A total of 33 Texas doctors have settled health care fraud allegations

The The Department of Justice issued today, Tuesday, June 28, 2022, a press release announcing the settlement of health care fraud allegations by 33 Texas physicians.

Fifteen additional Texas doctors have agreed to pay a total of $2.83 million to resolve False Claims Act allegations involving illegal kickbacks in violation of the Anti-Kickback Act and the Stark Act, and to cooperate with Department of Justice investigations and litigation against other parties.

“The anti-kickback and Stark laws help protect the integrity of federal health care programs,” said Senior Assistant Deputy Attorney General Brian M. Boynton, Chief of the Civil Division of the Department of Justice. “We will continue to prosecute individuals and companies responsible for schemes that violate these important safeguards.”

“These regulations should reinforce the message that the Eastern District of Texas will not tolerate health care providers who seek to enrich themselves through kickback schemes,” U.S. Attorney Brit Featherston said for the Eastern District of Texas. “We will continue to work with our partner agencies to identify those who defraud our taxpayers and hold accountable those who engage in the schemes.”

“This result is the result of cooperation among law enforcement partners focused on maintaining the integrity of federal health care programs,” said Special Agent in Charge Miranda L. Bennett. from the US Department of Health and Human Services, Office of the Inspector General (HHS-BIG). “We will continue to prosecute physicians who engage in improper financial relationships to ensure patients receive quality medical care.”

Anti-bribery law prohibits offering, paying, soliciting, or receiving compensation to induce referrals for items or services covered by Medicare, Medicaid, and other federally funded programs. The Stark Act prohibits a hospital or laboratory from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital or laboratory. The Anti-Kickback Act and the Stark Act seek to ensure that the judgments of medical providers are not compromised by improper financial incentives and are instead based on the best interests of their patients.

Settlements announced today resolve allegations that 15 Texas doctors violated anti-bribery and Stark law by receiving thousands of dollars in compensation from nine management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital dba Little River Healthcare (Little River), True Health Diagnostics LLC (True Health) and/or Boston Heart Diagnostics Corporation (Boston Heart). Little River allegedly funded the compensation of some doctors, in the form of volume-based commissions paid to independent recruiters, who used MSOs to pay many doctors for their referrals. MSO payments to physicians were allegedly disguised as returns on investment, but were in fact based on, and offered in exchange for, physician recommendations.

  • Louis Coates, DO, of Garland, Texas, has agreed to pay $87,694 to settle allegations that from September 26, 2016 to March 14, 2018, he received kickbacks from an MSO, Herculis MG LLC, in exchange for ordering lab tests in Boston. Heart.
  • Jason DeMattia, MD, and Candice DeMattia, MD, both of Tomball, Texas, have agreed to pay $316,142 and $207,009, respectively, to settle claims that from August 1, 2014 through December 31, 2016, they received bribes from two MSOs. , North Houston MSO Group Inc. and Tomball Medical Management Inc., in exchange for ordering lab tests from True Health and Little River.
  • Emanuel Paul (EP) Descant II, MD, of Spring, Texas, has agreed to pay $256,466 to settle allegations that from January 5, 2015 to February 3, 2018, he received kickbacks from two MSOs, North Houston MSO Group Inc. and Tomball Medical Management Inc., in exchange for ordering lab tests from Little River.
  • Mitchell Finnie, MD, of San Antonio, Texas, has agreed to pay $582,522 to settle allegations that from June 4, 2015 to July 11, 2017, he received kickbacks from two MSOs, Alpha Rise Health LLC and Tango Rise Health Solutions LLC, returning to order lab tests from Boston Heart, True Health and Little River.
  • Mark Le, MD, of Tomball, Texas, has agreed to pay $57,900 to settle allegations that from May 9, 2016 to September 22, 2017, he received kickbacks from two MSOs, North Houston MSO Group Inc. and Tomball Medical Management Inc., in exchange for ordering lab tests from True Health and Little River.
  • Richard Le, MD, of Houston, Texas, has agreed to pay $41,000 to settle allegations that from September 29, 2016 to August 24, 2017, he received kickbacks from two MSOs, North Houston MSO Group Inc. and Tomball Medical Management Inc., in exchange for ordering lab tests from True Health and Little River.
  • Robert Jeremy Laningham, MD, and Rodney Jason Laningham, MD, both of Conroe, Texas, have agreed to pay $470,560 to settle allegations that from August 8, 2015 to July 6, 2016, they received bribes wine from two MSOs, SYNRG Partners LLC and Transparity Associates LP in exchange for ordering lab tests from Boston Heart, True Health and Little River.
  • Andres Mesa, MD, of Houston, Texas, has agreed to pay $45,484 to settle allegations that from May 1, 2016 to January 9, 2018, he received kickbacks from an MSO, Transparity Associates LP, in exchange for ordering lab tests in Boston. Heart and Little River.
  • Melissa Miskell, DO, of New Braunfels, Texas, has agreed to pay $100,392 to settle allegations that from July 13, 2015 to December 14, 2017, she received kickbacks from an MSO, Alpha Rise Health LLC, in exchange for ordering lab tests from Boston Heart and Little River.
  • Marco Munoz, MD, of Fort Worth, Texas, has agreed to pay $54,280 to settle allegations that from July 7, 2015 to April 6, 2016, he received kickbacks from an MSO, Alpha Rise Health LLC, in exchange for ordering lab tests from Boston Heart and Little River.
  • Kozhaya Sokhon, MD, of Woodlands, Texas, has agreed to pay $160,456 to settle allegations that from January 16, 2015 to May 18, 2018, he received kickbacks from two MSOs, SYNRG Partners LLC and Transparity Associates LP, in exchange for ordering lab tests from Boston Heart and Little River.
  • Annie Varughese, MD, of Woodlands, Texas, has agreed to pay $213,888 to settle allegations that from September 1, 2015 to November 17, 2017, she received kickbacks from three MSOs, SYNRG Partners LLC, Transparity Associates LP and North Houston MSO Group Inc., in exchange for ordering lab tests from True Health and Little River.
  • Paul Worrell, DO, of Dallas, Texas, has agreed to pay $237,487 to settle allegations that from October 9, 2015 to December 31, 2017, he received kickbacks from three MSOs, Ascend MSO of TX LLC , Eridanus MG LLC and BDS Healthcare LLC , dba Vybrem Labs, in exchange for ordering lab tests from Boston Heart, True Health and Little River.

