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July 23, 2014

Elsa Ruiz, the owner and administrator of the Miami-based home health care agencies Professional Home Care Solutions and LTC Professional Consultants, pleaded guilty for her participation in a $74M Medicare fraud scheme. According to court documents, Ruiz and her co-conspirators operated the two companies for the purpose of billing Medicare for expensive physical therapy and home health care services that were either never provided or not medically necessary. DOJ

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

June 23, 2014

Cruz Sonia Collado, the owner and operator of Nestor’s Health Services, a now-defunct Miami home health care agency, pleaded guilty to a $6.5M million health care fraud scheme. According to the government, Collado and her co-conspirators operated Nestor for the purpose of billing Medicare for expensive physical therapy and home health care services that were not medically necessary or never provided. As part of the scheme, Collado allegedly also paid kickbacks and bribes to patient recruiters, in return for those recruiters providing patients to Nestor for these unnecessary or phantom home health care and therapy services. DOJ

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

June 13, 2014

Gwendolyn Climmons-Johnson, the owner and operator of Urgent Response EMS, a Houston area ambulance company, was sentenced to 97 months in prison and to pay roughly $1M for her role in a $2.4M Medicare fraud scheme. In October she had been convicted by a federal jury in Houston of four counts of health care fraud. According to evidence presented at trial, from January 2010 through December 2011, Climmons-Johnson and others conspired to enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and/or not provided. DOJ

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

May 28, 2014

Kentucky-based hospital King’s Daughters Medical Center agreed to pay $40.9M to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare and Kentucky Medicaid programs for medically unnecessary coronary stents and diagnostic catheterizations. The government also alleged that several King’s Daughters physicians falsified medical records to justify these unnecessary cardiac procedures. Whistleblower Insider

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity,

May 14, 2014

Richard Shannon, a patient recruiter for All American and Patient Choice, two home health care companies that provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area, was sentenced to 86 months in prison for his role in a $14.5M Medicare fraud scheme. The evidence showed that Shannon paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. Shannon recruited destitute beneficiaries from housing projects and soup kitchens in the Detroit area, obtaining their patient information in exchange for cash and promises of prescription narcotics prescribed by co-conspirator physicians. DOJ

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

May 6, 2014

Baptist Health System, the parent company for a network of affiliated hospitals and medical providers in the Jacksonville, Florida area, agreed to pay $2.5M to settle allegations that its subsidiaries violated the False Claims Act by submitting claims to Medicare and Medicaid for medically unnecessary services and drugs. Specifically, the government charged that two neurologists in the Baptist Health network intentionally misdiagnosed patients with various neurological disorders so they could bill the government health care programs for services and drugs they did not actually need. The allegations were first raised in a qui tam lawsuit filed by former Baptist Health employee, Verchetta Wells, under the whistleblower provisions of the False Claims Act. DOJ

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

May 6, 2014

The owners of Alpha Ambulance Inc. , a now-defunct Los Angeles-area ambulance transportation company, were sentenced for committing Medicare fraud by providing non-emergency ambulance transportation to Medicare beneficiaries whose medical condition at that time did not require ambulance transportation and then altering required documentation to conceal the scheme. DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

February 25, 2014

Diagnostic Imaging Group agreed to pay $15.5M to resolve allegations that its diagnostic testing facility falsely billed federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians. The allegations were first raised in three qui tam lawsuits filed under the whistleblower provisions of the False Claims Act. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,

February 10, 2014

SelfRefind, a chain of addiction treatment clinics in Kentucky, and related entities and individuals, agreed to pay $15.75M to resolve allegations they violated the False Claims Act by submitting claims to Medicare and Kentucky’s Medicaid program for tests that were medically unnecessary, more expensive than those performed or billed in violation of the Stark Law. DOJ

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

January 29, 2014

Saint Joseph Health System agreed to pay $16.5 million to resolve allegations that Saint Joseph Hospital violated the False Claims Act by submitting false claims to the Medicare and Kentucky Medicaid programs for a variety of medically unnecessary cardiac procedures. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Whistleblower Case,

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