Healthcare Fraud

Hold the Phone: Telemarketer Sent to Prison for $67M Health Care Fraud and Money Laundering Scheme

In December 2024, Jose Goyos, (38, from West Palm Beach, Florida) was sentenced to 15 years in prison for defrauding Medicare by falsely billing over $67 million for medically unnecessary genetic tests. Goyos and his co-conspirators worked at a telemarketing call center that roped thousands of unsuspecting Medicare beneficiaries and their doctors into their scheme. According to the government, Goyos managed the...

Fraud alert! California Hospital Pays $10.25M to Resolve Whistleblower Suit Alleging Medically Unnecessary Inpatient Admissions and Kickbacks

On December 12, the DOJ announced that California’s Oroville Hospital will pay $10,250,000 to the United States and the State of California to resolve allegations that it submitted false claims to Medicare and Medicaid for medically unnecessary inpatient hospital admissions, a kickback and physician self-referral scheme, and the use of incorrect diagnosis codes to maximize reimbursements. Oroville Hospital will pay...

Predatory Pharmacies Targeted Low-Income HIV Patients: Former Owner of New York Pharmacies Sentenced for Ongoing $11 Million Medicaid Fraud Scheme

On November 20, 2024, New York Attorney General Letitia James announced that former pharmacy owner Aftab Hussain was sentenced to two to six years in prison for swindling over $11.5 million in a Medicaid fraud scheme that targeted low-income HIV patients who required life-saving medications. Hussain and his co-conspirators paid illegal kickbacks to patients to entice them as repeat customers at over 20...

Fishy Business and Fraudulent Bills: New York Internist Pleads Guilty to $891K Healthcare Fraud Scheme

The Hippocratic Oath was apparently not an ethical pledge Dr. Kenneth Fishberger took to heart. On Thursday, November 14, 2024, New York internist Dr. Fishberger, 75, pleaded guilty in Boston federal court to one count of conspiracy to commit healthcare fraud. Fishberger, an internist from East Setauket, N.Y., received kickbacks for ordering medically unnecessary transcranial doppler (TCD) brain scans, tests used...

Walgreens to Pay $106.8M to Settle Whistleblower Case Alleging it Billed the Government for Prescriptions it Did Not Dispense

Walgreens has agreed to pay $106.8 million to settle false claims allegations that between 2009 and 2020 it billed government healthcare programs, including Medicare and Medicaid, for prescriptions that it never dispensed because they were not picked up by patients. The government alleged that Walgreens received tens of millions of dollars to which it was not entitled for prescriptions that it never actually provided...

Rite Aid Settles Allegations Over Improper Opioid Dispensing

Rite Aid Corporation, one of the biggest names in the retail pharmacy industry, has reached a settlement following allegations of improper practices related to opioid dispensing. This settlement, announced by the U.S. Department of Justice, involves a total payment of $7.5 million to resolve claims under the False Claims Act  and Controlled Substances Act (CSA). 

From 2014 to 2019, Rite Aid allegedly dispensed...

Opioid Exploitation: Doctor and Staff Charged with Conspiracy and Fraud

VNS Health: $1M Settlement for Failing To Provide Services to Hospice Patients

The U.S. Attorney's Office for the Southern District of New York announced a substantial settlement with Visiting Nurse Service of New York (formerly VNSNY, now VNS Health) and its related entities. This settlement addresses allegations of fraudulent billing practices that undermined the Medicaid program meant to support some of the most vulnerable patients like those in hospice.  VNS Health is one of the largest...

Government Agencies Focus on PE Firms in Health Care

The government has increased its scrutiny of PE firms and other investors in healthcare companies.  Yesterday, the government announced a joint effort between the Department of Justice (DOJ), the Federal Trade Commission (FTC), and the Department of Health and Human Services (HHS), to inquire into “private-equity and other corporations’ increasing control over health care.”  This may signal increased...

Catch of the Week - Endo Health Solutions

This week's Department of Justice (DOJ) Catch of the Week goes to Endo Health Solutions.  Yesterday (February 29), the now-bankrupt pharmaceutical company agreed to pay up to $465 million over 10 years to settle criminal and civil charges relating to its sales and marketing of the opioid drug Opana.  Endo voluntarily withdrew the drug from the market in 2017. This bankruptcy-negotiated payout flows from a...