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Provider Fraud

This archive displays posts tagged as relevant to fraud by healthcare providers. You may also be interested in our pages:

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August 16, 2019

2d Chance PLLC, a Kentucky-based substance abuse center, will pay $200,494 to resolve allegations under the False Claims Act that it entered into an arrangement with Compliance Advantage, LLC, a toxicology lab, whereby 2d Chance referred patients to Compliance Advantage for complex drug testing, and Compliance Advantage provided a no-cost chemistry analyzer to 2d Chance, allowing 2d Chance to perform some urine testing at its site and bill Medicaid for those services.  The financial arrangement violated the Anti-Kickback Statute.  EDKY

August 16, 2019

Kentucky-based Ultimate Care Medical Services, LLC, doing business as Ultimate Treatment Center, and its principal, Dr. Rose O. Uradu, have agreed to pay $1.4 million to resolve allegations that they submitted false claims to Mediare and Kentucky's Medicaid program for services that were not provided.  Defendants billed for "evaluation & management" services when patients visited the clinic to receive methadone, visits which did not include a medical examination, which is required to bill for evaluation &  management.  In addition, defendants billed for complex urine drug testing when they lacked the equipment to perform such testing, and issued buprenorphine prescriptions at an rate greater than authorized.  USAO ED KY

August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million.  According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals.  As part of the settlement, Seddon will receive a $200,000 relator’s share.  USAO SDAL

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid.  As part of the settlement, they will pay $425,000USAO CT

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted  07/12/19
Pill container spilled over with pills fallen out.
On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

July 9, 2019

Two chiropractors who owned the Kansas City Health and Wellness Clinic have agreed to pay $350,000 to settle False Claims allegations.  Brothers Ryan Schell and Tyler Schell allegedly billed Medicare for medically unnecessary, unprovided, or uncovered treatments of peripheral neuropathy, which causes loss of sensation and/or burning sensations in the hands and feet.  USAO KS

June 28, 2019

The nation’s largest operator of inpatient rehabilitation facilities (IRFs) has agreed to pay $48 million to settle allegations that it violated the False Claims Act.  Three separate lawsuits filed by former contract physician Dr. Emese Simon, former director of therapy operations Melissa Higgins, and former medical director Dr. Darius Clarke, alleged a number of Encompass Health Corporation, f/k/a HealthSouth Corporation IDFs, falsely diagnosed patients with “disuse myopathy” and improperly admitted patients too sick or disabled to participate in physical therapy in order to earn higher reimbursements from Medicare.  The whistleblowers’ collective share of the settlement is $12.4 million.  DOJ; USAO MDFL

June 27, 2019

Following a whistleblower suit, Fusion Physical Therapy and Sports Wellness, P.C., and its founder and CEO, Carolyn Sue Mazur, have agreed to pay $37,500 to settle charges of billing Medicare for physical therapy services performed by uncredentialed personnel.  In addition the monetary penalty, Fusion and Mazur have also admitted to the misconduct.  USAO SDNY

June 18, 2019

Nevada Heart & Vascular Center has agreed to pay $2.5 million to settle allegations that it accepted kickbacks from genetic testing companies, Natural Molecular Testing Corp. and Iverson Genetic Diagnostics, Inc., in exchange for referrals of Medicare patients.  The alleged violations of the Anti-Kickback Statute and False Claims Act occurred for nearly a year in 2012.  USAO NV

June 7, 2019

Robert A. Glazer and Marina Menino have been found guilty at trial for their actions directing a Medicare fraud scheme that billed $33 million to the government.  Menino received kickbacks from Glazer in exchange for recruiting patients for his Glazer Clinic.  Glazer then billed Medicare for services the patients did not need or did not receive, referred them to medically unnecessary home health or hospice services, and ordered durable medical equipment that they did not need or receive. Defendants will be sentenced in September 2019. DOJ; USAO C.D.Cal.
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