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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 6 of 55

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

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, SNF,

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...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case,

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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

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Whistleblower Case,

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...

Tagged in: FCA Federal, Healthcare Fraud, Medicare,

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June 8, 2023

Billy Joe Taylor of Lavaca, Arkansas, will spend 15 years in prison and will pay nearly $30 million in restitution for submitting false and fraudulent claims to Medicare. During the COVID-19 pandemic, Taylor and his co-conspirators misused medical information and private personal information for Medicare beneficiaries, and then used that information to repeatedly submit fraudulent claims for medically unnecessary diagnostic laboratory testing. USAO WDAR

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

June 8, 2023

Steven King, chief compliance officer of A1C Holdings LLC, a pharmacy holding company, was convicted for violating Medicare and pharmacy benefit manager rules by securing prescriptions and refills for medically unnecessary lidocaine and diabetic testing supplies. King and his co-conspirators fraudulently billed Medicare over $50 million, taking steps to conceal their scheme by enrolling their mail order pharmacies as brick-and-mortar retail locations, shipping prescription refills for high-reimbursing medications and supplies without patient consent, concealing the ownership of A1C Holdings LLC and its pharmacies, and transferring patients among pharmacies without patient consent. King faces a maximum penalty of 20 years in prison for committing health care fraud and wire fraud. DOJ

Tagged in: Healthcare Fraud, Improper Medical Facility, Lack of Medical Necessity, Medicare, Pharma Fraud,

Catch of the Week: Detroit Medical Center

Posted  06/2/23
Handshake in room with dark window blinds
This week's Department of Justice (DOJ) "Catch of the Week" goes to Detroit Medical Center, Vanguard Health Systems, and Tenet Healthcare.  On Wednesday, they agreed to pay roughly $30 million to settle government and whistleblower charges of violating the False Claims Act by providing kickbacks to certain referring physicians.  It is just the latest in a string of False Claims Act settlements concerning kickbacks...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

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May 31, 2023

VHS of Michigan Inc., d/b/a, The Detroit Medical Center, Vanguard Health Systems Inc., and Tenet Healthcare Corporation will pay nearly $30 million for causing the submission of false or fraudulent claims to Medicare. From January 1, 2014 through December 31, 2017, DMC, Vanguard, and Tenet violated the Anti-Kickback Statute when they provided the services of mid-level practitioners to 13 physicians at no cost or below fair market value. The physicians were selected for their high number of referrals, which DMC hoped would cause an increase in referrals to their facilities. Whistleblower Dr. Jay Meythaler will receive $5.2 million as part of the settlement. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicare, Provider Fraud, Whistleblower Case,

May 25, 2023

Vascular surgeon Vasso Godiali of Michigan has been ordered to pay $19.5 million in restitution and serve over 6 years in prison to resolve criminal allegations of defrauding Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. Godiali also agreed to pay up to $43.4 million to resolve civil allegations of violating the False Claims Act.  Although Godiali allegedly began submitting false claims in 2009, his misconduct did not come to light until a 2015 qui tam suit by Innovative Solutions Consulting LLC, which alleged Godiali billed government programs for arterial thrombectomies and stent placements that were not medically necessary and not actually performed.  Additionally, Godiali allegedly falsified medical records to justify the procedures, and improperly used a modifier code to increase his reimbursements. DOJ

Tagged in: Criminal Proceedings, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 28, 2023

Joyce Agu, of Sugar Land, TX, will spend 60 months in prison and will pay over $3 million in restitution for conspiring to pay and receive kickbacks for services billed to Medicare. Agu paid others to certify that her clients were eligible for home health services, which they were not, but she used the certifications anyway as a basis to submit false claims to Medicare. TX AG

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

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