Kmart Corporation to Pay U.S. $32.3 Million to Resolve False Claims Act Allegations for Overbilling Federal Health Programs for Generic Prescription Drugs

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation (SHC), has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescripti

Miami, FL - Former Florida State Health Care Administration Official Sentenced to More Than Four Years in Prison for Accepting Bribes

A former employee of Florida’s Agency for Health Care Administration (AHCA) was sentenced today to 57 months in prison for accepting bribes in exchange for providing confidential information about health care facilities that received Medicare and Medicaid f

David Sizemore applied for disability benefits from the Social Security
Administration in July 2011, claiming that he was disabled due to diabetes and bipolar
disorder. After his application was denied by an administrative law judge (“ALJ”), who
found that Sizemore was not disabled, and review was denied by the Appeals Council, he
commenced this action in the district court. The di

Pittsburgh, PA - Iserve Technologies, Inc. Pled Guilty in Connection with Guilty Pleas of Former Exec and Manager of Med-Fast Pharmacy Inc.

Individuals and entities associated with Med-Fast Pharmacy, Inc. (“Med-Fast”) have resolved criminal and civil charges associated with Med-Fast’s improper submission of claims to the Medicare and Medicaid programs.

Iserve Technologies, Inc.,

Miami, FL - Owner of Miami Home Health Agency Sentenced to More Than Nine Years in Prison for Role in $15 Million Medicare Fraud Conspiracy

The owner and operator of a defunct Miami, Florida home health agency was sentenced to 115 months in prison on December 11, 2017 for his role in a $15 million conspiracy to defraud the Medicare program.

Yunesky Fornaris, 38, of Miami, was se

On April 23, 2015, a federal grand jury in Alexandria, Virginia, returned a seven
count indictment against the defendants — who were former employees of SunTrust’s
Annandale branch.2 The indictment’s first count charged them with conspiracy to commit wire fraud affecting a financial institution, in contravention of 18 U.S.C. § 1349.3
Counts 2 through 7 made substantive allegations

Part D of the Medicare program is a voluntary prescription drug benefit program that subsidizes the cost of prescription drugs and prescription drug insurance premiums for Medicare enrollees.2 The Part D program operates as a public-private partnership between the Centers for Medicare and Medicaid Services (“CMS”) and government contractors. CMS contracts with private insurance companies called “S

Defendant was a physician specializing in pain management. In 2004, he opened a pain management clinic in Queens. According to the People, the clinic was nothing more than a "pill mill" catering to people who were hopelessly addicted to pain medicine, primarily opioids. The People's evidence showed that, despite having been trained in the wide variety of methods for identifying legitimate pain and

Fresno, CA - CVC Heart Center to Pay $1.2 M to Settle Allegations of Billing Health Care Programs for Medically Unnecessary Nuclear Stress Tests

Cardiovascular Consultants Heart Center (CVC Heart Center), a cardiology clinic with offices in Fresno and Clovis, and its shareholder physicians — Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory, and Dr. William Hanks —

Los Angeles, CA - Former Employees of Southern California Ambulance Company and Dialysis Center Plead Guilty to Medicare Fraud Charges

A former employee of a Southern California ambulance company and a former employee of a Los Angeles dialysis treatment center both pleaded guilty on November 27, 2017 to fraud charges for their roles in a fraud scheme that resulted in more than $6.6 millio

Urbana, IL - Decatur Woman to Serve 18 Months in Prison for Defrauding Home Services Program

A Decatur, Ill., woman, Charissie Davis, was sentenced on November 20, 2017 to serve 18 months in federal prison for defrauding the Home Services Program, a Medicaid waiver program. The health care benefit program provides funding to pay personal assistants who aid qualifying disabled individuals

Tampa, FL - Former Wellcare General Counsel Sentenced For False Statements To The Florida Medicaid Program

Thaddeus M.S. Bereday pleaded guilty on June 26, 2017.

