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:
April 24, 2019
Two executives of Arriva Medical, LLC, a mail-order diabetic testing supply company acquired by Alere, Inc. in 2011, will pay a total of $1 million to settle claims that they caused Arriva to submit false claims to Medicare by supplying patients with free or no cost home blood glucose meters, waiving patient copayments, and billing for medically unnecessary home blood glucose meters. USAO MD TN; 2021 settlement with Arriva hereApril 9, 2019
A number of telemedicine and durable medical equipment companies, the principals of those companies, and three healthcare providers, were charged with submitting over $1.7 billion in false claims in a scheme to pay unlawful kickbacks and bribes from DME companies in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for medically unnecessary DME including back, shoulder, wrist and knee braces. DOJ; USAO MD FL; USAO NJ; USAO SC.April 5, 2019
Philip Esformes of Miami Beach, Florida, was found guilty of crimes arising from his role in the submission of over $1.3 billion in fraudulent claims to Medicare and Medicaid. According to evidence introduced at trial, between 1998 and 2016, Esformes, who owned a network of assisted living and skilled nursing facilities, bribed physicians to admit patients into his facilities, which were in poor condition and unable to provide adequate treatment. Patients often failed to receive appropriate medical services, or received medically unnecessary services. Esformes was later sentenced to 20 years in prison. USAO SD FLApril 4, 2019
Lee County Ambulance of Lexington, Kentucky, and its former director Joseph Broadwell, will pay $253,930 to settle a False Claims Act action alleging that defendants submitted fraudulent claims to Medicare for unnecessary non-emergency ambulance transports, including transportation of patients to and from dialysis treatment. USAO ED KYApril 4, 2019
Oral and Maxillofacial Surgical Associates P.C. of New Haven, Connecticut, and its former owner Robert Sorrentino DDS, have agreed to pay $252,000 to settle claims that they submitted false claims to Medicaid by billing for services that were not provided, were not medically necessary, or were covered under other claims submitted for the same date of service. The fraudulently-billed services included deep sedation or general anesthesia and removal of bone or tissue. USAO CTApril 4, 2019
Evelyn Mokwuah, a former administrator for Houston, Texas-based Beechwood Home Health and Criseven Health Management Corporation, was sentenced to ten years in prison for her role in the submission of approximately $20 million in false claims to Medicare. According to the evidence at trial, Mokwuah falsely certified and billed for patients who were not homebound or did not qualify for home health services; falsified patient records to show that patients were homebound when they were not; paid patient recruiters; and, paid doctors to certify false plans of care for Medicare beneficiaries. DOJApril 2, 2019
Paul Emordi, of Collin County, Texas, was sentenced to prison for 60 months for his part in a $3.7 million health care scheme involving Medicare. Emordi and Celestine “Tony” Okwilagwe, owners and operators of Elder Care, along with Adetutu Etti, the administrator of Elder Care, were convicted on counts of conspiracy to commit health care fraud and on counts of false statements in connection with a health care benefit program. Evidence in the investigation also shows that the defendants submitted fake and fraudulent bills to Medicare for providing services that were not necessary. DOJ; TexasBaltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims
Posted 03/28/19
