Half of last week’s announced enforcement actions involving the health care industry related to kickbacks. In a May 26 update to an earlier lab fraud complaint announced by the U.S. Department of Justice (DOJ) on April 4, the DOJ added six doctors to the case, alleging that they caused medically unnecessary laboratory testing to be billed to federal health care programs.
The doctors were alleged to have received kickbacks from True Health Diagnostics LLC (THD) and Boston Heart Diagnostics Corporation (BHD), along with small Texas hospitals, including Rockdale Hospital dba Little River Healthcare (LRH), in exchange for referrals to the hospitals for lab testing. Those tests were then performed by BHD and THD, then billed to various federal health care programs, despite not being medically necessary, alleges the DOJ in a statement.1
In other key cases from last week:
May 24: A San Francisco physician agreed to pay just over $1 million to settle False Claims Act violations. According to the DOJ, the doctor allegedly knowingly charged Medicare for non-FDA approved osteoarthritis drugs and associated services.2
May 24: A Florida-based pain doctor and former sales rep from now-defunct pharmaceutical company Insys Therapeutics were convicted for their roles in a health care fraud kickback scheme. The two were both found guilty of conspiring to receive and pay bribes and kickbacks in exchange for prescribing Subsys, a fentanyl spray produced by Insys. They were also convicted of receiving and paying kickbacks on certain dates and the sales rep was also convicted of two counts of identification fraud. The two each face up to five years in prison for the conspiracy conviction, and a maximum of 10 years for “each substantive kickback violation,” according to the DOJ. The sales rep also faces up to five years in prison for each count of ID fraud.3
May 27: Three final defendants of a total 16 involved in a health care fraud scheme pleaded guilty for their roles. According to the DOJ, the three were involved in four home care-related entities that billed Medicare for more than $87 million for home health care services that were never provided, or for which there was not enough documentation to support. The three will pay a combined restitution of just over $52.8 million in connection with their guilty pleas. Fifteen of the defendants have now pleaded guilty, and one remaining defendant passed away “during the pendency of the case,” the DOJ stated.4