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Medical Billing Fraud

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February 18, 2022

Muhammad Ateeq, of Rawalpindi, Pakistan, was sentenced to 12 years in prison and ordered to pay more than $50 million in restitution for forfeiture for submitting fraudulent claims to Medicare for home health services. Ateeq acquired and managed home health agencies in the United States, using false identities. He then used these home health agencies to submit fraudulent Medicare claims totaling over $40 million for services not rendered. The ill-gotten gains were laundered through U.S. bank accounts designated by overseas customers of overseas money transmitting businesses. Cash payments were then transmitted to accounts in Pakistan which Ateeq controlled. Fraud proceeds were also used to purchase luxury items which were delivered to Ateeq’s Dubai associates. DOJ

February 1, 2022

Two North Carolina medical providers will pay nearly $1.5 million combined for submitting false claims to the Medicaid program. Knowles, Smith, & Associates LLP will pay $1,150,000 to resolve allegations spanning five years of failure to monitor their anesthesia billing by not providing services billed, administering medically unnecessary procedures, or failing to maintain sufficient supporting documentation. Stacy Benton Lewis, M.D., and the Center for Women’s Health, P.A. will pay $340,000 to resolve false billing allegations covering a four-year period for submitting claims for complex visits that did not occur. NC DOJ

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Posted  01/14/22
cars in traffic
The U.S. Attorney this week announced the arrest of doctors, businesspeople, an attorney, a New York police officer, and several others in one of the largest no-fault automobile insurance fraud takedowns in history. The investigation leading to their arrest was conducted by the U.S. Attorney’s Office for the Southern District of New York, the FBI, and the Westchester County District Attorney’s Office.  The...

January 12, 2022

Six medical practices affiliated with Interventional Pain Management Center P.C. (IPMC), as well as physician-owner Dr. Amit Poonia, have agreed to pay nearly $7.5 million to resolve allegations of defrauding Medicare and the Federal Employees Health Benefit Program.  In a qui tam suit by Anu Doddapaneni and Christian Reyes, the whistleblowers alleged that Poonia and IPMC violated the False Claims Act by using a billing code that mischaracterized P-Stim and NeuroStim treatments—which transmit electrical pulses through needles placed just under the skin of a patient’s ear—as surgical implantation requiring anesthesia.  USAO EDNY

Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Top Ten Whistleblower Awards of 2021

Posted  01/6/22
Red Whistle with People
2021 was another banner year for whistleblowers, who once again collectively recovered billions of dollars for the government and hundreds of millions of dollars in whistleblower rewards under the various government whistleblower programs.  This includes awards under the qui tam provisions of the federal False Claims Act and various state False Claims Act programs.  It includes awards under the Dodd-Frank SEC...

December 15, 2021

David Bellamah, and his business, Bellamah Vein & Surgery, PLLC, will pay $3.75 million to resolve allegations that they billed government healthcare programs for medically unnecessary venous procedures based on false medical records.  Defendants allegedly used improper techniques to conduct and analyze ultrasounds and used false ultrasound findings to diagnoses and treat venous reflux disease and varicose veins. The government’s claims were initiated by the filing a qui tam complaint by Lenore Lezanne, who previously worked as a sonographer at the Bellamah Vein Center; Lezane will receive a whistleblower award of 17% of the amounts recovered.  USAO MT

December 13, 2021

Kevin Cooper, M.D. and his practice, Cooper Family Medical Center, will pay $375,000 to resolve allegations that they fraudulently billed Medicare of non-reimbursable acupuncture devices by using billing codes for surgically implanted devices for the provision of P-Stim electro-acupuncture devices that are affixed behind a patient’s ear using an adhesive.  USAO SD MI

December 7, 2021

New Jersey-based Princeton Pathology Services P.A. will pay $2.4 million to resolve allegations that it overbilled Medicare by submitting claims using a Current Procedural Terminology (CPT) code that required written analysis by a pathologist, when no such analysis was required or had been prepared.  A whistleblower, Jayant Barai, M.D., initiated the matter by filing a qui tam complaint under the False Claims Act, and will receive an award of $456,000USAO NJ

November 23, 2021

A number of related entities operating in Ohio and Tennessee as Crossroads Hospice have agreed to pay $5.5 million to resolve allegations that they submitted false claims for hospice services that were not covered by Medicare.  Specifically, the government alleged that over a period of three years, Crossroads submitted claims for dementia or Alzheimer’s patients who were not terminally ill for at least a portion of the more than three years that the patients received care.  Two qui tam actions were filed regarding the false claims; the three individuals who jointly filed the first action, Leanne Malone, Jackie Burns and Angela Heck, were previously employees of Crossroads, and will receive approximately $1.045 millionDOJ
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