Medicaid or Medicare Fraud

A settlement has been reached to resolve False Claims Act allegations against Norwalk Hospital.

The allegations arose from a lawsuit, claiming Norwalk Hospital submitted false claims to Medicare for kyphoplasty procedures. Kyphoplasty is a minimally-invasive procedure used to treat certain spinal fractures that often are due to the brittle bone condition called osteoporosis.

A total of 32 hospitals in 15 states have agreed to pay the federal government a total of approximately $28 million to settle these allegations. Norwalk Hospital will pay $920,000 to settle its portion of the case.

A settlement has been reached to resolve Medicaid rebate claims against Pfizer.

The allegations arose from a lawsuit, claiming that the company's Wyeth unit overcharged government Medicaid health programs for the heartburn drug Protonix.

The Justice Department filed a lawsuit in April 2009 against Wyeth, alleging Wyeth of failing to provide to state Medicaid programs the same price discounts for Protonix that Wyeth was providing to certain nongovernment customers between 2001 and 2006.

 “We are pleased to have reached an agreement in principle to resolve these cases, which involve historic conduct that occurred at least 10 years ago, before Pfizer acquired Wyeth,” said Doug Lankler, Executive Vice President and General Counsel. “The resolution of these cases reflects a desire by the Company to put these cases behind us and to focus on the needs of patients.”

Pfizer acquired Wyeth back in 2009.

A settlement has been reached to resolve False Claims Act allegations against Memorial University Medical Center.

The allegations arose from a lawsuit, claiming that Memorial University Medical Center submitted false claims for Medicare reimbursements.

In addition to the $9.9 Million Settlement, Memorial and its affiliates entered into a five year Corporate Integrity Agreement with the government’s Department of Health and Human Services, which will require Memorial to maintain an independent review organization to monitor and assess the hospital system’s compliance with federal law.

A settlement has been reached to resolve False Claims Act allegations against J & L Medical Services LLC.

The whistleblowers' share of the settlement will be approximately $102,000.

The allegations arose from a lawsuit that claimed J & L Medical Services used the services of unlicensed technicians to provide respiratory therapy services to Medicare and Medicaid beneficiaries, including setting up CPAP and BiPAP machines, fitting the patients with the masks used with those machines, and educating the patients about the use of the machines.

A settlement has been reached to resolve False Claims Act allegations against Wingate Healthcare Inc.

The allegations arose from a lawsuit that claimed Wingate Healthcare Inc played a role in submitting false claims to Medicare because they were based in part on therapy provided by RehabCare that were not reasonable, necessary and skilled, or that never occurred.

Wingate Healthcare Inc operates skilled nursing centers throughout Massachusetts and New York.

A settlement has been reached to resolve False Claims Act allegations against RehabCare.

The whistleblowers' share of the settlement will be approximately $24 million.

The allegations arose from a lawsuit that claimed RehabCare, a division of Kindred Healthcare Inc, intentionally caused skilled nursing facilities to submit false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary and skilled, or that never occurred, the Department of Justice announced on Tuesday. 

A settlement has been reached to resolve False Claims Act allegations against 21st Century Oncology.

The whistleblowers' share of the settlement will be approximately $3.2 million.

The allegations arose from a lawsuit that claimed 21st Century Oncology billed federal healthcare programs for laboratory tests that were not medically necessary.  The company also allegedly offered bonuses to physicians who ordered unnecessary test.

21st Century Oncology is a provider of cancer care services. 

A settlement has been reached to resolve False Claims Act allegations against Dynasplint Systems.

The whistleblowers' share of the settlement will be approximately $1.98 million.

The allegations arose from a lawsuit that claimed Dynasplint Systems mischarged Medicare for splints used by patients in Medicare certified skilled nursing facilities.

Founded in 1981, Dynasplint Systems designs, manufactures and sells dynamic splints that are used for range of motion rehabilitation.

A settlement has been reached to resolve False Claims Act allegations against 32 Hospitals.

The allegations arose claiming 32 Hospitals submitted false claims to Medicare for minimally-invasive kyphoplasty procedures.

The Justice Department has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures.

The settling facilities and the amounts they have agreed to pay, include the following:

• The Cleveland Clinic in Cleveland, Ohio, has agreed to pay $1.74 million.
• Citrus Memorial Health System in Inverness, Florida, has agreed to pay $2.6 million.
• Cullman Regional Medical Center in Cullman, Alabama, has agreed to pay $350,000.
• Martin Memorial Medical Center in Stuart, Florida, has agreed to pay $2 million.
• MultiCare Tacoma General Hospital in Tacoma, Washington, has agreed to pay $983,000.
• Norwalk Hospital in Norwalk, Connecticut, has agreed to pay $920,000.
• Princeton Community Hospital Association in Princeton, West Virginia, has agreed to pay $1,513,500.
• Sacred Heart Medical Center in Spokane, Washington, has agreed to pay $906,000.
• Sarasota Memorial Hospital in Sarasota, Florida, has agreed to pay $972,000.
• Spartanburg Regional Health Services District Inc. in Spartanburg, South Carolina, has agreed to pay $1.725 million.
• St. Cloud Hospital in St. Cloud, Minnesota, has agreed to pay $500,000.
• Tampa General Hospital in Tampa, Florida, has agreed to pay $2 million.
• Five hospitals affiliated with Community Health Systems Inc., in Franklin, Tennessee, have agreed to pay a total of $3.5 million.These include:Crestwood Medical Center in Huntsville, Alabama; St. Joseph’s Hospital in Fort Wayne, Indiana; Carolinas Hospital System in Florence, South Carolina; Mary Black Health System in Spartanburg, South Carolina; and Trinity Medical Center in Birmingham, Alabama.
• Five hospitals affiliated with Tenet Health Care Corporation in Dallas, Texas, have agreed to pay a total of $2.2 million. These include:East Cooper Medical Center in Mt. Pleasant, South Carolina; North Fulton Hospital in Roswell, Georgia; Providence Memorial Hospital in El Paso, Texas; St. Francis Hospital in Memphis, Tennessee; and Sierra Medical Center in El Paso.
• Five hospitals formerly owned and operated by Health Management Associates Inc., in Naples, Florida, have agreed to pay a total of $2 million.These include:Biloxi Regional Medical Center in Biloxi, Mississippi; Davis Regional Medical Center in Statesville, North Carolina; Lancaster Regional Medical Center in Lancaster, Pennsylvania; Physicians Regional Medical Center in Naples, Florida; and Riley Hospital in Meridian, Mississippi.
• Three hospitals affiliated with BayCare Health System in Clearwater, Florida, have agreed to pay a total of $1.5 million.These include:Winter Haven Hospital in Winter Haven, Florida; St. Joseph’s Hospital in Tampa, Florida; and St. Anthony’s Hospital in St. Petersburg, Florida.
• Two hospitals affiliated with Banner Health in Phoenix, Arizona, have agreed to pay a total of $2.685 million.These include Banner Boswell Medical Center in Sun City, Arizona, and Banner Thunderbird Medical Center in Glendale, Arizona.

The whistleblowers' share of the settlement will be approximately $4.75 million.

Source: www.justice.gov

A settlement has been reached to resolve False Claims Act allegations against Mobile Medical Inc.

The allegations arose from a lawsuit that claimed Mobile Medical billed Medicare for services and equipment it did not provide or were not subject to reimbursement or were worth less than what Mobile Medical claimed.

Based in Troy, Michigan Mobile Medical Inc provides dental, podiatric, vision and hearing services.