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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:

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June 13, 2023

The owner of Grace Healthcare Services, a home health company in Texas, has been sentenced to almost 5 years in prison and ordered to pay almost $1.5 million in restitution for defrauding the state’s Medicaid program.  Akintunde Oyewale was convicted of paying illegal kickbacks to medical clinics in exchange for false home health certifications and patient referrals, then billing the Texas Medicaid program for services that were medically unnecessary and not actually provided.  TX AG

May 25, 2023

Vascular surgeon Vasso Godiali of Michigan has been ordered to pay $19.5 million in restitution and serve over 6 years in prison to resolve criminal allegations of defrauding Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. Godiali also agreed to pay up to $43.4 million to resolve civil allegations of violating the False Claims Act.  Although Godiali allegedly began submitting false claims in 2009, his misconduct did not come to light until a 2015 qui tam suit by Innovative Solutions Consulting LLC, which alleged Godiali billed government programs for arterial thrombectomies and stent placements that were not medically necessary and not actually performed.  Additionally, Godiali allegedly falsified medical records to justify the procedures, and improperly used a modifier code to increase his reimbursements. DOJ

March 29, 2023

Michigan-based Covenant Healthcare System and two physicians, neurosurgeon Dr. Mark Adams and electrophysiologist Dr. Asim Yunus, have agreed to pay $69 million and about $406,500 and $346,000 respectively to resolve allegations of violating the Anti-Kickback Statute, Stark Law, and False Claims Act.  Covenant allegedly provided Dr. Yunus and five other physicians medical directorship roles, employed Dr. Adams, forgave rent payments from another physician, and permitted a physician group to secure a lease on advantageous terms in exchange for referrals.  Covenant then submitted false claims based on those referrals to Medicare, Medicaid, and TRICARE.  The claims were first raised by Dr. Stacy Goldsholl in a qui tam suit; Goldsholl will receive over $12 million from the three settlements.  USAO EDMI

March 29, 2023

A man who led a scheme to defraud New York’s Medicaid program has been sentenced to almost 8 years in prison, ordered to pay $8.5 million in restitution, and ordered to forfeit $8.5 million in ill-gotten gains.  While supervising more than a dozen others affiliated with KJ Transportation C Services Inc. (“KJ”), Julio Alvarado submitted or caused to be submitted false claims for transportation services to Medicaid beneficiaries, for which KJ was ultimately paid $20 million.  However, in many of those cases, the beneficiary was deceased or out of the country at the time of the alleged transport, or had never heard of or taken rides with KJ.  In other instances, the beneficiary received kickbacks from KJ in exchange for their Medicaid information.  USAO SDNY

As States Look to Expand Health Coverage, State FCAs Become More Important than Ever

Posted  03/22/23
Continental US Map
The increasing burden of healthcare costs has state governments looking at new programs to expand government healthcare options for their residents.  Such an expansion of government spending will require a corresponding expansion of efforts to root out fraud, waste, and abuse that steals taxpayer dollars and reduces the benefits available.  Existing anti-fraud measures, including state False Claims Acts, will play a...

March 20, 2023

Acute care hospital Luminis Health Doctors Community Medical Center, Inc. (“DCMC”) and radiology imaging practice Diagnostic Imaging Associates, LLC (“DIA”) have agreed to pay $2 million to resolve allegations of defrauding federal healthcare programs.  Because DCMC’s outpatient cancer screening facility was not enrolled in Medicare and Medicaid and was thus not eligible for reimbursements, it entered into a written agreement with DIA whereby DIA would bill the programs for services performed by DIA as well as DCMC’s outpatient cancer screening facility, in violation of program rules and the False Claims Act.  The alleged misconduct occurred between 2010 and 2020.  USAO MD

March 17, 2023

A man in New York who laundered millions of dollars of criminal proceeds from a panoply of illegal schemes—including computer hacking, healthcare fraud, loan fraud involving Small Business Administration (SBA) funds, and operating an unlicensed international money transmitting business—has been sentenced to 10 years in prison.  According to the DOJ, Djonibek Rahmankulov worked with computer hackers to gain control of U.S. bank accounts, then executed millions of dollars of fraudulent wire transfers into accounts controlled by him and his associates.  He also worked with pharmacies to launder millions of dollars of Medicare and Medicaid reimbursements for HIV medications that were not actually dispensed or legally obtained.  During the pandemic, Rahmankulov submitted fraudulent applications to the SBA for his companies, laundered the proceeds, and made false statements to financial institutions regarding his activities.  Finally during his trial, he repeatedly sought to obstruct justice by threatening a witness and producing fraudulent letters of support from the community.  USAO SDNY

March 3, 2023

Florida-based Lakeland Regional Medical Center (“LRMC”) has agreed to pay $4 million to resolve False Claims allegations of making improper non-bona fide donations to Florida’s Polk County in order to free up funds and increase the center’s reimbursements from Medicaid.  The donations involved paying off some of the county’s financial obligations to other healthcare providers, so the reimbursements that LRMC received were effectively funded by their own donations.  DOJ

February 27, 2023

Several individuals and entities involved with the Saratoga Center for Rehabilitation and Skilled Nursing Care have agreed to pay over $7.1 million to resolve allegations of violating the False Claims Act by submitting claims for essentially worthless services.  From 2017 until the center closed in 2021, while receiving reimbursements from New York’s Medicaid program, the center’s owners and operators failed to provide adequate staffing, hot water, and clean linens, and failed to dispose of solid waste.  As a result of these failures, conditions fell below regulatory standards, and residents suffered from unnecessary errors and neglect.  NY AG; DOJ

February 8, 2023

Centene Corporation has agreed to pay $215 million to resolve allegations of violating the California False Claims Act.  A government investigation revealed that for almost two years, Centene failed to disclose or pass on discounted prescription drug costs to the state’s Medicaid program, as mandated by program rules, and instead falsely reported higher costs incurred by two of its managed care plans, which together serve beneficiaries in over 20 counties.  CA AG
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