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November 16th, 2017

New York announced the arrests of unlicensed plastic surgeon Brad Jacobs, 56, of Westbury, NY, and licensed physician Nicholas Sewell, 74, of Jackson Heights, NY, on charges they engaged in a four-year scheme to illegally perform plastic surgeries on over 60 patients, including causing permanent disfigurement to one patient. Jacobs, a former plastic surgeon, surrendered his New York medical license in 2007 after the New York State Department of Health charged him with 29 specifications of Professional Medical Misconduct. From September 2012 to June 2016, Jacobs and Sewell allegedly defrauded patients undergoing costly cosmetic surgery procedures – each averaging between $8,000 and $10,000 – by falsely representing that Jacobs was authorized to practice medicine. NY

Tagged in: Healthcare Fraud, Improper Medical Personnel,

October 16, 2017

Louisiana announced the arrests of three New Orleans women as a result of an investigation exposing over $2 million in Medicaid Fraud. Lanice Stamps, 44 of New Orleans and owner of A New Direction Support Services, was arrested on 10 counts of Medicaid fraud for allegedly providing false and fraudulent claims for behavioral health services not rendered. Many recipients were fraudulently diagnosed as moderately mentally retarded or severely autistic so that the claims submitted could be billed at a higher level and they had never received counseling services. LA

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud,

July 17, 2017

Ohio-based nursing home operators Foundations Health Solutions Inc., Olympia Therapy Inc. and Tridia Hospice Care Inc., and their executives Brian Colleran and Daniel Parker, agreed to pay roughly $19.5 million to resolve allegations they violated the False Claims Act by submitting to Medicare claims for medically unnecessary rehabilitation therapy services and for hospice services to patients not eligible for the Medicare benefit, and by soliciting and receiving kickbacks to refer patients from their skilled nursing facilities to home health care provider Amber Home Care LLC.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by former Olympia employee Vladimir Trakhter and former Tridia employees Paula Bourne and La’Tasha Goodwin.  Mr. Trahkter will receive a whistleblower award of roughly $2.9 million and Ms. Bourne and Ms. Goodwin collectively will receive an award of roughly $740,000, all from the proceeds of the government’s recovery.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, Home Health and Hospice, Lack of Medical Necessity, Multiple Whistleblowers and First-to-File, SNF, Whistleblower Case, Whistleblower Rewards,

July 14, 2017

Rodney Hesson and Gertrude Parker, owners of Nursing Home Psychological Services and Psychological Care Services, were respectively sentenced to 180 months and 84 months in prison and to respectively pay $13.8 million and $7.3 million in restitution for their involvement in a $25.2 million Medicare fraud scheme involving billing Medicare for psychological testing services that nursing home residents did not need or in some instances did not receive.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF,

July 13, 2017

New York podiatrist Perrin D. Edwards pled guilty to health care fraud for illegally charging Medicare and private insurance companies for podiatry services he never provided and agreed to pay $410,000 to resolve charges of violating the False Claims Act.  DOJ (NDNY)

Tagged in: Medical Billing Fraud, Medicare, Provider Fraud,

July 6, 2017

Matthew Kolodesh, Alex Pugman, Svetlana Ganetsky, and Malvina Yakobashvili agreed to pay millions of dollars to settle False Claims Act allegations that they and their now-defunct company Home Care Hospice, Inc. falsely billed for hospice services that were either unnecessary or never provided.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former HCH employees Maureen Fox and Cathy Gonzales.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (EDPA)

Tagged in: FCA Federal, Home Health and Hospice, Medical Billing Fraud, Whistleblower Case,

July 6, 2017

Pennsylvania hospice company Compassionate Care of Gwynedd Inc., and a subsidiary of New Jersey-based Compassionate Care Hospice Group Inc., agreed to pay $2 million to resolve allegations it violated the False Claims Act by providing unnecessary hospice services.  The government alleged the company admitted patients by using a diagnosis of “debility” that was not medically justified.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive an award of more than $350,000 from the proceeds of the government's recovery.  DOJ (DNJ)

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

July 5, 2017

Reliant Care Group, Reliant Care Management Company, Reliant Care Rehabilitative Services, and a number of Reliant affiliated skilled nursing facilities agreed to pay roughly $8.4 million to settle charges they violated the False Claims Act by billing Medicare for unnecessary physical, speech, and occupational therapy to nursing home residents.  DOJ (EDMO)

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF,

June 30, 2017

Dawn Bentley, a Detroit-area medical biller, was sentenced to 50 months in prison and to pay roughly $3.3 million for her role in a $7.3 million Medicare and Medicaid fraud scheme involving medical services that were billed to Medicare and Medicaid but not rendered as billed.  DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare,

June 30, 2017

Charlotte-Mecklenburg Hospital Authority (dba Carolinas Healthcare System) agreed to pay $6.5 million to resolve charges it violated the False Claims Act by “upcoding” claims for urine drug tests in order to receive higher payment than allowed for the tests.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Mark McGuire, a former laboratory director for CHS.  He will receive a whistleblower award of roughly $1.4 million from the proceeds of the government's recovery.  DOJ (WDNC)

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

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