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Medicaid Law

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 ... More...
   $0 (12-03-2017 - )


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... More...   $0 (12-03-2017 - PA)

The People of the State of New York v. Stan XuHui Li Pain Clinic Doctor Is Sentenced in Overdose Deaths of 2 Patients

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... More...   $0 (12-02-2017 - NY)

David Richard Sizemore v. Nancy A. Berryhill United States Court of Appeals for the Third Circuit

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... More...
   $0 (12-01-2017 - NC)

United States of America v. Cardiovascular Consultants Heart Center (CVC Heart Center), et al. Eastern District of California Federal Courthouse - Fresno, California

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 — ... More...
   $1200000 (11-29-2017 - CA)

United States of America v. Aharon Aron Krkasharyan Central District of California Federal Courthouse - Los Angeles, California

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... More...
   $0 (11-28-2017 - CA)

United States of America v. Charissie Davis Central District of Illinois Federal Courthouse - Urbana, Illinois

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 ... More...
   $0 (11-27-2017 - IL)

United States of America v. Thaddeus M.S. Bereday Middle District of Florida Federal Courthouse - Tampa, Florida

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... More...
   $0 (11-25-2017 - FL)

United States of America, ex rel. Anthony R. Spay v. CVS Caremark Corporation Third Circuit Court of Appeals - Philadelphia, Pennsylvania

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... More...   $0 (11-23-2017 - )

Eileen Bransten v. State of New York New York Court of Appeals Hall - Albany, New York

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... More...   $0 (11-21-2017 - NY)

United States of America v. Suzanna Meliksetyan Eastern District of New York Courthouse - Brooklyn, New York

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... More...
   $0 (11-20-2017 - NY)

Artur Hefczyc v. Rady Children's Hospital-San Diego

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
patients or guarantors of patients who receive emergency room care, authorizes Rady to
charge only for the reasonable ... More...
   $0 (11-18-2017 - CA)

United States ex rel. Academy Health Center, Inc. v. Hyperion Foundation, Inc., et al. Southern District of Mississippi - Federal Courthouse - Jackson, Mississippi

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... More...
   $1250000 (11-16-2017 - MS)

United States of America v. Gurcharan Singh Kanwal Western District of Virginia Federal Courthouse - Abingdon, Virginia

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... More...
   $0 (11-14-2017 - VA)

Larisa's Home Care, LLC v. Karen Nichols-Sheilds

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... More...
   $0 (11-09-2017 - OR)

United States of America v. Wanda Shorter Seventh Circuit Court of Appeals Courthouse - Chicago, Illinois

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... More...
   $0 (11-01-2017 - IN)

United States of America v. Chemed Corporation, Vitas Hospice Services, LLC and Vitas Healthcare Corporation Western District of Missouri Federal Courthouse - Kansas City, Missouri

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... More...
   $75000000 (10-31-2017 - MO)

United States of America v. Cynthia Stiger Northern District of Texas Federal Courthouse - Dallas, Texas

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... More...
   $0 (10-28-2017 - TX)

Denise Pavlat, et al. United States of America v. Digestive & Liver Disease Consultants, P.A., et al.

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... More...
   $1575000 (10-24-2017 - TX)

Paul Kendall v. Schripps Health

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... More...
   $0 (10-24-2017 - CA)

United States of America v. Glen Elwood McKenzie, Jr. Western District of Texas Federal Courthouse - Austin, Texas

Austin, TX - Austin Area Patient Recruiter Pleads Guilty to Receiving Kickbacks in Health Care Fraud Scheme

Glen Elwood McKenzie, Jr., age 68, of Cedar Park, TX, pleaded guilty to federal charges in connection with a Health Care Fraud .

Appearing before United States Magistrate Judge Mark Lane, McKenzie pleaded guilty to one count of conspiracy to violate the federal anti-kickba... More...
   $0 (10-16-2017 - TX)

United States of America v. John Mac Sells Eastern District of Missouri Federal Courthouse - St. Louis, Missouri

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... More...
   $0 (10-06-2017 - MO)

United States of America v. Elechi N. Oti; Theodore E. Okechuku; Kelvin L. Rutledge; Emmanuel C. Iwuoha Fifth Circuit Court of Appeals - New Orleans, Louisiana

After a two-week jury trial, Defendant-Appellants Theodore Okechuku, Elechi Oti, Emmanuel Iwuoha, and Kevin Rutledge were convicted of conspiring to unlawfully distribute hydrocodone outside the scope of professional practice and without a legitimate medical purpose as part of an alleged pill mill. Okechuku was also convicted of two additional firearm counts—using, carrying, and brandishing a fire... More...   $0 (10-05-2017 - TX)

United States of America ex rel., Joshua Harman v. Trinity Industries, Inc.; Trinity Highway Products, LLC Fifth Circuit Court of Appeals - New Orleans, Louisiana

The trial in this case offers two narratives. One of a hardworking man
who, angered by failures of guardrails installed across the United States—with
sometimes devastating consequences—persuaded a Texas jury of a concealed
cause of those failures. The other of the inventive genius of professors at Texas
A&M’s Transportation Institute, who, over many years of study and testing,
... More...
   $0 (10-04-2017 - TX)

United States of America v. Kenneth Frank Harycki Federal Courthouse - Minneapolis, Minnesota

Minneapolis, MN - Former Mayor Of Stillwater Sentenced To A Year And A Day In Prison For Tax Fraud Conspiracy

Kenneth Frank Harycki, 54, was sentenced to a year and a day in prison for his involvement in a tax conspiracy. HARYCKI, who pleaded guilty to one count of conspiracy to defraud the United States in the ascertainment and collection of taxes on January 15, 2015.

“Mr. Haryc... More...
   $0 (09-28-2017 - MN)

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