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Medical Billing Fraud

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August 16, 2019

Kentucky-based Ultimate Care Medical Services, LLC, doing business as Ultimate Treatment Center, and its principal, Dr. Rose O. Uradu, have agreed to pay $1.4 million to resolve allegations that they submitted false claims to Mediare and Kentucky's Medicaid program for services that were not provided.  Defendants billed for "evaluation & management" services when patients visited the clinic to receive methadone, visits which did not include a medical examination, which is required to bill for evaluation &  management.  In addition, defendants billed for complex urine drug testing when they lacked the equipment to perform such testing, and issued buprenorphine prescriptions at an rate greater than authorized.  USAO ED KY

DOJ Catch of the Week — Beaver Medical Group

Posted  08/9/19
Yesterday, California-based Beaver Medical Group and one of its physicians, Dr. Sherif Khalil, agreed to pay roughly $5 million to resolve allegations they violated the False Claims Act by reporting invalid diagnoses to Medicare Advantage plans causing those plans to receive inflated payments from Medicare.  It is the latest example of what has become a strong government commitment to pursuing fraud in the Medicare...

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted  07/26/19
Laboratory sample vial lying on procedure coding form
Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states.  CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid.  As part of the settlement, they will pay $425,000USAO CT

July 10, 2019

Rural Metro of Southern Ohio, Inc. has agreed to pay $275,116 to resolve allegations of submitting, or causing the submission of, false claims to Medicare.  In a qui tam suit brought by Nicholas Ratterman, a former employee, Rural Metro was alleged to have billed Medicare for medically unnecessary overnight hospital discharge ambulance transports between 2013 to 2017.  As part of the settlement, Ratterman will receive about $44,000.  USAO EDKY

July 9, 2019

Two chiropractors who owned the Kansas City Health and Wellness Clinic have agreed to pay $350,000 to settle False Claims allegations.  Brothers Ryan Schell and Tyler Schell allegedly billed Medicare for medically unnecessary, unprovided, or uncovered treatments of peripheral neuropathy, which causes loss of sensation and/or burning sensations in the hands and feet.  USAO KS

July 2, 2019

For allegedly violating the False Claims Act, mental health nonprofit Wisconsin Community Services, Inc. (WCS) has agreed to pay $537,904 to the United States and the State of Wisconsin.  WCS voluntarily disclosed that one of its pharmacists had billed Medicare and Medicaid for brand name medications over several years, even though generic medications had been dispensed.  USAO EDWI

June 27, 2019

Following a whistleblower suit, Fusion Physical Therapy and Sports Wellness, P.C., and its founder and CEO, Carolyn Sue Mazur, have agreed to pay $37,500 to settle charges of billing Medicare for physical therapy services performed by uncredentialed personnel.  In addition the monetary penalty, Fusion and Mazur have also admitted to the misconduct.  USAO SDNY

June 27, 2019

Anne Arundel Medical Center (AAMC) has settled with the United States for alleged submissions of false claims to Medicare, TRICARE, and the Federal Employees Health Benefits Program.  In a whistleblower suit by former AAMC employee Barbara McHenry, the Maryland-based hospital was accused of billing for medically unnecessary Evaluation and Management (E/M) services from 2010 to 2013, and doubled billing for E/M services from 2014 to 2017 despite a 2014 update from CMS.  As part of the settlement, AAMC will pay $3 million and comply with a five-year Corporate Integrity Agreement, and McHenry will receive $473,100.  USAO MD
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