A family medicine doctor agreed to pay $96,000 to resolve allegations that he: (1) prescribed unsafe combinations of drugs; (2) wrote unlawful prescriptions; and (3) submitted claims to Medicare and Medicaid for services that were not performed. The settlement also restricts the doctor’s DEA registration for five years.
An oncology practice and its affiliated physicians, along with a reference laboratory have agreed to collectively pay over $4 million, plus accrued interest, to resolve FCA allegations that they entered into a kickback scheme where the laboratory paid for each biopsy referred by the oncology practice, in violation of the AKS. The settlement also resolves allegations of medically unnecessary services, treatments and tests being billed to federal healthcare programs from a specific doctor in the oncology practice, as well as her own practice entity. The doctor and her practice entered a three-year IA with HHS-OIG.
A chiropractic, medical, and DME provider and a group of doctors agreed to collectively pay $465,000 to resolve FCA allegations that they: (1) paid physicians to induce referrals of DME; or (2) accepted remuneration funds. Both actions resulted in false claims being submitted to the federal Medicare program, in violation of the AKS and Stark Law.
Two doctors and their family trust agreed to pay $342,466 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The parties agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A doctor and his pain management clinic agreed to pay $100,632 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The parties agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A doctor agreed to pay $217,430 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The doctor agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A doctor agreed to pay $120,634 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. The doctor agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
The owner of a nonprofit that secures and administers grants agreed to pay $500,000 to resolve FCA allegations that she and another company official forged signatures on federal grant applications and then used the received funds for personal use.
Two laboratory marketers and their marketing companies agreed to collectively pay $720,000 to resolve FCA allegations of involvement in a kickback scheme in exchange for laboratory referrals, in violation of the AKS. All parties agreed to cooperate with DOJ’s investigation of other participants in the alleged schemes.
A laboratory agreed to pay $2.1 million to resolve FCA allegations that it submitted false claims to North Carolina’s Medicaid program for both presumptive and definitive urine drug tests which were performed at the same time and often on the same sample, resulting in reimbursements being paid for confirmatory tests which were not medically necessary.
A teleradiology company and its owner agreed to pay $3.1 million to resolve FCA allegations that they submitted false claims to federal healthcare programs that: (1) misrepresented who performed the radiology services; (2) included services performed by non-U.S.-based contractors; and (3) were not properly reviewed by the correct U.S.-based provider.
A laboratory and three of its owners agreed to pay over $13.6 million to resolve FCA allegations that they submitted medically unnecessary laboratory tests that were not ordered by the patients’ treating physician. The parties also agreed to be excluded from participating in federal healthcare programs for 15 years.
A chemical importer and distributor agreed to pay $300,000 to resolve CSA allegations that it: (1) violated recordkeeping requirements; (2) repackaged and relabeled a List I chemical without being a registered manufacturer; and (3) drop shipped a List I chemical to a customer without first importing it through its registered location.
A doctor and his diagnostic centers agreed to pay $1.8 million to resolve FCA allegations that they submitted claims that were: (1) unreasonable; (2) medically unnecessary; (3) not supported by patients’ records and/or diagnoses; or (4) performed by untrained and unlicensed technicians. The doctor also referred patients to his personally owned diagnostic centers, in violation of the Stark Law.
A doctor and healthcare staffing company agreed to pay $700,000 to resolve allegations of their participation in a scheme to bill Medicare for diagnostic laboratory testing and DME which was medically unnecessary, in voilation of the AKS.
A home healthcare agency and its owner agreed to collectively pay $600,000 to resolve FCA allegations that they submitted false claims to federal and North Carolina healthcare programs for services that were: (1) never performed; (2) billed by staff who were not present in the facility; and (3) provided by family members and then billed as if they were performed by other staff, including the forging of documents. The settlement amount was based on the parties’ ability to pay.
A hospital agreed to pay $17.3 million to resolve self-disclosed FCA allegations that it paid kickbacks to physicians at its chemotherapy infusion center based on the volume of their referrals sent to the hospital, in violation of the AKS. The settlement also resolves allegations that the chemotherapy services billed to federal healthcare programs were provided by non-physicians and not properly supervised.
A company that develops and sells hemp-derived products agreed to pay $989,438 to resolve FCA allegations that it improperly acquired a Paycheck Protection Loan from the U.S. Small Business Administration. The company was not eligible for the loan program due to its participation with cannabis businesses, which remain illegal under federal law.
A drug manufacturer agreed to pay $2 million to resolve allegations that it did not implement proper controls as required by current good manufacturing practice regulations, causing the company to introduce adulterated drugs into interstate commerce. Those drugs were then used in claims submitted to multiple federal healthcare programs, in violation of the FCA. The company pleaded guilty to criminal charges that it introduced tainted drugs into interstate commerce, in violation of the Federal Food, Drug and Cosmetic Act (FDCA). It agreed to pay an additional penalty and forfeiture amount of $1.5 million.
A doctor agreed to pay $60,000 to resolve FCA allegations that he prescribed an opioid to patients without a cancer diagnosis and without reasonable medical purpose. The doctor then billed federal healthcare programs for the associated visits.
A drug manufacturer, currently in bankruptcy and that has ceased operations, agreed to a civil settlement of $475.6 million to resolve FCA allegations related to its marketing schemes and sales of the opioid drug Opana ER with INTAC which targeted providers the company knew it was prescribing for non-accepted uses. The payments will be made as claims in the company’s bankruptcy proceedings. Criminally, the company pleaded guilty to a one-count misdemeanor information charging it with violation of the Federal Food, Drug and Cosmetic Act (FDCA) by introducing misbranded drugs into interstate commerce.
A therapy provider and its current and former owners agreed to pay $1.5 million to resolve FCA allegations that they submitted false claims to Medicare for: (1) therapy services when the provider was not in the United States; (2) therapy services performed by massage therapists rather than licensed professionals; (3) services performed by an assistant-level professional and not properly supervised; (4) services improperly coded to avoid caps; and (5) services when there were no licensed professionals on site.
A clinical laboratory and its owner agreed to pay $14.3 million to resolve allegations that they paid volume-based commissions to contract sales representatives in exchange for their recommendations for medically unnecessary respiratory pathogen panels (RPPs) and urine drug tests, in violation of the AKS. The two parties agreed to cooperate with DOJ investigations of other participants in these alleged schemes. The owner has also pleaded guilty to criminal charges, along with four others in connection to the scheme.
A doctor agreed to pay $60,000 to resolve CSA allegations that she wrote controlled substance prescriptions and did not maintain the required patient files. The doctor surrendered her DEA Registration voluntarily in October 2023.
A doctor and his medical practice agreed to pay almost $700,000 to resolve FCA allegations that they: (1) upcoded CPT codes; (2) billed for more services than could possibly be provided in one day; and (3) billed for services when the doctor was not physically in the United States.
A toxicology lab, its owner, and its compliance officer agreed to collectively pay $10,458,933 for the submission of medically unnecessary urine drug tests to Medicare and the Kentucky Medicaid programs. The owner and compliance officer were also convicted criminally in December 2023 for their actions.
A specialty pharmaceutical company agreed to pay $750,000 to resolve allegations that it improperly hired and employed a physician’s girlfriend to induce prescriptions written for two specific medications the company sold, in violation of the AKS.
A DME supplier agreed to pay $25.5 million to resolve FCA allegations that it: (1) waived, in full or partially, co-insurance payments to induce federal healthcare beneficiaries, in violation of the AKS; and (2) billed for the rental of non-invasive ventilators when the beneficiary did not use or no longer needed the device. As part of the settlement, the company made truthful admissions regarding its conduct.
A pharmacy and its owner consented to pay $110,000 to resolve CSA violations that they did not keep accurate, complete, and timely inventories related to Schedule II controlled substances. The pharmacy has ceased operations.
A pharmaceutical distributor agreed to pay $19 million to resolve CSA allegations of failing to report thousands of unusually large orders of oxycodone and hydrocodone to DEA. The company agreed to the wrongdoing and will maintain a new compliance program for five years and will surrender one of its DEA registrations.
A multi-hospital health system agreed to pay $11,712,336 to resolve self-disclosed allegations that they submitted false claims to Medicare for Annual Wellness Visit services that were not supported by patients’ medical records.
Two healthcare transportation providers and their owner agreed to pay $1.6 million to resolve allegations that the companies submitted medically unnecessary and upcoded claims to state and federal healthcare programs. The two companies also agreed to retain an independent compliance monitor, which also includes implementation of future training and auditing.
Two pharmacies agreed to collectively pay $1.3 million to settle CSA violations that they filled invalid prescriptions for controlled substances which were prescribed outside the scope of a specific physician’s current practice.
A medical center agreed to pay almost $2.1 million to resolve voluntarily disclosed allegations that it overbilled Medi-Cal for prescription medication by charging the higher U&C rate versus the lower actual acquisition cost required by the 340B Drug Pricing Program.
An e-commerce company agreed to pay $59 million to resolve allegations that it violated the CSA by selling encapsulating machines and pill presses through its website, without the proper record-keeping required by DEA. The company has also agreed to enhance and maintain its compliance program concerning the prohibited and restricted items policy.
A laboratory and drug rehabilitation facility agreed to collectively pay over $7.1 million to resolve allegations that they submitted false claims to the Medicare and Kentucky Medicaid programs for urine drug testing services that were medically unnecessary or not used for diagnosis.
A physician agreed to pay $95,000 to resolve FCA allegations that he ordered medically unnecessary DME while participating in a kickback scheme, resulting in false claims being billed to Medicaid, Medicare, and other federal healthcare programs, in violation of the AKS.
A group of DME companies agreed to pay $2.1 million to resolve FCA allegations that they submitted false claims to multiple federal healthcare programs for billing of: (1) used beds as if the product was new; (2) certain products under a miscellaneous code, resulting in a higher reimbursement; and (3) travel time as repair time for it to become a reimbursable expense. After these allegations were identified, the DME companies were purchased by Baxter International. The group involved in the alleged violations are no longer operating.
A hospital agreed to pay $801,000 to resolve allegations that two radiology practices, which formerly operated under a predecessor’s contract and are currently not operational, billed Medicaid, Medicare and TRICARE for imaging used in radiation therapy that were either not reviewed or reviewed on time, making them unreasonable and unnecessary. One of the radiology practices also billed consultation services at a higher rate than allowed.
A pharmacy, its current owner, former owner, and pharmacist agreed to collectively pay over $4.6 million to resolve FCA allegations that they: (1) billed Medicare and Medicaid for prescriptions that were not dispensed; and (2) billed Medicare for high-cost formulations of specific medications when they actually dispensed a lower-cost formulation to program beneficiaries. As part of the resolution, the current owner and the pharmacist entered an IA with HHS-OIG. The former owner of the pharmacy is responsible for $700,530 of the total settlement to resolve FCA allegations that it and its principal benefited from prescription medications that were not actually dispensed.
A health clinic and its owners consented to pay $2 million to resolve admitted FCA allegations that they used inexperienced staff and pressured them to submit false claims to federal healthcare programs including Medicare, Medicaid, and TRICARE. The agreement also resolves unadmitted allegations to the CSA, AKS and PPP loan program.
The owners of a wellness clinic agreed to pay a total of up to $108,000 to settle allegations they submitted false claims to Medicare for the surgical implantation of neurostimulator devices when the patients received electro-acupuncture devices that were not surgically implanted. In addition to the settlement, the clinic agreed to a five-year exclusion from all federal healthcare programs.
A healthcare company and one of its cardiothoracic surgeons agreed to pay $430,000 to settle FCA allegations that they submitted false claims to Medicare, Medicaid, and TRICARE for procedures they knew did not meet reimbursement criteria.
A long-term care hospital agreed to pay over $18.6 million, plus interest, to resolve FCA allegations that it made false claims related to cost outlier payments from Medicare. The settlement was negotiated based on the hospital’s lack of ability to pay.
A behavioral health provider agreed to pay $61,000 to resolve FCA allegations that he billed psychiatric and psychotherapy diagnostic evaluation claims to the North Carolina Medicaid program without properly maintaining required documentation, to prove the services were medically necessary or provided.
A clinical laboratory and its owner/CEO agreed to pay a total of $13.25 million to resolve FCA allegations related to multiple forms of illegal kickbacks and testing which was medically unnecessary for several reasons. The parties agreed to cooperate with DOJ in its further investigations against other participants in the alleged schemes.
A home healthcare agency agreed to pay over $9.9 million to resolve FCA allegations that it submitted false claims to the Energy Employees Occupational Illness Compensation Program (EEOICP) for services when the provider was not present in the homes of patients. The settlement also resolves allegations of paid kickbacks via the company’s “friends and family program,” in violation of the AKS. The settlement is based on the company’s financial condition.
A nonprofit cancer treatment and research center agreed to pay over $19.5 million resolve self-disclosed FCA allegations that it submitted false claims for services and items provided during its clinical research studies which were not eligible under federal healthcare programs.
A hospital system agreed to pay $42.5 million to resolve federal FCA and Delaware False Claims and Reporting Act allegations that it provided remuneration in the form of ancillary support providers to surgeons and neonatologists not employed by the system to induce referrals, in violation of the AKS and Stark Law.
A hospital system agreed to pay $7.25 million to resolve FCA allegations that it engaged in an improper financial arrangement which resulted in the submission of false claims to Medicare, in violation of the Anti-Kickback Statute.
A DME manufacturer agreed to pay over $2.4 million to resolve FCA allegations that it gave kickbacks to sleep laboratories in exchange for referrals which were billed to federal healthcare programs.
An urgent care practice agreed to pay $9,150,794 to settle FCA allegations that it submitted false claims for COVID-19 testing and other medical services to three federal healthcare programs including: (1) office visits performed by a physician when a non-physician practitioner had actually performed them; (2) upcoded office visits; and (3) COVID-19 office visit claims that were upcoded. The settlement also resolves the company’s self-disclosure to CMS for bonuses paid to certain physicians based on referral volume or value.
A pharmaceutical company agreed to pay $6 million to resolve FCA allegations that it participated in kickbacks and caused false claims to be submitted to Medicare and Medicaid. The company paid for genetic tests, including an additional fee to receive test results for marketing purposes. As part of the settlement, the company admitted and accepted responsibility for some facts of the settlement.
A company that formerly operated hospitals agreed to pay $2 million, along with extra contingent payments, to resolve FCA allegations for: (1) double-billing the government for COVID-19 tests which were also billed to other federal programs within the state; and (2) claiming cost outlier payments considered excessive and avoiding reimbursement of these outlier overpayments it received.
A doctor and his practice agreed to pay $115,000 to resolve FCA allegations that they submitted false claims to Medicare, TRICARE, and VHA for E&M services when other services not covered by these programs were actually performed.
A healthcare network agreed to pay $345 million to resolve FCA allegations that it submitted claims to Medicare for services unlawfully referred to the company in violation of the Stark Law including: (1) above FMV compensation to physicians; and (2) granting bonuses to physicians based on the number of referrals issued. As part of the resolution, the company will enter into a five-year CIA with HHS-OIG.
A medical device company agreed to pay over $14.7 million to resolve FCA allegations that they submitted false claims to federal health care programs for remote cardiac monitoring at a higher level than physicians intended or which was medically necessary, thus maximizing the reimbursement paid.
A pharmacy agreed to pay $165,000 to resolve CSA allegations that it (1) failed to maintain complete and accurate records required for controlled substances; and (2) did not take a biennial inventory as required. As part of the resolution, the pharmacy will be subject to several monitoring requirements related to reporting, dispensing and prescribing.
A medical practice agreed to pay $1,450,000 to resolve FCA allegations that: (1) one of its clinics had been operating as a pill mill; (2) it submitted false claims to Medicare and Medicaid for presumptive and definitive urine drug testing, which were medically unnecessary; and (3) it billed for E&M services at a higher level than was actually provided.
A hospital executive and three physicians agreed to pay $880,199 collectively to resolve FCA allegations that they were involved in an illegal remuneration scheme, in violation of the AKS. As part of the settlement, all parties have agreed to cooperate with DOJ investigations and litigation against others in the alleged schemes.
Two sleep centers agreed to pay $644,562 to resolve FCA allegations that they submitted claims for services billed under a physician’s name when they were actually performed by lower-level providers and technicians.
A hospital system and one of its cardiologists agreed to collectively pay $3,033,861.92 to resolve FCA allegations that they submitted improper claims to Medicare and Kentucky Medicaid for: (1) medically unnecessary appointments; (2) hospital admissions that did not meet requirements; (3) procedures that did not include sufficient documentation to support their medical necessity; and (4) ambulance transfers for improper hospital admissions. The allegations were self-disclosed by the hospital system.
A pharmacy agreed to pay $800,000 to resolve FCA allegations that it falsely billed the U.S. Department of Labor for a compound supplement that was never delivered to the beneficiary or was not ordered by a licensed healthcare provider.
An owner, her management company and six SNFs owned and/or operated by the company agreed to pay over $45.6 million to resolve allegations that they submitted or paid kickbacks to physicians in an effort to induce patient referrals, in violation of the AKS. As part of the resolution, the parties entered into a five-year CIA with HHS-OIG.
A pharmaceutical distributor agreed to pay $12 million to resolve CSA allegations that it failed to: (1) report hundreds of suspicious orders to DEA for controlled substances; (2) properly record controlled substances orders pertaining to defectives, shipping and delivery; and (3) submit required reports to DEA via an automated system. The settlement is based on the company’s ability to pay, forfeiture, and exposure to other civil fines. The agreement also requires the company to implement widespread improvements in its compliance program.
A medical practice, physician and practice employee agreed to pay $225,000 to resolve FCA allegations that they billed federal healthcare programs for office visits that were not: (1) medically necessary; (2) provided as the submitted claim stated; and (3) supported by the patient’s medical record.
A clinical laboratory agreed to pay over $1.1 million to resolve FCA allegations that they paid illegal kickbacks in exchange for testing referrals from providers, in violation of the AKS. The laboratory used marketing companies that utilized MSOs to disguise the kickbacks to providers.
A laboratory and its founder and CEO agreed to pay a minimum of $3,825,000, and up to $50 million, based on financial contingencies met, to resolve FCA allegations that they knowledgeably underpaid Medicaid rebates due to issues with: (1) FDA approvals after a reformulation; (2) price increases; and (3) acquisition of a drug from another manufacturer while continuing to market under old FDA approvals. The settlement is based on the parties' financial circumstances.
A pain management physician agreed to pay $1.5 million to resolve FCA allegations that he caused over 400 false claims to be submitted to Medicare and TRICARE fentanyl prescriptions in exchange for kickbacks. The prescriptions were also medically unnecessary.
A medical center agreed to pay $1 million to resolve allegations that it violated the FCA by submitting claims to Medicare and TRICARE for services provided without the required level of physician supervision.
A medical supply company agreed to pay $932,000 to resolve allegations that it violated the Maryland FCA by submitting false claims for supplies that were not requested or used by beneficiaries.
An acupuncture provider agreed to pay $250,000 to resolve allegations that it submitted false claims to the U.S. Department of Veterans Affairs for procedures that were: (1) not authorized; (2) lacked supporting documentation; or (3) not allowed as originally coded.
Several parties that provide dialysis services and treatments agreed to pay over $9.5 million to resolve FCA and New York State FCA allegations that they double-billed Medicaid for injectable medications administered during the treatment of end-stage renal disease.
A medical group, its principals and physician agreed to pay $1,724,986.08 to resolve FCA allegations that they submitted claims to TRICARE and Medicare for procedures that were not medically necessary and/or performed by an unqualified technician. The medical group also washed and allowed the re-use of single-use catheters.
Several applied behavioral analysis providers and their owners agreed to collectively pay more than $2.5 million to resolve allegations that they submitted false claims to MassHealth for: (1) services that were not rendered; (2) services that were not properly documented; (3) failing to provide acceptable supervision of paraprofessionals; and/or (4) services provided by uncredentialed individuals. As part of the resolution, all parties have agreed to a three-year independent compliance monitoring program.
A hospitalist group agreed to pay $4,384,618 to resolve FCA allegations that they: (1) upcoded specific CPT codes which usually report complex services of E&M; (2) allowed hospitalists to bill for an impossible amount of procedures and services in a single day; and (3) submitted claims for procedures and services rendered on the same day and by the same provider for beneficiaries in Michigan and Indiana, in violation of Michigan federal healthcare programs.
A life sciences company that creates diagnostic tests agreed to pay $653,143 to resolve FCA allegations that it billed federal healthcare programs for orders it received from referred physicians, in violation of the AKS.
A DME provider agreed to pay $200,000 to resolve FCA allegations that it billed Medicare and Kentucky Medicaid over 300 times for non-invasive ventilators that the patient did not use or need as the program’s reimbursement rules require.
A doctor agreed to pay an undisclosed amount to settle FCA allegations that he received kickbacks from a therapeutics company in the form of sham speaker programs, which resulted in the doctor being the number one prescriber of the company’s fentanyl spray. The settlement occurred after the doctor filed Chapter 11 bankruptcy and four days before going to trial.
A pharmacy and its pharmacist-owner agreed to pay $275,000 to resolve allegations of improper dispensing of controlled substances including opioids, in violation of the CSA. The settlement includes: (1) future restrictions on the parties’ ability to dispense particular opioid prescriptions and those in combination prescriptions; and (2) intermittent comprehensive reviews to certify compliance with the CSA.
An imaging company and its owner/CEO agreed to collectively pay $85,480,000 to resolve FCA allegations that they violated the AKS and Stark Law by: (1) paying excessive fees above FMV to referring cardiologists to supervise PET scans; and (2) compensating cardiologists for services not provided. The settlements are based on the parties' ability to pay. As part of the settlement, both parties entered into a five-year CIA with HHS-OIG.
A mental health provider agreed to pay $700,000 to resolve FCA allegations that it billed MassHealth: (1) for services at a higher rate than actually provided; and (2) using an extra code that was not related to the service provided. As part of the settlement, the company agreed to participate in a three-year independent compliance monitoring program.
A professional services firm agreed to pay $465,293 to resolve FCA allegations that it submitted false claims to several government agencies by: (1) inflating billing rates; (2) invoicing for services that were not performed; and (3) moving recorded hours to other government projects to avoid going over budget.
A pharmacy and its owner agreed to pay $60,000 to resolve CSA allegations that they filled controlled substance prescriptions that: (1) were in high dosages and quantities; and (2) were prescribed from providers over 300 miles away from the pharmacy’s location without supplied documentation. As part of the settlement, the pharmacy agreed to enter a two-year compliance monitoring agreement with DEA.
A university agreed to pay $1.9 million to resolve allegations that it submitted proposals for federal research grants in which it failed to reveal existing and pending support from foreign sources.
A dental group and its doctor have agreed to pay $985,541 to resolve FCA and Tennessee Medicaid FCA allegations that they submitted false claims: (1) for dental services to TennCare; and (2) which included uncredentialed providers ineligible to bill the program.
A clinical diagnostic company that diagnoses and treats cancer patients agreed to pay $32.5 million to resolve FCA allegations that it violated Medicare’s 14-Day Rule by manipulating its billing practices in multiple ways including writing off unpaid fees, in violation of the AKS.
A health insurance company and its subsidiary MAO agreed to pay $37 million to resolve allegations that they submitted false and invalid diagnosis codes through their 360 comprehensive assessment program to increase payments received to their Medicare Advantage plan members. As part of the resolution, the company entered into a five-year CIA with HHS-OIG.
A health insurance program that owns and operates a MA Plan agreed to pay $172,294,350 to resolve FCA allegations that it submitted false diagnosis codes for MA enrollees in an effort to increase payments received from Medicare. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A specialty pharmacy and its CEO agreed to pay $20 million to resolve allegations that they paid kickbacks to: (1) patients in the form of waived copayments; and (2) physicians in exchange for patient referrals, in violation of the AKS. The settlement also resolves allegations of a specific doctor who received remuneration from the pharmacy and separately paid $480,000. The settlements were based on all parties’ ability to pay.
A behavioral healthcare provider agreed to pay $1.25 million to resolve allegations they billed the Indiana Medicaid program for care that did not include a signed and approved Individualized Integrated Care Plan, which is required by the state’s program for mental health sessions.
A behavioral health services provider and its owner agreed to pay $918,000 to resolve allegations that they submitted claims to Medicaid and TRICARE for services that were not provided. As part of the settlement, the company entered into a three-year IA with HHS-OIG.
A doctor and his medical practice agreed to pay over $585,000 to resolve FCA allegations that they received kickbacks for referring patients for laboratory testing, in violation of the AKS. The parties agreed to cooperate with DOJ’s further investigations of other participants in the alleged schemes.
A hospital district agreed to pay a $15,000 CSA penalty for improperly prescribing opioids at a drug store it owned. The company has entered into a MOA with the DEA as part of the resolution.
A company that provides at-home colon cancer-screening tests agreed to pay $13.75 million to resolve FCA allegations that they offered gift cards to prescribed patients in exchange for their samples for testing, in violation of the AKS.
A durable medical equipment provider was ordered to pay over $12 million for submitting almost 1,000 false claims to Medicare for medical braces which were filed using illegally purchased prescriptions from marketing companies. The owner agreed to separately pay $10,000 to resolve allegations of these charges and his role. As part of the owner’s agreement, he accepted a three-year exclusion from federal healthcare plans. The owner also agreed to relinquish $57,690.12 held in escrow held by HHS due to the suspension of payments.
A doctor agreed to pay $1.3 million to resolve allegations that he billed Medicare for critical care services when he actually provided routine care. The doctor also entered into a separate IA with HHS-OIG.
Three doctors and their pain management practices agreed to pay $653,796 to resolve FCA allegations that they accepted illegal kickbacks for referrals of patients’ laboratory testing, in violation of the AKS.
A community living care company agreed to pay $576,000 to settle allegations it submitted false claims to Medicaid for services which were: (1) not supported by medical records; (2) not allowed; (3) more than allowed; or (4) submitted without the required documentation. As part of the settlement, the company will begin a new EHR system for West Virginia locations.
A pharmacy agreed to pay $925,000 to resolve California FCA allegations it submitted claims and received reimbursement from Medi-Cal for drugs it dispensed and over-dispensed without the proper prescription.
A cardiologist and his practice agreed to pay over $6.5 million to resolve allegations of kickbacks being paid to physicians for patient referrals, in violation of the Stark Law and the AKS. The settlement amount is based on the doctor and practice’s ability to pay and the doctor has also agreed to surrender his ownership of the practice by Dec. 31, 2023. The doctor is barred from working for any company that bills federal healthcare programs and entered into a five-year Voluntary Exclusion Agreement with HHS-OIG.
A healthcare consultant agreed to pay $30,000 to settle allegations that she assisted in causing false claim submissions to Medicare for the surgical implantation of neurostimulator devices when the patients received acupuncture devices that were not surgically implanted. The consultant agreed to a three-year exclusion from participating in any federal healthcare programs.
A dermatology management company involved with a number of entities across the U.S. agreed to pay nearly $8.9 million to resolve self-reported allegations of the Stark Law and the AKS.
A former medical practice agreed to pay $850,949 to resolve allegations that it improperly submitted false claims for (1) evaluation and management services; and (2) billing patients under physician codes versus the non-physician provider who actually treated the patients.
A psychiatry practice and its owner agreed to pay $1.9 million to resolve allegations that they knowingly violated the FCA by double-billing evaluation and management services and psychotherapy services in the same patient visit resulting in increased payments from Medicaid and Medicare.
A senior living community operator agreed to pay $4.25 million to resolve allegations that it solicited and received kickbacks in exchange for referrals from its retirement facilities, in violation of the AKS.
A naturopathic physician agreed to pay $65,000 to resolve allegations she wrote prescriptions without a DEA registration in the state she was practicing and outside the limitation of a naturopathic physician. The physician also entered into a four-year Memorandum of Agreement (MOA) which will limit the doctor to prescribing only two controlled substances approved by state law along with other requirements.
A former physician and his medical practice agreed to pay $135,000 in civil penalties for supplying prescriptions outside the usual course of the practice, for non-legitimate purposes and in combinations which were dangerous to patients, including the “Holy Trinity.” As part of the settlement, the doctor surrendered his DEA registration and will not be able to seek renewal for a minimum of 15 years.
A healthcare provider agreed to pay $5 million to resolve FCA allegations that they submitted or caused the submission of false claims for "additional services" to Adult Expansion Medi-Cal members that were: (1) contractually not allowed; (2) duplicative of other required services; and/or (3) did not reflect the FMV of the services provided.
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.
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.
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.
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.
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.
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 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 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 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.
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.
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.
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.
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 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.
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 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 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 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.
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 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 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 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.
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.
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 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 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 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 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.
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 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.
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 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 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 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 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 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 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 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 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 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 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 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.
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 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 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 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.
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.
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.
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 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.
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 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 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.
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 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 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 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.
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.
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.
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 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.
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 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.
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.
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 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 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 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 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 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.
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 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 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.
Seven related clinics agreed to pay more than $7.1 million to settle claims that they billed Medicare for viscosupplementation injections and braces that were not medically necessary, used multiple brands of the viscosupplements on the same patients despite a lack of support for this practice, and used discounted and reimported viscosupplements.
An otolaryngologist agreed to pay $1 million to settle claims that she submitted claims for endoscopic sinus surgeries that were not medically necessary or which were not coded correctly.
An anesthesiology practice agreed to pay more than $600,000 to settle claims that it billed Medicare for medically directed anesthesia services when the conditions of payment and regulatory requirements were not met.
A dialysis clinic operator agreed to pay $5.2 million to settle claims that it billed Medicare for Hepatitis B tests that were not medically necessary due to the frequency at which they were conducted.
A genetic testing laboratory and its principals have agreed to pay more than $41 million to resolve claims that they provided remuneration to physicians in exchange for participating in a clincial trial as an attempt to increase orders for pharmacogenetic tests. They also allegedly provided tests that were billed to Medicare despite not being medically necessary.
A chiropractor and his practice agreed to pay almost $100,000 to settle claims that he billed Medicare for surgical procedures involving the implantation of an electro-acupuncture device when in fact the devices are not implanted and no surgery was performed.
An ophthalmolgy group and several associated physicians and groups agreed to pay $6.65 million to resolve allegations that they submitted bills to Medicare and Medicaid/Medi-Cal that were improperly coded for more complex exams than were actually performed and that they improperly waived co-payments and deductibles without proper documentation.
A licensed professional counselor and her business agreed to pay more than $45,000 to settle claims that she billed Medicaid for psychotherapy services that were actually provided by unlicensed individuals.
A surgeon and his practice agreed to pay $4.25 million to resolve allegations that he referred patients to two hospitals in exchange for payments from the hospital owner disguised as above fair market value payments for services.
An ambulance company agreed to pay more than $130,000 to resolve allegations that it billed Medicare for the ambulance transportation of patients being discharged for a hospital when such transportation was not medically necessary.
A pharmaceutical manufacturer agreed to pay more than $95 million in a civil settlement to resolve allegations that it provided payments and benefits to physicians in attempts to increase prescriptions of a certain drug. The company also allegedly attempted to persuade long-term care facilities that the drug could be used for purposes not approved by the FDA. Along with the civil settlement, the pharmaceutical company entered into a CIA and agreed to pay criminal penalties.
The operators of a hospital agreed to pay more than $500,000 to settle allegations that they received Medicare payments for procedures involving implantable automatic defibrillators although they did not report the procedures to a qualified registry as required.
A physician agreed to pay $300,000 to settle claims that he issued or approved prescriptions for compounded medications to TRICARE participants through his work with a telemedicine company, meaning that he did not have an established physican-paitent relationship with the patients in question and did not actually examine them.
The owners of a pharmacy agreed to pay $1.1 million to settle allegations that they billed Medicare for multiple prescription medications that were not dispensed over a five-year time period.
A mobile diagnostic services provider agreed to pay $8.5 million to settle claims in two civil lawsuits that it provided x-rays to skilled nursing facilities at prices below fair market value in attempts to get referrals for other federal health program business from the facilities.
A dentist and his practice agreed to pay $567,125 to settle claims that they submitted claims to North Carolina's Medicaid program for services which were not medically necessary, did not have supporting documentation, or which violated Medicaid policy.
A hospital and two emergency room physicians agreed to pay $1.45 million to settle allegations that medical residents, who were not licensed physicians, were paid to independently cover shifts in the hospital's emergency room, and the licensed emergency room physicians were paid extra to co-sign medical charts as if they were providing care alongside the residents.
The former vice president of operations of a compounding pharmacy agreed to pay at least $12,788 to settle allegations that the pharmacy paid marketers who then paid physicians to prescribe compounded creams and vitamins without seeing the patients. The pharmarcy also allegedly paid co-payments for patients referred by a marketer and then disguised the payments as being from a sham charitable organization. The pharmacy, a private equity firm, and the CEO of the pharmacy also reached settlements in this matter.
The CEO of a compounding pharmacy agreed to pay at least $300,000 to settle allegations that the pharmacy paid marketers who then paid physicians to prescribe compounded creams and vitamins without seeing the patients. The pharmarcy also allegedly paid co-payments for patients referred by a marketer and then disguised the payments as being from a sham charitable organization. The pharmacy, a private equity firm, and a former officer of the pharmacy also reached settlements in this matter.
A compounding pharmacy and private equity firm agreed to pay more than $21 million to settle allegations that the pharmacy paid marketers who then paid physicians to prescribe compounded creams and vitamins without seeing the patients. The pharmarcy also allegedly paid co-payments for patients referred by a marketer and then disguised the payments as being from a sham charitable organization. An officer and a former officer of the pharmacy also reached settlements in this matter.
A doctor and his practice agreed to pay $178,398 to settle claims that he applied an electric acupuncture device on patients and then billed Medicare as if he had implanted neurostimular electrodes in a surgical procedure. The devices actually used are not eligible for reimbursement under Medicare.
A medical device manufacturer and its subsidiary agreed to pay $9.5 million to resolve allegations that it sold devices that had not been cleared by the FDA. The providers who purchased the devices used them in various procedures and then submitted claims to Medicare and Medicaid for those procedures.
A physician agreed to pay more than $2.1 million to settle claims that he billed Medicare for an excessively high number of complicated diagnostic tests normally only ordered by specialists.
A hospice provider agreed to pay $3.1 million to resolve allegations that it billed Medicare for hospice services provided to patients who did not meet hospice eligibility guidelines.
An orthopedic surgeon agreed to pay $471,221 to settle claims that he accepted payment from a compounding pharmacy in exchange for writing prescriptions for their compounded pain creams.
A group of physicians and their practice agreed to pay more than $2.9 million to settle claims that they billed government healthcare programs for a drug that was sold in single-use vials when they combined partially used vials for use in other patients, thus resulting in overbilling. Other allegations include that they submitted claims for unused or diluted vials of the drug.
A pharmaceutical company agreed to pay $15.4 million to settle claims that it provided meals and entertainment for healthcare providers in attempts to induce the providers to prescribe their drug.
A provider of overseas healthcare services for the government agreed to pay $940,000 to settle claims that it billed TRICARE for aeromedical evacuations at rates that did not take into account discounts received from the third-party air ambulance providers.
Along with three physicians, a medical practice agreed to pay $411,300 to settle allegations that they accepted payments from a genetic testing company in exchange for using the company for testing. That company then submitted claims to Medicare for the tests.
Along with two other physicians and their medical practice, a doctor agreed to pay $107,900 to settle allegations that they accepted payments from a genetic testing company in exchange for using the company for testing. That company then submitted claims to Medicare for the tests.
Along with two other physicians and their medical practice, a doctor agreed to pay $95,053 to settle allegations that they accepted payments from a genetic testing company in exchange for using the company for testing. That company then submitted claims to Medicare for the tests.
Along with two other physicians and their medical practice, a doctor agreed to pay $519,750 to settle allegations that they accepted payments from a genetic testing company in exchange for using the company for testing. That company then submitted claims to Medicare for the tests.
A substance abuse treatment center agreed to pay $200,494 to settle claims that it received a chemistry analyzer from a toxicology laboratory to which it referred urine drug testing services and then did not pay for the use of the analyzer for several months despite the existence of a lease agreement. During this time, the center received payments from Kentucky Medicaid for tests done using the analyzer, and the center's physicians referred more complex testing to the toxicology lab that provided the analyzer to the center.
An addiction treatment physician and her substance abuse treatment center agreed to pay $1.4 million to settle claims that they billed Medicare and Kentucky Medicaid for evaluation and management services that were supposedly provided to patients receiving daily methadone doses when in fact the services were not actually provided. They also allegedly submitted claims for drug testing that their equipment was not able to perform.
A home healthcare company agreed to pay $1.95 million to settle claims that it submitted claims to the Massachusetts Medicaid program for services that either were not certified as medically necessary by a physician or for which such certifications were not maintained.
An orthopedic surgery and physical therapy practice agreed to pay $1.2 million to settle allegations that it billed Medicare and TRICARE for services provided by athletic trainers and an exercise physiologist who are not eligible to provide services under these programs.
A physician and the practice he was affiliated with agreed to pay more than $5 million to resolve claims that they entered into contracts with several Medicare Advantage Organizations that provided insurance to Medicare beneficiaries. Under the agreements, the practice received a share of the Medicare payments that the MAOs received. The practice allegedly submitted diagnoses that were not supported by patients' medical records in order to increase the payments they received from the MAOs.
A telemarketer and several of his businesses agreed to pay $2.5 million to settle allegations that they fraudulently obtained insurance information from individuals and then arranged for them to get prescription medicines which were not medically necessary. The prescriptions were then sold to pharmacies as marketing services with payments based on the number of prescriptions and their value.
A Kentucky county agreed to pay $30,393 to resolve claims that it transported a Medicare beneficiary to and from dialysis in an ambulance without proper documentation.
A Kentucky county agreed to pay $100,000 to settle allegations that it provided ambulance transport to a Medicare beneficiary when such transport was not medically necessary.
A hospital agreed to pay $2.85 million to settle claims that it submitted claims to Medicare, Medicaid, and the FEHB Program for hospital-level detoxification treatment instead of the lower-reimbursment residential-level treatment without demonstrating that the higher level of treatment was medically necessary.
A pharmacy and its owners agreed to pay $400,000 to resolve claims that they submitted claims to Medicare for prescription medicines that were not dispensed.
A pain management practice and its owner agreed to pay more than $425,000 to settle claims that it submitted claims to Medicare and Medicaid for quantitative testing of urine samples that was not actually performed. Additional claims were submitted for other tests on urine samples when in fact those tests were part of general drug screening tests that were already being reimbursed.
A hospital agreed to pay $2.451 million to settle claims that it billed Medicare for inpatient rehabilitation care for patients that did not qualify for the services and did not document that inpatient rehabilitation services were reasonable or medically necessary.
