FY 2007 FCA Fraud Settlements

FY 2007 FCA Fraud Settlements:

'via Blog this'As of October 01, 2007

FY 2007 False Claims Act Settlements

The cases below represent a "running tally" of False Claims Act cases compiled by the Taxpayers Against Fraud Education Fund for Fiscal Year 2007.

• To compare these results to last year's statistics >> click here
  

Company	Amount in Millions $	Date	Nature of the fraud	Medicare	Medicaid
Bristol-Myers Squibb	328	9/28/2007	A total $515 million settlement, with $328 million to be paid under the Federal False Claims Act, and the state's getting $187 million. Fraud charges included off-label marketing, kickbacks, AWP drug pricing violations and several other frauds involving 50 drugs and a total of seven qui tam cases.	X	X
Amerigroup	172	3//14/2007	Judgment for $334 million including penalties. Amerigroup cherry-picked patients in violation of its HMO Medicaid contract, purposely avoided women in their third trimester of pregnancy because they cost more to insure. Note that this judgment is on appeal and reflects a $190 million penalty on top of a $144 million jury verdict.
Combined settlement with four orthotics companies: Smith & Nephew, Biomet, Zimmer, DePuy (Johnson & Johnson)	310	9/27/2007	$310 million total settlement of broad practice of kickback in the orthotics industry. Zimmer to pay 169.5 million, DePuy to pay $84.7 million, Smith and Nephew to pay $28.9 million, Biomet to pay $26.9 million. Stryker agreed to be monitored, but has entered no civil settlement.
Aventis (sanofi-aventis)	180	9/17/2007	Medicaid Average Wholesale Price case involving the anti-nausea drug Anzemet. Total settlement was for $190 million
Medco	155	10/24/2006	Shorting prescriptions, canceling prescriptions to avoid paying non-performance penalties, soliciting and accepting kickbacks from pharmaceutical manufacturers to favor their drugs, and paying kickbacks to health plans to obtain business.	X	X
Purdue Pharma	140.5	5/10/2007	Company "mislabeled" the drug saying it was less addictive than it was. This is a $634.5 million settlement, with $276 million to be forfeited to the United States, $160 million allocated to federal and state government agencies to resolve false claims for government healthcare programs and $130 million will go to resolving private civil claims. Of the 160 million to go to State and Federal FCA claims, $19.5 million is to go to the states.
Bill L. Harbert-owned construction companies	102	5/15/2007	Bid rigging for US AID paid for water and sewer systems installed in Egypt in the 1980s as part of the Camp David peace accords.
Oracle / PeopleSoft	98.5	10/10/2006	Provided false pricing information to GSA to obtain a federal contract.
ConocoPhillips	97.5	8/15/2007	Underpaid royalties owed on natural gas produced from federal and Indian leases
Omnicare / Specialized Pharmacy Services (Michigan)	52.5	10/5/2006	Improper billing, failure to credit Medicare for returned drugs, billing drugs for dead patients.		X
Omnicare	49.5	11/14/2006	Illegal switching of generic pill to capsule forms of Zantac (ranitidine) in nursing homes and other facilities.
InterMune, Inc.	36.8	10/27/2006	Illegal off-label promotion of Actimmune.	X	X
Lourdes Perez, Provident Home Health Care Services Inc. and Tri-Regional Home Health Care Inc.	33.8	10/11/2006	Medicare "bill mill" in which Medicare was billed for patients who were not homebound and for services her companies did not perform, creating false medical records to support the claims.	X
Maximus Inc.	30.5	7/24/2007	Maximus billed DC Medicaid for targeted case management services that it either did not provide or had no records for.
Kerr-McGee Oil	30	1/25/2007	Jury verdict on case involving Kerr-McGee cheating the government out of millions of dollars in royalties on oil it produced in publicly owned coastal waters.
Robert I. Bourseau, Dr. Rudra Sabaratnam, and their two single-employee corporations, RIB Medical Management Services, Inc., and Navatkuda, Inc.,	23.8	10/2/2006	Used false cost reports to bill Medicare for unreimbursable services at the Chula Vista psychiatric hospital formerly known as Bayview Hospital & Mental Health Systems.	X
Akal Security Inc	18	7/13/2007	Akal violated terms of its contract to provide trained civilian guards at eight U.S. Army bases.
Harris County Hospital District	15.5	3/28/2007	Medicare Secondary Payer violations plus billing Medicaid for patients under custody of law enforcement.
Larkin Community Hospital in Miami and its current and former owners, Dr. Jack Michel, Dr. James Desnick, Morris Esformes and Philip Esformes	15.4	11/30/2006	Kickbacks	X	X
