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December 28, 2016

Bay Sleep Clinic, its related businesses -- Qualium Corporation and Amerimed Corporation -- and their owners and operators, Anooshiravan Mostowfipour and Tara Nader, agreed to pay $2.6 million to settle allegations they fraudulently charged Medicare for diagnostic sleep tests and medical devices in violation of Medicare payment rules. The allegations originated in a whistleblower lawsuit filed by Elma F. Dresser under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of approximately $545,000 from the proceeds of the government's recovery. DOJ (NDCA)

Tagged in: Healthcare Fraud, Improper Medical Facility, Improper Medical Personnel, Laboratory and IDTF, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 15, 2016

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc. was convicted for his role in a $2.5 million Medicare fraud scheme. According to evidence presented at trial, Leon and his co-conspirators used the companies to submit false claims to Medicare that were based on services that were not medically necessary, not actually provided and for patients that were procured through the payment of illegal kickbacks to doctors and patient recruiters.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare,

December 9, 2016

Michigan resident Renald Dasine pleaded guilty to fraud charges for his role in a scheme to defraud Medicare out of approximately $6.3 million while he acted as an unlicensed physician at Detroit in-home physician services company B&M Visiting Doctors PLC.  DOJ

Tagged in: Healthcare Fraud, Improper Medical Personnel,

December 7, 2016

Not-for-profit regional hospital South Miami Hospital agreed to pay approximately $12 million to settle allegations that it violated the False Claims Act by submitting false claims to federal healthcare programs for medically unnecessary electrophysiology studies and other procedures allegedly performed by Dr. John R. Dylewski.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by South Miami Hospital doctors James A. Burks and James D. Davenport.  They will receive a whistleblower award of roughly $2,748,500 from the proceeds of the government's recovery.  DOJ (SDFL)

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

December 7, 2016

Jacksonville, Florida-based orthopedic medical group Southeast Orthopedic Specialists agreed to pay roughly $4.5 million to resolve allegations that it violated the False Claims Act by billing federal healthcare programs for services that were not medically necessary.  DOJ (MDFL)

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

December 7, 2016

Lifepoint Dental Group, LLC, and its owners Aaron Blass, Angelina Blass, Mindy Richtsmeier, and Brad Richtsmeier, agreed to pay more than $300,000 to settle allegations that they violated the False Claims Act by submitting claims for dental procedures, including scalings and root planings, that were either medically unnecessary or did not happen.  The allegations originated in a whistleblower lawsuit filed by two former Lifepoint employees under the qui tam provisions of the False Claims Act.  The whistleblowers will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (NDIA)

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

December 20, 2016

Massachusetts announced that a Burlington woman has been sentenced to jail and ordered to pay up to $570,000 in restitution for stealing from public agencies by billing for unlicensed psychological services. Nita Guzman, age 52, pleaded guilty on Friday in Middlesex Superior Court to the charges of Medicaid False Claims (2 counts), False Claims to Public Agency (1 Count), Larceny (4 Counts), and Unlicensed Practice of Psychology (2 Counts). An AG’s investigation revealed that Guzman, through her company New England Psychological Consultants, Inc., billed Medicaid, Medicare, and Lawrence Public Schools more than $550,000 for unlicensed mental health services. MA

Tagged in: Improper Medical Personnel,

October 21, 2016

New York-based hematology and oncology practice Hudson Valley Associates agreed to pay $5.31 million to settle charges of violating the False Claims Act by improperly waiving patient copayments and submitting claims for services it did not provide and/or were not permitted under the Medicare and Medicaid program rules.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)

Tagged in: FCA Federal, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

September 28, 2016

Pennsylvania-based hospital chain Vibra Healthcare LLC agreed to $32.7 million to resolve claims it violated the False Claims Act by billing Medicare for medically unnecessary services.  According to the government, Vibra admitted numerous patients to five of its long term care hospitals and one of its inpatient rehab facilities who did not demonstrate signs or symptoms that would qualify them for admission.  In addition, Vibra allegedly extended the stays of its long term care patients without regard to medical necessity, qualification and/or quality of care.  In some instances, Vibra allegedly ignored the recommendations of its own clinicians, who deemed these patients ready for discharge.  The allegations originated in a whistleblower lawsuit filed by Sylvia Daniel, a former health information coder at Vibra Hospital of Southeastern Michigan, under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of at least $4 million from the proceeds of the government's recovery.  Whistleblower Insider

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

September 30, 2016

New York announced guilty pleas by Katia Donnelly and her durable medical equipment and supply store, Bennett Surgical Supply, Inc., for submitting thousands of false claims to Medicaid resulting in Medicaid paying them more than two million dollars over a six and a half year period. Donnelly admitted during her plea that she used the Medicaid identification numbers of Bennett Surgical customers to fraudulently bill for items she never purchased or delivered to them. She and her corporation plead guilty to Grand Larceny in the Second Degree, and it is expected that Donnelly will be sentenced to 2 to 6 years in State Prison. NY

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medical Devices and DME,

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