A federal grand jury in the Middle District of Florida returned an indictment on March 2, 2011, charging five former WellCare Health Plans, Inc. (“WellCare”) executives (Todd S. Farha, Paul L. Behrens, William L. Kale, P

We are asked to consider the viability of two potential defenses to an alleged False Claims Act violation that arise in the context of the Medicare Part D Program: the government knowledge inference, which can defeat a finding of scienter in certain circumstances, and the element of materiality.1 The District Court relied upon the government knowledge inference doctrine in dismissing the claims. A

Brooklyn, NY - Operator of Purported Durable Medical Equipment Providers Pleads Guilty to Health Care Fraud Charges for Role in Fraud Scheme

Suzanna Meliksetyan, an operator of multiple purported durable medical equipment (DME) companies pleaded guilty to one count of conspiracy to commit health care fraud for her role in a scheme to defraud Healthfirst, a non-profit, New York-based healt

The issue presented on this appeal is whether Civil Service Law § 167 (8), as amended, authorizing a reduction of the State's contribution to health insurance benefits for State employees, including members of the State judiciary, violates the Judicial Compensation Clause [*2]of the State Constitution (NY Const, art VI, § 25 [a]). We conclude the State's contribution is not judicial compensation p

Artur Hefczyc appeals from an order denying his motion for class certification in
his lawsuit against Rady Children's Hospital-San Diego (Rady). On behalf of a proposed
class, Hefczyc seeks declaratory relief to establish that Rady's form contract, signed by
2
patients or guarantors of patients who receive emergency room care, authorizes Rady to
charge only for the reasonable

Jackson, MS - Mississippi Skilled Nursing Facility, Related Companies, and Executives Agree to Pay $1.25 Million to Settle False Claims Act Allegations of Grossly Substandard Care to Facility Residents

The Department of Justice announced today that Hyperion Foundation, a Georgia not-for-profit entity (Hyperion), Julie Mittleider, a resident of Georgia and Hyperion’s former President, Alta

Abingdon, VA - Coeburn Doctor Pleads Guilty to Health Care Fraud, Distributing Ritalin - Gurcharan Kanwal Agrees to Surrender Medical License; Never Practice Medicine Again

A Coeburn, Virginia doctor, who prescribed Ritalin and hydrocodone to an undercover investigator without a legitimate medical purpose, pleaded guilty on November 9, 2017 to federal health care fraud and drug distribut

The issue presented is whether an adult foster care
provider claiming unjust enrichment may recover the reasonable
value of its services from a defendant who, through
fraud, obtained a lower rate from the provider for the services.
We conclude that, generally, a defendant who obtains
discounted services as a result of fraud is unjustly enriched
to the extent of the reasonab

In 2014, following investigations by the Indiana Attorney General and FBI, a grand jury issued a four-count indictment for Medicaid fraud against defendants Wanda Shorter and her company, Empowerment Non-Emer-gency Medical Transport, Inc. (“Empowerment”). Specifically,
∗ Of the Western District of Wisconsin, sitting by designation.
2 No. 16-2053
Shorter and Empowerment were charg

Kansas City, MO - Chemed Corp. and Vitas Hospice Services Agree to Pay $75 Million to Resolve False Claims Act Allegations Relating to Billing for Ineligible Patients and Inflated Levels of Care

Chemed Corporation and various wholly-owned subsidiaries, including Vitas Hospice Services LLC and Vitas Healthcare Corporation, have agreed to pay $75 million to resolve a government lawsuit all

Dallas, TX - Last Defendant Sentenced in Health Care Fraud Scheme

Cynthia Stiger, 52, of Dallas, Texas, who was convicted in April 2016 of one count of conspiracy to commit health care fraud, was sentenced yesterday by U.S. District Judge Sam A. Lindsay to 120 months in federal prison and ordered to pay $23,630,777.26 in restitution, joint and several with all codefendants to Medicare and

Houston, TX - Former President of Harris County Medical Society and Affiliated Facilities Settle Allegations of Medicare Fraud

Dr. Gurunath Thota Reddy, Memorial Hermann Endoscopy and Surgery Center North Houston, United Surgical Partners International and Digestive & Liver Disease Consultants P.A. entered into an agreement to pay $1,575,000 to settle allegations of Medicare fraud. The cl

Plaintiff and appellant Paul Kendall's second amended complaint asserts several
types of class-wide claims that challenge the billing and collection practices of the health
facility operating an emergency room where he received care, defendant and respondent
Scripps Health (Scripps). As relevant here, Kendall seeks declaratory relief on contract
interpretation theories, and remedi

St. Louis, MO - Former CEO of Benchmark Healthcare Sentenced on Health Care Fraud Charges

John Mac Sells, 53, of St. Peters, Missouri, was sentenced to 41months in prison and ordered to pay $667,201.85 in restitution.

According to court documents, between 2013 and 2016, John Sells was the chief executive officer (CEO) of Benchmark Healthcare of Festus, Inc. (Benchmark), and a nu