Tag Archives: Tricare Fraud

Feds claim Kansas physician involved in $30M billing fraud scheme

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https://www.beckershospitalreview.com/legal-regulatory-issues/feds-claim-kansas-physician-involved-in-30m-billing-fraud-scheme.html

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A Kansas physician and Hutchinson (Kan.) Clinic are defendants in a False Claims Act case the federal government recently intervened in, according to the Great Bend Tribune.

The government alleges Mark Fesen, MD, and Hutchinson Clinic billed Medicare and Tricare for more than $30 million for medically unnecessary medications and treatments, including chemotherapy.

The 45-page federal complaint provides nine examples of patients who received unnecessary treatments.

“These patient examples are not isolated examples, but instead representative examples of the medically unnecessary services Fesen and Hutchinson Clinic repeatedly billed to Medicare and Tricare,” states the complaint. “This is supported by the clinic’s own internal audits that found widespread problems with Fesen’s chemotherapy regimens, and particularly his use of Rituxan.”

A clinical pharmacist who worked in Hutchinson Clinic’s oncology department from 2007-14 originally brought the allegations against Dr. Fesen and the clinic under the qui tam, or whistle-blower, provisions of the False Claims Act.

 

 

Court Slaps $114M Judgment in Lab Kickback Scheme

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http://www.healthleadersmedia.com/health-plans/court-slaps-114m-judgment-lab-kickback-scheme?utm_source=silverpop&utm_medium=email&utm_campaign=20180530_HLM_Daily_resend%20(1)&spMailingID=13608756&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1402748019&spReportId=MTQwMjc0ODAxOQS2

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A U.S. District judge in South Carolina trebled the False Claims Act liability of three defendants who submitted nearly 39,000 false claims to Medicare and other government health programs.

The CEO of a medical testing lab and two affiliated sales executives have been hit with a civil judgement totaling $114 million for paying kickbacks to physicians for referrals.

The defendants are: Tonya Mallory, the former CEO of Richmond, Virginia-based Health Diagnostic Laboratory; and Floyd Calhoun Dent III, and Robert Bradford Johnson, co-owners of Alabama-based BlueWave Healthcare Consultants Inc., a third-party sales firm that contracted with HDL.

The facts:

  • The three defendants were found guilty of civil fraud in three whistleblower suits that were heard by federal jury in Charleston, South Carolina in January.
  • The defendants disguised payments to physicians as processing and handling fees of between $10 and $17 for each patient they referred to blood testing labs: HDL, and Singulex Inc., of Alameda, California.
  • Physicians referred patients to HDL and Singulex for medically unnecessary tests, which were then billed to federal healthcare programs.
  • The three defendants were found liable for submitting 35,074 false claims, worth $16.6 million submitted to Medicare and TRICARE by HDL, and 3,813 false claims, worth $467,935, submitted by Singulex.
  • Under the False Claims Act, the court trebled damages, offset settlement payments received from HDL and Singulex for the same claims, and awarded $63.8 million in penalties requested by the United States, for a total judgment of $114.1 million.