Health Care Fraud Report Index-Summary

FALSE CLAIMS

– Adult day care center in N.J. fined for services not provided, 516; penalty set, 811
– Ambulance services, office manager found guilty (W.D. Va.), 578
– Ariz., Scottsdale doctor sentenced (D. Ariz.), 663
– Armenian-American organized crime, 44 people charged (S.D.N.Y.), 828
– Auto insurance claims, doctor and acupuncturist, sentence (S.D.N.Y.), 134
– Cardiac bioimpedance tests, Ariz. doctor settles charges, 836
– Chiropractors

See CHIROPRACTIC SERVICES

– Clinics

– – Cancer clinic and doctor settle whistleblower case (M.D. Fla.), 290
– – Detroit-area, Medicare scheme, sentence (S.D. Fla.), 117
– – Doctors no longer employed, sentences (E.D. Mo.), 295
– – Lymphatic therapy (11th Cir.), 166

– Dentists

– – Drug trafficking and fraud, sentence (Ky. Cir. Ct.), 37
– – FCA case to proceed against dentist convicted of Medicaid fraud (W.D. Va.), 554
– – Public schools billed for “free” checkups, guilty plea, 393
– – Tex. dentist indicted (N.D. Tex.), 702

– Derivative suit alleging illegal conduct in false claims case dismissed (E.D. Pa.), 748
– Dialysis services firm must repay $19.3M (M.D. Tenn.), 291
– DME

See also Medical devices, this heading
– – Hialeah, Fla., $1.4M fraud, conviction (S.D. Fla.), 121
– – Houston firm, resentencing ordered on willful obstruction (5th Cir.), 419
– – Kickbacks, government's pleadings sufficient (N.D. Miss.), 288; motion to compel documents denied, 846
– – Longview, Tex., operator pleads guilty (S.D. Tex.), 619
– – Los Angeles, Medicare fraud, guilty plea (C.D. Cal.), 127
– – Mechanic's sentence upheld (11th Cir.), 839
– – Medical supply firm charged (E.D. Pa.), 20
– – Orthotic equipment, supply owner sentenced (N.D. Tex.), 340
– – Sham firm, $1.5M scheme, operator convicted (D. Mass.), 344; sentenced, 700
– – Southern Cal., firm owner pleads guilty (C.D. Cal.), 342
– – Wheelchairs

See WHEELCHAIRS

– Drugs

– – AIDS treatment, pharmacy technicians (N.J. Super. Ct.), 85
– – Aranesp, whistleblower suit dismissed (D. Mass.), 416; amended complaint to proceed, 803
– – Cardiac drugs, unapproved, settlement, 373
– – Generic prices, false reporting verdict against Merck (D. Mass.), 796
– – Kadian, manufacturer settles claims (D. Md.), 247
– – Methadone clinics, N.J. seeks $51.5M, 84
– – Nitroglycerin SR, ineligible for Medicaid (D. Mass.), 165

– Enforcement

– – DOJ official pledges to use FCA to fight fraud, 523
– – Fairness issues raised by private FCA enforcement, 523
– – “Falsity” in litigation, differing court views debated, 525
– – FERA, effect discussed at conference, 284
– – Health care reform, Senator seeks compliance review, 375
– – Increased litigation discussed, 284

– Genesys Health Sys. settles (E.D. Mich.), 24
– Home health care

– – Agency owner's sentence for bogus orders affirmed (6th Cir.), 455
– – Bogus claims filed by individual, conviction affirmed (9th Cir.), 520
– – Disclosure, DOJ requests Amedisys documents, 789
– – Mich., $9.5M settlement, 23
– – N.J. couple plead guilty (N.J. Super. Ct.), 669

– Hospitals

– – Alzheimer's disease, case charging data alteration dismissed (D. Mass.), 844
– – Am. Hospitals Assn. letter on alleged inappropriate probes, 735
– – Blood gas tests, Tex. hospital, 14
– – Del. health care system settles kickback claims (D. Del.), 210
– – Inducing referrals for medical services, settlement, 10
– – Medicaid reimbursement claims, WellStar/Ga. settlement, 762
– – New York

– – – Health care network settles false claims case (S.D.N.Y.), 751
– – – Outlier payments inflation alleged, settlement (D.N.J.), 211

