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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 1 of 128

NJ Rehab Center Will Pay $19.75M to Resolve False Claims Act Allegations

Posted  05/2/25
rehab facility with bikes and benches
On April 30, a New Jersey-based drug and alcohol rehabilitation facility, Summit BHC New Jersey, LLC, d/b/a Seabrook, agreed to pay $19.75 million to resolve allegations that it violated the False Claims Act by billing for services it was not authorized to provide. This case was initiated by a former Seabrook employee who filed suit under the whistleblower or qui tam provisions of the False Claims Act. According to...

Tagged in: False Claims Act, Healthcare Fraud, Medicaid, qui tam,

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$127M Health Care Fraud and Kickback Scheme: Business Operators Sentenced, Settle False Claim Act Allegations

Posted  04/29/25
money in pocket
By the Constantine Cannon Whistleblower Team The government continues to prioritize healthcare fraud enforcement. As we detailed in our round-up of top healthcare-related False Claims Act recoveries from 2024, more than $1.67 billion (58% of all FCA recoveries that year) came from healthcare fraud cases alone. With several settlements already announced this year, 2025 is shaping up to be another active year in...

Tagged in: False Claims Act, Healthcare Fraud, Medicare, qui tam,

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Government Files False Claims Act Complaint Against Vohra Wound Physicians Management and Its Owner

Posted  04/9/25
bedside care in health facility
On April 4, the government announced it filed a complaint under the False Claims Act against Vohra Wound Physicians Management LLC (Vohra), its entities, and its founder Dr. Ameet Vohra. Among other violations, the government alleged the company submitted false claims to Medicare for upcoded and medically unnecessary wound care services. Vohra, one of the country’s largest wound care providers, has contracts...

Tagged in: False Claims Act, Healthcare Fraud, Medicare, qui tam,

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Texas Nursing Facility and Hospital Agree to Pay $6.5 Million to Resolve False Claims Act Allegations

Posted  03/11/25
Healthcare fraud image showing stethoscope with gavel
On February 28, the government announced that the Texas-based skilled nursing facility, Providence Park, Inc., (DBA Ascension Living Providence Village) and acute care hospital, Ascension Providence, (FKA Providence Health Services of Waco), settled allegations that the Federal False Claims Act and the Texas Health Care Program Fraud Prevention Act were violated. The total amount paid to resolve the claims is...

Tagged in: False Claims Act, Healthcare Fraud, qui tam,

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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),...

Tagged in: Healthcare Fraud, Medicare,

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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,...

Tagged in: Healthcare Fraud, Medicare,

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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)...

Tagged in: Healthcare Fraud, Medicare,

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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...

Tagged in: Anti-Kickback and Stark, False Claims Act, Healthcare Fraud, qui tam, Top 10,

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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...

Tagged in: Anti-Kickback and Stark, False Claims Act, Healthcare Fraud,

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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...

Tagged in: Healthcare Fraud, Medicare, Money Laundering,

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