Medical Billing Fraud Archives - Page 24 of 52

February 21, 2019

Hooshang Poor, a doctor of geriatric medicine based in Newton, Massachusetts, has agreed to pay $680,000 to resolve claims under the False Claims Act that he knowingly submitted inflated charges to Medicare and the Massachusetts Medicaid program. Dr. Poor was alleged to submit bills with false procedural codes that overstated the length, extent, and scope of services that he furnished to nursing home residents, and misrepresented services provided by non-physician employees. USAO Mass.

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

February 19, 2019

Xerox Corporation will pay $236 million to the State of Texas to resolve claims that the company and its subsidiary Conduent, which provided services to the Texas Medicaid program, improperly approved requests for orthodontic procedures without ensuring that the procedures met Medicaid program requirements. As a result, the state paid for orthodontic work that was unnecessary or did not meet program requirements. Texas

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

February 13, 2019

Ashraf Hasan-Hafez and Ilya Kogan have been sentenced to over three years in prison for their participation in a scheme that defrauded Medicare and New York State Medicaid out of $1.3M dollars. Hasan-Hafez, the owner of a physical therapy practice, and Kogan, the owner of an acupuncture company, fraudulently submitted bills for services that were not rendered, or for services performed by unlicensed individuals. In addition to jail time, Hasan-Hafez and Kogan have been ordered to forfeit $1,297,000 in restitution to the Medicare and Medicaid programs. DOJ

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

February 12, 2019

Jefferson Medical Associates, a Laurel-based physicians group, and neurologist, Dr. Aremmia Tanious, will pay the United States $817,635.06 to settle allegations under the False Claims Act regarding Medicare overpayments. The government’s investigation discovered that from 2012 to 2014, Jefferson Medical Associates and Dr. Tanious allegedly did not return overpayments they received on claims from Medicare. It is further alleged that from February 1, 2013, through June 30, 2017, Jefferson Medical Associates and Dr. Tanious allegedly used multiple medical codes when billing Medicare but the medical documentation did not support those billing practices. DOJ

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

February 8, 2019

Two executives from the South Carolina Early Autism Project (SCEAP) have been convicted of causing false statements to be submitted to Medicare and TRICARE and causing them to be overcharged by millions of dollars. According to statements by SCEAP employees, co-founder Ann Davis Eldridge and executive Angela Breitweiser Keith instructed employees to include travel and wait time in their billing in order to inflate time spent providing services. To further incentivize this practice, they implemented billing goals that had to be met in order to qualify for bonuses such as gift cards and vacations, all paid for by the company. Since then SCEAP has repaid almost $9 million, and as part of their plea agreement, both Keith and Eldridge will serve 1-year sentences. USAO SC

Tagged in: Healthcare Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

February 7, 2019

Six people associated with a string of substance abuse treatment centers have been indicted for defrauding Ohio's Medicaid program of over $31 million. Ryan Sheridan, the owner and operator of the businesses, along with Jennifer Sheridan, Kortney Gherardi, Lisa Pertee, Thomas Bailey, and Arthur Smith, allegedly submitted claims that were false on a number of fronts, including but not limited to: billing without proper documentation, for medically unnecessary services, provided by unqualified persons, and upcoded to a more costly service. Altogether, 134,744 false claims were submitted for more than $48.5 million in services. USAO NDOH

Tagged in: Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Upcoding,

February 6, 2019

Families United Services, Inc. (FUS) and owner Pamela McKenzie have agreed to pay $645,000 to settle allegations of defrauding Georgia's Medicaid program from 2010 to 2012 by submitting claims for unprovided mental health services. As part of the settlement, FUS has been excluded from participating in federal healthcare programs for a period of five years. USAO NDGA

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

February 5, 2019

Two doctors from the Florida-based Fishman & Sheridan Eye Care Specialists clinic have agreed to pay a combined $157,312.32 to settle their liability under the False Claims Act. Drs. Craig D. Fishman and Jeffrey A. Sheridan were outed in a qui tam complaint filed by former business partner Dr. Michael Pennachio and office manager Sharon Drake, which alleged that from 2011 to 2017, Fishman and Sheridan knowingly billed Medicare for blepharoplasty and ptosis repair surgeries that were purportedly performed on the same patients, even though they are mutually exclusive eyelid repair surgeries. For exposing the fraud, Pennachio and Drake will receive a relator's share of $26,000. USAO MDFL

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

January 28, 2019

East Cost Stepping Stones, Inc., a behavioral services provider based in Jacksonville, Florida, has agreed to pay $360,000 to resolve allegations under the False Claims Act. The company was alleged to have falsely billed TRICARE for applied behavioral analysis therapy services for children with autism by misrepresenting the services provided and who provided them, failing to document services as required, and fabricating and altering medical records. USAO MDFL

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

January 15, 2019

New York has reached a $9 million settlement with Diamond Braces, a chain of dental offices, and its principal Oleg Drut, DDS, for false claims Diamond made to NY's Medicaid program for orthodontic procedures that were performed by personnel who were not certified to perform the work they did as required by NY state law. NY

Tagged in: Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud,

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