A pharmaceutical distributor agreed to pay $700 million in a civil settlement 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 ambulance company agreed to pay more than $275,000 to settle claims that it submitted claims to Medicare for ambulance transports when such transport was medically unnecessary.
Two chiropractors and their former clinic agreed to pay $350,000 to resolve claims that they submitted claims to Medicare for services that were not performed by doctors as required, procedures that were medically unncessary, or were not covered by Medicare.
Two ambulance companies and their owners agreed to pay more than $450,000 to resolve claims that they made false statements to Medicare officials in an attempt to avoid repaying Medicare overpayments and to conceal the fact that one of the owners had previously had his paramedic license suspended. After one company's ambulance license was revoked, the company continued to bill Medicare for ambulance services and make false statements.
A physician agreed to pay almost $130,000 to settle allegations that he prescribed certain compounded pain creams in exchange for payments from the compounding pharmacy.
A nonprofit community services operator agreed to pay more than $500,000 to settle claims that it's pharmacy billed Medicare and Medicaid for name brand drugs when it actually dispensed generic equivalents.
A company that operated inpatient rehabilitation facilities agreed to pay $48 million to settle allegations that some of the facilities falsely diagnosed patients in order to maintain their status as inpatient facilities and also admitted patients when it was medically unnecessary.
A laboratory testing provider and its owners agreed to pay more than $1.5 million to resolve allegations that it received payments from Connecticut Medicaid in higher amounts than it charged to perform the services.
A hospital agreed to pay $3.154 million to resolve claims that one of its clinics submitted claims to Medicare, TRICARE, and the FEHB Program for services that were not medically necessary. Following an update to the codes that were to be used for such services, the clinic submitted claims under two codes when in fact the claims should only have been submitted under one bundled code.
A physical therapy company and its CEO agreed to pay $37,500 to settle claims that they billed Medicare for services that were performed by non-credentialed physical therapists as if the services were performed by approved individuals.
A hospital agreed to pay $275,000 to resolve claims that it submitted claims to Medicaid based on physician reports that were not completed in a timely manner.
An ambulance company agreed to pay $1.25 million to settle claims that it submitted claims to Medicare for ambulance transports that were not medically necessary and could have been provided via other means.
A cardiology practice agreed to pay $2.5 million to resolve claims that it received payments from two genetic testing companies in exchange for the referrals of patients to the companies.
A compounding pharmacy and its principals agreed to pay $365,000 to resolve claims that it billed Medicaid, Medicare, and TRICARE for compounded medicines that were made with non-reimbursable powders instead of the reimbursable tablet form.
A skillled nursing facility agreed to pay $1.17 million to settle claims that worked with a physical therapy provider to obtain inflated Medicare reimbursements when the therapy provider upcoded patients' Resource Utillization Group scores and provided therapy services to patients who did not need such services. The company and its owner reached settlements related to these charges as well, in addition to settlements with three other skilled nursing facilities.
A skillled nursing facility agreed to pay $2.73 million to settle claims that it worked with a physical therapy provider to obtain inflated Medicare reimbursements when the therapy provider upcoded patients' Resource Utillization Group scores and provided therapy services to patients who did not need such services. The company and its owner reached settlements related to these charges as well, in addition to settlements with three other skilled nursing facilities.
A skillled nursing facility agreed to pay $1 million to settle claims that it worked with a physical therapy provider to obtain inflated Medicare reimbursements when the therapy provider upcoded patients' Resource Utillization Group scores and provided therapy services to patients who did not need such services. The company and its owner reached settlements related to these charges as well, in addition to settlements with three other skilled nursing facilities.
A skillled nursing facility agreed to pay $3.63 million to settle claims that it worked with a physical therapy provider to obtain inflated Medicare reimbursements when the therapy provider upcoded patients' Resource Utillization Group scores and provided therapy services to patients who did not need such services. The company and its owner reached settlements related to these charges as well, in addition to settlements with three other skilled nursing facilities.
The owner of a physical therapy provider agreed to pay $160,000 to settle claims that the therapy center worked with four nursing facilities to upcode patients' Resource Utillization Group scores, resulting in higher Medicare reimbursements, and also provided therapy services to patients who did not need such services. The company and the four nursing facilities also reached settlements related to these charges.
A physical therapy provider agreed to pay $1.09 million to settle claims that it worked with four nursing facilities to upcode patients' Resource Utillization Group scores, resulting in higher Medicare reimbursements, and also provided therapy services to patients who did not need such services. The owner of the company and the four nursing facilities also reached settlements related to these charges.
A medical device manufacturer agreed to pay $15 million to settle claims that its sales representatives made claims regarding the safety and effectiveness of a wound dressing product which were not backed up by clinical data. The company also provided incorrect coding information for its devices, resulting in over-reimbursements from Medicare, and provided illegal inducements in attempts to increase the number of prescriptions for its products. Along with the civil settlement, the company pleaded guilty to related criminal charges.
A home health agency settled two cases alleging that it paid a physician as a medical director in exchange for referrals of patients, paid employees based on referrals by their physician spouses, and asked another medical director to approve patient care plans for patients that the director did not see.
A physician agreed to pay more than $911,000 to resolve allegations that he referred Medicare patients to a laboratory for testing while he was being paid by the laboratory.
The former chairman and CEO of a medical device company agreed to pay $2.5 million to resolve claims that he permitted sales representatives to provide doctors and clinics with illegal kickbacks such as travel, entertainment, supplies, and cash, in attempts to induce sales of their human skin substitute.
An opioid manufacturer agreed to pay $195 million in a civil settlement to resolve allegations that it paid illegal kickbacks to practitioners to increase the number of prescriptions for its Subsys painkiller. The manufacturer also settled criminal charges relating to these matters.
The owners of a hospital agreed to pay $3.6 million to settle claims that the hospital provided loans to two doctors who referred patients to the hospital and then did not collect on the loans.
A drug manufacturer agreed to pay more than $7 million to settle claims that it participated in a plan to inflate and fix prices for a number of generic drugs as well as paying and receiving remuneration from other drug manufacturers over a three-year period.
Two hospitals agreed to pay $2.8 million to resolve allegations that they submitted claims to Medicare for procedures that were billed as inpatient services when the procedures were actually outpatient.
A hyperbaric oxygen therapy facility agreed to pay more than $400,000 to settle allegations that it submitted claims to TRICARE for services for one patient that were not medically necessary and which were not supervised by a physician.
A cardiologist and his practice agreed to pay $5.8 million to resolve allegations that they billed Medicare, the Defense Health Agency, and the FEHB Program for medically unnecessary procedures involving cardiac stents.
A pharmaceutical company agreed to pay $3.5 million to resolve claims that it gave dermatology providers meals, trips, entertainment, and other forms of compensation as well as providing speaking and consulting opportunities in an attempt to induce the physicians to prescribe their drugs.
A pharmacist and owner of a pharmacy agreed to pay $100,000 to settle claims that she submitted claims to Medicare and Medicaid for prescriptions that were not picked up, not ordered, or were provided in generic form rather than the billed-for brand name drug.
A hospital agreed to pay $250,000 to settle charges that it submitted false attestations to Medicare claiming that its electronic health records technology met certain requirements when in fact it did not. The hospital also falsely claimed that it had conducted and/or reviewed a required security risk analysis.
A physician agreed to pay $118,000 to settle allegations that services provided by advanced practice nurses at his clinics were billed to Medicare as if they were provided under physician supervision, when instead the services were provided without such supervision and so, should have been billed at a lower rate.
A medical device distributor agreed to pay $3.3 million to resolve claims that it bought and sold devices which were not approved by the FDA or for which the manufacturer was relying on an exemption from the FDA, but did not provide sufficient evidence that the devices in question qualified for the exemption.
A physical therapy provider agreed to pay $790,000 to settle allegations that it submitted claims to Medicare and TRICARE for services provided to multiple patients at a time as if they were individually provided. Also, claims were submitted for services provided by physical therapy assistants who were not supervised by a physical therapist and for electrical stimulation services that were billed as if they were attended by a therapist or assistant when they were unattended.
A home health company agreed to pay more than $8.3 million to settle claims that it submitted claims to the Massachusetts Medicaid program for services when there was no required signed plan of care authorizing the services.
A home health company agreed to pay more than $2 million to settle claims that it submitted claims to the Massachusetts Medicaid program for services when there was no required signed plan of care authorizing the services.
The former CEO of a hospital chain agreed to pay $3.46 million to settle allegations that, as CEO, he pressured emergency department doctors to recommend that patients be admitted even when such admissions were not medically necessary.
A pharmaceutical company agreed to pay $17.5 million to settle allegations that it provided money to a foundation for a fund that paid co-pays for patients taking the company's drug. The company also compensated two physicians with entertainment and speaking and consulting fees to induce the physicians to prescribe their drugs.
A pharmaceutical company agreed to pay $24.75 million to settle allegations that it set up a fund through a foundation that covered co-pays for patients taking its drug that treats secondary hyperparathyroidism. The settlement also covers allegations that a predecessor company set up a fund through a different foundation that covered travel expenses for patients taking its drug for multiple myeloma.
A pharmaceutical company agreed to pay $100 million to settle claims that it worked with two nonprofit foundations to provide funds that covered co-pays for metastic castration resistrant prostate cancer drugs, but the restrictions were such that almost all of the funds went to cover the company's drug.
Two pain management clinics agreed to pay about $3.3 million to settle allegations that they submitted claims for drug tests that violated the Stark Law or Anti-Kickback Statute, ordered drug tests that were not medically necessary, and submitted claims that appeared to be for services provided by physicians when in fact the services were provided by physician assistants and nurse practitioners.
Two former executives of a diabetic testing supply company agreed to pay $500,000 each to resolve allegations that they caused the company to submit Medicare claims for medically uncessary supplies as well as providing providing free or no cost supplies and waiving co-pays, thus violating the anti-kickback statute.
A retired physician agreed to pay $82,000 to settle claims that he submitted reimbursement claims for psychotherapy services that required specific amounts of face-to-face time with the patient despite the fact that his records show less than the required amount of face-to-face time. This settlement with the state of Maryland is in addition to a December 2018 settlement with the federal government for the same allegations.
A cardiac practice agreed to pay almost $400,000 to settle claims that it billed Medicare and Medicaid for two procedures on the same patient on the same date when in fact only one of the procedures was performed.
A benefit corporation providing healthcare services through affiliates agreed to pay $30 million to resolve allegations that it submitted claims to Medicare Advantage Organizations that were coded with unsupported diagnosis codes.
A social worker agreed to pay more than $145,000 to settle claims that she billed Medicaid for psychotherapy services that were actually provided by unlicensed individuals.
An operator of drug treatment centers agreed to pay $17 million to resolve claims that several treatment centers sent urine and blood samples to an outside laboratory for testing and then submitted claims to Medicaid as if they had conducted the testing themselves.
A doctor specializing in pain medicine agreed to pay more than $228,000 to settle allegations that he was paid by a compounding service in exchange for prescribing its pain cream.
A doctor of osteopathic medicine agreed to pay almost $125,000 to settle allegations that he was paid by a compounding service in exchange for prescribing its pain cream.
A pharmaceutical company agreed to pay $13 million to settle allegations that it asked a foundation to create a fund using its donations to assist patients taking their drug.
A pharmaceutical company agreed to pay $52.6 million to resolve claims that it donated money to a fund run by a foundation and allegedly used to cover co-pays for patients with Huntington's Disease, but that the fund actually covered co-pays for any patient taking the company's drug regardless of use.
A pharmaceutical company agreed to pay $57 million to settle claims that it asked a foundation to create funds to cover the the co-pays of Medicare beneficiaries taking narcolepsy drugs and drugs for chronic pain, and that these funds were used almost exclusively to cover the co-pays of patients taking the pharmaceutical company's drugs.
A county ambulance service and its director have agreed to pay $253,930 to settle allegations that the service submitted claims to Medicare for the medically unnecessary non-emergency ambulance transport of patients to and from dialysis treatment.
A retired oral surgeon and his former practice agreed to pay $252,000 to settle claims that he billed Medicaid for sedation and anesthesia services which were not provided and other services which were either not performed, were not medically necessary, or were included in other claims.
A mental health and drug dependency clinic and its owner agreed to pay more than $4 million to settle allegations that it billed Medicaid for more complex urine tests than were actually performed, submitted claims for medically unnecessary urine tests, and billed Medicaid for telemedicine services which were illegally provided by psychiatrists outside the United States.
A group of urgent care centers agreed to pay $2 million to settle allegations that they submitted incorrect bills to Medicare and Medicaid by implying that more body systems were examined during patient encounters than actually were.
A dental practice and its owners agreed to pay $1 million to resolve allegations that they billed the Washington Medicaid program for non-covered services as covered services, as well as coding bills as if more expensives procedures were performed than actually were.
A home healthcare company agreed to pay more than $700,000 to settle claims that it billed the Minnesota Medicaid program and private insurers for the same services and kept the Medicaid payments.
A health system and two of its hospitals agreed to pay $35 million to resolve claims that they paid kickbacks to a cardiology practice disguised as professional services agreements in exchange for the referral of patients needing cardiovascular procedures. Other claims resolved in the settlement are that a doctor affiliated with the cardiology practice, and later employed by the health system, performed and billed Medicare for unnecessary procedures.
A podiatrist agreed to pay more than $76,000 to settle allegations that she received payment from a compounding pharmacy in exchange for prescribing certain compounded drugs.
A doctor of osteopathic medicine agreed to pay more than $52,000 to settle allegations that he received payment from a compounding pharmacy in exchange for prescribing certain compounded drugs.
A law firm agreed to pay $250,000 to settle claims that it did not repay Medicare for conditional payments made on behalf of a firm client once the client received a settlement.
A psychiatrist and his practice agreed to pay more than $3.3 million to resolve allegations that they submitted claims to Medicare which were coded for multiple units of service, instead of the one unit allowed to be billed, and for tests which should have been billed as a component of the larger drug screening test. They also submitted claims for tests that were not performed.
A device manufacturer agreed to pay more than $17 million to resolve allegations that it provided services such as the development of marketing plans and assistance with special events to healthcare providers in an effort to get those providers to purchase their radiofrequency ablation catheters.
A medical equipment supplier agreed to pay more than $467,000 to settle claims that it billed Medicaid for equipment that was either not provided or was not medically necessary.
A pharmaceutical company agreed to pay $23 million to settle claims that it donated money to a patient-assistance charity which then used the money to cover the cost of co-pays for drugs manufactured by the pharmaceutical company.
A nursing home company agreed to pay more than $18 million to settle claims that it submitted forms to TennCare which had forged physician or nurse signatures, and that it provided services that were substandard.
A urology practice agreed to pay $1.85 million to settle allegations that it billed Medicare for evaluation and management services that should have been bundled with other provided services for billing purposes.
A physical therapy provider agreed to pay $2 million to settle allegations that it billed TRICARE for services provided by unauthorized physical therapy assistants as if they were provided by authorized providers.
A marketing company agreed to pay more than $414,000 to settle claims that it received payment from a pharmaceutical compounding company in exchange for the referral of prescriptions for certain compounded drugs.
A pharmaceutical company agreed to pay $4 million to settle allegations that it agreed to pay two companies to submit new drug applications for a drug that it had developed and for which it previously received a fee waiver. The company was ineligible to receive another fee waiver so it agreed to pay two other companies to for their submissions of new drug applications if these companies received fee waivers.
A geriatric medicine physician agreed to pay $680,000 to settle claims that he submitted claims for nursing home services that were incorrectly coded, causing MassCare to reimburse him at higher than necessary rates.
A doctor of osteopathic medicine agreed to pay almost $85,000 to settle allegations that he received payment from a compounding pharmacy in exchange for prescribing certain skin creams.
A compounding pharmacy and its owners agreed to pay at least $775,000 to settle claims that they agreed to pay a third-party marketing company a share of their TRICARE and Medicare reimbursesments in exchange for the solicitation of prescriptions for compounded drugs.
A hospital company and its founder and CEO agreed to pay $1.25 million to settle allegations that two of its hospitals unnecessarily admitted emergency room Medicare patients for overnight stays and also billed Medicare for diagnoses that were more serious than what patients actually had.
Two physicial therapy clinics and their owners agreed to pay $450,000 to resolve claims that they billed TRICARE for services provided by medical doctors when the services were actually provided by unqualified individuals.
A physician and her practice agreed to pay more than $817,000 to settle claims that they improperly billed Medicare using multiple medical codes when the documentation did not support the use of multiple codes. This practice resulted in overpayments being received from Medicare, and such overpayments were not reported and returned.
A genetic testing laboratory agreed to pay almost $2 million to resolve claims that it billed Medicare for genetic tests for prostate cancer patients that were not medically necessary.
A marketer agreed to pay almost $340,000 to settle claims that he received payments from a compounding pharmacy for referring prescriptions for compounded drugs to the pharmacy.
A hospital agreed to pay $5 million to settle claims that it violated the Stark Law by paying physicians more than fair market value or in a way that accounted for the number or value of referrals made by the physicians.
A provider of behavioral health services and its owner agreed to pay $645,000 to settle allegations that they billed the Georgia Medicaid Program for services which were never provided. In addition, they will be excluded from federal healthcare programs for five years.
An electronic health records software developer agreed to pay $$57.25 million to settle claims that it obtained certification for one of its products by hiding the fact that the software did not actually comply with all the requirements for certification. In addition, a flaw in the software caused healthcare providers using the product to receive EHR incentive payments when in fact they were not eligible for such payments, and the company did not fix the problem after being made aware of it.
A skilled nursing facility management company agreed to pay more than $9.7 million to resolve allegations that it submitted pre-admission placement evaluations to TennCare that contained photocopied or pre-signed physician signatures.
Two ophthalmologists agreed to pay more than $150,000 to settle claims that over a six-year period they submitted claims for simultaneously performing two eyelid surgies that should be performed and billed separately.
A provider of pharmacy compounding services agreed to pay $17 million to settle allegations that it billed federal healthcare programs for excessive amounts of wasted product from the compounding of the Proplete drug and that it waived co-payments and deductibles in exchange for the prescription of Proplete. The company also submitted claims that were not coded properly or were duplcate claims to the FEHB Program.
A physician agreed to pay more than $200,000, including restitution and damages, to resolve allegations that he participated in a scheme to defraud the West Virginia Medicaid program.
A pathology laboratory agreed to pay $63.5 million to settle claims that it gave subsidies to physicians for electronic health records systems and provided free or discounted technology consulting services in exchange for patient referrals.
A dialysis facility agreed to pay more than $3.2 million to settle claims that it provided illegal inducements to physicians for referrals and then submitted claims to Medicare, TRICARE, and TennCare for services provided to patients referred by these physicians.
A provider of autism therapy services agreed to pay $360,000 to resolve allegations that it submitted claims to TRICARE that misrepresented what services were provided and by whom. Allegations also included claims that services were not documented as required and that medical records were altered.
A behavioral health group and its owner agreed to pay $100,000 to settle claims that they submitted claims to the Connecticut Medical Assistance Program for psychotherapy services that were provided by unlicensed individuals.
Walgreens agreed to pay more than $209 million to settle charges that it billed Medicare, Medicaid, and other federal programs for insulin pens that were dispensed to program beneficiaries who did not require them.
A hospital agreed to pay $10 million to resolve allegations that it received payments from the company who was the exclusive provider of radiology services for the hospital in exchange for referrals to an outpatient imaging center which was owned by the hospital and the radiology services provider.
A chain of dental offices agreed to pay $9 million to settle claims that it billed Medicaid for orthodontic procedures which were performed by uncertified individuals.
Walgreens agreed to pay $60 million to settle claims that it charged Medicaid higher prices for drugs than were available through a discount program offered to the public.
An orthopedic surgeon agreed to pay $500,000 to settle claims that he received payment to refer patients to a skilled nursing faciity and a home health agency in violation of the Anti-Kickback Statute and Stark Law. In a separate settlement, the skilled nursing facility settled related charges.
A skilled nursing facility, its management company, the facility administrator, and the company's president and senior vice president agreed to pay $1 million to resolve claims that they paid an orthopedic surgeon to refer patients to the facility for rehabilitation services that were billed to Medicare and TRICARE.
A drug store chain agreed to pay $3.5 million to settle allegations that it billed Medicaid for stimulant medications that were dispensed to beneficiaries of the Wisconsin Medicaid program without verification that the medications were prescribed for medically appropriate treatment.
A hospital company agreed to pay more than $8 million to resolve allegations that several of its hospitals paid a physician a rate higher than fair market value to induce him to refer patients to the hospitals, in violation of the Anti-Kickback Statute and Stark Law.
A medical transportation and ambulance services company agreed to pay $300,000 to settle claims that it billed Medicare and Medicaid for transporting dialysis patients who did not qualify for ambulance transport.
A pain management specialist agreed to pay $1.718 million to settle claims that he submitted claims to Medicare and TRICARE for urine drug testing services that were not medically necessary. Other claims resolved with this settlement involve allegations that the owners of the pain management practice also owned an anethesia services provider which provided services exclusively to their pain management practice, resulting in improper referrals.
A physician and his vascular surgery practice agreed to pay $2.2 million to resolve claims that they submitted reimbursement claims that contained false diagnoses and symptoms. They also submitted claims for reimbursement that had been coded for levels of service that were not supported by medical records, were medically unnecessary, or were not performed by qualified individuals.
A toxicology and genetic testing laboratory agreed to pay $1,777,738 to settle claims that it paid local laboratories to make referrals for work covered by TRICARE and Medicare, and then submitted reimbursement claims for these referred services.
A hospice provider agreed to pay almost $6 million to settle allegations that it submitted Medicare claims for hospice care that was not medically necessary or for which required documentation was lacking.
An audiology practice agreed to pay more than $566,000 to settle claims alleging two distinct violations of the FCA: (1) reimbursement claims were submitted for services provided by unlicensed individuals working without supervision; and (2) gift cards and contests were offered to Medicare and Medicaid beneficiaries in attempts to get them to receive eligible services.
A healthcare system agreed to pay $12 million to resolve allegations that at certain times over a four-year period it entered into unfair compensation arrangements with two physicians and then billed Medicare and Medicaid for services provided by those physicians. The physician compensation arrangements were not for identifiable services, exceeded fair market value, and took into consideration referrals anticipated from the physicians.
A pharmacy services provider agreed to pay $3 million to settle claims that it enrolled beneficiaries of the Massachusetts' Medicaid program (MassHealth) in automatic refills of prescriptions in violation of MassHealth regulations.
A hospital system and its founder and CEO agreed to pay a total of $12.5 million to settle claims that it improperly unbundled reimbursement claims for orthopedic surgeries, causing a global fee to be paid for knee replacement surgeries in addition to a separate reimbursement for a procedure that was performed during the surgery, but billed as if it was performed separately.
A retired physician agreed to pay $400,000 to settle claims that he submitted reimbursement claims for psychotherapy services that required specific amounts of face-to-face time with the patient despite the fact that his records show less than the required amount of face-to-face time.
A drug manufacturer agreed to pay $360 million to settle claims that it used a foundation to pay the co-pays of Medicare beneficiaries taking its pulmonary arterial hypertension drugs. As part of the plan, the company received information about the amount of money being spent by the foundation for specific drugs and then funded the foundation based on these numbers.
A physician and two practices he owns agreed to pay $213,000 to resolve claims that they submitted claims to Medicare and Medicaid for treatment of patients using a specific drug when there is no record of the practices purchasing enough of the drug to be used in the number of treatments billed. In addition, claims were submitted for the use of another drug which had not received FDA approval.
A physician agreed to pay $3.07 million to resolve claims that companies he owns submitted reimbursement claims for services that were not medically necessary, were not eligible for reimbursement, listed the incorrect provider, and/or listed the wrong service or were not supported by documentation. This settlement is part of a larger global settlement involving additional charges and criminal proceedings.
A medical device company agreed to pay $1.87 million to resolve claims that it violated the Anti-Kickback Statute by paying speaking fees to physicians for participating in events at which the physicians and their staff were the primary audience. The physicians who were so compensated were also the source of a high number of referrals for one of LivaNova's devices.
A medical device manufacturer agreed to pay $13 million to settle allegations that it maintained a registry of hospitals using a device designed to help treat stroke patients and paid the participating hospitals for reporting data regarding their stroke treatment practices. Hospitals were allegedly recruited to participate in this registry in order to sell them these devices.
A dermatology practice agreed to pay more than $800,000 to settle allegations that it submitted claims to Medicare, Medicaid, and TRICARE for services provided by non-physician providers at times when no physician was present in the office to supervise or assist.
A physician agreed to pay more than $484,000 to settle allegations that he submitted false claims to Medicare due to particpation in a kickback scheme with various laboratories.
A physician agreed to pay more than $650,000 to settle allegations that she submitted false claims to Medicare due to particpation in a kickback scheme with various laboratories.
A physician agreed to pay more than $277,000 to settle allegations that he submitted false claims to Medicare due to particpation in a kickback scheme with various laboratories.
A physician agreed to pay more than $129,000 to settle allegations that she submitted false claims to Medicare due to particpation in a kickback scheme with various laboratories.
A provider of various therapy services agreed to pay $200,000 to settle claims that it billed Medicare and Medicaid for individual therapy services instead of the group services that were in fact provided and also that some claims were submitted using the names and billing numbers of individuals who did not provide the services.
A nurse agreed to pay $130,000 to resolve allegations that she prescribed pain creams in exchange for payments made to her by the compounding company that sold the creams. Some of the patients who were prescribed the pain creams were insured by TRICARE, making the kickback fees illegal.
An operator of dental practices and its administrative support provider, will pay $5.139 million to settle allegations that they submitted claims to Indiana's Medcaid program for tooth extractions which were improperly classified as surgical extractions and for deep cleanings which were not medically necessary or not performed at all.
A pharmacy agreed to pay $9.5 million to settle claims that it improperly changed or waived co-pays, changed prescriptions without proper physician consent, submitted reimbursement claims for prescriptions that were different from what was dispensed, and autofilled prescriptions without receiving patient consent.
An ophthalmologist and his practice agreed to pay more than $2 million to resolve claims that they billed Medicare and Medicaid for diagnostic tests that were of such poor quality as to be useless or were never actually performed.
A provider of mental health and substance abuse services agreed to pay $500,000 to resolve claims that it failed to document services provided, but for which claims were submitted to Medicaid and reimbursment was paid.
A hospital operator agreed to settle a lawsuit claiming that it convinced a radiology group to enter into a joint venture with the hospital instead of opening an independent facility and then planned to refer outpatient examinations to the radiology center in exchange for payment. The partnership also included a noncompete provision which prevented employees from working with any other outpatient imaging center. The United States is not a party to this settlement.
Two drug companies will pay $25 million to settle allegations that they provided kickbacks to doctors in an effort to increase prescriptions for the drug TriCor. Claims were also made that they marketed this drug for purposes which were not approved by the FDA and therefore not eligible for reimbursement.
A nursing home operator agreed to pay $2.2 million to settle allegations that it forced the discharge of residents who were nearing the end of Medicare eligibility.
A pharmacy company agreed to pay $1.85 million to settle claims that it dispensed drugs without a valid prescription and then submitted reimbursment claims to Medicare and Medicaid for these drugs.
A Pennsylvania couple and their businesses agreed to pay $3 million to settle allegations that they managed several mental health clinics despite the husband being excluded from such activity due to a prior fraud conviction. In addition, they profited from these activities by funneling money from the clinics. Additional claims included allegations that reimbursement claims inflated the length of patient visits and services were performed by unqualified individuals.
An ophthalmology practice agreed to pay $525,000 to resolve allegations that employees falsified medical records so that the patients appeared eligible for cataract surgeries, allowing the practice to bill for the unnecessary surgeries.
A medical equipment supplier agreed to pay more than $5.25 million to settle claims that it misrepresented the ingredients in its compounded medical creams, resulting in the submission of incorrect reimbursement claims.
A group of specialty care centers agreed to pay up to $18.3 million to settle claims that it performed vascular surgery procedures without a documented need for the services.
The operator of a medical services organization agreed to pay $270 million to settle allegations that it obtained overpayments based on the submission of incorrect diagnoses. Additional allegations include the scouring of medical records for diagnoses that were initially not recorded and then submitting claims for reimbursment for such diagnoses.
A now-defunct compounding pharmacy and its owner have settled claims that they billed TRICARE at least 2,000 percent more than cash-paying customers were charged for the same drugs.
A drug company agreed to pay $625 million to settle claims that it engaged in a scheme involving repackaging drugs which resulted in multiple reimbursment claims being submitted for the same vial of drug. It also offered discounts in an effort to gain customers or retain current customers.
A healthcare system, along with subsidiaries and related entitites, agreed to pay $24 million to settle allegations that it excessively compensated physicians and charged for administrative services at below fair market value in attempts to obtain referrals.
A physician will pay $99,912 to settle claims that he submitted claims using higher-paying billing codes that were not accurate for the services provided.
A hospital company agreed to pay the state of Florida $5.54 million to settle claims that two of its hospitals submitted claims to the Florida Medicaid program for services provided by physicians that had received payments and free office space from the hospitals.
A health system agreed to pay $4 million to settle allegations that it overbilled Medicare, TRICARE, and theFEHB Program for radiation oncology services over a period of about five years.
A hospital company will pay more than $260 million to settle claims that it unnecessarily admitted patients when inpatient treatment was not needed. Other allegations include the provision of kickbacks to physicians to induce referrals.
A program providing compensation for expenses relating to birth-related neurological injuries agreed to pay more than $20 million to resolve allegations that it: (1) caused claims to be submitted to government programs before considering them for payment when the government programs should have been the payor of last resort; (2) that it failed to seek third party reimbursements on behalf of Medicaid; and (3) that it did not take steps to ascertain the program's legal liability for claims.
A provider of long-term care services agreed to pay $1.65 million to resolve allegations that it biilled Medicare for services provided to individuals who were not eligible for Medicare reimbursement.
A family practitioner agreed to pay $300,000 to settle allegations that he submitted or caused to be submitted claims to Medicare, Medicaid, TRICARE, and the FEHB Program on dates when he was out of the country.
A laboratory testing services company agreed to pay $1.25 million to settle claims that it submitted claims to Medicare and TRICARE that were not accurately coded and also pressured healthcare providers to order tests regardless of medical necessity.
A provider of mobile x-ray services agreed to pay $321,388.50 to settle allegations that it billed the federal government for mobile x-ray services provided after its license had expired.
A dermatology practice and related individuals agreed to pay $4 million to settle claims that claims submitted to Medicare and Medicaid over a five-year period were for treatments that were not adequately supervised, procedures that were upcoded, or procedures that were not neccesary.
In related settlements, several ambulance industry companies and municipal clients agreed to settle allegations that the companies offered kickbacks to municipal entities in order to obtain their ambulance business.
In related settlements, several ambulance industry companies and municipal clients agreed to settle allegations that the companies offered kickbacks to municipal entities in order to obtain their ambulance business.
In related settlements, several ambulance industry companies and municipal clients agreed to settle allegations that the companies offered kickbacks to municipal entities in order to obtain their ambulance business.
In related settlements, several ambulance industry companies and municipal clients agreed to settle allegations that the companies offered kickbacks to municipal entities in order to obtain their ambulance business.
A provider of rehabilitation therapy and related services agreed to pay $6.1 million to settle claims that it employed nurse practitioners to work at client nursing homes for below fair market fees in an attempt to get the nursing homes to contract with the company for rehabilitation services.
A provider of oxygen and respiratory therapy services has paid $5.25 million to resolve claims that it waived or reduced co-insurance, co-payments, and deductibles for beneficiares participating in Medicare Advantage Plans through private insurers, in violation of the Anti-Kickback Statute. This practice resulted in false claims being submitting to Medicare for payment.
An operator of long-term care and rehabilitation hospitals has agreed to pay more than $13 million to resolve allegations that it entered into contracts with physicians that called for payments that violated the Anti-Kickback Statute and the Stark Law. The company also maintained relationships with unaffiliated providers in violation of the Anti-Kickback Statute.
A pharmacy and some of its officers agreed to pay more than $2.2 million to settle allegations that it billed TRICARE for reimbursement for compounded medicine claims obtained through payment of kickbacks. It also resolves allegations that the pharmacy did not disclose the prior felony conviction of an officer when it sought to become an authorized provider with Express Scripts, the pharmacy benefit manager for TRICARE.
A physician and his wife, who managed his practice, have paid $428,700 to settle claims that they billed Medicare, TennCare, and the FEHB Program for anticancer drugs that were not approved by the FDA, and therefore not eligible for reimbursement.
An addiction treatment clinic and its owner agreed to pay $23,000 to resolve claims that they violated the FCA and the Controlled Substances Act in their handling of prescriptions and related services.
A hospital has agreed to pay more than $1.1 million to settle claims that it submitted claims to Medicare for Intensive Outpatient Psychotherapy services that were not medically necessary and so, did not qualify for reimbursement.
A California hospital systems and its founder and CEO agreed to pay $65 million to resolve allegations that it billed Medicare for more expensive diagnoses than patients actually had and by admitting patients for inpatient treatment when outpatient treatment was appropriate.
A drugmaker agreed to pay at least $150 million, with the possibility of up to $75 million more, to resolve claims that it paid kickbacks to doctors to prescribe pain management drug Subsys.
A provider of behavioral treatment to children with autism agreed to pay more than $8.8 million to settle claims that it misrepresented services provided when submitting claims to TRICARE and South Carolina's Medicaid program, and that in some cases, claims were submitted for services that were not provided.
A regional hospital system agreed to pay $84.5 million to settle allegations that they violated the Anti-Kickback Statute and Stark Law by making compensation arrangement with certain physicians to obtain their referrals of patients and then submitted claims for services provided to those patients. The settlement also covers allegations that the hospital falsely represented that a radiology center qualified as an outpatient department of the hospital.
A group of ENT physicians agreed to pay almost $1.2 million to settle claims that they reused balloon catheters which are intended for single use and then billed Medicare for single use procedures.
Nine skilled nursing facilities and two affiliated companies will pay $10 million to resolve allegations that they submitted claims to Medicare for rehabilitation therapy services which were not medically necessary.
A medical device manufacturer agreed to pay $11.5 million to settle claims that it submitted claims for procedures involving LC Bead, a drug-delivery device which has not been approved. Allegations also included claims that the company told providers to use inaccurate billing codes for uses routinely denied coverage by insurance companies. Another $1 million settlement will resolve claims that the company falsely told providers that Medicare would cover use of a device for treatment of perforator veins after the device was recalled.
An ambulance company agreed to pay $16,776.74 to settle allegations that it used money received from Medicare and MaineCare to pay salary and benefits for an employee who was excluded from MaineCare and federal healthcare programs.
An orthopedic practice and several affiliated physicians agreed to pay $670,000 to resolve allegations that they submitted claims to Medicare, Medicaid, and TRICARE for medically unnecessary procedures. In addition, the settlement resolves allegations that the practice and one of the physicians submitted claims for services which were not provided by the indicated individual.
A food retailer agreed to pay $77,320 to settle claims that it induced Medicaid and Medicare beneficiaries to use their pharmacies by using gift cards.
A behavioral health practice and its owners agreed to pay the state of Connecticut $300,000 to resolve allegations that they submitted claims to the Connecticut Medial Assistance Program for services supposedly provided by licensed individuals when instead unlicensed providers were actually providing the services.
An ambulance company agreed to pay $1.2 million to resolve claims that throughout almost 11 years it transported patients unncessarily, or in an unnecessarily emergent manner, and submitted claims for life support services that were coded as Advanced instead of Basic.
An optometrist and her clinic agreed to pay more than $25,000 to settle allegations that she submitted claims to Medicaid for photography services that were not medically necessary.
A hospital and healthcare system and two of its subsidiaries agreed to pay more than $14.7 million to settle claims that they submitted claims without proper documentation, causing some to be billed at higher levels than appropriate. Subsidiary Putnam Health Center submitted claims for services which were referred to the company in violation of the Stark Law and Anti-Kickback Statute.
A family practice physician agreed to pay $360,000 to resolve claims that he billed Medicare and Medicaid for services that were medically unnecessary and unreasonable.
A psychologist agreed to pay $126,760 to resolve claims that she billed Medicaid for services that were not provided and for family psychotherapy sessions when individual services should have been billed.
The owner of three companies providing medical support services agreed to pay an initial payment of $50,000 and a futher consent judment of $1,061,613 to settle claims involving submission of Medicaid claims for services that were not provided or were provided to ineligible recipients and payment of kickbacks.
A home healh provider agreed to pay $3 million to resolve claims that it submitted claims to the Virginia Medicaid Program for ineligible personal care aides, provided false information in order to qualify ineligible beneficiaries for Medicaid services and obtain reimbursement for non-reimbursable services, and billed for services that were not provided.
A network of urogynecology practitioners agreed to pay $1.7 million to resolve claims that it overbilled or billed Medicare for services that were not provided.
A skilled nursing facility agreed to pay $540,000 to resolve claims that it submitted claims to Medicare and the Kentucky Medicaid program which were improperly coded, resulting in higher payments.
A home health agency and two employees agreed to a settlement agreement to resolve allegations that they provided medically unnecessary services and paid kickbacks to Medicare beneficiaries, facilities, and marketers.
A company providing treatment for varicose veins agreed to pay $1.2 million to settle allegations that it billed Medicare for services provided by non-physicians as if they had been supervised by a physician when in fact they were not. The settlement also resolves allegations that the company submitted claims for ultrasounds that were either not performed or were administered by unqualified individuals.
An urgent care provider agreed to pay $110,000 to settle claims tht it billed Medicare for services provided by physician assistants and nurse practitioners at rates indicating the services had been provided by or supervised by physicians.
A wound care services provider has agreed to pay up to $22.51 million to settle claims that it caused wound care centers to submit claims to Medicare for therapy which was medically unnecessary and unreasonable.
A provider of wound care services agreed to pay almost $400,000 to settle allegations that it submitted claims to Medicare indicating that two services were provided when in fact only one had been provided.
A social worker agreed to pay $200,000 to settle claims that he billed the Connecticut Medicaid programs for counseling services that were either not provided or were provided by unlicensed individuals.
A personal injury attorney and his law firm have agreed to pay $28,000 and set up a compliance progam in order to settle allegations that they failed to reimburse Medicare for conditional payments made to satisfy medical bills of firm clients under the Medicare Secondary Payor provisions.
A company that operated skilled nursing facilities agreed to pay more than $30 million to settle claims that it billed Medicare for rehabilitation therapy services that were not reasonable, necessary, and skilled.
A physician agreed to pay $300,000 to resolve claims that he submitted Medicare claims which were coded for a higher level of care than was actually provided.
An urgent care chain agreed to pay $883,000 to the state of New York to resolve allegations that it billed the state's insurance program for government workers' facility fees, when such fees are not permitted under the plan.
