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February 21, 2019

Hooshang Poor, a doctor of geriatric medicine based in Newton, Massachusetts, has agreed to pay $680,000 to resolve claims under the False Claims Act that he knowingly submitted inflated charges to Medicare and the Massachusetts Medicaid program.  Dr. Poor was alleged to submit bills with false procedural codes that overstated the length, extent, and scope of services that he furnished to nursing home residents, and misrepresented services provided by non-physician employees.  USAO Mass.

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

February 20, 2019

Hope Thomley of Hattiesburg, Mississippi, pleaded guilty for her role in a compounding pharmacy kickback scheme.  Thomley was the owner and operator of acompany that marketed for Advantage Pharmacy in Hattiesburg, and received 50% of Advantage's reimbursements.  Thomley admitted that she knew Advantage submitted false claims for payment to federal healthcare programs for medications that had not been prescribed by a doctor or were not medically necessary.  Between 2012 and 2016, health care benefit programs, including TRICARE, reimbursed Advantage Pharmacy and other pharmacies involved in the scheme at least $200 million. DOJ

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

February 19, 2019

Xerox Corporation will pay $236 million to the State of Texas to resolve claims that the company and its subsidiary Conduent, which provided services to the Texas Medicaid program, improperly approved requests for orthodontic procedures without ensuring that the procedures met Medicaid program requirements.  As a result, the state paid for orthodontic work that was unnecessary or did not meet program requirements.  Texas

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

February 14, 2019

Prime Healthcare Services and its CEO Prem Reddy, will pay $1.25 million to settle claims under the False Claims Act that two Prime Healthcare hospitals in Pennsylvania, Roxborough Memorial Hospital and Lower Bucks Hospital, billed Medicare for patients who were admitted when they could have been treated on an outpatient basis, and up-coded patient diagnoses to increase Medicare payments.  The investigation was initiated by an anonymous whistleblower identified as a former employee of the Roxborough hospital.  USAO ED PA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case,

February 13, 2019

Ashraf Hasan-Hafez and Ilya Kogan have been sentenced to over three years in prison for their participation in a scheme that defrauded Medicare and New York State Medicaid out of $1.3M dollars. Hasan-Hafez, the owner of a physical therapy practice, and Kogan, the owner of an acupuncture company, fraudulently submitted bills for services that were not rendered, or for services performed by unlicensed individuals. In addition to jail time, Hasan-Hafez and Kogan have been ordered to forfeit $1,297,000 in restitution to the Medicare and Medicaid programs.  DOJ    

Tagged in: Criminal Proceedings, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare,

February 12, 2019

Jefferson Medical Associates, a Laurel-based physicians group, and neurologist, Dr. Aremmia Tanious, will pay the United States $817,635.06 to settle allegations under the False Claims Act regarding Medicare overpayments. The government’s investigation discovered that from 2012 to 2014, Jefferson Medical Associates and Dr. Tanious allegedly did not return overpayments they received on claims from Medicare. It is further alleged that from February 1, 2013, through June 30, 2017, Jefferson Medical Associates and Dr. Tanious allegedly used multiple medical codes when billing Medicare but the medical documentation did not support those billing practices. DOJ    

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

February 8, 2019

Two executives from the South Carolina Early Autism Project (SCEAP) have been convicted of causing false statements to be submitted to Medicare and TRICARE and causing them to be overcharged by millions of dollars. According to statements by SCEAP employees, co-founder Ann Davis Eldridge and executive Angela Breitweiser Keith instructed employees to include travel and wait time in their billing in order to inflate time spent providing services. To further incentivize this practice, they implemented billing goals that had to be met in order to qualify for bonuses such as gift cards and vacations, all paid for by the company. Since then SCEAP has repaid almost $9 million, and as part of their plea agreement, both Keith and Eldridge will serve 1-year sentences. USAO SC

Tagged in: Healthcare Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

February 7, 2019

Six people associated with a string of substance abuse treatment centers have been indicted for defrauding Ohio's Medicaid program of over $31 million. Ryan Sheridan, the owner and operator of the businesses, along with Jennifer Sheridan, Kortney Gherardi, Lisa Pertee, Thomas Bailey, and Arthur Smith, allegedly submitted claims that were false on a number of fronts, including but not limited to: billing without proper documentation, for medically unnecessary services, provided by unqualified persons, and upcoded to a more costly service. Altogether, 134,744 false claims were submitted for more than $48.5 million in services. USAO NDOH

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

February 7, 2019

A former bus driver with the New York Metropolitan Transit Authority has been sentenced to 20 months in prison for defrauding the authority's health benefit plan of $2.8 million. Enver Kalaba, who was recruited into the scheme by former bus driver Christopher Frusci, worked on behalf of an unnamed company to pay bribes to fellow MTA employees in exchange for medically unnecessary prescription compounded medications. For each prescription for medications such as pain creams, scar creams, and metabolic supplements, Kalaba and Frusci paid $100. As part of his sentence, Kalaba must now forfeit $138,630 in fraudulent earnings and pay $2.9 million in restitution. Frusci is scheduled to be sentenced next month. USAO NJ

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

February 6, 2019

Families United Services, Inc. (FUS) and owner Pamela McKenzie have agreed to pay $645,000 to settle allegations of defrauding Georgia's Medicaid program from 2010 to 2012 by submitting claims for unprovided mental health services. As part of the settlement, FUS has been excluded from participating in federal healthcare programs for a period of five years. USAO NDGA

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

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