Charges Filed in Shameful COVID-19 and Genetic-Cancer-Screening Test Scam
Posted 04/3/20
Provider Fraud
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March 13, 2020
Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, LLC, have agreed to pay $1.74 million to settle claims of submitting false and inflated claims to Medicare. From 2011 to 2016, defendants billed and caused Medicare to pay for lower-level wound repairs as if they were more complex adjacent tissue transfers. The misconduct was eventually exposed by whistleblowers Dr. Robert Green and Emily Kennedy, who will share in a $305,000 award. USAO MDFLMarch 2, 2020
The owners and operators of Middlesex Rheumatology in Connecticut, Dr. Crispin Abarientos and his wife Dr. Antonieta Abarientos, have agreed to pay $4.9 million to settle allegations of violating federal and state False Claims Act. Between 2013 to 2017, the Abarientos allegedly billed Medicaid for an injectable prescription drug called Remicade, which is used to treat rheumatoid arthritis, but then failed to administer the drugs on Medicaid patients. Instead, they administered them on patients covered by Medicare or the Connecticut State Employees Health Plan, then billed the two providers for the drugs again even though the cost had already been covered by Medicaid. USAO CTFebruary 27, 2020
Wichita clinic Trina Health–Wichita NW, LLC, together with its principal, Jack West, will pay $775,000 to resolve allegations under the False Claims Act that they billed for outpatient insulin infusion that was not medically reasonable or necessary, calling the service "artificial pancreas treatment" for diabetes. USAO KSFebruary 19, 2020
Guardian Elder Care Holdings, Inc. has agreed to pay $15.5 million to settle claims of defrauding Medicare and Medicaid. In a qui tam suit filed in 2015, whistleblowers Philippa Krauss and Julie White alleged that from 2011 to 2017, the Pennsylvania-based nursing home chain pressured its therapists to provide medically unnecessary rehabilitation to patients suffering from dementia or dying in hospice care in order to boost its profits. During the subsequent government investigation, Guardian Elder Care self-disclosed that it had also billed federal healthcare programs for services performed by two excluded individuals. As part of the settlement, Guardian Elder Care has entered into a chain-wide Corporate Integrity Agreement with the Department of Health and Human Services, and Krauss and White will split a $2.8 million relator's share. USAO EDPA; USAO WDPAFebruary 4, 2020
Psychotherapy, adolescent therapy, and tutoring company The Center of Attention, LLC: No One Left Behind, together with its owner Selina Christian, will pay $200,000 and be suspended from Connecticut's Medicaid program, based on allegations that defendants violated the Connecticut False Claims Act and submitted false claims for services that were either never provided, or that were for non-psychotherapy services that were not covered by Medicaid. CTFebruary 4, 2020
Southeastern Retina Associates (SERA), which operates in parts of Tennessee, Georgia, and Virginia, has agreed to pay $1.5 million and enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services for allegedly defrauding Medicare and Medicaid. The investigation was launched by a qui tam suit filed by an unnamed whistleblower, which alleged that between 2009 to 2016, the practice improperly billed exams at a higher rate than appropriate, and used a billing code called Modifier 25 to bill for exams that were not separately billable from other services billed the same day. For exposing the misconduct, the relator in this case will receive a $270,000 share of the settlement. USAO EDTNTop Ten Healthcare Fraud Recoveries of 2019
Posted 01/24/20
