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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:

Page 27 of 48

Medicare Fraudsters Beware; DOJ May Be Reviewing Your Billing Data

Posted  05/15/18
By the C|C Whistleblower Lawyer Team Maryland physician Sureshkumar Muttath agreed to pay more than $1.5 million to settle claims he violated the False Claims Act by submitting claims to Medicare for medically unnecessary autonomic nervous function tests and neurobehavioral status exams.  The settlement originated under DOJ’s new initiative of tracking irregularities in Medicare billing data.  See DOJ Press...

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

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April 19, 2018

San Diego-based diagnostic lab testing company Biotheranostics Inc. agreed to pay $2 million to settle claims it violated the False Claims Act by submitting claims to Medicare for Breast Cancer Index (BCI) tests not reasonable and necessary for the diagnosis and treatment of breast cancer. DOJ

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

April 16, 2018

Aharon Aron Krkasharyan, a former employee Mauran Ambulence Inc., was sentenced to 36 months in prison and pay roughly $485,000 for his role in a scheme that resulted in more than $1.1 million in fraudulent claims to Medicare.  Krkasharyan admitted he conspired with other Mauran employees to submit claims to Medicare for ambulance transportation services for individuals who did not need such services. Krkasharyan also admitted that he and his co-conspirators instructed Mauran emergency medical technicians to conceal the patients’ true medical conditions by altering paperwork and creating fraudulent reasons to justify the ambulance services. DOJ

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

March 29, 2018

Juan Yrorita, the assistant director of nursing at Detroit area home health agency Annointed Care Services, was sentenced to 36 months in prison and pay and forfeit roughly $50 million for his role in a scheme involving approximately $1.6 million in fraudulent Medicare claims for home health services that were procured through the payment of kickbacks, and that were medically unnecessary and not provided. DOJ

Tagged in: Anti-Kickback and Stark, Home Health and Hospice, Lack of Medical Necessity,

March 29, 2018

Louisville-based skilled nursing facility New Oaklawn Investments, LLC (d/b/a Oaklawn Health and Rehabilitation Center and Elmcroft Senior Living, Inc.) agreed to pay roughly $5 million to resolve allegations it violated the False Claims Act by submitting false claims to Medicare for patient rehabilitation services at the resource utilization (“RUG”) Code Series Rehabilitation Ultra High and Rehabilitation Very High, for certain services that were not reasonably or medically necessary. DOJ (WDKY)

Tagged in: Defendants, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, SNF, Upcoding,

March 28, 2018

New Orleans resident Sandra Parkman was sentenced to 32 months in prison for her involvement in a $3.2 million Medicare fraud and kickback scheme. According to the evidence presented at trial, Parkman and others engaged in a scheme to defraud Medicare by supplying medically unnecessary durable medical equipment, including power wheelchairs, to Medicare beneficiaries in and around New Orleans. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME,

March 28, 2018

Medical Transport LLC, a Virginia Beach-based provider of ambulance services, agreed to pay $9 million to resolve allegations it violated the False Claims Act by submitting claims for ambulance transports not medically necessary, that did not qualify as Specialty Care Transports, and that were billed improperly to the federal health care programs when they should have been billed to other payers. DOJ

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

March 22, 2018

Four Maryland skilled nursing facilities and two consulting companies, Caring Heart Rehabilitation and Nursing Center, GNH, LLC, OPOP, LLC, Riverview SNF, LLC, Global Healthcare Services Group, LLC, and GHC Clinical Consultants, LLC, agreed to pay a total of $6 million to settle claims of violating the False Claims Act by billing Medicare for skilled therapy services that were either not delivered or not medically necessary. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive an award of $990,000 from the proceeds of the government’s recovery. DOJ (MD)

Tagged in: FCA Federal, Lack of Medical Necessity, SNF, Whistleblower Case, Whistleblower Rewards,

March 7, 2018

UPMC Hamot, affiliated with the University of Pittsburgh Medical Center, and Medicor Associates Inc., a regional physician cardiology practice, agreed to pay $20.7 million to settle charges of violating the False Claims Act, Anti‑Kickback Statute and Stark Law through Hamot's payment under twelve physician and administrative services arrangements to secure Medicor patient referrals. Hamot allegedly had no legitimate need for the services contracted for, and in some instances the services either were duplicative or were not performed. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Medicor employee Dr. Tullio Emanuele. He will receive a whistleblower award of roughly $6 million from the proceeds of the government's recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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