Archive

November 14, 2018

After pleading guilty last year, the owner of two health clinics in Detroit has been sentenced to 160 months in prison and ordered to pay over $6 million for defrauding Medicare. Along with multiple co-defendants, Jacklyn Price allegedly took part in a scheme to bill Medicare for services that were obtained through kickbacks, not medically necessary, not actually provided, or provided by an unlicensed practitioner. Her co-defendants, Millicent Traylor, Muhammad Qazi, and Christina Kimbrough, were all sentenced in September. DOJ

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

November 8, 2018

Renee Christine Borunda of Greensboro, North Carolina, was sentenced to prison and ordered to make restitution to the North Carolina Medicaid program for conduct that defrauded Medicaid. Borunda, who worked for a behavioral health services provider, used a therapist's personal information to submit false bills for behavioral services, claiming that services were provided to over 200 different Medicaid recipients when no such services were rendered. USAO EDNC; NC

Tagged in: Criminal Proceedings, Medicaid, Medical Billing Fraud, Provider Fraud,

November 7, 2018

Convicted of defrauding the Medicare program, former Houston-area healthcare clinics owner Joy Aneke was sentenced to 36 months in federal prison and ordered to pay $2,760,464.57. Aneke submitted false claims for medical services that were either not performed or not authorized by a licensed physician. None of Aneke’s clinics even had equipment necessary to provide the services -- allergy testing, complex cystometrograms, anal/urinary muscle studies, and others -- for which Aneke billed Medicare. Additionally, Aneke used “recruiters” or “marketers” to encourage patients to visit her clinics, and instructed co-defendant Maureen Henshall to pay patients illegal kickbacks. DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

November 6, 2018

An Indiana-based dental care practice and admin support company have agreed to pay a total of $5.139 million to settle allegations they violated the federal and Indiana state False Claims Acts. According to whistleblower and qui tam plaintiff Dr. Jihaad Abdul-Majid, between 2009 and 2013, ImmediaDent of Indiana, LLC and Samson Dental Partners, LLC allegedly billed Indiana's Medicaid program for procedures that were either upcoded (i.e. represented to be more serious and more expensive than they actually were), were not actually performed, or were not medically necessary. Samson Dental Partners is additionally accused of violating Indiana’s law prohibiting the corporate practice of dentistry. Because the companies refused oversight proposed during settlement, they have now been classified as "high risk" to federal healthcare programs. IN AG; USAO WDKY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

November 5, 2018

A Michigan-based patient recruiter for home health care agencies was convicted, following trial, for her role in a scheme to bill Medicare for claims arising from illegal kickbacks. Together with co-conspiring home healthcare agencies, Sophia Eggleston defrauded Medicare of $1.1 million. The scheme, which was active for at least three years, involved Eggleston soliciting and receiving kickbacks in exchange for patient referrals to co-conspirator home health agency contacts, who then submitted Medicare claims for services purportedly provided to the referred patients. Eggleston faces sentencing in February. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Medicare,

November 2, 2018

Metropolitan Retina Associates, Inc. and its owner, Dr. Kenneth S. Felder, have settled a False Claims Act investigation by agreeing to pay $2,064,559 for Medicare and Medicaid fraud. As part of the settlement, the New York-based ophthalmology practice admitted and accepted responsibility for submitting claims involving medically unnecessary and improperly documented fluorescein angiograms, as well as ultrasounds of the eye. USAO SDNY

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare,

November 1, 2018

The CEO and COO of Smart Lab LLC have been sentenced to a cumulative 10 years in prison for defrauding TRICARE of millions of dollars. CEO H. Hamilton Wayne and COO Justin Morgan Wayne allegedly paid kickbacks to substance abuse treatment centers in exchange for using Smart Lab for expensive confirmatory urinalysis testing. In some cases, treatment center patients were required to submit three medically unnecessary samples a week, but exempt from paying co-payments, co-insurance, or deductibles that should've been mandatory. Altogether, they have been ordered to pay restitution amounting to $2,897,389.50. Separately, H. Wayne has been ordered to pay $104,344, and J. Wayne has been ordered to pay $20,000. A third defendant, Smart Lab sales representative Lanny Fried, remains to be sentenced later this month. USAO SDFL

Tagged in: Criminal Proceedings, Healthcare Fraud, Other Government Health Programs,

October 31, 2018

A London-based doctor has been sentenced to 42 months in federal prison for defrauding Medicare, Medicaid, and private insurers. The doctor, Dr. Anis Chalhoub, was convicted in April of implanting over 200 medically unnecessary pacemakers in patients at St. Joseph London hospital, reportedly even pressuring patients and giving them misleading information so that they would agree to the procedures. He is ordered to pay $257,515 in restitution to Medicare, Medicaid, and private insurers, as well as a $50,000 fine. USAO EDKY

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare,

October 30, 2018

Four people connected to a Texas-based home health agency have been found guilty of fraudulently obtaining $3.7 million in reimbursements from Medicare and Medicaid. Despite being previously banned from participating in any federal healthcare reimbursement programs, Celestine Okwilagwe and Paul Emordi co-owned and operated a Medicare and Medicaid provider in the Dallas area called Elder Care. Adetutu Etti, the provider's administrator, was recruited to falsely certify that someone else was the owner, and Okwilagwe's wife, Loveth Isidaehomen, was recruited to sign checks. Some of the claims that were eventually reimbursed by Medicare were also found to be for services that were not medically necessary. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

October 25, 2018

Passavant Memorial Homes and its pharmacy subsidiaries have agreed to pay $1,850,000 to resolve allegations that it billed federal healthcare programs, including Medicare and Medicaid, for improperly prescribed controlled substances, in violation of the False Claims Act and Controlled Substances Act. While the controlled substances were prescribed for a legitimate medical purpose, they were not deemed valid with only a doctor's order by Medicare and Medicaid rules. The company later self-disclosed to the government and has since changed its policy to comply with these rules. USAO EDPA; USAO WDPA

Tagged in: FCA Federal, Medicaid, Medical Billing Fraud, Medicare,

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