Healthcare Fraud Archives - Page 66 of 126

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid. As part of the settlement, they will pay $425,000. USAO CT

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

July 15, 2019

Millcreek Community Hospital has agreed to pay $2.4 million and enter into a Corporate Integrity Agreement requiring five years of monitoring to resolve allegations of violating the False Claims Act. For a period of four years, the Pennsylvania-based hospital’s inpatient rehabilitation unit allegedly admitted ineligible patients, then failed to document in medical records that such services were medically necessary and reasonable. USAO WDPA

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

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted 07/12/19

Pill container spilled over with pills fallen out.

On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

Tagged in: Anti-Kickback and Stark, FDA Fraud, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Provider Fraud,

July 10, 2019

Rural Metro of Southern Ohio, Inc. has agreed to pay $275,116 to resolve allegations of submitting, or causing the submission of, false claims to Medicare. In a qui tam suit brought by Nicholas Ratterman, a former employee, Rural Metro was alleged to have billed Medicare for medically unnecessary overnight hospital discharge ambulance transports between 2013 to 2017. As part of the settlement, Ratterman will receive about $44,000. USAO EDKY

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

July 9, 2019

Two chiropractors who owned the Kansas City Health and Wellness Clinic have agreed to pay $350,000 to settle False Claims allegations. Brothers Ryan Schell and Tyler Schell allegedly billed Medicare for medically unnecessary, unprovided, or uncovered treatments of peripheral neuropathy, which causes loss of sensation and/or burning sensations in the hands and feet. USAO KS

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

July 8, 2019

Anthony Camillo, the owner of Illinois-based Allegiance Medical Laboratory and AMS Medical Laboratory, has been sentenced to 2.5 years in prison and ordered to pay $3.5 million in restitution for defrauding Medicare and Medicaid. According to the DOJ, Camillo paid Missouri-based marketers between $150-$200 for urine and saliva samples sent to his labs. His conduct incentivized other fraudulent conduct, including medically unnecessary testing of disabled and elderly patients living in residential care facilities, and the use of doctors’ names on test orders without the doctors’ knowledge. USAO EDMO

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare,

July 5, 2019

A New York doctor is the latest defendant in a widespread OK Compounding pharmacy fraud scheme to settle with the government. From 2014 to 2015, Dr. George Lehner allegedly prescribed compounded pain creams for his Medicare patients in exchange for an hourly “medical director fee” by OK Compounding LLC. To settle the case against him, Lehner will pay about $130,000. USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

July 2, 2019

For allegedly violating the False Claims Act, mental health nonprofit Wisconsin Community Services, Inc. (WCS) has agreed to pay $537,904 to the United States and the State of Wisconsin. WCS voluntarily disclosed that one of its pharmacists had billed Medicare and Medicaid for brand name medications over several years, even though generic medications had been dispensed. USAO EDWI

Tagged in: Drug Switching, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Pharma Fraud,

June 28, 2019

The nation’s largest operator of inpatient rehabilitation facilities (IRFs) has agreed to pay $48 million to settle allegations that it violated the False Claims Act. Three separate lawsuits filed by former contract physician Dr. Emese Simon, former director of therapy operations Melissa Higgins, and former medical director Dr. Darius Clarke, alleged a number of Encompass Health Corporation, f/k/a HealthSouth Corporation IDFs, falsely diagnosed patients with “disuse myopathy” and improperly admitted patients too sick or disabled to participate in physical therapy in order to earn higher reimbursements from Medicare. The whistleblowers’ collective share of the settlement is $12.4 million. DOJ; USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

June 27, 2019

Following a whistleblower suit, Fusion Physical Therapy and Sports Wellness, P.C., and its founder and CEO, Carolyn Sue Mazur, have agreed to pay $37,500 to settle charges of billing Medicare for physical therapy services performed by uncredentialed personnel. In addition the monetary penalty, Fusion and Mazur have also admitted to the misconduct. USAO SDNY

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

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