Archive

February 22, 2018

Samuel Konell was sentenced to 60 months in prison and pay roughly $10 million for his role in a $63 million health care fraud scheme involving now-defunct Greater Miami Behavioral Healthcare Center Inc. which purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness. Konell admitted he received kickbacks and/or bribes in return for referring Medicare beneficiaries from the Miami-Dade state court system to Greater Miami to serve as patients. He admitted he coordinated with criminal defendants in the state court system to obtain court orders for mental health treatment in lieu of incarceration so that he could refer those individuals to Greater Miami to serve as patients in return for kickbacks and/or bribes. Konell further admitted that he did so knowing that certain of those individuals were not mentally ill or otherwise did not meet the criteria for PHP treatment. DOJ

Tagged in: Anti-Kickback and Stark, Lack of Medical Necessity, Provider Fraud,

February 13, 2018

Detroit-area doctor Mahmoud Rahim was sentenced to 72 months in prison and ordered to forfeit roughly $1.7 million for his role in a $10.4 million conspiracy to defraud the Medicare program. According to the evidence presented at trial, Rahim accepted kickbacks in exchange for referring Medicare patients for electromyogram tests, some of which were unnecessary, and physical therapy performed by unlicensed individuals. DOJ

Tagged in: Anti-Kickback and Stark, Improper Medical Personnel, Lack of Medical Necessity, Provider Fraud,

February 8, 2018

Dr. Vincent Koh and his wife and office manager Milly Koh agreed to pay $500,000 for violating the False Claims Act by submitting claims to Medicare for unapproved chemotherapy drugs. DOJ (EDNY)

Tagged in: FCA Federal, Off-Label and Unapproved Use, Pharma Fraud, Provider Fraud,

February 7, 2018

New York surgeon Syed Imran Ahmed was sentenced to 156 months in prison -- and ordered to pay roughly $7 million in restitution, forfeit roughly $7 million and pay a $20,000 fine -- for his role in a scheme that involved the submission of millions of dollars in false and fraudulent claims to Medicare. According to evidence presented at trial, Ahmed, who practiced at Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center in Brooklyn, Franklin Hospital in Valley Stream, and Mercy Medical Center in Rockville Centre, New York, billed the Medicare program for incision-and-drainage and wound debridement procedures that he did not perform. DOJ

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

February 6, 2018

Kentucky ENT physician Phillip B. Klapper, M.D., Patricia Klapper, and Phillip B. Klapper, P.S.C. agreed to pay roughly $2.8 million to settle claims they violated the False Claims Act by submitting claims under the Federal Employees’ Compensation Act which falsely indicated that audiological tests were performed by licensed and certified personnel and/or the testing results were altered to enable some claimants to appear to have hearing losses. DOJ (WDKY)

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

January 24, 2018

Tennessee chiropractor Matthew Anderson agreed to pay $1.45 million to resolve allegations he violated the False Claims Act. Specifically, the government alleged that Anderson and his management company, PMC LLC, caused pharmacies to submit requests for Medicare and TennCare payments for pain killers dispensed based upon prescriptions written at the Cookeville Center for Pain Management, one of the pain clinics Anderson managed, which had no legitimate medical purpose. The government further alleged that Anderson caused four pain clinics he managed to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. The allegations originated in a whistleblower lawsuit filed by a former office manager for the Cookeville Center for Pain Management under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $246,500 from the proceeds of the government's recovery. DOJ

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

January 23, 2018

Drs. Aytac Apaydin and Stephen Worsham, urologists based in Northern California who own Salinas Valley Urology Associates and formerly owned Advance Radiation Oncology Center, will pay roughly $1 million to settle claims they violated the False Claims Act by submitting claims to Medicare for image guided radiation therapy (IGRT) that was referred and billed in violation of the physician self-referral law (the “Stark Law”) and the Anti-Kickback Statute. DOJ

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

April 27, 2018

A behavioral health and substance abuse treatment provider with locations in Connecticut and its owners have agreed to pay $1,378,533 to resolve a joint state-federal investigation into allegations that they submitted false claims for payment to Connecticut’s Medicaid program. New Era Rehabilitation Center and its co-founders and owners – Dr. Ebenezer Kolade and Dr. Christina Kolade – are enrolled as providers in the Connecticut Medical Assistance Program (CMAP), which includes the state’s Medicaid program. As part of their practice, they provide methadone treatment services for patients dealing with opioid addiction. Most of their patients are CMAP beneficiaries. CT

Tagged in: Medicaid, Provider Fraud,

January 19, 2018

San Diego-based health care system Scripps Health agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by charging federal health care programs for physical therapy services that were rendered by therapists who did not have billing privileges for these programs and were not supervised by an authorized provider. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Scripps employee Suzanne Forrest. She will receive a whistleblower award of $225,000 from the proceeds of the government's recovery. DOJ

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

January 18, 2018

Detroit-area doctor Gerald Daneshvar was sentenced to 24 months in prison for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulted in inappropriately high payments. DOJ

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

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