Omnicare agrees to settle kickback case for $120M

CINCINNATI (AP) — Omnicare Inc., the nation's biggest dispenser of prescription drugs in nursing homes, said Wednesday it will pay $120 million to settle a whistle-blower lawsuit accusing the Cincinnati-based company of giving kickbacks to facilities in return for more patient referrals.

Under the settlement agreement, reached Tuesday, Omnicare does not admit liability. The agreement still needs to be approved by the Department of Justice and federal court, Omnicare said in a Securities and Exchange Commission filing Wednesday.

"Omnicare continues to deny that there was any wrongdoing," Patrick Lee, vice president of investor relations at Omnicare, said in a statement to The Associated Press.

"The company agreed to settle the matter in order to avoid continued litigation and to focus on its mission of helping to ensure the health of seniors and other patient populations in a cost-effective manner," Lee said. "Omnicare is committed to ensuring that it remains in strict compliance with all applicable laws, regulations and standards in each of the markets and jurisdictions in which it operates."

The settlement is the result of a lawsuit filed in federal court in Cleveland in 2010 by an Ohio pharmacist named Donald Gale who worked for Omnicare from 1993 until 2010, his attorneys say.

Gale, who stands to get between 25 and 30 percent of the settlement — or up to $36 million — accused Omnicare of violating the federal anti-kickback statute, which prohibits anyone from lying in applications for benefits under a federal health care program, such as Medicare.

The lawsuit accused Omnicare of giving steep discounts for prescription drugs to nursing homes for some Medicare patients in exchange for the referrals of other patients at higher prices paid for by the federal government.

"What Omnicare would do some of the time, when it wanted to keep the business of a nursing home, it would say, 'Well, we'll give you rock-bottom or below-cost prices on the drugs of your Medicare Part A patients' ... to get the rest of the patients to pay higher," said Virginia Davidson, one of Gale's attorneys.

She called the settlement a "pretty significant figure" and praised Gale, a 45-year-old resident of Wadsworth in northeastern Ohio, for filing the lawsuit.

"Not too many people sitting at work getting a paycheck are going to stand up and risk their livelihood by pointing out illegal conduct," she said.

The federal government would get between 65 and 70 percent of the settlement, or up to $84 million.

Omnicare settled another major lawsuit in 2009, when it agreed to pay $98 million stemming from allegations that it paid kickbacks to nursing homes to gain their business, and received kickbacks for buying and recommending drugs.

Omnicare's stock fell 5.7 percent to $54.16 in afternoon trading.

http://www.mysanantonio.com/news/article/Omnicare-agrees-to-settle-kickback-case-for-120M-4919948.php

Medical Clinic Owners and Patient Recruiters Charged in Miami for Role in $8 Million Health Care Fraud Scheme

Department of Justice

Office of Public Affairs

FOR IMMEDIATE RELEASE

Thursday, September 26, 2013

Medical Clinic Owners and Patient Recruiters Charged in Miami for Role in $8 Million Health Care Fraud Scheme

Several patient recruiters, including two medical clinic owners, have been arrested in connection with a health care fraud scheme involving defunct home health care company Flores Home Health Care Inc. (Flores Home Health).
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG) Office of Investigations Miami Office made the announcement.
In an indictment returned on Sept. 24, 2013, and unsealed this afternoon, Isabel Medina, 49, and Lerida Labrada, 59, were charged with conspiracy to commit health care fraud, which carries a maximum penalty of 10 years in prison upon conviction.  Together with Mayra Flores, 49, and German Martinez, 36, Medina and Labrada also face charges for allegedly conspiring to defraud the United States and to receive health care kickbacks as well as receipt of kickbacks in connection with a federal health care program, which carry a maximum penalty of five years in prison upon conviction.
According to the indictment, the defendants worked as patient recruiters for the owners and operators of Flores Home Health, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.  Medina and Labrada were also the owners and operators of Miami medical clinics which allegedly provided fraudulent prescriptions to the owners and operators of Flores Home Health.
Flores Home Health was allegedly operated for the purpose of billing the Medicare program for, among other services, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.
From approximately October 2009 through approximately June 2012, Flores Home Health was paid approximately $8 million by Medicare for allegedly fraudulent claims for home health services.

GreatCare Home Health CEO to Pay $15 Million for Medicare Fraud

Hee Jung "Angela" Mun of Rancho Palos Verdes operated GreatCare Home Health Agency.

The owner of a home health agency was ordered to pay nearly $15 million—about three times the losses suffered by Medicare as a result of a kickback scheme she masterminded, federal prosecutors announced Wednesday.

U.S. District Judge Stephen V. Wilson's $15 million default judgment against Hee Jung "Angela" Mun of Rancho Palos Verdes resolves a whistleblower lawsuit filed by the agency's then-receptionist, according to the U.S. Attorney's Office.

The judgment against Mun and the conclusion of the lawsuit were announced Wednesday when the U.S. Marshals Service transferred to the U.S. Treasury more than $1 million seized in March 2011 when federal agents executed a search warrant at GreatCare and seizure warrants on the bank accounts of both the agency and Mun.Mun, 51, is a former registered nurse who owned and operated GreatCare Home Health Agency in the Westlake district of Los Angeles.

