Monthly Newsletter

The five most important Federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL).

Government agencies, including the Department of Justice (DOJ), Department of Health & Human Services Office of Inspector General (OIG), and the Centers for Medicare & Medicaid Services (CMS), are charged with enforcing these laws. As a provider and/or healthcare administrator, it is crucial to understand these laws not only because following them is the right thing to do.  Persons who knowingly make a false claim may be subject to:

• Criminal fines up to $250,000;
• Imprisonment for up to 20 years; and
• If the violations resulted in death, the individual may be imprisoned for any term of years or for life.

For more information, refer to 18 USC Section 1347.  To learn more, read “The Importance of Staying Informed – Compliance through Lessons Learned” published by the American Institute of Healthcare Compliance, a licensing/certification partner with CMS.

Please use the recent OIG cases below as examples of lessons to learn from so your organization can mitigate risk by detecting nonconformances early.

Allegations to Increase Payments by Medicare Advantage Provider & Related Parties

Seoul Medical Group Inc. and its subsidiary Advanced Medical Management Inc., have agreed to pay $58.74 million and their former president and majority owner, Dr. Min Young Cha, has agreed to pay $1.76 million for allegedly violating the False Claims Act by causing the submission of false diagnosis codes for two spinal conditions to increase payments from the Medicare Advantage program.

The civil settlement resolves claims brought under the qui tam or whistleblower provisions of the False Claims Act by Paul Pew, the former Vice President and Chief Financial Officer of Advanced Medical Management. Read more about this case.

70-year-old Junyi (Jenny) Liu, a licensed acupuncturist and leader of this scheme, pled guilty on March 27, 2025 to conspiracy to commit health care fraud in connection with a scheme to fraudulently bill insurance providers for acupuncture and physical therapy services that were unnecessary or never performed at medical offices. 

This offense carries a maximum sentence of 10 years in prison. As part of her plea agreement with the Government, LIU agreed to pay $23,855,425 in restitution to the Insurance Providers and $40,075 to the New York State Department of Labor. She additionally agreed to forfeiture of $15,368,171. Read more about this case.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Dr. Atul Jain, a California ophthalmologist.

The settlement resolves allegations relating to Diopsys’ NOVA device, an electrophysiological device that the U.S. Food and Drug Administration (FDA) cleared for visual evoked potential (VEP) testing. The United States alleged that, during the period from January 1, 2015 through December 31, 2021, Diopsys caused healthcare providers to submit false claims to Medicare and Medicaid for services in which the NOVA device was utilized for medically unnecessary uses, specifically electroretinography (ERG) vision testing, a substantially different vision test for which the NOVA device lacked FDA clearance. The government further contended that Diopsys made substantial changes to the NOVA device that it never submitted to FDA for clearance or approval despite knowing that such a submission was required. Read more about this case.

Whistleblower claim under the Qui Tam Provision of FCA

Payment settles allegations that between 2008 and 2023, Walgreens’ pharmacies submitted a higher usual and customary price to the MassHealth and Georgia Medicaid programs for certain generic medications at certain times. By failing to report the correct usual and customary price, Walgreens’ pharmacies allegedly caused the MassHealth and Georgia Medicaid programs to pay more for these generic medications than they should have. Read more about this case.

Prison Followed by 1 Year Supervised Release & $561,141.89 in Restitution

Miguel Saravia, the Chief Executive Officer of Dana Group Associates and former Chief Operating Officer of Prime Behavioral Health, was sentenced on March 26, 2025 for a scheme to defraud health care benefit programs by directing false billing for patient visits.

From approximately 2017 to 2022, Saravia directed a group of individuals with no billing or medical training to enter Current Procedural Terminology codes (CPT) for therapy services that were not provided and to upcode CPT codes used for psychotherapy visits. Saravia submitted, or directed the submission of, false claims for treatment that was not provided or for more complex and expensive treatment than was provided.  Read more about this case.