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Medicare Law
 
United States of America v. Gerald Daneshvar, M.D. Eastern District of Michigan Federal Courthouse - Detroit, Michigan

Detroit, MI - Michigan Doctor Sentenced to Prison for $1.7 Million Health Care Fraud Scheme

A Detroit, Michigan-area doctor was sentenced to 24 months in prison on January 18, 2018 for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulte... More...
   $0 (01-19-2018 - MI)

United States of America v. Diana J. Gumila Northern District of Illinois Courthouse - Chicago, Illinois

Diana Gumila ran a home-healthcare company that defrauded the federal government of several million dollars. She was convicted of multiple counts of healthcare fraud and making false statements in connection
∗ Circuit Judge Posner retired on September 2, 2017, and did not partici-pate in the decision of this case, which is being resolved by a quorum of the panel under 28 U.S.C. § 46(d).<... More...
   $0 (01-17-2018 - IL)

Don Karms and Robert Parker v. Kathleen Shanahan, Sandra McKeon Crow and New Jersey Transit District of New Jersey Federal Courthouses

Don Karns and Robert Parker filed civil rights actions against the New Jersey Transit Corporation (“NJ Transit”) and NJ Transit Officers Kathleen Shanahan and Sandra McKeon Crowe in their official and individual capacities, alleging violations of the First, Fourth, and Fourteenth Amendments. Officers Shanahan and Crowe arrested Karns and Parker for defiant trespass and obstruction of justice after... More...   $0 (01-14-2018 - NJ)

United States of America v. Gibson Buckley Condie District of Wyoming Federal Courthouse - Cheyenne, Wyoming

Cheyenne, WY - Powell, Wyoming Psychologist Sentenced to Three Years in Prison for Health Care Fraud

Gibson Buckley Condie, 57, of Powell, Wyoming, was sentenced on January 8, 2018, to serve three years in prison for felony health care fraud involving mental health services falsely billed to Wyoming Medicaid, announced United States Attorney Mark A. Klaassen. Condie was also ordered to pa... More...
   $0 (01-10-2018 - WY)

United States of America v. Kim Ricard Eastern District of Louisiana Federal Courthouse - New Orleans, Louisiana

New Orleans, LA - New Orleans Area Woman Sentenced to More Than Four Years in Prison for Role in Approximately $2 Million Home Health Kickback and Identity Theft Scheme

A New Orleans woman was sentenced today to 51 months in prison for her involvement in a $2 million home health kickback scheme carried out through a New Orleans area home health agency.

Kim Ricard, 51, of Gonzales... More...
   $1958000 (01-05-2018 - LA)

United States of America v. EmCare, Inc. a subdivision of Envision Healthcare Corporation Western District of North Carolina Courthouse - Charlotte, North Carolina

Charlotte, NC - EmCare, Inc. to Pay $29.8 Million To Resolve False Claims Act Allegations

The Department of Justice on December 19, 2017 announced a settlement with Dallas based EmCare, Inc. a subdivision of Envision Healthcare Corporation that provides physicians to hospitals to staff their Emergency Departments (EDs). EmCare agreed to pay $29.8 million to resolve claims that, from 2008... More...
   $29800000 (12-28-2017 - NC)

United States of America v. United Theapeutics Corporation District of Massachusetts Federal Courthouse - Boston, Massachusetts

Boston, MA - Drug Maker United Therapeutics Agrees to Pay $210 Million to Resolve False Claims Act Liability for Paying Kickbacks

Pharmaceutical company United Therapeutics Corporation (UT), based in Silver Spring, Maryland, has agreed to pay $210 million to resolve claims that it used a foundation as a conduit to pay the copays of Medicare patients taking UT’s pulmonary arterial hyperten... More...
   $210000000 (12-26-2017 - MA)

United States of America, et rel. Garbe v. Kmart Corporation Southern District of Illinois Federal Courthouse - Benton, Illinois

Kmart Corporation to Pay U.S. $32.3 Million to Resolve False Claims Act Allegations for Overbilling Federal Health Programs for Generic Prescription Drugs

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation (SHC), has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescripti... More...
   $32300000 (12-26-2017 - IL)

United States ex rel. Mason v. HMA, et al, Federal Courthouse - District of Columbia

Dallas, TX - Two Physician Groups Pay Over $33 Million to Resolve Claims Involving HMA Hospitals

