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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 31 of 53

June 7, 2019

Robert A. Glazer and Marina Menino have been found guilty at trial for their actions directing a Medicare fraud scheme that billed $33 million to the government.  Menino received kickbacks from Glazer in exchange for recruiting patients for his Glazer Clinic.  Glazer then billed Medicare for services the patients did not need or did not receive, referred them to medically unnecessary home health or hospice services, and ordered durable medical equipment that they did not need or receive. Defendants will be sentenced in September 2019. DOJ; USAO C.D.Cal.

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

Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Posted  06/7/19
businessmen showing inside of briefcase
Opioid manufacturer Insys Therapeutics agreed to a $225 million settlement related to allegations that it unlawfully marketed its drug Subsys and paid kickbacks to providers through “speaker programs” that rewarded providers who prescribed Subsys. We previously asked whether our readers thought CEOs should be more liable for corporate wrongdoing after the Insys CEO was convicted for participating in a criminal...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Question of the Week, Reporting to Government, Whistleblower Rewards,

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June 3, 2019

A former physician’s assistant in New Hampshire has been sentenced to 4 years in prison for writing prescriptions of a fentanyl spray in exchange for over $49,000 in kickbacks masked as speaker honorariums.  After being approached by a drug manufacturer in 2013, Christopher Clough wrote upwards of 750 prescriptions for the spray, which was intended for management of breakthrough cancer pain (BTCP).  Over 215 of those prescriptions were for Medicare and TRICARE patients and led to payments of over $2.1 million by Medicare and almost $600,000 by TRICARE.  On top of the kickback charges, Clough was accused of causing patient harm for prescribing the drug, in high doses, to patients who didn’t have BTCP, and then rebuffing patient and family requests to get off the drug.  USAO NH

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicare, Other Government Health Programs,

May 31, 2019

A Kansas hospital accused of submitting false claims to Medicare and Medicaid has agreed to pay $250,000 to settle a qui tam suit by Bashar Awad and Cynthia McKerrigan, with about $50,000 of the recovery going to the whistleblowers.  According to the suit, from 2012 to 2013, Coffey Health System falsely attested to having conducted or reviewed security risk analyses of electronic health records (EHR), which was a requirement under a federal incentive program that pays healthcare providers for adopting certified EHR technology.  USAO KS

Tagged in: Certifications, Electronic Health Records, FCA Federal, Hospital Fraud, Medicaid, Medicare, Whistleblower Case, Whistleblower Rewards,

May 29, 2019

Houston-based patient recruiter and home health clinic owner Egondu “Kate” Koko has been sentenced to over 15 years in prison and ordered to pay $14 million for participating in a $20 million kickback scheme involving Medicare beneficiaries.  Koko had plead guilty in October to paying bribes to both physicians and patients in order to earn between $9.5 and $25 million in ill-gotten gains, as well as to laundering money under another person’s identity and using proceeds from the fraud to buy a home.  DOJ

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

May 29, 2019

Almirall, LLC, f/k/a Aqua Pharmaceuticals, LLC , will pay $3.5 million to settle kickback allegations exposed by a former Aqua sales representative.  According to the whistleblower, the pharmaceutical company paid kickbacks in the form of free meals, trips, gift cards, and gifts, to dermatology providers in exchange for prescriptions of their drugs to Medicare and TRICARE patients.  It also paid kickbacks by compensating healthcare providers for speaking engagements and consulting services. For coming forward with details of the fraud, the unnamed whistleblower will receive a $735,000 share of the recovery.  USAO EDPA

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

May 20, 2019

A secret co-owner of Medsel Home Health Care Corp, a fake home health agency, has been sentenced to 2 years in prison and ordered to pay nearly $1 million for his role in a Medicare fraud scheme that caused at least $950,000 in unnecessary payments.  Dennys Hernandez and co-defendants Elanier Gonzalez Moncho and Rafael Arias submitted claims for services that were never provided.  Moncho, the nominee owner, was sentenced to a year and a half in prison, while Arias, the owner of multiple other home health agencies in Miami, was sentenced to 20 years.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

May 17, 2019

Dr. Donald Douglas, the physician owner of three healthcare clinics in Texas, has agreed to pay $118,000 to resolve allegations of improperly billing Medicare at the physician rate for services performed by advance practice nurses (“APNs”) without direct physician supervision.  Under Texas law, APN-provided services performed with physician supervision may be billed to Medicare at the full physician rate.  USAO EDTX

Tagged in: Healthcare Fraud, Medical Billing Fraud, Medicare,

May 9, 2019

Paul J. Mathieu and Hatem Behiry were found guilty for their part in a $30 million scheme to defraud Medicare and the New York State Medicaid program. Between 2007 and 2013, Mathieu falsely posed as an owner of three medical clinics (the “Clinics”) in Brooklyn. During that time, the Clinics fraudulently billed Medicare and Medicaid for medical services and supplies that were not necessary, or were not even provided. Furthermore, Mathieu did not see any patients at that time. Instead, he falsified large stacks of bogus medical records in which he stated that he did see and treat those patients. Behiry, a physical therapy doctor, also participated in the Clinic’s fraudulent billing practices by pretending to provide physical therapy services to patients. Mathieu and Behiry have not yet been sentenced. DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare,

May 8, 2019

A South Florida woman who received kickbacks in exchange for patient referrals has been sentenced to over 7 years in prison. In exchange for at least $710,000, Yamilet Diaz allegedly referred Medicare beneficiaries to five home health agencies, aiding the agencies in unlawfully receiving over $1.6 million in reimbursements from Medicare that were tainted by the kickbacks. DOJ

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

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