Middle District Of Florida U.S. Attorney’s Office Collects More Than $142 Million In Civil And Criminal Actions For U.S. Taxpayers In Fiscal Year 2018

Tampa - U.S. Attorney Maria Chapa Lopez announced today that the Middle District of Florida (MDFL) collected $38,073,605.20 in criminal and civil actions in the fiscal year ending September 30, 2018 (FY 2018). Of this amount, $27,941,783.60 was collected in local civil actions and $10,131,821.60 was collected in criminal actions. The MDFL’s Civil Division, led by Civil Chief Randy Harwell, recovered a total of $96,663,640 on behalf of federal agencies and programs in affirmative civil enforcement cases during the last fiscal year. This amount has two components. In addition to its efforts in local civil cases noted above, the district’s Civil Division also joins forces with other U.S. Attorney’s Offices and with the Department of Justice Civil Frauds Section to address fraud schemes and illegal practices extending beyond district boundaries. The Middle District of Florida’s Civil Division recovered an additional $68,721,857.63 in these jointly handled cases. 

Additionally, the Office’s Asset Forfeiture Division, led by Anita Cream, recovered $35,367,506 in asset forfeiture actions last fiscal year. Forfeited assets deposited into the Department of Justice Assets Forfeiture Fund are used to restore funds to crime victims and for a variety of law enforcement purposes. For instance, in FY 2018, more than $1 million forfeited in the MDFL in prior years was returned to victims of the criminal offenses upon which the forfeitures were based (with more than $150 million pending distribution to additional crime victims), and more than $2.8 million was shared with federal, state, and local law enforcement agencies. 

As a whole, the Justice Department collected nearly $15 billion in civil and criminal actions in the fiscal year ending Sept. 30, 2018. The $14,839,821,650 in collections in FY 2018 is nearly seven times the appropriated $2.13 billion ($2,136,750,000) budget for the 94 U.S. Attorneys’ offices.

“The U.S. Attorney’s Office will continue working with its partners to investigate and prosecute fraud at every level,” said U.S. Attorney Chapa Lopez. “Our coordinated efforts aim to ensure that criminals are held accountable for their illegal actions and that victims are able to recover from their losses, wherever possible.”

“The men and women of the U.S. Attorneys’ offices across the country work diligently, day in and day out, to see that the citizens of our nation receive justice. The money that we are able to recover for victims and this country as a whole is a direct result of their hard work,” Director James A. Crowell, IV, Executive Office for U.S. Attorneys.

U.S. Attorneys’ Offices, along with the department’s litigating divisions, are responsible for enforcing and collecting civil and criminal debts owed to the U.S. and criminal debts owed to federal crime victims. The law requires defendants to pay restitution to victims of certain federal crimes who have suffered a physical injury or financial loss. While restitution is paid to the victim, criminal fines and felony assessments are paid to the department’s Crime Victims’ Fund, which distributes the funds to state victim compensation and victim assistance programs.

The largest civil collections were from affirmative civil enforcement cases, in which the United States recovered government money lost to fraud or other misconduct or collected fines imposed on individuals and/or corporations for violations of federal health, safety, civil rights, or environmental laws. In addition, civil debts were collected on behalf of several federal agencies, including the U.S. Department of Housing and Urban Development, Health and Human Services, the Defense Health Agency, the Internal Revenue Service, the Small Business Administration, and the Department of Education. See below for MDFL significant civil case highlights.

 

CIVIL HEALTHCARE FRAUD ENFORCEMENT CASE SUMMARIES

United States ex rel. Nurkin v. Health Management Associates, Case no. 2:11-cv-14-FtM-29DNF

The former Chief Executive Officer of the Charlotte Regional Medical Center (CRMC) filed a qui tam case alleging that CRMC’s owner, Health Management Associates, Inc. (HMA), implemented a scheme to generate referrals of Medicare business to CRMC and to Peace River Medical Center in violation of the federal Anti‑Kickback and Stark statutes. Specifically, HMA offered referring physicians free office space, staff, equipment, and direct expense payments of $20,000 to $40,000 per month. During the investigation, the HMA hospital chain was purchased by a larger nationwide hospital chain based in Nashville, Tennessee, Community Health Services.

A nationwide investigation of HMA and its hospitals around the country ensued and led the Department of Justice to consolidate this case with eight other related qui tam cases that had been filed in other judicial districts. The nine overlapping qui tam cases were eventually consolidated in the District of Columbia for pretrial proceedings. 

