Litigation News

Ambulance Service Settles FCA Allegations for $1.25 Million

Hart to Heart Ambulance Service d/b/a Hart to Heart Transportation Services will pay $1,250,000 to settle False Claims Act allegations relating to medically unnecessary ambulance transport. The ambulance service and its billing affiliate allegedly submitted false claims to Medicare between January 2, 2010 and December 31, 2017 for patients who could have been transported by wheelchair van or other means, rather than via ambulance.

The qui tam lawsuit was originally filed by a former Hart to Heart employee, and the complaint contained several employee accounts regarding management’s directions to falsify records to ensure Medicare reimbursement. The employee will receive approximately $251,000 from the settlement with Hart to Heart.

The USAO press release is here. 

DOJ Unseals Indictment Alleging $7 Million TRICARE Fraud Scheme

Two physicians and two registered nurses in Mississippi were indicted on allegations that they engaged in a multimillion dollar scheme to defraud TRICARE. The 15-count indictment alleges that the four providers prescribed and dispensed compounded medications, some of which included ketamine, a controlled substance, that were medically unnecessary, and often times were prescribed without first examining the patient. The medically unnecessary prescriptions were allegedly compounded by an Ocean Springs, Mississippi compounding pharmacy.

According to the indictment, TRICARE and private health care benefit programs reimbursed the compounding pharmacy more than $7 million between March 2014 and February 2015 for dispensing the medically unnecessary prescriptions. Additionally, the two physicians allegedly were paid portions of the reimbursements in return for prescribing the compounded medications.

The DOJ press release is here.

$1.5 Million Home Health Care Kickback Scheme Lands Michigan Patient Recruiter in Jail

A Michigan patient recruiter was sentenced to 60 months in prison for her participation in a kickback scheme relating to home health care. From 2009 to 2012, the recruiter referred Medicare beneficiaries to home health agencies operated by her co-conspirators in exchange for kickbacks. The co-conspirators in turn submitted false claims to Medicare for services that were never provided to the beneficiaries, defrauding Medicare of approximately $1.5 million. The recruiter has been ordered to pay the $1.5 million in restitution.

The DOJ press release is here.