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Page 26 of 42

May 18, 2018

New York podiatrist Perrin Edwards pled guilty to billing Medicare and private insurance companies for medical services he had not performed and for upcoding normal nail trimming, which is not reimbursable, to nail debridement, a covered service. Edwards will pay a $5,000 fine, serve one year of probation, and perform 50 hours of community service. USAO NDNY

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

May 14, 2018

Missouri-based podiatry provider Foot Healers agreed to pay the United States $125,000 to settle allegations the company violated the False Claims Act by using improper billing modifiers to inflate Medicare claims and falsely upcoding routine toenail trimmings performed on Medicare patients by claiming the service provided was medically necessary toenail debridement. USAO EDMO

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

May 7, 2018

Dr. Robert Fetchero, Dr. Sridhar Pinnamaneni, and Dr. Thelma Green-Mack agreed respectively to pay $200,000, $370,000 and $130,000 to settle allegations that they violated the False Claims Act, Anti-Kickback Statute, and the Stark Law by receiving improper payments for referrals from Pennsylvania-based drug testing lab Universal Oral Fluid Laboratories. According to the government, these physicians referred Medicare patients to Universal for drug testing services while engaged in a financial relationship with the lab. (DOJ (WDPA)

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Provider Fraud,

May 4, 2018

New York City-based urgent care company CityMD agreed to pay roughly $6.6 million to settle claims it violated the False Claims Act by billing Medicare for services rendered by physicians who did not actually perform those services and for more expensive and complex services than were actually provided to patients. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ

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

April 27, 2018

New Era Rehabilitation Center and its owners agreed to pay roughly $1.4 million to resolve allegations they violated the False Claims Act by improperly billing Medicaid for methadone maintenance counseling services and psychotherapy services for the same patients. DOJ (CT)

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

April 27, 2018

Las Vegas medical practice Cardiovascular and Thoracic Surgeons of Nevada, Inc. agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by billing federal healthcare programs for surgical services not actually provided to its cardiac patients and billing for more expensive surgical and evaluation and management services than actually provided. DOJ (NV)

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

April 26, 2018

Tennessee physician Brenna Green paid roughly $200,000 to settle claims she violated the False Claims Act, the Stark Law and the Anti-Kickback Statute for her role in a kickback scheme with Southwest Laboratories, Medscan Laboratory, and sales representatives affiliated with Southwest and Medscan. According to the government, Green acquired shares in Southwest for a nominal sum in exchange for a guaranteed “dividend” of approximately $5,000 per month as long as she met or exceeded the number of urine drug screen referrals required by Southwest. DOJ (NDVA)

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Provider Fraud,

April 25, 2018

Long Island-based pediatrics practice Freed, Kleinberg, Nussbaum, Festa & Kronberg M.D., LLP (dba Pediatrics and Adolescent Medicine), along with some of the practice’s current and former physicians, agreed to pay $750,000 to resolve allegations they violated the False Claims Act by billing Medicaid for services provided by physicians who were not enrolled in the program. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (EDNY)

Tagged in: FCA Federal, Improper Medical Personnel, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 16, 2018

Aharon Aron Krkasharyan, a former employee Mauran Ambulence Inc., was sentenced to 36 months in prison and pay roughly $485,000 for his role in a scheme that resulted in more than $1.1 million in fraudulent claims to Medicare.  Krkasharyan admitted he conspired with other Mauran employees to submit claims to Medicare for ambulance transportation services for individuals who did not need such services. Krkasharyan also admitted that he and his co-conspirators instructed Mauran emergency medical technicians to conceal the patients’ true medical conditions by altering paperwork and creating fraudulent reasons to justify the ambulance services. DOJ

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

April 10, 2018

Connecticut-based medical practice World Health Clinicians, Inc., its CEO Scott Gretz, and former World Health physician Gary Blick agreed to pay roughly $650,000 to settle claims they violated the False Claims Act by submitting claims for physical therapy and other covered services when in fact the patients received massages provided by a massage therapist. DOJ (CT)

Tagged in: FCA Federal, Provider Fraud, Upcoding,

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