INDIVIDUAL PROVIDERS
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
The founder of a nonprofit organization that provides services to developmentally disabled individuals, including Medicaid beneficiaries, agreed to pay $220,000 to resolve allegations that his organization submitted cost reports to the state that claimed as allowable expenses millions of dollars that was not spent on providing care to disabled individuals, but instead spent on for-profit companies owned by them, on salaries for his family members and on his personal expenses. The founder agreed to never work for or accept payments from any entity that receives reimbursement from federal healthcare programs and entered into a 15-year voluntary exclusion agreement with HHS-OIG. 153 A medical sales representative agreed to pay $100,000 to resolve allegations that he sold electro-acupuncture devices to providers, knowing that they would bill Medicare for procedures involving surgical implantation of devices instead of the non-surgical use of the electro-acupuncture devices. 154 The founder, former CEO and medical director of an ENT practice agreed to pay $3 million to settle allegations that, in exchange for kickback payments from a medical device company, he directed the practice's physicians to use the medical device company’s products and to increase the number of sinus surgeries requiring the company’s products. The medical device company entered into a separate settlement regarding these allegations. This settlement also resolved allegations that the former CEO directed the practice’s physicians to order toxicology and genetic tests from a now-defunct laboratory, regardless of medical necessity, in exchange for the laboratory paying “commissions” to the clinic equaling 50% of the revenue from these tests. 155 A physician agreed to pay $125,000 to resolve allegations that he prescribed controlled substances in combinations disfavored by the medical community, outside the usual course of a professional practice, and without a legitimate medical purpose, in violation of the CSA, and caused the submission of false claims to Medicare for such prescriptions. The physician also agreed to forfeit his medical license and prescribing privileges. 156
Henry Alfonso Coley
11/24/2021
$220,000
Matthew Thibaut
$100,000
12/1/2021
Dr. Jeffrey M. Gallups
12/8/2021
$3 million
Dr. James J. Cole
$125,000
12/10/2021
153 https://www.justice.gov/usao-sdny/pr/us-attorney-files-civil-fraud-lawsuit-against-non-profit-and-settles-fraud-claims. 154 https://www.justice.gov/usao-sdtx/pr/cypress-medical-sales-representative-agrees-settle-allegations-regarding. 155 https://www.justice.gov/usao-ndga/pr/dr-jeffrey-m-gallups-and-entellus-medical-agree-pay-42-million-resolve-false-claims-act. 156 https://www.justice.gov/usao-ndny/pr/former-albany-physician-pays-125000-overprescribing-opioids.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 75
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