A hospital management company and four of its hospitals have agreed to pay more than $1.7 million to resolve claims that they provided Intensive Outpatient Psychotherapy services to patients who did not qualify for reimbursement.
A physician has agreed to pay $2.8 million to settle allegations that he received illegal kickbacks for the referral of prescriptions and also as speaker fees. Allegations also include billing Medicare and TRICARE for tests which were not medically necessary. In addition to this settlement, the physician has pleaded guilty to two counts of conspiracy.
Part of a group of settlements, a rehab therapy provider and physicians agreed to pay $750,000 to resolve allegations that they conspired with two other entities to avoid repaying Texas Medicaid $2.7 million the state had overpaid.
A pharmacy provider agreed to pay $825,000 to resolve claims that it enrolled patients in an automatic refill program, then billed the Minnesota Medicaid program for such refills, in violation of the program's policy.
A pain management practice agreed to pay $1.2 million to settle claims that it billed the government for drug tests which were not medically necessary.
A pharmaceutical company agreed to pay $23.85 million to settle claims that is used a foundation to pay the co-pay obligations of three patients taking its drugs.
Hospice service providers agreed to pay $2.5 million to settle allegations that they submitted Medicare claims for patients who were not eligible for the services.
A non-profit community health center agreed to pay more than $47,000 to settle claims that unqualified individuals issued refills for controlled substances and that prescriptions or refills for non-controlled substanced were improperly issued.
An internist agreed to pay $1.5 million to resolve allegations that he submitted claims for tests that were not medically necessary and for which he did not have the proper equipment or training. For other services, he misrepresented them on claims because he did not spend the required amount of time with patients or conduct the necessary assessments.
A podiatry practice agreed to pay $125,000 to resolve allegations that it submitted claims that were improperly coded and claims for procedures that were not performed.
A hospital system agreed to pay $1.9 million to settle claims that it charged Medicare for inpatient surgical procedures when the procedures should have been billed as outpatient.
A psychiatrist has agreed to pay $805,071 to settle allegations that they billed Medicare for multiple units of service instead of a single unit for drug screening tests and also submitted claims for tests that did not occur or did not occur in a timely manner.
A medical assistant agreed to be excluded from federal healthcare programs for 10 years to settle allegations tht he impersonated a physician, which resulted in false claims being submitted to the government.
A hospital system agreed to pay more than $14 million to resolve allegations that it compensated six physicians at rates that exceeded the fair market value of their services.
A physician agreed to pay $130,000 to settle allegations that she received payment from a drug testing lab in exchange for referring Medicare patients to the lab.
A physician agreed to pay $370,000 to settle allegations that he received payment from a drug testing lab in exchange for referring Medicare patients to the lab.
A physician agreed to pay $200,000 to settle allegations that he received payment from a drug testing lab in exchange for referring Medicare patients to the lab.
A medical equipment supplier agreed to pay $1.9 million to resolve claims that it provided illegal kickbacks to sales representatives, submitted claims for equipment that was not medically necessary, and forged documents in order to get reimbursements.
A nonprofit hospital agreed to pay $3.7 million to settle allegations that it billed Medicare incorrectly and failed to perform face-to-face encounters with patients prior to recertification. The two allegations were self-disclosed.
An urgent care chain agreed to pay $6.6 million to resolve allegations that it billed Medicare for services that either were not provided or were more expensive and complex than the services that were actually provided.
A company providing behavioral health and substance abuse services agreed to pay $1,378,533 to settle allegations that they billed Medicaid for psychotherapy services which were not provided to patients.
A cardiovascular practice agreed to pay $1.5 million to resolve allegations it violated the FCA by billing Medicare and the Department of Veterans Affairs for surgical services not actually provided to cardiac patients and billing for more expensive surgical and evaluation and management services than those actually provided to patients.
A physician has agreed to pay $199,425.56 to settle allegations that she received dividends from a laboratory in exchange for providing a certain number or urine drug screen referrals.
An organization serving people with intellectual and developmental disabilities agreed to pay almost $2.3 million to settle claims that it billed Medicaid for services that were not provided, billed providers for basic services that had already been billed in more comprehensive packages, and did not repay funds owed to Medicaid and identified through self-audits.
A diagnostic laboratory agreed to pay $2 million to resolve allegations it submitted false claims to Medicare for Breast Cancer Index (BDI) tests that were not reasonable and necessary. The government alleged Biotheranostics knowingly promoted and performed the BCI test for patients who had not been in remission for five years and who had not been taking treatment and prevention drugs.
A respiratory equipment supplier has agreed to pay $9.68 million to settle allegations it knowingly billed Medicare for portable oxygen contents not used by beneficiaries. The government alleged Rotech automatically billed Medicare for portable oxygen contents without verifying that the beneficiaries used or needed portable oxygen, and without obtaining the requisite proof of delivery despite knowing it resulted in claims ineligible for reimbursement.
A hospital system agreed to pay $18 million to settle allegations 12 of its hospitals knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis. The government alleged that: (1) Medicare was billed for short-stay, inpatient procedures that should have been billed on an outpatient basis; and (2) reports to Medicare inflated the number of hours for which patients received outpatient observation care. As part of the settlement, Banner Health entered into a five-year CIA with HHS-OIG.
A medical practice specializing in the treatment of HIV/AIDS and sexually transmitted infections, along with the CEO and a former physician, agreed to pay $650,830 to settle allegations that they billed Medicaid for physical therapy and office visit services when the patients instead received massages from a massage therapist.
A laboratory service provider has agreed to pay $525,000 to resolve allegations that it billed Medicare for travel fees for each individual specimen when in fact multiple specimens were transported together and for fees that were not related to travel by a laboratory technician.
A medical device manufacturer agreed to pay $3.5 million to resolve allegations it caused providers to submit false claims to Medicare and other federal healthcare programs relating to its LAP-BAND Adjustable Gastric Banding System. The government alleged Allergan: (1) knowingly sold defective LAP-BANDS; (2) misrepresented facts to conceal the defect; (3) failed to collect or maintain required data and complaint files; (4) offered and provided remuneration to health care professionals who reported the defect; and (5) knowingly advertised, marketed, and distributed the LAP-BAND for use in two procedures that were not approved by the FDA and provided remuneration to healthcare professionals to induce them to use LAP-BAND for unapproved uses.
The estate of a pain relief physician and practice owner agreed to pay $625,000 to settle allegations that he violated the FCA by submitting numerous improper payment claims for trigger point injections, which were upcoded to receive a higher reimbursement amount than permitted.
Orthopaedic clinics and an associated nurse anesthetist agreed to pay $3.2 million to resolve allegations they violated the Anti-Kickback Statute by providing a free medical director to Summit Surgery Center in order to induce it to choose to perform more procedures at the surgery center. Additionally, it was alleged GBJ and LaGuardia caused the submission of false claims to Medicare for prescription drugs purchased outside of the United States and not approved by the FDA.
A skilled nursing facility agreed to pay $5,191,470 to resolve allegations it violated the FCA by submitting false claims for payment to Medicare. The government alleged Oaklawn improperly billed for patient rehabilitation services that were not reasonable or medically necessary.
A radiation therapy provider agreed to settle a lawsuit alleging FCA and Anti-Kickback Statute violations for $11.5 million. The lawsuit alleged Sightline (later acquired by ION) targeted physicians that were able to refer patients to its cancer treatment centers and paid those physicians a share of its profits pursuant to investment arrangements that were set up to allow physicians to profit from their referrals. The government further alleged SightLine formed a series of leasing companies in which referring physicians were permitted to invest and through which SightLine allegedly distributed the profits that its physician-investors generated by referring cancer patients for radiation therapy. As part of the settlement, Sightline and ION entered into a five-year CIA with HHS-OIG.
An ambulance service provider agreed to pay $9 million to resolve allegations it violated the FCA by submitting false claims for ambulance transports to to Medicare, Medicaid, and TRICARE. As part of the settlement, Medical Transport LLC entered into a five-year CIA with HHS-OIG.
A long-term care provider agreed to pay $10.3 million to resolve state and federal FCA allegations. It is alleged Centerlight submitted fraudulent requests to New York’s Medicaid program for monthly premiums and failed to repay Medicaid for falsely-obtained payments. New York’s Medicaid program will receive $6.36 million in restitution and penalties from the total settlement payment.
An acute care hospital agreed to pay $1.88 million to resolve allegations it violated the FCA by improperly retaining Medicare overpayments for hospital inpatient admission claims when those claims should have been billed at the lower reimbursement rate for either outpatient or observation services.
A medical device manufacturer agreed to pay $33.2 million to resolve allegations that Alere caused hospitals to submit false claims to Medicare, Medicaid, and other federal healthcare programs by knowingly selling materially unreliable point-of-care diagnostic testing devices.
Four skilled nursing facilities and two medical consulting companies agreed to pay a total of $6 million to resolve allegations they fraudulently billed Medicare for skilled therapy that was either not delivered or that were medically unnecessary. The government alleged the consulting companies and the SNFs put systems in place to maximize Medicare and TRICARE reimbursement and that caused the submission of claims for therapy services that were either not provided or that were unnecessary.
Part of a group of settlements, two therapy providers and related individual agreed to pay $13 million to resolve allegations that they conspired with two other entities to avoid repaying Texas Medicaid $2.7 million the state had overpaid.
A medical practice specializing in vascular care agreed to pay almost $520,000 to resolve claims that it billed Medicare for tests that were not conducted.
A surgical monitoring company agreed to pay $550,000 to resolve allegations it violated the FCA by submitting false claims to Medicare for failing to provide a qualified interpreting physician to monitor each surgery for which it purportedly provided remote Intraoperative Neurophysiological Monitoring (IONM).
A pediatrics practice and its physician partners agreed to pay $750,000 to settle allegations that they billed Medicaid for services provided by physicians who were not enrolled in the Medicaid program.
A pharmacy services provider agreed to pay $525,000 to settle claims that it billed Medi-Cal for drugs which were dispensed for non-approved diagnoses or that it did not confirm and document diagnoses as required.
A genetic testing company agreed to pay $11 million to resolve claims it improperly billed federal healthcare programs for Natera’s non-invasive prenatal test known as Panorama to TRICARE, the FEHB Program, and state Medicaid programs.
A medical device company agreed to pay $3.1 million to resolve allegations it violated the FCA by purchasing lavish meals for physicians to induce them to use a line of heart pumps. The government alleged Abiomed: (1) paid for excessive alcohol; (2) paid for expensive meals for physicians' spouses; (3) costs far exceeded the $150 guideline; and (4) misrepresented the number of attendants so the cost per attendee appear lower.
A hospital and a physician cardiology practice have agreed to pay $20.75 million to settle a lawsuit alleging violations of the FCA, Anti-Kickback Statue, and Stark Law. The lawsuit alleged Hamot paid Medicor $2 million a year under 12 physician and administrative services arrangements which were created to secure Medicor patient referrals.
A chiropractor and his clinic will pay almost $80,000 to settle claims that they provided free electrical stimulation to Medicaid beneficiaries in order to convince them to receive additional chiropractic care from the clinic.
A hospital agreed to pay $1.655 million to resolve claims it violated state and federal FCAs by presenting false claims to Medicare and Medicaid. The government alleged the hospital knowingly submitted or caused to be submitted a number of outpatient laboratory claims lacking documentation necessary to support reimbursement by Medicare and Medicaid.
An ambulance provider and a hospital have agreed to pay $1.425 million to resolve allegations they improperly billed Medicare for non-emergency ambulance transportation of patients. The government alleged that North East improperly billed Medicare for ambulance transports of patients it falsely claimed were either “bed-confined” or for whom such transport was otherwise medically necessary, and knowingly retained Medicare overpayments. MMC allegedly provided North East with statements containing incomplete or inaccurate information about the medical necessity of transporting patients by ambulance, which North East thereafter used to bill Medicare.
A urogynecology practice and its physician partners agreed to pay $877,474 to settle allegations that they submitted claims for services that were incorrectly coded or not actually provided.
A physician has agreed to pay $2.9 million to settle allegations that he accepted kickbacks from Sightpath, Precision Lense, and Dr. Paul Ehlen, resulting in false claims for ophthalmological services and products being submitted to Medicare. He also allegedly received consulting agreements for services which were not tracked.
An oncologist and his wife and office manager agreed to pay $500,000 to resolve allegations that they knowingly billed Medicare for chemotherapy drugs which had not been approved by the FDA and were therefore not eligible for reimbursement.
A hospice company and its CEO agreed to pay $1.24 million to resolve allegations the company fraudulently billed Medicare and Medicaid for hospice services for patients who were ineligible for hospice because they did not have a life expectancy prognosis of six months or less.
A mental health facility agreed to pay $4 million to resolve allegations it fraudulently billed MassHealth for services provided to patients by unlicensed, unqualified, and unsupervised staff members.
An ear, nose, and throat physician agreed to pay $2,791,758 to settle allegations that he submitted reimbursement claims for audiological tests that were performed by unqualified personnel for which results were altered.
A nursing home agreed to pay $500,000 to resolve allegations it violated the FCA by submitting false claims to Medicare and TennCare for services that were materially substandard, worthless, and provided in violation of essential requirements. As part of the settlement, Spring Gate entered in to a CIA with HHS-OIG.
The former vice president of a company providing home healthcare services agreed to pay $100,000 to resolve allegations that the company billed Medicaid for home health aide and personal care aid services that were not provided to Medicaid recipients. The company and current president entered into a separate settlement agreement to resolve the same allegations.
A company providing home health care services agreed to pay $6.415 million to resolve allegations that it billed Medicaid for home health aide and personal care aid services that were not provided to Medicaid recipients. The company's former vice president entered into a separate settlement agreement to resolve the same allegations.
An ambulance provider and its sister company agreed to pay $5.5 million to resolve allegations it improperly billed Medicare and TRICARE for medically unnecessary ambulance transportation services.
The owner of a lab management services company agreed to pay $270,000 to resolve allegations that it provided in-office medical technicians to physicians, entered into improper agreements, and submitted claims for pharmacogenetic tests that were not necessary.
A laboratory providing clinical diagnostic testing services agreed to pay $3.5 million to resolve allegations that it provided in-office medical technicians to physicians, entered into improper agreements, and submitted claims for pharmacogenetic tests that were not necessary.
A chiropractor agreed to pay $1.45 million to resolve allegations he violated the FCA by: (1) causing pharmacies to submit requests for Medicare and TennCare payments for pain killers which had no legitimate medical purpose; (2) upcoding claims for office visits that were not reimbursable at the levels sought; and (3) submitting claims for services provided by two nurse practitioners who were not collaborating with a physician as required by Tennessee law.
A medical device company agreed to pay $7.62 million to resolve allegations its defunct subsidiary (Empi) submitted false claims to TRICARE for excessive, unnecessary transcutaneous electrical nerve stimulation (TENS) electrodes that beneficiaries did not need or use. The government alleged Empi used inappropriate techniques such as “assumptive selling” to persuade some TRICARE beneficiaries to seek and accept unjustifiably large quantities.
Two urologists agreed to pay $1.085 million to resolve allegations they submitted false claims to Medicare for image guided radiation therapy that was referred and billed in violation of the Anti-Kickback Statute and Stark Law. The government alleged the urologists solicited other urologists to enter into lease agreements with the radiation oncology center they owned.
A nurse practitioner who worked at pain clinics has agreed to pay $32,000 to settle claims that she wrote prescriptions for drugs which were not medically appropriate.
A physical therapy provider agreed to pay $1.5 million to resolve allegations it violated the FCA by charging Medicare and TRICARE for physical therapy services that were rendered by therapists who did not have billing privileges for these programs and were not supervised by an authorized provider.
A dentist agreed to pay $100,000 to resolve allegations that she submitted claims to the North Carolina Medicaid program for procedures that were not medically necessary and were performed in violation of Medicaid policy.
A hospital and related entities agreed to pay $403.960.75 to resolve allegations that they submitted claims coded for new patients when in fact the patients were actually in the category of established patients.
A city fire department has agreed to resolve allegations that it coded claims as if advanced life support had been provided when basic life support was actually provided. Payments totaling $203,006 will be made to HHS, the U.S. Department of Defense, and the State of Washington Medicaid Fraud Control Unit.
A pharmacy agreed to pay $350,000 to resolve allegations that it violated TRICARE's policy on telemedicine by participating in unsolicited calls, provided medically unnecessary compound medications to TRICARE beneficiaries and filled prescriptions from doctors who did not meet with or consult beneficiaries.
A dental management company and its affiliate clinics agreed to pay $23.9 million to resolve allegations they knowingly submitted false claims for payment to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid. The government alleged false claims were submitted for medically unnecessary pulpotomies (baby root canals), tooth extractions, and stainless steel crowns, in addition to seeking payment for pulpotomies that were never performed.
A community healthcare center agreed to pay $1.25 million to resolve allegations that its Methadone Maintenance Treatment Program failed to properly document patient treatment plans, resulting in improper billing.
A chain store agreed to pay $32.3 million to resolve claims that in-store pharmacies did not report to federal healthcare programs the generic drug prices offered to customers through various store programs as usual and customary pricing.
A hospice company agreed to pay more than $5 million to settle allegations that it submitted claims to Medicare for hospice services that were not supported with adequate documentation, resulting in reimbursements being received for hospice care for longer terms than appropriate.
A drug monitoring lab has agreed to pay $815,000 to resolve FCA allegations it made claims for urine specimen validity testing when referring physicians did not specifically order specimen validity testing.
A pharmaceutical company agreed to pay $210 million to resolve allegations it funneled money through a foundation to cover the costs of co-pays for Medicare beneficiaries taking certain hypertension drugs. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A physician groups agreed to pay more than $4 million to resolve claims that it received illegal kickbacks from a now-defunct hospital company in exchange for referring patients to two of the company's hospitals.
A provider of physicians to staff hospital emergency rooms agreed to pay $29.6 million to resolve claims that a now-defunct hospital owner provided incentives for their physicians to recommend that patients be admitted for inpatient treatment when outpatient treatment was warranted.
A pharmacy agreed to pay $300,000 to settle claims that it waived or did not collect co-payments from beneficiaries in attempts to increase the number of prescriptions for medications eligible for Medicare and TRICARE reimbursement.
A mental health clinic has agreed to pay $6.93 million to resolve FCA allegations it either did not provide treatment or treatment was not provided by qualified individuals as part of its preschool Day Treatment program. Also as part of the settlement, the clinic entered into a five-year CIA with HHS-OIG.
A pharmacy specializing in serving patients with severe kidney disease agreed to pay $63.7 million to resolve FCA allegations related to improper billing practices and unlawful financial inducements to healthcare beneficiaries. The government alleged the pharmacy billed federal programs for prescribed medications that never shipped, shipped but were later returned, and prescriptions that did not comply with documentation requirements such as proof of delivery, refill requests, or patient consent. The settlement also resolves alleged violations of the Anti-Kickback Statute that involved accepting manufacturer co-payment discount cards in lieu of collecting co-payments from Medicare beneficiaries, routinely writing off unpaid beneficiary debt, and extending discounts to beneficiaries who paid for their medications by credit card.
A cancer center agreed to pay $26 million to settle allegations it violated the FCA and Stark Law by paying off physicians for referrals. The settlement is part of a Chapter 11 bankruptcy filing to avoid litigation on whether the allegations can be discharged.
A behavioral health and substance abuse healthcare organization and its CEO have agreed to pay $883,859 to settle FCA allegations it caused overpayments for urine drug testing to be paid to the Connecticut Medicaid Program.
A home healthcare company agreed to pay more than $14 million to resolve claims that it submitted claims to MassHealth for services provided by home health aids when these services were not medically necessary.
An addiction care provider agreed to pay almost $80,000 to settle allegations that it received point of care test cups from a laboratory in exchange for referring tests to the lab. This created an improper financial relationship, resulting in claims submitted by the lab to be ineligible for reimbursement.
A primary care physician and her practice agreed to pay $60,000 to resolve claims that her practice billed for services that required her supervision when she was away from the office, billed for services provided by unlicensed providers, and received kickbacks from laboratories in exchange for patient referrals.
A hospital agreed to pay $7.5 million to resolve claims that it provided marketing and advertising services for physicians, in exchange for referrals of patients to the hospital. As part of the settlement, the hospital has agreed to enter into a five-year CIA with HHS-OIG.
A dermatologist practice and its CEO and founder agreed to $850,000 to resolve FCA allegations that they improperly billed Medicare by billing for free samples of a phototherapy drug and upcoding office visits, lesion removal procedures, and phototherapy services.
A cardiovascular physician agreed to pay $1.95 million to resolve allegations the practice violated the FCA by seeking reimbursement from Medicare for medically unnecessary carotid ultrasounds, lower extremity arterial ultrasounds, abdominal aortic ultrasounds, renal and renal artery ultrasounds, and echocardiograms. As part of the settlement, the physician agreed to enter in to an IA with HHS-OIG.
A pharmacy agreed to pay $170,000 to settle allegations that it submitted claims to TRICARE for compounded medicines for which prescriptions were not medically necessary or were issued after short calls between physicians and patients in violation of telemedicine laws, or which were tainted by kickbacks.
A substance abuse recovery services provider agreed to pay more than $4,000 to settle claims that it used funds received from MaineCare to pay the salary and benefits of an employee who was excluded from federal healthcare programs and MaineCare.
A physical therapist and his practice agreed to pay $500,000 to settle claims that they submitted claims for services that were not provided by qualified individuals or supervised by on-site therapists, and for group therapy services instead of the required one-on-one services.
A cardiology clinic and its shareholder physicians agreed to pay $1.2 million to resolve federal and state FCA allegations that they improperly performed and billed state and federal healthcare programs for medically unnecessary diagnostic procedures. The government alleged the clinic automatically scheduled patients for nuclear stress tests without seeing them beforehand to confirm the necessity of the procedures.
A hospital agreed to pay $12.875 million to resolve claims that it submitted claims for patients referred by physicians with whom the hospital had financial arrangements that violated the Stark Law and Anti-Kickback Statute. Additionally, as part of the settlement Meadows Regional entered into a CIA with HHS-OIG.
Four skilled nursing facility operators agreed to pay up to $6.9 million to resolve civil FCA allegations involving employees' payment of kickbacks to discharge planners at a hospital for patient referrals through the use of corporate credit cards to pay for gift cards, massages, tickets to sporting events, and a cruise. As part of the settlement, the nursing homes entered into five-year CIAs with HHS-OIG. The nursing homes previously entered into deferred prosecution agreements (DPAs) in 2016 to resolve related criminal allegations.
Four nursing homes and their owner have agreed to pay up to $6.9 million to resolve civil allegations that employees paid kickbacks for patient referrals and submitted fraudulent bills to federal and California state health care programs. The nursing homes entered into Deferred Prosecution Agreements (DPAs) in 2016, admitting employees used corporate credit cards to pay for gift cards, massages, tickets to sporting events, and a cruise that were given to discharge planners at a hospital as kickbacks. The DPAs further stipulate this was done without the knowledge of Brius. In addition, the nursing homes have entered into CIAs with HHS-OIG.
Two insurance companies agreed to pay $2 million, plus interest, to resolve allegations that care insurance plans they offered improperly pushed first payor status to Medicare and Medicaid.
An operator of medical clinics agreed to pay $1.625 million to resolve FCA allegations in a qui tam action, in which the government declined to intervene, that the operator, related individuals, and an insurance company: (1) submitted false claims for payment to Medicare resulting from purportedly unsupported diagnosis codes that the defendants submitted or caused to be submitted to Medicare for Medicare Advantage members; and (2) failed to timely return overpayments to Medicare.
An insurance company agreed to pay $1.375 million to resolve FCA allegations in a qui tam action, in which the government declined to intervene, that the company and its co-defendants: (1) submitted false claims for payment to Medicare resulting from purportedly unsupported diagnosis codes that the defendants submitted or caused to be submitted to Medicare for Medicare Advantage members; and (2) failed to timely return overpayments to Medicare.
A hospital agreed to pay more than $1.5 million to resolve allegations that it received reimbursements from Medicare and MaineCare for multiple same-day urinalysis drug screening tests by billing for them on a per-test basis instead of bundling them and submitting one claim per patient encounter as appropriate.
A health system agreed to pay $6 million to resolve FCA allegations that its subsidiary billed Medicare for rehabilitation therapy services that were provided at levels that were medically unnecessary and not supported by the medical records. In addition, CHS entered into a five-year CIA with HHS-OIG.
A hospice services provider agreed to pay $75 million to resolve allegations that it submitted claims to Medicare for hospice services provided to patients who were not eligible for hospice services and provided employees with bonuses based on the number of patients receiving hospice services, regardless of patient eligibility. The settlement also covers claims that the company submitted claims for services provided at the highest rate when the services required were at lower rates.
A nursing home agreed to pay $5 million to resolve FCA allegations that it billed Medicare for services that were not provided or which were so substandard and deficient that they were considered worthless and potentially harmful to specific patients.
Three ambulance companies agreed to pay more than $100,000 to settle claims that they submitted claims to Medicare for emergency transports that should have been coded as non-emergencies.
A cardiovascular practice agreed to pay $448,821.58 to settle claims that it received overpayments for services and did not refund the money to federal healthcare programs in a timely manner as required.
A physician and affiliated entities agreed to pay $1.575 million to settle claims that physicians at the facilities performed colonoscopies that did not meet established medical standards by performing them too quickly. The relator also claimed that established sanitation guidelines were not followed, with the physician not always using clean gowns for each procedure.
Four hospitals agreed to pay $8.6 million to settle FCA allegations that they received kickbacks in “swapping” arrangements with various ambulance companies, whereby the hospitals’ patients received free or heavily discounted ambulance transports in exchange for rights to the hospitals’ more lucrative Medicare and Medicaid transport referrals.
A pharmacy chain agreed to pay $2.67 million to resolve FCA allegations that it submitted claims to Medicare and Medicaid: (1) while providing patients at nursing homes with unused recycled drugs; and (2) for reimbursement of retail-packaged diabetes testing strips when cheaper mail-order-packaged versions of the same strips were given to patients.
A specialty medical practice agreed to pay more than $1.9 million to resolve allegations that it billed for moderate sedation services which require physicians to be present with the patient for at least 16 minutes, when this minimum time requirement was not met.
A pain management practice agreed to pay more than $186,000 to settle claims that it had an improper financial relationship with a laboratory to which it referred testing.
An adult daycare, its former owner, and its current owner agreed to pay $2.72 million to resolve FCA allegations that it received payments from Medicaid even though the former owner was excluded from Medicaid participation.
A podiatrist agreed to pay $35,000 to settle allegations that he billed Medicare for routine foot care services under a code used to bill for surgical procedures.
A hospital agreed to pay $7 million to resolve FCA allegations that it billed Medicare for radiation oncology services that were not provided under the supervision of a qualified practitioner. It also billed emergency department services provided by mid-level providers as if they were provided by physicians and billed for services provided by a minor care clinic as if it was an emergency department.
A pharmaceutical manufacturer and its parent company agreed to pay $36 million in civil and criminal penalties to resolve allegations that it failed to provide physicians with full and accurate information about a rare disorder and a drug designed to treat it. The company also allegedly channeled funds through a nonprofit to assist with co-payments for the drug.
The owner of a medical supplies company agreed to pay $220,000 to settle allegations that, in his ownership capacity, instructed physician office employees to prepare authorizations and orders for medical equipment that were not ordered by physicians and sometimes included forged physician signatures, then submitted claims for equipment provided under such orders, submitted claims for equipment and supplies that were not provided, and provided kickbacks to physician office employees and others in exchange for patient information used to submit false claims.
A drug addiction treatment center agreed to pay more than $64,000 to resolve allegations that it received point of care test cups from a laboratory to which it referred patients. The acceptance of these supplies created an improper financial relationship between the companies.
The former CFO and COO of an orthopedic practice agreed to pay $100,000 to settle claims that he allowed claims to be submitted to federal healthcare programs for injections that were not medically necessary.
A hospital operator agreed to pay $4 million to resolve FCA allegations that its hospitals submitted false claims to the government for services rendered to patients referred by physicians with whom the defendants had improper financial relationships. These relationships took the form of compensation and office lease arrangements that did not comply with the requirements of the Stark Law.
A physician practice agreed to pay $1.56 million to resolve FCA allegations that it submitted or caused the submission of: (1) claims to Medicare that violated the physician self-referral prohibition; and (2) false claims to Medicare and TRICARE for medically unnecessary laboratory services by creating custom laboratory panels comprised of diagnostic tests not appropriate for routine measurement, performing these tests without an order from the treating physician, implementing standing orders to assure these custom panels were performed with defined frequency and not in reaction to clinical need, and programming the practice’s billing software to systematically change certain billing codes for laboratory tests to ensure payment by Medicare. As part of the settlement, the business agreed to enter into a five-year CIA with HHS-OIG.
The owner and former CEO of a physician practice and its former laboratory director agreed to pay $443,000 to resolve FCA allegations that they submitted or caused the submission of: (1) claims to the Medicare program that violated the physician self-referral prohibition; and (2) false claims to Medicare and TRICARE for medically unnecessary laboratory services by creating custom laboratory panels composed of diagnostic tests not appropriate for routine measurement, performing these tests without an order from the treating physician, implementing standing orders to assure these custom panels were performed with defined frequency and not in reaction to clinical need, and programming the practice’s billing software to systematically change certain billing codes for laboratory tests to ensure payment by Medicare. As part of the settlement, they agreed to enter into a five-year CIA with HHS-OIG.
A pharmaceutical company agreed to pay $7.55 million to settle claims that it provided kickbacks to physicians in the form of meals, payments for the cost of attendance at events and meetings, and a performance-based rebate program in attempts to induce the physicians to prescribe an opioid drug. The company also allegedly paid physicians to refer patients to a study which was ultimately designed to result in additional prescriptions of the drug.
A provider of behavioral health and substance use disorder treatment services agreed to pay $627,000 to settle claims that it represented to the government that it had a medical director who met all the federal requirements and was performing the necessary duties, when it fact it did not. These false representations and certifications were material to claims submitted for Medicaid reimbursement.
Several affiliated home healthcare providers agreed to pay $1.8 million to settle allegations that they billed Medicare for services which were provided to patients referred by physicians with whom the companies had financial arrangements that rendered the services ineligible for reimbursement. They also submitted claims for services that did not have the required certifications and were therefore not eligible for reimbursement.
A dental chain agreed to pay $1.3 million to resolve FCA allegations that it improperly billed the Massachusetts Medicaid program (MassHealth) for unnecessary and unjustifiable dental procedures.
A pharmaceutical manufactuer agreed to pay $58.65 million to resolve allegations that its sales representatives provided information to physicians indicating that an FDA-required notification about the risks of a drug was unimportant or erroneous, thus violating the FDCA and causing some physicians to be unaware of the drug's dangers.
A health system agreed to pay $12.24 million, plus interest, to resolve allegations that they made illegal donations to county governments used to fund the state share of Medicaid payments to the hospital and thus causing the presentment of false claims by the state of New Mexico to the federal government under Medicaid.
A health system has agreed to pay $122,928 to resolve claims under the FCA alleging that it submitted claims to Medicare for existing patients of a cardiology practice that the sytem acquired as if they were new patients.
A specialty pharmacy agreed to pay $13.4 million to resolve FCA allegations that it conspired with a drug manufacturer to receive referrals and benefits in the form of rebates and fees in exchange for refilling more prescriptions for a drug used to treat iron overload than other pharmacies.
Two eye surgery product suppliers, a subsidiary (Sightpath), and its former CEO (James Tiffany) agreed to pay $12 million to resolve FCA allegations that they paid kickbacks to physicians in various forms, including travel, entertainment, and improper consulting agreements to induce the use of their products and services, which resulted in the submission of false claims to Medicare for ophthalmological products and services. As part of the settlement, Sightpath agreed to enter into a five-year CIA with HHS-OIG. Although not a signatory to the CIA, TLC Vision is participating in the CIA as a “covered person.”
Two subsidiaries of a pharmaceutical company agreed to pay $465 million to resolve FCA allegations that they reported the EpiPen as a generic drug, despite there being no equivalent drugs, thereby increasing the price of the EpiPen while not increasing their rebate obligations to Medicaid. The company also entered into a five-year CIA with HHS-OIG.
A medical center agreed to pay more than $2.5 million to settle allegations that it submitted claims for ambulance transports at higher than appropriate rates by claiming the trips were emergencies when they were not. They also submitted claims for ambulance transports in situations where the use of an ambulance was not medically necessary or was not the emergency that was purported.
A pain management clinic and its owner agreed to pay $250,000 to settle claims that they received Medicare reimbursements for services provided by a physician who was suspended from the Medicare program by describing the services as provided by another physician. They also received reimbursement from Medicare for a drug that was obtained from a foreign supplier.
A physician agreed to pay $4 million to resolve FCA allegations that he billed Medicare, TRICARE, and the FEHB Program for pre-operative exams performed the day of or day before the surgery and for services for which he had already been paid. In addition to the settlement, the physician entered into an IA with HHS-OIG.
A pharmaceuticals manufacturer agreed to pay $280 million to resolve FCA allegations that it promoted two cancer drugs for uses that were not approved by the FDA and not covered by federal healthcare programs. The allegations included: (1) the use of false and misleading statements about the drugs; and (2) paying kickbacks to physicians to induce them to prescribe the drugs.
A pain management company agreed to pay $312,000 to resolve claims that it billed Medicare and TennCare for urine drug tests that were not medically necessary. It also allegedly submitted claims to Medicare and TennCare for drugs purchased from foreign suppliers and not approved by the FDA.
A pain management specialist agreed to pay $399,895.92 to resolve claims that his practice submitted claims for payment by using a modifier for multiple units of a codes for when only a single unit of that code may be billed.
A home health company agreed to pay $1.7 million to resolve FCA allegations that, through its officers, paid individuals for patient referrals in violation of Medicare’s anti-kickback provisions. As part of the settlement, the company also entered into a five-year CIA with HHS-OIG.
The corporate successor to a skilled nursing facility management company, a rehabilitation therapy services provider, a hospice provider, and certain owners of each of these entities agreed to pay $19.5 million to resolve allegations that: (1) the management company submitted claims to Medicare for rehabilitation therapy services that were provided at excessive levels; (2) the hospice company provided services to patients without conducting the required certifications or examinations, making those patients ineligible for such services; and (3) the individual owners received payments in exchange for referring patients from the involved nursing homes to a home health services provider.
A managed care plan and its nursing service agreed to pay $4.4 million to resolve FCA allegations that it did not remove beneficiaries from enrollement in its plan in a timely manner, thus continuing to receive Medicaid funds for these patients when no services were being provided. Once the patients were disenrolled, the company did not repay the funds received in error.
A short-term residence operator and its co-owner agreed to pay $300,000 to settle claims that they referred residents to outpatient chemical dependency clinics and enforced attendance at the treatment programs in exchange for cash payments.
A former operator of outpatient chemical dependency clinics will pay more than $50.5 million as part of a bankruptcy proceeding to settle allegations that it: (1) made payments to an operator of short-term residences in exchange for referrals and the enforcement of attendance at outpatient programs by the residents; and (2) provided below-cost housing to patients to induce them to enroll in outpatient treatment programs and then evicted the residents once the maximum Medicaid reimbursements had been received. The company also allegedly instructed and paid employees of outpatient programs to create false treatment records. As part of the settlement, Narco agreed to be excluded from all federal healthcare programs for 50 years. The short-term residence provider and its co-owner entered into a separate settlement agreement.
A podiatrist pled guilty to health care fraud for illegally charging Medicare and private insurance companies for services that he never provided. He has also paid $410,000 to the United States to resolve his civil liability for his submission of false claims for payment to the Medicare program.
A physician agreed to pay more than $124,000 to settle allegations that he billed Medicare for evaluation and management services which were integral to treatments provided on the same day and therefore not eligible for reimbursement.
A pharmacy services provider paid $1.65 million to resolve FCA allegations that it dispensed certain drugs on the Medi-Cal formulary without confirming that they were to be used for approved diagnoses. In some cases, the pharmacies purportedly dispensed drugs for nonapproved diagnoses and billed Medi-Cal for them.
An optometry practice agreed to pay more than $16 million to settle claims that it used money received as Medicare, TRICARE, the Department of Veterans Affairs, and MaineCare reimbursements to pay the salary and benefits of an employee who was excluded from participation in federal healthcare programs.
The owners of a now-defunct hospice facility agreed to turn over $8 million in assets to resolve FCA allegations that through their business, they billed Medicare for services supposedly provided to patients who were not eligible for hospice services.
A for-profit hospice provider agreed to pay $2 million to resolve FCA allegations that it admitted patients who did not qualify for hospice care and provided unneeded services to them on the basis of a medically unjustified diagnosis of “debility.”
A hospice group agreed to pay $2.4 million to resolve FCA allegations that it paid a medical director for referrals and also entered into sham contracts with associate medical directors in exchange for referrals. The company then submitted claims to Medicare and Medicaid for services provided to the referred patients.
An operator of skilled nursing facilities and its affiliates agreed to pay more than $8.3 million to resolve FCA allegations that it provided speech, physical, and occupational therapy services to residents for whom such services were unnecessary, even pressuring therapists to provide the services when the therapists did not agree that it was necessary. The company then submitted claims to Medicare for these services. As part of the settlement, Reliant and its affiliates entered into a five-year CIA with the HHS-OIG.
A healthcare system agreed to pay $6.5 million to resolve FCA allegations that it billed for urine tests as if they were of higher complexity than they actually were. Reimbursements for tests of moderate complexity were submitted as if they were high complexity tests, resulting in greater reimbursement than was appropriate.
A medical equipment manufacturer and its parent company agreed to pay $2.715 million to resolve FCA allegations that they marketed certain models of their devices as DME, despite knowing that the devices did not have the expected life of a durable device. This marketing caused DME suppliers to bill for the devices as DME when they did not meet the standards for a durable device, resulting in the submission of false claims.
A physician agreed to pay $133,464 to resolve claims that he submitted claims to Medicare for services that were not eligible for reimbursement because they were integral to treatments provided on the same day.
An acute care hospital agreed to pay $42 million to resolve allegations that it submitted claims to Medicare and MediCal for services provided to patients that were referred by physicians from whom the hospital rented space at above market values and whom benefited from marketing arrangements in violation of the Stark Law and Anti-Kickback Statute.
An oxygen and respiratory therapy services and equipment provider agreed to pay $20 million to resolve FCA allegations that it: (1) billed federal healthcare programs for oxygen equipment and tanks even when customers did not use or require them; (2) fabricated customer oxygen orders; and (3) improperly waived customer co-payments and deductibles.
A physician and his spouse agreed to pay $1.2 million to resolve FCA allegations that their medical practice billed Medicare and TennCare for anticancer and infusion drugs that were produced for sale in foreign countries and not approved by the FDA for marketing or reimbursement in the United States. The unapproved drugs were less expensive than the drugs approved by the FDA. Thus, the individuals allegedly profited by administering the cheaper unapproved drugs.
