Medical Billing Fraud Archives - Page 51 of 52

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

Tagged in: FCA State, Medicaid, Medical Billing Fraud,

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

Tagged in: FCA State, Medicaid, Medical Billing Fraud,

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

Tagged in: FCA Federal, Improper Medical Personnel, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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

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

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

Tagged in: Medical Billing Fraud, Pharma Fraud,

February 4, 2015

Pennsylvania Attorney General Kathleen G. Kane and the Office of Inspector General of the U.S. Department of Health & Human Services announced Medicaid fraud and other charges against Philadelphia-based Infinite Care Inc., sister company Infinite Care Special Needs Inc., and the companies’ vice president and treasurer. According to the Grand Jury, Infinite Care fraudulently billed Medicaid by more than $1M for services not rendered from January 2010 to the present, and after the company received a Grand Jury subpoena, it held a meeting where the decision was made to destroy the fraudulent paperwork submitted to the Commonwealth for services not provided and for inflated services. PA

Tagged in: Medicaid, Medical Billing Fraud,

January 16, 2015

Washington Attorney General Bob Ferguson announced Sea Mar Community Health Centers agreed to pay $3.35M to settle charges of improperly billing Medicaid for thousands of dental appointments. According to the government, Sea Mar billed fluoride treatments as stand-alone appointments with a dentist or hygienist when they could have been performed much more cheaply by dental assistants as part of a patient’s regular six-month checkups. WA

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

October 31, 2014

Oklahoma-based dental company, Ocean Dental PC, which operates 28 clinics in seven states, agreed to pay more than $5M to settle charges it violated the False Claims Act by submitting false claims to the Oklahoma Medicaid program for dental work never performed or billed at a higher rate than allowed. The charges apparently stem from dental restorations by former employee Robin Lockwood who was sentenced to 18 months in federal prison in a separate case. NewsOK

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

August 12, 2014

New York Attorney General Eric T. Schneiderman announced that the Northern Manor Multicare Center nursing home agreed to pay $6.5M to resolve allegations it was not providing services as represented in its claims for payment to Medicaid. NYAG

Tagged in: Medical Billing Fraud, SNF,

April 14, 2014

Hope Cancer Institute, a cancer treatment facility in Kansas, and its owner Dr. Raj Sadasivan, agreed to pay $2.9M to resolve allegations they violated the False Claims Act by submitting claims to Medicare, Medicaid and the Federal Employee Health Benefits Program for chemotherapy drugs and services not actually provided. The allegations were first raised in a qui tam lawsuit filed by former employees of the facility Krisha Turner, Crystal Dercher and Amanda Reynolds under the whistleblower provisions of the False Claims Act. DOJ

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

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