Archive

January 14, 2015

Michigan physician Paula Williamson was sentenced to 15 months in prison and to pay more than $1M in restitution for her role in a $2.1M home health care fraud scheme involving Michigan-based home health care agency AMB Healthcare Inc. According to her plea agreement, Williamson conspired with others to commit health care fraud by referring Medicare beneficiaries for home health care services that were medically unnecessary and never provided. She also falsified documents used to support the false Medicare claims. DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

January 9, 2015

Felix Gonzalez, owner of Miami-based home health care company AA Advanced Care Inc. pleaded guilty in connection with a $32 million Medicare fraud scheme. Specifically, Gonzalez admitted he and his co-conspirators operated AA Advanced for the purpose of billing Medicare for, among other things, expensive physical therapy and home health care services not medically necessary or not provided at all. He also admitted he paid kickbacks and bribes to patient recruiters in exchange for patient referrals, prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services. DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

December 17, 2014

Mark Morad and Dr. Divini Luccioni, both of Louisiana, pleaded guilty to their role in a $56M Medicare fraud scheme. According to court documents, Morad directed the scheme through multiple New Orleans-area companies he owned, including Interlink Health Care Services Inc.,Memorial Home Health Inc., Lakeland Health Care Services Inc., Lexmark Health Care LLC, and Med Rite Pharmacy Inc. Morad paid kickbacks to recruiters who canvassed New Orleans neighborhoods for Medicare beneficiary numbers, which Morad then used to bill Medicare for services that were not medically necessary or not provided. Dr. Luccioni admitted that he signed home health referrals and wrote DME prescriptions that were used to support these fraudulent billings. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME,

November 12, 2014

Home healthcare agency CareAll Management LLC agreed to pay $25M to settle charges it violated the False Claims Act by submitting false and upcoded home healthcare billings to Medicare and Medicaid. According to the government, between 2006 and 2013, CareAll overstated the severity of patients’ conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound. The current allegations first arose in a whistleblower lawsuit filed by Toney Gonzales under the qui tam provisions of the False Claims Act. Gonzales will receive a whistleblower award in an undisclosed amount. Whistleblower Insider

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

October 22, 2014

Tayyab Aziz, founder of three Detroit-area home health agencies Prestige Home Health Services Inc., Royal Home Health Care Inc., and Platinum Home Health Services Inc. pleaded guilty for his role in a $22M home health care fraud scheme. Specifically, Aziz admitted he and his co-conspirators submitted fraudulent claims to Medicare for services that were medically unnecessary or never performed. They also submitted claims for services purportedly provided to Medicare beneficiaries who were recruited through illegal kickbacks paid to the patients and recruiters. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

October 10, 2014

Extendicare Health Services Inc., an operator of a chain of skilled nursing facilities, and its subsidiary Progressive Step Corporation (ProStep), agreed to pay $38 million that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient they were effectively worthless and billed Medicare for medically unreasonable and unnecessary rehabilitation therapy services. It is the largest failure of care settlement with a chain-wide skilled nursing facility in the Justice Department’s history. The government’s charges originated from two whistleblower lawsuits filed by Tracy Lovvron and Donald Gallick under the qui tam provisions of the False Claim Act. They will receive whistleblower awards of more than $1.8 million and $250,000, respectively. DOJ

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

September 26, 2014

Detroit-area physician Dr. Vicha Janviriya pleaded guilty for making fraudulent referrals for home health care in a $1.3 million Medicare fraud scheme. He admitted that he falsified medical documentation which would be used to support false claims to Medicare for services that were never rendered or not medically necessary, or where the Medicare beneficiary referrals were obtained through the payment of kickbacks. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Provider Fraud,

September 22, 2014

Akinola Afolabi, former owner of Long Beach, California medical supply company Emmanuel Medical Supply was sentenced to serve 30 months in prison and ordered to pay $1.5 million in restitution for his role in a scheme to provide unnecessary power wheelchairs to Medicare patients, resulting in $2.6 million in fraudulent claims to Medicare.DOJ

Tagged in: Lack of Medical Necessity, Medical Devices and DME,

September 16, 2014

Wesley Harlan Kingsbury, general manager of the Southern California ambulance company Alpha Ambulance Inc., pleaded guilty to conspiracy to commit Medicare fraud. According to court documents, Kingsbury conspired with Alex Kapri and Aleksey (Russ) Muratov, the owners of Alpha Ambulance, as well as the training supervisor Danielle Medina, to bill Medicare for ambulance transportation services for individuals that Kingsbury knew did not need to be transported by ambulance. In addition, he instructed emergency medical technicians that worked at Alpha Ambulance to conceal the true medical condition of patients they were transporting by altering requisite paperwork and creating false reasons to justify the transportation services. DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

August 1, 2014

Olufunke Ibiyemi Fadojutimi, a registered nurse and former owner of Lutemi Medical Supply, a durable medical equipment (DME) supply company, was found guilty of health care fraud relating to a 10-year scheme in which Medicare was fraudulently billed more than $8 million for DME that was not medically necessary. The trial evidence showed that between September 2003 and January 2013, Fadojutimi and others paid cash kickbacks to patient recruiters and physicians for fraudulent prescriptions for DME, such as power wheelchairs, that the Medicare patients did not actually need. DOJ

Tagged in: Lack of Medical Necessity, Medical Devices and DME,

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