The two-week period since our last Weekly Enforcement Report again saw a lack of lab-related enforcement actions, but several healthcare companies and providers were involved in false billing cases. A former lawmaker was also sentenced for her role in two schemes—one involving an almost $900,000 COVID-19 scam, and another involving a $200,000 fake stem cell treatment scam run through her clinics.
Key Healthcare-Related Enforcement Actions Announced from February 15 – March 1, 2023
|Date Action Announced
|· Tonda Renee Ward
· Southwestern Health Solutions L.L.C.
|Southwestern Health Solutions L.L.C. was found guilty of one count of submitting false claims: Medicaid fraud, while Ward, who owns Southwestern, was found guilty of intentional failure to maintain records.
|Southwestern was made to pay $775,000 in penalties, costs, and restitution, while Ward received a sentence of 364 days in a detention center, which was suspended. She was then put on probation, and ordered to pay an extra $25,000.1
|· Milena Menzui Hernandez
· Milena Hernandez Therapy, LLC
|Similar to the case above, Hernandez was found guilty of intentional failure to maintain records, while her company, Milena Hernandez Therapy, LLC, was found guilty of one count of submitting false claims: Medicaid fraud and one count of obtaining and using personal identifying information of five or more persons.
|Milena Hernandez Therapy was sentenced to 36-96 months for the false claims count and 12-30 months for the personal information count. However, that sentence was suspended and the company placed on probation for 36 months. The company must also pay $350,000 in restitution. Hernandez was sentenced to 364 days in a detention center, suspended, placed on probation, and ordered to pay an extra $100,000.2
|· Cornerstone Healthcare Group Holding Inc. and CHG Hospital Medical Center LLC. dba Cornerstone Hospital Medical Center
|Houston long-term acute care facility allegedly submitted false claims for “unauthorized services, services not provided, and services which were deemed so inadequate they were considered worthless.”
|Settled for $21,637,512.3
|· James L. Luketich, M.D.
· University of Pittsburgh Medical Center (UPMC)
· University of Pittsburgh Physicians (UPP)
|Luketich was accused by a former UPMC surgeon of regularly performing up to three “complex surgical procedures at the same time.” He was also accused of subjecting his patients to “hours of medically unnecessary anesthesia time” and failing to “participate in all of the ‘key and critical’ portions of his surgeries.” These practices, of which UPMC leadership was apparently aware of, violated regulations and statutes that allowed Luketich to bill Medicare as a teaching physician.
|Settled for $8.5 million. Defendants must also develop and implement a Corrective Action Plan for Luketich and undergo a three-year audit of the doctor’s physician fee services billings to Medicare.4
|Patricia “Tricia” Ashton Derges
|The former Missouri state representative was found guilty in June 2022 of two counts of making false statements to a federal law enforcement agent, 10 counts of distributing drugs over the internet without a valid prescription, and 10 counts of wire fraud related to two separate fraud schemes—an almost $900,000 COVID-19-related scheme and a $200,000 scheme involving a phony stem cell treatment advertised in her clinics.
|Must pay $500,600 in restitution to her victims and was also sentenced to six years and three months in prison without parole.5