Specifically, the United States determined that St. John made payments to 23 individual physicians or physician groups to induce referrals for medical services. Federal law prohibits healthcare providers from billing federal health care programs for referrals from doctors with whom they have a financial relationship, unless that relationship falls within certain exceptions.

St. John’s fraudulent financial relationships were disclosed in a report filed by the health provider to the Department of Health and Human Service’s Office of Inspector General. The report suggested that the agreements with physicians may have violated federal law.

“The resolution of this matter yielded a substantial recovery for taxpayers, and it underscores our commitment to ensure that services reimbursable by federal health care programs are based on the best interests of patients rather than the personal financial interests of referring physicians,” said Tony West, Assistant Attorney General for the Department’s Civil Division.

If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

Under the terms of the settlement, B&H Health Care Services, Inc., known as Nursing Personnel Home Care, Excellent Home Care Services, LLC, and Extended Nursing Personnel CHHA, LLC, will return $23,963,100 to Medicaid–a program jointly funded by the state and federal governments. Of this amount, the State of New York will receive a total of $14,377,860.

The settlements were initiated by lawsuits filed under the whistleblower provisions of the False Claims Act, which allow private citizens to file suit on behalf of the United States for fraud and share in any recovery. Maurice Keshner will receive approximately $1,693,343 from New York’s recovery from Nursing Personnel. Deborah Yannicelli will receive approximately $994,080 from New York’s recovery from Extended and Excellent. The Act also provides protection against job retaliation for whistleblowing.

Medicaid requires home health aides – who primarily care for elderly patients, administer medication, and provide services such as catheter care, colostomy care and wound care – to successfully complete a training program licensed by the Department of Health or the State Education Department. All such aides must receive a minimum of 75 hours of training, including sixteen hours of supervised practical training conducted by a registered nurse.
If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

The suit alleged that Schering deliberately inflated the average wholesale price it reported to California for Albuterol, a treatment for asthma and other breathing problems, as well as other drugs. As a result, California’s Medi-Cal program overpaid millions of dollars in pharmacy reimbursements.

Schlering was recently acquired by Merck & Co. of New Jersey. Merck didn’t admit wrongdoing and said its pricing practices complied with regulations and contracts. The settlement amount was reserved and significantly funded by Schering-Plough prior to its merger with Merck in November, Merck said.
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One June 3, 2009, The United States Attorney Office, District of Hawaii, announced that Queen’s Medical Center (QMC) of Honolulu has paid $2.5 million to resolve allegations that it overbilled Medicare, Hawaii’s Medicaid, and TRICARE. This marks the settlement of two congruent lawsuits that were filed by two “whistleblowers” that were former pharmacy technicians at QMC.

Under the federal and State of Hawaii False Claims Acts, the government is able to recover up to triple damages, plus penalties, for fraudulent claims made to government programs. Of the $2.5 million QMC has paid, the government received $2 million, of which it shared $400,000 with the whistleblowers. United States Attorney for the District of Hawaii Edward H. Kubo, Jr., praised the two technicians for their courage in coming forward with the case.

As part of the settlement, QMC, the largest private hospital in Hawaii, will maintain a compliance program to ensure its fulfillment of all applicable program rules and requirements for the next five years. The hospital has pledged to continue its efforts to provide high quality health care while complying with health care rules.

In the case, the former technicians alleged that QMC submitted false bills for medications it dispensed and billed federal programs for services the hospital was not eligible to perform. While QMC has agreed to the settlement, it has denied the government’s contentions.

If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

Kyphoplasties, which are minimally-invasive procedures used to treat osteoporosis-evoked spinal fractures, are typically performed on an outpatient basis. “Outpatient” procedures do not require admission to a hospital and can even be performed outside hospital facilities. By performing kyphoplasties on an inpatient basis, patients were unnecessarily admitted to the hospital and closely monitored before, during, and after the procedure. 

In this fashion, the hospitals overcharged Medicare thousands of dollars for each kyphoplasty they performed.

“By keeping patients overnight, hospitals could seek greater reimbursement from Medicare and make much larger profits on kyphoplasty,” said Kathleen Mehltretter, Acting U.S. Attorney for the Western District of New York in Buffalo.

The whistleblower suit was brought under the False Claims Act, which permits private citizens to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant. The lawsuit was filed in 2008 in federal district court in Buffalo, N.Y. by Craig Patrick and Charles Bates. Mr. Patrick of Hudson, Wis., is a former reimbursement manager for Kyphon, and Mr. Bates was formerly a regional sales manager for Kyphon in Birmingham, Ala.

If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

According to the case, Regency sought Medicare and Medicaid reimbursement for services that nursing home residents did not qualify for, were unnecessary, and were unsupported by required certification. 

“With the number of Medicare and Medicaid beneficiaries increasing every year, we will take whatever action is necessary to make certain healthcare providers are reimbursed only for legitimate services provided to qualified beneficiaries,” said Tim Johnson, Acting U.S. Attorney for the Southern District of Texas.

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On December 1, the Memphis Business Journal reported that two Tennessee hospitals will pay $8 million to resolve Medicare fraud allegations.  The U.S. Department of Justice argued that claims submitted by the Jackson-Madison County and Milan General Hospitals violated the Federal False Claims Act.

Between July 1997 and June 2002, Jackson-Madison County General Hospital was found to have submitted claims to Medicare that did not meet medical necessity and documentation requirements.  The hospital will pay $2.6 million to resolve these charges.

Milan General was charged with improperly admitting Medicare patients into its psychiatric unit and billing Medicare for lengths of stay in units that exceeded coverage criteria. These offenses were reported to have happened between July 1999 and December 2003.  Milan General will pay $5.3 million to settle the allegations.

“These settlements with Jackson Madison General and Milan General should serve as a warning to other health care providers who seek to defraud Medicare or any other federal health care programs,” said Lawrence Laurenzi, acting U.S. Attorney for the Western District of Tennessee.

If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

The U.S. Department of Justice reported on July 26, 2008, the settlement of a False Claims Act case against CoxHealth of Springfield, Missouri.  Cox improperly billed and received payments from the Medicare trust fund, and agreed to pay $60 million to the United States in compensation.  It was also alleged that Cox provided kickbacks to physicians of the for-profit Ferrell-Duncan Clinic Inc.  If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

On August 11, 2008, the Department of Justice announced a $2.1 million settlement to be paid by BlueCross BlueShield of Tennessee (BCBS-T) to the United States. BCBS-T, which operates as Riverbend Government Benefit Administrators, agreed to the settlement in response to allegations of its violating the False Claims Act. 

The allegations against BCBS-T came in response to the company’s failure to modify the cost-to-charge ratios of hospitals in the state of New Jersey, for which it is the primary Medicare Part A Fiscal Intermediary (Part A Fiscal Intermediary’s are private insurance companies that manage Medicare claims). Because the cost-to-charge ratios were not conducted in a timely manner, many medical facilities were given excessive “outlier payments,” or supplementary reimbursements for unusually high-costing care, by Medicare.

“Today’s settlement demonstrates that the Justice Department will be vigilant in protecting the Medicare program from all who abuse it, including contractors that falsely bill for crucial tasks that they do not perform,” said Gregory G. Katsas, Assistant Attorney General of the Civil Division.

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The Oncology Infusion Service was also accused of giving medications and conducting lab studies without a doctor order. Federal Medicare only allows payment for one unit of infusion therapy, chemotherapy or blood transfusion per patient per day, but the hospital had billed Medicare as often as five times per day for the same patient. This is the second False Claims Act settlement by this hospital.

If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.