Two Florida men have agreed collectively to pay at least $4 million to resolve allegations that they violated the False Claims Act by engaging in schemes to generate prescriptions for compounded drugs and refer those prescriptions to pharmacies in exchange for illegal kickbacks. Many of those prescriptions were billed to TRICARE, the federal health care program providing insurance for active duty military personnel, military retirees, and military dependents. 

Jack Lee Stapleton, of Gulf Stream, and Jack Hunter Stapleton, of Fort Lauderdale, formerly owned a marketing business in Fort Lauderdale which operated under various names, including CV McDowell LLC, and J&J Tel Marketing LLC (the Stapleton Entities). The United States alleged that the Stapleton Entities, under the Stapletons’ direction, used telemarketing to solicit prospective patients to accept compounded drugs regardless of patient need, procured prescriptions for those patients, and then sent those prescriptions to compounding pharmacies that agreed to pay the Stapleton Entities half of the amount TRICARE reimbursed for each prescription. The Stapletons and Stapleton Entities worked with pharmacies to identify compounded drug formulas that maximized the level of reimbursement for the drugs, regardless of the medical need for the chosen formula. They then sought to procure large volumes of prescriptions for those formulas. In many cases, the Stapleton Entities procured prescriptions by paying telemedicine providers who prescribed expensive compounded drugs without ever seeing the patients or conducting any meaningful medical examination.  

“Kickback arrangements undermine confidence in our health care system,” said Acting Assistant Attorney General Brian M. Boynton of the Department of Justice’s Civil Division. “This case demonstrates how kickback schemes often result in the provision of medically unnecessary services at the taxpayer’s expense. The department is committed to holding accountable those who engage in such unlawful conduct.” 

“This is another in a long line of this office’s civil and criminal prosecutions of pharmacies, marketers, and prescribers – both individual and corporate – who exploited the TRICARE program for their personal gain and at substantial expense to taxpayers,” said Acting U.S. Attorney Karin Hoppmann for the Middle District of Florida. “We will continue to use all available resources to pursue those who defraud this and other federal healthcare programs and to return monies to those programs.” 

“The Defense Criminal Investigative Service (DCIS) protects the integrity of Department of Defense programs, such as TRICARE, by rooting out those who choose to divert into their own pockets American taxpayer dollars intended to support our men and women in uniform,” said Special Agent in Charge Cyndy Bruce of the DCIS Southeast Field Office. “Individuals who unjustly enrich themselves will be held accountable.” 

“We are grateful to those who came forward to expose these fraudulent practices and vow to continue our efforts to protect taxpayers from fraudsters siphoning money from the nation’s health care system,” said Special Agent in Charge Michael McPherson of the FBI’s Tampa Division. 

As part of the settlement, the Stapletons have agreed to pay additional amounts in the event of certain contingencies. 

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Dwayne Thornton against the Stapletons. Under the qui tam provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of the settlement if the government takes over the case and reaches a monetary agreement with the defendant. Thornton is a former employee of one of the pharmacies to which the Stapleton Entities referred prescriptions. The share to be awarded from this settlement has not yet been determined. The qui tam case is captioned United States ex rel. Thornton v. National Compounding Co. et al., Case No. 8:15-cv-2647 (M.D. Fla.). 

The resolutions obtained in this matter were the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch (Fraud Section), the U.S. Attorney’s Office for the Middle District of Florida, the FBI, and DCIS. The matter was investigated by Trial Attorney Nathan Green and Assistant U.S. Attorney Charles Harden.

Oglethorpe Inc. and its three Ohio facilities, Cambridge Behavioral Hospital, Ridgeview Behavioral Hospital, and The Woods at Parkside, will pay $10.25 million to resolve alleged violations of the False Claims Act for improperly providing free long-distance transportation to patients and admitting patients at Cambridge and Ridgeview who did not require inpatient psychiatric treatment, resulting in the submission of false claims to the Medicare program.  

