The federal government recently announced it won or negotiated more than $2.6 billion in healthcare fraud adjustments and settlements during the last fiscal year (2019). As a result of its efforts, as well as those of preceding years, approximately $3.6 billion was recovered. Of that total, approximately $2.5 billion was transferred to the Medicare Trust Funds.
The 2019 recovery is slightly more than the $2.3 billion it recovered in fiscal year 2018. Of that recovery, $1.2 billion was returned to the Medicare Trust Funds.
The annual look back released by the U.S. Department of Health and Human Services (HHS), noted that the Department of Justice (DOJ) opened 1,060 new criminal healthcare fraud investigations in FY 2019, slightly less than the 1,139 new cases opened in the previous fiscal year.
A few examples:
- In May 2019, the owner of Your Health EMS in Texas pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to five years and three months in prison and ordered to pay $1.3 million in restitution.
- In April 2019, the owner of Sunshine Medical Care Group, a medical clinic in South Florida, was sentenced to 91 months in prison and ordered to pay $2.5 million in restitution.
- In March 2019, medical device manufacturer Covidien LP (Covidien) agreed to pay $17.5 million to resolve civil FCA allegations that it provided free or discounted practice and market development support to physicians in California and Florida to induce purchases of Covidien’s vein ablation products in violation of the Anti-Kickback Statute.
- In June 2019, Insys Therapeutics (Insys), based in Arizona, agreed to pay $225 million to resolve criminal and civil liability relating to its marketing of the opioid drug Subsys.
- In July 2019, Reckitt Benckiser Group plc (RB Group) agreed to pay $1.4 billion to resolve criminal and civil liability related to the marketing of the opioid addiction treatment drug Suboxone, which is a formulation of buprenorphine.
- In May 2019, the CEO of a string of DME companies based in Savannah, Georgia, was sentenced to 3 years and 4 months in prison for his role in a scheme that defrauded Medicare out of millions of dollars and was ordered to pay more than $1.9 million in restitution.
- In February 2019, Greenway Health LLC (Greenway), a Tampa, Florida-based developer of electronic health records (EHR) software, agreed to pay $57.2 million to resolve civil FCA allegations that Greenway caused its users to submit false claims to the government by misrepresenting the capabilities of its EHR product “Prime Suite” and providing unlawful remuneration to users to induce them to recommend Prime Suite.
- In April 2019, a former medical doctor and his business partner were each sentenced to 33 months in prison in the District of Nevada for their roles in a $7.1 million Medicare healthcare fraud scheme that occurred at three Las Vegas hospice and home healthcare agencies.
- In September 2019, a hospital administrator at Atrium Medical Center and Pristine Healthcare, was sentenced to 120 months in prison and ordered to pay $6.3 million in restitution, for his role in a $16.9 million Medicare fraud scheme.
- In January 2019, pathology laboratory company Inform Diagnostics, formerly known as Miraca Life Sciences Inc., which is headquartered in Irving, Texas, agreed to pay $63.5 million to resolve civil FCA allegations that it engaged in improper financial relationships with referring physicians.
The Health Law Offices of Anthony C. Vitale has a long and successful track record of assisting clients in criminal matters. If you have any questions contact us at 305-358-4500 or email us at [email protected].