Lack of Medical Necessity Archives

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted 02/23/24

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

Tagged in: FCA Federal, Government Programs Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud, Reporting to Government,

Catch of the Week: Lincare, Inc.

Posted 02/16/24

This week's Department of Justice (DOJ) Catch of the Week goes to Lincare, Inc., a durable medical equipment supplier with locations throughout the country. Yesterday (February 15), the company agreed to pay $25.5 million to settle DOJ charges of violating the False Claims Act by billing Medicare for the rental of non-invasive ventilators (NIVs) when patients no longer needed or used them. DOJ also charged Lincare...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs, Whistleblower Case,

Catch of the Week: New York-Presbyterian Hospital

Posted 01/26/24

This week's Department of Justice (DOJ) Catch of the Week goes to New York-Presbyterian Hospital. Yesterday (January 25), the hospital agreed to pay $801,000 to settle charges it violated the False Claims Act by billing Medicare, Medicaid and TRICARE for medically unnecessary images for radiation therapy treatments provided to cancer patients. The settlement is notable not for the relatively small amount of money...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

Testing Lab and Owner/CEO Settle False Claims Act Case for $13.25 Million

Posted 01/12/24

Laboratory Analysis. Scientist Measuring Sample

RDx Bioscience Inc. (“RDx”), a clinical laboratory that operated in New Jersey, and its owner and CEO agreed to pay $13.25 million to settle a False Claims Act case alleging kickbacks and unnecessary testing schemes, according to a recent DOJ press release. The press release also notes that RDx and its owner/CEO agreed to cooperate with the DOJ’s “investigations of, and litigation against, other participants...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity,

January 10, 2024

Clinical laboratory RDx Bioscience Inc. and its owner and CEO Eric Leykin have agreed to pay over $10 million to the federal government and about $3 million to the State of New Jersey for violating the Anti-Kickback Statute and federal and state False Claims Acts. From 2018 to 2022, RDx and Leykin were allegedly involved with five types of kickback schemes in order to induce referrals to RDx for laboratory testing, then submitted or caused false claims to be submitted to Medicare and Medicaid that were unnecessary or uncovered. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare,

December 21, 2023

A Florida woman who submitted over $192 million in claims to Medicare for medically unnecessary and unprovided tests, equipment, and services, has been sentenced to 20 years in prison. Elizabeth Hernandez ordered thousands of genetic testing and orthotic braces for patients she never spoke to or examined, ultimately ordering more cancer genetic tests than any other provider in the nation. She also billed for thousands of telemedicine visits that she never performed, often billing for over 24 hours in a single day. DOJ

Tagged in: Criminal Proceedings, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,

November 16, 2023

A Florida man who was the Chief Compliance Officer of pharmacy holding company A1C Holdings LLC has been ordered to pay $21.7 million in restitution for his role in a $50 million fraud scheme against Medicare. Pharmacies associated with Steven King and his co-conspirators allegedly secured prescriptions and refills for medically unnecessary lidocaine and diabetic testing supplies, and took steps to avoid oversight by registering as brick-and-mortar pharmacies, concealing their ownership, and shipping expensive prescriptions without patient authorization. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Pharma Fraud,

October 18, 2023

The president of a California-based medical technology company has been sentenced to 8 years in prison and ordered to pay $24 million in restitution in the first COVID-related criminal securities fraud case charged by DOJ and the first COVID-related criminal healthcare fraud case brought to trial. Among many things, Mark Schena of Arrayit Corporation was found to have taken advantage of the pandemic by claiming he and his company had developed a technology to test for just about any disease, including COVID, using a single drop of blood. In doing so, Schena and Arrayit lied to investors to give them a false sense of credibility, paid illegal kickbacks to marketers to run deceptive plans about the accuracy of its tests, and submitted false claims to Medicare and private insurers for medically unnecessary allergy testing. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Financial and Investment Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

Genetic Testing Scheme Leads to Another Fraud Conviction

Posted 10/11/23

The DOJ recently announced another fraud conviction in connection with genetic testing. This conviction from a federal jury in Florida is the latest word in a string of fraud actions against companies and individuals offering to provide genetic testing services. According to the DOJ, Jose Goyos and others managed the “‘doctor chase’ division” of a call center, which “contacted the primary care physicians...

Tagged in: Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Provider Fraud,

Scoundrel Spotlight - COVID-19 Fraudster Lourdes Navarro

Posted 10/9/23

This week's Scoundrel in the Spotlight is Lourdes Navarro and her husband Imran Shams. The married pair ran the LA County medical lab Clinical Laboratory Inc. (also called Health Care Providers Laboratory). Their lab performed COVID-19 screening tests primarily for nursing homes and other facilities catering to the elderly population. Last Thursday (October 5), Navarro pleaded guilty to fraudulently billing the...

Tagged in: COVID-19, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Risk Adjustment Fraud,

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Lack of Medical Necessity

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Catch of the Week: Lincare, Inc.

Catch of the Week: New York-Presbyterian Hospital

Testing Lab and Owner/CEO Settle False Claims Act Case for $13.25 Million

January 10, 2024

December 21, 2023

November 16, 2023

October 18, 2023

Genetic Testing Scheme Leads to Another Fraud Conviction

Scoundrel Spotlight - COVID-19 Fraudster Lourdes Navarro

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