A global resolution of the kickback allegations was finalized in September 2018 that paid the United States $143 million to address the claims in the Nurkin case as well as those raised in a separate qui tam case filed in the Eastern District of Pennsylvania. Of the total settlement amount, $93.5 million was allocated to the Middle District of Florida’s Nurkin case. It was the largest recovery of all nine of the consolidated cases against HMA. Community Health Services also entered into a non-prosecution agreement with the Department of Justice, Criminal Frauds Section that addresses allegations unrelated to the MDFL case.

Press release: https://www.justice.gov/opa/pr/hospital-chain-will-pay-over-260-million-resolve-false-billing-and-kickback-allegations-one

 

United States ex rel. Moore v. 21^st Century Oncology, Inc., et al., Case no. 2:16-civ-99-FtM-29MRM

The relator in this case alleged that a nationwide oncology provider, 21^st Century Oncology, had entered into illegal compensation agreements with physicians that paid incentives that violated federal law. During our investigation, the defendant also voluntarily disclosed that it had falsified reports to CMS to justify incentive payments under a Medicare program called the EHR Incentive Program.  Commercial pressures drove the defendant to seek bankruptcy protection. While the bankruptcy was pending, settlement discussions ensued to address the civil fraud claims, and resulted in an ability to pay agreement that will pay the United States $26 million.

Press release: https://www.justice.gov/opa/pr/21st-century-oncology-pay-26-million-settle-false-claims-act-allegations  

 

United States ex rel. Van Raalte, et al. v. Healogics, Inc., Case no. 6:14-civ-283-Orl-41KRS;

DAB United States ex rel. Wilcox v. Healogics, Inc., Case no. 6:15-civ-1510-Orl-41

Two overlapping qui tam cases were filed in Orlando against a Jacksonville based management consultant, Healogics, Inc., that provides management services to wound healing clinics owned by hospitals around the country. The relators were several wound healing physicians employed by a Healogics wound healing center, and a former management level employee of Healogics. The relators alleged that the defendant had caused the hospitals to submit false claims to federal health programs for medically unnecessary hyperbaric oxygen services and debridements, among other things. After a lengthy investigation, we opened settlement discussions that culminated in an ability to pay resolution that will pay up to $22.5 million to resolve all claims in the cases. 

Press release: https://www.justice.gov/opa/pr/healogics-agrees-pay-2251-million-settle-false-claims-act-liability-improper-billing

 

United States ex rel. Sharpe v. Americare Ambulance, Inc., Case no. 8:13-civ-1171-T-36AEP

The relator in this qui tam case was a former employee of the largest ambulance company in Hillsborough County who alleged that the defendant had submitted false claims to Medicare and TRICARE for up-coded patient transportation services. Our investigation corroborated the allegations but pre-intervention settlement discussions were not fruitful. We intervened in the case and after a year of litigation, we reached a settlement of the claims that paid the United States $5,496,816.

Press release: https://www.justice.gov/usao-mdfl/pr/tampa-s-largest-ambulance-providers-agree-pay-55-million-resolve-false-claims-act

 

United States ex rel. Gross v. James Norman, MD, PA et al., Case no. 8:14-civ-978-T-33EAJ

Patients of this Tampa thyroid surgeon, James Norman, MD, filed a qui tam complaint alleging that he had staged pre-surgery patient consultations to improperly circumvent Medicare’s reimbursement rules for thyroid surgery services. We determined that the practice was widespread among the defendant’s patients and constituted a violation of his participation agreement with Medicare. We reached an agreement that resolved the allegations under the False Claims Act in return for $4,070,800.

Press release: https://www.justice.gov/usao-mdfl/pr/owner-tampa-parathyroid-practice-agrees-pay-4-million-resolve-false-claims-act

 

United States ex rel. Simons v. North Central Florida Hospice, Inc., Case no. 3:16-civ-330-J-41JRK

A former employee of this Jacksonville, Florida based hospice provider (doing business as Haven Hospice, Inc.) alleged that the defendant had provided hospice services to Medicare patients who did not qualify for the service, and improperly billed Medicare for those services. A civil investigation corroborated this claim and led to an ability to pay settlement that paid $5,085,024 to the United States.

Press release: https://www.justice.gov/usao-mdfl/pr/united-states-settles-false-claims-allegations-against-haven-hospice-more-5-million

 

Trinity Medical Pharmacy, LLC

This was a direct referral from the TRICARE program that centered upon allegations that a New Port Richey based compounding pharmacy, Trinity Medical Pharmacy, and a handful of its executives had engaged in a variety of illegal practices designed to defraud the military’s health program. Trinity, its Chief Executive Officer Krutika Patel, its Chief Operating Officer Devan Patel, its National Sales Director Jay Martinez, and its National Account Director Nicholas Petrillo, implemented a variety of kickback schemes designed to incentivize overutilization of compounded pain creams. These kickback arrangements included bogus philanthropies, waiver of patient co-payments, and kickbacks to physicians in the guise of speaker programs and honoraria. The pharmacy also failed to disclose to the TRICARE program that Devan Patel was a convicted felon when it applied to become an authorized provider with the program’s pharmacy benefit manager, Express Scripts. Trinity and the four individual defendants ultimately agreed to pay $2,244,270 to resolve these civil claims.

