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Provider Fraud

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Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

Posted  12/14/18
Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act for submitting false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health is a for-profit hospital and health system based in the Lehigh Valley region of Pennsylvania. It...

December 4, 2018

Dermatology Associates of Central New York, PLLC has agreed to pay $811,196.88 to settle claims that it overcharged Medicaid, Medicare, and TRICARE by falsely submitting claims under physicians' names, in violation of both the federal and New York False Claims Acts. A whistleblower complaint revealed that many of the physicians named on invoices were not in the office the day care was provided and could not have supervised in the rendering of services, and that some of the non-physician practitioners who provided care were not licensed to do so in the state of New York. As a result of bringing the fraud to light, the unnamed whistleblower will receive $138,000. USAO NDNY

December 3, 2018

Feng Qin, M.D., a vascular surgeon who in 2015 settled claims that he performed medically-unnecessary vascular surgeries, has again been charged with such unlawful practices.  As reported by an unidentified whistleblower who brought a case under the False Claims Act, Qin routinely scheduled patients for surgeries months in advance, regardless of whether there was a justifiable clinical reason for the surgery.  At times, Qin would alter medical records.  Qin would then bill Medicare for these procedures, despite his knowledge that procedures on patients that are not medically reasonable and necessary are not covered by Medicare.  USAO SDNY

November 28, 2018

Dr. Thomas Baker, Dr. Carolyn Kochert, Dr. Larry L. Zhou, and Dr. Julie Y. Chao, have agreed to settle with the United States Government for violation of the Federal False Claims Act, the Physician Self-Referral law (“Stark”), and the Anti-Kickback Statute due to their involvement in a kickback scheme with Southwest Laboratories and Medscan Laboratory, thus causing false claims to be submitted to Medicare. The four physicians will pay a total amount of over $1.5 million. The individual amounts paid are as follows: Dr. Baker, of Tennessee - $484,481.80; Dr. Kochert, of Indiana - $129,682.84; Dr. Zhou, of Kentucky - $277,758.18; Dr. Chao, of Indiana - $650,000. DOJ

November 26, 2018

Vital Energy Occupational Therapy and Wellness Center, LLC agreed to pay $200,000 to settle charges that between 2013 and 2016 it submitted false claims for physical and occupational therapy services.  The therapy practice was alleged to have submitted claims to Medicare and Medicaid for individual therapy services, when group therapy was actually provided, and claims for therapy services with false practitioner information using the names of former employees.  Whistleblower Ashley C. Baggett, who filed the False Claims Act action, will receive $36,000.  USAO S.C.

November 20, 2018

Gray Wesley Barrow, a doctor and co-owner of Louisiana Spine & Sports LLC, a pain management clinic in Baton Rouge, has pleaded guilty to receiving approximately $336,000 in unlawful kickbacks.  According to the plea, between 2014 and 2016 Barrow sent urine specimens collected from his patients to a drug testing laboratory that agreed to pay him a percentage of the reimbursements paid to the laboratory by health care benefit programs including Medicare. DOJ; USAO M.D. La.

November 8, 2018

Renee Christine Borunda of Greensboro, North Carolina, was sentenced to prison and ordered to make restitution to the North Carolina Medicaid program for conduct that defrauded Medicaid.  Borunda, who worked for a behavioral health services provider, used a therapist's personal information to submit false bills for behavioral services, claiming that services were provided to over 200 different Medicaid recipients when no such services were rendered.  USAO EDNC; NC

November 7, 2018

Convicted of defrauding the Medicare program, former Houston-area healthcare clinics owner Joy Aneke was sentenced to 36 months in federal prison and ordered to pay $2,760,464.57. Aneke submitted false claims for medical services that were either not performed or not authorized by a licensed physician. None of Aneke’s clinics even had equipment necessary to provide the services -- allergy testing, complex cystometrograms, anal/urinary muscle studies, and others -- for which Aneke billed Medicare. Additionally, Aneke used “recruiters” or “marketers” to encourage patients to visit her clinics, and instructed co-defendant Maureen Henshall to pay patients illegal kickbacks. DOJ  

October 23, 2018

Eye Centers of Florida, owned by Dr. David C. Brown, has agreed to pay $525,000 to settle claims of that it knowingly falsified the medical records of certain Medicare patients in order to submit qualifying reimbursement claims. In violation of the False Claims Act, Eye Centers allegedly altered the paperwork to make it appear that patients had worse vision than they actually did, allowing Eye Centers to bill for cataract surgeries that would ordinarily not have been reimbursable. The case was revealed through a lawsuit filed by two former employees, Patti Nilsson and Joann Smith, who are set to receive $115,500 from the settlement. USAO MDFL

October 23, 2018

Vascular Access Centers LP (VAC) and its 20+ related corporations in multiple states have agreed to pay $3.825 million over five years to settle whistleblower-brought allegations that VAC took part in an illegal patient referral kickback scheme and fraudulently billed Medicare for certain non-reimbursable procedures. The alleged fraud violated the Anti-Kickback Statute and False Claims Act and involved regularly scheduling, performing, and billing Medicare for certain vascular access procedures for End Stage Renal Disease (ESRD) beneficiaries that were not routinely necessary. Two whistleblowers will share in the relator's share of $612,000. DOJ; USAO EDLA; USAO SDNY
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