larger nationwide investigation of the company.
A substance abuse company and its owner agreed to pay $850,000 to resolve FCA allegations that they billed North Carolina Medicaid for medically unnecessary urine drug tests.
A doctor and his behavioral health company agreed to pay $900,000 to resolve FCA allegations that they submitted claims to Medicaid for medication management appointments that did not meet the minimum time requirements and often resulted in more appointments than could be completed in a workday. The company ceased operations in 2018.
A pharmaceutical company agreed to pay nearly $60 million to resolve FCA allegations that an acquired pharmaceutical company paid kickbacks to healthcare providers to induce prescriptions of a specific drug, in violation of the AKS.
An anesthesiology provider agreed to pay nearly $1 million to resolve FCA allegations that it incorrectly calculated bonus payments independently contracted pain management practices resulting in kickbacks for their referrals, in violation of the AKS.
A medical device and supply company and its affiliates agreed to pay $17 million to resolve FCA allegations that they provided free samples and discounts to persuade urology practice groups to use its prescription form for prescribing intermittent catheters, in violation of the AKS.
A doctor and his medical practice agreed to pay $3.5 million to resolve FCA and CSA allegations that they billed for medically unnecessary and duplicative laboratory testing. He also pre-signed opioid prescriptions which were dispensed by nurse practitioners while the doctor was out of the country. As part of the resolution, the parties agreed to: (1) submit regular monitoring reports to the DEA for five years; and (2) enter into a three-year IA with HHS-OIG.
A veterinarian hospital and its owner agreed to pay $53,500 to resolve CSA allegations that they failed to keep accurate records of controlled substances, including inventories, altered documents and forged signatures.
A laboratory company and its parent company agreed to pay over $700,000 to resolve FCA allegations that it submitted claims for laboratory testing that: (1) had not been ordered by a patient’s provider or was processed at a more expensive rate; and (2) were not medically necessary.
A skilled nursing facilities chain, its affiliates and its owner agreed to collectively pay $18 million to resolve FCA allegations that they submitted false information on PPP loan applications and loan forgiveness applications.
A Medicare Advantage Plan agreed to pay over $520,000 to resolve self-disclosed FCA allegations that a company it acquired in 2022 provided cash payments to induce Medicare beneficiary referrals to enroll in their MA Plan, in violation of the AKS.
A nurse practitioner and doctor agreed to collectively pay over $164,000 to resolve FCA allegations that they participated in a telemedicine scheme resulting in false claims being submitted to Medicare for medically unnecessary services and DME.
A former laboratory employee agreed to pay $67,500 to resolve FCA allegations that he submitted false claims for time and expenses that allegedly incurred during business trips.
A pharmacy agreed to pay $625,000 to resolve FCA allegations that it billed federal healthcare programs for medications that were not actually dispensed.
A dentist and her dental practices agreed to pay over $600,000 to resolve FCA allegations that they submitted false claims to the Connecticut Medical Assistance Program CTMAP for claims referred by a third-party patient recruiting company, in violation of the AKS. The dentist also pled guilty to conspiracy to violate the AKS and was sentenced to two years of probation and ordered to forfeit $500,000 in December 2024.
Two laboratory marketers, three healthcare providers, an outpatient clinic, and associated entities agreed to collectively pay $1.14 million to resolve FCA violations 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 biopharmaceutical company agreed to pay over $4.01 million to resolve FCA allegations that it failed to disclose and report allegations of research misconduct to the National Institutes of Health and HHS’s Office of Research Integrity in grant applications and grant award progress reports and guarantees.
A laboratory and its owners agreed to collectively pay $4.425 million to resolve FCA allegations that they submitted false claims to Medicare and Medicaid for presumptive and definitive urine drug testing and hormone tests which were medically unnecessary. As part of the resolution, the parties entered into a three-year IA with HHS-OIG.
A telehealth company agreed to pay $358,514 to resolve FCA allegations that it billed Medicare for psychotherapy sessions that did not satisfy minimum time requirements.
A doctor and his practice agreed to pay $625,000 to resolve FCA allegations that they billed for services: (1) that were not medically necessary; (2) at separate times to increase government reimbursement without medical justification; and (3) under a specific code when they were not actually performing that code.
A psychiatry doctor agreed to pay over $455,000 to resolve FCA and CSA allegations that he: (1) billed Medicare and Medicaid for medically unnecessary office visits; (2) issued medically unnecessary prescriptions for controlled substances without legitimate medical purpose; and (3) failed to maintain proper patient files and treatment records.
A laboratory group and a health system agreed to pay over $388,000 to resolve FCA allegations that they delayed the submission of physician orders for specific laboratory tests to circumvent Medicare’s Date of Service Rule resulting in improper claims being made to Medicare.
Health system agreed to pay $135 million to resolve a qui tam lawsuit involving allegations that it paid above FMV compensation to employed physicians so that they would refer patients to the health system’s facilities, in violation of the Stark Law, and that the health system paid above FMV rent to a physician-owned real estate partnership to induce referrals to the health system’s surgery centers, in violation of the AKS. The government previously declined to intervene as to these Stark Law and AKS allegations. In 2023, the government partially intervened in this qui tam lawsuit to reach a $345 million settlement with the health system as to different alleged Stark Law violations.
Physician, a medical center he founded, his reference and esoteric laboratory, and an executive at these entities agreed to pay $15 million to resolve allegations that they submitted false claims to Medicare and Medi-Cal by: (1) compensating marketers for referrals to the medical center, in violation of the AKS; (2) providing above-market rent, complimentary and discounted services, and payment balance write-downs to third-party clinics in exchange for referrals to the lab, in violation of the AKS; and (3) referring beneficiaries from the medical center to the lab, in violation of the Stark Law.
Clinical laboratory agreed to pay $2.9 million to resolve self-disclosed allegations that it had purchased test arrangements with physician practice customers, in violation of the AKS, resulting in the submission of false claims.
MA plan agreed to pay over $15 million to resolve allegations that it distributed gift cards to administrative assistants of providers to induce the referral, recommendation or arrangement for enrollment of Medicare beneficiaries in its Medicare Advantage plan, in violation of the AKS. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
Regional grocery store chain agreed to pay over $8.5 million to resolve allegations that its store pharmacies dispensed opioids and other controlled substances that: (1) were medically unnecessary; (2) lacked a legitimate medical purpose or medically accepted indication; and/ or (3) were not dispensed pursuant to valid prescriptions, resulting in false claims being submitted to federal healthcare programs.
Physician agreed to pay $220,000 to resolve allegations that he prescribed controlled substances outside the usual course of professional practice, including by failing to check the state administered drug monitoring program before prescribing Schedule II controlled substances.
Sixteen cardiology practices and their associated physicians across 12 states agreed to pay amounts totaling more than $17.7 million to resolve allegations that they overbilled Medicare for diagnostic radiopharmaceuticals. The government alleged the settling cardiology practices regularly reported inflated acquisition costs to Medicare for these drugs, even though Medicare contractors with jurisdiction over these states have issued guidance explaining the reimbursement methodology and providers’ obligation to accurately report their invoice costs for diagnostic radiopharmaceuticals.
Dentist agreed to pay $120,000 to resolve allegations that he failed to comply with multiple recordkeeping requirements related to the CSA, including failing to maintain a biennial inventory and use required DEA Forms 222.
MA operators agreed to pay more than $34 million, with additional contingent payments of more than $63 million, to resolve allegations that they knowingly submitted diagnoses to Medicare that were not supported by the beneficiaries’ medical records in order to inflate Medicare’s payments to the companies. As part of the resolution, Independent Health Association entered into a five-year CIA with HHS-OIG.
Pharmacy agreed to pay over $8.2 million to resolve allegations that it submitted claims for over-the-counter COVID-19 tests that were not actually provided to Medicare beneficiaries.
Behavioral health and substance use treatment provider agreed to pay $2 million to resolve allegations that it billed MassHealth and MassHealth MCOs for medically unnecessary confirmatory urine tests and for upcoded E&M office visits. As part of the resolution, the provider entered into a three-year independent compliance monitoring program.
Specialty medical and pharmaceutical distributor agreed to pay $1.67 million to resolve allegations that it provided a free inventory management system to retina practices who entered into prime vendor agreements with the distributor that required the practices to purchase a certain percentage of their specialty drugs from the distributor, in violation of the AKS.
Hospital agreed to pay $10.25 million to resolve allegations related to: (1) medically unnecessary inpatient hospital admissions; (2) payment of bonuses to hospital physicians that took into account the volume or value of their inpatient admissions; and (3) false diagnosis codes for Systemic Inflammatory Response Syndrome. As part of the resolution, the hospital entered into a five-year CIA with HHS-OIG.
Independent retail pharmacy agreed to pay over $270,000 to resolve allegations that it submitted claims to Medicaid for automatically refilled prescription medications that were not explicitly requested by a beneficiary or caregiver. As part of the resolution, the pharmacy will implement a three-year compliance monitoring program.
Independent retail pharmacy agreed to pay over $230,000 to resolve allegations that it submitted false claims for a prescription vitamin by misrepresenting to physicians that their nursing home patients had requested the prescriptions when they had not. As part of the resolution, the pharmacy will implement a three-year compliance monitoring program.
Clinical laboratory and its owner agreed to pay $825,000 to resolve allegations that they billed Medicaid for medically unnecessary UDTs and for peer support services that it failed to document and/or were unnecessary.
Nurse practitioner agreed to pay $90,000 to resolve allegations that she wrote prescriptions for controlled substances that were in dosages, at frequencies and in combinations with other controlled substances that were not for a legitimate medical purpose. As part of the resolution, the nurse agreed to permanently forgo her DEA registration.
Neurologist and pain medicine doctor agreed to pay nearly $950,000 to resolve allegations that he billed Medicare for the surgical implantation of neurostimulator devices when the patients received electro-acupuncture devices that were not surgically implanted.
Pharmacy agreed to be bound by a $500,000 consent decree to resolve allegations that it dispensed prescription opioids while disregarding various red flags including dangerous drug combinations and evidence of doctor or pharmacy shopping.
Home health company and its current and former owners agreed to pay over $360,000 to resolve allegations that they were reimbursed for services that did not comply with Medicaid conditions of payment related to having signed plans of care.
Neuromonitoring company, its parent company, its founder, a neurosurgeon and an associated businessman agreed to collectively pay more than $2 million to resolve allegations that they engaged in a kickback arrangement involving the payment of illegal remuneration to surgeons through joint venture companies to induce the surgeons to order intraoperative neuromonitoring services from the company, in violation of the AKS.
Health imaging company and its former CEO agreed to pay $5.25 million to resolve allegations that they: (1) provided physicians with meals, event tickets and other gifts to induce them to refer diagnostic scans to the company’s independent testing facilities; and (2) entered into above FMV personal services agreements with referring physicians, in violation of the AKS.
Behavioral healthcare provider and its owners agreed to pay over $2.5 million to resolve allegations that they billed North Carolina Medicaid for services that were not medically necessary, not performed as billed, and billed for beneficiaries who were incarcerated or deceased. As part of the resolution, the company entered into a three-year IA with HHS-OIG.
Pain medicine specialist and his medical corporation agreed to pay $835,000 to resolve allegations that they participated in an illegal kickback arrangement causing false claims to be submitted to federal healthcare programs, in violation of the AKS.
Podiatrist and his medical corporation agreed to collectively pay nearly $1.6 million to resolve allegations that the podiatrist received kickback payments, described as investment returns, in connection with investments in purported MSOs, in exchange for directing prescriptions to mail order pharmacies, all of which were controlled by a third-party individual (Matthew Peters). The settlement also resolved allegations that the podiatrist and his medical corporation submitted false claims for peripheral venous studies that they knew were not covered by Medicare, under the guise of covered E&M services.
Pharmaceutical company and its CEO/co-owner agreed to pay $47 million to resolve allegations that they caused the submission of false claims by offering providers free testing kits that they claimed could rule in or out congenital sucrase-isomaltase deficiency (CSID) in the providers’ patients. The company allegedly paid a lab to provide de-identified test results to the company in addition to the providers, so that the company’s sales team could market its CSID drug to providers whose patients tested positive. As part of the resolution, the parties entered into a five-year CIA with HHS-OIG.
Hospital system and affiliated entities agreed to pay over $2.37 million to resolve self-disclosed allegations that it submitted claims for sterilization and hysterectomy procedures that contained improperly modified documentation.
Ophthalmology practice agreed to pay $1.3 million to resolve allegations that it submitted false claims for transcranial doppler ultrasounds (TCDs) that were: (1) medically unnecessary; (2) premised on false diagnoses; and (3) tainted by an arrangement with a third-party TCD provider, in violation of the AKS and Stark Law.
University health system agreed to pay $23 million to resolve allegations that it automatically coded certain claims for emergency room visits using the highest E&M code in the series based on the frequency of vital sign checks without regard for the severity of the patient’s medical condition or the actual resources used for treatment.
Laboratory agreed to pay $6.5 million to resolve allegations that it submitted false claims to Medicare for: (1) concurrent presumptive and definitive UDTs performed regardless of the results of the presumptive UDT and without determining that definitive UDT was necessary; (2) UDTs pursuant to blanket orders for all patients from a specific provider’s practice that lacked any individualized determination of medical necessity; and (3) proprietary tests for chronic pain that were medically unnecessary and at times performed without the provider’s knowledge. As part of the resolution, the laboratory entered into a five-year CIA with HHS-OIG.
Online mental health company entered into a non-prosecution agreement and agreed to pay more than $3.6 million to resolve allegations that it engaged in practices that encouraged the unlawful distribution of controlled substances, including: (1) encouraging and incentivizing providers to issue stimulant medication for ADHD patients; and (2) failing to maintain adequate operational controls against drug diversion.
Doctor, pharmacist and office complex owner agreed to collectively pay over $700,000 to resolve allegations that: (1) the doctor accepted above FMV rent from a lab for a room rented from the office complex owner to induce patient referrals; and (2) the doctor prescribed multiple medically unnecessary drugs, including opioids, which were filled at a pharmacy onsite, owned by the pharmacist. As part of the resolution, the doctor agreed to void his DEA registration and cease prescribing, dispensing or administering controlled substances.
Medical center agreed to pay $14.2 million to resolve self-disclosed allegations that it failed to include PN modifiers and location information on Medicare claims to identify services that were provided at non-excepted off-campus outpatient surgery centers. The medical center also self-disclosed possible Stark Law violations related to management agreements with companies affiliated with physicians performing surgery at the outpatient facilities and lease agreements for equipment from companies owned by a physician performing procedures at the surgery centers.
Compound ingredient supplier agreed to pay $21.75 million to resolve allegations that it overstated the average wholesale price (AWP) of two ingredients used in compound prescriptions, causing pharmacies to submit false claims to the Defense Health Agency. Because compounding pharmacies’ reimbursement is based in part on listed AWP, the supplier allegedly used the inflated AWP to create a profit potential for its customers as an inducement to purchase its ingredients.
Physician group that focuses on substance abuse treatment agreed to pay $650,000 to resolve allegations that it billed MassHealth and MassHealth Managed Care Organizations (MCOs) for confirmatory urine tests that it did not actually provide and for upcoded E&M office visits. As part of the resolution, the company entered into a three-year independent compliance monitoring program.
Veterinary pharmaceutical distributor agreed to pay over $1 million to resolve allegations that it, among other things, failed to provide adequate explanation to DEA for distributing certain opioid orders that its own internal system had flagged as suspicious. As part of the resolution, the company entered into a one-year MOA with DEA. An employee of the veterinary office that placed those orders was convicted after admitting she diverted drugs from the orders for her own personal use.
Medical transportation company agreed to pay $380,000 to resolve allegations that it billed for services that were not actually provided to MassHealth members, including at times when relevant medical facilities were closed. As part of the resolution, the company implemented a three-year independent compliance monitoring program.
Plastic surgeon agreed to pay nearly $199,000 to resolve allegations that he billed federal healthcare programs for medically unnecessary procedures and procedures that were more complex than were actually performed, including claiming to perform complicated hernia repair or tissue transfer procedures when actually performing various uncovered cosmetic procedures, and for upcoded wound care procedures and office visits. In February 2021, the doctor pleaded guilty to falsely describing a cosmetic procedure as medically necessary and reimbursable by Medicare. The doctor voluntarily surrendered his medical licenses in South Dakota and Iowa in 2019 and 2021. In 2021, the government resolved the same allegations with the physician’s employer.
Healthcare company and its owner agreed to pay over $320,000 to resolve allegations that they submitted or caused the submission of false claims to Medicaid for psychotherapy, language interpretation and other services that were not provided or were not provided by a qualified professional. A former therapist also consented to a judgment of $40,000 as a result of the investigation.
Doctor agreed to pay over $65,000 to resolve allegations that, through his work for a purported telemedicine company (REMN), he billed Medicare for DME and genetic testing that were medically unnecessary or unreasonable.
Mobile phlebotomy laboratory and its owners agreed to pay a minimum of $135,000 to resolve allegations that they: (1) billed 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 laboratory agreed to pay additional amounts based on the sale of company property.
Primary care provider agreed to pay over $1.1 million to resolve allegations that it billed Medicare for the surgical implantation of neurostimulator devices when the patients received electro-acupuncture devices that were not surgically implanted.
Physician assistant and his medical practice, along with a doctor practicing with him, agreed to pay $300,000 to resolve allegations that they prescribed controlled substances to patients who exhibited signs of diversion and drug abuse through inconsistent UDTs. As part of the resolution, the doctor and physician assistant surrendered their DEA registrations and agreed not to 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).
Medicare support services contractor agreed to pay over $300,000 and waive its rights to reimbursement for at least $877,578 of data breach remediation costs to resolve self-disclosed allegations that it and a subcontractor stored Medicare beneficiaries’ personally identifiable information and potentially personal health information on the subcontractor’s server without appropriate encryption measures, in violation of contractual cybersecurity requirements.
Laboratory and its owner agreed to pay $235,000 to resolve allegations that they billed Medicaid for UDTs that were medically unnecessary and were tainted by illegal kickbacks between the lab and a referring entity (BPolloni Consulting, LLC), in violation of the AKS. The CEO of BPolloni previously pleaded guilty to related criminal charges.
Home health agency and its owner agreed to pay $399,990 to resolve allegations that they applied for, received and retained more than one PPP loan prior to December 31, 2020, in violation of program rules.
Generic pharmaceutical manufacturer agreed to pay $425 million to resolve allegations that it violated the AKS by conspiring with two co-pay assistance foundations to direct its charitable donations to patients taking its own multiple sclerosis drug.
Generic pharmaceutical manufacturer agreed to pay $25 million to resolve allegations that it conspired to fix the price of its generic drug by paying and receiving compensation in violation of the AKS through arrangements on price, supply and allocation of customers with other manufacturers. The company previously resolved related criminal charges.
Doctor and his practice agreed to pay $625,000 to resolve allegations that they received kickbacks from a laboratory disguised as payments for phlebotomy services, rental of office space and lease of a chemistry analyzer machine in return for lab test referrals, in violation of the AKS.
Physician and her former practice agreed to pay $3.8 million to resolve allegations that they billed Medicare and TRICARE for non-covered services by: (1) disguising the rendering provider; (2) misrepresenting the services provided; (3) unbundling services that should have been billed as a single code; and (4) billing for medically unnecessary services. As part of the resolution, the doctor is excluded from participating in all federal healthcare programs for five years.
Chiropractor and his clinic agreed to pay $170,000 to resolve allegations that they improperly billed Medicare for medically unnecessary or non-reimbursable treatments involving Sanexas devices and various related modalities, including vitamin injections, TM Flow testing and ENFD testing, used to treat pain and other medical conditions.
Operator of South Carolina Medicaid’s member call center agreed to pay $11.35 million to resolve self-disclosed allegations that it fraudulently reported call center performance metrics and adjusted invoices to increase reimbursement. Two former employees pleaded guilty for their role in the alleged conduct.
Operator of South Carolina Medicaid’s member call center agreed to pay $11.35 million to resolve self-disclosed allegations that it fraudulently reported call center performance metrics and adjusted invoices to increase reimbursement. Two former employees pleaded guilty for their role in the alleged conduct.
Former critical access hospital CEO agreed to pay over $5.3 million to resolve the government’s lawsuit alleging that he: (1) agreed to a kickback scheme in which the hospital paid commissions to recruiters using MSOs to pay physicians to induce lab test referrals to the hospital; (2) falsely certified AKS compliance on the hospital’s Medicare cost reports; and (3) paid a referring physician monthly medical director fees to induce lab test referrals, all in violation of the AKS. As part of the resolution, the CEO agreed to a 25-year exclusion from federal healthcare programs.
Laboratory agreed to pay $27 million to resolve allegations that it: (1) billed federal healthcare programs for medically unnecessary UDTs, in part by promoting to physicians “custom profiles,” which effectively were standing orders that caused physicians to order a significant number of tests without an individualized patient assessment; and (2) provided free urine test cups to physicians who agreed to refer lab testing, in violation of the AKS. As part of the resolution, the laboratory entered into a five-year CIA with HHS-OIG.
Laboratory agreed to pay $27 million to resolve allegations that it: (1) billed federal healthcare programs for medically unnecessary UDTs, in part by promoting to physicians “custom profiles,” which effectively were standing orders that caused physicians to order a significant number of tests without an individualized patient assessment; and (2) provided free urine test cups to physicians who agreed to refer lab testing, in violation of the AKS. As part of the resolution, the laboratory entered into a five-year CIA with HHS-OIG.
Former critical access hospital CEO agreed to pay over $5.3 million to resolve the government’s lawsuit alleging that he: (1) agreed to a kickback scheme in which the hospital paid commissions to recruiters using MSOs to pay physicians to induce lab test referrals to the hospital; (2) falsely certified AKS compliance on the hospital’s Medicare cost reports; and (3) paid a referring physician monthly medical director fees to induce lab test referrals, all in violation of the AKS. As part of the resolution, the CEO agreed to a 25-year exclusion from federal healthcare programs.
Behavioral health organization and hospital agreed to pay a minimum of $5.5 million and up to $6.5 million to resolve allegations that they entered into improper contractual arrangements with sober homes to house patients in their partial hospitalization program (PHP), through which they only paid housing fees to sober homes for government beneficiaries that remained in the PHP program and did not require that patients be homeless or housing insecure to receive the housing, in violation of the AKS. One of the contracted sober home operators was sentenced to multiple years in prison for criminal violations related to his conduct overseeing the sober home, and other operators have been indicted or found civilly liable for misconduct in managing the sober homes.
Bariatric and general surgeon agreed to pay $45,000 to resolve allegations that he improperly billed Medicare and Medicaid for esophagogastroduodenoscopy (EGD) procedures that were only partially completed.
Behavioral health organization and hospital agreed to pay a minimum of $5.5 million and up to $6.5 million to resolve allegations that they entered into improper contractual arrangements with sober homes to house patients in their partial hospitalization program (PHP), through which they only paid housing fees to sober homes for government beneficiaries that remained in the PHP program and did not require that patients be homeless or housing insecure to receive the housing, in violation of the AKS. One of the contracted sober home operators was sentenced to multiple years in prison for criminal violations related to his conduct overseeing the sober home, and other operators have been indicted or found civilly liable for misconduct in managing the sober homes.
Bariatric and general surgeon agreed to pay $45,000 to resolve allegations that he improperly billed Medicare and Medicaid for esophagogastroduodenoscopy (EGD) procedures that were only partially completed.
Two related home healthcare companies agreed to pay $9.75 million to resolve allegations that they submitted false claims to Medicaid when they failed to pay home healthcare aides the minimum wages required by state law, upon which Medicaid reimbursement is contingent. The companies also agreed to pay an additional $7.5 million in wages and benefits to current and former aides under New York’s Wage Parity Act.
Two related home healthcare companies agreed to pay $9.75 million to resolve allegations that they submitted false claims to Medicaid when they failed to pay home healthcare aides the minimum wages required by state law, upon which Medicaid reimbursement is contingent. The companies also agreed to pay an additional $7.5 million in wages and benefits to current and former aides under New York’s Wage Parity Act.
DME supplier and its founder agreed to pay $20 million to resolve allegations that they billed federal healthcare programs for excessive and medically unnecessary supplies used with Transcutaneous Electrical Nerve Stimulation and related devices.
Hospital and its clinical laboratory, an independent laboratory and employees of the labs agreed to pay more than $7.2 million to resolve allegations that they submitted, or caused the submission of, false claims for UDTs that were not used for medical diagnosis or treatment as required for reimbursement, and instead were only used by homeless shelters, peer recovery centers and other non-medical entities to monitor clients’ compliance with programs and court orders. The settlement also resolves related allegations that a sales representative for the labs and the hospital paid kickbacks to a physician and his wife/office manager to induce referrals to the labs. The hospital’s settlement also resolves allegations related to claims for lab tests referred by providers at a practice owned by the hospital’s lab manager, which directed practice providers’ referral of tests to the lab and then received most of the reimbursement, in violation of the AKS.
DME supplier and its founder agreed to pay $20 million to resolve allegations that they billed federal healthcare programs for excessive and medically unnecessary supplies used with Transcutaneous Electrical Nerve Stimulation and related devices.
Hospital and its clinical laboratory, an independent laboratory and employees of the labs agreed to pay more than $7.2 million to resolve allegations that they submitted, or caused the submission of, false claims for UDTs that were not used for medical diagnosis or treatment as required for reimbursement, and instead were only used by homeless shelters, peer recovery centers and other non-medical entities to monitor clients’ compliance with programs and court orders. The settlement also resolves related allegations that a sales representative for the labs and the hospital paid kickbacks to a physician and his wife/office manager to induce referrals to the labs. The hospital’s settlement also resolves allegations related to claims for lab tests referred by providers at a practice owned by the hospital’s lab manager, which directed practice providers’ referral of tests to the lab and then received most of the reimbursement, in violation of the AKS.
Physician and his office manager/wife agreed to pay $450,000 to resolve allegations that they received kickbacks from two laboratories in the form of cash and payment of additional salaries for lab specimen collectors working in the physician’s office to induce referrals of lab tests, in violation of the AKS. The specimen collectors, who were employed by one of the laboratories, were also alleged to be performing work unrelated to specimen collection. The settlement also resolved allegations that the physician violated the CSA by writing invalid prescriptions. A hospital, a laboratory and three lab employees resolved related allegations.
Behavioral health and addiction treatment services network, along with its president and chief executive officer, and medical director, agreed to a consent order that imposes a $1 million civil penalty, monitoring and compliance obligations to resolve allegations that they violated recordkeeping and dispensing requirements. The government had alleged that one of the company’s treatment centers routinely dispensed controlled substances to patients before a qualified practitioner had evaluated them.
Operator of behavioral health facilities agreed to pay $19.85 million to resolve allegations that certain of its facilities submitted false claims to Medicare, Medicaid and TRICARE for inpatient behavioral health services that were not reasonable or medically necessary. The government also alleged that the facilities did not provide adequate staffing, training and/ or supervision of staff, and provided care that did not comply with certain federal and state regulations.
Operator of behavioral health facilities agreed to pay $19.85 million to resolve allegations that certain of its facilities submitted false claims to Medicare, Medicaid and TRICARE for inpatient behavioral health services that were not reasonable or medically necessary. The government also alleged that the facilities did not provide adequate staffing, training and/ or supervision of staff, and provided care that did not comply with certain federal and state regulations.
Behavioral health and addiction treatment services network, along with its president and chief executive officer, and medical director, agreed to a consent order that imposes a $1 million civil penalty, monitoring and compliance obligations to resolve allegations that they violated recordkeeping and dispensing requirements. The government had alleged that one of the company’s treatment centers routinely dispensed controlled substances to patients before a qualified practitioner had evaluated them.
Medical device company agreed to pay $7.5 million to resolve allegations that it: (1) marketed its DABRA Laser for use in atherectomy procedures for which it was not FDA approved; (2) marketed the DABRA Laser despite performance issues that prompted a recall; and (3) paid cash, training fees and consulting fees to physicians to induce them to use the DABRA Laser, in violation of the AKS. Two of the physicians entered into separate related settlements.
Pharmacy and its owner agreed to pay $1.4 million to resolve allegations that they submitted claims to Medicare and Medicaid for prescription drugs dispensed to patients in excess of the total volume of those drugs that the pharmacy purchased from legitimate wholesalers.
Pharmacy and its owner agreed to pay over $725,000 to resolve allegations that they submitted claims to Medicare and Medicaid for prescription drugs dispensed to patients in excess of the total volume of those drugs that the pharmacy purchased from legitimate wholesalers.
Pain clinic agreed to pay $750,000 to resolve allegations that it submitted or caused the submission of false claims to Medicare for the use of amniotic fluid injections for pain management that it knew Medicare did not cover. As part of the resolution, the clinic entered into a three-year IA with HHS-OIG.
Medical device company agreed to pay $7.5 million to resolve allegations that it: (1) marketed its DABRA Laser for use in atherectomy procedures for which it was not FDA approved; (2) marketed the DABRA Laser despite performance issues that prompted a recall; and (3) paid cash, training fees and consulting fees to physicians to induce them to use the DABRA Laser, in violation of the AKS. Two of the physicians entered into separate related settlements.
Pharmacy and its owner agreed to pay $1.4 million to resolve allegations that they submitted claims to Medicare and Medicaid for prescription drugs dispensed to patients in excess of the total volume of those drugs that the pharmacy purchased from legitimate wholesalers.
Pharmacy and its owner agreed to pay over $725,000 to resolve allegations that they submitted claims to Medicare and Medicaid for prescription drugs dispensed to patients in excess of the total volume of those drugs that the pharmacy purchased from legitimate wholesalers.
Two physicians and their respective companies agreed to collectively pay $700,000 to resolve allegations that they accepted cash, training fees and consulting fees from a medical device company, in exchange for using the company’s DABRA Laser, in violation of the AKS. The medical device company entered into a separate related settlement.
Pain clinic agreed to pay $750,000 to resolve allegations that it submitted or caused the submission of false claims to Medicare for the use of amniotic fluid injections for pain management that it knew Medicare did not cover. As part of the resolution, the clinic entered into a three-year IA with HHS-OIG.
Medical device distributor agreed to pay over $1 million to resolve allegations that it caused improper billing for P-Stim devices when it marketed and sold its device as reimbursable under a code used for surgically implanted neurostimulators, even though the company’s customers applied this electro-acupuncture device using only adhesive without any surgery.
Medical device distributor agreed to pay over $1 million to resolve allegations that it caused improper billing for P-Stim devices when it marketed and sold its device as reimbursable under a code used for surgically implanted neurostimulators, even though the company’s customers applied this electro-acupuncture device using only adhesive without any surgery.
Company operating primary care centers that contracts with MA plans agreed to pay $60 million to resolve allegations that it paid kickbacks to third-party insurance agents in exchange for recruiting patients to its clinics, in violation of the AKS. The government alleged that: (1) the company developed a program to increase patient membership, through which third-party insurance agents contacted seniors eligible for or enrolled in MA and sent marketing messages intended to create interest in the company; (2) the agents then referred interested seniors to a company employee via a “warm-transfer” three-way phone call or e-mail; and (3) in exchange, the operator paid agents typically $200 per beneficiary referred or recommended.
Company operating primary care centers that contracts with MA plans agreed to pay $60 million to resolve allegations that it paid kickbacks to third-party insurance agents in exchange for recruiting patients to its clinics, in violation of the AKS. The government alleged that: (1) the company developed a program to increase patient membership, through which third-party insurance agents contacted seniors eligible for or enrolled in MA and sent marketing messages intended to create interest in the company; (2) the agents then referred interested seniors to a company employee via a “warm-transfer” three-way phone call or e-mail; and (3) in exchange, the operator paid agents typically $200 per beneficiary referred or recommended.
Surgical hospital and related entities agreed to pay approximately $12.76 million to resolve self-disclosed allegations that the hospital: (1) made financial contributions to a nonprofit affiliate of a referring physician group to fund the salaries of athletic trainers who generated referrals to both the group and the hospital; and (2) provided another physician group with free or below FMV clinic space, staff and supplies, both in violation of the AKS and Stark Law.
Pharmacy chain agreed to pay $106.8 million to resolve allegations that it submitted claims to federal healthcare programs for prescriptions that it filled but which were never picked up by beneficiaries. The companies received cooperation credit for self-disclosing certain conduct and implementing relevant enhancements to their electronic pharmacy management system.
Physician who operates weight-loss clinics agreed to pay $100,000 to resolve allegations that he failed to maintain complete records for prescription weight-loss drugs at his clinics and that he failed to keep certain controlled substances at registered locations, instead transferring them to his home. The physician also entered into an agreement that includes a two-year term of increased oversight by DEA.
Physician agreed to pay $1.08 million to resolve allegations that he ordered medically unnecessary DME, particularly orthotic devices, for Medicare and FEHBP patients with whom the physician had no medical relationship. Patients’ records were allegedly provided to the physician by a telemedicine company that previously pleaded guilty to healthcare fraud conspiracy.
Physician agreed to pay $25,000 to resolve allegations that he prescribed opioids outside the usual course of professional practice, with one patient experiencing an overdose in connection with those prescriptions. As part of the resolution, the doctor entered into a three-year MOA with DEA.
Medical device manufacturer and its corporate parent agreed to pay $700,000 to resolve allegations that they encouraged surgeons to bill using improper CPT codes to obtain inflated Medicare and Medicaid reimbursements for a hemorrhoid removal system.
Urologist agreed to pay $65,000 to resolve allegations that he failed to: (1) maintain 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.
Generic pharmaceutical manufacturer agreed to pay $25 million to resolve allegations that it conspired to fix the price of its generic drug, paying and receiving compensation in violation of the AKS through arrangements on price, supply and allocation of customers with other manufacturers. The company previously resolved related criminal charges.
Two dentists and their three dental practices agreed to collectively pay $1.7 million to resolve allegations that they paid a patient recruiting company for each referral of Connecticut Medical Assistance Program patients whenever the patient received services above routine preventative care, and then submitted claims for those services, in violation of the AKS and their Medicaid provider agreements.
Nonprofit healthcare system agreed to pay over $10.8 million to resolve self-disclosed allegations that it submitted false claims to federal healthcare programs for services by an employed oncologist. The government alleged that: (1) the oncologist submitted claims for office visits that were coded at a higher level than performed or did not meet the requirements for a separate service when performed on the same day as chemotherapy administration; and (2) these false claims led the healthcare system to pay the oncologist a salary that was inconsistent with FMV.
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.
Chiropractic physician, his clinic, a partial owner of the clinic, and a certified physician assistant working at the clinic agreed to collectively pay $246,000 to resolve allegations that they billed Medicare for medically unnecessary ultrasound services that the physician assistant performed.
Physician agreed to pay $165,000 to resolve allegations that he dispensed prescriptions for Schedule III controlled substances without the required registration from the state’s Bureau of Narcotics, in violation of the CSA’s requirement that a practitioner be authorized to prescribe the substance at issue by the jurisdiction in which he or she is licensed.
DME company agreed to pay $13.5 million to resolve self-disclosed allegations that it submitted false claims for custom wheelchairs and wheelchair parts based on patient evaluations that were not properly authored, completed or signed by qualified medical professionals.
Acupuncturist agreed to pay $850,000 to resolve allegations that he billed the VA for healthcare services that were not actually provided or were significantly overstated, such as claims totaling more than 24 hours in a single day.
Pharmacy agreed to pay over $141,000 to resolve allegations that it failed to maintain accurate records related to its purchases and sales of controlled substances and billed federal healthcare programs for medications it never dispensed.
Radiology practice and its founder/CEO agreed to pay over $8.8 million to resolve allegations that they engaged in an improper arrangement with physicians investing in their clinics to induce referrals to the clinics for treatment of peripheral arterial disease, in violation of the AKS. The government contended, for example, that the founder/CEO’s pitch to physician investors was that they could ensure high returns on their investment in each clinic from referring large numbers of patients to the clinics.
Home healthcare and hospice company and it’s subsidiaries agreed to pay $3.85 million to resolve allegations that they submitted false claims to Medicare for home health services that were: (1) provided to patients who did not qualify or were not accurately certified for home health benefits; (2) not reasonable or not medically necessary; (3) provided by untrained staff; or (4) not actually performed. The settlement also resolves allegations that hospice facilities submitted claims for services to patients who were ineligible for hospice care because they were not terminally ill.
Two physicians and their practice agreed to pay $600,000 to resolve allegations that they submitted claims for primary care services that were not rendered or supervised by the physician identified in the claim and were rendered by non-credentialed providers, including nurse practitioners and physician assistants. As part of the resolution, the parties executed a $1.65 million consent judgment, which will be enforced if the settlement payments are not made.
Health insurance company agreed to pay $90 million to settle a qui tam lawsuit, in which the government declined to intervene, involving allegations that the insurer mispresented its anticipated costs in submitting bids to CMS for Medicare Part D prescription drug contracts, resulting in overcharges to the government.
Nonprofit health system, physician group and the former president of the physician group agreed to pay $3.15 million to resolve allegations that the group received a PPP loan for which it was not eligible and subsequently sought and received forgiveness on the loan.
Pharmacy and its nurse practitioner owner agreed to pay $115,000 to resolve allegations that they used a rubber stamp of a doctor’s signature to prescribe drugs without that doctor’s knowledge or approval.
Doctor and owner/operator of two urgent cares and a medical clinic agreed to pay nearly $620,000 to resolve allegations that he submitted claims to federal healthcare programs for services rendered when he was out of the office and traveling.
