Medical Billing Fraud
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July 26, 2018
New York announced guilty pleas by transportation company 716 Transportation, Inc., its president, and one of its drivers, in connection with a $1.2 million Medicaid fraud scheme. The company and its president admitted to billing Medicaid for transportation services that were either never provided or that violated Medicaid rules and regulations. NY AGJuly 13, 2018
Orthopedic specialists in Oklahoma have agreed to pay $670,000 to settle allegations in a False Claims Act qui tam that they falsely billed Medicare, Medicaid, and Tricare for unnecessary ultrasonic guidance procedures and for services that were not performed. The settlement resolved two claims in the whistleblower action, brought by a former employee, in which the government had intervened prior to settlement; other claims continue to be litigated. USAO WDOKJuly 10, 2018
The New Mexico U.S. Attorney’s Office announced the sentencing of a cardiologist to 51 months in prison for healthcare fraud and obstruction of justice. Roy Heilbron had been indicted for regularly performing unnecessary diagnostic tests on his patients and falsifying medical records to cover the fraudulent billing; he also had billed for procedures that were never performed. USAO NMJuly 9, 2018
NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) entered a $14.7 million settlement with DOJ and a $895,427 settlement with New York based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid. Specifically, the defendants billed Medicare for undocumented E&M services, billed for home-health services without supporting medical records, and billed for orthopedic surgeons who referred patients in violation of the Physician Self-Referral Law, also known as the Stark Law. Three former Health Quest employees, who filed suit under the qui tam provisions of the False Claims Act, will receive a share of the recovery, including a reward of nearly $2 million to one of the relators. DOJ; USAO NDNYJuly 3, 2018
A Virginia woman who owned several Medicaid support services companies has agreed to pay $1 million and to accept a lifetime ban on participation in the Virginia Medicaid Program as part of a settlement of allegations that she defrauded the program. Dawn Sykes allegedly paid illegal kickbacks and sought reimbursement for services that were not provided or were provided to ineligible recipients. The investigation was launched by a qui tam lawsuit under the FCA and Virginia Fraud Against Taxpayers Act, and the whistleblower will receive 18 percent of the settlement. USAO EDVAJuly 2, 2018
Virginia in-home healthcare provider Hope In-Home Care, LLC, will pay $3.3 million to resolve allegations that it fraudulently billed Medicaid for a series of false statements and billing related to the provision of personal care services. Specifically, the USAO and Virginia Attorney General alleged that Hope In-Home Care billed for services that it did not perform and for services provided by uncertified personal care aides, and it falsified records to conceal these frauds. USAO EDVACatch of the Week -- Health Quest Systems and Putnam Hospital Center
Posted 07/13/18
This week, DOJ announced a $14.7 million settlement with NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid, making Health Quest and Putnam our Catch of the Week.
The settlement resolves allegations stemming from three separate lawsuits bought by...