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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 22 of 41

April 30, 2019

Home healthcare company Avenue Homecare Services, Inc, of Dracut, Massachusetts, will pay $8.3 million to resolve allegations that between 2013 and 2016 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Avenue submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 30, 2019

Home healthcare company Amigos Homecare, LLC, of Lawrence, Massachusetts, will pay $2.13 million to resolve allegations that between 2014 and 2018 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Amigos submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 4, 2019

Oral and Maxillofacial Surgical Associates P.C. of New Haven, Connecticut, and its former owner Robert Sorrentino DDS, have agreed to pay $252,000 to settle claims that they submitted false claims to Medicaid by billing for services that were not provided, were not medically necessary, or were covered under other claims submitted for the same date of service.  The fraudulently-billed services included deep sedation or general anesthesia and removal of bone or tissue.  USAO CT

Tagged in: Bundling and Unbundling, FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

March 29, 2019

CareWell Urgent Care of Rhode Island, P.C., and Urgent Care Centers of New England Inc. have agreed to pay $2 million to settle a qui tam suit brought on by a former employee, Aileen Cartier. In violation of the False Claims Act, CareWell had falsely inflated the level of services provided and failed to identify service providers in claims submitted to Medicare, Massachusetts and Rhode Island Medicaid, and the Massachusetts Group Insurance Commission (GIC) between 2013 to 2018. For bringing on the suit, Cartier will receive a 17% relator's share. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

March 29, 2019

Acacia Mental Health Clinic and its owner, Abraham Freud, have agreed to pay $4.1 million to the United States and the State of Wisconsin for submitting false claims to Medicaid in violation of the False Claims Act. According to a qui tam complaint filed by whistleblower Rose Presser, Acacia billed for urine drug screens in simple "cup" tests as if a more sophisticated test had been performed. Acacia also billed for medically unnecessary and duplicative urine drug tests and telemedicine services performed by foreign-based psychiatrists in violation of Medicaid regulations. USAO EDWI

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 27, 2019

In the second largest resolution of a Medicaid fraud case based in Washington State, CareOne Dental Corporation and its owners will pay $1 million to settle allegations of violating Washington's Medicaid False Claims Act. According to the AG's office, CareOne and defendants Dr. Liem Do and Dr. Phuong-Oanh Tran defrauded Medicaid by using higher paying codes, masking ineligible services as eligible services, and billing for services the practice didn't even provide. Ultimately, the defendants racked up about $1 million over the course of four years. AG WA

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Upcoding,

March 26, 2019

Accurate Home Care, LLC, a Minnesota-based home health provider has agreed to pay $726,957.59 after voluntarily self-disclosing its violations of the False Claims Act in duplicated bills sent to both Medicaid and private insurers. Accurate had also admitted to fraudulently retaining payments from Medicaid even when Medicaid wasn't the primary insurer. USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

March 7, 2019

A Connecticut-based durable medical equipment supplier, Med Tech, and its owner, Thomas Macre, Sr., have agreed to pay more than $467,000 to resolve allegations of violating the federal and state False Claims Acts. The alleged misconduct involved billing Medicaid for unprovided and medically unnecessary back braces and electrical stimulation units. USAO CT

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

March 6, 2019

A Texas woman has been sentenced to 30 years in prison and ordered to pay more than $15 million for her role in a $50 million scheme involving healthcare fraud and money laundering. Daniela Gozes-Wagner was accused of running 28 fake medical testing facilities from 2009, and billing Medicare and Medicaid for tests that were not performed or medically necessary. As part of the scheme, she employed personnel to answer phones and prevent inspectors from entering "testing facilities" that were virtually empty. USAO SDTX

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Misrepresentations,

March 1, 2019

The owner of a mental health clinic in North Carolina was sentenced to 5 years in prison for submitting about $4 million in false claims and evading almost $400,000 in unpaid taxes over the course of four years. Using patient information provided to her by co-defendant Haydn Thomas, who was employed as an office manager for an oral surgeon, Catinia Denise Farrington of Durham County Mental Health and Behavioral Health Services, LLC allegedly submitted thousands of false claims to Medicaid for services that were not performed. In addition to her prison sentence, Farrington has been ordered to pay restitution of about $4 million to NC Fund for Medical Assistance and almost $400,000 to the IRS for paying personal expenses out of business accounts into which she has transferred her fraudulently obtained gains. Her co-defendant faces sentencing later this month. DOJ; USAO MDNC

Tagged in: Healthcare Fraud, Medicaid, Tax Fraud,

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