Dental network operator and its founders and former owners agreed to pay $6.3 million to resolve allegations that they received seven improper loans under the PPP.
Owner of a DME and medical supply company agreed to pay nearly $225,000 to resolve allegations that he participated in a scheme to bill Medicare for medically unnecessary DME ordered by physicians who solicited and received kickbacks in exchange for ordering the DME, in violation of the AKS.
Florida County agreed to pay $3.5 million to resolve allegations that it billed government healthcare programs for emergency medical services and transportation by technicians who did not have the necessary certifications.
Ophthalmology practice and its owner-ophthalmologist agreed to pay nearly $470,000 to resolve allegations that they submitted or caused the submission of claims to Medicare and the FEHBP that were false because: (1) the transcranial doppler tests were medically unnecessary; (2) the professional services were not performed; and (3) the practice entered into an improper kickback arrangement with a radiology company that interpreted the test results.
Ophthalmic device company and the estate of its former principal agreed to pay $12 million to resolve a judgment related to their provision of luxury travel and entertainment to surgeons to induce the use of their product in procedures, in violation of the AKS. The parties reached this agreement after a jury found the company liable for FCA violations in 2023, and a court entered a judgment of more than $216 million.
Group of substance treatment clinics agreed to pay over $860,000 to resolve allegations that they submitted false claims to Virginia Medicaid for high-level E&M services when the patient meetings were actually routine check-ins.
Former clinical laboratory (now biopharmaceutical research provider) agreed to pay over $5.3 million to resolve allegations that they paid value and volume-based commissions to third-party independent contractor marketers, in exchange for recommendations of genetic testing services, in violation of the AKS. The government alleged that Admera was informed that commission payments to independent contractors did not comply with the AKS but continued to enter into such contractual arrangements.
Two mental healthcare providers agreed to pay over $1 million to resolve allegations that they billed federal healthcare programs for physician services when physicians had not rendered or provided the requisite direct supervision of the services.
Chiropractor agreed to pay $180,000 to resolve allegations that he, through his companies Revive Medical of San Diego and Revive Medical LLC, billed 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.
Osteopathic doctor agreed to pay $72,000 to resolve allegations that he improperly prescribed opioids outside the usual course of professional practice. The settlement agreement permanently prevents the doctor from prescribing almost all controlled substances in the future. He also entered into an administrative agreement with DEA that includes additional compliance and education measures.
Dialysis clinic provider agreed to pay over $34 million to resolve allegations that it paid improper kickbacks to: (1) a competitor by paying to acquire certain of its dialysis clinics and agreeing to extend a prior commitment to purchase dialysis products from the competitor, in order to induce referrals to a former DaVita subsidiary that provided pharmacy services for dialysis patients; (2) physician owners of vascular access centers in the form of uncollected management fees to induce referrals to the company’s dialysis centers; and (3) a large nephrology practice through a right of first refusal to staff the medical director position at any new dialysis center that opened near the nephrology practice and a $50,000 payment despite the practice’s decision not to staff the medical director position for those clinics, to induce referrals to the company’s clinics, all in violation of the AKS.
Pharmacy company agreed to pay $100 million to settle a qui tam lawsuit, in which the government declined to intervene, involving allegations the company violated the AKS by offering below-cost, flat per-diem rates for servicing nursing home customers’ Medicare A patients, in order to secure lucrative contracts to supply drugs to patients covered under Medicare Part D for which the company could bill on a cost basis.
Acupuncturist and his clinic agreed to pay $2.3 million to resolve allegations that they billed the VA for acupuncture services that were not provided or were unreasonable.
Hospice and home healthcare company agreed to pay $19.42 million to resolve allegations that its predecessor, Kindred at Home and related entities, submitted false claims and retained overpayments for services provided to patients who were ineligible for hospice care because they were not terminally ill. The settlement also resolves self-disclosed allegations that one entity violated the AKS by paying remuneration to a consulting physician to induce Medicare referrals for hospice care.
Pharmacy agreed to pay $150,000 to resolve allegations that it improperly dispensed controlled substances, including oxycodone, that were not prescribed for a legitimate medical purpose and/or in the usual course of professional practice. As part of the resolution, the pharmacy surrendered its DEA registration.
Pharmacy agreed to pay $150,000 to resolve allegations that it improperly dispensed controlled substances, including oxycodone, that were not prescribed for a legitimate medical purpose and/or in the usual course of professional practice. As part of the resolution, the pharmacy surrendered its DEA registration.
Precision oncology company agreed to pay over $910,000 to resolve self-disclosed allegations that it submitted claims for diagnostic tests referred by a physician with whom Guardant had an improper financial arrangement under the Stark Law, due to its employment of a family member of the physician.
Maintenance and detoxification facility that treats individuals for substance use disorder agreed to pay $300,000 to resolve allegations that DEA inspections over a five-year period identified ongoing failures to maintain accurate records of its controlled substance inventory. The facility also allegedly had not performed the required biennial inventory and was co-mingling controlled substances between different registrants. As part of the resolution, the company entered into a MOA with DEA.
Maintenance and detoxification facility that treats individuals for substance use disorder agreed to pay $300,000 to resolve allegations that DEA inspections over a five-year period identified ongoing failures to maintain accurate records of its controlled substance inventory. The facility also allegedly had not performed the required biennial inventory and was co-mingling 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 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 bankruptcy court approved this settlement agreement.
Healthcare system and 12 of its skilled nursing facilities agreed to pay $21.3 million to resolve allegations that they billed federal healthcare programs for rehabilitation services that were unnecessary, unreasonable, unskilled or that did not occur or did not last as long as billed. As part of the resolution, the company admitted that management-level employees implemented facility quotas that incentivized unnecessary services, and the company entered into a five-year CIA with HHS-OIG.
Pharmacy company and three subsidiaries that offer PBM services agreed to pay $101 million and have an additional $20 million allowed in the company’s bankruptcy case to resolve allegations that they inaccurately reported drug rebates to Medicare. The government alleged the companies improperly reported portions of rebates received from pharmaceutical manufacturers as bona fide service fees, even though manufacturers did not negotiate with the defendants to pay such fees.
Pharmacy company 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 hundreds of thousands of prescriptions for controlled substances that: (1) lacked legitimate medical purpose and were not issued in the usual course of professional practice; and/or (2) were not valid prescriptions, were not for a medically accepted indication or were medically unnecessary. Rite Aid allegedly filled the prescriptions despite clear “red flags” indicating the prescriptions were unlawful. Where Rite Aid sought reimbursement from the federal government, those claims allegedly gave rise to FCA liability in addition to violating the CSA. As part of the resolution, Rite Aid entered into a Memorandum of Agreement (MOA) with DEA and a five-year CIA with HHS-OIG.
Laboratory agreed to pay $1 million to resolve allegations that it improperly billed Medicare for confirmatory UDTs for certain opioid use disorder patients when Medicare had already paid for that testing pursuant to a bundled payment rate for Opioid Treatment Programs.
Related home health agencies and their corporate owner agreed to collectively pay nearly $4.5 million to resolve self-disclosed allegations that they provided lease payments, wellness services and other items of value to assisted living facilities and physicians in exchange for Medicare referrals, in violation of the AKS.
Dermatology practice, its dermatologist and CEO have agreed to collectively pay $1.63 million to resolve allegations that they submitted false claims for dermatology services, including for: (1) services billed 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 improperly waived beneficiary co-pays; and (3) the use of specific skin grafts in situations where their usage was not justified as billed.
Prescription drug benefit provider agreed to pay $20 million to resolve allegations that it improperly filled certain opioid prescriptions in dangerous combinations with other drugs, including “trinity” prescriptions consisting of an opioid, a benzodiazepine and a muscle relaxant. Numerous prescriptions allegedly raised red flags, but the provider filled many of them without first resolving the issues.
Operator of nonprofit home- and community-based healthcare organization and related entities agreed to pay over $950,000 to resolve allegations that they submitted claims to Medicaid for Assertive Community Treatment Program services that were not provided or not properly documented for persons with serious mental illness, as required by program regulations, guidelines and contracts.
Neurologist and pain management physician entered into a consent judgment and agreed to pay $550,000 to resolve FCA and CSA allegations that he falsified records and improperly billed Medicare and Medicaid for sleep studies and prescriptions that he conducted, interpreted or issued while residing outside the U.S. As part of the resolution, the physician also agreed: (1) to the government’s sale of his real property in Panama City, Florida; (2) not to contest a forfeiture judgment of $506,017 in a separate case with the government; and (3) not to reapply for a DEA registration.
Teaching hospital, its affiliated medical school and surgical group agreed to pay $15 million to resolve allegations that they billed for concurrent heart surgeries in violation of Medicare regulations relating to teaching physician supervision, presence and informed consent when residents were performing surgeries.
Doctor agreed to pay nearly $630,000 to resolve allegations that he prescribed medically unreasonable and unnecessary orthotic braces to individuals with whom he did not have a valid prescriber-patient relationship on the basis of a telemedicine company’s prepared prescriptions.
Hospice company and its owners and managers agreed to pay $1.4 million to resolve allegations that they paid monthly stipends and signing bonuses to 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.
Forensic drug testing company agreed to pay over $1.3 million to settle allegations that it submitted false claims for positive drug tests for oral fluid samples that were not confirmed using a mass spectrometric method analytically different than the screening method and did not conform to the terms of its contract with the Michigan Department of Health and Human Services to provide screening and confirmation testing for the state children’s protective services and foster care program.
Independent nurse practitioner group and its former owners agreed to pay almost $2 million to resolve allegations that they required staff to use its proprietary patient charting software knowing it caused upcoded claims to be submitted to Medicare and Medicaid.
Chiropractor and his company agreed to pay $52,000 to resolve allegations that they improperly billed federal healthcare programs for medically unnecessary treatments involving Sanexas, an electric stimulation device used to treat diabetic neuropathy, and ENFD testing, used to identify nerve damage that could be treated with the Sanexas device, in violation of various federal billing requirements. The government filed a complaint and finalized a settlement following the chiropractor’s declaration of Chapter 7 bankruptcy.
Two chiropractors and their clinic agreed to pay $1.9 million to resolve allegations that they improperly billed federal healthcare programs for medically unnecessary treatments involving Sanexas, an electric stimulation device used to treat diabetic neuropathy, and two other related testing modalities, including TM Flow devices and epidermal nerve fiber density (ENFD) testing, used to identify nerve damage or other diseases that could be treated with the Sanexas device, in violation of various federal billing requirements.
Nonprofit substance abuse treatment facility agreed to pay over $1.4 million to resolve allegations that it double-billed Medicare for drug treatment services that had already been paid pursuant to weekly bundled billing codes.
Behavioral health company, its related healthcare companies and its CEO agreed to collectively pay over $4.5 million to resolve allegations that they submitted false claims to Medicare and Connecticut Medicaid for telehealth originating site facility fees using HCPCS code Q3014, while providing psychological services to patients residing in skilled nursing facilities, when the site fees should have been billed only by the nursing facilities. The settlement also resolved allegations that the companies and their CEO billed for psychological services allegedly provided to nursing home residents who were not, in fact, residing in the nursing homes, but had been transferred to various hospitals and admitted as inpatients.
Doctor and his pain management company agreed to pay $1.2 million to resolve allegations that they: (1) falsely indicated that ultrasound guidance was used on certain pain management injections; (2) submitted claims for facet joint injections that did not meet billing requirements; and (3) improperly coded claims to receive excess reimbursement.
Several entities that collectively operate and manage multiple urgent care practices agreed to pay over $12 million to resolve allegations that they submitted or caused the submission of false claims for COVID-19 testing for uninsured patients to the HRSA program. The government alleged in part that they did not adequately confirm whether these patients had health insurance coverage prior to submitting their claims to the HRSA’s uninsured program, including in instances where they already had a patient’s insurance card on file. In connection with the resolution, they received cooperation credit from the government for voluntarily contracting with a third-party to assist in determining the amount of losses that the government contends were caused by the alleged false claims.
Public healthcare district agreed to pay $250,000 to resolve allegations that over a five-month period, numerous vials of fentanyl were diverted from its automated dispensing machines and unused fentanyl was not properly disposed of. As part of the resolution, the company entered into a MOA with DEA.
Ophthalmologist and his ophthalmology practice agreed to pay $2.5 million to resolve allegations that they billed for services that: (1) were medically unnecessary by manipulating test readings to make the services appear necessary, when the readings did not in fact indicate such a need; and (2) 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.
Group of chronic disease management providers agreed to pay over $14.9 million to resolve allegations that they submitted false claims to Medicaid, Medicare and TRICARE for E&M services that did not support the level of service provided. As part of the resolution, the companies entered into a five-year CIA with HHS-OIG.
Ambulatory surgical center agreed to pay $125,000 to resolve allegations following the discovery of fentanyl diversion by an employed nurse. The center allegedly failed to maintain accurate and complete records by allowing employees to batch sign witness records for waste of controlled substances and failed to timely report the fentanyl theft to DEA.
Doctor agreed to pay $200,000 to resolve allegations that he solicited and received free products from a medical device company in return for ordering the company’s products for use in his procedures, including some performed overseas, in violation of the AKS. The medical device company settled related allegations with the government in January 2023.
Spinal device manufacturer and two senior executives agreed to pay $12 million to resolve allegations that they gave remuneration including excessive consulting fees, excessive IP acquisition and licensing fees, company performance shares and other extravagant benefits to 17 surgeons to induce them to use the company’s spinal devices, in violation of the AKS.
Nonprofit hospital operator and its hospital agreed to pay $735,000 to resolve allegations in a partially intervened lawsuit that it violated the Stark Law, resulting in the submission of false claims to Medicaid and Medicare. The settlement resolves allegations related to the hospital compensating two non-employed referring physicians for services provided pursuant to a Consulting, Medical Director and Related Services Agreement before the agreement went into effect.
Health and diagnostic companies and their owner agreed to collectively pay over $27 million to resolve allegations that they submitted false claims to Medicare for cancer genomic tests that were medically unnecessary and procured via illegal kickbacks, in violation of the AKS. All parties agreed to be excluded by HHS-OIG from all federal healthcare programs. The owner previously pleaded guilty to related criminal violations.
Nonprofit corporations that administer a Managed Long Term Care Plan for Medicaid beneficiaries agreed to pay over $10.1 million to resolve allegations that they failed to provide, or failed to adequately document, certain long-term care services to members as obligated by the applicable Medicaid contract.
Academic medical foundation agreed to pay $7.6 million to resolve allegations that it: (1) submitted federal grant applications and progress reports to the NIH that failed to disclose that the employee designated as principal investigator on the three grants had pending and/or active financial research support from foreign institutions; (2) falsely certified to the truth and accuracy of grant submissions; and (3) violated NIH password policies by allowing employees to share passwords, enabling unqualified employees to access the grant reporting platform. As part of the resolution, NIH imposed Specific Award Conditions on all the foundation’s grants for a minimum of one year. These conditions include requiring a high-level employee to attest to information provided to the NIH and development of a corrective action plan.
Hospital agreed to pay $24.3 million to resolve allegations that it billed for transcatheter aortic valve replacement procedures that did not comply with Medicare rules relating to the evaluation of patients for suitability for the procedure prior to performing it. The hospital received cooperation credit for voluntarily producing materials, identifying the most relevant documents for the government and implementing appropriate remedial measures. As part of the resolution, the hospital entered into a five-year CIA with HHS-OIG.
DME company and one of its owners agreed to pay $352,800 to resolve allegations that they submitted claims to the Federal Employees Health Benefit Program (FEHBP) for compression stockings using an improper HCPCS code.
Pharmacy and its pharmacist-in-charge agreed to pay $215,000 to resolve allegations that they filled controlled substances prescriptions without a valid medical purpose; those prescriptions allegedly exhibited red flags for diversion or abuse including high dosages of controlled substances and patients traveling to out-of-state physicians to obtain prescriptions. As part of the resolution, the pharmacy entered into a four-year MOA with DEA and hired a different pharmacist-in-charge.
Nonprofit hospital agreed to pay $38 million to settle a qui tam lawsuit, filed in 2012, involving allegations that certain employed neurosurgeons received above FMV compensation for referring procedures to the hospital, in violation of the Stark Law. The government declined to intervene in these allegations. In 2016, the government partially intervened in this qui tam lawsuit to reach a settlement with the hospital as to different allegations concerning the employed neurosurgeons’ claims for assisting with or supervising surgical procedures.
Otolaryngologist and his practice agreed to pay over $2 million to resolve allegations that they submitted claims to Medicare and Medicaid for ear care services under the physician’s NPI that were conducted by physician assistants without the physician providing the requisite supervision.
Nonprofit health system and its hospital agreed to pay over $745,000 resolve allegations that the hospital billed the VA, Medicare and TRICARE for spinal surgeries at more spinal levels than necessary and for medically unnecessary spinal fusions.
Orthopedic surgeon agreed to pay over $197,000 to resolve allegations that he performed spinal surgeries at more spinal levels than necessary and medically unnecessary spinal fusions. He retired in 2018 and surrendered his license in 2019.
Two dentists and their dental practices agreed to collectively pay over $498,000 to resolve allegations that they paid a patient recruiting company for each referral of Connecticut Medical Assistance Program patients whenever the patient received services above routine preventative care, and then submitted claims for those services, in violation of the AKS and their Medicaid provider agreements.
Health system agreed to pay $1.5 million to resolve self-disclosed allegations that it offered discounts to patients not based on financial need to induce the purchase or referral of the health system’s services, in violation of the AKS.
Now-dissolved healthcare company and its owner agreed to a consent judgment and settlement agreement through which they will pay $1 million to resolve allegations that they billed 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.
Pharmacy chain agreed to pay $350,000 to resolve allegations that it: (1) failed to control its inventory of controlled substances; (2) improperly sold pseudoephedrine chemical products; and (3) failed to maintain a complete record of controlled substances and their transactions. As part of the resolution, the pharmacy entered into a MOA with the DEA.
Operator of a multi-specialty medical group agreed to pay $200,000 to resolve allegations that it failed to keep and produce records documenting: (1) the transfers of Schedule III and Schedule IV controlled substances between its supply warehouse and physicians; (2) transfers to unregistered clinics; and (3) the loss or theft of a Schedule III controlled substance.
Hospice company and subsidiaries agreed to pay $4.2 million to resolve allegations that they submitted false claims and retained overpayments for the care of patients who were ineligible for hospice benefits because they were not terminally ill.
Staffing company agreed to pay $2.7 million to resolve allegations that it failed to implement adequate cybersecurity measures to protect patient health information obtained during COVID-19 contact tracing. Allegations included that the company: (1) transmitted subjects’ personal health and/or personally identifiable information in unencrypted emails; (2) used shared passwords among staff; (3) stored and transmitted patient information in non-password-protected Google files that were potentially publicly accessible; and (4) failed to timely remediate these issues despite receiving staff complaints.
Doctor and his medical practice agreed to pay $205,000 to resolve allegations that they received kickbacks in the form of purported office space rental and phlebotomy payments from a laboratory in return for ordering testing, in violation of the AKS. In connection with the resolution, they received cooperation credit for providing information that assisted the government’s investigation.
Laboratory marketer and his marketing company agreed to pay $400,000 to resolve allegations that they: (1) offered physicians kickbacks disguised as purported office space rental and phlebotomy payments to induce physicians to order lab tests; and (2) received commissions from the lab as independent contractors based on the volume and/or value of Medicare and TRICARE referrals they arranged for and/or recommended, in violation of the AKS.
Doctor and his medical practice agreed to pay $383,400 to resolve allegations that they received kickbacks from a laboratory disguised as the purchase price for used laboratory equipment, office space rental and phlebotomy payments in return for ordering testing, in violation of the AKS.
Doctor and his medical practice agreed to pay more than $380,000 to resolve allegations that they received kickbacks disguised as purported office space rental and phlebotomy payments from a laboratory in return for ordering testing, in violation of the AKS.
Nursing home operator, related consulting entity and two corporate executives agreed to pay over $7 million to resolve allegations that they submitted false claims for nursing home residents who did not have any acute illness or injury, but who had merely been near other people who had COVID-19, during a period when CMS waived the requirement that a person must have had a hospital stay of at least three days before being eligible for reimbursement for skilled care in a nursing home. As part of the resolution, the parties entered into a five-year CIA with HHS-OIG.
Physician agreed to pay $60,000 to resolve allegations that he failed to comply with recordkeeping violations, including maintaining invoices for purchases of certain controlled substances and conducting the required biennial inventory.
Physician agreed to pay $200,000 to resolve allegations that he failed to maintain proper records of DEA Forms 222 for the purchase of Schedule II controlled substances.
Nurse practitioner agreed to pay more than $50,000 to resolve allegations that she signed hundreds of medically unnecessary prescriptions for expensive orthotic braces in exchange for kickbacks, in violation of the AKS.
Pharmacy and its owner agreed to pay $120,000 to resolve allegations that they filled prescriptions for controlled substances that were issued without a legitimate medical purpose, including prescriptions that displayed red flags of addiction and abuse and were in dangerous combinations or unsafe or excessive amounts. The owner agreed to surrender the DEA license for the pharmacy.
Family medicine doctor agreed to pay $96,000 to resolve FCA and CSA allegations that he: (1) wrote unlawful prescriptions; (2) prescribed dangerous combinations of drugs; and (3) billed Medicare and Medicaid for services that were not performed. As part of the resolution, the doctor’s DEA registration was restricted for five years.
Diagnostic reference laboratory agreed to pay more than $2.7 million to resolve allegations that it entered into a kickback arrangement with an oncology practice where the lab paid the practice for each biopsy it referred. The government contended that these payments violated the AKS and that the written agreement between the lab and the practice failed to satisfy any AKS safe harbor.
Chiropractic, medical and DME provider, and a group of doctors, agreed to collectively pay $465,000 to resolve allegations that they either paid or received remuneration to induce referrals of DME, in violation of the AKS and Stark Law.
Oncology practice and its affiliated physicians agreed to collectively pay $1.3 million to resolve allegations that they entered into a kickback scheme where the laboratory (CorePath Laboratories) paid for each biopsy referred by the oncology practice, in violation of the AKS. The settlement also resolves that the practice, one of its doctors and that doctor’s own practice entity billed for medically unnecessary services, treatments and tests provided by the doctor. As part of the resolution, the parties entered into a three-year IA with HHS-OIG.
Two physicians and their family trust agreed to pay over $340,000 to resolve allegations that they received kickbacks from laboratory marketers’ MSOs in return for ordering lab tests from an affiliated clinical laboratory, in violation of the AKS.
Physician and his pain management practice agreed to pay more than $100,000 to resolve allegations that they received kickbacks from a laboratory marketer’s MSO in return for ordering lab tests from an affiliated clinical laboratory, in violation of the AKS.
Physician agreed to pay over $217,000 to resolve allegations that he and his medical practice received kickbacks from laboratory marketers’ MSOs in return for ordering lab tests from affiliated laboratories, in violation of the AKS. The government previously settled related allegations with Dr. Malik’s practice and one of the clinical laboratories.
Physician and his medical practice agreed to pay over $120,000 to resolve allegations that they received kickbacks from laboratory marketers’ MSOs in return for ordering lab tests from affiliated laboratories, in violation of the AKS.
Owner of a nonprofit entity that secures and administers grants from the Substance Abuse and Mental Health Services Administration to address youth substance use agreed to pay $500,000 to resolve admitted allegations that she and another company official forged signatures of community leaders on federal grant applications, diverted federal funds received for personal use and misappropriated grant funds for unallowable costs.
Two laboratory marketers and their marketing companies agreed to pay $720,000 to resolve allegations that they entered into illegal schemes to pay kickbacks, including payments disguised as consulting and medical director fees, to physicians for laboratory referrals, in violation of the AKS.
Laboratory agreed to pay $2.1 million to resolve allegations that it submitted false claims to North Carolina’s Medicaid program for medically unnecessary definitive UDTs where the lab performed both presumptive and definitive UDTs on the same sample, at or near the same time.
Teleradiology company and its CEO and part owner agreed to pay $3.1 million to resolve 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 radiologists; and (3) included services for imaging that a U.S.-based radiologist did not meaningfully and adequately review.
Laboratory and three of its owners agreed to pay over $13.6 million to resolve allegations that they billed for PCR urinalysis lab tests that were medically unnecessary and not ordered by the patients’ treating physician. The lab and two of the owners also agreed to be excluded from participating in federal healthcare programs for 15 years.
Chemical importer and distributor agreed to pay $300,000 to resolve allegations that it: (1) violated recordkeeping requirements; (2) manufactured a List I chemical by repackaging and relabeling registering as a manufacturer; and (3) drop shipped a List I chemical to a customer without first importing it through the distributor’s registered location.
Doctor and his diagnostic centers agreed to pay $1.8 million to resolve allegations that they billed for services that were: (1) not reasonable or medically unnecessary because they were unsupported by the patients’ diagnosis or medical records; or (2) because unlicensed and untrained technicians had incorrectly or inadequately rendered them. The settlement also resolved allegations that the doctor referred patients to his personally owned diagnostic centers, in violation of the Stark Law.
Doctor and a healthcare staffing company for which the doctor was independently contracted to provide telemedicine services agreed to pay $700,000 to resolve allegations that they participated in a kickback scheme to bill Medicare for medically unnecessary DME and diagnostic laboratory testing, in violation of the AKS. Under the alleged arrangement, a client of the staffing company (Nationwide Health Advocates) employed telemarketing companies to obtain personal information and supporting documentation from Medicare beneficiaries to generate physician orders for DME and laboratory tests. The physician and JCLT allegedly received payment in exchange for reviewing and approving the client’s orders. The government noted that the staffing company’s cooperation was significant in facilitating its investigation and that the company had taken significant remedial measures, including improving its internal controls in placing providers with telemedicine clients, which was accounted for in the resolution. The former owner and president of Nationwide Health Advocates previously pleaded guilty to criminal charges for related conduct.
Pharmaceutical manufacturer agreed to pay $1.99 million to resolve allegations that it took a PPP loan to which it was not entitled based on restrictions on certain foreign organization and ownership, and then sought and received forgiveness of the loan.
Home healthcare agency and its owner agreed to pay $600,000 to resolve allegations that they submitted false claims to Medicaid for services that were: (1) never performed, such as when patients were hospitalized; (2) purportedly provided by employees who were not in the area at the time of service; and (3) provided by family members’ aides in violation of Medicaid regulations but billed as if they were performed by non-related aides.
Hospital agreed to pay $17.3 million to resolve self-disclosed allegations that it compensated physicians at its chemotherapy infusion center in a way that was tied to the volume of their referrals to the hospital, in violation of the AKS. The settlement also resolved allegations that chemotherapy services billed to federal healthcare programs were not properly supervised by physicians.
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.
Physician agreed to pay $95,000 to resolve allegations that he ordered medically unnecessary genetic tests for Medicare beneficiaries with whom he did not have a medical relationship.
Generic drug manufacturer agreed to pay $2 million to resolve civil allegations that it failed to exercise proper controls as required by good manufacturing practice regulations in connection with using an active pharmaceutical ingredient manufactured in a foreign facility, causing the company to introduce adulterated drugs into interstate commerce. Those drugs were then used in claims submitted to multiple federal healthcare programs. The manufacturer agreed to a three-year deferred prosecution agreement for related criminal charges. An affiliated entity pleaded guilty on charges that it violated the FDCA, with a fine and forfeiture in the amount of $1.5 million.
Doctor agreed to pay $60,000 to resolve allegations that he prescribed the opioid medication Subsys without a legitimate medical purpose to patients who lacked a cancer diagnosis and then billed Medicaid and TRICARE for the associated visits.
Drug manufacturer agreed to pay $475.6 million to resolve civil allegations that the company engaged in a marketing scheme to target its opioid drug to providers the company knew were prescribing it for non-medically accepted indications or at high volumes. The company also agreed to plead guilty to FDCA violations related to misbranding of drugs, with the criminal resolution including a fine of $1.08 billion and an additional $450 million in forfeiture. A condition of a global bankruptcy resolution was that the company would cease operating in its current form and would not emerge from the bankruptcy.
Physical therapy provider and its current and former owners agreed to pay $1.5 million to resolve allegations that they submitted false claims to Medicare for therapy services: (1) when the provider was not in the United States; (2) performed by massage therapists rather than licensed physical or occupational therapists; (3) performed by an OTA or PTA that were not properly supervised; (4) improperly coded to avoid service caps; and (5) when there was no licensed physical or occupational therapist on site.
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 and UDTs, in violation of the AKS. The owner has also pleaded guilty to criminal charges, along with four others in connection to the scheme.
Physician agreed to pay $60,000 to resolve allegations that she wrote prescriptions for a controlled diet drug and did not maintain any patient files for those prescriptions. The doctor surrendered her DEA registration in October 2023.
Doctor and his medical practice agreed to pay nearly $700,000 to resolve allegations that they: (1) upcoded E&M CPT codes; (2) billed for more services than could possibly be provided in one day; and (3) billed for services the physician never provided.
Toxicology lab, its owner and its compliance officer agreed to civil judgments totaling more than $10.4 million and holding them liable for the submission of false claims for UDTs that were court-ordered or referred from places that did not provide medical treatments (like faith-based residential programs or homeless shelters) and that they knew were not performed for any medical purpose. The owner and compliance officer were convicted in December 2023 for related criminal violations.
Pharmacy agreed to pay $140,000 to resolve allegations that it violated CSA recordkeeping regulations by accepting blank-signed DEA Forms 222 from purchasers.
Specialty pharmaceutical company agreed to pay $750,000 to resolve allegations that it employed and made bonus payments to a physician’s girlfriend to induce the physician to prescribe two opioid medications the company sold, in violation of the AKS.
DME supplier agreed to pay $25.5 million to resolve allegations that it billed for the rental of non-invasive ventilators to patients when the ventilator was either not being used or not needed by the patient. The settlement also resolves allegations that the company waived patient co-payments to induce patients to rent the company’s ventilators instead of a competitor’s, in violation of the AKS.
District court entered into a consent decree requiring a pharmacy and its owner to pay $110,000 to resolve violations that they did not keep accurate, complete and timely inventories related to Schedule II controlled substances, resulting in thousands of unaccounted.
Pharmaceutical distributor agreed to forfeit $19 million in the first-ever DEA administrative forfeiture to resolve allegations that it failed to maintain effective controls against diversion, including failure to report thousands of unusually large orders of oxycodone and hydrocodone to DEA. The company agreed to maintain a new compliance program for five years and will surrender one of its DEA registrations as part of the resolution.
Multi-hospital health system agreed to pay over $11.7 million to resolve self-disclosed allegations that it billed 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 MassHealth and Medicare. The two companies also agreed to retain an independent compliance monitor and to implement future training and auditing.
Two pharmacies agreed to collectively pay $1.3 million to resolve allegations that they filled invalid prescriptions for opioids and benzodiazepines that were prescribed outside the scope of the prescribing physician’s medical practice.
Medical center agreed to pay nearly $2.1 million to resolve self-disclosed allegations that it overbilled Medi-Cal for prescription medication by charging its usual and customary cost rather than the lower actual acquisition cost after a federal court lifted a stay on a California law requiring 340B Drug Pricing Program participants to bill Medi-Cal at actual acquisition cost rates.
E-commerce company agreed to pay $59 million to resolve allegations that it failed to comply with CSA requirements of identity verification, recordkeeping and reporting to DEA in connection with pill presses and encapsulating machines sold through its website. The company also agreed to enhance its compliance program with respect to its prohibited and restricted items policy.
Laboratory entered into an agreed judgment for over $4.9 million, holding it liable for the submission of false claims to Medicare and Kentucky Medicaid for UDT services that it knew were not typically used for medical diagnosis or treatment, and for urine drug screens without a proper medical order. To satisfy the judgment, the lab was required to pay in part the proceeds resulting from ceasing its lab operations.
Operator of residential and outpatient drug rehabilitation facilities agreed to pay $2.2 million to resolve allegations that it caused the submission of false claims for UDT services that were medically unnecessary. The government alleged that the facility requested the same complex panel of tests for all its patients weekly, without an individualized determination of need and often without using the results for diagnosis. As part of the resolution, the facility entered into a five-year CIA with HHS-OIG.
Physician agreed to pay $95,000 to resolve allegations that he ordered medically unnecessary DME and participated in a kickback scheme with his employer, a nationwide telemedicine company (RediDoc LLC), whereby he received kickbacks to sign DME orders, in violation of the AKS. The owners of the telemedicine company previously pleaded guilty to various federal offenses, including conspiracy to violate the AKS.
DME company and related entities agreed to pay $2.1 million to resolve allegations that they submitted claims for: (1) used beds as if they were new; (2) certain products under a miscellaneous code, resulting in a higher reimbursement; and (3) travel time mischaracterized as repair time for it to be reimbursable.
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.
Pharmacy, its current owner, former owner and pharmacist agreed to collectively pay over $4.6 million to resolve allegations that they billed Medicare and Medicaid for prescriptions that were not dispensed and 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 into a three-year IA with HHS-OIG.
Health clinic operator and its owners consented to a $2 million civil judgment after admitting to FCA violations stemming from their use of vulnerable and inexperienced staff who they then pressured into providing unnecessary and worthless care, which resulted in false claims to federal healthcare programs. The consent judgment also resolved additional, unadmitted allegations relating to the CSA, AKS and PPP loan program.
Two nurse practitioners and a chiropractor, all owners of a wellness clinic, agreed to pay up to $108,000 to resolve allegations they billed Medicare for the surgical implantation of neurostimulator devices when patients received electro-acupuncture devices, which do not require surgery. As part of the resolution, the clinic (Texas Wellness Clinic) agreed to a five-year exclusion from all federal healthcare programs. In 2021, the chiropractor-owner of the providers’ former employer agreed to a $2.6 million settlement and a ten-year exclusion from federal healthcare programs for related allegations.
Hospital system and one of its cardiothoracic surgeons agreed to pay $430,000 to resolve allegations that they submitted false claims to Medicare, Medicaid and TRICARE for various cardiothoracic procedures that they knew did not meet reimbursement criteria.
Long-term care hospital agreed to pay over $18.6 million to resolve allegations that it improperly distorted Medicare’s cost outlier payment program to keep excessive payments. Certain Silver Lake investors also agreed to pay $12 million to resolve alleged Federal Debt Collection Procedures Act (FDCPA) violations related to the transfer of money by the hospital to investors when the hospital had reason to believe it would not be able to make required cost outlier reconciliation payments to Medicare. As part of the resolution, the hospital agreed to a five-year CIA with HHS-OIG.
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.
Clinical laboratory and its owner/CEO agreed to pay a total of $13.25 million to resolve allegations that they engaged in several kickback schemes to induce referrals for lab testing in violation of AKS, including: (1) commission payments to third-party marketers based on the volume and value of referrals; (2) purported Management Services Organization (MSO) payments, disguised as investment returns, from third-party marketers to providers; (3) payments to providers disguised as consulting or medical director fees; and (4) specimen collection fee payments to staff members of referring providers. The settlement also resolved allegations that the lab and its owner submitted or caused false claims to be submitted for laboratory tests that were: (1) not reasonable and necessary; (2) not covered because they were blanket orders of UDT panels for all patients within a physician’s practice without an individualized assessment of need; or (3) not covered because they were improperly duplicative of other claims for UDT for the same date of service, the same patient and the same drugs.
Home healthcare agency agreed to pay over $9.99 million to resolve allegations that it submitted claims to a Department of Labor healthcare program for Department of Energy employees for nursing and personal care services when the provider was not present in patients’ homes. The settlement also resolves self-disclosed allegations that the agency gave cash and in-kind benefits to patients and their families, in violation of the AKS.
Nonprofit cancer treatment and research center agreed to pay over $19.5 million to resolve self-disclosed allegations that it submitted false claims for services and items provided as part of clinical trial research that should have been billed to non-government trial sponsors under CMS rules.
Hospital system agreed to pay $42.5 million to resolve allegations that it provided ancillary support providers such as nurse practitioners, hospitalists and physician assistants to surgeons and neonatologists to induce referrals to the system, in violation of the AKS and Stark Law.
Hospital system agreed to pay $7.25 million to resolve allegations that payments to an oncology practice pursuant to a multi-agreement affiliation for management and professional services violated the AKS and resulted in the submission of false claims to Medicare.
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.
A long-term care healthcare company and pharmacy group agreed to pay $499,525 to resolve allegations that they violated the CSA by: (1) allowing non-registered practitioners to dispense controlled substances; (2) failing to properly maintain DEA Form 222s; and (3) failing to reject order forms that were altered, incomplete or properly prepared. As part of the settlement, the companies agreed to enter into a three-year DEA Corrective Action Plan.
A durable medical equipment company and wholly-owned subsidiary of a German multinational chemical corporation agreed to pay $29 million to resolve allegations that it billed Medicare, Medicare Advantage Plans and beneficiaries for oxygen equipment after three years of payments were received, in violation of the FCA. As part of the settlement, the company will enter a five-year CIA with HHS-OIG.
A doctor operating multiple clinics agreed to pay $85,000 to resolve CSA allegations that he: (1) failed to maintain complete and accurate records; (2) did not maintain a separate DEA registration at all facilities; and (3) failed to provide distribution or administration records for ketamine as required by DEA. In addition to the civil payment, the doctor will be barred from prescribing controlled substances to himself, his immediate family, or office staff for a period of five years. He will also be required to attend training on CSA and comply with record-keeping requirements.
