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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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October 22, 2020

Jerry Taylor of North Carolina has been sentenced to five years in prison and ordered to pay more than $6.1 million in restitution for his role in a $9.4 million fraud scheme targeting North Carolina’s Medicaid program.  Along with his brother Tony and co-conspirators in Ohio and New York, Taylor submitted claims for behavioral health services benefiting local at-risk youth that were purportedly performed at companies he owned and operated with his brother, but that were in reality not actually performed or misrepresented in the claims.  In addition to defrauding Medicaid, Taylor also evaded taxes by failing to report more than $1.6 million in reimbursements in 2016 and 2017.  For those charges, Taylor will pay over $346,000 to the IRS.  USAO WDNC

Constantine Cannon Settles Case Alleging Kickbacks to Multi-Practice Physicians’ Group for Referrals to Wholly Owned Ambulatory Surgery Center – Whistleblower Was Former CEO

Posted  10/9/20
doctor operating with nurse
Constantine Cannon, on behalf of whistleblower Jeffery Neuberger, has settled a False Claims Act action against Mid Dakota Clinic and a related entity.  Mr. Neuberger, the former CEO of the medical group, filed his case in 2017 alleging a scheme in violation of the Anti-Kickback Statute (AKS) between the medical group and its wholly owned ambulatory surgery center (ASC).  At issue was a financial arrangement whereby...

October 2, 2020

Advanced Pain Management Holdings, Inc. and its subsidiaries will pay $1 million to resolve claims brought by a whistleblower under the False Claims Act.  Defendants, which run ambulatory surgical centers, were alleged to have violated the Anti-Kickback Statute by improperly gifting incentive stock shares to non-employee physicians allegedly as a reward for past and anticipated referrals to APMH facilities, and by paying those physicians “medical director” fees tied to the volume of procedures at APMH facilities, without proper documentation of the agreement.  In addition, defendants were alleged to have performed unnecessary confirmatory urine drug testing on patients.  USAO ED WI

Mid Dakota Clinic – Medicare Fraud/ASC Kickbacks ($5.45M)

The Constantine Cannon team represented Jeffery Neuberger, the former CEO of a medical group in North Dakota, in a 2017 False Claims Act case alleging a scheme in violation of the Anti-Kickback Statute (AKS) between the medical group and its wholly owned ambulatory surgery center (ASC).  The AKS is intended to prevent abuses (such as unnecessary treatments) that can occur when a doctor makes money from referring patients for goods or services.  The ASC safe-harbor to the AKS is limited; it essentially permits ASC ownership only by surgeons who perform procedures or surgeries in the ASC as a functional extension of his or her office.  The lawsuit alleges that all of the multi-practice physician owners profited from referrals, not only the surgeons, and that they refused to give up this lucrative income stream despite knowing that it violated the AKS.  In November 2019, Mid Dakota Clinic, its affiliated building partnership, and insurer agreed to pay the United States $4.15 million to resolve the case.  The clinic additionally paid $1.3 million for the whistleblower’s attorneys’ fees and costs, for a total payment of $5.45 million.  The United States awarded Mr. Neuberger a 25% relator’s share of its recovery.

Catch of the Week: 345 Charged in $6 Billion National Health Care Fraud and Opioid Takedown

Posted  10/2/20
Paper Ripped Uncovering Medical Necessity Wording
In the largest health care fraud and opioid enforcement action in the Justice Department’s history, 345 defendants—including more than 100 doctors, nurses, and other medical professionals—face charges for submitting over $6 billion in false or fraudulent claims to federal and private insurers.  Defendants stand accused of submitting $4.5 billion in fraudulent claims linked to telemedicine, $845 million...

September 29, 2020

Laredo optometrist David Mora will pay $3.23 million and enter into a corporate integrity agreement to resolve claims that he submitted false claims to Medicare between 2013 and 2019.  Mora allegedly billed for services including punctal plug insertion, sensorimotor testing, vision therapy, and amniotic membrane placement, where the patient’s condition did not warrant the service as medically necessary or reasonable.  USAO SD TX

September 21, 2020

Neurosurgical Care LLC, its medical director Sagi Kuznits, and its practice director Pnina Kuznits, will pay over $1 million to resolve claims that they overbilled Medicare, TRICARE, and the Federal Employees Health Benefits Program, for the implantation of neuro-stimulators.  Defendants improperly billed the non-surgical application of P-Stim and Stivax devices as surgical procedures, and improperly billed for the application of an eVox device which was not approved for Medicare reimbursement.  USAO ED PA

September 9, 2020

Southern California radiology facility operators William M. Kelly Inc. and Omega Imaging Inc. paid $5 million to resolve claims initiated by a qui tam action under the False Claims Act filed by former employee Syd Ackerman.  The action alleged that defendants submitted claims for CT scans and MRIs involving contrast injections that were not supervised by a physician as required by applicable program rules.  The whistleblower will receive $925,000 of the settlement.  DOJ

September 9, 2020

West Virginia-based acute care hospital, Wheeling Hospital, Inc., has agreed to pay $50 million to resolve claims of violating the Anti-Kickback Statute, Physician Self-Referral (Stark) Law, and False Claims Act.  According to a former executive turned whistleblower, Louis Longo, Wheeling knowingly provided referring physicians with compensation above fair market value, based on the volume or value of their referrals, then submitted claims resulting from those improper referrals to Medicare.  As part of the settlement, Longo will receive a $10 million relator’s share.  DOJ; USAO WDPA; USAO NDWV

September 3, 2020

Having previously pleaded guilty to healthcare fraud and related charges, Arizona urgent care provider UCXtra Umbrella, LLC, which did business as "Urgent Care Extra," was sentenced to pay restitution of $12.5 million.  Defendant admitted that it ordered tests and procedures that were not medically necessary and that its billings intentionally overstated the complexity of services to patients in order to receive inflated reimbursements from private insurance companies. USAO AZ
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