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Medical Billing Fraud

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December 18, 2015

Thirty-two hospitals in 15 states agreed to pay more than $28 million to settle charges they violated the False Claims Act by submitting false claims to Medicare for minimally-invasive kyphoplasty procedures used to treat certain spinal fractures often arising from osteoporosis.  According to the government, the settling hospitals billed Medicare for these procedures on a more costly inpatient basis when they should have been billed on a less costly outpatient basis.  The government has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations of overcharging Medicare for kyphoplasty procedures.  The 15 current settling hospitals include: The Cleveland Clinic (Ohio); Citrus Memorial Health System (Florida); Cullman Regional Medical Center (Alabama); Martin Memorial Medical Center (Florida); MultiCare Tacoma General Hospital (Washington); Norwalk Hospital (Connecticut); Princeton Community Hospital Association (West Virginia); Sacred Heart Medical Center (Washington); Sarasota Memorial Hospital (Florida); Spartanburg Regional Health Services District Inc. (South Carolina); St. Cloud Hospital (Minnesota); Tampa General Hospital (Florida); 5 hospitals affiliated with Community Health Systems Inc. (Tennessee); 5 hospitals affiliated with Tenet Health Care Corporation (Texas); 5 hospitals formerly owned and operated by Health Management Associates (Florida); 3 hospitals affiliated with BayCare Health System (Florida); and 2 hospitals affiliated with Banner Health (Arizona).  In addition, the government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations the company caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.  All but 3 of the current settlements originated in a whistleblower lawsuit filed by Craig Patrick, a former Kyphon reimbursement manager, and Charles Bates, a former Kyphon sales manager for Kyphon.  They will receive a whistleblower award of roughly $4.75 million from the proceeds of the government’s recovery.  DOJ

DOJ Gives Major Shoutout To Whistleblowers In $450M DaVita False Claims Act Settlement

Posted  06/26/15
By Gordon Schnell On Wednesday, Denver-based provider of dialysis services DaVita Healthcare Partners, Inc. agreed to pay $450 million to resolve charges it violated the False Claims Act by purposely creating and then billing the government for unnecessary waste in administering the drugs Zemplar and Venofer to dialysis patients.  DaVita is the largest provider of dialysis services in the US with dialysis clinics...

June 23, 2015

Georgia announced a prison sentence for the owner of Senior Care of Columbus, Inc., following her guilty plea to Medicaid fraud and related charges. From 2009 until 2011, the defendant submitted numerous fraudulent claims for and was reimbursed for services that were not provided to patients. An extraordinarily high percentage of claims submitted by defendant for reimbursement to Georgia Medicaid lacked any documentation, and it was discovered that in many instances, the defendant billed Medicaid on days when patients received no services at all, and for patients who had been discharged. GA

April 28, 2015

Life Focus Center of Charlestown, Inc., a former nonprofit that provided day habilitation services to individuals with developmental disabilities, agreed to pay more than $94,000 to settle claims it violated the Massachusetts False Claims Act by billing the state’s Medicaid program (MassHealth) for services not provided. MA

April 23, 2015

Grady Health System agreed to pay $2,950,000 to settle claims it inaccurately coded claims for neo-natal intensive care unit patients, resulting in alleged damages to the Georgia Medicaid program. GA

April 13, 2015

Hallmark Health Systems agreed to pay $1.75 million to settle allegations it improperly billed the Massachusetts Medicaid Program (MassHealth) for certain inpatient admissions at its hospitals, resulting in overpayments by MassHealth. The settlement alleges that from March 2008 to December 2013, Hallmark used a specific default code that classified MassHealth patients as having received short-stay inpatient services, when an observation or outpatient level of care would have been more appropriate. MA

April 7, 2015

Texas Attorney General Ken Paxton announced New Jersey-based pharmaceutical product manufacturer Glenmark Generics Inc. USA agreed to pay $25 million to resolve the State’s investigation under the Texas Medicaid Fraud Prevention Act against Glenmark for fraudulently reporting inflated drug prices to the Medicaid program. TX

March 19, 2015

Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A, will receive a whistleblower award of $1,082,500 from the $5,412,502 settlement resolving allegations Adventist Health System Sunbelt Healthcare Corporation violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons.  DOJ

March 11, 2015

Olufemi Afuape and Oluyemisi Afuape, owners of Zion Rehab Services, were ordered to pay $1,407,325.50 in restitution to the Georgia Department of Community Health for billing the Georgia Medicaid program for physical, occupational and speech therapy without regard to whether the services were medically necessary and without regard to whether the services were actually delivered. GA

March 6, 2015

Florida Attorney General Pam Bondi announced the arrest of three men for their alleged involvement in an $11 million multi-state drug diversion ring which involved the purchase of millions of dollars of medications on the black market, primarily from Medicaid recipients in Miami and Newark, and their resale to pharmacies in the Northeast, including North Philly Pharmacy in Philadelphia and Lu Puja Pharmacy in Chicago. FL
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