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January 13, 2017

Massachusetts-based ambulance company Medstar Ambulance Inc., including four subsidiary companies and its two owners, Nicholas and Gregory Melehov, agreed to pay $12.7 million to resolve allegations that they violated the False Claims Act by submitting false claims to Medicare for ambulance transport services. According to the government, Medstar routinely billed for services that did not qualify for reimbursement because the transports were not medically reasonable and necessary, billed for higher levels of services than were required by patients’ conditions, and billed for higher levels of services than were actually provided. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dale Meehan, a former employee in Medstar’s billing office. Mr. Meehan will receive a whistleblower award of roughly $3.5 million. DOJ

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

January 12, 2017

Idia Oriakhi, the administrator of five Houston-area home health agencies, pleaded guilty to conspiring to defraud the State of Texas’ Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. Oriakhi’s parents owned and operated Aabraham Blessings, LLC; Baptist Home Care Providers, Inc.; Community Wide Home Health, Inc.; Four Seasons Home Healthcare, Inc. and Kis Med Concepts, Inc. and admitted that she, her father Godwin Oriakhi and others obtained patients for her family’s home health agencies by paying illegal kickback payments to patient recruiters and physicians for referring and certifying Medicaid patients for services not medically necessary and often not provided. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

January 12, 2017

The Confederated Tribes of the Colville Reservation (CGT) agreed to pay roughly $246,000 to settle charges it violated the False Claims Act by submitting false claims to Medicaid seeking the reimbursement of mental health counseling services either not provided or not medically indicated or necessary. The CCT is a federally recognized, sovereign Indian tribe, with tribal offices located at Nespelem, Washington, on the Tribes’ reservation. DOJ (EDWA)

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

January 9, 2017

Detroit-area neurosurgeon Aria O. Sabit was sentenced to 235 months in prison for his role in a $2.8 million health care fraud scheme in which he caused serious bodily harm to patients by performing unnecessary invasive spinal surgeries. Sabit owned and operated the Michigan Brain and Spine Physicians Group. He admitted deriving significant profits by convincing patients to undergo spinal fusion surgeries with “instrumentation” (medical devices designed to stabilize and strengthen the spine) that he never performed and billed public and private healthcare benefit programs for those fraudulent services. Whistleblower Insider

Tagged in: Healthcare Fraud, Lack of Medical Necessity,

January 12, 2017

Texas announced a settlement with MB2 Dental Solutions (MB2) and 21 affiliated pediatric dental practices. MB2 agreed to pay the United States and the State of Texas $8.45 million for alleged violations of the federal False Claims Act (FCA) and the Texas Medicaid Fraud Prevention Act (TMFPA). Three lawsuits were resolved with this settlement alleging that MB2 knowingly submitted claims for children’s dental services which were either not performed or were provided after false identification was used. The claims also involved illegal kickbacks to Medicaid beneficiaries and their families, marketers and marketing entities. The allegations were brought to the attention of the U.S. and Texas authorities by whistleblowers who filed one lawsuit under the FCA and two under the TMFPA. TX

Tagged in: Anti-Kickback and Stark, FCA State, Lack of Medical Necessity, Medicaid,

December 15, 2016

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc. was convicted for his role in a $2.5 million Medicare fraud scheme. According to evidence presented at trial, Leon and his co-conspirators used the companies to submit false claims to Medicare that were based on services that were not medically necessary, not actually provided and for patients that were procured through the payment of illegal kickbacks to doctors and patient recruiters.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare,

December 7, 2016

Not-for-profit regional hospital South Miami Hospital agreed to pay approximately $12 million to settle allegations that it violated the False Claims Act by submitting false claims to federal healthcare programs for medically unnecessary electrophysiology studies and other procedures allegedly performed by Dr. John R. Dylewski.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by South Miami Hospital doctors James A. Burks and James D. Davenport.  They will receive a whistleblower award of roughly $2,748,500 from the proceeds of the government's recovery.  DOJ (SDFL)

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

December 7, 2016

Jacksonville, Florida-based orthopedic medical group Southeast Orthopedic Specialists agreed to pay roughly $4.5 million to resolve allegations that it violated the False Claims Act by billing federal healthcare programs for services that were not medically necessary.  DOJ (MDFL)

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

December 7, 2016

Lifepoint Dental Group, LLC, and its owners Aaron Blass, Angelina Blass, Mindy Richtsmeier, and Brad Richtsmeier, agreed to pay more than $300,000 to settle allegations that they violated the False Claims Act by submitting claims for dental procedures, including scalings and root planings, that were either medically unnecessary or did not happen.  The allegations originated in a whistleblower lawsuit filed by two former Lifepoint employees under the qui tam provisions of the False Claims Act.  The whistleblowers will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (NDIA)

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

September 28, 2016

Pennsylvania-based hospital chain Vibra Healthcare LLC agreed to $32.7 million to resolve claims it violated the False Claims Act by billing Medicare for medically unnecessary services.  According to the government, Vibra admitted numerous patients to five of its long term care hospitals and one of its inpatient rehab facilities who did not demonstrate signs or symptoms that would qualify them for admission.  In addition, Vibra allegedly extended the stays of its long term care patients without regard to medical necessity, qualification and/or quality of care.  In some instances, Vibra allegedly ignored the recommendations of its own clinicians, who deemed these patients ready for discharge.  The allegations originated in a whistleblower lawsuit filed by Sylvia Daniel, a former health information coder at Vibra Hospital of Southeastern Michigan, under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of at least $4 million from the proceeds of the government's recovery.  Whistleblower Insider

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

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