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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 6 of 52

October 20, 2021

South Carolina provider Colonial Family Practice, LLC, has agreed to pay $1.25 million to resolve claims that they submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary nuclear stress tests and Cystatin-C tests, the latter of which were routinely submitted as part of a panel run on most patients, despite being payable for only a narrow set of patients.  The settlements resolve two qui tam actions brought by a former clinical manager and by a former physician assistant.  USAO SC

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

October 14, 2021

Owners and executives of Massachusetts mental health provider South Bay Mental Health Center, Inc. have agreed to pay $25 million to resolve claims that they caused the submission of false claims to the state’s Medicaid program, MassHealth, by billing for services provided by unlicensed, unqualified, and improperly supervised staff members in violation of MassHealth regulations. Defendants  H.I.G. Growth Partners, LLC and H.I.G. Capital, LLC will pay $19.95 million and defendants Peter J. Scanlon and Kevin P. Sheehan, who held executive and board positions at relevant entities, will pay $5.05 million.  The case was initiated by the filing of a whistleblower complaint under the Massachusetts False Claims Act.  SBMHC previously agreed to pay $4 million to resolve related charges.  Mass

Tagged in: Defendants, FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

August 27, 2021

John Peter Smith Hospital (JPS) in Texas has agreed to pay more than $3.3 million to resolve a qui tam suit filed by its former Director of Compliance, Erma Lee, which alleged that the hospital routinely applied billing modifiers that essentially double-billed federal healthcare programs for certain aspects of patients’ care.  Even after raising the issue internally, JPS allegedly failed to reimburse payors, prompting Lee to file the case in 2018.  For doing so, Lee will receive over $900,000 of the settlement proceeds.  USAO NDTX

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

August 26, 2021

Mental health and addiction services provider Connections Community Support Programs, Inc. has consented to the entry of judgment ordering payment of $15.3 million to resolve claims that it billed federal healthcare programs for mental health services performed by individuals without required professional qualification, billed using incorrect procedure codes, and failed to keep proper records regarding controlled substances.  Connections has filed for bankruptcy, and the government recovery will be limited by the availability of funds in the bankruptcy estate.  The settlement resolves claims brought in a qui tam lawsuit by two former Connections employees.  USAO Del

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

August 26, 2021

SuperCare Health, Inc., which provides home respiratory services and DME, will pay $3.3 million to resolve claims that the company submitted false claims for non-invasive ventilators in cases where those patients were no longer using the NIVs.  The case was initiated by the filing a whistleblower complaint by a former SuperCare respiratory therapist, Benjamin Martinez.  Mr. Martinez will receive a $612,000 whistleblower reward from the federal government.  USAO CD Cal

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

August 26, 2021

In-home care provider At Home Care LLC and its principal, Kevin Cox, will pay a total of $2.9 million to resolve allegations that they overcharged the Oregon Medicaid program, including by altering caregiver scheduling records and falsely billing for hours of in-home care that were not actually provided.  The company pleaded guilty to healthcare fraud charges, and agreed to be excluded from government healthcare programs.  USAO Or

Tagged in: Criminal Proceedings, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

August 25, 2021

Georgia-based psychotherapy provide Carenow Services, LLC, together with its CEO Leena Karun, will pay $2 million to resolve allegations of FCA violations through their billing for services at nursing homes that were not medically necessary, that were improperly documented, and at higher intensity levels than justified.  The investigation was initiated when a former Carenow employee filed a qui tam complaint; the whistleblower will receive an undisclosed whistleblower reward.  USAO ND Ga

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

August 19, 2021

Nevada Advanced Pain Specialists agreed to pay $1 million to resolve allegations that it submitted false claims for confirmatory urine drug testing performed without regard to the results of presumptive tests that had been performed. The allegations were first brought in a qui tam lawsuit filed by an whistleblower Omni Healthcare, Inc., which will receive a relator’s share of $150,000 of the settlement.  USAO MA

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

August 17, 2021

Following a voluntary self-disclosure to authorities, Blessing Hospital in Quincy, Illinois, has agreed to pay $2.82 million to resolve allegations that it submitted false claims for the facility component of medically unnecessary cardiac catheterization procedures.  The federal government will receive $2.6 million of the settlement, with the remainder going to Illinois, Iowa, and Missouri.  USAO CD IL

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

August 5, 2021

Ascension Michigan and related hospitals, which allegedly billed federal healthcare programs for services performed by a gynecologic oncologist that were not medically necessary or rendered as represented, has agreed to pay $2.8 million to resolve their liability under the False Claims Act.  The settlement resolves claims from a 2017 qui tam suit by whistleblowers Pamela Satchwell, Dawn Kasdorf, and Bethany Silva-Gomez, that Ascension knowingly submitted claims for medically unnecessary hysterectomies and chemotherapy, and unrendered evaluation and management services.  Spurred by patient complaints, Ascension launched an internal investigation, ultimately self-disclosing the misconduct to the government in 2018.  As part of the settlement, Satchwell, Kasdorf, and Silva-Gomez will share in a $532,000 award.  USAO EDMI

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

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