Hospital Executive and Three Physicians to Pay More Than $880,000 to Resolve Kickback Allegations

On Monday, December 4, 2023, a Lexington, Texas, hospital executive and three health care providers agreed to pay more than $880,000 to resolve a series of False Claims Act (FCA) allegations involving illegal remuneration in violation of the Anti-Kickback Statute.

As alleged by prosecutors, physicians Linh Nguyen and Thuy Nguyen purportedly received thousands of dollars in payments from a management service organization (MSO) called Ascend MSO of TX LLC in return for ordering laboratory tests from multiple other health care facilities. Additionally, both physicians were separately alleged to have received thousands of dollars in payments from a separate MSO named Geminorium MG LLC in return for ordering laboratory tests from a clinical laboratory in Frisco, Texas. Both doctors have agreed to pay $404,813 to resolve these allegations.

Additionally, physician Heriberto Salinas was also accused by prosecutors of receiving thousands of dollars in MSO payments in return for ordering laboratory tests. Dr. Salinas agreed to pay $150,386 to resolve the allegations against him. Finally, hospital executive Peggy Borgfeld of Lexington, Texas, agreed to pay $325,000 plus additional contingent payments to resolve allegations that she caused the submission of numerous false claims to Medicare, Medicaid, and TRICARE.

As part of their settlement agreement, the defendants also agreed to cooperate with the government in its ongoing investigation of other participants in the alleged scheme.

The US Department of Justice’s (DOJ) press release can be found here.

Operators of Texas Pill Mill Convicted at Trial of Conspiracy and Illegally Dispensing Controlled Substances

On Thursday, November 30, 2023, Dr. Oscar Lightner, a physician in Texas, was sentenced for his role in operating a Texas pill mill clinic. Dr. Lightner had been accused and convicted by prosecutors of illegally prescribing over 600,000 opioid pills for cash.

As detailed by prosecutors at trial, Dr. Lightner and co-defendant Andres Martinez Jr. operated the Houston-based Jomori Health and Wellness pain management clinic as a pill mill. Dr. Lightner, in his capacity as owner and physician of the clinic, unlawfully prescribed dangerous combinations of controlled substances to his patients without a legitimate medical purpose. Dr. Lightner prescribed numerous types of pills, including hydrocodone, carisoprodol, and alprazolam, all in exchange for cash payments ranging from $250 to $500. Martinez, who is Jomori’s office manager and Lightner’s stepson, brought multiple people, including unhoused persons living in homeless shelters, into the clinic to pose as patients to obtain prescriptions for controlled substances.

As a result of the scheme, the clinic received over $1.2 million in cash over 14 months. Dr. Lightner was sentenced to seven years for his role in the scheme; Martinez is scheduled to be sentenced on December 12.

The DOJ’s press release can be found here.

Florida Medical Clinic Owner and Pharmacy Technician Incarcerated Over Role in Clinical Trial Fraud Scheme

On Thursday, November 30, 2023, US District Judge K. Michael Moore sentenced two people – Miguel Angel Montalvo Villa and Ivette Maria Portela Martinez – to 71 months in prison and 46 months in prison, respectively, following their conviction at a jury trial of one count of conspiracy to commit wire fraud and one count of wire fraud.

Montalvo Villa was a co-owner, president, and CEO of AMB Research Center Inc. (AMB), a Miami-based medical clinic that conducted clinical trials of new drugs for pharmaceutical companies and sponsors. Portela Martinez was an employee of AMB who served as recruiter, site manager, data entry specialist, and pharmacist.

According to documents presented at trial, Montalvo Villa and Portela Martinez used personal information of individuals without their consent and listed them as enrolled subjects in clinical drug trials. Prosecutors also accused Montalvo Villa and Portela Martinez of using the names of family members and friends who purportedly participated as eligible subjects in the same drug trials when, in fact, no subject actually participated in the trial. Montalvo Villa and Portela Martinez were paid $277,920 in response to falsified and fraudulent invoices submitted in connection with the scheme.

The DOJ’s press release can be found here.

Owner of Diagnostic Laboratory Indicted for $148 Million Medicare and Medicaid Fraud Scheme

On, Thursday, November 30, 2023, a federal grand jury in Baton Rouge, Louisiana, indicted the owner of a diagnostic laboratory for one count of conspiracy to commit health care fraud, five counts of health care fraud, and three counts of engaging in unlawful monetary transactions for conducting medically unnecessary urine drug tests.

Brad Paul Schaeffer of Zachary, Louisiana, was a co-owner and chief executive officer of the diagnostic laboratory, MedComp Sciences LLC (MedComp). As alleged by prosecutors, from January 2013 to August 2022, MedComp, under Schaeffer’s direction, billed Medicare and Medicaid for multiple tests, regardless of whether those tests were indicated by the patient’s condition or even requested by the referring provider. Additionally, prosecutors further allege that Schaeffer attempted to conceal the scheme by writing off patient co-pays, directing MedComp staff to fill out and submit order forms on providers’ “behalf,” concealing the true nature, permissibility, and extent of testing from providers, orchestrating a pass-through billing scheme using hospitals, and paying kickbacks to physicians disguised as laboratory ownership interests.

If convicted, Schaeffer faces a maximum penalty of 10 years in prison on each count.

The DOJ’s press release can be found here.