An interventional pain management specialist and his two medical entities agreed to collectively pay $6,500,000 to resolve FCA allegations that they submitted medically unnecessary claims for: (1) presumptive and definitive urine drug tests; (2) laboratory charges that were not able to be billed with the urine drug tests; (3) moderate sedation services; and (4) expensive back braces normally ineligible for reimbursement.
A sonography company agreed to pay $95,000 to resolve allegations it offered remuneration to referral physicians in the form of office rental payments that were commercially unreasonable and above FMV in violation of the AKS. The company also entered into a three-year deferred prosecution agreement to resolve the criminal charges.
A husband and wife have agreed to pay $315,380 to resolve allegations that they falsified their income to generate eligibility for Mississippi Medicaid benefits.
A national provider of air medical transport services agreed to pay $1,050,873 to resolve allegations that it violated the FCA by retaining known overpayments received from Medicare, Kentucky Medicaid, Tricare, and the Department of Veterans Affairs for flights it knew were medically unnecessary.
A non-profit charitable organization agreed to pay $364,126 to resolve allegations that it violated the FCA by submitting false information in connection to an Economic Development Administration grant it received in 2008 to design and construct a medical and nursing training facility.
A federally qualified health center agreed to pay $470,093.93 to resolve allegations that it submitted false claims for dual-eligible beneficiaries of Medicare and Medicaid. The claims were submitted with incorrect Medicare denial codes causing Medicaid to pay claims it normally would have denied. The company also billed Medicaid for group therapy services who were not eligible.
A neuroscience company and its co-founder/CEO agreed to collectively pay $220,000 to resolve allegations they caused false claims to be submitted to Medicare for a “brain health” device by promoting six false billing codes to providers.
A laboratory and its owner agreed to pay over $1.95 million to resolve FCA allegations that they billed North Carolina Medicaid for urine drug tests tainted by illegal kickbacks, in violation of the AKS. The urine tests were also medically unnecessary.
A drug wholesaler and its owner agreed to pay $2.475 million to resolve CSA violations over the course of 10 years. The parties had previously violated multiple CSA requirements and were under a Memorandum of Agreement (MOA) with the DEA. A DEA criminal investigation also resulted in the parties pleading guilty to trafficking counterfeit drugs, conspiracy, and money laundering conspiracy.
A medical lab and its owner agreed to pay $1,951,090 to resolve allegations that submitted unnecessary urine drug tests to the North Carolina Medicaid program and paid illegal kickbacks for these tests.
An ambulance provider and its parent corporation and affiliates agreed to pay $2.6 million to resolve FCA allegations that the company submitted false claims to MassHealth for emergency services when a less expensive non-emergency service was actually provided. They also provided services that were not medically necessary based on documentation. The parties agreed to implement a company-wide training program and update policies related to MassHealth compliance.
A pharmacy agreed to pay a $20,000 penalty to resolve multiple violations of the CSA including: (1) filling prescriptions that contained “red flags;” (2) violating the Combat Methamphetamine Epidemic Act of 2005; and (3) not keeping proper records or accounting for certain controlled substances. The pharmacy has also entered into a Memorandum of Agreement with the DEA and will be required to conduct regular inventory audits, provide employee training, and update its controlled substance procedures and policies.
Two pharmacies and their corresponding owners agreed to pay over $3.5 million to resolve FCA allegations that they billed Medicare for prescription medications that were not actually dispensed. The two pharmacies agreed to be excluded from federal healthcare programs for five years, surrendered their DEA Certificates of Registration, and terminated operations.
A clinical laboratory and its owner agreed to pay an additional $5.7 million to settle allegations from an outstanding FCA judgment against them for submitting false claims related to travel reimbursements. The settlement includes the possibility of further annual payments for five years based on the owner's future income and is in addition to the $789,652 that the United States previously collected since the original 2018 settlement. The settlement amount is based on DOJ’s ability-to-pay policy.
A managed care plan agreed to pay $22.485 million to resolve FCA allegations that it submitted false diagnosis codes not supported by patients’ medical records for its Medicare Advantage Plan participants in an effort to increase beneficiary reimbursements.
A clinical testing laboratory agreed to pay $1.9 million and surrender another approximately $7 million being held in escrow to resolve FCA allegations that it submitted claims to Medicare, Medicaid, TRICARE and the Railroad Retirement Board for tests which were not medically necessary or reasonable.
A non-profit foundation agreed to pay $250,000 to resolve allegations that it violated the CSA by failing to maintain the required records related to inventory, unit acquisition, and theft or loss.
A group of physician practices agreed to pay $475,000 to resolve FCA allegations that they used physician names and NPI’s who often were no longer employed by the companies or did not supervise or perform the services in the submitted claims.
A health system group collectively agreed to pay $671,310 to resolve allegations that they submitted false claims for services performed by mid-level providers at a rate that covers services incidental to those provided by a physician when no physician was present, violating Medicare's "incident to" rule.
A physician agreed to pay $310,000 to resolve allegations that he submitted false claims for beneficiaries he referred for cardiovascular stress tests to a facility where he had an ownership interest, in violation of the Stark Law.
A doctor and his surgical center agreed to pay over $750,000 to resolve allegations they submitted claims for multiple mole removals on the same day and made it appear that the procedures were performed on multiple dates, causing overpayments from Medicare and a federal employee health program. The doctor was also criminally prosecuted and received a 6-month prison sentence plus a fine of $1 million.
Two physicians and two medical practices agreed to collectively pay $525,610 to resolve FCA allegations that they received illegal kickbacks for referring patients for testing to laboratories in Florida, New Jersey, and Texas, in violation of the AKS. Each party has agreed to cooperate with DOJ’s investigations of other participants in the alleged schemes.
An EHR vendor agreed to pay $31 million to resolve allegations that it violated the FCA by falsifying the abilities of certain versions of its software. The company also engaged in unlawful remuneration to users in an effort to induce sales and recommendations of its software, in violation of the AKS.
A dermatology practice and its doctor agreed to pay $6.6 million to resolve allegations that they violated the FCA by submitting false claims for: (1) Mohs procedures which were billed as both portions being performed by the doctor when at least one portion was actually performed by another individual; and (2) billing multiple procedures which were performed on the same patient on the same day in violation of Medicare’s “multiple procedure reduction rule.” As part of the settlement, the parties entered into an Integrity Agreement with HHS-OIG.
A long-term care and rehabilitation services provider, along with two occupational therapy assistants, agreed to pay a total of $1,377,696 to resolve allegations they submitted Medicare claims for services that were not provided.
A spine and sportscare medical practice and its owner and medical director agreed to pay $11,388,887 to resolve allegations that they violated the FCA by submitting false claims to multiple federal healthcare programs for skin biopsies, spinal cord stimulation surgeries and urine drug testing which were medically unnecessary. The settlement amount is based on the parties’ ability to pay. As part of the settlement, the owner and medical director agreed to be excluded from federal healthcare programs for five years.
A dentist agreed to pay $150,000 to resolve allegations that her practice violated the Controlled Substance Act by: (1) failing to uphold effective controls against diversion; (2) practicing dentistry in an unsanitary or unsafe manner; (3) failing to keep complete and proper records; and (4) failing to retain accurate forms and inventories. Gross negligence was also found during the investigation from the practice administering dangerous doses of legend drug to minors.
A behavioral health provider agreed to pay $4,611,375 to resolve allegations that it violated the FCA by billing Virginia Medicaid for services which were not provided within two of its programs. The allegations also included a third program which billed for services provided by non-credentialed or improperly trained mental health professionals. As part of the resolution, the company agreed to a five-year period of increased compliance and oversight.
Two medical practices agreed to pay $155,254.92 to resolve allegations that they submitted false claims for implanted neuro-simulators when a P-Stim device had actually been used. P-Stim devices are not reimbursable by Medicare.
A medical practice agreed to pay $357,913.18 to resolve allegations that it submitted false claims for implanted neuro-simulators when a P-Stim device had actually been used. P-Stim devices are not reimbursable by Medicare.
A hospice company agreed to pay $48,830.70 to resolve allegations that it billed hospice services to Medicare for beneficiaries who were not terminally ill and which were not medically necessary.
A county-organized health system along with three healthcare providers based in Santa Barbara and San Luis Obispo counties, California, agreed to pay a total of $68 million to resolve FCA allegations that they caused the submission of false claims for "enhanced 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.
A national pharmacy agreed to pay $70,000 to resolve allegations that it violated the CSA at certain stores by filling forged prescriptions of Adderall, Ritalin, and Xanax.
A skilled nursing facility and its management company agreed to collectively pay $3.825 million to resolve allegations they violated the AKS in an effort to induce patient referrals by paying kickbacks to physicians. This settlement was negotiated based on the companies’ lack of ability to pay. As part of the settlement, the companies entered into a five-year CIA with HHS-OIG.
A medical center agreed to pay $2 million to resolve allegations that it violated the CSA by failing to keep precise records of controlled substances, including opioids, resulting in thousands of missing controlled substance units. As part of the settlement, the medical center has agreed to additional security and recordkeeping measures.
Two urgent care chains agreed to pay $1,600,000 to resolve allegations that they violated the FCA by submitting upcoded E&M claims for the testing and treatment of patients who were suspected of COVID-19 exposure.
A healthcare information technology company agreed to pay $1,712,949.44 to resolve allegations that it billed the National Institutes of Health for costs that were unallowable for reimbursement such as luxury vehicles, residential mortgage payments, housekeeping services, wedding costs, along with other unreasonable items or for work which was not performed.
A billing company for diagnostic laboratories agreed to pay over $300,000 to resolve allegations that it submitted false claims for medically unnecessary panels run on seniors who also received COVID-19 tests.
Two compounding pharmacies and their owner agreed to pay at least $7.4 million to resolve allegations that they violated the FCA by adding the antipsychotic drug aripiprazole to compounded topical pain creams in order to increase reimbursements. They also routinely waived patient copayments to induce patients to accept the pain cream prescriptions. The settlement amount is based on the defendants’ ability to pay. As part of the settlement, the owner agreed to enter into a three-year integrity agreement with HHS-OIG.
A nonprofit health system agreed to pay $36.5 million to resolve allegations that it violated the FCA, the Stark Law, and the AKS by making compensation payments to orthopedic surgeons which were tied to the value or volume of the practice’s referrals.
A physician and his practice agreed to pay $5,015,554 to resolve allegations that they overstated diagnoses to justify performing medically unnecessary atherectomy procedures on patients. These procedures were considered risky and invasive, and were not supported by medical records.
A pharmacy and its owner agreed to pay $275,000 to resolve allegations that they violated the federal CSA by unlawfully dispensing or distributing controlled substances based on invalid prescriptions and for failing to maintain correct records of specific controlled substances.
A group of hospital systems agreed to pay $29,744,065 to resolve allegations that they provided services to physicians at no cost or below-FMV, in violation of the AKS. The physicians were chosen due to the large number of patient referrals they produced.
A pain management center and its doctor, along with an ambulatory surgical center, agreed to pay $625,000 to resolve allegations that they: (1) submitted improper claims for E&M services; (2) submitted claims for medically unnecessary urine drug screening tests; and (3) partnered with a laboratory to pay the salary of an employee who worked in exchange for the doctor’s referrals of many medically unnecessary urine drug tests.
A primary care practice and two physicians agreed to pay $1,500,000 collectively to resolve allegations that they submitted false claims by: (1) misrepresenting the severity of illnesses and services rendered; (2) submitting unsupported diagnosis codes; (3) submitting claims not supported by medical documentation including E&M visits, smoking cessation, and vaccine administration; and (4) billing physician assistant services “incident to” the professional services of a physician when the physician was out of the country.
A vascular surgeon agreed to pay up to $43,419,000 to resolve allegations that he defrauded federal healthcare programs by: (1) submitting claims for services he did not perform; (2) billing for multiple vascular stents in the same blood vessel and arterial thrombectomies while preparing inaccurate medical records to justify the billing and each procedure’s medical necessity; and (3) improperly using Modifier 59 to “unbundle” services that should have been billed together. As part of the settlement, the surgeon was sentenced to 80 months in prison and was ordered to pay $19.5 million in restitution to Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan.
A group of specialty eye and ear practices agreed to pay over $5.7 million to resolve allegations that seven of their physician compensation plans, which involved a total of 44 doctors, were in violation of the Stark Law.
A physician practice and its owner agreed to pay almost $400,000 to resolve allegations that they submitted claims for: (1) physician services when the services were provided by nurse practitioners; (2) more units than were actually prepared for allergy immunotherapy; and (3) unnecessary E&M services. These all resulted in overpayments from Medicare and Medicaid programs.
A specialty spine and musculoskeletal practice and its doctor agreed to pay $135,871.84 to resolve allegations that they knowingly used foreign and non-FDA approved Botox to treat Medicare beneficiaries and then billed for the services. The Government seized many packages of the unapproved Botox and warned the practice, but they continued to use and bill for it.
A home health provider, its CEO, and two doctors have collectively agreed to pay over $490,000 to resolve allegations that they participated in a kickback scheme where sham medical director or sublease agreements were paid in exchange for patient referrals.
A nonprofit hospital agreed to pay $300,000 to resolve allegations that it violated the FCA due to former employees defrauding the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) by: (1) allowing ineligible persons to be qualified for WIC benefits resulting in misappropriated WIC program funds; (2) falsifying time sheets and other records related to work performed by breastfeeding peer counselors; and (3) falsifying budget records to inflate the hospital’s requirements for WIC funds.
A SNF and two individuals agreed to pay $3.46 million collectively to resolve allegations that they engaged in two schemes in violation of the FCA and AKS. The violations involved: (1) offers and payments to a supervisor at a local hospital in exchange for patient referrals; and (2) switching residents’ coverage from their MA plan to an original Medicare plan, without patient consent, in order to increase payments received to the SNF.
A medical device supplier agreed to pay $400,000 to resolve allegations it sold electrocardiogram cables (ECG) to federal government purchasers which were manufactured in non-designated countries, in violation of the Trade Agreements Act of 1979, which restricts the procurement of goods under certain government contracts to purchases from specific designated countries.
A behavioral health provider has agreed to pay $150,000 to resolve allegations that it submitted false claims for Diagnostic Assessments (DA) in violation of North Carolina Medicaid. The provider improperly: (1) maintained supporting documents that the DA were rendered; (2) billed claims without a signature from required professionals; and (3) backdated DA.
A doctor and his wife agreed to pay more than $3 million to resolve allegations that they requested and received kickbacks from a home health agency in exchange for the doctor’s referrals of Medicare patients.
A hospital agreed to pay $12.5 million to resolve allegations that it submitted claims for urgent care services which were billed at a higher rate of service.
A former medical director and owner of a family medical practice agreed to pay $330,607 to resolve allegations that he submitted false claims for services that were not provided or medically reasonable or necessary.
A hospital and hospitalist group agreed to pay over $560,000 to resolve allegations they submitted claims for E&M services billed by physicians when the services should have been billed by mid-level providers.
Two laboratory companies and an owner agreed to collectively pay $1,740,620 to resolve allegations they submitted false claims to Kentucky Medicaid and Medicare for urine drug tests collected and tested for a family court system and not used for the purposes of medical diagnosis or treatment.
A wound care services provider agreed to pay $292,132 to resolve allegations that it submitted claims for E&M services provided on the same day as another medical procedure which is prohibited by Medicare and Medicaid.
A psychologist agreed to pay $658,294 to resolve allegations that she received payments from Medicare and Medicaid for services that were not provided. Her husband was responsible for submitting the reimbursement claims and has separately pleaded guilty to healthcare fraud charges.
An ophthalmology group and two related surgery centers agreed to pay $17 million to resolve allegations that they improperly induced primary care physicians for cataract surgery referrals, in violation of the AKS.
A hospital agreed to pay over $1 million to settle allegations it submitted false claims based on medical evaluations, diagnoses, and supporting documentation certified by a subcontracted physician and non-physician providers working under his supervision, in violation of the Arkansas Medicaid FCA.
Two doctors and their medical practice agreed to pay $1 million to resolve allegations that they billed for medically unnecessary tests performed on Medicare and Medicaid beneficiaries.
A plastic surgeon, along with his son, medical practices, and billing company agreed to pay $23.9 million to resolve allegations they: (1) falsified the place of service code on skin grafts to maximize reimbursements; (2) failed to properly dispose of single-use skin graft materials; and (3) used leftover skin graft materials in other procedures involving different Medicare and Medicaid beneficiaries which resulted in double billing. As part of the settlement, the surgeon and Tower Multi-Specialty Medical Group agreed to a voluntary exclusion from federal healthcare programs for 15 years. The son agreed to be excluded for three years.
A non-profit private school agreed to pay $354,000 to resolve allegations that it submitted false claims to TRICARE for autism therapy provided in a group setting when it should be provided one-on-one.
A doctor has agreed to pay $7.96 million to resolve allegations that he and the pharmacy owned by his wife submitted false claims to the federal Workers' Compensation Program for expensive and unnecessary pain creams, gels and patches using preprinted prescription pads. The doctor also allegedly received kickbacks for his referrals to the pharmacy.
A former physician agreed to pay $1,174,849 to resolve allegations that he performed medically unnecessary neurosurgery procedures which caused false claims to be submitted to Medicare, Medicaid, and other federal healthcare programs. As part of the settlement, the physician agreed to enter into an exclusion agreement with HHS-OIG for at least nine years. The physician was also part of a settlement reached with Providence Health & Services Washington in April 2022 when the hospital agreed to pay over $22 million to resolve similar allegations of unnecessary neurosurgery procedures.
A physical rehabilitation hospital and its management company agreed to pay $1.2 million to resolve allegations that they submitted false claims to Medicare for inpatient rehabilitation services that were medically unnecessary. A doctor within the group also agreed to pay $575,000 to resolve the same allegations.
A durable medical equipment provider agreed to pay $5.3 million to resolve allegations it submitted false claims to federal healthcare programs for non-invasive ventilators when patients were prescribed and used a BiPAP machine, which reimburse suppliers thousands of dollars less per year. The company also allegedly continued to bill federal healthcare programs for equipment after patients no longer needed or were using them, and double-billed for some ventilator rentals.
An optometrist and former owner of a chain of ophthalmology practices agreed to pay $1,166,072 to resolve allegations that he paid kickbacks to optometrists who referred patients to him and his practice for laser-assisted cataract surgeries, in violation of the AKS.
A physician practice agreed to pay $3,000,000 to resolve allegations that it billed Virginia Medicaid for in-home health care services for patients who were hospitalized at the time of service. The company also billed for home health services that were not actually provided.
A behavioral health practice and its owner agreed to pay $234,064.89 to resolve allegations that they submitted false claims to Medicaid for services delivered by a licensed provider when an unlicensed individual rendered the services. In a separate state criminal case, the owner pleaded nolo contendere to health insurance fraud and agreed to pay $63,764.23 in restitution, be subject to a three-year suspended jail sentence and five-year conditional discharge.
A hospital and health system agreed to pay $5 million to resolve allegations that the hospital billed Medicare for services referred by ten cardiologists who were receiving compensation that exceeded the fair market value of the service, in violation of the Stark Law. The allegations were self-disclosed.
A medical college agreed to pay $100,749 to settle allegations it submitted false claims for physician services when the services were performed by unsupervised, non-physician residents.
A pharmaceutical distributor agreed to pay $765,000 to resolve allegations that it failed to pay certain customs duties on imported pharmaceutical products which lacked markings to identify the country of origin.
A pharmacy agreed to pay $213,677 to resolve allegations it billed federal healthcare programs for medications that were never dispensed to beneficiaries.
A laboratory agreed to pay $5.9 million to resolve allegations it: (1) submitted claims to federal healthcare programs for unnecessary drug tests and; (2) paid volume-based commissions to third-party marketers, in violation of the AKS. This settlement amount was based on the company’s ability to pay. The company also entered into a five-year CIA with HHS-OIG as part of the settlement. In parallel proceedings, the company entered into an eighteen-month Deferred Prosecution Agreement with the Western District of Texas to resolve a criminal investigation relating to the same conduct.
A pharmacist agreed to pay $3,933,993 to resolve allegations that she fraudulently billed claims to the Medicare Part D Program for medications that were never dispensed to beneficiaries.
A diagnostic testing company agreed to pay $195,000 to resolve allegations it encouraged customers to submit claims for its test after the test was no longer approved for reimbursement from Medicare and Medicaid by: (1) encouraging labs to continue billing for its test using a specific CPT code; and (2) printing and distributing marketing materials that stated “reimbursed by Medicare” and including a specific CPT code.
A hospital system and two physicians agreed to pay over $69 million in three related civil settlements to resolve allegations they participated in improper financial relationships causing false claims to be submitted to Medicare, Medicaid, TRICARE, and FECA, in violation of the Stark Law and AKS.
A former CEO of a mental health and addiction treatment center agreed to pay $300,000 to resolve allegations of violating the federal Controlled Substances Act. This settlement resolves the United States’ separate claims against the CEO for her personal role in the company’s violations.
A former owner of a home-visiting physician company agreed to pay over $25 million to resolve allegations of more than 4,000 violations of the FCA including submitting claims for services: (1) not rendered; (2) that were not medically necessary; and (3) which were upcoded to a reimbursement level higher than was appropriate or provided.
A pharmacy and its owner/pharmacist-in-charge agreed to pay $3.5 million to resolve allegations that they unlawfully dispensed controlled substances, including opioids and drug combinations, and ignored red flags showing that the prescriptions were not issued for legitimate medical purposes. As part of the resolution, the pharmacy agreed to permanently revoke its pharmacy license or DEA registration, and the owner/pharmacist agreed to not dispense any controlled substances in the future.
A laboratory company agreed to pay $2,100,000 to resolve allegations that it overbilled the Department of Defense for genetic testing performed by a reference lab.
An ophthalmology provider group agreed to pay $2,902,505 to resolve allegations that it paid kickbacks to optometrists to induce referrals of patients who were candidates for cataract surgery in violation of the AKS.
A neurosurgeon, his fiancée, and their companies agreed to pay $825,000 to resolve allegations they received kickbacks from spinal implant companies in exchange for use of the companies' products by the neurosurgeon.
A university agreed to pay $16,444 and will implement a mandatory training program for physicians to resolve allegations that its medical center billed Medicare for x-ray interpretations conducted by residents when review by an attending physician did not meet Medicare requirements.
A pain medicine specialist, his practice, and his practice manager agreed to pay $5 million to resolve allegations that they billed Medicare for urine drug tests that were not actually conducted and could not have been conducted on the practice's analyzer. They also allegedly billed Medicare for urine drug tests and diagnostic tests that were not medically necessary.
An ambulance company and its owner agreed to pay $862,500 to resolve allegations that they billed Medicaid for medical transport services that were not adequately or correctly documented or were never provided.
A hospital and a radiology imaging provider agreed to pay more than $2 million to resolve allegations that the imaging provider billed Medicare and Medicaid for services it provided to the hospital's patients as well as for technical services that were provided by the hospital's outpatient cancer screening facility. The imaging provider then returned a portion of the reimbursements received for the outpatient facility's services to the hospital. The outpatient facility was not enrolled in Medicare or Medicaid during the time the arrangement was in place, so its services were not eligible for reimbursement.
A website design company and its manager/co-owner/sole employee agreed to pay $293,771 to resolve allegations that they designed and hosted a website for the State of Florida which failed to comply with HIPAA requirements,
A former surgeon agreed to pay $42,000 to resolve allegations that he caused the submission of false claims for reimbursement from Medicare. After being excluded from participation in federal healthcare programs, St. Lucia opened a medical supply company and applied for the new company to participate in Medicare. When the application was denied due to his exclusion, he transferred his ownership in the company to another party while continuing to work for the company. Under the new ownership, the company was allowed to participate in Medicare. The physician billed Medicare for the physician's services and for products for Medicare beneficiaries under another physician's name to circumvent his personal exclusion.
A physician agreed to pay $500,000 to resolve allegations that she referred Medicare beneficiaries for genetic tests that were not medically necessary.
A health system agreed to pay more than $1.25 million to resolve allegations it submitted claims to Medicare for Evaluation & Management services on the same date that infusion services were provided, in violation of Medicare rules and regulations.
A physician and his practice agreed to pay $70,377 to resolve allegations they prescribed controlled substances in excessive amounts, causing false claims to be submitted to Medicare.
A hospice provider agreed to pay more than $1 million to resolve allegations it billed Medicare and Medicaid for care that was not justified by the patients' medical records and therefore not considered medically necessary.
A physician and several of his companies agreed to pay $3 million to resolve allegations that they submitted claims to Medicare for procedures that were: (1) not actually provided; (2) not medically necessary; or (3) provided without physician supervision.
A health system agreed to pay $4 million to resolve allegations that it made illegal donations to a county government, which allowed the county to make payments to the state Medicaid program. These payments were matched by the federal government, and then used to reimburse the hospital for Medicaid expenses.
A DME supplier agreed to pay $7 million to resolve allegations it received reimbursements from Medicaid programs in Kentucky, Missouri, and the District of Columbia for equipment that was manually priced. When submitting the claims, the company did not disclose the accurate cost it paid to the equipment manufacturers or discounts that it received, resulting in higher reimbursements. In addition to the settlement, the company entered into a five-year CIA with HHS-OIG.
An acupuncture clinic agreed to pay $300,000 to resolve allegations it billed the Department of Veterans Affairs for services which were not authorized, not coded appropriately, or not supported by the medical record.
A skilled nursing facility, its landlord, and individual and entities involved in its operation agreed to pay $7.168 million to resolve allegations that they billed Medicare for worthless services provided to residents, that the facility was understaffed and not physically maintained, and that residents were subject to unnecessary falls and pressure ulcers in addition to medication errors. The facility ceased to operate after the investigation, and as part of the settlement several of the individuals and entities will be excluded from participation in federal healthcare programs for periods of time ranging from ten to twenty years.
A surgeon, university hospital, and physician group agreed to pay $8.5 million to resolve allegations that the surgeon performed multiple surgeries simultaneously, resulting in Medicare being billed for procedures in which he did not fully participate. The surgeon's actions also caused unnecessary anesthesia services for longer than necessary surgeries. As part of the settlement, the surgeon will be subject to a Corrective Action Plan and his Medicare billings will be audited by a third party for one year.
A behavioral health provider agreed to pay $1.866 million to resolve allegations it submitted claims for services provided above its licensed Level IV status. In addition to the settlement, the entity entered into a non-prosecution agreement, to implement a compliance and ethics program, and to update policies and procedures as needed.
A law firm and one of its attorneys agreed to pay nearly $40,000 to resolve allegations that it did not reimburse the United States Government for conditional payments that Medicare made to firm clients under the Medicare Secondary Payer provisions of the Social Security Act.
A long-term care hospital and its operator agreed to pay more than $21.6 million to resolve allegations that it submitted claims to Medicare for services that were: (1) provided by unqualified and unlicensed individuals; (2) provided while the treating physicans were out of the country; (3) not supported by the patient's medical records; and (4) not actually performed or performed adequately.
A mental health services provider and its former owners agreed to pay $940,000 to resolve allegations it submitted claims to the MassHealth for services provided by clinicians who were not properly supervised.
A cardiology practice and ten affiliated physicians agreed to pay $2 million to resolve multiple allegations of false billing. Two of the physicians allegedly caused the practice to bill for more intravascular stents than were actually used in patient procedures. One of the physicians billed for procedures that were not performed by himself or, in some instances, by any qualified practitioner. All of the physicians submitted claims for services and procedures that were performed at times they were not in the United States.
An orthopedic surgery practice agreed to pay $700,000 to resolve allegations that its physician operator submitted claims to Medicaid for spinal manipulation procedures performed while patients were under anesthesia. The associated records did not include documentation of billing for a hospital or surgical center where the procedures could have been performed or for an anesthesiologist.
An autism therapy provider and its owner agreed to pay $2 million to resolve allegations they submitted claims to TRICARE and the Indiana Medicaid program for services: (1) provided by technicians that were upcoded or duplicate; (2) that were not eligible for TRICARE; (3) provided concurrently to the same patient, on the same date; and (4) that were not billed appropriately and, in some instances, which had already been paid by other sources.
A managed care company agreed to pay more than $215 million to resolve allegations it overcharged Medi-Cal for pharmacy services. California joined a list of 7 other states to resolve similar allegations in the past year.
An online pharmacy operator agreed to pay $15 million to resolve allegations it billed Medi-Cal for counseling services that were not provided and for products that beneficiaries did not request.
A clinical laboratory agreed to pay $19 million to resolve allegations it provided phlebotomy services ordered by providers who were receiving process and handling fees in exchange for patient referrals to two other laboratories causing false claims to be submitted to Medicare.
A home healthcare provider and related entitiesagreed to pay $9 million to resolve allegations they submitted claims to the U.S. Department of Labor for services provided to beneficiaries of the Energy Employees Occupational Illness Compensation Program Act when the services were either not provided or were not medically necessary.
A specialty pharmacy agreed to pay $100,000 to resolve allegations that it employed account managers who were eligible to receive incentive compensation for the sale of oral health prescription medications. Some of the account managers worked as dental hygienists without disclosing such employment to the pharmacy in violation of the company's conflicts-of-interest policies and the AKS.
A remote cardiac monitoring service agreed to pay more than $673,000 to resolve allegations that its services were performed by technicians who did not have the required credentials. The company also falsely represented that it performed services in New York State to receive higher Medicare reimbursements.
A healthcare services provider agreed to pay almost $26 million to resolve self-disclosed allegations it misrepresented its income in financial reports submitted to the state, resulting in higher reimbursements from Medi-Cal.
A mental health services provider agreed to pay $384,322 to resolve allegations it billed Connecticut Medicaid for Medicaid Rehabilitation Option services provided to clients when the documentation did not show that the required 40 hours of service per month were provided.
A medical device manufacturer agreed to pay $500,000 to resolve allegations that it arranged for providers to bill North Carolina Medicaid for its range-of-motion devices as orthotics because the company did not meet the requirements to bill North Carolina Medicaid directly. In exchange, the providers retained a portion of the reimbursements. The company eventually received reimbursement approval of its deviced to be billed as DME, but it continued using providers to bill using the orthotics code to bypass any medical necessity reviews or authorizations.
A pharmacy benefits manager agreed to pay more than $66 million to resolve allegations that it: (1) did not pass along discounts on pharmacy benefits and services to the state Medicaid program; and (2) inflated dispensing fees charged to the state Medicaid program. Indiana joined a list of 6 other states to resolve imilar allegations in the past year.
A pharmacy operator agreed to pay $7 million to resolve allegations that a former pharmacist and store manager falsified the required prior authorization requests and clinical records for a Hepatitis C medication. The pharmacy submitted reimbursement claims to the Tennessee Medicaid program for prescriptions that were dispensed based on the falsified records. The pharmacy also knowingly retained these overpayments after the issue was discovered.
A medical device manufacturer agreed to pay $9.75 million to resolve allegations it provided free implants and surgical instruments to a surgeon for use in surgeries he conducted overseas to induce the surgeon to use its products in surgeries performed in the United States for beneficiaries of federal healthcare programs.
A medical billing company agreed to pay $153,300 to resolve allegations that it submitted claims, on behalf of a provider, to the Connecticut Medicaid program where the incorrect practitioner was identified as providing the services. This resulted in claims that would otherwise not have been paid.
An orthopaedic practice, its owner, and a subsidiary agreed to pay more than $1.87 million to resolve allegations that they billed Medicare and Medicaid for a brand name product used in knee injections but instead used an inexpensive compounded agent for the injections.
A physician and her practice agreed to pay $1.85 million to resolve allegations that she billed federal healthcare programs for testing and procedures that were performed on patients who were not qualified for the procedures or had been falsely diagnosed to justify the treatments, and were, in some cases, injured by the procedures. Additionally, some of the tests were allegedly performed using broken equipment or not interpreted in the medical record.
A cardiologist agreed to pay $900,000 to resolve allegations that he inserted cardiac stents into Medicare beneficiaries when the stents were not medically necessary. Claims for the procedures were then submitted to Medicare. As part of the resolution, the physician has entered into an IA with HHS-OIG.
A physician agreed to pay more than $900,000 to resolve allegations that he referred patients to a laboratory for genetic tests in exchange for payments from the laboratory. In some instances the tests were not medically necessary or reasonable.
A medical device distributor agreed to pay $200,000 to resolve criminal allegations that it distributed a device intended to treat migraines without obtaining approval from the FDA or conducting an investigational study to determine the device's safety and effectiveness. The company also entered into a deferred prosecution agreement. In addition to the criminal settlement, the medical device distributor and two other companies agreed to pay $545,133 to resolve allegations they caused providers to submit claims to Medicare for the device despite the lack of FDA approval.
A podiatrist agreed to pay $90,000 to resolve allegations that he billed Medicare for the surgical implantation of neurostimulator devices when the patients received acupuncture devices that were not surgically implanted.
Medical device manufacturer agreed to pay nearly $500,000 to resolve FCA allegations that it submitted claims to Medicare in connection with infusion medication administration sets that it knew were materially defective.
Physician and two affiliated practices agreed to pay over $2.13 million to resolve FCA allegations that they submitted over 1,000 claims to Medicaid for procedures that lacked adequate documentation as to whether they were actually performed or medically necessary. As part of the resolution, the physician also agreed to withdraw from the New York State Medicaid program.
Medical device manufacturer agreed to pay more than $12 million to resolve FCA allegations that it misrepresented the results of radio-frequency emissions tests for certain cochlear implant processors in pre-market approval applications to the FDA and billed federal healthcare programs for the defective devices. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
Medical device company and its subsidiary agreed to pay more than $44.8 million to resolve FCA allegations that they submitted claims for heart monitoring tests that were performed, in part, outside the United States, and in many cases by technicians who were not qualified to perform such tests. As part of the settlement, the companies entered into a five-year CIA with HHS-OIG.
Youth rehabilitation center and its operator agreed to pay over $3.49 million to resolve allegations that it submitted claims to Alabama Medicaid for services provided to youth beneficiaries, when the services were not actually provided.
Marketing company and its subsidiary agreed to pay $3 million to resolve FCA allegations that they paid and received kickbacks in connection with genetic cancer tests, in violation of the AKS. Ocenture allegedly solicited genetic testing samples directly from Medicare beneficiaries, paid physicians to attest to the medical necessity of the testing, and arranged for laboratories to process and bill Medicare for the testing. The laboratories then paid a portion of the reimbursements to Ocenture.
Physician and his office manager/wife agreed to pay $422,789 to resolve FCA allegations that they received kickbacks from three laboratories in exchange for referrals, in violation of the AKS. The Patels allegedly received kickback payments disguised as investment returns, commercially unreasonable space rental payments, and commercially unreasonable urine specimen collection fees.
Long-term care pharmacy agreed to pay $3 million to resolve FCA allegations that it billed Medicare and Medicaid for controlled substances dispensed to nursing home and long-term care residents without valid prescriptions.
Home health provider agreed to pay more than $1.26 million to resolve FCA allegations that it falsely claimed to have paid its home care aides the minimum wage required under New York State law, thereby receiving Medicaid reimbursement to which it was not entitled. White Glove has also agreed to pay its aides $2 million for past due wages under a separate agreement with the Labor Bureau of the New York State Attorney General’s Office.
Two Tenet Healthcare-owned acute care hospitals operating in San Luis Obispo County, California, agreed to pay $7.5 million to resolve FCA allegations that they caused the submission of claims for "enhanced 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. As part of the resolution, the hospitals entered into a five-year CIA with HHS-OIG.
Health system that operates three hospitals and one clinic in Santa Barbara County and San Luis Obispo County, California, agreed to pay $15 million to resolve FCA allegations that it caused the submission of claims for "enhanced 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.
Medical device manufacturer and affiliated companies agreed to pay $23.8 million to resolve allegations that it submitted claims tainted by kickbacks in the form of up-front cash payments to eye care providers in exchange for the referral of certain volumes of business, in violation of the AKS and California’s Insurance Frauds Prevention Act.
Opioid abuse treatment provider agreed to pay a total of $3.15 million to resolve: (1) civil FCA allegations that it billed Medicaid for methadone mixing services tainted by kickbacks in the form of profit-sharing to Camden by the mixing company, who was owned by the same entity; and (2) criminal penalties related to the kickback allegations and allegations that Camden obstructed a Medicaid audit by falsifying documents. The company also entered into a three-year deferred prosecution agreement in connection with the criminal information.
Physician agreed to pay $50,000 to resolve FCA allegations that he referred Medicare beneficiaries to certain home health agencies in exchange for free office space, the use of a medical assistant, and a credit card payment, in violation of the AKS.
Nursing home operator agreed to pay $2.3 million to resolve allegations that it billed Medicare and Medi-Cal for grossly substandard nursing services that did not meet the minimum required standards for skilled nursing care.
Physician agreed to pay more than $86,000 to resolve allegations that he billed Medicare for inflated E&M services that were not sufficiently supported by the medical record, including claims for E&M services when the only service provided was the COVID-19 vaccination.
Ambulance company agreed to pay more than $300,000 to resolve FCA allegations that it billed Medicare for transporting patients to and from dialysis treatment when the services were not medically necessary.
Physician and his practice agreed to pay more than $3.1 million to resolve FCA allegations that he wrote and referred compounded drug prescriptions in exchange for illegal kickback payments from pharmacists involved in the alleged scheme. In addition to the civil settlement, Raley was sentenced to three years in prison for his participation in the kickback scheme. Three others involved in the alleged scheme previously received prison sentences ranging from one year and a day to four years.
