Medical Billing Fraud Archives - Page 13 of 52

September 29, 2020

Laredo optometrist David Mora will pay $3.23 million and enter into a corporate integrity agreement to resolve claims that he submitted false claims to Medicare between 2013 and 2019. Mora allegedly billed for services including punctal plug insertion, sensorimotor testing, vision therapy, and amniotic membrane placement, where the patient’s condition did not warrant the service as medically necessary or reasonable. USAO SD TX

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

September 22, 2020

New Jersey biotechnology company Bio-Reference Laboratories, Inc., will pay $11.5 million to resolve two actions brought by whistleblowers alleging that defendant violated the Anti-Kickback statute by paying unlawful remuneration to physicians based on the volume of those doctors’ referrals to defendant. The remuneration took the form of payments for a percentage of the cost of electronic medical records software used by the doctors. In addition, defendant was alleged to have unlawfully billed Medicare and Tricare for testing performed on hospital inpatients, instead of billing the hospitals themselves. USAO SDNY

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud,

September 21, 2020

Neurosurgical Care LLC, its medical director Sagi Kuznits, and its practice director Pnina Kuznits, will pay over $1 million to resolve claims that they overbilled Medicare, TRICARE, and the Federal Employees Health Benefits Program, for the implantation of neuro-stimulators. Defendants improperly billed the non-surgical application of P-Stim and Stivax devices as surgical procedures, and improperly billed for the application of an eVox device which was not approved for Medicare reimbursement. USAO ED PA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Off-Label and Unapproved Use, Provider Fraud,

September 10, 2020

Shreveport Prosthetics, Inc. will pay $1.6 million to resolve claims in an action brought by the company’s former office administrator, Kimberly Throgmorton, under the qui tam provisions of the False Claims Act. The company was alleged to have submitted false bills to Medicare by using the supplier number of a different company after its own supplier number was deactivated, and by routinely waiving patient co-payments. Ms. Throgmorton will receive over $250,000 as a whistleblower reward. USAO WD LA

Tagged in: FCA Federal, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

September 9, 2020

Southern California radiology facility operators William M. Kelly Inc. and Omega Imaging Inc. paid $5 million to resolve claims initiated by a qui tam action under the False Claims Act filed by former employee Syd Ackerman. The action alleged that defendants submitted claims for CT scans and MRIs involving contrast injections that were not supervised by a physician as required by applicable program rules. The whistleblower will receive $925,000 of the settlement. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

September 3, 2020

Having previously pleaded guilty to healthcare fraud and related charges, Arizona urgent care provider UCXtra Umbrella, LLC, which did business as "Urgent Care Extra," was sentenced to pay restitution of $12.5 million. Defendant admitted that it ordered tests and procedures that were not medically necessary and that its billings intentionally overstated the complexity of services to patients in order to receive inflated reimbursements from private insurance companies. USAO AZ

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding,

August 21, 2020

A Georgia-based chiropractor and her medical practice have been ordered to pay more than $5 million for violating the False Claims Act. The government alleged that Dr. Jennifer Heller, D.C. caused Medicare to pay $1.4 million more than it would have had it known that hundreds of Heller’s charges for a surgical neurostimulator procedure were in actuality for acupuncture devices, which are not covered by Medicare, and which do not require surgery. To resolve the charges, Heller Family Medicine, LLC will have to pay $4.3 million, while Heller herself will have to pay $700,000. USAO SDGA

Tagged in: Chiropractic, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

August 11, 2020

The former owner of Texas-based All Smiles Dental Center has been ordered to pay $16.5 million to the State of Texas for improperly billing Texas Medicaid for tens of millions of dollars in services that he did not deliver, including services allegedly performed while he was vacationing abroad. In total, Dr. Richard Malouf was found to have committed 1,842 unlawful acts under the Texas Medicaid Fraud Prevention Act. AG TX

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

July 30, 2020

Computer Sciences Corporation (CSC), now known as DXC Technology, and New York City have agreed to pay approximately $2.8 million to resolve allegations of violating the federal and New York State False Claims Acts in connection with New York City’s Early Intervention Program (EIP), which provides speech and physical therapy services for infants and toddlers with possible developmental disabilities. According to a qui tam lawsuit, while retained by the City to process and submit its EIP claims to various insurers, CSC allegedly received permission from the City to categorize claims submitted to private insurers as “denied” if no response was received within 90 days. CSC then resubmitted those claims to Medicaid using an improper code, causing Medicaid to make payments it would not have otherwise. For revealing the misconduct, the unnamed whistleblower in this case will receive $416,250. AG NY; USAO SDNY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

July 23, 2020

Progenity, Inc., f/k/a Ascendant MDx, Inc., has agreed to pay a total of $49 million to resolve allegations that the California-based clinical laboratory submitted false claims to Medicaid, the VA, TRICARE, and the Federal Employees Health Benefits Program (FEHBP) through different fraudulent schemes. First, from 2012 to 2016, Progenity allegedly billed the programs for non-reimbursable prenatal tests using a reimbursable billing code. Second, in claims originally brought by a whistleblower under the False Claims Act, the company was alleged to violate the Anti-Kickback Statue by providing improper incentives to physicians—including paying above fair market value for blood specimen “draw fees”, providing tens of thousands of dollars in free food and alcohol, and routinely reducing or waiving co-insurance or deductibles—in order to induce physicians to order their tests. Approximately $35.9 million of the settlement proceeds will go toward resolving federal claims, with the remaining $13.1 million paid to different states. AG NC; USAO SDCA; USAO SDNY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud, Other Government Health Programs, Upcoding, Whistleblower Case,

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