Medical Billing Fraud Archives - Page 20 of 52

September 5, 2019

Dentist Santa Maria McKibbens has agreed to pay North Carolina $375,000 to resolve allegations that she submitted false claims to the North Carolina Medicaid Program by billing for dental restorations that were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy. NC

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

Is Data the Future of Whistleblowing?

Posted 08/28/19

Two recent decisions, one in California and the other in Texas, might be signaling a new frontier in False Claims Act (FCA) litigation: the data-driven whistleblower. Both cases are brought by the same whistleblower, Integra. Integra is not a typical whistleblower, which are generally corporate insiders or other employees of a company that is accused of defrauding the government. Instead, Integra is a corporation that...

Tagged in: FCA Federal, FCA State, Hospital Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, Public Disclosure and Public Information, Whistleblower Case, Whistleblower Eligibility,

August 16, 2019

Kentucky-based Ultimate Care Medical Services, LLC, doing business as Ultimate Treatment Center, and its principal, Dr. Rose O. Uradu, have agreed to pay $1.4 million to resolve allegations that they submitted false claims to Mediare and Kentucky's Medicaid program for services that were not provided. Defendants billed for "evaluation & management" services when patients visited the clinic to receive methadone, visits which did not include a medical examination, which is required to bill for evaluation & management. In addition, defendants billed for complex urine drug testing when they lacked the equipment to perform such testing, and issued buprenorphine prescriptions at an rate greater than authorized. USAO ED KY

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

DOJ Catch of the Week — Beaver Medical Group

Posted 08/9/19

Yesterday, California-based Beaver Medical Group and one of its physicians, Dr. Sherif Khalil, agreed to pay roughly $5 million to resolve allegations they violated the False Claims Act by reporting invalid diagnoses to Medicare Advantage plans causing those plans to receive inflated payments from Medicare. It is the latest example of what has become a strong government commitment to pursuing fraud in the Medicare...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted 07/26/19

Laboratory sample vial lying on procedure coding form

Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states. CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...

Tagged in: Anti-Kickback and Stark, Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,

July 23, 2019

The owners of Pennsylvania-based E-Z Pharmacy II, Darshan Bapa Inc. and Natverbhai Patel, have agreed to pay $400,000 to resolve their liability under the False Claims Act. E-Z Pharmacy allegedly billing Medicare for prescription drugs that were never dispensed. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Pharma Fraud,

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid. As part of the settlement, they will pay $425,000. USAO CT

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

July 10, 2019

Rural Metro of Southern Ohio, Inc. has agreed to pay $275,116 to resolve allegations of submitting, or causing the submission of, false claims to Medicare. In a qui tam suit brought by Nicholas Ratterman, a former employee, Rural Metro was alleged to have billed Medicare for medically unnecessary overnight hospital discharge ambulance transports between 2013 to 2017. As part of the settlement, Ratterman will receive about $44,000. USAO EDKY

Tagged in: Ambulance, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

July 9, 2019

Two chiropractors who owned the Kansas City Health and Wellness Clinic have agreed to pay $350,000 to settle False Claims allegations. Brothers Ryan Schell and Tyler Schell allegedly billed Medicare for medically unnecessary, unprovided, or uncovered treatments of peripheral neuropathy, which causes loss of sensation and/or burning sensations in the hands and feet. USAO KS

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

July 2, 2019

For allegedly violating the False Claims Act, mental health nonprofit Wisconsin Community Services, Inc. (WCS) has agreed to pay $537,904 to the United States and the State of Wisconsin. WCS voluntarily disclosed that one of its pharmacists had billed Medicare and Medicaid for brand name medications over several years, even though generic medications had been dispensed. USAO EDWI

Tagged in: Drug Switching, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Pharma Fraud,

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