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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 110 of 126

February 19, 2016

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $2.09 million to resolve allegations that patients were administered portions of single-dose vials of chemotherapy drugs that were left over from administrations to prior patients.  The settlement also resolves allegations that some platinum based drugs were administered inappropriately and that certain infusion services were upcoded.  The allegations originated in a whistleblower lawsuit filed by former Adventist employee Heather Huddleston under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $376,452 from the proceeds of the government's recovery.  DOJ (MDFL)

Tagged in: Dosage Fraud, Drug Switching, Healthcare Fraud, Medical Billing Fraud, Medicare, Pharma Fraud, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

February 12, 2016

New Jersey Doctor Labib E. Riachi and two companies he owns, Riachi, Inc. and Center for Advanced Pelvic Surgery, agreed to pay $5.25 million to resolve allegations they violated the False Claims Act by billing Medicare and Medicaid for anorectal manometry and electromyography diagnostic tests, even though most of the tests were never performed.  The settlement also resolves charges that they submitted claims to Medicare for physical therapy services that should not have been paid because they were not performed by a qualified therapist.  DOJ (NJ)

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

February 10, 2016

An Oklahoma jury convicted Antonella Carpenter, former owner of purported cancer treatment clinic Lase Med Inc., of committing a fraudulent scheme claiming to cure patients’ cancer.  According to the evidence, Carpenter, who is a physicist and not a medical doctor, orchestrated a scheme to obtain money from cancer patients by means of false and fraudulent representations, including claiming to cure various kinds of cancers, when in fact, she would inject a patient’s tumor with a mixture consisting of saline solution and food coloring or walnut hull extract.  DOJ

Tagged in: Healthcare Fraud,

February 9, 2016

Miami physician Henry Lora, medical director of Miami-area clinic Merfi Corporation, pleaded guilty for his role in a Medicare fraud scheme that caused more than $20 million in losses.  Lora admitted that in exchange for kickbacks and bribes, he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided.  Lora and his co-conspirators also falsified patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Isabel Medina, the owner of Merfi, was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud,

February 9, 2016

A federal jury convicted registered nurse Patricia McGill of four counts of health care fraud.  McGill was the director of professional services for Home Care Hospice, a for-profit business that provided hospice services for patients at nursing homes, hospitals and private residences.  According to the evidence, McGill authorized and supervised the admission of inappropriate and ineligible patients for hospice services, which contributed to HCH submitting millions of dollars in fraudulent claims to Medicare.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

January 27, 2016

Mohammed Elsaleh, owner and operator of former Houston-area ambulance company National Care EMS agreed to settle allegations that he and the company provided kickbacks to various nursing facilities and hospitals in exchange for rights to the institutions’ more lucrative Medicare and Medicaid transport referrals.  The settlement calls for Elsaleh to pay $125,000 to resolve the “swapping” allegations made against him and the company.  Elsaleh’s brother, Husam Alsaleh, the owner and operator of a successor company also called National Care EMS agreed to pay $120,000 in furtherance of the settlement.  DOJ (SDTX)

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Provider Fraud,

January 29, 2016

Florida arrested three individuals for allegedly defrauding Medicaid out of more than half a million dollars. Two more defendants are being sought by authorities for arrest. According to the investigation, Matthew, Micah and Jimmie Harrell, along with Kenneith Durden and Keith Daly, billed Medicaid for services not provided and fraudulently used a licensed mental health provider’s information without that provider’s knowledge or consent to become accepted as a Medicaid provider. Matthew Harrell and Kenneith Durden allegedly set up parallel, fraudulent business operations in Florida, Georgia and Louisiana that all engaged in similar criminal activities. The businesses operated under the names Revive Athletics Florida, Divine Consulting Services, and Durden Consulting Services of Florida. FL

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud,

January 27, 2016

New York announced that it reached an agreement with a Capital Region transportation company, Advantage Transit Group, Inc., for repayment of Medicaid funds totaling over $1 million dollars that the company was not entitled to receive. Advantage Transit Group provides, among other services, transportation for Medicaid recipients to and from appointments and submits claims for reimbursement to Medicaid. Under the settlement agreement, Advantage Transit Group acknowledged that it submitted claims for reimbursement to Medicaid for transportation services and received payment for services that were not rendered. NY

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

Sleep Disorder Fraud: With the uptick in sleep disorder services and government spending comes the discovery of schemes and scams.

Posted  01/26/16
By Jessica Moore, published in ADVANCE Healthcare Network  Increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders that affect more than fifty million Americans.  The significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous to engage in fraudulent services and billing of federal and state heath care programs that...

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Devices and DME, Medicare,

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