Medicare reimbursement consultant Ted Albin and his wholly-owned consulting and billing firm Grapevine Billing and Consulting Services Inc. (Grapevine), both based in Stuart, Florida, have agreed to pay $50,000 to resolve allegations that they violated the False Claims Act. This settlement resolves allegations that Albin and Grapevine caused the submission of false claims to Medicare because of kickbacks to Medicare beneficiaries and because patients were ineligible to receive glucometers. This settlement is based on the United States’ analysis of financial disclosures made by Grapevine.
“Consultants must abide by federal requirements when providing Medicare billing advice,” said Acting Assistant Attorney General Brian M. Boynton for the Justice Department’s Civil Division. “We will continue to protect the integrity of federal health insurance programs by pursuing individuals or entities responsible for the submission of false or fraudulent claims, including those who cause such claims to be submitted.”
In its complaint, the United States alleged that, from 2008 until 2017, Albin and Grapevine provided consulting services to now-defunct diabetic testing supplier Arriva Medical LLC (Arriva), its parent Alere Inc. (Alere), and starting in January 2018, Abbott Laboratories (Abbott), after Abbott acquired Arriva and Alere in October 2017. From at least 2009 until 2011, Albin, through Grapevine, allegedly served effectively as the Head of Reimbursement at Arriva, overseeing Arriva’s reimbursement department, developing Arriva’s policies for the collection of beneficiary copayment obligations and submitting claims to Medicare on Arriva’s behalf for diabetic testing supplies.
The United States alleged that, as consultants to Arriva, from April 2010 until the end of 2016, Albin and Grapevine knowingly caused the submission of claims to Medicare that were tainted by the payment of kickbacks to Medicare beneficiaries in the form of (i) free or “no cost” glucometers, or (ii) the routine waiver of beneficiary copayment obligations. Additionally, the United States alleged that Albin and Grapevine knowingly caused the submission of claims to Medicare for glucometers on behalf of beneficiaries who were not eligible to seek reimbursement because they had received a meter paid for by Medicare within the previous five years.
The United States produced sworn testimony from Albin in the litigation in which he admitted that, as a reimbursement consultant for Arriva, Albin personally (1) would “write off customer co-payments” because “I could tell someone on my team ‘Yes, write this off,’” (2) engaged in such write-offs “probably every week,” (3) engaged in “mass write-offs of denials by Medicare” for ineligible meters, (4) created Arriva’s “routine policy not to send a bill for customers who owed less than $5,” and (5) “came up with the policy” of “courtesy adjustments” in the form of copayment waivers in response to customer complaints about their Medicare coinsurance obligations.
“The resolution of this matter brings about the conclusion of a lengthy and protracted investigation and litigation in which the United States sought and received substantial penalties and damages as a result of allegations of False Claims Act violations,” said U.S. Attorney Mark H. Wildasin for the Middle District of Tennessee. “I commend the legal team and investigators for working diligently to preserve the integrity of our federal healthcare programs.”
“Those who provide advice to health care providers about Medicare billing must do so with integrity,” said Special Agent in Charge Tamala E. Miles of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working with our law enforcement partners, we will continue to investigate those who cause fraudulent claims to be submitted to federal health care programs.”
The litigation resolved by this settlement originally included claims against Arriva and Alere that were brought under the qui tam or whistleblower provisions of the False Claims Act by Gregory Goodman, a former employee in Arriva’s Antioch, Tennessee call center. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The act also permits the United States to intervene and take over the litigation of a qui tam action, as the United States did here. In August 2021, Arriva and Alere agreed to pay $160 million to resolve the claims against them. The United States also previously settled for $1 million claims against Arriva’s founders, David Wallace and Timothy Stocksdale, for their alleged part in the scheme. The litigation, which is concluded by the settlement announced today, is currently captioned United States v. Albin, et al., Case No. 3:13-cv-00760 (M.D. Tenn.).
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the U.S. Attorney’s Office for the Middle District of Tennessee and HHS-OIG, with the assistance of the Tennessee Bureau of Investigation.
The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The matter was handled by Trial Attorney Jake M. Shields of the Civil Division and Assistant U.S. Attorney Ellen Bowden McIntyre of the Middle District of Tennessee.
The claims resolved by the settlement are allegations only and there has been no determination of liability.