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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 43 of 48

May 13, 2015

Olufunke Ibiyemi Fadojutimi, a registered nurse and former owner of Lutemi Medical Supply, was sentenced to four years in prison and ordered to pay restitution in the amount of $4,372,466 for her role in an $8.3 million Medicare fraud scheme.  The evidence at trial showed that Fadojutimi and her co-conspirators paid cash kickbacks to patient recruiters in exchange for patient referrals, and additional kickbacks to physicians for fraudulent prescriptions for medically unnecessary durable medical equipment, such as power wheelchairs.  DOJ

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

May 12, 2015

Alexander Lara,  an owner of Miami home health care company Longcare Home Health Corporation was sentenced to 10 years in prison and ordered to pay $13,771,528.94 in restitution and to forfeit $13,771,528.94 for his leading role in a $13 million Medicare fraud scheme that involved paying kickbacks and bribes to patient recruiters, Medicare beneficiaries and others in South Florida doctors’ offices and medical clinics.  Lara admitted his company fraudulently billed the Medicare program for expensive physical therapy and home health care services that were not medically necessary or not provided at all.  DOJ

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

May 7, 2015

Health Management Associates Inc. (and 14 hospitals it previously owned), along with Community Health Systems and North Texas Medical Center, agreed to collectively pay $15.69 million to settle whistleblower charges they violated the False Claims Act by seeking and receiving Medicare reimbursement for Intensive Outpatient Psychotherapy (IOP) services that were not medically reasonable or necessary.  The IOP services in question were typically performed on the providers’ behalf by Louisiana-based Allegiance Health Management.  The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The unidentified whistleblower will receive a whistleblower award of $2,667,300.  Whistleblower Insider

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

May 7, 2015

Tennessee-based Jackson-Madison County General Hospital agreed to pay $1,328,465 to resolve allegations it improperly billed Medicare and Medicaid for the placement of unnecessary cardiac stents and other unnecessary cardiac procedures including angioplasty, catheterization, and ultrasound imaging.  The allegations were first raised in a whistleblower lawsuit filed by Dr. Wood D. Deming under the qui tam provisions of the False Claims Act.  Mr. Deming will receive an undisclosed portion of the settlement as a whistleblower award.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

April 30, 2015

Miami-area doctor Barry Kaplowitz was sentenced to 60 months in prison and ordered to pay more than $2.9 million in restitution for his role in a $5.5 million Medicare fraud scheme involving fraudulent billings by Hollywood Pavilion, a psychiatric hospital in Hollywood, Florida.  According to evidence, Kaplowitz signed fraudulent medical records in order to make it appear that the hospital’s patients qualified for and received intensive outpatient services, even though they did not.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

April 23, 2015

Louisiana doctor Winston Murray pleaded guilty to federal health care fraud charges, admitting (i) he wrote home health care referrals for Medicare beneficiaries he knew were not confined to their homes, and (ii) his referrals were used by home health companies Interlink Health Care Services Inc. and Lakeland Health Care Services Inc., among others, to fraudulently bill Medicare for home health services not medically needed or not provided.  From 2007 through 2014, these companies and other companies involved in this scheme submitted more than $56 million in claims to Medicare, a vast majority of which were fraudulent.  DOJ

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

April 16, 2015

Felix Gonzalez, owner of Miami home health care company AA Advanced Care Inc. was ordered to pay $21,423,160 in restitution and sentenced to 113 months in prison in connection with a $32 million Medicare fraud scheme.  Gonzalez admitted operating his company for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were not medically necessary or provided at all.  He further admitted he negotiated and paid kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.  DOJ

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

April 9, 2015

Virginia-based cardiovascular testing disease laboratory Health Diagnostics Laboratory Inc. agreed to pay $47 million to resolve allegations it violated the False Claims Act by paying kickbacks to physicians in exchange for patient referrals and billing federal health care programs for medically unnecessary testing.  A second cardio testing lab, California-based Singulex Inc., agreed to pay $1.5 million to settle similar charges.  The allegations first arose in a whistleblower lawsuit filed by Dr. Michael Mayes, Scarlett Lutz, Kayla Webster and Chris Reidel under the qui tam provisions of the False Claims Act.  The whistleblower award they will receive has yet to be determined.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

March 23, 2015

Michigan-based Portage Hospital, LLC agreed to pay $4,446,392 to settle allegations its hospital-owned home health care agency, Portage Health Home Care & Hospice, violated the False Claims Act by submitting false claims to Medicare for unnecessary or unwarranted physical therapy services.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Hospital Fraud, Lack of Medical Necessity,

March 20, 2015

A federal jury in Los Angeles convicted Hakop Gambaryan, owner of Colonial Medical Supply, of four counts of health care fraud in connection with a $3.3 million Medicare fraud scheme.  According to evidence presented at trial, Gambaryan paid cash kickbacks to medical clinics for fraudulent prescriptions for durable medical equipment, such as expensive power wheelchairs, which the patients did not need, and then used these fraudulent prescriptions to bill Medicare.  DOJ

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

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