– – Rehabilitation therapy not provided, Mass. hospital settlement, 161
– – S.C. hospital violated Stark law, not FCA (D.S.C.), 335; new trial on FCA charges granted, 503
– – Unnecessary admissions, settlement (D. Minn.), 21
– – Whistleblowers

– – – N.J. hospital settles claims over outlier payments (D.N.J.), 247
– – – Tex. professor's report of alleged violations raises fact issue (Tex. Ct. App.), 617

– Ind., Medicaid fraud unit begins FCA education effort, Special Report, 773
– Infusion therapy

– – Conn. hospital settles claims, 207
– – Fla., clinic owner arraigned (S.D. Fla.), 21
– – Operators and recruiters sentenced (S.D. Fla.), 660
– – Sham clinic, Detroit, doctor and employee convicted (E.D. Mich.), 290; sentenced, 342; clinic operator sentenced, 700

– Medicaid fraud

– – Florida

– – – Overpayments, $287M recovered, 84
– – – Reversed claims, $282,000 recovered, 392

– – Nationwide crackdown leads to $251M in charges, 606
– – Reimbursement claims, WellStar/Ga. settlement, 762

– Medical devices

– – Cardioverter-defibrillators, probe announced, 412; 416
– – Italian firm Sorin Group settles claims over marketing practices, 245
– – Stents, off-label marketing (N.D. Tex.), 71
– – Surgical supplies, Medline Indus., relator claims adequate (N.D. Ill.), 213

– Mental health

– – Behavioral care, May Inst. settles claims, 207
– – Houston counseling firm, unqualified provider of services charged (S.D. Tex.), 217
– – Pleading, complaint lacks particularity (S.D. Fla.), 846
– – Psychiatrist, guilty plea (N.Y. Sup. Ct.), 35

– Neb., state limitations period extended, 347
– New York

– – PPACA and state self-disclosure duties overlap, official says, 761
– – State law strengthened, bill signed, 708

– Nursing home chains settle charges of soliciting Omnicare kickbacks (D. Mass.), 209
– Orthopedic clinic, St. Louis, settlement, 67
– Otolarynologist, sentence (E.D. Mo.), 34
– Pain management clinic and billing firm settle charges (E.D. Mo.), 250
– Pediatricians, Conn., after-hours care, settlement, 333
– Pharmacists and pharmacies

– – DME claims, pharmacy owner settles charges (S.D.N.Y.), 801
– – Guilty plea (Conn. Super. Ct.), 302
– – Restitution ordered (D.N.J.), 670

– Physical therapy clinics, Lakeland, owner arrested (M.D. Fla.), 80
– Physicians

– – Billing for services not performed, doctor pleads not guilty (E.D. Tex.), 757
– – Pittsburgh, $3.3M plea agreement (W.D. Pa.), 80
– – Supplier/physician deals, compliance, 17

– Podiatrists

– – Convicted doctor, $1M settlement (S.D.N.Y.), 81
– – Houston clinic, guilty plea (S.D. Tex.), 127
– – Obstruction of justice, guilty plea (E.D. Mo.), 81; sentence, 343

– PPACA

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

– Qui tam suits

See QUI TAM SUITS

– Rheumatologist settles (D. Conn.), 25
– SNFs

– – Convicted owner not denied effective counsel (C.D. Cal.), 453
– – Mental health therapy, conviction upheld (7th Cir.), 213

– Social worker, fine not excessive (Mo.), 589
– Substandard services as basis for relief, Insight, 226
– Transportation services, Va., patients' identities (4th Cir.), 121
– Wheelchairs

See WHEELCHAIRS

FCA (FALSE CLAIMS ACT)

See FALSE CLAIMS

FCPA

See FOREIGN CORRUPT PRACTICES ACT (FCPA)

FEDERAL TRADE COMMISSION (FTC)

– Accountable care organizations, workshop scheduled, 729

FEDERALLY QUALIFIED HEALTH CENTERS (FQHCs)

– Qui tam suit, pleading deficiency (M.D. Ga.), 75

FERA

See FRAUD ENFORCEMENT AND RECOVERY ACT (FERA)

