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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 25 of 41

December 11, 2018

Target Corp. will pay $3 million to settle allegations that it improperly billed and received payments from the state’s Medicaid program (MassHealth). Between August 2009 and July 2015, at their Massachusetts locations, Target allowed auto-refills on prescriptions that were not clearly requested by a MassHealth patient or caregiver at the time of refill. The investigation arose from a qui tam action by an unnamed whistleblower in the United States District Court for the District of Minnesota. Mass AG  

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 11, 2018

Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act in claims submitted to Medicare, Medicaid, and federal employee health insurers. From 2007 until 2014, under DiIorio's direction, Coordinated Health allegedly exploited a billing code called Modifier 59 in order to separately bill for orthopedic surgery charges that, properly billed, instead fall under a single "global" payment for each surgery. Even after outside consultants warned company executives about the improper practice in 2011 and 2013 and provided on-site training on the proper use of Modifier 59, Coordinated Health continued making false claims, causing federal healthcare payers to overpay by millions of dollars. As part of the settlement, the company has signed a Corporate Integrity Agreement for additional government oversight into its billing practices over the next five years. USAO EDPA

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs,

December 11, 2018

Aurora Health Care, Inc. has agreed to pay $12 million to settle allegations of defrauding Medicare and Wisconsin's Medicaid program in certain reimbursement claims filed between 2008 to 2012. According to the United States and State of Wisconsin, the healthcare provider and two physicians entered into improper financial relationships in violation of the federal and state False Claims Acts as well as the Stark Law. As a result, some of the claims that Aurora submitted to the government health programs were improper. Despite alerting the government to the illegal arrangement, a qui tam complaint filed by unnamed whistleblowers alleged different claims. Although the whistleblowers will still receive a share of the recovery, the government did not intervene in their lawsuit, which will be dismissed as part of the settlement. USAO EDWI

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

December 4, 2018

Dermatology Associates of Central New York, PLLC has agreed to pay $811,196.88 to settle claims that it overcharged Medicaid, Medicare, and TRICARE by falsely submitting claims under physicians' names, in violation of both the federal and New York False Claims Acts. A whistleblower complaint revealed that many of the physicians named on invoices were not in the office the day care was provided and could not have supervised in the rendering of services, and that some of the non-physician practitioners who provided care were not licensed to do so in the state of New York. As a result of bringing the fraud to light, the unnamed whistleblower will receive $138,000. USAO NDNY

Tagged in: FCA Federal, FCA State, Improper Medical Personnel, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

November 27, 2018

Twelve individuals have been charged by a federal grand jury in a 22-count indictment related to a multi-year conspiracy to defraud the Pennsylvania Medicaid Home Care Program. The indictment lists a multitude of fraudulent acts by the defendants, alleging that they: submitted false claims for services that were not provided, misused consumers’ personal identifying information, provided false documentation during state audits, and even submitted claims to Medicaid for home care services for consumers who were hospitalized or no longer alive. Ten of the defendants reside in Western Pennsylvania, one is a resident of Georgia, and the twelfth defendant is a resident of South Carolina. Between January 2011 and April 2017, the conspirators, who owned and operated the home health care companies, received more than $87,000,000 in Medicaid payments.  The conspiracy and health care fraud charges each carry a maximum total sentence of 10 years in prison, a fine of $250,000, or both.  DOJ

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

November 8, 2018

Renee Christine Borunda of Greensboro, North Carolina, was sentenced to prison and ordered to make restitution to the North Carolina Medicaid program for conduct that defrauded Medicaid.  Borunda, who worked for a behavioral health services provider, used a therapist's personal information to submit false bills for behavioral services, claiming that services were provided to over 200 different Medicaid recipients when no such services were rendered.  USAO EDNC; NC

Tagged in: Criminal Proceedings, Medicaid, Medical Billing Fraud, Provider Fraud,

November 6, 2018

An Indiana-based dental care practice and admin support company have agreed to pay a total of $5.139 million to settle allegations they violated the federal and Indiana state False Claims Acts. According to whistleblower and qui tam plaintiff Dr. Jihaad Abdul-Majid, between 2009 and 2013, ImmediaDent of Indiana, LLC and Samson Dental Partners, LLC allegedly billed Indiana's Medicaid program for procedures that were either upcoded (i.e. represented to be more serious and more expensive than they actually were), were not actually performed, or were not medically necessary. Samson Dental Partners is additionally accused of violating Indiana’s law prohibiting the corporate practice of dentistry. Because the companies refused oversight proposed during settlement, they have now been classified as "high risk" to federal healthcare programs. IN AG; USAO WDKY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

November 2, 2018

Metropolitan Retina Associates, Inc. and its owner, Dr. Kenneth S. Felder, have settled a False Claims Act investigation by agreeing to pay $2,064,559 for Medicare and Medicaid fraud. As part of the settlement, the New York-based ophthalmology practice admitted and accepted responsibility for submitting claims involving medically unnecessary and improperly documented fluorescein angiograms, as well as ultrasounds of the eye. USAO SDNY

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

October 31, 2018

A London-based doctor has been sentenced to 42 months in federal prison for defrauding Medicare, Medicaid, and private insurers. The doctor, Dr. Anis Chalhoub, was convicted in April of implanting over 200 medically unnecessary pacemakers in patients at St. Joseph London hospital, reportedly even pressuring patients and giving them misleading information so that they would agree to the procedures. He is ordered to pay $257,515 in restitution to Medicare, Medicaid, and private insurers, as well as a $50,000 fine. USAO EDKY

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

October 30, 2018

Four people connected to a Texas-based home health agency have been found guilty of fraudulently obtaining $3.7 million in reimbursements from Medicare and Medicaid. Despite being previously banned from participating in any federal healthcare reimbursement programs, Celestine Okwilagwe and Paul Emordi co-owned and operated a Medicare and Medicaid provider in the Dallas area called Elder Care. Adetutu Etti, the provider's administrator, was recruited to falsely certify that someone else was the owner, and Okwilagwe's wife, Loveth Isidaehomen, was recruited to sign checks. Some of the claims that were eventually reimbursed by Medicare were also found to be for services that were not medically necessary. DOJ

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

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