Provider Fraud Archives - Page 28 of 50

September 12, 2018

A New York based long-term care facility, Centers Plan for Healthy Living, has agreed to pay $1,650,000 to settle allegations that it violated the state and federal False Claims Acts in billing Medicaid for services not provided to Medicaid beneficiaries. The alleged fraud involved enrolling unqualified patients and failing to disenroll recently unqualified patients from a Medicaid-funded care program over the span of two and a half years. It was eventually exposed by an unnamed whistleblower. AG NY; USAO EDNY

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

September 4, 2018

Houston psychiatrist Riyaz Mazcuri was sentenced to 12.5 years in prison following his conviction at trial for defrauding Medicare and Medicaid through the submission of $155 million in false and fraudulent claims for "partial hospitalization program" services, a form of intensive outpatient treatment for patients with mental illness. Mazcuri falsified records to make it appear as if patients admitted to the PHPs qualified for, required, and actually received the intensive psychiatric services. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

August 28, 2018

Dermatology Healthcare will pay $4 Million to settle allegations of healthcare fraud which violate the False Claims Act. Dermatology Healthcare submitted false claims in order to be paid millions in Medicare and Medicaid reimbursements for treatment of non-melanoma skin cancer during which superficial radiation therapy is administered. It is alleged that the superficial radiation therapy was not properly supervised during treatment and that other procedures in relation to superficial radiation therapy were up-coded. It is further alleged that the radiation simulations were overly used. This settlement is the conclusion of a lawsuit filed by dermatologist Theodore A. Schiff, M.D., under the qui tam provisions of the False Claims Act in the United States District Court for the Middle District of Florida. DOJ

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

August 23, 2018

Reliant Rehabilitation Holdings Inc has agreed to pay $6.1 million to settle claims brought on by whistleblower Dr. Thomas Prose that it paid kickbacks to doctors and nursing homes to promote its business and filed reimbursement claims arising from improper contracts — both violations of the False Claims Act. Under the settlement agreement, Dr. Prose will receive a relator’s share of $915,000. DOJ

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

August 21, 2018

Physician Ewald J. Antoine, of Valley Stream, New York, was convicted today and sentenced to one year and one day in prison for his part in a $30 million health care scheme involving Medicare and Medicaid. Dr. Antoine is one of eight defendants sentenced in this case. Under the direction of Aleksandr Burman, co-conspirator and owner of six medical clinics in Brooklyn, Antoine feigned ownership of two of the six clinics and fraudulently billed Medicare and Medicaid for unprovided medical services and supplies. In addition to prison time, Dr. Antoine has been ordered to pay $1,825,544 in restitution. He has also been ordered to give up $269,412 in illegally-gained profits. DOJ See related sentencing of Dr. Paul Mathieu and Lina Zhitnik.

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

August 16, 2018

Lincare, Inc—one of the largest home providers of respiratory therapy products and services in the nation—has paid $5.25 million to settle a suit filed by whistleblower Brian Thomas. In 2015, the former billing supervisor accused the company of violating the Anti-Kickback Statute and False Claims Act over a period of six years by unlawfully waiving or reducing fees paid by Medicare Advantage recipients and submitting false claims for reimbursement. Thomas will receive $918,750 for his role in exposing the alleged fraud. USAO SDIL

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

August 13, 2018

Nurse practitioner Sandra Haar, founder and chief executive officer of Horisons Unlimited, a non-profit provider of health and dental services in Merced, California, pleaded guilty to health care fraud and conspiracy to receive kickbacks. Haar's scheme billed for services that were not rendered or were medically unnecessary, even submitting bills for office visits with doctors when, in fact, patients were met in local parking lots and given Suboxone, an opioid medication, in plastic baggies. Haar also received thousands in kickbacks from a laboratory in exchange for sending Horisons patients to the lab. ED CA (later sentencing and civil settlement here)

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

August 8, 2018

Dr. Donald Chamberlain and Karen Chamberlain, the owners of a Chattanooga gynecology practice, will pay $428,000 to settle False Claims Act allegations. According to the government, the Chamberlains used foreign-sourced, non-FDA approved, anticancer drugs, and billed Medicare and Tennessee’s Medicaid programs for similar, approved drugs. The drugs the Chamberlains used were cheaper than similar drugs that were approved by the FDA. USAO Eastern District of Tennessee

Tagged in: Drug Switching, FCA Federal, Healthcare Fraud, Provider Fraud,

August 6, 2018

Grenada Lake Medical Center will pay $1.1M to settle allegations that it violated the FCA by submitting claims for medically unnecessary psychotherapy services to the Medicare program. The alleged fraud lasted over eight years and was brought to light by a whistleblower, a former programs manager at the company, who will receive an award of $195k. USAO Eastern District of Arkansas

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

August 3, 2018

Northwest ENT Associates, P.C. agreed to pay $1,195,361 to settle allegations under the federal False Claims Act that they re-used balloon catheters in medical procedures, even though they were intended only for a single use. By choosing to cut a corner for their own financial benefit, Northwest ENT put their patients’ health in jeopardy as well as impacting federal funds needed for other medical procedures. Northwest ENT has entered into a three-year Integrity Agreement with the Office of the Inspector General of the Department of Health and Human Services. DOJ

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

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