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Medical Billing Fraud

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Page 32 of 52

May 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 SDTX

Tagged in: Hospital Fraud, Medical Billing Fraud, Upcoding,

Medicare 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...

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud,

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May 4, 2018

New York City-based urgent care company CityMD agreed to pay roughly $6.6 million to settle claims it violated the False Claims Act by billing Medicare for services rendered by physicians who did not actually perform those services and for more expensive and complex services than were actually provided to patients. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Upcoding, Whistleblower Case,

April 27, 2018

New Era Rehabilitation Center and its owners agreed to pay roughly $1.4 million to resolve allegations they violated the False Claims Act by improperly billing Medicaid for methadone maintenance counseling services and psychotherapy services for the same patients. DOJ (CT)

Tagged in: FCA Federal, Medicaid, Medical Billing Fraud, Provider Fraud,

April 27, 2018

Las Vegas medical practice Cardiovascular and Thoracic Surgeons of Nevada, Inc. agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by billing federal healthcare programs for surgical services not actually provided to its cardiac patients and billing for more expensive surgical and evaluation and management services than actually provided. DOJ (NV)

Tagged in: FCA Federal, Medical Billing Fraud, Provider Fraud, Upcoding,

April 16, 2018

Aharon Aron Krkasharyan, a former employee Mauran Ambulence Inc., was sentenced to 36 months in prison and pay roughly $485,000 for his role in a scheme that resulted in more than $1.1 million in fraudulent claims to Medicare.  Krkasharyan admitted he conspired with other Mauran employees to submit claims to Medicare for ambulance transportation services for individuals who did not need such services. Krkasharyan also admitted that he and his co-conspirators instructed Mauran emergency medical technicians to conceal the patients’ true medical conditions by altering paperwork and creating fraudulent reasons to justify the ambulance services. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

April 12, 2018

Florida-based respiratory equipment supplier Rotech Healthcare Inc. agreed to pay $9.68 million to settle claims of violating the False Claims Act by submitting claims for portable oxygen contents to Medicare for beneficiaries who did not use or require them. The Company further admitted to billing Medicare regardless of whether such contents were delivered. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Rotech employee Janet Hale. She will receive a whistleblower award of $1,645,600 from the proceeds of the government’s recovery. DOJ

Tagged in: FCA Federal, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

April 5, 2018

A judgement for roughly $30.6 million was entered against Texas-based BestCare Laboratory Services LLC and its founder Karim Maghareh for violating the False Claims Act by billing the government for thousands of miles that were not actually travelled. Dr. Richard Drummond discovered the fraud after hiring a former BestCare employee and learning of their billing practices. He then filed a whistleblower lawsuit under the qui tam provisions of the False Claims Act. He will receive a whistleblower reward from the proceeds of the judgment. DOJ (SDTX)

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

March 16, 2018

Four Maryland healthcare providers settled claims they violated the False Claims Act by improperly coding for certain medical tests they billed to Medicare: St. Agnes Healthcare, Inc., which owns and operates St Agnes hospital in Baltimore, agreed to pay roughly $70,000; Horizon Vascular Specialists agreed to pay roughly $518,000; Riverside Medical Associates agreed to pay roughly $177,000; and Maryland Specialty Group agreed to pay roughly $87,000.  Dr. Itsuro Uchino agreed to pay roughly $91,000. DOJ (MD)

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud, Provider Fraud,

March 13, 2018

Marshfield Medical, Inc. (formerly known as Bromedicon, Inc.) agreed to pay $550,000 to settle claims it violated the False Claims Act for submitting claims to Medicare and other federal health care programs without providing a qualified interpreting physician to monitor each surgery for which it purportedly provided remote Intraoperative Neurophysiological Monitoring. According to the government, in some of those cases, no one monitored the data stream from the surgeries and in others, Bromedicon’s medical director, a foreign medical school graduate with no license to practice medicine in the United States, was the only monitor. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  DOJ (EDPA)

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

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