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Medical Billing Fraud

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Page 34 of 52

January 31, 2018

New York announced that Home Family Care, Inc. ("Home Family") of Brooklyn, NY and its President, Alexander Kiselev, will pay $6.415 million to resolve allegations that they violated the federal and New York False Claims Acts by falsely billing the New York State Medicaid program for home health care services that were not provided or that were provided by unqualified staff. The settlement resolves allegations in a complaint filed by the State of New York and the United States that Home Family routinely permitted its aides to circumvent verification procedures purportedly put in place by Home Family to ensure that its aides were providing scheduled services to Medicaid recipients who depended upon them. As alleged in the complaint, even after Home Family put in place an electronic attendance verification system which purportedly required aides to call a central number to "clock in" and "clock out" of their shifts before their services could be billed, Home Family aides routinely ignored this requirement and failed to clock in or out of their shifts – yet were still paid for them. NY

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medical Billing Fraud,

January 19, 2018

San Diego-based health care system Scripps Health agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by charging federal health care programs for physical therapy services that were rendered by therapists who did not have billing privileges for these programs and were not supervised by an authorized provider. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Scripps employee Suzanne Forrest. She will receive a whistleblower award of $225,000 from the proceeds of the government's recovery. DOJ

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

January 18, 2018

Detroit-area doctor Gerald Daneshvar was sentenced to 24 months in prison for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulted in inappropriately high payments. DOJ

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

January 22, 2018

Maryland announced it has joined the United States, the District of Columbia, and 19 other states in a settlement agreement relating to allegations against Benevis, LLC (formerly known as NCDR, LLC) and 133 Kool Smiles clinics that received non-clinical practice support from Benevis, LLC. Maryland will receive $1.022 million as a result of the settlement. The settlement will resolve allegations that Benevis/Kool Smiles knowingly submitted or caused to be submitted false claims to the Medicaid program related to dental services provided to pediatric patients. Under the settlement, Benevis/Kool Smiles agreed to pay $23.9 million collectively to the federal and state governments. The participating states will share $9.65 million of the total settlement. MD

Tagged in: FCA State, Medicaid, Medical Billing Fraud,

December 29, 2017

Maryland physician Nwaehihie H. Onyeaghala of Krystal Medical Associates, LLC agreed to pay $1 million to settle allegations he violated the False Claims Act by submitting false claims to Medicare for medically unnecessary autonomic nervous function tests and peripheral vascular tests.  According to the government, the tests were not medically necessary because Dr. Onyeaghala lacked the necessary equipment to conduct the tests, the patients did not have an autonomic nervous function disorder before the test was conducted, Dr. Onyeaghala lacked the specific training to conduct such tests and he only used the tests to monitor patient symptoms, not make any clinical decisions about future patient care.  DOJ (DMD)

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

December 21, 2017

Rhode Island-based Dominion Diagnostics, Inc. agreed to pay $815,000 to resolve claims of violating the False Claims Act by presenting claims to Medicare and Vermont Medicaid for urine specimen validity testing when referring physicians did not specifically order the testing. DOJ (DVT)

Tagged in: FCA Federal, Laboratory and IDTF, Medical Billing Fraud,

December 14, 2017

Texas-based DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with severe kidney disease, agreed to pay $63.7 million to resolve charges of violating the False Claims Act by billing Medicare for prescription medications never shipped, shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent. The settlement also resolves allegations that DaVita paid financial inducements to Medicare beneficiaries in violation of the Anti-Kickback Statute. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by two former DaVita employees Patsy Gallian and Monique Jones. The whistleblowers will receive an award of $2.1 million from the proceeds of the government's recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 14, 2017

Mississippi-based Region 8 Mental Health Services agreed to pay roughly $7 million resolve charges of violating the False Claims Act allegations by submitting claims for services not provided or not provided by qualified individuals as part of its preschool Day Treatment program. It is believed to be the largest False Claims Act healthcare settlement in the history of the State of Mississippi. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Region 8 employee. The whistleblower will receive an award of more than $1 million from the proceeds of the government's settlement. DOJ (SDMS)

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

December 12, 2017

Med-Fast Pharmacy, Inc. agreed to pay roughly $2.7 million to resolve both criminal and civil charges of violating the False Claims Act relating to the conduct of Iserve Technologies, Inc., a company co-located with and operated out of Med-Fast, filling prescriptions for nursing homes with recycled unused drugs that were commingled with drug stocks on hand at Med-Fast’s Institutional Pharmacy. The settlement also resolves allegations that Med-Fast sought Medicare and Medicaid reimbursement for the retail-packaged version of diabetes testing strips while actually supplying patients with cheaper mail-order-packaged version of the same strips. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ (WDPA)

Tagged in: Healthcare Fraud, Medical Billing Fraud, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

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