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This archive displays posts tagged as relevant to chiropractic services and chiropractic services fraud.

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April 25, 2023

Attorneys George Constantine and Marc Elefant, and orthopedic surgeon Andrew Dowd, were sentenced to prison for their $31 million trip-and-fall fraud scheme. Constantine (102 months), Elefant (24 months), and Dowd (102 months) recruited participants to stage falls or falsely claim to have fallen and would then file fraudulent suits against the businesses and insurance companies where the “falls” allegedly occurred. In addition to staging the accidents and then filing suit, Constantine and Elefant would require the “victims” to receive ongoing chiropractic and medical treatment from certain designated chiropractors and doctors—including Dowd. Dowd performed nearly 300 medically unnecessary surgeries on patient-clients, at the behest of Constantine and Elefant, who then used the surgeries to boost the value of any potential settlement. In addition to prison time, they will forfeit over $8 million acquired via their fraud. DOJ

Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

P-Stim Fraud: A New DOJ Enforcement Priority?

Posted  04/23/21
The Department of Justice regularly publicizes its fraud prevention and False Claims Act enforcement priorities. These announced priorities typically focus on broad issues that affect the lives of millions of Americans – COVID-19 fraud, the opioid crisis, and the rapid expansion of telehealth.  In addition, we keep an eye on DOJ enforcement actions, and these can reveal emerging trends, often in narrow areas.  One...

August 21, 2020

A Georgia-based chiropractor and her medical practice have been ordered to pay more than $5 million for violating the False Claims Act.  The government alleged that Dr. Jennifer Heller, D.C. caused Medicare to pay $1.4 million more than it would have had it known that hundreds of Heller’s charges for a surgical neurostimulator procedure were in actuality for acupuncture devices, which are not covered by Medicare, and which do not require surgery.  To resolve the charges, Heller Family Medicine, LLC will have to pay $4.3 million, while Heller herself will have to pay $700,000.  USAO SDGA

July 9, 2019

Two chiropractors who owned the Kansas City Health and Wellness Clinic have agreed to pay $350,000 to settle False Claims allegations.  Brothers Ryan Schell and Tyler Schell allegedly billed Medicare for medically unnecessary, unprovided, or uncovered treatments of peripheral neuropathy, which causes loss of sensation and/or burning sensations in the hands and feet.  USAO KS

March 15, 2019

Long Island chiropractor Raymond R. Pellegrino pleaded guilty to charges arising from his fraudulent billing of private insurance companies.   Pellegrino falsely billed Anthem Empire Blue Cross/Blue Shield over $2 million for services claimed to have been provided by doctors employed by him, when knew those services had not, in fact, been provided.  USAO EDNY

March 6, 2018

Iowa chiropractor Bradley Brown and his clinic Brown Chiropractic, P.C. agreed to pay roughly $80,000 to settle claims they violated the False Claims Act and Anti-Kickback Statute by billing Medicare and Medicaid for chiropractic adjustments after providing free electrical stimulation to beneficiaries to influence those beneficiaries to receive chiropractic adjustments from Brown. DOJ (NDIA)

January 24, 2018

Tennessee chiropractor Matthew Anderson agreed to pay $1.45 million to resolve allegations he violated the False Claims Act. Specifically, the government alleged that Anderson and his management company, PMC LLC, caused pharmacies to submit requests for Medicare and TennCare payments for pain killers dispensed based upon prescriptions written at the Cookeville Center for Pain Management, one of the pain clinics Anderson managed, which had no legitimate medical purpose. The government further alleged that Anderson caused four pain clinics he managed to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. The allegations originated in a whistleblower lawsuit filed by a former office manager for the Cookeville Center for Pain Management under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $246,500 from the proceeds of the government's recovery. DOJ

Tennessee Chiropractor Pays More Than $1.45 Million to Resolve False Claims Act Allegations

Posted  01/26/18
By the C|C Whistleblower Lawyer Team A Lenior City, Tennessee, chiropractor has paid $1.45 million, plus interest, to resolve False Claims Act violations. Matthew Anderson and his management company, PMC LLC, managed four pain clinics in Tennessee, most recently known as; Cookeville Center for Pain Management; Spinal Pain Solutions in Harriman; Preferred Pain Center of Grundy County in Gruetli Laager; and McMinnville...

June 13, 2017

New Jersey doctor Robert Claude McGrath and his chiropractor son Robert Christopher McGrath admitted to conspiring to defraud Medicare by using unqualified people to give physical therapy to Medicare recipients. Together with their practice, the Atlantic Spine & Joint Institute, they also agreed to pay $1.78 million to resolve allegations they violated the False Claims Act through the illegal billings. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Linda Stevens, a former billing manager at Atlantic Spine. She will receive a whistleblower award of roughly $338,200 from the proceeds of the government's recovery. DOJ (DNJ)
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