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September 28, 2015

American Access Care Holdings, LLC agreed to pay $3,594,791 to resolve allegations it violated the False Claims Act by improperly billing Medicare and Medicaid for multiple percutaneous transluminal angioplasties performed during the same patient encounter and improperly submitting claims to Medicare and Medicaid for procedures performed during follow-up visits that were not medically necessary.  The conduct addressed by the settlement occurred prior to AAC’s merger with Fresenius Vascular Care, Inc. in October 2011. DOJ (CT)

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

September 10, 2015

Tennessee-based non-profit hospice care provider Alive Hospice, Inc.paid roughly $1.5 million to reimburse the government for alleged violations of the False Claims Act through overbilling of Medicare and TennCare for hospice services.  According to the government, Alive submitted claims to Medicare and TennCare for general inpatient hospice care for patients who did not qualify for that care.  The allegations originated in a whistleblower lawsuit filed by Linda Anderson, a triage nurse who previously worked for Alive, under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $263,197. Whistleblower Insider

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

August 31, 2015

Laran Lerner, a Detroit-area physician who prescribed unnecessary controlled substances and billed for unperformed office visits and diagnostic testing, pleaded guilty for his role in a $5.7 million health care fraud scheme.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

August 25, 2015

A federal jury in Miami convicted Roger Rousseau, former medical director of Health Care Solutions Network Inc. (HCSN), and three HCSN therapists for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.  HCSN is a now-defunct partial hospitalization program that purported to provide intensive treatment for mental illness.  According to the evidence presented at trial, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided and paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.  DOJ

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

August 19, 2015

Yaroslav (Steven) Proshak, former owner of Southern California ambulance company ProMed Medical Transportation, was convicted of health care fraud charges in connection with a Medicare fraud scheme of at least $2.4 million.  According to the evidence, Proshak and two of his managers conspired to bill Medicare for ambulance transportation services for individuals whom the defendants knew did not need such services.  They also instructed EMTs who worked at ProMed to conceal the true medical conditions of patients they were transporting by altering requisite paperwork and creating fraudulent documents to justify the transportation services.  DOJ

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

August 19, 2015

Arizona physician Dr. Bashir Azher agreed to pay $207,988 to resolve allegations he violated the False Claims Act by submitting false bills to Medicare for prostate laser ablation procedures, commonly known as Green Light prostatectomies.  Specifically, the government charged Dr. Azher with submitting false claims for reimbursement for prostate laser ablation procedures that were too short to generate a therapeutic benefit, failed to meet professionally recognized standards of care, were medically unnecessary, and/or violated applicable Medicare regulations.  The government’s allegations originated in a whistleblower lawsuit filed by Dr. Arnaldo Trabucco under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award.  DOJ

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

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare.  Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic.  Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided.  DOJ

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

July 24, 2015

Mohammed Sadiq was sentenced to 80 months in prison and to pay $14.1 million in restitution for his leading role in a $12.6 million Medicare and tax fraud scheme.  Sadiq, who owned and directed operations at two home health care companies in Detroit, admitted billing Medicare for home health services not medically necessary or provided and paying kickbacks to patient recruiters to obtain Medicare beneficiary information used in his scheme.  DOJ

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

July 10, 2015

Detroit area doctor Farid Fata was sentenced to 45 years in prison and to forfeit $17.6 million for his role in a health care fraud scheme that included administering medically unnecessary infusions or injections to 553 individual patients and submitting to Medicare and private insurance companies approximately $34 million in fraudulent claims.  DOJ

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

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services.  According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level.  The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Upcoding,

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