DAILY WHISTLEBLOWER HEADLINES:

11th Circ. Rules For HHS In Drug Dosage Medicaid Billing Suit

Law360, Miami (April 29, 2016, 9:32 PM ET) -- The Eleventh Circuit affirmed a decision Friday that a Florida eye doctor's clinic overbilled Medicare by nearly $9 million by extracting multiple doses from a single-dose vial of medication, agreeing with the U.S. Department of Health and Human Services that the charges were not medically reasonable.

The appeals court rejected arguments from Dr. Salomon Melgen — who is facing criminal charges that he bribed U.S. Sen. Robert Menendez, D-N.J. — that the determination had to be overturned because Medicare has for years reimbursed for double-dosing other drugs, like Botox and Avastin, even though those also carry the “single-use” instruction.

The court said the “single-use” instruction for those two drugs is intended to prevent doctors from using product that has been stored past the acceptable eight-hour time frame. That is not the case with the macular degeneration drug at issue in this case, Lucentis, which has a label expressly stating that each vial should be used for just one treatment and the excess drug should be drawn into the syringe and expelled, according to the Eleventh Circuit.

Melgen's clinic Vitreo Retinal Consultants of the Palm Beaches “failed to follow the instructions regarding that use, without any support from an established medical practice that differs from the label's instructions,” the appeals court said. read more »

New Orleans Jury Convicts Company Owner for Directing $3 Million Fraud and Kickback Scheme

On Saturday, a jury in New Orleans convicted the owner of a health care company for her role in a $3.2 million Medicare fraud scheme operating in and around New Orleans. 

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth A. Polite of the Eastern District of Louisiana, Special Agent in Charge Jeffrey S. Sallet of the FBI’s New Orleans Division and Special Agent in Charge CJ Porter of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG)’s Dallas Regional Office made the announcement.

Tracy Richardson Brown, 46, of New Orleans, was convicted of 18 counts after a five-day trial before U.S. District Judge Stanwood R. Duval Jr. of the Eastern District of Louisiana.  Brown was convicted of one count of conspiracy to commit health care fraud, nine counts of health care fraud, one count of conspiracy to pay illegal kickbacks and seven counts of paying illegal kickbacks.  Brown’s sentencing hearing is scheduled for Aug. 10, 2016. read more »