Tag Archives: Healthcare

10 Texas Doctors agree to pay $1.7 million to settle allegations of kickbacks

Ten Texas Doctors, including five from the Houston-area, have agreed to pay of total of $1.68 million to resolve allegations involving illegal kickbacks. There was no determination of liability.



The cases revolve around Little River Healthcare, an operator of a hospital (and related clinics) based in Rockdale, TX, located between Austin and College Station. Little River went into bankruptcy in June 2018 and closed in December of that year.

The Scheme

Between 2013 and 2016, the hospital embarked on an aggressive growth strategy by adding surgery centers, diagnostic imaging centers and over 50 physician offices. It utilized third party laboratories to perform tests that the hospital itself was unable to perform. They created a way for physicians, who were ordering tests from out-of-network laboratories to provide those services in-network through Little River’s hospital contract with Blue Cross Blue Shield (BCBS).

Unfortunately, this way also involved volume-based commissions paid to independent contractor recruiters, who used management service organizations (MSO) to pay doctors for their referrals. That is illegal under Medicare, Medicaid and other federally funded programs. The scheme ran from 2015 to 2018.

Settlements

The Houston doctors involved are (together with the settlement they have agreed to pay);

  • Tamar Brionez, M.D., Spring – $85,006
  • Rakesh Patel, D.O., Houston – $174,539
  • Cuong Trinh, M.D., Houston – $45,056
  • Randall Walker, M.D., Magnolia – $60,898
  • Michael Whiteley, D.O., Tomball – $52,015

The largest settlement involved Gary Goff, M.D. of Dallas who agreed to pay $454,088.

Back in January, in a related case involving Little River Healthcare, seven TX doctors and a hospital CEO agreed to settle allegations of kickbacks for $1.1 million.

Arbitration award

In 2016, BCBS started investigating Little River’s billing practices in relation to third party laboratories and started withholding payments to Little River. That caused a severe liquidity crisis for Little River which forced it into bankruptcy. Prior to bankruptcy, Little River had filed for arbitration in its dispute with BCBS. In May 2020, a Texas arbitrator awarded Little River $108 million.

 

https://www.justice.gov/usao-edtx/pr/ten-texas-doctors-and-healthcare-executive-agree-pay-over-168-million-settle-kickback

CFO resigns from struggling healthcare company

Brandon Moreno, the CFO of Nobilis Health Corp, has resigned from his position. He was only promoted to the role in January 2019. He lasted a lot longer than previous CEO, Jim Springfield, who joined in December 2018 and left in May 2019!



Marissa Arreola also resigned as the Chief Legal Officer. No replacements were named for either Mr Moreno or Ms Arreola.

Amazingly the company is still not in Chapter 11 and its stock was still trading until 3 September (at 12 cents per share).

The last quarter or annual report filed by the company was for the quarter ended 30 June 2018. In November 2018 the company said it was working with its auditors, Crowe Horwath, to make a significant adjustment to the carrying value of accounts receivable, primarily out-of-network claims over one year old.

According to the last 10-Q filed, the company had $144 million in accounts receivable, of which $39 million was over a year old. The company had ZERO allowance for doubtful debts. That’s despite the amount over one year old virtually doubling since the previous year end.

In November 2018, the NYSE had sent a notice to the company that it was not in compliance with the listing standards. The company sent a plan to regain compliance back in May. That resulted in the NYSE offering an extension of the grace period to August 31. The stock was delisted on September 3 following that expiry.

The company owes its lenders $132 million. A few months ago the lenders hired an Investment Banker to effect a transaction. They also hired a Chief Restructuring Officer from Morris Anderson to assist them in their efforts to recover as much value as possible.

SEC filing – Moreno resignation

Two Houston doctors indicted in $16 million Healthcare fraud

Douglas Sharp, D.O. of Katy and Innad Husaini, M.D. of Sugar Land have been indicted in a $16 million healthcare fraud. Hanh Hong Thi Nguyen of Houston was also charged. The three defendants were arrested this morning and appeared this afternoon before US Magistrate Judge Peter Bray of the Southern District of Texas.



Dr Husaini was the owner and operator of Verimed Health and Medical Wellness Clinic. This was based in the Richmond/Hillcroft area of Houston. Dr Sharp was the medical director and Nguyen was worked at the clinic.

The clinic operated from February 2015 to April 2019.

The indictment alleges that the defendants submitted false and fraudulent claims to Medicare and Medicaid for home health services, diagnostic tests and eye procedures, including injections into the eye, that were medically unnecessary, not provided or both.

The defendants allegedly submitted $16 million in fraudulent claims to Medicare and Medicaid. Medicare paid $12.2 million on these claims, Medicare $67,000.

Each defendant is charged with one count of conspiracy to commit health care fraud. Dr Sharp is also charged with three counts of false statements related to health care matters. Dr Husaini is charged with three counts of health care fraud.  Nguyen was charged with two counts of health care fraud.

In March 2016, the Texas Medical Board found that Dr Husaini was involved in the operation of an unregistered pain management clinic. The Board restricted his license solely to the practice of Opthalmology and Neuro-Opthalmology. After that, the indictment alleges that Husaini and Nguyen paid Sharp to sign false and fraudulent plans of care and other medical documents.

The indictment also seeks the forefeiture of two houses owned by Nguyen (appraised at $550,000) and 93 acres in Wallis, TX owned by Husaini (currently for sale for $935,000).

https://www.justice.gov/opa/pr/former-medical-director-and-two-former-operators-houston-medical-clinic-charged-multimillion

Kingwood Doctor charged with healthcare fraud

Dr Jerry Keepers of Kingwood, Texas has been charged with healthcare fraud along with two other physicians and five marketeers. The charges were made in the Northern District of Oklahoma in a superseding indictment. The three physicians were originally indicted in December 2018, the marketeers are newly-charged. Most of the defendants live in the Tulsa area.

The indictment alleges that, since November 2012, Dr Gary Lee and Christopher Parks, a physician marketeer, both of Tulsa, engaged in a conspiracy to unlawfully pay bribes and kickbacks to physicians in order to induce the physicians to write expensive compounding prescriptions to pharmacies they controlled. Two of these, NBJ Pharmacy and Airport McKay Pharmacy, were based in Houston.



Dr Keepers allegedly solicited and received more than $860,000 in illegal bribes from Lee and Parks.

Dr Keepers specializes in anesthesiology and also has an office in Friendswood.

According to the indictment, kickback payments were disguised through various sham business arrangements, including contracts where physicians purported to serve as “medical directors” or “consulting physicians” for the pharmacies. Doctors were also recruited as “medical directors” for a university study. In actuality, the sham arrangements were meant to conceal the fact doctors were receiving kickback payments for writing prescriptions.

Jonathan Boyd of Sugar Land was also charged for conspiring to pay health care kickbacks. Boyd recruited physicians to write prescriptions for compounded drugs. From November 2012 to September 2014, he conspired to pay kickbacks to physicians to induce them to write prescriptions to the pharmacies controlled by Lee and Parks.

Each face up to 10 years in prison and a maximum $100,000 fine.

https://www.justice.gov/usao-ndok/pr/three-physicians-and-five-marketers-charged-violations-federal-anti-kickback-statutes