Archive

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,

Catch of the Week: Lincare Holdings

Posted 08/31/23

This week's Department of Justice (DOJ) Catch of the Week goes to Florida-based Lincare Holdings, Inc., a wholly-owned subsidiary of the German chemical corporation Linde plc. On Monday (August 28), the DOJ announced that the company agreed to pay $29 million to settle charges of violating the False Claims Act by overbilling Medicare and Medicare Advantage Plans for oxygen equipment. Lincare provides oxygen...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case,

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,

It's Medicare Fraud Prevention Week - What Can You Do?

Posted 06/9/23

This week is Medicare Fraud Prevention Week. You probably did not even know it because of the relative lack of attention this important week has received. All the more surprising because Medicare fraud and abuse costs the government an estimated $60 billion per year. But according to Senior Medicare Patrol (SMP), the government-sponsored public education organization, there is a lot we can do to attack this...

Tagged in: FCA Federal, Healthcare Fraud, Medicare,

Catch of the Week: Detroit Medical Center

Posted 06/2/23

Handshake in room with dark window blinds

This week's Department of Justice (DOJ) "Catch of the Week" goes to Detroit Medical Center, Vanguard Health Systems, and Tenet Healthcare. On Wednesday, they agreed to pay roughly $30 million to settle government and whistleblower charges of violating the False Claims Act by providing kickbacks to certain referring physicians. It is just the latest in a string of False Claims Act settlements concerning kickbacks...

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

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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

Catch of the Week: Lincare Holdings

Scoundrel Spotlight - Medicare Fraudster Minal Patel

Catch of the Week: National Health Care Fraud Sweep

Catch of the Week: Smart Pharmacy, Inc.

It's Medicare Fraud Prevention Week - What Can You Do?

Catch of the Week: Detroit Medical Center

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