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Medical Billing Fraud

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Page 27 of 52

September 26, 2018

A Connecticut-based doctor, Helar Campos, has agreed to pay $99,912 to settle claims of violating the False Claims Act. The alleged fraud occurred over a span of three years from 2009 to 2012 and involved upcoding claims for doctor visits to Medicare and Medicaid. USAO CT

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

September 26, 2018

Health Management Associates, LLC (HMA)—now part of Community Health Systems Inc. (CHS)—has agreed to pay a combined $260 million to settle civil and criminal charges of defrauding Medicare, Medicaid, and TRICARE and violating the Anti-Kickback Statute, the Stark Law, and False Claims Act. The alleged fraud was revealed by eight whistleblowers and involved paying kickbacks to doctors for patient referrals, pressuring doctors to meet emergency patient admission quotas, billing outpatient or observational services as inpatient services, and inflating the cost of emergency services. The eight whistleblowers have been granted a combined $27 million award so far. DOJ; USAO EDPA; USAO SDFL; USAO WDNC

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Other Government Health Programs, Whistleblower Rewards,

September 25, 2018

Six individuals in the New Orleans area - four physicians, a medical biller, and a medical office manager - were sentenced after having been found guilty of conspiracy to commit health care fraud and to pay and receive unlawful kickbacks.   The defendants fraudulently billed Medicare for medically unnecessary home health services for patients who were not homebound and had no legitimate medical need for the services, creating false and fraudulent home health orders.   USAO E.D. La.

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

September 25, 2018

Virginia Commonwealth University Health System Authority, which operates a hospital and related facilities in Richmond, Virginia, agreed to pay $4 million to resolve claims that it overbilled government healthcare programs for radiation oncology services from 2009 through 2014.  The settlement follows VCU's voluntary disclosure of the overbilling after an audit of patient files and billing data.    E.D. Va. USAO

Tagged in: Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Provider Fraud,

September 24, 2018

The owner and operator of several Superdrugs pharmacies in Queens, New York, was charged with submitting false claims to Medicare Part D and Medicaid for prescription drugs that were not dispensed, were not prescribed as claimed, or not medically necessary.  The pharmacies allegedly received $7.9 million from Medicare and Medicaid based on the fraudulent claims.  DOJ

Tagged in: Lack of Medical Necessity, Medical Billing Fraud, Part D, Pharma Fraud,

September 19, 2018

A physician and two clinic operators were convicted after trial for charges arising from a $17 million Medicare fraud scheme.  The doctor, John Ramirez, provided medical orders falsely certifying the need for home-health services, which the other defendants then sold to to home-health agencies in the Houston, Texas area.  These agencies then used the false and fraudulent paperwork signed by Ramirez to submit false claims to Medicare for medical services that were not medically necessary or not provided.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

September 12, 2018

A New York based long-term care facility, Centers Plan for Healthy Living, has agreed to pay $1,650,000 to settle allegations that it violated the state and federal False Claims Acts in billing Medicaid for services not provided to Medicaid beneficiaries. The alleged fraud involved enrolling unqualified patients and failing to disenroll recently unqualified patients from a Medicaid-funded care program over the span of two and a half years. It was eventually exposed by an unnamed whistleblower. AG NY; USAO EDNY

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

September 4, 2018

Houston psychiatrist Riyaz Mazcuri was sentenced to 12.5 years in prison following his conviction at trial for defrauding Medicare and Medicaid through the submission of $155 million in false and fraudulent claims for "partial hospitalization program" services, a form of intensive outpatient treatment for patients with mental illness.  Mazcuri falsified records to make it appear as if patients admitted to the PHPs qualified for, required, and actually received the intensive psychiatric services. DOJ

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

August 29, 2018

Atlantic Mobile Imaging Services, Inc. has agreed to pay $321,388.50 to settle allegations that it knowingly billing federal healthcare programs over $160,000 for x-ray services provided while it was unlicensed, in violation of the False Claims Act. The alleged fraud took place over a span of six months in 2015. USAO MDFL

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

August 28, 2018

Dermatology Healthcare will pay $4 Million to settle allegations of healthcare fraud which violate the False Claims Act. Dermatology Healthcare submitted false claims in order to be paid millions in Medicare and Medicaid reimbursements for treatment of non-melanoma skin cancer during which superficial radiation therapy is administered. It is alleged that the superficial radiation therapy was not properly supervised during treatment and that other procedures in relation to superficial radiation therapy were up-coded. It is further alleged that the radiation simulations were overly used. This settlement is the conclusion of a lawsuit filed by dermatologist Theodore A. Schiff, M.D., under the qui tam provisions of the False Claims Act in the United States District Court for the Middle District of Florida. DOJ

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

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