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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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A $5.4M Health Care Fraud Scheme: Louisiana Doctor Sentenced for Illegally Distributing Over 1.8M Opioid Doses

Posted  02/13/25
Money with Pills Spilled Over
On February 6, 2025, the government announced that Louisiana physician, Adrian Dexter Talbot M.D., 59, was sentenced to 87 months in prison for conspiring to illegally distribute 1.8+ million doses of Schedule II controlled substances (including oxycodone, hydrocodone, and morphine), and for defrauding health care benefit programs of over $5.4 million. Talbot owned and operated Medex Clinical Consultants (Medex),...

A $1.2B+ Health Care Graft Grift! Arizona Couple Pleads Guilty to Fraud

Posted  02/4/25
doctor's office with stethoscope
On January 31, 2025, the government announced an update in a case involving a Phoenix, Arizona couple pleading guilty to causing the submission of over $1.2 billion of fraudulent claims to Medicare and other health insurance programs. The couple submitted claims for costly, medically unnecessary wound grafts applied to elderly and terminally ill patients. Alexandra Gehrke, 39, and her husband, Jeffrey King, 46,...

California Woman Sentenced in $369M Fraud Scheme Involving Billing for Medically Unnecessary Respiratory Tests

Posted  02/3/25
COVID-19 tests fraudulent claims
On January 28, the government announced that California resident Lourdes Navarro, 66, was sentenced to nine years in prison for her involvement in submitting fraudulent claims to both government and private insurance companies during the COVID-19 pandemic. Navarro and her co-conspirator, Imran Shams, illegally bundled COVID-19 screening tests with expensive and medically unnecessary respiratory pathogen panel (RPP)...

Top 10 False Claims Act Recoveries in Healthcare for 2024

Posted  01/22/25
Healthcare fraud image showing stethoscope with gavel
As we noted in our Top 10 False Claims Act Recoveries post, it was another big year of recoveries under the False Claims Act.  As usual, the majority of recoveries occurred in cases involving healthcare fraud. As the Department of Justice (DOJ) just reported in its annual roundup of False Claims Act successes, of the $2.9 billion the government and whistleblowers recovered this past fiscal year (ending September...

Healthcare Providers and Marketers Will Pay $1.1M to Settle Laboratory Kickback Allegations

Posted  01/10/25
Person wearing lab coat in laboratory
In January 2025, the government announced that lab marketers, physicians and their associated entities have agreed to pay $1,137,914 to resolve False Claims Act allegations that they participated in laboratory kickback schemes in violation of the Anti-Kickback Statute. The parties involved include physicians Dr. Abbesalom Ghermay (from Plano, Texas); Dr. Daniel Theesfeld (from Longview, Texas) and his medical...

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

Posted  12/17/24
Doctor on phone
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

Posted  12/16/24
Healthcare Fraud
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

Posted  12/4/24
dollars with a prescription signifying healthcare fraud
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

Posted  11/22/24
Doctor holding hundred dollar bills
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

Posted  09/17/24

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...

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