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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 32 of 53

May 3, 2019

Dr. Richard E. Paulus, an Ashland cardiologist, was sentenced to five years in prison for defrauding Medicare, Medicaid, and private insurers. Evidence showed that Paulus implanted medically unnecessary stents in his patients and falsified the degree of stenosis in their medical records. He has been charged with one count of health care fraud and ten counts of making false statements in regard to health care matters. In addition to time in prison, Paulus must also pay $1.1 million in restitution to Medicare, Medicaid, and other private insurers who were also victims of his financial scheme. DOJ

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

May 2, 2019

Insys Therapeutics executives were convicted for their part in a racketeering conspiracy where they defrauded Medicare and private insurance carriers. From May 2012 to December 2015, the defendants bribed medical practitioners to prescribe Subsys, an extremely addictive sublingual fentayl spray intended for use by cancer patients. In furtherance of these efforts, the defendants provided kickbacks to practitioners who increased their Subsys prescriptions. The defendants also defrauded health insurance providers who were hesitant to approve payment for the drug when it was prescribed for non-cancer patients. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medicare, Off-Label and Unapproved Use, Pharma Fraud,

April 18, 2019

Two former business partners behind three hospice and home healthcare agencies in the Las Vegas area have been sentenced for their roles in a $7.1 million Medicare fraud scheme.  Camilo Primero and Aurora Beltran—the owners of Advent Hospice, Angel Eye Hospice, and Vision Home Health Care—had been previously convicted of defrauding California’s insurance system in connection with another business, the Beltran House for disabled adults, and Primero had been excluded from participating in federal healthcare programs.  To get around the exclusion, the two filed false enrollment forms to Medicare, then submitted false claims for unqualified beneficiaries.  Each has been sentenced to three years of supervised release and ordered to pay $2,492,627.  USAO NV

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

April 15, 2019

Cardiac Associates, P.C. will pay the United States over $399,000 to settle False Claims Act allegations related to improper billing practices. The U.S. contends that between January 1, 2012, and December 21, 2016, Cardiac Associates double billed for procedures on the same date for the one patient, when only one of the procedures was performed. Cardiac Associates also allegedly billed for two tests when testing patients for venous sufficiency, even though Medicare rules prohibit billing for both CPT 93970, the newer test, and CPT 93965, an older test using different technology. DOJ

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

April 4, 2019

Jazz Pharmaceuticals will pay $57 million to settle allegations that the company violated the False Claims Act by providing funds to a purportedly independent patient assistance program in a form that created an improper kickback.  The funds provided by Jazz were used to cover the copayments for patients to purchase Jazz's drugs Xyrem, a narcolepsy medication, and Prialt, an injectable pain medication.  Jazz referred Medicare patients to the fund, and denied them access to Jazz's free drug program, enabling Jazz to bill Medicare for their purchases. DOJ  

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Medicare, Pharma Fraud,

April 2, 2019

Paul Emordi, of Collin County, Texas, was sentenced to prison for 60 months for his part in a $3.7 million health care scheme involving Medicare. Emordi and Celestine “Tony” Okwilagwe, owners and operators of Elder Care, along with Adetutu Etti, the administrator of Elder Care, were convicted on counts of conspiracy to commit health care fraud and on counts of false statements in connection with a health care benefit program. Evidence in the investigation also shows that the defendants submitted fake and fraudulent bills to Medicare for providing services that were not necessary. DOJ; Texas

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

March 29, 2019

CareWell Urgent Care of Rhode Island, P.C., and Urgent Care Centers of New England Inc. have agreed to pay $2 million to settle a qui tam suit brought on by a former employee, Aileen Cartier. In violation of the False Claims Act, CareWell had falsely inflated the level of services provided and failed to identify service providers in claims submitted to Medicare, Massachusetts and Rhode Island Medicaid, and the Massachusetts Group Insurance Commission (GIC) between 2013 to 2018. For bringing on the suit, Cartier will receive a 17% relator's share. USAO MA

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

March 21, 2019

Nonprofit healthcare organization MedStar Health Inc. has agreed to pay $35 million to the United States to settle two qui tam lawsuits alleging violations of the False Claims Act at two of its hospitals in Baltimore. According to the first complaint, filed by three cardiac surgeons, MedStar paid illegal remuneration to MidAtlantic Cardiovascular Associates (MACVA) to induce referrals of Medicare patients. The second complaint, filed by former patients, alleged that while employed by MedStar, former MACVA employee Dr. John Wang engaged in a pattern of performing and billing for medically unnecessary cardiac stent procedures. DOJ

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

March 19, 2019

Ademola O. Adebayo was sentenced to 10 years in prison for his role in a huge $100 million compounding pharmacy scheme that defrauded private insurance companies, Medicare and TRICARE. Adebayo was also ordered to pay $3.2 million in restitution and $1.4 million in forfeiture, and properties, cars and a yacht have been sequestered as part of the sentencing. After a four-day trial on January 11, Adebayo was convicted on counts of conspiracy to commit health care fraud and wire fraud, and conspiracy to commit money laundering. Eight other defendants have pleaded guilty in connection with the scheme. DOJ

Tagged in: Healthcare Fraud, Medicare, Pharma Fraud,

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