Here are six cases centering on False Claims Act violations, as reported by Becker's since Oct. 2:
1. Sherman, Texas-based Arlington Ophthalmology Association, operating as Kleiman Evangelista Eye Centers, agreed to pay nearly $3 million to resolve False Claims Act violations. Kleiman allegedly offered paid kickbacks to optometrists who referred patients to its facility for cataract surgeries. The system was accused of regularly engaging in co-management of cataract surgery patients with optometrists who referred patients to them.
2. Tampa, Fla.-based pain management physician Edward Lubin, MD, agreed to pay $1.5 million to resolve allegations he submitted medically unnecessary claims for fentanyl prescriptions in exchange for kickback payments. Dr. Lubin allegedly accepted around $159,580 in kickback payments from fentanyl-spray manufacturer Insys in return for prescribing their products and caused more than 400 false claims submitted to Medicare and Tricare programs, which paid more than $4 million for these claims.
3. Internal medicine physician Charles Adams, MD, and his Ringold, Ga.-based medical practice were ordered to pay more than $27.5 million for submitting false claims to Medicare for chelation therapy reimbursements. From November 2008 to September 2015, Dr. Adams administered the drug edetate calcium disodium for a wide range of conditions not recognized as treatable using that drug. Medicare reimbursed more than $1.1 million for the medically unnecessary treatments.
4. Health insurer Cigna was ordered to pay more than $172 million to settle claims that it submitted false diagnosis codes to Medicare Advantage. Cigna promised to enter a corporate integrity agreement for five years with HHS' Office of Inspector General. A recent audit on another major insurer, Aetna, estimates that the payer received at least $25.5 million in overpayments in a one-year period.
5. The Supreme Court denied a request to review a circuit court's decision on a case outlining when a provider's claim for reimbursement results from a violation of the Anti-kickback Statute for purposes of liability under the False Claims Act. The circuit court case questioned whether a hospital's decision not to hire an ophthalmologist in return for a general commitment of continued surgery referrals from another ophthalmologist fell under the anti-kickback rule.
6. South Carolina physician Moustafa Moustafa, MD, and his practice will pay $585,540 to resolve False Claims Act allegations that they received illegal kickbacks for referring patients for laboratory testing. Dr. Moustafa and his practice allegedly received thousands of dollars in remuneration from a clinical laboratory in Anderson, S.C., in exchange for referrals.