Medical Billing Fraud

May 22, 2014

Zahir Yousafzai, the co-owner or operator of four Detroit-area home health agencies involved in a $13.8M Medicare fraud scheme was sentenced to serve 72 months in prison and pay $4.1M in restitution. According to court records, Yousafzai and his co-conspirators paid and directed the payment of various medical professionals, including doctors, nurses, physical therapists and physical therapist assistants, to create fictitious patient files to document purported home health services that were never provided. The healthcare companies involved included First Care Home Health Care, Moonlite Home Care, Physicians Choice Home Health Care and Quantum Home Care. DOJ

May 14, 2014

Richard Shannon, a patient recruiter for All American and Patient Choice, two home health care companies that provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area, was sentenced to 86 months in prison for his role in a $14.5M Medicare fraud scheme. The evidence showed that Shannon paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. Shannon recruited destitute beneficiaries from housing projects and soup kitchens in the Detroit area, obtaining their patient information in exchange for cash and promises of prescription narcotics prescribed by co-conspirator physicians. DOJ

February 25, 2014

Diagnostic Imaging Group agreed to pay $15.5M to resolve allegations that its diagnostic testing facility falsely billed federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians. The allegations were first raised in three qui tam lawsuits filed under the whistleblower provisions of the False Claims Act. DOJ

February 19, 2014

Medical device manufacturer EndoGastric Solutions agreed to pay up to $5.25M to resolve allegations that it violated the False Claims Act by misleading health care providers about how to bill federal health care programs for a procedure using a device manufactured by the company and by paying kickbacks. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

January 10, 2014

Two former executives of HealthEssentials Solutions agreed to pay more than $1 million to resolve False Claims Act allegations that they knowingly caused the company to submit false Medicare claims between 1999 and 2004 by billing for services that were inflated or not medically necessary and by pressuring employees to do the same. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

September 13, 2013

Gulf Region Radiation Oncology Centers, Sacred Heart Health System, West Florida Medical Center Clinic and others agreed to pay $3.5M to resolve allegations that they billed Medicare, Medicaid and TRICARE – the health care program for uniformed service members, retirees and their families worldwide – for radiation oncology services that were not eligible for payment. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

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