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April 16, 2015

Felix Gonzalez, owner of Miami home health care company AA Advanced Care Inc. was ordered to pay $21,423,160 in restitution and sentenced to 113 months in prison in connection with a $32 million Medicare fraud scheme.  Gonzalez admitted operating his company for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were not medically necessary or provided at all.  He further admitted he negotiated and paid kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.  DOJ

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

April 9, 2015

Virginia-based cardiovascular testing disease laboratory Health Diagnostics Laboratory Inc. agreed to pay $47 million to resolve allegations it violated the False Claims Act by paying kickbacks to physicians in exchange for patient referrals and billing federal health care programs for medically unnecessary testing.  A second cardio testing lab, California-based Singulex Inc., agreed to pay $1.5 million to settle similar charges.  The allegations first arose in a whistleblower lawsuit filed by Dr. Michael Mayes, Scarlett Lutz, Kayla Webster and Chris Reidel under the qui tam provisions of the False Claims Act.  The whistleblower award they will receive has yet to be determined.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

March 23, 2015

Michigan-based Portage Hospital, LLC agreed to pay $4,446,392 to settle allegations its hospital-owned home health care agency, Portage Health Home Care & Hospice, violated the False Claims Act by submitting false claims to Medicare for unnecessary or unwarranted physical therapy services.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Hospital Fraud, Lack of Medical Necessity,

March 20, 2015

A federal jury in Los Angeles convicted Hakop Gambaryan, owner of Colonial Medical Supply, of four counts of health care fraud in connection with a $3.3 million Medicare fraud scheme.  According to evidence presented at trial, Gambaryan paid cash kickbacks to medical clinics for fraudulent prescriptions for durable medical equipment, such as expensive power wheelchairs, which the patients did not need, and then used these fraudulent prescriptions to bill Medicare.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME,

March 18, 2015

Paige Okpalobi, the owner and operator of a New Orleans-based medical clinic and her accountant Christopher White pleaded guilty for their roles in a $50 million Medicare fraud scheme, which involved fraudulently billing Medicare for home health care services not needed or provided.  DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

March 12, 2015

Huey P. Williams Jr., owner of Texas-based Hermann Medical Supply, was convicted for his role in a $3.4 million Medicare fraud scheme.  According to the evidence submitted at trial, Williams submitted claims to Medicare for durable medical equipment, including orthotic devices, which were medically unnecessary or never provided to the patients.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME,

March 6, 2015

New York physician Roman Johnson pleaded guilty for his involvement in a scheme to fraudulently bill Medicare for $14.2 million in claims for medically unnecessary treatments.  Johnson admitted that he and other medical providers at his clinic submitted claims to Medicare for medically unnecessary vitamin infusions, physical therapy, and occupational therapy that did not qualify for reimbursement by Medicare.  Johnson agreed to pay $5,386,363 in restitution which represents the total amount of money Medicare paid as the result of the fraudulent claims.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

February 27, 2015

Miami residents Blanca Ruiz and Alina Fonts were sentenced to serve 72 months in prison for their roles in a $63M Medicare fraud scheme involving intensive mental health treatment programs.  According to the evidence, Ruiz and Fonts were employed at Health Care Solutions Network Inc. which purported to provide intensive treatment for severe mental illness but instead billed Medicare and Medicaid for treatment not medically necessary and often not provided at all.  DOJ

Tagged in: Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

February 27, 2015

Gerald R. Funderburg Jr., owner of Funderburg Clinical & Community Services, was sentenced to 87 months in prison and to pay $1.45M in restitution for violating the False Claims Act through his submission of false claims to Medicare for purported psychotherapy services.  Specifically, Funderburg admitted he used the Medicare information and identities of hundreds of Medicare beneficiaries without their consent to submit claims for psychotherapy services not actually provided.  DOJ

Tagged in: FCA Federal, Medical Billing Fraud, Provider Fraud,

February 25, 2015

A federal jury in Detroit convicted Michigan patient recruiter Reginald Smith and Michigan physical therapist Rajan Patel for their roles in a $1.6M Medicare fraud scheme.  According to the evidence, Smith worked as a patient recruiter for Angle’s Touch Home Health Care LLC where he solicited patients for foot care services at adult foster care homes and then referred them to Angle’s Touch for medically unnecessary home health care services in exchange for kickbacks.  The kickbacks were disguised as payments to Smith’s nonprofit Medicare provider People Helping People of Detroit.  Patel worked as a physical therapist at Angle’s Touch where he fabricated patient medical records to make it appear that the recruited patients qualified for and received the home health care services, when they did not.  DOJ

Tagged in: Home Health and Hospice, Medical Billing Fraud,

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