Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.
Posted 05/10/19
Healthcare Fraud
This archive displays posts tagged as relevant to healthcare fraud.
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May 9, 2019
Carolina Physical Therapy and Sports Medicine, Inc. agreed to pay $790,000 to settle a whistleblower lawsuit alleging the company knowingly submitted false claims to Medicare and TRICARE. According to former employee Hilary Moore, Carolina PT submitted claims for group physical therapy services that were billed as though they were one-on-one sessions. Additionally, claims for certain services performed by physical therapy assistants were billed as though they were performed under the supervision of qualified therapists. For exposing the fraudulent conduct, Moore will receive a relator’s share of $142,200. USAO SCMay 9, 2019
Paul J. Mathieu and Hatem Behiry were found guilty for their part in a $30 million scheme to defraud Medicare and the New York State Medicaid program. Between 2007 and 2013, Mathieu falsely posed as an owner of three medical clinics (the “Clinics”) in Brooklyn. During that time, the Clinics fraudulently billed Medicare and Medicaid for medical services and supplies that were not necessary, or were not even provided. Furthermore, Mathieu did not see any patients at that time. Instead, he falsified large stacks of bogus medical records in which he stated that he did see and treat those patients. Behiry, a physical therapy doctor, also participated in the Clinic’s fraudulent billing practices by pretending to provide physical therapy services to patients. Mathieu and Behiry have not yet been sentenced. DOJMay 8, 2019
A South Florida woman who received kickbacks in exchange for patient referrals has been sentenced to over 7 years in prison. In exchange for at least $710,000, Yamilet Diaz allegedly referred Medicare beneficiaries to five home health agencies, aiding the agencies in unlawfully receiving over $1.6 million in reimbursements from Medicare that were tainted by the kickbacks. DOJMay 8, 2019
Tea Kaganovich and Ramazi Mitaishvili, co-owners of New York Diagnostic Testing Centers, each pleaded guilty to health care fraud and conspiracy to defraud the lawful functions of the Internal Revenue Service (IRS). The couple submitted false health care claims for diagnostic testing services and paid over $18 million in kickbacks for the referral of beneficiaries who signed up for diagnostic testing and other alleged medical services. They fraudulently reported to the IRS that the illegal kickback payments were valid business expenses, thus causing relevant tax forms to under-report business income and claim deductions. DOJMay 6, 2019
Acadia Healthcare Company, Inc., which operates outpatient drug treatment centers in West Virginia through its subsidiary CRC Health, L.L.C., will pay $17 million to resolve claims that it improperly billed the state's Medicaid program for urine and blood testing services as if they had performed the testing themselves, despite the fact that Acadia lacked the certification to perform the tests. In fact, the testing was performed by an independent outside laboratory, and that lab independently billed Medicaid for the tests, at a lower rate. Medicaid paid Acadia’s treatment centers $8,500,000 for the improperly-billed tests. As part of this settlement, defendants also entered into a five-year corporate integrity agreement to maintain specified compliance programs and procedures. USAO SDWVMay 3, 2019
Texas-based Decatur Hospital Authority, d/b/a Wise Health System, has agreed to pay $431,182.96 to the United States for billing Medicare for medically unnecessary genetic testing panels. The alleged False Claims Act violations had occurred between 2016 and 2018 and involved patient samples from Tennessee-based Total Diagnostic II, LLC. DOJMay 3, 2019
Dr. Richard E. Paulus, an Ashland cardiologist, was sentenced to five years in prison for defrauding Medicare, Medicaid, and private insurers. Evidence showed that Paulus implanted medically unnecessary stents in his patients and falsified the degree of stenosis in their medical records. He has been charged with one count of health care fraud and ten counts of making false statements in regard to health care matters. In addition to time in prison, Paulus must also pay $1.1 million in restitution to Medicare, Medicaid, and other private insurers who were also victims of his financial scheme. DOJMay 3, 2019
Yazan B. Al-Madani, the last of four defendants who conspired to defraud the MetroHealth Hospital System was sentenced to over 10 years in prison. From 2008 through 2016, Madani and his co-conspirators defrauded MetroHealth out of hundreds of thousands of dollars through a multitude of bribes and kickbacks centered around the hospital’s dental program. Former hospital Chief Operating Officer, Edward R. Hills, was sentenced to more than 15 years in prison. Defendant Sari Alqsous was sentenced to more than 12 years in prison. And defendant Tariq Sayegh was sentenced to five years in prison. DOJCatch of the Week — Florida Hospital Chain CEO Settles False Billing Allegations
Posted 05/3/19