Oglethorpe Inc. is a Florida company that operates two Ohio inpatient psychiatric hospitals, Cambridge and Ridgeview, and one Ohio substance abuse treatment facility, Parkside. The settlement was based on analysis of the companies’ ability to pay after review of their financial condition. 

This settlement resolves allegations that, between August 2013 and June 2019, defendants provided free long-distance van transportation to patients to induce them to seek treatment at the defendants’ facilities, in violation of the Anti-Kickback Statute, and then submitted claims for services provided to these patients, in violation of the False Claims Act. The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by a federal health care program, such as Medicare, Medicaid or TRICARE. Claims submitted to these programs in violation of the Anti-Kickback Statute give rise to liability under the False Claims Act. The government also alleged that Oglethorpe, Cambridge, and Ridgeview submitted, or caused to be submitted, false claims to Medicare for medically unnecessary inpatient psychiatric admissions and associated services at the two hospitals. 

“Kickbacks to patients can result in unnecessary services that serve neither the patients nor our federal health care programs,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The Justice Department is committed to pursuing unlawful remunerations in whatever form they occur to safeguard taxpayer funded health care benefits.” 

“Submitting false claims by billing for unnecessary inpatient psychiatric hospitalizations is not only inappropriate – it’s illegal,” said Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio. “This settlement shows that the United States will hold accountable those who seek to profit by flouting proper standards of medical practice and appropriate review and submission of Medicare billings.” 

“Kickbacks in the form of free van rides and the false claims subsequently submitted to federal health care programs come at a tremendous cost to patients and the taxpayers,” said Special Agent in Charge Lamont Pugh for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG). “We will continue to work with our law enforcement partners to pursue and hold accountable entities who engage in such acts.”  

Contemporaneous with the settlement, Oglethorpe entered into a corporate integrity agreement (CIA) with HHS-OIG. Among other things, the CIA requires that for the next five years Oglethorpe must retain an Independent Review Organization to review its claims to Medicare and Medicaid. 

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Darlene Baker, a former client advocate at Cambridge. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery if the government takes over the case and reaches a monetary agreement with the defendant. The qui tam case is captioned United States ex rel. Baker v. Oglethorpe, Inc., et al., No. 2:16-cv-1040 (S.D. Ohio).  

The resolutions obtained in this matter were the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section; the U.S. Attorney’s Office for the Southern District of Ohio; and HHS-OIG. The matter was investigated by Trial Attorney Christopher Wilson of the Civil Division and Assistant U.S. Attorney Andrew Malek.

United Airlines Inc. (United), the world’s third largest airline, has agreed to pay over $49 million to resolve criminal charges and civil claims relating to fraud on postal service contracts for transportation of international mail. 

United entered into a non-prosecution agreement (NPA) with the Criminal Division’s Fraud Section and agreed to pay $17,271,415 in criminal penalties and disgorgement to resolve a criminal investigation into a fraud scheme perpetrated by former employees of United’s Cargo Division in connection with United’s execution of contracts to deliver mail internationally on behalf of the U.S. Postal Service (USPS). Separately, United has entered into a False Claims Act settlement with the Civil Division’s Commercial Litigation Branch, Fraud Section, for related conduct, under which it is obligated to pay $32,186,687. 

“United was entrusted by the U.S. Postal Service with fulfilling a critical government function – the transportation of U.S. mail abroad,” said Acting Assistant Attorney General Nicholas L. McQuaid of the Justice Department’s Criminal Division. “Instead of performing this duty with transparency, United defrauded the U.S. Postal Service by providing falsified parcel delivery information over a period of years and accepting millions of dollars of payments to which the company was not entitled. Today’s resolution emphasizes that companies that defraud the government – no matter the context, contract, or federal program – will be held accountable.” 

“Companies that do business with the United States must adhere to their contractual obligations,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The Department of Justice will pursue those who knowingly fail to provide the government with the goods or services for which it has paid and that it is entitled to receive.” 

