Taylor Bean & Whitaker Mortgage Corp. and Home America Mortgage, Inc. (N.D. Ga.)
This $320 million settlement with a mortgage originator and loan processor resolved allegations that they hid or falsified data related to borrower eligibility on government-backed home loans. When thousands of these individuals inevitably defaulted on loans they could not afford, the federal government picked up the tab, resulting in hundreds of millions in payments for loans that never should have been permitted in the first place.
Air Ideal, Inc. (M.D. Fla.)
Businesses in Historically Underutilized Business Zones (HUBZones) receive special certifications to be used in bidding on government contracts, and in some cases, bids are restricted to HUBZone-certified companies. This government contractor settled allegations that it falsely certified being in a HUBZone via a virtual office with no actual employees.
Dennis Jaffe, D.M.D. (N.D. Ga.)
Our relator alleged that her dentist employer submitted false claims to Medicaid for services not provided, such as by performing simple extractions and billing for complicated surgeries, billing for multiple tooth extractions when performing only one, and having a dental assistant perform procedures on days he was not in the office. Dr. Jaffe also pleaded guilty to criminal charges and surrendered his license.
Guardian Hospice (N.D. Ga.)
To be covered by Medicare, hospice services require a terminal prognosis of six months or less. This Atlanta hospice care provider paid Medicare $3 million to settle allegations that it enrolled and billed for non-terminal patients that did not qualify for hospice services, including some who received hospice services for years before being disenrolled.
Hospital Authority of Irwin County (M.D. Ga.)
The hospital employee relators alleged that the hospital and various physician contractors violated the Anti-Kickback Statute and Stark Law by engaging in unlawful compensation agreements, including both payment agreements and office leases.
Signal Mountain Pharmacy (E.D. Tenn.)
The Chattanooga-based compound pharmacy was alleged to have submitted false claims to Medicare for non-covered bulk product ingredients, while billing for brand-name pills.
Southern Spine & Pain (N.D. Ga.)
Our relators—a nurse practitioner and front office worker—alleged that the owner of this pain management practice required patients to agree to medically unnecessary and undocumented procedures in exchange for prescription pain medications.
Toccoa Clinic Medical Associates, LLC (N.D. Ga.)
The north Georgia dermatology practice settled allegations that it performed and billed for medically unnecessary procedures, billed office (E/M visits) on the same days as procedures, and upcoded certain therapies and office visits, repaying the federal government $1.9 million.
Nashville Pharmacy Services, LLC (M.D. Tenn.)
The Nashville-based AIDS specialty pharmacy settled allegations that it defrauded Medicare and TennCare by automatically refilling medications with patient approval, waiving copayments (a violation of the Anti-Kickback Statute), billing for medications that were dispensed after patients had died, and billing for medications without a valid prescription.
Georgia Pediatric Cardiology (N.D. Ga.)
Our relators—an office manager and a pediatric echocardiographer—alleged that this pediatric cardiologist upcoded his claims to Medicare and Medicaid by, among other allegations, billing for more expensive scans than were actually performed.
William Beaumont Hospitals (E.D. Mich.)
This $84.5 million settlement resulted from allegations that a hospital chain engaged in unlawful agreements with its providers in order to ensure that it received their patient referrals, in violation of Anti-Kickback Statute and Stark Laws.
Lake Country Pharmacy (M.D. Ga.)
The Athens-area compound pharmacy and its owners settled claims brought by a former pharmacist that it was alleged to have submitted false claims to Medicare, Medicaid, and TRICARE by using non-reimbursable bulk powders in its compounds but billing for brand-name tablets.
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.
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.
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.
Radiotherapy Clinics of Georgia LLC (N.N. 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.
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.
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.
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.
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.