Provider Fraud Archives - Page 14 of 50

Disturbing New Evidence Suggests Fraud Underlies Five-Star Ratings for Some Nursing Homes

Posted 03/19/21

Nurse helping elder man walking in rehab facility

Twelve years after the implementation of the nursing-home star-ratings system, a disturbing New York Times exposé and a lawsuit by California against Brookdale Senior Living reveals how the ratings are manipulated to the detriment of families in their time of crisis. The NYT’s investigation and California’s allegations in combination paint the troubling picture of profits tied to higher star ratings, and...

Tagged in: FCA Federal, Financial and Investment Fraud, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Provider Fraud, SNF,

March 18, 2021

A Michigan-based cardiologist, Dinesh Shah, and his practice, Michigan Physicians Group, P.C. (MPG), have agreed to pay $2 million to resolve allegations of defrauding Medicare, Medicaid, and TRICARE by submitting claims for medically unnecessary diagnostic testing, in violation of the False Claims Act. In separate qui tam suits filed by former employees Arlene Klinke and Khrystyna Mala, the whistleblowers alleged that between 2006 and 2017, Shah and MPG billed government healthcare programs for Ankle Brachial Index tests, Toe Brachial Index tests, and Nuclear Stress Tests that were ordered and provided without regard to necessity. USAO EDMI

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

March 8, 2021

Vascular surgeon Feng Qin and his medical practice Qin Medical P.C. will pay $800,000 to resolve civil claims and criminal charges that Qin performed procedures on end-stage renal disease patients that were not medically reasonable and necessary, and fraudulently billed Medicare. Qin performed vascular access procedures on patients on a routine scheduled basis, without documenting the required clinical findings. The government’s investigation was initiated by the filing of a qui tam complaint by Mark Favors. USAO SDNY

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

March 5, 2021

A substance abuse treatment facility and two inpatient psychiatric hospitals in Ohio, along with their corporate parent, have agreed to pay $10.25 million to resolve claims under the Anti-Kickback Statute and False Claims Act. According to DOJ, between 2013 and 2019, The Woods at Parkside, Cambridge Behavioral Hospital, and Ridgeview Behavioral Hospital—all owned by Florida-based Oglethorpe Inc.—allegedly provided improper inducements in the form of free long-distance transportation in order to entice patients to seek treatment at their facilities, and then submitted claims for services provided to those patients to Medicare. The case was initiated by a former client advocate working at Cambridge, Darlene Baker. DOJ; USAO SDOH

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

March 3, 2021

The CEO of a group of medical providers in Michigan and Ohio has been sentenced to 15 years in prison and ordered to pay over $51 million in restitution to Medicare, as well as forfeit over $11.5 million in cash along with multiple properties and a Detroit Pistons season ticket membership, following a trial that found him guilty for his role in an extensive fraud scheme against Medicare. Mashiyat Rashid, the CEO of Tri-County Wellness Group, allegedly instituted a corporate policy that forced patients—many of whom were addicted to opioids and recruited from homeless shelters and soup kitchens—to submit to medically unnecessary but highly reimbursed back injections in exchange for prescriptions to medically unnecessary opioids. To implement the policy, Rashid made a point to hire physicians who were willing to put profit over patient care, further incentivizing them by offering to split reimbursements with them. Yet according to trial testimony, many of the patients did not want, need, or benefit from the painful back injections, which left some of them suffering from adverse conditions, including open holes in their back. Rashid is the second defendant to be sentenced in this case; twenty-one other defendants, including two physicians, have been convicted so far. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud,

March 2, 2021

Medical practice Allergy and Asthma Associates Inc., in Roanoke, Virginia, will pay $2.1 million to resolve allegations that it fraudulently billed Medicare and Medicaid for asthma treatments. AAA treated patients with Xolair, an asthma treatment sold in single-use vials, and billed government healthcare programs for the entire vial when, in fact, they were splitting vials between different patients. USAO WDVA

Tagged in: Dosage Fraud, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

February 25, 2021

Texas Center for Orthopedic and Spinal Disorders and its owner, osteopath Mark Kuper, have agreed to a judgment of $11.2 million to resolve claims arising from their fraudulent billing of government healthcare programs. Kuper also pleaded guilty to healthcare fraud, and was sentenced to 10 years in prison. Defendants admitted that they submitted claims for services that were never rendered, including claims for one-on-one physical therapy pursuant to an individualized plan of care, when patients were actually attending group sessions with an athletic trainer, and claims for 60-minute psychotherapy sessions when patients actually spoke with unqualified individuals for just 15-20 minutes. In addition, Kuper permitted his wife to use his credentials to issue prescriptions for controlled substances. The civil investigation was initiated by a qui tam complaint filed by Richard Brown, who will receive 17% of the government’s recovery. USAO ND TX

Tagged in: Criminal Proceedings, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

February 1, 2021

Florida pain clinics Collier Anesthesia Pain, LLC and Tampa Pain Relief Center, Inc., will together pay $1.7 million to resolve claims that they violated the False Claims Act. The clinics were alleged to have paid unlawful kickbacks to affiliated surgery centers by waiving copayments for surgical facility fees in order to induce patients to receive injection procedures. In addition, the government contended that the clinics improperly billed for evaluation and management services and psychological testing services. USAO MD FL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

January 28, 2021

Electronic health records vendor athenahealth Inc. will pay $18.25 million to resolve claims brought in two separate whistleblower actions alleging that certain Athena marketing programs provided unlawful remuneration to healthcare providers and others to induce providers to purchase Athena’s EHR systems. Remuneration to current and prospective customers included all-expenses paid trips to sporting, entertainment, and recreational events, as well as cash payments to customers who referred others to Athena. In addition, Athena paid other EHR vendors who referred clients to Athena when they were discontinuing their own EHR products and services. The kickbacks allegedly improperly generated sales for Athena while causing healthcare providers to submit false claims to the federal government for incentive payments related to the adoption and “meaningful use” of Athena’s EHR technology. The whistleblowers, Geordie Sanborn, Cheryl Lovell, and William McKusick, will receive a share of the total settlement that remains to be determined. DOJ; USAO Mass

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Rewards,

January 22, 2021

The estate of Dr. Patrick T. Hunter has agreed to pay more than $1.7 million to resolve allegations that the urologist, who passed away in 2019, submitted false claims to Medicare and TRICARE for medically unnecessary procedures and received improper payments for them from the Orlando Center for Outpatient Surgery. Between 2010 and 2016, Dr. Hunter allegedly performed the lithotripsy procedures, which break up kidney stones, on patients who either did not have kidney stones or were not medically indicated for them. For initiating the successful qui tam suit, whistleblower Scott Thompson will receive a relator’s share of $385,000. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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