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Lack of Medical Necessity

This archive displays posts tagged as relevant to fraud arising from medically unnecessary healthcare services. You may also be interested in our pages:

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December 5, 2019

Maryland-based internist Noman Thanwy, M.D. has paid over $176,000 to settle allegations of submitting false claims to Medicare for medically unnecessary autonomic nervous function and vestibular function tests.  Although the tests are typically performed only once per beneficiary to confirm diagnoses of relatively uncommon disorders, Dr. Thanwy, who lacked the necessary training and equipment to perform the tests, was allegedly using them to monitor patient symptoms.  USAO MD

November 8, 2019

In the eleventh settlement involving the multi-state OK Compounding Pharmacy fraud scheme, podiatrist Jonathan Moore of Kentucky has agreed to pay $65,404 for the role he played in defrauding federal healthcare programs.  In exchange for illegal kickbacks disguised as “medical director fees,” Dr. Moore allegedly prescribed medically unnecessary compounded pain creams to patients, many of whom were insured by Medicare and TRICARE.  USAO NDOK

October 28, 2019

Sanford Health, Sanford Medical Center, and Sanford Clinic have agreed to pay $20.25 million and enter into a Corporate Integrity Agreement in order to resolve alleged violations of the Anti-Kickback Statute and False Claims Act.  Despite warnings by several physicians that a top neurosurgeon was illegally profiting off his use of implantable medical devices as well as performing medically unnecessary surgeries involving the devices, Sanford did nothing to stop the offender, allowing Medicare and Medicaid to continue being defrauded.  The allegations were raised by Sanford surgeons Drs. Carl Dustin Bechtold and Bryan Wellman, who will share in a $3.4 million cut of the settlement proceeds.  DOJ; USAO SD

CATCH OF THE WEEK – Osteo Relief Institutes, Pedaling Dubious Treatment for Arthritis, Tagged for Charging Medicare for Medically Unnecessary Services

Posted  10/25/19
x-ray of a knee
On October 18, 2019, the Department of Justice announced a settlement with arthritis treatment provider Osteo Relief Institutes and seven of its locations in Phoenix, Arizona; San Diego, California; Lexington, Kentucky; Wall Township, New Jersey; Dallas, Texas; San Antonio, Texas; and, Colorado Springs, Colorado.  According to the DOJ press release, the ORI entities, together with their principals, will collectively...

October 18, 2019

Following a government analysis of Medicare claims data and a whistleblower's qui tam lawsuit, seven former Osteo Relief Institutes and their owners have agreed to pay more than $7.1 million to settle claims of defrauding Medicare.  The alleged fraud involved clinics in Arizona, California, Kentucky, New Jersey, and Texas billing Medicare for medically unnecessary treatments for osteoarthritis, including viscosupplementation injections and knee braces.  The whistleblower involved will receive $857,550.  DOJ

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

October 15, 2019

Otolaryngologist Dr. Tracey Wellendorf has agreed to pay $1 million to resolve allegations of violating the False Claims Act in at least 115 procedures billed to Iowa Medicaid.  The alleged misconduct occurred between 2014 and 2015 and involved endoscopic sinus surgeries that were either medically unnecessary or incorrectly coded.  USAO NDIA

October 9, 2019

The largest operator of kidney dialysis clinics in the United States has agreed to pay $5.2 million to resolve a lawsuit alleging it submitted false claims to Medicare for excessive and unnecessary immune tests.  From 2013 to 2010, Fresenius Medical Care Holdings, Inc. allegedly billed Medicare for Hepatitis B surface antigen tests it performed on patients already known to be immune, at a frequency well above that established by Medicare.  For exposing the alleged False Claims Act violations, former employee Christopher Drennen will receive a 27.5% share of the recovery.  USAO MA

October 4, 2019

Florida man Brock Lovelace has been sentenced to nearly six years in federal prison following his conviction at trial on charges related to his payment of kickbacks to medical clinics in the Miami area in exchange for the clinics providing him with DNA samples for submission to a DNA testing laboratory between 2013 and 2014.  Lovelace requested that the medical clinics collect the DNA of all the patients who visited the clinics; in turn, the clinics provided food and other inducements to beneficiaries to get them to visit.  Lovelace then submitted the DNA swabs to a testing lab, which billed Medicare.  The patients were not provided with the results of the DNA testing, and typically did not have any medical need for the DNA testing.  Lovelace was previously sentenced to 14 years in prison on other healthcare fraud charges; he will serve the present sentence consecutively.  DOJ

October 4, 2019

Southern California-based Retina Institute of California Medical Group (RIC), its former CEO, and several of its physicians have agreed to pay the State of California and United States $6.65 million to settle alleged violations of state and federal False Claims Acts.  According to former administrators Bobbette Smith and Susan Rogers, between 2006 and 2017, the ophthalmology group improperly billed Medicare and Medicaid for unnecessary and unperformed eye exams, upcoded simple exams using codes normally reserved for emergency conditions, and waived mandatory co-payments and deductibles to induce patient referrals.  Smith and Rogers will receive a relator’s share, which remains to be determined.  USAO CDCA
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