“The USPS contracts with commercial airlines for the safeguarding and timely delivery of U.S. Mail to foreign posts, including the mail sent to our soldiers deployed to foreign operating bases,” said Director Steven Stuller of the U.S. Postal Service (USPS) Office of Inspector General. “The Office of Inspector General supports the Postal Service by aggressively investigating allegations of contractual non-compliance within the mail delivery process, including the falsification of delivery information. Our special agents worked hand-in-hand with the Department of Justice to help ensure a reasonable resolution and we applaud the exceptional work done by the investigative and legal teams.” 

According to the criminal NPA and civil settlement agreement, United entered into International Commercial Air (ICAIR) contracts with USPS, by which United transported U.S. mail internationally on behalf of USPS. Pursuant to these ICAIR contracts, United was obligated to provide bar code scans of mail receptacles to USPS when United took possession of the mail receptacles and when the receptacles were delivered to the foreign postal administration or other intended recipient. United was entitled to full payment under these ICAIR contracts only if accurate mail scans were provided and mail was timely delivered to the foreign postal administration or intended recipient. 

Between 2012 and 2015, United engaged in a scheme to defraud USPS by submitting false delivery scan data to make it appear that United and partner airlines with which it worked were complying with the ICAIR requirements, when in fact they were not. Instead of providing USPS accurate delivery scans based on the movement of the mail, United submitted automated delivery scans based on aspirational delivery times. These automated scans did not correspond to the actual movement of the mail, as mandated by the contracts. Because this scan data was not tethered to the actual delivery of mail to the foreign recipients, payment was inappropriate under the ICAIR contracts. Through this data automation scheme, United secured millions of dollars in payments from the USPS to which United was not entitled under the ICAIR contacts. 

United further admitted that it concealed problems related to scanning and mail movements that, if known, would have subjected United to financial penalties under the ICAIR contracts. Certain individuals at United worked to conceal United’s automation efforts from the USPS, as they knew that the data being transmitted was fabricated. These individuals further knew that the transmission of false data violated the terms of the ICAIR contracts. The attempts to hide the automation practices included efforts to revise the falsified delivery times to make the automated scans appear less suspicious to USPS. 

As part of the criminal resolution, United has agreed to continue to cooperate with the Criminal Division’s Fraud Section and to report any evidence or allegation of a violation of U.S. fraud laws. United has further agreed to strengthen its compliance program and to specific reporting requirements, which require United to submit yearly reports to the Fraud Section regarding the status of its remediation and implementation of United’s compliance program and internal controls, policies, and procedures aimed at deterring and detecting violations of U.S. fraud laws in connection with government contracting. 

The Criminal Division’s Fraud Section reached this resolution with United based on a number of factors, including the nature and seriousness of the offense conduct; United’s failure to timely and voluntarily self‑disclose the offense conduct to the department; and United’s prior history, including a 2016 non-prosecution agreement relating to potential criminal bribery or corruption violations arising out of United’s establishment and operation of a non-stop route between Newark Liberty International Airport in New Jersey and Columbia Metropolitan Airport in South Carolina. In addition, United, responding to the Fraud Section’s requests, cooperated with the Fraud Section’s investigation by collecting, organizing, and producing voluminous documents, assisting in making employees available to be interviewed, and making a factual presentation to the Fraud Section. The Fraud Section did not require United to pay a victim compensation payment as part of the NPA because United agreed to a global resolution of its criminal and civil liability, entering into a separate civil settlement agreement with the Department’s Civil Division.  

The Criminal Division’s Fraud Section also considered that United engaged in remedial measures after the offense conduct, including: (i) removing and replacing the principal manager of the criminal scheme detailed in the Statement of Facts; (ii) hiring outside legal and accounting advisors to review and consult on United’s government contracting compliance and related policies and procedures; (iii) establishing an independent Government Contracts Organization to manage and ensure contractual compliance for United’s government contracts that reports directly to United’s Legal Department; (iv) establishing a training curriculum and holding a monthly training call for employees who have government contracting-related duties and responsibilities; (v) prohibiting automation and limiting access to flight configuration data to ensure that data transmitted to the USPS cannot be manipulated by employees; (vi) conducting international mail operations process reviews; and (vii) enhancing its policies and procedures relating to obtaining and complying with government contracts, including assignment of roles and responsibilities, ensuring accurate representations to the U.S. government, and subcontracting. 

