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Improper Medical Personnel

This archive displays posts tagged as relevant to healthcare billings for unlicensed, unsupervised, or otherwise improper personnel. You may also be interested in our pages:

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January 6, 2020

A now defunct behavioral health clinic, Tree of Life, Inc., and its owners and operators, Ada and Victor Vidal, have agreed to pay $1.65 million to settle a whistleblower's claims that they violated the False Claims Act and Anti-Kickback Statute in claims to Pennsylvania's Medicaid program.  According to Erika Desjardins, the former Clinical Director, Tree of Life billed for therapy sessions where either the patient or therapist could not possibly have attended (in some cases due to a patient’s hospitalization or death), as well as therapy sessions provided by unqualified individuals.  To facilitate the fraud scheme, it created fake records, including forged signatures, and improperly paid a social worker for patient referrals.  As part of the settlement, the Vidals have been excluded from future participation in federal healthcare programs, and Desjardins, who had been fired for reporting internally, will receive $330,000 as their share of the recovery.  USAO EDPA

January 2, 2020

Two physicians in the San Diego area have agreed to pay nearly $1 million to settle allegations that they violated the False Claims Act by improperly billing Medicare for care provided by an uncredentialed physician.  The fraudulent conduct by Drs. Mark Smith and Fane Robinson of San Diego Retina Associates was revealed in a qui tam lawsuit by fellow ophthalmologist and former partner, Dr. Atul Jain, who will receive $170,778 of the settlement proceeds.  USAO SDCA

November 8, 2019

Lenox Hill Hospital and its corporate parent, Northwell Health, Inc., have agreed to pay $12.3 million for violating the Stark Law and False Claims Act in submissions to Medicare.  From 2013 to 2018, Lenox Hill paid the chair of its urology department, Dr. David Samadi, a salary and bonus that improperly took into account the value of his referrals and grossly exceeded fair market value.  In an effort to maximize revenue-generating surgeries, Samadi was repeatedly scheduled to perform overlapping surgeries, leaving patients with unsupervised medical residents in violation of both hospital and Medicare rules.  The department also billed Medicare for minor procedures performed in operating rooms with an unnecessarily full operating room staff.  USAO SDNY

October 17, 2019

Five home health providers in Iowa and South Dakota have been ordered to pay a combined $3.1 million for submitting false claims to Medicare.  Affiliates of Minnesota-based Welcov Healthcare LLC allegedly billed Medicare for therapy services that were not provided by skilled employees or not medically necessary.  Sergeant Bluff Healthcare, LLC will pay over $1.2 million, Logan Healthcare, LLC and Elk Point Healthcare #1, LLC will each pay over $775,000, Red Oak Healthcare, LLC will pay over $228,000, and Flandreau Healthcare 2, LLC will pay about $116,000.  USAO NDIA

September 19, 2019

Selma, Alabama hospital Vaughan Regional Medical Center, together with two of its ER physicians and an affiliated company, will pay $1.45 million to resolve allegations that they violated the False Claims Act by having medical residents who were not fully licensed and credentialed provide emergency room services.  The hospital then falsified medical records and submitted claims to Medicare as if the services had been provided by a licensed physician.  The case originated with a qui tam action filed by Dr. Samuel Clemmons, who will receive $275,000.  USAO SD AL

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted  07/26/19
Laboratory sample vial lying on procedure coding form
Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states.  CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...

June 27, 2019

Following a whistleblower suit, Fusion Physical Therapy and Sports Wellness, P.C., and its founder and CEO, Carolyn Sue Mazur, have agreed to pay $37,500 to settle charges of billing Medicare for physical therapy services performed by uncredentialed personnel.  In addition the monetary penalty, Fusion and Mazur have also admitted to the misconduct.  USAO SDNY

May 30, 2019

HyperHeal Hyperbarics, an oxygen therapy facility in Maryland, has agreed to pay over $400,000 to settle whistleblower allegations filed under the False Claims Act.  In their 2016 qui tam suit, former employees Lesa Schrum and Juliette Skelton alleged that from 2013 to 2014, HyperHeal and its part-owner Eric Shapiro billed TRICARE for medically unnecessary services, services performed without physician supervision, or services that weren't ever performed.  As part of the settlement, Schrum and Skelton will receive $74,635.25.  USAO MD

May 9, 2019

Carolina Physical Therapy and Sports Medicine, Inc. agreed to pay $790,000 to settle a whistleblower lawsuit alleging the company knowingly submitted false claims to Medicare and TRICARE. According to former employee Hilary Moore, Carolina PT submitted claims for group physical therapy services that were billed as though they were one-on-one sessions. Additionally, claims for certain services performed by physical therapy assistants were billed as though they were performed under the supervision of qualified therapists. For exposing the fraudulent conduct, Moore will receive a relator’s share of $142,200USAO SC
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