Healthcare Fraud & Abuse Review 2021

INDIVIDUAL PROVIDERS

DA TE

ENTITY

FCA ALLEGATIONS

AMOUNT

A podiatrist agreed to pay $535,000 to resolve FCA allegations that he billed Medicare for surgical procedures involving the implantation of neurostimulators when in fact the devices were not implanted and did not require surgery. 135 A pain physician agreed to pay more than $183,000 to resolve allegations that his practice billed Medicare for surgical procedures involving the implantation of neurostimulators when in fact the devices were electro-acupuncture devices that were not implanted and did not require surgery. 136 A pain physician and anesthesiologist agreed to pay more than $340,000 to resolve allegations that he billed Medicare for the surgical implantation of neurostimulator devices when the patients received acupuncture devices that were not surgically implanted. 137 A former physician agreed to pay at least $21,000 to resolve allegations that he issued prescriptions for controlled substances after his medical license expired, in violation of the CSA, and caused the submission of claims for such prescriptions to Medicare in violation of the FCA. The physician agreed to never practice medicine again or seek a medical license in any state and to not seek reinstatement of his DEA controlled substances registration. 138 A neurologist and his practice agreed to pay $800,000 to resolve allegations that the neurologist issued prescriptions for an expensive drug (Acthar Gel®) which was not medically necessary or reasonable. 139 The former CEO of a pain management company agreed, in resolving civil FCA allegations, to be permanently excluded from participation in federal healthcare programs or employment in any industry in which he might play a direct or indirect role in causing claims to be submitted to federal healthcare programs. He was previously convicted on criminal charges related to the matter but had his sentence commuted. 140 The pain management company, its four majority owners and a former executive entered into a separate settlement related to these allegations.

Harold Ledger

6/10/2021

$535,000

Dr. Yurii Borshch

6/10/2021

$183,190

Dr. Marte A. Martinez, Jr.

6/11/2021

$340,437

Loren D. Sherwood

$21,000

6/15/2021

Dr. Lance Kim; Florida Neurological Center, LLC

$800,000

7/16/2021

Non-monetary (Exclusion)

John Davis

8/3/2021

135 https://www.justice.gov/usao-wdtx/pr/healthcare-practitioners-pay-over-1-million-resolve-false-claims-act-liability-arising. 136 https://www.justice.gov/usao-wdtx/pr/healthcare-practitioners-pay-over-1-million-resolve-false-claims-act-liability-arising. 137 https://www.justice.gov/usao-sdtx/pr/pain-doctor-pays-settle-allegations-arising-false-billing. 138 https://www.justice.gov/usao-co/pr/former-ridgway-physician-agrees-forgo-practicing-medicine-and-pay-penalty-resolve. 139 https://www.justice.gov/usao-mdfl/pr/ocala-neurologist-agrees-pay-800000-resolve-allegations-prescribing-medically. 140 https://www.justice.gov/usao-mdtn/pr/former-ceo-comprehensive-pain-specialists-resolves-civil-lawsuit-united-states.

NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 72

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