Improper Medical Personnel Archives - Page 3 of 12

April 10, 2020

To settle fraud allegations by four relators in three qui tam suits, Michigan-based Encore Rehabilitation Services LLC has agreed to pay $4 million to the United States. According to Linda Anderson, Reza Saffarian and Audrey Theile, and Adam LaFerriere, from roughly 2010 to 2018, the owner and operator of over 600 healthcare facilities allegedly caused three of its skilled nursing facilities to submit false claims to Medicare for services that were not medically necessary, reasonable, or provided by skilled therapists, and improperly billed group therapy sessions as if they were individual therapy sessions. DOJ; USAO EDMI; USAO WDMI

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicare, SNF, Whistleblower Case,

March 11, 2020

Millennium Physicians Association PLLC, d/b/a Millennium Respiratory & Sleep Disorder Specialists, has agreed to pay $1.2 million to resolve whistleblower-brought allegations of fraud in connection with two sleep centers in Texas. From 2015 to 2019, Millennium allegedly violated Medicare rules and the False Claims Act by improperly billing Medicare for sleep studies conducted without the presence of properly credentialed technicians. As part of the settlement, the anonymous relator will receive a $187,344 share of the settlement. USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicare, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Guardian Elder Care

Posted 02/21/20

This week's DOJ Catch of the Week goes to Guardian Elder Care. On Wednesday, the operator of more than 50 nursing homes in Pennsylvania, Ohio and West Virginia agreed to pay roughly $15.5 million to resolve allegations it violated the False Claims Act by billing the government -- Medicare and the Federal Employees Health Benefits Program -- for medically unnecessary rehabilitation therapy services. According to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Improper Medical Facility, Improper Medical Personnel, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

February 19, 2020

Guardian Elder Care Holdings, Inc. has agreed to pay $15.5 million to settle claims of defrauding Medicare and Medicaid. In a qui tam suit filed in 2015, whistleblowers Philippa Krauss and Julie White alleged that from 2011 to 2017, the Pennsylvania-based nursing home chain pressured its therapists to provide medically unnecessary rehabilitation to patients suffering from dementia or dying in hospice care in order to boost its profits. During the subsequent government investigation, Guardian Elder Care self-disclosed that it had also billed federal healthcare programs for services performed by two excluded individuals. As part of the settlement, Guardian Elder Care has entered into a chain-wide Corporate Integrity Agreement with the Department of Health and Human Services, and Krauss and White will split a $2.8 million relator's share. USAO EDPA; USAO WDPA

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

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

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Improper Medical Personnel, Medicare,

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

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

October 3, 2019

Counselor Valerie Williams and her business, Circle of Life Transition Center, LLC, will pay $45,500 to resolve claims that they submitted false claims to the Connecticut Medicaid program, representing that services had been provided by Williams when, in fact, those services had been provided by unlicensed individuals. USAO CT

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud,

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

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Improper Medical Personnel, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

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