Archive

August 28, 2018

Dermatology Healthcare will pay $4 Million to settle allegations of healthcare fraud which violate the False Claims Act. Dermatology Healthcare submitted false claims in order to be paid millions in Medicare and Medicaid reimbursements for treatment of non-melanoma skin cancer during which superficial radiation therapy is administered. It is alleged that the superficial radiation therapy was not properly supervised during treatment and that other procedures in relation to superficial radiation therapy were up-coded. It is further alleged that the radiation simulations were overly used. This settlement is the conclusion of a lawsuit filed by dermatologist Theodore A. Schiff, M.D., under the qui tam provisions of the False Claims Act in the United States District Court for the Middle District of Florida. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

August 20, 2018

The owner of an ambulance company has been convicted of defrauding Medicare by submitting claims for over $3 million in unprovided or unnecessary transport services. Anthony Nwosah of Tonieann EMS and Rosenberg EMS also admitted to falsifying and instructing others to falsify transport records, as well as submitting some under the name of an EMT who didn’t even work for him. He received $1,094,260 before the fraud was uncovered, and at his sentencing in November, he stands to receive a $250,000 fine and ten year sentence. USAO SDTX

Tagged in: Ambulance, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud,

August 6, 2018

Grenada Lake Medical Center will pay $1.1M to settle allegations that it violated the FCA by submitting claims for medically unnecessary psychotherapy services to the Medicare program. The alleged fraud lasted over eight years and was brought to light by a whistleblower, a former programs manager at the company, who will receive an award of $195k. USAO Eastern District of Arkansas

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 3, 2018

Prime Healthcare Services and related entities, as well as its CEO Dr. Prem Reddy, will pay $65 million to settle two Medicare fraud allegations. First, Prime and Dr. Reddy allegedly engaged in a centralized scheme to boost inpatient admissions of patients who had no medical need to be admitted. Second, they allegedly falsely upcoded patients’ diagnoses in order to increase reimbursements. Whistleblower Karin Berntsen, who initiated the lawsuit, will receive over $17 million of the settlement. DOJ; CDCA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Upcoding, Whistleblower Case, Whistleblower Rewards,

July 26, 2018

New York announced guilty pleas by transportation company 716 Transportation, Inc., its president, and one of its drivers, in connection with a $1.2 million Medicaid fraud scheme. The company and its president admitted to billing Medicaid for transportation services that were either never provided or that violated Medicaid rules and regulations. NY AG

Tagged in: Ambulance, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

July 18, 2018

Two consulting companies and nine nursing homes will pay $10M to resolve allegations that they submitted claims for medically unnecessary rehabilitation services to Medicare. Medicare reimburses nursing homes based on Resource Utilization Group (RUG) levels, which are supposed to determine the amount of skilled therapy required by a patient. The government alleges that the nursing homes, as advised by the consulting companies, encouraged medically unreasonable and unnecessary therapy to inflate RUG levels. The case was filed by three whistleblower, who will receive a total award of $2M. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, SNF, Whistleblower Case, Whistleblower Rewards,

July 13, 2018

Orthopedic specialists in Oklahoma have agreed to pay $670,000 to settle allegations in a False Claims Act qui tam that they falsely billed Medicare, Medicaid, and Tricare for unnecessary ultrasonic guidance procedures and for services that were not performed. The settlement resolved two claims in the whistleblower action, brought by a former employee, in which the government had intervened prior to settlement; other claims continue to be litigated. USAO WDOK

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 10, 2018

The New Mexico U.S. Attorney’s Office announced the sentencing of a cardiologist to 51 months in prison for healthcare fraud and obstruction of justice. Roy Heilbron had been indicted for regularly performing unnecessary diagnostic tests on his patients and falsifying medical records to cover the fraudulent billing; he also had billed for procedures that were never performed. USAO NM

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

June 22, 2018

Dr. Kelly Robinett and Kingsley Nwanguma were each convicted of multiple counts of conspiracy to commit health care fraud and health care fraud. Joy Ogwuegbu was also convicted of four counts of health care fraud. The conviction were related to a scheme by the three to overbill Medicare for medically unnecessary home health services that in many cases were not provided. The scheme billed Medicare $11.3 million for home health care services pursuant to certifications signed by Robinett and approximately $1 million related to medically unnecessary home health services. Sentencing has not yet been scheduled. DOJ

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

June 21, 2018

Livingston Regional Hospital, a healthcare provider outside of Nashville, has paid $784K to settle FCA allegations that it improperly billed Medicare Part A for inpatient psychiatric care that was not medically necessary. The allegations were first brought forward by two whistleblowers who will receive a $156K reward. USAO Middle District of Tennessee

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

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