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Medical Billing Fraud

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Page 26 of 52

November 8, 2018

Renee Christine Borunda of Greensboro, North Carolina, was sentenced to prison and ordered to make restitution to the North Carolina Medicaid program for conduct that defrauded Medicaid.  Borunda, who worked for a behavioral health services provider, used a therapist's personal information to submit false bills for behavioral services, claiming that services were provided to over 200 different Medicaid recipients when no such services were rendered.  USAO EDNC; NC

Tagged in: Criminal Proceedings, Medicaid, Medical Billing Fraud, Provider Fraud,

November 7, 2018

Convicted of defrauding the Medicare program, former Houston-area healthcare clinics owner Joy Aneke was sentenced to 36 months in federal prison and ordered to pay $2,760,464.57. Aneke submitted false claims for medical services that were either not performed or not authorized by a licensed physician. None of Aneke’s clinics even had equipment necessary to provide the services -- allergy testing, complex cystometrograms, anal/urinary muscle studies, and others -- for which Aneke billed Medicare. Additionally, Aneke used “recruiters” or “marketers” to encourage patients to visit her clinics, and instructed co-defendant Maureen Henshall to pay patients illegal kickbacks. DOJ  

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

November 6, 2018

An Indiana-based dental care practice and admin support company have agreed to pay a total of $5.139 million to settle allegations they violated the federal and Indiana state False Claims Acts. According to whistleblower and qui tam plaintiff Dr. Jihaad Abdul-Majid, between 2009 and 2013, ImmediaDent of Indiana, LLC and Samson Dental Partners, LLC allegedly billed Indiana's Medicaid program for procedures that were either upcoded (i.e. represented to be more serious and more expensive than they actually were), were not actually performed, or were not medically necessary. Samson Dental Partners is additionally accused of violating Indiana’s law prohibiting the corporate practice of dentistry. Because the companies refused oversight proposed during settlement, they have now been classified as "high risk" to federal healthcare programs. IN AG; USAO WDKY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

October 30, 2018

Four people connected to a Texas-based home health agency have been found guilty of fraudulently obtaining $3.7 million in reimbursements from Medicare and Medicaid. Despite being previously banned from participating in any federal healthcare reimbursement programs, Celestine Okwilagwe and Paul Emordi co-owned and operated a Medicare and Medicaid provider in the Dallas area called Elder Care. Adetutu Etti, the provider's administrator, was recruited to falsely certify that someone else was the owner, and Okwilagwe's wife, Loveth Isidaehomen, was recruited to sign checks. Some of the claims that were eventually reimbursed by Medicare were also found to be for services that were not medically necessary. DOJ

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

October 25, 2018

Passavant Memorial Homes and its pharmacy subsidiaries have agreed to pay $1,850,000 to resolve allegations that it billed federal healthcare programs, including Medicare and Medicaid, for improperly prescribed controlled substances, in violation of the False Claims Act and Controlled Substances Act. While the controlled substances were prescribed for a legitimate medical purpose, they were not deemed valid with only a doctor's order by Medicare and Medicaid rules. The company later self-disclosed to the government and has since changed its policy to comply with these rules. USAO EDPA; USAO WDPA

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

October 24, 2018

The owners and operators of two community mental health clinics in Pennsylvania and North Carolina have entered into a $3 million consent judgment with the United States to resolve allegations of violating the False Claims Act. In 2000, Melchor Martinez was convicted of Medicaid fraud by the State of Pennsylvania and subsequently banned from owning and operating health clinics or seeking reimbursement from all federally funded healthcare programs. Despite this, he allegedly continued to own and operate three chains of mental health clinics—including Northeast Community Health Centers, Lehigh Valley Community Mental Health Centers, and Carolina Community Mental Health Centers—by enlisting the help of his wife, Melissa Chlebowski, to act as the true owner and operator. In addition, the two allegedly failed to operate according to rules set by Medicare and Medicaid, including seeing patients for only 2-3 minutes and billing for 15, and billing for services provided by unqualified staff. They were eventually outed in a qui tam lawsuit filed by a former employee. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Case,

October 23, 2018

Eye Centers of Florida, owned by Dr. David C. Brown, has agreed to pay $525,000 to settle claims of that it knowingly falsified the medical records of certain Medicare patients in order to submit qualifying reimbursement claims. In violation of the False Claims Act, Eye Centers allegedly altered the paperwork to make it appear that patients had worse vision than they actually did, allowing Eye Centers to bill for cataract surgeries that would ordinarily not have been reimbursable. The case was revealed through a lawsuit filed by two former employees, Patti Nilsson and Joann Smith, who are set to receive $115,500 from the settlement. USAO MDFL

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

October 16, 2018

Two doctors and three nurses were sentenced to prison for their roles in fraudulently billing Medicare $11 million through claims submitted by two companies—Timely Home Health Services Inc., a home health provider, and Boomer House Calls, a house call provider, both in the Dallas area. The scheme allegedly took place from 2007 to 2015 and involved falsifying records so it appeared that Medicare beneficiaries received home health services when in fact they did not. The five defendants will serve sentences ranging from as little as 6 months to as much as 10 years in prison. DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medical Billing Fraud,

October 16, 2018

A Medicaid transportation provider, its president, and a driver have been sentenced to pay a $10,000 fine and serve 2-4 years in prison for stealing a total of $1.2 million from New York's Medicaid program. The driver who was sentenced, Haimid Thompson, was accused of paying a Medicaid recipient to enroll in services from his employer and submitting falsified logs showing daily trips on behalf of the recipient. He was ordered to pay $23,598. The company, 716 Transportation, Inc., was sentenced to a fine of $10,000, and the president, Wossen Ambaye was ordered to pay restitution of $900,497, for knowing the services billed were not actually provided. NY AG

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

October 9, 2018

The former CFO and COO of Houston-area Atrium Medical Center and Pristine Healthcare, Starsky Bomer, has been convicted for his role in a $16 million Medicare kickback scheme.  Bomer and others paid illegal kickbacks to group home owners and patient recruiters in exchange for the referral of Medicare patients for outpatient mental health treatment through the hospitals' partial hospitalization program (PHP).  While the hospitals billed Medicare $16 million for these patients, the evidence at trial demonstrated that Bomer knew that PHP services were not necessary for most of the patients, and that the patients were not, in fact, provided with such services.   DOJ

Tagged in: Anti-Kickback and Stark, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

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