Aggregate Industries	15	7/27/2007	Total settlement of $50 million, of which $27 million will go into a special fund to be used to pay for future maintenance and repair of the Big Dig highway project, and an additional $8 million will be paid in criminal fines.
Jackson Memorial Health System	14.25	12/20/2006	Jackson Memorial was deliberately making use of unallowable or reopened cost reports, getting wrongful overpayments as a result.	X
Ajax Paving Industries Inc. and Dan's Excavating Inc.	11.75	3/16/2007	Knowingly violated Disadvantaged Business Enterprise (DBE) contracting requirements for federally funded construction projects at Detroit Wayne County Metropolitan Airport
Cell Therapeutics	10.5	4/18/2007	Off-label marketing of Trisenox billed to Medicare.
Intergris Baptist Medical Center	10	11/28/2006	Inflated costs for organ transplants
Emory Worldwide	10	11/14/2006	Inflated bills for handling priority mail for USPS
Medicis Pharmaceutical	9.8	5/8/2007	Off-label marketing: Company promoted the use of a topical anti-fungal, Loprox, for diaper rash on children under the age of 10, without approval by the Food & Drug Administration.
American Medical Response Inc.	9	10/5/2006	Ambulance services fraud.	X
KBR Inc.	8	11/29/2006	Overcharged the U.S. Army for logistical support in the Balkans during 1999 and 2000
Crane Co.	7.6	8/14/2007	Substandard valves sold to the U.S.
SCCI Health Services Corporation, and its subsidiary, SCCI Hospital Ventures Inc	7.5	1/7/2007	Kickback and self-referral (Stark violations)	X
Raritan Bay Medical Center	7.5	3/16/2007	Purposefully inflated outlier charges for inpatient and outpatient care to make these cases appear more costly than they actually were.
PBSJ	6.4	1/25/2007	PBSJ submitted claims to the overstated overhead rates in its Government contracts.
Atlanta's Northside Hospital	5.75	10/20/2006	Kickbacks
Oakland City University	5.3	7/31/2007	University paid incentives to admissions recruiters contrary to federal regulations.
IBM & PriceWaterhouseCoopers	5.2	8/16/2007	Companies solicited and provided improper payments and other things of value on technology contracts with government agencies
Keystone Mercy Health Plan	5	10/27/2006	Medicaid HMO Kept Medicaid overpayments		X
Cook County, Illinois	5	12/20/2006	County mismanaged a federally funded study involving pregnant drug addicts.
AIT Worldwide Logistics of Itasca, Ill.	4.2	10/20/2006	Kickbacks and bill padding.
St. Elizabeth Regional Medical Center (NE)	4	10/31/2006	Used false cost reports to overbill l Medicare for neonatal and burn units.
Scooter Stores	4	5/14/2007	Settlement includes $4 million in cash and $13 million in foregone Medicare payments to settle charges the company billed Medicare medically unnecessary power wheelchairs.
HealthSouth Corporation	4	11/3/2006	HealthSouth submitted fraudulent Medicare claims for prosthetic and orthotic devices - such as artificial limbs and braces - used to treat HealthSouth hospital inpatients	X
Our Lady of Lourdes Regional Medical Center	3.8	5/9/2007	Billing Medicare, Medicaid and private insurance providers $2.5 million for unnecessary cardiac procedures, such as angiograms and angioplasties, on more than 70 patients.
Orphan Medical/ Jazz Pharmaceuticals Inc	3.75	7/13/2007	Aggressive marketing of Xyrem (GBH, the "date rape" drug) for unapproved use. Part of a total settlement of $20 million, including criminal.
Cabrini Medical Center	3.4	3/29/2007	Kickbacks billed as administrative services for referral of patients.
Korrect Optical	3.25	1/25/2007	Korrect Optical submitted false claims to the Department of Veteran Affairs ( VA )through ophthalmic prescriptions for eyewear for veterans.
Dr. Daniel Nixon and other board members of the Institute for Cancer Prevention, Tatum, LLC and Weiser, LLP	3.2	1/17/2007	Unlawful receipt and use of federal grant money.
Electronic Data Systems Inc. and Travelers Casualty	2.85	1/23/2007	EDS was processing National Flood Insurance Program claims based on backdated policies written by Travelers.
Dey	2.8	4/26/2007	Settle charges of price inflation and defrauding Mass. Medicaid program (AWP).
Rural/Metro Corporation	2.5	6/11/2007	Kickback for referrals
David Rommel	2.48	11/13/2006	Dental practice fraud. Won by summary judgment.
Danbury Hospital (CN)	2.4	10/27/2006	Self-reported upcoding for septicemia, respiratory failure, respiratory infections and inflammations.	X
