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October 23, 2018

Eye Centers of Florida, owned by Dr. David C. Brown, has agreed to pay $525,000 to settle claims of that it knowingly falsified the medical records of certain Medicare patients in order to submit qualifying reimbursement claims. In violation of the False Claims Act, Eye Centers allegedly altered the paperwork to make it appear that patients had worse vision than they actually did, allowing Eye Centers to bill for cataract surgeries that would ordinarily not have been reimbursable. The case was revealed through a lawsuit filed by two former employees, Patti Nilsson and Joann Smith, who are set to receive $115,500 from the settlement. USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

October 23, 2018

Vascular Access Centers LP (VAC) and its 20+ related corporations in multiple states have agreed to pay $3.825 million over five years to settle whistleblower-brought allegations that VAC took part in an illegal patient referral kickback scheme and fraudulently billed Medicare for certain non-reimbursable procedures. The alleged fraud violated the Anti-Kickback Statute and False Claims Act and involved regularly scheduling, performing, and billing Medicare for certain vascular access procedures for End Stage Renal Disease (ESRD) beneficiaries that were not routinely necessary. Two whistleblowers will share in the relator's share of $612,000. DOJ; USAO EDLA; USAO SDNY

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

October 15, 2018

The CEO of Tri-County Wellness Group, Mashiyat Rashid, has plead guilty and agreed to forfeit millions of dollars worth of ill-gotten funds and property in connection with a $150 million healthcare fraud. Over the course of almost 10 years, Rashid and physicians working in his pain clinics allegedly prescribed millions of units of medically unnecessary painkillers to Medicare beneficiaries, whom they also subjected to medically unnecessary but expensive injections. A similar fraud was repeated at laboratories owned by Rashid, with medically unnecessary but expensive urine tests for drugs. When Medicare realized that none of the claims were reimbursable, Rashid and others created fake companies to perpetuate the fraud. DOJ

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

September 28, 2018

Kalispell Regional Healthcare System and six of its related entities agreed to pay $24 million to settle a False Claims Act case based on its compensation arrangements with physicians, which were alleged to violate the Stark Law, and other arrangements alleged to violate the Anti-Kickback Statute.  Between 2010 and 2018, KRH entities reportedly paid excessive and above-market full-time compensation to more than 60 physicians, even if those physicians worked far less than full-time.  In addition, some of the KRH entities were alleged to unlawfully seek referrals from physicians through excessive compensation arrangements and the provision of administrative services at below market rates.  Jon Mohatt, the former CFO of a related entity, initiated the action with a qui tam filing; Mohatt will receive $5.4 million dollars as a relator's share of the government's recovery.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

September 26, 2018

A psychologist, John R. Sink, and his wife, Diane Sink, pled guilty to making false statements to Wyoming Medicaid.  According to the plea, between 2012 and 2016, the Sinks submitted over $6.2 million in claims for group therapy, knowing that the activities provided and billed for did not qualify as group therapy.  In addition, the hours billed did not accurately report the time each Medicaid beneficiary was actively participating in any activities, and the Sinks were not using up-to-date treatment plans to guide each Medicaid beneficiaries treatment as required by Wyoming Medicaid.  USAO D. Wy.

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud,

September 25, 2018

Six individuals in the New Orleans area - four physicians, a medical biller, and a medical office manager - were sentenced after having been found guilty of conspiracy to commit health care fraud and to pay and receive unlawful kickbacks.   The defendants fraudulently billed Medicare for medically unnecessary home health services for patients who were not homebound and had no legitimate medical need for the services, creating false and fraudulent home health orders.   USAO E.D. La.

Tagged in: Healthcare Fraud, Home Health and Hospice, Medical Billing Fraud, Provider Fraud,

September 25, 2018

Virginia Commonwealth University Health System Authority, which operates a hospital and related facilities in Richmond, Virginia, agreed to pay $4 million to resolve claims that it overbilled government healthcare programs for radiation oncology services from 2009 through 2014.  The settlement follows VCU's voluntary disclosure of the overbilling after an audit of patient files and billing data.    E.D. Va. USAO

Tagged in: Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Provider Fraud,

September 12, 2018

A New York based long-term care facility, Centers Plan for Healthy Living, has agreed to pay $1,650,000 to settle allegations that it violated the state and federal False Claims Acts in billing Medicaid for services not provided to Medicaid beneficiaries. The alleged fraud involved enrolling unqualified patients and failing to disenroll recently unqualified patients from a Medicaid-funded care program over the span of two and a half years. It was eventually exposed by an unnamed whistleblower. AG NY; USAO EDNY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

September 4, 2018

Houston psychiatrist Riyaz Mazcuri was sentenced to 12.5 years in prison following his conviction at trial for defrauding Medicare and Medicaid through the submission of $155 million in false and fraudulent claims for "partial hospitalization program" services, a form of intensive outpatient treatment for patients with mental illness.  Mazcuri falsified records to make it appear as if patients admitted to the PHPs qualified for, required, and actually received the intensive psychiatric services. DOJ

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

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,

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