Oct. 7, 2005
FY 2005 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 2005.
A total of 99 cases were settled or brought to judgment in FY 2005.
These 99 cases yielded a total of $1,498,824 million in settlements.
Just four cases -- Gambro, HealthSouth, Caremark and GlaxoSmithKline-- represented 61 percent of the settlement revenue.
Of the 99 cases settled or brought to judgment in FY 2005, 48 cases yielded more than $2 million.
To compare these results to last year's statistics >> click here
Company Amount in Millions $ Date Nature of the fraud
Medicare Medicaid Gambro 325.5 12/15/2005 Gambro paid kickbacks to physicians for referrals to the company’s clinics, set up a sham company to feed inflated billings to Medicare, and falsified billing statements to patients to justify compensation for unnecessary tests and services. Gambro also paid a $25 million criminal fine and paid $15 million to resolve state claims. X HealthSouth 325 12/31/2004 HealthSouth billed group physical therapy at individual physical therapy rates and often had unlicensed personnel doing the work.
X GlaxoSmithKline 140 9/20/2005 False pricing of anti-nausea drugs Zofran and Kytril in order to market the spread. GSK also paid $10 million to resolve state claims.
X X Caremark 137.5 9/9/2005 Reselling of drugs by AdvancePCS, acquired by Caremark X Staten Island (N.Y.) University Hospital 76.5 5/19/2005 Medicaid false-billing charges related to a program designed to encourage providers to operate in medically underserved areas
Northrop Grumman 62 3/1/2005 Northrop Grumman fraudulently inflated scrapping claims on the B2 bomber in order to inflate total contract price. Novartis / OPI Properties 44.7 2/16/2005 Novartis / OPI Properties fraudulently billed and marketed enteral nutritional products. X PricewaterhouseCoopers 41.9 6/2/2005 Over-billed the government for travel-related expenses.
Gambro 37.5 9/26/2005 State settlement of Gambro renal care fraud involving kickbacks, unnecessary tests, over billing.
X PolyMedica 35 12/2/2004 Medicare was not reimbursed for packages that were returned to PolyMedica and billed for test strips mailed to people that did not order them. X Harvard University, Andrei Schleifer, Jonathan Hay 31 8/3/2005 USAID contract violation involving work on Russian stock market. Fraud by Shleifer and Hay who worked for Harvard. USAID contract with Harvard. Apria Healthcare 17.6 8/10/2005 Incomplete or inaccurate documentation supporting a portion of the Company’s Medicare billings during the period from mid-1995 through 1998.
X Gold Banc 16 11/19/2004 Gold Banc, a Kansas banking company, charged excessive interest rates and fees on federally guaranteed agricultural loans. Florida International University 11.5 2/15/2005 Florida International University mis-charged costs and over billed under several contracts and grants with the U.S. Department of Energy. These contracts and grants dealt with testing and developing environmental technologies. Wiggins, Kenneth Earl (King Drugs and Pharmacy) 10.5 6/20/2005 Wiggins and pharmacy submitted reimbursement claims to Medicaid and federal employee benefits programs for “free samples” collected and repackaged. OfficeMax 9.8 5/19/2005 OfficeMax agrees to pay $9.8 million to settle charges it submitted false claims when it sold office products to the U.S. Government that were not permitted by a GSA contract that required all covered office products to be made in countries covered by the Trade Agreements Act. Humanscale Corporation (formerly Softview Computer Products) 9 6/30/2005 Failed to disclose current, accurate and complete discount and pricing information to the General Services Administration (GSA). Oracle 8 5/13/2005 Billing for services not provided and keeping the overpayment.
