Home Health Agency Operator Agrees to Pay $17 Million to Resolve False Claims Act Allegations

Friday Enforcement Wrap

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Home Health Agency Operator Agrees to Pay $17 Million to Resolve False Claims Act Allegations

A group of New Jersey home health care companies (collectively, the BAYADA Companies), have agreed to pay $17 million to resolve claims that they violated the False Claims Act and Anti-Kickback Statute. The BAYADA Companies are alleged to have purchased two home health agencies from a retirement home operator in order to induce it to send Medicare patients staying at its retirement homes to BAYADA. BAYADA is also alleged to have submitted false claims for payment to Medicare for services provided to beneficiaries referred to BAYADA as a result of the kickback scheme.

As part of the resolution, the former director of strategic growth for BAYADA from 2009 to 2016 will receive more than $3 million under the whistleblower provision of the False Claims Act that allows a private party to file a civil action on behalf of the United States and receive a portion of any recovery.

The DOJ press release can be found here.

Former NFL Players Plead Guilty to Health Care Fraud Scheme

Clinton Portis, Tamarick Vanover, and Robert McCune pleaded guilty for their alleged roles in a scheme to defraud a health care benefit program for retired NFL players that provides for a tax-free reimbursement up to $350,000 of out-of-pocket medical care expenses incurred by former players, their spouses, and dependents. In total, the scheme is alleged to have led to approximately $2.5 million in benefits being paid out on claims submitted between June 2017 and April 2018.

According to the government, Portis obtained nearly $100,000 in benefits as a result of the submission of false claims for medical equipment that was not actually provided. Similarly, Vanover obtained about $160,000 in benefits based on fraudulent claims and recruited other former NFL players to participate in the scheme. McCune is alleged to have orchestrated the nationwide scheme.

Portis and Vanover pleaded guilty to conspiracy to commit health care fraud and agreed to pay full restitution. They face up to ten years imprisonment. McCune pleaded guilty to conspiracy to commit wire fraud and health care fraud, 13 counts of health care fraud, 11 counts of wire fraud, and three counts of aggravated identity theft, and faces a maximum penalty of 20 years imprisonment for each count of wire fraud, and two years for each count of aggravated identity theft. The defendants join 12 others who have already pleaded guilty to conspiracy to commit health care fraud.

The DOJ press release can be found here.

Government Brings False Claims Act Suit Against
University of Pittsburgh Medical Center

The United States filed a complaint against the University of Pittsburgh Medical Center (UPMC) and Dr. James Luketich, chair of UPMC’s Department of Cardiothoracic Surgery, alleging violations of the False Claims Act. Specifically, the complaint alleges that UPMC and Dr. Luketich knowingly submitted, or caused the submission of, hundreds of materially false claims to Medicare, Medicaid, and other health benefit programs over the past six years.

The complaint was based on a two-year investigation that allegedly revealed that Dr. Luketich frequently performed multiple complex surgical procedures simultaneously by moving between different operating rooms, failed to participate in critical portions of surgeries, and subjected patients to longer-than-necessary anesthesia time while he performed other surgeries. These alleged actions violate prevailing standards of patient care as well as regulations that prohibit teaching physicians like Dr. Luketich from performing or billing concurrent surgeries. According to the complaint, UPMC was aware of the risks associated with Dr. Luketich’s alleged practices and had warned him about his practices. Despite these risks, UPMC allegedly failed to curtail Dr. Luketich’s actions and prominently featured him in UPMC’s advertising.

The government’s investigation arose out of a whistleblower complaint filed in 2019 by a cardiothoracic surgeon who previously worked alongside the Dr. Luketich. The case is U.S. ex rel. D’Cunha v. Luketich et al., case number 2:19-cv-00495, in the U.S. District Court for the Western District of Pennsylvania.