Gambro to pay $355 million in fraud case

Gambro to pay $355 million in fraud case

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Gambro US to pay $355 mln in fraud case - Gambro Healthcare US, Lakewood, Colo., said it will pay $355 mln to settle civil and criminal charges stemming from illegal relationships with doctors and pharmaceutical companies in an alleged decade-long fraud scheme that began in 1991. [Healthcare Fraud News]

The settlement resolves civil liabilities from alleged kickbacks paid to physicians, false statements made to obtain payment for unnecessary services, and payments made to Gambro Supply, a sham DME company.

The case was the result of a whistleblower complaint brought by Steven J. Bander, Gambro’s former Chief Medical Officer. The civil settlement resolves allegations that Gambro Healthcare:

  • Used a sham company, Gambro Supply, to bill home dialysis equipment and supplies to receive a higher rate of reimbursement than it would have if it had directly submitted the claims for payment. In addition, emergency home dialysis supplies were not provided as billed by Gambro;
  • Filed False Claims. “Hard coded” diagnostic codes on submitted claims (the diagnosis codes were automatically put on the claim regardless of the patients’ actual diagnosis), which allowed them to bill for medically unnecessary services.
  • Paid Kickbacks. Physician hiring and compensated was based on the number and volume of anticipated patient referrals to Gambro clinics. Physician remuneration often exceeded fair market value. Gambro allegedly paid physician partners illegal remuneration to refer patients to Gambro clinics.

“Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services. Not only does such fraudulent conduct cause enormous losses to the trust funds intended to protect and preserve the health of the elderly and the poor, but it also raises the cost of medical care for everyone. We will continue to prosecute such cases vigorously,” said United States Attorney James G. Martin. “The federal government does not obtain a settlement of this magnitude without tremendous effort and cooperation within the law enforcement community. The outstanding work of the Federal Bureau of Investigation and Department of Health and Human Services Office of Inspector General, along with the superb legal work of Assistant U.S. Attorneys Claire Schenk and Dorothy McMurtry, have resulted in the largest fraud settlement ever in this District,” Martin added.

Read the US Attorney Press Release