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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 76 of 126

February 8, 2019

Two executives from the South Carolina Early Autism Project (SCEAP) have been convicted of causing false statements to be submitted to Medicare and TRICARE and causing them to be overcharged by millions of dollars. According to statements by SCEAP employees, co-founder Ann Davis Eldridge and executive Angela Breitweiser Keith instructed employees to include travel and wait time in their billing in order to inflate time spent providing services. To further incentivize this practice, they implemented billing goals that had to be met in order to qualify for bonuses such as gift cards and vacations, all paid for by the company. Since then SCEAP has repaid almost $9 million, and as part of their plea agreement, both Keith and Eldridge will serve 1-year sentences. USAO SC

Tagged in: Healthcare Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

February 8, 2019

A Texas-based marketing company, One Source Healthcare Organization, and its owner, James Paul Adams, have agreed to pay $339,412.50 to resolve allegations that it violated the Anti-Kickback Statute in accepting illegal payments from a compounding pharmacy to market their drug. Because the payments resulted in false claims being paid by Medicare and TRICARE, they were also alleged to be in violation of the federal False Claims Act. Two men affiliated with the compounding pharmacy, Oklahoma-based OK Compounding, LLC, were previously indicted on similar charges. USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs,

February 7, 2019

Six people associated with a string of substance abuse treatment centers have been indicted for defrauding Ohio's Medicaid program of over $31 million. Ryan Sheridan, the owner and operator of the businesses, along with Jennifer Sheridan, Kortney Gherardi, Lisa Pertee, Thomas Bailey, and Arthur Smith, allegedly submitted claims that were false on a number of fronts, including but not limited to: billing without proper documentation, for medically unnecessary services, provided by unqualified persons, and upcoded to a more costly service. Altogether, 134,744 false claims were submitted for more than $48.5 million in services. USAO NDOH

Tagged in: Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Upcoding,

February 7, 2019

A former bus driver with the New York Metropolitan Transit Authority has been sentenced to 20 months in prison for defrauding the authority's health benefit plan of $2.8 million. Enver Kalaba, who was recruited into the scheme by former bus driver Christopher Frusci, worked on behalf of an unnamed company to pay bribes to fellow MTA employees in exchange for medically unnecessary prescription compounded medications. For each prescription for medications such as pain creams, scar creams, and metabolic supplements, Kalaba and Frusci paid $100. As part of his sentence, Kalaba must now forfeit $138,630 in fraudulent earnings and pay $2.9 million in restitution. Frusci is scheduled to be sentenced next month. USAO NJ

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

February 6, 2019

An electronic health records provider, Greenway Health LLC, will pay $57.25 million to settle a False Claims Act case brought by the U.S. alleging that Greenway fraudulently obtained certification that is product, Prime Suite, complied with HHS requirements and therefore that healthcare providers using Prime Suite could receive payments under the Medicare and Medicaid EHR Incentive Program.  Greenway allegedly modified the software tested by the certification body to make it appear that Prime Suite was performing as required when it was not, and failed to correct known errors in the software.  In addition, the government alleged that Greenway violated the Anti-Kickback Statute by providing incentives including payments to clients to recommend Prime Suite. Greenway entered into a five-year Corporate Integrity Agreement which includes an independent monitoring process.  DOJ

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud,

February 6, 2019

Families United Services, Inc. (FUS) and owner Pamela McKenzie have agreed to pay $645,000 to settle allegations of defrauding Georgia's Medicaid program from 2010 to 2012 by submitting claims for unprovided mental health services. As part of the settlement, FUS has been excluded from participating in federal healthcare programs for a period of five years. USAO NDGA

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

February 6, 2019

Abbott Labs has agreed to pay a total of $25 million to settle allegations of paying kickbacks to healthcare professionals in exchange for promotion of its drug, and inappropriately marketing its drug, TriCor, for cardiovascular events not approved by the FDA. The case was initiated by the State of North Carolina and joined by California, Illinois, Nevada, Maryland, Michigan, and Texas, as well as the federal government. NC AG

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicaid, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud,

February 6, 2019

Georgia-based Union General Hospital has agreed to pay $5 million to settle allegations that from 2012 to 2016, it billed Medicare for services stemming from improper financial relationships with physicians, in violation of the Stark Law and the False Claims Act. The misconduct was uncovered during an internal investigation sparked by a federal investigation into an unrelated matter; UGH then voluntarily self-disclosed details of the instant case to the U.S. Attorney's Office. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicare,

February 5, 2019

Tennessee Health Management, Inc (THM) has agreed to pay over $9.7 million to settle fraud allegations, with over $5 million going to the United States and over $4 million going to the State of Tennessee. From 2010 to 2017, the skilled nursing facility management company allegedly submitted claims with false physician certifications to the state's Medicaid Program, TennCare, in violation of TennCare's rules as well as the False Claims Act. As part of the settlement, THM has also agreed to sign a Corporate Integrity Agreement. USAO MDTN

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Medicaid, SNF,

February 5, 2019

Two doctors from the Florida-based Fishman & Sheridan Eye Care Specialists clinic have agreed to pay a combined $157,312.32 to settle their liability under the False Claims Act. Drs. Craig D. Fishman and Jeffrey A. Sheridan were outed in a qui tam complaint filed by former business partner Dr. Michael Pennachio and office manager Sharon Drake, which alleged that from 2011 to 2017, Fishman and Sheridan knowingly billed Medicare for blepharoplasty and ptosis repair surgeries that were purportedly performed on the same patients, even though they are mutually exclusive eyelid repair surgeries. For exposing the fraud, Pennachio and Drake will receive a relator's share of $26,000. USAO MDFL

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

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