Lack of Medical Necessity Archives - Page 42 of 48

August 19, 2015

Arizona physician Dr. Bashir Azher agreed to pay $207,988 to resolve allegations he violated the False Claims Act by submitting false bills to Medicare for prostate laser ablation procedures, commonly known as Green Light prostatectomies. Specifically, the government charged Dr. Azher with submitting false claims for reimbursement for prostate laser ablation procedures that were too short to generate a therapeutic benefit, failed to meet professionally recognized standards of care, were medically unnecessary, and/or violated applicable Medicare regulations. The government’s allegations originated in a whistleblower lawsuit filed by Dr. Arnaldo Trabucco under the qui tam provisions of the False Claims Act. He will receive a yet-to-be-determined whistleblower award. DOJ

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

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare. Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic. Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided. DOJ

Tagged in: Anti-Kickback and Stark, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

July 24, 2015

Mohammed Sadiq was sentenced to 80 months in prison and to pay $14.1 million in restitution for his leading role in a $12.6 million Medicare and tax fraud scheme. Sadiq, who owned and directed operations at two home health care companies in Detroit, admitted billing Medicare for home health services not medically necessary or provided and paying kickbacks to patient recruiters to obtain Medicare beneficiary information used in his scheme. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity,

July 10, 2015

Detroit area doctor Farid Fata was sentenced to 45 years in prison and to forfeit $17.6 million for his role in a health care fraud scheme that included administering medically unnecessary infusions or injections to 553 individual patients and submitting to Medicare and private insurance companies approximately $34 million in fraudulent claims. DOJ

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

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services. According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level. The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Upcoding,

June 16, 2015

Jacksonville, Florida-based home health company Advanced Homecare, Inc.agreed to pay $1,293,169 to settle charges it violated the False Claims Act by billing the government for millions of dollars of medically unnecessary services. According to the government, Advanced Homecare accepted and treated patients who were not actually homebound and did not have a valid physician certification of home health need, as required by Medicare. The allegations first arose in a whistleblower lawsuit filed by Advanced Homecare former employee Marsha Yandell under the qui tam provisions of the False Claims Act. Ms. Yandell will receive a whistleblower award of more than $200,000. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

May 28, 2015

Garden State Cardiovascular Specialists P.C., a New Jersey-based cardiology practice which owns and operates several facilities in New Jersey under the name NJ MedCare/NJ Heart, agreed to pay more than $3.6 million to resolve allegations the company and its principals, Dr. Jasjit Walia and Dr. Preet Randhawa, submitted claims to Medicare for various cardiology diagnostic tests and procedures, including stress tests, cardiac catheterizations and external counterpulsation, which were not medically necessary. The allegations were first raised in a whistleblower lawsuit filed by Cheryl Mazurek under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of more than $648,000. DOJ

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

May 21, 2015

Mohammad Khan, the former assistant administrator of Riverside General Hospital, was sentenced to 40 years in prison and to pay restitution in the amount of $31,321,200 for his role in a $116 million Medicare fraud scheme. He previously pled guilty to his role in the scheme. According to admissions made in connection with his guilty plea, from January 2008 through February 2012, Khan and others at Riverside General Hospital operated a scheme to defraud Medicare by submitting claims for partial hospitalization program (PHP) services that were not medically necessary and, in some cases, never provided. Khan also admitted he and his co-conspirators paid kickbacks to patient recruiters and to owners and operators of group care homes in exchange for which those individuals delivered ineligible Medicare beneficiaries to the hospital’s PHPs. To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme. DOJ

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

May 20, 2015

Florida-based neurologist Dr. Sean Orr agreed to pay $150,000 to settle allegations he violated the False Claims Act by providing medically unnecessary services and drugs to federal health care program beneficiaries. According to the government, from September 2009 to April 2012 Orr knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal health care programs to be billed for medically unnecessary services and drugs. In 2014, the government settled related allegations against Baptist Health System Inc. – Orr’s former employer and the parent company for Baptist Neurology Inc. and Baptist Medical Center-Jacksonville – for $2.5 million. The allegations first arose in a whistleblower lawsuit filed by former Baptist Neurology employee Verchetta Wells under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $26,250. DOJ

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

May 14, 2015

PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country, agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs. The government’s allegations against PharMerica arose out of whistleblower lawsuit brought by Jennifer Denk, a pharmacist formerly employed by PharMerica, under the qui tam provisions of the False Claims Act. Ms. Denk will receive a whistleblower award of $4.3 million. Whistleblower Insider

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

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