Medicaid
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February 27, 2019
Tennessee-based skilled nursing facility chain Vanguard Healthcare LLC, along with former executives William Orand and Mark Miller, have agreed to pay upward of $18 million to resolve False Claims allegations of billing Medicare and Medicaid for worthless and "grossly substandard nursing home services." According to press releases, five facilities in the Vanguard network allegedly submitted false claims for reimbursement, despite a litany of failures, including forging nurse and physician signatures, using unnecessary physical restraints on residents, failing to prevent pressure ulcers, failing to provide wound care as ordered, failing to provide standard infection control, failing to administer medications as prescribed, and failing to meet basic nutrition and hygiene requirements. The case is considered the largest case of fraud involving worthless services in state history. DOJ; USAO MDTNFebruary 22, 2019
The owner of New York Pharmacy, Inc., NYC Pharmacy Inc., and NY Healthfirst Pharmacy Inc., pharmacist Hin T. Wong, has pleaded guilty to criminal charges arising from millions of dollars in false billing to New York's Medicaid program for HIV drugs. Wong billed Medicaid for medications that she never dispensed, a scheme disclosed by an investigation confirming that Wong's pharmacies did not purchase a sufficient inventory of medication from licensed drug wholesalers to account for the quantity of medication for which Wong’s pharmacies billed Medicaid and Medicaid Managed Care Organizations. In addition, Wong paid kickbacks to individuals to bill for medications that were not, in fact, dispensed. Under a related civil settlement, Wong will surrender over $3.6 million to the state. NYOhio Seeks to Recover Overcharges from OptumRx
Posted 02/21/19
