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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 7 of 54

February 27, 2023

The University of Pittsburgh Medical Center (“UPMC”), University of Pittsburgh Physicians (“UPP”), and Dr. James Luketich have agreed to pay $8.5 million to settle a False Claims Act suit launched by a former UPMC surgeon, Dr. Jonathan D’Cunha.  According to the qui tam suit, which was joined by the government, Dr. Luketich regularly billed Medicare for concurrently performed complex cardiothoracic surgeries, often as many as three at a time, in violation of statutes and regulations.  The practice increased the risk of surgical complications to patients, as it meant the physician was not present for key portions of the surgeries, and patients were under anesthesia for longer than necessary.  USAO WDPA

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Whistleblower Case,

January 30, 2023

A doctor in Michigan who was involved in a $250 million fraud scheme against Medicare, Medicaid, and other insurers, has been sentenced to 16.5 years in prison.  Along with 21 co-conspirators, Dr. Francisco Patino took advantage of patients suffering from addiction by forcing them to receive medically unnecessary, painful, but lucrative spinal injections in exchange for opioid prescriptions.  Additionally, Patino knowingly violated the Anti-Kickback and Stark laws by receiving kickbacks from a laboratory in exchange for sending patient samples to that lab.  All told, Patino submitted more claims to Medicare for spinal injections than any other provider in the country between 2012 and 2017, prescribed more Oxycodone than any other provider in Michigan in 2016 and 2017, and was personally responsible for $120 million of the $250 million in false claims billed to insurers.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud,

January 9, 2023

Doctor Aarti Pandya and her practice, Aarti D. Pandya, M.D. P.C., have agreed to pay $1.8 million to resolve a whistleblower suit that alleged they billed federal healthcare programs for medically unnecessary cataract surgeries and diagnostic tests, incomplete or worthless tests, and office visits that failed to provide the level of service claimed.  The allegations were brought in a 2013 qui tam suit by former employee Laura Dildine, which the government intervened on in 2018. In addition to the false claims listed above, Pandya also allegedly falsely diagnosed patients with glaucoma in order to justify claims for reimbursement.  USAO SDGA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

Top Ten Healthcare Fraud Recoveries of 2022

Posted  01/6/23
Healthcare fraud image showing stethoscope with gavel
Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare.  As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

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December 15, 2022

A physician and his Connecticut-based urgent care practices have agreed to pay over $4.2 million to settle allegations of submitting false claims to Medicare and the Connecticut Medicaid program.  Jasdeep Sidana—the owner and CEO of Docs Medical Group, Inc., Docs Medical Inc., Docs Urgent Care LLP, Lung Docs of CT, P.C., Epic Family Physicians, LLP, and Continuum Medical Group, LLC (collectively, DOCS)—allegedly billed for immunotherapy services, including allergy testing and treatment, that were not medically necessary and not directly supervised by a physician.  Additionally, the defendants allegedly billed for COVID test administration using codes for more complex evaluation and management (“E&M”) services.  USAO CT

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Upcoding,

December 15, 2022

Florida-based Ocenture LLC and its subsidiary, Carelumina LLC, have agreed to pay $3 million to settle allegations of submitting claims to Medicare that were tainted by illegal kickbacks.  Two marketers approached by Ocenture to participate in the kickback scheme, Christopher Improta and Peter Brandt, filed a qui tam suit against Ocenture which alleged the company provided kickbacks to physicians to have them falsely attest that genetic tests Ocenture solicited directly from Medicare beneficiaries was medically necessary.  The whistleblowers also alleged that Ocenture arranged for laboratories to process those tests and pay it a portion of the laboratories’ Medicare reimbursements.  For instigating a successful enforcement action, Improta and Brandt will share a $570,000 award.  DOJ

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

November 3, 2022

Titan Medical Compliance, LLC, and its chiropractor owner Timothy Warren, have been ordered to pay over $15 million to resolve claims that they falsely marketed auricular electro-acupuncture devices as FDA-approved and Medicare-reimbursable, when in fact they are not.  The judgment against Warren and Titan is the latest in a federal investigation into the improper billing of these non-surgical devices.  USAO EDPA

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

October 31, 2022

Felix Amos of Houston, TX will serve 30 months in federal prison and will pay over $21 million in restitution for his role in a Medicare fraud scheme carried out with two other co-defendants. From 2010 to 2015, Amos owned and operated home health companies Dayton Health Bridges, Access Practical Solutions, Advanced Holistic, GetUpandWalk Inc., and Guaranty Home Health Agency. Amos and his co-conspirators submitted false claims to Medicare for patients that did not need or receive services, including deceased or incarcerated persons, and for services not ordered by a physician. USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud,

October 18, 2022

Carter Healthcare LLC, affiliates CHC Holdings and Carter-Florida, president Stanley Carter, and Chief Operations Officer Bradley Carter have agreed to pay $23 million and $7.2 million to settle two whistleblower cases alleging violations of the False Claims Act.  The first case, filed in the Western District of Oklahoma, alleged that the Oklahoma-based home health company paid illegal kickbacks to physicians under the guise of medical directorships in order to induce referrals.  The second case, filed in the Southern District of Florida by former therapists Sharon Mahaffey and Mark Brimer, alleged that Carter Healthcare billed Medicare for medically unnecessary therapy and upcoded patient diagnoses for higher reimbursements.  As part of the settlements, defendants Stanley and Bradley Carter have agreed to be excluded from participating in government healthcare programs for 5 years, and whistleblowers Mahaffey and Brimer will split a $1.3 million relator’s share.  USAO WDOK; USAO SDFL

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

October 17, 2022

Sutter Health has agreed to pay more than $13 million to settle claims of billing Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program for quantitative urine testing that were in fact performed by third-party labs.  The company has already paid more than $6.5 million and is due to pay the remaining $6.5 million in the next 30 days.  USAO NDCA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medicare, Other Government Health Programs,

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