While labs weren’t featured in this week’s enforcement actions, clinics and hospitals, and individuals involved in these organizations, were in hot water, mainly for False Claims Act violations.
April 6: The former owner of a cash-only pain management clinic in Miami—General Care Center Inc.—was sentenced for unlawfully distributing opioids to almost all patients who visited the clinic. That amounted to more than three million oxycodone pills, which generated $9 million in cash. The owner now faces 200 months in prison, as well as three years of supervised release. Seven doctors who worked at the clinic have also been charged in connection with unlawfully distributing opioids, with six pleading guilty so far, states the U.S. Department of Justice (DOJ).1
April 6: The largest health care system in the Tampa Bay area as well as entities responsible for four affiliated Florida hospitals paid $20 million to settle False Claims Act (FCA) allegations involving improper Medicaid donations. BayCare Health System Inc. and the organizations operating the hospitals (known collectively as BayCare) allegedly made donations to the Juvenile Welfare Board of Pinellas County “to improperly fund the state’s share of Medicaid payments to BayCare,” according to the DOJ.2
April 6: A naturopathic doctor pleaded guilty in the Northern District of California for her scheme involving faking COVID-19 vaccination cards and planning to sell homeoprophylaxis immunization pellets, which she claimed would provide lifelong protection from COVID-19. According to the DOJ, she provided fake vaccination cards, which were made to appear as if clients had received the Moderna vaccine, to more than 100 people. She is set to be sentenced on July 29.3
April 7: Two people already convicted of health care fraud and conspiracy charges were named in a multi-million-dollar whistleblower lawsuit. The two, who were the owner and administrator of Merida hospice and home health entities based in Texas, are alleged to have violated the FCA by submitting fraudulent and false claims to Medicare for medically unnecessary services. For their earlier criminal convictions, the two are already serving 240 months and 180 months, respectively, in the custody of the Bureau of Prisons.
The Merida owner was also ordered to pay $120 million in restitution to Medicare. According to the DOJ, the US is “entitled to recover triple the damages for violations of the civil False Claims Act as well as civil monetary penalties between $11,803 and $23,607 for each false claim submitted to Medicare.”4
April 8: A doctor who operated the Valley Center for Nerve Studies and Rehabilitation in Alabama was charged with conspiring to commit health care fraud. The doctor is alleged to have conspired with the owner of Alabama testing company QBR to bill insurers more than $28 million “for electro-diagnostic testing that [QBR] technicians performed, regardless of whether there was a medical need for them,” according to a DOJ statement. If convicted, the doctor faces up to five years in prison.5
April 11: The Skagit Family Health Clinic of Mount Vernon, Washington, paid $120,000 to settle claims that it unlawfully imported birth control medications from a foreign source that were not approved by the U.S. Food and Drug Administration. The clinic then allegedly submitted false claims for the unapproved medications to state and federal medical programs, according to the DOJ.6
April 11: The US filed a lawsuit against Methodist Le Bonheur Healthcare and Methodist Healthcare-Memphis Hospitals in relation to alleged violations of the Anti-Kickback Statute and FCA. According to a DOJ statement, the Tennessee health care delivery system and affiliated hospitals allegedly paid millions of dollars in unlawful kickbacks to West Clinic, P.C., in exchange for patient referrals, which it made millions of dollars in profits from.7