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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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April 24, 2019

Two executives of Arriva Medical, LLC, a mail-order diabetic testing supply company acquired by Alere, Inc. in 2011, will pay a total of $1 million to settle claims that they caused Arriva to submit false claims to Medicare by supplying patients with free or no cost home blood glucose meters, waiving patient copayments, and billing for medically unnecessary home blood glucose meters.  USAO MD TN

April 12, 2019

California-based Sutter Health LLC and its affiliated medical foundations will pay $30 million to resolve allegations under the False Claims Act that they submitted unsupported diagnosis codes for certain patients, thereby inflating the the risk scores for those patients.  These inflated risk scores increased Medicare Advantage payments to Medicare Advantage Organizations with whom Sutter contracted.  Sutter's contracts with the MAOs gave Sutter a share of those improper increased payments.  DOJ; USAO ND Cal

DOJ Announces Criminal Indictments in International Health Care Fraud Scheme that Caused $1.2 Billion in Medicare Losses

Posted  04/12/19
doctor adjusting patients knee brace
The U.S. Department of Justice announced this week that it had issued criminal indictments against two dozen individuals in one of the largest health care fraud schemes in U.S. history. The indictments target an alleged scheme involving the payment of illegal kickbacks and bribes by durable medical equipment (DME) companies in exchange for the referral of Medicare beneficiaries by doctors working with fraudulent...

April 4, 2019

Lee County Ambulance of Lexington, Kentucky, and its former director Joseph Broadwell, will pay $253,930 to settle a False Claims Act action alleging that defendants submitted fraudulent claims to Medicare for unnecessary non-emergency ambulance transports, including transportation of patients to and from dialysis treatment.  USAO ED KY

April 4, 2019

Oral and Maxillofacial Surgical Associates P.C. of New Haven, Connecticut, and its former owner Robert Sorrentino DDS, have agreed to pay $252,000 to settle claims that they submitted false claims to Medicaid by billing for services that were not provided, were not medically necessary, or were covered under other claims submitted for the same date of service.  The fraudulently-billed services included deep sedation or general anesthesia and removal of bone or tissue.  USAO CT

April 4, 2019

Evelyn Mokwuah, a former administrator for Houston, Texas-based Beechwood Home Health and Criseven Health Management Corporation, was sentenced to ten years in prison for her role in the submission of approximately $20 million in false claims to Medicare.  According to the evidence at trial,  Mokwuah falsely certified and billed for patients who were not homebound or did not qualify for home health services; falsified patient records to show that patients were homebound when they were not; paid patient recruiters; and, paid doctors to certify false plans of care for Medicare beneficiaries.  DOJ

April 2, 2019

Paul Emordi, of Collin County, Texas, was sentenced to prison for 60 months for his part in a $3.7 million health care scheme involving Medicare. Emordi and Celestine “Tony” Okwilagwe, owners and operators of Elder Care, along with Adetutu Etti, the administrator of Elder Care, were convicted on counts of conspiracy to commit health care fraud and on counts of false statements in connection with a health care benefit program. Evidence in the investigation also shows that the defendants submitted fake and fraudulent bills to Medicare for providing services that were not necessary. DOJ

March 29, 2019

CareWell Urgent Care of Rhode Island, P.C., and Urgent Care Centers of New England Inc. have agreed to pay $2 million to settle a qui tam suit brought on by a former employee, Aileen Cartier. In violation of the False Claims Act, CareWell had falsely inflated the level of services provided and failed to identify service providers in claims submitted to Medicare, Massachusetts and Rhode Island Medicaid, and the Massachusetts Group Insurance Commission (GIC) between 2013 to 2018. For bringing on the suit, Cartier will receive a 17% relator's share. USAO MA

March 29, 2019

Acacia Mental Health Clinic and its owner, Abraham Freud, have agreed to pay $4.1 million to the United States and the State of Wisconsin for submitting false claims to Medicaid in violation of the False Claims Act. According to a qui tam complaint filed by whistleblower Rose Presser, Acacia billed for urine drug screens in simple "cup" tests as if a more sophisticated test had been performed. Acacia also billed for medically unnecessary and duplicative urine drug tests and telemedicine services performed by foreign-based psychiatrists in violation of Medicaid regulations. USAO EDWI

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

Posted  03/28/19
Man Holding a Heart
MedStar Health, a health system in Maryland and Washington, DC, and two of its hospitals have settled allegations that they violated the False Claims Act by violating the Anti-Kickback Statute. The settlement is not a determination of liability. It settles specific allegations that MedStar paid kickbacks to MidAtlantic Cardiovascular Associates, a cardiology group based in Maryland, in exchange for...
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