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Genetic Testing Scheme Leads to Another Fraud Conviction

Posted 10/11/23

The DOJ recently announced another fraud conviction in connection with genetic testing. This conviction from a federal jury in Florida is the latest word in a string of fraud actions against companies and individuals offering to provide genetic testing services. According to the DOJ, Jose Goyos and others managed the “‘doctor chase’ division” of a call center, which “contacted the primary care physicians...

Tagged in: Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Provider Fraud,

Scoundrel Spotlight - COVID-19 Fraudster Lourdes Navarro

Posted 10/9/23

This week's Scoundrel in the Spotlight is Lourdes Navarro and her husband Imran Shams. The married pair ran the LA County medical lab Clinical Laboratory Inc. (also called Health Care Providers Laboratory). Their lab performed COVID-19 screening tests primarily for nursing homes and other facilities catering to the elderly population. Last Thursday (October 5), Navarro pleaded guilty to fraudulently billing the...

Tagged in: COVID-19, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Risk Adjustment Fraud,

Scoundrel Spotlight - Medicare Fraudster Jesus Virlar-Cadena

Posted 10/2/23

This week’s Scoundrel in the Spotlight is Jesus Virlar-Cadena, a former medical director of a Texas-based healthcare provider called Merida Group, who was recently sentenced to over four years in prison in connection with a fraudulent scheme involving over $150 million in false Medicare claims, according to a DOJ press release. The Merida Group marketed hospice services to patients with long-term incurable...

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare, Provider Fraud,

Nurse Practitioner Convicted in $200 Million Medicare Fraud Scheme

Posted 09/28/23

In a landmark healthcare fraud case, a federal jury in Miami has convicted a nurse practitioner $200 million for her central role in a massive Medicare fraud scheme in which she conspired with telemarketing companies to submit false claims for unnecessary genetic testing and medical equipment. Evidence presented during trial outlined the scheme: telemarketers targeted Medicare beneficiaries, and pressured them to...

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,

Scoundrel Spotlight - Medicare Fraudster Minal Patel

Posted 08/23/23

This week's Scoundrel in the Spotlight is Minal Patel who last week (August 18) was sentenced to 27 years in prison for defrauding Medicare of almost half a billion dollars for genetic testing patients did not need and were procured through bribes and kickbacks. In announcing the sentencing, the government trumpeted the matter as one of the largest genetic testing fraud cases ever tried to verdict. Here is how...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

Catch of the Week: National Health Care Fraud Sweep

Posted 06/30/23

This week's Department of Justice (DOJ) Catch of the Week goes to the 78 individuals criminally charged with participating in health care fraud and opioid abuse schemes across the country. On Wednesday, DOJ announced the "strategically coordinated, two-week nationwide law enforcement action" it brought with federal and state law enforcement partners, which targeted misconduct resulting in over $2.5 billion in...

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Pharma Fraud, Provider Fraud,

Catch of the Week: Smart Pharmacy, Inc.

Posted 06/16/23

This week's Department of Justice (DOJ) Catch of the Week goes to Florida-based compounding pharmacies Smart Pharmacy, Inc. and SP₂, and their owner Gregory Balotin. Yesterday, they agreed to pay at least $7.4 million to settle charges they violated the False Claims Act by adding an antipsychotic drug to topical pain creams solely to boost Medicare reimbursement. Not because of any medical purpose the drug...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case,

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Posted 01/28/22

A federal judge in Texas sentenced Bradley Harris, former head of Novus Health Services, Inc. hospice company in Frisco, to more than thirteen years in prison and ordered him to pay $27.6 million in restitution. The sentence, announced in a DOJ press release, follows his guilty plea on charges of conspiracy and fraud on Medicare and Medicaid. Harris is the latest to be sentenced in a fraud scheme spanning...

Tagged in: Catch of the Week, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Improper Medical Facility, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare,

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Posted 01/28/22

Individuals involved in financial and healthcare fraud schemes face not just civil liability, but also criminal penalties – including prison time. In 2021, the Department of Justice obtained substantial prison sentences in a myriad of cases involving healthcare and financial frauds, many of which involved convictions of the type of fraudulent schemes that whistleblowers report. Whistleblowers play an essential role...

Tagged in: Compounding Pharmacy Fraud, COVID-19, Criminal Proceedings, Education Fraud, Financial and Investment Fraud, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare, Money Laundering, Ponzi Schemes, Securities Fraud, Top 10,

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Posted 01/14/22

The U.S. Attorney this week announced the arrest of doctors, businesspeople, an attorney, a New York police officer, and several others in one of the largest no-fault automobile insurance fraud takedowns in history. The investigation leading to their arrest was conducted by the U.S. Attorney’s Office for the Southern District of New York, the FBI, and the Westchester County District Attorney’s Office. The...

Tagged in: Catch of the Week, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

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Genetic Testing Scheme Leads to Another Fraud Conviction

Scoundrel Spotlight - COVID-19 Fraudster Lourdes Navarro

Scoundrel Spotlight - Medicare Fraudster Jesus Virlar-Cadena

Nurse Practitioner Convicted in $200 Million Medicare Fraud Scheme

Scoundrel Spotlight - Medicare Fraudster Minal Patel

Catch of the Week: National Health Care Fraud Sweep

Catch of the Week: Smart Pharmacy, Inc.

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

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