Legislatively-created compensation plan established to provide compensation for the care of children who suffer certain categories of birth-related neurological injuries and the plan administrator agreed to pay $51 million to resolve FCA allegations that they caused program participants to submit claims to Medicaid instead of to the program itself, in violation of Medicaid's status as the payor of last resort under federal law.
Primary care practice and its principal member and owner agreed to pay more than $2.6 million to resolve allegations that they billed government healthcare programs for: (1) medical visits when fitness services were actually provided, with no legitimate medical component, at a gym the practice operated staffed by medically unlicensed personnel, and then created false medical records and diagnoses; (2) office visits provided by the physician that occurred when he was not actually present in the office; (3) telemedicine visits that did not meet the requirements for office location or the use of an interactive telecommunication system; and (4) medically unnecessary testing and procedures. The settlement also resolved allegations that they accepted payments — in the form of “processing and handling” fees and “speaker” fees above FMV — from a laboratory company in exchange for ordering services for Medicare patients from the company, in violation of the AKS. As part of the resolution, the practice and its owner entered into a three-year IA with HHS-OIG.
Real estate investment trust agreed to pay $3 million to resolve FCA allegations that its predecessor in interest offered physicians low-risk, high-reward investment opportunities in a realty group in exchange for referring patients to the hospital it owned, in violation of the AKS.
SNF provider and its owner agreed to pay $175,000 to resolve FCA allegations that they submitted claims to MassHealth despite knowledge that they were not implementing mandatory infection control and prevention procedures during the COVID-19 pandemic, which allegedly resulted in some residents contracting and at least one dying from COVID-19. As part of the resolution, the company and its owner agreed to no longer own, operate, or manage long-term care or assisted living facilities in Massachusetts.
Psychiatric practice and its owner agreed to pay $532,830 to resolve allegations that they billed the Connecticut Medical Assistance Program for longer psychotherapy sessions than were actually provided. The investigation originated from a fraud referral from the state Department of Social Services.
EHR vendor agreed to pay $45 million to resolve intervened FCA allegations that it violated the AKS through three marketing programs: (1) recommending a specific pathology laboratory to its customers in exchange for payments from the laboratory; (2) working with the laboratory to donate EHR to providers in an effort to increase orders to the lab and its own user base; and (3) paying kickbacks to existing customers and other sources to recommend its EHR to potential new customers.
Pain medicine specialist and his practice agreed to pay $1 million to resolve allegations that the practice billed Medicare and TRICARE for medically unnecessary and upcoded evaluation and management services and for psychological testing services that were not appropriately administered. The settlement also resolved allegations that the physician did not comply with specific recordkeeping requirements of the CSA in conjunction with a worker's compensation pharmacy that he operated from the practice's offices. The physician and his practice also entered into a three-year Memorandum of Agreement with the DEA.
Hospital agreed to pay more than $98,000 to resolve FCA allegations that it billed Medicare and Medicaid for unsupervised or inadequately documented outpatient mental healthcare services provided by two social workers.
Physician and his practice agreed to pay $900,000 to resolve FCA and CSA allegations that they billed federal healthcare programs for: (1) upcoded medical services, (2) inadequately documented smoking cessation counseling services; and (3) improperly prescribed opioids.
Physician agreed to pay $720,000 to resolve allegations that he billed Medicare for medically unnecessary DME and genetic tests and received illegal kickbacks from physician staffing agencies and telehealth companies in exchange for ordering the medically unnecessary DME and genetic tests and services. As part of the resolution, the physician agreed to exclusion from federal healthcare programs for 15 years and to make additional payments contingent upon his income over the next five years.
Home health provider agreed to pay $6.92 million, its former CEO agreed to pay $75,000, and its former COO agreed to pay $175,000 to resolve FCA allegations that the company billed Medicare for medically unnecessary and/or upcoded therapy services. As part of the resolution, Carter Healthcare entered into a five-year CIA with HHS-OIG. The two former officers are excluded from participating in federal healthcare programs for five years.
Home health provider, its former CEO, and its former COO agreed to pay more than $22 million to resolve FCA allegations that they paid physicians sham medical director payments to induce the referral of patients, in violation of the AKS. As part of the resolution, Carter Healthcare entered into a five-year CIA with HHS-OIG. The two former officers are excluded from participating in federal healthcare programs for five years.
Hospital system agreed to pay more than $13 million to resolve FCA allegations that it billed government healthcare programs for toxicology screening tests that were actually performed by third-party laboratories.
Several pharmacies and related entities and owners agreed to pay more than $6.8 million to resolve FCA allegations that they: (1) waived co-pays for compound pain creams based on unverified statements of financial need; (2) misrepresented to federal healthcare programs the price of pain creams charged to uninsured patients; and (3) after being terminated from various payor networks, engaged in pass-through billing to circumvent the terminations.
Pediatric dentist, his management company, and affiliated practices agreed to pay $753,457 to resolve allegations that they billed Medicaid for unnecessary therapeutic procedures on pediatric patients and provided incorrect provider information on claims submitted to Medicaid MCOs.
Home health provider and its CEO agreed to pay $430,000 to resolve FCA allegations that they submitted claims to MassHealth for services that were not appropriately authorized by a physician. In order to continue to participate in MassHealth, Allied is required to implement a three-year compliance program through an independent compliance monitor.
Physician practice agreed to pay $700,000 to resolve allegations that it billed Medicaid for quantitative urine drug tests that were not individualized to each patient's needs, rendering the tests medically unnecessary.
Physician group agreed to pay $138,612 to resolve FCA allegations that it received overpayments for E&M services performed by one of its providers and knowingly retained such overpayments.
Adult day health provider agreed to pay $386,861 to resolve allegations that it billed MassHealth for COVID-19 emergency-related retainer payments equal to the full per diem rate for each day a member would have been scheduled to attend, at higher frequencies than members were actually scheduled to attend. The center allegedly submitted claims for members who were in nursing homes or other inpatient settings and therefore not able or scheduled to attend.
Clinical laboratory agreed to pay more than $3.6 million to resolve FCA allegations that it billed North Carolina Medicaid for both presumptive and confirmatory urine drug tests which were performed at the same time, resulting in reimbursements being paid for confirmatory tests which were not medically necessary. In March 2022, the laboratory agreed to a five-year CIA with HHS-OIG in connection with a separate resolution related to Medicare billing.
Hematology and oncology practice agreed to pay $130,000 to resolve allegations that it received upfront discounts from a pharmaceutical distributor that were not tied to specific purchases of the distributor's drugs, in violation of the AKS. The distributor entered into a separate settlement earlier in 2022 to resolve these and other related allegations.
Pharmacy benefits manager agreed to pay more than $14 million to resolve allegations that some of its subsidiary companies overcharged the state Medicaid program for pharmacy services.
Hospital system agreed to pay $2.9 million to resolve FCA allegations that several of its hospitals submitted claims and retained overpayments related to improperly coded bloodclotting tests.
Consulting company hired by the state of New Jersey to manage a program whereby schools could obtain Medicaid funds for providing covered services to Medicaid-eligible students agreed to pay $2.5 million to resolve FCA allegations that it caused school districts to submit claims for evaluation services that were not covered by Medicaid.
Pharmaceutical company agreed to pay $900 million to resolve FCA allegations in a declined qui tam action that it provided speaker honoraria, training fees, consulting fees, and meals to physicians and other healthcare professionals in attempt to persuade them to prescribe specific drugs, in violation of the AKS.
Medical device manufacturer agreed to pay more than $1.2 million to resolve FCA allegations that it helped a DME supplier procure a 12-month, interest-free loan by fully guaranteeing the loan itself, in violation of the AKS. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
Pharmaceutical company agreed to pay $7.9 million to resolve allegations that it delayed seeking FDA approval to switch three medications from prescription-only status to generic, over-the-counter medications and continued to sell generic versions using prescription packaging, resulting in Medicare reimbursements being paid for generic medications in violation of Medicare regulations.
Hospital agreed to pay more than $2.5 million to resolve FCA allegations that it submitted claims related to medically unnecessary surgical procedures to replace the batteries of implanted medical devices performed by a physician formerly affiliated with the hospital.
Cosmetic surgeon and his practice agreed to pay $800,000 to resolve allegations that he billed federal healthcare programs for: (1) services that were provided by other individuals and in which he was not involved to the extent necessary to bill under his name or which were provided when he was not present; and (2) the application of skin substitute products that were not medically necessary or unreasonable.
Ophthalmologist and his practice agreed to pay more than $900,000 to resolve allegations that they submitted false claims for medically unnecessary eye injections. HHS-OIG identified the physician as one of the top outliers for billing Medicare across all medical specialists in West Virginia.
A chiropractic clinic and its owner agreed to pay $200,000 to resolve allegations that they improperly billed Medicare for the surgical implantation of neurostimulator devices when, in fact, the clinic’s nurse practitioner applied non-covered electro-acupuncture devices to patients’ ears with an adhesive.
Physical therapy company and its owner agreed to pay $400,000 to resolve allegations that they billed Medicaid and Medicare for individual aquatic therapy sessions instead of the group sessions that were actually provided and for group sessions without accurate documentation of the patients’ participation. They also allegedly billed TRICARE for physical therapy services that were provided by an unauthorized individual.
Pharmaceutical manufacturer and related entities agreed to pay $40 million to resolve FCA allegations in a declined qui tam action that they paid kickbacks to physicians and hospitals in attempts to persuade them to use two drugs, in violation of the AKS, and also marketed the drugs for off-label uses that were not reasonable and necessary. In addition, the companies allegedly downplayed the risks of two of their drugs and misrepresented one of the drug's efficacy. As a result of those misrepresentations, the Defense Logistics Agency allegedly was induced to renew contracts for one of the drugs.
Nonprofit community service organization agreed to pay $850,000 to resolve allegations that it provided funds to for-profit entities owned by its founder, paid consulting fees and salaries to the founder's family members, and paid personal expenses for the founder, claiming many of these expenditures as allowable costs when reporting expenses to Medicaid. Maranatha’s founder, Henry Alfonso Coley, previously agreed to pay $220,000 to resolve allegations related to his role and entered into a 15-year exclusion agreement with HHS-OIG in November 2021.
Two Medicaid recipients agreed to pay $130,000 to resolve allegations that they misrepresented their income on Medicaid benefit applications and renewals in order to obtain Medicaid benefits to which they and their families were not entitled.
Medical device manufacturer agreed to pay $24.75 million to resolve FCA allegations that it provided physician prescribing data to suppliers to assist with the suppliers' marketing efforts in exchange for equipment orders from the suppliers, in violation of the AKS. The company entered into a five-year CIA with HHS-OIG as part of the resolution.
Pharmaceutical company agreed to pay $6.3 million to resolve FCA allegations that it sold needles manufactured in non-designated countries to United States government agencies, in violation of the Trade Agreements Act of 1979, which restricts the procurement of goods under certain government contracts to purchases from specific designated countries.
Medical device manufacturer agreed to pay $2.25 million to resolve FCA allegations that it paid commissions to an independent sales representative and his company for each knee brace ordered by a group of clinics for which they facilitated sales, in violation of the AKS. In connection with the settlement, the company entered into a five-year CIA with HHS-OIG.
Medical equipment manufacturer agreed to pay more than $785,000 to resolve FCA allegations that it marketed and promoted devices that were not approved for Medicare coverage or for which approval had expired.
Pharmacy benefits manager agreed to pay $19 million to the state of Washington and $13 million to the federal government to resolve allegations that it: (1) did not pass along discounts on pharmacy benefits and services to the state Medicaid program; and (2) inflated dispensing fees charged to the state Medicaid program.
Dermatopathology clinic agreed to pay $3.75 million to resolve allegations that it allowed a laboratory management company to use the clinic's lab license to submit claims to federal healthcare programs for medically unnecessary tests in exchange for a percentage of the revenue from the tests. The clinic and its owner also allegedly knowingly avoided and concealed their obligation to repay the government for the monies received from the false claims. Under the agreement, the clinic’s owner and principal physician will be liable for any part of the settlement amount the clinic fails to pay.
Medical device manufacturer and affiliated companies agreed to pay $16.4 million to resolve FCA allegations that they created programs to provide remuneration to eye care providers to induce purchases of their optical lenses, in violation of the AKS. In connection with the settlement, the companies entered into a five-year CIA with HHS-OIG.
Hospice provider agreed to pay more than $990,000 to resolve FCA allegations that it submitted claims to Medicare for hospice services provided to patients who were not eligible or qualified to receive the hospice benefit.
Healthcare organization headquartered in Ventura County, California, agreed to pay $12.5 million to resolve FCA allegations that it submitted 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.
Health system that operates two acute care hospitals in Ventura County, California, agreed to pay $12 million to resolve FCA allegations that it submitted 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.
County agreed to pay $29 million and county-organized health system agreed to pay $17.2 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. Gold Coast and Ventura County entered into a five-year CIA with HHS-OIG as part of the resolution.
Physician and his practice agreed to pay almost $2 million to resolve allegations that they: (1) submitted claims to Medicare for the surgical implantation of neurostimulator devices without actually performing the surgery or implanting the device, instead taping non-covered disposable electroacupuncture devices to patients’ ears; and (2) violated the AKS by paying a marketing company a percentage of the improper Medicare reimbursements in exchange for patient referrals for the non-covered devices. The physician and his practice entered into a three-year IA with HHS-OIG as part of the resolution.
Pharmacy and its owner-pharmacist agreed to pay more than $4.1 million as part of a civil consent judgment. The judgment resolves FCA allegations that they dispensed controlled substances despite indications of abuse then made false statements in order to maintain a stock of the drugs. The judgment also resolves allegations that the pharmacy routinely billed federal healthcare programs for drugs that were not actually dispensed. The owner-pharmacist separately forfeited $500,000, and the parties will also be banned from prescribing, dispensing, or distributing controlled substances and will be excluded from participating in Medicare and Medicaid for 22 years.
SNF operator agreed to pay more than $5.5 million to resolve FCA allegations that it billed Medicare for various therapy services provided to beneficiaries who had already been placed in hospice, resulting in double-billing for services already covered by patients’ Medicare hospice benefit.
A pain management clinic, its anesthesiologist and pain management specialist owner, and the clinic’s CEO agreed to pay $980,000 to resolve allegations that they billed government healthcare programs for medically unnecessary urine drug testing, using blanket orders for testing and ignoring test results when prescribing patients opioids and other controlled substances. As part of the settlement, the clinic and Dr. Gonzaga entered into a three-year IA with HHS-OIG.
Dermatologist and his practice agreed to pay $1.66 million to resolve allegations that they billed Medicare for upcoded dermatology office visits and related services. As part of the settlement, the physician and his practice entered into a three-year IA with HHS-OIG.
Neurology practice agreed to pay $850,000 to resolve allegations that it billed Medicare for services provided by a physician assistant as if they were provided or supervised by a physician, when no licensed physician was in the office at the time. The practice also allegedly billed Medicare for Botox in instances where the drug had already been paid for by private insurers.
SNF operator and affiliated facilities agreed to pay $950,000 to resolve allegations that they submitted claims to Medicare and Medicaid for medically unnecessary physical, occupational, and speech therapy services.
SNF provider agreed to pay $819,640 to resolve FCA allegations that it submitted claims to Medicare for services that were not medically necessary and/or were provided to patients who did not need or could not benefit from such services.
Two dental companies and their dentist owner agreed to pay $1.5 million to resolve allegations that they submitted claims to TennCare for dental services that falsely identified the rendering provider and that were actually furnished by uncredentialed dentists ineligible to bill TennCare. The government also settled with Cloudland Dental’s business manager for her role in the alleged conduct.
Infusion center and its owner agreed to pay $310,000 to resolve allegations that they billed Medicare and Medicaid for high-level office visits that could not have occurred because the center did not employ the qualified medical professionals required to provide such services. In addition, the center allegedly billed Medicare Part B for medications already billed to Medicare Part D.
Specialty pharmacy agreed to pay $115,000 to resolve FCA allegations that it altered patient medical records and submitted those altered records to Medicare in support of prior authorization requests.
Medical device manufacturer agreed to pay $12.95 million to resolve allegations that it paid physicians for training events in excess of what was necessary, including events that did not occur or had little value, in exchange for the physicians' use of the manufacturer's products. The government also alleged that the company paid for parties, winery tours, meals, airfare, and speaking fees in exchange for making brief appearances at conferences, in violation of the AKS. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
Two clinical laboratories and their owners agreed to pay $5.7 million to resolve FCA allegations that they: (1) entered into agreements with marketers to pay hourly rates for various services, but in reality paid those marketers a percentage of revenue, in violation of the AKS; and (2) billed for genetic tests that were conducted based on false assertions of medical necessity. The two owners each previously pleaded guilty to conspiracy to defraud the United States and are awaiting sentencing.
Clinical laboratory agreed to pay $16 million to resolve FCA allegations that it billed Medicare for additional testing of biopsy specimens that was conducted prior to a pathologist’s review to determine if the further testing was medically necessary.
Opioid treatment center agreed to pay $348,934 to resolve allegations that it billed Virginia Medicaid for addiction treatment counseling provided by individuals without the required credentialing as if it had been provided by properly-credentialed professionals.
Pain specialist agreed to pay more than $270,000 to resolve allegations that he prescribed certain medications to Medicare beneficiaries in exchange for receiving paid consulting work and speaking engagements from the manufacturers of the medications, in violation of the AKS.
Clinical laboratory and its parent company agreed to pay $9.85 million to resolve allegations that the laboratory leased space from physicians and physician groups at above-market rental rates in exchange for the referral of patients, in violation of the AKS. As part of the resolution, BioReference also entered into a five-year CIA with HHS-OIG.
Pharmacy and its CEO agreed to pay $1.31 million to resolve FCA allegations that they: (1) dispensed a high-priced drug used to reverse opioid overdoses after completing the prior authorization forms required by insurers themselves instead of requiring prescribing physicians to complete them, resulting in the submission of prior authorization requests with false signatures and, in some instances, incorrect clinical information; and (2) waived co-pay requirements for Medicare beneficiaries without analyzing whether they had a financial hardship. As part of the resolution, the company and its CEO entered into a three-year IA with HHS-OIG. The company also entered into a deferred prosecution agreement in connection with a criminal information charging the pharmacy with healthcare fraud.
Pharmacy benefits manager agreed to pay more than $165 million to resolve allegations that some of its practices violated the Texas Medicaid Fraud Prevention Act by overcharging the state Medicaid program for pharmacy services.
Hospital agreed to pay $1.5 million to resolve self-disclosed FCA allegations that it submitted claims to Medicare for services referred by physicians with whom it had improper compensation arrangements, in violation of the Stark Law. The settlement is expressly based on the hospital’s financial condition.
Medical device distributor, its owners, and two physician-owned distributorships (PODs) agreed to pay $1 million to resolve allegations that they operated the PODs in order to provide compensation to physicians based on their use of the distributor's devices in surgeries, in violation of the AKS. The government alleged that the PODs paid physicians based on their referrals, terminated physicians who did not generate enough referrals, and provided false information to providers. Other PODs’ owners previously settled their role in the alleged scheme for a total of more than $9 million.
Medicare Advantage plan operator agreed to pay $4.2 million to resolve FCA allegations that it gave gift cards to providers’ administrative assistants to induce them to enroll Medicare beneficiaries in one of the company's plans, in violation of the AKS.
Nursing home operator agreed to pay $1.75 million to resolve FCA allegations that it misused funds from the Centers for Disease Control and Prevention Pharmacy Partnership for Long-Term Care Program to facilitate COVID-19 vaccines for hundreds of persons who were neither residents nor staff, including board members, donors, and staff family members.
SNF provider and its management company agreed to pay $7.85 million to resolve allegations that Plaza, at the direction of Citadel, frequently changed residents' insurance coverage without their consent or knowledge, in an effort to increase Medicare reimbursements. As part of the resolution, Plaza and Citadel entered into a five-year CIA with HHS-OIG.
Three pharmacies agreed to pay more than $830,000 to resolve FCA allegations that they used unlawful collaborative practice agreements to delegate prescribing authority from physicians to pharmacists, resulting in unlawful prescriptions. The pharmacies allegedly then wrote and filled prescriptions without physician involvement and submitted claims for the unlawful prescriptions to Medicare and Medicaid.
A physician agreed to pay $237,487 to resolve allegations that he received kickbacks from three management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $213,888 to resolve allegations that she received kickbacks from three management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $160,456 to resolve allegations that he received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $54,280 to resolve allegations that he received kickbacks from a management service organization in exchange for using specific providers for laboratory tests.
A physician agreed to pay $100,392 to resolve allegations that she received kickbacks from a management service organization in exchange for using specific providers for laboratory tests.
A physician agreed to pay $45,484 to resolve allegations that he received kickbacks from a management service organization in exchange for using specific providers for laboratory tests.
Two physicians agreed to pay $470,560 to resolve allegations that they received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $41,000 to resolve allegations that he received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $57,900 to resolve allegations that he received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $582,522 to resolve allegations that he received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $256,466 to resolve allegations that he received kickbacks from two management service organizations in exchange for using a specific provider for laboratory tests.
Two physicians agreed to pay $523,151 to resolve allegations that they received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $87,694 to resolve allegations that he received kickbacks from a management service organization in exchange for using a specific provider for laboratory tests.
Fifteen physicians agreed to pay a total of $2.83 million to resolve allegations that they received illegal remuneration disguised as investment returns from nine MSOs in exchange for the physicians’ referrals for laboratory tests from three laboratory companies, in violation of the AKS and Stark Law. Cumulatively, the government has recovered over $32 million from 33 physicians, two healthcare executives, and one laboratory through civil settlements involving these FCA allegations. These 15 physicians also agreed to cooperate with the government’s ongoing related investigations and litigation, including a separate qui tam action pending against healthcare executives and others for their involvement in the allegations.
Physician agreed to pay $561,800 in a civil consent judgment to resolve FCA allegations that he: (1) entered into financial arrangements with a physician staffing firm and received illegal remuneration in violation of the AKS in exchange for referring Medicare patients for or ordering DME and genetic testing items and services; and (2) improperly billed Medicare for DME and genetic testing claims that were medically unnecessary and tainted by AKS violations. The physician admitted his FCA violations.
Managed care company and its former mental health centers subsidiary agreed to pay over $4.62 million to resolve FCA allegations that they billed MassHelath for services provided by staff who were not properly licensed or properly supervised and for which supervision was not adequately documented.
Podiatrist clinic and its podiatrist co-owners agreed to pay more than $181,000 to resolve allegations that they billed Medicare for the application of an electric stimulation device (Sanexas) or vitamin injections used in conjunction with the device even though they were administered in a way that was not covered under a Medicare NCD and other LCDs.
Pharmacy benefits manager agreed to pay $13.7 million to resolve allegations that it layered fees and did not pass on retail discounts to the New Mexico Medicaid progam, thus receiving higher reimbursements.
Medical equipment supplier agreed to pay $363,116 to resolve allegations that it submitted claims to the Oklahoma Medicaid program for equipment and services using inflated pricing and shipping charges.
Physician agreed to pay over $9.4 million to resolve: (1) civil FCA allegations that he submitted claims to Medicare and Medi-Cal for a variety of procedures, services, and tests that were never performed; and (2) a related guilty plea for one count of healthcare fraud in a separate criminal case. The physician was sentenced to 41 months in prison with two years’ supervised release.
Health system and related corporate entities agreed to pay $4.73 million to resolve FCA allegations that an affiliated medical center entered agreements with a urology clinic and separate physician practice to administer a prostate cancer center and made payments under the same, even though the center was never created and the practice never provided a physician to serve as the center’s director, in violation of the AKS and Stark Law. The settlement also resolves self-disclosed FCA allegations that the medical center: (1) improperly paid a medical director for services it could not confirm were performed; and (2) had below FMV lease arrangements with other referring providers, in violation of the AKS and Stark Law. As part of the resolution, the health system entered into a five-year CIA with HHS-OIG.
Physician agreed to pay $500,000 to resolve FCA and Controlled Substances Act allegations that she: (1) billed Medicare and Medicaid for services she did not perform, including office visits where patients met only with unlicensed office staff, often to obtain monthly controlled substance prescriptions; and (2) wrote controlled substance prescriptions for illegitimate purposes and outside the scope of her professional practice. The physician surrendered her DEA registration for cause and agreed to never reapply for a new registration. She also pleaded guilty to one count of healthcare fraud.
Otolaryngologist agreed to pay more than $600,000 to resolve allegations that he billed Medicare and Medicaid for procedures that were not performed or were not documented in patient medical records.
Home sleep testing provider agreed to pay $3.5 million, and its founder and vice president agreed to pay $300,000 and $125,000, respectively, to resolve allegations that, at the founder’s direction, the company billed federal healthcare programs for multiple nights of home sleep testing, when it knew that only one night was necessary and routinely tested and billed only one night for patients with private insurance. The government also alleged that the company multiplied co-pay amounts from Medicare beneficiaries and provided incentives to physicians and staff in exchange for the referral of home sleep testing services, in violation of the AKS. As part of the resolution, the company and its founder entered into a five-year CIA with HHS-OIG.
The owner of a group of pain clinics agreed to pay $900,000 to resolve allegations that he caused claims for urine drug tests to be submitted to Medicare when the tests were not medically necessary and not used for diagnosis or treatment of the patients. The owner also agreed to be excluded from federal healthcare programs for 22 years. In March 2022, he pleaded guilty to related criminal charges.
Molecular testing company agreed to pay over $2.88 million to resolve FCA allegations that it violated Medicare's 14-Day Rule by submitting claims directly to Medicare for: (1) tests ordered within 14 days of inpatient discharge; (2) tests ordered within 14 days of inpatient or outpatient discharge instead of encouraging providers to wait until after the 14-day period to order tests; and (3) tests ordered within 14 days of outpatient procedures.
Behavioral healthcare provider agreed to pay $2.1 million to resolve allegations that it received reimbursements from North Carolina Medicaid for case management services that are not covered.
Rheumatology specialist agreed to pay more than $1 million to resolve FCA allegations that he billed Medicare and Medicaid for non-FDA-approved drugs used to treat osteoarthritis pain and for the related injection procedures.
Diagnostic testing facility operator agreed to pay $3.15 million to resolve FCA allegations that it submitted or caused the submission of claims to Medicare that falsely indicated that pulse oximetry tests were performed at a different location in order to receive a higher reimbursement rate. The settlement also resolves allegations that the company submitted claims for both overnight tests and spot checks on the same patients when only overnight tests were performed. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
Health system agreed to pay $296,870 to resolve FCA allegations that it billed Medicare for radiation therapy and diagnostic services that were performed without the required physician supervision.
Hospital agreed to pay $1.15 million to resolve self-disclosed FCA allegations that it submitted claims for intensive cardiac rehabilitation services for Medicare beneficiaries when the required physician-authorized treatment plan had not been completed or updated as required.
A provider of behavioral therapy for autistic children agreed to pay $650,000 to resolve allegations that it billed Medi-Cal for services that were not provided, including billing for cancelled appointments.
Home health provider and its owners agreed to pay $550,000 to resolve FCA allegations that they submitted claims to MassHealth for services that were not appropriately authorized by a physician. In order to continue to participate in MassHealth, Integrity is required to implement a three-year compliance program through an independent compliance monitor.
Home health company operator agreed to pay $2.1 million to resolve FCA allegations that it submitted claims to Medicare for home health services provided to beneficiaries who: (1) were not homebound; (2) did not require the level of care provided; (3) did not have a valid or otherwise appropriate plan of care in place; and/or (4) were not appropriately certified for home health services.
Online pharmacy agreed to pay $5.79 million to resolve FCA allegations that it dispensed insulin pens to patients in higher quantities than needed according to their prescriptions and then under-reported the days-of-supply dispensed. As a result of the under-reporting, the pharmacy dispensed and submitted claims for refills prematurely.
Medical device distributor agreed to pay $34.37 million to resolve FCA and common law allegations that it submitted claims to the Federal Employees Health Benefit Program (FEHBP) for hearing aids using diagnosis codes that were not supported by a required hearing loss diagnosis. The government alleged that, after conducting an internal review of its coding and billing practices, the distributor continued to submit the unsupported claims and on bills that it knew FEHBP participants would use to obtain reimbursement.
Two urgent care clinics and their physician-owner agreed to pay more than $550,000 to resolve allegations that they billed Medicare for mid- and high-level evaluation and management office visits when the only service provided was a routine COVID-19 test or vaccine.
Substance abuse treatment clinic and its owner/CEO agreed to pay a minimum of $125,000 and up to a maximum of $335,494 to resolve FCA allegations that they billed Medicare and Medicaid for high-complexity, more expensive E&M services when less expensive counseling services, or no services at all, were actually rendered. The ranged resolution is based on the parties’ ability to pay.
Gynecologic oncologist agreed to pay $775,000 to resolve FCA allegations that he billed federal healthcare programs for medically unnecessary hysterectomies and chemotherapy services, as well as evaluation and management services that he did not perform or misrepresented. The physician agreed to a three-year exclusion from federal healthcare programs. In August 2021, the government settled with several hospitals for their role in the allegations.
A company that owns and operates anesthesia practices, its founders, and 18 of its practices, agreed to pay $7.2 million to resolve allegations that they induced the physician owners of outpatient surgery centers to award them exclusive services agreements by: (1) allowing physician owners of the centers to be partial owners of the companies created to provide the exclusive services; and (2) subsidizing the costs of drugs, supplies, and equipment the centers used, all in violation of the AKS.
Health system agreed to pay more than $22 million to resolve FCA allegations that it submitted claims to federal healthcare programs for medically unnecessary procedures performed by two neurosurgeons. As part of the resolution, the health system entered into a five-year CIA with HHS-OIG.
Pain management practice, its physician-founder and its former chief medical officer agreed to pay $24.5 million to resolve allegations that they violated the FCA by: (1) submitting claims for urine drug tests that were not medically necessary because they required physicians to order both initial and definitive testing at the same time; (2) compensating physicians a portion of the profits received from initial testing, violating the Stark Law; (3) submitting claims for genetic and psychological tests performed prior to physician visits with patients, without regard for medical necessity; and (4) requiring physicians to schedule evaluation and management appointments more frequently than the practice’s normal monthly appointments and bill these visits using high-level procedure codes, after the state government suspended non-emergency medical procedures due to COVID-19. Simultaneously, the practice allegedly made false statements to obtain a PPP loan from the Small Business Administration by representing it was not engaged in unlawful activity. As part of the resolution, the company, its founder, and certain affiliated entities entered into a five-year CIA with HHS-OIG.
Clinic agreed to pay $120,000 to resolve allegations that it billed the Washington State Medicaid program for birth control medications that were imported from outside the United States and not approved by the FDA.
Podiatrist agreed to pay $865,000 to resolve FCA allegations that she submitted claims to Medicare for the surgical implantation of neurostimulator electrodes when the procedures performed were actually non-surgical application of electro-acupuncture devices.
Physician agreed to pay $40,800 to resolve FCA allegations that he received consultation fees from a third-party marketing company in exchange for ordering DME and topical pain creams for patients with whom he did not have an established provider-patient relationship, often having no interaction at all with the patients.
Health system and its operating entities agreed to pay $20 million to resolve allegations that the health system made improper, non-bona fide donations to a local unit of government to improperly fund the state’s share of Medicaid payments to the health system.
Clinical laboratory agreed to pay $11.6 million to resolve FCA allegations that it billed Medicare for both presumptive and confirmatory urine drug tests which were performed at the same time, resulting in reimbursements being paid for confirmatory tests which were not medically necessary. The government also alleged that the laboratory paid sales organizations based on the volume of drug test referrals those representatives made, in violation of the AKS. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
Behavioral health practice and its owner/executive director agreed to pay $750,000 to resolve FCA allegations that they: (1) falsified the identity and qualifications of healthcare providers to receive higher reimbursement; (2) inflated the amount of time spent with patients; (3) submitted claims for patient visits that never occurred; (4) misrepresented dates of service; and (5) fabricated documents in response to the government’s investigation. As a part of the resolution, the practice and its owner entered into a three-year IA with HHS-OIG.
Physician agreed to pay $555,000 to resolve allegations that she billed federal healthcare programs for ultrasound studies that occurred on dates she was out of the country or that were not actually performed as billed.
Ambulance company agreed to pay more than $600,000 to resolve allegations that it improperly billed Medicare and Medicaid for Advanced Life Support services when the company provided Basic Life Support services and in joint response situations with local fire departments because it lacked a written billing agreement with the departments. The company also entered into a consent agreement with the state of Connecticut to cease the prohibited conduct and pay a civil penalty.
Psychiatrist and his office assistant agreed to pay $3 million to resolve FCA allegations that they billed the Department of Labor Office of Workers’ Compensation Programs (OWCP) for services that were not provided, upcoded claims, and double-billed for claims to both patients and the OWCP. The Doyles agreed to voluntarily be excluded from federal healthcare programs for 25 years.
Medical practice and the estate of its former owner agreed to pay more than $286,000 to resolve allegations that it submitted false claims to Medicare for the following services: (1) blood draws that were actually performed by a laboratory company; (2) smoking cessation counseling that was not conducted; and (3) services performed by mid-level providers at a rate that covers services incidental to those provided by a physician when no physician was present, violating Medicare's "incident to" rule. In 2019, the former owner was indicted on related criminal charges, but died later that year.
Home health provider agreed to pay $1.4 million to resolve FCA allegations that it falsely claimed to have paid its home care aides the minimum wage required under New York State law, thereby receiving Medicaid reimbursement to which it was not entitled.
Home health provider agreed to pay $4 million to resolve FCA allegations that it falsely claimed to have paid its home care aides the minimum wage required under New York State law, thereby receiving Medicaid reimbursement to which it was not entitled.
Home health provider agreed to pay, and the bankruptcy court has approved, $6.53 million to resolve FCA allegations that it billed MassHealth for services that were not appropriately certified by a physician as medically necessary. In September 2019, Compassionate and its former owner pleaded guilty to separate criminal healthcare fraud charges. In May 2020, Compassionate filed for bankruptcy. Under the settlement agreement, up to $375,000 will be prioritized for distribution to former employees for unpaid wages.
The founder and CEO of a medical practice operator agreed to pay $185,000 to resolve allegations that a laboratory testing company paid referral fees to a company associated with the owner of the practice operator in exchange for patient referrals by the practices operated by his company.
A physician agreed to pay $52,015 to resolve allegations that he received kickbacks from two management service organizations in exchange for using a specific provider for laboratory tests.
A physician agreed to pay $60,898 to resolve allegations that he received kickbacks from two management service organizations in exchange for using a specific provider for laboratory tests.
A physician agreed to pay $45,056 to resolve allegations that she received kickbacks from a management service organization in exchange for using a specific provider for laboratory tests.
A physician agreed to pay $174,539 to resolve allegations that he received kickbacks from a management service organization in exchange for using specific providers for laboratory tests.
A physician agreed to pay $211,721 to resolve allegations that he received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $211,821 to resolve allegations that he received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $175,436 to resolve allegations that he received kickbacks from two management service organizations in exchange for using specific providers for laboratory tests.
A physician agreed to pay $24,850 to resolve allegations that he received kickbacks from a management service organization in exchange for using specific providers for laboratory tests.
A physician and two of his practices agreed to pay $454,088 to resolve allegations that they received kickbacks from management service organizations in exchange for using two specific providers for laboratory tests.
A physician agreed to pay $85,006 to resolve allegations that she received kickbacks from a management service organization in exchange for using a specific provider for laboratory tests.
As a follow-up to a settlement involving parallel allegations in January 2022, 10 physicians and two of their affiliated entities agreed to pay a total of over $1.68 million to resolve allegations that they received illegal remuneration disguised as investment returns from eight MSOs in exchange for the physicians’ referrals for laboratory tests from three laboratory companies, in violation of the AKS and Stark Law. In a related settlement, the founder and CEO of a medical practice operator agreed to pay $185,000 to resolve allegations that one of those laboratory companies paid referral fees to a company associated with the founder/CEO in exchange for patient referrals by the practices operated by his company, in violation of the AKS. The physicians and CEO agreed to cooperate with ongoing investigations of and litigation against other involved parties.
Ophthalmology practice and its owners agreed to pay $192,699 to resolve allegations that they employed a practice administrator who was excluded from participation in federal healthcare programs due to a conviction for healthcare fraud. During the time of his employment, the practice received reimbursements from Medicare, Medicaid, and TRICARE, some of which were used to pay the administrator's compensation.
SNF provider agreed to pay $400,000 to resolve FCA allegations that it billed Medicare for therapy services that were not reasonable, necessary, and/or skilled. New London allegedly: (1) upcoded patients’ Resource Utilization Group scores in order to receive higher Medicare reimbursement; (2) provided the minimum number of minutes required to bill a given reimbursement level while discouraging therapy beyond those minutes; (3) ramped up therapy during reimbursement determination periods solely to receive higher Medicare reimbursement; and (4) provided therapy services to patients who did not need or could not benefit from such services.
Global medical services provider agreed to pay $930,000 to resolve allegations that it stored patients' electronic medical records at government-run facilities in Iraq and Afghanistan in unsecured locations, in violation of its contract with the State Department to provide a secure system. The company also allegedly provided supplies, including controlled substances, that were not approved by the FDA or European Medicines Agency as contractually required.
Toxicology laboratory agreed to pay more than $4.7 million to resolve FCA allegations that it billed Connecticut Medicaid for urine drug tests at higher rates than it billed other third parties, in violation of Connecticut's "Most Favored Nation" regulation.
