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:
Catch of the Week -- Signature HealthCARE
Posted 06/15/18
In a major victory for patients and taxpayers alike, DOJ announced an over $30 million settlement with Signature HealthCARE, LLC, a Kentucky-based company accused of overbilling federal healthcare programs for rehabilitation and skilled-nursing services. As a prime example of how valuing profits over patients can lead to fraudulent behavior, Signature HealthCARE wins the title of Catch of the Week.
The settlement...
June 8, 2018
Disgraced former neurologist Rassan Tarabein-who operated Alabama’s Eastern Shore Neurology and Pain Center-was sentenced to 60 months in prison and ordered to pay over $15 million and forfeit his medical license after he pled guilty to orchestrating a thirteen-year scheme in which he induced Medicare, Medicaid, and privately-insured patients to visit his clinic and undergo medically unnecessary tests and procedures. USAO SDALJune 8, 2018
Skilled nursing facility company Signature HealthCARE, LLC will pay more than $30 million to the federal and Tennessee state governments to resolve False Claims Act allegations it placed patients in the highest therapy reimbursement level regardless of need; limited its therapy services to the minimum number of minutes required to bill at a given reimbursement level and discouraged the provision of care beyond that minimum; and pressured therapists to complete therapy even when patients were too ill or declined to participate. The suit was brought by two former employees and whistleblowers, who will receive a portion of the recovery. DOJJune 5, 2018
Louisiana-based post-acute healthcare management company Allegiance Health Management will pay over $1.7 million to resolve False Claims Act allegations it billed Medicare for intensive outpatient psychotherapy services to hospitalized patients who did not need the services, received inappropriate levels of treatment, or were provided nontherapeutic treatment. The settlement also resolves claims Allegiance Health Management failed to provide treatment pursuant to an individualized treatment plan and neither tracked nor document patient progress adequately. The suit was brought by whistleblower and former Allegiance employee Ryan Ladner, who will receive a $300,000 share of the settlement. DOJMay 29, 2018
Following a two-week jury trial, LaTonya Mallory, Floyd Calhoun Dent III, and Robert Bradford Johnson were collectively found liable for $114 million for violating the False Claims Act and Anti-Kickback Statute by paying physicians for patient referrals to two blood-testing laboratories, and for causing those laboratories to bill federal health care programs for medically unnecessary testing. The verdict resolves three separate whistleblower suits filed by Dr. Michael Mayes, Scarlett Lutz, Kayla Webster, and Chris Reidel, who will receive a yet-to-be-determined share of any recoveries. USAO DDCMay 29, 2018
Wal-Mart and Sam’s Club will collectively pay $825,000 to resolve federal and state False Claims Act allegations the company’s automatic prescription refills for Minnesota Medicaid patients violated Minnesota law and wasted taxpayer dollars on unnecessary and unused medications. USAO DMNMay 25, 2018
Florida pain management clinic Riverside Spine & Pain Physicians agreed to pay $1.2 million to settle allegations under the False Claims Act that it billed federal health care programs for medically unnecessary tests and indiscriminately ordered quantitative urine drug tests; whistleblower and former employee Dr. Carissa Stone will receive approximately $240,000 for her role in shining a light on the fraud. USAO MDFLMay 18, 2018
Three Florida hospice providers-Health and Palliative Services of the Treasure Coast, Inc., The Hospice of Martin and St. Lucie, Inc., and Hospice of the Treasure Coast, Inc.-will pay $2.5 million to resolve False Claims Act allegations that between 2005 and 2011, they billed Medicare for hospice services provided to patients who were not eligible for all or part of their hospice care under Medicare requirements. Two whistleblowers who initiated the suit, John Simons, M.D. and Lewis Cook, M.D, will receive more than $467,000 from the recovery for their role in bringing the fraud to light. USAO SDFLUS Obtains $114M FCA Judgement in Kickbacks Case
Posted 05/31/18
On May 23, the US District Court in South Carolina issued judgment for the US for roughly $114M against three individuals, LaTonya Mallory, Floyd Dent III, and Robert Johnson, for violating the FCA by paying kickbacks to doctors in exchange for patient referrals. The defendants also caused two labs to bill Medicare, TRICARE, and Medicaid for medically unnecessary tests. The judgment follows a January jury verdict that...