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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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New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted  02/23/24
doctor with dollars

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

Tagged in: FCA Federal, Government Programs Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud, Reporting to Government,

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February 1, 2024

One of the nation’s largest healthcare systems, Providence, has agreed to forgive more than $137 million in medical debt and refund more than $20 million to patients following a lawsuit by Washington State.  According to the Attorney General’s Office, between 2018 and 2023, Providence trained staff to demand payments from low income patients who were eligible for financial assistance, then sent some of those same patients to debt collectors even if they were Medicaid beneficiaries.  Almost 99,500 patients will receive relief as a result of this settlement, with the average refund amounting to about $478.  WA AG

Tagged in: Healthcare Fraud, Provider Fraud,

January 16, 2024

Silver Lake Hospital, a long-term care hospital in New Jersey, will pay $18.6 million, and its principal investors Dr. Richard Lipsky and Columbus Management South LLC will pay another $12 million, to resolve allegations of violating the False Claims Act and Federal Debt Collection Procedures Act (FDCPA).  The hospital allegedly claimed excessive cost outlier payments from Medicare, well in excess of its needs or ability to repay, and transferred millions of dollars to investors without receiving equivalent value in return.  DOJ

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

January 4, 2024

ChristianaCare has paid $42.5 million for violations of the federal False Claims Act and the Delaware False Claims and Reporting Act. In a qui tam whistleblower complaint filed in 2017, ChristianaCare's former chief compliance officer alleged illegal remuneration was provided to non-employee neonatologists and surgeons in the form of free or below fair market services by ancillary support providers, such as nurse practitioners, hospitalists, and physician assistants. These services were meant to induce referrals from the non-employees, creating a financial relationship. USAO DE

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

January 4, 2024

Florida-based H. Lee Moffitt Cancer Center & Research Institute Hospital Inc. (Moffitt) has agreed to pay over $19.5 million to resolve allegations of violating federal and state False Claims Acts over a 6-year period.  A majority of the settlement proceeds, $18.2 million, will go to the federal government, while $1.3 million will go to the State of Florida.  The hospital allegedly billed the government for items and services that should have been billed to non-government sponsors.  DOJ

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Provider Fraud,

December 22, 2023

Christiana Care Health System has agreed to pay over $7.6 million to the State of Delaware for violating the federal and state False Claims Acts, and Delaware’s Patient Brokering and Anti-Kickback laws.  According to a qui tam whistleblower, who filed a case in 2017, the healthcare system provided free or below-market rate support services to doctors in exchange for referrals of Medicaid patients, then submitted false claims stemming from those referrals to Delaware’s Medicaid program.  DE AG

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

December 19, 2023

Indiana-based Community Health Network Inc. has agreed to pay $345 million to resolve claims by its former CFO and COO Thomas Fischer, which alleged the healthcare system submitted claims to Medicare that were tainted by violations of the Stark Law.  In order to capture physicians’ downstream referrals, Community paid physicians salaries that were sometimes double market rate, and awarded them bonuses based on the number of referrals.  Community then submitted claims resulting from these referrals for reimbursement.  DOJ

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

November 16, 2023

A doctor and a clinic owner were sentenced to 10 years and 12 years in prison for their roles in a $5 million pill mill scheme.  Jonathan Rosenfield, M.D. owned and operated two clinics with co-owner and co-operator Elmer Taylor.  Together, the two issued prescriptions for over 750,000 oxycodone pills and nearly 420,000 hydrocodone pills that were ultimately diverted to the illegal market.  DOJ

Tagged in: Healthcare Fraud, Provider Fraud,

Genetic Testing Scheme Leads to Another Fraud Conviction

Posted  10/11/23
Scientist Testing a Specimen
The DOJ recently announced another fraud conviction in connection with genetic testing. This conviction from a federal jury in Florida is the latest word in a string of fraud actions against companies and individuals offering to provide genetic testing services. According to the DOJ, Jose Goyos and others managed the “‘doctor chase’ division” of a call center, which “contacted the primary care physicians...

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

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October 10, 2023

Mobile cardiac PET scan provider Cardiac Imaging Inc. (CII), and its founder and owner Sam Kancherlapalli, have agreed to pay over $75 million and over $10 million, respectively, to resolve a qui tam case by former billing manager Lynda Pinto, which alleged the company, Kancherlapalli, and part-owner Richard Nassenstein defrauded Medicare.  In violation of the Anti-Kickback Statute, Stark Law, and False Claims Act, CII and Kancherlapalli allegedly paid kickbacks to referring cardiologists in the form of fees, ostensibly for supervising PET scans, that were far above fair market value.  The alleged misconduct occurred over a ten year period.  DOJ

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

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