Provider Fraud Archives - Page 26 of 50

January 15, 2019

New York has reached a $9 million settlement with Diamond Braces, a chain of dental offices, and its principal Oleg Drut, DDS, for false claims Diamond made to NY's Medicaid program for orthodontic procedures that were performed by personnel who were not certified to perform the work they did as required by NY state law. NY

Tagged in: Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud,

Sharp HealthCare - Healthcare Fraud/Kickbacks (Undisclosed)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Sharp HealthCare Center for Research, Sharp’s clinical-trial research arm, paid kickbacks to entice prospective trial sponsors to host clinical trials at Sharp. In November 2019, the company agreed to pay an undisclosed amount to settle the matter. Our client received a whistleblower award of an undisclosed portion of the government's recovery. Read more -- CC.

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Whistleblower Rewards,

December 20, 2018

Pain specialist Dr. Jonathan Daitch, a principal in Ft. Myers-based Advanced Pain Management Specialists, P.A., has agreed to pay more than $1.7 million to resolve allegations that he violated the False Claims Act. Dr. Daitch caused Medicare and Tricare to be billed for medically-unnecessary urine drug testing performed at Advanced Pain's in-house laboratory. In addition, Daitch received kickbacks for anesthesia services. A co-owner of Advanced Pain, Dr. Michael Frey, previously agreed to pay $2.8 million to settle similar claims. USAO MD Fla

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

December 19, 2018

A vascular surgeon and his practice group, Dr. Irfan Siddiqui and the Heart and Vascular Institute of Florida (HAVI), have agreed to pay $2.23 million to settle a False Claims Act brought by a whistleblower, Lois Hawks, who had been a patient of the doctor. Defendants were alleged to have submitted false claims for vein ablation services that were not medically necessary, were performed by unqualified personnel, or were based on medical records containing false diagnoses and symptoms. In addition, defendants were alleged to have upcoded evaluation and management service claims. Ms. Haws will receive a relator's share of $446,000. USAO MDFL

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

Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

Posted 12/14/18

Doctor discussing knee injury with patient seated on exam table

Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act for submitting false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health is a for-profit hospital and health system based in the Lehigh...

Tagged in: Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

December 4, 2018

Dermatology Associates of Central New York, PLLC has agreed to pay $811,196.88 to settle claims that it overcharged Medicaid, Medicare, and TRICARE by falsely submitting claims under physicians' names, in violation of both the federal and New York False Claims Acts. A whistleblower complaint revealed that many of the physicians named on invoices were not in the office the day care was provided and could not have supervised in the rendering of services, and that some of the non-physician practitioners who provided care were not licensed to do so in the state of New York. As a result of bringing the fraud to light, the unnamed whistleblower will receive $138,000. USAO NDNY

Tagged in: FCA Federal, FCA State, Improper Medical Personnel, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 3, 2018

Feng Qin, M.D., a vascular surgeon who in 2015 settled claims that he performed medically-unnecessary vascular surgeries, has again been charged with such unlawful practices. As reported by an unidentified whistleblower who brought a case under the False Claims Act, Qin routinely scheduled patients for surgeries months in advance, regardless of whether there was a justifiable clinical reason for the surgery. At times, Qin would alter medical records. Qin would then bill Medicare for these procedures, despite his knowledge that procedures on patients that are not medically reasonable and necessary are not covered by Medicare. USAO SDNY

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

November 28, 2018

Dr. Thomas Baker, Dr. Carolyn Kochert, Dr. Larry L. Zhou, and Dr. Julie Y. Chao, have agreed to settle with the United States Government for violation of the Federal False Claims Act, the Physician Self-Referral law (“Stark”), and the Anti-Kickback Statute due to their involvement in a kickback scheme with Southwest Laboratories and Medscan Laboratory, thus causing false claims to be submitted to Medicare. The four physicians will pay a total amount of over $1.5 million. The individual amounts paid are as follows: Dr. Baker, of Tennessee - $484,481.80; Dr. Kochert, of Indiana - $129,682.84; Dr. Zhou, of Kentucky - $277,758.18; Dr. Chao, of Indiana - $650,000. DOJ

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

November 26, 2018

Vital Energy Occupational Therapy and Wellness Center, LLC agreed to pay $200,000 to settle charges that between 2013 and 2016 it submitted false claims for physical and occupational therapy services. The therapy practice was alleged to have submitted claims to Medicare and Medicaid for individual therapy services, when group therapy was actually provided, and claims for therapy services with false practitioner information using the names of former employees. Whistleblower Ashley C. Baggett, who filed the False Claims Act action, will receive $36,000. USAO S.C.

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

November 20, 2018

Gray Wesley Barrow, a doctor and co-owner of Louisiana Spine & Sports LLC, a pain management clinic in Baton Rouge, has pleaded guilty to receiving approximately $336,000 in unlawful kickbacks. According to the plea, between 2014 and 2016 Barrow sent urine specimens collected from his patients to a drug testing laboratory that agreed to pay him a percentage of the reimbursements paid to the laboratory by health care benefit programs including Medicare. DOJ; USAO M.D. La.

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

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