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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 113 of 126

September 29, 2015

Juan Carlos Delgado and Nereyda Infante, who owned and operated several Orlando-based health care clinics under variations of the name Prestige Medical, were sentenced to five years in prison and to pay $1,520,850 in restitution and forfeit $1,520,850 for their role in a $2.4 million health care fraud scheme.  According to admissions made in connection with their guilty pleas, between February 2012 and September 2014, the defendants fraudulently billed Medicare on behalf of the Prestige clinics for services never provided and for medications not prescribed or administered.  In particular, Delgado and Infante admitted to billing Medicare for pentostatin, an expensive anticancer chemotherapeutic medication used to treat Leukemia, despite never administering the drug.  DOJ

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

September 18, 2015

Mary Talaga, the primary medical biller at Medicall Physicians Group Ltd., a Chicago-area visiting physician practice, was sentenced to 45 months in prison and to pay $1 million in restitution for her role in a $4 million health care fraud scheme.  The evidence at trial showed that Talaga and her co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely provided the service.  DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud,

September 11, 2015

A federal jury convicted Houston psychiatrist Sharon Iglehart of participating in a $158 million Medicare fraud scheme involving false claims for mental health treatment.  According to evidence presented at trial, from 2006 until June 2012, Iglehart and others engaged in a scheme to defraud Medicare by submitting, through Riverside General Hospital, approximately $158 million in false and fraudulent claims for partial hospitalization program services to Medicare beneficiaries who did not actually receive the services.  DOJ

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

August 25, 2015

A federal jury in Miami convicted Roger Rousseau, former medical director of Health Care Solutions Network Inc. (HCSN), and three HCSN therapists for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.  HCSN is a now-defunct partial hospitalization program that purported to provide intensive treatment for mental illness.  According to the evidence presented at trial, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided and paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.  DOJ

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

August 19, 2015

Yaroslav (Steven) Proshak, former owner of Southern California ambulance company ProMed Medical Transportation, was convicted of health care fraud charges in connection with a Medicare fraud scheme of at least $2.4 million.  According to the evidence, Proshak and two of his managers conspired to bill Medicare for ambulance transportation services for individuals whom the defendants knew did not need such services.  They also instructed EMTs who worked at ProMed to conceal the true medical conditions of patients they were transporting by altering requisite paperwork and creating fraudulent documents to justify the transportation services.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

August 14, 2015

Connecticut doctor Okon Umana was sentenced to two years in prison, to pay $6,429,330 in restitution and to forfeit $6,550,036 for his role in a $13 million health care fraud scheme.  From 2009 to 2012, as the medical director of Cropsey Medical Care, Umana admitted submitting more than $13 million in claims to Medicare and Medicaid for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests.  DOJ

Tagged in: Healthcare Fraud, Provider Fraud,

August 7, 2015

Tamara Esponda, owner of Miami-based Biomax Pharmacy, pleaded guilty to submitting almost $1.6 million in fraudulent claims to Medicare.  Specifically, Esponda admitted that Biomax Pharmacy submitted fraudulent claims to Medicare for prescription drugs not prescribed by physicians, not medically necessary, not purchased by Biomax Pharmacy and not provided to Medicare beneficiaries.  DOJ

Tagged in: Healthcare Fraud, Medicare, Pharma Fraud,

July 24, 2015

California oncologist Dr. Neelesh Bangalore has paid $736,000 to settle allegations that he improperly billed Medicare, Medicaid, and Tricare for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical distributor, Warwick Healthcare Solutions Inc., also known as Richards Pharma, a former United Kingdom-based drug distributer that did not have a license to distribute drugs in the United States.  DOJ

Tagged in: Healthcare Fraud, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud, Provider Fraud,

July 24, 2015

Mohammed Sadiq was sentenced to 80 months in prison and to pay $14.1 million in restitution for his leading role in a $12.6 million Medicare and tax fraud scheme.  Sadiq, who owned and directed operations at two home health care companies in Detroit, admitted billing Medicare for home health services not medically necessary or provided and paying kickbacks to patient recruiters to obtain Medicare beneficiary information used in his scheme.  DOJ

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

July 10, 2015

Detroit area doctor Farid Fata was sentenced to 45 years in prison and to forfeit $17.6 million for his role in a health care fraud scheme that included administering medically unnecessary infusions or injections to 553 individual patients and submitting to Medicare and private insurance companies approximately $34 million in fraudulent claims.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

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