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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 33 of 55

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,

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,

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