Improper Medical Personnel Archives - Page 5 of 12

December 4, 2018

Dermatology Associates of Central New York, PLLC has agreed to pay $811,196.88 to settle claims that it overcharged Medicaid, Medicare, and TRICARE by falsely submitting claims under physicians' names, in violation of both the federal and New York False Claims Acts. A whistleblower complaint revealed that many of the physicians named on invoices were not in the office the day care was provided and could not have supervised in the rendering of services, and that some of the non-physician practitioners who provided care were not licensed to do so in the state of New York. As a result of bringing the fraud to light, the unnamed whistleblower will receive $138,000. USAO NDNY

Tagged in: FCA Federal, FCA State, Improper Medical Personnel, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

November 26, 2018

Vital Energy Occupational Therapy and Wellness Center, LLC agreed to pay $200,000 to settle charges that between 2013 and 2016 it submitted false claims for physical and occupational therapy services. The therapy practice was alleged to have submitted claims to Medicare and Medicaid for individual therapy services, when group therapy was actually provided, and claims for therapy services with false practitioner information using the names of former employees. Whistleblower Ashley C. Baggett, who filed the False Claims Act action, will receive $36,000. USAO S.C.

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

October 24, 2018

The owners and operators of two community mental health clinics in Pennsylvania and North Carolina have entered into a $3 million consent judgment with the United States to resolve allegations of violating the False Claims Act. In 2000, Melchor Martinez was convicted of Medicaid fraud by the State of Pennsylvania and subsequently banned from owning and operating health clinics or seeking reimbursement from all federally funded healthcare programs. Despite this, he allegedly continued to own and operate three chains of mental health clinics—including Northeast Community Health Centers, Lehigh Valley Community Mental Health Centers, and Carolina Community Mental Health Centers—by enlisting the help of his wife, Melissa Chlebowski, to act as the true owner and operator. In addition, the two allegedly failed to operate according to rules set by Medicare and Medicaid, including seeing patients for only 2-3 minutes and billing for 15, and billing for services provided by unqualified staff. They were eventually outed in a qui tam lawsuit filed by a former employee. USAO EDPA

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

September 27, 2018

Millicent Traylor, M.D., of Detroit, Michigan was sentenced to over 11 years in prison today for her part in a health care scheme against Medicare from 2011 to 2016. Traylor and her co-conspirators defrauded Medicare of an estimated $8.9 million during that period. They submitted fraudulent claims for home health care services and other services which were not provided or not medically necessary. At times, the physician services which were provided were provided by Dr. Traylor, though she was unlicensed during that period. Furthermore, evidence presented during the four-day trial showed that Traylor forged the signature of licensed physicians on prescriptions for opioid medications, oxycodone for instance, as a way to encourage patient participation in the scheme. Traylor’s three co-conspirators will also serve time in prison. DOJ

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

July 31, 2018

Compassionate Home Care Services, Inc., its owner Carol Anders, and her son Ryan Santiago will pay a $3 million judgment for violating the federal and North Carolina False Claims Acts by filing reimbursement claims for services not rendered or rendered by unlicensed aides and family members. Anders and Santiago were also found to have falsified documents to conceal evidence of fraud upon being investigated by the government. USAO EDNC

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medical Billing Fraud,

July 2, 2018

Virginia in-home healthcare provider Hope In-Home Care, LLC, will pay $3.3 million to resolve allegations that it fraudulently billed Medicaid for a series of false statements and billing related to the provision of personal care services. Specifically, the USAO and Virginia Attorney General alleged that Hope In-Home Care billed for services that it did not perform and for services provided by uncertified personal care aides, and it falsified records to conceal these frauds. USAO EDVA

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medical Billing Fraud,

July 10, 2018

A Norwich behavioral health practice and its co-owners, a mother and her daughter who are both licensed behavioral health clinicians, agreed to a $300,000 settlement to resolve alleged violations of Connecticut’s False Claims Act. Affinity Behavioral Health LLC (“Affinity”) is co-owned by Julie Longton, a licensed marital and family therapist, and her daughter, Leanda Zupka, a licensed clinical social worker. Affinity, Longton and Zupka are enrolled as behavioral health providers in the Connecticut Medical Assistance Program (CMAP), which includes the state’s Medicaid program. The state alleged that, from April 2013 to December 2016, Affinity, Longton and Zupka knowingly submitted claims to the CMAP for payment for behavioral health services purportedly performed by licensed behavioral health clinicians when, in fact, the services were rendered by unlicensed individuals employed by Longton and Zupka. CT

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

June 28, 2018

Varicose vein treatment company Circulatory Centers of America, LLC agreed to pay $1,205,000 to settle allegations that it violated the False Claims Act. The allegations stemmed from a qui tam lawsuit filed by a whistleblower in Pittsburgh, PA that alleged claims were submitted to Medicare for services by non-physicians “incident to” the supervision by a physician when in fact no physician was present in the office. These types of claims are reimbursed at higher rates than when billed without the physician supervision component. USAO WDPA

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

April 25, 2018

Long Island-based pediatrics practice Freed, Kleinberg, Nussbaum, Festa & Kronberg M.D., LLP (dba Pediatrics and Adolescent Medicine), along with some of the practice’s current and former physicians, agreed to pay $750,000 to resolve allegations they violated the False Claims Act by billing Medicaid for services provided by physicians who were not enrolled in the program. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (EDNY)

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

March 13, 2018

Marshfield Medical, Inc. (formerly known as Bromedicon, Inc.) agreed to pay $550,000 to settle claims it violated the False Claims Act for submitting claims to Medicare and other federal health care programs without providing a qualified interpreting physician to monitor each surgery for which it purportedly provided remote Intraoperative Neurophysiological Monitoring. According to the government, in some of those cases, no one monitored the data stream from the surgeries and in others, Bromedicon’s medical director, a foreign medical school graduate with no license to practice medicine in the United States, was the only monitor. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (EDPA)

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

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