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Medicare

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

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August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million.  According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals.  As part of the settlement, Seddon will receive a $200,000 relator’s share.  USAO SDAL

DOJ Catch of the Week — Beaver Medical Group

Posted  08/9/19
Yesterday, California-based Beaver Medical Group and one of its physicians, Dr. Sherif Khalil, agreed to pay roughly $5 million to resolve allegations they violated the False Claims Act by reporting invalid diagnoses to Medicare Advantage plans causing those plans to receive inflated payments from Medicare.  It is the latest example of what has become a strong government commitment to pursuing fraud in the Medicare...

August 8, 2019

California-based Beaver Medical Group LP and one of its physicians, Dr. Sherif Khalil, have agreed to pay $5 million to resolve allegations of violating the False Claims Act.  According to another physician formerly employed at Beaver, the defendants allegedly submitted false diagnoses to Medicare Advantage Organizations (MAOs) for the Medicare beneficiaries under its care, which caused Medicare to pay a needlessly inflated rate of reimbursement.  The whistleblower, Dr. David Nutter, will receive a relator’s share of $850,000 from the settlement proceeds.  DOJ

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Posted  08/2/19
Silhouette of People Around a Whistle
This week marks the seventh year in a row that Congress has designated July 30th National Whistleblower Day, honoring the occasion, on July 30, 1778, when the Continental Congress unanimously enacted the first whistleblower protection law in the United States. The law was passed in response to a petition to the Continental Congress filed by a group of ten American sailors and marines, who reported that their...

August 1, 2019

Tennessee-based telemarketer Scott Roix and his companies have agreed to pay $2.5 million to settle two whistleblowers’ False Claims suit alleging the submission of false claims to Medicare, TRICARE, and other federal health benefit programs.  Roix and his companies allegedly procured fraudulent insurance information from patients around the country in order to arrange prescriptions for medically unnecessary pain creams; they then sold these prescriptions to pharmacies, labeling proceeds as earned through marketing services.  The whistleblowers in this case, Jennifer Silva and Jessica Robertson, will receive $287,500 for revealing the fraudulent scheme.  USAO MDFL

July 24, 2019

Pennsylvania-based Eagleville Hospital has agreed to pay $2.85 million to settle allegations of defrauding Medicare, Medicaid, and the Federal Employees Health Benefits Program.  According to an anonymous relator, Eagleville violated the False Claims Act between 2011 and 2018 by submitting claims for substance abuse patients improperly admitted for high paying, hospital-level detoxification treatments.  The whistleblower will receive $500,000 of the recovery.  USAO EDPA

Government Documents Dangerous Failures in Hospice-Care Facilities

Posted  07/19/19
By Sarah “Poppy” Alexander
hand holding hospice patients hand
The Department of Health and Human Services (HHS) recently released two deeply concerning reports about failures in hospice care. Hospices put patients in harm’s way by failing to meet Medicare’s standards of care, failing to protect patients from abuse, and failing to report dangerous conditions. All told, the reports paint a grim picture of substandard health services for a particularly vulnerable patient...

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid.  As part of the settlement, they will pay $425,000USAO CT

July 15, 2019

Millcreek Community Hospital has agreed to pay $2.4 million and enter into a Corporate Integrity Agreement requiring five years of monitoring to resolve allegations of violating the False Claims Act.  For a period of four years, the Pennsylvania-based hospital’s inpatient rehabilitation unit allegedly admitted ineligible patients, then failed to document in medical records that such services were medically necessary and reasonable. USAO WDPA
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