GreatCare paid kickbacks to physicians and others to induce them to refer patients to the agency in a $5 million Medicare fraud scheme, prosecutors said.

In a related criminal case, Mun pleaded guilty to federal health care fraud charges and is scheduled to be sentenced in February.

The scheme targeted elderly and primarily Korean Medicare beneficiaries, according to federal prosecutors.

The case came to light in March 2010 when the receptionist filed a lawsuit on behalf of the U.S. government naming as defendants GreatCare; Mun, the company's owner/director; three physicians; a physical therapist and several licensed nurses; and other unlicensed persons employed by the agency.

—City News Service.

http://palosverdes.patch.com/groups/police-and-fire/p/rpv-woman-must-pay-15m-for-medicare-fraud

Tenet Healthcare and Health Management Associates allegedly paid kickbacks for referrals of pregnant illegal residents and filed fraudulent Medicaid claims.

(Photo: J. Kyle Keener for USA TODAY)

STORY HIGHLIGHTS

• Two large hospital operators allegedly violated anti-kickback statute of Medicaid law
• Hospital Management Associates official declined comment on pending litigation
• Tenet Healthcare says agreements under fire were "appropriate"

ATLANTA (AP) — Two large hospital operators paid kickbacks to clinics that directed expectant mothers living in the U.S. illegally to their hospitals and filed fraudulent Medicaid claims on those patients, a federal whistleblower lawsuit unsealed late Wednesday said.

Naples, Fla.-based Health Management Associates and Dallas-based Tenet Healthcare and their affiliates entered into contracts with clinics operated by Hispanic Medical Management and Clinica de la Mama and their affiliates, the lawsuit says.

The clinics then referred pregnant women living in the country without authorization to for-profit hospitals operated by HMA and Tenet in exchange for kickbacks from fraudulent Medicaid claims, the lawsuit says.

The Medicare and Medicaid Patient Protection Act, known as the anti-kickback statute, prohibits paying for or accepting money to arrange for medical treatment under federally funded programs.

An HMA representative said in an email that the company does not comment on pending litigation.

Tenet issued a statement on behalf of its hospitals named in the suit, saying it believes the agreements "were appropriate and provided substantial benefit to women in underserved Hispanic communities served by those hospitals. The services provided under these agreements included translation, determination of Medicaid eligibility, and other services designed to improve the delivery of obstetric care and increase the likelihood of a safe birth and a healthy baby."

Phone numbers for Hispanic Medical Management and Clinica de la Mama, both in Georgia, could not immediately be found.

The federal whistleblower lawsuit, filed by Ralph Williams, a former chief financial officer for HMA, says the kickback scheme went on for more than a decade. The state of Georgia has also joined the lawsuit to recover state Medicaid funds.

"These hospitals paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line," Georgia Attorney General Sam Olens said in a statement. "As attorney general, I take seriously my responsibility to protect the integrity of Georgia Medicaid and to ensure that those who defraud the program are held accountable."

Clinica recruits pregnant women who are in the country illegally to its prenatal clinics using the slogan, "we care about your health, not your immigration status," the lawsuit says. The clinics then directed these vulnerable patients to the HMA and Tenet hospitals, which pay for the referrals, the lawsuit says.

Those in the country illegally are not eligible for Medicaid coverage although hospitals can be reimbursed for treatment of emergency services provided to those in the country illegally and Medicaid rules consider childbirth an emergency medical condition.

The lawsuit says Williams began working at HMA in April 2009 and one of his duties was to monitor contracts and approve the payment of bills. Shortly after he arrived, he discovered a contract between an HMA hospital in Monroe, Ga., and Clinica for Spanish interpreter services, the lawsuit says. He investigated and found no evidence of interpreter services, but eventually found that Clinica was being paid for referring pregnant women in the country illegally "for government subsidized deliveries," the lawsuit says.

Soon after he voiced his concerns about the fraudulent arrangement to company leaders, Williams was fired without reason, the lawsuit alleges.

The lawsuit says Williams' direct supervisor had previously worked for Tenet in South Carolina. The lawsuit alleges that Tenet used a similar scheme in a number of its hospitals, including Atlanta Medical Center, four others in Georgia and Hilton Head Hospital in Hilton Head, S.C.

http://www.usatoday.com/story/money/business/2013/07/31/whistleblower-suit-hospitals-defrauded-medicaid/2607219/

Texas man sentenced for Medicare scam

Associated Press

Posted on June 18, 2013 at 7:32 PM

HOUSTON (AP) — Federal prosecutors say a 48-year-old man has been sentenced to six years in prison for operating bogus ambulance companies that fraudulently collected $3.6 million in Medicare payments.

Julian Kimble was sentenced Tuesday after being convicted of conspiracy to commit health care fraud and other charges. He also must pay back the money he collected. Kimble pleaded guilty to the charges in November 2011.

Prosecutors say Kimble operated four ambulance companies in the Houston area from 2008 to 2010. He routinely billed the federal Medicare program for ambulance transports that were not provided, not needed or not ordered by a treating physician.

He and others transported Medicare beneficiaries in vans or sedans. Kimble received kickbacks from the owners of community mental health centers in exchange for supplying patients to their facilities.

http://www.khou.com/news/national/212047771.html