Healthcare Fraud

February 25, 2019

A Southern California pharmacy owner has been ordered to pay $1.5 million to Medicare after her conviction for one count of healthcare fraud and two counts of wire fraud. Tamar Tatarian, the owner of Akhtamar Phamarcy, was recently convicted of submitting false claims for prescription drugs never ordered from wholesalers or dispensed to beneficiaries. DOJ

February 22, 2019

Marketers, doctors, lawyers, and medical service provider defendants were sentenced this week for their roles in a multi-million dollar California worker's compensation fraud scheme in the San Diego area.  The defendants recruited patients and referred them to co-defendant attorneys to file fraudulent claims on their behalf and medical providers who performed often unnecessary and painful medical procedures for which they would then bill insurers including California Workers' Compensation.  Ronald Grusd, a doctor who owned a diagnostic imaging company, was sentenced to 10 years in prison and ordered to forfeit $1.3 million.  Fermin Iglesias, who worked as a patient capper, was sentenced to 5 years in prison and ordered to forfeit $1 million. Julian Garcia, who provided services to assist the referrals and kickbacks, was sentenced to three years in prison.  Jennifer Louise White, who marketed to providers in the network, was sentenced to two years in prison.  Sean O'Keefe, an attorney who filed fraudulent claims on behalf of patients, was sentenced to 13 months in prison and ordered to forfeit $300,000.  Steven Rigler, a chiropractor, was sentenced to six months in prison.  USAO SD Cal.

February 21, 2019

Hooshang Poor, a doctor of geriatric medicine based in Newton, Massachusetts, has agreed to pay $680,000 to resolve claims under the False Claims Act that he knowingly submitted inflated charges to Medicare and the Massachusetts Medicaid program.  Dr. Poor was alleged to submit bills with false procedural codes that overstated the length, extent, and scope of services that he furnished to nursing home residents, and misrepresented services provided by non-physician employees.  USAO Mass.

February 19, 2019

Xerox Corporation will pay $236 million to the State of Texas to resolve claims that the company and its subsidiary Conduent, which provided services to the Texas Medicaid program, improperly approved requests for orthodontic procedures without ensuring that the procedures met Medicaid program requirements.  As a result, the state paid for orthodontic work that was unnecessary or did not meet program requirements.  Texas

February 14, 2019

Prime Healthcare Services and its CEO Prem Reddy, will pay $1.25 million to settle claims under the False Claims Act that two Prime Healthcare hospitals in Pennsylvania, Roxborough Memorial Hospital and Lower Bucks Hospital, billed Medicare for patients who were admitted when they could have been treated on an outpatient basis, and up-coded patient diagnoses to increase Medicare payments.  The investigation was initiated by an anonymous whistleblower identified as a former employee of the Roxborough hospital.  USAO ED PA

February 13, 2019

Ashraf Hasan-Hafez and Ilya Kogan have been sentenced to over three years in prison for their participation in a scheme that defrauded Medicare and New York State Medicaid out of $1.3M dollars. Hasan-Hafez, the owner of a physical therapy practice, and Kogan, the owner of an acupuncture company, fraudulently submitted bills for services that were not rendered, or for services performed by unlicensed individuals. In addition to jail time, Hasan-Hafez and Kogan have been ordered to forfeit $1,297,000 in restitution to the Medicare and Medicaid programs.  DOJ    

February 11, 2019

GenomeDx Biosciences Corp. has agreed to pay $1.99 million in connection with a whistleblower complaint by two former employees, which alleged that the genetic testing laboratory violated the False Claims Act in its submissions to Medicare. According to the unnamed whistleblowers, from 2015 to 2017, GenomeDx submitted reimbursement claims for running a post-operative genetic test on prostate cancer patients, even though that population did not have risk factors that called for the test. They will share in a $348,316.50 award as part of the settlement. USAO SDCA