Medicare
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January 27, 2017
Brooklyn residents Olga Proskurovsky, Yuriy Omelchenko and Isak Aharanov pleaded guilty in connection with a health care fraud scheme involving two Brooklyn clinics that caused approximately $55 million in false claims to Medicare and Medicaid. They agreed to forfeiture money judgments in the amount of roughly $17 million. Proskurovsky served as a medical biller and Omelchenko worked as a therapist manager at Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. where they assisted in a scheme to defraud the Medicare and Medicaid programs in which patients subjected themselves to medically unnecessary health services, including physical and occupational therapy, provided by unlicensed staff. DOJJanuary 25, 2017
Rodney Hesson and Gertrude Parker, owners of several psychological services companies, were convicted for their involvement in a $25.2 million Medicare fraud scheme carried out through eight companies at nursing homes in four states in the Southeastern United States. According to evidence presented at trial, the defendants’ companies contracted with nursing homes for psychological testing services the nursing home residents did not need or did not receive. DOJJanuary 19, 2017
The University of Pennsylvania Health System agreed to pay $845,000 to settle charges of violating the False Claims Act by improperly billing Medicare for stent procedures two interventional cardiologists performed at Pennsylvania Hospital. DOJ (EDPA)Kentucky Pain Management Physician Pays $20M to Settle FCA Charges
Posted 02/2/17
By the C|C Whistleblower Lawyer Team
Dr. Robert Windsor, the owner of several Kentucky and Georgia pain management clinics operating under the umbrella of National Pain Care, Inc., agreed to a $20 million consent judgment resolving government allegations he billed federal health care programs for surgical monitoring services he did not perform, and for medically unnecessary diagnostic tests. To satisfy the...
Major Insulin Makers Accused of Price Fixing
Posted 01/31/17
By the C|C Whistleblower Lawyer Team
As reported in the New York Times, a group of diabetes patients filed suit yesterday against the three dominant providers of insulin, alleging they systematically raised prices through a price-fixing scheme that imposed on patients “crushing out-of-pocket expenses.” The lawsuit -- brought against Sanofi, Novo Nordisk and Eli Lilly -- comes only a few months after Senator...
Medicare Fraud Alert: Inpatient Rehabilitation Hospitals
Posted 01/26/17
By the C|C Whistleblower Lawyer Team
A recently-released report from Department of Health and Human Services Office of the Inspector General (HHS-OIG) revealed potentially serious problems related to Medicare beneficiary stays in inpatient rehabilitation hospitals. Such hospitals—either standalone or included as distinct units within general-purpose hospitals—are designed to address the needs of patients who...
HHS-OIG Continues to Uncover Unfounded Malnutrition Claims in Medicare Data
Posted 01/25/17
By the C|C Whistleblower Lawyer Team
Inaccurate medical coding of malnutrition in seniors is a multi-billion dollar problem for Medicare, the federal health insurance program that primarily provides coverage to people aged 65 and older. As obscure as it sounds, it’s also an issue for the average American taxpayer, whose tax dollars are wrongly paid out to hospitals clever—or careless—enough to falsely claim...
The Importance of Medical Loss Ratio Minimum Requirements
Posted 01/24/17
By the C|C Whistleblower Lawyer Team
We’ve covered Medical Loss Ratio (MLR) minimum requirements before. The MLR is, generally, the percentage of premium revenues an insurer spends on clinical services and quality improvements as opposed to on things like executive salaries, overhead, or marketing. Requiring a minimum MLR standard, something that the Federal Medicare Program does and several State Medicaid...