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Medicaid

This archive displays posts tagged as relevant to Medicaid and fraud in the Medicaid program. You may also be interested in our pages:

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July 2, 2021

An Ohio-based hospital system that has since been acquired by the Cleveland Clinic Foundation has agreed to pay over $21 million to resolve alleged violations of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act.  Between 2010 and 2016, Akron General Health System (AGHS) allegedly paid area physician groups far above fair market value in order to induce referrals, then submitted claims arising from those illegal referrals to federal healthcare programs.  The settlement resolves a qui tam suit brought forth by former internal audit director at AGHS, Beverly Brouse, and Ethical Solutions LLC.  DOJ

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

June 14, 2021

Centene Corp. will pay a total of $143.8 million to resolve claims by Ohio and Mississippi that it overbilled the states' Medicaid programs in its role as a pharmacy benefit manager.  The states alleged that Centene engaged in practices including "spread pricing," charging more than allowed price caps based on industry standards, inflation of dispensing fees, failure to disclose discounts received, and claiming reimbursement for prescriptions already paid for by third parties.  Ohio will receive $88.3 million, and Mississippi will receive $55.5 million.  OH; MS

Catch of the Week: Dental Clinics to Pay $2.7M for Using Unsterilized Tools on Medicaid Patients

Posted  05/28/21
Dental Chair and Equipment
For over five years, Upper Allegheny Health Systems, a health care system operating several dental clinics in New York and Pennsylvania, allegedly performed dental services without sterilizing equipment between patients and falsely billed Medicaid for those services. After a former employee blew the whistle, the United States and the State of New York stepped in to investigate, and the defendant agreed to a $2.7...

May 26, 2021

HEAG Pain Management Center, P.A. (HEAG) and its owner, Dr. Kwadwo Gyarteng-Dakwa (Dr. Dakwa), have agreed to pay $500,000 to settle allegations of defrauding Medicare and Medicaid.  According to the government, the defendants knowingly submitted or caused the submission of claims for medically unnecessary diagnostic testing between 2011 and 2016.  AG NC; USAO MDNC

May 25, 2021

Upper Allegheny Health System (UAHS), which operates dental clinics in New York and Pennsylvania, has agreed to pay $2.7 million to resolve whistleblower-brought allegations of submitting false claims to Medicaid in violation of the federal and New York False Claims Acts.  Between 2010 and 2015, UAHS had billed Medicaid for dental services performed using improperly sterilized handpieces, which are considered semi-critical devices and need to be properly heat sterilized between patients.  AG NY; USAO WDNY; USAO WDPA

May 21, 2021

SavaSeniorCare LLC and related entities (“Sava”) will pay $11.2 million, plus potentially more pursuant to an “ability-to-pay” settlement, to resolve allegations that Sava violated the False Claims Act by causing its skilled nursing facilities to bill Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled, and that Sava billed the Medicare and Medicaid programs for grossly substandard (i.e., “worthless”) skilled nursing services.  The settlement stems from four separate qui tam complaints filed by whistleblowers Rita Hayward, Trammel Kukoyi, Terrence Scott, James Thornton, and Barbara Roberts, who will share an undisclosed portion of the government’s recovery.  In 2015, the United States intervened in the litigation and filed a consolidated False Claims Act complaint, alleging inter alia that Sava had exerted significant pressure on its skilled nursing facilities to meet unrealistic corporate targets for the highest Medicare reimbursement rates without regard to patients’ actual clinical needs, and improperly delayed the discharge of patients from its facilities in order to increase billings.  Sava will enter into a five-year Corporate Integrity Agreement as part of the settlement.  DOJ

Catch of the Week: Virginia OB/GYN Sentenced to 59 Years in Prison for Performing Medically Unnecessary Procedures for More Than Ten Years

Posted  05/21/21
OB/GYN looking at a sonogram on screen
Healthcare fraudsters are typically motivated by greed. But in satisfying that greed, some fraudsters perform reprehensible acts that permanently affect the victims of the fraud, making even the penalty they receive pale in comparison. This week we focus on the conviction of Javaid Perwaiz, an OB/GYN in Hampton Roads, Virginia, who was sentenced to 59 years in prison for performing medically unnecessary surgeries...

May 19, 2021

Latisha Harron of North Carolina has been sentenced to over 14 years in prison and ordered to pay over $13 million in restitution after pleading guilty to charges of defrauding the North Carolina Medicaid Program, aggravated identity theft, and money laundering.  Together with husband Timothy Harron, the defendant scoured obituaries for recently deceased Medicaid recipients and billed Medicaid for up to a year of home health services that were allegedly provided to the deceased by her company, Agape Healthcare Services, Inc.  By concealing the fact that both Harrons were previously convicted felons, the defendant was able to obtain millions in reimbursements, which she then laundered into expenses such as business properties, a private jet, clothing and jewelry, and gym equipment.  NC AG
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