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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 90 of 108

June 13, 2016

Oklahoma-based FedCare, LLC and its related entity The Broadway Clinic of Tulsa, LLC, agreed to pay $2.5 million to settle charges of violating the False Claims Act by submitting false claims to the Office of Workers Compensation Programs of the Department of Labor.  According to the government, FedCare and Broadway submitted claims for medical services furnished to federal employees of fourteen federal agencies that were false because they were either (1) billed at a higher rate than allowed or (2) not performed at all.  DOJ (WDOK)

DOJ Catch of the Week -- Medicare Fraud Strike Force

Posted  06/24/16
By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to the 301 medical professionals that were the target of Wednesday's government healthcare fraud takedown involving roughly $900 million in alleged fraudulent Medicare and Medicaid billings.  The "unprecedented nationwide sweep" was led by the Medicare Fraud Strike Force and included the Medicaid Fraud Control Units of...

June 22, 2016

New York announced a $28 million settlement of a civil lawsuit that claimed the owners of Medford Multicare Center for Living, Inc. (“Medford”) located in Medford, New York looted the corporation and committed fraud and illegality in operating a business. The civil lawsuits claims were based on a history of criminal conduct by employees of the nursing home, staffing and service cuts and diversion of Medicaid funds to themselves and their controlled entities. The assurance of discontinuance provides that the settlement funds, which will be administered by an Independent Financial Monitor, will in part be used to establish a “Resident Care Fund” to fund care recommendations by the Independent Operator. That fund will provide the much needed reforms and improvements in the delivery of care and services to Medford’s elderly and frail residents. In addition, ten million dollars will be returned to the Medicaid program. The Medford corporation was also sentenced for its role in the cover-up of a patient death in 2012.‎ NY

June 20, 2016

New York announced the arrest of Joseph Wright, 52, of Middletown NY, for allegedly stealing over $5 million dollars from Medicaid. Prosecutors allege that Wright, as owner of a purportedly not-for-profit organization “Assistance By Improv II, Inc.” (ABI), located at 953 Southern Boulevard in the Bronx, lured thousands of low-income New Yorkers to ABI with the promise of affordable housing, arranged to have them subjected to unnecessary medical tests and then filed false claims for reimbursement with the State Medicaid program. Prosecutors alleged in papers filed in court that Wright unlawfully owns and operates ABI as a medical mill that masquerades as a charitable housing organization. Prosecutors allege that Wright ignored ABI’s professed charitable mission and duped potential clients, most of whom were Medicaid recipients, into surrendering their personal health care information and undergoing purported medical screening to qualify for housing. NY

June 1, 2016

Florence Bikundi and her husband Michael D. Bikundi Sr., owners of home care agency Global Healthcare Inc., were sentenced to prison for 10 years and 7 years, respectively, for health care fraud, money laundering, and other charges stemming from a scheme in which they and others defrauded the District of Columbia Medicaid program of over $80 million.  They were also ordered to forfeit over $11 million seized from 76 bank accounts; their $1 million residence; $73,000 in cash seized from their residence and five luxury vehicles.  The court also imposed a forfeiture money judgment of roughly $40 million and ordered them to pay roughly $80 million in restitution to D.C. Medicaid.  The government’s evidence showed the Bikundis led a scheme to bill Medicaid for services that were not fully provided, recruiting others, including family members, into the scam and creating fraudulent paperwork to hide the illegal activity.  DOJ

May 27, 2016

Carlos Rodriguez Nerey, the owner and president of Miami-area consulting and staffing company Nerey Professional Services Inc., was sentenced to 60 months in prison (and ordered to pay roughly $2.4 million in restitution) for his role in a $2.3 million Medicare fraud scheme.  According to evidence presented at trial, Nerey was involved in a conspiracy to accept kickbacks in return for referring Medicare beneficiaries to Mercy Home Care Inc. and D&D&D Home Health Care Inc. to serve as patients, including those who did not qualify for home health care services.  DOJ

May 20, 2016

New Jersey announced that a chiropractor from Morris County pleaded guilty to taking more than $250,000 in illegal kickbacks from doctors and other individuals in return for referring patients to their practices, clinics and medical imaging centers. Dr. Alexander Dimeo, 61, of Budd Lake, N.J., and Fort Myers, Fla., pleaded guilty to two separate accusations before Superior Court Judge Michael A. Toto in Middlesex County. Dimeo retired last year, but he formerly operated Passaic Chiropractic & Therapy Center PC in Passaic. In pleading guilty, Dimeo admitted that between 2009 and 2015, he received approximately $254,500 in illegal kickbacks for patient referrals. NJ

May 12, 2016

Kentucky anesthesiologist Jaime Guerrero was sentenced to 100 months in prison for his role in the unlawful distribution of controlled substances, including the prescription opioid hydrocodone without a legitimate medical purpose.  Guerrero also agreed to pay $827,000 in victim restitution to nine health care benefit programs.  He also pleaded guilty to multiple counts of unlawful distribution or dispensing of controlled substances, health care fraud, conspiracy and money laundering.  DOJ

May 13, 2016

A Somerville-based ambulance services provider has been sued for allegedly overbilling the state’s Medicaid program (MassHealth) for more than $600,000 in ambulance services that reflected a higher level of care than was actually provided. The complaint against Cataldo Ambulance Service, Inc. (Cataldo), filed on Thursday in Suffolk Superior Court, alleges that from 2005 to November 2015, Cataldo billed MassHealth for Emergency Advanced Life Support (ALS) services when, in fact, the patient’s condition at the scene only required, and the patient only received, Emergency Basic Life Support (BLS) services. Cataldo provides a variety of transportation services, including emergency ambulance services, throughout the Greater Boston area. According to the complaint, Cataldo’s inappropriate billing practices persisted despite being notified that, in many instances, the patient’s condition and the services rendered were insufficient to justify billing at an ALS level. MA

April 19, 2016

Michigan doctor Ali Elhorr pleaded guilty for his role in a $2.4 million health care fraud scheme.  Elhorr, who worked at House Calls Physicians P.L.L.C., admitted to conspiring with others, including his brother, Dr. Hicham Elhorr, to commit health care fraud by agreeing to serve as a “supervising” physician for unlicensed individuals purportedly providing in-home physician services.  The unlicensed individuals prepared medical documentation that Elhorr and other licensed physicians signed as if they had performed the visits when, in fact, Elhorr and the other licensed physicians had not treated the beneficiaries.  The visits were then billed as if performed by the licensed physicians.  DOJ
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