The civil settlement resolves allegations under the False Claims Act that United falsely reported the times it transferred possession of United States mail to foreign postal administrations or other intended recipients. This is the fourth civil settlement involving air carrier liability for false delivery scans under the USPS ICAIR Contracts. Including the civil settlement announced today, the United States has recovered nearly $65 million in connection with its investigation of delivery scan practices under the ICAIR Contracts through these civil settlements. 

The criminal case was investigated by the USPS Office of the Inspector General. Assistant Chief Timothy A. Duree of the Criminal Division’s Fraud Section prosecuted this case. The civil matter was handled by the Civil Division’s Commercial Litigation Branch, Fraud Section, with assistance from the USPS Office of the Inspector General and the USPS Office of General Counsel. Senior Trial Counsel Don Williamson of the Civil Division’s Commercial Litigation Branch, Fraud Section, represented the government in the civil case.

Virginia-based Information Innovators Inc. (Triple-I) has agreed to pay the United States $6.05 million to resolve allegations that a predecessor company, Creative Computing Solutions Inc. (CCSi), violated the False Claims Act by knowingly overbilling the U.S. Department of Homeland Security (DHS) for work performed by CCSi employees who lacked required job qualifications. 

Triple-I, which provides IT services and solutions to federal agencies, acquired Maryland-based CCSi in 2015. CCSi formerly provided IT services to DHS pursuant to an Enterprise Acquisition Gateway for Leading Edge Solutions Contract (EAGLE Contract). The settlement resolves allegations that, from October 2007 to April 2014, CCSi knowingly submitted claims for payment to DHS for work performed by CCSi employees who lacked required job qualifications. CCSi allegedly violated the terms of the EAGLE Contract by using under-qualified personnel who were billed to DHS at higher rates reserved for more qualified employees.  

“Contractors that knowingly overcharge the government will be held accountable,” said Acting Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The department will ensure that that those who do business with the government, and seek taxpayer funds, do so fairly and in accordance with their contractual commitments.” 

“Defense contractors are required to bill for costs actually incurred, and to be truthful in the claims they submit to federal agencies,” said Acting U.S. Attorney Jonathan F. Lenzner for the District of Maryland. “The U.S. Attorney’s Office and our partners are committed to protecting taxpayer dollars and ensuring integrity and compliance with federal agency standards.”  

“DHS OIG remains committed to protecting government programs, and American taxpayers who contribute to them, from fraudsters,” said Inspector General Joseph V. Cuffari. “Our agency, working closely with our law enforcement partners, will continue to root out these unlawful contracting fraud schemes.” 

The settlement was a result of a joint investigation by the Civil Division’s Commercial Litigation Branch (Fraud Section), the U.S. Attorney’s Office for the District of Maryland, and the Department of Homeland Security Office of the Inspector General’s Major Frauds and Corruption Unit. The claims resolved by the settlement are allegations only and there has been no determination of liability.
 

COLAS Djibouti SARL (Colas Djibouti) ­has agreed to resolve for $3.9 million civil allegations that it violated the False Claims Act by selling substandard concrete used to construct U.S. Navy airfields in the Republic of Djibouti, the Department of Justice announced today. Colas Djibouti, a French limited liability company, is a wholly owned subsidiary of Colas SA, a French civil engineering company. 

The civil settlement announced today resolves allegations that Colas Djibouti knowingly provided contractually non-compliant concrete that did not meet gradation requirements, contained excessive alkali-silica reactive material, and contained elevated chloride content. These conditions had the potential to promote early-age cracking, surface defects, and the corrosion of embedded steel, and thus, could significantly impair the long-term durability of the concrete utilized on U.S. military bases.  

