Medical Billing Fraud

March 13, 2017

Massachusetts-based Charles River Laboratories International Inc. agreed to pay $1.8 million to settle claims it violated the False Claims Act by improperly charging for labor and other associated costs not actually provided on certain National Institutes of Health contracts relating to the provision of laboratory animals to the NIH. DOJ

March 6, 2017

Simon Hong, owner of Los Angeles-based JH Physical Therapy Inc., was sentenced to 63 months in prison and to pay roughly $2.4 million in restitution, for his role in a $3.4 million Medicare fraud scheme that involved billing for occupational therapy services that were not medically necessary and not provided.   Hong admitted billing Medicare for occupational therapy services when what were provided instead were acupuncture and massage services, not reimbursable by Medicare.  Hong further admitted directing co-conspirator therapists to falsify medical records to make it appear as if the services billed actually had been provided. DOJ

March 2, 2017

Detroit-area physician Aaron Goldfein pleaded guilty for his role in a $5.4 million Medicare fraud scheme involving phony physician visits and drug prescriptions.  As part of his plea, Goldfein admitted to being part of a scheme in which his co-conspirators would hold themselves out as licensed physicians and purport to perform physician home visits and other services for Medicare beneficiaries, although these co-conspirators were not licensed to practice medicine in Michigan.  Goldfein would then bill Medicare through Tri-City Medical Center as if he himself had completed these visits.  Goldfein also admitted to being part of a scheme in which he received kickbacks in exchange for writing home health prescriptions. DOJ

March 2, 2017

New York announced the sentencing of two pharmacy owners, a supervising pharmacist and ten corporations for defrauding several government-funded healthcare programs, including Medicaid and Medicare. An investigation revealed that on at least eight separate occasions between November 2013 and February 2014, the defendants paid patients hundreds of dollars in cash to forgo their prescription medications, the vast majority of which were to treat HIV. The defendants then submitted false claims to Medicare, Medicaid and Medicaid-managed care organizations and were reimbursed for distributing the medications, despite the fact that they were never dispensed to patients. Tarek Elsayed, 50, of Elmhurst Queens, the co-owner of 184th Street Pharmacy in the Bronx, was sentenced in Bronx County Supreme Court by the Honorable Stephen Barrett to one to three years in state prison. Previously, in August of 2016, Ahmed Hamed, 39, of Elmhurst Queens, the second co-owner of 184th Street Pharmacy, was sentenced to two to six years in state prison. In October of 2016, Mohamed Hassan Ahmed, 38, of Bayside, the supervising pharmacist at 184th Street Pharmacy, was sentenced to one to three years in state prison and was required to surrender his license to practice pharmacy. Collectively, the three defendants stole over $10 million from government-funded health care programs. In addition, the Attorney General’s Medicaid Fraud Control Unit (MFCU) reached a $4.1 million civil settlement agreement with defendant Elsayed and a $3.8 million civil settlement agreement with defendant Hamed. NY

February 24, 2017

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc., two Miami-area home health agencies, was sentenced to a 126 month prison term for his role in a $2.5 million Medicare fraud scheme.  The evidence at trial showed that Leon and his co-conspirators used the companies to submit false claims to Medicare based on services not medically necessary, not actually provided, and for patients procured through the payment of illegal kickbacks to doctors and patient recruiters.  DOJ

February 10, 2017

Dr. Paul B. Tartell, an ENT physician practicing in Plantation, Florida and his practice Paul B. Tartell, M.D., P.L., have agreed to pay $750,000 to resolve allegations that he violated the False Claims Act by billing for surgical endoscopies with debridement and laryngeal stroboscopies that were not provided or not medically necessary.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Theodore Duay, a former patient of Dr. Tartell.  Mr. Duay will receive a whistleblower award of $135,000 from the proceeds of the government's recovery.  DOJ (SDFL)

February 8, 2017

Florida-based Comprehensive Health Services, Inc., one of the country’s largest providers of workforce medical services, agreed to pay roughly $3.8 million to settle charges it violated the False Claims Act by double-billing and mischarging the government for medical services in connection with work it performed on an Internal Revenue Service contract.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by James J. Kerr, Jr.  He will receive a whistleblower reward of roughly $645,000 from the proceeds of the government’s recovery.  Whistleblower Insider

February 2, 2017

Pain management physician Dr. Robert Windsor, owner of National Pain Care, Inc. which owns pain management clinics in Georgia and Kentucky, agreed to the entry of a $20 million consent judgment to resolve allegations he violated the False Claims Act by billing federal health care programs for surgical monitoring services he did not perform and for medically unnecessary diagnostic tests.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Kris Frankenberg, Stephanie Herder and Bradley Davis.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government’s recovery.  Whistleblower Insider