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Catch of the Week: Smart Pharmacy, Inc.

Posted  06/16/23
topical cream spilled out
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...

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

Posted  01/28/22
doctor touching hospice patient
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...

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Posted  01/28/22
handcuff and money
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...

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

Posted  01/14/22
cars in traffic
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...

Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Catch of the Week: Classic Medicare Fraud

Posted  11/5/21
medicare dollars
For those like your correspondents who spend their days deep in the weeds of complex Medicare fraud, it’s a delight when something refreshingly simple comes along.  Thanks to Billy Joe Taylor of Arkansas, we can relax this Friday with a cool glass of straightforward Medicare fraud.  For allegedly making $100 million in claims to CMS for tests that were not ordered or ever performed, he is our Catch of the...

Catch of the Week: Fraudulent Sleep Tests in Fresno

Posted  10/29/21
bed with pillow and sheets scattered
Fraud permeates through all aspects of America’s healthcare system- from hospitals to big pharma to chiropractors. This week’s catch of the week focuses on another part of the system, sleep clinics. As increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders, the significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous...

Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

Posted  10/22/21
Person wearing lab coat in laboratory
Clinical laboratory MD Labs Inc., and co-founders and owners, Denis Grizelj and Matthew Rutledge, settled charges the lab falsely billed Medicare, Medicaid, and other federal payors for pricey and unnecessary urine drug tests. Over a four-year period, the lab regularly ran two different drug tests at once and then sent results from both tests to the ordering healthcare physician simultaneously, according to the...

Catch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme

Posted  09/3/21
telemedicine doctor on computer with patient
Editor’s Note: For this week’s biggest story, the record $90 million settlement secured by a Constantine Cannon client against Sutter Health, read more here.
Healthcare fraudsters have a track record of exploiting health crises for personal gain. The COVID-19 pandemic created new telemedicine opportunities for patients to receive care without having to see doctors in person. As expected, fraudsters seized on...

Medically Unnecessary Procedures Harm Patients, Raise U.S. Healthcare Costs, Atlantic Feature Emphasizes

Posted  08/20/21
surgeons operating on patient under bright lights
Unnecessary procedures have long plagued the U.S. healthcare system, costing taxpayers billions and subjecting thousands of patients to invasive procedures that sometimes do more harm than good. For decades, various government actors have acknowledged the problem.

Why then is it so difficult to prevent unnecessary procedures in the U.S.?

Reporter Chris Outcalt recently pondered in a piece for The Atlantic. The...
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