Pharmaceutical company agreed to pay, and the bankruptcy court has approved, $260 million to resolve allegations that it: (1) underpaid drug rebates to Medicaid by calculating rebates as if its drug, Acthar, was new in 2013, when it was actually approved in 1952; and (2) used a foundation as a conduit to pay co-pay subsidies, in violation of the AKS. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
University agreed to pay nearly $900,000 to resolve a voluntary disclosure related to its behavioral health clinic submitting allegedly improper claims with respect to: (1) supervision of doctoral students; (2) "incident-to" billing requirements; (3) practitioner Medicare credentialing; and (4) evaluation & management (E&M) services that were not supported by documentation in the medical record.
Mental health practice and its owner agreed to pay $138,984 to resolve FCA allegations that they billed Medicaid for services provided by unlicensed and unqualified therapists who were not contracted with the state or eligible to obtain Medicaid reimbursements for their services and for misrepresenting that services were provided by licensed and qualified therapists.
Physician agreed to pay more than $500,000 to resolve FCA allegations that he billed Medicare for excessive ultrasounds that were medically unnecessary or unreasonable. The investigation arose out of a proactive review of claims showing the physician was a significant statistical outlier for ultrasound claims. The physician and his clinic entered into a three-year IA with HHS-OIG as part of the resolution.
Psychiatric practice and its owner agreed to pay more than $300,000 to resolve allegations that they employed a physician as the practice's clinical director after he had been excluded from participating in federal healthcare programs as a result of his conviction of conspiracy to commit healthcare fraud. During the director’s employment, the practice submitted claims to government healthcare programs in violation of HHS rules.
Diagnostic testing company agreed to pay $142,718 to resolve FCA allegations that it billed Medicare for laboratory tests conducted during inpatient hospital stays when the tests were already covered under the inpatient admission.
Naturopathic physician agreed to pay over $70,000 to resolve FCA and CSA allegations that she improperly prescribed controlled substances she was not authorized to prescribe. The physician voluntarily surrendered her DEA registration and was required to implement additional controls and procedures to prevent her conduct from recurring.
Urology practice agreed to pay $100,000 to resolve allegations that it received payments from a hospital purportedly pursuant to an agreement to administer a prostate cancer center, even though the center was never created and the practice never provided a physician to serve as the center’s director.
Orthopedic surgeon agreed to pay $342,750 to resolve allegations that he received illegal kickbacks disguised as medical director fees from a specialty pharmacy in exchange for prescribing and recommending pain creams the pharmacy compounded and produced to patients insured under the Federal Employees Compensation Act Program.
Medicare reimbursement consulting firm and its owner who provided services to a diabetic testing supplier agreed to pay $50,000 to resolve intervened FCA allegations that they caused the submission of claims to Medicare that: (1) were tainted by kickbacks to beneficiaries in the form of "no cost" glucometers or the waiver of co-payments and/or (2) related to beneficiaries ineligible to seek reimbursement for the glucometers. The settlement amount is expressly based on the defendants’ ability to pay. The diabetic testing supplier and its parent previously agreed to pay $160 million for their role in the alleged scheme in August 2021.
Hospital operator agreed to pay $5.5 million to resolve allegations that it made improper, non-bona fide donations to local units of government, including in the form of free nursing and athletic training services to a local school board, to improperly fund the state’s share of Medicaid payments to the health system.
Hospital agreed to pay $3.8 million to resolve FCA allegations that it provided free call coverage services for a cardiologist in exchange for patient referrals, in violation of the AKS.
Youth development center agreed to pay over $12.9 million to resolve allegations that it over-reported the number of visits to its facility in order to receive excessive funding from the federal and New York-funded Indigent Care Pool program that reimburses providers for healthcare services provided to low-income residents.
Pharmaceutical distributor agreed to pay more than $13 million to resolve FCA allegations that it provided upfront discounts to physician practices that were not tied to specific purchases, in violation of the AKS. As part of the resolution, the company’s subsidiary at issue entered into a five-year CIA with HHS-OIG.
Pharmacy agreed to pay more than $2 million to resolve FCA allegations that it billed Medicare and Medicaid for two prescription medications after switching beneficiaries to these medications from lower-cost options without any medical need and/or valid prescription.
Management services company and its owner agreed to pay $589,000 to resolve FCA allegations related to an arrangement with a Critical Access Hospital (CAH) whereby they charged the CAH a fixed monthly fee plus a percentage of billed charges in exchange for the recruitment and referral of intensive outpatient therapy patients, in violation of the AKS.
Addiction treatment provider agreed to pay more than $2 million to resolve FCA allegations that it: (1) performed definitive urine drug testing (UDT) on the same day as presumptive UDT without first reviewing the results of the presumptive test and assessing the individualized need for a definitive test; (2) unnecessarily tested at higher rates when testing at a lower rate associated with less reimbursement would have been sufficient; and (3) used standing orders for definitive UDT in violation of Medicaid and Medicare guidelines. As part of the resolution, the company entered into a three-year IA with HHS-OIG.
Physician group agreed to pay more than $612,000 to settle allegations that it knowingly submitted false claims for the following services performed by a plastic surgeon formerly with the group: (1) cosmetic procedures that were not reimbursable and billed as medically necessary; (2) insufficient services sufficient to support billing for certain high-value surgical procedures; and (3) high-value office visits and surgical procedures when the services provided were not sufficient to justify high-value claims.
The former CEO of a small hospital agreed to pay $50,000 to settle allegations that he worked with laboratory test companies to pay physicians for referrals to the testing companies through management service organizations. The hospital then billed commercial insurers for the referred tests, while the laboratories billed federal healthcare programs for the same tests. The former CEO will be excluded from participating in federal healthcare programs for three years.
A physician agreed to pay $166,500 to settle allegations that she received kickbacks from two management service organizations in exchange for ordering specific laboratory tests.
A physician agreed to pay $57,324 to settle allegations that he received kickbacks from a management service organization in exchange for ordering specific laboratory tests.
A physician agreed to pay $200,000 to settle allegations that he received kickbacks from a management service organization in exchange for ordering laboratory tests from a certain laboratory.
A physician agreed to pay $215,000 to settle allegations that he received kickbacks from two management service organizations in exchange for ordering laboratory tests from two specific laboratories.
A physician and his practice agreed to pay $60,000 to settle allegations that he received kickbacks from two management service organizations in exchange for ordering laboratory tests from two specific laboratories.
A physician agreed to pay $232,000 to settle allegations that he received kickbacks from two management service organizations in exchange for ordering laboratory tests from two specific laboratories.
A physician agreed to pay $125,625 to settle allegations that he received kickbacks from a laboratory in exchange for the referral of patient tests. He also received kickbacks from a management service organization which coordinated the referral of tests between physicians and laboratories.
Seven physicians and one of their professional associations agreed to pay more than $1.1 million in total to resolve allegations that they received illegal remuneration disguised as investment returns from eight MSOs in exchange for the physicians’ referrals for laboratory tests from three laboratory companies, in violation of the AKS and Stark Law. In a related settlement, the former hospital CEO agreed to pay $50,000 to settle allegations that he worked with two of those laboratory companies to pay physicians for referrals to the laboratories through MSOs. The hospital allegedly billed commercial insurers for the referred tests, while the laboratories billed federal healthcare programs for the same tests. The former CEO will be excluded from participating in federal healthcare programs for three years. The physicians and former CEO agreed to cooperate with the government’s ongoing investigations of and litigation against other involved parties. This settlement followed the government’s separate settlements with a laboratory and other providers in 2019 and 2020 for their involvement in the alleged conduct.
Physician agreed to pay $228,000 to resolve allegations that he billed Medicare and Medicaid for urine drug tests that were never performed or were performed too late to be useful. For much of the time claims were submitted, the medical equipment for testing the urine samples was broken, resulting in some samples being frozen for testing at a later date and some samples never being tested.
Various medical practices and surgery centers and one physician-owner agreed to pay more than $7.4 million to settle allegations that they billed federal healthcare programs for the use of surgically implanted neurostimulators when they actually used electro-acupuncture devices that are not implanted surgically and not eligible for reimbursement. As part of the resolution, the entities and owner entered into a three-year IA with HHS-OIG.
Medical equipment supplier and its CEO agreed to pay more than $5.5 million to resolve claims that they provided diabetic patients with shoe inserts made from generic foot models when the customers ordered custom-made inserts. The company billed Medicare and Medicaid for custom inserts or sold the products to other companies who in turn billed the government for custom inserts. As part of the settlement, the company and its CEO entered into a three-year IA with HHS-OIG.
Home health provider and its owners agreed to pay $630,000 to resolve FCA allegations that they billed MassHealth for services that were not appropriately authorized by a physician as medically necessary. The settlement also resolves allegations that Home Care VNA became aware of home health payments to which it was not entitled but failed to disclose or refund the overpayments in a timely manner.
Managed care company agreed to pay almost $8 million to resolve allegations that it violated the Arkansas Medicaid False Claims Act by improperly reporting expenses. The settlement comprised $1 million in civil penalties and costs and an adjustment to Empower’s report of expenses that increased its year end reconciliation payment to the Medicaid Fraud program by $6,983,511.
Home health provider agreed to pay $500,000 to resolve FCA allegations that it billed Medicare for individual services when: (1) group services were actually provided; and/or (2) the provider did not spend the requisite time with the patient to receive reimbursement for individual services. The agency agreed to cease operations by June 2022 as part of the settlement.
Medical equipment supplier, its owner/president, and his wife agreed to pay $600,000 to resolve FCA allegations that the owner changed item quantities in the billing software, thereby inflating the company's Medicare reimbursements. In addition, after the United States intervened and Medicare suspended payments to the company, the government alleged that the owner and his wife conspired with another company to bypass the suspension and continue to receive Medicare payments. The owner pleaded guilty to related criminal charges in 2020 and was sentenced to 15 months in prison.
An addiction treatment center chain and its owner agreed to pay $4.5 million to settle allegations that it required patients to have urine drug tests that were not always medically necessary, resulting in the submission of false claims to MassHealth. Also, the centers adopted policies requiring laboratory work to be referred to a laboratory under the same ownership as the clinics, violating self-referral laws.
A pain clinic and associated ambulatory surgery center agreed to pay more than $836,000 to resolve FCA allegations that they overbilled Medicare, Medicaid and TRICARE for more units or levels of various injections and procedures than were actually administered.
A residential behavioral treatment facility serving children agreed to pay more than $500,000 to resolve allegations that it billed the Missouri Medicaid program for therapy sessions that were not provided.
A physician agreed to pay $125,000 to resolve allegations that he prescribed controlled substances in combinations disfavored by the medical community, outside the usual course of a professional practice, and without a legitimate medical purpose, in violation of the CSA, and caused the submission of false claims to Medicare for such prescriptions. The physician also agreed to forfeit his medical license and prescribing privileges.
Home health provider agreed to pay more than $45,000 to resolve allegations that it billed the Department of Veterans Affairs (VA) for services provided to an Army veteran by an employee who was also living with the veteran and falsified time sheets related to the care. The former employee was also convicted of wire fraud and sentenced to 12 months in prison, and ordered to pay over $90,000 in restitution related to the conduct.
A vascular surgeon and his practice agreed to pay more than $3.7 million to resolve allegations that he and his staff utilized improper techniques in performing and analyzing ultrasounds and used false ultrasound findings to conduct and bill for medically unnecessary and unreasonable services. The surgeon and the practice entered into a three-year IA with HHSOIG as part of the resolution.
A physician and his practice agreed to pay $375,000 to settle allegations that he billed Medicare for the surgical implantation of neurostimulator devices when the devices actually used were acupuncture devices that do not require surgery.
A pharmacy chain agreed to pay over $512,000 to settle allegations that it provided discounts on retail products to health care professionals who wrote prescriptions that were filled at locations in Puerto Rico. This violation was self-disclosed.
Two specialty pharmacies and their pharmacist owner agreed to pay $1 million to resolve FCA allegations that they submitted prior authorization requests to Medicare for a drug used to reverse the effects of opioid overdose that were not reviewed or signed by prescribing physicians. The settlement also resolves allegations that the pharmacies filled prescriptions for the drug without collecting or attempting to collect co-payments from Medicare beneficiaries, in violation of the AKS.
Medical device manufacturer agreed to pay $1.2 million to settle FCA allegations that it paid kickbacks to the CEO and medical director of an ENT practice to induce the practice's physicians to use the medical device company’s products and to increase the number of sinus surgeries requiring the company’s products. The CEO/medical director entered into a separate settlement regarding these allegations.
The founder, former CEO and medical director of an ENT practice agreed to pay $3 million to settle allegations that, in exchange for kickback payments from a medical device company, he directed the practice's physicians to use the medical device company’s products and to increase the number of sinus surgeries requiring the company’s products. The medical device company entered into a separate settlement regarding these allegations. This settlement also resolved allegations that the former CEO directed the practice’s physicians to order toxicology and genetic tests from a now-defunct laboratory, regardless of medical necessity, in exchange for the laboratory paying “commissions” to the clinic equaling 50% of the revenue from these tests.
Pathology practice agreed to pay $2.4 million to resolve FCA allegations that it billed Medicare for procedures that require written analysis by a pathologist when the corresponding medical records did not contain the required written substantiation. As part of the resolution, the practice entered into a three-year IA with HHS-OIG.
Hospital agreed to pay $18.2 million to resolve FCA allegations that it repurchased shares from physician-owners and resold the shares to younger physicians. In determining which physicians purchased the shares and how many each would be able to purchase, the hospital allegedly considered the value and volume of referrals generated by the physicians, in violation of the AKS and Stark Law.
A medical sales representative agreed to pay $100,000 to resolve allegations that he sold electro-acupuncture devices to providers, knowing that they would bill Medicare for procedures involving surgical implantation of devices instead of the non-surgical use of the electro-acupuncture devices.
Medical practice agreed to pay $500,000 to resolve FCA allegations that it billed Medicare and Medicaid for medically unnecessary cardiac catheterization procedures performed by one of its formerly employed physicians. The hospital where the physician performed the procedures entered into a separate settlement regarding these allegations.
The founder of a nonprofit organization that provides services to developmentally disabled individuals, including Medicaid beneficiaries, agreed to pay $220,000 to resolve allegations that his organization submitted cost reports to the state that claimed as allowable expenses millions of dollars that was not spent on providing care to disabled individuals, but instead spent on for-profit companies owned by them, on salaries for his family members and on his personal expenses. The founder agreed to never work for or accept payments from any entity that receives reimbursement from federal healthcare programs and entered into a 15-year voluntary exclusion agreement with HHS-OIG.
Hospice chain agreed to pay $5.5 million to resolve FCA allegations that it billed Medicare for hospice services provided to patients with Alzheimer’s or dementia who were not terminally ill.
Home health agency and its affiliated entities agreed to pay $4.2 million to resolve FCA allegations that they improperly billed Medicare and Medicaid for home health services that were not eligible for reimbursement because, among other things, they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services. The settlement also resolves allegations that PruittHealth became aware of payments for home health services to which it was not entitled, but failed to disclose or refund the overpayments in a timely manner.
A physician agreed to pay $110,000 to resolve allegations that he prescribed opioids and other controlled substances without a legitimate medical purpose and outside the course of professional practice, in violation of the CSA, and caused the submission of false claims for such prescriptions. As part of the settlement, the physician agreed to certain restrictions on his ability to see new patients for whom opioids were already prescribed.
A pharmacist who was former owner of a pharmacy agreed to pay $275,000 to resolve allegations that he and his pharmacy filled prescriptions for controlled substances despite red flags indicating that the prescriptions were not medically necessary – specifically, they were prescribed by a doctor recently convicted for healthcare fraud and unlawfully dispensing controlled substances.
An anesthesiologist and pain management physician agreed to pay more than $520,000 to resolve allegations that he: (1) billed for surgical procedures involving the implantation of neurostimulator electrodes when in fact the procedures involved the non-surgical application of electro-acupuncture devices, and (2) made false statements when applying for a loan from the Paycheck Protection Program. The physician also agreed to be excluded from federal healthcare programs for seven years.
Several outpatient surgery centers, their physician-owners, an administrator and three anesthesia providers agreed to pay more than $28 million to resolve FCA allegations that they billed for services tainted by kickbacks, in violation of the AKS. The anesthesia providers allegedly made payments for drugs, supplies, equipment and labor, and provided free staffing for a number of the surgery centers to induce the surgery centers to name them the exclusive anesthesia providers for the centers.
Pharmaceutical manufacturer of an injectable drug indicated for use to reverse opioid overdose agreed to pay $12.7 million to resolve FCA allegations that it paid kickbacks to increase prescriptions for its drug, Evzio, through a scheme whereby kaléo: (1) directed prescribing physicians to certain preferred pharmacies that falsified prior authorization paperwork to obtain the prescription drug; (2) waived co-pays for government beneficiaries; and (3) provided illegal remuneration to prescribing physicians and their office staff to induce and reward prescriptions.
Medical device manufacturer agreed to pay $16 million to resolve FCA allegations that it paid kickbacks to a surgeon in the form of sham royalty payments for the surgeon’s contributions to its SutureBridge and SpeedBridge products when the payments were in fact intended to induce the surgeon’s use and recommendation of the products. As part of the resolution, the company entered a five-year CIA with HHS-OIG.
Psychiatric hospital and its owner agreed to pay $425,000 to resolve FCA allegations that they billed Medicare and Ohio Medicaid for diagnostic testing that was: (1) performed during patients’ inpatient stays at the hospital and thus ineligible for separate reimbursement; (2) not used in the management of patients’ conditions; and (3) not medically necessary.
Home health agency, affiliated physical therapy provider and their owner agreed to pay $450,000 to resolve FCA allegations that they submitted fraudulent claims to Medicare for: (1) therapy services that were not actually provided; (2) services provided by an employee who was actually on maternity leave at the time; (3) services provided to homebound beneficiaries by an unqualified social worker; and (4) claims for which they altered the dates of physician signatures on certifications of beneficiary eligibility for home health services. In September 2021, the former office manager of the physical therapy provider entity, Daniel R. McGoran, agreed to pay more than $75,000 to resolve allegations related to his role in the alleged scheme.
Health system agreed to pay more than $18.5 million to resolve self-disclosed FCA allegations that it submitted claims to Medicare for home health and hospice services that violated rules and regulations regarding certification of terminal illness, patient election of hospice care and physician face-to-face encounters with home health patients.
An infectious disease clinic agreed to pay $325,000 to resolve FCA allegations that it billed Medicare for infusion services that were provided by unlicensed or unapproved individuals.
Physical therapy provider agreed to pay $4 million to resolve FCA allegations that it improperly billed federal healthcare programs for one-on-one outpatient therapy sessions that were not provided.
Pediatric clinic chain and its owner agreed to pay more than $700,000 to resolve FCA allegations that they submitted claims to Medicaid for medically unnecessary testing and treatments as well as claims that relied on falsified diagnosis codes to justify unnecessary and otherwise non-reimbursable office visits.
Pharmacy chain, its owners and related entities agreed to pay $4.6 million to resolve FCA allegations that they billed TRICARE for: (1) prescription drugs at higher than their U&C price to other patients; (2) medically unnecessary compound creams; and (3) claims tainted by kickbacks in the form of waived beneficiary co-pays and payments to marketers for arranging for doctors to send prescriptions to Curant. The settlement also resolves allegations that Curant failed to return overpayments to TRICARE after learning about them.
A pain management physician who was former co-owner of a pain clinic agreed to pay $1.8 million to resolve allegations that he and his clinic ordered urine drug tests conducted at the clinic’s in-house laboratory that were not medically necessary. The other co-owner of the now-defunct clinic also reached a settlement in the case.
A pain management physician who was former co-owner of a pain clinic agreed to pay $2.1 million to resolve allegations that he and his clinic ordered urine drug tests conducted at the clinic’s in-house laboratory that were not medically necessary. The other co-owner of the now-defunct clinic also reached a settlement in the case.
Clinical laboratory and two of its owners and co-founders agreed to pay no less than $11.6 million, with future contingent payments up to $16 million based on specific criteria, to resolve FCA allegations that they billed federal healthcare payors for medically unnecessary urine drug tests by performing both presumptive and confirmatory urine drug tests on the same sample simultaneously. As part of the resolution, the laboratory and the owners entered into a five-year CIA with HHS-OIG. A pain management practice entered into a separate settlement related to these allegations.
Physician-owned primary and urgent care practice agreed to pay $1.25 million to resolve FCA allegations that its clinics billed federal healthcare programs for medically unnecessary services and falsified medical records to support the claims. The settlement also resolves allegations that the practice created a protocol that resulted in the systematic billing of medically unnecessary kidney dysfunction tests by adding the test to a panel run on most of its patients.
The former CEO of a now-defunct medical testing laboratory agreed to pay $1.1 million to resolve kickback allegations that the lab received payments from at least two other laboratories in exchange for the referrals of testing for beneficiaries of government healthcare programs which his lab was not eligible to conduct. The laboratories paying for the referrals previously reached settlements in the matter, and the CEO pleaded guilty to related criminal charges.
Private equity owner of a mental health clinic operator agreed to pay $19.95 million, and two former executives of the clinic operator agreed to pay $5.05 million, to resolve FCA allegations that they: (1) knew the clinic operator employed individuals who were unlicensed or unqualified to perform the services they were providing, or who provided services in unsupervised settings, in violation of state Medicaid regulations; and (2) caused false claims to be submitted to the Massachusetts Medicaid agency by failing to adopt recommendations to bring the operator into compliance. The mental health services operator entered into a prior settlement relating to the allegations.
An internal medicine physician agreed to pay $640,000 to resolve allegations that he received fees as a medical director of a former home health agency that were above FMV and based on his referral of patients to the agency, in violation of the AKS.
Two home health service providers agreed to pay $8.5 million to resolve FCA allegations that they submitted claims to Medicare for medically unnecessary or unreasonable laboratory and diagnostic testing services.
A pharmacy and a pharmacy technician agreed to pay more than $1.5 million to resolve FCA and CSA allegations that they repeatedly dispensed controlled substances despite “red flags” for diversion and dispensed the oral fentanyl spray Subsys to patients who were not medically qualified to receive the drug. As part of the resolution, Irina Shlafshteyn surrendered her Missouri pharmacy technician license, is permanently enjoined from dispensing controlled substances or being employed by any establishment that does so and is excluded from participating in federal healthcare programs for 10 years. Olive Street terminated its enrollment in the Transmucosal Immediate Release Fentanyl Risk Evaluation and Mitigation Strategy Program (TIRF REMS) and is permanently enjoined from seeking re-enrollment. Olive Street also entered into a three-year CIA with HHS-OIG.
A Certified Registered Nurse Practitioner agreed to pay $21,000 to resolve allegations that she received a per-patient consulting fee from a marketing company in exchange for ordering DME for patients with whom she did not have an existing relationship and without any physical examination of the patients.
Pharmaceutical manufacturer agreed to pay $49 million to resolve FCA allegations related to price fixing for certain generic drugs. The government alleged that Apotex and two other pharmaceutical manufacturers, Taro and Sandoz, paid and received compensation prohibited by the AKS in connection with agreements on price, supply and allocation of customers for certain generic drugs, resulting in higher drug prices for federal healthcare programs and beneficiaries. As part of the resolution, the company entered into a five-year CIA with HHS-OIG. Apotex entered into a deferred prosecution agreement with DOJ’s Antitrust division in 2020 for related criminal charges and paid a $24.1 million criminal penalty.
Pharmaceutical manufacturer agreed to pay $185 million to resolve FCA allegations related to price fixing for certain generic drugs. The government alleged that Sandoz and two other pharmaceutical manufacturers, Taro and Apotex, paid and received compensation prohibited by the AKS in connection with agreements on price, supply and allocation of customers for certain generic drugs, resulting in higher drug prices for federal healthcare programs and beneficiaries. As part of the resolution, the company entered into a five-year CIA with HHS-OIG. Sandoz entered into a deferred prosecution agreement with DOJ’s Antitrust division in 2020 for related criminal charges and paid an additional $195 million criminal penalty.
Pharmaceutical manufacturer agreed to pay more than $213 million to resolve FCA allegations related to price fixing for certain generic drugs. The government alleged that Taro and two other pharmaceutical manufacturers, Sandoz and Apotex, paid and received compensation prohibited by the AKS in connection with agreements on price, supply and allocation of customers for certain generic drugs, resulting in higher drug prices for federal healthcare programs and beneficiaries. As part of the resolution, the company entered into a five-year CIA with HHS-OIG. Taro entered into a deferred prosecution agreement with DOJ’s Antitrust division in 2020 for related criminal charges and paid a $205.6 million criminal penalty.
A physician agreed to pay $2 million to resolve allegations that he prescribed controlled substances without a valid medical purpose, in violation of the CSA, and many of these prescriptions were paid for by Medicaid and Medicare, resulting in FCA violations. The physician also pleaded guilty to related criminal charges and will be excluded from participating in Medicare for at least 10 years.
Two pain clinics, their owners and a former employee agreed to pay $163,400 to resolve FCA allegations that they improperly billed Medicare for a procedure involving electro-acupuncture devices using a code that indicated the devices were surgically implanted when in fact they were not. The clinics and their owners entered into a three-year IA with HHS-OIG as part of the resolution.
Mental health services provider and its CEO agreed to pay $700,000 to resolve state and federal FCA allegations that they billed Virginia Medicaid for: (1) services that they did not provide; (2) services that were provided by unlicensed individuals; and (3) services provided without the requisite initial assessment completed by a licensed counselor.
Genetics testing laboratory agreed to pay no less than $35,000 and a percentage of its future gross annual revenues up to $200,000 to resolve FCA allegations that it paid kickbacks to a now-defunct counseling group to induce genetic testing referrals. Specifically, the government alleged that the lab paid the salary of an individual who primarily worked for the counseling group. The counseling group’s owner was sentenced to three years of probation and ordered to pay restitution after pleading guilty to related healthcare fraud and drug offenses in February 2020.
A cardiologist agreed to pay $6.75 million to resolve allegations that he billed for medically unnecessary ablations and vein stent procedures, often performed by technicians who were not qualified to administer the procedures, and, to justify the treatments, the cardiologist made misrepresentations in medical records. The physician and his practice concurrently entered into a three-year IA with HHS-OIG as part of the resolution.
Home health company operator agreed to pay $17 million to resolve FCA allegations that it purchased two home health agencies to obtain referrals of Medicare beneficiaries from other retirement communities operated by the seller of the home health agencies, in violation of the AKS.
Therapy clinic operator and its parent company agreed to pay more than $390,000 to resolve FCA allegations that two of its facilities licensed to provide Community Support Programs submitted claims to Wisconsin Medicaid for services provided by unqualified individuals, group services that were billed as if they were individual services, and non-face-to-face services that were not eligible for payment.
Health system and affiliated entities agreed to pay $90 million to resolve FCA allegations that they submitted unsupported diagnosis codes for Medicare Advantage Plan beneficiaries to receive inflated reimbursements for beneficiaries. As part of the settlement, Sutter Health, Sutter Bay Medical Foundation and Sutter Valley Medical Foundation entered into a five-yearCIA with HHS-OIG.
Hospital agreed to pay more than $3.3 million to resolve FCA allegations that it improperly appended billing modifiers to claims, resulting in double billing for certain aspects of bundled payments.
A home care company and its owner agreed to pay $2.9 million to settle claims that the company billed Oregon Medicaid for home care services that were not actually provided after changing scheduling calendars to make it appear that the care was provided.
Home health provider and its owner agreed to pay $2.9 million to resolve state and federal FCA allegations that they billed Oregon Medicaid for in-home care that was not actually provided. The company also pleaded guilty to two counts of making a false claim for healthcare payment. As part of the resolution, AHCG and its owner were excluded from participating in Medicare, Medicaid and all other federal healthcare programs for 15 and 8 years, respectively.
Community-based behavioral health provider agreed to two consent judgments totaling over $15 million to resolve FCA and CSA allegations. The provider agreed to pay more than $13.758 million to resolve FCA allegations that it billed Medicare for upcoded mental health services and other ineligible claims. The provider also agreed to pay more than $1.62 million to resolve CSA allegations that it did not keep proper records of its use of controlled substances and transferred controlled substances between locations without proper documentation.
A chiropractor agreed to pay more than $290,000 to resolve allegations that he billed the U.S. Department of Labor's Office of Workers’ Compensation Programs for extended medical examination services provided to a federal employee receiving Federal Employees Compensation Act benefits, when the services were not actually provided at the level billed.
Psychotherapy services provider and its CEO agreed to pay $2 million to resolve FCA allegations that they billed Medicare and Medicaid for psychotherapy services provided at nursing homes and SNFs that were medically unnecessary, improperly documented or upcoded to reflect services performed at higher intensity levels than justified.
DME and home respiratory services provider agreed to pay more than $3.3 million to resolve FCA allegations that it billed Medicare and Medicaid for non-invasive ventilator services that were not medically necessary or reasonable.
Pain management practice agreed to pay $1 million to resolve allegations that it billed Medicare for medically unnecessary confirmatory urine drug tests despite failing to first receive the results from presumptive urine drug tests.
Hospital agreed to pay approximately $2.82 million to resolve self-disclosed FCA allegations that it submitted claims to Medicare and Medicaid for medically unnecessary cardiac catheterizations. Physician group that formerly employed the physician who performed the procedures entered into a separate settlement regarding these allegations.
SNF agreed to pay $360,000 to resolve FCA allegations that it: (1) upcoded patients’ Resource Utilization Group (RUG) scores to receive higher Medicare reimbursement; (2) billed for therapy services provided to patients who did not need or could not benefit from such services; and (3) billed for services not provided or that were provided without a physician order.
Physician-owned medical group agreed to pay $200,000 to resolve FCA allegations that it billed Medicare for medically unnecessary advanced care planning and tobacco cessation counseling, including cessation services provided to patients who did not use tobacco.
Community healthcare center agreed to pay $350,000 to resolve FCA allegations that it improperly billed Connecticut Medicaid for certain dental services. Specifically, the government alleged CSH instituted a policy requiring patients to receive dental cleanings and dental exams on separate days so that the center could bill Connecticut Medicaid for two encounters.
Optometry practice and optician owner agreed to pay more than $678,000 to resolve FCA allegations that they billed Connecticut Medicaid using a code covering miscellaneous services each time they submitted a claim for eyeglasses, despite no miscellaneous services being provided. The settlement also resolves allegations that the practice encouraged Medicaid beneficiaries to select extra pairs of eyeglasses then submitted claims for multiple pairs of eyeglasses that were not medically necessary. The practice and optician entered into a three-year IA with HHS-OIG as part of the resolution.
Owners of a now-defunct compounding pharmacy agreed to pay more than $1 million to resolve FCA allegations that they submitted claims to TRICARE tainted by payments to physicians and marketers intended to induce referrals and compounded drug prescriptions. The settlement also resolves allegations that the owners misrepresented their joint ownership of the pharmacy to conceal the fact that David Tsui was excluded from participating in federal healthcare programs.
Medical center and county agreed to pay $11.4 million to resolve FCA allegations that they billed Medicare for inpatient admissions that were not reasonable or necessary, including patients admitted for social reasons and lack of available alternative placements. As a part of the settlement, the medical center and county entered into a five-year CIA with HHS-OIG.
Physician management services organization and an affiliate physician group agreed to pay $5.1 million to resolve FCA and AKS allegations that NSPC and PMA employees solicited and received kickbacks in the guise of clinical research payments from a defunct genetic testing company in exchange for referrals. Nine individuals face pending criminal charges in connection with the alleged scheme.
Pharmacy chain owner, his consulting company, affiliated pharmacies and an employed pharmacist, Mark Zulewski, agreed to pay $250,000 to resolve FCA allegations that Kaushal Patel hired Zulewski to work in his pharmacies with knowledge Zulewski had been convicted of a felony controlled substance offense and was excluded from participating in federal healthcare programs as a result. The government also alleged that despite this knowledge, Zulewski was granted broad administrative authority, including filling prescriptions as needed when pharmacists-in-charge at certain pharmacies were unavailable.
Hospital system and four of its hospitals agreed to pay $2.8 million to resolve FCA allegations that they submitted claims and retained overpayments related to a gynecologist’s services that were not medically necessary, not performed as represented or were never performed. The settlement resolved Ascension’s self-disclosure related to improper billing and additional qui tam allegations.
The former CEO of a pain management company agreed, in resolving civil FCA allegations, to be permanently excluded from participation in federal healthcare programs or employment in any industry in which he might play a direct or indirect role in causing claims to be submitted to federal healthcare programs. He was previously convicted on criminal charges related to the matter but had his sentence commuted. The pain management company, its four majority owners and a former executive entered into a separate settlement related to these allegations.
Mail-order diabetic testing supplier and its parent agreed to pay $160 million to resolve intervened FCA allegations that they made or caused false claims to be submitted to Medicare that were: (1) tainted by kickbacks to Medicare beneficiaries in the form of free glucometers or waived co-pays; (2) false because the patient was not eligible to receive a new glucometer; or (3) false because the patient was deceased. Arriva’s two founders previously paid $1 million to resolve allegations that they participated in the scheme.
Nonprofit clinic and its CEO agreed to pay $130,000 to resolve FCA allegations that they caused the submission of medically unnecessary Schedule II drugs that were prescribed by a former physician, Dr. Smith, without appropriate medical review and judgment. The government alleged that physician assistants – and not Dr. Smith – saw most of the patients at NGHC and Dr. Smith routinely signed prescriptions, including for Schedule II drugs, for patients he had neither seen nor evaluated. As part of the resolution, Dr. Smith consented to a voluntary exclusion from federal healthcare programs for 10 years.
Nonprofit integrated healthcare services company agreed to pay $1 million to resolve FCA allegations that it submitted claims to Medicaid for services that were billed without proper or complete documentation, billed more than once, or otherwise improperly billed, and that it failed to return overpayments.
Rehabilitation therapy provider agreed to pay $2 million to resolve FCA allegations that it submitted or caused the submission of false claims to Medicare for medically unnecessary or unreasonable therapy services provided at 11 SNFs. The SNF operator and 27 other affiliated SNFs previously agreed to pay $16.7 million to resolve allegations related to their role in the alleged conduct in July 2020.
Clinical laboratory agreed to pay more than $1.25 million to resolve self-disclosed FCA allegations that it improperly billed federal healthcare programs for claims that misrepresented the number of drug classes tested or lacked the required supporting physician documentation, and for specimen validity testing, despite Medicare guidelines stating that such testing should not be billed separately.
Hospital agreed to pay more than $560,000 to resolve allegations related to an employed physician’s billing practices. After the hospital self-disclosed concerns, the government concluded that the hospital billed federal healthcare programs for services the physician did not provide or properly supervise.
Ambulatory electroencephalography (EEG) testing company and private investment company agreed to pay more than $15 million to resolve FCA allegations that Alliance: (1) paid kickbacks to referring physicians in the form of free EEG test-interpretation reports, thereby enabling primary care physicians who were not neurologists to bill the government as if they had interpreted the tests; (2) used an inaccurate billing code for certain EEG testing to generate higher reimbursements; and (3) billed for a specialized digital analysis that it did not actually perform. The settlement also resolves allegations that Ancor Holdings caused false claims because it learned of the kickback scheme during diligence, but allowed the conduct to continue once it entered into a management agreement with Alliance. As part of the resolution, Alliance entered into a five-year CIA with HHS-OIG.
A now-defunct medical practice and its rheumatologist owner agreed to pay more than $2 million to resolve FCA allegations that they billed federal healthcare programs for medically unnecessary or improper MRI scans, rheumatoid arthritis treatments and other upcoded patient visits.
Hospital system, its physician CEO and a physician agreed to pay $37.5 million to resolve federal and state FCA allegations that: (1) Prime paid above FMV to purchase the physician’s practice to induce referrals to the hospital, then compensated the physician through an employment agreement that was improperly based on the volume and value of his referrals, in violation of the AKS; (2) a hospital and the physician used the physician’s billing number to submit claims to Medicare and Medi-Cal for services that were actually provided by a physician whose billing privileges they knew had been revoked; and (3) hospitals submitted inflated invoices for implantable medical hardware to Medi-Cal and other government payors. The settlement resolves allegations raised in two qui tam lawsuits in which the government declined to intervene. Prime agreed to pay $33.725 million, with the CEO and physician agreeing to pay $1.775 million and $2 million, respectively. As part of the settlement, Prime and its CEO entered into a five-year CIA with HHS-OIG.
A neurologist and his practice agreed to pay $800,000 to resolve allegations that the neurologist issued prescriptions for an expensive drug (Acthar Gel®) which was not medically necessary or reasonable.
Diagnostic laboratory agreed to pay $1.4 million to resolve FCA allegations that it billed Medicare for genetic tests that were performed without valid physician oversight. A contractor involved in the allegations previously pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to 50 months in prison in May 2019.
Two medical device manufacturers agreed to pay $38.75 million to resolve FCA allegations that they knowingly billed Medicare for defective point-of-care blood coagulation testing devices.
Medical device distributor agreed to pay more than $22 million under a deferred prosecution agreement (DPA) to resolve a criminal healthcare fraud charge related to misbranding surgical gowns. As part of the DPA, Avanos admitted that between 2014 and 2015, it falsely marketed its MicroCool gowns as meeting the standards for the highest protection level for surgical gowns and thus eligible for use in surgeries and other high-risk procedures involving patients suspected of having infectious diseases.
