Medical Billing Fraud Archives - Page 41 of 52

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)

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

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

Tagged in: FCA State, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

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

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud,

May 20, 2016

Hospicio La Paz, Inc. agreed to pay $2.5 million to settle charges of violating the False Claims Act in connection with approximately $1.5 million in questionable billings it submitted for payment to the Medicare Part A program. DOJ (D.PR)

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

May 6, 2016

The Trustees of the University of Pennsylvania, on behalf of its operating divisions, including the University of Pennsylvania Health System (UPHS), agreed to pay roughly $76,000 to settle charge of violating the False Claims for the alleged submission of false home health care billings to the Medicare program. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (EDPA)

Tagged in: FCA Federal, Home Health and Hospice, Medical Billing Fraud, Whistleblower Case,

April 28, 2016

California doctor Gary J. Ordog pleaded guilty to submitting more than $2.4 million in fraudulent claims to Medicare. Ordog, who purported to be a physician specializing in toxicology, admitted submitting false claims to Medicare for purported visits with Medicare beneficiaries, when in fact those visits never actually occurred, including on dates when Ordog was out of the country. He also admitted to billing for services provided to beneficiaries who were deceased and for services totaling more than 24 hours in one day. DOJ

Tagged in: Medical Billing Fraud, Medicare,

April 18, 2016

Maryland-based Bon Secours Health System and one of its surgical oncologists, Dr. Eugene Chang, agreed to pay $400,000 to settle charges of violating the False Claims Act by billing Medicare and other federal healthcare programs for non-covered breast examinations and ultrasounds. The allegations originated in a whistleblower lawsuit filed by a former Bon Secours practice manager and a former colleague of Dr. Chang under the qui tam provisions of the False Claims Act. They will receive a whistleblower award of $108,000 out of the proceeds of the government’s recovery. Whistleblower Insider

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

April 14, 2016

Boston Medical Center (BMC) and two of its physician practice organizations agreed to pay $1.1 million to resolve allegations they violated the False Claims Act by improperly billing Medicare and Medicaid. Specifically, the government charged that (1) BMC billed Medicare for more units of Rituxan, an expensive cancer drug, than BMC actually infused in its patients; (2) BMC billed Medicare and Medicaid for services at its pre-surgical treatment center even though the global fee for the subsequent surgeries covered those same treatments; and (3) BMC submitted claims to Medicare for outpatient podiatry services where the clinical documentation did not support the reasonableness and necessity of the services. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by BMC’s former Chief Compliance Officer, Kathleen Heffernan. She will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (DMA)

Tagged in: FCA Federal, Hospital Fraud, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Eligibility, Whistleblower Rewards,

March 25, 2016

Damian Mayol, the president of Miami-based transportation company Transportation Services Providers Inc. was sentenced to 60 months in prison and to pay $26.8 million in restitution (and forfeit the same amount) for his role in a health care fraud scheme involving three mental health centers that resulted in the submission of approximately $70 million in false Medicare claims. According to evidence presented at trial, Mayol and his co-conspirators used his company to coordinate the payment of illegal kickbacks to recruiters, who in return referred patients to three now-defunct community mental health centers -- R&S Community Mental Health Inc., St. Theresa Community Mental Health Center Inc. and New Day Community Mental Health Center LLC -- for costly partial hospitalization program services that were not medically necessary or not actually provided. DOJ

Tagged in: Anti-Kickback and Stark, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

March 23, 2016

Detroit-area doctor Laran Lerner was sentenced to 45 months in prison and to pay $2.8 million in restitution for his role in a $5.7 million Medicare fraud scheme in which he prescribed medically unnecessary controlled substances and billed for office visits and diagnostic testing that never took place. DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud, Pharma Fraud,

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