Lack of Medical Necessity Archives - Page 23 of 48

November 16, 2018

A New Jersey-based doctor, Dr. Bernard Ogon, has been charged with participating in a compound pharmacy fraud that caused over $20 million in losses to health care benefit programs, including $3 million in losses to TRICARE. In exchange for a per-prescription payment, Ogon allegedly signed prescriptions that were pre-filled by telemedicine companies on behalf of patients he never saw. On multiple occasions, the prescriptions were for pain and scar creams that were not medically necessary, and were in fact exorbitantly expensive when made by a compound pharmacy. Ogon was also accused of writing prescriptions for patients in states that he was not licensed to practice in; if convicted, he faces a maximum of 10 years in prison. USAO NJ

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

November 14, 2018

After pleading guilty last year, the owner of two health clinics in Detroit has been sentenced to 160 months in prison and ordered to pay over $6 million for defrauding Medicare. Along with multiple co-defendants, Jacklyn Price allegedly took part in a scheme to bill Medicare for services that were obtained through kickbacks, not medically necessary, not actually provided, or provided by an unlicensed practitioner. Her co-defendants, Millicent Traylor, Muhammad Qazi, and Christina Kimbrough, were all sentenced in September. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

November 6, 2018

An Indiana-based dental care practice and admin support company have agreed to pay a total of $5.139 million to settle allegations they violated the federal and Indiana state False Claims Acts. According to whistleblower and qui tam plaintiff Dr. Jihaad Abdul-Majid, between 2009 and 2013, ImmediaDent of Indiana, LLC and Samson Dental Partners, LLC allegedly billed Indiana's Medicaid program for procedures that were either upcoded (i.e. represented to be more serious and more expensive than they actually were), were not actually performed, or were not medically necessary. Samson Dental Partners is additionally accused of violating Indiana’s law prohibiting the corporate practice of dentistry. Because the companies refused oversight proposed during settlement, they have now been classified as "high risk" to federal healthcare programs. IN AG; USAO WDKY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

November 2, 2018

Metropolitan Retina Associates, Inc. and its owner, Dr. Kenneth S. Felder, have settled a False Claims Act investigation by agreeing to pay $2,064,559 for Medicare and Medicaid fraud. As part of the settlement, the New York-based ophthalmology practice admitted and accepted responsibility for submitting claims involving medically unnecessary and improperly documented fluorescein angiograms, as well as ultrasounds of the eye. USAO SDNY

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

October 31, 2018

A London-based doctor has been sentenced to 42 months in federal prison for defrauding Medicare, Medicaid, and private insurers. The doctor, Dr. Anis Chalhoub, was convicted in April of implanting over 200 medically unnecessary pacemakers in patients at St. Joseph London hospital, reportedly even pressuring patients and giving them misleading information so that they would agree to the procedures. He is ordered to pay $257,515 in restitution to Medicare, Medicaid, and private insurers, as well as a $50,000 fine. USAO EDKY

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare,

October 30, 2018

Four people connected to a Texas-based home health agency have been found guilty of fraudulently obtaining $3.7 million in reimbursements from Medicare and Medicaid. Despite being previously banned from participating in any federal healthcare reimbursement programs, Celestine Okwilagwe and Paul Emordi co-owned and operated a Medicare and Medicaid provider in the Dallas area called Elder Care. Adetutu Etti, the provider's administrator, was recruited to falsely certify that someone else was the owner, and Okwilagwe's wife, Loveth Isidaehomen, was recruited to sign checks. Some of the claims that were eventually reimbursed by Medicare were also found to be for services that were not medically necessary. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

October 23, 2018

Vascular Access Centers LP (VAC) and its 20+ related corporations in multiple states have agreed to pay $3.825 million over five years to settle whistleblower-brought allegations that VAC took part in an illegal patient referral kickback scheme and fraudulently billed Medicare for certain non-reimbursable procedures. The alleged fraud violated the Anti-Kickback Statute and False Claims Act and involved regularly scheduling, performing, and billing Medicare for certain vascular access procedures for End Stage Renal Disease (ESRD) beneficiaries that were not routinely necessary. Two whistleblowers will share in the relator's share of $612,000. DOJ; USAO EDLA; USAO SDNY

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

October 18, 2018

Dr. Felmor Agatep, a Florida-based doctor, has plead guilty to receiving kickbacks and defrauding TRICARE over prescriptions to outrageously expensive and medically unnecessary pain and scar creams. According to the DOJ press release, a one month supply of the creams in question cost more than $16,000 when made by a compounding pharmacy. At some point in late 2014, Agatep agreed to receive kickbacks from a marketing group of $100 per TRICARE patient in exchange for writing prescriptions for these creams. In just a month and a half, Agatep allegedly wrote a total of 265 prescriptions, which amounted to a bill of $4.4 million for TRICARE. He now faces a maximum penalty of 10 years in prison. USAO MDFL

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

October 15, 2018

The CEO of Tri-County Wellness Group, Mashiyat Rashid, has plead guilty and agreed to forfeit millions of dollars worth of ill-gotten funds and property in connection with a $150 million healthcare fraud. Over the course of almost 10 years, Rashid and physicians working in his pain clinics allegedly prescribed millions of units of medically unnecessary painkillers to Medicare beneficiaries, whom they also subjected to medically unnecessary but expensive injections. A similar fraud was repeated at laboratories owned by Rashid, with medically unnecessary but expensive urine tests for drugs. When Medicare realized that none of the claims were reimbursable, Rashid and others created fake companies to perpetuate the fraud. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

October 12, 2018

The owner of a small chain of hospices has plead guilty to healthcare fraud in one of the largest hospice fraud cases ever to come out of Mississippi. Charline Brandon is alleged to have submitted fraudulent claims worth $11 million to Medicare and $2 million to Medicaid for services not rendered or needed, as well as illegally soliciting patients who were not eligible for hospice services. USAO NDMS

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity,

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