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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:

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Scoundrel Spotlight - Medicare Fraudster Minal Patel

Posted  08/23/23
Medicare Paper on Hundred Dollar Bills
This week's Scoundrel in the Spotlight is Minal Patel who last week (August 18) was sentenced to 27 years in prison for defrauding Medicare of almost half a billion dollars for genetic testing patients did not need and were procured through bribes and kickbacks.  In announcing the sentencing, the government trumpeted the matter as one of the largest genetic testing fraud cases ever tried to verdict. Here is how...

August 18, 2023

The owner and operator of Georgia-based LabSolutions LLC has been sentenced to 27 years in prison for submitting over $463 million in medically unnecessary genetic and other laboratory tests derived from illegal kickbacks.  Minal Patel allegedly paid kickbacks to telemarketing companies to talk Medicare beneficiaries into getting the tests, then paid kickbacks to telemedicine doctors who signed orders for the tests without ever speaking to beneficiaries to determine need.  As a result of these fraudulent actions, Medicare paid over $187 million in reimbursement, with Patel receiving over $21 million personally, between 2016 and 2019.  DOJ

August 1, 2023

A now defunct clinical laboratory in Texas, BestCare Laboratory Services LLC, and its owner, Karim Maghareh, have agreed to pay another $5.7 million on top of nearly $800,000 already paid to the government to resolve an outstanding obligation under a 2018 judgment for violating the False Claims Act.  The underlying lawsuit, filed in 2008 by whistleblower Richard Drummond, alleged that BestCare billed Medicare for travel by lab technicians that did not reflect the actual mileage traveled.  DOJ

July 31, 2023

Martin’s Point Health Care Inc. in Maine has agreed to pay almost $22.5 million to resolve a lawsuit by a former manager in its Risk Adjustment Operations group, which alleged the health plan administrator defrauded Medicare over a three year period.  The former manager, Alicia Wilbur, alleged that Martin’s Point reviewed charts for their Medicare Advantage beneficiaries to identify additional diagnosis codes, then submitted those codes in claims to Medicare in order to increase reimbursements even though they were not properly supported by patient medical records.  For blowing the whistle on this misconduct, Wilbur will receive a $3.8 million award.  DOJ

July 11, 2023

The owner of one of California’s largest chains of pain management clinics has agreed to pay nearly $11.4 million to the federal government and the states of California and Oregon to settle allegations of defrauding Medicare and state Medicaid programs of millions of dollars.  A nearly four-year investigation by government data analysts found that Dr. Francis Lagattuta and his business, Lags Medical Clinics—which operates more than 20 facilities in California and Oregon—billed the healthcare programs for medically unnecessary tests and procedures that were provided to every patient as part of clinic protocols.  The investigation also found that patients who did not consent to such procedures had their pain medication reduced.  Furthermore, a respiratory therapist who was the spouse of an executive was recruited to interpret certain test results despite having no formal medical training.  In addition to the monetary penalty, Dr. Lagattuta is also barred from serving Medi-Cal beneficiaries for the next five years.  CA AG

Catch of the Week: National Health Care Fraud Sweep

Posted  06/30/23
Person Having Doctor Consultation
This week's Department of Justice (DOJ) Catch of the Week goes to the 78 individuals criminally charged with participating in health care fraud and opioid abuse schemes across the country.  On Wednesday, DOJ announced the "strategically coordinated, two-week nationwide law enforcement action" it brought with federal and state law enforcement partners, which targeted misconduct resulting in over $2.5 billion in...

June 21, 2023

Skilled nursing facility Alta Vista Healthcare & Wellness Centre and its management company Rockport Healthcare Services have agreed to pay $3.8 million to resolve allegations that it paid kickbacks to physicians to induce referrals of Medicare and Medicaid beneficiaries to its center.  The violations of the federal Anti-Kickback Statute, federal False Claims Act, and California False Claims Act were uncovered during a government investigation, and showed illegal kickbacks in the form of cash, gifts, and salaries paid from 2009 through 2019.  CA AG; DOJ

Catch of the Week: Smart Pharmacy, Inc.

Posted  06/16/23
topical cream spilled out
This week's Department of Justice (DOJ) Catch of the Week goes to Florida-based compounding pharmacies Smart Pharmacy, Inc. and SP2, and their owner Gregory Balotin.  Yesterday, they agreed to pay at least $7.4 million to settle charges they violated the False Claims Act by adding an antipsychotic drug to topical pain creams solely to boost Medicare reimbursement.  Not because of any medical purpose the drug...

June 15, 2023

Two compounding pharmacies, Smart Pharmacy, Inc. and SP2, LLC, and their owner, Gregory Balotin, have agreed to pay at least $7.4 million to resolve two qui tam lawsuits by whistleblowers Amy Sanchez and Ashok Kohli, both former employees of Smart Pharmacy.  According to the suits, in order to increase orders for expensive compounded pain creams, the pharmacy routinely waived mandatory patient co-payments for them, and in order to boost reimbursements from Medicare and TRICARE, it added the antipsychotic drug aripiprazole to the topical creams.  DOJ

It's Medicare Fraud Prevention Week - What Can You Do?

Posted  06/9/23
Photo of person Medicare card
This week is Medicare Fraud Prevention Week.  You probably did not even know it because of the relative lack of attention this important week has received.  All the more surprising because Medicare fraud and abuse costs the government an estimated $60 billion per year.  But according to Senior Medicare Patrol (SMP), the government-sponsored public education organization, there is a lot we can do to attack this...
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