Articles Posted in kickbacks

IMG_0350-300x200Scott Roix, as well as HealthRight, LLC, Health Savings Solutions, LLC, Vici Marketing, LLC, and Vici Marketing Group, LLC, have agreed to pay $2.5 million to resolve allegations that they violated the False Claims Act through their telemedicine scheme.

According to the Department of Justice, Roix and the marketing companies fraudulently obtained insurance coverage information from patients with the purpose of prescribing them unnecessary pain cream products. The defendants then sold the prescriptions to numerous pharmacies, profiting from payments that were determined by the volume and value of the prescriptions. Roix and the marketing companies disguised the sale of these prescriptions by noting them as marketing services in their financial records.

As part of the telemedicine scheme, Roix and the marketing companies targeted consumers across the country, convincing them to divulge their insurance information to what they thought was a trusted entity. This scheme represents one of many attempts by scammers to utilize telemedicine for fraudulent activities. The elderly community is particularly prone to this method of fraud, and as a result has been impacted significantly.

IMG_0315-300x200A civil health care fraud lawsuit has been filed against Life Spine Inc., as well as its founder and president, Michael Butler, and Vice President of development, Richard Greiber, for allegedly paying millions of dollars in kickbacks to surgeons for using their spinal implants, equipment, and other devices. According to the lawsuit, the surgeons who received kickbacks from Life Spine Inc. accounted for half of the company’s total sales from 2012-2018.

Life Spine Inc. is headquartered out of Huntley, Illinois and specializes in the development and manufacturing of devices used in spinal surgeries. This includes spinal implants and instruments under the Life Spine Products line.

In 2012, Butler and Greiber began aggressively recruiting surgeons to act as paid consultants for the company. Butler and Greiber also promised surgeons that any patent applications that were transferred to Life Spine Inc. would result in the related products being brought to market. However, these agreements were contingent on the surgeons’ continued use of Life Spine Products. In exchange, the surgeons received up-front intellectual property acquisition fees for their patent transfers, as well as royalties for sales from the patented products, and regular consulting fees.

IMG_0299-300x200Heritage Pharmaceuticals Inc., a New Jersey-based company, has been ordered to pay more than $7 million after being charged with conspiring with its competitors to fix prices, rig bids, and allocate customers.

According to the Department of Justice, Heritage Pharmaceuticals Inc. was part of an antitrust conspiracy which involved several other companies and leaders in the pharmaceutical space. This conspiracy took place from 2014 to 2015 and had the shared goal of fixing the prices of a medication that is used to treat diabetes.

In addition to the $7 million that Heritage Pharmaceuticals Inc. will have to pay as part of a civil claim, they will also have to pay a $225,000 criminal penalty and cooperate with a criminal investigation that remains open. The $7 million fee will resolve allegations against the company that fall under the False Claims Act since it allegedly violated the Anti-Kickback Statute.

IMG_0265-300x200Daniel Ferguson, John Frohrip, and Kevin Partin, pleaded guilty to violating federal anti-kickback statutes following allegations that they paid illegal kickbacks and recruited doctors to write prescriptions for expensive drugs as part of their health care fraud scheme.

According to the Department of Justice, the defendants recruited physicians to write prescriptions for complex drugs that would qualify for lucrative reimbursements from insurance programs. After the drugs were prescribed to patients, the defendants would then apply for reimbursements through various federal health care insurance programs and use the profits for their personal expenses.

Each of the defendants admitted to offering to pay kickbacks to the physicians they were attempting to recruit in their scheme. On many occasions they were successful in their recruitment, including the payment of $15,000 to Dr. John Main of Tulsa for his participation in the scheme.

big-pharma-300x196Jazz Pharma, Alexion, and Lundbeck were the subject of SOJ lawsuits asserting kickbacks and committing general violations of Medicare laws. The United States Department of Justice has decided to agree to a settlement of $122.6 million in total from these three alleged Medicare violators.

The drug companies were accused of offering remuneration in hopes of encouraging patients to purchase their medications. They would pay kickbacks, a form of negotiated bribery, to patients of Medicare and Civilian Health and Medical Program (ChampVA) under the guise of charitable organizations that subsidized the co-pays. This is not an uncommon practice, but it is one many law enforcement programs are attempting to discontinue.

