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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 63 of 126

September 17, 2019

Physician Alliance Ltd. and Richard Frey, D.O. will pay $178,400 to resolve allegations that they submitted false claims to Medicare.  When defendants provided patients with "P-Stim" devices, which are worn on a patient's ear and marketed as an acupuncture treatment, they billed Medicare for the implantation of neurostimulator electrodes, which is a surgical procedure for which Medicare reimburses thousands of dollars.  By contrast, Medicare does not reimburse for acupuncture or acupuncture devices.  USAO EDPA

September 13, 2019

Texas hospital administrator Starsky Bomer was convicted of violating the Anti-Kickback Statute and conspiring to commit healthcare fraud for paying kickbacks to group homes and others in exchange for referrals to outpatient treatments for severe mental illness at his affiliated hospital, resulting in $16 million dollars of false claims to Medicare. The kickbacks came in the form of salary payments and payments for transportation to owners of group homes. Mr. Bomer was sentenced to ten years in prison for his involvement in the scheme. DOJ

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Posted  09/13/19
Philip Esformes, 50, of Miami Beach, Florida, was sentenced to 20 years in prison for his role in a decades-long billion-dollar scheme to submit fraudulent claims to Medicare and Medicaid both for services deemed medically unnecessary and services that were medically necessary but that he did not provide.  Esformes personally pocketed $37 million from this scheme to fund his lavish lifestyle, while leaving elderly...

September 13, 2019

Medical device manufacturer Avalign Technologies, Inc. and its subsidiary Instrumed International, Inc., will pay $9.5 million to resolve allegations that the companies unlawfully marketed devices not properly approved by the FDA for use in spinal surgeries, circumcisions, and other medical procedures, with knowledge that the devices did not have the required FDA approvals.  The allegations were originally made in False Claims Act action brought by a whistleblower.  USAO SDNY

Medicare Whistleblowers: The Most Common Questions Answered About Reporting Medicare Fraud

Posted  09/10/19
medicare fraud whistleblower

What potential whistleblowers need to know about reporting fraud in government healthcare programs.

Get answers to 6 common Medicare whistleblower questions

In this article, our experienced whistleblower attorneys have answered 6 of the most important and common questions posed by individuals who have knowledge of potential healthcare fraud, specifically, fraud in the Medicare program. Click the links below to...

September 9, 2019

Dr. Augusto Castrillon of Texas has agreed to pay $2 million to settle allegations he fraudulently billed Medicare for medically unnecessary diagnostic tests in violation of the federal False Claims Act.  From 2009 to 2015, the owner and operator of Castrillon Family Clinic allegedly submitted false claims for transcranial doppler imaging studies, electromyography, nerve conduction studies, and autonomic function testing that were ordered for the same patients on a recurring basis.  The claims submitted by Dr. Castrillion were so excessive that they stood out as a significant statistical outlier in a proactive review of claims data by the U.S. Attorney’s Office.  USAO SDTX

Catch of the Week – Mallinckrodt Pays for Kickbacks on Acthar; Investigation into Copayment Subsidies Continues

Posted  09/6/19
This week, the Department of Justice announced that pharmaceutical company Mallinckrodt ARD LLC had agreed to pay over $15 million to resolve allegations that it paid illegal kickbacks to physicians to induce them to prescribe Acthar.

AKS Allegations

Two whistleblower lawsuits brought under the False Claims Act against Mallinckrodt alleged that from 2009 to 2013, the pharma company, then known as Questcor,...

September 5, 2019

Dentist Santa Maria McKibbens has agreed to pay North Carolina $375,000 to resolve allegations that she submitted false claims to the North Carolina Medicaid Program by billing for dental restorations that were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy.  NC

September 5, 2019

In yet another enforcement action relating to a nationwide compounding pharmacy fraud scheme involving OK Compounding, Dr. James Womack of Missouri has agreed to pay $471,221 to resolve his liability under the False Claims Act.  Womack allegedly accepting kickbacks disguised as medical director fees in exchange for prescribing medically unnecessary pain creams.  USAO NDOK
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