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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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February 13, 2019

Ashraf Hasan-Hafez and Ilya Kogan have been sentenced to over three years in prison for their participation in a scheme that defrauded Medicare and New York State Medicaid out of $1.3M dollars. Hasan-Hafez, the owner of a physical therapy practice, and Kogan, the owner of an acupuncture company, fraudulently submitted bills for services that were not rendered, or for services performed by unlicensed individuals. In addition to jail time, Hasan-Hafez and Kogan have been ordered to forfeit $1,297,000 in restitution to the Medicare and Medicaid programs.  DOJ    

February 12, 2019

Jefferson Medical Associates, a Laurel-based physicians group, and neurologist, Dr. Aremmia Tanious, will pay the United States $817,635.06 to settle allegations under the False Claims Act regarding Medicare overpayments. The government’s investigation discovered that from 2012 to 2014, Jefferson Medical Associates and Dr. Tanious allegedly did not return overpayments they received on claims from Medicare. It is further alleged that from February 1, 2013, through June 30, 2017, Jefferson Medical Associates and Dr. Tanious allegedly used multiple medical codes when billing Medicare but the medical documentation did not support those billing practices. DOJ    

February 11, 2019

GenomeDx Biosciences Corp. has agreed to pay $1.99 million in connection with a whistleblower complaint by two former employees, which alleged that the genetic testing laboratory violated the False Claims Act in its submissions to Medicare. According to the unnamed whistleblowers, from 2015 to 2017, GenomeDx submitted reimbursement claims for running a post-operative genetic test on prostate cancer patients, even though that population did not have risk factors that called for the test. They will share in a $348,316.50 award as part of the settlement. USAO SDCA

February 8, 2019

Two executives from the South Carolina Early Autism Project (SCEAP) have been convicted of causing false statements to be submitted to Medicare and TRICARE and causing them to be overcharged by millions of dollars. According to statements by SCEAP employees, co-founder Ann Davis Eldridge and executive Angela Breitweiser Keith instructed employees to include travel and wait time in their billing in order to inflate time spent providing services. To further incentivize this practice, they implemented billing goals that had to be met in order to qualify for bonuses such as gift cards and vacations, all paid for by the company. Since then SCEAP has repaid almost $9 million, and as part of their plea agreement, both Keith and Eldridge will serve 1-year sentences. USAO SC

February 8, 2019

A Texas-based marketing company, One Source Healthcare Organization, and its owner, James Paul Adams, have agreed to pay $339,412.50 to resolve allegations that it violated the Anti-Kickback Statute in accepting illegal payments from a compounding pharmacy to market their drug. Because the payments resulted in false claims being paid by Medicare and TRICARE, they were also alleged to be in violation of the federal False Claims Act. Two men affiliated with the compounding pharmacy, Oklahoma-based OK Compounding, LLC, were previously indicted on similar charges. USAO NDOK

February 6, 2019

Georgia-based Union General Hospital has agreed to pay $5 million to settle allegations that from 2012 to 2016, it billed Medicare for services stemming from improper financial relationships with physicians, in violation of the Stark Law and the False Claims Act. The misconduct was uncovered during an internal investigation sparked by a federal investigation into an unrelated matter; UGH then voluntarily self-disclosed details of the instant case to the U.S. Attorney's Office. USAO NDGA

February 5, 2019

Two doctors from the Florida-based Fishman & Sheridan Eye Care Specialists clinic have agreed to pay a combined $157,312.32 to settle their liability under the False Claims Act. Drs. Craig D. Fishman and Jeffrey A. Sheridan were outed in a qui tam complaint filed by former business partner Dr. Michael Pennachio and office manager Sharon Drake, which alleged that from 2011 to 2017, Fishman and Sheridan knowingly billed Medicare for blepharoplasty and ptosis repair surgeries that were purportedly performed on the same patients, even though they are mutually exclusive eyelid repair surgeries. For exposing the fraud, Pennachio and Drake will receive a relator's share of $26,000. USAO MDFL

February 1, 2019

Ali Jama, co-owner of Alpha Star Health Care Inc., was sentenced to 18 months in prison for health care fraud and tax fraud schemes against Medicare and Medicaid. Jama billed the government for services performed by unqualified individuals with criminal backgrounds who were prohibited from providing direct care. Jama also billed for services provided by untrained home health aides and provided false documents and false records for his taxes to reduce his company’s tax liability from approximately $680,000 to $81,000. Jama has been ordered to forfeit $300,000 and pay $392,000 in restitution to Medicaid. He must also pay the IRS $311,000 in restitution. DOJ

January 29, 2019

Two doctors and a health clinic owner in the Houston area have each been sentenced to decades in prison following their convictions for Medicare fraud. In one case involving three defendants—clinic owner Ann Shepherd, doctor John Ramirez, and Yvette Nwoko—Medicare paid over $17 million in fraudulent claims resulting from false certifications related to services not medically necessary or properly provided. Defendants Shepherd was sentenced to 30 years in prison, and ordered to pay $20 million; Ramirez was sentenced to 25 years in priosn and ordered to pay $26 million; Nwoko awaits sentencing. In a second case, related case, doctor Anh Do was sentenced to three years in prison and ordered to pay almost $2 million in restitution on similar charges. DOJ 1; DOJ 2

January 29, 2019

Tennessee-based home dialysis provider WellBound of Memphis agreed to pay $3,246,000 to the State of Tennessee and the United States for allegedly submitting false claims to Medicare, TRICARE, and Tenncare from 2016 to 2018. According to a qui tam complaint filed by whistleblower Dr. Darryl Quarles, the claims resulted from illegal inducements for patient referrals, which violated the anti-kickback statute (AKS) and are not payable under state or federal laws. USAO WDTN
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