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Medical Billing Fraud

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Page 45 of 52

September 21, 2015

Non-profit healthcare organization Adventist Health System agreed to pay $115 million to settle allegations it violated the False Claims Act by maintaining improper compensation arrangements with referring physicians and by miscoding claims.  The allegations originated in two whistleblower lawsuits filed by former Adventist hospital employees Michael Payne, Melissa Church and Gloria Pryor under the qui tam provisions of the False Claims Act.  The will receive a yet-to-be-determined whistleblower award from the government’s recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Medical Billing Fraud, Multiple Whistleblowers and First-to-File, Whistleblower Case, Whistleblower Rewards,

September 18, 2015

Mary Talaga, the primary medical biller at Medicall Physicians Group Ltd., a Chicago-area visiting physician practice, was sentenced to 45 months in prison and to pay $1 million in restitution for her role in a $4 million health care fraud scheme.  The evidence at trial showed that Talaga and her co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely provided the service.  DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud,

September 11, 2015

A federal jury convicted Houston psychiatrist Sharon Iglehart of participating in a $158 million Medicare fraud scheme involving false claims for mental health treatment.  According to evidence presented at trial, from 2006 until June 2012, Iglehart and others engaged in a scheme to defraud Medicare by submitting, through Riverside General Hospital, approximately $158 million in false and fraudulent claims for partial hospitalization program services to Medicare beneficiaries who did not actually receive the services.  DOJ

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

September 4, 2015

Rick Brown, former president of Home Care America Inc., which managed the daily business operations of Medicall Physicians Group Ltd., was sentenced to 87 months in prison and to pay $1.3  million in restitution for his role in a $4 million health care fraud scheme.  Medicall is a physician practice that visited patients in their homes and prescribed home health care.  The evidence at trial showed that Brown and his co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely did so.  The evidence also showed that Brown and his co-conspirators billed Medicare for services never provided, including services rendered to patients who were deceased, services purportedly provided by medical professionals no longer employed by Medicall, and services purportedly provided by medical professionals who, based on billing records, worked over 24 hours per day. DOJ

Tagged in: Home Health and Hospice, Medical Billing Fraud, Medicare,

September 4, 2015

Columbus Regional Healthcare System and Dr. Andrew Pippas agreed to pay more than $25 million to resolve allegations they violated the False Claims Act by submitting claims in violation of the Stark Law.  The settlement also resolves allegations that Columbus Regional and Pippas submitted claims for payment to federal health care programs that misrepresented the level of services they provided.  According to the government, between 2003 and 2013, Columbus Regional provided excessive salary and directorship payments to Pippas that violated the Stark Law.  The government further alleged Columbus Regional submitted claims to federal health care programs for services at higher levels than supported by the documentation.  The allegations first arose in two whistleblower lawsuits filed former Columbus Regional executive Richard Barker under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act.  Barker will receive a yet-to-be-determined whistleblower award.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

September 3, 2015

St. Joseph Hospice Entities, which consists of 13 hospice facilities in Mississippi, Louisiana, Texas and Alabama, and Patrick T. Mitchell, its majority owner and manager, agreed to pay $5,867,518 to resolve allegations they violated the False Claims Act by submitting false claims for delivery of continuous home care hospice services to patients who were not entitled to receive them.  The allegations originated in a whistleblower lawsuit filed by 3 former employees of the company under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $1 million.  DOJ

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

August 25, 2015

A federal jury in Miami convicted Roger Rousseau, former medical director of Health Care Solutions Network Inc. (HCSN), and three HCSN therapists for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.  HCSN is a now-defunct partial hospitalization program that purported to provide intensive treatment for mental illness.  According to the evidence presented at trial, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided and paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.  DOJ

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

August 19, 2015

Arizona physician Dr. Bashir Azher agreed to pay $207,988 to resolve allegations he violated the False Claims Act by submitting false bills to Medicare for prostate laser ablation procedures, commonly known as Green Light prostatectomies.  Specifically, the government charged Dr. Azher with submitting false claims for reimbursement for prostate laser ablation procedures that were too short to generate a therapeutic benefit, failed to meet professionally recognized standards of care, were medically unnecessary, and/or violated applicable Medicare regulations.  The government’s allegations originated in a whistleblower lawsuit filed by Dr. Arnaldo Trabucco under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare.  Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic.  Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided.  DOJ

Tagged in: Anti-Kickback and Stark, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

August 14, 2015

Oklahoma-based East Central Family Health Center agreed to pay $825,000 to settle charges it violated the False Claims Act by submitting false Medicaid claims.  Specifically, the government charged East Central, which is a designated federally qualified health center (FQHC), with submitting claims to the Oklahoma Medicaid Program for reimbursement for patients of non-FQHC health care providers and who were not East Central patients.  DOJ

Tagged in: FCA Federal, Medicaid, Medical Billing Fraud, Provider Fraud,

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