Medicaid Archives - Page 36 of 42

March 29, 2016

New York announced the guilty pleas of licensed pharmacist Glenn Schabel, 55, of Melville, and his company, Glenn Schabel, Inc. in connection with a nation-wide scheme to sell diverted HIV medication to unsuspecting New Yorkers. Schabel pled guilty to Criminal Diversion of Prescription Medications and Prescriptions in the First Degree, and Commercial Bribe Receiving in the First Degree. Schabel will be sentenced to up to two and one-third to seven years state prison and forfeit $5,456,267 to the New York State Medicaid Program. Glenn Schabel Inc., pled guilty to Money Laundering in the First Degree. In April 2012, MFCU investigators arrested Schabel and three other individuals and charged ten companies, for using a network of bogus prescription medication wholesalers in Alabama, Mississippi, North Carolina, and California to launder money and to sell over $274 million in diverted prescription medications. NY

Tagged in: Medicaid, Pharma Fraud,

March 8, 2016

A Connecticut psychiatrist will pay $404,798 to settle a civil False Claims Act lawsuit alleging that she submitted false claims for payments to Connecticut’s Medicaid program. The state alleged that, from March 2010 to September 2013, while operating a private practice in Mansfield, Dr. Panoor submitted upcoded claims indicating that she provided Medicaid patients with both group counseling and either individual psychotherapy or a detailed examination on the same dates of service when, in fact, she did not provide psychotherapy or detailed examination sessions but instead provided medication management services or a brief meeting with the patient for the purpose of monitoring or changing a patient’s drug prescription – services that are coded, and thus reimbursed, at lower payment rates.

Tagged in: FCA State, Medicaid, Provider Fraud, Upcoding,

February 12, 2016

New Jersey Doctor Labib E. Riachi and two companies he owns, Riachi, Inc. and Center for Advanced Pelvic Surgery, agreed to pay $5.25 million to resolve allegations they violated the False Claims Act by billing Medicare and Medicaid for anorectal manometry and electromyography diagnostic tests, even though most of the tests were never performed. The settlement also resolves charges that they submitted claims to Medicare for physical therapy services that should not have been paid because they were not performed by a qualified therapist. DOJ (NJ)

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

January 29, 2016

Florida arrested three individuals for allegedly defrauding Medicaid out of more than half a million dollars. Two more defendants are being sought by authorities for arrest. According to the investigation, Matthew, Micah and Jimmie Harrell, along with Kenneith Durden and Keith Daly, billed Medicaid for services not provided and fraudulently used a licensed mental health provider’s information without that provider’s knowledge or consent to become accepted as a Medicaid provider. Matthew Harrell and Kenneith Durden allegedly set up parallel, fraudulent business operations in Florida, Georgia and Louisiana that all engaged in similar criminal activities. The businesses operated under the names Revive Athletics Florida, Divine Consulting Services, and Durden Consulting Services of Florida. FL

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

January 27, 2016

New York announced that it reached an agreement with a Capital Region transportation company, Advantage Transit Group, Inc., for repayment of Medicaid funds totaling over $1 million dollars that the company was not entitled to receive. Advantage Transit Group provides, among other services, transportation for Medicaid recipients to and from appointments and submits claims for reimbursement to Medicaid. Under the settlement agreement, Advantage Transit Group acknowledged that it submitted claims for reimbursement to Medicaid for transportation services and received payment for services that were not rendered. NY

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

January 12, 2016

Connecticut-based J&L Medical Services agreed to pay $600,000 to resolve allegations it violated the federal and state False Claims Acts. J&L Medical is a durable medical equipment company that provides Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) devices and accessories to Medicare and Medicaid beneficiaries who have been diagnosed with obstructive sleep apnea. According to the government, the company regularly used the services of unlicensed technicians to provide respiratory therapy services to Medicare and Medicaid beneficiaries, including setting up CPAP and BiPAP machines, fitting the patients with the masks used with those machines, and educating the patients about the use of the machines. The allegations originated in a whistleblower lawsuit filed by John Hart, a former employee of J&L Medical and a licensed respiratory therapist, under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $102,000 from the proceeds of the government’s recovery. DOJ (CT)

