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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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February 17, 2016

Fifty-one hospitals in 15 states agreed to pay more than $23 million to settle charges of violating the False Claims Act by implanting cardiac devices in Medicare patients in violation of Medicare coverage requirements.  These settlements represent the final stage of a nationwide investigation into the practices of hundreds of hospitals improperly billing Medicare for these devices, which in total have yielded more than $280 million.  The allegations against most of the current settling hospitals originated in a whistleblower lawsuit brought under the qui tam provisions of the False Claims Act by Leatrice Ford Richards, a cardiac nurse and Thomas Schuhmann, a health care reimbursement consultant.  They will receive a whistleblower reward of more than $3.5 million from the proceeds of the government's recovery from these current settlements.  The settling hospitals and health care companies included Arkansas Heart Hospital (AK); Aurora Health Care (WI); Cleveland Clinic Foundation (OH); Dignity Health (CA); MGH Wind Down (MI); Monongalia County General Hospital (WV); Mount Sinai Medical Center (FL); Nacogdoches Memorial Hospital (TX); Northwell Health (NY); Sentara Healthcare (VA); and Sisters of Charity of Leavenworth Health System (CO).  DOJ

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

February 12, 2016

New Jersey Doctor Labib E. Riachi and two companies he owns, Riachi, Inc. and Center for Advanced Pelvic Surgery, agreed to pay $5.25 million to resolve allegations they violated the False Claims Act by billing Medicare and Medicaid for anorectal manometry and electromyography diagnostic tests, even though most of the tests were never performed.  The settlement also resolves charges that they submitted claims to Medicare for physical therapy services that should not have been paid because they were not performed by a qualified therapist.  DOJ (NJ)

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

February 9, 2016

Miami physician Henry Lora, medical director of Miami-area clinic Merfi Corporation, pleaded guilty for his role in a Medicare fraud scheme that caused more than $20 million in losses.  Lora 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.  Lora and his co-conspirators also falsified patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Isabel Medina, the owner of Merfi, was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ

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

January 29, 2016

Amalya Cherniavsky and her husband Vladislav Tcherniavsky, the former owner and former operator of California-based durable medical equipment supply company JC Medical Supply were sentenced  for their roles in a $1.5 million Medicare fraud scheme.  They were ordered to pay $614,418 in restitution and Tcherniavsky was ordered to serve 51 months in prison.  The evidence at trial demonstrated that they paid illegal kickbacks to patient recruiters in exchange for patient referrals and paid kickbacks to physicians for fraudulent prescriptions—primarily for expensive, medically unnecessary power wheelchairs—which the defendants then used to support fraudulent bills to Medicare.  DOJ

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

Sleep Disorder Fraud: With the uptick in sleep disorder services and government spending comes the discovery of schemes and scams.

Posted  01/26/16
By Jessica Moore, published in ADVANCE Healthcare Network  Increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders that affect more than fifty million Americans.  The significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous to engage in fraudulent services and billing of federal and state heath care programs that...

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Devices and DME, Medicare,

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January 14, 2016

Nery Cowan, a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center Inc., pleaded guilty in connection with a $63 million health care fraud and money laundering scheme.  Behavioral Healthcare is a now-defunct Miami-area partial hospitalization program (PHP) that purported to provide intensive treatment for severe mental illness.  Specifically, Cowan directed the payment of kickbacks to patient brokers and others in exchange for Medicare beneficiary referrals and admitted concealing the kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida.  Cowan and her co-conspirators disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc., a sham staffing company.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicare, Provider Fraud,

January 12, 2016

Kentucky-based healthcare provider Kindred Healthcare, Inc. and its two RehabCare Group subsidiaries agreed to pay $125 million to resolve allegations of violating the False Claims Act by knowingly causing skilled nursing facilities to submit false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary and skilled, or that never occurred at all.  According to the government, RehabCare’s policy has been to achieve the highest Medicare reimbursement level regardless of the clinical needs of its patients, resulting in the provision of unreasonable and unnecessary services to Medicare patients, and its skilled nursing facility customers submitting inflated bills to Medicare covering those services.  The allegations originated in a whistleblower lawsuit filed by Janet Halpin, a RehabCare physical therapist and former rehabilitation manager, and Shawn Fahey, a RehabCare occupational therapist, under the qui tamprovisions of the False Claims Act.  They will receive a whistleblower award of nearly $24 million from the government proceeds of the settlement.  Whistleblower Insider

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, SNF, Whistleblower Case, Whistleblower Rewards,

January 12, 2016

Connecticut-based J&L Medical Services agreed to pay $600,000 to resolve allegations it violated the federal and state False Claims Acts.  J&L Medical is a durable medical equipment company that provides Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) devices and accessories to Medicare and Medicaid beneficiaries who have been diagnosed with obstructive sleep apnea.  According to the government, the company regularly used the services of unlicensed technicians to provide respiratory therapy services to Medicare and Medicaid beneficiaries, including setting up CPAP and BiPAP machines, fitting the patients with the masks used with those machines, and educating the patients about the use of the machines.  The allegations originated in a whistleblower lawsuit filed by John Hart, a former employee of J&L Medical and a licensed respiratory therapist, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $102,000 from the proceeds of the government’s recovery.  DOJ (CT)

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Medicaid, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

January 5, 2016

Nashville Pharmacy Services, LLC, and its majority owner Kevin Hartman, agreed to pay up to $7.8 million to settle charges they violated the False Claims Act by overbilling Medicare and TennCare for pharmacy services.  Specifically, the government claimed the Nashville-based pharmacy that specializes in dispensing HIV and AIDS-related medications automatically refilled medications without a request from the beneficiary or their physician; improperly waived TennCare and Medicare co-payments without an individualized assessment of ability to pay; improperly used pharmaceutical manufacturers’ co-payment cards to pay the co-payments of Medicare beneficiaries; billed for medications dispensed after the deaths of certain beneficiaries; and billed for medications that lacked a valid prescription.  The allegations originated in a whistleblower lawsuit filed by Marsha McCullough, a former Nashville Pharmacy order entry technician, under the qui tamprovisions of the False Claims Act.  She will receive a whistleblower award of 18 percent of the government’s recovery which could amount to $1.4 million.  Whistleblower Insider

Tagged in: Drug and DME Pricing, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 18, 2015

Ohio cardiologist Dr. Harold Persaud, with hospital privileges at Fairview Hospital, St. John’s Medical Center and Southwest General Hospital, was sentenced to 20 years in prison for performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $29 million.  DOJ

Tagged in: Lack of Medical Necessity, Medicare, Provider Fraud,

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