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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:

Page 15 of 42

July 23, 2020

Progenity, Inc., f/k/a Ascendant MDx, Inc., has agreed to pay a total of $49 million to resolve allegations that the California-based clinical laboratory submitted false claims to Medicaid, the VA, TRICARE, and the Federal Employees Health Benefits Program (FEHBP) through different fraudulent schemes.  First, from 2012 to 2016, Progenity allegedly billed the programs for non-reimbursable prenatal tests using a reimbursable billing code.  Second, in claims originally brought by a whistleblower under the False Claims Act, the company was alleged to violate the Anti-Kickback Statue by providing improper incentives to physicians—including paying above fair market value for blood specimen “draw fees”, providing tens of thousands of dollars in free food and alcohol, and routinely reducing or waiving co-insurance or deductibles—in order to induce physicians to order their tests.  Approximately $35.9 million of the settlement proceeds will go toward resolving federal claims, with the remaining $13.1 million paid to different states.  AG NC; USAO SDCA; USAO SDNY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud, Other Government Health Programs, Upcoding, Whistleblower Case,

July 22, 2020

Tony Garrett Taylor has been sentenced to 8 years in prison and ordered to pay over $6 million to the North Carolina Medicaid program and over $1 million to the IRS after pleading guilty to committing healthcare fraud and tax evasion.  Along with his brother, Jerry Lewis Taylor, the defendant conspired to use outpatient behavioral health services companies owned and operated by the brothers to submit false claims to Medicaid for services that were either never provided or misrepresented.  Jerry Lewis Taylor has also pleaded guilty and is currently awaiting sentencing.  AG NC

Tagged in: Criminal Proceedings, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Tax Fraud,

July 21, 2020

The Montachusett Regional Transit Authority (MART), a quasi-public transportation authority that brokers medical transportation, will pay $300,000 to resolve allegations that it improperly caused false claims to be submitted to MassHealth, the Massachusetts state Medicaid program. MART allegedly did not have appropriate procedures in place to verify that its transportation subcontractors had actually provided rides as they claimed, and MART billed MassHealth for thousands of rides that were not, in fact, provided. MA; USAO MA

Tagged in: Ambulance, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

July 13, 2020

The owner and operator of a skilled nursing facility has agreed to pay $1 million to settle allegations of submitting false claims to Medi-Cal in violation of the California False Claims Act.  According to the Attorney General, Legacy Post-Acute Rehabilitation Center (Legacy) failed to provide the minimum number of nursing hours required for the level of care that it billed for.  AG CA

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, SNF,

July 10, 2020

Universal Health Services, Inc. and UHS of Delaware, Inc. (collectively, UHS), and a Georgia-based UHS facility, Turning Point Care Center, LLC, have agreed to pay a combined $122 million to settle 18 qui tam cases pending in four jurisdictions.  In violation of the False Claims Act, UHS allegedly billed federal healthcare programs—including Medicare, Medicaid, TRICARE, the Department of Veteran Affairs, and the Federal Employee Health Benefit programs—for medically unnecessary inpatient behavioral health services, failed to provide adequate or appropriate services, and paid illegal inducements to beneficiaries of those programs.  UHS will pay over $88 million to the federal government and nearly $29 million to individual states, for a combined penalty of $117 million, with a relator share of about $15.8 million.  Turning Point will pay $5 million to the federal government and the State of Georgia; the whistleblower in that case will receive $861,853.64.  USAO MDFL; USAO NDGA; USAO EDPA; AG FL; AG MI; AG NC; AG VA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

Oklahoma City Hospital, Management Company, And Physician Group to Pay $72.3 Million To Settle Kickback and Stark Allegations

Posted  07/10/20
Anti-Kickback Stark Law Whistleblower Examples
Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM), a specialty hospital affiliated with Tenet Healthcare in Oklahoma City, Oklahoma, its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), Southwest Orthopaedic Specialists, PLLC (SOS), an Oklahoma City-based physician group, and two SOS physicians, will pay $72.3 million to resolve kickback allegations...

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Medicaid,

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July 8, 2020

A Florida-based nonprofit that provides hospice care, palliative care, and other services to the elderly, has agreed to pay $3.2 million to resolve its liability under the False Claims Act.  According to former Director of Hospice Care, Margaret Peters, Hope Hospice knowingly submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary but highly reimbursed general inpatient (GIP) hospice services over a five year period.  For blowing the whistle on the alleged fraud, Peters will receive a 19% share of the settlement.  USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, SNF, Whistleblower Case, Whistleblower Rewards,

July 8, 2020

An orthopedic hospital, its management company, a physician’s group, and two physicians have agreed to pay $72.3 million to resolve whistleblower-brought allegations under the Anti-Kickback Statute, federal False Claims Act, and Oklahoma Medicaid False Claims Act of defrauding Medicare, Medicaid, and TRICARE.  Between 2006 and 2018, the Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM) and its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), allegedly provided free or below-fair market rate services and compensation to Southwest Orthopaedic Specialists, PLLC (SOS), including SOS physicians Anthony Cruse, D.O., and R.J. Langerman, Jr., D.O., in exchange for patient referrals.  USP also allegedly offered preferential investment opportunities to physicians in Texas.  As part of the settlement, USP will pay $60.86 million to the United States, $5 million to the State of Oklahoma, and $206,000 to the State of Texas, while SOS and its physician defendants will pay $5.7 million to the United States and $495,619 to the State of Oklahoma.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

June 25, 2020

Georgia-based Piedmont Healthcare, Inc. has agreed to pay $16 million to resolve whistleblower-brought allegations that it violated the Anti-Kickback Statute and False Claims Act.  The relator in this case, a former Piedmont physician, alleged that between 2009 and 2013, Piedmont’s case managers overturned physician recommendations for outpatient care by submitting claims for more expensive inpatient care to Medicare and Medicaid.  Furthermore, when the healthcare system acquired the Atlanta Cardiology Group in 2007, it allegedly paid far above fair market value for a catherization lab that was partly owned by the practice group.  For bringing a successful enforcement action, the unnamed relator will receive a share of nearly $3 million of the settlement proceeds. USAO SDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 24, 2020

Augusta University Medical Center (AUMC) has agreed to pay $2.6 million to resolve fraud allegations by the United States, State of Georgia, and State of South Carolina under state and federal False Claims Acts.  According to the government, AUMC knowingly submitted claims to Medicare and Medicaid for a medically unnecessary procedure that was billed as a covered procedure.  USAO SDGA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

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