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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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October 16, 2018

Two doctors and three nurses were sentenced to prison for their roles in fraudulently billing Medicare $11 million through claims submitted by two companies—Timely Home Health Services Inc., a home health provider, and Boomer House Calls, a house call provider, both in the Dallas area. The scheme allegedly took place from 2007 to 2015 and involved falsifying records so it appeared that Medicare beneficiaries received home health services when in fact they did not. The five defendants will serve sentences ranging from as little as 6 months to as much as 10 years in prison. DOJ

October 16, 2018

A Medicaid transportation provider, its president, and a driver have been sentenced to pay a $10,000 fine and serve 2-4 years in prison for stealing a total of $1.2 million from New York's Medicaid program. The driver who was sentenced, Haimid Thompson, was accused of paying a Medicaid recipient to enroll in services from his employer and submitting falsified logs showing daily trips on behalf of the recipient. He was ordered to pay $23,598. The company, 716 Transportation, Inc., was sentenced to a fine of $10,000, and the president, Wossen Ambaye was ordered to pay restitution of $900,497, for knowing the services billed were not actually provided. NY AG

October 15, 2018

The CEO of Tri-County Wellness Group, Mashiyat Rashid, has plead guilty and agreed to forfeit millions of dollars worth of ill-gotten funds and property in connection with a $150 million healthcare fraud. Over the course of almost 10 years, Rashid and physicians working in his pain clinics allegedly prescribed millions of units of medically unnecessary painkillers to Medicare beneficiaries, whom they also subjected to medically unnecessary but expensive injections. A similar fraud was repeated at laboratories owned by Rashid, with medically unnecessary but expensive urine tests for drugs. When Medicare realized that none of the claims were reimbursable, Rashid and others created fake companies to perpetuate the fraud. DOJ

October 12, 2018

A father and son duo has plead guilty to causing over $27 million in losses from Affordable Care Act (ACA) programs in twelve states, including Arizona, California, Connecticut, Delaware, Indiana, Kentucky, New Jersey, Ohio, Oregon, Pennsylvania, Tennessee, and Texas. Jeffrey and Nicholas White of California allegedly made a living from drug rehabilitation centers through patient referral bonuses and cuts of money paid out by ACA programs. To maximize their profits, they enrolled participants in ACA programs in high paying states, regardless of whether the participants even lived in that state. The Whites also went to great lengths to further the fraud, including creating fictitious contact information, paying patients' insurance premiums, and paying for their transport to out-of-state rehabilitation centers. They each face a maximum of 10 years in prison. USAO CT

October 12, 2018

The owner of a small chain of hospices has plead guilty to healthcare fraud in one of the largest hospice fraud cases ever to come out of Mississippi. Charline Brandon is alleged to have submitted fraudulent claims worth $11 million to Medicare and $2 million to Medicaid for services not rendered or needed, as well as illegally soliciting patients who were not eligible for hospice services. USAO NDMS

Catch of the Week – AmerisourceBergen Corporation

Posted  10/12/18
Last Monday, one of the largest drug wholesalers in the country agreed to pay $625 million to settle allegations that it put cancer patients at risk by illegally repackaging and distributing millions of vials of oncology drugs. The federal government and forty-four states claimed that AmerisourceBergen Corp. (“ABC”) and one of its subsidiaries, Medical Initiatives, Inc. (“MII”) engaged in a thirteen-year-long...

October 9, 2018

A Florida-based pharmacy owner has plead guilty to defrauding Medicare of $8.4 million. In order to generate income for his pharmacy, Valles Pharmacy Discount, Antonio Perez Jr. allegedly paid kickbacks to Medicare beneficiaries and submitted claims on their behalf for medically unnecessary prescriptions that were not purchased by the pharmacy or provided to the beneficiaries. DOJ

October 4, 2018

Mercy Ainabe of Houston, Texas, was sentenced to nine years in prison for her role in a $3.6 million home healthcare Medicare fraud scheme.  Ainabe served as a patient recruiter, selling patient information to home healthcare companies, including Texas Tender Care, which then submitted claims to Medicare for home health services that were not medically necessary, were not provided, or both. USAO SDTX

October 1, 2018

Pharmaceutical distributor AmerisourceBergen Corporation will pay $625 million to the federal government and 43 states to settle claims that between 2001 and 2014 a pre-filled syringe program at one of its subsidiaries, Medical Initiatives, Inc., violated federal law.  Despite lacking the proper licensing and registration, MII opened FDA-approved sterile vials of oncology drugs, and in a non-sterile environment, pooled the medicine and transfered it into non-FDA approved pre-filled syringes which were then sold to oncology practices and physicians.  This practice allowed Amerisource to capture the "overfill" in the original FDA-approved sterile vials and produce a larger number of pre-filled syringes.  AmerisourceBergen also resolved claims that it provided unlawful kickbacks to physicians to induce them to purchase pre-filled syringes rather than vials.  The settlement resolved three qui tam actions initiated by whistleblowers Michael Mullen, Daniel Sypula, Kelly Hodge, and Omni Healthcare, Inc.; a payment of over $93 million will be made to relators. Previously, in September, 2017, AmerisourceBergen Specialty Group pleaded guilty to illegally distributing misbranded drugs and agreed to pay $260 million in criminal fines and forfeitures. USAO E.D.N.Y.NY

September 28, 2018

Kalispell Regional Healthcare System and six of its related entities agreed to pay $24 million to settle a False Claims Act case based on its compensation arrangements with physicians, which were alleged to violate the Stark Law, and other arrangements alleged to violate the Anti-Kickback Statute.  Between 2010 and 2018, KRH entities reportedly paid excessive and above-market full-time compensation to more than 60 physicians, even if those physicians worked far less than full-time.  In addition, some of the KRH entities were alleged to unlawfully seek referrals from physicians through excessive compensation arrangements and the provision of administrative services at below market rates.  Jon Mohatt, the former CFO of a related entity, initiated the action with a qui tam filing; Mohatt will receive $5.4 million dollars as a relator's share of the government's recovery.  DOJ
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