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June 27, 2017

Dr. Anindya Sen, owner of Tennessee-based East Tennessee Cancer & Blood Center and East Tennessee Hematology Oncology and Internal Medicine, and his wife Patricia Posey Sen, agreed to pay $1.2 million to resolve charges they violated the False Claims Act by billing Medicare and Tennessee Medicaid for non-FDA approved anticancer and infusion drugs manufactured in foreign countries.  DOJ

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

June 26, 2017

Dr. Miguel Burgos, the medical director of four Florida infusion clinics, and Yosbel Marimon, the owner of the clinics, were sentenced respectively to 64 months and 90 months in prison for their roles in a $13.7 million Medicare fraud conspiracy that involved submitting claims for expensive infusion-therapy drugs that were never purchased, never provided and not medically necessary.  DOJ

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

June 26, 2017

AMI Monitoring Inc. (aka Spectocor), its owner Joseph Bogdan, Medi-Lynx Cardiac Monitoring LLC, and Medicalgorithmics SA, the current majority owner of Medi-Lynx, agreed to pay roughly $13.5 million to resolve allegations they violated the False Claims Act by billing Medicare for higher and more expensive levels of cardiac monitoring services than requested by the ordering physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Spectocor sales manager Eben Steele.  He will receive a whistleblower award of roughly $2.4 million from the proceeds of the government's recovery.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 22, 2017

Dr. James M. Crumb, a physical medicine and rehabilitative specialist currently practicing in Alabama as Mobility Metabolism and Wellness, P.C.,and Coastal Neurological Institute, P.C., a local neurosurgeon physician group, agreed collectively to pay $1.4 million to resolve allegations they violated the False Claims Act by billing federal health care programs for medically unreasonable and unnecessary ultrasound guidance used with routine lab blood draws, and with Botox and trigger point injections. As a result of this billing scheme, the defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient office visit. DOJ (SDAL)

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

June 15, 2017

Kentucky allergists Bruce Wolf and Kiro John Yun agreed to pay $740,578 to resolve allegations their medical practice group of otolaryngologists Wolf and Yun, P.S.C., specializing in allergy, asthma and immunology, violated the False Claims Act by billing the government for Sublingual Immunotherapy serum preparation and overstated units of serum preparation for injection vials. Sublingual immunotherapy is an alternative way to treat allergies without injections whereby an allergist prescribes a patient with an allergen that is sprayed under the tongue to boost tolerance to substances and reduce symptoms but it is not covered by Medicare because it is considered investigational. DOJ (WDKY)

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

May 9, 2017

California-based radiation therapy center Valley Tumor Medical Group agreed to pay $3 million to resolve allegations it submitted fraudulent bills over a nearly 10-year period to three government-run healthcare programs for unsupervised radiation oncology services.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Valley Tumor employee Jared Shindler.  He will received a whistleblower award of $555,000 from the proceeds of the government's recovery. DOJ (CDCA)

Tagged in: FCA Federal, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 2, 2017

North Carolina-based Piedmont Pathology agreed to pay $601,000 to settle allegations it violated the False Claims Act by submitting false claims to Medicare and Medicaid for medically unnecessary procedures. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Piedmont pathologist Dr. Kim Geisinger. She will receive a whistleblower award of roughly $120,000. DOJ (WDNC)

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

April 27, 2017

Forrest S. Kuhn, Jr., M.D., a Kentucky physician specializing in allergy, asthma and immunology, agreed to pay roughly $750,000 to resolve allegations he violated the False Claims Act by submitting false claims to Medicare, Medicaid, and other government health care programs for allergy tests never performed. DOJ (WDKY)

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

April 20, 2017

Dr. Norman A. Brooks, a dermatologist and surgeon and owner of Skin Cancer Medical Center in Encino, agreed to pay roughly $2.7 million to resolve allegations he submitted bills to Medicare for Mohs micrographic surgeries for skin cancers that were medically unnecessary. The government alleged that Brooks falsely diagnosed skin cancer in some of his patients so that he could perform, and bill for, Mohs surgeries. The allegations originated in a whistleblower lawsuit by former employee Janet Burke. She will receive a whistleblower award of roughly $483,000 from the proceeds of the government's recovery. DOJ (CDCA)

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

March 6, 2017

Simon Hong, owner of Los Angeles-based JH Physical Therapy Inc., was sentenced to 63 months in prison and to pay roughly $2.4 million in restitution, for his role in a $3.4 million Medicare fraud scheme that involved billing for occupational therapy services that were not medically necessary and not provided.   Hong admitted billing Medicare for occupational therapy services when what were provided instead were acupuncture and massage services, not reimbursable by Medicare.  Hong further admitted directing co-conspirator therapists to falsify medical records to make it appear as if the services billed actually had been provided. DOJ

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

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