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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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January 22, 2021

Apria Healthcare Group, Inc. and Apria Healthcare LLC have agreed to a $40 million nationwide settlement to resolve allegations of violating federal and state False Claims Acts in seeking reimbursement for their non-invasive ventilators (NIVs).  Of the three types of respiratory equipment offered by Apria, NIVs receive the highest reimbursements and for the longest period of time, due to the amount of maintenance they require.  Following a qui tam suit filed in New York in 2017, state and federal government investigators found that between 2014 and 2019, Apria persuaded healthcare providers to switch patients from a ventilator with lower reimbursements to the NIVs, then billed state Medicaid programs for the NIVs even when they were either not used, not used consistently, or not medically necessary.  CA AG; FL AG

Top Ten Healthcare Fraud Recoveries of 2020

Posted  01/5/21
Healthcare Fraud
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

January 4, 2021

Three providers, James P. Anderson, as owner of Affiliated Neurologists, PLC; Charles F. Spencer, as owner of Total Family Physicians Center PLLC; and Mitchell P. Shea, as owner of Chiro2Med of Tennessee P.C., have agreed to pay the United States and Tennessee a total of $1.72 million to resolve allegations under the False Claims Act for improperly billing Medicare and TennCare for “P-Stim” electro-acupuncture devices that do not qualify for reimbursement.  The defendants billed for the disposable P-Stim devices using a code reserved for neurostimulator devices that are implanted during a surgical procedure. USAO MDTN

December 21, 2020

Substance abuse treatment provider A.R.E.B.A.-CASRIEL, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (“ACI”) and its owner, Steven Yohay, agreed to pay a total of $6 million to resolve federal and New York state claims that they defrauded Medicaid including through the payment of kickbacks and other fraudulent conduct in connection with the enrollment of Medicaid beneficiaries into ACI’s inpatient treatment program.  Defendants allegedly employed drivers who were compensated in part based on the number of patients they recruited, to target homeless individuals to enroll in ACI’s inpatient treatment program by offering food, cash, and money to purchase drugs, and/or alcohol. In addition, ACI unlawfully paid a patient recruiter, and enrolled Medicaid patients who had not been evaluated by a qualified healthcare professional, including by copying a physician’s signature.  The government’s investigation was initiated by a whistleblower complaint filed by a former employee, who will receive an undisclosed amount of the settlement.  USAO SDNY; NY

December 4, 2020

Joint Active Systems, Inc. (JAS), a durable medical equipment manufacturer, and New England Orthotics & Prosthetics, LLP (NEOPS) have agreed to pay $1.59 million and $90,000 respectively to resolve allegations of defrauding multiple federal healthcare programsincluding TRICARE, Medicare, and Medicaid programs in Connecticut, Massachusetts, and Rhode Islandthrough a variety of fraudulent schemes.  According to a qui tam suit filed by two former NEOPS employees, JAS allegedly recruited NEOPS to bill Medicare and Medicaid for custom-fabricated orthotics that were not custom-fabricated orthotics, nor medically necessary, and falsely claim that JAS-affiliated sales representatives were properly trained to treat patients during fittings.  Additionally, JAS allegedly overcharged the VA for its devices by as much as 300%.  For blowing the whistle on these fraud schemes, the whistleblowers will receive a 17% share of the settlement proceeds.  USAO MA

Medicaid Whistleblowers: Answering Common Questions About Reporting Medicaid Fraud

Posted  12/3/20
what is Medicaid fraud and abuse

What Potential Healthcare Whistleblowers Should Know About Reporting Fraud

In the United States, healthcare fraud is big business. According to the Department of Justice, the United States government obtained more than $3 billion in fraud settlements in 2019. Approximately $2.6 billion of that amount came from fraud involving the healthcare industry. Recoveries of this magnitude are possible because of...

December 2, 2020

The owner and operator of Atlanta-based Elite Homecare has been sentenced to over five years in prison and ordered to pay $999,999 in restitution for defrauding Medicaid of nearly $1 million.  As a provider under the Georgia Pediatric Program (GAPP)—an in-home nursing program for Medicaid-eligible children with severe physical and cognitive disabilities—Diandra Bankhead allegedly submitted thousands of claims for services that were fraudulent in a myriad of ways.  Some of the claims falsely represented that employees provided more than 24 hours of services in a given day to multiple children simultaneously (including to children whose families had not retained Elite, and by RNs who did not know their credentials were being used), while other claims contained fraudulent credentialing information and fraudulent supporting documentation, or were upcoded to induce higher payments from Medicaid.  Additionally, Bankhead allegedly “sold” information about twenty of Elite’s former clients to another Atlanta-based home health provider in exchange for a percentage of the reimbursements from Medicaid.  USAO NDGA

November 20, 2020

Mori, Bean and Brookes, P.A. (MBB), a Florida-based radiology practice, has agreed to pay $1.4 million to resolve allegations of violating the False Claims Act.  In a qui tam suit by Thomas Heyck, a radiologist formerly employed at MBB, the practice improperly billed Medicare and Medicaid for radiological images that were interpreted outside the U.S., which are not eligible for reimbursement.  MBB also submitted claims for images that were initially interpreted overseas, then reinterpreted and billed to a domestic radiologist.  For blowing the whistle, Heyck will receive a 19% relator’s share.  USAO MDFL

November 19, 2020

Johnson & Johnson (J&J) subsidiary Medical Device Business Services, Inc. (MDBS) has agreed to pay $10 million to settle allegations that a former J&J subsidiary, Therakos, Inc., promoted two medical devices for unapproved uses in pediatric patients.  A second entity, The Gores Group (TGG), agreed to pay $1.5 million to settle allegations of continuing to promote the devices for unapproved uses after it acquired Therakos in 2012.  According to qui tam relator Brian McCormick of Ross Feller Casey LLP, between 2006 and 2015, Therakos improperly promoted its extracorporeal photopheresis (ECP) systems, used to treat cutaneous T-cell lymphoma, for use in children despite the fact that no ECP devices had been approved for that population.  In so doing, Therakos allegedly caused false claims to be submitted to Medicaid, the Federal Employee Health Benefits Program, and TRICARE, in violation of the False Claims Act.  USAO EDPA
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