St. Jude Medical, Inc. agreed to pay $27 million to resolve FCA allegations that it caused the submission of false claims by knowingly selling defective heart devices to healthcare facilities that, in turn, implanted the devices into patients insured by federal healthcare programs.
Hospital system agreed to pay $21.25 million to resolve FCA allegations that it compensated physicians in excess of FMV in exchange for the referrals of patients, in violation of the AKS | and Stark Law. Cleveland Clinic Foundation, which acquired the hospital system in 2015, self-disclosed the physician compensation arrangements and received cooperation credit in the settlement. The settlement also resolves related allegations made by a former director of internal audit in a qui tam action.
Former parent company of a SNF chain and its successor-in-interest agreed to pay $8.4 million to resolve FCA allegations that the chain’s corporate policies and practices resulted in the submission of false claims to Medicare for rehabilitation therapy services that were not medically necessary, reasonable or skilled.
Substance abuse and mental health services provider agreed to pay more than $170,000 to resolve self-disclosed FCA allegations that it submitted claims to federal healthcare programs for services provided by an employee who was excluded from participating in federal healthcare programs.
SNF and its parent company agreed to pay more than $450,000 to resolve FCA allegations that an employee falsified and submitted claims to Medicare for services not provided. The government further alleged that when the SNF’s management became aware of the issue, it did not conduct an adequate investigation or submit a refund for the full amount management knew had been overbilled, or otherwise disclose the misconduct to the government.
Outpatient surgery center and its affiliate agreed to pay $3.4 million to resolve FCA allegations that they submitted claims to Medicare and TRICARE for medically unnecessary lithotripsy procedures. The settlement also resolves allegations that the surgery center paid a urologist who performed the procedures at the center per-procedure payments to induce the urologist to perform such procedures at the center, in violation of the AKS.
Company that subcontracts with physicians to provide services to prison inmates agreed to pay more than $690,000 to resolve FCA allegations that it billed the Federal Bureau of Prisons for higher-level services than were actually provided.
Behavioral health and addiction medicine practice and its two owners agreed to pay more than $1 million to resolve FCA allegations that they submitted claims to Medicare and Medicaid for medically unnecessary urine drug tests.
ENT group agreed to pay $750,000 to resolve FCA allegations that they billed federal healthcare programs for more expensive E&M services than were actually provided.
Two medical practices and a doctor agreed to pay $330,000 to resolve FCA allegations that they billed Medicare and Medicaid for nerve conduction studies and arterial studies that were: (1) not medically necessary; (2) not supported by patient records; (3) not eligible for reimbursement.
Chiropractic practice and two chiropractors agreed to pay $143,486 to resolve FCA allegations that they billed federal healthcare programs for surgical procedures to implant neurostimulator electrodes when the procedures performed were actually the non-surgical application of a device.
Chiropractic practice, chiropractor and his affiliate agreed to pay $662,492 to resolve FCA allegations that they billed federal healthcare programs for surgical procedures involving the implantation of neurostimulator devices when in fact the procedures involved the non-surgical application of electro-acupuncture devices in an office setting.
A former physician agreed to pay at least $21,000 to resolve allegations that he issued prescriptions for controlled substances after his medical license expired, in violation of the CSA, and caused the submission of claims for such prescriptions to Medicare in violation of the FCA. The physician agreed to never practice medicine again or seek a medical license in any state and to not seek reinstatement of his DEA controlled substances registration.
Urgent care center, a physician and affiliated entities agreed to pay $650,000 to resolve allegations that they submitted claims to Medicare and Medicaid for more complex urine drug testing than they actually performed.
A pain physician and anesthesiologist agreed to pay more than $340,000 to resolve allegations that he billed Medicare for the surgical implantation of neurostimulator devices when the patients received acupuncture devices that were not surgically implanted.
A pain physician agreed to pay more than $183,000 to resolve allegations that his practice billed Medicare for surgical procedures involving the implantation of neurostimulators when in fact the devices were electro-acupuncture devices that were not implanted and did not require surgery.
A medical group agreed to pay more than $338,000 to resolve self-disclosed FCA allegations that it billed Medicare for surgical procedures involving the implantation of an electro-acupuncture device when in fact the devices were not implanted and no surgery was performed.
A podiatrist agreed to pay $535,000 to resolve FCA allegations that he billed Medicare for surgical procedures involving the implantation of neurostimulators when in fact the devices were not implanted and did not require surgery.
Chiropractic clinic and its chiropractor owner agreed to pay $2.6 million to resolve allegations that they billed Medicare and TRICARE for surgical procedures involving the implantation of neurostimulator devices when in fact the procedures involved the non-surgical application of electro-acupuncture devices in an office setting. As part of the resolution, the clinics and chiropractor owner are excluded from participation in federal healthcare programs for 10 years.
A pain management practice and its physician owner agreed to pay $500,000 to resolve FCA allegations that they billed Medicare and Medicaid for medically unnecessary diagnostic nerve conduction tests that were often performed by unqualified staff, despite coverage rules requiring a physician perform the tests. The practice and physician owner entered into a three-year IA with HHS-OIG as part of the resolution.
Health system that operates dental clinics agreed to pay $2.7 million to resolve federal and state FCA allegations that it submitted claims to Medicaid for dental services performed using hand pieces that had not been properly sterilized.
SNF operator agreed to pay $11.2 million to resolve FCA allegations that its corporate-wide policies and practices caused facilities to submit claims for medically unreasonable, unnecessary or unskilled rehabilitation therapy services. As part of the resolution, the company entered into a chain-wide five-year CIA with HHS-OIG.
French medical device manufacturer and its U.S. affiliate agreed to pay $1 million to resolve FCA allegations that they violated the AKS by providing entertainment and travel expenses to U.S. doctors in connection with a scoliosis conference in France to induce the physicians to purchase or order its spinal devices. The companies agreed to pay an additional $1 million to resolve allegations that the manufacturer violated CMS’s Open Payments Program by not reporting the entertainment expenses to CMS.
Two dentists, their dental management companies, and certain affiliated pediatric dental practices agreed to pay $3.1 million to resolve allegations that they billed the Texas Medicaid for fillings in children that were not actually performed. The settlement also resolves allegations that they submitted or caused the submission of claims using erroneous Medicaid provider numbers misrepresenting the dentists who performed pediatric procedures.
Long-term care pharmacy operator agreed to pay $2.75 million to resolve FCA and CSA allegations that it billed Medicare for fraudulently requested emergency refills of Schedule II controlled substances when the refills were not emergencies and no written prescriptions were ever obtained and also submitted claims to Medicare Part D after the same claims had already been reimbursed through claims paid to the long-term care facilities under Medicare Part A.
SNF operator agreed to pay $214,200 to resolve allegations that the United States was entitled to restitution for the federal share of Medicaid funds that an affiliated facility received for a 10 week period that residents were suffering from or testing positive for COVID-19. The United States alleged that repayment of these funds was warranted due to the facility’s practices surrounding COVID-19 infections, including the facility’s procedures and criteria for screening symptomatic employees.
A university agreed to pay $22 million to settle FCA allegations that it: (1) improperly billed at certain hospital facilities that were converted from physician offices because it failed to provide proper notice to Beneficiaries of the conversion, even after a Medicare Administrative | Contractor informed the university that its notice practices were deficient; (2) billed for laboratory tests that were not medically necessary; and (3) caused a hospital to submit inflated claims for laboratory testing performed at a related institute in violation of related party regulations, by controlling the hospital’s decision to purchase the tests at inflated rates in exchange for the university’s surgeons continuing to perform surgeries at the hospital. The hospital reached a separate settlement related to these last allegations.
Health system and affiliated physician practice agreed to pay $10 million to resolve allegations that they submitted claims to Medicare for concurrent and overlapping surgeries in violation of regulations and reimbursement policies. As part of the settlement, the physician practice entered into a five-year CIA with HHS-OIG.
Home health provider and its owners agreed to pay more than $300,000 to resolve allegations that they submitted claims to the Missouri Medicaid program that billed for more hours than were actually spent providing care to beneficiaries and that they intentionally altered timesheets and other records. As part of the resolution, the company agreed to submit a corrective action plan and be subject to a one-year provider enrollment agreement.
Pharmaceutical manufacturer agreed to pay $12.6 million to resolve FCA allegations that it channeled money through a foundation to pay co-pays for its myelofibrosis drug to induce Medicare and TRICARE beneficiaries to purchase it, in violation of the AKS. The government also alleged that as the sole donor to the fund, Incyte used its influence to pressure the foundation to pay the co-pays of government beneficiaries taking its drug that did not have myelofibrosis, and thus were not eligible for assistance from the fund.
Two medical device distributorships and their neurosurgeon owner agreed to pay more than $4.4 million to resolve FCA allegations relating to alleged violations of the AKS and medically unnecessary surgeries. The government alleged three separate kickback schemes led to tainted claims and claims for medically unnecessary surgeries in which: (1) the two distributorships paid Dr. Asfora profit distributions in exchange for his use of their own devices; (2) Medical Designs split profits with Dr. Asfora when he used certain devices for which it acted as a distributor; and (3) Dr. Asfora received kickbacks in the form of meals and alcohol paid through a restaurant he owned from another device company in exchange for the use of its devices. Each distributorship will also pay $100,000 to resolve allegations that it violated the Open Payments Program by not reporting payments to Dr. Asfora, and all three parties are excluded from participation in federal healthcare programs for six years.
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A pharmaceutical distributor agreed to pay $300 million in civil settlements with DOJ and several states to resolve allegations that it marketed its opioid addiction treatment drug to physicians who were prescribing it incorrectly, promoted the drug using false claims about it, and attempted to delay the entry of generic competitors in order to control pricing. A separate settlement was reached with the FTC resolving unfair competition claims, and criminal claims have also been resolved.
An EHR software developer agreed to pay more than $3.8 million to resolve allegations that it provided its current customers with cash equivalent credits, cash bonuses and percentage success payments in exchange for recommending its product to potential customers and agreeing in writing to not provide negative information about the company’s products, in violation of the AKS. The government alleged the company violated the FCA because the kickback payments rendered false the company’s claims for federal EHR incentive payments.
Internal medicine practice and its physician operator agreed to pay $300,000 to resolve FCA allegations that they billed Medicare and Medicaid for medically unnecessary Autonomic Nervous System testing. As part of the resolution, the parties entered into a three-year IA with HHS-OIG.
The former corporate owner of a nursing home and its owners and officers agreed to pay $110,000 to settle allegations that the nursing home did not have staff that were appropriately trained to care for certain residents, did not have proper equipment to meet some medical needs of residents, and did not prevent pressure ulcers from forming on residents.
A now-defunct pain clinic operator, its four majority owners and a former executive agreed to pay more than $4.1 million to resolve intervened FCA allegations that CPS’s pain clinics submitted claims to federal healthcare programs for medically unnecessary and/or non-reimbursable testing and electro-auricular acupuncture.
Provider of services related to eye, ear, nose and throat issues agreed to pay $2.678 million to resolve FCA allegations that it improperly billed Medicare and MassHealth for procedures that were not separately billable from the office visits at which they were performed.
A physician and his practice agreed to pay back $60,000 to the North Carolina Medicaid Program to resolve claims that they billed the program for tests that were not medically necessary or were not supported by medical records, or which were performed in violation of Medicaid policies.
A family practice physician agreed to pay more than $660,000 to resolve allegations that she billed Medicare for the surgical implantation of neurostimulator devices when the patients received acupuncture devices that were not surgically implanted.
Pain management company and its owner agreed to pay more than $789,000 to resolve FCA allegations that it improperly billed federal healthcare programs for medically unnecessary urine drug tests. The settlement also resolves allegations that PPM submitted claims to Medicare for specimen validity testing during 2014 and 2015, despite explicit guidance from Medicare beginning in January 2014 stating that such testing should not be separately billed to Medicare.
Home health provider and its owner/CEO agreed to pay $28,246 to resolve allegations that they employed a physical therapist who was excluded from participation in all federal healthcare programs. The physical therapist was excluded from all federal healthcare programs in 2015 after he defaulted on his obligations under an Integrity Agreement (IA) with HHS-OIG.
Urgent care provider network and its management company agreed to pay $22.5 million to resolve FCA allegations that they submitted claims to Medicaid, Medicare and TRICARE for services provided by non-credentialed providers. As part of the settlement, both companies entered into a five-year CIA with HHS-OIG.
The CFO of a physical medicine clinic and licensed chiropractor, agreed to pay $273,000 to resolve allegations that her clinic billed Medicare for surgical procedures involving the implantation of neurostimulator electrodes, when the procedures performed were actually the non-surgical application of electro-acupuncture devices.
A health insurer agreed to pay more than $97 million to settle allegations that, as the third-party administrator responsible for obtaining private healthcare for veterans and handling the billing for the care, it submitted duplicate claims and did not reduce billings as required by the contract.
In-home family therapy and counseling provider and its owners agreed to pay $273,000 to resolve FCA allegations that they improperly billed Medicaid for services provided by unlicensed individuals.
Pharmaceutical manufacturer agreed to pay $75 million, plus interest, to resolve FCA allegations that it underpaid required quarterly rebates owed under the Medicaid Drug Rebate Program.
A former owner of a now-defunct diagnostic testing laboratory entered a consent judgment to pay $4.5 million to resolve allegations that he paid kickbacks to the owner of a medical practice in exchange for referrals to the company's laboratories.
A former owner of a diagnostic testing laboratory agreed to pay more than $2 million to resolve allegations that he caused the now-defunct laboratory to submit false claims to Medicare by participating in the following kickback schemes: (1) providing urine drug testing equipment to two physicians; (2) the laboratory paying an individual volume-based commission and then a salary in exchange for the individual working with physician groups to induce referrals; and (3) providing loans to two physicians in exchange for referrals.
An ambulance service provider agreed to pay $650,000 to settle allegations that it submitted claims to Medicare for ambulance transports when the patients either did not require ambulance transport or were not qualified for the services. The government also alleged that the provider lacked proper documentation showing the reasons for the ambulance transports.
The former owner and sole-shareholder of a children's autism therapy provider agreed to pay more than $2.7 million to resolve allegations that nine of the company's locations submitted claims to TRICARE that: (1) did not correctly identify the provider of services; (2) could not be substantiated by medical records; or (3) covered services allegedly provided on dates when the individual providers billed excessive hours.
A cardiologist and his practice agreed to pay $2 million to resolve FCA allegations that they billed Medicare, Medicaid and TRICARE for diagnostic tests that were medically unnecessary or not conducted. The cardiologist and the practice entered into a three-year IA with HHS-OIG as part of the resolution.
A physician agreed to pay $475,000 to resolve allegations that he certified patients for home health services based solely on the forms provided by the home health company without examining the patients. He also allegedly received payments from the agency for referrals, in violation of the AKS.
The former owners of a telemarketing company agreed to pay at least $4 million to settle claims that they used telemarketing to solicit patients to accept compounded drugs even if the drugs were not medically necessary, obtained prescriptions for the drugs and then provided the prescriptions to compounding pharmacies that agreed to pay the telemarketers half of the TRICARE reimbursement for each prescription. The telemarketing company allegedly paid telemedicine providers to issue the prescriptions, often without a patient exam.
A primary care physician agreed to pay $350,000 to resolve allegations that he violated the CSA and FCA by: (1) pre-signing prescriptions for controlled substances and being out of the state when the prescriptions were issued; (2) issuing prescriptions for controlled substances to patients who were either not examined or were examined by non-physicians; and (3) billing Medicare for services that were provided by other individuals while he was travelling.
A physician and his practice agreed to pay $106,255 to resolve allegations that they billed for procedures performed by nurse practitioners as if the procedures had been performed by the physician.
A physician and his practice agreed to pay $800,000 to resolve allegations that he billed Medicare for vascular surgery procedures that he routinely performed regardless of whether they were medically necessary and, at multiple points, misrepresented patient conditions in medical records to justify the procedures. The physician also consented to exclusion from federal healthcare programs for four years, and the prosecution of related criminal charges was deferred for one year.
Healthcare company, two of its hospitals and an affiliated substance abuse treatment facility agreed to pay $10.25 million to resolve FCA allegations that they provided free long-distance van transportation to patients to induce them to use their facilities, in violation of the AKS. The settlement also resolves allegations that the company and two hospitals submitted or caused the submission of claims to Medicare for medically unnecessary inpatient psychiatric admissions and associated services. As part of the resolution, Oglethorpe entered a five-year CIA with HHS-OIG.
Medical research company agreed to pay $1.1 million to resolve FCA allegations that its member physicians referred patients for genetic testing in exchange for kickbacks from a now-defunct molecular testing company, in violation of the AKS.
A physician agreed to pay $215,228 to resolve allegations that he received compensation as a medical director from a hospital that exceeded the FMV of his services and was an effort to incentivize him to make referrals to the hospital, in violation of the Stark Law and the AKS. The hospital and six of its owners previously agreed to pay $8.1 million to settle similar allegations. The physician entered into a three-year IA with HHS-OIG as part of the resolution.
An employee of a durable medical equipment provider will pay more than $34.7 million under a civil judgement in a case involving allegations that the company submitted claims to Medicaid for equipment that included information of recipients who did not order or receive equipment, including some Medicaid recipients who were deceased. She also pled guilty and will be sentenced in a related criminal case. The company also reached a civil settlement in the matter and will also pay a criminal fine and restitution. The owner of the company also reached a settlement.
DME provider agreed to pay more than $20 million and one of its co-owners, Margaret Gibson, agreed to pay $4 million to resolve state and federal FCA allegations that they submitted false claims to Medicaid for equipment never ordered or received by patients, some of whom were deceased for many years prior to the claims’ submission. APFFY was also sentenced to five years of probation and ordered to pay a $2 million criminal fine and more than $10 million in restitution. In connection with this conduct, the United States and North Carolina previously obtained a $34.709 million civil default judgment against APFFY’s other co-owner, Shelley Bandy. Bandy pleaded guilty to related criminal charges in December 2020 and was sentenced to 30 months’ imprisonment and ordered to pay $374,800 in restitution on August 27, 2021. APFFY self-reported suspected fraudulent activity related to the above conduct after appointment of a receiver.
A durable medical equipment provider agreed to pay $20,138,772.70 to settle allegations that it submitted claims to Medicaid for equipment that included information of recipients who did not order or receive equipment, including some Medicaid recipients who were deceased. The company will also pay a criminal fine and restitution. The owner of the company also reached a settlement in the matter, and a company employee will pay under a civil judgment and also be sentenced in a related criminal matter.
Allergy and asthma treatment center agreed to pay $2.15 million to resolve FCA allegations that they double-billed and over-billed Medicare and Medicaid by combining partially used vials of an asthma treatment sold in single-use vials for use in other patients. In June 2020 the medical practice also pleaded guilty to one count of criminal healthcare fraud related to the allegations.
Pharmacy and its pharmacist co-owner agreed to pay a $2.9 million consent judgment to resolve civil FCA and CSA allegations that they: (1) dispensed controlled substances, including hydrocodone, without prescriptions; and (2) dispensed generic versions of drugs but billed Medicare for the brand-name drugs. As part of the resolution, both the pharmacy and Jeffrey Eshelman are permanently prohibited from dispensing controlled substances and Eshelman is excluded from federal healthcare programs for nine years.
A medical technology company agreed to pay more than $3.6 million to resolve allegations, originating from a self-disclosure to HHS-OIG, that the company billed Medicare for a bone growth stimulator when some of the medical necessity forms included in claim submissions had been completed by sales representatives instead of physicians or a physician’s office.
Hospital agreed to pay more than $320,000 to resolve FCA allegations that it submitted claims to federal healthcare programs using the NPIs of credentialed physicians for services actually performed by non-credentialed physicians.
A senior care company agreed to pay $714,996 to settle claims that it submitted reimbursement claims for bad debt to Medicare that included false representations that reasonable collection efforts had been made.
A physical therapy company and its owner agreed to pay $152,000 to settle allegations that they billed the VA for medical devices that were not medically necessary and received kickbacks from the manufacturer of the devices in exchange for prescribing them. The government also alleged that the owner provided a copy of his signature to a salesperson, who then used it to complete medical necessity forms included with invoices and that he did not examine patients before prescribing the device.
Laboratory services provider and its subsidiary agreed to pay $845,108 to resolve FCA allegations that they: (1) submitted claims to Connecticut Medicaid for medically unnecessary urine drug tests for residents at a behavioral health residential treatment center; and (2) failed to report and return overpayments related to the tests.
A business owner and her company agreed to pay more than $20 million to resolve allegations that they fraudulently established DME companies by submitting falsified paperwork. The companies then allegedly billed Medicare for equipment that was not medically necessary and used marketing techniques that violated the AKS. In addition to the civil settlement, the owner pleaded guilty to related criminal charges.
A business owner and her company agreed to pay more than $20 million to resolve allegations that they fraudulently established DME companies by submitting falsified paperwork. The companies then allegedly billed Medicare for equipment that was not medically necessary and used marketing techniques that violated the AKS. In addition to the civil settlement, the owner pleaded guilty to related criminal charges.
Two pain management clinics agreed to pay $1.665 million to resolve FCA allegations that they engaged in a kickback scheme by causing affiliated surgery centers to waive co-payments for surgical facility fees to induce patients to receive injection procedures. The settlement also resolves allegations that the clinics improperly billed for Evaluation and Management (E&M) and psychological testing services.
Diagnostic imaging services provider agreed to pay nearly $750,000 to resolve FCA allegations that it billed Medicare for more than 1,500 procedures performed without the requisite physician supervision or for which Akumin was unable to determine whether a physician was present.
Behavioral health practice and its owner agreed to pay more than $100,000 to resolve FCA allegations that they improperly: (1) billed Medicaid for services provided by unlicensed individuals; (2) billed for one-on-one sessions when group sessions were actually provided; and (3) billed claims that falsely represented that biofeedback was provided when it was not.
Two pain management clinics agreed to pay $1.665 million to resolve FCA allegations that they engaged in a kickback scheme by causing affiliated surgery centers to waive co-payments for surgical facility fees to induce patients to receive injection procedures. The settlement also resolves allegations that the clinics improperly billed for Evaluation and Management (E&M) and psychological testing services.
Diagnostic imaging services provider agreed to pay nearly $750,000 to resolve FCA allegations that it billed Medicare for more than 1,500 procedures performed without the requisite physician supervision or for which Akumin was unable to determine whether a physician was present.
Behavioral health practice and its owner agreed to pay more than $100,000 to resolve FCA allegations that they improperly: (1) billed Medicaid for services provided by unlicensed individuals; (2) billed for one-on-one sessions when group sessions were actually provided; and (3) billed claims that falsely represented that biofeedback was provided when it was not.
Two affiliated adult day health centers agreed to pay more than $1 million to resolve allegations that they improperly submitted claims to Massachusetts Medicaid for services not provided or that were in excess of permissible per diem billing requirements. As part of the resolution, both centers agreed to contract with an independent compliance monitor to oversee a three-year independent compliance program.
A developer of EHR services agreed to pay $18.25 million to resolve allegations that it engaged in three marketing schemes in violation of the AKS that caused providers to submit false claims related to federal EHR incentive payments. The EHR developer allegedly: (1) invited customers and prospective customers to all-expenses-paid “bucket list” events; (2) entered into “Conversion Deals” whereby it paid competitors to refer customers when their products were discontinued, tied to the value and volume of business ultimately converted; and (3) paid fees to customers for each referral that signed up for the product.
Two affiliated adult day health centers agreed to pay more than $1 million to resolve allegations that they improperly submitted claims to Massachusetts Medicaid for services not provided or that were in excess of permissible per diem billing requirements. As part of the resolution, both centers agreed to contract with an independent compliance monitor to oversee a three-year independent compliance program.
A developer of EHR services agreed to pay $18.25 million to resolve allegations that it engaged in three marketing schemes in violation of the AKS that caused providers to submit false claims related to federal EHR incentive payments. The EHR developer allegedly: (1) invited customers and prospective customers to all-expenses-paid “bucket list” events; (2) entered into “Conversion Deals” whereby it paid competitors to refer customers when their products were discontinued, tied to the value and volume of business ultimately converted; and (3) paid fees to customers for each referral that signed up for the product.
A management services company, its owner and a medical practice agreed collectively to pay $150,000 to resolve allegations that they submitted claims to Medicare for the surgical implantation of neurostimulation devices when electro-acupuncture devices that were not surgically implanted were used.
A management services company, its owner and a medical practice agreed collectively to pay $150,000 to resolve allegations that they submitted claims to Medicare for the surgical implantation of neurostimulation devices when electro-acupuncture devices that were not surgically implanted were used.
A urologist's estate agreed to pay $1.75 million to resolve allegations that he billed for kidney stone procedures that were not medically necessary because they were not medically indicated or because no kidney stones were in the patients. The settlement also resolved allegations that the urologist performed the procedures at a surgery center from which he allegedly received kickback payments.
A urologist's estate agreed to pay $1.75 million to resolve allegations that he billed for kidney stone procedures that were not medically necessary because they were not medically indicated or because no kidney stones were in the patients. The settlement also resolved allegations that the urologist performed the procedures at a surgery center from which he allegedly received kickback payments.
Hospice provider, home health provider and their owners agreed to pay more than $1.8 million to resolve FCA allegations that they submitted claims to Medicare that were tainted by improper compensation arrangements and referral relationships, in violation of the AKS and Stark Law. The providers allegedly paid referral sources above FMV for medical directorship services and provided physicians other gifts and benefits, including travel and sporting event tickets. Allstate also sold interests in the company to five different physicians which ultimately netted them substantial quarterly dividends.
Hospice provider, home health provider and their owners agreed to pay more than $1.8 million to resolve FCA allegations that they submitted claims to Medicare that were tainted by improper compensation arrangements and referral relationships, in violation of the AKS and Stark Law. The providers allegedly paid referral sources above FMV for medical directorship services and provided physicians other gifts and benefits, including travel and sporting event tickets. Allstate also sold interests in the company to five different physicians which ultimately netted them substantial quarterly dividends.
Spinal decompression clinic agreed to pay more than $330,000 to resolve FCA allegations that it billed Medicare for surgical procedures involving the implantation of neurostimulator electrodes when in fact the procedures involved the non-surgical application of electro-acupuncture devices in an office setting.
Spinal decompression clinic agreed to pay more than $330,000 to resolve FCA allegations that it billed Medicare for surgical procedures involving the implantation of neurostimulator electrodes when in fact the procedures involved the non-surgical application of electro-acupuncture devices in an office setting.
Genetic testing laboratory agreed to pay more than $2.5 million to resolve FCA allegations that it billed Medicare for genetic tests tainted by payments the lab paid to a healthcare marketing company for referrals, in violation of the AKS. A residential nursing home operator previously entered a $1 million settlement regarding these allegations.
Genetic testing laboratory agreed to pay more than $2.5 million to resolve FCA allegations that it billed Medicare for genetic tests tainted by payments the lab paid to a healthcare marketing company for referrals, in violation of the AKS. A residential nursing home operator previously entered a $1 million settlement regarding these allegations.
Diagnostic laboratory agreed to pay $357,584 to resolve FCA allegations that it billed Medicare for genetic tests that were performed without valid physician oversight. A contractor involved in the allegations previously pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to 50 months in prison in May 2019.
Diagnostic laboratory agreed to pay $357,584 to resolve FCA allegations that it billed Medicare for genetic tests that were performed without valid physician oversight. A contractor involved in the allegations previously pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to 50 months in prison in May 2019.
A chiropractor and his medical group agreed to pay $20,000 to resolve allegations that he billed Medicare and TennCare for an electro-acupuncture stimulation device as if the device had to be implanted surgically when it did not.
A chiropractor and his medical group agreed to pay $700,000 to resolve allegations that they billed Medicare and TennCare for an electro-acupuncture stimulation device as if the device had to be implanted surgically when it did not.
A physician agreed to pay $1 million to resolve allegations that he billed Medicare and TennCare for an electro-acupuncture stimulation device as if the device had to be implanted surgically when it did not. The physician entered into a three-year IA with HHS-OIG as part of the resolution.
A chiropractor and his medical group agreed to pay $20,000 to resolve allegations that he billed Medicare and TennCare for an electro-acupuncture stimulation device as if the device had to be implanted surgically when it did not.
A chiropractor and his medical group agreed to pay $700,000 to resolve allegations that they billed Medicare and TennCare for an electro-acupuncture stimulation device as if the device had to be implanted surgically when it did not.
A physician agreed to pay $1 million to resolve allegations that he billed Medicare and TennCare for an electro-acupuncture stimulation device as if the device had to be implanted surgically when it did not. The physician entered into a three-year IA with HHS-OIG as part of the resolution.
A company that administers government healthcare programs agreed to pay more than $179 million to settle claims that it received and retained overpayments from the Department of Veterans Affairs in the course of administering two healthcare programs for veterans.
A company that administers government healthcare programs agreed to pay more than $179 million to settle claims that it received and retained overpayments from the Department of Veterans Affairs in the course of administering two healthcare programs for veterans.
A substance abuse treatment center and its owner agreed to pay $6 million to settle allegations that provided gifts to individuals to induce them to enroll in an inpatient program and also provided kickbacks to an individual to induce her to refer patients to the center. The center also allegedly used photocopied physician signatures on admission forms in order to give the appearance that patients had been evaluated by a qualified professional.
A durable medical equipment provider agreed to pay $40.5 million to resolve allegations that it billed Medicare and Medicaid for the rental of non-invasive ventilators to beneficiaries who did not have a medical necessity for these devices. The company also waived insurance co-pays for patients in order to induce them to use their ventilators.
A substance abuse treatment center and its owner agreed to pay $6 million to settle allegations that provided gifts to individuals to induce them to enroll in an inpatient program and also provided kickbacks to an individual to induce her to refer patients to the center. The center also allegedly used photocopied physician signatures on admission forms in order to give the appearance that patients had been evaluated by a qualified professional.
A durable medical equipment provider agreed to pay $40.5 million to resolve allegations that it billed Medicare and Medicaid for the rental of non-invasive ventilators to beneficiaries who did not have a medical necessity for these devices. The company also waived insurance co-pays for patients in order to induce them to use their ventilators.
A specialty heart hospital and its subsidiary agreed to pay $48 million to settle allegations that it submitted claims to Medicare for services that were referrals from physicians that had a financial relationship to the hospital, violating the Stark Law and Anti-Kickback Statute.
A specialty heart hospital and its subsidiary agreed to pay $48 million to settle allegations that it submitted claims to Medicare for services that were referrals from physicians that had a financial relationship to the hospital, violating the Stark Law and Anti-Kickback Statute.
A sleep laboratory agreed to pay more than $150,000 to resolve allegations that it billed Medicare for sleep studies that were administered by personnel who were not properly trained or certified.
A pharmaceutical company agreed to pay $22 million to settle allegations that it channeled money through foundations to cover co-pay costs for Medicare beneficiares who were taking its multiple sclerosis drugs.
A sleep laboratory agreed to pay more than $150,000 to resolve allegations that it billed Medicare for sleep studies that were administered by personnel who were not properly trained or certified.
A pharmaceutical company agreed to pay $22 million to settle allegations that it channeled money through foundations to cover co-pay costs for Medicare beneficiares who were taking its multiple sclerosis drugs.
A medical equipment company agreed to pay $800,000 to settle claims that it charged the Department of Veterans Affairs for patient lift systems that contained parts made outside the United States.
A medical equipment company agreed to pay $800,000 to settle claims that it charged the Department of Veterans Affairs for patient lift systems that contained parts made outside the United States.
A physical therapy company and its owner agreed to pay more than $500,000 to settle allegations that it submitted claims for physical therapy services to Medicare and TRICARE when the individual providers of the services were not approved for reimbursement.
A physical therapy company and its owner agreed to pay more than $500,000 to settle allegations that it submitted claims for physical therapy services to Medicare and TRICARE when the individual providers of the services were not approved for reimbursement.
The former owner of a hospice and a home healthcare company agreed to pay $1 million to settle allegations that she made payments to a medical director in excess of fair market value and also submitted claims to Medicare that listed a physician who was at the time incarcerated.
The former owner of a hospice and a home healthcare company agreed to pay $1 million to settle allegations that she made payments to a medical director in excess of fair market value and also submitted claims to Medicare that listed a physician who was at the time incarcerated.
A chiropractor and his practice agreed to pay $175,000 to settle claims that he billed Medicare for electro-acupuncture devices as if they were implantable devices when Medicare does not reimburse for such devices.
A chiropractor and his practice agreed to pay $175,000 to settle claims that he billed Medicare for electro-acupuncture devices as if they were implantable devices when Medicare does not reimburse for such devices.
An orthotic device provider agreed to pay $90,000 to resolve claims that it worked with a device manufacturer to bill Medicaid for devices because the manufacturer did not have participation agreements with some states' Medicaid programs. The billed devices were not medically necessary nor were they custom-fabricated as represented. The provider also billed Medicaid for the fitting and delivery of the devices when those services were provided by the manufacturer. The manufacturer entered into a separate settlement relating to these allegations.
An orthotic device manufacturer agreed to pay $1.5 million to resolve claims that it recruited a provider to bill Medicaid for its devices because the manufacturer did not have participation agreements with some states' Medicaid programs. The billed devices were not medically necessary nor were they custom-fabricated as represented. The provider also billed Medicaid for the fitting and delivery of the devices when those services were provided by the manufacturer. The provider entered into a separate settlement relating to these allegations. The settlement also resolves allegations that it violated the terms of a contract with the Department of Veterans Affairs by failing to offer the same discounts as were provided to other customers.
An orthotic device provider agreed to pay $90,000 to resolve claims that it worked with a device manufacturer to bill Medicaid for devices because the manufacturer did not have participation agreements with some states' Medicaid programs. The billed devices were not medically necessary nor were they custom-fabricated as represented. The provider also billed Medicaid for the fitting and delivery of the devices when those services were provided by the manufacturer. The manufacturer entered into a separate settlement relating to these allegations.
An orthotic device manufacturer agreed to pay $1.5 million to resolve claims that it recruited a provider to bill Medicaid for its devices because the manufacturer did not have participation agreements with some states' Medicaid programs. The billed devices were not medically necessary nor were they custom-fabricated as represented. The provider also billed Medicaid for the fitting and delivery of the devices when those services were provided by the manufacturer. The provider entered into a separate settlement relating to these allegations. The settlement also resolves allegations that it violated the terms of a contract with the Department of Veterans Affairs by failing to offer the same discounts as were provided to other customers.
A health system agreed to pay more than $325,000 to resolve claims that it employed a neurosurgeon after receiving warnings that he was involved in a kickback scheme and performing unnecessary procedures. This settlement relates to a federal settlement reached in October 2019.
A health system agreed to pay more than $325,000 to resolve claims that it employed a neurosurgeon after receiving warnings that he was involved in a kickback scheme and performing unnecessary procedures. This settlement relates to a federal settlement reached in October 2019.
A radiology practice agreed to pay $1.4 million to settle claims that it billed Medicare and Medicaid for radiological images that had been interpreted outside the United States, thus making them ineligible for reimbursement. The company also submitted claims for services that were initially performed outside the United States but then reinterpreted and charged to a physician within the United States.
A former top executive of a home health agency agreed to pay $647,000 to resolve claims that the company provided kickbacks in exchange for referrals by agreeing to sham medical directorships with physicians and providing bonuses to company employees based on referrals from physician spouses of the employees. Another executive and the company entered into related settlement agreements
A former top executive of a home health agency agreed to pay $647,000 to resolve claims that the company provided kickbacks in exchange for referrals by agreeing to sham medical directorships with physicians and providing bonuses to company employees based on referrals from physician spouses of the employees. Another executive and the company entered into related settlement agreements
A home health agency agreed to pay more than $4.5 million to resolve claims that it provided kickbacks in exchange for referrals by agreeing to sham medical directorships with physicians and providing bonuses to company employees based on referrals from physician spouses of the employees. This settlement also covers claims that provided services to Medicare patients which were not medically necessary in order to avoid a decreased reimbursement based on fewer home health visits. Two former top executives entered into settlement agreements related to the kickback charges.
A radiology practice agreed to pay $1.4 million to settle claims that it billed Medicare and Medicaid for radiological images that had been interpreted outside the United States, thus making them ineligible for reimbursement. The company also submitted claims for services that were initially performed outside the United States but then reinterpreted and charged to a physician within the United States.
A former top executive of a home health agency agreed to pay $647,000 to resolve claims that the company provided kickbacks in exchange for referrals by agreeing to sham medical directorships with physicians and providing bonuses to company employees based on referrals from physician spouses of the employees. Another executive and the company entered into related settlement agreements
A former top executive of a home health agency agreed to pay $647,000 to resolve claims that the company provided kickbacks in exchange for referrals by agreeing to sham medical directorships with physicians and providing bonuses to company employees based on referrals from physician spouses of the employees. Another executive and the company entered into related settlement agreements
A home health agency agreed to pay more than $4.5 million to resolve claims that it provided kickbacks in exchange for referrals by agreeing to sham medical directorships with physicians and providing bonuses to company employees based on referrals from physician spouses of the employees. This settlement also covers claims that provided services to Medicare patients which were not medically necessary in order to avoid a decreased reimbursement based on fewer home health visits. Two former top executives entered into settlement agreements related to the kickback charges.
An investment firm agreed to pay $1,500,000 to resolve allegations that a company it owns promoted the use of its extracorporeal photopheresis systems for pediatric patients, resulting in reimbursement claims being submitted to Medicaid, TRICARE, and the FEHB Program when pediatric use of these systems was not approved by the FDA. The previous owner of the company settled similar claims for $10 million.
