Whistleblower Attorneys Blog

The U.S. Department of Justice announced today that North Atlantic Medical Services Inc. (“NAMS”), doing business as Regional Home Care Inc., has agreed to pay $852,378 to settle the allegations of two relators realtor’s that it had violated the federal False Claims Act and the Massachusetts False Claims Act by submitting claims to Medicare and Medicaid for respiratory therapy services provided by unlicensed personnel. From September 2010 through January 2013, NAMS had allegedly used unlicensed employees to set up and provide instructions for sleep apnea masks and oxygen therapy equipment for patients in Massachusetts, even after the state’s Department of Public Health informed the company that the practice was illegal. NAMS is a Massachusetts-based medical device company that provides equipment and services for the treatment of respiratory ailments, such as oxygen deficiency and sleep apnea. Continue reading ›

On Tuesday, the state of Nevada and the federal government announced that they had elected to intervene in a complaint filed by two relators under the False Claims Act against Creekside Hospice II LLC (“Creekside”) that alleges that it aggressively lured non-terminally ill patients into its care in order to fraudulently seek reimbursement from Medicare and Medicaid since at least 2010. Creekside allegedly paid bonuses to employees who sold its inpatient services to people who did not have the requisite prognoses of six months or less to live and falsified patient medical records accordingly. The hospice received $66.56 million in payments from Medicare between April 2010 and March 2013, and an additional $4.73 million from the Nevada Medicaid program throughout the same period. Creekside’s hospice operations are primarily financed through the receipt of Medicare and Medicaid dollars, with approximately 90% of its revenue is derived from government health care programs. Continue reading ›

A federal judge in California denied Prime Healthcare Services, Inc.’s (“Prime”) motion to dismiss a relator’s False Claims Act case alleging that the hospital group overcharged Medicare and Medicaid by more than $50 million. Prime was founded in 2001 by Dr. Prem Reddy. Thereafter, Prime engaged in a strategy of acquiring hospitals in financial distress and transforming them into financially stable businesses. Prime claims to have “saved” 29 hospitals. It operates 14 hospitals throughout California. In order to achieve some of these successes, Prime allegedly required hospital personnel to charge government health care programs the highest possible rates for patient admissions by falsely including comorbidities and complications including encephalopathy, septicemia, and malnutrition. Additionally, Prime allegedly eliminated less costly observation stays and refused to discharge patients to post-acute care centers in order to fraudulently increase its payments. Continue reading ›

The U.S. Department of Justice announced today that CareAll Management LLC and its affiliated entities (“CareAll”) have agreed to pay $25 million, plus interest, to the United States and the state of Tennessee to settle a relator’s allegations that the home health provider violated the False Claims Act by submitting fraudulent and upcoded home health care billings to the Medicare and Medicaid programs. The settlement resolves conduct that allegedly occurred between 2006 and 2013 where CareAll overstated the severity of its patients’ conditions in order to increase the billing of, and in turn the reimbursement for, services that were not medically necessary and were rendered to patients who were not in fact homebound. The company had allegedly predetermined its desired profit margins and billed government health care programs accordingly to hit those targets. The wrongdoing was claimed to have permeated all branches of the CareAll system throughout Tennessee. Continue reading ›

On Friday, the United States Attorney for the Western District of Oklahoma and the Attorney General for the State of Oklahoma jointly announced that Ocean Dental, P.C. has agreed to pay $5 million to settle civil claims stemming from allegations that it violated the False Claims Act by submitting fraudulent Medicaid claims. Oklahoma-based Ocean Dental operates 28 clinics in seven states. As part of its practice, it provides dental services to patients, including children, covered by the Oklahoma’s Medicaid program. The federal government and the state of Oklahoma specifically alleged that Ocean Dental submitted false claims for payment to the Oklahoma Medicaid program for dental restorations that took place during the period from January 1, 2005 through September 30, 2010. Claims for dental restorations furnished to Medicaid beneficiaries by Ocean Dental’s then-employee Robin Lockwood, D.D.S., were false because they were either not performed, or upcoded by billing for more restored surfaces than were actually performed. Continue reading ›