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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 5 of 52

Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Tagged in: Anti-Kickback and Stark, Chiropractic, Criminal Proceedings, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Provider Fraud, Top 10,

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Top Ten Whistleblower Awards of 2021

Posted  01/6/22
Red Whistle with People
2021 was another banner year for whistleblowers, who once again collectively recovered billions of dollars for the government and hundreds of millions of dollars in whistleblower rewards under the various government whistleblower programs.  This includes awards under the qui tam provisions of the federal False Claims Act and various state False Claims Act programs.  It includes awards under the Dodd-Frank SEC...

Tagged in: Anti-Kickback and Stark, Auto Safety, CFTC Whistleblower Reward Program, FCA Federal, FCA State, Financial and Investment Fraud, Financial Institution Fraud, Healthcare Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, SEC Whistleblower Reward Program, Securities Fraud, Top 10, Whistleblower Case, Whistleblower Rewards,

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December 15, 2021

David Bellamah, and his business, Bellamah Vein & Surgery, PLLC, will pay $3.75 million to resolve allegations that they billed government healthcare programs for medically unnecessary venous procedures based on false medical records.  Defendants allegedly used improper techniques to conduct and analyze ultrasounds and used false ultrasound findings to diagnoses and treat venous reflux disease and varicose veins. The government’s claims were initiated by the filing a qui tam complaint by Lenore Lezanne, who previously worked as a sonographer at the Bellamah Vein Center; Lezane will receive a whistleblower award of 17% of the amounts recovered.  USAO MT

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

December 13, 2021

Kevin Cooper, M.D. and his practice, Cooper Family Medical Center, will pay $375,000 to resolve allegations that they fraudulently billed Medicare of non-reimbursable acupuncture devices by using billing codes for surgically implanted devices for the provision of P-Stim electro-acupuncture devices that are affixed behind a patient’s ear using an adhesive.  USAO SD MI

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Upcoding,

December 7, 2021

New Jersey-based Princeton Pathology Services P.A. will pay $2.4 million to resolve allegations that it overbilled Medicare by submitting claims using a Current Procedural Terminology (CPT) code that required written analysis by a pathologist, when no such analysis was required or had been prepared.  A whistleblower, Jayant Barai, M.D., initiated the matter by filing a qui tam complaint under the False Claims Act, and will receive an award of $456,000.  USAO NJ

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

November 23, 2021

A number of related entities operating in Ohio and Tennessee as Crossroads Hospice have agreed to pay $5.5 million to resolve allegations that they submitted false claims for hospice services that were not covered by Medicare.  Specifically, the government alleged that over a period of three years, Crossroads submitted claims for dementia or Alzheimer’s patients who were not terminally ill for at least a portion of the more than three years that the patients received care.  Two qui tam actions were filed regarding the false claims; the three individuals who jointly filed the first action, Leanne Malone, Jackie Burns and Angela Heck, were previously employees of Crossroads, and will receive approximately $1.045 million.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Classic Medicare Fraud

Posted  11/5/21
medicare dollars
For those like your correspondents who spend their days deep in the weeds of complex Medicare fraud, it’s a delight when something refreshingly simple comes along.  Thanks to Billy Joe Taylor of Arkansas, we can relax this Friday with a cool glass of straightforward Medicare fraud.  For allegedly making $100 million in claims to CMS for tests that were not ordered or ever performed, he is our Catch of the...

Tagged in: Catch of the Week, COVID-19, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud,

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Catch of the Week: Fraudulent Sleep Tests in Fresno

Posted  10/29/21
bed with pillow and sheets scattered
Fraud permeates through all aspects of America’s healthcare system- from hospitals to big pharma to chiropractors. This week’s catch of the week focuses on another part of the system, sleep clinics. As increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders, the significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous...

Tagged in: Catch of the Week, Healthcare Fraud, Improper Medical Facility, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

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October 22, 2021

Texas doctors Robert Wills and Brannon Frank, who previously operated Austin Pain Associates, will pay $3.9 million to resolve allegations that they billed federal and state healthcare programs for medically unnecessary urine drug tests that were performed at Austin Pain Associates’ in-house lab.  The investigation was initiated after a whistleblower complaint was filed by former Austin Pain Associates employees Jennifer Nuessner and Robert Hoffman; they will receive approximately $618,000 from the federal share of the settlements. DOJ

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

Posted  10/22/21
Person wearing lab coat in laboratory
Clinical laboratory MD Labs Inc., and co-founders and owners, Denis Grizelj and Matthew Rutledge, settled charges the lab falsely billed Medicare, Medicaid, and other federal payors for pricey and unnecessary urine drug tests. Over a four-year period, the lab regularly ran two different drug tests at once and then sent results from both tests to the ordering healthcare physician simultaneously, according to the...

Tagged in: Catch of the Week, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

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