Contact

Click here for a confidential contact or call:

1-212-350-2764

Medical Billing Fraud

This archive displays posts tagged as relevant to medical billing fraud. You may also be interested in our pages:

Page 1 of 36

February 4, 2020

Southeastern Retina Associates (SERA), which operates in parts of Tennessee, Georgia, and Virginia, has agreed to pay $1.5 million and enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services for allegedly defrauding Medicare and Medicaid.  The investigation was launched by a qui tam suit filed by an unnamed whistleblower, which alleged that between 2009 to 2016, the practice improperly billed exams at a higher rate than appropriate, and used a billing code called Modifier 25 to bill for exams that were not separately billable from other services billed the same day.  For exposing the misconduct, the relator in this case will receive a $270,000 share of the settlement.  USAO EDTN

January 15, 2020

TMJ & Orofacial Pain Treatment Centers of Wisconsin has agreed to pay $1 million to settle a qui tam suit alleging submissions of false claims to Medicare and TRICARE.  According to the anonymous whistleblower, who will receive an undisclosed share of the settlement, TMJ billed the government health programs for prosthetic devices as if they had been fabricated by in-house surgeons, when in fact they had been fabricated by an outside laboratory.  USAO EDWI

December 30, 2019

A defense contractor accused of submitting false claims on a contract with the U.S. Army has agreed to pay $3 million to resolve its liability.  Kansas-based LaForge & Budd Construction Company, Inc., had been tasked with raising the elevation of a dam at the Fort Sill Army Post in Oklahoma.  Although the contract specified that satisfactory fill be used, LaForge defied this by using materials such as pieces of concrete, rebar, and rubble, and then represented to the Army that it had fully complied with the contract's terms and conditions.  USAO WDOK

December 30, 2019

Medsurant Holdings, LLC, the nation's largest independent provider of Interoperative Neuromonitoring (IONM) services, has agreed to pay $1.9 million to settle allegations of defrauding Medicare.  According to the DOJ, from 2013 to 2016, Medsurant billed Medicare for IONM services—used to monitor patients’ nervous systems during high-risk surgeries—that were not provided exclusively to one patient or were concurrently provided to patients insured by private payors, in violation of Medicare rules as well as the False Claims Act.  USAO MDTN

December 20, 2019

Florida residents and married couple Rodolfo Pichardo and Marta Pichardo were sentenced to 15 years and 8 years, respectively, following earlier guilty pleas to healthcare fraud and wire fraud.  Defendants were also ordered to pay over $34 million in restitution. The Pichardos ran a network of home health agencies, pharmacies, and therapy staffing companies, that submitted more than $38 million in false claims to Medicare.  Defendants paid kickbacks to patient recruiters and medical clinics for patient referrals.  USAO SD FL

December 19, 2019

Nassir Medical Corp., which does business as the Cancer Care Institute, and its owner, Dr. Youram Nassir, have agreed to pay $3.4 million to resolve allegations that they violated the False Claims Act by billing Medicare and Medicaid for oncology drugs that were not actually purchased, dispensed, or administered, and for infusion services that were not actually provided.  The case was initiated by whistleblower Kenneth Bryan, who will receive a whistleblower reward of $475,000 from the federal government.  USAO CD Cal

December 17, 2019

Miracle Home Care, Inc. and its owner, Shashicka Tyre-Hill, have together been ordered to pay more than $10 million following judgment in an action under the False Claims Act finding that defendants defrauded Georgia’s Medicaid program.  In a civil complaint filed in July 2018, the federal government and State of Georgia alleged that Miracle Home Care submitted thousands of fraudulent reimbursement claims for medically unnecessary transportation and health services.  USAO SDGA

Sharp HealthCare — Medicare Fraud/Kickbacks (undisclosed settlement amount)

Three of our whistleblower attorneys represented a whistleblower in a qui tam action under the False Claims Act against Sharp HealthCare, a regional hospital system in San Diego.  Our client alleged that the Sharp Healthcare Center for Research, Sharp’s clinical-trial research arm, fraudulently billed government payers in violation of “secondary payer” rules that prohibit billing the government when other payers will pay for a patient’s care. Our whistleblower client also alleged that Sharp cultivated an illegal kickback scheme to entice prospective trial sponsors to host clinical trials at Sharp by regularly undervaluing Sharp’s costs involved in managing clinical trials.  By offering below-market value incentives and billing government and commercial insurers for injuries, the lawsuit alleged that Sharp sought to increase its attractiveness to trial sponsors. Sharp’s alleged purpose was to burnish the organization’s reputation and offer a lucrative stream of income for Sharp-affiliated physicians involved in clinical trials. Sharp settled the whistleblower’s case for an undisclosed amount.  Read more here.

December 10, 2019

Dr. Paul J. Mathieu and occupational therapist Lina Zhitnik have been sentenced to, respectively, 4 years and 1.2 years in prison, for their roles in a $30 million scheme to defraud Medicare and New York's Medicaid program.  Mathieu falsely posed as the owner of three medical clinics, which were actually owned by Aleksandr Burman, and Mathieu and Zhitnik falsely claimed to have treated thousands of patients at those clinics.  Over six years, Mathieu prepared or assisted in the preparation of false and fraudulent medical charts, issued referrals for expensive and unnecessary additional testing by providers also participating in the scheme, and wrote prescriptions for unnecessary medical supplies that were filled by a company also owned by Burman.  Another doctor participating in Burman's scheme, Ewald J. Antoine, was previously sentenced.  USAO SDNY

November 22, 2019

Ave Maria Family Practice PLLC and its principal, Dr. Dorothy Agbafe-Mosley, have agreed to pay $1.25 million to the State of North Carolina to resolve claims that they falsely billed the state's Medicaid program for addiction treatment services allegedly provided to Medicaid beneficiaries.  In fact, the services were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy.  NC
1 2 3 36

Newsletter

Subscribe to receive email updates from the Constantine Cannon blogs

Sign up for: