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:
July 8, 2019
Anthony Camillo, the owner of Illinois-based Allegiance Medical Laboratory and AMS Medical Laboratory, has been sentenced to 2.5 years in prison and ordered to pay $3.5 million in restitution for defrauding Medicare and Medicaid. According to the DOJ, Camillo paid Missouri-based marketers between $150-$200 for urine and saliva samples sent to his labs. His conduct incentivized other fraudulent conduct, including medically unnecessary testing of disabled and elderly patients living in residential care facilities, and the use of doctors’ names on test orders without the doctors’ knowledge. USAO EDMOJune 20, 2019
Hart to Heart Ambulance Services, d/b/a Hart to Heart Transportation Services, has agreed to pay $1.25 million to settle allegations that it defrauded Medicare by submitting claims for medically unnecessary services, violating the False Claims Act. Allegations were first brought to the government’s attention by former employee, Bryan Arvey, who alleged that from 2010 to 2017, Hart to Heart management pressured employees to falsify claims for non-emergency ambulance transports, such as hospital discharges. For aiding in the recovery of public funds, Arvey will receive a share of $251,000. USAO MDJune 11, 2019
Two additional co-defendants in a recently reported home health fraud case have been sentenced to 6-10 years in prison and ordered to pay over $4.3 million each for their involvement. Angela Avetisyan and Ashot Minasyan, the co-owners and operators of Fifth Avenue Home Health, paid kickbacks to Marina Merino and other patient recruiters to bring Medicare patients to a clinic owned by Robert Glazer. In exchange, they received referrals from Glazer’s clinic for home health services that were allegedly medically unnecessary. DOJ; USAO CDCADOJ Catch of the Week — Dr. Joseph Galichia
Posted 05/31/19
May 30, 2019
HyperHeal Hyperbarics, an oxygen therapy facility in Maryland, has agreed to pay over $400,000 to settle whistleblower allegations filed under the False Claims Act. In their 2016 qui tam suit, former employees Lesa Schrum and Juliette Skelton alleged that from 2013 to 2014, HyperHeal and its part-owner Eric Shapiro billed TRICARE for medically unnecessary services, services performed without physician supervision, or services that weren't ever performed. As part of the settlement, Schrum and Skelton will receive $74,635.25. USAO MDMay 30, 2019
Joseph P. Galichia, a cardiologist in Wichita, Kansas, will pay $5.8 million to resolve allegations under the False Claims Act that he and his practice, Galichia Medical Group, P.A., implanted cardiac stents in patients who did not need them, and billed Medicare, the Defense Health Agency, and the Federal Employees Health Benefits Program for these medically unnecessary procedures. Galichia will also be excluded from participating in federal healthcare programs for three years. The case was initiated by a whistleblower, Aly Gadalla, M.D., who filed a qui tam complaint. Dr. Gadalla will receive a whistleblower reward of $1.16 million. This is the third time Galichia had settled FCA claims against him and his practice. DOJ; USAO KanIntermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved
Posted 05/24/19
Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.
Posted 05/10/19
