Medical Billing Fraud
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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. DOJJune 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 SDTXMay 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 EDPAMay 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 NDNYMay 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 SDILMay 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 EDMOMay 14, 2018
Houston-based healthcare provider Memorial Hermann Health System agreed to pay nearly $2 million to resolve allegations it admitted Medicare patients for surgical procedures to three company-owned hospitals, then fraudulently billed for the services provided to these patients at inpatient rates when it should have billed at lower outpatient rates. USAO SDTXMedicare Fraudsters Beware; DOJ May Be Reviewing Your Billing Data
Posted 05/15/18
By the C|C Whistleblower Lawyer Team
Maryland physician Sureshkumar Muttath agreed to pay more than $1.5 million to settle claims he violated the False Claims Act by submitting claims to Medicare for medically unnecessary autonomic nervous function tests and neurobehavioral status exams. The settlement originated under DOJ’s new initiative of tracking irregularities in Medicare billing data. See DOJ Press...