Medical Billing Fraud

August 24, 2017

Nashville-based transportation service provider Employment & Assessment Solutions, Inc. and its principal Chris Manus agreed to pay $550,000 to settle allegations they violated the False Claims Act by submitting false claims to TennCare for transportation services which were never provided, including claims for patients who were actually incarcerated or hospitalized at the time of the purported transport. DOJ (MDTN)

November 17th, 2017

New York announced the indictment of Hin T. Wong ("Wong"), 49, of Manhattan, Mery Gooden, 58, of the Bronx, and three pharmacies. The indictment charges Wong, the owner of three Manhattan pharmacies – New York Pharmacy Inc. ("NY Pharmacy"), NYC Pharmacy Inc. ("NYC Pharmacy"), and New York Healthfirst Pharmacy Inc. ("NY Healthfirst") – for defrauding several government-funded healthcare programs, including Medicaid and Medicare, by falsely billing prescription refills and stealing over $3 million in reimbursement for medication they did not dispense. Wong was indicted for Grand Larceny in the First Degree, a class "B" felony, and other crimes. In addition, Mery Gooden, a pharmacist at NYC Pharmacy, was indicted for Grand Larceny in the Second Degree and other related crimes. NY

October 16, 2017

Louisiana announced the arrests of three New Orleans women as a result of an investigation exposing over $2 million in Medicaid Fraud. Lanice Stamps, 44 of New Orleans and owner of A New Direction Support Services, was arrested on 10 counts of Medicaid fraud for allegedly providing false and fraudulent claims for behavioral health services not rendered. Many recipients were fraudulently diagnosed as moderately mentally retarded or severely autistic so that the claims submitted could be billed at a higher level and they had never received counseling services. LA

July 13, 2017

New York podiatrist Perrin D. Edwards pled guilty to health care fraud for illegally charging Medicare and private insurance companies for podiatry services he never provided and agreed to pay $410,000 to resolve charges of violating the False Claims Act.  DOJ (NDNY)

July 6, 2017

Matthew Kolodesh, Alex Pugman, Svetlana Ganetsky, and Malvina Yakobashvili agreed to pay millions of dollars to settle False Claims Act allegations that they and their now-defunct company Home Care Hospice, Inc. falsely billed for hospice services that were either unnecessary or never provided.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former HCH employees Maureen Fox and Cathy Gonzales.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (EDPA)

June 30, 2017

Dawn Bentley, a Detroit-area medical biller, was sentenced to 50 months in prison and to pay roughly $3.3 million for her role in a $7.3 million Medicare and Medicaid fraud scheme involving medical services that were billed to Medicare and Medicaid but not rendered as billed.  DOJ