samuel-zeller-360588-copy-200x300Two California urologists, Dr. Aytac Apaydin and Dr. Stephen Worsham, have agreed to pay $1.085 million based on allegations of violating the False Claim Act, the Anti-Kickback Statute, and Stark Law, which prohibits physician self-referral, between April 2008 and December 2014.

Apaydin and Worsham currently own and run Salinas Valley Urology Associates. They also owned the Advance Radiation Oncology Center (AROC), which was shut down in 2016. The physicians were accused of submitting and causing to be submitted false claims to Medicare in relation to image guided radiation therapy (IGRT), which is used to treat cancer patients at AROC. The claims were false based on the fact that the services arose from illegal kickbacks and self-referrals.

An Illegal Referral and Kickback Scheme

hush-naidoo-382152-copy-300x200Scripps Health, a San Diego-based health care system, will pay $1.5 million to resolve allegations of False Claims Act (FCA) violations. Scripps is accused of seeking reimbursements from federal health care programs for physical therapy services rendered by therapists who lacked billing privileges.

If you have any information regarding an individual or business within the health care industry providing the government with incorrect claims in order to increase their reimbursements, then contact a San Francisco health care fraud attorney at Brod Law Firm right away. You may have the right to bring a claim under the FCA or take your information to the proper authorities.

Unauthorized Physical Therapists

vladimir-kudinov-71455-copy-300x241On January 12, the former owner of Pacific Hospital in Long Beach, California was sentenced to 63 months in prison. The owner, Michael D. Drobot, 73, was charged with crimes related to running a 15-year health care fraud scheme. In 2014, he pleaded guilty to conspiracy and paying illegal kickbacks to physicians. In addition to the prison sentence, Drobot has been ordered to liquidate numerous assets in order to forfeit $10 million to the government and pay a $500,000 criminal fine. A restitution hearing is scheduled for May 11, which may result in additional financial consequences for Drobot.

Owner Created Massive Kickback Scheme

Between 1997 and 2013, Drobot created a scheme in which he would bill workers’ compensation insurers for spinal surgeries performed on patients who had been referred by physicians who received illegal kickbacks from Drobot for sending patients to his facility. Drobot had dozens of physicians, chiropractors, and others involved in sending patients to his hospital for services in exchange for illegal payments.

jonathan-perez-409943-copy-300x200Kmart Corporation, a subsidiary of Sears Holding Corporation, will pay the federal government $32.3 million to settle allegations of violations of the False Claims Act. A whistleblower alleged that Kmart stores did not report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, thereby receiving larger reimbursements than it was entitled to.

Kmart Wrongdoing Exposed by Whistleblower

In 2008, pharmacist James Garbe filed a qui tam suit under the FCA against Kmart. He alleged that Kmart pharmacies offered discounted generic drug prices to customers who paid cash through various programs, yet knowingly failed to disclose those prices to federal health programs. Instead, between 2004 and 2016, it reported to Medicare, Medicaid, and TRICARE its customary prices for drugs, which were then used to establish reimbursement rates. The incorrect claims lead to Kmart receiving higher reimbursements than the business was entitled to.

josh-appel-423804-copy-300x225The operator and two employees of a former medical supply company in Hawthorne and Ventura, California have been arrested by special agents of the U.S. Department of Health and Human Services’ Office of Inspector General and the Federal Bureau of Investigations (FBI) for health care fraud. The allegations state that the three individuals fraudulently charged Medicare for more than $24 million in unnecessary power wheelchairs and repairs.

The Defendants

The three individuals arrested for this healthcare fraud scheme were:

hush-naidoo-382152-copy-300x200In December, California’s Division of Workers’ Compensation (DWC) announced it suspended 37 medical providers’ from being part of the state’s workers’ compensation system due to fraud. 21 suspensions were announced on December 4 and 16 additional suspensions were announced on December 21, bringing to the total suspensions for the year to 131. Many of these suspensions arise after being convicted of health care fraud or after a physician loses their medical license.

Suspended Medical Providers

The DWC suspended the following physicians due to fraud or other illegal acts:

vladimir-kudinov-71455-copy-300x241Physicians Vilasini Ganesh, 47, and Gregory Belcher, 56, were convicted in December of committing health care fraud and making false statements to health care programs. A federal jury found Ganesh guilty of five counts of health care fraud and five counts of making false statements relating to fraudulently submitted claims. Belcher was found guilty of one count of making a false statement regarding a health care benefit program. Both were acquitted of conspiracy and money laundering charges.

Health Care Fraud and False Statements

Evidence presented at trial showed Ganesh, who was the head of Campbell Medical Group, submitted false and fraudulent claims to several health benefit programs for services. She submitted claims for days when patients had not seen a health care provider and claims that patients had been seen by another physician who was no longer with her practice.

hush-naidoo-382152-copy-300x200In mid-December, a federal jury found Ronald Grusd and two corporations, California Imaging Network Medical Group and Willows Consulting Company, guilty of fraud and bribery related to a health care fraud scheme involving California’s Workers’ Compensation program. More specifically, the jury was found guilty of Conspiracy, Honest Services Mail and Wire Fraud, Health Care Fraud, and violations of the Travel Act. Grusd, the companies, and his administrator, Gonzalo Paredes, were indicted by a federal grand jury in November 2015. Grusd will return for sentencing in March 2018. Paredes is to return to court for a hearing regarding a retrial in January 2018.

Grusd’s Health Care Scheme

Grusd and his two companies paid kickbacks to multiple clinics in San Diego County and Imperial County for patient referrals. The purpose of these illegally obtained patient referrals was to fraudulently bill insurers more than $25 million in medical services.

piron-guillaume-96228-copy-300x200On November 28, the U.S. Department of Justice (DOJ) announced a $1.2 million settlement with Cardiovascular Consultants Heart Center, known as CVC Heart Center, and its shareholder physicians. CVC Health Center is a cardiology clinic with offices in Fresno and Clovis, California.

The CVC Heart Center along with Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory, and Dr. William Hanks resolved state and federal False Claims Act (FCA) allegations based on their allegedly performing medically unnecessary tests and billing state and federal health care programs for them.

If you are aware of any medical false billing to a California or federal health care program like Medicare or Medi-Cal, contact the San Francisco health care fraud lawyers of Brod Law Firm right away. You may have information that would be important to the authorities. You may also have standing to bring a qui tam suit on behalf of a state and/or federal government.

osman-rana-193633-copy-300x169The U.S. Department of Justice announced on November 28 that two former health care employees pleaded guilty to Medicare fraud. Aharon Aron Krkasharyan, 53, was employed as a quality improvement coordinator at Mauran Ambulance Inc., a Los Angeles area ambulance company that provided non-emergency services to Medicare patients. Maria Espinoza, 47, was an administrative assistant at DaVita Doctors Dialysis of East Los Angeles.

Both pleaded guilty to fraud charges for a scheme that caused $6.6 million in fraudulent claims to be submitted to Medicare. They are scheduled to be sentenced in the spring of 2018.

If you have any information regarding a similar Medicare or Medi-Cal kickback or fraudulent claim scheme, you should contact a San Francisco health care fraud attorney from Brod Law Firm right away. You may be able to bring this illegal activity to state and federal authorities’ attention or to file a False Claims Act (FCA) qui tam suit yourself, potentially benefiting from a jury award or settlement.