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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 27 of 128

January 12, 2022

Six medical practices affiliated with Interventional Pain Management Center P.C. (IPMC), as well as physician-owner Dr. Amit Poonia, have agreed to pay nearly $7.5 million to resolve allegations of defrauding Medicare and the Federal Employees Health Benefit Program.  In a qui tam suit by Anu Doddapaneni and Christian Reyes, the whistleblowers alleged that Poonia and IPMC violated the False Claims Act by using a billing code that mischaracterized P-Stim and NeuroStim treatments—which transmit electrical pulses through needles placed just under the skin of a patient’s ear—as surgical implantation requiring anesthesia.  USAO EDNY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Misrepresentations, Other Government Health Programs, Provider Fraud, Whistleblower Case,

January 12, 2022

A diabetic shoe company, Foot Care Store, Inc., d/b/a Dia-Foot, and its President and CEO, Robert Gaynor, have agreed to pay $5.5 million to resolve allegations of billing Medicare and Medicaid for custom diabetic shoe inserts when in fact, their inserts were made using generic foot models.  The alleged misconduct occurred between 2013 and 2018 and was revealed in a whistleblower’s 2018 qui tam suit.  In addition to the monetary penalty, Dia-Foot has entered into a three-year Integrity Agreement that requires the company to implement updated policies and procedures and submit to quarterly independent review of its claims to Medicare and Medicaid.  USAO SDFL

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Whistleblower Case,

Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Tagged in: Anti-Kickback and Stark, Chiropractic, Criminal Proceedings, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Provider Fraud, Top 10,

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January 11, 2022

UC San Diego Health has agreed to pay $2.98 million to resolve allegations that it ordered and submitted referrals for medically unnecessary genetic testing, leading to the submission of false claims to Medicare.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare,

Catch of the Week: Jury Finds Teva Pharmaceuticals Liable for Contributing to Opioid-Related Deaths in New York State

Posted  01/7/22
spilt pills
In a significant development in the ongoing effort to assess blame and responsibility for the opioid epidemic, which has led to the deaths of hundreds of thousands of individuals and ravaged communities throughout the United States, on December 30th, after a six-month trial, a New York jury found that Teva Pharmaceuticals USA, Inc. (“Teva”) and its affiliates, including Anda Inc., created a “public nuisance”...

Tagged in: Catch of the Week, Healthcare Fraud, Pharma Fraud,

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Top Ten Whistleblower Awards of 2021

Posted  01/6/22
Red Whistle with People
2021 was another banner year for whistleblowers, who once again collectively recovered billions of dollars for the government and hundreds of millions of dollars in whistleblower rewards under the various government whistleblower programs.  This includes awards under the qui tam provisions of the federal False Claims Act and various state False Claims Act programs.  It includes awards under the Dodd-Frank SEC...

Tagged in: Anti-Kickback and Stark, Auto Safety, CFTC Whistleblower Reward Program, FCA Federal, FCA State, Financial and Investment Fraud, Financial Institution Fraud, Healthcare Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, SEC Whistleblower Reward Program, Securities Fraud, Top 10, Whistleblower Case, Whistleblower Rewards,

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January 5, 2022

Two Florida men, Reinier Gonzalez Caballero and Alexeis Napoles Manresa, have each been sentenced to a little over four years in prison for laundering the ill-gotten proceeds of a $3 million healthcare fraud scheme against Medicare.  Over a couple months in 2019, durable medical equipment company Universal Ortho Supplies, Inc. billed Medicare for orthosis and prosthetics that were never prescribed by physicians, nor provided to patients.  The reimbursements were then turned over to the defendants, who attempted to disguise the source of the funds by setting up shell corporations and opening up fake bank accounts.  Two co-conspirators have already been convicted and sentenced; another two have pleaded guilty and await sentencing.  USAO SDFL

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Devices and DME, Medicare, Money Laundering,

December 15, 2021

David Bellamah, and his business, Bellamah Vein & Surgery, PLLC, will pay $3.75 million to resolve allegations that they billed government healthcare programs for medically unnecessary venous procedures based on false medical records.  Defendants allegedly used improper techniques to conduct and analyze ultrasounds and used false ultrasound findings to diagnoses and treat venous reflux disease and varicose veins. The government’s claims were initiated by the filing a qui tam complaint by Lenore Lezanne, who previously worked as a sonographer at the Bellamah Vein Center; Lezane will receive a whistleblower award of 17% of the amounts recovered.  USAO MT

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

December 13, 2021

Kevin Cooper, M.D. and his practice, Cooper Family Medical Center, will pay $375,000 to resolve allegations that they fraudulently billed Medicare of non-reimbursable acupuncture devices by using billing codes for surgically implanted devices for the provision of P-Stim electro-acupuncture devices that are affixed behind a patient’s ear using an adhesive.  USAO SD MI

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

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