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

Page 15 of 53

July 8, 2021

Alere Inc. and Alere San Diego Inc. have agreed to pay nearly $39 million to settle allegations of knowingly selling defective blood coagulation monitors, which are used to determine safe dosages of anticoagulant drugs, to Medicare beneficiaries.  Too much anticoagulant could result in massive bleeding, while too little can result in blood clots and strokes.  By 2008, Alere had allegedly become aware of the fact that the software used in its INRatio monitors contained a material defect that caused some patients to see inaccurate results.  Although the company was also aware of dozens of deaths and hundreds of injuries associated with the devices, it failed to take them off the market and even continued to bill Medicare for them, in violation of the False Claims Act, until the FDA requested a Class I recall in 2016.  USAO NJ

Tagged in: Defective Products, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare,

June 28, 2021

Surgical Care Affiliates, LLC and Orlando Center for Outpatient Surgery, LP have agreed to pay $3.4 million to resolve a whistleblower’s allegations that they billed Medicare and TRICARE for medically unnecessary kidney stone procedures.  The centers also engaged in an illegal kickback arrangement whereby urologist Dr. Patrick Hunter performed lithotripsy procedures in exchange for per-procedure payments from the Orlando Center.  For bringing a successful action, whistleblower Scott Thompson will receive a relator’s share of $748,000 from the settlement with SCA and the Orlando Center.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 2, 2021

An Ohio-based hospital system that has since been acquired by the Cleveland Clinic Foundation has agreed to pay over $21 million to resolve alleged violations of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act.  Between 2010 and 2016, Akron General Health System (AGHS) allegedly paid area physician groups far above fair market value in order to induce referrals, then submitted claims arising from those illegal referrals to federal healthcare programs.  The settlement resolves a qui tam suit brought forth by former internal audit director at AGHS, Beverly Brouse, and Ethical Solutions LLC.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Provider Fraud, Whistleblower Case,

July 2, 2021

Select Medical Corporation (SMC) and Encore GC Acquisition LLL have agreed to pay $8.4 million to settle allegations that contract rehabilitation therapy provider Select Medical Rehabilitation Services Inc. (SMRS)—a previous subsidiary of SMC and current subsidiary of Encore—violated the False Claims Act.  According to former SMRS employee Melissa Vail, SMRS’s desire to maximize profits led it to provide medically unnecessary, unreasonable, and unskilled therapy services, and subsequently caused twelve skilled nursing facilities in the New York and New Jersey area to submit false claims to Medicare over a six-year period.  USAO NJ

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

June 25, 2021

Connecticut Addiction Medicine, LLC (CAM) and its owners, Dr. Jay Benson and Dr. Mahboob Aslam, have agreed to pay over $1 million to resolve their liability under the False Claims Act in connection with overcharges for urine drug tests that they caused to Medicare and Medicaid.  As part of their standard practice, CAM ran presumptive tests in-house but also sent the same sample out to an independent reference laboratory for definitive tests.  CAM then billed federal healthcare programs for the medically unnecessary presumptive tests.  USAO CT

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

June 23, 2021

El Paso Ear, Nose & Throat Associates (EPENT) has agreed to pay $750,000 to settle allegations of defrauding Medicaid, Medicare, and TRICARE.  In violation of the False Claims Act, EPENT allegedly billed the programs at a higher rate of reimbursement than what they were actually entitled to by upcoding evaluation and management codes.  USAO WDTX

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Upcoding,

June 11, 2021

Two integrative chiropractic practices in Pennsylvania and their chiropractor owners have agreed to pay over $800,000 to resolve liability under the False Claims Act in connection with an electro-acupuncture device.  The settling parties are Discover Optimal Healthcare, affiliate Weigner Healthcare Management Group, LLC, and owner Jason Weigner (collectively, “Weigner”), and Yucha Medical Pain Management & Chiropractic Rehabilitation, LLC, and owners Randolph Yucha and Rodney Gabel.  Between 2016 and 2017, the parties allegedly billed Medicare and the Federal Employees Health Benefit Program for the surgical implantation of neuro-stimulators, even though the devices involved—ANSiStim—are not reimbursable and can be applied with adhesives.  USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs, Provider Fraud,

June 10, 2021

Three Texas-based healthcare providers who allegedly billed Medicare for non-reimbursable procedures involving electro-acupuncture devices have agreed to pay over $1 million in settle their liability under the False Claims Act.  For up to two years, each of the providers—Ledger Foot & Ankle, P.A., SPR Medical Group d/b/a Superior Physical Medicine, and Precision Spine and Pain Management—allegedly billed the application of two pain management devices, ANSiStim and STIVAX, as though they were implantable neurostimulators, when in fact their application was non-surgical and non-invasive.  Following a Medicare audit, Superior and Precision self-disclosed improperly billed claims and initiated refund payments to Medicare.  USAO WDTX

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

June 8, 2021

The chiropractor owner and operator of Texas-based Campbell Medical Group PLLC and Johnson Medical Group PLLC d/b/a Campbell Medical Clinic has agreed to pay $2.6 million to settle claims that she and the entities defrauded Medicare and TRICARE.  As part of the settlement, Suhyun An and her medical entities will be excluded from participating in federal healthcare programs for ten years.  Ms. An and the medical entities allegedly improperly obtained over $3.9 million in reimbursement for unbillable implantations of neurostimulator electrodes.  USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs,

May 26, 2021

HEAG Pain Management Center, P.A. (HEAG) and its owner, Dr. Kwadwo Gyarteng-Dakwa (Dr. Dakwa), have agreed to pay $500,000 to settle allegations of defrauding Medicare and Medicaid.  According to the government, the defendants knowingly submitted or caused the submission of claims for medically unnecessary diagnostic testing between 2011 and 2016.  AG NC; USAO MDNC

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud,

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