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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 24 of 53

February 11, 2020

Tenet Healthcare Corporation and its affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.4 million to settle allegations that they knowingly charged Medicare for medically unnecessary cardiac monitors, in violation of the False Claims Act.  According to former DRMC employee, Michael Grace, the devices were implanted between 2014 to 2017, exposing beneficiaries to unnecessary risk and causing the government unnecessary expenses.  For exposing the fraud, Grace will receive a $240,789 share of the recovery.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

February 6, 2020

A patient recruiter in Kentucky has been sentenced to 5 years in prison and ordered to pay or forfeit over $1.2 million in total for accepting more than $1 million in kickbacks from home health agencies in exchange for providing information about Medicare beneficiaries.  The owner of Trumbo Consulting Agency in Virginia, Dominic Trumbo recruited and paid others to recruit over 4,000 Medicare beneficiaries for home health services by offering incentives to get them to sign up.  Trumbo then sold the information to home health agencies around the country in exchange for kickbacks, then created fake contracts and invoices to conceal the fraud from Medicare.  DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

February 4, 2020

Southeastern Retina Associates (SERA), which operates in parts of Tennessee, Georgia, and Virginia, has agreed to pay $1.5 million and enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services for allegedly defrauding Medicare and Medicaid.  The investigation was launched by a qui tam suit filed by an unnamed whistleblower, which alleged that between 2009 to 2016, the practice improperly billed exams at a higher rate than appropriate, and used a billing code called Modifier 25 to bill for exams that were not separately billable from other services billed the same day.  For exposing the misconduct, the relator in this case will receive a $270,000 share of the settlement.  USAO EDTN

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

Opioid Executive Sentenced to Over Five Years in Prison for Role in Healthcare Fraud Scheme

Posted  01/31/20
opioid pills scattered around
Insys Therapeutics, an opioid manufacturer whose main product is Subsys, a spray from of fentanyl that is 100 times stronger than morphine and cost tens of thousands a month, is in the news again. The company and its former CEO, John Kapoor, have been facing a mountain of legal issues in the past three years. Last week, in a decision that most of our readers agree with, Kapoor was sentenced to 66 months in prison. 

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, SEC Whistleblower Reward Program, Whistleblower Case, Whistleblower Rewards,

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January 29, 2020

A Florida-based physician, Erik Schabert, and his ex-wife, Mika Harris, have been sentenced to 3.5 years and 3 months in prison, and ordered to pay almost $4.5 million in restitution to Blue Cross Blue Shield for attempting to defraud the insurer and the Medicare program of more than $8 million.  Between 2013 and 2016, the two owners and operators of Reliant Family Practice falsely diagnosed actinic keratosis and rosacea in order to make fraudulent claims for chemical peels and dermabrasions.  Along with prison time and restitution, the two have forfeited their private residence, commercial property, and over $260,000 in an annuity account, to the federal government.  USAO NDFL

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare,

Top Ten Healthcare Fraud Recoveries of 2019

Posted  01/24/20
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters.  And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act.  Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

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January 23, 2020

Arch Health Partners, Inc. has agreed to pay $2.9 million to resolve fraud allegations brought by a former employee turned whistleblower, Catherine Jones.  Jones alleged in a qui tam suit that the San Diego-based healthcare provider had falsely billed Medicare for evaluation and management services that lacked sufficient documentation, in violation of the False Claims Act.  Based on self-disclosures by Arch Health, the United States also alleged that referring physicians were being compensated above fair market value, in violation of the Anti-Kickback and Stark Acts.  Jones will receive $183,830 of the settlement proceeds.  USAO SDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare,

January 16, 2020

Udaya Shetty, a psychiatrist in Virginia, was sentenced to over two years in prison and has agreed to pay over $1 million to the United States and the Commonwealth of Virginia to resolve allegations of submitting false claims to Medicare, Medicaid, and TRICARE.  Shetty was accused of billing for services that average about 40-60 minutes long, despite quadruple booking patients and only seeing them for about 5-10 minutes each.  The scheme began at his own practice, Behavioral & Neuropsychiatric Group, in 2013, and continued at a new practice, Quietly Radiant Psychiatric Services, in 2017.  As a result of his actions, government health programs were defrauded of more than $450,000.  USAO EDVA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs,

January 15, 2020

ResMed Corp. has agreed to pay $37.5 million to resolve five whistleblower-brought lawsuits alleging that the durable medical equipment (DME) manufacturer paid illegal kickbacks to suppliers, sleep labs, and other health providers, in violation of the Anti-Kickback Statute and False Claims Act.  $6.2 million of the settlement will be split amongst the whistleblowers, who had revealed that ResMed improperly provided or helped provide free or below cost call center services, patient outreach services, medical equipment and installation, and interest-free loans, in exchange for business.  DOJ; USAO EDNY; USAO NC; USAO NDIA; USAO SC; USAO SDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

January 15, 2020

TMJ & Orofacial Pain Treatment Centers of Wisconsin has agreed to pay $1 million to settle a qui tam suit alleging submissions of false claims to Medicare and TRICARE.  According to the anonymous whistleblower, who will receive an undisclosed share of the settlement, TMJ billed the government health programs for prosthetic devices as if they had been fabricated by in-house surgeons, when in fact they had been fabricated by an outside laboratory.  USAO EDWI

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

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