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Page 26 of 79

September 12, 2019

New Jersey doctor Joseph DeCorso pleaded guilty to fraudulently prescribing orthotic braces over the phone for two telemedicine companies, resulting in a $13 million loss to Medicare. Dr. DeCorso admitted that the telemedicine companies preyed on elderly and disabled Medicare beneficiaries, on behalf of whom he submitted orders for medically unnecessary braces. He prescribed these braces without ever speaking to or consulting with these patients. The case was investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General. DOJ

Tagged in: Lack of Medical Necessity, Medicare,

September 9, 2019

Dr. Augusto Castrillon of Texas has agreed to pay $2 million to settle allegations he fraudulently billed Medicare for medically unnecessary diagnostic tests in violation of the federal False Claims Act.  From 2009 to 2015, the owner and operator of Castrillon Family Clinic allegedly submitted false claims for transcranial doppler imaging studies, electromyography, nerve conduction studies, and autonomic function testing that were ordered for the same patients on a recurring basis.  The claims submitted by Dr. Castrillion were so excessive that they stood out as a significant statistical outlier in a proactive review of claims data by the U.S. Attorney’s Office.  USAO SDTX

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

September 5, 2019

El Paso Integrated Physicians Group, P.A., several physicians in the group, and Accutrack Medical Claims Services, LLC, have agreed to pay $2.93 million to resolve a False Claims Act case filed by whistleblower Sergio Garcia alleging that they double-billed and over-billed government payors for the infusion drug Remicade (Infiximab).  Remicade is sold in single-use vials; defendants were alleged to have pooled Remicade from partially-used vials, diluted Remicade, and illegally imported drugs from Canada and other foreign countries.  USAO WD Tex

Tagged in: Dosage Fraud, FCA Federal, Medical Billing Fraud, Pharma Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

September 5, 2019

Dentist Santa Maria McKibbens has agreed to pay North Carolina $375,000 to resolve allegations that she submitted false claims to the North Carolina Medicaid Program by billing for dental restorations that were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy.  NC

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

August 16, 2019

Kentucky-based Ultimate Care Medical Services, LLC, doing business as Ultimate Treatment Center, and its principal, Dr. Rose O. Uradu, have agreed to pay $1.4 million to resolve allegations that they submitted false claims to Mediare and Kentucky's Medicaid program for services that were not provided.  Defendants billed for "evaluation & management" services when patients visited the clinic to receive methadone, visits which did not include a medical examination, which is required to bill for evaluation &  management.  In addition, defendants billed for complex urine drug testing when they lacked the equipment to perform such testing, and issued buprenorphine prescriptions at an rate greater than authorized.  USAO ED KY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

August 2, 2019

A Georgia man accused of masterminding a fraud scheme against TRICARE has been sentenced to 8 years in prison and ordered to pay a combined $8 million in restitution and forfeiture.  Coordinated by Michael Burton, the scheme ran from 2014 to 2015 and involved multiple co-defendants and a Florida-based pharmacy.  Together, their cumulative actions caused TRICARE to spent millions of dollars on medically unnecessary compounded prescription drugs, and earned Burton over $1.4 million in commissions.  USAO NDFL

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

July 24, 2019

Pennsylvania-based Eagleville Hospital has agreed to pay $2.85 million to settle allegations of defrauding Medicare, Medicaid, and the Federal Employees Health Benefits Program.  According to an anonymous relator, Eagleville violated the False Claims Act between 2011 and 2018 by submitting claims for substance abuse patients improperly admitted for high paying, hospital-level detoxification treatments.  The whistleblower will receive $500,000 of the recovery.  USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Other Government Health Programs, Upcoding, Whistleblower Case, Whistleblower Rewards,

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid.  As part of the settlement, they will pay $425,000.  USAO CT

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

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