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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 96 of 117

September 30, 2016

New York announced guilty pleas by Katia Donnelly and her durable medical equipment and supply store, Bennett Surgical Supply, Inc., for submitting thousands of false claims to Medicaid resulting in Medicaid paying them more than two million dollars over a six and a half year period. Donnelly admitted during her plea that she used the Medicaid identification numbers of Bennett Surgical customers to fraudulently bill for items she never purchased or delivered to them. She and her corporation plead guilty to Grand Larceny in the Second Degree, and it is expected that Donnelly will be sentenced to 2 to 6 years in State Prison. NY

September 26, 2016

New York announced that it has entered into a settlement agreement with First Call, Inc., to resolve allegations that it billed Medicaid for transportation services provided by unqualified drivers and without required documentation. The investigation settled False Claims Act allegations that are identified in the settlement agreement, pursuant to a qui tam lawsuit filed by whistleblower Thomas D. Ayers asserting claims under the New York False Claims Act. As a result of the settlement, the company will pay New York State $173,650.83 in restitution and damages pursuant to the New York False Claims Act. NY

September 22, 2016

A federal jury in Los Angeles convicted Michael Huynh, the owner of a California medical clinic, for his role in a health care fraud scheme and for filing false income tax returns. Evidence at trial showed that Huynh provided false prescriptions to a pharmacist and co-conspirator, Farhad N. Dany Sharim, who submitted false claims to insurance companies for drugs that were never dispensed.  DOJ

September 19, 2016

North American Health Care Inc., a California-based operator of dozens of skilled nursing facilities (along with its Chairman John Sorenson and Senior Vice President of Reimbursement Analysis Margaret Gelvezon) agreed to pay $30 million to resolve charges they violated the False Claims Act by billing for medically unnecessary rehabilitation therapy services.  Whistleblower Insider

September 12, 2016

Pennsylvania announced the arrest of a licensed professional counselor charged with submitting hundreds of fraudulent Medicaid claims in an alleged scheme that netted him more than $100,000 for counseling services that he never provided. Michael Clarence Johnston, 55, the former owner and operator of Vision Counseling Services in Brodheadsville, Monroe County, was charged with various criminal offenses following an investigation by the Office of Attorney General’s Medicaid Fraud Control Section. PA

September 9, 2016

Los Angeles nursing home Westlake Convalescent Hospital and two physicians who worked there, Dr. Jasvant Modi and his wife Dr. Meera Modi, agreed to pay $3,563,140 to resolve charges they violated the False Claims Act by participating in a scheme to improperly transfer patients recruited from the “Skid Row” district to a hospital for medically unnecessary services, and then transfer the patients from the hospital to the nursing home for medically unnecessary stays.  According to the government, Westlake paid illegal kickbacks to a “care consortium” on Skid Row in exchange for patient referrals to Westlake.  Jasvant Modi allegedly readmitted patients from Westlake to the now-closed Temple Community Hospital and then back to Westlake to extend the patients’ Medicare-covered stays at Westlake, knowing the patients did not require further services at either facility.  Meera Modi allegedly signed medical orders for non-payable services for these same patients. Westlake allegedly billed Medicare and Medi-Cal for medically unnecessary services provided to these patients.  The allegations originated in a whistleblower lawsuit brought by former Westlake employee Ricardo Gonzales under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $534,471 from the proceeds of the government's recovery.  DOJ (CDCA)

August 17, 2016

Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital and affiliated entities including a related pain clinic, Lehigh Valley Pain Management, agreed to pay $690,441 to resolve allegations they violated the False Claims Act by submitting false health care billings for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising.  The allegations originated in whistleblower lawsuit filed Margaret Reynard under the qui tam provisions of the False Claims Act.  Ms. Reynard will receive a whistleblower award of roughly $124,000 from the proceeds of the government's recovery.  DOJ (EDPA)

August 15, 2016

Miami resident Ramon Collado Gonzalez pleaded guilty to participating in a $4.2 million home health care fraud scheme.  As part of his guilty plea, Gonzalez admitted being recruited by Mildrey Gonzalez and Milka Alfaro, the owners of Miami health care agency Golden Home Health Care Inc., to falsely represent himself to be Golden’s owner so they could improperly obtain funds from Medicare.  DOJ

August 22, 2016

New York announced a settlement with HealthNow, New York, Inc., after an investigation uncovered the wrongful denial of thousands of claims for outpatient psychotherapy and more than one hundred claims for nutritional counseling for eating disorders. The wrongful denials totaled more than $1.6 million in patient claims. Under the agreement, the Buffalo-based company, a not-for profit health service corporation providing health care coverage for approximately 573,700 New Yorkers (including 291,000 who are enrolled in commercial health plans), will pay members for the wrongfully denied claims, revise its policies, and will eliminate a company policy that subjected all psychotherapy claims to review after a member’s 20th visit. Attorney General Schneiderman’s Health Care Bureau launched an investigation in 2015 into HealthNow’s administration of behavioral health benefits following the receipt of consumer complaints. The complaints alleged that HealthNow had improperly denied coverage for treatments by requiring that all outpatient behavioral health visits be preauthorized after the first 20 visits per year, and by excluding coverage for nutritional counseling for eating disorders. NY

August 22, 2016

Two Florida companies have been ordered to pay $17 million for deceptively marketing and billing for medications and services relating to the treatment of erectile dysfunction at an unlicensed medical clinic in Framingham, Massachusetts announced. The judgment, ordered by the Suffolk Superior Court, permanently prohibits Florida Men’s Medical Clinic, LLC (FMMC) and Men’s Medical Clinic, LLC (MMC) from operating unlicensed medical clinics in Massachusetts or deceptively marketing any medication or medical service relating to the treatment of erectile dysfunction in the state. Under the judgment, the two companies are also ordered to pay, between them, in excess of $17 million, with $6.3 million for restitution to Massachusetts consumers and the remainder in payments to the Commonwealth, including civil penalties. The companies have represented that they have ceased operations, and recovery of the amounts they are ordered to pay is uncertain. MA
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