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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 28 of 52

August 21, 2018

Physician Ewald J. Antoine, of Valley Stream, New York, was convicted today and sentenced to one year and one day in prison for his part in a $30 million health care scheme involving Medicare and Medicaid. Dr. Antoine is one of eight defendants sentenced in this case. Under the direction of Aleksandr Burman, co-conspirator and owner of six medical clinics in Brooklyn, Antoine feigned ownership of two of the six clinics and fraudulently billed Medicare and Medicaid for unprovided medical services and supplies. In addition to prison time, Dr. Antoine has been ordered to pay $1,825,544 in restitution. He has also been ordered to give up $269,412 in illegally-gained profits.   DOJ  See related sentencing of Dr. Paul Mathieu and Lina Zhitnik.

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

August 20, 2018

The owner of an ambulance company has been convicted of defrauding Medicare by submitting claims for over $3 million in unprovided or unnecessary transport services. Anthony Nwosah of Tonieann EMS and Rosenberg EMS also admitted to falsifying and instructing others to falsify transport records, as well as submitting some under the name of an EMT who didn’t even work for him. He received $1,094,260 before the fraud was uncovered, and at his sentencing in November, he stands to receive a $250,000 fine and ten year sentence. USAO SDTX

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

August 16, 2018

Lincare, Inc—one of the largest home providers of respiratory therapy products and services in the nation—has paid $5.25 million to settle a suit filed by whistleblower Brian Thomas. In 2015, the former billing supervisor accused the company of violating the Anti-Kickback Statute and False Claims Act over a period of six years by unlawfully waiving or reducing fees paid by Medicare Advantage recipients and submitting false claims for reimbursement. Thomas will receive $918,750 for his role in exposing the alleged fraud. USAO SDIL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 14, 2018

An Illinois pharmacist, Steven Gibson, has pleaded guilty to fraudulently billing Medicare, Medicaid, and private insurance companies for unauthorized and often expensive prescriptions that were never intended to be dispensed to any patient. The reimbursements he received eventually netted him over $630,000—as well as the prospect of a $250,000 fine and ten years in prison. USAO SDIL

Tagged in: Medical Billing Fraud, Pharma Fraud,

August 13, 2018

Nurse practitioner Sandra Haar, founder and chief executive officer of Horisons Unlimited, a non-profit provider of health and dental services in Merced, California, pleaded guilty to health care fraud and conspiracy to receive kickbacks.  Haar's scheme billed for services that were not rendered or were medically unnecessary, even submitting bills for office visits with doctors when, in fact, patients were met in local parking lots and given Suboxone, an opioid medication, in plastic baggies.   Haar also received thousands in kickbacks from a laboratory in exchange for sending Horisons patients to the lab.  ED CA (later sentencing and civil settlement here)

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

August 10, 2018

An Illinois personal assistant, Betsy Gutowski, has pleaded guilty to filing fraudulent Medicaid reimbursement claims for work purportedly performed for a client under the Home Services Program, which is designed to keep clients out of nursing homes and in their own homes. At the time of the fraud, which spanned the year 2012, the client was in fact hospitalized or living in a nursing home, yet Gutowski billed for and received payments totaling $4,036.73. She now faces a possible maximum sentence of 10 years in prison and a $250,000 fine. USAO SDIL

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

August 3, 2018

Northwest ENT Associates, P.C. agreed to pay $1,195,361 to settle allegations under the federal False Claims Act that they re-used balloon catheters in medical procedures, even though they were intended only for a single use. By choosing to cut a corner for their own financial benefit, Northwest ENT put their patients’ health in jeopardy as well as impacting federal funds needed for other medical procedures. Northwest ENT has entered into a three-year Integrity Agreement with the Office of the Inspector General of the Department of Health and Human Services. DOJ

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

August 1, 2018

Early Autism Project, Inc. (“EAP”) agreed to pay the United States $8,833,615 to settle allegations brought by whistleblower and former employee of EAP, Olivia Zeigler, that it submitted false claims to TRICARE (a military insurance program) and South Carolina’s Medicaid program for therapy services for children with autism. The therapy services were misrepresented or were never provided. EAP allegedly also created a program under which it billed Medicaid for functions that were not related to therapy services at all and permitted its therapists to regularly bill for more hours than they actually provided therapy services. Olivia Zeigler will be awarded $435,000. DOJ

Tagged in: FCA Federal, FCA State, Medicaid, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 1, 2018

Gena Randolph, a speech therapist in Mount Pleasant, South Carolina who owned and controlled Palmetto Speech and Language Associates and Per Diem Healthcare Services, was convicted after committing a health care fraud scheme amounting to a total of $2 million by, among other things, submitting claims for services provided by others or not provided at all. Ms. Randolph faces over ten years in federal prison. DOJ

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

July 31, 2018

Compassionate Home Care Services, Inc., its owner Carol Anders, and her son Ryan Santiago will pay a $3 million judgment for violating the federal and North Carolina False Claims Acts by filing reimbursement claims for services not rendered or rendered by unlicensed aides and family members. Anders and Santiago were also found to have falsified documents to conceal evidence of fraud upon being investigated by the government. USAO EDNC

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medical Billing Fraud,

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