The Justice Department on December 19, 2017 announced settlements with two physician groups, EmCare Inc. (EmCare) and Physician’s Alliance Ltd (PAL), for allegedly receiving illegal remuneration in exchange for patient referrals to hospitals owned by the now-defunct Health Management Associate... More...
   $33000000 (12-20-2017 - OK)

United States of America v. Bertha Blanco Southern District of Florida Courthouse - Miami, Florida

Miami, FL - Former Florida State Health Care Administration Official Sentenced to More Than Four Years in Prison for Accepting Bribes

A former employee of Florida’s Agency for Health Care Administration (AHCA) was sentenced today to 57 months in prison for accepting bribes in exchange for providing confidential information about health care facilities that received Medicare and Medicaid f... More...
   $0 (12-15-2017 - FL)

United States ex rel. Darla Reid v. Med-Fast Pharmacy, Inc. Western District of Pennsylvania Courthouse - Pittsburgh, Pennsylvania

Pittsburgh, PA - Iserve Technologies, Inc. Pled Guilty in Connection with Guilty Pleas of Former Exec and Manager of Med-Fast Pharmacy Inc.

Individuals and entities associated with Med-Fast Pharmacy, Inc. (“Med-Fast”) have resolved criminal and civil charges associated with Med-Fast’s improper submission of claims to the Medicare and Medicaid programs.

Iserve Technologies, Inc., ... More...
   $0 (12-13-2017 - PA)

United States of America v. Yunesky Fornaris Southern District of Florida Courthouse - Miami, Florida

Miami, FL - Owner of Miami Home Health Agency Sentenced to More Than Nine Years in Prison for Role in $15 Million Medicare Fraud Conspiracy

The owner and operator of a defunct Miami, Florida home health agency was sentenced to 115 months in prison on December 11, 2017 for his role in a $15 million conspiracy to defraud the Medicare program.

Yunesky Fornaris, 38, of Miami, was se... More...
   $0 (12-12-2017 - FL)

United States of America v. Editha Manzano Eastern District of Michigan Federal Courthouse - Detroit, Michigan

Detroit, MI - Owner of Michigan Home Health Agency Convicted in $1.6 Million Healthcare Fraud Scheme

A federal jury found a Detroit home health agency owner guilty on December 4, 2017 for her role in a scheme involving approximately $1.6 million in fraudulent Medicare claims for home health services that were procured through the payment of kickbacks, and that were medically unnecessary a... More...
   $0 (12-05-2017 - MI)

United States of America ex rel. Suzanne Scott, et al. v. Pine Creek Medical Center, LLC Northern District of Texas Federal Courthouse - Dallas, Texas

Dallas, TX - Dallas-Based Physician-Owned Hospital to Pay $7.5 Million to Settle Allegations of Paying Kickbacks to Physicians in Exchange for Surgical Referrals

Pine Creek Medical Center LLC (“Pine Creek”), a physician-owned hospital serving the Dallas/Fort Worth area, agreed to pay $7.5 million to resolve claims that it violated the False Claims Act by paying physicians kickbacks in the... More...
   $7500000 (12-05-2017 - TX)

UNITED STATES OF AMERICA, EX REL ANTHONY R. SPAY v. CVS CAREMARK CORPORATION; CAREMARK RX UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT

Part D of the Medicare program is a voluntary prescription drug benefit program that subsidizes the cost of prescription drugs and prescription drug insurance premiums for Medicare enrollees.2 The Part D program operates as a public-private partnership between the Centers for Medicare and Medicaid Services (“CMS”) and government contractors. CMS contracts with private insurance companies called “S... More...   $0 (12-03-2017 - PA)

The People of the State of New York v. Stan XuHui Li Pain Clinic Doctor Is Sentenced in Overdose Deaths of 2 Patients

Defendant was a physician specializing in pain management. In 2004, he opened a pain management clinic in Queens. According to the People, the clinic was nothing more than a "pill mill" catering to people who were hopelessly addicted to pain medicine, primarily opioids. The People's evidence showed that, despite having been trained in the wide variety of methods for identifying legitimate pain and... More...   $0 (12-02-2017 - NY)

United States of America and the State of Minnesota ex rel. Jeff Samuelson, M.D. v. Skin Care Doctors, P.A., and Michael J. Ebertz, M.D. District of Minnesota Federal Courthouse - Minneapolis, Minnesota

Minneapolis, MN - Local Dermatologist Pays $850,000 To Settle False Claims Act Allegations - Skin Care Doctors, P.A. and its CEO allegedly engaged in improper Medicare billing

