Provider Fraud Archives - Page 13 of 50

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

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Devices and DME, Provider Fraud, Whistleblower Case,

Private-Equity Red Flags Signal Potential False Claims Act Liability

Posted 05/21/21

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...

Tagged in: COVID-19, Defendants, FCA Federal, Financial and Investment Fraud, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud, SNF,

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

Tagged in: Criminal Proceedings, Lack of Medical Necessity, Provider Fraud,

May 14, 2021

Texas dentists Gunjan Dhir and Gaurav Puri and their affiliated management companies and practice groups will pay $3.1 million to resolve allegations that they fraudulently charged the Texas Medicaid program for pediatric dental services. The investigation was initiated by the filing of a qui tam complaint by whistleblowers Sandy Puga, Nelda Torres-Brown, and Sonia Cardoso, who were former employees of defendants and will receive an undisclosed share the settlement. Defendants allegedly billed for services that were not actually provided and/or misreported the provider of services by using erroneous Medicaid provider numbers. USAO ND Texas

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

May 5, 2021

Neurosurgical Associates, LTD and Dignity Health, d/b/a St. Joseph’s Hospital, have agreed to a $10 million settlement and five-year corporate integrity agreement to resolve allegations of violating the federal False Claims Act. According to whistleblower Dr. Bruce P. Kingsley, Neurological Associates and St. Joseph’s Hospital improperly billed Medicare for certain doubly and triply concurrent and overlapping surgeries. USAO AZ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

P-Stim Fraud: A New DOJ Enforcement Priority?

Posted 04/23/21

The Department of Justice regularly publicizes its fraud prevention and False Claims Act enforcement priorities. These announced priorities typically focus on broad issues that affect the lives of millions of Americans – COVID-19 fraud, the opioid crisis, and the rapid expansion of telehealth. In addition, we keep an eye on DOJ enforcement actions, and these can reveal emerging trends, often in narrow areas. One...

Tagged in: Chiropractic, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Provider Fraud,

April 21, 2021

Tennessee-based Anesthesia Services Associates, PLLC d/b/a Comprehensive Pain Specialists (CPS) and its four majority owners have agreed to pay a total of $4.1 million to resolve allegations of violating the federal False Claims Act and Tennessee Medicaid False Claims Act. According to the government, CPS billed Medicare and TennCare for medically unnecessary or non-reimbursable genetic tests, psychological tests, specimen validity tests, and urine drug tests, as well as medically unnecessary or non-reimbursable acupuncture. For bringing a successful qui tam suit, the whistleblowers in this case will receive a relator’s share of over $610,000. USAO MDTN

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 20, 2021

In order to resolve a whistleblower suit alleging violations of the False Claims Act, Massachusetts Eye and Ear and its related entities have agreed to pay over $2.6 million. Over an eight-year period ending in 2020, Massachusetts Eye and Ear allegedly made a habit of submitting false claims to Medicare and Medicaid for office visits that were not reimbursable under program rules. Altogether, the government programs were defrauded of over a million dollars. As a reward for blowing the whistle, the unnamed relator will receive a 15% share of the settlement proceeds. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 19, 2021

Maryland physician Njideka Udochi of Millennium Family Practice will pay $660,000 to resolve allegations that she submitted false claims for auricular stimulation, or "P-Stim," devices. Udochi billed Medicare using a billing code covering the surgical implantation of a type of neurostimulator, but P-Stim devices are not surgically implanted, and are not approved for reimbursement from Medicare. USAO MD

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Provider Fraud, Upcoding,

March 23, 2021

The former owner of Shape of Behavior (TSOB), a Texas-based therapy service provider for children with autism, has agreed to pay $2.7 million to resolve allegations that nine of the provider’s locations submitted improper claims to TRICARE. The misconduct was uncovered by TRICARE’s managed care support contractor, Humana Military Program Integrity, and involved claims that could not be substantiated by medical records, claims involving excessive hours by individual providers, and misrepresentations of the identities of actual rendering providers. USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

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