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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 58 of 126

December 30, 2019

Medsurant Holdings, LLC, the nation's largest independent provider of Interoperative Neuromonitoring (IONM) services, has agreed to pay $1.9 million to settle allegations of defrauding Medicare.  According to the DOJ, from 2013 to 2016, Medsurant billed Medicare for IONM services—used to monitor patients’ nervous systems during high-risk surgeries—that were not provided exclusively to one patient or were concurrently provided to patients insured by private payors, in violation of Medicare rules as well as the False Claims Act.  USAO MDTN

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

December 20, 2019

Florida residents and married couple Rodolfo Pichardo and Marta Pichardo were sentenced to 15 years and 8 years, respectively, following earlier guilty pleas to healthcare fraud and wire fraud.  Defendants were also ordered to pay over $34 million in restitution. The Pichardos ran a network of home health agencies, pharmacies, and therapy staffing companies, that submitted more than $38 million in false claims to Medicare.  Defendants paid kickbacks to patient recruiters and medical clinics for patient referrals.  USAO SD FL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medical Billing Fraud, Pharma Fraud,

Federal Audit Reveals Billions of Dollars in Medicare Advantage Overpayments

Posted  12/20/19
A new government report reveals what whistleblowers and their counsel have known for some time: the Medicare Advantage program is vulnerable to fraud committed by unscrupulous private health insurance companies, as well as their owners, vendors, affiliates, and even some doctors.  These bad actors make patients enrolled in MA plans appear sicker than they actually are in order to increase their corporate profits. ...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Managed Care, Risk Adjustment Fraud,

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December 19, 2019

Nassir Medical Corp., which does business as the Cancer Care Institute, and its owner, Dr. Youram Nassir, have agreed to pay $3.4 million to resolve allegations that they violated the False Claims Act by billing Medicare and Medicaid for oncology drugs that were not actually purchased, dispensed, or administered, and for infusion services that were not actually provided.  The case was initiated by whistleblower Kenneth Bryan, who will receive a whistleblower reward of $475,000 from the federal government.  USAO CD Cal

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

December 17, 2019

Miracle Home Care, Inc. and its owner, Shashicka Tyre-Hill, have together been ordered to pay more than $10 million following judgment in an action under the False Claims Act finding that defendants defrauded Georgia’s Medicaid program.  In a civil complaint filed in July 2018, the federal government and State of Georgia alleged that Miracle Home Care submitted thousands of fraudulent reimbursement claims for medically unnecessary transportation and health services.  USAO SDGA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

December 13, 2019

In the Attorney General’s first-ever trial under the Connecticut False Claims Act, Dr. Aram Agadjanian, a dentist in Connecticut, has been ordered to pay the State of Connecticut more than $1.7 million for defrauding the state's Medicaid program from 2014 to 2015.  Dr. Agadjanian, also known as Aram Yuri Agadzanov, submitted claims to Medicaid for dental work that was never provided to Medicaid patients, even going so far as to create fake records to back up the claims. CT AG

Tagged in: Healthcare Fraud, Medicaid,

December 10, 2019

Dr. Paul J. Mathieu and occupational therapist Lina Zhitnik have been sentenced to, respectively, 4 years and 1.2 years in prison, for their roles in a $30 million scheme to defraud Medicare and New York's Medicaid program.  Mathieu falsely posed as the owner of three medical clinics, which were actually owned by Aleksandr Burman, and Mathieu and Zhitnik falsely claimed to have treated thousands of patients at those clinics.  Over six years, Mathieu prepared or assisted in the preparation of false and fraudulent medical charts, issued referrals for expensive and unnecessary additional testing by providers also participating in the scheme, and wrote prescriptions for unnecessary medical supplies that were filled by a company also owned by Burman.  Another doctor participating in Burman's scheme, Ewald J. Antoine, was previously sentenced.  USAO SDNY

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

December 5, 2019

Maryland-based internist Noman Thanwy, M.D. has paid over $176,000 to settle allegations of submitting false claims to Medicare for medically unnecessary autonomic nervous function and vestibular function tests.  Although the tests are typically performed only once per beneficiary to confirm diagnoses of relatively uncommon disorders, Dr. Thanwy, who lacked the necessary training and equipment to perform the tests, was allegedly using them to monitor patient symptoms.  USAO MD

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

December 3, 2019

In the second settlement to come out of a federal investigation into the generic pharmaceutical industry, Rising Pharmaceuticals Inc. has agreed to pay over $4 million to settle civil and criminal charges stemming from violations of the False Claims Act and Anti-Kickback Statute.  In the criminal case, Rising allegedly teamed up with a competing generic drug manufacturer to fix prices and divide up the market for a hypertension drug, Benazepril HCTZ, while in the civil case, the company allegedly paid and received illegal remuneration through similar arrangements with another generic drug manufacturer.  Under the newly signed deferred prosecution agreement, Rising has agreed to cooperate fully with the ongoing investigation.  DOJ; USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Pharma Fraud, Price Fixing, Pricing Fraud,

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