Medical Billing Fraud Archives - Page 41 of 52

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,

March 21, 2016

Florida audiologist Terri L. Schneider was sentenced to 94 months in prison and to pay $2.5 million in restitution for her role in a multimillion-dollar health care fraud and money laundering scheme. According to evidence presented at trial, Schneider and her co-conspirators used three purported medical clinics in Florida -- Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists -- to submit approximately $12.3 million in false Medicare claims seeking reimbursement for radiology, audiology, cardiology and neurology services. The evidence showed that Schneider and her co-conspirators used forged and falsified documents in the Medicare enrollment process for the medical clinics that they operated under false pretenses, and billed Medicare for services that had not been rendered by physicians. They also paid illegal kickbacks in exchange for access to Medicare patients and Medicare patient information used in the fraud scheme. DOJ

Tagged in: Medical Billing Fraud, Medicare,

March 7, 2016

Florida businessman David Brock Lovelace was sentenced to 174 months in prison and to pay $2,512,460 in restitution for his role in a multimillion-dollar health care fraud and money laundering scheme. According to evidence presented at trial, Lovelace and co-conspirators used Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists, three purported medical clinics in Florida, to submit to Medicare more than $12 million in fraudulent claims for radiology, audiology, cardiology and neurology services not rendered by physicians, secured by kickbacks or the subject of forged or falsified documents. DOJ

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

February 19, 2016

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $2.09 million to resolve allegations that patients were administered portions of single-dose vials of chemotherapy drugs that were left over from administrations to prior patients. The settlement also resolves allegations that some platinum based drugs were administered inappropriately and that certain infusion services were upcoded. The allegations originated in a whistleblower lawsuit filed by former Adventist employee Heather Huddleston under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $376,452 from the proceeds of the government's recovery. DOJ (MDFL)

Tagged in: Dosage Fraud, Drug Switching, Healthcare Fraud, Medical Billing Fraud, Medicare, Pharma Fraud, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

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