Healthcare Fraud

July 6, 2015

New York announced a $400,000 settlement with a transportation company that was unable to provide documentation for services it had billed to Medicaid. “Providers must be able to properly document services for which they received payment from Medicaid,” said Attorney General Schneiderman. “Doing otherwise drains Medicaid of precious resources, and my office will steadfastly guard New York taxpayer dollars expended to ensure quality care to those most in need.” NY

June 23, 2015

Georgia announced a prison sentence for the owner of Senior Care of Columbus, Inc., following her guilty plea to Medicaid fraud and related charges. From 2009 until 2011, the defendant submitted numerous fraudulent claims for and was reimbursed for services that were not provided to patients. An extraordinarily high percentage of claims submitted by defendant for reimbursement to Georgia Medicaid lacked any documentation, and it was discovered that in many instances, the defendant billed Medicaid on days when patients received no services at all, and for patients who had been discharged. GA

June 18, 2015

Florida joined the federal government in announcing charges against 73 South Florida residents for their alleged participation in various schemes to defraud Medicare and Medicaid out of more than $262 million. FL

May 6, 2015

New York Attorney General Eric T. Schneiderman announced that Carewell Ambulette, Inc. and its owner, Kurien Palliankal have pleaded guilty to stealing more than $200,000 from the New York Medicaid program. Palliankal will be sentenced to six months in jail, followed by five years of probation, and will also be required to pay full restitution to Medicaid. Carewell will be fined $10,000. From July 2006 through March 2010, Palliankal and Carewell defrauded the Medicaid system by doctoring the request forms received from the medical providers. These forms authorized taxi service, but Palliankal changed the forms to appear as though they authorized the more expensive ambulette service, which Medicaid pays at a rate four times higher than taxi service. NY

April 23, 2015

Grady Health System agreed to pay $2,950,000 to settle claims it inaccurately coded claims for neo-natal intensive care unit patients, resulting in alleged damages to the Georgia Medicaid program. GA

April 22, 2015

Massachusetts Attorney General Maura Healey announced the filing of a complaint against the Center for Psychiatric Medicine for unlawfully profiting off of patients seeking treatment for opiate addiction. The state alleges that since October 2010, the company charged hundreds of its patients cash fees to receive Suboxone treatment, a medication covered by MassHealth, when they should not have been charged at all. MA

April 7, 2015

Dr. Punyamurtula Kishore along with his company Preventive Medicine Associates, Inc. pleaded guilty for running a Medicaid fraud scheme involving millions of dollars in taxpayer funds. Kishore was sentenced to 360 days in jail and ordered to pay $9.3 million in restitution. Based on the government’s investigation, Dr. Kishore used bribes, or kickbacks, to induce sober house owners to send their residents’ urine drug screening business to his laboratories for testing. MA

March 20, 2015

Florida Attorney General Pam Bondi’s Medicaid Fraud Control Unit announced the arrests of four individuals for allegedly recruiting the homeless to defraud Medicaid. According to the investigation, Christina Benson, owner of Tranquility Healthcare Solutions, billed Medicaid for services not provided or warranted for homeless men and women who were recruited by her associates to pose as patients. In less than a year and a half, Tranquility fraudulently billed Medicaid approximately $3.2 million. FL