Healthcare Fraud & Abuse Review 2021

SPECIALTY CARE AND OTHER PROVIDER ENTITIES

DA TE

ENTITY

FCA ALLEGATIONS

AMOUNT

Two medical practices and a doctor agreed to pay $330,000 to resolve FCA allegations that they billed Medicare and Medicaid for nerve conduction studies and arterial studies that were: (1) not medically necessary; (2) not supported by patient records; (3) not eligible for reimbursement. 98

Palladium Primary Care, P.A.; Premiere Health Care Plus, P.A.; Dr. George Osei-Bonsu

6/22/2021

$330,000

ENT group agreed to pay $750,000 to resolve FCA allegations that they billed federal healthcare programs for more expensive E&M services than were actually provided. 99

El Paso Ear, Nose & Throat Associates

$750,000

6/23/2021

Company that subcontracts with physicians to provide services to prison inmates agreed to pay more than $690,000 to resolve FCA allegations that it billed the Federal Bureau of Prisons for higher-level services than were actually provided. 100 Outpatient surgery center and its affiliate agreed to pay $3.4 million to resolve FCA allegations that they submitted claims to Medicare and TRICARE for medically unnecessary lithotripsy procedures. The settlement also resolves allegations that the surgery center paid a urologist who performed the procedures at the center per-procedure payments to induce the urologist to perform such procedures at the center, in violation of the AKS. 101 A now-defunct medical practice and its rheumatologist owner agreed to pay more than $2 million to resolve FCA allegations that they billed federal healthcare programs for medically unnecessary or improper MRI scans, rheumatoid arthritis treatments and other upcoded patient visits. 102 Rehabilitation therapy provider agreed to pay $2 million to resolve FCA allegations that it submitted or caused the submission of false claims to Medicare for medically unnecessary or unreasonable therapy services provided at 11 SNFs. The SNF operator and 27 other affiliated SNFs previously agreed to pay $16.7 million to resolve allegations related to their role in the alleged conduct in July 2020. 103

NaphCare Inc.

6/25/2021

$694,593

Surgical Care Affiliates, LLC; Orlando Center for Outpatient Surgery, LP

$3.4 million

6/28/2021

Arthritis and Osteoporosis Center; Dr. Enrico Arguelles

7/20/2021

$2.071 million

Interface Rehab

7/23/2021

$2 million

98 https://www.justice.gov/usao-mdnc/pr/acting-us-attorney-hairston-and-ag-stein-announce-330000-health-care-fraud-settlement. 99 https://www.justice.gov/usao-wdtx/pr/justice-department-reaches-settlement-agreement-physicians-group-el-paso-over. 100 https://www.justice.gov/opa/pr/prison-health-care-provider-naphcare-agrees-settle-false-claims-act-allegations. 101 https://www.justice.gov/usao-mdfl/pr/surgical-care-affiliates-and-orlando-surgery-center-agree-pay-34-million-settle-false. 102 https://www.justice.gov/usao-mt/pr/former-billings-rheumatologist-settles-alleged-health-care-fraud-claims-2-million. 103 https://www.justice.gov/opa/pr/interface-rehab-pay-2-million-resolve-false-claims-act-allegations.

NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 65

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