Healthcare Fraud Archives - Page 84 of 126

September 12, 2018

A New York based long-term care facility, Centers Plan for Healthy Living, has agreed to pay $1,650,000 to settle allegations that it violated the state and federal False Claims Acts in billing Medicaid for services not provided to Medicaid beneficiaries. The alleged fraud involved enrolling unqualified patients and failing to disenroll recently unqualified patients from a Medicaid-funded care program over the span of two and a half years. It was eventually exposed by an unnamed whistleblower. AG NY; USAO EDNY

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

Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica

Posted 09/7/18

Whistleblower Marc Silver secured a victory from the Third Circuit on September 4, 2018, which held that his action was not blocked by the “public disclosure bar” of the False Claims Act, reversing a lower court that had dismissed his action. The Third Circuit’s opinion appropriately recognizes that a whistleblower can use non-public information as a bridge between public information and allegations of fraud,...

Tagged in: Anti-Kickback and Stark, Court Decision, FCA Federal, Healthcare Fraud, Medicaid, Part D, Pharma Fraud, Public Disclosure and Public Information,

September 4, 2018

Houston psychiatrist Riyaz Mazcuri was sentenced to 12.5 years in prison following his conviction at trial for defrauding Medicare and Medicaid through the submission of $155 million in false and fraudulent claims for "partial hospitalization program" services, a form of intensive outpatient treatment for patients with mental illness. Mazcuri falsified records to make it appear as if patients admitted to the PHPs qualified for, required, and actually received the intensive psychiatric services. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

Catch of the Week — Ambulance Company and Clients Busted for Illegal Kickbacks and Cozy Financial Relationships

Posted 08/31/18

Here’s a question you shouldn’t have to ask when you’re in an ambulance: Did a bribe put me here? Our Catch of the Week goes to a $21 million settlement of a case against several ambulance-industry companies for allegedly paying kickbacks to secure lucrative exclusive contracts. Paramedics Plus, the East Texas Medical Center, the Emergency Medical Services Authority (EMSA), and EMSA’s president and CEO Herbert...

Tagged in: Ambulance, Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

Integra Med Analytics Files Whistleblower Lawsuit against Providence Health & Services and J.A. Thomas and Associates

Posted 08/30/18

London whistleblower attorney Mary Inman published in RAC Monitor (August 30, 2018). Click here to read the article.

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Eligibility,

August 29, 2018

Atlantic Mobile Imaging Services, Inc. has agreed to pay $321,388.50 to settle allegations that it knowingly billing federal healthcare programs over $160,000 for x-ray services provided while it was unlicensed, in violation of the False Claims Act. The alleged fraud took place over a span of six months in 2015. USAO MDFL

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

August 28, 2018

Dermatology Healthcare will pay $4 Million to settle allegations of healthcare fraud which violate the False Claims Act. Dermatology Healthcare submitted false claims in order to be paid millions in Medicare and Medicaid reimbursements for treatment of non-melanoma skin cancer during which superficial radiation therapy is administered. It is alleged that the superficial radiation therapy was not properly supervised during treatment and that other procedures in relation to superficial radiation therapy were up-coded. It is further alleged that the radiation simulations were overly used. This settlement is the conclusion of a lawsuit filed by dermatologist Theodore A. Schiff, M.D., under the qui tam provisions of the False Claims Act in the United States District Court for the Middle District of Florida. DOJ

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

August 23, 2018

Reliant Rehabilitation Holdings Inc has agreed to pay $6.1 million to settle claims brought on by whistleblower Dr. Thomas Prose that it paid kickbacks to doctors and nursing homes to promote its business and filed reimbursement claims arising from improper contracts — both violations of the False Claims Act. Under the settlement agreement, Dr. Prose will receive a relator’s share of $915,000. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

August 21, 2018

Physician Ewald J. Antoine, of Valley Stream, New York, was convicted today and sentenced to one year and one day in prison for his part in a $30 million health care scheme involving Medicare and Medicaid. Dr. Antoine is one of eight defendants sentenced in this case. Under the direction of Aleksandr Burman, co-conspirator and owner of six medical clinics in Brooklyn, Antoine feigned ownership of two of the six clinics and fraudulently billed Medicare and Medicaid for unprovided medical services and supplies. In addition to prison time, Dr. Antoine has been ordered to pay $1,825,544 in restitution. He has also been ordered to give up $269,412 in illegally-gained profits. DOJ See related sentencing of Dr. Paul Mathieu and Lina Zhitnik.

Tagged in: Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

August 20, 2018

The owner of an ambulance company has been convicted of defrauding Medicare by submitting claims for over $3 million in unprovided or unnecessary transport services. Anthony Nwosah of Tonieann EMS and Rosenberg EMS also admitted to falsifying and instructing others to falsify transport records, as well as submitting some under the name of an EMT who didn’t even work for him. He received $1,094,260 before the fraud was uncovered, and at his sentencing in November, he stands to receive a $250,000 fine and ten year sentence. USAO SDTX

Tagged in: Ambulance, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud,

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