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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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VNS Health: $1M Settlement for Failing To Provide Services to Hospice Patients

Posted  07/3/24
The U.S. Attorney's Office for the Southern District of New York announced a substantial settlement with Visiting Nurse Service of New York (formerly VNSNY, now VNS Health) and its related entities. This settlement addresses allegations of fraudulent billing practices that undermined the Medicaid program meant to support some of the most vulnerable patients like those in hospice.  VNS Health is one of the largest...

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted  02/23/24
doctor with dollars

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

Catch of the Week: Lincare, Inc.

Posted  02/16/24
DOJ website magnified logo
This week's Department of Justice (DOJ) Catch of the Week goes to Lincare, Inc., a durable medical equipment supplier with locations throughout the country.  Yesterday (February 15), the company agreed to pay $25.5 million to settle DOJ charges of violating the False Claims Act by billing Medicare for the rental of non-invasive ventilators (NIVs) when patients no longer needed or used them.  DOJ also charged Lincare...

Top Ten Healthcare False Claims Act Recoveries for 2023

Posted  01/30/24
Doctor Holding Stethoscope with Crossed Arms
This past year was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool.  And as we noted in our recent Top Ten listing of False Claims Act recoveries for 2023, all but 3 of the Top Ten recoveries were in the healthcare space involving various schemes to defraud Medicare and Medicaid.  So here is our look at the Top Ten healthcare recoveries for...

Catch of the Week: New York-Presbyterian Hospital

Posted  01/26/24
Hospital Building Sign
This week's Department of Justice (DOJ) Catch of the Week goes to New York-Presbyterian Hospital.  Yesterday (January 25), the hospital agreed to pay $801,000 to settle charges it violated the False Claims Act by billing Medicare, Medicaid and TRICARE for medically unnecessary images for radiation therapy treatments provided to cancer patients. The settlement is notable not for the relatively small amount of money...

Silver Lake Hospital and Investors Pay $30 Million to Settle Health Care Case

Posted  01/22/24
Medicare Card
Silver Lake Hospital, operating as Columbus LTACH in Newark, New Jersey, and certain investors recently agreed to pay a combined $30.6 million to settle False Claims Act allegations relating to Medicare payments and violations under the Federal Debt Collection Procedures Act (FDCPA). Silver Lake is a long-term care hospital a whistleblower alleged was claiming excessive "cost outlier" payments from Medicare, a...

January 16, 2024

Silver Lake Hospital, a long-term care hospital in New Jersey, will pay $18.6 million, and its principal investors Dr. Richard Lipsky and Columbus Management South LLC will pay another $12 million, to resolve allegations of violating the False Claims Act and Federal Debt Collection Procedures Act (FDCPA).  The hospital allegedly claimed excessive cost outlier payments from Medicare, well in excess of its needs or ability to repay, and transferred millions of dollars to investors without receiving equivalent value in return.  DOJ

Top Ten False Claims Act Recoveries in 2023

Posted  01/11/24
It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

January 10, 2024

Clinical laboratory RDx Bioscience Inc. and its owner and CEO Eric Leykin have agreed to pay over $10 million to the federal government and about $3 million to the State of New Jersey for violating the Anti-Kickback Statute and federal and state False Claims Acts.  From 2018 to 2022, RDx and Leykin were allegedly involved with five types of kickback schemes in order to induce referrals to RDx for laboratory testing, then submitted or caused false claims to be submitted to Medicare and Medicaid that were unnecessary or uncovered.  DOJ

January 5, 2024

A Florida man, Karel Felipe, and Florida woman, Tamara Quicutis, have been sentenced to 8 years and 5 years respectively for their roles in a $93 million fraud scheme against Medicare.  Felipe and Quicutis were found guilty last October of submitting claims on behalf of three Michigan-based home health companies, for services never rendered, using stolen patient information, and then laundering the proceeds through dozens of shell companies and hundreds of bank accounts.  Their fellow co-conspirators—Jesus Trujillo, Didier Arcia, Alexey Gil, and Jeffrey Avila—have already been sentenced for their roles.  DOJ
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