In addition to the civil settlement, U.S. Attorney Robert S. Brewer for the Southern District of California announced a separate Deferred Prosecution Agreement (DPA) with Colas Djibouti pursuant to which Colas Djibouti will admit to the underlying facts and accept responsibility to a one-count information for conspiracy to commit wire fraud and pay a $12,542,002 monetary penalty, comprised of a fine, forfeiture, and restitution. The civil settlement will credit $1,957,998 of Colas Djibouti’s payment under the DPA, and require an additional payment of $1,957,998. 

“Government contractors that supply substandard materials to our armed forces not only cheat the American taxpayers but also impose added costs and burdens on the military,” said Acting Assistant Attorney General Brian M. Boynton for the Department of Justice’s Civil Division. “Today’s settlement demonstrates our commitment to ensure that those who do business with the government comply with their contractual obligations.”   

“Wherever our Navy goes, we go,” said Robert S. Brewer, U.S. Attorney for the Southern District of California. “We will continue to unwaveringly protect our American warfighters from fraud, graft and corruption as they protect us from enemies foreign and domestic.”  

“Our Sailors and Marines depend upon high quality products and services from our Department of the Navy contractors in order to meet the department’s world-wide mission,” said acting Secretary of the Navy Thomas W. Harker. “This outcome demonstrates that the Department of the Navy will continue to insist that our contractors must meet our high standards. This global settlement demonstrates the strong cooperation between the Department of the Navy and the Department of Justice in preventing fraud, no matter where in the world it happens.”  

“Aircraft taxiways are essential to military operations, and therefore require concrete that conforms to the high standards and specifications of the Department of Defense” said Stanley A.  Newell, Special Agent in Charge for the DCIS Transnational Operations Field Office. “The DCIS along with our investigative partners will vigorously root out conduct like this that threatens U.S. military readiness and harms the integrity of the DoD procurement system.” 

"Protecting Navy interests is a top priority of the Naval Criminal Investigative Service. Anyone considering defrauding the Navy and U.S. taxpayers should know NCIS will aggressively pursue all such allegations, in concert with our law enforcement partners and the Department of Justice," said Todd Battaglia, Special Agent in Charge of the NCIS Europe and Africs Field Office. 

This civil settlement was the result of a coordinated effort among the Civil Division's Commercial Litigation Branch (Fraud Section), the U.S. Attorney’s Office for the Southern District of California, the DCIS, the NCIS, and the Defense Contract Audit Agency - Operations Investigative Support Division. Except as admitted in the DPA, the claims resolved by the civil settlement are allegations only and there has been no determination of liability.

 

A national electronic health records (EHR) technology vendor based in Watertown, Massachusetts, athenahealth Inc. (Athena), has agreed to pay $18.25 million to resolve allegations that it violated the False Claims Act by paying unlawful kickbacks to generate sales of its EHR product, athenaClinicals, the Justice Department announced January 28, 2021.

In a complaint filed in conjunction with today’s settlement, the United States alleged that Athena violated the False Claims Act and the Anti-Kickback Statute through three marketing programs. First, Athena invited prospective and existing customers to “Concierge Events,” providing free tickets to and amenities at sporting, entertainment, and recreational events, including trips to the Masters Tournament and the Kentucky Derby with complimentary travel and luxury accommodations, meals, and alcohol. Second, Athena paid kickbacks to its existing customers under a “Lead Generation” program designed to identify and refer new prospective clients to Athena. Under this program, Athena paid up to $3,000 to existing customers for each new client that signed up for Athena services, regardless of how much time, if any, the existing customer spent speaking to or meeting with the new client. Finally, Athena entered into deals with competing vendors that were discontinuing their EHR technology offerings to refer their clients to Athena. Under such deals, Athena paid remuneration to the competitor based on the value and volume of practices that were successfully converted into Athena clients. 

The settlement resolves allegations in a lawsuit filed by Geordie Sanborn and a separate lawsuit filed by Cheryl Lovell and William McKusick; both matters are pending in federal court in Boston, Massachusetts. The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act allows the government to intervene and take over the action, as it did in these two cases. The whistleblower share to be awarded in connection with the settlement has not been determined.

The government’s pursuit of these matters illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. 

