Medical Billing Fraud Archives - Constantine Cannon

Fishy Business and Fraudulent Bills: New York Internist Pleads Guilty to $891K Healthcare Fraud Scheme

Posted 11/22/24

The Hippocratic Oath was apparently not an ethical pledge Dr. Kenneth Fishberger took to heart. On Thursday, November 14, 2024, New York internist Dr. Fishberger, 75, pleaded guilty in Boston federal court to one count of conspiracy to commit healthcare fraud. Fishberger, an internist from East Setauket, N.Y., received kickbacks for ordering medically unnecessary transcranial doppler (TCD) brain scans, tests used...

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medical Billing Fraud,

Opioid Exploitation: Doctor and Staff Charged with Conspiracy and Fraud

Posted 07/8/24

In Saint Louis, Dr. David A. Parks along with his clinical manager and spouse, James M. Bilderback, and front desk staffer Michelle J. Scheer, face serious allegations of conspiracy and health care fraud. Indicted by the U.S. District Court, the three are accused of illegal prescription practices and fraudulent activities aimed to profit from controlled substances and fraudulent medical billing.

The...

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

VNS Health: $1M Settlement for Failing To Provide Services to Hospice Patients

Posted 07/3/24

The U.S. Attorney's Office for the Southern District of New York announced a substantial settlement with Visiting Nurse Service of New York (formerly VNSNY, now VNS Health) and its related entities. This settlement addresses allegations of fraudulent billing practices that undermined the Medicaid program meant to support some of the most vulnerable patients like those in hospice. VNS Health is one of the largest...

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

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted 02/23/24

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

Tagged in: FCA Federal, Government Programs Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud, Reporting to Government,

Top Ten Healthcare False Claims Act Recoveries for 2023

Posted 01/30/24

Doctor Holding Stethoscope with Crossed Arms

This past year was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. And as we noted in our recent Top Ten listing of False Claims Act recoveries for 2023, all but 3 of the Top Ten recoveries were in the healthcare space involving various schemes to defraud Medicare and Medicaid. So here is our look at the Top Ten healthcare recoveries for...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

Top Ten False Claims Act Recoveries in 2023

Posted 01/11/24

It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

Catch of the Week: Moffitt Cancer Center

Posted 01/5/24

This week's Department of Justice (DOJ) Catch of the Week goes to Tampa-based H. Lee Moffitt Cancer Center & Research Institute Hospital. Yesterday (January 4), the non-profit cancer treatment and research center agreed to pay roughly $19.6 million to settle DOJ charges of violating the False Claims Act by billing Medicare for patient care services provided during research studies not eligible for...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Facility, Medical Billing Fraud, Medicare,

Scoundrel Spotlight - COVID-19 Fraudster Lourdes Navarro

Posted 10/9/23

This week's Scoundrel in the Spotlight is Lourdes Navarro and her husband Imran Shams. The married pair ran the LA County medical lab Clinical Laboratory Inc. (also called Health Care Providers Laboratory). Their lab performed COVID-19 screening tests primarily for nursing homes and other facilities catering to the elderly population. Last Thursday (October 5), Navarro pleaded guilty to fraudulently billing the...

Tagged in: COVID-19, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Risk Adjustment Fraud,

August 30, 2023

Lompoc Valley Medical Center (LVMC) has agreed to pay $5 million to resolve allegations of causing false claims to be submitted to California’s Medicaid program. Under the Patient Protection and Affordable Care Act (ACA), Medi-Cal received federal funds to expand coverage to previously uninsured adults. However, LVMC knowingly claimed and received payments from the government for services that were duplicative, not reimbursable, or not priced at fair market value. CA AG

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

July 31, 2023

Martin’s Point Health Care Inc. in Maine has agreed to pay almost $22.5 million to resolve a lawsuit by a former manager in its Risk Adjustment Operations group, which alleged the health plan administrator defrauded Medicare over a three year period. The former manager, Alicia Wilbur, alleged that Martin’s Point reviewed charts for their Medicare Advantage beneficiaries to identify additional diagnosis codes, then submitted those codes in claims to Medicare in order to increase reimbursements even though they were not properly supported by patient medical records. For blowing the whistle on this misconduct, Wilbur will receive a $3.8 million award. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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Medical Billing Fraud

Fishy Business and Fraudulent Bills: New York Internist Pleads Guilty to $891K Healthcare Fraud Scheme

Opioid Exploitation: Doctor and Staff Charged with Conspiracy and Fraud

VNS Health: $1M Settlement for Failing To Provide Services to Hospice Patients

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Top Ten Healthcare False Claims Act Recoveries for 2023

Top Ten False Claims Act Recoveries in 2023

Catch of the Week: Moffitt Cancer Center

Scoundrel Spotlight - COVID-19 Fraudster Lourdes Navarro

August 30, 2023

July 31, 2023

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