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March 20, 2015

Florida Attorney General Pam Bondi’s Medicaid Fraud Control Unit announced the arrests of four individuals for allegedly recruiting the homeless to defraud Medicaid. According to the investigation, Christina Benson, owner of Tranquility Healthcare Solutions, billed Medicaid for services not provided or warranted for homeless men and women who were recruited by her associates to pose as patients. In less than a year and a half, Tranquility fraudulently billed Medicaid approximately $3.2 million. FL

Tagged in: Healthcare Fraud, Medicaid,

March 19, 2015

Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A, will receive a whistleblower award of $1,082,500 from the $5,412,502 settlement resolving allegations Adventist Health System Sunbelt Healthcare Corporation violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons.  DOJ

Tagged in: FCA Federal, Improper Medical Personnel, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 12, 2015

Florida Attorney General Pam Bondi announced the plea of a Gadsden County Home Health Care Provider, Melissa Simmons, for defrauding the Florida Medicaid program out of more than $13,000. The charges originated from the receipt of an anonymous tip through the Florida Medicaid Fraud Hotline. FL

Tagged in: Medicaid,

March 11, 2015

Olufemi Afuape and Oluyemisi Afuape, owners of Zion Rehab Services, were ordered to pay $1,407,325.50 in restitution to the Georgia Department of Community Health for billing the Georgia Medicaid program for physical, occupational and speech therapy without regard to whether the services were medically necessary and without regard to whether the services were actually delivered. GA

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

March 9, 2015

New York Attorney General Eric T. Schneiderman announced that Mental Health Association of Rockland County, Inc. agreed to pay $304,000 to resolve claims its managers and employees altered records in advance of a Medicaid audit so that the records would appear to support claims that were submitted by MHA Rockland to New York State’s Medicaid program. The allegations originated in a whistleblower lawsuit filed by two former MHA Rockland employees under the qui tam provisions of the New York False Claims Act, who will receive an undisclosed portion of the settlement. NY

Tagged in: Medicaid,

March 9, 2015

Two former employees of the Mental Health Association of Rockland County, Inc. will receive an undisclosed whistleblower award from the $304,000 settlement resolving allegations MHAR violated the New York False Claims Act through its managers and employees altering records in advance of a Medicaid audit so the records would appear to support claims MHAR submitted to New York State's Medicaid program.   NY

Tagged in: FCA State, Healthcare Fraud, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 3, 2015

Florida Attorney General Pam Bondi’s Medicaid Fraud Control Unit arrested Christopher A. Days, owner of Better Days of North Central Florida, LLC., for more than $65,000 in Medicaid fraud for billing for services not rendered and failing to properly document for services rendered. FL

Tagged in: Medicaid,

February 25, 2015

New York Attorney General Eric T. Schneiderman announced a settlement with nonprofit Regional Aid for Interim Needs, Inc. (RAIN) for diverting $800,000 in Medicaid funds to make mortgage payments on the agency’s administrative headquarters in violation of the organization’s funding agreements with the NYC Human Resource Administration. Under the settlement, RAIN, which provides home attendant services to elderly residents in the Bronx, must repay the illegally diverted $800,000 back to the Medicaid program. NY

Tagged in: Home Health and Hospice, Medicaid,

February 4, 2015

Pennsylvania Attorney General Kathleen G. Kane and the Office of Inspector General of the U.S. Department of Health & Human Services announced Medicaid fraud and other charges against Philadelphia-based Infinite Care Inc., sister company Infinite Care Special Needs Inc., and the companies’ vice president and treasurer. According to the Grand Jury, Infinite Care fraudulently billed Medicaid by more than $1M for services not rendered from January 2010 to the present, and after the company received a Grand Jury subpoena, it held a meeting where the decision was made to destroy the fraudulent paperwork submitted to the Commonwealth for services not provided and for inflated services. PA

Tagged in: Medicaid, Medical Billing Fraud,

January 30, 2015

Massachusetts Attorney General Maura Healey announced Neighborhood Diabetes, Inc. will pay more than $1.5M to settle allegations it improperly billed and received payments from the state’s Medicaid program when it automatically refilled prescription medications that were not specifically requested by MassHealth patients or caregivers. The settlement is the second case in the Commonwealth to address a pharmacy’s operation of an improper automatic refill program with MassHealth members. In September 2013, AllCare Pharmacy agreed to pay $1.6M to settle similar allegations. MA

Tagged in: FCA State, Medicaid, Pharma Fraud,

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