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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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August 15, 2019

North Carolina ambulance company Gate City Transportation has been ordered to pay $5.25 million in restitution for falsely billing the state's Medicaid program for convalescent ambulance services when, in fact, the company was providing only medical van service to ambulatory and wheelchair-bound patients.  During the investigation, agents confiscated more than $5 million in cash and property, which will be applied to the restitution.  USAO MD NC

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Posted  08/2/19
Silhouette of People Around a Whistle
This week marks the seventh year in a row that Congress has designated July 30th National Whistleblower Day, honoring the occasion, on July 30, 1778, when the Continental Congress unanimously enacted the first whistleblower protection law in the United States. The law was passed in response to a petition to the Continental Congress filed by a group of ten American sailors and marines, who reported that their...

July 24, 2019

Pennsylvania-based Eagleville Hospital has agreed to pay $2.85 million to settle allegations of defrauding Medicare, Medicaid, and the Federal Employees Health Benefits Program.  According to an anonymous relator, Eagleville violated the False Claims Act between 2011 and 2018 by submitting claims for substance abuse patients improperly admitted for high paying, hospital-level detoxification treatments.  The whistleblower will receive $500,000 of the recovery.  USAO EDPA

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid.  As part of the settlement, they will pay $425,000USAO CT

July 15, 2019

Millcreek Community Hospital has agreed to pay $2.4 million and enter into a Corporate Integrity Agreement requiring five years of monitoring to resolve allegations of violating the False Claims Act.  For a period of four years, the Pennsylvania-based hospital’s inpatient rehabilitation unit allegedly admitted ineligible patients, then failed to document in medical records that such services were medically necessary and reasonable. USAO WDPA

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted  07/12/19
Pill container spilled over with pills fallen out.
On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

July 8, 2019

Anthony Camillo, the owner of Illinois-based Allegiance Medical Laboratory and AMS Medical Laboratory, has been sentenced to 2.5 years in prison and ordered to pay $3.5 million in restitution for defrauding Medicare and Medicaid.  According to the DOJ, Camillo paid Missouri-based marketers between $150-$200 for urine and saliva samples sent to his labs.  His conduct incentivized other fraudulent conduct, including medically unnecessary testing of disabled and elderly patients living in residential care facilities, and the use of doctors’ names on test orders without the doctors’ knowledge.  USAO EDMO

July 2, 2019

For allegedly violating the False Claims Act, mental health nonprofit Wisconsin Community Services, Inc. (WCS) has agreed to pay $537,904 to the United States and the State of Wisconsin.  WCS voluntarily disclosed that one of its pharmacists had billed Medicare and Medicaid for brand name medications over several years, even though generic medications had been dispensed.  USAO EDWI

June 27, 2019

Massachusetts-based Clinical Science Laboratory, Inc. (CSL), and its owners, Stanley Elfbaum and Louis Amoruso, have agreed to pay $1.5 million to settle allegations under the False Claims Act that it charged Connecticut Medicaid 19 times what it charged other customers for urine drug screens.  According to the DOJ, from 2016 to 2017, CSL charged Connecticut $38 per test while charging substance abuse treatment centers only $2 per test.  USAO CT

June 26, 2019

The Trustees of the University of Pennsylvania Health System have agreed to pay $275,000 to settle allegations of submitting false claims to Medicaid in violation of the False Claims Act.  During a seven month period in 2017, the health system’s Lancaster General Hospital allegedly billed Medicaid for interpretations of obstetric ultrasounds despite its physicians failing to complete those reports in a timely manner.  In about 10% of the cases, the reports were not completed until more than 90 days after the ultrasound was performed, rendering them useless.  USAO EDPA
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