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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 48 of 53

July 19, 2016

Ann Anyanwu, a registered nurse at Texas-based Medpsych Home Health Care, was convicted for participating in an $8 million Medicare fraud scheme involving fraudulent claims for home-health services.  According to the evidence, Anyanwu and others executed a scheme to submit to Medicare through Medpsych claims for home-health services to patients who did not receive them and did not qualify for them.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

July 12, 2016

New Jersey couple Nita and Kirtish Patel and their diagnostic imaging companies Biosound Medical Services Inc. and Heart Solution PC were ordered to pay more than $7.75 million for violating the False Claims Act by submitting false claims to Medicare for thousands of falsified diagnostic test reports and the underlying tests.  The government had alleged that defendants created fraudulent diagnostic test reports, forged physician signatures on these reports, and then billed Medicare for the fraudulent reports and the underlying tests that were used solely to create these reports.  The government further alleged that defendants billed Medicare for neurological tests that they conducted without the required physician supervision.  The allegations originated in a whistleblower lawsuit filed by a former Biosound employee under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (DNJ)

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

July 7, 2016

MD2U Holding Company agreed to pay $3.3 million and a percentage of its net income over the next five years to settle charges they violated the False Claims Act by submitting false medical claims to Medicare and other government health care programs, altering records to support false claims and providing services that were medically unnecessary.  Specifically, the government alleged MD2U submitted false billings for patients who were neither homebound nor home-limited; improperly billed the government for medically unnecessary visits; billed government health care programs at the highest payment codes (upcoding) when a lower code would have been more appropriate; and cloned medical records (a cut, copy, paste electronic program) in order to justify patient visits.  The company admitted being liable to the government for roughly $21.5 million.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Medicare, Upcoding,

July 5, 2016

Massachusetts ophthalmologist Martin E. Cutler and his company Martin E. Cutler, M.D., P.C. agreed to pay $55,000 to resolve allegations they violated the False Claims Act by falsely billing Medicare for ophthalmic diagnostic imaging when there was no underlying diagnosis to justify the imaging.  They also allegedly falsely billed Medicare for office visits where a prior claim for the same visit had been denied and the new claim was not supported by Dr. Cutler’s documentation.  The allegations originated in a whistleblower lawsuit filed by Brian Sachs under the qui tam provisions of the False Claims Act.  Mr. Sachs will receive a whistleblower award of $11,000 from the proceeds of the government's recovery.  DOJ (DMA)

Tagged in: FCA Federal, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

June 30, 2016

California-based Marshall Medical Center agreed to pay $5.5 million to settle allegations that it, along with Marshall Foundation for Community Health, El Dorado Hematology & Medical Oncology II, Inc., Dr. Lin H. Soe and Dr. Tsuong Tsai, violated the federal False Claims Act and California False Claims Act through a variety of Medicare and Medicaid billing improprieties.  The allegations originated in a whistleblower lawsuit filed by oncology nurse Colleen Herren under the qui tam provisions of the False Claims Act. She will receive a whistleblower reward of roughly $1,430,000 from the proceeds of the government's recovery.  DOJ (EDCA)

Tagged in: FCA Federal, FCA State, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

June 30, 2016

Florida cardiologist Dr. Asad Qamar and his practice, the Institute of Cardiovascular Excellence (ICE), will pay $2 million plus release any claim to $5.3 million in suspended Medicare funds, to settle charges they violated the False Claims Act by billing for medically unnecessary procedures and paying kickbacks to patients by waiving Medicare copayments irrespective of financial hardship.  By waiving the required copayments, Dr. Qamar and ICE induced patients to agree to unnecessary and invasive procedures and other services.  Dr. Qamar’s and ICE’s illegal conduct made Dr. Qamar the highest paid Medicare cardiologist in the country in 2012 and 2013.  The allegations originated in two whistleblower lawsuits filed by Dr. Robert A. Green and Ms. Holly A. Taylor under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $1.3 million from the proceeds of the government's recovery.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

June 13, 2016

Ubert Guillermo Rodriguez, former owner of Florida-based durable medical equipment maker G.R. Services Equipment & Supplies Inc., was sentenced to 37 months in prison and to pay $918,402 in restitution for his role in a multimillion-dollar health care fraud scheme in the greater Tampa, Florida, area.  Rodriguez admitted that from May 2013 through July 2013, his company submitted approximately $2.6 million in fraudulent claims to Medicare seeking reimbursement for durable medical equipment not legitimately prescribed by doctors and not provided to beneficiaries.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,

April 28, 2016

California doctor Gary J. Ordog pleaded guilty to submitting more than $2.4 million in fraudulent claims to Medicare.  Ordog, who purported to be a physician specializing in toxicology, admitted submitting false claims to Medicare for purported visits with Medicare beneficiaries, when in fact those visits never actually occurred, including on dates when Ordog was out of the country.  He also admitted to billing for services provided to beneficiaries who were deceased and for services totaling more than 24 hours in one day.  DOJ

Tagged in: Medical Billing Fraud, Medicare,

April 18, 2016

Miami physician Henry Lora was sentenced to 108 months in prison for his role in a Medicare fraud scheme that caused approximately $30 million in losses.  Lora was the medical director of Miami-area clinic Merfi Corporation and admitted that in exchange for kickbacks and bribes, he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided.  He also admitted falsifying patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Merfi owner was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Antitrust, Lack of Medical Necessity, Medicare,

April 18, 2016

Georgia dermatologists Margaret Kopchick and Russell Burken and their practice group, Toccoa Clinic Medical Associates, agreed collectively to pay $1.9 million to settle claims that they violated the False Claims Act by billing Medicare for evaluation and management (E&M) services that were not permitted by Medicare rules.  According to the government, Drs. Burken and Kopchick’s improperly billed for E&M services along with procedures where no significant and separately identifiable service was performed, and upcoded E&M services to higher levels than were appropriate, leading to overpayments by Medicare.  DOJ (NDGA)

Tagged in: FCA Federal, Medicare, Upcoding,

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