SPECIALTY CARE AND OTHER PROVIDER ENTITIES
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Nonprofit clinic and its CEO agreed to pay $130,000 to resolve FCA allegations that they caused the submission of medically unnecessary Schedule II drugs that were prescribed by a former physician, Dr. Smith, without appropriate medical review and judgment. The government alleged that physician assistants – and not Dr. Smith – saw most of the patients at NGHC and Dr. Smith routinely signed prescriptions, including for Schedule II drugs, for patients he had neither seen nor evaluated. As part of the resolution, Dr. Smith consented to a voluntary exclusion from federal healthcare programs for 10 years. 104 Community healthcare center agreed to pay $350,000 to resolve FCA allegations that it improperly billed Connecticut Medicaid for certain dental services. Specifically, the government alleged CSH instituted a policy requiring patients to receive dental cleanings and dental exams on separate days so that the center could bill Connecticut Medicaid for two encounters. 105 Physician-owned medical group agreed to pay $200,000 to resolve FCA allegations that it billed Medicare for medically unnecessary advanced care planning and tobacco cessation counseling, including cessation services provided to patients who did not use tobacco. 106 Optometry practice and optician owner agreed to pay more than $678,000 to resolve FCA allegations that they billed Connecticut Medicaid using a code covering miscellaneous services each time they submitted a claim for eyeglasses, despite no miscellaneous services being provided. The settlement also resolves allegations that the practice encouraged Medicaid beneficiaries to select extra pairs of eyeglasses then submitted claims for multiple pairs of eyeglasses that were not medically necessary. The practice and optician entered into a three-year IA with HHS-OIG as part of the resolution. 107 Pain management practice agreed to pay $1 million to resolve allegations that it billed Medicare for medically unnecessary confirmatory urine drug tests despite failing to first receive the results from presumptive urine drug tests. 108
North Georgia Healthcare Center, Inc. (NGHC); DeLaine Hunter; Dr. Gary Smith
8/2/2021
$130,000
Cornell Scott-Hill Health Corporation (CSH)
$350,000
8/11/2021
Tri-County Hospitalists, LLC
$200,000
8/12/2021
L.A. Vision LLC; Lisa Azinheira
$678,901
8/13/2021
Nevada Advanced Pain Specialists
$1 million
8/19/2021
104 https://www.justice.gov/usao-ndga/pr/north-georgia-health-clinic-and-its-ceo-agree-pay-13000000-settle-false-claims-act. 105 https://www.justice.gov/usao-ct/pr/health-center-pays-350k-settle-improper-billing-allegations-related-medicaid-dental. 106 https://www.justice.gov/usao-edpa/pr/tri-county-hospitalists-llc-agrees-pay-200000-resolve-allegations-overbilling-medicare. 107 https://www.justice.gov/usao-ct/pr/hartford-optician-and-business-pay-more-678k-resolve-false-claims-act-allegations. 108 https://www.justice.gov/usao-ma/pr/nevada-medical-practice-agrees-pay-1-million-resolve-allegations-false-medicare.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 66
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