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Medical Billing Fraud

This archive displays posts tagged as relevant to medical billing fraud. You may also be interested in our pages:

Page 21 of 52

June 27, 2019

Following a whistleblower suit, Fusion Physical Therapy and Sports Wellness, P.C., and its founder and CEO, Carolyn Sue Mazur, have agreed to pay $37,500 to settle charges of billing Medicare for physical therapy services performed by uncredentialed personnel.  In addition the monetary penalty, Fusion and Mazur have also admitted to the misconduct.  USAO SDNY

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

June 27, 2019

Anne Arundel Medical Center (AAMC) has settled with the United States for alleged submissions of false claims to Medicare, TRICARE, and the Federal Employees Health Benefits Program.  In a whistleblower suit by former AAMC employee Barbara McHenry, the Maryland-based hospital was accused of billing for medically unnecessary Evaluation and Management (E/M) services from 2010 to 2013, and doubled billing for E/M services from 2014 to 2017 despite a 2014 update from CMS.  As part of the settlement, AAMC will pay $3 million and comply with a five-year Corporate Integrity Agreement, and McHenry will receive $473,100.  USAO MD

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

June 26, 2019

The Trustees of the University of Pennsylvania Health System have agreed to pay $275,000 to settle allegations of submitting false claims to Medicaid in violation of the False Claims Act.  During a seven month period in 2017, the health system’s Lancaster General Hospital allegedly billed Medicaid for interpretations of obstetric ultrasounds despite its physicians failing to complete those reports in a timely manner.  In about 10% of the cases, the reports were not completed until more than 90 days after the ultrasound was performed, rendering them useless.  USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medical Billing Fraud,

June 20, 2019

Hart to Heart Ambulance Services, d/b/a Hart to Heart Transportation Services, has agreed to pay $1.25 million to settle allegations that it defrauded Medicare by submitting claims for medically unnecessary services, violating the False Claims Act.  Allegations were first brought to the government’s attention by former employee, Bryan Arvey, who alleged that from 2010 to 2017, Hart to Heart management pressured employees to falsify claims for non-emergency ambulance transports, such as hospital discharges.  For aiding in the recovery of public funds, Arvey will receive a share of $251,000.  USAO MD

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

Question of the Week — Should providers who defraud Medicare be excluded from it?

Posted  06/18/19
Fortune Cookie with Message with Message Saying "Not Eligible for Medicare!"
Sometimes, though rarely, when a medical provider settles a False Claims Act case or is found to have violated the FCA at trial, they are excluded from participating in healthcare programs as a condition of resolving the case. Often, this is a limited-time ban that is meant to incentivize providers to follow Medicare’s rules in the future and to deter other providers from committing fraud. Between Medicare,...

Tagged in: FCA Federal, Medical Billing Fraud, Medicare, Question of the Week, Upcoding,

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May 17, 2019

Dr. Donald Douglas, the physician owner of three healthcare clinics in Texas, has agreed to pay $118,000 to resolve allegations of improperly billing Medicare at the physician rate for services performed by advance practice nurses (“APNs”) without direct physician supervision.  Under Texas law, APN-provided services performed with physician supervision may be billed to Medicare at the full physician rate.  USAO EDTX

Tagged in: Healthcare Fraud, Medical Billing Fraud, Medicare,

Skyline Urology - Healthcare Fraud ($2.1 million)

Constantine Cannon represented a whistleblower in a False Claim Act case alleging Skyline Urology misused a billing code to increase reimbursements from Medicare and private insurers in California.  In February 2019, the company agreed to pay roughly $2.1 million to settle the matter. Our client received a whistleblower award of roughly 18% of the government's recovery.  Read more -- NLR, Becker's, DOJ, CC.

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 9, 2019

Paul J. Mathieu and Hatem Behiry were found guilty for their part in a $30 million scheme to defraud Medicare and the New York State Medicaid program. Between 2007 and 2013, Mathieu falsely posed as an owner of three medical clinics (the “Clinics”) in Brooklyn. During that time, the Clinics fraudulently billed Medicare and Medicaid for medical services and supplies that were not necessary, or were not even provided. Furthermore, Mathieu did not see any patients at that time. Instead, he falsified large stacks of bogus medical records in which he stated that he did see and treat those patients. Behiry, a physical therapy doctor, also participated in the Clinic’s fraudulent billing practices by pretending to provide physical therapy services to patients. Mathieu and Behiry have not yet been sentenced. DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare,

May 8, 2019

Tea Kaganovich and Ramazi Mitaishvili, co-owners of New York Diagnostic Testing Centers, each pleaded guilty to health care fraud and conspiracy to defraud the lawful functions of the Internal Revenue Service (IRS). The couple submitted false health care claims for diagnostic testing services and paid over $18 million in kickbacks for the referral of beneficiaries who signed up for diagnostic testing and other alleged medical services. They fraudulently reported to the IRS that the illegal kickback payments were valid business expenses, thus causing relevant tax forms to under-report business income and claim deductions. DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud, Tax Fraud,

May 6, 2019

Acadia Healthcare Company, Inc., which operates outpatient drug treatment centers in West Virginia through its subsidiary CRC Health, L.L.C., will pay $17 million to resolve claims that it improperly billed the state's Medicaid program for urine and blood testing services as if they had performed the testing themselves, despite the fact that Acadia lacked the certification to perform the tests.  In fact, the testing was performed by an independent outside laboratory, and that lab independently billed Medicaid for the tests, at a lower rate. Medicaid paid Acadia’s treatment centers $8,500,000 for the improperly-billed tests.  As part of this settlement, defendants also entered into a five-year corporate integrity agreement to maintain specified compliance programs and procedures.  USAO SDWV

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud,

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