Top Ten Federal Financial and Healthcare Fraud Prison Sentences of 2022
Posted 02/2/23
Healthcare Fraud
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January 30, 2023
A doctor in Michigan who was involved in a $250 million fraud scheme against Medicare, Medicaid, and other insurers, has been sentenced to 16.5 years in prison. Along with 21 co-conspirators, Dr. Francisco Patino took advantage of patients suffering from addiction by forcing them to receive medically unnecessary, painful, but lucrative spinal injections in exchange for opioid prescriptions. Additionally, Patino knowingly violated the Anti-Kickback and Stark laws by receiving kickbacks from a laboratory in exchange for sending patient samples to that lab. All told, Patino submitted more claims to Medicare for spinal injections than any other provider in the country between 2012 and 2017, prescribed more Oxycodone than any other provider in Michigan in 2016 and 2017, and was personally responsible for $120 million of the $250 million in false claims billed to insurers. DOJJanuary 27, 2023
Walgreen Co. has paid $7 million to settle a False Claims Act lawsuit by the United States and State of Tennessee that alleged the company submitted claims to Tennessee’s Medicaid program for specialty medications that didn’t meet the program’s criteria for coverage. According to the governments’ 2021 complaint, one of Walgreens’ former pharmacists falsified prior authorization requests and records for 65 Medicaid beneficiaries who didn’t meet program requirements. The company then billed TennCare under those false prior authorization requests, and later failed to make repayments even after it discovered its employee’s misconduct. USAO EDTNJanuary 20, 2023
DePuy Synthes, Inc., a subsidiary of Johnson & Johnson that manufactures medical devices, has agreed to pay $9.75 million to resolve allegations of defrauding Medicare and Medicaid. According to former sales representative Aleksej Gusakovs, DePuy gave a Massachusetts-based orthopedic surgeon thousands of dollars’ worth of free implants and instruments for use in overseas surgeries. The illegal kickbacks induced the surgeon to use DePuy products in surgeries performed in the United States, and caused false claims to be submitted to Medicare and the Massachusetts Medicaid program. As the whistleblower in a successful qui tam action, Gusakovs will receive a $1.37 million share of the settlement. DOJTop Ten State Fraud Recoveries of 2022
Posted 01/19/23
January 9, 2023
Doctor Aarti Pandya and her practice, Aarti D. Pandya, M.D. P.C., have agreed to pay $1.8 million to resolve a whistleblower suit that alleged they billed federal healthcare programs for medically unnecessary cataract surgeries and diagnostic tests, incomplete or worthless tests, and office visits that failed to provide the level of service claimed. The allegations were brought in a 2013 qui tam suit by former employee Laura Dildine, which the government intervened on in 2018. In addition to the false claims listed above, Pandya also allegedly falsely diagnosed patients with glaucoma in order to justify claims for reimbursement. USAO SDGATop Ten Healthcare Fraud Recoveries of 2022
Posted 01/6/23
