Medical Billing Fraud

July 2, 2018

FWC Urogynecology, LLC agreed to pay $1.7 million to settle allegations under the False Claims Act. FWC allegedly misused Medicare billing codes by billing modifier 25 for services that were not billable or that it did not provide. The alleged conduct occurred between 2012 and 2017. USAO MDFL

July 11, 2018

A Florida man was charged with assuming the identity of a New Jersey doctor to submit more than $1 million in fraudulent medical claims for medical services purportedly rendered at a Morris County medical center that, in reality, did not exist. Yoandi Marrero, 33, of Hialeah, Florida, and PA Clinical Center, Inc., the registered company he allegedly used to front the phantom medical practice, were charged with insurance fraud and attempted theft by deception (2nd degree); theft by deception (3rd degree); and identity theft (4th degree) in an indictment handed up by a state Grand Jury in Trenton today. Marrero was also charged with fourth degree identity theft in the alleged scheme. NJ

July 10, 2018

A Norwich behavioral health practice and its co-owners, a mother and her daughter who are both licensed behavioral health clinicians, agreed to a $300,000 settlement to resolve alleged violations of Connecticut’s False Claims Act. Affinity Behavioral Health LLC (“Affinity”) is co-owned by Julie Longton, a licensed marital and family therapist, and her daughter, Leanda Zupka, a licensed clinical social worker. Affinity, Longton and Zupka are enrolled as behavioral health providers in the Connecticut Medical Assistance Program (CMAP), which includes the state’s Medicaid program. The state alleged that, from April 2013 to December 2016, Affinity, Longton and Zupka knowingly submitted claims to the CMAP for payment for behavioral health services purportedly performed by licensed behavioral health clinicians when, in fact, the services were rendered by unlicensed individuals employed by Longton and Zupka. CT

July 10, 2018

Maryland announced that Rebecca D. Norris pleaded guilty to one count of felony Medicaid fraud for masterminding a series of fraudulent schemes at two western Maryland clinics she owned, resulting in a $825,000 loss to the Maryland Medicaid program. Norris’s sister, Heidi M. Wiley, 32, also pleaded guilty to one count of Felony Medicaid Fraud for her role as a biller in Norris’ schemes. Norris used a series of financial incentives to induce Wiley and other unindicted co-conspirators to assist her in these fraudulent schemes, including paying commissions for billing services to Medicaid. She also directed her staff to conceal the fraud during a visit from state auditors by altering and doctoring patient records. MD

July 5, 2018

North Carolina announced it has settled with Rotech Healthcare Inc., a Florida-based respiratory equipment supplier, over civil allegations that Rotech knowingly submitted false claims for portable oxygen contents to Medicaid and Medicare. The settlement is joined by 22 other states and the federal government. The total settlement is $9.95 million, of which North Carolina will receive $43,671.23. Between 2009 and 2012, Rotech automatically billed Medicaid and Medicare for portable oxygen contents regardless of whether the beneficiaries used or needed portable oxygen and without obtaining the required proof of delivery. Rotech continued this practice despite knowing that it was submitting ineligible claims. NC  The settlement is part of previously-reported settlement with the federal government and other states.  April 12 Federal Settlement. The case was initiated by a whistleblower.

July 3, 2018

The state and federal governments reached a joint settlement resolving allegations that a Waterford psychologist submitted false claims for behavioral health services she never provided to her Connecticut Medicaid patients, Attorney General George Jepsen and Connecticut Department of Social Services (DSS) Commissioner Roderick L. Bremby. Dr. Arlene Werner, a licensed psychologist and owner and sole practitioner of a private psychology practice, will pay $126,760.09 and has been suspended from participation in the Connecticut Medical Assistance Program (CMAP) – which includes the state’s Medicaid program – for a period of two years. The state and federal governments alleged that, from January 2011 to July 2016, Dr. Werner submitted false claims to the CMAP for psychotherapy services that were not provided to her CMAP patients. CT

June 28, 2018

Varicose vein treatment company Circulatory Centers of America, LLC agreed to pay $1,205,000 to settle allegations that it violated the False Claims Act. The allegations stemmed from a qui tam lawsuit filed by a whistleblower in Pittsburgh, PA that alleged claims were submitted to Medicare for services by non-physicians “incident to” the supervision by a physician when in fact no physician was present in the office. These types of claims are reimbursed at higher rates than when billed without the physician supervision component. USAO WDPA

June 25, 2018

New York announced registered nurse Collins Anyanwu-Mueller has been sentenced to a year in prison for stealing over $390,000 from Medicaid. A MFCU investigation uncovered that Anyanwu-Mueller submitted false Medicaid claims for private duty nursing services that he never provided to two severely disabled Medicaid recipients. Both Medicaid recipients required around-the-clock care. Prior to sentencing, Anyanwu-Mueller paid the State of New York $25,000 and has agreed to pay the remaining $367,954 in restitution owed. NY

June 21, 2018

Connecticut has sued a behavioral health provider, Susan Britt, for violations of its FCA. Britt is a licensed professional counselor who runs her own practice, Inner Peace. According to the state’s allegations, Britt would provide counselling services to children, then meet with parents to discuss their children’s progress, and bill the state Medicaid program as if she provided counseling services to both parents and children. During the time period in question, Britt billed the state over $530K. CT