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Medicare

This archive displays posts tagged as relevant to Medicare and fraud in the Medicare program. You may also be interested in our pages:

Page 33 of 53

March 6, 2019

A Texas woman has been sentenced to 30 years in prison and ordered to pay more than $15 million for her role in a $50 million scheme involving healthcare fraud and money laundering. Daniela Gozes-Wagner was accused of running 28 fake medical testing facilities from 2009, and billing Medicare and Medicaid for tests that were not performed or medically necessary. As part of the scheme, she employed personnel to answer phones and prevent inspectors from entering "testing facilities" that were virtually empty. USAO SDTX

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

February 27, 2019

A Florida-based home health agency owner, Alexander Ros Lazo, has been sentenced to over 7 years in prison and ordered to pay $8.6 million in restitution for defrauding Medicare. In exchange for the referral of Medicare beneficiaries to his company, T.L.C. Health Services, Dos Lazo paid kickbacks to co-conspirators and caused his co-conspirators to submit billing for physical therapy services performed by an unlicensed practitioner, Misleady Ibarra. Along with Ros Lazo. Ibarra has been sentenced to 2 years in prison; the amount she will pay in restitution is still to be determined. DOJ

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

February 27, 2019

Tennessee-based skilled nursing facility chain Vanguard Healthcare LLC, along with former executives William Orand and Mark Miller, have agreed to pay upward of $18 million to resolve False Claims allegations of billing Medicare and Medicaid for worthless and "grossly substandard nursing home services." According to press releases, five facilities in the Vanguard network allegedly submitted false claims for reimbursement, despite a litany of failures, including forging nurse and physician signatures, using unnecessary physical restraints on residents, failing to prevent pressure ulcers, failing to provide wound care as ordered, failing to provide standard infection control, failing to administer medications as prescribed, and failing to meet basic nutrition and hygiene requirements. The case is considered the largest case of fraud involving worthless services in state history. DOJ; USAO MDTN

Tagged in: Certifications, FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Misrepresentations, SNF,

February 25, 2019

A Southern California pharmacy owner has been ordered to pay $1.5 million to Medicare after her conviction for one count of healthcare fraud and two counts of wire fraud. Tamar Tatarian, the owner of Akhtamar Phamarcy, was recently convicted of submitting false claims for prescription drugs never ordered from wholesalers or dispensed to beneficiaries. DOJ

Tagged in: Healthcare Fraud, Medicare, Pharma Fraud,

February 13, 2019

Ashraf Hasan-Hafez and Ilya Kogan have been sentenced to over three years in prison for their participation in a scheme that defrauded Medicare and New York State Medicaid out of $1.3M dollars. Hasan-Hafez, the owner of a physical therapy practice, and Kogan, the owner of an acupuncture company, fraudulently submitted bills for services that were not rendered, or for services performed by unlicensed individuals. In addition to jail time, Hasan-Hafez and Kogan have been ordered to forfeit $1,297,000 in restitution to the Medicare and Medicaid programs.  DOJ    

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

February 11, 2019

GenomeDx Biosciences Corp. has agreed to pay $1.99 million in connection with a whistleblower complaint by two former employees, which alleged that the genetic testing laboratory violated the False Claims Act in its submissions to Medicare. According to the unnamed whistleblowers, from 2015 to 2017, GenomeDx submitted reimbursement claims for running a post-operative genetic test on prostate cancer patients, even though that population did not have risk factors that called for the test. They will share in a $348,316.50 award as part of the settlement. USAO SDCA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare, Whistleblower Case,

February 12, 2019

Jefferson Medical Associates, a Laurel-based physicians group, and neurologist, Dr. Aremmia Tanious, will pay the United States $817,635.06 to settle allegations under the False Claims Act regarding Medicare overpayments. The government’s investigation discovered that from 2012 to 2014, Jefferson Medical Associates and Dr. Tanious allegedly did not return overpayments they received on claims from Medicare. It is further alleged that from February 1, 2013, through June 30, 2017, Jefferson Medical Associates and Dr. Tanious allegedly used multiple medical codes when billing Medicare but the medical documentation did not support those billing practices. DOJ    

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

February 8, 2019

Two executives from the South Carolina Early Autism Project (SCEAP) have been convicted of causing false statements to be submitted to Medicare and TRICARE and causing them to be overcharged by millions of dollars. According to statements by SCEAP employees, co-founder Ann Davis Eldridge and executive Angela Breitweiser Keith instructed employees to include travel and wait time in their billing in order to inflate time spent providing services. To further incentivize this practice, they implemented billing goals that had to be met in order to qualify for bonuses such as gift cards and vacations, all paid for by the company. Since then SCEAP has repaid almost $9 million, and as part of their plea agreement, both Keith and Eldridge will serve 1-year sentences. USAO SC

Tagged in: Healthcare Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

February 8, 2019

A Texas-based marketing company, One Source Healthcare Organization, and its owner, James Paul Adams, have agreed to pay $339,412.50 to resolve allegations that it violated the Anti-Kickback Statute in accepting illegal payments from a compounding pharmacy to market their drug. Because the payments resulted in false claims being paid by Medicare and TRICARE, they were also alleged to be in violation of the federal False Claims Act. Two men affiliated with the compounding pharmacy, Oklahoma-based OK Compounding, LLC, were previously indicted on similar charges. USAO NDOK

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

February 6, 2019

Georgia-based Union General Hospital has agreed to pay $5 million to settle allegations that from 2012 to 2016, it billed Medicare for services stemming from improper financial relationships with physicians, in violation of the Stark Law and the False Claims Act. The misconduct was uncovered during an internal investigation sparked by a federal investigation into an unrelated matter; UGH then voluntarily self-disclosed details of the instant case to the U.S. Attorney's Office. USAO NDGA

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

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