Archive

August 4, 2014

Community Health Systems (CHS), the nation’s largest operator of acute care hospitals, agreed to pay $98 million to resolve multiple whistleblower lawsuits alleging the company billed government health care programs for inpatient services that should have been billed as outpatient or observation services. According to the government, CHS engaged in a corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and TRICARE (military) beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals.Whistleblower Insider

Tagged in: FCA Federal, Hospital Fraud, Other Government Health Programs, Upcoding, Whistleblower Case,

August 1, 2014

Olufunke Ibiyemi Fadojutimi, a registered nurse and former owner of Lutemi Medical Supply, a durable medical equipment (DME) supply company, was found guilty of health care fraud relating to a 10-year scheme in which Medicare was fraudulently billed more than $8 million for DME that was not medically necessary. The trial evidence showed that between September 2003 and January 2013, Fadojutimi and others paid cash kickbacks to patient recruiters and physicians for fraudulent prescriptions for DME, such as power wheelchairs, that the Medicare patients did not actually need. DOJ

Tagged in: Lack of Medical Necessity, Medical Devices and DME,

July 23, 2014

Elsa Ruiz, the owner and administrator of the Miami-based home health care agencies Professional Home Care Solutions and LTC Professional Consultants, pleaded guilty for her participation in a $74M Medicare fraud scheme. According to court documents, Ruiz and her co-conspirators operated the two companies for the purpose of billing Medicare for expensive physical therapy and home health care services that were either never provided or not medically necessary. DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

July 21, 2014

Alabama-based hospital system Infirmary Health System Inc., along with two affiliated clinics and Diagnostic Physicians Group, agreed to pay $24.5M to resolve government allegations they violated the False Claims Act, the Anti-Kickback Statute and the Stark Law by paying or receiving financial inducements for medical referrals covered by Medicare.Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud,

July 11, 2014

Luis Alberto Garcia Perojo of Florida was sentenced to serve 4 years in prison and ordered to pay $6.2M in connection with a $10.5M Medicare fraud scheme involving physical and occupational therapy services. From November 2007 through August 2009, Garcia submitted on behalf of Renew Therapy Center, an outpatient rehabilitation facility he helped operate, roughly $10.5M in fraudulent claims for reimbursement to Medicare for therapy services not legitimately prescribed or provided. DOJ

Tagged in: Healthcare Fraud, Provider Fraud,

July 10, 2014

Four patient recruiters pleaded guilty in connection with a $20M health care fraud scheme involving the now defunct Miami-based home health care agency Trust Care Health Services. The defendants recruited patients for Trust Care and solicited and received kickbacks and bribes from the owners and operators of Trust Care in return for allowing the agency to bill the Medicare program on behalf of the recruited Medicare patients for home health care and therapy services that were not medically necessary and/or not provided. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

July 7, 2014

Vahe Tahmasian of Glendale, California was sentenced to 121 months in prison and ordered to pay roughly a million dollars for his role in a $1.5M Medicare fraud and identity theft scheme. Tahmasian and his co-conspirators purchased Orthomed Appliance Inc., a DME supply company, stole the personal identifying information of Medicare beneficiaries and doctors in the company’s patient files, and used that information to submit a large volume of fraudulent claims to Medicare. DOJ

Tagged in: Healthcare Fraud, Medical Devices and DME,

July 1, 2014

Detroit-area physician, Walayat Khan, pleaded guilty for his role in a $7M health care fraud scheme. According to court documents, beginning in January 2009, Dr. Khan and others agreed that he would refer Medicare beneficiaries to Advance Home Health Care Services, Inc., Perfect Home Health Care Services, LLP and other Detroit-area home health care agencies for medically unnecessary home health services. Dr. Khan signed medical documents for these beneficiaries, falsely certifying they required home health care and they were under his care. The complicit home health care agencies then used Dr. Khan’s false documents to support their claims to Medicare for home health services that were never rendered or not medically necessary. DOJ

Tagged in: Provider Fraud,

June 27, 2014

Euridice Borroto, a patient recruiter for a Miami home health care agency pleaded guilty today in connection with a health care fraud scheme involving defunct home health care company Nestor’s Health Services Inc. The owner and operator of Nestor pleaded guilty to charges related to the scheme earlier this month. According to court documents, Borroto solicited and received kickbacks and bribes from Nestor in return for recruiting and providing patients to Nestor for home health care and therapy services that were medically unnecessary or never provided. Borroto acknowledged her involvement in similar fraudulent schemes at other Miami health care agencies. DOJ

Tagged in: Healthcare Fraud,

June 25, 2014

Omnicare Inc., the nation’s largest provider of pharmaceuticals and pharmacy services to nursing homes, agreed to pay $124M to resolve charges it violated the Anti-Kickback Statute and the False Claims Act by providing improper financial incentives to skilled nursing facilities in return for their continued selection of Omnicare to supply drugs to elderly Medicare and Medicaid patients. The government’s action against Omnicare originated with two lawsuits filed by whistleblowers under the qui tam provisions of the False Claims Act. The first whistleblower, former Omnicare employee Donald Gale, will receive roughly $17M out of the government’s recovery. Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Multiple Whistleblowers and First-to-File, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

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