Archive

July 29, 2016

Syed Imran Ahmed, a New York surgeon who practiced at hospitals in Brooklyn and Long Island, was convicted of submitting millions of dollars in fraudulent claims to Medicare.  According to the evidence, Ahmed submitted more than $25 million in false claims to Medicare for incision-and-drainage and wound debridement surgeries he did not perform.  DOJ

July 27, 2016

The University of Pittsburgh Medical Center, together with the University of Pittsburgh Physicians, UPMC Community Medicine, Inc., and Tri-State Neurosurgical Associates-UPMC, Inc., agreed to pay roughly $2.5 million to settle charges they violated the False Claims Act by submitting false claims to Medicare.  Specifically, the government alleged that certain neurosurgeons employed by UPMC submitted claims for assisting with or supervising surgical procedures performed by other surgeons, residents, fellows, or physician assistants, when those neurosurgeons did not participate in the relevant surgeries to the degree required.  The allegations originated in a whistleblower lawsuit filed 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 (WDPA)

July 27, 2016

Connecticut psychiatrist Dr. Anton Fry and his company CPC Associates agreed to pay $36,704 to resolve allegations they violated the False Claims Act by submitting improper claims to Medicare for psychiatric services that were provided over the phone instead of by meeting with the beneficiaries in the office and treating them in person.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Jodi Cohen, a former patient of Dr. Fry, and Medical Bill Consultants, LLC, a billing company.  They will receive a whistleblower award of $6,239 from the proceeds of the government's recovery.  DOJ (DCT)

July 22, 2016

Preferred Imaging, LLC, a provider of diagnostic imaging services, agreed to pay $3,510,000 to resolve allegations it violated the False Claims Act by improperly billing Medicare and Texas Medicaid for services performed without proper medical supervision.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Preferred Imaging employee Tracy Sifuentes.  She will receive a whistleblower award of $596,700 from the proceeds of the government's recovery.  DOJ (NDTX)

July 19, 2016

Ann Anyanwu, a registered nurse at Texas-based Medpsych Home Health Care, was convicted for participating in an $8 million Medicare fraud scheme involving fraudulent claims for home-health services.  According to the evidence, Anyanwu and others executed a scheme to submit to Medicare through Medpsych claims for home-health services to patients who did not receive them and did not qualify for them.  DOJ

July 25, 2016

Florida announced the arrests of three individuals for operating a $1 billion Medicare and Medicaid fraud scheme involving numerous Miami-based health care providers. Attorney General Bondi’s MFCU, as part of the HEAT Strike Force, assisted in identifying more than $100 million of Medicaid fraud in connection to this scheme. According to the indictment, Philip Esformes, 47, operated a network of more than 30 skilled nursing homes and assisted living facilities that gave access to thousands of Medicare and Medicaid beneficiaries. Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility. However, Esformes and co-conspirators admitted the beneficiaries to Esformes Network facilities, and received medically unnecessary services billed to Medicare and Medicaid. The defendants also allegedly received kickbacks by steering the beneficiaries to other health care providers, including community mental health centers and home health care providers, who also performed medically unnecessary treatments billed to Medicare and Medicaid. In order to hide the kickbacks from law enforcement, the kickbacks were often paid in cash, or were disguised as payments to charitable donations, payments for services and sham lease payments. FL

July 12, 2016

New Jersey couple Nita and Kirtish Patel and their diagnostic imaging companies Biosound Medical Services Inc. and Heart Solution PC were ordered to pay more than $7.75 million for violating the False Claims Act by submitting false claims to Medicare for thousands of falsified diagnostic test reports and the underlying tests.  The government had alleged that defendants created fraudulent diagnostic test reports, forged physician signatures on these reports, and then billed Medicare for the fraudulent reports and the underlying tests that were used solely to create these reports.  The government further alleged that defendants billed Medicare for neurological tests that they conducted without the required physician supervision.  The allegations originated in a whistleblower lawsuit filed by a former Biosound employee 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 (DNJ)

July 7, 2016

MD2U Holding Company agreed to pay $3.3 million and a percentage of its net income over the next five years to settle charges they violated the False Claims Act by submitting false medical claims to Medicare and other government health care programs, altering records to support false claims and providing services that were medically unnecessary.  Specifically, the government alleged MD2U submitted false billings for patients who were neither homebound nor home-limited; improperly billed the government for medically unnecessary visits; billed government health care programs at the highest payment codes (upcoding) when a lower code would have been more appropriate; and cloned medical records (a cut, copy, paste electronic program) in order to justify patient visits.  The company admitted being liable to the government for roughly $21.5 million.  DOJ

July 5, 2016

Massachusetts ophthalmologist Martin E. Cutler and his company Martin E. Cutler, M.D., P.C. agreed to pay $55,000 to resolve allegations they violated the False Claims Act by falsely billing Medicare for ophthalmic diagnostic imaging when there was no underlying diagnosis to justify the imaging.  They also allegedly falsely billed Medicare for office visits where a prior claim for the same visit had been denied and the new claim was not supported by Dr. Cutler’s documentation.  The allegations originated in a whistleblower lawsuit filed by Brian Sachs under the qui tam provisions of the False Claims Act.  Mr. Sachs will receive a whistleblower award of $11,000 from the proceeds of the government's recovery.  DOJ (DMA)

June 30, 2016

California-based Marshall Medical Center agreed to pay $5.5 million to settle allegations that it, along with Marshall Foundation for Community Health, El Dorado Hematology & Medical Oncology II, Inc., Dr. Lin H. Soe and Dr. Tsuong Tsai, violated the federal False Claims Act and California False Claims Act through a variety of Medicare and Medicaid billing improprieties.  The allegations originated in a whistleblower lawsuit filed by oncology nurse Colleen Herren under the qui tam provisions of the False Claims Act. She will receive a whistleblower reward of roughly $1,430,000 from the proceeds of the government's recovery.  DOJ (EDCA)