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:
September 15, 2021
A cardiologist in Florida who allegedly billed Medicare and Medicaid for medically unnecessary procedures has agreed to pay $6.75 million to resolve claims under the False Claims Act. Between 2013 and 2019, Dr. Ashish Pal allegedly made misrepresentations in patient medical records to justify ablations and vein stent procedures that were not reimbursable under program rules. Additionally, some of the procedures were later found to have been performed primarily by unqualified ultrasound technicians. As part of the settlement, Pal and Interventional Cardiology & Vascular Consultants, PLC, will enter in a multiyear integrity agreement and comply with training and reporting requirements, as well as a quarterly claims review by an independent organization. USAO MDFLSeptember 3, 2021
A number of South Carolina pain management clinics, drug testing laboratories and other entities associated with chiropractor Daniel McCollum have had default judgments entered against them ordering the payment of $140 million. The defendant entities, Oaktree Medical Centre P.C., FirstChoice Healthcare P.C., Labsource LLC, Pain Management Associates entities, ProLab LLC, and ProCare Counseling Center LLC, were alleged to have provided illegal financial incentives to providers to induce their referrals of urine drug tests in violation of the Stark Law and the Anti-Kickback Statute, and to have submitted false claims to federal healthcare programs for medically unnecessary urine drug testing, steroid injections, opioid prescriptions, and lidocaine ointment prescriptions. The settlement resolves claims against the entities brought in three separate qui tam actions Donna Rauch, Muriel Calhoun, Brandy Knight, Karen Mathewson and Tracy Hawkins, former employees of pain management clinics owned or operated by McCollum. The government continues to pursue claims against McCollum. DOJ; USAO SC; November, 2021 judgment against McCollumCatch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme
Posted 09/3/21
Editor’s Note: For this week’s biggest story, the record $90 million settlement secured by a Constantine Cannon client against Sutter Health, read more here.
Healthcare fraudsters have a track record of exploiting health crises for personal gain. The COVID-19 pandemic created new telemedicine opportunities for patients to receive care without having to see doctors in person. As expected, fraudsters seized on...August 25, 2021
A California-based provider of home respiratory services and durable medical equipment has agreed to pay $3.3 million to the United States and States of California and Nevada to settle allegations of defrauding Medicare and Medicaid. The claims against SuperCare Health, Inc. were brought in a 2018 qui tam suit by respiratory therapist Benjamin Martinez, who alleged that the provider billed for non-invasive ventilators (NIVs) that were no longer needed or being used by patients. CA AG; USAO CDCAAugust 25, 2021
Georgia-based psychotherapy provide Carenow Services, LLC, together with its CEO Leena Karun, will pay $2 million to resolve allegations of FCA violations through their billing for services at nursing homes that were not medically necessary, that were improperly documented, and at higher intensity levels than justified. The investigation was initiated when a former Carenow employee filed a qui tam complaint; the whistleblower will receive an undisclosed whistleblower reward. USAO ND GaMedically Unnecessary Procedures Harm Patients, Raise U.S. Healthcare Costs, Atlantic Feature Emphasizes
Posted 08/20/21
Why then is it so difficult to prevent unnecessary procedures in the U.S.?
Reporter Chris Outcalt recently pondered in a piece for The Atlantic. The...Catch of the Week: Telemedicine Company Owner Charged in $784 Million Kickback Scheme
Posted 08/20/21
