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A $5.4M Health Care Fraud Scheme: Louisiana Doctor Sentenced for Illegally Distributing Over 1.8M Opioid Doses

Posted  02/13/25
Money with Pills Spilled Over
On February 6, 2025, the government announced that Louisiana physician, Adrian Dexter Talbot M.D., 59, was sentenced to 87 months in prison for conspiring to illegally distribute 1.8+ million doses of Schedule II controlled substances (including oxycodone, hydrocodone, and morphine), and for defrauding health care benefit programs of over $5.4 million. Talbot owned and operated Medex Clinical Consultants (Medex),...

A $1.2B+ Health Care Graft Grift! Arizona Couple Pleads Guilty to Fraud

Posted  02/4/25
doctor's office with stethoscope
On January 31, 2025, the government announced an update in a case involving a Phoenix, Arizona couple pleading guilty to causing the submission of over $1.2 billion of fraudulent claims to Medicare and other health insurance programs. The couple submitted claims for costly, medically unnecessary wound grafts applied to elderly and terminally ill patients. Alexandra Gehrke, 39, and her husband, Jeffrey King, 46,...

California Woman Sentenced in $369M Fraud Scheme Involving Billing for Medically Unnecessary Respiratory Tests

Posted  02/3/25
COVID-19 tests fraudulent claims
On January 28, the government announced that California resident Lourdes Navarro, 66, was sentenced to nine years in prison for her involvement in submitting fraudulent claims to both government and private insurance companies during the COVID-19 pandemic. Navarro and her co-conspirator, Imran Shams, illegally bundled COVID-19 screening tests with expensive and medically unnecessary respiratory pathogen panel (RPP)...

California Clinics, Lab, and Their Owners Pay $10M to Resolve False Claims, Kickback, and Stark Law Allegations

Posted  12/30/24
Medical lab equipment
On December 26, the DOJ announced that medical clinics, a lab, and the owners will pay $10 million to settle allegations that they submitted false claims to Medicare and California’s Medicaid program, Medi-Cal, in violation of the Anti-Kickback Statute (AKS) and Stark Law (Physician Self-Referral Law). The defendants include Southern California Medical Center (SCMC), R & B Medical Group Inc., doing business as...

16 Cardiology Practices Across 12 States Pay $17.7M to Settle False Claims Act Allegations

Posted  12/27/24
Medical professional at computer
On December 20, 2024, the government announced that 16 cardiology practices and physicians across 12 states will pay a total of $17,761,564 to settle claims that they overbilled Medicare for diagnostic radiopharmaceuticals and thereby violated the False Claims Act (FCA). Diagnostic radiopharmaceuticals are “radioactive drugs that healthcare providers use for special imaging tests and for treating certain types of...

Hold the Phone: Telemarketer Sent to Prison for $67M Health Care Fraud and Money Laundering Scheme

Posted  12/17/24
Doctor on phone
In December 2024, Jose Goyos, (38, from West Palm Beach, Florida) was sentenced to 15 years in prison for defrauding Medicare by falsely billing over $67 million for medically unnecessary genetic tests. Goyos and his co-conspirators worked at a telemarketing call center that roped thousands of unsuspecting Medicare beneficiaries and their doctors into their scheme. According to the government, Goyos managed the...

Walgreens to Pay $106.8M to Settle Whistleblower Case Alleging it Billed the Government for Prescriptions it Did Not Dispense

Posted  09/17/24

Walgreens has agreed to pay $106.8 million to settle false claims allegations that between 2009 and 2020 it billed government healthcare programs, including Medicare and Medicaid, for prescriptions that it never dispensed because they were not picked up by patients. The government alleged that Walgreens received tens of millions of dollars to which it was not entitled for prescriptions that it never actually provided...

Opioid Exploitation: Doctor and Staff Charged with Conspiracy and Fraud

Posted  07/8/24
In Saint Louis, Dr. David A. Parks along with his clinical manager and spouse, James M. Bilderback, and front desk staffer Michelle J. Scheer, face serious allegations of conspiracy and health care fraud. Indicted by the U.S. District Court, the three are accused of illegal prescription practices and fraudulent activities aimed to profit from controlled substances and fraudulent medical billing.
The...

VNS Health: $1M Settlement for Failing To Provide Services to Hospice Patients

Posted  07/3/24
The U.S. Attorney's Office for the Southern District of New York announced a substantial settlement with Visiting Nurse Service of New York (formerly VNSNY, now VNS Health) and its related entities. This settlement addresses allegations of fraudulent billing practices that undermined the Medicaid program meant to support some of the most vulnerable patients like those in hospice.  VNS Health is one of the largest...

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted  02/23/24
doctor with dollars

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

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