Medicare Intermediary Quality Control Fraud

BlueCross/Blue Shield of Michigan, the fiscal intermediary for Medicare in Michigan, paid more than $27.6 million to settle qui tam whistleblower claims alleging that it cheated on quality control tests in order to misrepresent the quality of the auditing services it was providing for the Medicare program.

Medically Unnecessary Services (Laboratories)

UroCor, Inc., and Dianon Systems, Inc. medical laboratories, paid $9 million and $4.8 million, respectively, to resolve claims in qui tam whistleblower lawsuits alleging that they billed Medicare for medically unnecessary lab tests that physicians did not know they were ordering.

Medical Device Manufacturer Kickbacks

Blackstone Medical Inc., a medical device manufacturer, and former orthopedic surgeon Patrick Chan, paid $3.3 million to settle allegations in a qui tam whistleblower action that Blackstone paid kickbacks to surgeons who used Blackstone products.

Durable Medical Equipment Fraud

Home Americair of California, Inc., a durable medical equipment company that supplied home oxygen, paid $5 million to the Government to settle claims in a qui tam whistleblower case that it used false records to support claims to Medicare.

Defective Medical Devices

LifeScan, Inc., a medical device manufacturer, paid $30.6 million to settle allegations in a qui tam lawsuit that it sold defective blood glucose monitors to Medicare patients and failed to report adverse events to the FDA.

Radiology Billing Fraud

Drew Medical Center, Inc., a Florida diagnostic radiology company, agreed to pay approximately $1.5 million to resolve qui tam whistleblower claims in a qui tam suit that it systemically charged Medicare for venograms although the company was not performing those procedures.

Medically Unnecessary Radiology Services

Florida radiologist Fred Steinberg paid $7 million to settle qui tam whistleblower claims in a qui tam lawsuit that he billed Medicare for medical imaging tests that were not ordered and were medically unnecessary. The settlement was among the largest recoveries ever for Medicare fraud against a single physician and his practice.

Overcharging Medicare for Emergency Physician Services

Emergency Physicians Billing Service paid over $28.8 million to resolve whistleblower claims in a qui tam lawsuit that it systematically overcharged Medicare for emergency physician services. The settlement followed a trial conducted by qui tam attorney Mr. Vogel, co-counsel, and government counsel that established the defendant’s liability under the False Claims Act.

Ambulance Transport Fraud

Adventist Health System Sunbelt Healthcare Corporation, a hospital system, paid $8.7 million to resolve whistleblower claims in a qui tam case that it overcharged Medicare for costs of ambulance services.

Medically Unnecessary Services (Nursing Home)

Extendicare Health Services, Inc., a nationwide nursing home chain, paid $10 million to settle qui tam whistleblower claims that the company’s skilled nursing facilities were providing patients with unnecessary rehabilitation therapy services for the sole purpose of obtaining higher reimbursements from Medicare. Extendicare paid VSG client Tracy Lovvorn an additional $990,000 in settlement of her claims for unlawful retaliation and attorney’s fees.

Hospital Kickbacks for Patient Referrals

HCA, Inc., the nation’s largest hospital chain at the time, paid $225.5 million to resolve claims by multiple qui tam whistleblowers that HCA unlawfully paid kickbacks to physicians, and violated the federal “Stark” law, to induce physicians to refer patients whose care would be billed to federal health programs.

Hospital Cost Report Fraud

Tenet Healthcare, Inc., operator of the nation’s second largest health care chain at the time, paid more than $900 million to settle claims in multiple qui tam whistleblower lawsuits that it had over-billed Medicare through use of an overstated “cost-to-charge” ratio that inflated “outlier” and other cost-based payments sought by this hospital chain.