Affiliated Computer Services, Inc	2.3	7/2/2007	ACS allegedly Submitted inflated claims for programs run by and through the U.S. Department of Agriculture (USDA), the U.S. Department of Labor (DOL), and the Administration for Children and Families of the U.S. Department of Health and Human Services. Self reported.
APAC Atlantic	2.25	10/3/2006	False asphalt testing
University of Miami Medical School	2.2	12/27/2006	UM sometimes billed for critical care services when patients were not critically ill or where critical services were not rendered.	X	X
Loma Linda Behavioral Medicine Center (Loma Linda BMC) in Redlands	2	4/26/2007	Fraudulently overbilled federal health insurance programs by manipulating cost reports.
O'Hara Regional Center for Rehabilitation, Health Care Management Partners, ORCR Inc., Solomon Health Management, Solomon Health Services	1.9	10/5/2006	Abuse and neglect and substandard nursing home services.		X
Emeritus Corp	1.86	8/30/2007	False and inaccurate billing to the Texas Medicaid program.
COSMOS Corp	1.5	1/23/2007	COSMOS improperly charged government contracts for costs that dealt with the company's operations, and also shifted labor costs from private contracts to government contracts.
Crawford and Company	1.36	10/11/2006	Billing the government for health care services to federal employees at rates set by Crawford managers, rather than billing the actual time spent performing that service.
Ciena Healthcare Management	1.25	8/20/2007	Improperly billed Medicaid and Medicare for inadequate care of and services to residents at four metro Detroit nursing homes.
Bli Farms, Richard Bli and the estate of James E. Bli	1.229	11/29/2006	False crop insurance claims.
Lancaster Community Hospital	1.2	6/8/2007	Knowingly overbilled Medicare for physical therapy costs.
Lakewood Cheder School	1.2	10/31/2006	False information to obtain funds for preschool lunch program.
Robert E. Eberhart and Jonathan Holzaepfel, orthopedic surgeons and partners in Seacoast Trust, and Thomas King	1	3/8/2007	HealthSouth paid higher than normal rent equivalent to income from referrals made by the doctors
Parkway Hospital, Inc	1	8/14/2007	Inflated hospital costs reports.
Environmental Management Inc.	1	4/2/2007	Overbilling and illegal disposal of chemicals in methamphetamine lab cleanups for DEA.
Dey	1	4/4/2007	Settlement of Hawaii FCA marketing the spread cases
Julio C. Melo, M.D.,	0.984	7/23/2007	Billed Medicare for Evaluation and Management services that exceeded the number of hours there were in a day.
RightCHOICE Managed Care Inc.	0.975	1/31/2007	RightCHOICE paid higher fees to physicians serving government0insured patients than for other plans.
Comprehensive Cancer Centers	0.9	11/8/2006	Upcoding led to overbilling of Medicare for CCC services at Desert Regional Medical Center (owned by Tenet)	X
Iftakhar Khan and Amjad Khan	0.825	1/9/2007	Owners of Livonia-based Michigan Rehabilitation and Pain Management fraudulently billed Medicare.	X
Green Valley Pavilion, LLC	0.55	5/14/2007	Forging and altering patient charts to maximize reimbursement from Delaware's Medicaid Program
Oregon Imaging Center	0.51	12/12/2006	Tests not ordered by doctor.
Moritz Embroidery Works	0.5	7/10/2007	False "Buy American Act" certification to the United States government for military and police emblems and patches.
John Dempsey Hospital	0.475	6/27/2007	Overbilled Medicare for chemotherapy treatment.
Colquitt Regional Medical Center	0.475	3/5/2007	Overcharged the government for services through CRMC's Home Health Office in Sylvester, GA	X	X
Hillsboro Area Hospital, in Hillsboro, Ill.	0.3	2/7/2007	Over billing for the treatment of Medicare beneficiaries who were diagnosed with pneumonia, sepsis, and renal failure.	X
Beacon Ambulance Company.	0.219	3/29/2007	Use of one basic technician and a single Paramedic on ambulance run, and billing for two Paramedics.
Promark, Inc.	0.2	11/14/2006	Overstating warranty on epoxy paint to DoT
Riverview Cancer Center	0.165	10/5/2006	Upcoding and services not provided
LS Technologies	0.145	3/16/07	Submitted duplicate claims for two different subcontracts and was paid $50,000 based on these false claims.
Madison County, Alabama	0.11	2/19/2007	Diversion of money from "Working Connection," a welfare-to-work program.
Kansas City, Missouri School District	0.066	5/18/200	66,000 paid in money and over $13.6 in claims relinquished in E-Rate fraud case.
Armstrong Williams	0.035	10/22/2006	Failing to do contracted work for Dept. of Education
Dr. Roberto Ramirez	0.03	12/21/2007	False dental billing	X	X
Clark's Trading Company (Clark's	0.012	10/18/2006	Product substitution (meat) at Federal Bureau of Prisons
TOTAL	2117.20