Medical Billing Fraud Archives - Page 28 of 52

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,

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,

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