Medical Billing Fraud

September 21, 2016

Michigan doctor Hussein Awada agreed to pay $200,000 to resolve charges he violated the False Claims Act by writing prescriptions for oxycodone and other controlled medications and billing for medical services without medical justification.  According to the government, Awada conspired with patient “marketers” to write prescriptions for tens of thousands of dosages of oxycodone and other controlled medications for no medical purpose and then used the patient data to submit bills to Medicare for services that were either never performed or were medically unjustified.  Awada also caused these same patients to receive medically unnecessary monthly x-rays, and other invasive tests, to help conceal his fraud.  Awada previously pled guilty to these charges and was sentenced to 84 months in prison and pay $2.3 million in restitution.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Heather Henson, who worked as a receptionist for Awada at his medical practice.  She will receive a whistleblower award of $36,000.  DOJ (EDMI)

September 22, 2016

A federal jury in Los Angeles convicted the owner of a medical clinic for his role in a health care fraud scheme and for filing false income tax returns. Evidence introduced at trial showed that Michael Huynh, 66, the office manager and part-owner of a medical clinic, provided false prescriptions to a pharmacist and co-conspirator, Farhad N. Dany Sharim, who submitted false claims to insurance companies for drugs that were never dispensed. Once Sharim received payments from the insurance companies, he paid Huynh for the false prescriptions. Trial evidence showed that between January 2004 and November 2009, Huynh received 82 checks from Sharim totaling over $1.1 million. Evidence at trial also demonstrated that Huynh filed false federal tax returns for tax years 2007 through 2011 that underreported the medical clinic’s gross receipts and sales on the corporate tax returns and total income on the individual tax returns. Trial evidence showed underreported income of over $1.6 million. DOJ

August 31, 2016

Clear Vue Eye Center and its owner, Dr. Monique Barbour, agreed to pay $1 million to resolve allegations that they violated the False Claims Act by overbilling Medicare for patient visits at nursing homes and assisted living facilities, and for billing for procedures purportedly performed while Dr. Barbour was out of the country.  According to the government, Dr. Barbour billed excessively for patient visits, billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period.  Records reviews show that many of the procedures billed were medically unnecessary with little patient benefit and that Dr. Barbour billed procedures at the most profitable rates regardless of the procedure’s proper billing code.  The allegations originated in a whistleblower lawsuit brought by former Clear Vue employee Lori Moore under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $200,000 from the proceeds of the government's recovery.  DOJ (SDFL)

August 24, 2016

New York hospitals Beth Israel Medical Center (d/b/a Mount Sinai Beth Israel), St. Luke’s-Roosevelt Hospital Center (d/b/a Mount Sinai St. Luke’s) and Mount Sinai Roosevelt, and Continuum Health Partners, agreed to pay $2,950,000 to settle charges that they violated the federal and New York False Claims Act by willfully delaying repayment of over $800,000 in Medicaid overpayments that resulted from improper claims submitted because of a software error.  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 (SDNY)

August 24, 2016

New York and the Justice Department announced that three hospitals in the Mount Sinai Health System are paying a total of $2.95 million to resolve allegations that the hospitals knowingly retained over $844,000 in overpayments made by Medicaid in violation of the federal and New York False Claims Acts. Knowing retention of an overpayment from the government for more than sixty days is known as a “reverse false claim” and is a violation of both federal and state false claim acts. The entities involved include Mount Sinai Beth Israel (“Beth Israel”) (formerly Beth Israel Medical Center), Mount Sinai St. Luke’s (“St. Luke’s”) (formerly St. Luke’s Hospital) and Mount Sinai Roosevelt (“Roosevelt”) (formerly Roosevelt Hospital) (together, the “Hospitals”) – and the Hospitals’ former partnership group, Continuum Health Partners, Inc. (“Continuum,” and together with the Hospitals, “Defendants”). As part of the settlements, Defendants admitted that, beginning in 2009 due to a software compatibility issue, a coding error caused Defendants to submit claims for payment above and beyond what they had received from the managed care organization, and that Medicaid paid these claims as a secondary payor. In September 2010, the New York Office of the State Comptroller brought to Continuum’s attention a small number of these claims, and Defendants admitted that in late 2010 they were made aware of the coding error. NY

July 29, 2016

A judgment for $4,752,101.50 was entered against LXE Counseling, LLC and its owner Lexie Darlene George (a/k/a Lexie Darlene Batchelor) for violations of the False Claims Act, the Oklahoma Medicaid False Claims Act and the Oklahoma Medicaid Program Integrity Act.  Specifically, LXE and Batchelor were found to have submitted claims to Oklahoma Medicaid for services that were, among other things: provided by unqualified persons; based on falsified time and service records; double billed; unauthorized or not provided.  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 whistleblower award from the proceeds of the government's recovery.  DOJ (WDOK)

July 29, 2016

Syed Imran Ahmed, a New York surgeon who practiced at hospitals in Brooklyn and Long Island, was convicted of submitting millions of dollars in fraudulent claims to Medicare.  According to the evidence, Ahmed submitted more than $25 million in false claims to Medicare for incision-and-drainage and wound debridement surgeries he did not perform.  DOJ

June 30, 2016

California-based Marshall Medical Center agreed to pay $5.5 million to settle allegations that it, along with Marshall Foundation for Community Health, El Dorado Hematology & Medical Oncology II, Inc., Dr. Lin H. Soe and Dr. Tsuong Tsai, violated the federal False Claims Act and California False Claims Act through a variety of Medicare and Medicaid billing improprieties.  The allegations originated in a whistleblower lawsuit filed by oncology nurse Colleen Herren under the qui tam provisions of the False Claims Act. She will receive a whistleblower reward of roughly $1,430,000 from the proceeds of the government's recovery.  DOJ (EDCA)

July 7, 2016

A Bedford-based transportation service provider has agreed to pay more than $700,000 to resolve allegations that it submitted false claims to the state’s Medicaid program (MassHealth) for medically unnecessary wheelchair van rides, Massachusetts announced. It also allegedly submitted claims for services that should have been provided at a lower cost through a MassHealth transportation broker. The AG’s investigation revealed that REM Transportation Services, LLC (REM) submitted the false claims from January 5, 2010 to December 31, 2014. Many of the MassHealth members allegedly receiving the rides were ambulatory and did not use wheelchairs or need assistance, as required under MassHealth regulations. MA

June 1, 2016

Florence Bikundi and her husband Michael D. Bikundi Sr., owners of home care agency Global Healthcare Inc., were sentenced to prison for 10 years and 7 years, respectively, for health care fraud, money laundering, and other charges stemming from a scheme in which they and others defrauded the District of Columbia Medicaid program of over $80 million.  They were also ordered to forfeit over $11 million seized from 76 bank accounts; their $1 million residence; $73,000 in cash seized from their residence and five luxury vehicles.  The court also imposed a forfeiture money judgment of roughly $40 million and ordered them to pay roughly $80 million in restitution to D.C. Medicaid.  The government’s evidence showed the Bikundis led a scheme to bill Medicaid for services that were not fully provided, recruiting others, including family members, into the scam and creating fraudulent paperwork to hide the illegal activity.  DOJ