Contact

Click here for a confidential contact or call:

1-212-350-2774

Medicare

This archive displays posts tagged as relevant to Medicare and fraud in the Medicare program. You may also be interested in our pages:

Page 1 of 52

OIG Identifies Fraud as Top Challenge in 2023 HHS Annual Report - Bring on the Whistleblowers

Posted  11/21/23
Person with Magnifying Glass and Pen Examining Stack of Papers
The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) just released its 2023 Annual Report on its Top Management and Performance Challenges for the past year.  Among the key challenges OIG identified is better protecting HHS programs -- Medicare and Medicaid being chief among them -- from fraud, waste, and abuse.  No big surprise as this is a perennial challenge for the federal...

October 18, 2023

The president of a California-based medical technology company has been sentenced to 8 years in prison and ordered to pay $24 million in restitution in the first COVID-related criminal securities fraud case charged by DOJ and the first COVID-related criminal healthcare fraud case brought to trial.  Among many things, Mark Schena of Arrayit Corporation was found to have taken advantage of the pandemic by claiming he and his company had developed a technology to test for just about any disease, including COVID, using a single drop of blood.  In doing so, Schena and Arrayit lied to investors to give them a false sense of credibility, paid illegal kickbacks to marketers to run deceptive plans about the accuracy of its tests, and submitted false claims to Medicare and private insurers for medically unnecessary allergy testing.  DOJ

Genetic Testing Scheme Leads to Another Fraud Conviction

Posted  10/11/23
Scientist Testing a Specimen
The DOJ recently announced another fraud conviction in connection with genetic testing. This conviction from a federal jury in Florida is the latest word in a string of fraud actions against companies and individuals offering to provide genetic testing services. According to the DOJ, Jose Goyos and others managed the “‘doctor chase’ division” of a call center, which “contacted the primary care physicians...

Scoundrel Spotlight - COVID-19 Fraudster Lourdes Navarro

Posted  10/9/23
Laboratory Worker Taking a Swab Test
This week's Scoundrel in the Spotlight is Lourdes Navarro and her husband Imran Shams.  The married pair ran the LA County medical lab Clinical Laboratory Inc. (also called Health Care Providers Laboratory).  Their lab performed COVID-19 screening tests primarily for nursing homes and other facilities catering to the elderly population.  Last Thursday (October 5), Navarro pleaded guilty to fraudulently billing the...

Scoundrel Spotlight - Medicare Fraudster Jesus Virlar-Cadena

Posted  10/2/23
hand holding hospice patients hand
This week’s Scoundrel in the Spotlight is Jesus Virlar-Cadena, a former medical director of a Texas-based healthcare provider called Merida Group, who was recently sentenced to over four years in prison in connection with a fraudulent scheme involving over $150 million in false Medicare claims, according to a DOJ press release. The Merida Group marketed hospice services to patients with long-term incurable...

October 2, 2023

Genomic Health, Inc. (GHI), a wholly-owned subsidiary of Exact Sciences Corporation that provides clinical diagnostic tests, has agreed to pay $32.5 million to resolve two separate qui tam suits alleging violations of the False Claims Act and Anti-Kickback Statute in connection with lab tests for cancer patients.  GHI allegedly evaded Medicare’s 14-Day Rule—which prohibits labs from separately billing for the same covered tests within 14 days of a patient’s discharge from a hospital—by canceling and reordering tests so they fell within appropriate time frames, seeking reimbursement directly from Medicare, and writing off unpaid lab fees owed by hospitals.  As a result of this settlement, the whistleblowers in the case will receive over $5.5 million.  DOJ

September 30, 2023

The Cigna Group has agreed to pay over $172 million and enter into a five-year Corporate Integrity Agreement in order to resolve allegations of violating the False Claims Act.  According to qui tam suit by a former part-owner of a Cigna vendor, Robert Cutler—who will receive an $8.1 million share of the settlement—the healthcare company knowingly submitted inaccurate and untruthful diagnosis codes on behalf of Medicare Advantage Plan beneficiaries in order to inflate their reimbursements from Medicare.  DOJ

Nurse Practitioner Convicted in $200 Million Medicare Fraud Scheme

Posted  09/28/23
Stethoscope Placed Down
In a landmark healthcare fraud case, a federal jury in Miami has convicted a nurse practitioner $200 million for her central role in a massive Medicare fraud scheme in which she conspired with telemarketing companies to submit false claims for unnecessary genetic testing and medical equipment. Evidence presented during trial outlined the scheme: telemarketers targeted Medicare beneficiaries, and pressured them to...

September 13, 2023

Texas-based Oliver Street Dermatology Management LLC, which manages dermatology practices, surgical centers, and pathology labs across the country, has agreed to pay $8.9 million to resolve self-reported violations of the Anti-Kickback Statute, Stark Law, and False Claims Act.  The company revealed in 2021 that some of its former senior managers had fraudulently increased the purchase price of 11 dermatology practices acquired between 2013 and 2018 in exchange for referrals.  Claims arising from those referrals were found to have been submitted to Medicare.  USAO NDTX

Catch of the Week: Lincare Holdings

Posted  08/31/23
Medical Oxygen Tanks
This week's Department of Justice (DOJ) Catch of the Week goes to Florida-based Lincare Holdings, Inc., a wholly-owned subsidiary of the German chemical corporation Linde plc.  On Monday (August 28), the DOJ announced that the company agreed to pay $29 million to settle charges of violating the False Claims Act by overbilling Medicare and Medicare Advantage Plans for oxygen equipment. Lincare provides oxygen...
1 2 3 52