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The Medical Center of Southeastern Oklahoma (MCSO) and its parent, Health Management Associates, Inc., have agreed to pay $1,065,000 to the U.S. and $435,000 to the State of Oklahoma to resolve allegations that the hospital knowingly submitted or caused the submission of false claims to the Oklahoma Medicaid Program, the U.S. Attorney’s Office for the Eastern District of Oklahoma announced last month.  MCSO is an acute care hospital located in Durant, Okla.  HMA was acquired by Community Health Systems last year.

The settlement announced today resolves allegations that MCSO submitted claims to SoonerCare for surgical procedures performed by Dr. Daniel Castro, and related hospital services that were not medically necessary. The surgical procedures in question were functional endoscopic sinus surgeries (FESS) performed by Dr. Castro on children who were SoonerCare beneficiaries. According to the United States, Dr. Castro performed FESS’s on children that were not medically indicated, and Dr. Castro and the hospital billed SoonerCare for the unnecessary surgeries and related hospital services. The settlement also resolves claims that MCSO billed SoonerCare for hospital services related to FESS’s that Dr. Castro did not actually perform.

The allegations that the government has settled with MCSO and HMA were raised in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act. The Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The whistleblower, Sandra Simmons, will receive $159,750 as part of today’s settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

CRC Health Corp. has agreed to pay $9.25 million to settle allegations that the company knowingly submitted or caused the submission of false claims to Medicaid and Tennessee Medicaid, the U.S. Department of Justice announced last week.  CRC is a nationwide provider of substance abuse and mental health treatment services.

CRC owns and operates a residential substance abuse treatment facility in Burns, Tenn., called New Life Lodge.  The government alleged that New Life Lodge billed the Tennessee Medicaid program (TennCare) for substance abuse therapy services that were not provided or were provided by therapists who were not properly licensed by the state of Tennessee.  The government also alleged that New Life Lodge failed to make a licensed psychiatrist available to patients at the facility, as required by the state’s regulations; failed to maintain patient-staffing ratios required by Tennessee Department of Mental Health regulations and billed for Medicaid patients in excess of the state-licensed bed capacity at the facility.  In addition, the government alleged that New Life Lodge double-billed Medicaid for prescription substance abuse medications given to residents at the facility.  New Life Lodge currently is not treating Medicaid patients at its facility.

The allegations were originally raised in a lawsuit filed by Angie Cederoth, a former New Life Lodge employee, under the whistleblower provisions of the False Claims Act.  The Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Cederoth will receive $1.5 million as her portion of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

The federal government has intervened in a False Claims Act lawsuit against Orbit Medical Inc. and its former Vice President Jake Kilgore, alleging that Orbit Medical’s sales representatives boosted power wheelchair and accessory sales by altering and forging physician prescriptions and supporting documentation, the Justice Department announced earlier this week.

Medicare pays for power wheelchairs for beneficiaries who cannot perform mobility- related activities of daily living in their home using other mobility assistance equipment, such as a cane, walker or power scooter. To qualify for reimbursement, a physician must conduct a face-to-face examination of the beneficiary and provide the supplier with a written prescription for a power wheelchair within 45 days of such an encounter, along with documentation that supports the medical necessity of the device. The prescription must be completed by the physician who performed the exam and must include the beneficiary’s name, the exam date, the diagnoses and conditions the wheelchair is expected to accommodate, the length of need, and the physician’s signature.  

The lawsuit alleges that Orbit Medical sales representatives, at Kilgore’s direction and encouragement, knowingly altered physician prescriptions and supporting documentation to get Orbit Medical’s power wheelchair and accessory claims paid by Medicare, the Federal Employees Health Benefits Plan, and the Defense Health Agency. In particular, the lawsuit alleges that Orbit Medical sales representatives created documents to falsely establish that physicians examined beneficiaries in person; changed physicians’ prescriptions to falsely establish medical necessity for the power wheelchair or accessory; created or altered chart notes and other documents to falsely establish the medical necessity of the power wheelchair or accessory; forged physicians’ signatures on prescriptions and chart notes; and added facsimile stamps to supporting documentation to make it appear as though physicians’ offices had sent the documents to Orbit Medical.  

On Oct. 23, 2013, a federal grand jury in Utah indicted Jake Kilgore on three counts of health care fraud, three counts of false statements related to health care and three counts of wire fraud, all arising from his tenure with Orbit Medical.

The lawsuit was originally filed by two former Orbit employees, Dustin Clyde and Tyler Jackson, under the whistleblower provisions of the False Claims Act.  The Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  The Act also allows the government to intervene, which it has elected to do in this case.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.

Alliance Rehabilitation, LLC and Active Physical Therapy Services, LLC, along with three individuals associated with those businesses, have agreed to pay the federal government $2.78 million to settle allegations that the companies knowingly submitted or caused the submission of false claims to Medicare and the TRICARE health care program, the U.S. Attorney’s Office for the District of Columbia announced yesterday.

The settlement resolves allegations that the companies submitted claims which falsely represented that the physical therapy services being billed were either rendered or directly supervised by the physical therapist identified on the claims by his or her National Provider Identifier (NPI) number. In fact, the physical therapist identified on the claim had no involvement in the services rendered.  The settlement also resolves allegations that Alliance Rehabilitation, LLC, and Active Physical Therapy Services, LLC, sought payment from TRICARE for physical therapy services that were not provided by the physical therapist identified on the claim.

In addition to the False Claims Act settlement, the companies and the associated individuals have entered into a five-year Corporate Integrity Agreement with the U.S Department of Human Health and Services Office of Inspector General.  That agreement imposes integrity obligations on each of the entities and individuals and requires them, among other things, to retain an independent review organization to review their coding, billing, and claims submissions to Federal health care programs.

The lawsuit was originally filed by two former Alliance employees under the whistleblower provisions of the False Claims Act.  The Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  The whistleblowers in this case will receive $400,000 as their portion of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases andhow you can take action.

Connecticut-based Sikorsky Aircraft Corporation has agreed to pay $3.5 million to settle allegations that the company knowingly submitted or caused the submission of false claims in connection with inflated prices for Black Hawk helicopter parts, the U.S. Attorney’s Office for the District of Connecticut announced earlier this week.

Sikorsky, which manufactures Black Hawk helicopters and spare parts for the U.S. military, allegedly failed to disclose accurate, complete and current cost and pricing data to the Army Aviation and Missile Life Cycle Management Command (“AMCOM”).  AMCOM is one of the purchasing commands of the Army that is charged with purchasing spare parts for the Black Hawk.

The Truth In Negotiations Act requires that contractors disclose accurate, complete and current cost and pricing data to the government during the negotiation process.  When determining the prices to be charged to the government, Sikorsky failed to disclose that it had lower prices for certain parts.  As a result, the government paid artificially excessive prices for those parts.

The False Claims Act allows private parties with knowledge of fraud against the government to sue on behalf of the government and share in the recovery.  Had there been a whistleblower in this case, the whistleblower could have received up to a million dollars as their portion of the settlement.

The Chanler Group, in association with the Hirst Law Group, represents whistleblowers who take action under the False Claims Act to report fraud committed against the federal and state governments.  We have years of experience representing whistleblower clients who expose every kind of fraud against the government, including health care fraud, contract fraud, and tax fraud.  Read more about our expertise in False Claims Act cases and how you can take action.