A subsidiary of Johnson & Johnson agreed to pay $10,000,000 to resolve allegations that a former subsidiary promoted the use of its extracorporeal photopheresis systems for pediatric patients, resulting in reimbursement claims being submitted to Medicaid, TRICARE, and the FEHB Program when pediatric use of these systems was not approved by the FDA. The new owner of the subsidary business settled similar claims for $1.5 million.
An investment firm agreed to pay $1,500,000 to resolve allegations that a company it owns promoted the use of its extracorporeal photopheresis systems for pediatric patients, resulting in reimbursement claims being submitted to Medicaid, TRICARE, and the FEHB Program when pediatric use of these systems was not approved by the FDA. The previous owner of the company settled similar claims for $10 million.
A subsidiary of Johnson & Johnson agreed to pay $10,000,000 to resolve allegations that a former subsidiary promoted the use of its extracorporeal photopheresis systems for pediatric patients, resulting in reimbursement claims being submitted to Medicaid, TRICARE, and the FEHB Program when pediatric use of these systems was not approved by the FDA. The new owner of the subsidary business settled similar claims for $1.5 million.
An insurance provider operating as a Medicare Advantage Organization agreed to pay more than $6.3 million to resolve claims that it submitted diagnoses to Medicare for Medicare beneficiaries that were not supported by the beneficiaries' medical records, resulting in higher rates of reimbursement.
An insurance provider operating as a Medicare Advantage Organization agreed to pay more than $6.3 million to resolve claims that it submitted diagnoses to Medicare for Medicare beneficiaries that were not supported by the beneficiaries' medical records, resulting in higher rates of reimbursement.
A cardiology practice and cardiologist agreed to pay $500,000 to settle claims that they submitted claims to Medicare and Medicaid that required interpretive reports to be generated in addition to the performance of procedures but the required reports were never generated.
A cardiology practice and cardiologist agreed to pay $500,000 to settle claims that they submitted claims to Medicare and Medicaid that required interpretive reports to be generated in addition to the performance of procedures but the required reports were never generated.
A physician agreed to pay $850,000 to resolve allegations that she used her company to submit travel reimbursement claims that misrepresented the distances traveled, causing her to receive reimbursements for travel that did not happen.
A physician agreed to pay $150,000 to resolve allegations that he paid kickbacks to pain management companies in exchange for allowing him to receive payments from Medicare for services that were not actually provided.
A physician agreed to pay $850,000 to resolve allegations that she used her company to submit travel reimbursement claims that misrepresented the distances traveled, causing her to receive reimbursements for travel that did not happen.
A physician agreed to pay $150,000 to resolve allegations that he paid kickbacks to pain management companies in exchange for allowing him to receive payments from Medicare for services that were not actually provided.
A company that sells home medical supplies agreed to pay $565,873 to settle claims that it submitted claims to Medicare and TRICARE for supplies that were not medically necessary and were never provided to the patients.
A company that sells home medical supplies agreed to pay $565,873 to settle claims that it submitted claims to Medicare and TRICARE for supplies that were not medically necessary and were never provided to the patients.
A nonprofit healthcare organization agreed to pay more than $31.5 million to resolve claims that it billed Medicaid for drugs at a higher cost than the required acquisition cost.
A nonprofit healthcare organization agreed to pay more than $31.5 million to resolve claims that it billed Medicaid for drugs at a higher cost than the required acquisition cost.
Two physicians and their clinics agreed to pay more than $340,000 to settle claims that they billed Medicare for services provided by nurse practitioners at rates indicating that the services were either performed or supervised by physicians when they were not.
Two physicians and their clinics agreed to pay more than $340,000 to settle claims that they billed Medicare for services provided by nurse practitioners at rates indicating that the services were either performed or supervised by physicians when they were not.
A medical device manufacturer agreed to pay more than $9.2 million to settle allegations that it paid for social events at a restaurant owned by a neurosurgeon in exchange for the surgeon's use of its intrathecal infusion pumps, and then underreported these payments to CMS.
A medical device manufacturer agreed to pay more than $9.2 million to settle allegations that it paid for social events at a restaurant owned by a neurosurgeon in exchange for the surgeon's use of its intrathecal infusion pumps, and then underreported these payments to CMS.
A laboratory agreed to pay more than $1.2 million to settle allegations that it billed Medicare and the United Mine Workers of America for services that were also included in bills for other laboratory services. In addition, some of these services had not actually been ordered by physicians and possibly were not performed.
A laboratory agreed to pay more than $1.2 million to settle allegations that it billed Medicare and the United Mine Workers of America for services that were also included in bills for other laboratory services. In addition, some of these services had not actually been ordered by physicians and possibly were not performed.
A healthcare organization agreed to pay $6.5 million to settle claims that it incorrectly billed Medicaid instead of Medicare for services provided to a certain class of Medicare beneficiaries, as well as overbilling or billing for services not provided.
A healthcare organization agreed to pay $6.5 million to settle claims that it incorrectly billed Medicaid instead of Medicare for services provided to a certain class of Medicare beneficiaries, as well as overbilling or billing for services not provided.
A pharmaceutical company agreed to pay $2.8 billion to resolve allegations that it paid kickbacks to physicians in attempts to increase prescriptions of its opioids and entered into contracts with pharmacies to fill opioid prescriptions that were denied by other pharmacies as being medically unecessary. Related civil and criminal settlements with the pharmaceutical company and members of the family owning the company were also reached.
A pharmaceutical company agreed to pay $2.8 billion to resolve allegations that it paid kickbacks to physicians in attempts to increase prescriptions of its opioids and entered into contracts with pharmacies to fill opioid prescriptions that were denied by other pharmacies as being medically unecessary. Related civil and criminal settlements with the pharmaceutical company and members of the family owning the company were also reached.
A home healthcare provider and its owners agreed to pay $3.1 million to settle allegations that they submitted claims to the Massachusetts Medicaid program for services when they did not have care plans signed by a physician authorizing the services, as required.
A home healthcare provider and its owners agreed to pay $3.1 million to settle allegations that they submitted claims to the Massachusetts Medicaid program for services when they did not have care plans signed by a physician authorizing the services, as required.
A manufacturer of medical devices agreed to pay $18 million to settle claims that it provided practice development and support, advertising assistance, and educational grants to healthcare providers in attempts to induce them to use the company's devices.
A manufacturer of medical devices agreed to pay $18 million to settle claims that it provided practice development and support, advertising assistance, and educational grants to healthcare providers in attempts to induce them to use the company's devices.
Two physical therapy clinics agreed to pay $4 million to settle allegations that they billed federal healthcare programs for services provided by individuals other than the physical therapist identified on the claims. They also allegedly backdated services in order to receive reimbursement after treatment authorizations had expired.
A company that provides laboratory testing and manufactures diagnostic devices and its founder and CEO agreed to pay more than $3 million to settle claims that it paid a clinic a per-specimen fee for the referral of drug tests.
Two physical therapy clinics agreed to pay $4 million to settle allegations that they billed federal healthcare programs for services provided by individuals other than the physical therapist identified on the claims. They also allegedly backdated services in order to receive reimbursement after treatment authorizations had expired.
A company that provides laboratory testing and manufactures diagnostic devices and its founder and CEO agreed to pay more than $3 million to settle claims that it paid a clinic a per-specimen fee for the referral of drug tests.
A drug and alcohol counselor and his practice agreed to pay $230,000 to settle claims that he billed Medicare for services that were provided by unlicensed providers.
A dentist and two businesses he owns agreed to pay $300,000 to resolve claims that they billed Medicaid for services that either were not provided or were not medically necessary and for x-ray services performed by individuals who were not appropriately certified.
Several pain management companies agreed to pay $885,452 to resolve allegations that they gave incentive stock to non-employee physicians in exchange for referrals and also paid some physicians to serve as medical directors with compensation being based on the volume of procedures.
A drug and alcohol counselor and his practice agreed to pay $230,000 to settle claims that he billed Medicare for services that were provided by unlicensed providers.
A dentist and two businesses he owns agreed to pay $300,000 to resolve claims that they billed Medicaid for services that either were not provided or were not medically necessary and for x-ray services performed by individuals who were not appropriately certified.
Several pain management companies agreed to pay $885,452 to resolve allegations that they gave incentive stock to non-employee physicians in exchange for referrals and also paid some physicians to serve as medical directors with compensation being based on the volume of procedures.
An eye doctor agreed to pay more than $3 million to settle claims that he billed Medicare for tests and procedures that were not medically necessary or were perfomed on the same patient more often than would be medically necessary.
An eye doctor agreed to pay more than $3 million to settle claims that he billed Medicare for tests and procedures that were not medically necessary or were perfomed on the same patient more often than would be medically necessary.
An addiction recovery specialist and his clinic agreed to pay $530,000 to resolve claims that they submitted claims to Medicaid and Medicare for services that were provided by unlicensed individuals or were unsupervised, services that were not included in the practice's contract or should not have been provided in group settings, and allegations that they coded claims at higher levels than were correct.
A radiology center agreed to pay $501,000 to settle allegations that it submitted claims to Medicare and TRICARE for scans that were administered without physician supervision and for services performed by physicians who did not have the correct credentials to be eligible for Medicare reimbursement.
An addiction recovery specialist and his clinic agreed to pay $530,000 to resolve claims that they submitted claims to Medicaid and Medicare for services that were provided by unlicensed individuals or were unsupervised, services that were not included in the practice's contract or should not have been provided in group settings, and allegations that they coded claims at higher levels than were correct.
A radiology center agreed to pay $501,000 to settle allegations that it submitted claims to Medicare and TRICARE for scans that were administered without physician supervision and for services performed by physicians who did not have the correct credentials to be eligible for Medicare reimbursement.
A pharmaceutical company agreed to pay $97 million to settle claims that it funneled money through a foundation to cover the co-pays of Medicare beneficiaries taking its pulmonary arterial hypertension drug.
A pharmaceutical company agreed to pay $97 million to settle claims that it funneled money through a foundation to cover the co-pays of Medicare beneficiaries taking its pulmonary arterial hypertension drug.
A company that provides molecular and diagnostic tests agreed to pay $11.5 million to resolve allegations that it billed Medicare and TRICARE for tests conducted on hospital patients instead of charging the the hospitals for the tests. The company also provided payments to physicians' offices for electronic medical records software based on the volume of referrals from those physicians.
A company that provides molecular and diagnostic tests agreed to pay $11.5 million to resolve allegations that it billed Medicare and TRICARE for tests conducted on hospital patients instead of charging the the hospitals for the tests. The company also provided payments to physicians' offices for electronic medical records software based on the volume of referrals from those physicians.
A neurosurgery practice, the neurosurgeon, and the practice director agreed to pay more than $1 million to resolve allegations that they billed Medicare, TRICARE, and the FEHB Program for surgical procedures involving the implantation of neurostimulators, when the procedures performed involved the non-surgical implantation of electro-acupunture devices by a physican assistant. The settlement also covers allegations that they submitted claims to Medicare for the application of a memory-loss device under multiple billing codes instead of the correct code for one test.
A neurosurgery practice, the neurosurgeon, and the practice director agreed to pay more than $1 million to resolve allegations that they billed Medicare, TRICARE, and the FEHB Program for surgical procedures involving the implantation of neurostimulators, when the procedures performed involved the non-surgical implantation of electro-acupunture devices by a physican assistant. The settlement also covers allegations that they submitted claims to Medicare for the application of a memory-loss device under multiple billing codes instead of the correct code for one test.
A physician agreed to pay more than $1.25 million to settle allegations that he billed federal healthcare plans for several drugs used in his practice when in fact he actually used non-FDA-approved versions of the drugs purchased from foreign countries.
A physician agreed to pay more than $1.25 million to settle allegations that he billed federal healthcare plans for several drugs used in his practice when in fact he actually used non-FDA-approved versions of the drugs purchased from foreign countries.
A behavioral therapy and mental health services provider agreed to pay more than $260,000 to resolve claims that it overstated hours spent providing services, resulting in inflated bills being submitted to Medicaid. The provider also failed to repay Medicaid for overpayments in the required time.
A prosthetic provider agreed to pay $1.6 million to settle claims that it billed Medicare through another supplier during a time when its supplier number was deactivated. The company also allegedly waived coinsurance payments, so Medicare was overcharged for some services.
A behavioral therapy and mental health services provider agreed to pay more than $260,000 to resolve claims that it overstated hours spent providing services, resulting in inflated bills being submitted to Medicaid. The provider also failed to repay Medicaid for overpayments in the required time.
A prosthetic provider agreed to pay $1.6 million to settle claims that it billed Medicare through another supplier during a time when its supplier number was deactivated. The company also allegedly waived coinsurance payments, so Medicare was overcharged for some services.
The former owner of a now-defunct healthcare practice and two of its former managers agreed to pay $900,000 to settle allegations that the practice submitted claims to Medicare and Medicaid for unnecessary diagnostic procedures.
A hospital agreed to pay $50 million to resolve allegations that it paid referring physicians amounts based on the number or value of the referrals or higher than fair market value.
Two companies that jointly operate radiology facilities agreed to pay $5 million to settle claims that they submitted claims for CT scans and MRIs that were not supervised by a physician and that several of the radiology facilities were not accredited.
The former owner of a now-defunct healthcare practice and two of its former managers agreed to pay $900,000 to settle allegations that the practice submitted claims to Medicare and Medicaid for unnecessary diagnostic procedures.
A hospital agreed to pay $50 million to resolve allegations that it paid referring physicians amounts based on the number or value of the referrals or higher than fair market value.
Two companies that jointly operate radiology facilities agreed to pay $5 million to settle claims that they submitted claims for CT scans and MRIs that were not supervised by a physician and that several of the radiology facilities were not accredited.
A provider of Medicare Advantage plans agreed to pay $2,250,000 to settle allegations that it incorrectly calculated costs that were used in bids submitted to CMS, resulting in CMS overpaying reimbursements to the company.
A provider of Medicare Advantage plans agreed to pay $2,250,000 to settle allegations that it incorrectly calculated costs that were used in bids submitted to CMS, resulting in CMS overpaying reimbursements to the company.
An electronic health records company agreed to pay $500,000 to settle claims that a subsidiary misrepresented the capabilities of an electronic health records product in order to obtain certification of the product, causing providers using the software to falsely state they were in compliance with the requirements for such software.
An electronic health records company agreed to pay $500,000 to settle claims that a subsidiary misrepresented the capabilities of an electronic health records product in order to obtain certification of the product, causing providers using the software to falsely state they were in compliance with the requirements for such software.
A pain management doctor agreed to pay $530,000 to settle allegations that he billed Medicare for surgical procedures to implant neurostimulator electrodes when in fact he actually applied electro-acupunture devices in non-surgical procedures.
A pain management doctor agreed to pay $530,000 to settle allegations that he billed Medicare for surgical procedures to implant neurostimulator electrodes when in fact he actually applied electro-acupunture devices in non-surgical procedures.
A chiropractor and her practice agreed to pay more than $5 million to settle claims that she billed Medicare for surgical procedures instead of the acupuncture services that were actually performed.
A pharmaceutical company agreed to pay $20.75 million to settle allegations that it provided incentives to physicians to encourage the use of a drug in ways that were not approved by the FDA.
A chiropractor and her practice agreed to pay more than $5 million to settle claims that she billed Medicare for surgical procedures instead of the acupuncture services that were actually performed.
A pharmaceutical company agreed to pay $20.75 million to settle allegations that it provided incentives to physicians to encourage the use of a drug in ways that were not approved by the FDA.
A cardiologist agreed to pay $2 million to resolve allegations that he made payments to other physicians for patient referrals under the guise of making rent payments. He also allegedly justified performing cardiac procedures by falsifying records.
A cardiologist agreed to pay $2 million to resolve allegations that he made payments to other physicians for patient referrals under the guise of making rent payments. He also allegedly justified performing cardiac procedures by falsifying records.
A university hospital system agreed to pay $3.1 million to settle claims that it billed Medicare for transcatheter aortic valve replacements despite not having performed the minimum number of the procedures required to be performed prior to billing Medicare.
A revenue cycle management services provider agreed to pay $225,000 to settle allegations that it processed Medicaid claims based on altered forms on behalf of a hospital. The hospital reached a separate settlement for these claims.
A hospital agreed to pay $100,000 to settle claims that it allowed an altered form to be used, causing patients who should not have been eligible for Medicaid to receive Medicaid coverage. A related settlement was reached in the case of the company that assisted in processing the claims.
A university hospital system agreed to pay $3.1 million to settle claims that it billed Medicare for transcatheter aortic valve replacements despite not having performed the minimum number of the procedures required to be performed prior to billing Medicare.
A revenue cycle management services provider agreed to pay $225,000 to settle allegations that it processed Medicaid claims based on altered forms on behalf of a hospital. The hospital reached a separate settlement for these claims.
A hospital agreed to pay $100,000 to settle claims that it allowed an altered form to be used, causing patients who should not have been eligible for Medicaid to receive Medicaid coverage. A related settlement was reached in the case of the company that assisted in processing the claims.
A hospice provider agreed to pay more than $4.8 million to settle allegations that it billed Medicare and Medicaid for services at heightened levels of care when the patients receiving the services did not qualify for those levels.
A hospice provider agreed to pay more than $4.8 million to settle allegations that it billed Medicare and Medicaid for services at heightened levels of care when the patients receiving the services did not qualify for those levels.
A specialty pharmacy agreed to pay $3.5 million to settle claims that it conspired with a drug manufacturer for which it was a contracted vendor to pass along data from two foundations that allowed the manufacturer to donate money to the foundations in amounts that covered co-payments for its drug or enable the foundation to accept additional applications for co-payment coverage from Medicare beneficiaries.
A specialty pharmacy agreed to pay $3.5 million to settle claims that it conspired with a drug manufacturer for which it was a contracted vendor to pass along data from two foundations that allowed the manufacturer to donate money to the foundations in amounts that covered co-payments for its drug or enable the foundation to accept additional applications for co-payment coverage from Medicare beneficiaries.
A mobile x-ray company agreed to pay almost $50,000 to settle claims that it provided services to multiple Medicare beneficiaries at the same location and billed Medicare for the full transportation services for each patient instead of apportioning the cost.
A mobile x-ray company agreed to pay almost $50,000 to settle claims that it provided services to multiple Medicare beneficiaries at the same location and billed Medicare for the full transportation services for each patient instead of apportioning the cost.
A dentist agreed to pay more than $148,000 to settle allegations that he billed Medicaid for anesthesia and sedations services after his conscious sedation permit had lapsed, making him ineligible to provide such services.
A dentist agreed to pay more than $148,000 to settle allegations that he billed Medicaid for anesthesia and sedations services after his conscious sedation permit had lapsed, making him ineligible to provide such services.
The city of New York and a company retained as its billing agent agreed to pay a total of $2.775 million to settle allegations that they submitted claims to Medicaid for early intervention program services without making a reaonsable attempt to obtain private insurance coverage for such services first.
The city of New York and a company retained as its billing agent agreed to pay a total of $2.775 million to settle allegations that they submitted claims to Medicaid for early intervention program services without making a reaonsable attempt to obtain private insurance coverage for such services first.
A pharmaceutical company agreed to pay $3.5 million to settle claims that it provided grants to healthcare providers and institutions in exchange for sales of its local analgesic.
A pharmaceutical company agreed to pay $3.5 million to settle claims that it provided grants to healthcare providers and institutions in exchange for sales of its local analgesic.
A substance abuse and mental health services provider agreed to pay more than $350,000 to resolve claims that it received payments from Medicaid for urine drug tests as part of a bundled payment and also referred the tests to an outside laboratory which then also received reimbursement for the tests.
A laboratory agreed to pay $49 millon to settle claims that it improperly coded claims for noninvasive prenatal tests in order to obtain TRICARE reimbursement.
A substance abuse and mental health services provider agreed to pay more than $350,000 to resolve claims that it received payments from Medicaid for urine drug tests as part of a bundled payment and also referred the tests to an outside laboratory which then also received reimbursement for the tests.
A laboratory agreed to pay $49 millon to settle claims that it improperly coded claims for noninvasive prenatal tests in order to obtain TRICARE reimbursement.
A transportation broker for MassHealth agreed to pay $300,000 to settle claims that it failed to prevent contracted transportation companies from submitting bills for trips which did not occur, and then, as a broker, it submitted these bills to MassHealth for reimbursement.
A transportation broker for MassHealth agreed to pay $300,000 to settle claims that it failed to prevent contracted transportation companies from submitting bills for trips which did not occur, and then, as a broker, it submitted these bills to MassHealth for reimbursement.
A drug testing lab agreed to pay more than $11.9 million to settle allegations that it paid kickbacks in order to have urine drug tests referred to its labs.
A drug testing lab agreed to pay more than $11.9 million to settle allegations that it paid kickbacks in order to have urine drug tests referred to its labs.
An operator of skilled nursing facilities and twenty-seven of the facilities agreed to pay $16.7 million to settle allegations that they billed Medicare for rehabilitation therapy billed at the highest level when such a level of care was not medically necessary.
An operator of skilled nursing facilities and twenty-seven of the facilities agreed to pay $16.7 million to settle allegations that they billed Medicare for rehabilitation therapy billed at the highest level when such a level of care was not medically necessary.
A hospital agreed to pay $5 million to resolve allegations that it provided free or discounted transportation services to Medicare and Medicaid beneficiaries attending its programs.
A physician agreed to pay $400,000 to settle allegations that he billed Medicare for occupational and physical therapy services that were not provided by licensed practitioners.
A physician assistant agreed to pay $25,000 to settle claims that she received kickbacks such as food, meals, gift cards, and gifts from a pharmaceutical company in exchange for prescribing the company's drugs.
An owner and manager of psychiatric and behavioral hospitals and facilities agreed to pay $117 million to resolve claims that it did not discharge patients when inpatient care was no longer necessary and admitted other patients who did not need inpatient care. Additional allegations included improper billing procedures, inadequate staffing or training of staff, and lack of provision of treatment and discharge plans and therapy services.
A hospital agreed to pay $5 million to resolve allegations that it provided free or discounted transportation services to Medicare and Medicaid beneficiaries attending its programs.
A physician agreed to pay $400,000 to settle allegations that he billed Medicare for occupational and physical therapy services that were not provided by licensed practitioners.
A physician assistant agreed to pay $25,000 to settle claims that she received kickbacks such as food, meals, gift cards, and gifts from a pharmaceutical company in exchange for prescribing the company's drugs.
An owner and manager of psychiatric and behavioral hospitals and facilities agreed to pay $117 million to resolve claims that it did not discharge patients when inpatient care was no longer necessary and admitted other patients who did not need inpatient care. Additional allegations included improper billing procedures, inadequate staffing or training of staff, and lack of provision of treatment and discharge plans and therapy services.
A specialty hospital and a physician group agreed to pay $72.3 million to settle claims that the hospital provided physician compensation, office space and employees, equity buyback provisions and payments, and investment opportunities to the physicians at the group in exchange for referrals of patients.
A hospice provider agreed to pay $3.2 million to settle allegations that it submitted claims to Medicare for patients who were not terminally ill and submitted claims to Medicare, Medicaid, and TRICARE for inpatient hospice care when such a level of care was unnecessary.
A specialty hospital and a physician group agreed to pay $72.3 million to settle claims that the hospital provided physician compensation, office space and employees, equity buyback provisions and payments, and investment opportunities to the physicians at the group in exchange for referrals of patients.
A hospice provider agreed to pay $3.2 million to settle allegations that it submitted claims to Medicare for patients who were not terminally ill and submitted claims to Medicare, Medicaid, and TRICARE for inpatient hospice care when such a level of care was unnecessary.
An oncology group agreed to repay more than $2.3 million that it received in overpayments from the Department of Veteran Affairs for physician-administered drug claims.
An oncology group agreed to repay more than $2.3 million that it received in overpayments from the Department of Veteran Affairs for physician-administered drug claims.
An osteopathic physician and her practice agreed to pay $210,000 to settle claims that she received payments from a laboratory owned by her parents in exchange for referring patients to the laboratory for blood tests.
A physician and his practice agreed to pay $1 million in a civil consent judgment to resolve allegations that they submitted claims to Medicare while the doctor's Medicare billing privileges were revoked.
An osteopathic physician and her practice agreed to pay $210,000 to settle claims that she received payments from a laboratory owned by her parents in exchange for referring patients to the laboratory for blood tests.
A physician and his practice agreed to pay $1 million in a civil consent judgment to resolve allegations that they submitted claims to Medicare while the doctor's Medicare billing privileges were revoked.
A cardiology clinic, its owner, and its administrator agreed to pay $400,000 to settle allegations that it submitted claims to Medicare for services that were not medically necessary and lacked the necessary documentation.
A diagnostics testing company agreed to pay $8.25 million to resolve allegations that it delayed breast cancer screening tests until 14 days after patients were discharged from the hospital so the company could bill Medicare directly for the tests given that laboratories cannot bill directly for tests ordered within two weeks of discharge.
A pharmaceutical manufacturer agreed to pay $678 million to state and federal governments to resolve claims that it arranged for educational events for physicians and provided large speaker fees and other benefits to doctors who presented at the events in exchange for the doctors prescribing their drugs.
A cardiology clinic, its owner, and its administrator agreed to pay $400,000 to settle allegations that it submitted claims to Medicare for services that were not medically necessary and lacked the necessary documentation.
A diagnostics testing company agreed to pay $8.25 million to resolve allegations that it delayed breast cancer screening tests until 14 days after patients were discharged from the hospital so the company could bill Medicare directly for the tests given that laboratories cannot bill directly for tests ordered within two weeks of discharge.
A pharmaceutical manufacturer agreed to pay $678 million to state and federal governments to resolve claims that it arranged for educational events for physicians and provided large speaker fees and other benefits to doctors who presented at the events in exchange for the doctors prescribing their drugs.
A drug manufacturer agreed to pay more than $51 million to settle claims that it worked with three foundations to channel money for co-pays to patients taking the company's drugs.
An ophthalmology practice agreed to pay $4.8 to settle allegations that it billed federal healthcare programs for single-use drugs but actually used the single-use vials to treat multiple patients.
An anesthesiologist agreed to pay $100,000 to settle claims that he submitted bills for surgical procedures to implant neurostimulator electrodes when the procedures performed were actually the non-surgical application of a device, which is not covered by Medicare.
A drug manufacturer agreed to pay more than $51 million to settle claims that it worked with three foundations to channel money for co-pays to patients taking the company's drugs.
An ophthalmology practice agreed to pay $4.8 to settle allegations that it billed federal healthcare programs for single-use drugs but actually used the single-use vials to treat multiple patients.
An anesthesiologist agreed to pay $100,000 to settle claims that he submitted bills for surgical procedures to implant neurostimulator electrodes when the procedures performed were actually the non-surgical application of a device, which is not covered by Medicare.
A pain management clinic agreed to pay $400,000 to resolve allegations that it billed Medicare and TennCare for tests that were not necessary based on the patients' medical records and the results that were not used in subsequent treatment.
A pain management clinic agreed to pay $400,000 to resolve allegations that it billed Medicare and TennCare for tests that were not necessary based on the patients' medical records and the results that were not used in subsequent treatment.
A hospital system agreed to pay $16 million to settle two separate allegations. One claim involved case managers billing for procedures at inpatient care levels despite physicians recommending outpatient or observation levels of care. The other claim involved the acquisition of a physician practice group by the hospital. Allegations were made that the hospital paid above fair market value for a lab partially owned by the physican practice group as part of the transaction, falling in violation of the Anti-Kickback Statute.
A hospital system agreed to pay $16 million to settle two separate allegations. One claim involved case managers billing for procedures at inpatient care levels despite physicians recommending outpatient or observation levels of care. The other claim involved the acquisition of a physician practice group by the hospital. Allegations were made that the hospital paid above fair market value for a lab partially owned by the physican practice group as part of the transaction, falling in violation of the Anti-Kickback Statute.
A university medical center agreed to pay $2.625 million to resolve claims that it billed Medicare and Medicaid for a certain procedure and post-surgical follow-up care when the procedure is considered not medically necessary and not covered by federal healthcare programs.
A university medical center agreed to pay $2.625 million to resolve claims that it billed Medicare and Medicaid for a certain procedure and post-surgical follow-up care when the procedure is considered not medically necessary and not covered by federal healthcare programs.
A home healthcare company and its owner agreed to pay more than $111,000 to settle allegations that they submitted claims to MaineCare for services provided to patients with mental health diagnoses despite being notified multiple times that they were not licensed to bill for the services.
A home healthcare company and its owner agreed to pay more than $111,000 to settle allegations that they submitted claims to MaineCare for services provided to patients with mental health diagnoses despite being notified multiple times that they were not licensed to bill for the services.
A chiropractic clinic and two chiropractors agreed to pay more than $30,000 to settle allegations that they billed Medicaid for treatments of conditions which Medicaid does not cover.
A neurology center and its owner agreed to pay $2 million to settle allegations that they submitted claims to federal healthcare programs for services performed by unqualified assistants, services that were performed on different dates than were represented on the claims, physical therapy when the service performed was actually massage therapy, claims coded with multiple unbundled codes instead of the correct single code, claims with incorrect provider names, and claims that were resubmitted with altered information after being originally denied.
A chiropractic clinic and two chiropractors agreed to pay more than $30,000 to settle allegations that they billed Medicaid for treatments of conditions which Medicaid does not cover.
A neurology center and its owner agreed to pay $2 million to settle allegations that they submitted claims to federal healthcare programs for services performed by unqualified assistants, services that were performed on different dates than were represented on the claims, physical therapy when the service performed was actually massage therapy, claims coded with multiple unbundled codes instead of the correct single code, claims with incorrect provider names, and claims that were resubmitted with altered information after being originally denied.
A home healthcare company agreed to pay $175,000 to settle allegations that it submitted bills to federal healthcare programs for visits that were not medically necessary and services for patients who were not homebound. The company also allegedly manipulated records to justify these false claims.
A home healthcare company agreed to pay $175,000 to settle allegations that it submitted bills to federal healthcare programs for visits that were not medically necessary and services for patients who were not homebound. The company also allegedly manipulated records to justify these false claims.
A dentist agreed to pay $82,500 to settle claims that she charged the Connecticut Medical Assistance Program for dental work that was either not provided or was more limited and less expensive than what was billed.
A dentist agreed to pay $82,500 to settle claims that she charged the Connecticut Medical Assistance Program for dental work that was either not provided or was more limited and less expensive than what was billed.
A medical practice agreed to pay $750,000 to settle allegations that it billed federal healthcare programs for more expensive levels of service than were actually provided and billed for some services as if separate evaluation and management services were provided when they were not.
A pain clinic operator agreed to pay more than $480,000 to settle claims that it got new Medicare payment numbers in order to receive Medicare reimbursements for claims submitted by clinics that had previously been owned and operated by a company that had all Medicare payments suspended.
A medical practice agreed to pay $750,000 to settle allegations that it billed federal healthcare programs for more expensive levels of service than were actually provided and billed for some services as if separate evaluation and management services were provided when they were not.
A pain clinic operator agreed to pay more than $480,000 to settle claims that it got new Medicare payment numbers in order to receive Medicare reimbursements for claims submitted by clinics that had previously been owned and operated by a company that had all Medicare payments suspended.
A physician agreed to pay $450,000 to resolve claims that he received payments from a home health company in exchange for certifying patients for home health services when he had no knowledge of the patients' medical status.
A physician agreed to pay $450,000 to resolve claims that he received payments from a home health company in exchange for certifying patients for home health services when he had no knowledge of the patients' medical status.
A physician and owner of pain clinics, the clinics, and a testing laboratory also owned by the doctor agreed to pay $2.85 million to settle claims that the pain clinics conducted full urine drug tests on patients every time they were seen, resulting in many medically unnecessary tests being billed to government healthcare programs.
A physician and owner of pain clinics, the clinics, and a testing laboratory also owned by the doctor agreed to pay $2.85 million to settle claims that the pain clinics conducted full urine drug tests on patients every time they were seen, resulting in many medically unnecessary tests being billed to government healthcare programs.
A substance abuse and mental health treatment provider agreed to pay $295,000 to settle claims that it received reimbursements from Medicaid for bundled services that included on-site drug testing when in fact the drug tests were performed by an outside party who also received reimbursement.
A substance abuse and mental health treatment provider agreed to pay $295,000 to settle claims that it received reimbursements from Medicaid for bundled services that included on-site drug testing when in fact the drug tests were performed by an outside party who also received reimbursement.
A podiatry clinic and an associated physician agreed to pay $750,000 to settle allegations that they submitted claims to Medicare and the FEHB Program for nail debridement services that were not medically necessary or not appropriately assessed, or for cases in which procedures with lower reimbursements were actually performed. The allegations include the falsification of patient records to support the false claims.
A podiatry clinic and an associated physician agreed to pay $750,000 to settle allegations that they submitted claims to Medicare and the FEHB Program for nail debridement services that were not medically necessary or not appropriately assessed, or for cases in which procedures with lower reimbursements were actually performed. The allegations include the falsification of patient records to support the false claims.
A pain management clinic operator and its owner agreed to pay at least $1.35 million to settle claims that they ordered urine drug tests that were not medically necessary in exchange for kickbacks from the drug testing laboratory.
A pain management clinic operator and its owner agreed to pay at least $1.35 million to settle claims that they ordered urine drug tests that were not medically necessary in exchange for kickbacks from the drug testing laboratory.
A doctor, his wife, and their medical practice agreed to pay $5.5 million and relinquish $3.3 million in assets to settle allegations that they billed Medicare for a massive number of diagnostic tests and then did not appropriately reimburse the physicians who interpreted the tests, submitted claims for office visits that were for medication refills instead of the more complex procedures represented on the claims or were for an excessive length of time, and received reimbursement for tests that the doctor was not qualified to interpret.
A doctor, his wife, and their medical practice agreed to pay $5.5 million and relinquish $3.3 million in assets to settle allegations that they billed Medicare for a massive number of diagnostic tests and then did not appropriately reimburse the physicians who interpreted the tests, submitted claims for office visits that were for medication refills instead of the more complex procedures represented on the claims or were for an excessive length of time, and received reimbursement for tests that the doctor was not qualified to interpret.
A clinical testing laboratory agreed to pay up to $43 million to resolve allegations that it submitted claims to Medicare, TRICARE, and the FEHB Program for tests that were not medically necessary, used improper billing techniques, and provided three vendors with compensation in the form of illegal kickbacks.
A clinical testing laboratory agreed to pay up to $43 million to resolve allegations that it submitted claims to Medicare, TRICARE, and the FEHB Program for tests that were not medically necessary, used improper billing techniques, and provided three vendors with compensation in the form of illegal kickbacks.
A home health agency and its owners agreed to pay $450,000 to settle allegations that they billed the Massachusetts Medicaid program for services that were provided when patients were not at home, when nurses were not in the state, when physicians had not approved the services, and for services provided by the same nurse at the same time to two individuals not at the same location. They also billed without using the proper modifier codes, resulting in higher reimbursement rates for services.
An orthopedic surgeon agreed to pay $1.75 million to settle allegations that he received consulting payments and free meals from a medical device manufacturer or its false third-party entity. The payments were for consulting time that the surgeon estimated based on how often he used the company's devices and cannot be documented.
A home health agency and its owners agreed to pay $450,000 to settle allegations that they billed the Massachusetts Medicaid program for services that were provided when patients were not at home, when nurses were not in the state, when physicians had not approved the services, and for services provided by the same nurse at the same time to two individuals not at the same location. They also billed without using the proper modifier codes, resulting in higher reimbursement rates for services.
An orthopedic surgeon agreed to pay $1.75 million to settle allegations that he received consulting payments and free meals from a medical device manufacturer or its false third-party entity. The payments were for consulting time that the surgeon estimated based on how often he used the company's devices and cannot be documented.
An ambulance company agreed to pay $110,000 to settle claims that it submitted claims to Medicare for ambulance transport services that were not supported by the medical record or were not medically necessary.
An ambulance company agreed to pay $110,000 to settle claims that it submitted claims to Medicare for ambulance transport services that were not supported by the medical record or were not medically necessary.
A hospital operator and an ENT clinic agreed to pay more than $9.3 million to resolve allegations that they had a financial agreement in place whereby the hospital would reimburse the clinic for actual costs attributed to certain doctors, guaranteeing certain income for some physicians. The clinic then received reimbursements beyond the allowable amounts for these costs.
A hospital operator and an ENT clinic agreed to pay more than $9.3 million to resolve allegations that they had a financial agreement in place whereby the hospital would reimburse the clinic for actual costs attributed to certain doctors, guaranteeing certain income for some physicians. The clinic then received reimbursements beyond the allowable amounts for these costs.
A psychiatrist agreed to pay more than $91,000 to settle allegations that on several occasions he claimed to have seen more than 120 patients in a single day and falsely stated beginning and end times for those appointments since it would not be possible to see that number of patients for the required 15 minute appointments in a single day.
A psychiatrist agreed to pay more than $91,000 to settle allegations that on several occasions he claimed to have seen more than 120 patients in a single day and falsely stated beginning and end times for those appointments since it would not be possible to see that number of patients for the required 15 minute appointments in a single day.
A cardiologist and three related practices agreed to pay $750,000 to settle claims that they provided ankle-brachial index testing to patients without collecting the fair market value for the tests from the referring physicians, thus inducing patient referrals in violation of Medicare and TRICARE.
