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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:

Page 25 of 50

February 25, 2019

PhysioHealth Inc. and its wholly owned company, Dynamic Therapy Services, LLC, have agreed to pay $2 million following a self-disclosure that Dynamic had improperly billed TRICARE for services performed at clinics in Delaware, Maryland, and Pennsylvania, between 2011 and 2017. The reported misconduct involved billing for services performed by unauthorized physical therapy assistants, using the supervising physical therapist's authorized provider number, which was in violation of TRICARE rules at the time. USAO EDPA

Tagged in: Healthcare Fraud, Other Government Health Programs, Provider Fraud,

February 25, 2019

Skyline Urology will pay $1.85 million to resolve allegations under the federal False Claims Act that it improperly billed Medicare for evaluation and management (E&M) services that did not meet the criteria for separate billing.  Skyline allegedly used "Modifier 25" to unbundle its E&M billing even when the E&M services were provided on the same day as other billed medical services and were not significant, separately identifiable, and beyond those ordinarily involved with the associated procedure.  A whistleblower, James M. Cesare, filed a qui tam complaint, and will receive a relator's share of approximately $323,750.  DOJ

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

February 22, 2019

Marketers, doctors, lawyers, and medical service provider defendants were sentenced this week for their roles in a multi-million dollar California worker's compensation fraud scheme in the San Diego area.  The defendants recruited patients and referred them to co-defendant attorneys to file fraudulent claims on their behalf and medical providers who performed often unnecessary and painful medical procedures for which they would then bill insurers including California Workers' Compensation.  Ronald Grusd, a doctor who owned a diagnostic imaging company, was sentenced to 10 years in prison and ordered to forfeit $1.3 million.  Fermin Iglesias, who worked as a patient capper, was sentenced to 5 years in prison and ordered to forfeit $1 million. Julian Garcia, who provided services to assist the referrals and kickbacks, was sentenced to three years in prison.  Jennifer Louise White, who marketed to providers in the network, was sentenced to two years in prison.  Sean O'Keefe, an attorney who filed fraudulent claims on behalf of patients, was sentenced to 13 months in prison and ordered to forfeit $300,000.  Steven Rigler, a chiropractor, was sentenced to six months in prison.  USAO SD Cal.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

February 21, 2019

Hooshang Poor, a doctor of geriatric medicine based in Newton, Massachusetts, has agreed to pay $680,000 to resolve claims under the False Claims Act that he knowingly submitted inflated charges to Medicare and the Massachusetts Medicaid program.  Dr. Poor was alleged to submit bills with false procedural codes that overstated the length, extent, and scope of services that he furnished to nursing home residents, and misrepresented services provided by non-physician employees.  USAO Mass.

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

February 12, 2019

Michael Frey of Ft. Myers, Florida, a physician specializing in pain management, was sentenced to 18 months in prison for his role in an illegal kickback scheme.  Frey was a co-owner of Advanced Pain Management Specialists, P.A., and received kickbacks from A&G Spinal Solutions, LLC (which made checks payable to his wife) for a share of its profits from patient referrals; from a compound pharmacy provider; and as "speaker fees" from Insys Therapeutics, a pain medication manufacturer.  Frey previously agreed to pay $2.8 million in civil settlement of claims under the False Claims Act.  USAO MD FL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Pharma Fraud, Provider Fraud,

February 8, 2019

Two executives from the South Carolina Early Autism Project (SCEAP) have been convicted of causing false statements to be submitted to Medicare and TRICARE and causing them to be overcharged by millions of dollars. According to statements by SCEAP employees, co-founder Ann Davis Eldridge and executive Angela Breitweiser Keith instructed employees to include travel and wait time in their billing in order to inflate time spent providing services. To further incentivize this practice, they implemented billing goals that had to be met in order to qualify for bonuses such as gift cards and vacations, all paid for by the company. Since then SCEAP has repaid almost $9 million, and as part of their plea agreement, both Keith and Eldridge will serve 1-year sentences. USAO SC

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

February 6, 2019

Families United Services, Inc. (FUS) and owner Pamela McKenzie have agreed to pay $645,000 to settle allegations of defrauding Georgia's Medicaid program from 2010 to 2012 by submitting claims for unprovided mental health services. As part of the settlement, FUS has been excluded from participating in federal healthcare programs for a period of five years. USAO NDGA

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

February 5, 2019

Two doctors from the Florida-based Fishman & Sheridan Eye Care Specialists clinic have agreed to pay a combined $157,312.32 to settle their liability under the False Claims Act. Drs. Craig D. Fishman and Jeffrey A. Sheridan were outed in a qui tam complaint filed by former business partner Dr. Michael Pennachio and office manager Sharon Drake, which alleged that from 2011 to 2017, Fishman and Sheridan knowingly billed Medicare for blepharoplasty and ptosis repair surgeries that were purportedly performed on the same patients, even though they are mutually exclusive eyelid repair surgeries. For exposing the fraud, Pennachio and Drake will receive a relator's share of $26,000. USAO MDFL

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

January 28, 2019

East Cost Stepping Stones, Inc., a behavioral services provider based in Jacksonville, Florida, has agreed to pay $360,000 to resolve allegations under the False Claims Act.  The company was alleged to have falsely billed TRICARE for applied behavioral analysis therapy services for children with autism by misrepresenting the services provided and who provided them, failing to document services as required, and fabricating and altering medical records.  USAO MDFL

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

January 28, 2019

A skilled nursing facility based in Orlando, Florida, Conway Lakes NC, LLC, and related entities and physicians, have agreed to pay $1.5 million to resolve allegations that they engaged in a unlawful kickback and referral scheme for Medicare and TRICARE beneficiaries.  Conway Lakes was alleged to have contracted with orthopedic surgeon Kenneth Krumins under a sham “medical director” arrangement in violation of the Stark Law and Anti-Kickback Statute to induce him to refer patients for rehabilitation services.  A former employee of Conway Lakes, Jonathan Montes de Oca, reported the arrangement by filing a qui tam case under the False Claims Act and will receive $267,000 of the proceeds.  USAO MDFL

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

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