Medical Billing Fraud Archives - Page 2 of 52

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,

December 15, 2022

A physician and his Connecticut-based urgent care practices have agreed to pay over $4.2 million to settle allegations of submitting false claims to Medicare and the Connecticut Medicaid program. Jasdeep Sidana—the owner and CEO of Docs Medical Group, Inc., Docs Medical Inc., Docs Urgent Care LLP, Lung Docs of CT, P.C., Epic Family Physicians, LLP, and Continuum Medical Group, LLC (collectively, DOCS)—allegedly billed for immunotherapy services, including allergy testing and treatment, that were not medically necessary and not directly supervised by a physician. Additionally, the defendants allegedly billed for COVID test administration using codes for more complex evaluation and management (“E&M”) services. USAO CT

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Upcoding,

November 14, 2022

The Florida Birth-Related Neurological Injury Compensation Association and a related entity, which were created by the State of Florida to provide compensation for the medical, rehabilitative and custodial care of children who suffered certain categories of birth-related neurological injuries, will pay $51 million to resolve a whistleblower’s qui tam lawsuit, pursued on a non-intervened basis, alleging that they fraudulently caused NICA participants to submit their healthcare claims to Medicaid rather than NICA, in violation of Medicaid’s status as the payer of last resort under federal law. The relators, Veronica Arven and the estate of Theodore Arven III, will receive $12,750,000 as their share of the recovery. DOJ

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

October 31, 2022

Felix Amos of Houston, TX will serve 30 months in federal prison and will pay over $21 million in restitution for his role in a Medicare fraud scheme carried out with two other co-defendants. From 2010 to 2015, Amos owned and operated home health companies Dayton Health Bridges, Access Practical Solutions, Advanced Holistic, GetUpandWalk Inc., and Guaranty Home Health Agency. Amos and his co-conspirators submitted false claims to Medicare for patients that did not need or receive services, including deceased or incarcerated persons, and for services not ordered by a physician. USAO SDTX

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

September 27, 2022

Following a whistleblower complaint that alleged Massachusetts-based Public Consulting Group LLC (PCG) overbilled Medicaid, in violation of the False Claims Act, the company has agreed to pay $2.5 million. According to whistleblower Shane Shackford, PCG caused local school districts to submit false claims to Medicaid while under contract with the State of New Jersey to administer its Special Education Medicaid Initiative (SEMI) program—which provides federal funding to the state and local school districts for providing certain medical services to eligible students. For his role in the case, Shackford will received a 21% share of the settlement. USAO NJ

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

August 18, 2022

The organized healthcare system for Ventura County, as well as three healthcare providers, have agreed to pay a combined total of $70.7 million to resolve allegations of violating the California and federal False Claims Acts in connection with Medi-Cal’s Adult Expansion program, which extended coverage to previously uninsured adults without dependents. Gold Coast Health Plan, Dignity Health, Clinicas del Camino Real, Inc., and Ventura County (the owner and operator of Ventura County Medical Center) allegedly submitted, or caused to be submitted, bills for unallowed expenses, bills for “Additional Services” that were duplicative of services already required, and bills with pre-determined costs that weren’t reflective of fair market value. CA AG; USAO CDCA

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

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