backHealthcare Management Company to Pay $4 Million to Resolve False Claims Act Allegations
CVR Management, LLC, doing business as the Center for Vein Restoration, along with Center for Vascular Medicine, LLC and their CEO, have agreed to pay $4 million to resolve allegations that they violated the False Claims Act by submitting claims for medically unnecessary procedures used to treat chronic venous insufficiency. The government alleged that the defendants billed federal healthcare programs for vein treatments that did not meet applicable medical necessity requirements, resulting in improper payments from Medicare, Medicaid, and TRICARE.
According to the government, the defendants submitted claims for reimbursement for procedures including sclerotherapy, radiofrequency ablation, and endovenous laser ablations that were not medically necessary. Federal healthcare programs generally do not cover vein treatment procedures when performed for cosmetic purposes only and require that they be supported by specific clinical criteria, including the presence of qualifying symptoms and after a period of alternative treatment that was proven unsuccessful. The government contended that the defendants knowingly billed for services that did not satisfy these requirements.
The allegations were brought under the False Claims Act, which imposes liability on individuals and entities that knowingly submit false or fraudulent claims for payment to the government. The settlement amount totals $4 million, with approximately $3.4 million allocated to the federal government and approximately $604,000 designated for participating states and the District of Columbia to resolve Medicaid-related claims. The matter originated from a qui tam lawsuit filed by two former employees under the whistleblower provisions of the False Claims Act, which allow private individuals to bring claims on behalf of the government and share in any recovery. As part of the resolution, the relators will receive approximately $752,000. The settlement resolves the allegations without a determination of liability.
The link to the DOJ’s press release is available here.
Reporter, Dennis Mkrtchian, Los Angeles, + 1 213 218 4046, dmkrtchian@kslaw.com
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