Medical Billing Fraud
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October 3, 2019
Counselor Valerie Williams and her business, Circle of Life Transition Center, LLC, will pay $45,500 to resolve claims that they submitted false claims to the Connecticut Medicaid program, representing that services had been provided by Williams when, in fact, those services had been provided by unlicensed individuals. USAO CTSeptember 26, 2019
The Biomedical Research Foundation of Northwest Louisiana, together with related entities and the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College, which operate University Health Hospital in Shreveport, Louisiana, will pay $530,000 to resolve claims that they submitted improper claims for implantable automatic defibrillators. To be reimbursed for the procedures, Medicare requires providers and hospitals to submit data regarding them to a qualified registry, so that the procedures can be further studied; University Health Hospital failed to make the required data submissions. The investigation was initiated by a qui tam lawsuit filed by a whistleblower under the False Claims Act. USAO WD LASeptember 19, 2019
Selma, Alabama hospital Vaughan Regional Medical Center, together with two of its ER physicians and an affiliated company, will pay $1.45 million to resolve allegations that they violated the False Claims Act by having medical residents who were not fully licensed and credentialed provide emergency room services. The hospital then falsified medical records and submitted claims to Medicare as if the services had been provided by a licensed physician. The case originated with a qui tam action filed by Dr. Samuel Clemmons, who will receive $275,000. USAO SD ALCatch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud
Posted 09/18/19
September 17, 2019
Physician Alliance Ltd. (PAL) and its medical director agreed to pay $178,000 to resolve False Claims Act allegations for improperly billing Medicare for providing patients with electric acupuncture medical devices that is affixed behind patients' ears. Since Medicare does not reimburse for acupunctural devices, PAL allegedly billed Medicare for the “implantation of neurostimulator electrodes,” a procedure that requires surgery and for which Medicare reimburses in the thousands of dollars. The case was investigated out of the Eastern District of Pennsylvania. DOJSeptember 17, 2019
Physician Alliance Ltd. and Richard Frey, D.O. will pay $178,400 to resolve allegations that they submitted false claims to Medicare. When defendants provided patients with "P-Stim" devices, which are worn on a patient's ear and marketed as an acupuncture treatment, they billed Medicare for the implantation of neurostimulator electrodes, which is a surgical procedure for which Medicare reimburses thousands of dollars. By contrast, Medicare does not reimburse for acupuncture or acupuncture devices. USAO EDPACatch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ
Posted 09/13/19