This matter is being handled by the Civil Division’s Commercial Litigation Branch (Fraud Section) and the U.S. Attorney’s Office for the District of Massachusetts, with assistance from the U.S. Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation; the Department of Veterans Affairs, Office of Inspector General; and the U.S. Postal Service, Office of Inspector General. The two lawsuits are captioned United States ex rel. Sanborn. v. athenahealth, Inc., No. 17-cv-12125 (D. Mass.) and United States ex rel. Lovell and McKusick v. athenahealth, Inc., No. 17-cv-12543 (D. Mass.)

Orlando, FL – United States Attorney Maria Chapa Lopez announces January 22, 2021, that the Estate of Dr. Patrick T. Hunter has paid the United States $1.75 million to resolve allegations that Dr. Hunter violated the False Claims Act by submitting claims for kidney stone procedures that were not medically justified and for engaging in an illegal kickback arrangement. Dr. Hunter passed away in March 2019.

The settlement relates to Dr. Hunter’s submission of claims for extracorporeal shock wave lithotripsy, a procedure used to break up kidney stones. According to the settlement agreement, between January 2010 and April of 2016, Dr. Hunter performed lithotripsy procedures on Medicare and TRICARE patients that were medically unnecessary because the procedures were not medically indicated or because there were no kidney stones in those patients. 

The settlement agreement also resolves allegations that Dr. Hunter engaged in an illegal kickback arrangement with the Orlando Center for Outpatient Surgery, LP, where he performed the lithotripsy procedures. Dr. Hunter and the Orlando Center allegedly entered into an illegal kickback arrangement where Dr. Hunter agreed to perform his lithotripsy procedures at the Orlando Center in exchange for payments from the Orlando Center, in violation of the Anti-Kickback Statute. These procedures were then billed to and paid by Medicare and TRICARE in violation of the False Claims Act.

The settlement resulted from a lawsuit originally filed in the United States District Court for the Middle District of Florida by Scott Thompson. Mr. Thompson sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen to sue on behalf of the United States for false claims and to share in the recovery. The Act also allows the United States to intervene and prosecute the action. Mr. Thompson will receive $385,000 of the proceeds from the settlement with Dr. Hunter’s Estate.

The case is captioned United States ex rel. Thompson v. Surgical Care Affiliates et al., Case No. 6:16-cv-2189-Orl-22KRS. The settlement resolves the United States’ claims against Dr. Hunter’s Estate in that case. The case remains pending against the other defendants.

The former owner of Providence Home Health and Providence Hospice has agreed to pay $1.05 million to settle claims she knowingly and willfully paid improper kickbacks for referrals of Medicare patients to her businesses, announced U.S. Attorney Ryan K. Patrick along with Special Agent in Charge Miranda Bennett of the Department of Health and Human Services - Office of Inspector General (DHHS-OIG) on December 10, 2020.

Teresita Lumanas Alquero owned both entities at the time of the alleged violations but has since sold them.  Alquero had employed two individuals who filed a whistleblower lawsuit in June 2017 alleging various instances of fraud. Alquero allegedly paid kickbacks to a medical director for Providence. The medical directorship payments exceeded fair market value and were paid over a two-year period to induce him to refer Medicare patients to Providence for home health care and hospice services.  Medicare rules and guidelines prohibit such payments for referrals.

Alquero also allegedly submitted false claims for payment to Medicare identifying a specific attending physician from April 1, 2016, through Sept. 30, 2016. That physician was actually incarcerated during that time. His medical license was suspended April 12, 2016.

Under the False Claims Act, a private party can file an action known as a qui tam on behalf of the United States and receive a portion of the recovery. In this case, the relators will share $168,000 as a result of the settlement.

Doctor Shoaib Qureshi, Doctor Imran Mirza, Memphis Primary Care Specialists, Lunceford Family Health Center, and Getwell Family Medicine agreed to pay $341,690 to resolve allegations that they violated the False Claims Act by knowingly charging Medicare for services rendered by nurse practitioners at the higher reimbursement rate for physician services, the Justice Department announced October 30, 2020.  

