Medical Billing Fraud

June 20, 2018

Healogics, a Florida-based company which runs a chain of wound care centers, has settled FCA allegations that it improperly billed for hyperbaric oxygen therapy (a modality in which the entire body is exposed to oxygen under increased atmospheric pressure, as an adjunctive therapy to treat certain chronic wounds). The company paid $22.5M to settle allegations that it billed for unnecessary or unreasonable hyperbaric oxygen therapy. The allegations were brought to the government’s attention by four whistleblowers, James Wilcox, Dr. Benjamin Van Raalte, Dr. Michael Cascio, and John Murtangh. The whistleblowers will receive a $4.28M reward. Separately, Healogics also paid $398K to settle another FCA case alleging that it improperly applied Modifier 25, which signifies that a separate evaluation and management service was performed on the same day as another procedure, to claims that were sent to Medicare, Medicaid, and TRICARE. The allegations were brought to light by a whistleblower, who will receive a $91K reward. DOJ;  USAO Northern District of Iowa

June 18, 2018

Connecticut has reached a $200K FCA settlement with Dr. Elijah Caldwell, a behavioral health clinician, and two practices that he owns or controls. According to the state, Dr. Caldwell billed Connecticut’s Medicaid program for psychotherapy services that were never rendered. In addition to the monetary settlement, Dr. Caldwell will be excluded from the Medicaid program for the next decade. The fraud was brought to light by a whistleblower. CT

June 12, 2018

North Carolina announced the sentencing of Dr. Duke Ellington Ellis, who allegedly assisted Nature’s Reflections, a Durham-based behavioral health company, forge the signature of a licensed psychologist in order to submit millions of dollars in false claims to Medicaid. Ellis will face thirteen months in prison and will pay over a million dollars in restitution to the North Carolina Medicaid Program. NC

June 8, 2018

Skilled nursing facility company Signature HealthCARE, LLC will pay more than $30 million to the federal and Tennessee state governments to resolve False Claims Act allegations it placed patients in the highest therapy reimbursement level regardless of need; limited its therapy services to the minimum number of minutes required to bill at a given reimbursement level and discouraged the provision of care beyond that minimum; and pressured therapists to complete therapy even when patients were too ill or declined to participate. The suit was brought by two former employees and whistleblowers, who will receive a portion of the recovery. DOJ

June 1, 2018

Multi-state physical therapy provider Team Work Ready CEO Jeffrey Rose Sr. was sentenced to more than 19 years imprisonment for his role in an $18 million fraud scheme in which he and his co-conspirators billed the DOL for inadequate and inappropriate care, as well as for one-on-one physical therapy services never provided. USAO SDTX

May 31, 2018

Irina Minkovich and Yelena Babchinetskya, owners of Philadelphia-based I&L Express Pharmacy, entered into an integrity agreement and will pay $3.2 million to the federal government to resolve allegations that they violated the False Claims Act over a six-year period by billing Medicare for prescription drugs never dispensed to patients. USAO EDPA

May 18, 2018

New York podiatrist Perrin Edwards pled guilty to billing Medicare and private insurance companies for medical services he had not performed and for upcoding normal nail trimming, which is not reimbursable, to nail debridement, a covered service. Edwards will pay a $5,000 fine, serve one year of probation, and perform 50 hours of community service. USAO NDNY

May 16, 2018

Stephanie L. Patterson was sentenced to five years of probation and ordered to pay more than $81,000 for falsely claiming payments from the State of Illinois Medicaid Home Services Program for hundreds of hours of home health services not performed. USAO SDIL

May 14, 2018

Missouri-based podiatry provider Foot Healers agreed to pay the United States $125,000 to settle allegations the company violated the False Claims Act by using improper billing modifiers to inflate Medicare claims and falsely upcoding routine toenail trimmings performed on Medicare patients by claiming the service provided was medically necessary toenail debridement. USAO EDMO