Press release: https://www.justice.gov/usao-mdfl/pr/united-states-settles-false-claims-act-allegations-against-trinity-medical-pharmacy-and

 

United States ex rel. Sawicki v. Arthur Portnow, MD, et al., Case no. 8:15-civ-987-T-27MAP

An ultrasound technician alleged that her former employer – a Sarasota internist – had conducted medically unnecessary carotid and arterial ultrasound tests, and falsified patient records to justify those tests in claims to federal health programs.  A civil investigation corroborated these allegations and we resolved the claims in a settlement that paid $1.95 million to the United States. 

Press release: https://www.justice.gov/usao-mdfl/pr/sarasota-physician-agrees-pay-195-million-resolve-false-claims-act-allegations

 

United States ex rel. Loebl v. Eurogynecology Specialists of Florida, Inc., et al., Case no. 6:16-cv-1722-Orl-37KRS

A physician’s assistant, formerly employed by a large gynecology practice with multiple offices all over central Florida, filed a qui tam complaint alleging that the practice group had defrauded Medicare by improperly using a billing modifier in connection with certain gynecology services. The modifier justifies additional payment from government health programs when used in connection with “separate identifiable” services that cannot be bundled with an underlying service. Our investigation corroborated widespread billing improprieties involving this modifier code, and we negotiated a settlement resolving the civil claims in return for $1.7 million.

Press release: https://www.justice.gov/usao-mdfl/pr/fwc-urogynecology-llc-agrees-pay-17-million-settle-false-claims-act-liability-misuse

 

United States ex rel. Stone v. Riverside Spine and Pain Physicians, LLC, Case no. 8:16-civ-945-T-36EAJ

A Tampa pain management doctor filed a qui tam complaint alleging that her former employer, a large Jacksonville-based physicians group, had filed false claims to federal payors for unnecessary urine drug testing services. Our investigation corroborated these allegations and separately revealed that the practice group had accepted kickbacks from a nationwide urine drug-testing lab in the form of specimen cups. We negotiated a settlement of these civil claims for the total amount of $1,491,478.

Press release: https://www.justice.gov/usao-mdfl/pr/united-states-settles-false-claims-act-allegations-against-riverside-spine-pain

 

United States ex rel. Pelletier v. Liberty Ambulance Co., Case no. 3:11-civ-911-J-37JRK

A former employee of a Jacksonville ambulance company filed a qui tam complaint alleging that the defendant had submitted false claims to Medicare and other federal payors for up-coded patient transportation services. We settled these claims with other named defendants, but our negotiations with Liberty Ambulance broke down. We intervened in the case and after over a year of litigation, we reached an ability to pay settlement with Liberty wherein it agreed to pay $1.2 million to resolve all claims.

Press release: https://www.justice.gov/usao-mdfl/pr/united-states-settles-false-claims-act-allegations-against-liberty-ambulance-12-million

 

United States ex rel. Steppe v. RS Compounding, LLC and Renier Gobea, Case no. 8:13-cv-3150-T-33AEP

This qui tam case was filed by a former sales representative of a Tampa, Florida compounding pharmacy, RS Compounding d/b/a Westchase Pharmacy.  She alleged that the pharmacy and its owner, Renier Gobea, engaged in a number of schemes to defraud the military’s TRICARE health program. Notable of these was the pharmacy’s practice of billing compounded pain creams to TRICARE at rates that were astronomically higher than the rates the pharmacy charged to private insurers and cash-paying customers. This practice violated the TRICARE program’s reimbursement requirements and came at a time when the program was reeling from the impact of a vast network of fraud schemes underway around the country that involved illegal marketing of compounded pain creams. An investigation confirmed that the Westchase Pharmacy was charging TRICARE prices that were in excess of 2,000% higher than prices charged to private insurers for the same pain cream products. 

We intervened in the case in April 2017 and after a period of litigation, eventually resolved the allegations in the case against the pharmacy and Mr. Gobea in exchange for $1.2 million.

Press Release: https://www.justice.gov/usao-mdfl/pr/government-settles-12-million-lawsuit-against-florida-compounding-pharmacy-and-its