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Medical Billing Fraud

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Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

Posted  12/14/18
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 for submitting false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health is a for-profit hospital and health system based in the Lehigh Valley region of Pennsylvania. It...

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

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  

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

November 26, 2018

Vital Energy Occupational Therapy and Wellness Center, LLC agreed to pay $200,000 to settle charges that between 2013 and 2016 it submitted false claims for physical and occupational therapy services.  The therapy practice was alleged to have submitted claims to Medicare and Medicaid for individual therapy services, when group therapy was actually provided, and claims for therapy services with false practitioner information using the names of former employees.  Whistleblower Ashley C. Baggett, who filed the False Claims Act action, will receive $36,000.  USAO S.C.

November 14, 2018

After pleading guilty last year, the owner of two health clinics in Detroit has been sentenced to 160 months in prison and ordered to pay over $6 million for defrauding Medicare. Along with multiple co-defendants, Jacklyn Price allegedly took part in a scheme to bill Medicare for services that were obtained through kickbacks, not medically necessary, not actually provided, or provided by an unlicensed practitioner. Her co-defendants, Millicent Traylor, Muhammad Qazi, and Christina Kimbrough, were all sentenced in September. DOJ

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

November 7, 2018

Convicted of defrauding the Medicare program, former Houston-area healthcare clinics owner Joy Aneke was sentenced to 36 months in federal prison and ordered to pay $2,760,464.57. Aneke submitted false claims for medical services that were either not performed or not authorized by a licensed physician. None of Aneke’s clinics even had equipment necessary to provide the services -- allergy testing, complex cystometrograms, anal/urinary muscle studies, and others -- for which Aneke billed Medicare. Additionally, Aneke used “recruiters” or “marketers” to encourage patients to visit her clinics, and instructed co-defendant Maureen Henshall to pay patients illegal kickbacks. DOJ  

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

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
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