Skin Care Doctors, P.A. and its founder and CEO, Michael J. Ebertz, M.D. agreed to pay $850,000 to the United States to resolve allegations of false claims submitted for certain dermatology procedures in violation ... More...
   $850000 (12-01-2017 - MN)

United States of America v. Cardiovascular Consultants Heart Center (CVC Heart Center), et al. Eastern District of California Federal Courthouse - Fresno, California

Fresno, CA - CVC Heart Center to Pay $1.2 M to Settle Allegations of Billing Health Care Programs for Medically Unnecessary Nuclear Stress Tests

Cardiovascular Consultants Heart Center (CVC Heart Center), a cardiology clinic with offices in Fresno and Clovis, and its shareholder physicians — Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory, and Dr. William Hanks — ... More...
   $1200000 (11-29-2017 - CA)

United States of America v. Aharon Aron Krkasharyan Central District of California Federal Courthouse - Los Angeles, California

Los Angeles, CA - Former Employees of Southern California Ambulance Company and Dialysis Center Plead Guilty to Medicare Fraud Charges

A former employee of a Southern California ambulance company and a former employee of a Los Angeles dialysis treatment center both pleaded guilty on November 27, 2017 to fraud charges for their roles in a fraud scheme that resulted in more than $6.6 millio... More...
   $0 (11-28-2017 - CA)

United States of America, ex rel. Anthony R. Spay v. CVS Caremark Corporation Third Circuit Court of Appeals - Philadelphia, Pennsylvania

We are asked to consider the viability of two potential defenses to an alleged False Claims Act violation that arise in the context of the Medicare Part D Program: the government knowledge inference, which can defeat a finding of scienter in certain circumstances, and the element of materiality.1 The District Court relied upon the government knowledge inference doctrine in dismissing the claims. A... More...   $0 (11-23-2017 - )

Eileen Bransten v. State of New York New York Court of Appeals Hall - Albany, New York

The issue presented on this appeal is whether Civil Service Law § 167 (8), as amended, authorizing a reduction of the State's contribution to health insurance benefits for State employees, including members of the State judiciary, violates the Judicial Compensation Clause [*2]of the State Constitution (NY Const, art VI, § 25 [a]). We conclude the State's contribution is not judicial compensation p... More...   $0 (11-21-2017 - NY)

United States of America v. Suzanna Meliksetyan Eastern District of New York Courthouse - Brooklyn, New York

Brooklyn, NY - Operator of Purported Durable Medical Equipment Providers Pleads Guilty to Health Care Fraud Charges for Role in Fraud Scheme

Suzanna Meliksetyan, an operator of multiple purported durable medical equipment (DME) companies pleaded guilty to one count of conspiracy to commit health care fraud for her role in a scheme to defraud Healthfirst, a non-profit, New York-based healt... More...
   $0 (11-20-2017 - NY)

Artur Hefczyc v. Rady Children's Hospital-San Diego

Artur Hefczyc appeals from an order denying his motion for class certification in
his lawsuit against Rady Children's Hospital-San Diego (Rady). On behalf of a proposed
class, Hefczyc seeks declaratory relief to establish that Rady's form contract, signed by
2
patients or guarantors of patients who receive emergency room care, authorizes Rady to
charge only for the reasonable ... More...
   $0 (11-18-2017 - CA)

United States ex rel. Academy Health Center, Inc. v. Hyperion Foundation, Inc., et al. Southern District of Mississippi - Federal Courthouse - Jackson, Mississippi

Jackson, MS - Mississippi Skilled Nursing Facility, Related Companies, and Executives Agree to Pay $1.25 Million to Settle False Claims Act Allegations of Grossly Substandard Care to Facility Residents

The Department of Justice announced today that Hyperion Foundation, a Georgia not-for-profit entity (Hyperion), Julie Mittleider, a resident of Georgia and Hyperion’s former President, Alta... More...
   $1250000 (11-16-2017 - MS)

United States of America v. Nicholas A. Borgesano Jr. and owner of A to Z Pharmacy of New Port Richey Middle District of Florida Federal Courthouse - Tampa, Florida

Tampa, FL - Owner of Florida Pharmacy Pleads Guilty in $100 Million Compounding Pharmacy Fraud Scheme; Real Properties, Cars and a 50-Foot Boat Will Be Forfeited

The president and owner of a Florida pharmacy that was at the center of a massive compounding pharmacy fraud scheme, which impacted private insurance companies, Medicare and TRICARE, pleaded guilty on November 6, 2017 for his rol... More...
   $0 (11-07-2017 - FL)

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