January 22, 2013

162017_132140396847214_292624_nThe U.S. Attorney’s Office for the Eastern District of Michigan has filed its Annual Report for 2012 (“Annual Report”) that highlights some of its activities and accomplishments during 2012. The Annual Report included the following health care fraud actions undertaken during 2012 by the Eastern District of Michigan:

In United States v. Patel, six defendants including five pharmacists were convicted at trial for their role in a $37 million drug distribution and health care fraud scheme. Defendants billed Medicare, Medicaid, and private insurers for drugs that were never provided or were medically unnecessary. Patients would receive Oxycodone, Vicodin, and Xanax as kickbacks in exchange for their personal insurance information. The lead defendant owned or controlled more than 20 pharmacies in metro-Detroit.

In United States v. Sharma, four individuals were charged in a $23 million scheme to defraud Medicare by submitting fraudulent claims for home health care and psychotherapy services. The defendants subjected patients in adult day care to unnecessary psychotherapy sessions.

In United States v. Shah, owners of a home health care company were charged with submitting $8.8 million in fraudulent billings to Medicare for services that were not provided or were medically unnecessary and paying cash kickbacks to patients in exchange for their personal Medicare information.

In United States v. Agbebiyi, a physician was sentenced to five years in prison for committing $5 million in Medicare fraud by subjecting patients to unnecessary and potentially dangerous neurological testing.

In civil matters, a $7.9 million settlement was reached with the Walgreens pharmacy chain to resolve claims that it violated the False Claims Act when it offered illegal inducements in the form of gift cards to beneficiaries of government health programs, such as Medicare, to transfer their prescriptions to Walgreens.

A $6 million settlement was reached with the owners of a Troy laboratory and an associated billing firm in Tennessee to resolve claims that they violated the False Claims Act by billing Medicare $900 per patient for testing that doctors had not ordered.

A $3 million settlement was reached with 14 physicians or physician groups and a radiology testing company to resolve allegations that the company paid kickbacks to the physicians for patient referrals under the guise that the payments were for test supervision or rent.

In Bazzo v. United States, the government prevailed in a medical malpractice case involving a federally funded health center. The U.S. Court of Appeals for the Sixth Circuit affirmed the decision.


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