Medicaid
This archive displays posts tagged as relevant to Medicaid and fraud in the Medicaid program. You may also be interested in our pages:
Catch of the Week: Colorado Neurosurgeon and His Three Companies Settle Spinal Implant Kickback Claims for $2.35M
Posted 02/14/20
February 14, 2020
Tennessee-based Cookeville Regional Medical Center Authority (CRMC) has agreed to pay $4.1 million to settle allegations of violating the Anti-Kickback Statute, Stark Law, and False Claims Act from 2012 to 2017. In a qui tam suit that initiated the investigation, an unnamed whistleblower alleged that CRMC submitted claims to Medicare and TennCare that arose from improper financial arrangements with physicians at its wholly owned subsidiary, CRMC MSO-Sub 1, Inc., d/b/a Tennessee Heart. $3.6 million of the settlement proceeds will go to the United States, $453,000 will go to the State of Tennessee, and $779,000 will go to the whistleblower. USAO MDTNFebruary 12, 2020
A neurosurgeon accused of receiving illegal kickbacks from distributors of spinal implant devices has agreed to pay $2.35 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act. While practicing at three Colorado area hospitals, Dr. William Choi created distributorships Nexus Spine, LLC and 4D Spine, LLC to provide spinal implant equipment for surgeries he performed. Despite naming third parties as the registered owners, Dr. Choi maintained control of the distributorships and their profits, thus soliciting and receiving improper payments from these entities. His fraudulent conduct was eventually revealed by a former 4D employee, Mark Rahe, who filed the civil action. USAO COFebruary 4, 2020
Psychotherapy, adolescent therapy, and tutoring company The Center of Attention, LLC: No One Left Behind, together with its owner Selina Christian, will pay $200,000 and be suspended from Connecticut's Medicaid program, based on allegations that defendants violated the Connecticut False Claims Act and submitted false claims for services that were either never provided, or that were for non-psychotherapy services that were not covered by Medicaid. CTFebruary 4, 2020
Southeastern Retina Associates (SERA), which operates in parts of Tennessee, Georgia, and Virginia, has agreed to pay $1.5 million and enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services for allegedly defrauding Medicare and Medicaid. The investigation was launched by a qui tam suit filed by an unnamed whistleblower, which alleged that between 2009 to 2016, the practice improperly billed exams at a higher rate than appropriate, and used a billing code called Modifier 25 to bill for exams that were not separately billable from other services billed the same day. For exposing the misconduct, the relator in this case will receive a $270,000 share of the settlement. USAO EDTNOpioid Executive Sentenced to Over Five Years in Prison for Role in Healthcare Fraud Scheme
Posted 01/31/20
Top Ten State Healthcare and Financial Fraud Recoveries of 2019
Posted 01/30/20
Top Ten Healthcare Fraud Recoveries of 2019
Posted 01/24/20
