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May 28, 2014

Kentucky-based hospital King’s Daughters Medical Center agreed to pay $40.9M to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare and Kentucky Medicaid programs for medically unnecessary coronary stents and diagnostic catheterizations. The government also alleged that several King’s Daughters physicians falsified medical records to justify these unnecessary cardiac procedures. Whistleblower Insider

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

May 22, 2014

An owner and operator of community mental health centers in Baton Rouge as well as a patient recruiter for a related facility in Houston were convicted for their roles in a $258M Medicare fraud scheme involving three facilities that filed fraudulent claims for psychiatric services that were unnecessary or never actually provided. The ongoing investigation into these three community mental health centers — Shifa Community Mental Health Center, Serenity Center and Shifa Community Mental Health Center — has so far resulted in the convictions of 17 employees of these facilities, including therapists, marketers, administrators, owners and the medical director. DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud,

May 22, 2014

Zahir Yousafzai, the co-owner or operator of four Detroit-area home health agencies involved in a $13.8M Medicare fraud scheme was sentenced to serve 72 months in prison and pay $4.1M in restitution. According to court records, Yousafzai and his co-conspirators paid and directed the payment of various medical professionals, including doctors, nurses, physical therapists and physical therapist assistants, to create fictitious patient files to document purported home health services that were never provided. The healthcare companies involved included First Care Home Health Care, Moonlite Home Care, Physicians Choice Home Health Care and Quantum Home Care. DOJ

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

May 14, 2014

Richard Shannon, a patient recruiter for All American and Patient Choice, two home health care companies that provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area, was sentenced to 86 months in prison for his role in a $14.5M Medicare fraud scheme. The evidence showed that Shannon paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. Shannon recruited destitute beneficiaries from housing projects and soup kitchens in the Detroit area, obtaining their patient information in exchange for cash and promises of prescription narcotics prescribed by co-conspirator physicians. DOJ

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

May 6, 2014

Baptist Health System, the parent company for a network of affiliated hospitals and medical providers in the Jacksonville, Florida area, agreed to pay $2.5M to settle allegations that its subsidiaries violated the False Claims Act by submitting claims to Medicare and Medicaid for medically unnecessary services and drugs. Specifically, the government charged that two neurologists in the Baptist Health network intentionally misdiagnosed patients with various neurological disorders so they could bill the government health care programs for services and drugs they did not actually need. The allegations were first raised in a qui tam lawsuit filed by former Baptist Health employee, Verchetta Wells, under the whistleblower provisions of the False Claims Act. DOJ

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

May 6, 2014

The owners of Alpha Ambulance Inc. , a now-defunct Los Angeles-area ambulance transportation company, were sentenced for committing Medicare fraud by providing non-emergency ambulance transportation to Medicare beneficiaries whose medical condition at that time did not require ambulance transportation and then altering required documentation to conceal the scheme. DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

April 30, 2014

A federal jury in Detroit convicted a physical therapist, physical therapy assistant and unlicensed doctor for their participation in a $15M Medicare fraud scheme at Detroit area companies Physicians Choice Home Health Care, Quantum Home Care, First Care Home Health Care, Moonlite Home Care and Phoenix Visiting Physicians. According to evidence presented at trial, these companies operated a fraudulent scheme to bill Medicare for home health care services that were never provided and paid kickbacks to recruiters who in turn paid Medicare beneficiaries cash and promised them access to narcotic prescriptions. DOJ

Tagged in: Home Health and Hospice, Improper Medical Personnel,

March 18, 2014

American Family Care Inc., a network of walk-in medical clinics with offices in Alabama, Tennessee and Georgia, agreed to pay $1.2M to resolve allegations under the False Claims Act that it knowingly submitted claims to Medicare for outpatient office visits that were billed at a higher rate than was appropriate. The settlement resolves a qui tam lawsuit filed by a former employee of American Family Care under the whistleblower provision of the False Claims Act. DOJ

Tagged in: FCA Federal, Provider Fraud, Upcoding, Whistleblower Case,

February 25, 2014

Diagnostic Imaging Group agreed to pay $15.5M to resolve allegations that its diagnostic testing facility falsely billed federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians. The allegations were first raised in three qui tam lawsuits filed under the whistleblower provisions of the False Claims Act. DOJ

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

February 19, 2014

Medical device manufacturer EndoGastric Solutions agreed to pay up to $5.25M to resolve allegations that it violated the False Claims Act by misleading health care providers about how to bill federal health care programs for a procedure using a device manufactured by the company and by paying kickbacks. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

Tagged in: FCA Federal, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case,

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