Medicaid Archives - Page 19 of 41

October 3, 2019

Counselor Valerie Williams and her business, Circle of Life Transition Center, LLC, will pay $45,500 to resolve claims that they submitted false claims to the Connecticut Medicaid program, representing that services had been provided by Williams when, in fact, those services had been provided by unlicensed individuals. USAO CT

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud,

September 25, 2019

Mobile diagnostic service provider Trident USA Health Services LLC has agreed to pay $8.5 million to settle two whistleblower cases alleging violations of the False Claims Act. Trident’s CIO, Ravi Srivastava, and a regional sales manager, Peter Goldman, had each filed their own qui tam suits alleging Trident had been engaged in a kickback scheme with skilled nursing facilities between 2006 and 2019. For their efforts, Srivastava will receive $2 million and Goldman will receive $106,250 of the government’s recovery. USAO EDPA

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

Catch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Posted 09/18/19

On Monday, a federal judge in Houston sentenced Starsky Bomer, the former CFO and COO of Atrium Medical Center and Pristine Healthcare, to ten years in prison for his role in a Medicare fraud scheme that bilked the government of $16m. Bomer was convicted by a jury in October of last year. His co-conspirator, Dr. Sohail R. Siddiqui, took a plea deal in 2017 and is serving five years in prison. Bomer will do time...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Eligibility,

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Posted 09/13/19

Philip Esformes, 50, of Miami Beach, Florida, was sentenced to 20 years in prison for his role in a decades-long billion-dollar scheme to submit fraudulent claims to Medicare and Medicaid both for services deemed medically unnecessary and services that were medically necessary but that he did not provide. Esformes personally pocketed $37 million from this scheme to fund his lavish lifestyle, while leaving elderly...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, SNF,

September 5, 2019

Dentist Santa Maria McKibbens has agreed to pay North Carolina $375,000 to resolve allegations that she submitted false claims to the North Carolina Medicaid Program by billing for dental restorations that were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy. NC

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

August 15, 2019

North Carolina ambulance company Gate City Transportation has been ordered to pay $5.25 million in restitution for falsely billing the state's Medicaid program for convalescent ambulance services when, in fact, the company was providing only medical van service to ambulatory and wheelchair-bound patients. During the investigation, agents confiscated more than $5 million in cash and property, which will be applied to the restitution. USAO MD NC

Tagged in: Ambulance, Criminal Proceedings, Healthcare Fraud, Medicaid,

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Posted 08/2/19

This week marks the seventh year in a row that Congress has designated July 30^th National Whistleblower Day, honoring the occasion, on July 30, 1778, when the Continental Congress unanimously enacted the first whistleblower protection law in the United States. The law was passed in response to a petition to the Continental Congress filed by a group of ten American sailors and marines, who reported that their...

Tagged in: Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, Whistleblower Eligibility, Whistleblower Rewards,

July 24, 2019

Pennsylvania-based Eagleville Hospital has agreed to pay $2.85 million to settle allegations of defrauding Medicare, Medicaid, and the Federal Employees Health Benefits Program. According to an anonymous relator, Eagleville violated the False Claims Act between 2011 and 2018 by submitting claims for substance abuse patients improperly admitted for high paying, hospital-level detoxification treatments. The whistleblower will receive $500,000 of the recovery. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Other Government Health Programs, Upcoding, Whistleblower Case, Whistleblower Rewards,

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid. As part of the settlement, they will pay $425,000. USAO CT

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

July 15, 2019

Millcreek Community Hospital has agreed to pay $2.4 million and enter into a Corporate Integrity Agreement requiring five years of monitoring to resolve allegations of violating the False Claims Act. For a period of four years, the Pennsylvania-based hospital’s inpatient rehabilitation unit allegedly admitted ineligible patients, then failed to document in medical records that such services were medically necessary and reasonable. USAO WDPA

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

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