Healthcare Fraud

May 13, 2016

A Somerville-based ambulance services provider has been sued for allegedly overbilling the state’s Medicaid program (MassHealth) for more than $600,000 in ambulance services that reflected a higher level of care than was actually provided. The complaint against Cataldo Ambulance Service, Inc. (Cataldo), filed on Thursday in Suffolk Superior Court, alleges that from 2005 to November 2015, Cataldo billed MassHealth for Emergency Advanced Life Support (ALS) services when, in fact, the patient’s condition at the scene only required, and the patient only received, Emergency Basic Life Support (BLS) services. Cataldo provides a variety of transportation services, including emergency ambulance services, throughout the Greater Boston area. According to the complaint, Cataldo’s inappropriate billing practices persisted despite being notified that, in many instances, the patient’s condition and the services rendered were insufficient to justify billing at an ALS level. MA

April 19, 2016

Michigan doctor Ali Elhorr pleaded guilty for his role in a $2.4 million health care fraud scheme.  Elhorr, who worked at House Calls Physicians P.L.L.C., admitted to conspiring with others, including his brother, Dr. Hicham Elhorr, to commit health care fraud by agreeing to serve as a “supervising” physician for unlicensed individuals purportedly providing in-home physician services.  The unlicensed individuals prepared medical documentation that Elhorr and other licensed physicians signed as if they had performed the visits when, in fact, Elhorr and the other licensed physicians had not treated the beneficiaries.  The visits were then billed as if performed by the licensed physicians.  DOJ

April 13, 2016

Nery Cowan, a former health care clinic consultant and Medicare biller for partial hospitalization program Greater Miami Behavioral Healthcare Center Inc. was sentenced to 135 months in prison and ordered to pay a $100,000 fine for her role in laundering money in connection with a $63 million health care fraud scheme.  As part of her guilty plea, Cowan admitted to directing and authorizing the payment of kickbacks and bribes to patient brokers and others in exchange for Medicare beneficiary referrals.  Cowan also admitted that Greater Miami personnel routinely falsified medical records affiliated with these recruited Medicare beneficiaries to support false claims to Medicare.  Cowan also admitted that she, along with co-defendants Dean Butler and Irina Mora, took great lengths to conceal kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida.  Judge Bloom previously sentenced Butler and Mora to 16 years and nine years in prison, respectively, following their guilty pleas.  DOJ

April 11, 2016

Naseem Minhas, the owner and operator of Detroit-area home health care agency TriCounty Home Care Services Inc. pleaded guilty today for his participation in a $4 million health care fraud scheme.  According to admissions made as part of his plea agreement, Minhas paid a physician and recruiters to refer Medicare beneficiaries to TriCounty and sign medical documents falsely certifying that they required home health care.  Minhas, a licensed physical therapist, also admitted that he assisted in creating fake patient files to make it appear as though the patients needed and received services that were unnecessary or not provided.  DOJ

March 23, 2016

Detroit-area doctor Laran Lerner was sentenced to 45 months in prison and to pay $2.8 million in restitution for his role in a $5.7 million Medicare fraud scheme in which he prescribed medically unnecessary controlled substances and billed for office visits and diagnostic testing that never took place.  DOJ

March 15, 2016

Tennessee-based Southern Tennessee Medical Center agreed to pay roughly $2.5 million to settle charges it violated the False Claims Act by submitting Medicare claims for medically unnecessary days of in-patient geriatric psychiatric services and in-patient geriatric psychiatric services for which a Physician Certification or Recertification was not obtained.  DOJ (MDTN)

March 7, 2016

Florida businessman David Brock Lovelace was sentenced to 174 months in prison and to pay $2,512,460 in restitution for his role in a multimillion-dollar health care fraud and money laundering scheme.  According to evidence presented at trial, Lovelace and co-conspirators used Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists, three purported medical clinics in Florida, to submit to Medicare more than $12 million in fraudulent claims for radiology, audiology, cardiology and neurology services not rendered by physicians, secured by kickbacks or the subject of forged or falsified documents.  DOJ

March 2, 2016

Mark T. Conklin, the former owner and operator of Florida-based Recovery Home Care Inc. and Recovery Home Care Services Inc. (RHC) agreed to pay $1.75 million to resolve charges of violating the False Claims Act by paying illegal kickbacks to doctors who agreed to refer Medicare patients to RHC for home health care services.  Conklin sold RHC to National Home Care Holdings in October 2012.   According to the government, Conklin ran a scheme under which RHC paid dozens of physicians thousands of dollars per month to serve as sham medical directors who performed little or no work in exchange for referring their patients to RHC.  The allegations originated in a whistleblower lawsuit filed by former RHC employee Gregory Simony under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of up to $315,000 from the proceeds of the government's recovery.  DOJ

March 1, 2016

Ubert Guillermo Rodriguez, president and owner of Florida-based durable equipment provider G.R. Services Equipment & Supplies Inc., pleaded guilty to conspiracy to commit health care fraud.  According to the government, Rodriguez’s company submitted approximately $2.6 million worth of claims to Medicare seeking reimbursement for durable medical equipment, such as wound care supplies, that was not legitimately prescribed by doctors and was not provided to beneficiaries.  DOJ