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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 23 of 128

April 27, 2022

Dr. Josef Schenker and his urgent care facilities, Josef Schenker, M.D., P.C., and Care Partners Medical Management, LLC will pay $564,217.70 for violations of the False Claims Act, by submitting up-coded claims to Medicare related to administration of the COVID-19 vaccine. Schenker and the two facilities provided higher-level CPT codes for services not actually provided, charging, e.g., for an office visit or exam when the patient only actually received a vaccine or a COVID test. EDNY

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

April 26, 2022

A former pharmacist in Mississippi named Mitchell Barrett has been sentenced to 10 years in prison and ordered to pay restitution as well as forfeit all assets stemming from a $180 million healthcare fraud scheme against TRICARE and other health benefit programs.  Barrett had adjusted prescription formulas to ensure the highest possible reimbursement, solicited recruiters to procure prescriptions for expensive compounded drugs, paid those recruiters a commission based on reimbursements from TRICARE, routinely waived copayments required to be paid by TRICARE beneficiaries, and took steps to disguise the waived payments.  DOJ

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

DOJ Ramps Up Enforcement Against COVID-19 Fraud

Posted  04/25/22
COVID-19-Fraud-Whistleblower-Lawyers
Even as mask restrictions are being relaxed in most parts of the country, the U.S. Department of Justice is ramping up its oversight of federal funds spent to fight the COVID-19 pandemic.  Just last week, DOJ announced criminal charges against 21 defendants in nine federal districts for their alleged participation in COVID-19 fraud schemes that resulted in over $149 million in false billings to federal programs. 

Tagged in: COVID-19, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud,

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April 21, 2022

Susan H. Poon, 57, will spend 70 months in federal prison, and will pay nearly $1.4 million in restitution for a scheme spanning over 3 years, and which resulted in approximately $2.2 million in fraudulent billings. Poon submitted prescriptions both with PII obtained at health fairs held by Costco and UPS, and by soliciting information from actual patients about their dependents—dependents whom Poon never saw or treated. Poon used the stolen PII to submit fraudulent durable medical equipment prescriptions to a DME manufacturer, who then unknowingly submitted false claims for reimbursement to a health insurer. In addition to the prison sentence and the owed restitution, Poon’s chiropractic license was revoked in 2019. USAO CDCA

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud,

Gordon Schnell and Max Voldman Published in Newsweek on How Whistleblowers are Key to Reining in Prescription Drug Costs

Posted  04/21/22
Newsweek published an OpEd by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman on the need to expand the Medicaid Drug Rebate Program to Medicare.  The piece was prompted by DOJ's recent $235 million settlement with U.K. and St. Louis-based pharma company Mallinckrodt for allegedly violating the Medicaid rebate rule. On the books since 1990, the rule requires drug companies to rebate state...

Tagged in: CC Lawyers, Drug and DME Pricing, Healthcare Fraud, Medicaid, Medicare, Pharma Fraud,

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Constantine Cannon Whistleblower Practice Group 2021 Roundup: Another Banner Year

Posted  04/21/22
Whistleblower Rewards
2021 was another banner year for Constantine Cannon’s whistleblower practice group, with three historic whistleblower successes, including the first-ever award under the Motor Vehicle Safety Whistleblower Act. This string of successes follows the firm's record-shattering 2020 year where our whistleblower team secured blockbuster settlements that recovered more than $600 million for the government and roughly $115...

Tagged in: Auto Safety, CC Lawyers, Dark Pools, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, SEC Whistleblower Reward Program, Whistleblower Rewards,

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April 13, 2022

Pharmacy owner Aleah Mohammed was sentenced to 78 months in prison for stealing more than $6.5 million from the government via her prescription fraud on Medicare and Medicaid drug plans. Mohammad submitted claims for drugs that weren’t dispensed, weren’t prescribed as claimed, were not medically necessary, or that were dispensed while the pharmacy was no longer registered with the State of New York. The proceeds were used by Mohammed and her family members to buy luxury vehicles, jewelry, and properties in Queens and Pocono Pines, Pennsylvania. USAO EDNY

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medicaid, Medicare, Pharma Fraud,

April 13, 2022

A number of anesthesia entities owned and operated by Care Plus Management, LLC (Care Plus), which itself is owned and operated by doctors Paul D. Weir and John R. Morgan, have agreed to pay $7.2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  A qui tam suit by whistleblower Robert Douglas had alleged that between 2012 and 2016, Care Plus entered into illegal revenue-sharing arrangements with physicians in exchange for patient referrals.  For his contributions to a successful enforcement action, Douglas will receive a $1.3 million share of the settlement.  USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 12, 2022

Providence Health & Services Washington has agreed to pay $22.7 million to settle allegations of submitting false claims to Medicare, Medicaid, and TRICARE.  According to an unnamed whistleblower, who will receive a $4.2 million relator’s share, the hospital allegedly gave their neurosurgeons volume-based financial incentives to perform complex surgeries, thereby incentivizing two neurosurgeons to perform an excessive number of complex surgeries on inappropriate candidates without regard to medical necessity or patient safety, and ultimately causing an excessive level of complications.  USAO EDWA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 12, 2022

Physician Partners of America LLC (PPOA), its founder Rodolfo Gari, and its former chief medical officer Dr. Abraham Rivera, have agreed to pay $24.5 million to settle allegations of violating the Stark Law, False Claims Act, and Financial Institutions Reform, Recovery and Enforcement Act (FIRREA).  The settlement resolved claims by whistleblowers Donald Haight, Dawn Baker, Dr. Harold Cho, Dr. Venus Dookwah-Roberts, and Dr. Michael Lupi, all currently or formerly employed with PPOA.  According to the whistleblowers and the government, PPOA allegedly billed Medicare and Medicaid for medically unnecessary testing, paid illegal kickbacks to its physician employees, and made false statements on a loan from the Paycheck Protection Program.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Programs Fraud, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Whistleblower Case,

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