Medicare
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Nursing Home Operators Face Over $115M for Medicare Fraud
Posted 02/20/17
By the C|C Whistleblower Lawyer Team
On February 15, a jury in the United States District Court for the Middle District of Florida found the operators of 53 skilled nursing facilities liable for over $115 million from false claims submitted to Medicare and Medicaid. The fraudulent claims involved a scheme where nursing facilities pretended patients needed and in turn received more care than they actually needed....
United States Intervenes in Constantine Cannon Whistleblower’s suit against UnitedHealth Group, WellMed Medical Management
Posted 02/16/17
By the C|C Whistleblower Lawyer Team
The U.S. Department of Justice has joined Constantine Cannon in bringing a whistleblower’s False Claims Act lawsuit against UnitedHealth Group, the nation’s largest health insurer and largest operator of Medicare managed healthcare insurance plans. The suit alleges UnitedHealth and its various subsidiaries and affiliates defrauded Medicare by improperly inflating its risk...
TeamHealth to Pay $60M to Settle Whistleblower Charges
Posted 02/7/17
By the C|C Whistleblower Lawyer Team
U.S. hospital service provider TeamHealth Holdings agreed to pay $60 million to settle charges its predecessor company IPC Healthcare Inc. violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed. See DOJ Press...
February 1, 2017
Florida urologist Dr. Meir Daller agreed to pay $3.81 million to resolve allegations he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary. Dr. Meir practices as part of Gulfstream Urology, a division of 21st Century Oncology, LLC, which is a nationwide provider of integrated cancer care services. The government previously entered into settlements relating to similar allegations with 21st Century Oncology for $19.75 million and urologists David Spellberg and Robert Scappa for $1,050,000 and $250,000, respectively. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Mariela Barnes, a former medical assistant for Dr. Spellberg at Naples Urology Associates, also a division of 21st Century Oncology. She will receive a whistleblower award of $571,500 from the proceeds of the government's recovery in this settlement. This is in addition to a $3,437,000 million award she already received from the prior settlements. DOJ (MDFL)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...