Medical Billing Fraud
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December 2, 2020
The owner and operator of Atlanta-based Elite Homecare has been sentenced to over five years in prison and ordered to pay $999,999 in restitution for defrauding Medicaid of nearly $1 million. As a provider under the Georgia Pediatric Program (GAPP)—an in-home nursing program for Medicaid-eligible children with severe physical and cognitive disabilities—Diandra Bankhead allegedly submitted thousands of claims for services that were fraudulent in a myriad of ways. Some of the claims falsely represented that employees provided more than 24 hours of services in a given day to multiple children simultaneously (including to children whose families had not retained Elite, and by RNs who did not know their credentials were being used), while other claims contained fraudulent credentialing information and fraudulent supporting documentation, or were upcoded to induce higher payments from Medicaid. Additionally, Bankhead allegedly “sold” information about twenty of Elite’s former clients to another Atlanta-based home health provider in exchange for a percentage of the reimbursements from Medicaid. USAO NDGANovember 24, 2020
Florida-based Doctor’s Choice Home Care, Inc. and its founders and former top executives Timothy Beach and Stuart Christensen have agreed to pay a combined $5.15 million to settle qui tam suits filed under the False Claims Act by former employees—one by Corina Herbold, and the other by Sara Billings, Misty Sykes, and Marina Eschoyez-Quiroga. In violation of the Anti-Kickback Statute and the Stark Law, the home health agency had allegedly set up sham medical director agreements with physicians to pay them for referrals, linked employee bonuses to referrals made by physician spouses, and provided medically unnecessary services to Medicare patients in order to avoid decreased reimbursements triggered by fewer than five skilled service visits. To settle the allegations, Doctor’s Choice will pay over $4.5 million, while Beach and Christensen will pay $647,000 each. Billings, Sykes, and Eschoyez-Quiroga will jointly receive $145,000 of the settlement proceeds; Herbold’s share has yet to be determined. DOJ; USAO MDFLConstantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.
Posted 11/17/20
November 16, 2020
Seattle’s Group Health Cooperative, now part of Kaiser, will pay $6.375 million to settle allegations in a whistleblower suit that it falsely reported unsupported diagnosis codes to Medicare in order to receive inflated payments. The suit alleges that GHC utilized the services of a coding review company, DxID, that proposed unsupported diagnosis codes, which GHC knowingly submitted to CMS as part of seeking higher payment for the affected Medicare Advantage beneficiaries. Whistleblower Teresa Ross, represented by Constantine Cannon, will receive approximately $1.5 million. DOJOctober 23, 2020
Great Lakes Medical Laboratory, Inc. will pay $1.2 million to resolve claims that it overbilled for urine and blood sample testing in West Virginia and elsewhere, including by separately charging for tests that were already covered by other laboratory services billing, and by billing for tests that were not ordered and/or not actually performed. USAO SDWVOctober 22, 2020
Jerry Taylor of North Carolina has been sentenced to five years in prison and ordered to pay more than $6.1 million in restitution for his role in a $9.4 million fraud scheme targeting North Carolina’s Medicaid program. Along with his brother Tony and co-conspirators in Ohio and New York, Taylor submitted claims for behavioral health services benefiting local at-risk youth that were purportedly performed at companies he owned and operated with his brother, but that were in reality not actually performed or misrepresented in the claims. In addition to defrauding Medicaid, Taylor also evaded taxes by failing to report more than $1.6 million in reimbursements in 2016 and 2017. For those charges, Taylor will pay over $346,000 to the IRS. USAO WDNCOctober 16, 2020
Massachusetts home health agency Altranais Home Care, LLC and its owners, Constant Ogutt and Shakira Lubega, will pay $3.1 million to resolved claims that they submitted false claims to the state’s Medicaid program, MassHealth. According to the state, the defendants billed for services for which they did not have a physician-authorized plan of care. MassCatch of the Week: 345 Charged in $6 Billion National Health Care Fraud and Opioid Takedown
Posted 10/2/20
