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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 30 of 53

June 28, 2019

The nation’s largest operator of inpatient rehabilitation facilities (IRFs) has agreed to pay $48 million to settle allegations that it violated the False Claims Act.  Three separate lawsuits filed by former contract physician Dr. Emese Simon, former director of therapy operations Melissa Higgins, and former medical director Dr. Darius Clarke, alleged a number of Encompass Health Corporation, f/k/a HealthSouth Corporation IDFs, falsely diagnosed patients with “disuse myopathy” and improperly admitted patients too sick or disabled to participate in physical therapy in order to earn higher reimbursements from Medicare.  The whistleblowers’ collective share of the settlement is $12.4 million.  DOJ; USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

June 27, 2019

Following a whistleblower suit, Fusion Physical Therapy and Sports Wellness, P.C., and its founder and CEO, Carolyn Sue Mazur, have agreed to pay $37,500 to settle charges of billing Medicare for physical therapy services performed by uncredentialed personnel.  In addition the monetary penalty, Fusion and Mazur have also admitted to the misconduct.  USAO SDNY

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

June 27, 2019

Anne Arundel Medical Center (AAMC) has settled with the United States for alleged submissions of false claims to Medicare, TRICARE, and the Federal Employees Health Benefits Program.  In a whistleblower suit by former AAMC employee Barbara McHenry, the Maryland-based hospital was accused of billing for medically unnecessary Evaluation and Management (E/M) services from 2010 to 2013, and doubled billing for E/M services from 2014 to 2017 despite a 2014 update from CMS.  As part of the settlement, AAMC will pay $3 million and comply with a five-year Corporate Integrity Agreement, and McHenry will receive $473,100.  USAO MD

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

June 26, 2019

A patient recruiter in Michigan has been sentenced to 5 years in prison and ordered to pay $1.5 million in restitution for taking part in a three-year scheme to defraud Medicare. Defendant Sophia Eggleston had allegedly solicited and received kickbacks in exchange for her referrals, causing Medicare to pay $1.5 million to a home health agency connected to the fraud scheme.  DOJ

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

June 20, 2019

Hart to Heart Ambulance Services, d/b/a Hart to Heart Transportation Services, has agreed to pay $1.25 million to settle allegations that it defrauded Medicare by submitting claims for medically unnecessary services, violating the False Claims Act.  Allegations were first brought to the government’s attention by former employee, Bryan Arvey, who alleged that from 2010 to 2017, Hart to Heart management pressured employees to falsify claims for non-emergency ambulance transports, such as hospital discharges.  For aiding in the recovery of public funds, Arvey will receive a share of $251,000.  USAO MD

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

Question of the Week — Should providers who defraud Medicare be excluded from it?

Posted  06/18/19
Fortune Cookie with Message with Message Saying "Not Eligible for Medicare!"
Sometimes, though rarely, when a medical provider settles a False Claims Act case or is found to have violated the FCA at trial, they are excluded from participating in healthcare programs as a condition of resolving the case. Often, this is a limited-time ban that is meant to incentivize providers to follow Medicare’s rules in the future and to deter other providers from committing fraud. Between Medicare,...

Tagged in: FCA Federal, Medical Billing Fraud, Medicare, Question of the Week, Upcoding,

Read More

Mid Dakota Clinic - Healthcare Fraud/Kickbacks ($5.45 million)

Constantine Cannon represented a whistleblower in a False Claim Act alleging Mid Dakota Clinic engaged in a kickback scheme with its wholly owned ambulatory surgery center to elicit improper patient referrals.  In November 2019, the medical clinic agreed to pay $4.15 million to settle the matter.  Our client received a whistleblower award of 25% of the government's recovery.  Read more -- AP, Becker's, CC.

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

June 12, 2019

Lake Country Pharmacy and Compounding Center in Georgia, along with two of its principals, Chris and Carey Vaughan, have settled allegations filed by a whistleblower under the federal False Claims Act and Georgia False Medicaid Claims Act.  According to former pharmacist Chris Coleman, Lake Country submitted bills to Medicare, Medicaid, and TRICARE for compounded medications that were made from non-reimbursable bulk powders but billed as if they were made from reimbursable tablets.  Without admitting or denying these charges, Lake Country agreed to pay $365,000 and enter into an Integrity Agreement with the Department of Health and Human Services.  USAO MDGA

Tagged in: Compounding Pharmacy Fraud, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare,

June 11, 2019

A physical therapy center, its owner, and four nursing facilities in the Chicago area have settled an intervened qui tam suit that alleged that they upcoded patient Resource Utilization Group (RUG) scores, in violation of the False Claims Act, in order to increase Medicare payments.  Quality Therapy & Consultation Inc and owner Francise Parise allegedly worked in conjunction with Carlton at the Lake Inc, Ridgeview Rehab and Nursing Center, Lake Shore Healthcare and Rehabilitation Centre LLC, and Balmoral Home Inc to manipulate the RUG scores, which indicate the level of skilled nursing care each patient requires.  By upcoding the scores, the defendants allegedly claimed higher reimbursement rates from Medicare.  As part of the settlement, each of the facilities will pay between $1 and $4 million, and Parise will pay $160,000, for a combined recovery of $9.7 million.  USAO NDIL

Tagged in: FCA Federal, Healthcare Fraud, Medicare, SNF, Upcoding, Whistleblower Case,

June 11, 2019

A Maryland-based medical device manufacturer facing criminal charges and civil charges under the False Claims Act has agreed to pay $15 million to settle all claims.  According to former employee and whistleblower John Murtaugh, when the company discovered that its MicroMatrix wound dressing powder was contaminated with high levels of endotoxins, it allegedly removed certain MicroMatrix products off the market, but failed to report the removal to the FDA and disclose the reason to doctors, hospitals, and its own sales representatives.  ACell also allegedly caused false claims to be submitted to federal healthcare programs by directing its sales representatives to market the product as safe and effective, providing coding recommendations designed to elicit higher payments from Medicare, and providing improper inducements to encourage use of its product.  As part of the settlement, Murtaugh will receive $2.3 million, and ACell will enter into a 5-year corporate integrity agreement.  DOJ

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

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