Provider Fraud Archives - Page 23 of 50

June 7, 2019

Robert A. Glazer and Marina Menino have been found guilty at trial for their actions directing a Medicare fraud scheme that billed $33 million to the government. Menino received kickbacks from Glazer in exchange for recruiting patients for his Glazer Clinic. Glazer then billed Medicare for services the patients did not need or did not receive, referred them to medically unnecessary home health or hospice services, and ordered durable medical equipment that they did not need or receive. Defendants will be sentenced in September 2019. DOJ; USAO C.D.Cal.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medicare, Provider Fraud,

DOJ Catch of the Week — Dr. Joseph Galichia

Posted 05/31/19

Paper Ripped Uncovering Medical Necessity Wording

This week's DOJ Catch of the Week goes to Kansas cardiologist Joseph Galichia. Yesterday, he agreed to pay $5.8 million to resolve allegations that he and his company, Galichia Medical Group, violated the False Claims Act by billing federal health care programs for medically unnecessary cardiac stent procedures. This is the government's third False Claims Act settlement with Dr. Galichia. Which may explain why he also...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 30, 2019

Joseph P. Galichia, a cardiologist in Wichita, Kansas, will pay $5.8 million to resolve allegations under the False Claims Act that he and his practice, Galichia Medical Group, P.A., implanted cardiac stents in patients who did not need them, and billed Medicare, the Defense Health Agency, and the Federal Employees Health Benefits Program for these medically unnecessary procedures. Galichia will also be excluded from participating in federal healthcare programs for three years. The case was initiated by a whistleblower, Aly Gadalla, M.D., who filed a qui tam complaint. Dr. Gadalla will receive a whistleblower reward of $1.16 million. This is the third time Galichia had settled FCA claims against him and his practice. DOJ; USAO Kan

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

May 29, 2019

A doctor in South Carolina has agreed to pay $92,506.30 to settle allegations of accepting illegal payments from OK Compounding, LLC, in exchange for prescribing their pain creams to TRICARE patients. The False Claims Act violations allegedly occurred between February and May 2013, and involved “medical director fees” paid to Dr. Jerry Back that were in reality, kickbacks. This was the eighth kickback settlement in the Northern District of Oklahoma since the beginning of the year. USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud, Provider Fraud,

Skyline Urology - Healthcare Fraud ($2.1 million)

Constantine Cannon represented a whistleblower in a False Claim Act case alleging Skyline Urology misused a billing code to increase reimbursements from Medicare and private insurers in California. In February 2019, the company agreed to pay roughly $2.1 million to settle the matter. Our client received a whistleblower award of roughly 18% of the government's recovery. Read more -- NLR, Becker's, DOJ, CC.

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 9, 2019

Carolina Physical Therapy and Sports Medicine, Inc. agreed to pay $790,000 to settle a whistleblower lawsuit alleging the company knowingly submitted false claims to Medicare and TRICARE. According to former employee Hilary Moore, Carolina PT submitted claims for group physical therapy services that were billed as though they were one-on-one sessions. Additionally, claims for certain services performed by physical therapy assistants were billed as though they were performed under the supervision of qualified therapists. For exposing the fraudulent conduct, Moore will receive a relator’s share of $142,200. USAO SC

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

May 2, 2019

Chimes Delaware, which provides services to individuals with developmental disabilities in Delaware, will return $4.5 million in Medicaid funding to the state to resolve claims of billing errors in its supported employment programs and transportation services. Chimes also agreed to institute new internal controls and billing procedures. DE

Tagged in: Ambulance, Medicaid, Medical Billing Fraud, Provider Fraud,

April 25, 2019

Two pain management clinics in Northern Virginia, National Spine and Pain Centers and Physical Medicine Associates, will pay $3.3 million to resolve a False Claims Act case first filed by a whistleblower who was a former physician assistant at one of the clinics. The clinics were alleged to have billed services provided by physician assistants and nurse practitioners as if they were provided by a physician, to have ordered medically-unnecessary urine drug tests, and to have submitted claims for urine drug testing that did not comply with the Stark Law and/or Anti-Kickback Statute. USAO EDVA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 9, 2019

A number of telemedicine and durable medical equipment companies, the principals of those companies, and three healthcare providers, were charged with submitting over $1.7 billion in false claims in a scheme to pay unlawful kickbacks and bribes from DME companies in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for medically unnecessary DME including back, shoulder, wrist and knee braces. DOJ; USAO MD FL; USAO NJ; USAO SC.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Drug and DME Pricing, Lack of Medical Necessity, Provider Fraud,

April 4, 2019

Oral and Maxillofacial Surgical Associates P.C. of New Haven, Connecticut, and its former owner Robert Sorrentino DDS, have agreed to pay $252,000 to settle claims that they submitted false claims to Medicaid by billing for services that were not provided, were not medically necessary, or were covered under other claims submitted for the same date of service. The fraudulently-billed services included deep sedation or general anesthesia and removal of bone or tissue. USAO CT

Tagged in: Bundling and Unbundling, FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

Contact

Click here for a confidential contact or call:

Tags

Provider Fraud