Harlan, Sprague, Dawley Inc. 7.2 3/1/2005 Harlan, Sprague, Dawley Inc., a supplier of genetically pure laboratory mice and rats, sold genetically contaminated stock wrecking untold amounts of medical research. NIH Inter-Tel Technologies 7 1/5/2005 Inter-Tel agreed to plead guilty and to pay fines totaling $8.71 on charges of bid rigging and wire fraud in connection with a program intended to connect schools and libraries to the internet (the E-Rate program). In addition to the $7 million FCA fine, and additional $1.71 million was levied in criminal fines. Omnicare and Upstate Pharmacies in Western NY 6.75 5/16/2005 Billing for drugs never delivered and a wide variety of billing irregularities.
Turner Construction Company 6.6 7/25/2005 Turner received credits for bonds on dozens of federal contracts without passing on the credits to the federal government.
Turner Construction Company 6.6 6/28/2005 Company received credits for bonds on dozens of federal contracts without passing the credits on to the federal government. Arthur D. Little (aka Dehon Inc.) 6.5 3/25/2005 Inflated overhead on government contracts. Providian and Total System Services 6 9/20/2005 Postage rate fraud - claiming a lower postage rate than entitled.
AdminaStar Federal Inc. 6 9/21/2005 Company misrepresented Medicare evaluations and overcharged CMS for claims processing. X PharMerica 5.95 3/29/2005 PharMerica paid a kickback for Medicare and Medicaid contracts and disguised it in the form of an inflated price for a long-term care pharmacy that existed to do only one day’s worth of business. X X Office Depot 4.75 9/19/2005 Sold office supply products manufactured in countries not permitted by the Trade Agreements Act to United States government agencies. Cornell University 4.3 6/21/05 Defrauded government by charging all or too much salary to NIH grant given to university’s Children’s Clinical Research Center even though employees did not do work on grant. U. of Miami 3.9 5/18/2005 U. of Miami double-billed and overcharged Medicaid through several of its outpatient clinics.
Resurgens 3.8 5/23/2005 Resurgens doctors paid kickbacks to the surgery center for using the Center’s Medicare provider number. The kickbacks were steered to a lockbox at an Atlanta bank. X X Simi Valley Hospital 3.7 7/21/2005 Pneumonia upcoding.
X X UnitedHealthcare 3.5 12/12/2004 While working as a Medicare contractor, UnitedHealthcare mishandled telephone calls involving the Medicare program, and then reported to Medicare they were doing a good job in order to retain the contract and get bonuses. X McKesson Corp (TBC Products) 3.4 11/13/2004 TBC Products, a McKesson subsidiary, distributing tube-feeding equipment to patients too sick to eat on their own. As part of its sales plan, TBC distributed invoices that made it look like McKesson was charging for tube-feeding pumps that were free. This paperwork made it possible for nursing homes to bill taxpayers for the free pumps. Along with the $3.4 million civil False Claims Act fine, McKesson pled guilty and paid a $4 million criminal fine. X Frank S. Chuang 3.4 2/8/2005 Mr. Huang submitted false claims to state and federal transportation agencies for work not performed. U. of Alabama at Birmingham 3.39 4/14/2005 Double billing Medicare for patients in research trials.
Engenderhealth 3.3 4/29/2004 Failure to return unused USAID funding for family planning.
Western Sales and Testing 3 3/23/2005 Western Sales and Testing faked pressure tests and inspection of high-pressure truck cylinders used for over-the-road transportation of hydrogen, helium, methane, hydrogen chloride, and other gases. Several federal agencies were defrauded, include the DoE, NASA, and DoD. Cleveland Clinic Florida Hospital 2.75 2/14/2005 From 1993 to 2001, the Cleveland Clinic billed for “for extra observation charges during normal recovery periods following minor surgery or emergency room visits.” X Applied Consulting and sister company Applied Case Management 2.75 9/13/2005 Firms signed contracts with Mount Vernon (N.Y.) Hospital and Catskill Regional Medical Center in which kickbacks for patient referrals were disguised as “administrative service contracts.” X X Honeywell 2.75 5/26/2005 Falsely stated in a contract proposal to the United States Air Force that it had a fully compliant cost management system, then tried to bill Government to create one. Mount Vernon Hospital 2.65 8/2/2005 Kickbacks and billing for unlicensed drug and alcohol treatment centers X Diebold 2.6 11/11/2004 Diebold made false claims about the security and certification status of its electronic voting machines and tabulation systems. As a result, six counties were misled into buying the machines. Westinghouse Savannah River Co. 2.6 1/11/2005 Westinghouse Savannah River Co. filed travel reimbursement for more than 100 workers who were not traveling. The company also improperly sought government funds for moving expenses, temporary lodging and meals for employees transferred to Washington, D.C.; Los Alamos, New Mexico; and Southern California. SAIC (Science Applications International Corp) 2.5 4/27/2005 Bill padding, defective pricing and false estimates.
