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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 26 of 53

November 5, 2019

A home health agency that allegedly defrauded Medicare and Louisiana’s Medicaid program has agreed to pay $2.5 million to settle claims arising from a qui tam suit.  Defendants Health Care Options, Inc., Health Care Options of Lafayette, Inc., Home Care Options Houston, Inc., and Howard Austin, II allegedly submitted reimbursement claims involving non-face-to-face encounters, as required by program rules.  USAO MDLA

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Whistleblower Case,

October 29, 2019

Encompass Health Corporation (EHC), f/k/a HealthSouth Corporation, has agreed to pay $4 million to resolve of improperly billing Medicare.  According to the DOJ, between 2008 and 2012, an inpatient rehabilitation facility owned by EHC had improperly assigned low Functional Independence Measure scores on Patient Assessment Instrument forms in a bid to receive higher reimbursements from Medicare.  USAO NV

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Upcoding,

October 28, 2019

Atheir Amarrah, the owner of Michigan-based Prompt Care Home Health Services Inc, has been sentenced to 5 years in prison and ordered to pay $1 million in restitution after pleading guilty to paying recruiters for referrals to Medicare beneficiaries.  In his guilty plea, Amarrah also admitted to billing Medicare for claims tainted by illegal kickbacks.  DOJ

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

October 28, 2019

Sanford Health, Sanford Medical Center, and Sanford Clinic have agreed to pay $20.25 million and enter into a Corporate Integrity Agreement in order to resolve alleged violations of the Anti-Kickback Statute and False Claims Act.  Despite warnings by several physicians that a top neurosurgeon was illegally profiting off his use of implantable medical devices as well as performing medically unnecessary surgeries involving the devices, Sanford did nothing to stop the offender, allowing Medicare and Medicaid to continue being defrauded.  The allegations were raised by Sanford surgeons Drs. Carl Dustin Bechtold and Bryan Wellman, who will share in a $3.4 million cut of the settlement proceeds.  DOJ; USAO SD

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Devices and DME, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

October 17, 2019

Five home health providers in Iowa and South Dakota have been ordered to pay a combined $3.1 million for submitting false claims to Medicare.  Affiliates of Minnesota-based Welcov Healthcare LLC allegedly billed Medicare for therapy services that were not provided by skilled employees or not medically necessary.  Sergeant Bluff Healthcare, LLC will pay over $1.2 million, Logan Healthcare, LLC and Elk Point Healthcare #1, LLC will each pay over $775,000, Red Oak Healthcare, LLC will pay over $228,000, and Flandreau Healthcare 2, LLC will pay about $116,000.  USAO NDIA

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

October 10, 2019

Traverse Anesthesia Associates, P.C. (TAA) and six of its anesthesiologists have agreed to pay $607,966 to resolve a partially-intervened qui tam lawsuit jointly filed by two former employees.  In violation of the False Claims Act, TAA allegedly failed to meet regulatory requirements and conditions of payment in submissions to Medicare.  The unnamed whistleblowers will share a $120,000 award.  USAO WDMI

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

October 9, 2019

Genetic testing company UTC Laboratories, Inc. (RenRX), along with three principals, have agreed to pay a combined $42.6 million to settle six suits alleging violations of the Anti-Kickback Statue and False Claims Act.  Between 2013 and 2017, RenRX and principals Tarun Jolly, M.D., Patrick Ridgeway, and Barry Griffith allegedly paid cash bribes to physician entities and individuals to induce orders of medically unnecessary pharmacogenetic tests that were subsequently billed to Medicare.  As part of the settlement, RenRX also agreed to a twenty-five year period of exclusion from participating in any federal healthcare program.  USAO EDLA

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

October 9, 2019

The largest operator of kidney dialysis clinics in the United States has agreed to pay $5.2 million to resolve a lawsuit alleging it submitted false claims to Medicare for excessive and unnecessary immune tests.  From 2013 to 2010, Fresenius Medical Care Holdings, Inc. allegedly billed Medicare for Hepatitis B surface antigen tests it performed on patients already known to be immune, at a frequency well above that established by Medicare.  For exposing the alleged False Claims Act violations, former employee Christopher Drennen will receive a 27.5% share of the recovery.  USAO MA

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

October 4, 2019

Southern California-based Retina Institute of California Medical Group (RIC), its former CEO, and several of its physicians have agreed to pay the State of California and United States $6.65 million to settle alleged violations of state and federal False Claims Acts.  According to former administrators Bobbette Smith and Susan Rogers, between 2006 and 2017, the ophthalmology group improperly billed Medicare and Medicaid for unnecessary and unperformed eye exams, upcoded simple exams using codes normally reserved for emergency conditions, and waived mandatory co-payments and deductibles to induce patient referrals.  Smith and Rogers will receive a relator’s share, which remains to be determined.  USAO CDCA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Upcoding, Whistleblower Case,

September 27, 2019

In an investigation dubbed Operation Double Helix, charges have been brought against 35 defendants associated with a number of telemedicine and cancer genetic testing laboratories involved in a scheme that resulted in the submission of more than $2.1 billion in fraudulent Medicare claims.  Cancer genetic testing laboratories involved in the scheme are alleged to have paid illegal kickbacks to providers and others working with fraudulent telemedicine companies in exchange for the referral of Medicare beneficiaries for expensive and medically unnecessary cancer genetic tests, which Medicare was then billed for. Some of the defendants allegedly controlled a telemarketing network that lured hundreds of thousands of elderly and/or disabled patients into signing up for unnecessary genetic tests, often without any interaction with the provider who would prescribe the testing.  DOJ; USAO ED LA

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Laboratory and IDTF, Medicare,

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