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Health Care Fraud

DOJ Announces National Health Care Fraud Enforcement Actions Result in Charges Involving over $1.4 Billion in Alleged Losses

On September 17, 2021, the Department of Justice announced in a PRESS RELEASE that criminal charges had been brought against 138 defendants, including 42 doctors, nurses and other licensed medical professionals. These charges spanned 31 federal districts across the U.S. for alleged participation in various health care fraud schemes that resulted in approximately $1.4 billion in alleged losses. Watch Assistant Attorney General Kenneth A. Polite Jr.’s remarks on health care fraud enforcement actions HERE. The largest amount of the alleged fraud charged related to schemes… Read More »DOJ Announces National Health Care Fraud Enforcement Actions Result in Charges Involving over $1.4 Billion in Alleged Losses

Florida’s Middle District Denies Defendant’s Motion to Dismiss FCA Claims Filed by the United States; Complaint Satisfied Both Elements of the 11th Circuit’s Ruckh Proximate Cause Test

The United States brought a two-count Complaint against Defendant, alleging that he violated the False Claims Act (“FCA”), 31 U.S.C. § 3729(a)(1)(A) (Count I), and conspired to violate the FCA, 31 U.S.C. § 3729(a)(1)(C) (Count II), by causing a pharmacy to file fraudulent claims with TRICARE, a federal health program. The Complaint alleges the pharmacy paid kickbacks to a marketing company, who in turn marketed compound medications to patients and then referred those patients to the pharmacy for fulfillment of the prescriptions for those medications.… Read More »Florida’s Middle District Denies Defendant’s Motion to Dismiss FCA Claims Filed by the United States; Complaint Satisfied Both Elements of the 11th Circuit’s Ruckh Proximate Cause Test

Mail-Order Diabetic Testing Supplier and Parent Company Agree to Pay $160 Million to Resolve Alleged False Claims to Medicare

On Monday, August 2, 2021, the DOJ announced that Arriva Medical LLC (“Arriva”), a mail-order diabetic testing supplier, and its parent, Alere Inc. (“Alere”) have agreed to pay $160 million to resolve allegations that they violated the False Claims Act. According to the July 2021 Settlement Agreement: -From 2009 until December 2017, Arriva was a Florida-based mail-order supplier of diabetic testing supplies to, amongst others, beneficiaries of the Medicare program. Arriva was founded in 2009 by David Wallace and Timothy Stocksdale, who, along with other… Read More »Mail-Order Diabetic Testing Supplier and Parent Company Agree to Pay $160 Million to Resolve Alleged False Claims to Medicare

Former Delray Beach Physician Sentenced to Six Years in Federal Prison for $20M Health Care Fraud Scheme

On July 26, 2021, the DOJ (U.S. Attorney’s Office – Middle District of Florida) announced that U.S. District Judge William Jung sentenced Dr. Richard Davidson to six years in federal prison for conspiracy to commit health care fraud. As part of his sentence, the court ordered Davidson to forfeit approximately $650,000 in funds traceable to the offense or as substitute assets. The court also entered a money judgment of $2.47 million and ordered $10.72 million in restitution. Davidson lost his medical license due to his… Read More »Former Delray Beach Physician Sentenced to Six Years in Federal Prison for $20M Health Care Fraud Scheme

DOJ Publishes Health Care Fraud and Abuse Control Program Annual Report FY 2020

This month, the 120-page Annual Report of the Departments of Health and Human Services and Justice Health Care Fraud and Abuse Control Program FY 2020 was published. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a nationalHealth Care Fraud and Abuse Control Program (HCFAC or the Program) under the jointdirection of the Attorney General and the Secretary of the Department of Health and HumanServices (HHS), acting through the Inspector General, designed to coordinate federal, state, andlocal law enforcement activities with respect to… Read More »DOJ Publishes Health Care Fraud and Abuse Control Program Annual Report FY 2020

DOJ Announces Coordinated Law Enforcement Action to Combat Health Care Fraud Related to COVID-19, Including Two South Florida Kickback Schemes

Today, Wednesday, May 26, 2021, the Department of Justice announced criminal charges against a telemedicine company executive, physician, marketers, and medical business owners for COVID-19 related fraud schemes. More specifically, the DOJ announced criminal charges against 14 defendants, including 11 newly-charged defendants and three who were charged in superseding indictments, in seven federal districts across the United States for their alleged participation in various health care fraud schemes that exploited the COVID-19 pandemic and resulted in over $143 million in false billings. Included in those… Read More »DOJ Announces Coordinated Law Enforcement Action to Combat Health Care Fraud Related to COVID-19, Including Two South Florida Kickback Schemes

SavaSeniorCare LLC Agrees to Pay $11.2 Million to Resolve False Claims Act Allegations

On Friday, May 21, 2021, the DOJ announced in a press release that Georgie-based, SavaSeniorCare LLC and its related entities (“Sava”) agreed to pay $11.2 million, plus additional amounts if certain financial contingencies occur, to resolve civil allegations that Sava violated the False Claims Act. A copy of the Settlement Agreement* is here -> Sava, through its subsidiaries, provides skilled nursing services and rehabilitation therapy services, including physical, occupational, and speech therapy, to patients at numerous skilled nursing facilities (“SNFs”) nationwide, and bills the Medicare… Read More »SavaSeniorCare LLC Agrees to Pay $11.2 Million to Resolve False Claims Act Allegations

North Carolina Pain Management Company to Pay $789,292.95 to Resolve Civil Allegations of False Claims for Urine Drug Testing

On April 16, 2021, the DOJ announced in a PRESS RELEASE that Preferred Pain Management & Spine Care, P.A. (“PPM”) and its owner, Dr. David Spivey, have agreed to pay $789,292.95 to resolve civil allegations that PPM violated the False Claims Act by billing Medicare, Medicaid, and other federal health care programs for medically unnecessary urine drug testing (“UDT”). The Relator/Whistleblower will receive $118,911.12 as her share of the federal recovery in this case. According to the Qui Tam Relator’s Complaint filed on January 22,… Read More »North Carolina Pain Management Company to Pay $789,292.95 to Resolve Civil Allegations of False Claims for Urine Drug Testing

United States Intervenes in False Claims Act Case Against One of the Largest Providers of OutPatient Mental Health and Substance Abuse Services in Delaware

The original complaint was filed in 2019 under the qui tam or whistleblower provisions of the False Claims Act. On April 9, 2021, the United States filed its Complaint in Intervention, partially intervening in a False Claims Act case in the U.S.D.C. for the District of Delaware, bringing claims against Connections Community Support Programs, Inc. (“Connections”), to recover treble damages sustained by, and civil penalties owed to, the United States based on Connections’ conduct. A copy of the Complaint in Intervention can be found below:… Read More »United States Intervenes in False Claims Act Case Against One of the Largest Providers of OutPatient Mental Health and Substance Abuse Services in Delaware