Dey Pharmaceuticals (state FCA case) 2.5 8/8/2005 Marketing the spread on albuterol.
X Loma Linda University 2.2 12/1/2004 Loma Linda University Hospital billing for doctor services that were actually performed by residents or interns (PATH case). X West Coast Medical Supply (OR) 2.07 3/20/2005 West Coast Medical Supply repeatedly billed for durable medical equipment that was never supplied.
X Maxwell Manor Nursing, ABS Long-Term Care Management Co. Inc. and an affiliated company MBA-LTC Inc. 1.9 11/11/2004 The Maxwell Manor Nursing home is described as “house of death, terror and filth,” with incredible lapses in care, decayed buildings, sexual assaults, medication used as punishment, rat infestation, and more. Medicare and Medicaid were billed for services and care not provided. X X Kaiser Permanente (Hawaii) 1.9 5/16/2005 Submitted inaccurate Medicare and Medicaid claims over 17 years.
Temple University 1.88 10/28/2004 Temple University submitted claims for hospital care that was allegedly performed by doctors, but lacked sufficient documentation that those services were actually performed by those doctors. In addition, the government said Temple billed for a higher level of care than was actually provided. X George Washington U. 1.825 4/19/2005 Fictitious labor, expenses, scholarships and stipends stolen by Nabih E. Bedewi from the National Crash Analysis Center (not sure if FCA or not, but presented as so on one list). Americhoice of Pennsylvania Inc. (formerly Healthcare Management Alternatives) 1.6 6/30/2005 Improper claims processing and coverage determinations between 1995 and 1998.
X X Professional Ambulance Service of Norwich Conn. 1.5 Oct. 20- 04 The Professional Ambulance Service company transported Medicare kidney patients for non-emergency dialysis treatments when such trips are not covered. X Catskill Regional Medical Center 1.5 1/7/2005 Treating illegally referred drug and alcohol patients (kickbacks). X Anthem Insurance 1.5 8/8/2005 Overcharged the Federal Employee Health Benefits Program (FEHBP) through rebate retention.
Nursing Home Care Management 1.456 10/26/2004 Inadequately trained health care aides.
X University of Medicine and Dentistry of New Jersey 1.4 3/18/2005 University of Medicine and Dentistry of New Jersey billed at doctor rates for services done by interns. (PATH case).
X Lockheed Martin Corp 1.4 1/4/2005 Procurement mis-charging.
University of Pennsylvania 1.31 2/9/2005 A professor at the University faked gene therapy research that ended with the death of an Arizona teenager. Spayne, Timothy R. 1.24 1/31/2005 Attorney submitted false legal bills to Electric Boat.
Tender Loving Care Health Care Services 1 11/29/2004 False cost reports.
X TransTechnology 1 9/9/2005 Rescue hoists alleged to be defective.
Perini Corp. 0.998 11/19/2004 Perini submitted submitted inflated claims related to construction of the U.S. Embassy building in Venezuela. Allied Home Medical 0.93 10/3/2005 Overbilled on motorized wheelchairs.
X X (TennCare) CVS 0.895 8/2/2005 Pill shorting and full billing.