An orthopedic practice and its owners agreed to pay more than $1.5 million to resolve self-reported FCA allegations that they improperly billed Medicare, Medicaid, the Department of Veterans Affairs, and TRICARE for physician extenders, medical equipment, physical therapy, and hospital consults.
A medical device company and its owner agreed to pay $10.56 million to resolve FCA allegations that it billed Medicare for higher and more expensive levels of monitoring services than requested by the ordering physicians.
A medical device company and its owner agreed to pay $2.89 million to resolve FCA allegations that it billed Medicare for higher and more expensive levels of monitoring services than requested by the ordering physicians.
A physician, his practice, and a local neurosurgeon physician group agreed to pay $1.4 million to resolve FCA allegations that they billed federal healthcare programs for ultrasound guidance that was unreasonable and not medically necessary, and they filed multiple identical claims for single office visits by manipulating billing codes.
A medical contractor and its owner have agreed to pay $2.475 million to resolve FCA allegations that they paid a consulting company for confidential information that was used in their bid for contracts to manage healthcare services for the federal prison system.
A DME store owner agreed to pay $898,523 to resolve civil FCA allegations that he billed Medicare and Medicaid for more expensive models of DME than what he actually provided. The store owner also pleaded guilty to a related criminal charge.
A hospital agreed to pay more than $300,000 to resolve claims that it submitted claims for established patients using the codes for new patient visits which are reimbursed at a higher rate.
A hospital agreed to pay more than $441,000 to settle allegations that it submitted claims for clinic visits as if the patients were new patients, instead of using the appropriate, and lower-rate, codes for established patients.
A healthcare company has agreed to pay $53,639,288 to resolve FCA allegations that companies and facilities it acquired billed Medicare for hospice services for patients who were ineligble for the services and submitted inappropriate bills for physician evaluation management services. Subsidary companies also allegedly submitted claims to federal healthcare programs for therapy provided in excess of what was necessary, billed for outpatient therapy that was medically unnecessary or unskilled, and submitted claims for services that were grossly substandard or worthless, thereby rendering them ineligible for reimbursement.
A chiropractor agreed to pay $225,000 to resolve allegations that he and his employees referred patients to a DME company that he owned, in violation of the Stark Law.
Two allergists agreed to pay more than $740,000 to settle claims that their practice submitted claims to Medicare, TRICARE, and the FEHB Program for services that are considered investigational and therefore are not eligible for reimbursement.
A university which operates a teaching hospital agreed to pay more than $113,000 to settle allegations that it improperly used modifier 25 on claims that did not meet the requirements for its use, thus receiving higher reimbursements than it should have.
A doctor and his chiropractor son agreed to pay $1.78 million to resolve FCA claims that they submitted fraudulent claims to Medicare for physical therapy services administered by unqualified and unlicensed employees.
A pharmacy and its owner agreed to pay a total of $2.175 million to resolve FCA allegations that they submitted claims to Medicare for drugs that Rhine Drug Company did not dispense to patients and violated the Controlled Substances Act by negligently failing to make, keep, or furnish certain records as required by federal law.
A medical and physical therapy provider agreed to pay $3 million to resolve FCA allegations that they fraudulently billed the FECA program for services it did not render, routinely overcharged for medical examinations, falsely inflated the time patients spent in therapy, and billed for unnecessary services and supplies. The United States also accused the company of offering, paying, soliciting, and receiving kickbacks in exchange for patient referrals.
A hospitalist group agreed to pay $4.2 million to resolve FCA allegations that it increased the level of evaluation and management codes to the highest code levels, resulting in increased reimbursement amounts paid by the federal healthcare payors to the billing defendants.
An electronic health records vendor agreed to pay $155 million to resolve FCA allegations that it: (1) falsely obtained certification for its EHR software when it concealed from its certifying entity that its software did not comply with the requirements for certification; and (2) that its software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from the company's software to the software of other vendors, causing the submission of false claims for federal incentive payments. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A skilled nursing facility agreed to pay $888,000 to resolve FCA allegations that it provided nursing services to certain patients that failed to meet federal standards of care and federal statutory and regulatory requirements. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A mental health provider and its owners agreed to pay $4.5 million to resolve FCA allegations that it: (1) billed Medicaid for claims while knowingly violating clinical supervision requirements; (2) impermissibly billed Medicaid for time completing paperwork; and (3) transferred $2 million in Medicaid funds from the company to the owners’ nonprofit entity.
A managed care services provider has agreed to pay $31,695,593 to resolve FCA allegations that it received inflated reimbursements from Medicare after the submission of claims with unsupported diagnosis codes. The settlement also resolves claims that the company misrepresented the scope and contents of its provider network to CMS when it applied to expand into new counties and states.
A hospital agreed to pay almost $500,000 to settle claims that an employee forged required physician signatures on claim forms submitted to Medicare for reimbursement.
A physician agreed to pay $100,000 to resolve claims that he billed Medicare for services after entering into an agreement to be excluded from federal healthcare programs for five years.
A pharmacy services provider agreed to pay $8 million to settle allegations that it designed and used an automated label verification system that caused the submission of claims for different generic drugs than were dispensed and for the dispensing of drugs with incorrect manufacturer information or National Drug Codes on the labels.
A benefits management company has agreed to pay $54 million to resolve FCA allegations that it authorized medical diagnostic procedures paid for with Medicare and Medicaid funds over a period of at least eight years without properly assessing whether the procedures were necessary or reasonable.
A radiation therapy center agreed to pay $3 million to resolve FCA allegations that its therapists administered radiation oncology treatments to beneficiaries of the three government healthcare programs when no doctor was on-site at the center.
A medical equipment supplier agreed to pay $1 million to resolve FCA allegations that it submitted false claims to Medicare for vacuum erection devices that weren't medically necessary, lacked documentation of medical necessity and weren't properly ordered by a physician.
Part of a group of settlements, a therapy provider and related individual agreed to pay $1.1 million to resolve allegations that they conspired with two other entities to avoid repaying Texas Medicaid $2.7 million the state had overpaid.
A drug manufacturer agreed to pay $5,885 million to settle claims that it treated actual payments to wholesalers as discounts instead of payments, resulting in the manufacturers reporting lower average prices, leading to lower rebates paid to Medicaid programs. The case was settled after the government declined to intervene.
A North Carolina pathology lab agreed to pay $601,000 to settle FCA allegations that it failed to analyze certain gastric biopsy specimens using a standard stain before a special stain was applied to the tissue for evaluation. Special stains are billed to government health-care programs separately and their use before the routinely stained tissue is evaluated is considered to be medically unnecessary.
Two health care providers have agreed to pay the United States $34,000,000 to resolve FCA allegations that they submitted false claims to the Medicare Program for chemotherapy services rendered to patients referred by oncologists whose compensation was based in part on a formula that improperly took into account the value of their referrals of patients to the infusion center operated by the Defendants.
A Kansas chiropractor agreed to pay $1 million to resolve FCA allegations that his clinics charged Medicare between July 2011 and May 2013 for nerve conduction tests, nerve-block injections and ultrasound treatments for peripheral neuropathy that were medically unnecessary or not covered by Medicare.
A provider of laboratory testing services agreed to pay almost $900,000 to settle allegations that it promoted a diagnostic test in a way that was inconsistent with FDA approval requirements, and billed the government for the tests, which were not medically necessary.
A diagnostic laboratory has agreed to pay $6 million to resolve FCA allegations that one of its subsidiaries charged federal healthcare programs for medically unnecessary cardiovascular tests by: (1) paying kickbacks to referring physicians disguised as “process and handling” fees; and (2) paying kickbacks to patients by routinely waiving copayments owed by certain patients who were legally required to pay for part of their tests.
A healthcare system and one of its hospitals have agreed to pay $10 million to resolve FCA allegations that a group of researchers employed at the hospital falsified and manipulated data to obtain federal National Institutes of Health research grants to conduct stem cell research.
A physician has agreed to pay $751,681 to resolve FCA allegations that he submitted or caused to be submitted claims for payment to Medicare, Medicaid, TRICARE, and FEHB Program for allergy tests that were never performed.
A health system and a provider of healthcare services to underserviced populations agreed to pay $18 million to settle allegations that the health system provided the service provider with an interest-free line of credit with no expectation that it would be repaid in an attempt to obtain referrals of OB/GYN patients.
A device manufacturer and its general partner agreed to pay $11.4 million to resolve allegations that it submitted claims to federal healthcare programs for oxygen and related equipment without receiving the required physician authorizations. The settlement also covers claims that company employees agreed to refer patients to certain sleep testing clinics in exchange for referrals by the clinic to the company for equipment.
A hospital has agreed to pay $791,000 to resolve FCA allegations that one of its physicians was giving chemotherapy treatments to more than 500 patients he had misdiagnosed with cancer. Crittenton voluntarily disclosed to the government the potential lack of medical necessity regarding laboratory testing under the physician's watch.
A dermatologist and his practice agreed to pay $2.7 million to resolve FCA allegations that he submitted bills to Medicare for Mohs micrographic surgeries for skin cancers that were medically unnecessary. As part of the settlement, the physician entered into a three-year IA with HHS-OIG.
A drugstore chain will pay $9.9 million to settle two FCA suits in California federal court alleging it submitted claims for reimbursements to the state's Medi-Cal health program for certain prescriptions without verifying the medical necessity of such drugs as required.The settlement resolves claims set forth in two FCA complaints filed in 2011 and 2014 by a former Walgreens pharmacist and technician that were ordered to be unsealed in light of the settlement reached between the company, the U.S. government, California and the whistleblowers. | The suits alleged that Walgreens failed to confirm and document the diagnoses for which certain prescriptions were being ordered, dispensed drugs for non-approved diagnoses and then knowingly billed Medi-Cal for the prescriptions.
A primary care practice agreed to pay $250,000 to settle claims that it billed Medicaid for complex blood removals and visual examinations instead of the blood draws and eye examinations with lower reimbursement rates that were actually performed.
Several hospice companies agreed to pay $12.21 million to resolve FCA allegations that they submitted claims to Medicare and Texas Medicaid that were rendered false as a result of the payment of kickbacks by the hospices, their owners and employees, and others.
A hospital, the former administrator, and several physicians agreed to pay more than $1.6 million to resolve allegations that they submitted claims to Medicare for services which were performed by radiological practitioner assistants without the required physician supervision.
A nursing home operator agreed to pay $995,500 to settle allegations that it utilized a genetics testing company to perform tests on patients without obtaining physician orders or notifying company physicians of the tests, and without providing patients or, when appropriate, their families, with information about the tests and opportunties to decline the testing.
More than a dozen individuals and health care providers must pay $42.8 million for defrauding the federal government in violation of the FCA. The overarching scheme, which involved billing for unnecessary or unprovided medical care, ran for more than 10 years. A total of $56 million in mostly false claims were submitted between 2007 and 2014, the DOJ said. Medicare reimbursed $50.7 million of those claims.
A provider of children's behavioral therapy, including services to autistic children, agreed to pay $20,000 and exclusion from TRICARE for three years in order to settle allegations that his company double-billed TRICARE for some services and billed for services that were not provided or were provided as group therapy but billed as individual therapy.
A cardiologist and several companies he owns agreed to pay $300,000 to settle claims that he billed Medicare and Medicaid for services provided to a vulnerable population during monthly clinics. The services billed were detailed patient evaluations and complete echocardiograms, when the services provided were actually short evaluations and limited echocardiograms.
A laboratory that contracts with the National Institutes of Health to develop and maintain colonies of animals and provide laboratory animals agreed to pay $1.8 million to resolve claims that it billed for labor and associated employee costs that were not provided.
An oncologist, his practice, and his practice manager wife agreed to pay $1.7 million to settle claims that they billed Medicare for chemotherapy drugs and related infusion services when the drugs had been imported from foreign distributors and were not approved by the FDA for sale in the United States.
An ENT specialist and his practice agreed to pay $750,000 to settle allegations that he billed federal healthcare programs for specialized surgical debridement procedures when the services performed were actually diagnostic endoscopies. The settlement also covers allegations that he submitted claims for laryngeal stroboscopies that were either not medically necessary or never performed.
A behavioral health hospital agreed to pay $860,000 to settle claims that it paid a physician for referrals by disguising the payments as being made under a professional services agreement.
A health services contractor agreed to pay more than $3.8 million to resolve allegations that it double-charged the United States for services provided to IRS agents by billing for charges that were already included in a bundled contract. The company also allegedly charged for physical exams that were not medically necessary.
A physician and the United States have stipulated to a consent final judgment of more than $18 million to settle FCA allegations that the physician knowingly submitted claims to federal healthcare programs for: (1) medically unnecessary biopsies and radiation therapy services; (2) radiation therapy services performed in contravention of standard practice regarding the amount of time between radiation treatments; (3) and radiation therapy services performed without direct supervision and by unlicensed and/or unqualified physician assistants.
A hospital service provider agreed to pay $60 million to settle allegations that it encouraged hospitalists to bill federal healthcare programs for higher levels of service than were provided.
A physician agreed to pay $250,000 to settle FCA allegations that he submitted false claims to federal and state healthcare programs for laboratory services tainted by kickbacks to, and improper financial relationships with, another physician.
A skilled nursing facility and related individuals agreed to pay $100,000 to resolve claims that they submitted claims to Medicaid for care that was alleged to be grossly substandard, thus rendering the care without value.
A pain management physician agreed to the entry of a $20 million consent judgment to settle allegations that he submitted claims to federal healthcare programs for surgical monitoring services that were performed by an unqualified medical assistant and for diagnostic tests that were not medically necessary.
A urologist agreed to pay $3.81 million to settle allegations that he submitted claims to Medicare and TRICARE for laboratory tests on urine designed to detect bladder cancer, despite the tests only being covered by Medicare in specific situations. The doctor referred all these tests to one laboratory, from which he received more than $2 million in bonus payments in exchange for the referrals.
A university medical center agreed to pay $6.5 million to settle claims that it submitted claims to Medicare for services performed at physician rates despite the services being performed by residents and not always under physician supervision.
A health system agreed to pay $845,000 to settle claims that two cardiologists it employed submitted claimst to Medicare for medically unnecessary stent procedures.
A pharmacy chain agreed to pay $50 million to resolve claims that it provided incentives to Medicare, Medicaid, and TRICARE beneficiaries who signed up for a discount program, despite the fact that participation in such programs by government beneficiaries is a violation of federal law.
An ambulance company agreed to pay more than $12 million to settle allegations that it billed Medicare for medical transports that were not medically necessary and billed for higher levels of services than were necessary or, in some cases, than were actually provided.
A sovereign Indian tribe agreed to pay $245,860 to settle allegations that it submitted claims to Medicaid based on invoices from a contractor that represented the contractor had conducted individual youth counseling sessions when in fact a group course took place.
A drug manufacturer has agreed to pay more than $18 million to settle civil and criminal claims that it did not follow current Good Manufacturing Practices when it manufactured sterile IV solutions in a room that had been identified to have moldy HEPA filters.
A home health care company and its owners agreed to pay more than $5 million to settle claims that they billed Medicaid for services that are required to be performed by a registered nurse when the services were not performed by a nurse. They also allegedly submitted claims to Medicaid when the claims should have been submitted to Medicare first.
A pharmaceutical company and related companies agreed to pay $350 million to resolve allegations that they violated the Anti-Kickback statute by paying for meals, entertainment, travel, medical supplies and equipment, and speaking engagements, as well as providing credits and rebates, to physicians in attempts to induce the physicians to use a human skin substitute.
Texas-based dental management firm MB2 Dental Solutions, along with 21 affiliated practices, agreed to pay a combined $8.45 million to resolve allegations of filing false claims to Medicaid for pediatric dental services. DOJ alleged that between Jan. 1, 2009 and Dec. 31, 2014, MB2 and its affiliated practices submitted claims to the Texas Medicaid Fee for Service Program for fillings in children that were never provided. DOJ alleged that MB2 paid kickbacks to Medicaid beneficiaries and their families, as well as marketers and marketing entities, and also used false Medicaid provider numbers to misrepresent which dentists were performing the pediatric procedures. As part of the settlement, five Texas-based MB2 dentists — Christopher Steven Villanueva, Trung Minh Tang, Mauricio Dardano, Gabriel Shahwan and Akhil Reddy — agreed to pay the government $250,000 a piece to resolve individual claims against them. MB2's marketing head, Frank Villanueva, agreed to pay $100,000 to resolve claims against him. Additionally, the five dentists entered into a five-year CIA with the HHS-OIG.
A home health company and its president agreed to pay $1 million to settle claims that they received reimbursement for services to Medicare beneficiaries based on cost reports that improperly included non-reimbursable travel and entertainment expenses and costs associated with services provided by related entities.
Two rehabilitation clinics agreed to pay $315,500 to settle allegations that they submitted claims to the Office of Workers Compensation Programs of the United States Department of Labor for services that were either not performed or were billed at a higher than permissible rate.
A sleep clinic, its related businesses, and their owners and operators agreed to pay $2.6 million to resolve FCA allegations that they billed Medicare: (1) for sleep tests performed by unlicensed or uncertified technicians; (2) for sleep tests conducted at unenrolled and unapproved locations; and (3) for medical devices in violation of Medicare regulations that prohibit providers of diagnostic sleep tests from supplying medical devices and from sharing a sleep laboratory location with a DME supplier. As part of the settlement, the defendants voluntarily terminated their two existing Medicare enrollments and agreed not to re-enroll as providers or suppliers in the Medicare program for three years.
A pharmaceutical company agreed to pay $38 million to resolve FCA allegations that it violated the Anti-Kickback Statute by providing payments and meals to certain physicians in connection with speaker programs about specific drugs even when the programs were cancelled (and no evidence was provided of a bona fide reason for the cancellation), when no licensed healthcare professionals attended the programs, when the same attendees had attended multiple programs over a short period of time, or when the meals associated with the programs exceeded the company’s internal cost limitations.
A physician agreed to pay $76,000 to resolve FCA allegations that she billed Medicare and Medicaid for trigger point injections consisting solely of saline or saline-based anthroposophic injectates that were devoid of any approved therapeutic agent and not considered reasonable and medically necessary under applicable Medicare and Medicaid laws, regulations, and program limitations.
A laboratory company and its owners agreed to pay $3.75 million to settle allegations that they submitted claims to Medicare with inflated mileage calculations beyond those actually driven by laboratory employees. The company will be excluded from participating in Medicare for eight years, one owner will be excluded for 10 years, and the other owner will be excluded for eight years.
A non-profit regional hospital agreed to pay $12 million to resolve FCA allegations that it billed federal healthcare programs for medically unnecessary electrophysiology studies and other cardiac procedures allegedly performed by a physician at the hospital.
An orthopedic medical group agreed to pay $4.488 million to resolve allegations that it engaged in several types of questionable billing practices, including that it: (1) certified that it met certain EHR “meaningful use” standards when the practice had not actually done so; (2) billed for certain claims as “incident to” physician supervision when no physician was present or there was no verification of any physician being present; (3) billed for certain claims using Modifier 25 signifying that a separate evaluation and management service was performed even when there was no such separate service; (4) billed for certain claims using Modifier 59 signifying that two procedures, rather than one, were billable even when these procedures should have more appropriately been billed as one such procedure; (5) scheduled patients’ follow-up operative visits 12 to 14 weeks following surgery in order to bill for a separate visit outside the normal Medicare 90 days DRG charge; (6) routinely used and billed for medically unnecessary ultrasound-guided injections; and (7) billed for certain physical therapy claims using Modifier KX so as to exceed the Medicare cap on physical therapy, even when medically unnecessary.
A dental clinic and its owners agreed to pay more than $300,000 to resolve FCA allegations that they billed for dental procedures, including scalings and root planings, which were either medically unnecessary or not actually performed.
A chain of eye care centers agreed to pay more than $135,000 to resolve FCA allegations that it billed Medicaid for more than four lenses per year, in violation of Pennsylvania Medicaid’s regulations, and then retained those payments upon becoming aware that it had done so.
A hospice provider and related entities agreed to pay $200,000 to resolve FCA allegations that it contributed more than $15,000 to a cancer charity established by a physician, in exchange for the referral 23 patients for hospice care, in violation of the Anti-Kickback Statute.
A pain management physician agreed to enter into a consent judgment for $430,000 to resolve FCA allegations that he billed federal healthcare programs for services that were medically unnecessary or where there was insufficient information to determine the amount due to the provider.
Two operators of opioid addiction treatment centers agreed to pay $750,000 to resolve allegations that they: (1) violated the Controlled Substances Act and DEA regulations by routinely representing to pharmacies that physicians had prescribed buprenorphine for patients when, in fact, only midlevel practitioners had seen the patients and the prescriptions were signed and backdated by part-time physicians; and (2) violated the FCA by improperly billing Medicare for patient visits using physicians’ identification numbers when, in fact, the patients saw midlevel practitioners and no physicians were on clinic premises to supervise those practitioners.
A radiology company agreed to pay $8.153 million and forfeit $2.4 million to resolve FCA civil allegations and related criminal charges that the company “bundled” the tests it performed, such that when a patient’s treating physician ordered one test to be performed, the company would automatically perform a related but unordered test. The civil settlement also resolves allegations that the company billed Medicare and Medicaid programs for procedures performed or supervised by physicians who were not properly credentialed, or which were performed at an unauthorized practice location. As part of the global resolution, the company pleaded guilty to the related criminal charges and agreed to enter into a five-year CIA with HHS-OIG.
Two pharmacies agreed to pay a total of $750,000 to resolve FCA allegations that they provided patients with generic versions of certain medications, but charged Medicare and Medicaid for the brand name versions of those medications.
A remote cardiac monitoring company agreed to pay more than $1.35 million to resolve FCA allegations that it: (1) entered into “fee-for-service” or “direct-bill” agreements with certain hospital and physician clinic customers; (2) charged a fee to the customers for certain services that the company performed in connection with event monitoring and telemetry; and (3) allowed the customers to bill Medicare directly for these same services and retain the reimbursements they received from Medicare, which exceeded the fee that the company charged them, in order to induce referrals from those customers for its services.
A psychiatrist agreed to pay $908,000 to resolve allegations that he submitted bills for evaluation and management services provided at long-term care facilities that were either not provided at all or not provided to the extent claimed. In addition to the monetary payment, the psychiatrist agreed to be excluded from participation in federal healthcare programs for 10 years.
A medical device manufacturer pleaded guilty to misbranding its embolic device used to treat liver cancer and agreed to pay more than $36 million to resolve criminal and civil FCA liability arising from its conduct. The government alleged that the company intended for the device, upon entering the U.S. market, to be used as a drug-delivery device in combination with chemotherapy drugs, despite the lack of FDA approval as a drug-device combination product. An application was subsequently filed with the FDA for approval of the device as a drug-eluting bead combination product, which the FDA did not accept because clinical studies did not provide adequate evidence of a therapeutic benefit. Nonetheless, the government alleged that a distributor of the device routinely advised healthcare providers that it provided “better” or “superior” therapy for certain types of cancer when, in fact, there was insufficient clinical evidence to support these claims.
A healthcare system and related practice agreed to pay $968,418.60 to resolve FCA allegations, which were voluntarily self-disclosed to the government, that they billed Medicare for services performed by a cardiologist which were not medically necessary or lacked sufficient documentation.
A home healthcare agency and its owner and operator agreed to pay $1.8 million to resolve FCA allegations resulting from an arrangement between the owner and an individual who transported patients from their homes to healthcare facilities, whereby the transportation provider was paid for the referrals of new patients based on a formula which accounted for each hour of service that the company billed to Medicaid.
A holding company for several subsidiaries that operate and manage skilled nursing facilities, agreed to pay $5.3 million to resolve FCA allegations that the nursing home operators billed Medicare and Medicaid for materially substandard and/or worthless nursing services at four facilities. The care was determined to be ineligible for reimbursement because the company failed to: (1) follow appropriate fall protocols for several residents; (2) follow appropriate pressure ulcer and infection control protocols for several residents; (3) properly administer medications to several residents to avoid medication errors; (4) follow doctors’ orders for several residents; (5) provide appropriate mental health treatment to several residents; (6) answer several residents’ call lights promptly; (7) institute appropriate infection control measures for several residents; (8) provide a habitable living environment, adequate equipment, and needed capital expenditures; and (9) investigate and report serious incidents to appropriate authorities on several occasions. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A skilled nursing facility operator and its owner agreed to pay $145 million to resolve FCA allegations it submitted false claims for rehabilitation therapy as a result of: (1) instituting corporate-wide policies and practices designed to place beneficiaries in the Ultra High reimbursement level irrespective of the clinical needs of the patients, resulting in the provision of unreasonable and unnecessary therapy to many beneficiaries; (2) seeking to keep patients longer than was necessary in order to continue billing for rehabilitation therapy; and (3) carefully tracking the minutes of therapy provided to each patient and number of days in therapy to ensure that as many patients as possible were at the highest level of reimbursement for the longest possible period. The settlement also resolves allegations that the company's owner, as the sole shareholder, was unjustly enriched by the company’s alleged fraudulent scheme. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A partial owner of a compound pharmacy agreed to pay $4.25 million to resolve FCA allegations that the pharmacy billed federal healthcare programs for compounded prescriptions that were tainted within the meaning of the Anti-Kickback Statute.
A hematology and oncology practice agreed to pay $5.31 million to resolve allegations that it: (1) routinely waived Medicare beneficiaries’ co-payments without an individualized documented determination of financial hardship or exhaustion of reasonable collection efforts and then billed Medicare for the waived co-payments; and (2) overbilled Medicare and Medicaid for evaluation and management service codes, in addition to billing for routine procedures on the same date, even though the practice had not documented that it provided any significant, separately identifiable evaluation and management services to the beneficiaries. In addition, the practice entered into a five-year CIA with HHS-OIG.
A nursing home pharmacy services provider agreed to pay $28.125 million to resolve FCA allegations that it solicited and received kickbacks—disguised as “grants” and “educational funding” or in the form of tickets to sporting events and funding of meetings—from a pharmaceutical manufacturer in exchange for promoting a prescription drug for nursing home patients. The government also alleged that the company entered into agreements with the manufacturer by which it was entitled to increasing levels of rebates based on the number of nursing home residents serviced and the amount of the drug prescribed per resident.
A medical device maker and its owner agreed to entry of a $1.96 million judgment against them to resolve FCA allegations that they made false statements about their personnel, facilities, and accounting systems in federal grant applications and falsely stated in grant reports that they had spent the funds for the grants and in compliance with grant regulations. Instead, the funds were allegedly spent on personal expenses and business expenses not allowed under grant regulations. In a related criminal case, the owner pleaded guilty and was sentenced to four months in prison.
A skilled nursing facility operator and its director of long-term care agreed to pay $2.5 million to resolve FCA allegations that they failed to take sufficient steps to prevent a rehabilitation therapy provider from fraudulently inflating the reported amounts of therapy provided to Medicare Part A patients in the company's facilities. The facilities allegedly submitted inflated therapy bills because therapists: (1) were actually conducting initial evaluations when they claimed to be providing therapy; and (2) reported therapy time using estimates that often were rounded up from the actual minutes of therapy provided, despite Medicare rules specifically prohibiting the reporting of estimated or rounded numbers of minutes. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A nonprofit community health system agreed to pay $5.85 million to resolve allegations that it misreported the hours worked by its employees on its annual cost reports, which artificially inflated the wage index for the Prescott, Arizona area and thus, inflated the amount of money the organization received from the Medicare program.
A hospital chain and two of its subsidiaries agreed to pay more than $513 million to resolve criminal charges and civil FCA allegations that four hospitals paid bribes and kickbacks to the owners and operators of prenatal care clinics serving primarily undocumented Hispanic women in exchange for the referral of those patients for labor and delivery medical services. The expectant mothers were allegedly provided with misinformation regarding their choice of hospitals or what Medicaid would cover, leaving them with the false belief that they could not select the hospital of their choice. To resolve the related criminal matter, two subsidiaries pleaded guilty, and the hospital chain and its subsidiaries agreed to a three-year non-prosecution agreement, which requires the retention of an independent compliance monitor, ongoing cooperation with the government, and an enhanced compliance and ethics program and internal controls.
An orthopedic clinic agreed to pay a $602,335 to resolve FCA allegations that it purchased deeply discounted osteoarthritis medications, known as viscosupplements, that were reimported from foreign countries and billed them to state and federal healthcare programs, even though such reimported viscosupplements were not reimbursable by those programs.
An orthopedic clinic agreed to pay a $971,903 to resolve FCA allegations that it purchased deeply discounted osteoarthritis medications, known as viscosupplements, that were reimported from foreign countries and billed them to state and federal healthcare programs, even though such reimported viscosupplements were not reimbursable by those programs.
An orthopedic clinic agreed to pay a $815,794 to resolve FCA allegations that it purchased deeply discounted osteoarthritis medications, known as viscosupplements, that were reimported from foreign countries and billed them to state and federal healthcare programs, even though such reimported viscosupplements were not reimbursable by those programs.
A home health agency was ordered to pay $6.15 million in FCA damages following a grant of summary judgment in a case alleging that it violated the FCA by repeatedly and routinely falsifying records to obtain funds from Medicaid. The government’s evidence included documents showing that patient files contained forged signatures or falsified timesheets, including a document showing several attempts at forging a doctor’s signature, which subsequently appeared in a patient file.
A skilled nursing facility operator and its chief operating officer agreed to pay $2.2 million to resolve allegations that they failed to take sufficient steps to prevent a rehabilition therapy provider from engaging in a pattern and practice of inflating the reported amounts of therapy provided to Medicare Part A patients in its facilities. Specifically, the government alleged that the facilities submitted inflated therapy bills because therapists: (1) were actually conducting initial evaluations when they claimed to be providing therapy; and (2) reported therapy time using estimates that often were rounded up from the actual minutes of therapy provided, which is prohibited under Medicare rules. As part of this settlement, the company entered into a five-year CIA with HHS-OIG.
A national hospital chain agreed to pay $32.7 million to resolve FCA allegations it billed Medicare for services provided when it: (1) admitted patients to five of its long-term care hospitals and to one of its inpatient rehabilitation facilities who did not demonstrate signs or symptoms that would qualify them for admission; and (2) extended the stays of patients at its long term care hospitals without regard to medical necessity, qualification and/or quality of care—in some instances, allegedly ignoring the recommendations of its own clinicians. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
The former CEO of a healthcare system, agreed to pay $1 million to resolve FCA allegations related to his involvement in the hospital’s employment and compensation of 19 part-time physicians in excess of fair market value and in a manner that varied with the volume or value of their referrals, in violation of the Stark Law. As part of the settlement, he will be excluded for four years from participating in federal healthcare programs, including providing management or administrative services paid for by federal healthcare programs. In October 2015, the healthcare system agreed to pay $74.9 million to resolve related allegations.
A clinical social worker agreed to pay $110,000 to resolve FCA allegations that he billed Medicare for therapy sessions that he never actually scheduled and for appointments which his clients cancelled or missed. He also agreed to be excluded from participation in federal healthcare programs for a period of five years.
A doctor agreed to pay $200,000 to resolve FCA allegations that he wrote prescriptions for oxycodone and other controlled medications without medical justification, and billed for medically unnecessary x-rays and other invasive tests and for services that were not performed. The physician pleaded guilty in a related criminal action and was sentenced to 84 months in prison.
A skilled nursing facility operator agreed to pay $28.5 million to resolve FCA allegations that it caused the submission of false claims to federal healthcare programs for medically unnecessary rehabilitation therapy services provided to residents at its facilities. As part of this settlement, the company has entered into a five-year CIA with HHS-OIG.
A senior vice president of a skilled nursing facility operator agreed to pay $500,000 to resolve FCA allegations that she created a scheme resulting in the submission of false claims to federal healthcare programs for medically unnecessary rehabilitation therapy services provided to residents at the companies facilities.
The chairman of the board of a skilled nursing facility operator agreed to pay a total of $1 million to resolve FCA allegations that he participated in the submission of false claims to federal healthcare programs for medically unnecessary rehabilitation therapy services provided to residents at the company's facilities by reinforcing the scheme.
A home healthcare company and its owner agreed to pay $6.8 million to resolve FCA allegations that the company and its subsidiaries paid monthly fees to medical directors for the sole purpose of obtaining patient referrals and not for any actual medical services. The owner pleaded guilty to violating the Anti-Kickback Statute in a related criminal case. As part of the settlement, the company and related entities entered into a five-year CIA with HHS-OIG.
Partial owners of a compound pharmacy agreed to pay $7.75 million to resolve FCA allegations that the pharmacy billed federal healthcare programs for compounded prescriptions that were tainted within the meaning of the Anti-Kickback Statute. Another owner settled related allegations in October 2016.
A university health system agreed to pay $184,984 to resolve FCA allegations that it billed Medicare using codes for higher paying wound closure procedures, rather than using codes for the lower paying wound closure procedures that were actually performed.
A nursing home and two physicians who worked at the facility agreed to pay $3,563,140 to settle claims that they paid kickbacks to a consortium in exchange for the referral of patients to the facility. One of the physicians allegedly unnecessarily moved patients from the facility to a now-defunct hospital and back to the facility in order to lengthen their Medicare-covered stays. The other physician allegedly ordered services that were not eligible for payment. As part of the settlement, the nursing home agreed to enter into a five-year CIA with HHS-OIG.
Two DME companies and their owners and presidents agreed to pay more than $12.2 million to resolve FCA allegations that they used a fictitious entity to make unsolicited telephone calls to Medicare beneficiaries in order to sell them DME, in violation of the Medicare Anti-Solicitation Statute. In connection with the settlement, one company agreed to be permanently excluded from participating in federal healthcare programs, and the other company entered into a five-year CIA with HHS-OIG.
A surgery and pain management clinic agreed to pay $7.4 million to resolve FCA allegations that, despite appropriately performing qualitative drug tests, the clinic also performed and billed for more expensive and more specific quantitative drug tests for all patients, regardless of the result of the qualitative test, which was medically unnecessary. The government developed this case through the proactive review of claims data, as the clinic was a statistical outlier in billing for quantitative drug test screens. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
An opthalmology practice and its owner agreed to pay $1 million to resolve FCA allegations that they billed Medicare for excessive patient visits at nursing homes and assisted living facilities—often for more than 20 hours in a 24-hour period. The visits were often not medically necessary, and with an inflated billing code. In addition, some of the claims were for procedures alledgedly performed while the ophthalmogist was out of the country.
An audiologist and his healthcare company agreed to pay $930,000 to resolve FCA allegations that they billed for services provided to nursing home residents which were not medically necessary, had not been requested or did not have the correct authorizations, were not supported by patient medical records, or were provided in reliance upon improper standing orders.
A dentist and his two pediatric dental clinics agreed to pay $1,367,466 to resolve FCA allegations that they improperly billed Medicaid for pediatric dental x-rays taken by dental assistants who were not certified by the Dental Assisting National Board as required by Connecticut law. As part of the settlement, the dentist entered into a three-year IA with HHS-OIG.
A hospital operator and three of its hospitals agreed to pay $2.95 million to resolve FCA allegations that they improperly retained $844,000 in overpayments, in violation of CMS’s 60-day overpayment rule. The defendants admitted that (1) claims were mistakenly submitted to Medicaid for payment due to a software error; (2) the company was alerted to the software error by the New York State Comptroller; (3) staff then analyzed billing data to discover possible affected claims; (4) the whistleblower was subsequently terminated; (5) the company never brought the whistleblower’s analysis to the attention of the Comptroller; and (6) it did not fully reimburse Medicaid for claims erroneously billed for more than two years.
A hospital, two physicians, and affiliated entities, including a related pain clinic, agreed to pay $690,441 to resolve FCA allegations that they billed for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising. As part of the settlement, they agreed that for the next two and a half years they would not bill for any services performed by non-physician providers under the “incident-to” rate, even if the claims could be billed properly in that manner.
A urologist agreed to pay $250,000 to resolve FCA allegations that he caused the submission of claims for “FISH” tests that were not medically necessary. He allegedly received bonuses from the owner of a laboratory based in part on the number of FISH tests he referred to the laboratory. In December 2015, the owner of the laboratory resolved related allegations in a $19.75 million settlement.
A hospital agreed to pay $325,000 to resolve FCA allegations that it billed inpatient Medicare Part A claims for routine procedures using certain primary diagnosis codes that did not justify admission to an acute care hospital because the codes correspond primarily to long-term, stable conditions, which should have been treated on an outpatient basis.
A group of anesthesia businesses agreed to pay $1,046,494.79 to resolve FCA allegations that it provided free anesthesia drugs to ambulatory surgery centers in exchange for an exclusive contract to provide anesthesia services at the centers and that an affiliate funded the construction of an ambulatory surgery center in exchange for contracts for their selection as the exclusive anesthesia provider at that facility and other affiliated podiatry-based centers. As part of the settlement, the companies entered into a five-year CIA with HHS-OIG.
A hospital agreed to pay $3.2 million to resolve FCA allegations that it billed New York’s Medicaid program for mobile-crisis outreach services rendered by personnel who failed to satisfy state regulatory staffing requirements.
A provider of behavioral and mental health counseling and its owner and CEO agreed to a stipulated order requiring them to pay $4,752,101.50 to resolve FCA allegations that they submitted or caused to be submitted Medicaid claims for: (1) services provided by unqualified individuals; (2) services where the dates or times of services or service codes were altered to make otherwise ineligible claims eligible for reimbursement; (3) face-to-face services that were double-billed for the same dates and times by the same person; (4) face-to-face services performed by the owner while she was out of the office; (5) telemedicine services when the company and its providers were not authorized or approved by Oklahoma Medicaid to provide such services; and (6) rehabilitation services provided to patients who never received any psychotherapy services, in violation of Oklahoma Medicaid regulations. The company and owner agreed to be excluded from participation in Medicaid and Medicare for five years.
A medical device manufacturer agreed to pay $11.5 million to resolve allegations that it violated the Anti-Kickback Statute by offering inducements to physicians to promote the unapproved use of its stents in patients’ arteries. The inducements allegedly included speaker fees, consulting arrangements, sponsorship grants for physician conferences, paid teaching assignments, paid preceptorships, paid product training assignments, other paid physician educations, and referral dinners.
A hospital agreed to pay $17 million to resolve FCA allegations that it maintained improper financial arrangements with 28 physicians in violation of the Stark Law. Specifically, the government alleged that the hospital entered into asset purchase agreements or employment agreements with physicians that took into account the volume or value of physician referrals, were not commercially reasonable, or provided compensation in excess of fair market value. As part of the settlement, the hospital agreed to enter into a five-year CIA with HHS-OIG.
