Medicaid
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Top Ten Healthcare Fraud Recoveries of 2020
Posted 01/5/21
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 MDTNDecember 21, 2020
DME provider Apria Healthcare Group, Inc. and Apria Healthcare LLC will pay $40.5 million to settle allegations brought in a qui tam action filed by three former Apria employees that they improperly billed government healthcare programs for beneficiary rentals of non-invasive ventilators (“NIVs”) that were not medically necessary or which were provided with improper waivers of patient co-payments. Medicare pays as much as $1,400 a month for NIVs, and providers are required to monitor patient usage of NIVs and stop billing when the NIVs are no longer being used. Apria respiratory therapists failed to monitor patient NIV usage and even when Apria knew that patients were no longer using the NIVs, Apria often did not take steps to stop seeking payment. In addition, Apria sales staff steered doctors and beneficiaries to use NIVs when less-expensive alternatives were available, and routinely waived co-payments for NIV patients without making an assessment of the patient’s financial need. USAO SDNY; CA AG; FL AGDecember 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; NYDecember 18, 2020
Massachusetts home health agency Maestro-Connections Health Systems, LLC and its CEO George Kiongera will pay $10 million to settle claims that it falsely billed the state’s Medicaid program, MassHealth, for home health services that lacked the required physician plan of care certifying that the home health services were medically necessary. MassDecember 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 programs—including TRICARE, Medicare, and Medicaid programs in Connecticut, Massachusetts, and Rhode Island—through 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 MAMedicaid Whistleblowers: Answering Common Questions About Reporting Medicaid Fraud
Posted 12/3/20
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...