Medical Billing Fraud Archives - Constantine Cannon

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,

June 29, 2023

Three healthcare providers—Community Health Centers of the Central Coast, Cottage Health System, and Sansum Clinic—and a California public health agency, CenCal Health, have agreed to pay a total of $68 million to settle allegations of submitting false claims to the state’s Medicaid program, in violation of state and federal False Claims Acts. The defendants allegedly took advantage of a federal expansion of Medi-Cal coverage for previously uninsured adults by submitting duplicative or unallowed claims. CA AG; DOJ

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

Catch of the Week: Vascular Surgeon Pays Over $60 Million for Defrauding Health Care Programs

Posted 05/26/23

This week's Department of Justice (DOJ) "Catch of the Week" goes to Michigan vascular surgeon Vasso Godiali. Yesterday, DOJ announced he was sentenced to 80 months in prison "for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of vascular stents and for thrombectomies that he did not perform." In addition to the jail time, Dr. Godiali also has to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

May 25, 2023

Vascular surgeon Vasso Godiali of Michigan has been ordered to pay $19.5 million in restitution and serve over 6 years in prison to resolve criminal allegations of defrauding Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. Godiali also agreed to pay up to $43.4 million to resolve civil allegations of violating the False Claims Act. Although Godiali allegedly began submitting false claims in 2009, his misconduct did not come to light until a 2015 qui tam suit by Innovative Solutions Consulting LLC, which alleged Godiali billed government programs for arterial thrombectomies and stent placements that were not medically necessary and not actually performed. Additionally, Godiali allegedly falsified medical records to justify the procedures, and improperly used a modifier code to increase his reimbursements. DOJ

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

April 28, 2023

Joyce Agu, of Sugar Land, TX, will spend 60 months in prison and will pay over $3 million in restitution for conspiring to pay and receive kickbacks for services billed to Medicare. Agu paid others to certify that her clients were eligible for home health services, which they were not, but she used the certifications anyway as a basis to submit false claims to Medicare. TX AG

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

April 20, 2023

Dr. Paul S. Koch, Koch Eye Associates, and Claris Vision violated the False Claims Act by paying kickbacks to optometrists who referred their patients to Koch and his companies for laser-assisted cataract surgery. Over a five-year period, from 2013 to 2017, Koch and his practices submitted false claims to Medicare based on those kickbacks. Koch will pay nearly $1.2 million to resolve the qui tam whistleblowers’ claims, and the two whistleblowers will receive $256,534.84 from the settlement. USAO RI

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 14, 2023

Nine defendants will spend a combined 70 years in prison for their respective roles in a $126 million compounding fraud scheme. The co-conspirators defrauded the Department of Labor’s Office of Workers’ Compensation Programs and TRICARE by submitting false claims and paying kickbacks to patient recruiters and physicians for prescribing certain medications, based not on medical necessity but instead on the drugs’ hefty reimbursement rates. The patients received the compounded medications via mail, despite never requesting, wanting, or needing them. DOJ

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Pharma Fraud, Provider Fraud,

March 27, 2023

Laboratory Corporation of America (“Labcorp”) has agreed to pay $2.1 million to settle a lawsuit by former employee Donna Hecker-Gross, who alleged that Labcorp overbilled the Department of Defense for genetic tests performed by a third party. Under a 2012 contract, Labcorp was to perform laboratory testing for military treatment facilities worldwide, but certain specialized tests would be performed by subcontractor GeneDx. However, when billing the Department of Defense for tests performed by GeneDx, LabCorp allegedly overcharged for them, double or triple billed for them, or billed for them even in the absence of evidence the tests were ever performed. For initiating a successful enforcement action, Hecker-Gross will receive a $357,000 relator’s share. USAO MD

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

March 20, 2023

Acute care hospital Luminis Health Doctors Community Medical Center, Inc. (“DCMC”) and radiology imaging practice Diagnostic Imaging Associates, LLC (“DIA”) have agreed to pay $2 million to resolve allegations of defrauding federal healthcare programs. Because DCMC’s outpatient cancer screening facility was not enrolled in Medicare and Medicaid and was thus not eligible for reimbursements, it entered into a written agreement with DIA whereby DIA would bill the programs for services performed by DIA as well as DCMC’s outpatient cancer screening facility, in violation of program rules and the False Claims Act. The alleged misconduct occurred between 2010 and 2020. USAO MD

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

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