Lack of Medical Necessity Archives - Page 9 of 48

August 6, 2021

A county in California and a county medical center have agreed to pay $11.4 million to resolve allegations of improperly billing a federal healthcare program between 2013 and 2017. According to whistleblower Felix Levy, a former employee of San Mateo County Medical Center (SMMC), San Mateo County and SMMC billed Medicare for uncovered hospital stays for patients that were admitted without regard to medical necessity. USAO NDCA

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

August 5, 2021

Ascension Michigan and related hospitals, which allegedly billed federal healthcare programs for services performed by a gynecologic oncologist that were not medically necessary or rendered as represented, has agreed to pay $2.8 million to resolve their liability under the False Claims Act. The settlement resolves claims from a 2017 qui tam suit by whistleblowers Pamela Satchwell, Dawn Kasdorf, and Bethany Silva-Gomez, that Ascension knowingly submitted claims for medically unnecessary hysterectomies and chemotherapy, and unrendered evaluation and management services. Spurred by patient complaints, Ascension launched an internal investigation, ultimately self-disclosing the misconduct to the government in 2018. As part of the settlement, Satchwell, Kasdorf, and Silva-Gomez will share in a $532,000 award. USAO EDMI

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

July 23, 2021

California-based Interface Rehab has agreed to pay $2 million to settle claims arising from a qui tam suit by its former director of rehab, Keith Pennetti. According to Pennetti, Interface violated the False Claims Act when it pressured its therapists to increase the amount of therapy provided to Medicare Part A residents at eleven facilities, with no regard to medical necessity, and caused false claims to be submitted to Medicare. For instigating the action, Pennetti will receive $360,000 of the settlement proceeds. USAO CDCA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF, Upcoding, Whistleblower Case, Whistleblower Rewards,

July 20, 2021

Rheumatologist Enrico Arguelles and his practice, Arthritis and Osteoporosis Center of Billings, Montana, agreed to pay $1.27 million and relinquish Medicare claims for $802,000 in settlement of claims that they improperly billed for MRI scans and patient visits, and billed for biologic infusions such as Remicade where the treatment was not medically necessary. USAO MT

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

July 16, 2021

Florida Neurological Center, LLC and its owner Dr. Lance Kim have agreed to settle a whistleblower-brought suit and pay $800,000 to resolve allegations of defrauding Medicare. The qui tam suit by Michael Singbush, Andrea Herrera, and Harvey Kessler Meyer, IV alleged that Dr. Kim prescribed medically unnecessary prescription drugs, which cost Medicare $35,000 each time it was prescribed. For their role in the successful enforcement action, the whistleblowers will share in a $144,000 award. USAO MDFL

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

FDA’s Approval of Alzheimer’s Drug Highlights Need for Whistleblowers

Posted 07/9/21

The Food and Drug Administration (FDA) is supposed to protect American consumers from unscrupulous private actors—charlatans, snake-oil salesmen, and the like—seeking to profit by selling unproven medical “cures,” treatments, and devices to the public. Emerging during the era of the robber barons as part of Theodore Roosevelt’s efforts to “civilize capitalism,” the FDA has prevented untold harm to...

Tagged in: FCA Federal, FDA Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicare, Pharma Fraud,

July 9, 2021

Genetworx Laboratories, a diagnostic laboratory in Virginia, has agreed to pay $1.4 million to resolve allegations of submitting false claims to Medicare in violation of the False Claims Act. Over the course of a year, Genetworx allegedly billed for genetic tests that were performed on groups of senior citizens in senior homes without valid physician oversight. USAO NJ

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

June 28, 2021

Surgical Care Affiliates, LLC and Orlando Center for Outpatient Surgery, LP have agreed to pay $3.4 million to resolve a whistleblower’s allegations that they billed Medicare and TRICARE for medically unnecessary kidney stone procedures. The centers also engaged in an illegal kickback arrangement whereby urologist Dr. Patrick Hunter performed lithotripsy procedures in exchange for per-procedure payments from the Orlando Center. For bringing a successful action, whistleblower Scott Thompson will receive a relator’s share of $748,000 from the settlement with SCA and the Orlando Center. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 2, 2021

Select Medical Corporation (SMC) and Encore GC Acquisition LLL have agreed to pay $8.4 million to settle allegations that contract rehabilitation therapy provider Select Medical Rehabilitation Services Inc. (SMRS)—a previous subsidiary of SMC and current subsidiary of Encore—violated the False Claims Act. According to former SMRS employee Melissa Vail, SMRS’s desire to maximize profits led it to provide medically unnecessary, unreasonable, and unskilled therapy services, and subsequently caused twelve skilled nursing facilities in the New York and New Jersey area to submit false claims to Medicare over a six-year period. USAO NJ

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud, SNF, Whistleblower Case,

June 25, 2021

Connecticut Addiction Medicine, LLC (CAM) and its owners, Dr. Jay Benson and Dr. Mahboob Aslam, have agreed to pay over $1 million to resolve their liability under the False Claims Act in connection with overcharges for urine drug tests that they caused to Medicare and Medicaid. As part of their standard practice, CAM ran presumptive tests in-house but also sent the same sample out to an independent reference laboratory for definitive tests. CAM then billed federal healthcare programs for the medically unnecessary presumptive tests. USAO CT

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

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