The DOJ states that in this case, the companies violated the Federal False Claims Act. This act is a way of imposing liability onto anyone, be it a group or individual, that has been discovered interfering with government-funded programs such as in this case with Medicare. This is one of the government’s main tools in defending against fraudulent acts.

Foreign-bribes-venezuela-300x194The president of a company based in Miami, as well as one of its former sales representatives, hoped to gain access to more work and receive payment of past due invoices by bribing officials at Venezuela’s state energy company.

The two men involved are Rafael Enrique Pinto Franceschi, referred to as Pinto, and Franz Herman Muller Huber, referred to as Muller. Pinto lives in Miami and is the president of the company in question at the age of 40, while Muller was a former sales representative for that company and is currently living in Weston, Florida at the age of 68.

Pinto and Muller were charged with two counts of wire fraud, one count of conspiracy to commit wire fraud, one count of conspiracy to launder money, and one count of conspiracy to violate the Foreign Corrupt Act. Altogether these two were charged in a five-count indictment in the Southern District of Texas on February 21, 2019.

Pharmacy fraudHolly Blakely, a former San Antonio pharmaceutical rep in Texas, plead guilty and confessed her involvement in an $8.8 million healthcare fraud scheme.

Initially, Holly Blakely was charged in a 30-count indictment. This allegedly means that she paid more than $400,000 in bribes and kickbacks to clinicians for prescribing compounded medications. Compound medication is basically personalized medications produced in order to fit an individual’s exact medical needs. In this case, these compound medications, in particular, were designed to ease pain, but the people these were being given to did not require them.

Blakely confessed that she worked with two compounding pharmacies in order to push prescriptions for compound drugs. The pharmacies would then submit claims to health plans such as Tricare. In exchange for her part of the fraud, Blakely was paid $1.15 million.

kickbacksIn 2009, the company Eli Lilly & Co. plead guilty to illegally marketing an antipsychotic drug, Zyprexa, for unapproved uses on patients, leading to a fine of $1.42 billion. This settlement ended a series of civil lawsuits, as well as a criminal investigation. At the time this large of a settlement was unheard of, but how did the company orchestrate such a massive kickback scheme?

The Kickback Scheme

Originally, Zyprexa was approved for a very narrow use of schizophrenia and bipolar disorder, however Eli Lilly & Co. soon began to market the drug for a variety of other purposes. In fact, it was alleged that Zyprexa was eventually marketed to treat dementia, and was even prescribed for illnesses related to pediatrics in high doses. The company was also accused of overcharging for the drug. This allowed the company to target a significantly wider audience, increasing their potential profits on the drug exponentially.

Medicare-fraud-300x200Rossana Ramirez, a once certified nursing assistant, was discovered to be helping run a business in West Miami-Dade that is responsible for $7 million in health care fraud. After pleading guilty Ramirez was stripped of her license permanently through an Emergency Suspension Order and is now serving time at a federal detention center with a release date of June 2022.

Rossana Ramirez was registered in the state corporation registration as the vice president of a company titled F&E Home Health Care. While Rossana Ramirez is currently taking the heat from the Florida Department of Health, her husband Evelio Ramirez Jr. is also involved as the president of F&E. He will soon be starting his sentence of three years and ten months in federal prison himself. Both husband and wife are 59 and will both serve their time. Their pleas of guiltily were fairly straightforward and show that this act of fraud is not very uncommon from what has already been seen from healthcare fraud schemes in South Florida.

F&E is accused of paying kickbacks, a form of negotiated bribery in which a commission of sorts is given in return for services rendered, to those who receive Medicare and Medicaid to become F&E patients. Additionally, some of these patients did not even require home healthcare and the services promised were not often necessary or even provided at times. F&E is also accused of paying recruiters of Medicare and Medicaid recipients to promote their health services for them.

shutterstock_505244407-300x188Pennsylvania cardiologist who sued his former colleagues and UPMC Hamot will receive $6 million as part of the $20.75 million whistleblower settlement.

According to GoEarie, Tullio Emanuele, M.D., claimed Hamot and the other defendant, Medicor Associates Inc., knowingly submitted claims to the Medicare and Medicaid programs that violated the Anti‑Kickback Statute and the Physician Self-Referral Law (the “Stark Law”).

Emanuele practiced with Medicor from 2001 to 2005. He contended that Hamot violated federal law between 2004 and 2010 by submitting claims, primarily to Medicare, while the hospital was paying millions of dollars a year to Medicor, an independent physician-owned group that remains in business.