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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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June 5, 2015

Atlanta-based dental practice Dennis B. Jaffe D.M.D., P.C. and its principal Dennis Jaffe agreed to pay $324,327.05 to settle charges they violated the False Claims Act by fraudulently billing Medicaid for tooth extraction procedures and for fraudulently billing for services rendered by a dental assistant when Jaffe was not present in the office. According to the government, Jaffe fraudulently sought payment from Medicaid for higher and more expensive levels of service than were actually performed, a practice commonly referred to as “upcoding.”  The allegations first arose in a whistleblower lawsuit filed by Michelle Smith under the qui tam provisions of the False Claims Act.  DOJ

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services.  Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing.  The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC.  The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be determined whistleblower award. DOJ

February 6, 2015

A federal jury in Detroit convicted unlicensed Detroit physician Wilfred Griffith for his participation in a nearly $4.7M fraud scheme. According to evidence presented at trial, Griffith worked as an unlicensed physician at Phoenix Visiting Physicians in 2010 and 2011 where he treated Medicare beneficiaries and used prescription pads pre-signed by Dr. Dwight Smith to prescribe medicine. He also referred Medicare beneficiaries to Detroit-area home health company Cherish Home Health Services Inc. in exchange for kickbacks. Griffith used the names and signatures of Dr. Smith and two other Detroit-area physicians to certify the beneficiaries were homebound and needed home health services when they did not. DOJ

December 1, 2014

North Atlantic Medical Services Inc., doing business as Regional Home Care Inc., agreed to pay $852,378 to resolve allegations it violated the False Claims Act by submitting claims to Medicare and Medicaid for respiratory therapy services provided by unlicensed personnel. NAMS is a medical device company based in Massachusetts that provides equipment and services for the treatment of respiratory ailments, such as oxygen deficiency and sleep apnea. According to the government, from September 2010 to January 2013, NAMS used unlicensed employees to set up sleep apnea masks and oxygen therapy equipment for patients in Massachusetts. The charges were initiated by former NAMS employees Konstantinos Gakis and Demetri Papageorgiou who filed a whistleblower action under the qui tamprovisions of the False Claims Act. They will receive a whistleblower award of $153,428. DOJ

April 30, 2014

A federal jury in Detroit convicted a physical therapist, physical therapy assistant and unlicensed doctor for their participation in a $15M Medicare fraud scheme at Detroit area companies Physicians Choice Home Health Care, Quantum Home Care, First Care Home Health Care, Moonlite Home Care and Phoenix Visiting Physicians. According to evidence presented at trial, these companies operated a fraudulent scheme to bill Medicare for home health care services that were never provided and paid kickbacks to recruiters who in turn paid Medicare beneficiaries cash and promised them access to narcotic prescriptions. DOJ

January 7, 2014

Dr. Ravi Sharma, owner and operator of Premier Vein Centers, agreed to pay $400,000 to resolve allegations that he and his clinics violated the False Claims Act by knowingly billing Medicare for vein injections and physician office visits performed by unqualified personnel. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

DOJ Catch Of The Week -- Pharmasan Labs

Posted  12/4/15
By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Wisconsin-based Pharmasan Labs, Inc. and its related billing company NeuroScience, Inc.  On Tuesday, both companies and their founders, Gottfried and Mieke Kellermann, agreed to pay $8.5 million to resolve charges they violated the False Claims Act by (i) submitting false information for laboratory services, and (ii)...

Constantine Cannon And Department of Justice Continue Joint Pursuit Against California Sleep-Clinic Chain

Posted  09/4/15
By Jessica T. Moore Constantine Cannon LLP has filed an amended complaint on behalf of a whistleblower alleging multi-faceted fraud on the part of Bay Sleep Clinic and its owners and operators, and billing company Access Medical Consultants.  The filing in United States ex rel. Dresser v. Qualium Corp., et al, Civil Action No. 12-1745 in the Northern District of California, comes on the same day the United...

August 24, 2015

The New York Attorney General announced settlement agreements with five defendants in a False Claims Act case that will return more than $8 million to the Medicaid and Medicare programs. The agreements resolve claims that SpecialCare Hospital Management Corporation defrauded Medicaid and Medicare by illegally referring patients to unlicensed drug and alcohol treatment programs in exchange for kickbacks. Investigation of the defendants began after whistleblowers Mathew I. Gelfand, M.D. and Enrico Montaperto filed complaints under New York’s False Claims Act. NY

March 19, 2015

Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A, will receive a whistleblower award of $1,082,500 from the $5,412,502 settlement resolving allegations Adventist Health System Sunbelt Healthcare Corporation violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons.  DOJ
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