As part of their settlements, the 15 doctors agreed to cooperate with Justice Department investigations and litigation against other parties involved in the alleged violations of the law.

“Today’s announcement is another step forward from the Department of Defense, the Defense Criminal Investigative Service (DCIS) of the Office of Inspector General and our law enforcement partners. law to protect the integrity of the military health care system, commonly referred to as TRICARE,” the acting special agent said. DCIS Southwest field office manager Gregory P. Shilling. “We will continue to aggressively investigate and hold accountable those who take advantage of the US government and US taxpayers.”

“The VA’s Office of Inspector General is actively investigating those who violate Stark Law and Anti-Kickback Law,” said Special Agent in Charge Jeffrey Breen of the VA’s South Central Field Office. Inspector General of the Department of Veterans Affairs (VA-BIG). “Today’s civil settlements demonstrate the continued work of the VA-OIG to hold individuals accountable and protect the integrity of federal health care programs.”

Christopher Grottenthaler, former CEO of True Health, Susan Hertzberg, former CEO of Boston Heart, Former Little River CEO Jeffrey Madison and others are charged in a separate False Claims Act lawsuit in which the United States filed a amended complaint in May 2022. This ongoing case is captioned United States ex rel. STF, LLC v True Health Diagnostics, LLC, et al., no. 4:16-cv-547 (ED Tex.). If a defendant is found to have violated the law, the United States can recover three times the amount of their losses plus any applicable penalties.

The civil settlements are the result of a coordinated effort between the Civil Division’s Commercial Litigation Division, Fraud Section, and the U.S. Attorney’s Office for the Eastern District of Texas, with assistance from HHS-OIG, DCIS and VA-OIG. Through their efforts, the United States has recovered more than $32 million related to conduct involving Boston Heart, True Health and Little River, including settlements under the False Claims Act with 33 doctors, two executives from the health and a laboratory. This and related cases were handled by Attorneys Christopher Terranova and Gavin Thole of the Civil Division’s Commercial Litigation Division (Fraud Section) and Assistant U.S. Attorneys James Gillingham, Adrian Garcia, and Betty Young for the Eastern District of Texas .

The government’s pursuit of these issues illustrates the government’s focus on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tipping and complaints from all sources regarding potential fraud, waste, abuse, and mismanagement may be reported to the Department of Health and Human Services at 1-800-HHS-TIPS (800-447-8477 ).

The claims resolved by the settlements are allegations only and no liability has been determined.

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