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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 27 of 52

October 4, 2018

Mercy Ainabe of Houston, Texas, was sentenced to nine years in prison for her role in a $3.6 million home healthcare Medicare fraud scheme.  Ainabe served as a patient recruiter, selling patient information to home healthcare companies, including Texas Tender Care, which then submitted claims to Medicare for home health services that were not medically necessary, were not provided, or both. USAO SDTX

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

September 27, 2018

Millicent Traylor, M.D., of Detroit, Michigan was sentenced to over 11 years in prison today for her part in a health care scheme against Medicare from 2011 to 2016. Traylor and her co-conspirators defrauded Medicare of an estimated $8.9 million during that period. They submitted fraudulent claims for home health care services and other services which were not provided or not medically necessary. At times, the physician services which were provided were provided by Dr. Traylor, though she was unlicensed during that period. Furthermore, evidence presented during the four-day trial showed that Traylor forged the signature of licensed physicians on prescriptions for opioid medications, oxycodone for instance, as a way to encourage patient participation in the scheme. Traylor’s three co-conspirators will also serve time in prison.  DOJ  

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

September 26, 2018

A psychologist, John R. Sink, and his wife, Diane Sink, pled guilty to making false statements to Wyoming Medicaid.  According to the plea, between 2012 and 2016, the Sinks submitted over $6.2 million in claims for group therapy, knowing that the activities provided and billed for did not qualify as group therapy.  In addition, the hours billed did not accurately report the time each Medicaid beneficiary was actively participating in any activities, and the Sinks were not using up-to-date treatment plans to guide each Medicaid beneficiaries treatment as required by Wyoming Medicaid.  USAO D. Wy.

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

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,

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