A university medical center and related entities agreed to pay $2,520,429 to resolve FCA allegations that (1) certain neurosurgeons employed by the hospital billed Medicare for assisting with or supervising surgical procedures performed by other surgeons, residents, fellows, or physician assistants, when those neurosurgeons did not participate in the surgeries to the degree required; and (2) one neurosurgeon billed Medicare for multi-level spinal surgeries for levels of spinal decompression that were not actually performed.
A mental health practice and its psychiatrist founder agreed to pay $36,704 to resolve FCA allegations that they billed Medicare for psychiatric services that were provided over the phone to certain Medicare beneficiaries who were not located in rural health professional shortage areas, instead of by meeting with the beneficiaries in the office and treating them in person, in violation of Medicare rules.
A dermatologist and his solo practice agreed to pay $302,227.11 to resolve allegations that he improperly billed Medicare and Medicaid: (1) for services performed as if he were supervising the procedures even though he was not in the office—in some cases, not in the country—during the procedures; (2) that for some days he submitted claims for more hours than he could have possibly worked in one day; and (3) by double-billing Medicare for certain examinations and procedures. As part of the settlement, he entered into a three-year IA with HHS-OIG.
A medical device manufacturer agreed to pay $18 million to settle claims that it caused healthcare providers to submit false claims to federal healthcare programs by promoting and distributing its sinus spacer product for use as a drug delivery device although the FDA had not approved the product for that use and continued to do so even after the FDA rejected the company’s request to expand the approved uses for the product. The company's former CEO and former VP of Sales were convicted in July 2016 following a jury trial in a related criminal case.
An operator of independent diagnostic facilities agreed to pay $3.51 million to resolve FCA allegations that it improperly billed Medicare, Medicaid, and TRICARE for procedures performed without a supervising physician on-site, as required for certain procedures. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A pharmaceutical company agreed to pay $30 million to resolve allegations under the California Insurance Fraud Prevention Act that it paid illegal remuneration to physicians and their staff for their participation in various conferences, advisory boards, and speaking programs, and provided physicians and their staff with lavish meals, liquor, gifts, gift cards, and tickets to sporting events, to induce the physicians to increase their prescriptions for the company’s drugs.
A university agreed to pay $9.5 million to resolve FCA allegations that it: (1) impermissibly applied its higher “on-campus” indirect cost rate when seeking federal reimbursement for 423 National Institutes of Health grants when the research was instead largely performed at off-campus facilities not owned or operated by the university; and (2) failed to disclose to NIH that it did not own or operate the facilities where the research was performed and did not pay for use of the space for most of the relevant period.
A federal district court entered a civil judgment of $4,506,267 against two medical device companies and their owner as part of a settlement agreement to resolve FCA allegations that the companies and their owner made false statements about their personnel, facilities, and accounting systems in Small Business Innovation Research grants from the National Institutes of Health. The defendants also acknowledged that they falsely stated on grant reports that they had spent the funds for the grants and in compliance with grant regulations, when, in fact, the funds were spent on personal expenses, such as plastic surgery, jewelry, home renovations, and massages, as well as certain business expenses not allowed under the grant regulations, such as costs associated with marketing and promoting the businesses. The owner pleaded guilty in a related criminal case and in March 2016 was sentenced to seven months in prison.
A hospice provider agreed to pay $18 million to resolve FCA allegations that it claimed Medicare reimbursement for hospice care for patients who were not eligible for such care because they were not terminally ill and because their medical records did not support that they were terminally ill. The government alleged that the provider's business practices were designed to maximize the number of patients for whom it could bill Medicare without regard to whether the patients were eligible for and needed hospice.
Two individuals and their diagnostic imaging companies were ordered to pay more than $7.75 million following a grant of summary judgment in favor of the government in an FCA case in which the court found the defendants liable for submitting false claims to Medicare for thousands of falsified diagnostic test reports and the underlying tests, and for neurological tests conducted without physician supervision. In August 2016, the two individuals were each sentenced to more than six years in prison in a related criminal case.
The holding company for a regional provider of home-based care, its related companies, and principal owners (the CEO, CIO, and COO) agreed to pay $3.3 million and a percentage of the company’s net income over the next five years to resolve allegations that the company billed government healthcare programs: (1) for patients who were neither homebound nor home-limited; (2) for medically unnecessary visits; and (3) at the highest payment codes when a lower code would have been more appropriate. The settlement also covers allegations that the company cloned medical records though an EMR system that allowed for easy cutting, copying, and pasting of medical notes from prior visits, in order to justify a subsequent patient encounter. Through a stipulation and court order, the company and its principal owners admitted to violating the FCA and causing damages of $21.5 million under the FCA. As part of the settlement, they also entered into a five-year CIA with HHS-OIG.
An ophthalmologist and his company agreed to pay $55,000 to resolve FCA allegations that they billed Medicare for ophthalmic diagnostic imaging when there was no underlying diagnosis to justify the imaging, and for office visits where a prior claim for the same visit had been denied and the new claim was not supported by the documentation.
An operator of outpatient physical therapy clinics agreed to pay $7 million to resolve FCA allegations that it billed federal healthcare programs for therapy services being provided to multiple patients simultaneously as though the services were being provided by a physical therapist or physical therapist assistant to one patient at a time. As part of the settlement, the company also entered into a five-year CIA with HHS-OIG.
The University of Missouri-Columbia agreed to pay $3,051,188 to resolve self-disclosed allegations that it improperly billed the government for several years (1) for certain blood tests without a proper supporting order; (2) for Neulasta injections without the proper clinical documentation to support drug-induced neutropenia; and (3) by failing to sufficiently document certain physician arrangements in violation of the Stark Law.
A university agreed to pay $2.2 million to resolve FCA allegations that it billed Medicare, Medicaid, and TRICARE for radiology services for which attending physicians certified that they had reviewed the images associated with interpretative reports prepared by resident physicians when, in fact, they had not reviewed those images. The university simultaneously settled separate self-disclosed allegations of improper billing that it discovered during its investigation of the qui tam action. As part of the settlements, the university entered into a five-year CIA with HHS-OIG.
A medical center agreed to pay $5.5 million to resolve FCA allegations that it and related parties improperly billed Medicare and Medi-Cal. The companies allegedly: (1) performed chemotherapy infusions without the required physician being present; (2) an oncologist referred cancer patients from an oncology clinic to the hospital for blood transfusions and then billed Medicare using observation codes that require visits by the doctor in conjunction with the transfusions although no doctor visited; and (3) an oncology clinic’s nurses used single dose vials on two patients and billed Medicare and Medicaid for two dosages.
A cardiologist and his practice agreed to pay $2 million and release any claim to $5.3 million in suspended Medicare funds to resolve FCA allegations that they billed Medicare, Medicaid, and TRICARE for procedures that were medically unnecessary and inadequately documented. They also allegedly waived Medicare copayments irrespective of patients' financial need to induce patients to agree to unnecessary and invasive procedures and other services. The physician also agreed to a three-year period of exclusion from participating in any federal healthcare program followed by a three-year IA with HHS-OIG.
A medical device company agreed to pay $8 million to resolve FCA allegations that it engaged in the following activities to induce doctors to begin to use or continue to use its devices by: (1) developing and distributing marketing materials to promote physicians utilizing its devices to referring physicians; (2) coordinating meetings between utilizing physicians and referring physicians; and (3) developing and implementing business expansion plans for utilizing physicians. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
Three individual executives and seven taxicab companies, who provide transportation to Medicare and Medicaid patients if they cannot travel or have no access to transportation, agreed to pay a total of $1.125 million to resolve FCA allegations that they misrepresented their compliance with regulations governing Medicaid transportation services, resulting in false claims being submitted to Texas Medicaid and CMS.
A specialty pharmaceutical company agreed to pay $54 million to resolve FCA allegations that it used sham speaker programs to pay kickbacks to doctors to induce them to prescribe its drugs and medical devices, in violation of the Anti-Kickback Statute.
Two pharmaceutical companies agreed to pay $67 million to resolve FCA allegations that they made misleading statements to healthcare providers about the effectiveness of a cancer drug which the two companies co-promote.
The former owner of a drug testing laboratory and the laboratory’s successor entities agreed to pay $9.35 million to resolve FCA allegations that the laboratory and former owner engaged in a kickback scheme whereby they made donations toward EHR systems purchased by their client physician practices, and, in making those contributions, violated the Anti-Kickback Statute’s EHR safe harbor and the Stark Law’s EHR exception by: (1) directly considering the volume and/or value of referrals and business, including return on investment, between the labotatory and the physicians’ practice when determining whether to make an EHR donation and the amount of the donation; (2) improperly considering the volume of Medicare business supplied by the physician practice when considering an EHR donation; and (3) occasionally withholding previously agreed-upon EHR donation payments until they received a certain number of referrals from the physicians’ practice. The government also alleged that the laboratory billed Medicare and TRICARE for “FISH” tests despite an adverse coverage determination for the particular type of test being used. As part of the settlement, the physician agreed to be excluded from participating in federal healthcare programs for five years.
A medical center agreed to pay $450,000 to resolve FCA allegations that it billed Medicare and Medicaid for percutaneous coronary interventions, catheterizations, and stents performed in its cardiac catheterization lab that were not medically necessary.
A former operator of group homes that provided residential and day services to the intellectually disabled and at-risk youth agreed to pay $1.5 million to resolve FCA allegations that it received overpayments from the Connecticut Medicaid Program, as a result of its submission of annual cost reports, which included certain interest expenses as allowable costs that were in fact not allowable under the state’s cost standards.
A medical device manufacturer agreed to pay $585,000 to resolve FCA allegations that it caused health care providers to submit false claims by: (1) marketing the company’s coflex-F® device for surgical uses that were not approved by the FDA; and (2) giving false recommendations on how to code health claims for procedures involving the coflex® device.
A hospice service provider agreed to pay $2.5 million to resolve FCA allegations stemming from a government investigation which purportedly uncovered approximately $1.5 million in questionable billings submitted to Medicare Part A. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
An oncologist and his wife, who served as the office administrator, agreed to pay $300,000 to resolve FCA allegations that they improperly billed Medicare for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical distributor.
A university, on behalf of its operating divisions which include a health system, agreed to pay $75,787 to resolve FCA allegations that its health system's home health care division billed Medicare for home health services not performed or that were unreasonable or unnecessary. As part of the settlement, the university health system agreed to implement new compliance oversight measures for its home health entities and annually submit certified compliance reports pertaining to those entities to the United States Attorney’s Office through 2019.
The City of New York agreed to pay $4.3 million to resolve FCA allegations involving the New York City Fire Department’s receipt of Medicare reimbursements for claims for emergency ambulance services that did not meet Medicare’s medical necessity requirement, which the City of New York had identified but did not take steps to inform Medicare of for more than four years. The City of New York voluntarily disclosed this matter to the government.
An adult day healthcare center agreed to pay $385,917 to resolve FCA allegations that it billed for transportation services purportedly provided to Virginia Medicaid recipients that were not present or transported to the center's facility on the claimed dates of service.
A supplier of medical products, agreed to pay $9.3 million to resolve FCA allegations that they engaged in an alleged kickback scheme with a manufacturer that purportedly included: (1) the manufacturer paying kickbacks to the company in return for marketing promotions, conversion campaigns, and other referrals of patients to its products; (2) the manufacturer agreeing to pay the costs of the supplier's bonus commissions paid to sales personnel for each new patient order for one of the products; (3) the manufacturer agreeing to pay for “catalog funding,” to induce recommendations of its products to patients; and (4) the supplier's receipt of kickbacks from manufacturers in return for its agreement to conduct promotional campaigns and to refer patients to the manufacturers’ products. The government also alleged that the company falsely billed the California Medi-Cal program by failing to account for substantial discounts that it knew, at the time of billing, reduced the prices it paid for the products. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A manufacturer of disposable health products agreed to pay $11.44 million to resolve FCA allegations that it engaged in an alleged kickback scheme with a medical products supplier that purportedly included: (1) paying kickbacks to the supplier in return for marketing promotions, conversion campaigns, and other referrals of patients to its products; (2) agreeing to pay the costs of the supplier's bonus commissions paid to sales personnel for each new patient order for one of the products; and (3) agreeing to pay for “catalog funding” to induce the supplier's recommendations of its products to patients.
A pharmaceutical company and its owner agreed to pay $784.6 million to resolve FCA allegations that it sold two proton pump inhibitor drugs through a bundled sales arrangement in which a hospital could earn deep discounts on the drugs if it placed them on formulary and made them “available” within the hospital. The company allegedly hid from Medicaid the bundled discounts it gave to hospitals in reporting its best prices offered to other customers for their brand name drugs, enabling it to avoid paying hundreds of millions of dollars in rebates to Medicaid.
A health system and one of its surgical oncologists agreed to pay $400,000 to settle FCA allegations that the oncologist billed federal healthcare payors for non-covered breast examinations and ultrasounds; by falsifying documents with diagnosis codes, such as "lump or mass in breast," where none existed, and arranging for certain patients to receive follow-up screening breast examinations and screening breast ultrasounds at approximately six-month intervals after screening mammograms and improperly billing these services as “diagnostic.”
Two dermatologists and their practice group agreed to pay $1.9 million to settle FCA allegations that they: (1) billed Medicare for evaluation and management services on the same day as procedures where no significant and separately identifiable service was performed, in violation of Medicare rules; and (2) upcoded evaluation and management services to higher levels than were appropriate, leading to overpayments by Medicare. In addition to the settlement, the dermatologists and their practice group entered into a five-year CIA with HHS-OIG.
A medical center and two of its physician practice organizations agreed to pay $1.1 million to resolve FCA allegations that it (1) billed Medicare for more units of a cancer drug than were actually infused in its patients; (2) billed Medicare and Medicaid separately for services at its pre-surgical treatment center even though the services were covered in the global fee for the subsequent surgeries; and (3) billed Medicare for outpatient podiatry services that were not medically necessary according to the clinical documentation. After learning of the government investigation, the medical center informed the government that it already had repaid certain improperly used funds, had undertaken an audit of the first issue, and was about to start an audit of the pre-surgical treatment billing issue.
A pain medicine practice and its owners agreed to pay $1.1 million to resolve FCA allegations that they billed Medicare for nerve conduction studies that were considered medically unnecessary, as they were often administered without an accompanying electromyography test, thereby substantially decreasing the diagnostic value of the procedure. The practice entered into a three-year IA with HHS-OIG as part of the settlement.
A provider of drug urine screening services agreed to pay $2.5 million to resolve FCA allegations that it: (1) engaged in a swapping arrangement, in which it gave below cost discounts on its urine drug screen tests to patients without insurance, in exchange for physician referrals of their patients with Medicare or TennCare coverage; (2) billed for laboratory testing that was medically unreasonable and unnecessary; and (3) provided point of care testing cups to medical offices free of charge to induce those providers to use the lab's services.
A rehab hospital, which closed in December 2014, agreed to pay $125,000 to resolve FCA allegations that it billed Medicare for medically unnecessary care to patients that were wrongfully admitted with a diagnosis of generalized debility.
A sleep apnea mask maker agreed to pay $34.8 million to resolve FCA allegations that it paid kickbacks in the form of free call center services to DME suppliers to meet their patients’ resupply needs at no charge as long as the patients were using masks that the company manufactured. If other masks were used, the DME companies would have to pay a monthly fee based on the number of patients who used competitors' masks. As part of the settlement, the manufacturer entered into a five-year CIA with HHS-OIG.
Part of a group of settlements, an individual agreed to pay $275,000 to resolve allegations that he conspired with other entities to avoid repaying Texas Medicaid $2.7 million the state had overpaid.
A medical center agreed to pay $2,481,856.50 to resolve FCA allegations that it self-disclosed to the government following an investigation by the company’s compliance program. Specifically, the allegations were that the hospital submitted certain claims for medically unnecessary days of inpatient geriatric psychiatric services and received overpayments relating to the billing of inpatient geriatric psychiatric services for which a physician certification or recertification was not obtained.
A radiation oncology provider and a subsidiary agreed to pay $34,695,243 to resolve FCA allegations that they performed and billed for Gamma function procedures: (1) where the procedure served no medically appropriate purpose; (2) when no physician reviewed the Gamma function results until seven or more days after the last day patients received radiation treatment therapy; and (3) when no Gamma function result was available due to technical failures in the imaging equipment.
The former owner, operator, and sole shareholder of two home healthcare companies agreed to pay $1.75 million to resolve FCA allegations that he led a scheme in which his companies paid physicians thousands of dollars per month to serve as sham medical directors who supposedly reviewed patient charts but in fact conducted little to no work, in violation of the Anti-Kickback Statute and Stark Law. His company was also a defendant in the qui tam action, and in 2015 the government reached a settlement with the current owner for $1.1 million to resolve similar allegations.
A medical device maker agreed to pay $623.2 million to resolve civil FCA allegations and related criminal charges that it paid millions in kickbacks—in the form of consulting payments, foreign travel, lavish meals, grants, and free endoscopes—to doctors and hospitals to secure new business and product sales. To resolve the criminal charges, the company entered into a three-year deferred prosecution agreement requiring an independent monitor and other compliance and reform measures. It also entered into a five-year CIA with HHS-OIG.
A healthare system agreed to pay $2.09 million to resolve allegations that: (1) portions of single-dose vials of chemotherapy drugs were used for more than one patient; (2) some drugs were administered inappropriately; (3) certain infusion services were upcoded; and (4) some patients had to be admitted for treatment because of the foregoing conduct. In January 2012, the company voluntarily self-disclosed certain of the described conduct to the government and repaid $819,828.82. This amount will be credited toward the $2.09 million obligation.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. In 2015, the government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
The government reached settlements with 51 hospitals in 15 states for more than $23 million to resolve FCA allegations related to implantable cardioverter defibrillators (ICDs) being implanted in Medicare patients who recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements. The government reached settlements involving 457 hospitals in 43 states involving similar allegations. These settlements represent the final stage of a nationwide investigation into hospital billing for these devices.
A physician and his gynecologic cancer center agreed to pay $500,000 to resolve FCA allegations that a portion of the drugs used by the doctor in chemotherapy treatments were purchased by his practice from a Canadian drug distributor and other sources and had not received final marketing approval from the FDA, therefore making them not eligible for coverage by Medicare and Medicaid.
A clinical laboratory agreed to forfeit $656,912 and be excluded from Connecticut's Medicaid program for 10 years to settle allegations it aggressively marketed an expensive and unnecessarily complex drug testing package to residential drug treatment facilities, knowing that: (1) the facilities did not provide physician-managed treatment; and (2) the need for drug testing was limited to ensure sobriety, which a less expensive test could have sufficed.
A physician and two companies he owns and operates agreed to pay $5.25 million to resolve FCA allegations that they falsely billed federal healthcare programs for various tests that were never provided and for physical therapy services that were not performed by a qualified therapist. The physician agreed to be excluded from participation in federal healthcare programs for 20 years.
Two compounding pharmacies and four physicians agreed to pay a total of approximately $10 million to resolve FCA allegations involving improper billing of prescriptions to TRICARE. The government alleged that a pharmacy created by the four physicians, but which was unable to obtain separate government healthcare program contracts sent its prescriptions to the other pharmacy, which in turn billed the prescriptions to TRICARE. The four physicians allegedly referred costly prescriptions, which often were not used by patients and which cost 4-5% of the submitted cost to actually compound. In some cases, the four physicians allegedly recruited other doctors to write prescriptions – promising to share revenue with them.
A radiology services provider agreed to pay $8.71 million to resolve FCA allegations that it improperly billed for radiology procedures as a result of: (1) administering contrast dye during MRI scans on patients without direct physician supervision as required by federal regulations; (2) accepting orders from chiropractors, but billing for them as if they were actually ordered by a company-employed physician; (3) the procedures not being ordered by the patients’ treatment providers; (4) the procedures being performed at facilities not enrolled as authorized Medicare providers, but billed as though they were performed at a different, authorized facility; and (5) a kickback scheme in which the company provided referring physicians with financial incentives in the form of lunches, gift cards, and tickets to concerts or sporting events in exchange for receiving radiology referrals. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
The former owner and operator of an ambulance company, which is no longer in business, and the owner and operator of a successor company by the same name agreed to pay $245,000 to resolve FCA allegations that the former owner and his company provided free and heavily discounted ambulance transports to various nursing facilities and hospitals in exchange for the institutions’ referral of more lucrative Medicare and Medicaid business, in violation of Anti-Kickback Statute.
A managed long-term care organization agreed to pay more than $46.7 million to resolve FCA allegations that it (1) received Medicaid reimbursements for more than 1,200 members who attended or were referred by social adult day care centers and whose needs did not meet the criteria of the managed care plan; and (2) engaged in improper marketing practices to recruit members through the centers and induced the ineligible members to use the day care centers as their primary source of personal care services. The organization admitted that some of the centers in its provider network did not provide services that qualified as personal care services under its Medicaid contract, or were not legally permitted to provide such services. The United States and State of New York partially intervened in this matter to reach this settlement. Other allegations remain under investigation.
A hospital agreed to pay $3,278,464 to resolve allegations that it maintained financial arrangements with physicians and physician groups that did not comply with the Stark Law. Specifically, the hospital identified five arrangements with its former chief of staff that appeared not to be commercially reasonable or for fair market value, as well as 92 financial arrangements with community-based physicians and practice groups that did not satisfy a Stark exception because, for example, the written agreements were expired, missing signatures or could not be located.
A medical equipment company agreed to pay $600,000 to resolve FCA allegations that it regularly utilized unlicensed technicians to provide respiratory therapy services to Medicare and Medicaid beneficiaries, including setting up airway pressure machines, fitting the patients with the masks used with those machines, and educating the patients about the use of the machines. The government alleged that under Connecticut law these services could only be performed by licensed respiratory therapists.
A skilled nursing facility operator and 16 of its facilities agreed to pay $3.9 million to resolve FCA allegations that they submitted inflated therapy reimbursement claims to Medicare based in part on therapy provided by RehabCare that was not reasonable, necessary and skilled, or that never occurred. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A contract therapy provider and its parent agreed to pay $125 million to resolve FCA allegations that they had policies and practices, including setting unrealistic financial goals and scheduling therapy to achieve the highest reimbursement level regardless of the clinical needs of its patients, that resulted in unreasonable and unnecessary services being provided to Medicare patients and led the company's skilled nursing facility customers to submit artificially and improperly inflated bills to Medicare that included those services. As part of the settlement, the companies entered into a five-year CIA with HHS-OIG.
A skilled nursing facility operator and one of its former facilities agreed to pay $750,000 to resolve FCA allegations that they submitted inflated therapy reimbursement claims to Medicare based in part on therapy provided by RehabCare that was not reasonable, necessary and skilled, or that never occurred. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A skilled nursing facility operator and two of its facilities agreed to pay $2.2 million to resolve FCA allegations that they submitted inflated therapy reimbursement claims to Medicare based in part on therapy provided by RehabCare that was not reasonable, necessary and skilled, or that never occurred. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A skilled nursing facility operator and two of its facilities agreed to pay $1.375 million to resolve FCA allegations that they submitted inflated therapy reimbursement claims to Medicare based in part on therapy provided by RehabCare that was not reasonable, necessary and skilled, or that never occurred. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A dermatologist and his medical practice agreed to pay $450,000 to resolve FCA allegations that the practice billed Medicare for unnecessary dermatological surgical procedures and office visits.
The former owner of Bostwick Laboratories agreed to pay up to $3.75 million to resolve FCA allegations in the qui tam action titled U.S. ex rel. Daugherty v. Bostwick Laboratories, et al. (S.D. Ohio) that Dr. Bostwick: (1) directed Bostwick Laboratories to bill for cancer detection tests that were medically unnecessary and performed without the treating physicians’ consent or order; and (2) offered various discounts and billing arrangements to treating physicians to induce them to refer business to Bostwick Laboratories in violation of the Anti-Kickback Statute. In 2014, Bostwick Laboratories agreed to pay $6.05 million to resolve the allegations in this matter, in which the government previously declined to intervene.
A former chiropractor entered into a consent decree to resolve a government lawsuit alleging that he remained involved in the management of a Medicare provider’s business despite his exclusion by HHS-OIG, in violation of the FCA. Pursuant to the decree, Bauer must pay $30,000, consent to a renewed exclusion for the next 25 years, and make bi-annual certifications to the U.S. Attorney’s Office for the next 5 years certifying that he is complying with his renewed exclusion.
A pharmacy company specializing in dispensing HIV and AIDS-related medications and its majority owner paid $500,000 and agreed to make additional contingency payments over the next five years (potentially up to $7.8 million) to resolve FCA allegations that they overbilled Medicare and TennCare as a result of: (1) automatically refilling medications without a request from the beneficiary, their physician, or a person acting as the beneficiary’s agent, in violation of TennCare’s contractual requirements; (2) routinely and improperly waiving TennCare and Medicare co-payments without an individualized assessment of those beneficiaries’ inability to pay; (3) improperly using pharmaceutical manufacturers’ co-payment cards to pay the co-payments of certain Medicare recipients; (4) billing for certain medications that were dispensed after the dates of death of 15 beneficiaries; and (5) billing for medications that lacked a valid prescription from a licensed provider for 22 beneficiaries. As part of the settlement, the company entered into a five-year CIA with the HHS-OIG.
A diagnostic laboratory agreed to pay $4.03 million to resolve FCA allegations that it induced healthcare providers to refer its genetic testing kits and services by offering physicians and medical groups reimbursements of up to $20 for each saliva kit they collected from patients and submitted to the laboratory for genetic testing, in violation of the Anti-Kickback Statute. The government alleged that individual physicians received as much $13,534 in reimbursements and that prior to enrolling in the reimbursement programs, most of these physicians had not ordered these genetic tests.
A nursing home operator agreed to pay $600,000 to resolve FCA allegations that the employees at one of its skilled nursing facilities failed to provide patient care activities as recorded in the medical record and failed to provide certain care activities consistent with standing physician orders. As part of the settlement, the company agreed to pay for a one-year transition consultant to assist the new operator of the facility.
A health system and its related entities agreed to pay more than $9.895 million to resolve FCA allegations involving Stark Law violations. As part of the settlement, Memorial Health entered into a five-year CIA with HHS-OIG.
A health system agreed to pay more than $3 million to resolve FCA and Stark Law violations that it self-disclosed to the government. Specifically, the allegations were that: (1) it made a trademark payment to an orthopedic group during an acquisition in excess of fair market value, based on an independent valuation performed during an internal investigation; (2) it paid a surgeon annual compensation in excess of fair market value; and (3) a cardiologist performed unnecessary invasive procedures, which the company became aware of after complaints were raised and an independent review of claims was performed.
A medical device manufacturer agreed to pay $3.16 million to resolve FCA allegations that it paid illegal kickbacks to several medical suppliers to induce them to conduct promotional campaigns designed to refer individual users to the company's products.
A medical supply distributor agreed to pay $500,000 to resolve FCA allegations that it accepted illegal kickbacks from a manufacturer in the form of price concessions to induce it to conduct promotional campaigns designed to refer individual users to the manufacturer's products.
A affiliated hospitals and their owner agreed to pay $2.685 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A health system and three of its hospitals agreed to pay $1.5 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
Five hospitals and their owner agreed to pay $2 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A health system and five affiliated hospitals agreed to pay $2.2 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A health system and five of its hospitals agreed to pay $3.5 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $2 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $500,000 as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $1.725 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $972,000 as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $906,000 as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $1,513,500 as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $920,000 as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $983,000 as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $2 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $350,000 as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A hospital agreed to pay $2.6 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
An oncology laboratory agreed to pay $19.75 million to resolve FCA allegations that it billed for “FISH” tests performed at its laboratory and ordered by four of its urologists that were not medically necessary and that it encouraged these urologists to order unnecessary tests by offering bonuses based in part on the number of tests referred to its laboratory.
A medical device manufacturer and its president agreed to pay approximately $10.3 million to resolve FCA allegations that they improperly billed Medicare for splints provided to skilled nursing facility patients by misrepresenting that patients were in their homes or other places that were not facilities in order to receive separate reimbursement, as these splints are among items covered in the bundled payment Medicare makes to skilled nursing facilities.
A hospice provider agreed to pay $1.08 million to resolve FCA allegations that it improperly billed for hospice services because, during some or all of the period that certain patients were receiving hospice care, the patients did not have a medical prognosis of six months or less if their illnesses ran their normal course.
A hospital agreed to pay $1.74 million as part of a group of 32 hospitals in 15 states that agreed to pay more than $28 million to settle FCA allegations that the hospitals improperly billed Medicare for kyphoplasty spinal fracture treatment by billing the procedure as an inpatient rather than an outpatient procedure. Currently, DOJ has settled FCA claims with more than 130 hospitals related to kyphoplasty treatment.
A pharmaceutical company, its parent corporation, and seven subsidiaries or affiliates agreed to pay $39 million to resolve federal and state FCA allegations that they knowingly manufactured and sold chewable fluoride tablets that contained less than half the amount of fluoride ion indicated on the drug label and thus caused federal healthcare programs to be fraudulently billed for these tablets.
A company that provides various medical services to nursing homes agreed to pay $4.5 million to resolve FCA allegations that it billed Medicare for podiatrist services that were not provided or were medically unnecessary, and that it provided kickbacks to nursing homes in the form of paying nursing home employees for transportation services, providing diabetic shoes, providing “warranties” on certain DME that were not supplied by the company, and waiving co-payments and deductibles on medical services. As part of the settlement, the provider agreed to enter into a CIA with HHS-OIG.
A laboratory, a related company that bills for the lab’s services, and the companies’ founders agreed to pay $8.5 million to resolve FCA allegations that the laboratory billed Medicare for ineligible food sensitivity testing, submitted false information to disguise the type of test that it was performing so Medicare would pay for the services, and billed for laboratory services referred from non-physician practitioners that were not eligible to refer Medicare paid services. As part of the settlement, the companies and their founders entered into a five-year CIA with HHS-OIG.
A pathology group agreed to pay $500,000 to resolve allegations that it engaged in improper financial relationships with referring physicians in violation of the Anti-Kickback Statute by providing electronic medical record software licenses at little to no cost to nine physicians’ practices close in time to when those practices entered contracts to refer specimens to their pathology lab.
A company which manages several skilled nursing facilities agreed to pay $3.19 million to resolve FCA allegations that it engaged in a “swapping” scheme whereby it received kickbacks from ambulance companies in exchange for rights to the company's more lucrative Medicare and Medicaid transport referrals. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
Several compounding pharmacies, their owners, and certain physicians agreed to pay in total more than $22 million in fixed payments, and certain pharmacies also agreed to pay 50% of their net profits during the next five years, to resolve FCA allegations that they fraudulently billed TRICARE. Specifically, the allegations were that (1) one pharmacy paid kickbacks to marketers, filled prescriptions it knew or should have known were not legitimate and sent prescriptions to states in which it did not have a valid license; (2) another pharmacy knew, or should have known, it was filling prescriptions from a doctor who was writing them outside the ordinary course of practice, considering the sheer magnitude and volume of prescriptions written; (3) a third pharmacy and its owner knowingly filled prescriptions that were written by referral sources that had a financial interest in the prescriptions in the form of a sham research study, the compensation for which exceeded fair market value; (4) a specialty pharmacy submitted prescriptions tainted by the aforementioned “research study” fees; (5) another pharmacy submitted prescriptions tainted by kickbacks and knew, or should have known, that the prescriptions it was filling from certain physicians were not legitimate because there was no bona fide patient/physician relationship; and (6) the final pharmacy filled prescriptions tainted by illegal kickbacks.
A university agreed to pay $19.875 million to resolve FCA allegations that it improperly charged HHS for salary and administrative costs on hundreds of federal grants awarded to the university between 2005 and 2010. The government alleged that the university overcharged for the salary costs of its employees without proper supporting documentation, and charged certain grants for administrative costs for equipment and supplies in contravention of federal regulations.
A pharmaceutical manufacturer agreed to pay $390 million, including a $20 million forfeiture of proceeds, to settle FCA allegations that it paid kickbacks to specialty pharmacies in return for recommending two of its drugs. One of the specialty pharmacies involved settled earlier in the year. As part of the settlement, the company agreed to bolster the terms of an existing CIA with HHS-OIG and extend the CIA by five years.
A hospice provider agreed to pay $3.02 million to resolve FCA allegations that it billed Medicare and Medicaid for medically unnecessary hospice care for at least 52 patients who had lengths of stay greater than 1,000 days. The government asserted that the documentation for these patients failed to support the length of hospice services, failed to document basic patient characteristics and included unsigned records or records signed with inconsistent practitioner information. Certain patients were allegedly admitted to the hospice because their spouse was in hospice care; other patients purportedly were approved to take multiple, lengthy, out-of-state trips during a five-year period.
A home healthcare company and its owners agreed to pay $435,000 to resolve FCA allegations that they billed Medicaid for personal care services for patients that did not need the services or did not need the level of services billed.
A home healthcare company and its owner agreed to pay $3.72 million to resolve civil FCA allegations involving the false billing of personal care services to Medicaid that were not medically necessary or that the company could not verify had ever been provided. In a related criminal case, the company pleaded guilty, while its owner entered into a deferred prosecution agreement with the government and agreed to an exclusion from federal healthcare programs for a period of 15 years.
A healthcare system and four of its hospitals agreed to pay $2 million to resolve FCA allegations that they submitted laboratory claims for direct count low-density lipids when the tests were not ordered and/or not medically necessary and improperly billed for fetal biophysical profiles with non-stress tests.
A dermatology and cosmetic surgery provider agreed to pay $152,043 to resolve FCA allegations that it billed Medicare for surgical closure procedures at a higher rate of complexity than was supported by certain patients’ condition or the circumstances of the closure.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
The government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million to resolve FCA allegations related to implantable cardioverter defibrillators being implanted in Medicare patients that recently had suffered a heart attack or had heart bypass surgery or angioplasty prior to certain waiting periods having passed, in violation of Medicare coverage requirements.
A behavioral health services provider, which provides psychiatric and psychological services to geriatric patients in long-term care and skilled nursing facilities, agreed to pay $1 million to resolve FCA allegations that it sought and obtained standing orders or other agreements with 128 facilities under which its clinicians performed evaluations on all new admissions to the facility regardless of whether such an evaluation was medically necessary. The settlement also resolved FCA allegations that the company self-disclosed to the government regarding the submission of Medicare claims for certain nursing facility evaluation and management services which were not supported by the patient’s medical record.
A pharmaceutical manufacturer agreed to pay $102.06 million to resolve civil FCA allegations that it paid illegal remuneration to prescribing physicians in connection with so-called “Medical Education Events” and speaker programs, in violation of the Anti-Kickback Statute, and caused the submission of false prior authorization requests for two of its osteoporosis drugs in order to overcome formulary restrictions that favored less expensive drugs. A subsidiary pleaded guilty to a related criminal charge involving the illegal marketing of seven drugs and agreed to pay a criminal fine of $22.94 million. Several individuals have pleaded guilty or been charged in connection with this fraud scheme.
A dermatology practice agreed to pay $629,816 to resolve FCA allegations that it billed Medicare for providing evaluation and management services to patients in violation of applicable Medicare billing guidelines.
A laboratory company agreed to pay $256 million to resolve FCA allegations that it billed for medically unnecessary urine drug and generic testing, in part through the promotion of “custom profiles” that were effectively standing orders that caused physicians to order a large number of tests without an individualized assessment of each patient’s needs. The settlement also resolved allegations that the company provided free items to physicians who agreed to refer expensive laboratory testing business to the company, in violation of the Stark Law and Anti-Kickback Statute. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
The United States and a hospital reached a settlement to resolve a $237 million judgment entered in 2013 by the trial court involving FCA allegations that the hospital employed and compensated 19 part-time physicians in excess of fair market value and in a manner that varied with the volume or value of their referrals, in violation of the Stark Law. On July 2, 2015, the U.S. Court of Appeals for the Fourth Circuit affirmed the trial court’s judgment. The hospital subsequently agreed to pay $72.4 million to the United States and $2.5 million for the relator’s attorneys’ costs and fees. The settlement was conditioned on the hospital being successfully acquired by another healthcare system prior to December 31, 2015. In connection with the settlement, the hospital agreed to enter into a five-year CIA with HHS-OIG.
A community mental health center and its parent company agreed to pay $3.5 million to resolve allegations that it falsified patient records, billed for services not medically necessary, billed for services that were not rendered, provided bribes to Medicare beneficiaries who did not qualify for partial hospitalization services and provided bribes and/or kickbacks to employees to further or to conceal the fraud. The investigation and settlement resulted from the hospital's self-disclosure to HHS-OIG.
A hospital and its parent company agreed to pay $4.1 million to resolve allegations that the hospital billed Medicare and Medicaid for medically unnecessary spine surgeries performed by a surgeon who was previously arrested and charged with related healthcare fraud violations in 2013 and subsequently fled the United States.
A long-term care pharmacy agreed to pay $9.25 million to resolve FCA allegations that it solicited and received illegal remuneration from a laboratory in exchange for promoting an anti-epileptic drug for nursing home patients.
A hospice company and its founder and former president agreed to pay $2.2 million to resolve FCA allegations that it billed Medicare for hospice services for patients that were ineligible to receive such services. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG, and its owner agreed to a five-year exclusion from federal healthcare programs.
A podiatrist agreed to pay $288,538 to resolve civil FCA allegations and pleaded guilty to a related criminal charge that she billed Medicare for nail avulsion procedures she knew she did not perform. Instead, she typically was performing routine foot care.
A hospice provider and its affiliates agreed to pay $3 million to resolve FCA allegations that they billed Medicare for hospice patients who were not terminally ill. The government asserted that its business practices contributed to its submission of false claims, including failing to properly train staff and medical directors on the hospice eligibility criteria, establishing aggressive targets to recruit and enroll patients, and failing to adequately oversee the hospice.
A laboratory agreed to pay $558,793 to resolve FCA allegations that it induced physicians to refer Medicare and Medicaid patients to it by paying kickbacks in the form of sham consulting fees and providing unlawful discounts to physicians through “account billing” arrangements that facilitated fee-splitting between the company and seven physicians, in violation of the Anti-Kickback Statute.
A home health company and its former owner and CEO’s estate agreed to an entry of a judgment of $16 million to resolve FCA allegations that the company, at its CEO's direction, billed Medicare for medically unnecessary home health services and services tainted by kickbacks to referring physicians. The agency allegedly falsified records to make it appear as if patients had a medical need for services and/or were homebound, and recertified ineligible patients for service.
A hospital agreed to pay $4.28 million to resolve FCA allegations that it billed for patients admitted into its inpatient rehabilitation unit when the admission was not medically necessary and/or the services provided did not fully qualify for reimbursement. The settlement also resolves allegations that the hospital employed an individual that was excluded from participating in federal healthcare programs. The organization voluntarily disclosed these issues to the government and took corrective action to address improper payment upon discovering these issues.
