"Patients and taxpayers rightly should expect that referrals be based on sound medical judgement, not driven by thinly veiled bribes, as alleged here," said a spokesperson for the U.S. Department of Health and Human Services Office of Inspector General.
Richard O. was an employee of Lockheed Martin Corporation working for Mission Support Alliance (MSA) in August 2009. Lockheed Martin Services, Inc. (LMSI), a Lockheed Martin subsidiary, and MSA were hired by the Department of Energy to perform environmental cleanup of the Hanford Nuclear Reservation in Washington. Through a subsidiary, Lockheed Martin was one of the owners of MSA, as well.
It was an interesting scheme. According to allegations by the Department of Justice, Reliant Rehabilitation Holdings, Inc., wanted to induce or reward its client nursing homes for referring patients to Reliant for rehabilitation therapy. So, it sent over nurse practitioners employed by Reliant to work for those nursing homes for free or below market value.
Cincinnati-based Mercy Health, a nonprofit healthcare organization operating in Ohio and Kentucky has agreed to pay the United States $14,250,000 to settle False Claims Act allegations. According to the Justice Department, Mercy Health made improper payments to physicians.
The Justice Department and six U.S. states have joined a whistleblower's lawsuit against Insys Therapeutics, Inc. In the lawsuit, the drug maker is accused of trying to make more profit on Subsys, a spray form of the opioid fentanyl, by paying kickbacks to induce doctors to prescribe the drug. It is also accused of knowingly having insurers and federal healthcare programs to pay for Subsys when it was not medically necessary.
"Improper financial arrangements between government officials and private contractors corrupt taxpayer-funded contracts," says the acting assistant attorney general of the Justice Department's Civil Division.
The Department of Justice has just brought a mammoth case against a Florida compounding pharmacy, two of its executives, and the private equity firm that owns it. The agency accuses the defendants of paying illegal kickbacks to telemedicine doctors and, in some cases, patients, to induce prescriptions for scar creams, vitamins and pain creams without regard for medical need. These prescriptions were then reimbursed by TRICARE, the federally funded healthcare program for military service members and their families.
Seven years ago, two doctors stood up to powerful players in the emergency medical field by blowing the whistle on Medicare fraud. Their courage and hard work contributed to settlements of more than $33 million between two large physician groups and the Justice Department. As a result, the two whistleblowers will receive over $6.2 million.
A New York City pharmacist is facing both a civil complaint and criminal charges after allegedly bilking Medicaid out of $11 million. The pharmacist is accused of giving kickbacks to Medicaid patients in exchange for the opportunity to refill their prescriptions -- or to buy the prescriptions outright and bill Medicaid despite never intending to fill them. The patients were typically poor and the prescriptions were often for expensive HIV medications.
After last month's takedown of some 400 medical professionals accused of $1.3 billion in false billings, the Justice Department intends to remain vigilant in its fight against healthcare fraud. It has just announced the creation of the nation's first Health Care Fraud Unit to focus on issues like kickback schemes, upcoding and false diagnoses.