Medical Billing Fraud
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November 13, 2019
The Louisiana Department of Health, which manages Louisiana’s Medicaid program, will pay $13.42 million to the federal government to resolve allegations that the state submitted false claims for federal share reimbursement of state Medicaid expenditures for long-term nursing care and hospice care. The federal government alleged that in anticipation of a reduction in federal payments for such services, the state agency directed its healthcare contractor, Molina Medical Solutions, to pre-bill for nursing home and hospice services in order to receive funds at the existing higher rates. DOJCatch of the Week: Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors
Posted 10/30/19
October 29, 2019
Encompass Health Corporation (EHC), f/k/a HealthSouth Corporation, has agreed to pay $4 million to resolve of improperly billing Medicare. According to the DOJ, between 2008 and 2012, an inpatient rehabilitation facility owned by EHC had improperly assigned low Functional Independence Measure scores on Patient Assessment Instrument forms in a bid to receive higher reimbursements from Medicare. USAO NVOctober 29, 2019
A former resident of Atlanta has been sentenced to 1.5 years in prison and ordered to pay $306,179 in restitution for defrauding PERACare, the Colorado Public Employees Retirement Association’s health insurance plan. For more than two years, Michael Bang allegedly submitted fraudulent reimbursement claims involving three Atlanta-area pharmacies to Express Scripts, which administers PERACare’s prescription benefits. Altogether, his scheme netted him over $300,000. USAO NDGACatch of the Week: Osteo Relief Institutes, Pedaling Dubious Treatment for Arthritis, Tagged for Charging Medicare for Medically Unnecessary Services
Posted 10/25/19
October 17, 2019
Five home health providers in Iowa and South Dakota have been ordered to pay a combined $3.1 million for submitting false claims to Medicare. Affiliates of Minnesota-based Welcov Healthcare LLC allegedly billed Medicare for therapy services that were not provided by skilled employees or not medically necessary. Sergeant Bluff Healthcare, LLC will pay over $1.2 million, Logan Healthcare, LLC and Elk Point Healthcare #1, LLC will each pay over $775,000, Red Oak Healthcare, LLC will pay over $228,000, and Flandreau Healthcare 2, LLC will pay about $116,000. USAO NDIAOctober 15, 2019
Otolaryngologist Dr. Tracey Wellendorf has agreed to pay $1 million to resolve allegations of violating the False Claims Act in at least 115 procedures billed to Iowa Medicaid. The alleged misconduct occurred between 2014 and 2015 and involved endoscopic sinus surgeries that were either medically unnecessary or incorrectly coded. USAO NDIACatch of the Week: Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M
Posted 10/11/19