The former operator of a vascular access center agreed to pay $3.59 million to resolve FCA allegations arising from the center that it billed Medicare for multiple percutaneous transluminal angioplasties (PTAs) performed during the same patient encounter and for medically unnecessary procedures during follow-up visits.
The former operator of a vascular access center agreed to pay $2.6 million to resolve FCA allegations arising from the center that it: (1) billed Medicare for medically unnecessary percutaneous transluminal angioplasties (PTAs); (2) billed for more PTAs per patient encounter than permitted; and (3) billed for medically unnecessary procedures during follow-up visits.
A chiropractor agreed to pay $62,349 to resolve FCA allegations that she billed Medicaid for medically unnecessary procedures and for the treatment of conditions for which payment is not allowed.
A health system agreed to pay $115 million to the federal government and $3.5 million to the state of Florida to resolve FCA allegations that it paid physician bonuses based on a formula that improperly took into account the value of the physicians’ referrals to its hospitals, in violation of the Stark Law, and billed Medicare for physicians’ professional services with improper coding modifiers.
A hospital district agreed to pay $69.5 million to resolve FCA allegations that it recruited, employed and agreed to pay nine physicians excessive compensation based in part on anticipated profits from referrals to entities it operates, in violation of the Stark Law. The organization purportedly monitored these referral profits in “Contribution Margin Reports” and pressured physicians to increase referrals if their value was not offsetting the physicians’ compensation. As part of the settlement, the district agreed to enter into a five-year CIA with HHS-OIG.
A healthcare system agreed to pay up to $35 million ($25 million in fixed payments, up to $10 million in contingent payments), and a physician agreed to pay $425,000, to resolve FCA allegations that during a 10-year period, the healthcare system provided excessive salary and directorship payments to the physician, in violation of the Stark Law, and that the organization billed for certain services at higher levels than was actually provided or supported by documentation. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A group of thirteen hospice entities and its majority owner and manager agreed to pay more than $5.86 million to resolve FCA allegations that they submitted false claims for delivery of continuous home care hospice services to patients when there was no crisis. According to the government, the hospice was identified as an outlier in billing for these services, the rate for which is the highest daily rate a hospice can bill Medicare. As part of the settlement, the organization agreed to enter into a five-year CIA with HHS-OIG.
A chain store agreed to pay $1.4 million to resolve FCA allegations that it improperly influenced the decisions of Medicare beneficiaries to use its in-store pharmacies by permitting them to use drug manufacturer coupons to reduce or eliminate co-pays that they otherwise would be obligated to pay, and by offering varying levels of discounts on gasoline purchases at participating gas stations based on the number of prescriptions they filled at the store.
An optometrist and related eye care entities agreed to pay $275,000 to resolve FCA allegations that they billed for eye examinations on nursing home patients that were either much shorter than the type of eye examination billed for or never performed. In 2014, the optometrist was sentenced to 33 months in prison for a related criminal conviction.
A diagnostic laboratory agreed to pay $1.79 million to settle FCA allegations that its facilities submitted duplicative claims to Medicare for certain venipuncture services and diagnostic tests and certain panel tests and select components of those panels.
A hospital agreed to pay $880,000 in connection with a long-running qui tam action related to the operation and marketing of inpatient drug and alcohol detoxification programs without having received licenses from the state.
A hospital agreed to pay $650,000 in connection with a long-running qui tam action related to the operation and marketing of inpatient drug and alcohol detoxification programs without having received licenses from the state.
A hospital agreed to pay $600,000 in connection with a long-running qui tam action related to the operation and marketing of inpatient drug and alcohol detoxification programs without having received licenses from the state.
A physician agreed to pay $207,988 to resolve FCA allegations that he billed Medicare for prostate laser ablation procedures that were too short to generate a therapeutic benefit, failed to meet professional standards of care, were medically unnecessary, and/or violated Medicare regulations.
A federally qualified health center (FQHC) agreed to pay $825,000 to resolve allegations that it billed Medicaid for behavioral health and dental services for patients of non-FQHC healthcare providers and who were not East Central patients, leading Medicaid to pay a higher amount for these services under the FQHC rate. As part of the settlement, the center entered into a CIA with HHS-OIG.
A health system and clinic agreed to pay $5.5 million to resolve FCA allegations that they paid physician bonuses based on a formula that improperly took into account the value of the physicians’ referrals to the clinic, in violation of the Stark Law.
Two physicians agreed to pay collectively $1.12 million to resolve allegations that they submitted claims to Medicare for nerve conduction studies that were not medically necessary.
A hospital agreed to pay more than $1.45 million to resolve FCA allegations related to billing improprieties that it voluntarily disclosed to the government and, upon discovery, took corrective action to remedy. Specifically, the hospital identified claims during an internal review where supporting documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes.
A physician formerly working as an independent contractor agreed to pay $204,365 to resolve FCA liability related to billing improprieties at a hospital where he worked.
A dental practice agreed to pay $420,000 to resolve FCA allegations in a declined qui tam action that the practice erased several accounts payable to Medicare and Medicaid.
A provider of nursing home services to children and certain affiliated entities, and its owner, agreed to pay $6.88 million to resolve FCA allegations that it knowingly: (1) failed to disclose and return overpayments that it received from Medicare and Medicaid; (2) submitted claims under the Georgia Pediatric Program for home nursing care without documenting the requisite monthly supervisory visits by a registered nurse; and (3) submitted claims to federal healthcare programs that overstated the length of time their staff had provided services. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A medical device manufacturer agreed to pay $13.5 million to resolve FCA allegations that it caused healthcare providers to submit false claims for spine surgeries ineligible for reimbursement by marketing the company’s CoRoent System for non-FDA approved surgical uses. The settlement also resolved allegations that the company paid illegal remuneration to induce physicians to use its CoRoent System in spine fusion surgeries, in violation of the Anti-Kickback Statute.
An oncologist agreed to pay $736,000 to resolve FCA allegations that he billed Medicare, Medicaid, and TRICARE for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical manufacturer.
An obstetrician and gynecologist agreed to pay $8.04 million to resolve allegations that he utilized unlicensed and often unsupervised staff to treat women suffering from urinary incontinence, in violation of Medicare and Medicaid regulations, and upcoded in billing for pelvic floor rehabilitation. To resolve a related criminal charge, the physician entered into a deferred prosecution agreement that requires him to install an independent billing monitor of his practice.
A compounding pharmacy agreed to pay $8.4 million to resolve FCA allegations that for a two-month period in early 2015, it billed government payors for compounding pharmaceutical prescriptions that were not medically necessary and were written by physicians that had never actually seen the patients.
A physician agreed to pay $270,528 to resolve FCA allegations that he billed Medicare for office visits, osteopathic manipulative treatment, and physical therapy services that were not performed. As part of the settlement, he has been excluded from participation in federal healthcare programs for five years. In January 2015, the physician pleaded guilty to a related criminal charge and subsequently was sentenced to three months in prison.
A pharmacy and affiliated entities agreed to pay $22.4 million to resolve FCA allegationsthat it: (1) submitted Medicaid claims for Synagis, an injectable drug for premature infants that can cost more than $2,000 per dose, without proper authorizations or prescriptions; (2) pushed families and physicians to use Synagis regardless of medical need; (3) used the names of pediatricians and physician assistants on Synagis prescriptions and Medicaid bills without authorization; and (4) billed for excess Synagis by overstating an infant’s weight.
Regional Hospital of Jackson agreed to pay an undisclosed amount to resolve FCA allegations in the qui tam action styled U.S. ex rel. Deming, et al. v. Jackson-Madison County General Hospital, et al. (W.D. Tenn.) that the hospital billed Medicare and Medicaid in connection with unnecessary cardiac stent placements and other unnecessary cardiac procedures. The government declined to intervene in the action as to the allegations against the hospital, only intervening against a physician.
The executive director of a home health agency agreed to pay $1.08 million to settle FCA allegations that she provided unlawful compensation to physicians who referred patients to the agency, in violation of the Stark Law.
A pharmaceutical company agreed to pay $7.6 million to resolve FCA allegations that it knowingly underpaid rebates owed under the Medicaid Drug Rebate Program by improperly reducing the reported average manufacturer prices for service fees it paid to wholesalers.
A pharmaceutical company agreed to pay $46.5 million to resolve FCA allegations that it knowingly underpaid rebates owed under the Medicaid Drug Rebate Program by improperly reducing the reported average manufacturer prices for service fees it paid to wholesalers.
The operator of a vascular access center agreed to pay $1.2 million to resolve FCA allegations that it billed Medicare for medically unnecessary percutaneous transluminal angioplasties (PTA) and thrombectomies performed at the center, and billed for more PTAs per patient encounter than permitted.
A neurologist and his pain and sleep center agreed to pay $861,571 to resolve allegations of upcoding claims for payment for evaluation and management of patients and for nerve conduction studies.
A nonprofit health system agreed to pay $20.32 million to resolve FCA allegations that it billed Medicare and Medicaid for outpatient surgeries performed in its hospitals when the surgeries were actually performed in free-standing ambulatory surgery centers (ASCs). The company, which contracted with the ASCs to provide surgical services to its patients and then billed for the services, allegedly billed in this fashion for nearly two years after being specifically placed on notice by CMS that services provided in an ASC should only be billed at ASC rates. As part of the settlement, the organization agreed to enter into a five-year CIA with HHS-OIG.
Two home healthcare companies agreed to pay $1.5 million to resolve FCA allegations that they engaged in a pattern of overbilling for personal care and attendant services, as patient files and billing data purportedly showed: (1) many billed services were not documented; (2) dates for which the company was reimbursed where the patient file showed no service was received; and (3) service hours were billed in excess of those actually provided.
A health system agreed to pay $550,000 to resolve FCA allegations that physicians who were contracted with the company to provide radiation therapy failed to properly supervise that treatment, which is a condition of payment for Medicare.
A specialized pharmacy and affiliated entities agreed to pay $2.5 million to resolve FCA allegations that it billed Medicaid for costly anti-hemophilic medications that were unneeded or unused, as a result of its delivery policy.
A hospice provider agreed to pay more than $10.1 million to resolve FCA allegations that it overbilled for hospice services by billing for general inpatient care when medical records supported only the necessity of routine care.
An ambulatory surgery center and its practice manager agreed to pay $4 million to resolve FCA allegations that they billed Medicare for Mohs surgeries and other surgical procedures that the physician either did not perform or were medically unnecessary. As part of the settlement, the physician agreed to be excluded from federally funded healthcare programs for at least five years.
A specialty pharmaceutical company agreed to pay $5.9 million to resolve FCA allegations it misleadingly focused on purported anti-inflammatory properties of one of its eye drugs that were unsupported by substantial evidence or substantial clinical experience in order to cause doctors to prescribe the drug for uses not covered by federal healthcare programs, which resulted in those programs paying millions of dollars in false claims.
A skilled nursing facilities owner, its operating subsidiaries and affiliates, and its former president and executive director agreed to pay $17 million to resolve FCA allegations that they operated a kickback scheme in which they hired numerous physicians ostensibly as contracted medical directors with specific job duties and hourly requirements, and yet most of the medical directors were required to perform few, if any, of their contracted duties. Instead, the government alleged they were paid for their patient referrals, in violation of the Anti-Kickback Statute. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A home health company agreed to pay $1.29 million to resolve FCA allegations that it developed protocols to accept home health referrals from two neurologists through which it treated and billed for patients who were not actually homebound and did not have a valid physician certification of home health need. The settlement also resolved allegations that the company recklessly permitted its employees to aggressively market its services to this neurology practice and that those marketing employees obtained access to the practice’s patient records to complete referral forms and used the doctors’ signature stamps to sign orders to evade the physician certification requirement.
A cardiology hospital, its owner, and affiliated entities agreed to pay $2.9 million to resolve FCA allegations that the hospital paid certain physicians salaries and bonuses that were above fair value and violated the Stark Law and Anti-Kickback Statute. The settlement also resolved allegations that hospital physicians upcoded evaluation & management patient visit codes and that it billed for cardiac rehabilitation therapy provided by a physician who was not properly supervising the therapists providing the services.
Two hospitals and affiliated entities agreed to pay $12.9 million to resolve FCA allegations that they submitted false information regarding their available bed count used to calculate reimbursement in an HHS pediatric program application and filed cost reports misstating their overhead costs.
A physician and his clinic agreed to pay $105,000 to resolve FCA allegations involving their permitting unlicensed personnel and staff to provide medical services to patients in violation of Medicare regulations.
A dentist and his practice agreed to pay $324,327 to resolve FCA allegations that he fraudulently billed Medicaid for tooth extraction procedures and for services rendered by a dental assistant when he was not in the office. The dentist also pleaded guilty to a related criminal charge and agreed to surrender his dental license as part of the plea.
A hospital and its owner agreed to pay $595,155 to resolve FCA allegations that the hospital paid kickbacks to an obstetric clinic that primarily served undocumented Hispanic women, in exchange for the referral of those patients to the hospital.
A group of home healthcare companies and their owner agreed to pay $6.5 million to resolve FCA allegations that they improperly billed for home health services. Specifically, the government alleged that the companies provided nursing services that were furnished or provided by a woman who had been excluded from federal healthcare programs, submitted required forms to TennCare that contained the forged signature of the Director of Nursing, billed TennCare for services without the required forms and signatures, and failed to repay TennCare within 60 days of learning that it had wrongly billed for care provided by a woman whose nursing license had lapsed. As part of the settlement, the entities and their owner agreed to enter into a five-year CIA with HHS-OIG.
A cardiology practice agreed to pay more than $3.6 million to resolve allegations that its facilities and its principals billed Medicare for various cardiology diagnostic tests and procedures which were not medically necessary.
A federally qualified health center agreed to pay $270,000 to resolve FCA allegations that it self-disclosed under the OIG’s Provider Self-Disclosure Protocol related to its employing, during a seven-year period, an individual previously excluded from participation in Medicare and Medicaid.
Two durable medical equipment suppliers agreed to pay $7.5 million to resolve FCA allegations that they falsely billed for power wheelchairs and accessories by falsifying or altering required prescriptions and medical documentation to make it appear as if the DME prescriptions and documentation met Medicare reimbursement criteria. This settlement does not resolve allegations against a principal of one company, who is another defendant in the ongoing action, and who was indicted in 2013 in a parallel criminal proceeding. As part of the settlement, each company agreed to enter into a five-year CIA with HHS-OIG.
Two California nursing homes and the owners, operators, and manager of the nursing homes agreed to pay $3.8 million to resolve FCA allegations that they provided materially substandard and/or worthless services to residents of the nursing homes as a result of persistent and severe overmedication. As part of the settlement, the two nursing homes and the two for-profit entities that owned and operated the nursing homes agreed to enter into a five-year CIA with HHS-OIG.
A neurologist agreed to pay $150,000—based on his ability to pay—to resolve FCA allegations that he knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal healthcare programs to be billed for medically unnecessary services and drugs. In 2014, the government settled related allegations against a health system for $2.5 million.
A pharmacy benefits manager agreed to pay $7.9 million to resolve FCA allegations that it knowingly caused false claims to be submitted through its role in a kickback scheme whereby it solicited illegal remuneration from a drug manufacturer in the form of price concessions on multiple drugs in exchange for its maintenance of AstraZeneca’s Nexium product as the “sole and exclusive” drug of its type on the company’s formulary.
Two ambulance providers agreed to pay $595,000 to resolve FCA allegations that during a five-year period they routinely billed Medicare and Medicaid for non-emergency, scheduled ambulance services for dialysis patients that were not medically necessary.
A long-term care pharmacy agreed to pay $23.5 million to resolve FCA allegations that it caused the submission of false claims to Medicare Part D for improperly dispensed Schedule II drugs. The company agreed to separately pay $8 million to resolve related allegations that it violated the Controlled Substances Act by enabling its staff to order, and pharmacists to dispense, Schedule II narcotics without confirming that a physician had deemed them medically necessary. As part of the settlement, it agreed to enter into a five-year CIA with HHS-OIG.
A hospital agreed to pay $18.8 million to resolve FCA allegations that it violated the Anti-Kickback Statute and Stark Law through an improper financial relationship with a cardiology practice during a six-year period. The government contended that: (1) the hospital advanced monies to the cardiology practice to open a practice for the express purpose of generating referrals to the hospital; (2) when the cardiology practice started repaying the advances, the hospital entered into retroactive, no-work consulting agreements under which it paid the cardiology practice tens of thousands of dollars; and (3) it permitted the cardiology practice to use its fellows in the practice’s office free of charge. The settlement also resolved related allegations that the hospital obtained Medicare reimbursement for costs it did not occur.
A health system agreed to pay $2.89 million to resolve FCA allegations that four of its hospitals allegedly provided Certificates of Medical Necessity that attested to the need for basic life support, non-emergency transports even when those transports were not medically necessary.
An ambulance company agreed to pay $1.25 million to settle allegations that it upcoded claims from basic to advanced life support, transported patients unnecessarily and transported patients to their homes in an “emergent” fashion. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A hospital agreed to pay $1 million to resolve FCA allegations that it provided Certificates of Medical Necessity that attested to the need for basic life support and non-emergency transports even when those transports were not medically necessary.
Four hospitals agreed to collectively pay $2.37 million to resolve FCA allegations that they provided Certificates of Medical Necessity that attested to the need for basic life support, non-emergency transports even when those transports were not medically necessary.
A health system and 14 hospitals it formerly owned and operated agreed to pay $15 million to resolve FCA allegations that they billed for intensive outpatient psychotherapy (IOP) services in violation of certain Medicare rules and policies because, for example, the patient’s condition did not qualify for IOP or the patient’s progress was not being adequately tracked and documented. The IOP services at issue were typically performed on the providers’ behalf by a separate post-acute healthcare management company.
A hospital agreed to pay more than $1.32 million to resolve FCA allegations that it billed Medicare and Medicaid in connection with unnecessary cardiac stent placements and other unnecessary cardiac procedures.
A hospital agreed to pay $480,000 to resolve FCA allegations that it billed for intensive outpatient psychotherapy (IOP) services in violation of certain Medicare rules and policies because, for example, the patient’s condition did not qualify for IOP or the patient’s progress was not being adequately tracked and documented. The IOP services at issue were typically performed on the providers’ behalf by a separate post-acute healthcare management company.
A health system and a subsidiary hospital agreed to pay $210,000 to resolve FCA allegations that they billed for intensive outpatient psychotherapy (IOP) services in violation of certain Medicare rules and policies because, for example, the patient’s condition did not qualify for IOP or the patient’s progress was not being adequately tracked and documented. The IOP services at issue were typically performed on the providers’ behalf by a separate post-acute healthcare management company.
A surgical practice specializing in dialysis care agreed to pay $1 million to settle allegations that it fraudulently billed for vascular surgical procedures not covered under Medicare. The practice also entered into a CIA with HHS-OIG.
A provider of home delivery pharmacy services agreed to pay $5 million to settle FCA allegations that, under prior ownership, the company provided gift cards to induce referrals or enrollments of Medicare or Medicaid patients and routinely waived co-payments for Medicare and Medicaid patients, in violation of the Anti-Kickback Statute.
A physician agreed to pay $150,000 to settle allegations that his practice fraudulently billed for vascular surgical procedures not covered under Medicare. He also entered into a CIA with HHS-OIG.
Five ambulance companies agreed to pay a total of $11.5 million to settle FCA allegations that they engaged in so-called “swapping” kickback schemes by providing deeply discounted—and often below cost—ambulance services to hospitals and/or skilled nursing facilities in exchange for exclusive rights to the facilities’ more lucrative Medicare patient referrals. As part of the settlement, Balboa agreed to enter into a five-year CIA with HHS-OIG.
A dialysis services provider agreed to pay $450 million, plus reserve an additional $45 million to cover fees, to resolve FCA claims that it developed and utilized dosing grids and protocols to create and maximize reimbursable waste of the dialysis drugs Zemplar and Venofer, which are packaged in single-use vials. For example, a protocol allegedly required a patient to receive 25 mg of Venofer, which is packaged in 100 mg vials, per week, so 300 mg of waste was billed to the government per month, whereas if the patient received the entire vial once per month, there would have been no waste.
A durable medical equipment supplier agreed to pay $300,000 to resolve FCA allegations that it overcharged Medicaid for custom power wheelchairs provided to nursing facilities residents by billing the “retail” price when it actually paid much less under wholesale and other special pricing agreements with vendors.
In an FCA jury trial, an optometrist was found liable for FCA violations stemming from his providing eye examinations to the vast majority of his nursing home patients, once a month, regardless of the patient’s condition or medical need. The jury found that the optometrist billed for more than 11,000 unnecessary eye examinations. As a result of the jury verdict, he was required to pay $1.257 million. His practice group previously settled related allegations in January 2015.
A pharmacy group agreed to pay $60 million to settle FCA allegations related to its role in a kickback scheme involving AstraZeneca. A drug manufacturer allegedly provided the pharmacy with kickbacks in the form of patient referrals and related benefits in exchange for the pharmacy’s recommending refills to patients taking a certain drug without counseling patients on potentially life-threatening side effects.
The owner of a rehabilitation center which provided administrative management services to a skilled nursing facility agreed to pay $300,000 to resolve FCA allegations that it submitted, or caused the submission of, false claims for the provision of unreasonable, unnecessary and/or unskilled rehabilitation therapy, or therapy that was not provided at all.
A hospital operator agreed to pay $520,000 to resolve FCA allegations of purported violations of the Anti-Kickback Statute and Stark Law related to the amount of compensation paid by the company to one physician, its leases with nine physicians, and the supervision of certain diagnostic imaging services.
A medical center agreed to pay $20 million to resolve FCA allegations that it billed for medically unnecessary inpatient admissions when the care provided should have billed as outpatient or observation services. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A company that owns and operates a dermatopathology laboratory and dermatology practices agreed to pay $3.24 million to settle FCA allegations that it routinely required its employed dermatologists to use its in-house pathology lab for their pathology services, in violation of the Stark Law, and billed for analyses on specimens sent to the lab by these employed physicians. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A county-owned hospital agreed to pay $21.75 million to resolve FCA allegations that it compensated several cardiologists in excess of the fair market value for their services and paid bonuses to emergency room physicians that improperly took into account the value of their cardiology referrals, in violation of the Stark Law.
A continuing-care retirement community agreed to pay $1.33 million to resolve FCA allegations it self-disclosed to the government concerning claims submitted for skilled nursing facility services that lacked the physician certifications and recertifications required by Medicare.
A fertility clinic and its owner agreed to pay $98,838 to resolve FCA allegations that they: (1) billed for work performed by a physician's assistant or nurse practitioner that were not “incident to” a physician’s course of treatment; (2) upcoded claims for payment; and (3) billed for services provided when the physician was out of the country.
A cardiovascular laboratory agreed to pay $47 million to resolve FCA allegations in three qui tam actions that it: (1) induced physicians to refer patients to them for blood tests by paying them processing and handling fees per referral and routinely waiving patient co-pays and deductibles; and (2) billed for medically unnecessary testing. As part of the settlements, the company agreed to enter into a five-year CIA with HHS-OIG.
A cardiovascular laboratory agreed to pay $1.5 million to resolve FCA allegations in three qui tam actions that it (1) induced physicians to refer patients for blood tests by paying them processing and handling fees per referral and routinely waiving patient co-pays and deductibles; and (2) billed for medically unnecessary testing. As part of the settlements, the company agreed to enter into a five-year CIA with HHS-OIG.
A generic drug manufacturer agreed to pay $25 million to resolve a state of Texas investigation involving state FCA allegations that it reported inflated drug prices to the Medicaid program.
A health system agreed to pay $10 million to resolve FCA allegations that it paid improper remuneration in exchange for referrals to more than 30 physicians during a 10-year period, in violation of the Anti-Kickback Statute and Stark Law. The remuneration allegedly took the form of management agreements with at least two physician groups when the payments were not justified by the good faith management services provided by the physicians, and lease and service agreements lacking adequate documentation. The investigation and settlement resulted from the company’s self-disclosure of questionable financial relationships to HHS-OIG, following a due diligence review conducted while searching for a partner health system.
A skilled nursing facility agreed to pay $1.2 million to resolve FCA allegations that it billed Medicare for inflated therapy services provided by a subcontractor. Specifically, Ross Manor failed to take sufficient steps to prevent the subcontractor from engaging in a practice of ramping up the amount of therapy provided to patients during the assessment reference period, providing significantly more therapy on the final day of a period to reach the next RUG level, placing patients in the highest reimbursement level unless it was shown that the patients could not tolerate that amount of therapy, and discouraging the provision of therapy in amounts lower than the minimum threshold required for the highest RUG level.
A nonprofit health system and hospital operator agreed to pay $5.41 million to resolve FCA allegations that several of its facilities wrongfully billed Medicare for radiation oncology services provided to beneficiaries without adequate supervision by radiation oncologists.
A dermatology practice and its owner agreed to pay $787,814 to resolve FCA allegations that they billed Medicare for procedures that were cosmetic in nature and not medically necessary, for procedures lacking the necessary clinical documentation, and for procedures billed at inappropriately high rates of reimbursement.
A cardiac monitoring company agreed to pay $6.4 million to resolve FCA allegations that its subsidiary overbilled Medicare for real-time Mobile Cardiac Outpatient Telemetry monitoring for patients whose symptoms could be adequately tracked with less expensive, periodic monitoring equipment.
A medical device manufacturer and several affiliated entities agreed to pay $4.41 million to resolve FCA allegations that they sought payment from the Departments of Veterans Affairs and Defense for medical devices manufactured in China and Malaysia despite their contractual promise to provide goods manufactured in the United States or other countries specified in the Trade Agreements Act.
Two home healthcare companies and their current owner agreed to pay $1.1 million to resolve FCA allegations that they paid several physicians to serve as medical directors for their office locations at rates substantially above the fair market value of the actual services provided by the physicians, in violation of the Anti-Kickback Statute and Stark Law.
A dentist agreed to pay $484,744 to resolve FCA allegations that he billed Medicaid for medically unnecessary tooth extractions and for narcotics prescribed without proper justification.
A skilled nursing facility operator agreed to pay $3.5 million in an administrative agreement to resolve allegations that it billed Medicare for inflated therapy services provided by a subcontractor. Specifically, three facilities failed to take sufficient steps to prevent the subcontractor from engaging in a practice of ramping up the amount of therapy provided to patients during the assessment reference period, placing patients in the highest reimbursement level unless it was shown that the patients could not tolerate that amount of therapy, discouraging the provision of therapy in amounts lower than the minimum threshold required for the highest RUG level, arbitrarily shifting planned therapy minutes between therapy disciplines to meet RUG targets, recording rounded or estimated minutes instead of the actual amount of therapy provided, reporting time spent on initial evaluations as therapy time to avoid prohibition on counting initial evaluation time as reimbursable therapy time, and reporting time providing unskilled palliative care as time spent on reimbursable skilled therapy.
A consulting company, research organization, and the patient safety consultant who operates both entities agreed to pay $1 million to resolve FCA allegations that the consultant solicited and received kickbacks from a medical technology company in exchange for influencing the recommendations of the National Quality Forum and for promoting the purchase of one of the company's products, in violation of the Anti-Kickback Statute. The prohibited payments allegedly took the form of monthly payments to to the consultant while he sat on the forum’s Safe Practices Committee. As part of the settlement, he and his two businesses have been excluded from participating in federal healthcare programs.
A hospital agreed to pay $2.7 million to resolve FCA allegations that it improperly billed Medicare for certain “short-stay” inpatient stays, defined as hospital stays lasting less than two nights, as a result of: (1) improper orders converted from outpatient status to inpatient status; (2) improper inpatient standing orders for admission without proper physician involvement; and (3) improper orders for inpatient status following scheduled outpatient procedures. As part of the settlement, the hospital agreed to enter into a five-year CIA with HHS-OIG.
An oncologist agreed to pay $550,000 to resolve FCA allegations that he wrongfully billed Medicare and Medicaid for non-FDA approved chemotherapy drugs that he purchased from a pharmaceutical distributor who was not licensed to distribute drugs in the United States.
Two cardiology practices and a cardiologist agreed to pay $650,000 to resolve FCA allegations that the physician performed and billed Medicare and Medicaid for medically unnecessary procedures. In 2008, the cardiologist was convicted in a parallel criminal proceeding of 94 counts of healthcare fraud.
A physician and his wife agreed to pay $90,000 to resolve FCA allegations involving a marketing kickback scheme with a home healthcare company whereby the company paid the spouses of physicians who referred patients to it for sham positions.
A physician-owned medical group agreed to pay $500,000 to resolve FCA allegations that, through the medical group, one of its physicians acquired, prescribed and billed for a foreign non-FDA approved version of an approved osteoporosis drug.
A hospital agreed to pay more than $4.44 million to resolve FCA allegations that one of its staff therapists had provided physical therapy services to Medicare home health patients that were medically unnecessary, inadequately documented, and/or not qualified for reimbursement for other reasons. This investigation and settlement resulted from the hospital's self-disclosure to HHS-OIG.
A provider of nursing home and rehabilitation care and the company that managed its therapy department and assisted with billing such services agreed to pay collectively $1 million to resolve FCA allegations involving billing Medicare for inpatient skilled therapy services that were not provided, were upcoded and were medically unnecessary. The settlement also resolved allegations that the management company caused false claims for durable medical equipment to be submitted to Medicare after an employee improperly disclosed protected health information to an outside vendor and that vendor used the information to bill Medicare for unnecessary medical equipment that some patients never received.
An optometrist and his business agreed to pay $150,000 to settle FCA allegations that the optometrist billed Medicare and Medicaid for services delivered in his office when they were actually delivered at nursing homes and billed for more than 12 hours per day, even more than 24 hours per day, on numerous occasions.
A physician agreed to pay $3.79 million to resolve civil FCA allegations involving his acceptance of kickbacks, in the form of a consulting agreement and various all-expenses paid trips, from a pharmaceutical manufacturer in exchange for prescribing generic clozapine, an anti-psychotic drug, in violation of the Anti-Kickback Statute. He also pleaded guilty to a related criminal charge.
A home health company agreed to pay $5.63 million to resolve allegations that it billed Medicare and Medicaid for home health services without properly documenting the continued medical necessity of the services, the types of services necessary, or the performance of the required face-to-face assessment of the patient by the certifying physician.
A hospice company and several related entities agreed to pay $4 million to resolve FCA allegations they fraudulently certified patients as hospice-eligible even though the patients did not have a terminal prognosis of six months or less. As part of the settlement, each of the entities agreed to enter into a five-year CIA with HHS-OIG.
A vascular device manufacturer agreed to pay $1.25 million to resolve FCA allegations that it had inappropriately advised various hospitals to bill arthrectomy procedures using its technologies as inpatient claims as opposed to less expensive outpatient claims.
An optometry practice agreed to pay $800,000 to settle FCA allegations that it billed for eye examinations performed by one of its optometrists that were purportedly worthless because he performed so many examinations per day that it was not possible for all his patients to have received legitimate eye examinations. The optometrist did not settle related allegations and was later found liable in a jury trial.
A national chain of testosterone replacement therapy clinics agreed to pay $1.6 million to resolve FCA allegations that it billed for medically unnecessary evaluation and management services each time a testosterone shot was administered. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A health system and three affiliated hospitals agreed to pay $75 million to resolve FCA allegations that they caused the state of New Mexico to submit false claims by making improper donations to various counties that were then impermissibly used to obtain federal matching payments under New Mexico’s Sole Community Provider program. In connection with the settlement, the relator agreed to the dismissal of similar claims against two other hospitals in which the United States previously declined to intervene.
Two related hospice providers agreed to pay $4.9 million to the United States and $1.6 million to New York to resolve FCA allegations that they sought payment from Medicare and Medicaid for hospice nursing services that were not delivered according to several regulatory guidelines governing the provision of reimbursable hospice services. Specifically, a provider failed to treat patients according to an individualized plan of care, meet the needs of certain patients, make nursing services available 24/7 as required and maintain adequate clinical records, while the other entity failed to provide sufficient oversight through its compliance audits. As part of the settlement, they agreed to enter into five-year CIAs with HHS-OIG.
A physician agreed to pay $338,493 to resolve civil FCA allegations that he illegally purchased and used foreign, non-FDA approved drugs on patients without informing them about the drugs, and then billed for the administration of these drugs as if they were the FDA-approved versions. He also pleaded guilty to a related criminal charge.
Trans-Star Ambulance Services agreed to pay $948,000 to settle FCA allegations that it billed Medicare for medically unnecessary ambulance transportation to and from dialysis clinics. As part of the settlement, Trans-Star entered into a five-year CIA with HHS-OIG.
A drug manufacturer agreed to pay $7.9 million to resolve FCA allegations that it provided remuneration to a pharmacy benefits manager in order to induce the pharmacy benefits manager to maintain its Nexium product as the “sole and exclusive” drug of its type on the PBM’s formulary. The prohibited remunerations allegedly took the form of price concessions on certain drugs other than Nexium.
A dermatology practice and its owner agreed to pay $3 million to resolve FCA allegations arising from having an unlicensed medical assistant performing radiation therapy without proper supervision, performing unnecessary destructions of skin lesions, and failing to properly document these destructions.
A physician agreed to pay $700,545 to resolve civil FCA allegations that he billed for physical therapy services and nerve conduction studies that were either not medically necessary, not properly supervised, or not actually provided. He also pleaded guilty to a related criminal charge.
A community-based organization that provides health and other services agreed to pay $3.35 million to resolve state FCA allegations that it overbilled Medicaid for thousands of fluoride treatments by billing as if they were stand-alone appointments instead of part of regular checkups and for more dental exams per patient than allowed without the required documentation.
A hospital system and its affiliates agreed to pay nearly $1.8 million to the United States and Massachusetts to resolve FCA allegations that it approved 103 recruitment cash grants to 33 physician groups who agreed to refer patients to participating providers. This action arose after the company voluntarily reported the results of its own independent review to regulatory officials.
An urgent care center and its owners agreed to pay $1.02 million to settle FCA allegations that they billed the physician rate for services actually provided by physician assistants, billed for medically unnecessary imaging tests, and billed for radiological services provided by a radiology technician who did not hold a current state license. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A medical device manufacturer agreed to pay $2.8 million to resolve FCA allegations that it induced several physicians to submit Medicare reimbursement claims for a non-reimbursable, investigational medical procedure known as SubQ stimulation.
A medical school agreed to pay $840,000 to resolve FCA allegations that it improperly billed Medicare and TRICARE for teaching physicians’ services involving residents when those physicians were responsible for multiple overlapping surgeries and did not provide the requisite level of supervision for the surgeries.
A global pharmaceutical company agreed to pay $39.01 million to resolve FCA allegations that it paid improper kickbacks to induce physicians to prescribe its drugs. The allegedly improper kickbacks took the form of speaker’s fees paid for duplicative speeches given at dinners exceeding the company's internal per person cost limitations, as well as payments for speeches made to the physician’s own staff. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A biotechnology company agreed to pay a total of $2.149 million to settle civil FCA allegations and related criminal charges that it defrauded the government by fabricating, altering, and/or manipulating the hours on timesheets used to track the amount of time spent on the development of an influenza drug under a $50 million National Institutes of Health research contract.
A physician and his wife agreed to pay $1.05 million to resolve FCA allegations that they had been party to a scheme under which the wife was paid by a home health company under a sham marketing agreement in order to induce her husband to refer patients to the company. The government previously settled with the agency, its owner and five other couples who accepted payments from the company.
A company which provides administrative healthcare management services and its CEO agreed to pay $6 million to settle FCA allegations that it caused several hospitals to submit false claims to Medicare and Medicaid for inpatient detoxification services provided to patients who suffered from substance abuse issues. The government alleged that SpecialCare helped hospitals provide emergency detox services without a required state certificate pursuant to illicit referrals and that were medically unnecessary and/or violated professional standards of care. Two defendant hospitals in these qui tam actions previously entered settlement agreements in 2008 and 2012. As part of the settlement, the company and its executive agreed to enter into a five-year CIA with HHS-OIG.
A hospital agreed to pay $662,000 to settle FCA allegations that it billed Medicare for a certain physician’s urologic procedures and tests that were either not performed, only partially completed, or medically unnecessary.
An acute care hospital agreed to pay $2.25 million to resolve FCA allegations that the hospital knowingly billed Medicare for medically unnecessary angioplasties and for inpatient angioplasty services that should have been performed in an outpatient setting.
A university research foundation agreed to pay $3.75 million to settle FCA allegations that one of its centers submitted false statements in connection with its state contract to perform audits designed to measure errors in local determinations as to which state residents were eligible to receive Medicaid and Children’s Health Insurance Program benefits. Because of the alleged data manipulation, the audits did not serve their purpose as random samples.
A sleep clinic and its physician and owner agreed to pay $250,000 to settle FCA allegations that they billed for services that were not medically necessary and were performed by unlicensed, uncredentialed, and unsupervised employees.
A medical device manufacturer and its CEO agreed to pay more than $80 million to resolve criminal and FCA allegations that they distributed unapproved cutting guides into interstate commerce while its application to the FDA for clearance to market the device was pending and after the application was denied. The government also alleged that the company encouraged healthcare providers to submit claims for MRIs that were not reimbursable because they were not for diagnostic use, but rather were performed solely to provide data for the creation of its device. The company agreed to be excluded from participating in federal healthcare programs for 20 years. The former CEO pleaded guilty to criminal charges related to the unapproved distribution of the cutting guides. As part of the settlement, a company that acquired the manufacturer during this timeframe agreed to conduct a review and audit regarding whether other marketed devices have the appropriate FDA approvals and share the results of that audit with the government, as well as to submit annual certifications regarding the effectiveness of its compliance program.
A pharmacy chain agreed to pay $2.99 million to resolve FCA allegations that it offered illegal payments in the form of gift cards to induce Medicare and Medicaid beneficiaries to transfer their prescriptions to its pharmacies.
A hospice provider and an affiliate agreed to pay $581,504 to settle FCA allegations that they billed Medicare for hospice services for patients who were ineligible for hospice care under Medicare regulations.
A medical device company agreed to pay $852,378 to settle FCA allegations that it submitted claims to Medicare and Medicaid for respiratory therapy services provided by unlicensed personnel, in violation of Massachusetts regulations. The government alleged that, even after the company was informed by the Massachusetts Department of Public Health that its practice was illegal, it did not stop the practice and continued to bill Medicare and Medicaid for these services.
A radiation oncologist agreed to pay $2.35 million to resolve allegations that he submitted or caused to be submitted claims for an experimental cancer treatment not eligible for reimbursement by Medicare. The affiliated hospital settled its portion of the matter for $25 million in September 2008.
A pain management clinic and its owner agreed to pay almost $1.2 million to resolve FCA allegations that they submitted fraudulent claims to federal and state healthcare programs for upcoded medical services.
