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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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July 16, 2021

Florida Neurological Center, LLC and its owner Dr. Lance Kim have agreed to settle a whistleblower-brought suit and pay $800,000 to resolve allegations of defrauding Medicare.  The qui tam suit by Michael Singbush, Andrea Herrera, and Harvey Kessler Meyer, IV alleged that Dr. Kim prescribed medically unnecessary prescription drugs, which cost Medicare $35,000 each time it was prescribed.  For their role in the successful enforcement action, the whistleblowers will share in a $144,000 award.  USAO MDFL

July 2, 2021

An Ohio-based hospital system that has since been acquired by the Cleveland Clinic Foundation has agreed to pay over $21 million to resolve alleged violations of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act.  Between 2010 and 2016, Akron General Health System (AGHS) allegedly paid area physician groups far above fair market value in order to induce referrals, then submitted claims arising from those illegal referrals to federal healthcare programs.  The settlement resolves a qui tam suit brought forth by former internal audit director at AGHS, Beverly Brouse, and Ethical Solutions LLC.  DOJ

June 25, 2021

Connecticut Addiction Medicine, LLC (CAM) and its owners, Dr. Jay Benson and Dr. Mahboob Aslam, have agreed to pay over $1 million to resolve their liability under the False Claims Act in connection with overcharges for urine drug tests that they caused to Medicare and Medicaid.  As part of their standard practice, CAM ran presumptive tests in-house but also sent the same sample out to an independent reference laboratory for definitive tests.  CAM then billed federal healthcare programs for the medically unnecessary presumptive tests.  USAO CT

June 11, 2021

Two integrative chiropractic practices in Pennsylvania and their chiropractor owners have agreed to pay over $800,000 to resolve liability under the False Claims Act in connection with an electro-acupuncture device.  The settling parties are Discover Optimal Healthcare, affiliate Weigner Healthcare Management Group, LLC, and owner Jason Weigner (collectively, “Weigner”), and Yucha Medical Pain Management & Chiropractic Rehabilitation, LLC, and owners Randolph Yucha and Rodney Gabel.  Between 2016 and 2017, the parties allegedly billed Medicare and the Federal Employees Health Benefit Program for the surgical implantation of neuro-stimulators, even though the devices involved—ANSiStim—are not reimbursable and can be applied with adhesives.  USAO EDPA

June 10, 2021

Three Texas-based healthcare providers who allegedly billed Medicare for non-reimbursable procedures involving electro-acupuncture devices have agreed to pay over $1 million in settle their liability under the False Claims Act.  For up to two years, each of the providers—Ledger Foot & Ankle, P.A., SPR Medical Group d/b/a Superior Physical Medicine, and Precision Spine and Pain Management—allegedly billed the application of two pain management devices, ANSiStim and STIVAX, as though they were implantable neurostimulators, when in fact their application was non-surgical and non-invasive.  Following a Medicare audit, Superior and Precision self-disclosed improperly billed claims and initiated refund payments to Medicare.  USAO WDTX

May 26, 2021

Nurse practitioner Trivikram Reddy was sentenced to 20 years in prison following his guilty plea on healthcare conspiracy and wire fraud charges.  Reddy stole the identities of six physicians to submit fraudulent bills to Medicare and private insurers including Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana, and Cigna. When federal agents began their investigation, Reddy took steps to manufacture medical records to support his fraudulently-submitted bills, and diverted millions of dollars in proceeds of the fraud to himself.  In addition to the prison sentence, Reddy was ordered to pay more than $52 million in restitution.  USAO ND TX

May 25, 2021

Upper Allegheny Health System (UAHS), which operates dental clinics in New York and Pennsylvania, has agreed to pay $2.7 million to resolve whistleblower-brought allegations of submitting false claims to Medicaid in violation of the federal and New York False Claims Acts.  Between 2010 and 2015, UAHS had billed Medicaid for dental services performed using improperly sterilized handpieces, which are considered semi-critical devices and need to be properly heat sterilized between patients.  AG NY; USAO WDNY; USAO WDPA

Private-Equity Red Flags Signal Potential False Claims Act Liability

Posted  05/21/21
By Jessica T. Moore
person following a trail of money
Private equity (PE) firms that manage healthcare entities have further reason to take note of the growing record of exposure for False Claims Act (FCA) liability.

Martino-Fleming Case

In the latest shot across the bow, the PE firm, a majority shareholder of a for-profit mental-health provider, knew about the false claims and played a sufficiently active role in operations potentially to have caused them. Evidence...

May 18, 2021

Javaid Perwaiz, an ob/gyn who practiced in Hampton Roads, Virginia, was sentenced to 59 years in prison after a jury convicted him of charges related to his performance of hysterectomies, sterilizations, and other medically unnecessary surgeries and procedures on patients without their informed consent - in many cases by falsely telling them they had cancer or needed the procedure to avoid cancer.  In addition, Perwaiz induced labor in patients early so that he could bill for the deliveries, sometimes falsifying records to support the induction.  USAO ED VA
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