Newark Beth Israel Medical Center will pay $250,000 to resolve allegations brought against the teaching hospital’s heart transplant program as part of a nationwide investigation by the United States Justice Department into health care fraud.
From Jan. 1, 2018, through Dec. 31, 2019, doctors working in Newark Beth Israel’s Center for Advanced Heart Failure and Transplant failed to provide adequate information to patients and their family members before asking them to consent to medical treatment, according to the U.S. Attorney’s Office.
Authorities allege this resulted in unnecessary medical treatments submitted for payment to Medicare.
Newark Beth Israel denies the allegations and contends it never asked patients or their family members to consent to medical treatment without having provided them with full information.
“This civil settlement is not in any way an admission of wrongdoing or liability on the part of Newark Beth Israel,” a hospital spokesperson said in a statement sent to NJ Advance Media.
Furthermore, the spokesperson said, “this matter is completely unrelated to any of the actions announced by the government in its omnibus press release.”
The settlement agreement with Newark Beth Israel was announced on Monday as part of “a national health care fraud takedown” that resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals across the country, according to a press release from the U.S. Attorney’s Office.
The charges involve physicians and pharmacies submitting reimbursements for drugs, devices, and tests that patients didn’t need, pharmacies seeking reimbursement for drugs they never sold, and healthcare providers who received kickbacks to drive phony prescriptions, according to the press release.
These health care schemes resulted in a loss of over $14.6 billion, according to federal authorities.
The nationwide fraud investigation also resulted in 25 civil settlement agreements, including the one with Newark Beth Israel.
In New Jersey, there were five other settlement agreements.
- Excel Pharmacy Inc. in Jersey City is paying $3 million to resolve allegations that from Jan. 2, 2015, through Jan. 25, 2022, the retail pharmacy submitted claims for reimbursement to Medicare and New Jersey Medicaid for drugs that were never sold, according to a settlement agreement. A pharmacist who answered the phone Thursday afternoon said the owner wasn’t around to provide a comment.
- QuickRx LLC., an entity affiliated with Community Pharmacy and authorized to settle claims on its behalf, has agreed to pay $962,821 to resolve allegations the pharmacy sought reimbursement from Medicare and New Jersey Medicaid for drugs it never sold from Jan. 7, 2015, through Jan. 24, 2022. A pharmacist said the owner of Community Pharmacy was not in when NJ Advance Media called Thursday afternoon for comment.
- Raghu Ram Inc., which does business as Camden Discount Pharmacy, is paying $310,000 to resolve claims it billed Medicare and New Jersey Medicaid between Jan. 2, 2015, through Jan. 24, 2022, for drugs it never sold. Raghu Ram claims in the settlement agreement that it underwent a stock sale in January 2018 that resulted in a change in ownership of Camden Discount Pharmacy. The owner was not around Thursday when NJ Advance Media called for comment and did not immediately respond via email.
- Rachit Drug Inc., a retail pharmacy located in Newark, has agreed to pay $250,000 to settle claims that it sought reimbursement from Medicare and New Jersey Medicaid from Jan. 2, 2015, through Jan. 25, 2022, for drugs it never sold. Rachit Drug claims in the settlement agreement that it was sold to new owners in May 2022 in an arms-length stock sale, but the conduct occurred prior to the sale. A pharmacist who answered the phone Thursday told NJ Advance Media the owner was not around to comment on the matter.
- Premier Dental Holdings, which does business as Sonrava Health, will pay $540,000 to resolve allegations that from Jan. 1, 2021 through July 31, 2023, it submitted reimbursements to Medicare and New Jersey Medicaid for services performed by providers who did not have the proper credentials. Sonrava Health did not immediately respond Thursday afternoon to requests for comment.
There were also three criminal cases announced in the District of New Jersey.
- Alan Vaughan, 56, of the United Kingdom, was charged with conspiracy to violate the federal anti-kickback statute in connection with an $80 million scheme to generate referrals for medical equipment and cancer genetic tests. Vaughan, who traveled between the United Kingdom and New Jersey, paid kickbacks to marketers in exchange for personal health and insurance information about Medicare beneficiaries, sent that information to telemedicine companies, and then got kickbacks for each item or each test for which Medicare provided reimbursement, according to the U.S. Attorney’s Office.
- Taejin Kim, 43, a licensed physical therapist from River Vale, was charged with defrauding the Amtrak health care program of approximately $2.25 million by submitting false and fraudulent claims. According to charging documents, Kim used businesses he owned and operated to bill the Amtrak health plan for services that were never provided and that were medically unnecessary.
- Nestor E. Jaime, the owner of Jaime Pharmacy in Paterson, was charged with health care fraud in connection with receiving $2.5 million from Medicare for prescription medications the pharmacy never sold.
Attorney information was not immediately provided for any of the defendants.
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Jackie Roman may be reached at jroman@njadvancemedia.com.
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