A home health provider and affiliated entities agreed to pay more than $25 million to the United States and Tennessee to settle FCA allegations that between 2006 and 2013, it overstated the severity of patients’ conditions in order to increase reimbursement and billed for services that were not medically necessary or rendered to homebound patients. As part of the agreement, the company agreed to be bound by an enhanced and extended CIA with HHS-OIG (it was already operating under a CIA related to a 2012 settlement).
A home healthcare agency and affiliates paid $35 million to resolve FCA allegations that it and its affiliates improperly billed Medicaid for members whose needs did not qualify for the company's managed long-term care plan. These members were alleged to have been improperly referred by social adult day care centers managed by the agency or received services from those centers that did not qualify as “personal care services” under the contract with New York’s Department of Health.
The owner of a chiropractic center agreed to pay $376,436 to settle FCA allegations that he improperly upcoded services and falsely certified that his services were medically necessary. As part of the settlement, he entered into a three-year CIA with HHS-OIG.
A medical device manufacturer agreed to pay $4.9 million to settle FCA allegations that it paid implanting physicians illegal remuneration in the form of repeated expensive meals and monthly payments for service on a nonexistent physician advisory board in order to induce the physicians to start or continue using its devices, thus causing hospitals and ambulatory surgery centers to submit false claims to Medicare and Medicaid for the devices.
An operator of dental clinics agreed to pay $5.05 million to resolve FCA allegations that it submitted false claims to Medicaid for more dental restorations than were actually performed or for work that was never actually performed at all. In connection with the settlement, the company entered into a five-year CIA with HHS-OIG.
A cancer research physician agreed to pay $475,000 to resolve allegations that he submitted false claims under NIH research grants for reimbursement for professional and consulting services, food, hotels, travel, conference registration fees and other expenses that benefitted him and his family and friends. The university where he worked settled its portion of the lawsuit in July 2013.
A hospital operator agreed to pay $37 million to resolve FCA allegations that 13 of its hospitals billed for inpatient services for patients that should have been treated in an outpatient setting. The hospitals were alleged to be billing for improper inpatient services across three groups of patients: (1) patients undergoing elective cardiovascular procedures in scheduled surgeries that should have been billed as outpatient surgeries; (2) patients undergoing elective, minimally-invasive kyphoplasty procedures; and (3) patients with common medical diagnoses where admission as an inpatient was medically unnecessary. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A medical device company agreed to pay $6.07 million to resolve FCA allegations that it paid staff at physicians’ offices for seven years purportedly pursuant to personal service agreements in order to induce the physicians to use their bone growth stimulators, in violation of the Anti-Kickback Statute.
A university and one of its affiliated public health programs agreed to pay $9.02 million to settle FCA allegations that the public health program submitted false claims to the government under federal AIDS research grants. The government alleged the university improperly charged work to government grants for several years by knowingly failing to use a suitable means of verifying whether the wages it paid employees of the affiliated organization were based on actual work done, as required under the grant terms.
A home healthcare agency agreed to pay $57,000 to resolve FCA allegations that it altered physician signature dates and other information on physician orders for home healthcare services. As part of the agreement, the company will implement a compliance program for at least two years relating to its documentation of physician orders for home health services.
A dialysis provider agreed to pay $400 million (including $39 million in civil forfeiture) to resolve federal and state FCA allegations that—in order to induce referrals of patients to its dialysis clinics—it: (1) paid kickbacks in the form of lucrative joint venture opportunities to physicians or physician groups with large patient populations with renal disease; (2) paid physicians to serve as medical directors of the joint venture clinics; and (3) entered into agreements with physicians in which the physicians agreed not to compete with the clinics and which bound all the physicians in a practice group. The company entered into a five-year CIA with HHS-OIG in connection with the settlement.
Two cardiologists and joint owners of a physician group agreed to pay $380,000 to settle FCA allegations that they entered into sham agreements with a hospital to be paid for management services they never performed in exchange for referring cardiology procedures and other healthcare services exclusively to the hospital, in violation of the Anti-Kickback Statute and Stark Law. As part of the settlement, the physicians agreed to enter into three-year IAs with HHS-OIG. Earlier in the year, the hospital reached a settlement agreement with the government to resolve related allegations.
A pharmaceutical company agreed to pay $31 million to settle FCA allegations—involving nearly every state Medicaid program—that it underpaid Medicaid rebates, paid illegal kickbacks to nursing homes in the form of market share discounts and rebates to encourage the use of two of its drugs over competing antidepressants, and promoted certain other drugs for non-approved uses.
A hospital agreed to pay $3.37 million to resolve FCA allegations that it improperly billed Medicare for hyperbaric oxygen therapy services provided by a third party at a facility that did not meet federal regulations for “provider based status.” The hospital discovered the improper billing during an internal review, took corrective action, and disclosed its findings to the government.
A diagnostic center operator and its owner agreed to pay $1.2 million to resolve FCA allegations that they violated the Stark Law by entering into sham consulting and medical director agreements with physicians who referred patients to the company's centers. As part of the settlement, the company and owner agreed to enter into a five-year CIA with HHS-OIG.
An operator of diagnostic facilities, its affiliate centers and its owner agreed to pay $1.45 million to settle FCA allegations that it engaged in improper financial relationships with referring doctors and billed Medicare using the provider number of a physician who neither gave his authorization nor was involved in providing the billed services.
A radiology billing company agreed to pay $1.95 million to resolve FCA allegations that it changed diagnosis codes on claims to Medicare and Medicaid in order to get rejected claims paid on behalf of radiologists.
An operator of skilled nursing facilities, and its subsidiary, a provider of rehabilitation therapy, agreed to pay $38 million to settle FCA allegations that the company billed Medicare and Medicaid for materially substandard skilled nursing services and failed to provide care that satisfied federal and state regulations and standards of care at 33 of its SNFs, and that the company and subsidiary provided medically unreasonable and unnecessary rehabilitation services to Medicare Part A patients at 33 SNFs, particularly during the patients’ assessment reference period, in order to bill at the highest RUG level. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A specialty pharmacy agreed to pay $10 million to resolve FCA allegations that company representatives made false statements to insurance companies to secure prior authorization for drug coverage by fabricating Medicare beneficiaries’ patient information and pretending to be from prescribing physicians’ offices when calling insurers. The settlement also resolves allegations that the pharmacy engaged in double-billing of unused doses of two drugs and submitted claims for automatic refills of medications that were not actually dispensed.
A pharmaceutical company agreed to pay $56.5 million to resolve FCA allegations that it improperly marketed and promoted several of its drugs. For example, the government contended that the company illegally promoted a drug by asserting that it was superior to all other ADHD drugs and would “normalize” patients, despite a lack of clinical data sufficient to support such a claim; and promoting a drug for treating conduct disorder, an indication for use unapproved by the FDA. As part of this settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A clinical laboratory and one of its subsidiaries agreed to pay $3.51 million to resolve FCA allegations that its employees input diagnosis codes—that they believed were most likely to secure reimbursement from CMS—into claim forms without going back to the physician to obtain the missing code and subsequently submitted the claims for payment to CMS.
A hospital agreed to pay $329,000 to settle FCA allegations that it compensated a cardiologist in a manner that violated the Stark Law. Specifically, the government alleged that in exchange for referrals of Medicare-eligible patients, the hospital compensated the cardiologist for professional services and medical director services in excess of fair market value. The hospital also agreed to enter into a five-year CIA with HHS-OIG. The physician reached a separate settlement in the case.
A cardiologist agreed to pay $200,000 to settle FCA allegations that he accepted compensation from a hospital that violated the Stark Law. Specifically, the government alleged the hospital compensated the cardiologist for professional services and medical director services in excess of fair market value in exchange for referrals of Medicare-eligible patients. The hospital reached a separate settlement in the case.
A medical device manufacturer agreed to pay $362,362 to 46 states and Washington, D.C. to resolve FCA allegations that it caused providers to submit false claims to the government by inducing physicians to use its products through kickback payments in the form of speaking fees, free business plans, and tickets to sporting events. The company agreed to pay $9.9 million to the federal government to resolve similar FCA allegations.
A not-for-profit organization that owns a skilled nursing facility agreed to pay $1.3 million to resolve FCA allegations that it billed Medicare for unreasonable or unnecessary rehabilitation therapy purportedly provided by a contract therapy provider. Specifically, the settlement resolved allegations that the organization failed to prevent practices intended to increase Medicare reimbursement, including: (1) providing unreasonable and unnecessary therapy; (2) placing patients in the highest Resource Utilization Group (RUG) level unless it was shown the patients could not tolerate that amount of therapy; (3) discouraging the provision of therapy in amounts lower than the minimum threshold required for the highest RUG level; (4) arbitrarily shifting planned therapy minutes between therapy disciplines to meet RUG targets; and (5) recording rounded or estimated minutes instead of the actual amount of therapy provided.
A home healthcare company and its owners agreed to pay $1.65 million to resolve FCA allegations involving a kickback scheme whereby the company provided marketing jobs for at least seven physicians’ spouses or significant others in exchange for referrals of Medicare beneficiaries to the company. The spouses and significant others did little, if any, actual marketing work and were paid, in part, based on the amount of referrals the physicians made. The United States previously settled with five couples that allegedly accepted similar kickbacks from the same company.
A pharmacy benefit management company agreed to pay $6 million to resolve FCA allegations that it failed to reimburse Medicaid for prescription drug costs paid on behalf of Medicaid beneficiaries who also were eligible for drug benefits under private health plans the company administered.
A manager of skilled nursing facilities and one of its facilities agreed to pay $3.75 million to settle FCA allegations that they submitted or caused to be submitted false claims to Medicare for unreasonable or unnecessary skilled rehabilitation therapy purportedly performed by a contract therapy provider. Specifically, the government alleged that the companies failed to prevent the contractor's practices at the facility and a former facility intended to increase Medicare reimbursement, including: (1) providing unreasonable and unnecessary therapy; (2) placing patients in the highest Resource Utilization Group (RUG) level unless it was shown the patients could not tolerate that amount of therapy; (3) discouraging the provision of therapy in amounts lower than the minimum threshold required for the highest RUG level; (4) arbitrarily shifting planned therapy minutes between therapy disciplines to meet RUG targets; and (5) recording rounded or estimated minutes instead of the actual amount of therapy provided.
An outpatient surgical clinic operator and its subsidiaries agreed to pay $3.3 million to the United States and $1.8 million to the relator for attorneys’ fees and costs to resolve allegations that the company paid certain physicians above fair market value and offered them investment opportunities to induce patient referrals, resulting in the submission of false claims. The United States previously declined intervention in the action.
A manufacturer of spinal surgery devices and a spinal surgeon agreed to pay $2.6 million to resolve FCA allegations that the manufacturer paid illegal kickbacks to the physician to induce him to use the company’s products. In addition, the company allegedly falsified financial documents in order to cover up the illegal scheme.
A laboratory agreed to pay $6.05 million to resolve FCA allegations that it improperly billed Medicare and Medicaid for tests and services referred in violation of the Anti-Kickback Statute and for tests performed without a doctor's order or consent. The United States previously declined to intervene in the matter.
A sleep clinic and an affiliated physician agreed to pay $200,000 to resolve FCA allegations that they billed for sleep studies and psychological testing that were not medically necessary, conducted by appropriately licensed individuals, or actually performed. As part of the settlement, they agreed to be excluded from participation in federal healthcare programs for eight years.
The medical director of a sleep clinic agreed to pay $90,324 to resolve FCA allegations that the clinic billed for sleep studies and psychological testing that were not medically necessary conducted by appropriately licensed individuals or actually performed. The practice and another physician reached a separate settlement in the matter.
A medical device manufacturer agreed to pay $11.3 million to resolve allegations that the company violated the FCA and Trade Agreements Act by selling products to the United States that had a country of origin that had not executed a trade agreement with the United States. In 2008, the manufacturer voluntarily disclosed to the government that some of its medical devices did not comply with country-of-origin regulations. The government initially declined to intervene in the matter.
A nursing home, its owner and the real estate holding company of the facility agreed to pay $1.32 million to New York and $880,000 to the United States to resolve FCA allegations that the facility submitted false information in Patient Review Instrument data to inflate the level of care provided to residents and thus submitted falsely inflated claims for reimbursement to Medicaid. The defendants attempted to conceal the scheme by forging signatures and making false entries in the residents’ medical records. As part of the settlement, the facility agreed to enter into a CIA with the New York State Office of the Medicaid Inspector General.
A nonprofit hospital operator agreed to pay $35 million to resolve FCA allegations that its hospitals submitted claims for inpatient rehabilitation facility services for patients that were not appropriate for these services. The organization disclosed some inpatient rehabilitation overpayments to the government and made a significant repayment, prior to becoming aware of the government’s investigation. While the government took these actions into account in reaching the settlement amount, it had concerns that the disclosure and repayment were not timely, complete or adequate.
A healthcare system and a medical practice agreed to pay $348,854 to resolve FCA allegations that the entities billed Medicare and Medicaid for services that were allegedly performed by a physician, but were actually performed by resident physicians where the physician was not appropriately performing teaching physician services. The physician also upcoded certain services to receive higher reimbursement and submitted other bills despite the lack of sufficient documentation to support the billable service. The companies disclosed these alleged violations to the government.
A cardiology practice agreed to pay $1.33 million to settle FCA allegations that it compensated its partner-physicians in a manner that accounted for their volume or value of referrals for nuclear and CT scans, in violation of the Stark Law.
A health system and one of its hospitals agreed to pay $4 million to settle FCA allegations that the company, through its physician-owned hospital and ambulatory surgical center, submitted false claims for procedures that were improperly inflated, misidentified in order to receive a higher rate of reimbursement, and/or in violation of the Stark Law.
A pharmaceutical distributor agreed to pay $18 million to resolve FCA allegations that it failed to comply with the shipping and handling requirements of its vaccine distribution contract with the CDC. The government alleged that the company improperly set monitors designed to detect when air temperatures inside shipping boxes moved outside a range considered safe for shipping vaccines and knowingly submitted false claims to the CDC that it had complied with its contractual obligations.
New York City agreed to pay $1.05 million to resolve FCA allegations that the New York City Human Resource Administration (HRA) caused various managed care organizations to provide health insurance to individuals that HRA knew or should have known were ineligible to receive Medicaid benefits because the individuals had moved out of state.
A health system and its affiliates agreed to pay $98.15 million to resolve seven qui tam actions involving allegations that the company billed for unnecessary inpatient services that should have been billed as outpatient or observation services. As part of the agreement, the company entered into a five-year CIA with HHS-OIG.
A medical device distributor which markets and sells medical devices that treat varicose veins with laser therapy agreed to pay $520,000 to resolve FCA allegations that it caused false claims to be submitted for its “Short Kit” medical device by marketing the kit for the sealing of perforator veins without FDA approval. In November 2014, the company and its CEO were criminally indicted for allegedly conspiring to defraud the United States by concealing the illegal sales activity and for introducing adulterated and misbranded devices into interstate commerce.
A laboratory testing company agreed to pay $343,739 to settle FCA allegations that it billed Medicare for genetic tests that were improperly referred to it as a result of a contract sales agent falsely marketing the tests to a medical practice and offering to pay per-patient kickbacks to an employee of the medical practice.
A health system agreed to pay $1 million to resolve the remaining allegations in a qui tam action that it submitted claims for medically unnecessary inpatient services that should have been billed as outpatient services. The government declined to intervene as to these allegations. The settlement was reached just prior to a scheduled July 2014 trial.
A health system, two affiliated clinics, and an independent clinic agreed to pay $24.5 million to resolve FCA allegations that the two affiliated clinics had an arrangement with the other practice to pay a percentage of Medicare payments to the independent practice for tests and procedures referred to the clinics by its physicians, in violation of the Stark Law and Anti-Kickback Statute. In connection with the settlement, the health system and its affiliated clinics entered into a five-year CIA with HHS-OIG.
A hospital agreed to pay $750,000 to settle FCA claims that it double-billed Medicare for operating room and ambulatory services from September 2006 through June 2010.
A long-term care pharmacy and its affiliates agreed to pay $124 million to resolve FCA allegations relating to a “swapping” kickback scheme the pharmacy purportedly engaged in whereby it provided 22 skilled nursing facilities with discounts on Medicare Part A prescription drugs in exchange for the referral of Medicare Part D patients. The government declined to intervene in these two matters (though the government later intervened in one, when the company moved to disqualify the relator after reaching a preliminary settlement agreement with relator in October 2013).
A medical practice and its former owner agreed to pay $6.2 million to settle FCA allegations that the physician and his practice billed Medicare and Medicaid for services that were not medically necessary, not provided, and/or provided to immediate family members, and otherwise failed to comply with Medicare and Medicaid rules and regulations from December 2007 through March 2013.
A skilled nursing facility which utilized a third-party therapy services provider, agreed to pay $500,000 to resolve FCA allegations that it submitted or caused to be submitted improper therapy services claims to the government because the claims were not justified by the residents’ conditions. The facility also allegedly submitted inflated cost reports to Medicaid by including the costs of the therapy services in its cost reports.
A nursing home company and its affiliated nursing facilities agreed to pay $750,000 to resolve FCA allegations that the nursing facilities billed Medicare and Medicaid for materially substandard and/or worthless nursing services. Among other allegations, the entities allegedly did not follow appropriate fall protocols; failed to provide for activities of daily living, including bathing and feeding residents; and failed to provide a habitable living environment. The facilities also allegedly failed to employ a sufficient number and skill-level of nursing staff to provide adequate care to residents. In connection with the settlement, the organization and the other facilities agreed to enter into a five-year CIA with HHS-OIG.
A healthcare system agreed to pay $3.25 million to settle the remaining allegations in the qui tam action styled U.S. ex rel. Myers v. Shands Healthcare, et al. (M.D. Fla.) that six of its healthcare facilities improperly billed federal healthcare programs for outpatient services that lacked physician orders or were otherwise deficient for the charges billed. The government declined to intervene as to these allegations. In July 2013, the organization paid $26 million to resolve allegations in this action as to which the government intervened—specifically, that six of its healthcare facilities billed for inpatient services that should have been billed as outpatient services.
An oncology practice and its owners agreed to pay $3.73 million to resolve allegations that they submitted or caused to be submitted false claims for unnecessary and improperly extended chemotherapy infusion treatment and for unnecessary office visit evaluations for infusion therapy treatments. In connection with the settlement, the clinic and a physician agreed to enter into a three-year CIA with the HHS-OIG.
An ambulance company agreed to pay $500,000 to resolve allegations that it submitted false claims to Medicaid for advanced life support services that were not medically necessary or not actually provided in order to receive higher rates of reimbursement. As part of the agreement, the company entered into a five-year CIA with HHS-OIG.
A medical device manufacturer agreed to pay $9.9 million to resolve FCA allegations that it caused providers to submit false claims to the government by inducing physicians to use its products through kickback payments in the form of speaking fees, free business plans and tickets to sporting events. In September 2014, the company agreed to pay a total of $362,362 to 46 states and D.C. to resolve similar FCA allegations.
A hospital agreed to pay $40.9 million to resolve FCA allegations that it maintained improper financial relationships with certain employed cardiologists, billed Medicare and Medicaid for numerous medically unnecessary coronary procedures, and had physicians falsify medical records in order to justify the procedures. The hospital agreed to enter into a five-year CIA with HHS-OIG in connection with the settlement.
A clinical laboratory agreed to pay $4.67 million to settle allegations that it falsely billed Medicare and Medicaid for urine testing services that were never actually ordered. Specifically, the laboratory routinely billed using a code designated for covered pathology services in addition to the code for urine drug testing, even though treating healthcare providers did not deem pathology services necessary or knowingly order the service. The company also entered into a five-year CIA with HHS-OIG as part of the settlement.
On May 14, a federal district judge issued an $89.6 million default judgment against an oncologist and his former business, alleging that he directed employees at the treatment centers to perform and bill for daily imaging procedures that were medically unnecessary. On October 15, 2014, the court vacated the default judgment and granted a new trial on damages, upon concluding that the damages award was calculated based on allegedly fraudulent claims that were outside the scope of the original complaint. The United States previously declined to intervene in this matter.
A medical center agreed to pay $435,640 to resolve FCA allegations that it violated the Anti-Kickback Statute by providing kickbacks to a physician group that referred a substantial number of patients to the hospital each year. The kickbacks were alleged to have been in the form of inflated rental payments for space it leased from the physician group.
A health system and two affiliated entities agreed to pay $2.5 million to resolve FCA allegations that its subsidiary facilities billed Medicare and Medicaid for medically unnecessary services as a result of the conduct of two neurologists in its network who misdiagnosed patients with neurological disease. Despite learning of the misdiagnoses as early as October 2011, the organization failed to disclose them to the government until September 2012.
A provider of home health services and its affiliates agreed to pay $150 million to resolve FCA allegations that it submitted claims for services that were medically unnecessary or were provided to patients who were not homebound. The government also alleged the company provided certain referring physicians with kickbacks in the form of below-market-rate coordination services in violation of the Anti-Kickback Statute and Stark Law. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A pediatric health system and its affiliates agreed to pay $7 million to resolve federal and state FCA allegations that the company established certain compensation arrangements that exceeded fair market value and improper productivity bonuses for physicians in violation of the Stark Law. The government previously declined to intervene in the matter.
A cardiology practice and its owner agreed to pay $1 million to settle allegations that they caused two hospitals to submit fraudulent claims to Medicare as a result of an improper compensation arrangement.
A pharmaceutical company agreed to pay $7.3 million to resolve FCA allegations that, between 2005 and 2010, it knowingly marketed and promoted the sale of the drug Mycamine for pediatric use, which was not an approved use for Mycamine at the time and, therefore, not covered by federal healthcare programs.
A hospital and its parent company agreed to pay $1.5 million to resolve federal and state FCA allegations that the hospital and one of its physicians billed Medicaid for sinus surgeries that were not medically indicated and for services related to surgical procedures that the physician did not perform.
A cancer treatment facility and its owner agreed to pay $2.9 million to resolve FCA allegations that the Institute submitted claims to federal healthcare programs for chemotherapy drugs that were not provided to beneficiaries. The owner and physician allegedly instructed employees to bill for a predetermined amount of cancer drugs at certain dosage levels, when lower dosages of these drugs were actually provided to beneficiaries.
Two physical therapy clinics and three affiliated individuals agreed to pay $2.78 million to settle FCA allegations that they billed Medicare and TRICARE for physical therapy services that were not provided or supervised by the physical therapist listed on the claim. As part of the agreement, the entities and three individuals associated with them entered into a five-year CIA with HHS-OIG.
A mental health and substance abuse treatment provider and its subsidiaries agreed to pay $9.2 million to resolve FCA allegations that one of its substance abuse treatment facilities billed Tennessee’s Medicaid program for therapy services that either were not provided or were provided by therapists who were not licensed to practice in Tennessee. The government also alleged that the facility: (1) failed to make a licensed psychiatrist available to patients at the facility or to maintain patient-staffing ratios, as required by Tennessee regulations; (2) billed for Medicaid patients in excess of the state-licensed bed capacity at the facility; and (3) double-billed for substance abuse medications provided to patients at the facility.
A cardiology practice and two physicians agreed to pay $3.9 million to resolve FCA allegations that between January 2004 and September 2010, they billed Medicare and Medicaid for nuclear stress tests that were substandard, conducted by non-licensed individuals, and medically unnecessary. Under the terms of the settlement, the parties agreed to enter into a five-year CIA with HHS-OIG.
A university health system agreed to pay $1 million to settle FCA allegations that its hospitals wrongfully billed Medicare and Medicaid for coronary artery bypass surgeries during which physician assistants and graduate medical students acted as surgical assistants and inappropriately unbundled claims related to anesthesia and cardiac services.
A health system agreed to pay $1.53 million to settle FCA allegations that it leased space to physicians at below-market rates to induce referrals to its hospital. The company self-disclosed the alleged violations to the government.
An ophthalmologist agreed to pay $1.4 million to resolve FCA allegations that he submitted claims to Medicare and Medicaid for laser eye procedures that fell outside of the requisite standard of care and were not medically necessary. Under the terms of the settlement, he also agreed to a 20-year exclusion from federal healthcare programs.
A hospital agreed to pay $8.5 million to settle FCA allegations that it violated the Stark Law and Anti-Kickback Statute by engaging in a joint venture with a pain management physician and by entering into an arrangement with an ophthalmologist under which the ophthalmologist resold certain medical equipment to the hospital at inflated prices. The hospital self-disclosed these alleged violations to the government.
A network of walk-in medical clinics agreed to pay $1.2 million to resolve FCA allegations that it knowingly submitted false claims to Medicare by selecting Evaluation and Management codes reflecting a level of services that exceeded those actually provided. As part of the settlement, the company and its affiliates entered into a five-year CIA with HHS-OIG.
A pharmaceutical manufacturer and a subsidiary agreed to pay $27.6 million to resolve FCA allegations that they made payments to a physician through a series of “consulting agreements” and all-expenses-paid trips in order to induce him to prescribe one of the company's drug. The physician became the largest prescriber of the drug and the scheme resulted in the submission of thousands of false claims to Medicare Part D and Illinois Medicaid.
A hospital system agreed to pay $85 million to resolve FCA allegations that it violated the Stark Law by knowingly executing contracts with six oncologists that contained an incentive bonus that improperly included the value of prescription drugs and tests the oncologists ordered and which the company billed to Medicare. The government also alleged the company compensated certain physicians at levels in excess of the fair market value of their work. As part of the settlement, it entered into a five-year CIA with HHS-OIG. The company entered into a second settlement in this qui tam action later in 2014 to resolve allegations as to which the government declined to intervene.
A long-term care pharmacy agreed to pay $4.19 million to resolve FCA allegations that it solicited and received kickbacks from a drug manufacturer in return for implementing “therapeutic interchange” programs designed to switch Medicaid beneficiaries from a competitor drug to the drug company's product. The drug manufacturer previously settled with the government in April 2013.
A physician and his pain clinic agreed to pay $750,000 to resolve FCA allegations that he systematically and inappropriately upcoded routine patient visits to the highest level possible and submitted claims for examinations he never conducted. Under the terms of the agreement, the doctor and clinic entered into a three-year CIA with HHS-OIG.
H.E. Butt Grocery and related entities agreed to pay $12 million to the state of Texas to resolve FCA allegations that the grocery store and pharmacy chain submitted inflated usual and customary pricing information to Texas Medicaid along with its claims for reimbursement by failing to account for discounted prices it charged members in its “Rx Rewards Program.”
A specialty pharmacy company and its subsidiary agreed to pay $192.7 million to resolve criminal and FCA allegations that they caused false claims to be submitted to federal programs by promoting one of its drugs for uses not approved by the FDA and, often, not medically indicated. As part of this global settlement, the company agreed to enter into a two and a half-year deferred prosecution agreement with DOJ and a five-year CIA with HHS-OIG.
The owner and operator of several imaging centers and a subsidiary agreed to pay $15.5 million to resolve FCA allegations that the company submitted claims to Medicare for imaging or interpretive services that were never performed, billed for medically unnecessary tests as part of a test-bundling scheme, and paid kickbacks to physicians for referrals in the form of a payment ostensibly for supervising patients who underwent nuclear stress tests. The company also entered into a five-year CIA with HHS-OIG as part of the agreement.
A medical device company, agreed to pay up to $5.25 million ($2.5 million in fixed payments, up to $2.75 million in contingent payments) to resolve FCA allegations that it knowingly misled providers into submitting claims for more invasive procedures even though its device permitted providers to conduct the same procedure less invasively and paid kickbacks to certain providers for participating in seminars to induce them to use its devices. As part of the settlement, the company entered into a five-year CIA with HHS-OIG.
A medical billing company and its owner agreed to pay $544,500 to resolve allegations that it double-billed federal and state healthcare programs for nuclear stress tests by using both the code for nuclear stress tests and a code for a repeated or distinct test, when in fact the test was not repeated and no distinct service was performed. Pursuant to this arrangement, the company sought referrals from general practitioners, promising them a portion of the double payment. The company is also alleged to have improperly unbundled certain interpretive services already included in the code for the nuclear stress tests.
A community mental health facility agreed to pay $800,000 to resolve FCA allegations that it upcoded psychosocial rehabilitation services provided to Medicaid beneficiaries and knowingly concealed overpayments resulting from double-billing for services already included in per-diem rates. In connection with the agreement, the entity entered into a five-year CIA with HHS-OIG.
A physician agreed to pay more than $659,726 to resolve allegations that a medical billing company he used double-billed federal and state healthcare programs for nuclear stress tests by using both the code for nuclear stress tests and a code for a repeated or distinct test when in fact the test was not repeated and no distinct service was performed. Pursuant to this arrangement, the billing company sought referrals from general practitioners, promising them a portion of the double payment.
A physician and her practice agreed to pay more than $242,204 to resolve allegations that a medical billing company used by the practice double-billed federal and state healthcare programs for nuclear stress tests by using both the code for nuclear stress tests and a code for a repeated or distinct test when in fact the test was not repeated and no distinct service was performed. Pursuant to this arrangement, the billing company sought referrals from general practitioners, promising them a portion of the double payment.
A cardiology practice and its owners agreed to pay more than $1.8 million to resolve allegations that a medical billing company it used double-billed federal and state healthcare programs for nuclear stress tests by using both the code for nuclear stress tests and a code for a repeated or distinct test when in fact the test was not repeated and no distinct service was performed. Pursuant to this arrangement, the billing company sought referrals from general practitioners, promising them a portion of the double payment.
A chain of addiction treatment clinics, a clinical laboratory and two physician owners agreed to pay $15.8 million to resolve FCA allegations that they billed Medicare and Medicaid for urine tests that were medically unnecessary or were more expensive than the actual tests performed. After becoming owners of the laboratory, the physicians allegedly referred all drug screens completed at the clinics to their laboratory for additional comprehensive screening that was often unnecessary or more expensive than suitable alternative tests. As part of the settlement, the laboratory agreed to enter into a five-year CIA with HHS-OIG.
A medical device vendor agreed to pay $3.6 million to settle FCA allegations that it overcharged the government by potentially more than $1 million in relation to a $2.4 million subcontract to sell medical equipment to military hospitals. The company purportedly submitted fabricated invoices and falsified product numbers in an attempt to satisfy certain procurement pricing requirements.
A hospital agreed to pay $16.5 million to resolve FCA allegations that it billed federal and state healthcare programs for numerous unnecessary cardiac procedures between January 2008 and August 2011 and that it entered into sham management agreements with certain physicians in order to induce referrals. The hospital also entered into a five-year CIA with HHS-OIG in connection with the agreement.
An orthopedic clinic agreed to pay $1.3 million to resolve FCA allegations that it knowingly billed state and federal healthcare programs for reimported osteoarthritis medications with uses not approved in the United States.
An orthopedic clinic agreed to pay $550,000 to resolve FCA allegations that it knowingly billed state and federal healthcare programs for reimported osteoarthritis medications not approved in the United States.
Three contract therapy providers and a management company (along with certain affiliates) agreed to pay $30 million to resolve FCA allegations that one of the companies made an arrangement with another to provide therapy services for residents of 60 nursing homes in exchange for a $400,000 to $600,000 upfront payment and a portion of the revenue from every referral, in violation of the Anti-Kickback Statute.
Dr. Swierzewski, a urologist, agreed to pay $300,000 to settle FCA allegations that he improperly billed Medicare at the doctor’s rate for services provided by physician’s assistants working without the doctor’s supervision.
A former CEO of a company that provides services to skilled nursing facilities agreed to pay $1 million to resolve FCA allegations that he and another executive pressured company staff to bill for services that were inflated or not medically necessary in connection with a larger scheme which the company settled in 2008. The executive also agreed to be excluded from participating in federally funded healthcare programs for three years.
The former CFO of a company that provides services to skilled nursing facilities agreed to pay $20,000 to resolve FCA allegations that he and another executive pressured company staff to bill for services that were inflated or not medically necessary in connection with a larger scheme that the company settled in 2008.
A specialty pharmacy agreed to pay $11,685,705.43 to the federal government and $3.31 million to a group of states to resolve FCA allegations that it received kickbacks from a drug manufacturer—in the form of patient referrals and purported rebates—to push patients to continue using an iron reduction drug.
A physician and his business agreed to pay $89,965.38 to resolve allegations that they submitted claims for certain sleep medicine services and tests that were either not provided by a licensed physician, duplicative, or performed by someone not associated with either the physician or his company.
A pharmaceutical manufacturer and distributor agreed to pay $40.1 million to resolve FCA allegations that it paid $11.6 million in kickbacks to a physician in order to induce him to recommend one of their drugs. The settlement also resolved allegations that the company knowingly promoted the drug for uses not approved by the FDA, not medically indicated or altogether unsubstantiated.
A pharmaceutical manufacturer agreed to pay $25 million to resolve FCA allegations that it provided inflated pricing information for its drugs to Texas Medicaid, which materially increased Medicaid’s reimbursement rate for those drugs.
A hospital agreed to pay more than $2.33 million to resolve FCA allegations that it administered 15 improper physician income guarantee agreements between January 2005 and August 2010. The organization discovered the problem independently and took corrective action immediately, including self-disclosing the violation.
A hospital and its parent company agreed to pay $3.85 million to resolve allegations that they violated the Anti-Kickback Statute, Stark Law, and FCA by providing improper financial incentives to physicians and physician groups that were involved in a joint venture with the hospital to own and operate a medical office building. The incentives included a payment to the joint venture that increased the physicians’ and physician groups’ share values in the joint venture and lowered the lease rates for physicians renting space in the building below fair market value. Other incentives included below fair market value ground lease rates and arrangements related to shared facilities, use, and maintenance. The hospital self-disclosed the allegedly improper physician incentives after they were discovered by an internal compliance audit and reviewed by an outside compliance firm.
A medical device company agreed to pay $5.475 million to resolve FCA allegations that it paid kickbacks – in the form of teaching assignments, speaking engagements, and conferences – to physicians with the expectation that the physicians have their affiliated hospitals purchase, and the physicians subsequently implant, the company’s carotid, biliary, and peripheral vascular products.
A hospice provider agreed to pay $3.9 million to resolve FCA allegations that it billed federal and state healthcare programs for hospice services provided to patients who were not terminally ill under Medicare and Medicaid regulations. This settlement was announced in March 2014.
An owner of several ambulance companies agreed to pay mre than $2.8 million to resolve FCA allegations that various of its ambulance companies billed Medicare for transporting patients from one hospital to another on an emergency basis when the calls were not actually emergencies.
A pharmaceutical manufacturer agreed to pay $22.28 million to resolve FCA allegations arising from two qui tam lawsuits that it marketed its Seprafilm surgical adhesive barrier to physicians and other staff for unapproved uses – specifically, for “key hole,” minimally invasive surgery as opposed to open abdominal surgery.
A cardiologist agreed to pay $1.15 million to resolve FCA allegations that he billed Medicare and Medicaid for medically unnecessary cardiac stent procedures and for services performed by substitute doctors when he was not able to perform the services himself. The qui tam lawsuit was originally brought against two West Tennessee hospitals, their respective CEOs and a radiologist, in addition to the cardiologist. The government intervened only as to the cardiologist. As a part of the agreement, he entered into a CIA with HHS-OIG.
A health system agreed to pay $5 million to resolve FCA allegations that it paid kickbacks to doctors by allowing them to lease offices at below-market rates in exchange for patient referrals.
A health system agreed to a settlement resolving FCA allegations that it unbundled payments for bundled medical services, improperly utilized a drug pricing code, and routinely billed for services not provided.
A physician and two clinics he owned and operated agreed to pay $400,000 to resolve FCA allegations that they knowingly billed Medicare for vein injections and physician office visits performed by unqualified personnel and for medically unnecessary procedures. As part of the settlement, the physician entered into a three-year CIA with HHS-OIG.
A pharmacy benefit management company agreed to pay $4.25 million to resolve FCA allegations that it failed to reimburse Medicaid programs in five states for the prescription drug costs of Medicaid beneficiaries, who were also eligible for drug benefits under private health plans.
A specialty practice and its affiliates agreed to pay $4.3 million to resolve FCA allegations that it billed for physical therapy services provided by unqualified therapists and for pneumatic pumps that were not medically necessary or sold to patients, but never actually provided to them. Pursuant to the agreement, the organization, which runs eight rehabilitation clinics in Texas, agreed to operate under a five-year CIA, and the institute’s founder and CEO agreed to be barred from participating in federal healthcare programs for 10 years.
A pediatrician and his former practice entered into a settlement and plea agreement to resolve civil and criminal FCA allegations that he billed – through his company – newborn hearing screenings and pediatric urinalysis as more comprehensive tests when in fact they lacked the equipment necessary to perform the higher-billed tests. The business joined the civil settlement. In total, to resolve the civil and criminal FCA allegations, the physician and his practice paid $1.6 million. Pursuant to the criminal plea and civil settlement, he was excluded from participation in all federal healthcare programs for 20 years and required to divest himself of ownership of the practice.
The owner of several radiation oncology centers agreed to pay $2.08 million to resolve FCA allegations that it improperly billed Medicare for radiation oncology services by double-billing, overbilling, billing for services without supporting documentation, and billing for services without the requisite physician supervision.
A skilled nursing facility operator agreed to pay $48 million to resolve FCA allegations that six of its skilled nursing facilities submitted claims to Medicare for medically unnecessary physical, occupational, and speech therapy services. The company purportedly created a corporate culture that improperly incentivized therapists to increase their therapy services to meet Medicare revenue targets that were set without regard to the therapy needs of individual patients. As part of the agreement, the business entered into a five-year CIA with HHS-OIG.
An ambulance company agreed to pay $3.05 million to resolve FCA allegations that it billed federal healthcare programs for ambulance transport of patients who were not “bed-confined” or whose transports otherwise were medically unnecessary. As part of the agreement, the company agreed to operate under a five-year CIA.
An optometry practice, its owners, and an affiliated practice agreed to pay $1.2 million to resolve FCA allegations that it billed Medicaid for services provided by an unauthorized provider using the Medicaid provider number of a different provider, for worthless services based on the number of Medicaid patients being seen in a single day, for services never performed, and for lenses that were never made. Under the agreement, the organization also entered into a three-year CIA with HHS-OIG.
A pharmaceutical company and its subsidiaries agreed to pay $2.2 billion in a global settlement to resolve civil and criminal allegations concerning the off-label marketing of three prescription drugs. As part of the global settlement, the company agreed to pay $1.273 billion to settle multiple FCA actions focused on the companies’ marketing practices the anti-psychotic drugs Risperdal and Invega, as well as kickbacks paid to physicians for prescribing Risperdal. The company has agreed to operate under a five-year CIA with HHS-OIG.
The owner of a hospital agreed to pay $475,000 to resolve FCA allegations that it billed Medicare for inpatient services that should have been billed as outpatient services.
