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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 22 of 128

May 19, 2022

Healthcare testing company VirtuOx, Inc. agreed to pay $3.15 million to resolve claims brought in an action initiated by a whistleblower alleging that falsely billed Medicare for pulse oximetry testing.  VirtuOx allegedly reported San Francisco as the location for overnight pulse oximetry testing when, in fact, no services were performed at that location, but that location resulted in a higher Medicare reimbursement.  In addition, VirtuOx allegedly billed Medicare for both oxygen “spot checks” and overnight pulse oximetry testing, when only the overnight testing was performed.  The whistleblower, Amber Watt, will receive an award of $630,000.  USAO SD FL

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

May 18, 2022

Pat Truglia will spend 120 months in prison, forfeit over $9.4 million, and will pay restitution of $33.7 million for conspiring to defraud Medicare, TRICARE, and CHAMPVA, among others, of approximately $50 million through their fraudulent billing scheme. The scheme involved offering, paying, soliciting, and receiving kickback for durable medical equipment—in this case, braces. Truglia and his conspirators obtained DME orders for Medicare and other federal healthcare program beneficiaries by running multiple call centers, which paid kickbacks and bribes to telemedicine companies, who then paid doctors to write medically unnecessary orders. The orders were filled by Truglia’s companies, who then fraudulently billed the healthcare programs. USAO NJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare, Other Government Health Programs, Provider Fraud,

May 18, 2022

Peter Bolos and Michael Palso, owners of Synergy Pharmacy, were sentenced to 14 years and 33 months in prison, respectively, and each will pay $24.6 million in restitution for defrauding pharmacy benefit managers into authorizing millions of dollars in claims paid to pharmacies controlled by the defendants. Bolos will forfeit an additional $2.5 million. The conspiracy involved cold-calling patients and deceiving them into accepting certain drugs (i.e., pain creams, scar creams, and vitamins) and providing their personal insurance information to receive them. The scheme impacted both private and public insurers, including Medicaid and TRICARE. DOJ, USAO EDTN

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, FCA Federal, Healthcare Fraud, Medicaid, Other Government Health Programs,

May 17, 2022

R360 LLC and its owner, Steven Doumar, were hit with a $3.8 million civil penalty judgment under the Opioid Addiction Recovery Fraud Prevention Act of 2018, for deceiving people seeking addiction treatment. The case, a first for the FTC under the Act, alleges that R360 made misrepresentations in its television ads for its “R360 Network,” comprised of supposed addiction treatment and recovery specialists. R360 and Doumar touted a rigorous evaluation process for its service providers, to meet the customers’ individualized needs, when, according to the government’s complaint, Doumar was the one responsible for assessing and selecting the treatment centers, even though he had no expertise or education in the field. The FTC also secured an order prohibiting Doumar from making similar misrepresentations going forward. FTC

Tagged in: Healthcare Fraud, Misrepresentations, Provider Fraud,

May 16, 2022

Oklahoma Heart Hospital South, LLC paid over $1.1 million to settle alleged violations of the False Claims Act. An OHHS internal review and audit exposed Medicare billing irregularities related to their Intensive Cardiac Rehabilitation services, which they self-disclosed to the government. The US government’s follow-up investigation, with which OHHS cooperated, revealed that for a 6-year period—from 2013 to 2019—OHHS physicians failed to complete and update patients’ individualized treatment plans for care that lasted longer than 30 days. The settlement is not an admission of OHHS’ liability, and the government did not concede any of its claims. WDOK USAO

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

May 9, 2022

Prism Behavioral Solutions has agreed to pay $650,000 to resolve allegations of violating the federal and California False Claims Acts by billing California’s Medicaid program for services not provided to autistic children and young adults.  The whistleblower in this case, Diana Mason, is a behavioral analyst employed by Prism, and will receive a $170,000 share of the settlement.  USAO SDCA; CA AG

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 3, 2022

McKesson Corp., Cardinal Health Inc., and AmerisourceBergen Drug Corp. will pay $518 million for their role in fueling the opioid epidemic. The three companies made billions by shipping excessive amounts of oxycodone, fentanyl, hydrocodone, and other prescription opioids, knowing they would likely wind up in the hands of drug dealers and people suffering from substance use disorder, and often filled orders without adequate identification or reporting. WA AG

Tagged in: Healthcare Fraud, Pharma Fraud,

April 29, 2022

Eargo Inc., which sells direct-to-consumer hearing aid devices to customers nationwide, has agreed to pay $34.37 million to resolve allegations of defrauding the Federal Employees Health Benefits Program (FEHBP) over a four-year period.  Eargo allegedly submitted or caused to be submitted claims that contained unsupported diagnosis codes, even though an internal review of its billing and coding practices should have detected the error.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Other Government Health Programs,

April 28, 2022

Donald Woo Lee, a California-based doctor who recruited Medicare beneficiaries to his clinics, falsely diagnosed them and provided them with medically unnecessary procedures, and then submitted upcoded bills for those procedures to Medicare, has been sentenced to nearly 8 years in prison after being found guilty of seven counts of healthcare fraud.  In addition to submitting approximately $12 million in false claims to Medicare, for which he received $4.5 million in reimbursement, Lee also repackaged and reused single-use catheters on his patients.  DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud, Upcoding,

April 27, 2022

The owner and operator of two Texas-based adult day care centers has been sentenced to 5 years in prison and ordered to pay $1.8 million in restitution after she was found to have billed the Texas Medicaid Program for items and services not provided.  Scherry Lynn Moses ran Scherry’s Adult Day Activity Center and New Creation Residential Care Homes, a room and board for Social Security recipients, but inconsistently provided boarders with basic needs.  USAO WDTX

Tagged in: Criminal Proceedings, Healthcare Fraud, Medicaid,

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