Healthcare Fraud Archives - Page 80 of 126

November 28, 2018

Dr. Thomas Baker, Dr. Carolyn Kochert, Dr. Larry L. Zhou, and Dr. Julie Y. Chao, have agreed to settle with the United States Government for violation of the Federal False Claims Act, the Physician Self-Referral law (“Stark”), and the Anti-Kickback Statute due to their involvement in a kickback scheme with Southwest Laboratories and Medscan Laboratory, thus causing false claims to be submitted to Medicare. The four physicians will pay a total amount of over $1.5 million. The individual amounts paid are as follows: Dr. Baker, of Tennessee - $484,481.80; Dr. Kochert, of Indiana - $129,682.84; Dr. Zhou, of Kentucky - $277,758.18; Dr. Chao, of Indiana - $650,000. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare, Provider Fraud,

November 27, 2018

Twelve individuals have been charged by a federal grand jury in a 22-count indictment related to a multi-year conspiracy to defraud the Pennsylvania Medicaid Home Care Program. The indictment lists a multitude of fraudulent acts by the defendants, alleging that they: submitted false claims for services that were not provided, misused consumers’ personal identifying information, provided false documentation during state audits, and even submitted claims to Medicaid for home care services for consumers who were hospitalized or no longer alive. Ten of the defendants reside in Western Pennsylvania, one is a resident of Georgia, and the twelfth defendant is a resident of South Carolina. Between January 2011 and April 2017, the conspirators, who owned and operated the home health care companies, received more than $87,000,000 in Medicaid payments. The conspiracy and health care fraud charges each carry a maximum total sentence of 10 years in prison, a fine of $250,000, or both. DOJ

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

November 26, 2018

Vital Energy Occupational Therapy and Wellness Center, LLC agreed to pay $200,000 to settle charges that between 2013 and 2016 it submitted false claims for physical and occupational therapy services. The therapy practice was alleged to have submitted claims to Medicare and Medicaid for individual therapy services, when group therapy was actually provided, and claims for therapy services with false practitioner information using the names of former employees. Whistleblower Ashley C. Baggett, who filed the False Claims Act action, will receive $36,000. USAO S.C.

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

November 20, 2018

Gray Wesley Barrow, a doctor and co-owner of Louisiana Spine & Sports LLC, a pain management clinic in Baton Rouge, has pleaded guilty to receiving approximately $336,000 in unlawful kickbacks. According to the plea, between 2014 and 2016 Barrow sent urine specimens collected from his patients to a drug testing laboratory that agreed to pay him a percentage of the reimbursements paid to the laboratory by health care benefit programs including Medicare. DOJ; USAO M.D. La.

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

November 16, 2018

A New Jersey-based doctor, Dr. Bernard Ogon, has been charged with participating in a compound pharmacy fraud that caused over $20 million in losses to health care benefit programs, including $3 million in losses to TRICARE. In exchange for a per-prescription payment, Ogon allegedly signed prescriptions that were pre-filled by telemedicine companies on behalf of patients he never saw. On multiple occasions, the prescriptions were for pain and scar creams that were not medically necessary, and were in fact exorbitantly expensive when made by a compound pharmacy. Ogon was also accused of writing prescriptions for patients in states that he was not licensed to practice in; if convicted, he faces a maximum of 10 years in prison. USAO NJ

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

November 14, 2018

After pleading guilty last year, the owner of two health clinics in Detroit has been sentenced to 160 months in prison and ordered to pay over $6 million for defrauding Medicare. Along with multiple co-defendants, Jacklyn Price allegedly took part in a scheme to bill Medicare for services that were obtained through kickbacks, not medically necessary, not actually provided, or provided by an unlicensed practitioner. Her co-defendants, Millicent Traylor, Muhammad Qazi, and Christina Kimbrough, were all sentenced in September. DOJ

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

November 7, 2018

Convicted of defrauding the Medicare program, former Houston-area healthcare clinics owner Joy Aneke was sentenced to 36 months in federal prison and ordered to pay $2,760,464.57. Aneke submitted false claims for medical services that were either not performed or not authorized by a licensed physician. None of Aneke’s clinics even had equipment necessary to provide the services -- allergy testing, complex cystometrograms, anal/urinary muscle studies, and others -- for which Aneke billed Medicare. Additionally, Aneke used “recruiters” or “marketers” to encourage patients to visit her clinics, and instructed co-defendant Maureen Henshall to pay patients illegal kickbacks. DOJ

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

November 6, 2018

An Indiana-based dental care practice and admin support company have agreed to pay a total of $5.139 million to settle allegations they violated the federal and Indiana state False Claims Acts. According to whistleblower and qui tam plaintiff Dr. Jihaad Abdul-Majid, between 2009 and 2013, ImmediaDent of Indiana, LLC and Samson Dental Partners, LLC allegedly billed Indiana's Medicaid program for procedures that were either upcoded (i.e. represented to be more serious and more expensive than they actually were), were not actually performed, or were not medically necessary. Samson Dental Partners is additionally accused of violating Indiana’s law prohibiting the corporate practice of dentistry. Because the companies refused oversight proposed during settlement, they have now been classified as "high risk" to federal healthcare programs. IN AG; USAO WDKY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

November 5, 2018

A Michigan-based patient recruiter for home health care agencies was convicted, following trial, for her role in a scheme to bill Medicare for claims arising from illegal kickbacks. Together with co-conspiring home healthcare agencies, Sophia Eggleston defrauded Medicare of $1.1 million. The scheme, which was active for at least three years, involved Eggleston soliciting and receiving kickbacks in exchange for patient referrals to co-conspirator home health agency contacts, who then submitted Medicare claims for services purportedly provided to the referred patients. Eggleston faces sentencing in February. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Medicare,

November 2, 2018

Metropolitan Retina Associates, Inc. and its owner, Dr. Kenneth S. Felder, have settled a False Claims Act investigation by agreeing to pay $2,064,559 for Medicare and Medicaid fraud. As part of the settlement, the New York-based ophthalmology practice admitted and accepted responsibility for submitting claims involving medically unnecessary and improperly documented fluorescein angiograms, as well as ultrasounds of the eye. USAO SDNY

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

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