Archive

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,

March 18, 2014

American Family Care Inc., a network of walk-in medical clinics with offices in Alabama, Tennessee and Georgia, agreed to pay $1.2M to resolve allegations under the False Claims Act that it knowingly submitted claims to Medicare for outpatient office visits that were billed at a higher rate than was appropriate. The settlement resolves a qui tam lawsuit filed by a former employee of American Family Care under the whistleblower provision of the False Claims Act. DOJ

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

February 3, 2014

Louis Duluc, former owner and operator of multiple physical therapy rehabilitation facilities, pleaded guilty for conspiracy to commit healthcare fraud for his role in organizing and leading a $28M Medicare fraud scheme involving physical and occupational therapy services.DOJ

Tagged in: Provider Fraud,

January 24, 2014

Tennessee Orthopedic Clinics and Appalachian Orthopedic Clinics agreed to pay a combined $1.85M to resolve state and federal False Claims Act allegations that they knowingly billed state and federal health care programs for reimported osteoarthritis medications. 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, Pharma Fraud, Provider Fraud, Whistleblower Case,

January 10, 2014

Two former executives of HealthEssentials Solutions agreed to pay more than $1 million to resolve False Claims Act allegations that they knowingly caused the company to submit false Medicare claims between 1999 and 2004 by billing for services that were inflated or not medically necessary and by pressuring employees to do the same. 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, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

January 7, 2014

Dr. Ravi Sharma, owner and operator of Premier Vein Centers, agreed to pay $400,000 to resolve allegations that he and his clinics violated the False Claims Act by knowingly billing Medicare for vein injections and physician office visits performed by unqualified personnel. 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, Improper Medical Personnel, Provider Fraud, Whistleblower Case,

December 19, 2013

Dr. Elie Korban will pay $1.2M to resolve False Claims Act allegations that he billed Medicare and Medicaid for medically unnecessary cardiac stent placements. 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, Lack of Medical Necessity, Medical Devices and DME, Provider Fraud,

November 21, 2013

Vantage Oncology agreed to pay $2M to settle allegations that it submitted false claims to Medicare for radiation oncology services performed at its Illinois centers from 2007 through June 2012. 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, Provider Fraud, Whistleblower Case,

November 19, 2013

The Ensign Group agreed to pay $48M to resolve allegations that it knowingly submitted to Medicare false claims for medically unnecessary rehabilitation therapy services. 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, Lack of Medical Necessity, Provider Fraud, Whistleblower Case,

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