A cardiologist and three related practices agreed to pay $750,000 to settle claims that they provided ankle-brachial index testing to patients without collecting the fair market value for the tests from the referring physicians, thus inducing patient referrals in violation of Medicare and TRICARE.
A laboratory, a pain clinic, and two executives agreed to pay $41 million to settle claims that they billed Medicare, Medicaid, and TRICARE for urine drug testing that was not medically necessary.
A physician agreed to pay $436,000 to resolve claims that he billed Medicare for tests and injections that were not medically necessary and were used to monitor symptoms rather than make decisions about care.
A laboratory, a pain clinic, and two executives agreed to pay $41 million to settle claims that they billed Medicare, Medicaid, and TRICARE for urine drug testing that was not medically necessary.
A physician agreed to pay $436,000 to resolve claims that he billed Medicare for tests and injections that were not medically necessary and were used to monitor symptoms rather than make decisions about care.
A nursing home chain agreed to pay $10 million to settle allegations that it submitted claims to Medicare for rehabilitation services that were coded as if higher levels of care were provided than were necessary.
A nursing home chain agreed to pay $10 million to settle allegations that it submitted claims to Medicare for rehabilitation services that were coded as if higher levels of care were provided than were necessary.
A hospital agreed to pay more than $1.7 million to settle claims that it received Medicare reimbursements for claims which were not supported by the medical records.
A hospital agreed to pay more than $1.7 million to settle claims that it received Medicare reimbursements for claims which were not supported by the medical records.
A provider of rehabilitation services agreed to pay more than $4 million to settle allegations that its policies and practices caused three skilled nursing facilities to bill Medicare for rehabilitation therapy that was unnecessary, unreasonable, or unskilled. It also caused therapy records to be recorded as if individual sessions occurred when in fact they were group sessions.
A provider of rehabilitation services agreed to pay more than $4 million to settle allegations that its policies and practices caused three skilled nursing facilities to bill Medicare for rehabilitation therapy that was unnecessary, unreasonable, or unskilled. It also caused therapy records to be recorded as if individual sessions occurred when in fact they were group sessions.
A company that manufactures and sells human tissue grafts agreed to pay $6.5 million to settle claims that it charged the Department of Veterans Affairs inflated prices for the grafts by disclosing false information about their commercial pricing practices.
A chiropractor agreed to pay $2 million to settle claims that he billed Medicare for injections that were not medically necessary as well as custom knee braces that were not medically ncessary while receiving kickbacks from the manufacturer of the knee braces.
A physician agreed to pay $175,000 to settle claims under both the Controlled Substance Act and FCA. The FCA allegations involve claims that he billed Medicare for patient visits that did not actually take place.
A company that manufactures and sells human tissue grafts agreed to pay $6.5 million to settle claims that it charged the Department of Veterans Affairs inflated prices for the grafts by disclosing false information about their commercial pricing practices.
A chiropractor agreed to pay $2 million to settle claims that he billed Medicare for injections that were not medically necessary as well as custom knee braces that were not medically ncessary while receiving kickbacks from the manufacturer of the knee braces.
A physician agreed to pay $175,000 to settle claims under both the Controlled Substance Act and FCA. The FCA allegations involve claims that he billed Medicare for patient visits that did not actually take place.
The co-owner of two pharmaies agreed to pay $61,000 to settle claims that the pharmacies sold a compounded cream to patients in states in which the pharmacies were not licensed, waived part or all of the co-payments for the cream, and attempted to increase the number of prescriptions by paying sales representatives a commission for each prescription.
Two pharmacies and an owner agreed to pay $365,000 to settle claims that they sold a compounded cream to patients in states in which the pharmacies were not licensed, waived part or all of the co-payments for the cream, and attempted to increase the number of prescriptions by paying sales representatives a commission for each prescription.
Two pharmacies and an owner agreed to pay $365,000 to settle claims that they sold a compounded cream to patients in states in which the pharmacies were not licensed, waived part or all of the co-payments for the cream, and attempted to increase the number of prescriptions by paying sales representatives a commission for each prescription.
A physician assistant agreed to pay more than $620,500 to settle claims that he received payments from a compounding company disguised as medical director fees in exchange for prescribing and recommending the compounding company's pain creams.
A physician assistant agreed to pay more than $620,500 to settle claims that he received payments from a compounding company disguised as medical director fees in exchange for prescribing and recommending the compounding company's pain creams.
An optician group and its owner agreed to pay $263,000 to settle claims that they submitted claims to Medicare for repair services when the services provided were actually final adjustments for new glasses and were covered by the claims for the initial fittings.
An optician group and its owner agreed to pay $263,000 to settle claims that they submitted claims to Medicare for repair services when the services provided were actually final adjustments for new glasses and were covered by the claims for the initial fittings.
A behavioral therapy provider and a formerly-employed mental therapist agreed to pay $27,500 to settle allegations that they submitted claims to Medicaid for outpatient sessions that never occurred and for which the therapist forged documentation.
A behavioral therapy provider and a formerly-employed mental therapist agreed to pay $27,500 to settle allegations that they submitted claims to Medicaid for outpatient sessions that never occurred and for which the therapist forged documentation.
A pharmacy and its pharmacist-in-charge agreed to pay up to $2.1 million to resolve allegations that it filled prescriptions written by a doctor who has since been sentenced to 240 months in prison for operating a "pill mill" when there were numerous indications that the presciriptions were not legitimate.
A pharmacy and its pharmacist-in-charge agreed to pay up to $2.1 million to resolve allegations that it filled prescriptions written by a doctor who has since been sentenced to 240 months in prison for operating a "pill mill" when there were numerous indications that the presciriptions were not legitimate.
A physician agreed to pay $850,000 to settle claims that she received kickbacks from a pharmaceutical company in exchange for prescribing one of its drugs.
A physician agreed to pay $850,000 to settle claims that she received kickbacks from a pharmaceutical company in exchange for prescribing one of its drugs.
A physician agreed to pay $2.8 million to resolve allegations under the FCA and the Controlled Substances Act that his business dispensed drugs regardless of whether they were medically necessary and then submitted claims to insurance providers and Medicare for the drugs and for services that were not actually provided. He has pleaded guilty to related criminal charges.
A physician agreed to pay $2.8 million to resolve allegations under the FCA and the Controlled Substances Act that his business dispensed drugs regardless of whether they were medically necessary and then submitted claims to insurance providers and Medicare for the drugs and for services that were not actually provided. He has pleaded guilty to related criminal charges.
An internal medicine practice agreed to pay $425,000 to settle allegations that it submitted claims to Medicaid, Medicare, and the FEHB Program for products that were only to be distributed in foreign markets as if they were approved products.
An internal medicine practice agreed to pay $425,000 to settle allegations that it submitted claims to Medicaid, Medicare, and the FEHB Program for products that were only to be distributed in foreign markets as if they were approved products.
A dermatologist and his practice agreed to pay more than $1.7 million to settle claims that he submitted claims to Medicare for adjacent tissue transfers, when in fact, the procedures performed were less complex wound repairs.
A dermatologist and his practice agreed to pay more than $1.7 million to settle claims that he submitted claims to Medicare for adjacent tissue transfers, when in fact, the procedures performed were less complex wound repairs.
A pharmacist and his pharmacy agreed to pay $300,000 to resolve civil claims that they submitted claims to Medicare for a brand name drug when they had substituted the generic equivalent. The settlement resolves civil claims, but the pharmacist also pleaded guilty to related criminal charges.
A company that operates outpatient clinics agreed to pay $1.85 million to resolve allegations that it violated the terms of its contract with the Department of Veterans Affairs to operate two clinics in Minnesota by not scheduling appointments within 14 days of the requested date and also changed the requested appointment dates to make the times between those dates and the actual appointment dates appear shorter.
A pharmacist and his pharmacy agreed to pay $300,000 to resolve civil claims that they submitted claims to Medicare for a brand name drug when they had substituted the generic equivalent. The settlement resolves civil claims, but the pharmacist also pleaded guilty to related criminal charges.
A company that operates outpatient clinics agreed to pay $1.85 million to resolve allegations that it violated the terms of its contract with the Department of Veterans Affairs to operate two clinics in Minnesota by not scheduling appointments within 14 days of the requested date and also changed the requested appointment dates to make the times between those dates and the actual appointment dates appear shorter.
A physician group agreed to pay more than $1.2 million to settle claims that they billed Medicare for sleep tests that were conducted without certified sleep technicians present as required by Medicare.
A physician group agreed to pay more than $1.2 million to settle claims that they billed Medicare for sleep tests that were conducted without certified sleep technicians present as required by Medicare.
A hospice provider and two of its senior executives agreed to pay $1.75 million to settle claims that it submitted claims for hospice benefits for patients who were not terminally ill. The company also submitted claims for services provided by a physician who was not actually a provider at the hospice, but instead was paid to be a "back up" medical director.
A hospice provider and two of its senior executives agreed to pay $1.75 million to settle claims that it submitted claims for hospice benefits for patients who were not terminally ill. The company also submitted claims for services provided by a physician who was not actually a provider at the hospice, but instead was paid to be a "back up" medical director.
Two physicians agreed to pay more than $4.9 million to settle allegations that they fraudulently obtained a prescription rheumatoid arthrititis drug for free by submitting false claims to Medicaid, resulting in the delivery of the drug to their clinic. They then provided the drug to other patients and submitted claims for those patients to the Connecticut State Employees Health Plan, pocketing the proceeds.
Two physicians agreed to pay more than $4.9 million to settle allegations that they fraudulently obtained a prescription rheumatoid arthrititis drug for free by submitting false claims to Medicaid, resulting in the delivery of the drug to their clinic. They then provided the drug to other patients and submitted claims for those patients to the Connecticut State Employees Health Plan, pocketing the proceeds.
A hospice provider agreed to pay $1 million to settle allegations that it submitted claims to Medicare for patients who were not terminally ill and thus, not eligible for the Medicare hospice benefit.
An operator of skilled nursing and rehabilitation facilities agreed to pay $9.5 million to settle allegations that it classified Medicare patients under the highest level of reimbursement when the patients did not warrant such classification, resulting in reimbursements for therapy services that were not medically necessary. The settlement also resolves allegations that the company forged pre-admission evaluation certifications.
A pharmaceutical company agreed to pay $11.85 million to settle claims that covered the cost of co-pays for Medicare beneficiaries who were prescribed a specific multiple sclerosis drug through contributions to a charitable foundation.
A hospice provider agreed to pay $1 million to settle allegations that it submitted claims to Medicare for patients who were not terminally ill and thus, not eligible for the Medicare hospice benefit.
An operator of skilled nursing and rehabilitation facilities agreed to pay $9.5 million to settle allegations that it classified Medicare patients under the highest level of reimbursement when the patients did not warrant such classification, resulting in reimbursements for therapy services that were not medically necessary. The settlement also resolves allegations that the company forged pre-admission evaluation certifications.
A pharmaceutical company agreed to pay $11.85 million to settle claims that covered the cost of co-pays for Medicare beneficiaries who were prescribed a specific multiple sclerosis drug through contributions to a charitable foundation.
A healthcare clinic agreed to pay $775,000 to settle allegations that it submitted claims for outpatient insulin infusion treatments, which are not covered by Medicare or TRICARE, by referring to the treatments as "artificial pancreas treatments" instead.
A healthcare clinic agreed to pay $775,000 to settle allegations that it submitted claims for outpatient insulin infusion treatments, which are not covered by Medicare or TRICARE, by referring to the treatments as "artificial pancreas treatments" instead.
A dentist and his practice agreed to pay $135,000 to resolve allegations that he rewarded customers who attended appointments and referred patients with monetary incentives and raffle prizes, violating Massachusetts state law.
An operator of elder care facilities and several subsidiaries agreed to pay more than $15.4 million to settle allegations that some of the facilities billed Medicare for rehabilitation services that were not medically necessary. The company also disclosed that it received payment for ineligible services due to its employment of two individuals who were excluded from federal healthcare programs.
A dentist and his practice agreed to pay $135,000 to resolve allegations that he rewarded customers who attended appointments and referred patients with monetary incentives and raffle prizes, violating Massachusetts state law.
An operator of elder care facilities and several subsidiaries agreed to pay more than $15.4 million to settle allegations that some of the facilities billed Medicare for rehabilitation services that were not medically necessary. The company also disclosed that it received payment for ineligible services due to its employment of two individuals who were excluded from federal healthcare programs.
A hospital agreed to pay $4.1 million to settle claims that it submitted claims to Medicare and TennCare that resulted from improper financial arrangements between the hospital and a physician practice owned by the hospital.
A hospital agreed to pay $4.1 million to settle claims that it submitted claims to Medicare and TennCare that resulted from improper financial arrangements between the hospital and a physician practice owned by the hospital.
A neurosurgeon agreed to pay $2.35 million to settle allegations that he created, secretly controlled, and profited from companies that distributed spinal implant equipment which was purchased by hospitals at which the doctor performed surgeries and was used in surgeries he performed.
A neurosurgeon agreed to pay $2.35 million to settle allegations that he created, secretly controlled, and profited from companies that distributed spinal implant equipment which was purchased by hospitals at which the doctor performed surgeries and was used in surgeries he performed.
A healthcare company and an affiliated hospital agreed to pay $1.41 million to settle claims that they charged Medicare for cardiac monitors implanted in Medicare beneficiaries and which were not medically necessary.
A healthcare company and an affiliated hospital agreed to pay $1.41 million to settle claims that they charged Medicare for cardiac monitors implanted in Medicare beneficiaries and which were not medically necessary.
A behavioral health provider and its owner agreed to pay $200,000 to settle allegations that it submitted claims to the Connecticut Medical Assistance Program for psychotherapy services that were never provided and for non-psychotherapy services that were not eligible for reimbursement.
An opthalmology practice agreed to pay $1.5 million to settle claims that it charged Medicare and Medicaid for exams that were included in the billings for other procedures performed on the same day and should not have been billed separately. The settlement also resolves charges that exams were billed at higher levels than they should have been.
A behavioral health provider and its owner agreed to pay $200,000 to settle allegations that it submitted claims to the Connecticut Medical Assistance Program for psychotherapy services that were never provided and for non-psychotherapy services that were not eligible for reimbursement.
An opthalmology practice agreed to pay $1.5 million to settle claims that it charged Medicare and Medicaid for exams that were included in the billings for other procedures performed on the same day and should not have been billed separately. The settlement also resolves charges that exams were billed at higher levels than they should have been.
An electronic health records software company agreed to pay $118,642,000 to resolve civil claims and an additional $25,398,300 criminal fine plus the forfeiture of almost $1 million in criminal proceeds. The civil allegations settled by the agreement include claims that the company received kickbacks from pharmaceutical companies in exchange for implementing alerts in its electronic health records system designed to influence healthcare providers to increase the use of the pharmaceutical companies' products. The civil settlement also covers allegations that the software did not meet all requirements that it purported to meet.
An electronic health records software company agreed to pay $118,642,000 to resolve civil claims and an additional $25,398,300 criminal fine plus the forfeiture of almost $1 million in criminal proceeds. The civil allegations settled by the agreement include claims that the company received kickbacks from pharmaceutical companies in exchange for implementing alerts in its electronic health records system designed to influence healthcare providers to increase the use of the pharmaceutical companies' products. The civil settlement also covers allegations that the software did not meet all requirements that it purported to meet.
A family physician and his practice agreed to pay $285,000 to settle claims that he billed Medicare, Medicaid, and TRICARE for services as if they were provided by a physician when in fact they were provided by a nurse practitioner.
A licensed professional counselor and her practice agreed to pay more than $39,000 to settle allegations that she repeatedly billed Medicaid for 60-minute individual service sessions when the sessions were actually shorter than the time billed.
A pain clinic and its owner agreed to pay $650,000 to settle allegations that it billed Medicare for nerve conduction studies and substance abuse assessments that were not medically necessary or were not performed as billed.
A family physician and his practice agreed to pay $285,000 to settle claims that he billed Medicare, Medicaid, and TRICARE for services as if they were provided by a physician when in fact they were provided by a nurse practitioner.
A licensed professional counselor and her practice agreed to pay more than $39,000 to settle allegations that she repeatedly billed Medicaid for 60-minute individual service sessions when the sessions were actually shorter than the time billed.
A pain clinic and its owner agreed to pay $650,000 to settle allegations that it billed Medicare for nerve conduction studies and substance abuse assessments that were not medically necessary or were not performed as billed.
A company that contracts with physician groups to provide care through a health system agreed to pay more than $2.9 million to resolve allegations that it did not provide appropriate documentation of the nature and complexity of services provided when submitting claims to Medicare. Additional allegations included the payment of compensation to physicians and physician groups in amounts higher than fair market value.
A company that contracts with physician groups to provide care through a health system agreed to pay more than $2.9 million to resolve allegations that it did not provide appropriate documentation of the nature and complexity of services provided when submitting claims to Medicare. Additional allegations included the payment of compensation to physicians and physician groups in amounts higher than fair market value.
An otolaryngologist agreed to pay more than $1.1 million to settle claims that he and his practice provided benefits to medical management companies for adult homes in order to have exclusive access to the residents for allergy testing and other services. These services were not always medically necessary and were performed by a nurse practitioner rather than the physician, and then billed to Medicare and the FEHB Program.
A nonprofit foundation agreed to pay $3 million to settle allegations that it worked with three drug manufacturers to enable the manufacturers to cover the cost of co-pays for Medicare patients using specific drugs.
An otolaryngologist agreed to pay more than $1.1 million to settle claims that he and his practice provided benefits to medical management companies for adult homes in order to have exclusive access to the residents for allergy testing and other services. These services were not always medically necessary and were performed by a nurse practitioner rather than the physician, and then billed to Medicare and the FEHB Program.
A nonprofit foundation agreed to pay $3 million to settle allegations that it worked with three drug manufacturers to enable the manufacturers to cover the cost of co-pays for Medicare patients using specific drugs.
A physician agreed to pay more than $300,000 to settle civil claims that he billed Medicare for visits to patients at nursing homes as if he had spent more time with the patients than he actually did, causing Medicare to reimburse at a higher rate. In a related criminal case, the doctor will pay a fine and was sentenced to two months in prison.
A physician agreed to pay more than $300,000 to settle civil claims that he billed Medicare for visits to patients at nursing homes as if he had spent more time with the patients than he actually did, causing Medicare to reimburse at a higher rate. In a related criminal case, the doctor will pay a fine and was sentenced to two months in prison.
An operator of clinics specializing in temporomandibular joint disorder treatment agreed to pay $1 million to resolve claims that it billed Medicaid and TRICARE for oral appliances as if the appliances were fabricated by the company when in fact they were purchased from an outside laboratory.
A durable medical equipment manufacturer agreed to pay more than $37.5 million to settle claims that it provided services to suppliers that would allow them to easily reorder sleep apnea supplies, provided equipment and installation services for free to sleep labs, assisted suppliers in arranging for financing of the manufacturer's equipment, and provided sleep apnea testing devices to non-sleep specialist physicians.
An operator of clinics specializing in temporomandibular joint disorder treatment agreed to pay $1 million to resolve claims that it billed Medicaid and TRICARE for oral appliances as if the appliances were fabricated by the company when in fact they were purchased from an outside laboratory.
A durable medical equipment manufacturer agreed to pay more than $37.5 million to settle claims that it provided services to suppliers that would allow them to easily reorder sleep apnea supplies, provided equipment and installation services for free to sleep labs, assisted suppliers in arranging for financing of the manufacturer's equipment, and provided sleep apnea testing devices to non-sleep specialist physicians.
A personal injury law firm agreed to pay more than $6,600 and meet other conditions to settle allegations that it received Medicare payments from the United States on behalf of the firm's clients and then failed to reimburse Medicare as required.
A personal injury law firm agreed to pay more than $6,600 and meet other conditions to settle allegations that it received Medicare payments from the United States on behalf of the firm's clients and then failed to reimburse Medicare as required.
A pain management physician agreed to pay more than $100,000 to settle allegations that she issued prescriptions for opioids which were not medically necessary. This civil settlement is related to criminal charges to which she pleaded guilty in 2018.
An autism service provider agreed to pay $675,000 to settle claims that it submitted claims to TRICARE that mispresented the services provided and/or who provided the service, were not supported by a medical record, or requested payment for more units of time than the medical record indicated.
A pain management physician agreed to pay more than $100,000 to settle allegations that she issued prescriptions for opioids which were not medically necessary. This civil settlement is related to criminal charges to which she pleaded guilty in 2018.
An autism service provider agreed to pay $675,000 to settle claims that it submitted claims to TRICARE that mispresented the services provided and/or who provided the service, were not supported by a medical record, or requested payment for more units of time than the medical record indicated.
A behavioral health clinic and its owners agreed to pay $1.65 million to resolve allegations that it submitted claims to Medicaid for therapy sessions that were not held, for services to clients who were deceased or hospitalized at the time of the alleged services, and for services provided by unqualified individuals. Additional claims were inflated and based on patient notes that were false or contained forged signatures.
A behavioral health clinic and its owners agreed to pay $1.65 million to resolve allegations that it submitted claims to Medicaid for therapy sessions that were not held, for services to clients who were deceased or hospitalized at the time of the alleged services, and for services provided by unqualified individuals. Additional claims were inflated and based on patient notes that were false or contained forged signatures.
Two eye doctors agreed to pay almost $950,000 to settle claims that they received Medicare payments for care that was provided by another physician in their practice who did not have the correct credentials to provide care to Medicare patients.
Two eye doctors agreed to pay almost $950,000 to settle claims that they received Medicare payments for care that was provided by another physician in their practice who did not have the correct credentials to provide care to Medicare patients.
A company providing interoperative neuromonitoring services to hospitals and surgeons agreed to pay $1.9 million to resolve claims that it billed Medicare for units of such services not provided exclusively to one patient, as required by Medicare.
A company providing interoperative neuromonitoring services to hospitals and surgeons agreed to pay $1.9 million to resolve claims that it billed Medicare for units of such services not provided exclusively to one patient, as required by Medicare.
A compounding pharmacy and its owners agreed to pay more than $1.9 million to settle claims that they provided benefits to physicians to induce them to prescribe a topical pain cream, and then also put in place a high-dose refill scheme without taking into account patient need, thus increasing the amount of claims submitted to TRICARE.
A cardiologist and his company agreed to pay $1.2 million to settle civil claims that they submitted claims to Medicare that did not comply with Medicare regulations, were upcoded, or which indicated services were provided on multiple days when they were not. Relatedly, both the physician and the company pleaded guilty to criminal charges in the case.
A company providing physician services to patients at their residences and its management services affiliate agreed to pay $829,611 to settle claims that it billed Medicare for physician visits which were not medically necessary.
A compounding pharmacy and its owners agreed to pay more than $1.9 million to settle claims that they provided benefits to physicians to induce them to prescribe a topical pain cream, and then also put in place a high-dose refill scheme without taking into account patient need, thus increasing the amount of claims submitted to TRICARE.
A cardiologist and his company agreed to pay $1.2 million to settle civil claims that they submitted claims to Medicare that did not comply with Medicare regulations, were upcoded, or which indicated services were provided on multiple days when they were not. Relatedly, both the physician and the company pleaded guilty to criminal charges in the case.
A company providing physician services to patients at their residences and its management services affiliate agreed to pay $829,611 to settle claims that it billed Medicare for physician visits which were not medically necessary.
A hematology and oncology practice and its owner agreed to pay $3,356,565 to settle allegations that it billed Medicare and Medi-Cal for drugs that were not purchased, dispensed, or administered and for services that were never provided.
A hematology and oncology practice and its owner agreed to pay $3,356,565 to settle allegations that it billed Medicare and Medi-Cal for drugs that were not purchased, dispensed, or administered and for services that were never provided.
The owner of a home care company agreed to pay $400,000 to resolve allegations that the company submitted false claims to Medicaid for adult day health services and non-emergency transportation services, and then falsified records to hide the false claims. The company will pay $9.7 million under a separate settlement.
A home care provider agreed to pay $9.7 million to resolve allegations that it submitted false claims to Medicaid for adult day health services and non-emergency transportation services, and then falsified records to hide the false claims. The owner of the company agreed to pay $400,000 in a separate settlement.
The owner of a home care company agreed to pay $400,000 to resolve allegations that the company submitted false claims to Medicaid for adult day health services and non-emergency transportation services, and then falsified records to hide the false claims. The company will pay $9.7 million under a separate settlement.
A home care provider agreed to pay $9.7 million to resolve allegations that it submitted false claims to Medicaid for adult day health services and non-emergency transportation services, and then falsified records to hide the false claims. The owner of the company agreed to pay $400,000 in a separate settlement.
A former laboratory manager and sales representative agreed to pay almost $650,000 to settle allegations that he provided equipment and services to doctors in exchange for them sending urine samples to the laboratory for testing that was medically unnecessary.
A hospital agreed to pay $11,332 to settle claims that it billed Medicare and Medicaid for medically unnecessary tests for tick-borne diseases through the use of testing panels which prompted the laboratory to test for diseases not likely to be present.
A former laboratory manager and sales representative agreed to pay almost $650,000 to settle allegations that he provided equipment and services to doctors in exchange for them sending urine samples to the laboratory for testing that was medically unnecessary.
A hospital agreed to pay $11,332 to settle claims that it billed Medicare and Medicaid for medically unnecessary tests for tick-borne diseases through the use of testing panels which prompted the laboratory to test for diseases not likely to be present.
An internist agreed to pay more than $175,000 to resolve claims that he billed Medicare for peripheral autonomic nervous function tests and vestibular function tests that were medically unnecessary. The test results were not used in clinical decision making regarding patient care, and, in some cases, the physician did not have the needed equipment or training.
An internist agreed to pay more than $175,000 to resolve claims that he billed Medicare for peripheral autonomic nervous function tests and vestibular function tests that were medically unnecessary. The test results were not used in clinical decision making regarding patient care, and, in some cases, the physician did not have the needed equipment or training.
A pharmaceutical company agreed to pay $1.1 million to resolve claims that it made arrangements with another pharmaceutical company regarding price, supply, and customer allocation of some generic drugs, and, as part of these arrangements, paid and received remuneration. The civil settlement is accompanied by a deferred prosecution agreement in a related criminal case against the company.
A pharmaceutical company agreed to pay $1.1 million to resolve claims that it made arrangements with another pharmaceutical company regarding price, supply, and customer allocation of some generic drugs, and, as part of these arrangements, paid and received remuneration. The civil settlement is accompanied by a deferred prosecution agreement in a related criminal case against the company.
A laboratory agreed to pay $26.67 million to settle allegations that it worked with independent marketers to make payments to physicians as investment returns in exchange for referrals to the laboratory for tests. The settlement also resolves allegations that the laboratory worked with hospitals to submit claims for outpatient testing for individuals who were not actually hospital outpatients.
A physician agreed to pay $300,000 to settle claims that he received payments disguised as medical director fees from a compounding pharmacy in exchange for prescribing the pharmacy's pain creams.
A laboratory agreed to pay $26.67 million to settle allegations that it worked with independent marketers to make payments to physicians as investment returns in exchange for referrals to the laboratory for tests. The settlement also resolves allegations that the laboratory worked with hospitals to submit claims for outpatient testing for individuals who were not actually hospital outpatients.
A physician agreed to pay $300,000 to settle claims that he received payments disguised as medical director fees from a compounding pharmacy in exchange for prescribing the pharmacy's pain creams.
A hospital agreed to pay more than $10 million to settle allegations that it submitted claims to Medicare for drugs that were not confirmed to be medically necessary and claims that were the result of Medicare beneficiaries receiving free supplies and waivers of deductibles and co-payments.
A nonprofit foundation agreed to pay $4 million to resolve allegations that it worked with three drug manufacturers to function as a pass-through by operating funds that enabled the companies to pay kickbacks to patients taking their multiple sclerosis drugs under the guise of receiving funds from a charity.
A hospital agreed to pay more than $10 million to settle allegations that it submitted claims to Medicare for drugs that were not confirmed to be medically necessary and claims that were the result of Medicare beneficiaries receiving free supplies and waivers of deductibles and co-payments.
A nonprofit foundation agreed to pay $4 million to resolve allegations that it worked with three drug manufacturers to function as a pass-through by operating funds that enabled the companies to pay kickbacks to patients taking their multiple sclerosis drugs under the guise of receiving funds from a charity.
A clinical laboratory agreed to pay more than $2 million to settle claims that it billed Medicare and Kentucky Medicaid for urine drug screens as if they were completed by a high complexity method when they were actually completed in a low complexity method. The settled claims also include allegations that the laboratory billed Medicare for specimen validity testing when Medicare guidance states that such testing should not be billed separately.
A clinical laboratory agreed to pay more than $2 million to settle claims that it billed Medicare and Kentucky Medicaid for urine drug screens as if they were completed by a high complexity method when they were actually completed in a low complexity method. The settled claims also include allegations that the laboratory billed Medicare for specimen validity testing when Medicare guidance states that such testing should not be billed separately.
A compounding pharmacy and its owner agreed to pay $205,000 to settle claims that it submitted claims to TRICARE for medications which had redundant active ingredients, were not prescribed in medically necessary dosages, or were the result of illegal arrangements between the pharmacy and the physicians prescribing the medications.
Several hospitals and a group of cardiovascular surgeons have agreed to pay more than $46 million to settle claims that the surgeons received payment from the hospitals in exchange for the referral of patients. The physician group settlement also covers claims that duplicative bills were submitted to Medicare for services rendered by physician assistants that were leased to the hospitals. The hospital owner is also settling allegations that some of its facilities submitted claims to Medicare for services referred by other physicians who were improperly compensated for the referrals and claims that were double-billed because the entity actually providing the services received reimbursement from Medicare directly.
A compounding pharmacy and its owner agreed to pay $205,000 to settle claims that it submitted claims to TRICARE for medications which had redundant active ingredients, were not prescribed in medically necessary dosages, or were the result of illegal arrangements between the pharmacy and the physicians prescribing the medications.
Several hospitals and a group of cardiovascular surgeons have agreed to pay more than $46 million to settle claims that the surgeons received payment from the hospitals in exchange for the referral of patients. The physician group settlement also covers claims that duplicative bills were submitted to Medicare for services rendered by physician assistants that were leased to the hospitals. The hospital owner is also settling allegations that some of its facilities submitted claims to Medicare for services referred by other physicians who were improperly compensated for the referrals and claims that were double-billed because the entity actually providing the services received reimbursement from Medicare directly.
A founder and former CEO of a chain of clinics, who has been sentenced to 5 years in prison for related criminal charges, agreed to sell 13 properties with the proceeds designated to resolve allegations that she billed Medi-Cal for a variety of false claims and also received kickbacks from a lab in exchange for referring the lab testing from her clinics to the lab. The allegations to be settled involve claims for services that were unnecessary, provided by unlicensed providers, or not provided at all.
A founder and former CEO of a chain of clinics, who has been sentenced to 5 years in prison for related criminal charges, agreed to sell 13 properties with the proceeds designated to resolve allegations that she billed Medi-Cal for a variety of false claims and also received kickbacks from a lab in exchange for referring the lab testing from her clinics to the lab. The allegations to be settled involve claims for services that were unnecessary, provided by unlicensed providers, or not provided at all.
A state health department agreed to pay more than $13.42 million to the federal government to settle claims that it caused its healthcare contractor to submit claims for nursing home and hospice services before providers had submitted the claims to the contractor in the months just before reimbursement rates were to decrease.
A hospital operator agreed to pay $6.25 million to resolve allegations that some of its hospitals submitted claims to Medicare for services that did not meet the requirements for the intensive levels of services being billed.
A state health department agreed to pay more than $13.42 million to the federal government to settle claims that it caused its healthcare contractor to submit claims for nursing home and hospice services before providers had submitted the claims to the contractor in the months just before reimbursement rates were to decrease.
A hospital operator agreed to pay $6.25 million to resolve allegations that some of its hospitals submitted claims to Medicare for services that did not meet the requirements for the intensive levels of services being billed.
A physician and his practice agreed to pay more than $244,000 to resolve claims that he billed Medicare and TRICARE for procedures invoving the insertion of arterial stents when such procedures were not medically necessary.
A physician and his practice agreed to pay more than $244,000 to resolve claims that he billed Medicare and TRICARE for procedures invoving the insertion of arterial stents when such procedures were not medically necessary.
A hospital agreed to pay $12.3 million to resolve allegations that it submitted Medicare claims for procedures and surgeries that were not properly supervised and for services that were not medically necessary. The settlement also covers claims that the hospital received reimbursement for referrals from a physician whose compensation was based in part on the referrals.
A doctor agreed to pay more than $65,000 to settle claims that he accepted payments disguised as medical director fees from a compounding pharmacy in exchange for prescribing the pharmacy's pain creams.
A hospital agreed to pay $12.3 million to resolve allegations that it submitted Medicare claims for procedures and surgeries that were not properly supervised and for services that were not medically necessary. The settlement also covers claims that the hospital received reimbursement for referrals from a physician whose compensation was based in part on the referrals.
A doctor agreed to pay more than $65,000 to settle claims that he accepted payments disguised as medical director fees from a compounding pharmacy in exchange for prescribing the pharmacy's pain creams.
A manufacturer of devices and equipment used in spinal surgeries agreed to pay $5.5 million to resolve claims that it identified surgeons who were likely to use their products and then entered into agreements to use the surgeons as consultants or to assist them in bringing products to market in exchange for the transfer of their patents or patent applications, all while tying these promises to the use of the company's products by the surgeons.
A compounding pharmacy agreed to pay $22.05 million to settle claims that its subsidiary reported inflated average wholesale prices, which are used in determining reimbursement rates. The settlement also settles claims that another subsidary provided kickbacks to doctors, waived co-pays, and used sham insurance programs in attempts to manipulate pricing and reimbursements.
A manufacturer of devices and equipment used in spinal surgeries agreed to pay $5.5 million to resolve claims that it identified surgeons who were likely to use their products and then entered into agreements to use the surgeons as consultants or to assist them in bringing products to market in exchange for the transfer of their patents or patent applications, all while tying these promises to the use of the company's products by the surgeons.
A compounding pharmacy agreed to pay $22.05 million to settle claims that its subsidiary reported inflated average wholesale prices, which are used in determining reimbursement rates. The settlement also settles claims that another subsidary provided kickbacks to doctors, waived co-pays, and used sham insurance programs in attempts to manipulate pricing and reimbursements.
Several home health companies agreed to pay $2.5 million to resolve allegations that they submitted claims to Medicaire and the Louisiana Medicaid program for home health services when there were no face-to-face meetings between patients and physicians.
Several home health companies agreed to pay $2.5 million to resolve allegations that they submitted claims to Medicaire and the Louisiana Medicaid program for home health services when there were no face-to-face meetings between patients and physicians.
A law firm agreed to pay more than $91,000 to settle allegations that it did not reimburse Medicare for conditional payments that Medicare made to medical providers for medical bills of firm clients after the firm received settlement proceeds.
A law firm agreed to pay more than $91,000 to settle allegations that it did not reimburse Medicare for conditional payments that Medicare made to medical providers for medical bills of firm clients after the firm received settlement proceeds.
A physician practice and three affiliated doctors agreed to pay $150,000 to settle claims that they charged patients out-of-pocket cash payments for a substance abuse treatment instead of billing it to the state Medicaid program.
A physician practice and three affiliated doctors agreed to pay $150,000 to settle claims that they charged patients out-of-pocket cash payments for a substance abuse treatment instead of billing it to the state Medicaid program.
A therapy services provider for autistic children agreed to pay $300,000 to settle claims that it billed TRICARE for services as if they were provided on an individual basis when in fact groups of children were provided the services together.
A therapy services provider for autistic children agreed to pay $300,000 to settle claims that it billed TRICARE for services as if they were provided on an individual basis when in fact groups of children were provided the services together.
A healthcare system agreed to pay $4 million to resolve claims that one of its rehabilitation hospitals submitted claims to Medicare that were based on inaccurate scores on the Patient Assessment Instrument forms, resulting in higher reimbursement for services for those patients than was correct.
A healthcare system agreed to pay $4 million to resolve claims that one of its rehabilitation hospitals submitted claims to Medicare that were based on inaccurate scores on the Patient Assessment Instrument forms, resulting in higher reimbursement for services for those patients than was correct.
A group of hospitals agreed to pay $20.25 million to settle claims that they employed a neurosurgeon even after being informed by his colleagues that he was receiving kickbacks for using devices distributed by a distributorship that he owned and was implanting the devices when they were not medically necessary.
A group of hospitals agreed to pay $20.25 million to settle claims that they employed a neurosurgeon even after being informed by his colleagues that he was receiving kickbacks for using devices distributed by a distributorship that he owned and was implanting the devices when they were not medically necessary.
A nonprofit foundation agreed to pay $4 million to resolve allegations that it worked with five pharmaceutical companies to function as a pass-through by operating funds that enabled the companies to pay kickbacks to patients taking their drugs under the guise of receiving funds from a charity.
A nonprofit foundation agreed to pay $2 million to resolve allegations that it worked with five pharmaceutical companies to function as a pass-through by operating funds that enabled the companies to pay kickbacks to patients taking their drugs under the guise of receiving funds from a charity.
A nonprofit foundation agreed to pay $4 million to resolve allegations that it worked with five pharmaceutical companies to function as a pass-through by operating funds that enabled the companies to pay kickbacks to patients taking their drugs under the guise of receiving funds from a charity.