X Hillcrest Healthcare 0.775 5/19/2005 Substandard nursing home care—fatally neglecting patients, while at the same time billing for services not provided. X Emsco 0.7 5/24/2005 Over-billed Medicare and Medicaid for emergency room services by upcoding patients to a higher level of service than actually provided. A related claim was paid in June 2004. X X Fresno County 0.653 2/14/2005 Fresno County submitting false claims for services not reimbursable under Medicare.
X Hospital of St. Raphael 0.632 5/3/2005 Unnecessary hospital treatment for kidney patients.
X Mid-West Podiatry & Associates 0.575 3/5/2005 Mid-West Podiatry & Associates upcoding podiatric work, claiming less procedures were more extensive.
X MedQuest 0.519 9/20/2005 Settlement on alleged overpayments.
X Curran Contracting Inc. (Illinois) 0.5 5/18/2005 Submitted fraudulent documents overstating the amount of asphalt material delivered to state and municipal road projects.
Seattle Cancer Treatment and Wellness Center 0.478 3/18/2005 Seattle Cancer Treatment and Wellness Center billed for services that were more extensive than those performed, billed for drugs administered at home as if they had been taken in the doctor’s office. X and TRICARE Larossa, John T. MD 0.447 4/8/2005 Upcoding.
X Drs. Grover Christie Merritt, P.C. 0.443 3/14/2005 Upcoding and unbundling.
X Hunt Memorial Hospital District (Tx)/Presbyterian Hospital of Greenville (filed in middle district of TN) 0.406 11/4/2004 Hospitals upcoded pneumonia claims. Family Medical Management Services 0.4 3/5/2005 The company claimed that its medical director performed nearly all health care services, when nurse practitioners actually performed the majority of them. X and TRICARE Tucker, Charles, MD 0.366 4/13/2005 Billing nurses as physicians.
X Gambro Healthcare 0.328 12/8/2004 Gambro contracted with local laboratories to perform expedited lab tests on an as-needed basis and mis-billed for them. C. Patel MD and Fall Rive Walk-In Emergency Medical Office 0.315 6/30/2005 Overbilled Medicaid and Medicare, for physical therapy services not performed by a physical therapist or physician.
X X Professional Service Industries, Inc. 0.26 2/5/2005 PSI billed the government for the work of “certified welding inspectors” when the inspectors who performed the inspections were not so certified and the testing never took place. Aerometals 0.251 2/3/2005 Selling refurbished parts as new to the Air Force.
Holiner Psychiatric Group 0.25 10/22/2004 Upcoding of evaluation and management codes at two Texas hospitals, and billing for services not rendered.
X and TRICARE X Pediatric Adolescent Healthcare, P.C. and William Silberberg, MD 0.242 1/11/2005 Charging for free children’s vaccines. X Torrington-Winsted Pediatric Associates 0.201 1/11/2005 Charging for free children’s vaccines.
Dr. Gaetano Calise (RI) 0.2 3/20/2005 Billing for nursing home care not provided.
X Central Montgomery Medical Center 0.2 8/2/2005 Improperly restrained patients.
X Center for Pain Management 0.18 3/5/2005 Owner of Center used provider numbers of two anesthesiologists to bill for services that were not performed. X X Dr. Eric Poehlman 0.18 4/5/2005 Fabricated data on research grants.
S.C. Management 0.167 10/1/2004 Upcoding.
Dr. Peter Stickney 0.126 3/20/2005 Billing for medically unnecessary services.
X G. Craig Kiser, M.D. 0.104 11/9/2004 Dr. Kiser billed Medicare and Medicaid for drugs received as free samples from the Manufacturer (TAP Pharmaceuticals).
X X Bergoli, Dr. Arthur (Mass) 0.1 1/3/2005 Overcharging for nursing facility care.
X Shurlan, Dr. Vladimir 0.089 4/7/2005 Upcoding.
X Balco 0.06 10/28/2004 Filed $1.8 million in false Medicare claims by submitting multiple claims for the same tests.
X Memorial Hosp. of Carbondale Illinois 0.033 10/10/2004 Hospital not approved for services billed.
X TOTAL 1498.824 (1461.324 without Gambro state case)