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Medical Billing Fraud

This archive displays posts tagged as relevant to medical billing fraud. You may also be interested in our pages:

Page 46 of 52

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,

August 12, 2015

Oswego Hospital will pay $1,456,457.33 to resolve False Claims Act charges stemming from healthcare billing improprieties the hospital self disclosed to the federal government.  Dr. Vilas Patil, a physician formerly working as an independent contractor with Oswego, paid $204,365.97 to resolve False Claims Act liability in connection with a related investigation.  Specifically, Oswego identified claims that were paid by federal and state payors where the supporting medical record documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes.  DOJ

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

August 3, 2015

Rouzbeh Javaherian, owner of Los Angeles-based Westaid Pharmacy and Medical Supply, was sentenced to 18 months in prison and to pay $644,060 in restitution for his role in a fraud scheme involving the Medicare Part D prescription drug program.  Specifically, Javaherian paid illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid.  Javaherian then filled some of those prescriptions, but also submitted false claims to Medicare Part D plan sponsors for prescriptions that he did not actually fill.  DOJ

Tagged in: Drug and DME Pricing, Medical Billing Fraud, Part D, Pharma Fraud,

June 30, 2015

Community Health Network agreed to pay $20,324,902.22 to resolve allegations it violated the False Claims Act by submitting false claims to the Medicare and Medicaid programs.  According to the government, since the late 1990s through October 2009, CHN had contracts with free-standing ambulatory surgery centers under which they  would provide out-patient surgical services to CHN patients.  CHN would then bill Medicare and Medicaid for the surgical services through the billing departments of its hospitals so it could improperly receive higher reimbursement rates.  DOJ

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

June 24, 2015

Juan Carlos Delgado and Nereyda Infante, husband and wife owners of an Orlando health care clinic pleaded guilty to engaging in a $2.5 million health care fraud scheme.  They owned and operated several health care clinics under variations of the name Prestige Medical and from February 2012 to September 2014 they fraudulently billed Medicare on behalf of the Prestige clinics for services that never were administered.  DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud,

June 18, 2015

Edward Berman, a physician with a practice in Ridgefield, Connecticut, agreed to pay $218,633 to resolve allegations he violated the False Claims Act by submitting claims to Medicare for skilled nursing facility services that were not performed in accordance with Medicare requirements.  Specifically, the government alleges that Berman “upcoded” certain services, submitting claims to Medicare by using a higher-paying billing code when services with lower-paying billing codes were actually provided.  DOJ

Tagged in: FCA Federal, Medical Billing Fraud, SNF, Upcoding,

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services.  According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level.  The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Upcoding,

June 9, 2015

Earnest Gibson III, the former president of Riverside General Hospital, Earnest Gibson IV, the operator of Devotions Care Solutions, a Riverside satellite psychiatric facility, and Regina Askew, the owner of Safe and Sound group home, were sentenced to 45 years, 20 years and 12 years in prison, respectively, for their roles in a $158 million Medicare fraud scheme.  They were also ordered to pay restitution in the amount of $46,753,180, $7,518,480 and $46,255,893 respectively.  According to the evidence, the defendants had patients sit around the facility watching movies while they received no treatment, ultimately billing Medicare more than $158 million for care that was never provided.  DOJ

Tagged in: Hospital Fraud, Medical Billing Fraud,

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