A hospice provider agreed to pay $3 million to resolve FCA allegations that it billed Medicare for patients that were not terminally ill as a result of instructing its staff to admit patients without regard to their Medicare eligibility, falsifying medical records for ineligible patients, employing field nurses without hospice training, delaying discharge for patients when they become ineligible for the Medicare hospice benefit, and implementing procedures to limit physicians’ roles in examining whether a patient is terminally ill. As part of the agreement, the organization entered into a five-year CIA with HHS-OIG.
A long-term care pharmacy agreed to pay $120 million to resolve FCA allegations that it engaged in a “swapping” kickback scheme whereby it provided discounts to nursing homes on Medicare Part A prescription drugs in exchange for the referral of Medicare Part D patients.
Two medical supply companies and their owners agreed to pay a combined $12 million to resolve criminal and civil FCA allegations that the owners caused the mail-order diabetic supply companies to enter marketing contracts with insurance brokerage and other companies with customer pools likely to include a large number of diabetes patients and paid the companies based on the number of patient referrals for diabetic supplies. As part of the settlement, the owners received 20-year exclusions from participation in federal healthcare programs.
A chain store which operates in-store pharmacies agreed to pay $2.55 million to the federal government and 32 states to resolve FCA allegations that its national pharmacy centers billed government healthcare programs for all drugs in a prescription, even though they dispensed only a portion of the prescribed drugs and returned the remaining drugs to their stock.
A nonprofit community health center agreed to pay $200,000 to resolve FCA allegations that it improperly billed Iowa Medicaid for dental outreach services performed on children that were not eligible for the service.
A medical device manufacturer and its subsidiaries agreed to pay $30 million to resolve FCA allegations that they sold defective implantable cardiac defibrillators to Medicare beneficiaries even after becoming aware of the defects. The company acquired another manufacturer in 2006, after the alleged misconduct occurred. In February 2010, the acquired entity pleaded guilty to criminal charges related to the defective devices for misleading the FDA and failing to provide a labeling change to the FDA.
A health system agreed to pay $3.675 million to resolve FCA allegations that it improperly submitted claims to Medicare by failing to disclose on the claim that the patient receiving treatment had another insurance policy that covered the treatment. In cooperating with the government to reach the agreement the company conducted an audit of the relevant claims and disclosed the audit to the government.
A physician and two corporations he owned settled allegations that he improperly billed Medicare and Medicaid for services never performed and overbilled the government programs for other services to patients.
An optometrist agreed to pay $283,499 to resolve allegations that he submitted improper claims to federal programs for bifocal lenses, trifocal lenses, and new patient visits, and for medically unnecessary exams. As part of the settlement agreement, the optometrist and his practice entered into a CIA with HHS-OIG.
Although not a settlement, a jury awarded the United States a significant FCA judgment. On October 2, 2013, the U.S. District Court for the District of South Carolina corrected the sum of a damages award and civil monetary penalties – from $276 million to $237 million – resulting from a jury verdict in May 2013 against a healthcare system based on allegations that the company entered into part-time employment agreements with several physicians that were in excess of the fair market value of their services in the hope that the physicians would refer outpatient procedures to it, in violation of the Stark Law.
A urology practice reached an agreement with a qui tam relator for an undisclosed amount to resolve FCA allegations that it billed Medicare for radiation therapy treatments without proper supervision from radiation oncologists rendering the procedures medically unnecessary and in violation of Medicare regulations.
The former owner and operator of cardiology hospitals announced that it agreed to pay $6.1 million to resolve any civil or administrative claims, including FCA claims, in connection with an industry-wide investigation of allegations that certain hospitals, including several of the organization’s former hospitals, were billing Medicare for implantable cardioverter defibrillators that were utilized in violation of Medicare coverage guidelines.
A diagnostic laboratory agreed to pay $17.5 million to resolve FCA allegations that it paid kickbacks in the form of deep discounts for less profitable mobile diagnostic services to skilled nursing facilities in exchange for the referral of more lucrative outpatient services.
A physician and his practice agreed to pay $300,000 to resolve FCA allegations that they billed Medicare for physical therapy services that were medically unnecessary or performed in violation of Medicare regulations – specifically, physical therapy services provided by message therapists and individual therapy services that were actually conducted in a group setting.
A federal district judge issued a $14.9 million default judgment against the former owner of a home health agency, concluding a civil FCA case alleging that he and his company operated a fraudulent scheme targeted at the elderly involving kickbacks to physicians for patient referrals, payments to patients to sign up for medically unnecessary home health services, billing Medicare for ineligible home health patients, creating false medical records, and upcoding. In January 2012, he pleaded guilty to defrauding Medicare in a parallel criminal proceeding.
Radiation oncology providers, their owners, and affiliated physicians agreed to pay $3.5 million to resolve FCA allegations that they improperly billed for services that were not rendered, already billed, upcoded, or performed by clinical staff not supervised by a physician as required by federal law. As part of the agreement, a group of centers entered into a three-year CIA with HHS-OIG.
A hospital agreed to pay $258,600 to resolve criminal and FCA allegations that it paid kickbacks to physicians in exchange for the referral of TRICARE patients. The physician-owned hospital also entered into a non-prosecution agreement, which included a 24-month federal monitoring program.
A hospital agreed to pay $853,651 to resolve FCA allegations that it billed Medicare for hyperbaric oxygen wound therapy services that were not medically necessary, lacked supporting documentation of medical necessity, or resulted from kickback arrangements between the hospital, at least one of its physicians, and the supplier of oxygen chambers. As part of the settlement, the hospital entered into a five-year CIA with HHS-OIG.
A hospital agreed to pay $451,428 to resolve FCA allegations that it billed federal government healthcare programs for services provided by residents without proper documentation of the teaching faculty’s supervision of the residents or of the coding of services performed.
A university agreed to pay $1.5 million to resolve FCA allegations that it billed Medicare and Medicaid for oncology clinical trial services that were already reimbursed by the sponsor of the clinical trial.
A diagnostic testing company and its former owners and former chief radiologist agreed to pay $3.57 million to resolve FCA allegations that it billed federal healthcare programs for MRI services performed with a contrast dye without the direct supervision of a qualified physician, in violation of federal regulations, and for services referred to the company by physicians with whom the company had improper financial relationships.
A pharmaceutical company agreed to pay an undisclosed amount to resolve a qui tam action, in which the government declined to intervene in 2005, involving allegations that a company it now owns marketed the human growth hormone Gentropin for uses not approved by the FDA and provided kickbacks to physicians that caused pharmacies to submit false claims to Medicaid programs. The company entered into a deferred prosecution agreement in 2007 requiring it to pay $34.7 million to resolve criminal allegations that it violated the Anti-Kickback Statute through these allegedly illegal Gentropin payments.
A nonprofit organization agreed to pay $4.3 million to resolve FCA allegations that it overbilled several government healthcare programs for additional testing and services that were not medically necessary, not medically indicated, or not actually provided.
A clinical laboratory agreed to pay $503,668 to resolve FCA allegations that its sales representatives made illegal payments to physicians to induce them to enroll patients in a clinical study in order to utilize its laboratory testing services, some of which were not medically necessary.
The owner of multiple healthcare companies agreed to pay $1 million to resolve civil FCA allegations that he directed an “upcoding” scheme and a scheme to pay physicians for referring patients to medical clinics, physical therapy clinics, and a home healthcare agency. The individual owned and operated this network of affiliated companies. He agreed to a 20-year exclusion from federal healthcare programs as part of the settlement. In a parallel criminal proceeding, he was sentenced to four years in prison.
A university hospital and affiliated home health organization agreed to pay $956,590 to resolve FCA allegations resulting from a self-disclosure regarding Medicare billings for home health services that were not supported by a documented face-to-face encounter with a physician or authorized non-physician practitioner.
A pharmaceutical manufacturer agreed to pay $490.9 million to resolve criminal and FCA allegations that it unlawfully marketed its immunosuppressive drug Rapamune for uses not approved as safe and effective by the FDA. $257.4 million of the settlement was allocated to resolving the civil FCA claims. The current owner of the manufacturer is currently under a CIA with HHS-OIG covering former employees of the company who now perform sales and marketing functions for the new owner.
Although representing a judgment and not a settlement, the U.S. District Court for the District of Columbia entered a sizable judgment against a physician and his two practices for more than $17 million for submitting false nuclear cardiology claims to federal and state health care programs. The FCA allegations focused on the physician’s inappropriate claims for myocardial perfusion studies, commonly referred to as nuclear stress tests, claiming that he and his companies double-billed for multi-day nuclear stress test studies.
A university agreed to pay $2.93 million to resolve FCA allegations that it allowed a former researcher and physician at the university’s cancer center to submit improper claims for reimbursement under federal research grants for goods and services that did not meet the applicable National Institutes of Health and government guidelines.
A health system agreed to pay $26 million to resolve FCA allegations that six of its healthcare facilities billed federal healthcare programs for patients as inpatient when the patients should have been billed as outpatient services.
An orthopedic surgeon agreed to pay $388,000 to resolve FCA allegations that he submitted claims to Medicare for kyphoplasty treatment using incorrect billing codes assigned to more invasive and complicated surgeries.
A hospital agreed to pay $5.3 million to resolve FCA allegations that it admitted and billed federal healthcare programs for patients as inpatient when the patients should have been billed as outpatient or observation status.
A hospice provider agreed to pay $1 million to resolve FCA allegations that it submitted claims to Medicare for ineligible hospice services provided to patients who did not need end-of-life care or for whom the hospice billed at a higher reimbursement rate than it was entitled. The company also purportedly provided kickbacks through free services to skilled nursing facilities in exchange for patient referrals. As part of the agreement, the hospice entered into a five-year CIA with HHS-OIG.
Three affiliated entities providing a variety of medical services agreed to pay $1 million to resolve FCA allegations that they billed for psychiatric diagnostic examinations and psychotherapy services in violation of certain Medicare rules and policies. As part of the agreement, the companies entered into a five-year CIA with HHS-OIG.
A health system and one of its hospitals agreed to pay $8 million to resolve FCA allegations that it billed Medicare for long-term acute care hospitalizations that were medically unnecessary.
A drug manufacturer agreed to pay more than $15 million to resolve FCA allegations that it provided improper financial incentives to physicians and physician groups to induce them to prescribe the company’s cancer drug Xgeva.
A hospital agreed to pay $750,000 million to resolve FCA allegations that it improperly billed Medicare for cardiac perfusion studies by routinely utilizing three separate CPT codes to bill for a single study. Even after senior financial managers learned of the problem, the hospital allegedly failed to repay the overbilled amounts.
A cardiology practice and its owner agreed to pay $2.2 million to resolve FCA claims that cardiologists employed by the practice performed medically inappropriate cardiac procedures, including invasive catheterizations, at a hospital. Under the agreement, the practice entered into a five-year CIA with HHS-OIG. The hospital where the procedures were allegedly performed has also reached a settlement agreement.
A hospital agreed to pay $1.8 million to resolve FCA claims that physicians employed by a cardiology practice performed medically inappropriate cardiac procedures, including invasive catheterizations, at the hospital. A portion of the settlement also covered medically unnecessary outpatient peripheral stents. Under the agreement, the hospital entered into a five-year CIA with HHS-OIG. The cardiology practice and its owner also reached a settlement agreement.
A long-term care pharmacy agreed to pay an undisclosed amount to resolve FCA allegations that it improperly paid kickbacks as part of a $25 million purchase of a pharmaceutical benefits manager in 2004. In November 2009, the company agreed to pay $98 million to settle other FCA claims arising out of the same transaction.
A pharmaceutical manufacturer agreed to pay $3.5 million to resolve FCA allegations that the company paid physician consultants to participate in clinical trials, speaker programs, and meetings, or to complete specific forms, for the purpose of inducing them to prescribe the company’s drugs.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
A provider of hospitalists and other physicians to hospitals and other medical facilities agreed to pay $14.5 million to resolve FCA allegations that it submitted inflated Medicare claims on behalf of its hospitalist employees for higher and more expensive levels of service than were documented by hospitalists in patient medical records.
Three former partners in an oncology practice agreed to pay more than $4.25 million combined to resolve FCA allegations that their practice administered and submitted Medicare claims for misbranded, unapproved chemotherapy drugs. These drugs were manufactured in foreign facilities not registered with the FDA, and some of their labels were in foreign languages or lacked dosage information.The three physicians reached separate agreements in the matter.
In July 2013, 55 hospitals agreed to pay $34 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals submitted inflated and unnecessary bills to Medicare by treating the procedure as an inpatient rather than an outpatient procedure.
Three former partners in an oncology practice agreed to pay more than $4.25 million to resolve FCA allegations that their practice administered and submitted Medicare claims for misbranded, unapproved chemotherapy drugs. These drugs were manufactured in foreign facilities not registered with the FDA, and some of their labels were in foreign languages or lacked dosage information. The three physicians reached separate agreements in the matter.
Three former partners in an oncology practice agreed to pay more than $4.25 million to resolve FCA allegations that their practice administered and submitted Medicare claims for misbranded, unapproved chemotherapy drugs. These drugs were manufactured in foreign facilities not registered with the FDA, and some of their labels were in foreign languages or lacked dosage information. The three physicians reached separate agreements in the matter.
A university hospital agreed to pay more than $2.8 million to resolve FCA allegations that it submitted more than one Medicare claim for the work of certain physician assistants and nurse practitioners. The hospital claimed this work on cost reports filed with Medicare while the supervising physicians also billed and collected from Medicare for the physician assistants’ and nurse practitioners’ professional services.
A medical device manufacturer agreed to pay $6 million to resolve FCA allegations that it caused healthcare providers to submit claims with incorrect diagnosis or procedure codes for minimally-invasive spine fusion surgeries using one of its systems and that it paid illegal remuneration to certain physicians for participating in speaker programs and consultant meetings intended to induce them to use its products, in violation of the Anti-Kickback Statute.
An oncologist and his wife agreed to pay $3.1 million to resolve FCA allegations that they routinely billed federal healthcare programs for at least twice the amount of cancer treatment drugs actually administered to the physician’s patients. To conceal the fraud, they subsequently destroyed documents and falsified medical records.
A home healthcare agency agreed to pay $1 million to resolve FCA allegations that it provided unqualified home health aides to home health agencies, which in turn sent these unqualified aides into the homes of Medicaid recipients and billed Medicaid for their services.
A dentist agreed to pay $100,000 to resolve FCA allegations that he improperly billed Medicare for certain x-rays and exams, medically unnecessary procedures, and other medically unnecessary items.
A pharmaceutical company agreed to pay $33.5 million to resolve criminal and FCA allegations that it introduced a misbranded drug into interstate commerce and violated the Anti-Kickback Statute. The company allegedly used continuing medical education programs and post-operative instruction sheets to promote the drug for uses unapproved by the FDA, and it paid physicians in order to induce them to prescribe the drug.
An operator of outpatient dialysis facilities agreed to pay $7.3 million to resolve FCA allegations that a dialysis company it acquired billed Medicare for more of an anemia drug than it actually administered. The company allegedly billed for 10-11% overfill whenever it administered the drug, but it was not able to withdraw and administer 10-11% overfill in every administration because of the types of syringes the company used.
A urology practice agreed to pay $1 million to resolve FCA allegations that it improperly billed Medicare and other federal health care insurance programs for various urology services. As a part of the settlement, the government agreed not to seek to exclude the practice from federal healthcare programs, and the company entered into a CIA with HHS-OIG.
A durable medical equipment company, agreed to pay $1.2 million to resolve FCA allegations that it submitted claims to Medicare for various pieces of medical equipment that lacked physician orders, lacked the required supporting documentation, or lacked medical necessity. As a part of the agreement, the company entered into a CIA with HHS-OIG.
A corporation that develops, manufacturers, and markets medical products, agreed to pay $48.26 million to resolve FCA allegations that it provided illegal remuneration to customers and physicians to induce them to purchase its brachytherapy seeds, in violation of the Anti-Kickback Statute. The illegal remuneration took the form of grants, guaranteed minimum rebates, conference fees, marketing assistance, and free medical equipment. As a part of the settlement, the company has agreed to refine its written policies and procedures and to monitor medical education grants to ensure compliance with Federal requirements.
A drug manufacturer agreed to pay $500 million to resolve criminal and FCA allegations that it: (1) introduced batches of adulterated drugs into interstate commerce; (2) failed to maintain complete testing records; (3) failed to implement an adequate stability program; (4) failed to timely file field alerts for batches of drugs that had failed certain tests; and (5) made false, fictitious, and fraudulent statements to the FDA in Annual Reports regarding the dates of stability tests conducted on certain batches of drugs.
A health system and one of its hospitals agreed to pay $14.1 million to resolve FCA allegations that they violated the Anti-Kickback Statute and Stark Law by improperly compensating physicians who referred patients to the hospitals by transferring assets, including medical and non-medical supplies and inventory, in a transaction below fair market value and paying referring physicians compensation above fair market value to provide teaching services at a residency program. Under the terms of the agreement, the hospital also entered into a CIA with HHS-OIG.
Two hospitals agreed to pay $3.95 million to resolve FCA allegations that they violated the Stark Law by paying several physicians incentive compensation that took into account the value or volume of their referrals by improperly including certain designated health services in the formula for calculating physician incentive compensation.
The former owner of a clinical laboratory, agreed to pay $300,000 to resolve FCA allegations that he and his company violated the Stark Law and that they billed Medicare for identification and susceptibility tests, when, in fact, no such tests were performed and even when the initial testing indicated that no pathogen was actually present in the specimen.
A neurologist and his practice, of which he is the sole owner and operator, agreed to pay $2 million to resolve FCA allegations that the physician billed Medicare for intravenous immunoglobulin therapy services that failed to meet Medicare’s supervision regulations. As part of the agreement, he entered into a one-year CIA with HHS-OIG.
A biotechnology company, agreed to pay $24.9 million to resolve FCA allegations that it paid kickbacks to long-term care pharmacy providers in return for their implementing programs designed to switch Medicare and Medicaid beneficiaries from a competitor drug to one manufactured by the company. The kickbacks took the form of performance-based rebates tied to market-share or volume thresholds.
A health system agreed to pay $1.029 million to resolve FCA allegations that its hospitals improperly billed Medicare for evaluation and management services that were not permitted under Medicare regulations.
A group of clinics that employ physicians and other healthcare providers, agreed to pay $94,000 to resolve FCA allegations that it submitted false claims to Medicare for the services of an assistant surgeon who lacked required credentials during neurosurgery procedures.
A health system agreed to pay $25.5 million to resolve FCA allegations that it violated the Stark Law by entering into employment agreements under which the physicians received bonuses that improperly took into account the value of some of their patient referrals and entering into improper office leases and compensation arrangements with referring physicians.
Two hospice companies and their parent company agreed to pay $12 million to resolve FCA allegations that they submitted claims to Medicare for ineligible hospice services provided to patients who did not need end of life care or for whom the hospice billed at a higher reimbursement rate than it was entitled. As a part of the settlement, the parent organization entered into a CIA with HHS-OIG which provides for procedures and reviews to be put in place to avoid and promptly detect similar conduct.
A university health system agreed to pay $1.2 million to resolve FCA allegations that it submitted Medicare claims for anesthesia administered by Certified Registered Nurse Anesthetists or residents when there was no supervisory anesthesiologist present or immediately available, in violation of federal regulations.
A hospital agreed to pay $454,866 to resolve FCA allegations that it improperly billed Medicare for evaluation and management services that were not permitted under Medicare regulations.
A manufacturer of laboratory research products agreed to pay $5.65 million to resolve FCA allegations that its life sciences division failed to meet its contractual obligations to provide the General Services Administration (GSA) with current, accurate, and complete information about its commercial sales practices, including discounts offered to other customers, as required to participate in GSA’s Multiple Award Schedule program. The company allegedly knowingly made false statements to GSA about its sales practices and discounts for its commercial customers and failed to pass those discounts on to government customers, in violation of the price reduction clause of its GSA contract.
A pharmaceutical company agreed to pay $45 million to resolve criminal and FCA allegations that it engaged in off-label marketing of a prescription drug approved by the FDA to treat anorexia, cachexia, or other significant weight loss suffered by patients with AIDS. The company did not include in its application to the FDA that it also intended the drug to treat non-AIDS-related geriatric wasting. The civil portion of the settlement totaled $22.5 million. As a part of the agreement, the manufacturer entered into a CIA with HHS-OIG.
A nursing home operator and its affiliate agreed to pay $2.7 million to resolve FCA allegations that it knowingly submitted or caused the submission of false claims for medically unreasonable and unnecessary rehabilitation therapy. Under the terms of the agreement, the companies also entered into a CIA with HHS-OIG.
A home healthcare provider, agreed to pay $150,000 to resolve FCA allegations that it billed Medicare for home health services that were not eligible for reimbursement because the services were not medically reasonable and necessary or were not provided under a valid plan of care. Under the settlement, the company entered into a CIA with HHS-OIG.
An ambulance company agreed to pay $800,000 to resolve FCA allegations that it billed Medicare for routine, non-emergency ambulance transports that were not medically necessary and created false documents to make the transports appear to meet the Medicare requirements. Under the terms of the agreement, the entity also entered into a CIA with HHS-OIG.
A university health system agreed to pay $100,000 to resolve FCA allegations that it submitted claims for neurology services that were improperly coded higher than the appropriate codes supported by the documentation for those services.
A skilled nursing facility agreed to pay $700,000 to resolve FCA allegations that it provided and charged for excessive, medically unnecessary, or otherwise non-reimbursable physical, occupational, and speech therapy services to 37 Medicare beneficiaries. Allegedly, the therapy services were often excessive, duplicative, performed without clear goals or direction, and, in some instances, performed primarily to capture higher reimbursement rates.
A medical equipment manufacturer agreed to pay $2.5 million to resolve allegations that it sold patient monitoring equipment to the U.S. Department of Veterans Affairs and the Department of Defense at higher prices than it offered to another customer, in violation of a Price Reductions Clause in its contract with both government organizations.
A dermatologist has agreed to pay $26.1 million to resolve FCA allegations that he accepted illegal kickbacks from a pathology laboratory and billed the Medicare program for medically unnecessary services. The physician allegedly sent biopsy specimens for Medicare beneficiaries to a laboratory for testing, and the laboratory allegedly provided him a diagnosis on a pathology report that included a signature line to make it appear to Medicare that he had performed the diagnostic work. Further, he substantially increased the number of skin biopsies he performed on Medicare patients, thus increasing the referral business for the laboratory, and performed thousands of unnecessary adjacent tissue transfers on Medicare beneficiaries.
A hospital agreed to pay $4.9 million to resolve potential FCA liability after it disclosed that it engaged in a practice of admitting patients for short stays – typically one or two days – that were not warranted by the patient’s medical condition, and thereby generated a larger reimbursement than was proper for each patient.
A health system agreed to pay $2.325 million to resolve FCA allegations that it double-billed Medicare and Medicaid for outpatient psychiatric services by, inter alia, seeking and receiving payments for non-reimbursable costs relating to services provided by one of its outpatient clinics.
A physician and his professional corporation agreed to pay $700,000 to resolve FCA allegations that he billed Medicare for high-level physician services that were medically unnecessary or lacked adequate supporting documentation. In addition, he allegedly billed Medicare for nursing home services for patients who were not actually in nursing homes at the time, but were transferred to local hospitals for treatment. As part of this agreement, the physician entered into a CIA with HHS-OIG.
After a voluntary self-disclosure, a hospital agreed to pay $883,000 to resolve FCA allegations that it received payment for ambulance services that were not medically necessary or for which medical necessity was not documented, that were assigned an incorrect transport level, that were billed with incorrect mileage units, for which a Physician Certification Statement was not obtained, and for which the requisite signatures were not obtained.
A health system agreed to pay $12.6 million to resolve FCA allegations that it made improper payments to physicians under consulting and compensation agreements to induce the referral of patients to its cardiovascular program.
A nonprofit hospital system agreed to pay more than $3.8 million to resolve FCA allegations that it performed angioplasty and stent placement procedures on Medicare patients who had heart disease, but whose blood vessels were not sufficiently occluded to require the particular procedures at issue. A physician group also reached a settlement agreement in this matter.
A physician group agreed to pay $541,870 to resolve FCA allegations that it performed angioplasty and stent placement procedures on Medicare patients who had heart disease but whose blood vessels were not sufficiently occluded to require the particular procedures at issue. A nonprofit hospital system also reached a settlement agreement in this matter.
An independent diagnostic testing facility agreed to pay more than $15.1 million to resolve allegations it violated the FCA by billing Medicare for sleep diagnostic services not eligible for reimbursement because the procedures were performed by unlicensed or uncertified technicians.
A pharmaceutical company agreed to pay $11.4 million to settle FCA allegations that it paid doctors illegal kickbacks to encourage them to prescribe the company's products, including tickets to sporting events, dinners, ski and spa outings, and paying physicians to allow sales representatives to “shadow” them.
A skilled nursing facility operator agreed to pay $613,300 to resolve FCA allegations that it provided nursing home residents with inadequate and worthless monitoring, documentation, and prevention and treatment of wounds. Under the terms of the agreement, the company also entered a CIA with HHS-OIG.
A health system agreed to pay $8 million to resolve FCA allegations. The company allegedly billed for procedures performed on Medicare patients as inpatient when they should have been billed as outpatient because the patients were discharged in less than 24 hours. The provider also entered into a deferred prosecution agreement. In early 2013, the North Carolina District Court rejected the WakeMed settlement agreement and deferred prosecution agreement, arguing it is not severe enough.
Two subsidiaries of a pharmaceutical company agreed to pay $109 million to resolve FCA allegations that the company violated the Anti-Kickback Statute by providing physicians with free units of Hyalgan, a knee injection, to induce them to purchase and prescribe the product, and that the government paid inflated prices for Hyalgan because the company submitted false average sales price reports for Hyalgan that did not take into account free units distributed by its sales representatives to physicians, when Hyalgan was purchased.
A pharmaceutical company agreed to pay $762 million to resolve criminal and FCA liability related to the marketing and promotion of certain drugs. The company agreed to pay $612 million to resolve civil FCA allegations that it engaged in off-label promotion for uses and doses that were not approved by the FDA, offering kickbacks to healthcare providers, and false price reporting practices.
A pharmaceutical manufacturer and affiliated operating company agreed to pay up to $48 million to resolve FCA allegations that it allegedly marketed a drug without FDA approval and where the safety and efficacy data for the drug was insufficient, and misrepresented the unapproved status of the drug to the government in seeking Medicare and Medicaid reimbursement.
A hospice company and its CEOand owner agreed to pay $1.3 million to settle FCA allegations that the company submitted bills to Medicare for medically unnecessary services because beneficiaries were ineligible for hospice care because they did not have a terminal prognosis of six months or less.
A health system and its hospitals agreed to pay more than $10.1 million to the federal government to resolve allegations that they violated the FCA. The hospital group allegedly overbilled for interventional cardiac and vascular procedures performed on Medicare patients as inpatient when they should have been billed as outpatient or observation.
A university health system agreed to pay $907,355 to resolve FCA allegations that it filed false claims for radiation oncology services. The organization allegedly double-billed Medicare for services, billed for a higher level of service when a lower and less expensive level of service should have been billed, billed for procedures without supporting documentation in the medical record, and billed radiation treatment delivery without corroboration of a supervising physician.
A pharmaceutical company announced that it had agreed in principle with the DOJ to pay $257 million to resolve FCA allegations that it promoted an organ transplant drug for off-label uses.
A health system agreed to pay more than $9.3 million to resolve FCA allegations that it violated the Stark Law. The company allegedly provided incentive pay to approximately 70 physicians employed at clinics based on the revenue generated by the physicians’ referrals for diagnostic testing and other services performed at company-owned clinics. This allegedly created an incentive to refer such procedures to the facilities, and the company then billed Medicare for the services. The violations were self-disclosed.
A medical device manufacturer agreed to pay $30 million to resolve FCA allegations that its subsidiary paid kickbacks to spinal surgeons in the form of compensated travel and entertainment, sham consulting agreements, sham royalty agreements, and sham research grants, in order to induce them to implant the company's products.
A pharmaceutical company agreed to pay $95 million to resolve FCA allegations that it engaged in off-label drug promotion and illegal kickbacks with four of its prescription drugs, including promotion of off-label uses, off-label doses, and making unsubstantiated efficacy claims.
A hospital company and one of its hospitals agreed to pay $16.5 million to settle FCA allegations that it gave financial benefits to doctors in exchange for patient referrals. The hospital allegedly entered into financial transactions with a physician group in order to provide compensation in exchange for referrals. The transactions included above market rent for office space leased by the hospital from the practice to assist physicians in the group to meet mortgage obligations and to help release the physicians from a separate lease obligation. The hospital also entered into a five-year CIA with HHS-OIG.
A hospital chain, its parent company, and three of its hospitals agreed to pay $16.5 million to resolve FCA allegations. The hospitals were accused of violating the Anti-Kickback Statute by paying “recruiters” to transport homeless Medicare and Medicaid beneficiaries by ambulance from Skid Row in Los Angeles to hospitals for medically unnecessary treatment that was then billed to Medicare or Medi-Cal. Los Angeles A hospital also entered a guilty plea and the chain entered a deferred prosecution agreement.
A health system agreed to pay $1.3 million to resolve FCA liability for alleged Stark violations through financial arrangements with physician groups, including below market lease agreements and the provision of office space and services, offered to allegedly provide financial benefits to physicians in exchange for referrals.
A health plan agreed to pay $320 million to resolve FCA allegations that it artificially caused an inflation of some of its patients’ risk adjustment scores and that it knowingly retained payments at rates for long-term care-certified patients that were over the legal ceiling set by state statute and regulations.
A home health company, its owner, and affiliated entities settled allegations it violated the FCA for $9.4 million. The government alleged that the company violated the FCA through submission of false cost reports because it hid a relationship between its management company and its home health agencies. Had the relationship been disclosed, the Medicare reimbursement to the management company would have been lower.
A hospice provider agreed to pay $555,572 to settle FCA allegations that it submitted bills to the federal government for medically unnecessary services because patients did not qualify for the second highest level of hospice reimbursement – general inpatient care – because the patients did not meet the medical necessity requirement of a need for pain control or acute or chronic system management that could not be managed in another setting.
A radiologist and his practice agreed to pay $650,000 to resolve FCA allegations that they violated state laws, the Anti-Kickback Statute, and the Stark Law through entering into sham personal services agreements for medical directorships that took into account the value of referrals, and by entering into contracts to pay the salaries of employees in physician offices that took into account the value of referrals. The physician has submitted to a voluntarily suspension from the healthcare programs for six years.
An operator of dialysis clinics agreed to pay $55 million to settle FCA allegations that the company fraudulently billed for free supplies of an anemia drug.
A pharmaceutical company agreed to pay $3 billion to resolve criminal and civil allegations that it engaged in off-label promotion, paid kickbacks to physicians, failed to report certain safety data to the FDA, and engaged in false price reporting practices in violation of the FCA. The company’s civil FCA settlement amounted to $2 billion. It entered into a five-year CIA with HHS-OIG. Under the CIA, the company agreed that executives must forfeit up to three years of annual performance pay if found to be involved in significant misconduct, that executives will certify compliance, and to abolish compensation based on sales goals for its sales force.
A practice management company that operates a chain of urgent-care facilities entered into a $10 million settlement to resolve allegations that the company billed Medicare for medically unnecessary allergy, H1N1 virus, and respiratory panel testing and engaged in artificially inflating claims (upcoding).
A hospital agreed to pay $3.6 million to resolve FCA liability for: (1) allegedly billing for ambulance services that were not medically necessary or where medical necessity was not documented; (2) failure to obtain physician certification statements for ambulance trips; (3) documenting incorrect transport levels and mileage; and (4) failure to obtain required signatures. The settlement resulted from a self-disclosure of the violations.
A hospital and its owner and operator agreed to pay $9 million to settle allegations that it violated the FCA by overbilling Medicare for patients treated on an inpatient basis who should have been treated as outpatient or observation. As a result, the health system also entered a five-year CIA with HHS-OIG.
A medical device manufacturer agreed to pay $34 million to resolve FCA allegations that it misstated costs resulting in overpayments, waived patient co-payments, paid kickbacks to physicians to induce the use of their products, caused the submission of falsified certificates of medical necessity, and failed to advise patients of their right to rent rather than buy the products.
A hospice provider and its parent company agreed to pay $6.1 million to resolve FCA allegations that they billed federal programs for ineligible hospice services because patients did not have a medical prognosis of six months or less, and improper delays in discharges and misleading documentation resulting from employee payment based on patient census levels.
A medical device manufacturer agreed to pay $3.65 million to resolve FCA allegations that it overcharged the Veterans Administration and the Department of Defense for implantable cardiac devices (ICDs) by marketing that the devices were covered by warranties, but then failed to grant appropriate credits under the warranties so that invoices submitted to the government overstated the cost of replacement ICDs.
A manufacturer of products to treat erectile dysfunction and its founder agreed to pay $1.4 million to settle claims that it billed Medicare despite not being an approved provider.
On May 14, 2012, resulting from a self-disclosure that followed the August 2011 criminal conviction of a physician for healthcare fraud, a university medical center agreed to pay $412,474 to resolve FCA liability for allegedly billing Medicare for services performed by residents as if the physician was present when he was not. The hospital also settled for billing Medicare for plastic surgery services that were not performed by or in the presence of attending physicians.
A pharmaceutical company agreed to pay $1.5 billion to resolve criminal and civil liability with the federal government, 45 states, and the District of Columbia. The company's FCA civil settlement amounted to $800 million to resolve allegations that the company engaged in off-label marketing and promotion. As a result, it entered into a CIA with HHS-OIG. Under the CIA, the company agreed not to compensate its sales force for off-label sales and agreed its executives will certify compliance with the CIA.
A hospital agreed to pay $11.75 million to settle FCA allegations that it inflated charges for services to Medicare patients to obtain larger supplemental reimbursement (outlier payments) that Medicare pays to hospitals and providers in cases where the cost of care is unusually high.
A large drug wholesaler agreed to pay more than $190 million to the federal government to resolve allegations that it violated the FCA through inflated pricing information related to the Average Wholesale Price for some of its prescription drugs, causing Medicaid to overpay.
A nephrology practice, its owner, and affiliated dialysis clinics agreed to pay $4.4 million to resolve FCA allegations that it submitted bills to federal programs for physician services that were upcoded and submitted inaccurate claims for dialysis services.
A psychiatric hospital and its owners agreed to pay $3.5 million to resolve FCA allegations that the hospital facility billed for outpatient treatment when patients only attended sporadically and to resolve allegations that it violated conditions of payment for failure to: (1) obtain approval for inpatient care; (2) document individual outpatient therapy sessions; (3) obtain physician orders for lab work; and (4) obtain physician certification for certain admissions. As a result, the hospital also entered a five-year CIA with HHS-OIG.
A medical device supplier agreed to pay $18 million to resolve allegations that it submitted false claims for diabetic testing supplies. The company allegedly advertised free cookbooks to induce Medicare beneficiaries to contact the company. Once contacted, it attempted to sell the beneficiaries Medicare supplies. When beneficiaries tried to return the supplies, the business failed to timely refund Medicare.
A health system and six of its hospitals agreed to pay $5.1 million to resolve FCA allegations that all six hospitals used inpatient codes for billing federal healthcare programs that should have been outpatient. The hospitals allegedly billed outpatient surgeries as inpatient when patients were discharged in less than 24 hours.
A health system agreed to pay $42.8 million to resolve FCA allegations that its inpatient rehabilitation facilities billed medically unnecessary services for Medicare patients that did not meet the standard for admission. The allegations resulted from a disclosure under the company's CIA.
A radiation oncology practice agreed to pay $3.8 million to settle allegations that it billed for prostate cancer treatments that were not medically necessary and overbilled for consults and pre-plans that were either not medically necessary or that were not reviewed by a physician.
A managed care organization, agreed to pay $137.5 million to resolve FCA allegations that it had falsely inflated claimed expenses in order to avoid returning money to Medicaid, falsified patient records, knowingly retained overpayments, and engaged in marketing abuses by cherry-picking healthy patients.
A pharmaceutical manufacturer agreed to pay $180,000 to settle FCA allegations that it encouraged physicians to submit inflated claims to Medicare for imaging scans.
A provider of ambulatory diagnostic monitoring services settled with the government for $18.5 million to resolve allegations that it improperly billed for ambulatory cardiac telemetry services because it billed for non-reimbursable mild or moderate palpitations. The company also allegedly provided services of full-time employees to hospitals for free in exchange for referrals of monitoring services in violation of the Anti-Kickback Statute.
A generic drug manufacturer agreed to pay $57 million to resolve FCA allegations related to false reporting of inflated drug prices (Average Wholesale Price) for some of its prescription drugs, causing Medicaid to overpay for certain drugs.
A hospice provider agreed to pay $25 million to resolve allegations that it submitted false claims to federal programs for medically unnecessary continuous home care services billed at a higher rate than routine care services. As a result, the company entered into a CIA with HHS-OIG.
A pharmaceutical company agreed to pay $11 million to resolve allegations of misreporting drug prices in order to reduce its Medicaid drug rebate obligations.
In February 2012, 14 hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged that the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
Fourteen hospitals agreed to pay $12 million to settle FCA allegations related to kyphoplasty spinal fracture treatment. The government alleged the hospitals inflated unnecessary bills to Medicare by treating the procedure as inpatient rather than outpatient procedure.
A hospital agreed to pay $3.1 million to resolve FCA allegations that it violated the Stark Law by entering into improper physician recruitment agreements, paying physician practices greater amounts than the incidental costs of the recruited physicians, and paying advances on income even where the recruited physician was profitable in exchange for Medicare referrals.
A hospital agreed to pay $6.3 million to resolve FCA allegations that it admitted and billed federal healthcare programs for patients as inpatient when the patients should have been billed as outpatient or observation status.
An online pharmacy agreed to pay $300,000 to resolve allegations that it violated the CSA by failing to keep accurate records of ten Schedule III-V controlled substances including Codeine #4, Tramadol, Zolpidem, Butalbital, Alprazolam, Acetaminophen with Codeine #3, Clonazepam, Lorazepam Carisoprodol, and Lyrica.
A physician and several of his practices agreed to pay more than $4.2 million to resolve allegations that they: (1) submitted claims to Medicaid and Medicare for immunotherapy services that were not medically necessary and not supervised by a physician, and for annual allergy re-testing procedures that were not medically necessary; (2) submitted claims for procedures allegedly performed or supervised by the physician on dates when he was not in the country and could not have performed or supervised the services; and (3) submitted claims for services billed as office visits when the only services provided were COVID-19 tests. As part of the resolution, the physician and practices entered into a three-year IA with HHS-OIG.
