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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 4, 2019

Southern California-based Retina Institute of California Medical Group (RIC), its former CEO, and several of its physicians have agreed to pay the State of California and United States $6.65 million to settle alleged violations of state and federal False Claims Acts.  According to former administrators Bobbette Smith and Susan Rogers, between 2006 and 2017, the ophthalmology group improperly billed Medicare and Medicaid for unnecessary and unperformed eye exams, upcoded simple exams using codes normally reserved for emergency conditions, and waived mandatory co-payments and deductibles to induce patient referrals.  Smith and Rogers will receive a relator’s share, which remains to be determined.  USAO CDCA

October 3, 2019

Glenn A. Kline and Community Surgical Associates of Lancaster, Pennsylvania, will pay $4.25 million to resolve claims that Dr. Kline entered into an unlawful kickback arrangement with two hospitals owned by Health Management Associates in exchange for his referral of patients to the hospitals.  The hospitals paid Dr. Kline far above fair market value for his services, and made additional payments to Community Surgical Associates, structuring those payments to conceal their purpose.  HMA previously paid $260 million to resolve related claims; physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million; and, former HMA CEO Gary Newsome agreed to pay $3.5 million.  The claims against Kline and Community Surgical were original made in a qui tam complaint filed by former HMA executives George Miller and Michael Metts; they will receive $1.05 million of the settlement.  USAO ED PA

September 26, 2019

Physician Philippe R. Chain will pay $300,000 to resolve allegations that he caused the submission of false claims to Tricare while working for telemedicine company CallMD. Chain allegedly issued and approved prescriptions for compounded medications, many of which were not medically necessary, without speaking to, examining, or otherwise having a physician-patient relationship with the patients.  USAO CT

September 17, 2019

Physician Alliance Ltd. (PAL) and its medical director agreed to pay $178,000 to resolve False Claims Act allegations for improperly billing Medicare for providing patients with electric acupuncture medical devices that is affixed behind patients' ears. Since Medicare does not reimburse for acupunctural devices, PAL allegedly billed Medicare for the “implantation of neurostimulator electrodes,” a procedure that requires surgery and for which Medicare reimburses in the thousands of dollars. The case was investigated out of the Eastern District of Pennsylvania. DOJ

September 17, 2019

Physician Alliance Ltd. and Richard Frey, D.O. will pay $178,400 to resolve allegations that they submitted false claims to Medicare.  When defendants provided patients with "P-Stim" devices, which are worn on a patient's ear and marketed as an acupuncture treatment, they billed Medicare for the implantation of neurostimulator electrodes, which is a surgical procedure for which Medicare reimburses thousands of dollars.  By contrast, Medicare does not reimburse for acupuncture or acupuncture devices.  USAO EDPA

September 9, 2019

Dr. Augusto Castrillon of Texas has agreed to pay $2 million to settle allegations he fraudulently billed Medicare for medically unnecessary diagnostic tests in violation of the federal False Claims Act.  From 2009 to 2015, the owner and operator of Castrillon Family Clinic allegedly submitted false claims for transcranial doppler imaging studies, electromyography, nerve conduction studies, and autonomic function testing that were ordered for the same patients on a recurring basis.  The claims submitted by Dr. Castrillion were so excessive that they stood out as a significant statistical outlier in a proactive review of claims data by the U.S. Attorney’s Office.  USAO SDTX

September 5, 2019

El Paso Integrated Physicians Group, P.A., several physicians in the group, and Accutrack Medical Claims Services, LLC, have agreed to pay $2.93 million to resolve a False Claims Act case filed by whistleblower Sergio Garcia alleging that they double-billed and over-billed government payors for the infusion drug Remicade (Infiximab).  Remicade is sold in single-use vials; defendants were alleged to have pooled Remicade from partially-used vials, diluted Remicade, and illegally imported drugs from Canada and other foreign countries.  USAO WD Tex

September 5, 2019

Dentist Santa Maria McKibbens has agreed to pay North Carolina $375,000 to resolve allegations that she submitted false claims to the North Carolina Medicaid Program by billing for dental restorations that were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy.  NC

Fraud in Government Telehealth Programs: How to Report it Under the False Claims Act for a Whistleblower Reward

Posted  09/4/19
When patients are unable to see a doctor in person, technology can offer solutions. Telehealth or telemedicine is the provision of health services – including assessment, diagnosis, intervention, consultation, or supervision – across distance through the use of information technology. It can be especially valuable in rural areas, where specialty providers may not be available. And its use has grown...
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