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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 73 of 126

March 27, 2019

In the second largest resolution of a Medicaid fraud case based in Washington State, CareOne Dental Corporation and its owners will pay $1 million to settle allegations of violating Washington's Medicaid False Claims Act. According to the AG's office, CareOne and defendants Dr. Liem Do and Dr. Phuong-Oanh Tran defrauded Medicaid by using higher paying codes, masking ineligible services as eligible services, and billing for services the practice didn't even provide. Ultimately, the defendants racked up about $1 million over the course of four years. AG WA

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Upcoding,

March 26, 2019

Accurate Home Care, LLC, a Minnesota-based home health provider has agreed to pay $726,957.59 after voluntarily self-disclosing its violations of the False Claims Act in duplicated bills sent to both Medicaid and private insurers. Accurate had also admitted to fraudulently retaining payments from Medicaid even when Medicaid wasn't the primary insurer. USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

March 26, 2019

The owner and managing member of a Mississippi-based pharmacy has plead guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering and tax evasion in connection with a massive $200 million compounding pharmacy scheme involving at least 12 individuals over four years. Glenn Doyle Beach, Jr. of Advantage Pharmacy admitted to marketing and formulating compounded medications for TRICARE patients without regard to medical necessity, falsifying paperwork to mislead auditors, and engaging in money laundering and tax evasion to conceal proceeds. He is scheduled to be sentenced in July. DOJ; USAO SDMS

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs, Tax Fraud,

March 21, 2019

Nonprofit healthcare organization MedStar Health Inc. has agreed to pay $35 million to the United States to settle two qui tam lawsuits alleging violations of the False Claims Act at two of its hospitals in Baltimore. According to the first complaint, filed by three cardiac surgeons, MedStar paid illegal remuneration to MidAtlantic Cardiovascular Associates (MACVA) to induce referrals of Medicare patients. The second complaint, filed by former patients, alleged that while employed by MedStar, former MACVA employee Dr. John Wang engaged in a pattern of performing and billing for medically unnecessary cardiac stent procedures. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 19, 2019

Ademola O. Adebayo was sentenced to 10 years in prison for his role in a huge $100 million compounding pharmacy scheme that defrauded private insurance companies, Medicare and TRICARE. Adebayo was also ordered to pay $3.2 million in restitution and $1.4 million in forfeiture, and properties, cars and a yacht have been sequestered as part of the sentencing. After a four-day trial on January 11, Adebayo was convicted on counts of conspiracy to commit health care fraud and wire fraud, and conspiracy to commit money laundering. Eight other defendants have pleaded guilty in connection with the scheme. DOJ

Tagged in: Healthcare Fraud, Medicare, Pharma Fraud,

March 15, 2019

Long Island chiropractor Raymond R. Pellegrino pleaded guilty to charges arising from his fraudulent billing of private insurance companies.   Pellegrino falsely billed Anthem Empire Blue Cross/Blue Shield over $2 million for services claimed to have been provided by doctors employed by him, when knew those services had not, in fact, been provided.  USAO EDNY

Tagged in: Chiropractic, Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

March 15, 2019

Connecticut Behavioral Health Associates, P.C. and its principal, psychiatrist Bassam Awwa, who treat patients for substance abuse, will pay $3.3 million in a settlement with the federal government and Connecticut. Defendants allegedly billed Medicare and Medicaid for multiple drug screening tests per patient visit, instead of the single test authorized.  In addition, defendants submitted bills for urine alcohol screening that were already a component of the single test, and for definitive urine drug tests that were not actually performed.  USAO CT

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Provider Fraud,

March 14, 2019

The former owner and former COO of Atlanta-based Primera Medical Group, Shailesh Kothari and Timothy McMenamin, were sentenced to prison terms of 6.75 and 7.75 years, respectively, for their roles in submitting more than $8.5 million in fraudulent invoices to private insurance companies for allergy testing and allergy immunotherapy services that were never provided and were not medically necessary.  Defendants submitted bills using the NPIs of doctors who had not performed the tests and, in fact, had no knowledge of the services.  To cover up the fact that the services were not provided, defendants would create false laboratory reports for insurers and patients who requested them.  USAO ND GA

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud,

March 11, 2019

Medical device manufacturer Covidien LP will pay $20 million to resolve False Claims Act cases initiated by three whistleblowers alleging that Covidien violated the Anti-Kickback Statute by providing remuneration to healthcare providers in California and Florida.  Covidien markets radiofrequency ablation catheters to providers including vein surgery practices for use in procedures for the treatment of varicose veins and underlying conditions, and allegedly provided its customers with substantial assistance in connection with marketing vein screening and related services in order to increase demand for such services and therefore induce purchases of Covidien's vein ablation products.  Covidien will pay $17.5 million to the United States; $1.5 million to California; and $1 million to Florida.  Two whistleblowers who were sales managers for Covidien, Erin Hayes and Richard Ponder, will share a $3.1 million whistleblower reward.  The settlement also resolves claims by whistleblower Shawnea Howerton, a former employee of one of Covidien's customers.  DOJ; USAO NDCal; FL

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medical Devices and DME, Multiple Whistleblowers and First-to-File, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 7, 2019

A Connecticut-based durable medical equipment supplier, Med Tech, and its owner, Thomas Macre, Sr., have agreed to pay more than $467,000 to resolve allegations of violating the federal and state False Claims Acts. The alleged misconduct involved billing Medicaid for unprovided and medically unnecessary back braces and electrical stimulation units. USAO CT

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

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