AlixaRx LLC (N.D.Ga.)
This national provider of pharmacy services to long-term care facilities paid $2.75 million to resolve allegations that its dispensing practices allowed opioids and other controlled substances to be dispensed without a prescription. Our relator, a former pharmacist at AlixaRx, alleged that the company was submitting false claims for invalid prescriptions after abusing the “emergency prescription” provisions of the Controlled Substances Act.
Lockheed Martin Corporation (S.D. Ohio)
A consortium of four relators alleged that LMC overbilled the government for work on the F-22 Raptor fighter jet and the C-130J Super Hercules cargo plane, overcharging the government for tools used in the work, billing multiple times for the same tool, improperly charging the government for reworking faulty tools, as well as destroying destroyed paperwork to conceal defects in tools that had been approved without proper inspection. The declined case settled for a confidential amount in 2014.
Pediatric Services of America (S.D. Ga.)
A collection of defendants that provide home nursing services to medically fragile children paid $7 million dollars in a historically-significant case, in that it was the first settlement under the False Claims Act involving a healthcare provider’s failure to investigate credit balances on its books to determine whether they resulted from overpayments made by a federal healthcare program, as required by the Affordable Care Act.
Tennessee Orthopaedic Clinics P.C., and Appalachian Orthopaedic Clinics P.C. (E.D. Tenn.)
These orthopedic practices paid a combined $1.85 million to settle claims that they knowingly billed state and federal health care programs for reimported osteoarthritis medications, known as viscosupplements. Viscosupplements, such as Synvisc and Orthovisc, are FDA-approved for the treatment of osteoarthritis pain in the knee and are reimbursed by Medicare, Medicaid and other federal health care programs at a set rate based on the average sales price of the domestic product. The suit alleged that these clinics knowingly purchased deeply discounted viscosupplements that had been reimported from foreign countries and billed them to state and federal health care programs, when such reimported viscosupplements were not reimbursable by those programs.
B&H Health Care Services Inc. (S.D.N.Y.)
Nursing Personnel Home Care, a Brooklyn-based licensed home care service agency, as well as Excellent Home Care Services LLC of Brooklyn and Extended Nursing Personnel CHHA LLC of Manhattan, paid $23,963,100 to resolve two FCA cases that arose from their alleged use of hundreds of home health aides who had little to no required training. The aides were allegedly sent into the homes of New York’s elderly, frail and indigent daily to provide sensitive medical care. As a result of this practice, Medicaid was billed for millions of dollars in services that the aides were allegedly not qualified to perform.
Radiotherapy Clinics of Georgia LLC (N.D. Ga.)
This medical practice and its affiliates—RCOG Cancer Centers LLC, Physician Oncology Services Management Company LLC, Frank A. Critz, M.D., and Physician Oncology Services L.P. (collectively, RCOG)—agreed to pay $3.8 million to settle claims that they allegedly billed Medicare for medical treatment provided to prostate cancer patients in excess of those permitted by Medicare rules and for services that were not medically necessary. Our relator—a physicist—alleged that RCOG overbilled Medicare for port films (X-ray images of the treatment area) and for simulations (the process by which radiation treatment fields are defined, filmed, and marked on the skin in preparation for radiation therapy), as well as overbilling for physics consults and for pre-plans that were ordered but not medically necessary and/or never reviewed by the doctor.
Universal Health Services, Inc. (W.D. Mich.)
The psychiatric hospital chain settled numerous allegations for $117 million, including that it provided and billed for medically unnecessary services; billed for services that were not rendered; admitted patients who did not qualify for inpatient services; billed for excessive lengths of stay; failed to provide adequate staffing, training, and supervision of staff; and improperly used physical and chemical restraints and seclusion.
Community Comfort Center (N.D. Ga.)
The Marietta-based adult daycare was alleged to have provided inadequate supervision of “exceptional rate” clients, who require one-on-one or even two-on-one support, for which Medicaid pays a higher reimbursement than the facility’s standard clients.
Sesolinc Group (S.D. Ga.)
The Savannah-area defense contractor was alleged to have built defective products for the U.S. military and VA. The pre-fabricated equipment systems had potential safety issues that would cause not only system failure, but also fires and electrocution. The settlement included an agreement to make extensive repairs to existing systems.