Doctor Qureshi and Doctor Mirza are family medicine physicians who practice in and around Memphis, Tennessee.  Doctor Qureshi owns and operates Memphis Primary Care Specialists and Lunceford Family Health Center; Doctor Mirza owns and operates Getwell Family Medicine.

Medicare pays a higher rate for physician services than for non-physician services.  Medicare will pay the higher physician rate for services rendered by non-physician providers if the services are “incident to” the services of a physician.  Such “incident to” services, however, must be provided under the direct supervision of a physician.  The United States alleged that, from 2015 to 2018, Doctor Qureshi, Doctor Mirza, and their clinics billed Medicare as though the physicians had provided the services in question, when in fact nurse practitioners had treated the patients without the supervision required by Medicare's “incident to” rules.  Indeed, the government alleged that the services were rendered when the physicians were out of the office, including times when they were traveling out of state or abroad.     

The settlement resolves allegations filed in a lawsuit by Michael Grace under the qui tam provisions of the False Claims Act, which permit private individuals to sue for false claims on behalf of the government and to share in any recovery.  

The civil lawsuit is docketed in the Western District of Tennessee and is captioned United States; the States of California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Tennessee, and Texas; the Commonwealths of Massachusetts and Virginia; and the City of Chicago ex rel. Grace v. Tenet HealthCare Corp., St. Francis Hospital-Memphis, Desert Regional Medical Center, Apollo MD, Shoaib Qureshi, MD; and Imran Mirza, MD, Case No. 2:20-CV-2209.  As part of this settlement, Grace will receive $58,087 as his share of the government's recovery. 

A medical device maker has agreed to pay $18 million to resolve allegations that the company caused the submission of false claims to the Medicare, Medicaid, and TRICARE programs by paying kickbacks to physicians and hospitals to induce the use of its products, the U.S. Attorney's Office for the District of New Jersey and the Department of Justice announced October 14, 2020. 

The settlement resolves allegations that, for over six years, Merit Medical Systems Inc. (MMSI), of South Jordan, Utah, engaged in a kickback scheme to pay physicians, medical practices, and hospitals to induce their use of MMSI products in medical procedures performed on Medicare, Medicaid, and TRICARE beneficiaries. The federal Anti‑Kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by Medicare, Medicaid, TRICARE, and other federal healthcare programs. The statute is intended to ensure that medical providers' judgments are not compromised by improper financial incentives.

Under the guise of an internal program known as the Local Advertising Program, MMSI allegedly provided remuneration to healthcare providers in the form of millions of dollars in free advertising assistance, practice development, practice support, and purported unrestricted “educational” grants to induce the healthcare providers to purchase and use a wide variety of MMSI products. These products included MMSI's EmboSphere devices, which generally were used for uterine fibroid embolization procedures, and its QuadraSphere devices, which generally were used for other types of embolization procedures. Despite publicly claiming that its financial assistance was designed to “increase th[e] awareness” of medical treatments, MMSI allegedly provided it only to select healthcare providers to reward past sales, induce future sales, and steer business to MMSI and away from MMSI's competitors. The government alleged that MMSI disregarded numerous warnings that its conduct may violate the Anti-Kickback Statute, including warnings from MMSI's own Chief Compliance Officer, during the course of the alleged kickback scheme. Of the $18 million to be paid by MMSI, $15.21 million will be returned to the federal government, and a total of $2.79 million will be returned to individual states, which jointly funded claims involving MMSI devices that were submitted to state Medicaid programs.

Along with the civil settlement, MMSI entered into a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services-Office of Inspector General (HHS-OIG). The CIA requires MMSI to hire a compliance expert and an independent review organization to analyze its systems and transactions.  

The allegations were originally made in a lawsuit filed under the whistleblower provisions of the False Claims Act by Charles J. Wolf M.D., the former chief compliance officer of MMSI. The act permits private parties to sue for false claims on behalf of the United States and to share in any recovery. Wolf will receive $2.65 million from the federal share of the settlement.