The government resolved a number of FCA cases with medical providers in which DOJ alleged that the providers misrepresented services rendered in a manner that increased the reimbursement or permitted the providers to bill for services that were not reimbursable. 61 Such cases included three providers who settled claims that they had improperly billed Medicare and Medicaid for the provision of electro- acupuncture stimulation devices as if the devices had to be implanted surgically when they were not. 62 Finally, there were multiple settlements by individuals relating to medically unnecessary services, including vascular surgeries, diagnostic testing, cardiac procedures and urinalysis testing. 63 In one such case, a cardiologist agreed to pay $6.75 million to resolve claims that he billed
Private equity firms also settled FCA allegations related to causing the submission of false claims. In one such case, H.I.G. Capital, LLC, the private equity owner of a mental health clinic operator, agreed to pay $19.95 million, and two former executives of the clinic operator agreed to pay $5.05 million, to resolve FCA allegations that they knew the clinic operator employed individuals who were unlicensed, unqualified, or otherwise providing services in violation of state Medicaid regulations, and they caused false claims to be submitted to Massachusetts Medicaid by failing to adopt recommendations to bring the operator into compliance. 66 Similarly, Ancor Holdings LP agreed to pay a portion of a $15.35 million settlement to resolve allegations that it caused an ambulatory testing provider in its portfolio to submit false claims by allowing an alleged kickback scheme it learned about through diligence to continue after entering an agreement to manage the provider. 67
The government resolved a number of FCA cases with medical providers in which DOJ alleged that the providers misrepresented services rendered in a manner that increased the reimbursement or permitted the providers to bill for services that were not reimbursable.
for ablations and stent procedures that were not needed and performed by technicians who were not qualified to administer the procedures; he was also accused of falsifying patient records to obscure those facts. 64 OTHER ENTITIES AND PROVIDERS Multiple other entities and providers settled FCA allegations related to causing the submission of false claims. In one notable settlement, electronic health record (EHR) vendor athenahealth, Inc., agreed to pay over $18 million to resolve allegations that it engaged in three marketing schemes in violation of the AKS that caused providers to submit false claims related to federal EHR incentive payments. The vendor allegedly: (1) invited customers and prospective customers to all-expenses-paid “bucket list” events; (2) entered into “Conversion Deals” whereby it paid competitors to refer customers when their products were discontinued, tied to the value and volume of business ultimately converted; and (3) paid fees to customers for each referral that signed up for the product. 65 61 See, e.g. , https://dockets.justia.com/docket/texas/txndce/3:2021cv00157/343353; https://www.justice. gov/usao-md/pr/howard-county-physician-pays-more-660000-resolve-false-claims-act-allegations- fraudulent; https://www.justice.gov/usao-wdtx/pr/healthcare-practitioners-pay-over-1-million-resolve- false-claims-act-liability-arising. 62 https://www.justice.gov/usao-mdtn/pr/united-states-and-tennessee-resolve-claims-three-providers-false- claims-act-liability. 63 https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-announces-resolution-civil-and-criminal- healthcare-fraud-charges; https://www.justice.gov/usao-edmi/pr/cardiologist-dinesh-shah-pays-2-million- resolve-false-claims-act-allegations-relating; https://www.justice.gov/usao-cdil/pr/federal-and-state- authorities-reach-settlement-quincy-medical-group-over-medicare-and; https://www.justice.gov/opa/pr/ texas-pain-management-physicians-agree-pay-39-million-resolve-allegations-relating. 64 https://www.justice.gov/usao-mdfl/pr/orlando-cardiologist-pays-675-million-resolve-allegations- performing-unnecessary. 65 https://www.justice.gov/usao-ma/pr/athenahealth-agrees-pay-1825-million-resolve-allegations-it-paid- illegal-kickbacks.
66 https://www.mass.gov/news/private-equity-firm-and-former-mental-health-center-executives-pay-25- million-over-alleged-false-claims-submitted-for-unlicensed-and-unsupervised-patient-care. 67 https://www.justice.gov/opa/pr/eeg-testing-and-private-investment-companies-pay-153-million-resolve- kickback-and-false.
NOTEWORTHY SETTLEMENTS BASS, BERRY & SIMS | 10
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