FLORIDA

– AIDS and HIV, infusion clinics

– – Bogus claims, executive and employee plead guilty (S.D. Fla.), 343
– – Former fugitive pleads guilty (S.D. Fla.), 700
– – Kickbacks, sentence (S.D. Fla.), 126
– – Money laundering, owner found guilty (S.D. Fla.), 616
– – Operator detained (S.D. Fla.), 425
– – Project New Hope, conviction affirmed (11th Cir.), 506
– – Unnecessary treatments, sentence (11th Cir.), 120

– Auto insurance, staged accident, seven arrested (Fla. Cir. Ct.), 813
– Cancer clinic and doctor settle whistleblower case (M.D. Fla.), 290
– Cataract surgery, false claims, patient vs. doctor and clinic (M.D. Fla.), 123
– Clinic, S. Fla., six people charged in $13M scheme (S.D. Fla.), 342; brothers plead guilty, 659; employee and nurse plead guilty, 701
– DME

– – Hialeah, $1.4M Medicare billing, conviction (S.D. Fla.), 121
– – Lacary Med. Services, owner sentenced (S.D. Fla.), 425
– – Medicare fraud of $3.2M, sentence affirmed (11th Cir.), 383
– – Sentence, 87-month, operator upheld (11th Cir.), 513
– – Supplier sentence upheld (11th Cir.), 696
– – Threatening Medicare officials during probe, sentence (S.D. Fla.), 215

– Health insurance

– – Unauthorized insurers, regulators warn against solicitations, 222
– – Whistleblower suit filed against WellCare (M.D. Fla.), 576

– Home health care

– – Billing scheme, three defendants sentenced (S.D. Fla.), 798
– – Clinic owner, nurses and recruiter plead guilty (S.D. Fla.), 661
– – Medicare scheme, clinic owner, doctor and nurses plead guilty (S.D. Fla.), 745

– Hospitals

– – RAC, overpayment determination, report adopted (M.D. Fla.), 694
– – Unnecessary admissions, five people charged (Fla. Cir. Ct.), 630

– Infusion clinics

– – Doctor sentenced (S.D. Fla.), 166
– – J&F Community Med. Center., billing, owner pleads guilty (S.D. Fla.), 752
– – Operators and recruiters sentenced (S.D. Fla.), 660
– – Owner arraigned (S.D. Fla.), 21

– Lymphatic therapy clinic (11th Cir.), 166
– Managed care

– – Anti-fraud measure unveiled, 257; strike force to be established, 393
– – Quality Health Plans fined for noncompliance, 448

– Medicaid fraud

– – “Data mining” of billing records, state seeks CMS waiver, 589; waiver granted, 629
– – Improvements to oversight urged in report, 300
– – Overpayments, $287M recovered, 84
– – Racketeering, Fla. woman arrested (Mich. Dist. Ct.), 259
– – Reversed claims, $282,000 recovered, 392
– – 2009 recoveries reported, 709

– Medicare

– – Billing MA program, Fla. resident with Tenn. firm indicted (M. D. Tenn.), 797
– – MA schemes, sentence (S.D. Fla.), 128
– – Part B-covered drugs, falsified form resulted in overpayment (11th Cir.), 696

– Mental health centers, complaint lacks particularity (S.D. Fla.), 846
– Orthopedic surgeon, billing fraud, guilty plea (D.N.J.), 222
– Pharmaceuticals, charity discounts, illegal resales, sentence upheld (11th Cir.), 695
– Pharmacy billing, Medicare scheme, sentence (S.D. Fla.), 695
– Physical therapy clinics, Lakeland, owner arrested (M.D. Fla.), 80
– State regulations

– – Administrative sanctions, 224; 467; 769
– – Nurses, midwives, dental labs, school psychologists, 769

– State regulations, administrative sanctions, 672

FOREIGN CORRUPT PRACTICES ACT (FCPA)

– Eli Lilly updates marketing probe, 204
– Global firms, prosecution cooperation, Special Report, 186
– Life sciences firms warned of bribery schemes, 448
– Medical devices industry target for prosecutions, lawyer says, 792
– Merck probe, DOJ and SEC request data from firm, 691

FQHCs

See FEDERALLY QUALIFIED HEALTH CENTERS (FQHCs)

FRAUD ENFORCEMENT AND RECOVERY ACT (FERA)

– FCA liability, effect of FERA discussed, 284

FTC

See FEDERAL TRADE COMMISSION (FTC)