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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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March 29, 2019

CareWell Urgent Care of Rhode Island, P.C., and Urgent Care Centers of New England Inc. have agreed to pay $2 million to settle a qui tam suit brought on by a former employee, Aileen Cartier. In violation of the False Claims Act, CareWell had falsely inflated the level of services provided and failed to identify service providers in claims submitted to Medicare, Massachusetts and Rhode Island Medicaid, and the Massachusetts Group Insurance Commission (GIC) between 2013 to 2018. For bringing on the suit, Cartier will receive a 17% relator's share. USAO MA

March 29, 2019

Acacia Mental Health Clinic and its owner, Abraham Freud, have agreed to pay $4.1 million to the United States and the State of Wisconsin for submitting false claims to Medicaid in violation of the False Claims Act. According to a qui tam complaint filed by whistleblower Rose Presser, Acacia billed for urine drug screens in simple "cup" tests as if a more sophisticated test had been performed. Acacia also billed for medically unnecessary and duplicative urine drug tests and telemedicine services performed by foreign-based psychiatrists in violation of Medicaid regulations. USAO EDWI

March 27, 2019

In the second largest resolution of a Medicaid fraud case based in Washington State, CareOne Dental Corporation and its owners will pay $1 million to settle allegations of violating Washington's Medicaid False Claims Act. According to the AG's office, CareOne and defendants Dr. Liem Do and Dr. Phuong-Oanh Tran defrauded Medicaid by using higher paying codes, masking ineligible services as eligible services, and billing for services the practice didn't even provide. Ultimately, the defendants racked up about $1 million over the course of four years. AG WA

March 26, 2019

Accurate Home Care, LLC, a Minnesota-based home health provider has agreed to pay $726,957.59 after voluntarily self-disclosing its violations of the False Claims Act in duplicated bills sent to both Medicaid and private insurers. Accurate had also admitted to fraudulently retaining payments from Medicaid even when Medicaid wasn't the primary insurer. USAO MN

March 7, 2019

A Connecticut-based durable medical equipment supplier, Med Tech, and its owner, Thomas Macre, Sr., have agreed to pay more than $467,000 to resolve allegations of violating the federal and state False Claims Acts. The alleged misconduct involved billing Medicaid for unprovided and medically unnecessary back braces and electrical stimulation units. USAO CT

March 6, 2019

A Texas woman has been sentenced to 30 years in prison and ordered to pay more than $15 million for her role in a $50 million scheme involving healthcare fraud and money laundering. Daniela Gozes-Wagner was accused of running 28 fake medical testing facilities from 2009, and billing Medicare and Medicaid for tests that were not performed or medically necessary. As part of the scheme, she employed personnel to answer phones and prevent inspectors from entering "testing facilities" that were virtually empty. USAO SDTX

March 1, 2019

The owner of a mental health clinic in North Carolina was sentenced to 5 years in prison for submitting about $4 million in false claims and evading almost $400,000 in unpaid taxes over the course of four years. Using patient information provided to her by co-defendant Haydn Thomas, who was employed as an office manager for an oral surgeon, Catinia Denise Farrington of Durham County Mental Health and Behavioral Health Services, LLC allegedly submitted thousands of false claims to Medicaid for services that were not performed. In addition to her prison sentence, Farrington has been ordered to pay restitution of about $4 million to NC Fund for Medical Assistance and almost $400,000 to the IRS for paying personal expenses out of business accounts into which she has transferred her fraudulently obtained gains. Her co-defendant faces sentencing later this month. DOJ; USAO MDNC

February 28, 2019

A former employee within the Wayne County Adult Services division of the Michigan Department of Health and Human Services has been charged with defrauding the state's Medicaid program. As an Independent Living Services Specialist, Eliza Yulonda Ijames was responsible for approving Medicaid beneficiaries for home health services. In violation of anti-kickback rules, however, she used her position to refer clients to agencies with which she had an improper financial relationship. AG MI

February 27, 2019

Tennessee-based skilled nursing facility chain Vanguard Healthcare LLC, along with former executives William Orand and Mark Miller, have agreed to pay upward of $18 million to resolve False Claims allegations of billing Medicare and Medicaid for worthless and "grossly substandard nursing home services." According to press releases, five facilities in the Vanguard network allegedly submitted false claims for reimbursement, despite a litany of failures, including forging nurse and physician signatures, using unnecessary physical restraints on residents, failing to prevent pressure ulcers, failing to provide wound care as ordered, failing to provide standard infection control, failing to administer medications as prescribed, and failing to meet basic nutrition and hygiene requirements. The case is considered the largest case of fraud involving worthless services in state history. DOJ; USAO MDTN

February 22, 2019

The owner of New York Pharmacy, Inc., NYC Pharmacy Inc., and NY Healthfirst Pharmacy Inc., pharmacist Hin T. Wong, has pleaded guilty to criminal charges arising from millions of dollars in false billing to New York's Medicaid program for HIV drugs.  Wong billed Medicaid for medications that she never dispensed, a scheme disclosed by an investigation confirming that Wong's pharmacies did not purchase a sufficient inventory of medication from licensed drug wholesalers to account for the quantity of medication for which Wong’s pharmacies billed Medicaid and Medicaid Managed Care Organizations.  In addition, Wong paid kickbacks to individuals to bill for medications that were not, in fact, dispensed.  Under a related civil settlement, Wong will surrender over $3.6 million to the stateNY
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