Medicaid
This archive displays posts tagged as relevant to Medicaid and fraud in the Medicaid program. You may also be interested in our pages:
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 SDGAMay 7, 2020
Seattle Pain Center, Northwest Analytics, and owner/physician Dr. Frank Danger Li have agreed to pay $2.85 million to settle allegations of defrauding Washington’s Medicaid program. An investigation revealed that between 2013 and 2015, Li had instituted a policy required nearly every patient treated at Seattle Pain Center to be administered the full urine drug panel at each visit even if they were not medically necessary. The drug tests were then sent to Li’s exclusively-owned laboratory to be analyzed. Additionally, the investigation revealed that between 2007 and 2016, Li wrote an excessive amount of prescriptions for opioids, and at least 60 of his patients died due to opioid-related causes during this period. AG WA; USAO WDWAKeeping Our Eyes Open for COVID-19 Fraud
Posted 05/1/20
April 29, 2020
North Carolina physician Ibrahim Oudeh and his wife Teresa Sloan-Oudeh will pay up to $8.8 million to resolve claims of Medicare and Medicaid fraud. Between 2010 and 2017, the Oudehs reportedly submitted more than 40,000 false claims, including more than 37,000 claims for laboratory tests, including nerve-conduction studies that Dr. Oudeh was not qualified to interpret, the vast majority of which were medically unnecessary. To submit as many claims as they did, defendants falsely billed for office visits, in some instances billing for more than 24 hours of visits in a single calendar day. The Oudehs sometimes used outside physicians to interpret laboratory tests, but paid those physicians less than their practice’s Medicare reimbursement, a violation of the Anti-Markup Rule. Defendants will forfeit $3.3 million in assets and pay an additional $5.5 million. USAO EDNC; NCApril 21, 2020
KPMD, Inc., technology company in California, has been ordered to pay $1.7 million in restitution for defrauding Medicare and Medicaid. According to the DOJ’s press release, KPMD entered into a contract with Ohio-based Southwest Regional Medical Center in 2011 where it agreed to implement an electronic health records software program for the hospital in exchange for government incentive payments under the federal Health Information Technology for Economic and Clinical Health Act (HITECH Act). After KPMD’s CEO purchased the hospital, however, the company falsely attested to meeting criteria for the incentive payments even though the hospital was winding down operations. $1.3 million of the settlement will go to Medicare, with the remaining $800,000 to go to Medicaid. USAO SDOHApril 15, 2020
A Florida-based reference laboratory, pain clinic, and two former executives have agreed to pay $41 million to settle claims of defrauding Medicaid, Medicare, TRICARE, and other government health programs by billing for medically unnecessary urine drug tests between 2010 to 2017. Led by Michael T. Doyle and Christopher Utz Toepke, the defendants allegedly had a policy of automatically ordering both presumptive and definitive urine drug tests for all patients at every visit regardless of need, with Toepke’s Tampa Pain Relief Centers Inc. performing all presumptive tests, and Doyle’s Logan Laboratories Inc. performing all definitive tests. The alleged False Claims Act violations were eventually brought to light in two qui tam cases; the whistleblowers of those cases will split a relator’s share of approximately $7.79 million. DOJ; EDPA; MDFL; FLTracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report
Posted 04/2/20
March 11, 2020
The organizer of a $2 million multi-state Medicaid fraud scheme has been sentenced to 11 years in prison and ordered to pay $2.5 million in restitution. Along with two other co-defendants, Matthew Harrell fraudulently obtained the Medicaid provider number of mental health service providers in Georgia and Florida, as well as the Medicaid member numbers of children in foster care, welfare, and other programs in Louisiana. Using companies purporting to be mental health providers, the defendants then submitted $3.5 million in false claims and received $2.5 million in reimbursements. Harrell's co-defendants, Nikki Richardson and Tomeka Howard, have also been ordered to serve time and pay restitution. USAO NDGAMedicaid Drug Rebate Fraud: Should it be an Enforcement Priority?
Posted 03/10/20
