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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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August 16, 2019

2d Chance PLLC, a Kentucky-based substance abuse center, will pay $200,494 to resolve allegations under the False Claims Act that it entered into an arrangement with Compliance Advantage, LLC, a toxicology lab, whereby 2d Chance referred patients to Compliance Advantage for complex drug testing, and Compliance Advantage provided a no-cost chemistry analyzer to 2d Chance, allowing 2d Chance to perform some urine testing at its site and bill Medicaid for those services.  The financial arrangement violated the Anti-Kickback Statute.  EDKY

August 16, 2019

Kentucky-based Ultimate Care Medical Services, LLC, doing business as Ultimate Treatment Center, and its principal, Dr. Rose O. Uradu, have agreed to pay $1.4 million to resolve allegations that they submitted false claims to Mediare and Kentucky's Medicaid program for services that were not provided.  Defendants billed for "evaluation & management" services when patients visited the clinic to receive methadone, visits which did not include a medical examination, which is required to bill for evaluation &  management.  In addition, defendants billed for complex urine drug testing when they lacked the equipment to perform such testing, and issued buprenorphine prescriptions at an rate greater than authorized.  USAO ED KY

August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million.  According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals.  As part of the settlement, Seddon will receive a $200,000 relator’s share.  USAO SDAL

August 15, 2019

North Carolina ambulance company Gate City Transportation has been ordered to pay $5.25 million in restitution for falsely billing the state's Medicaid program for convalescent ambulance services when, in fact, the company was providing only medical van service to ambulatory and wheelchair-bound patients.  During the investigation, agents confiscated more than $5 million in cash and property, which will be applied to the restitution.  USAO MD NC

DOJ Catch of the Week — Beaver Medical Group

Posted  08/9/19
Yesterday, California-based Beaver Medical Group and one of its physicians, Dr. Sherif Khalil, agreed to pay roughly $5 million to resolve allegations they violated the False Claims Act by reporting invalid diagnoses to Medicare Advantage plans causing those plans to receive inflated payments from Medicare.  It is the latest example of what has become a strong government commitment to pursuing fraud in the Medicare...

August 8, 2019

California-based Beaver Medical Group LP and one of its physicians, Dr. Sherif Khalil, have agreed to pay $5 million to resolve allegations of violating the False Claims Act.  According to another physician formerly employed at Beaver, the defendants allegedly submitted false diagnoses to Medicare Advantage Organizations (MAOs) for the Medicare beneficiaries under its care, which caused Medicare to pay a needlessly inflated rate of reimbursement.  The whistleblower, Dr. David Nutter, will receive a relator’s share of $850,000 from the settlement proceeds.  DOJ

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Posted  08/2/19
Silhouette of People Around a Whistle
This week marks the seventh year in a row that Congress has designated July 30th National Whistleblower Day, honoring the occasion, on July 30, 1778, when the Continental Congress unanimously enacted the first whistleblower protection law in the United States. The law was passed in response to a petition to the Continental Congress filed by a group of ten American sailors and marines, who reported that their...

August 2, 2019

A Georgia man accused of masterminding a fraud scheme against TRICARE has been sentenced to 8 years in prison and ordered to pay a combined $8 million in restitution and forfeiture.  Coordinated by Michael Burton, the scheme ran from 2014 to 2015 and involved multiple co-defendants and a Florida-based pharmacy.  Together, their cumulative actions caused TRICARE to spent millions of dollars on medically unnecessary compounded prescription drugs, and earned Burton over $1.4 million in commissions.  USAO NDFL

August 1, 2019

Tennessee-based telemarketer Scott Roix and his companies have agreed to pay $2.5 million to settle two whistleblowers’ False Claims suit alleging the submission of false claims to Medicare, TRICARE, and other federal health benefit programs.  Roix and his companies allegedly procured fraudulent insurance information from patients around the country in order to arrange prescriptions for medically unnecessary pain creams; they then sold these prescriptions to pharmacies, labeling proceeds as earned through marketing services.  The whistleblowers in this case, Jennifer Silva and Jessica Robertson, will receive $287,500 for revealing the fraudulent scheme.  USAO MDFL

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted  07/26/19
Laboratory sample vial lying on procedure coding form
Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states.  CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...
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