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Medicaid, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

January 5, 2016

Nashville Pharmacy Services, LLC, and its majority owner Kevin Hartman, agreed to pay up to $7.8 million to settle charges they violated the False Claims Act by overbilling Medicare and TennCare for pharmacy services. Specifically, the government claimed the Nashville-based pharmacy that specializes in dispensing HIV and AIDS-related medications automatically refilled medications without a request from the beneficiary or their physician; improperly waived TennCare and Medicare co-payments without an individualized assessment of ability to pay; improperly used pharmaceutical manufacturers’ co-payment cards to pay the co-payments of Medicare beneficiaries; billed for medications dispensed after the deaths of certain beneficiaries; and billed for medications that lacked a valid prescription. The allegations originated in a whistleblower lawsuit filed by Marsha McCullough, a former Nashville Pharmacy order entry technician, under the qui tamprovisions of the False Claims Act. She will receive a whistleblower award of 18 percent of the government’s recovery which could amount to $1.4 million. Whistleblower Insider

Tagged in: Drug and DME Pricing, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

November 19, 2015

Florida-based hospice company Hospice of Citrus County agreed to pay roughly $3 million to settle charges the company violated the False Claims Act by knowingly billing Medicare and Medicaid for medically unnecessary and undocumented hospice services. The allegations resolved included liability under the False Claims Act. Specifically, the government alleged the company treated at least 52 patients with lengths of stay in excess of 1,000 days and either knowingly or recklessly failed to document a valid basis for the initial start of hospice care and/or subsequent hospice coverage. The failure in documentation included no support for the length of hospice services; patient files that failed to document basic patient characteristics; and patient records that were either unsigned or signed with inconsistent practitioner information. In some cases, patients were admitted to HOCC simply because their spouse was in hospice care. DOJ (MDFL)

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

November 18, 2015

Deaconess Home Health, Inc. (formerly known as Outreach Home Health) and its owner, Lazarus Bonilla, agreed to pay $3,724,000 to resolve charges they violated the False Claims Act through the false billing of personal care worker services to the Wisconsin Medicaid Program. Specifically, the defendants (1) intentionally recruited patients for personal care services without regards to whether the services were medically necessary; (2) instructed nurses employed by Deaconess to routinely inflate, without regard to medical necessity, the assessment of the patient that was provided to the Medicaid program; (3) failed to conduct required supervisory visits to ensure that services were in fact being provided, that services continued to be medically necessary, and that any services provided were appropriate for the needs of the patient; and (4) hired physicians to act as medical directors to sign plans of care for patients on whom they had not completed a physical examination. The allegations first arose in three whistleblower lawsuits filed under the qui tam provisions of the False Claims Act. Two of the whistleblowers are former employees of Deaconess. The whistleblowers collectively will receive a whistleblower award of approximately $600,000. (DOJ (EDWI)

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

November 6, 2015

Roger Rousseau, former medical director of defunct health provider Health Care Solutions Network Inc. (HCSN) was sentenced to 192 months in prison for his role in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million. Also sentenced to prison for their role in the scheme were therapists Liliana Marks for 72 months and Doris Crabtree and Angela Salafia, each for 60 months. According to evidence presented at trial, HCSN purported to provide intensive mental health services to Medicare and Medicaid beneficiaries but these services were not medically necessary and were often never even provided. HCSN also paid kickbacks to assisted living facility owners and operators who in exchange referred beneficiaries to HCSN. In support of this scheme, Rousseau routinely signed what he knew to be fabricated and altered medical records. And Crabtree, Salafia and Marks fabricated HCSN medical records to support the fraudulent claims. In total, HCSN submitted roughly $63.7 million in false and fraudulent claims to Medicare. DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

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