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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 29 of 50

August 1, 2018

Gena Randolph, a speech therapist in Mount Pleasant, South Carolina who owned and controlled Palmetto Speech and Language Associates and Per Diem Healthcare Services, was convicted after committing a health care fraud scheme amounting to a total of $2 million by, among other things, submitting claims for services provided by others or not provided at all. Ms. Randolph faces over ten years in federal prison. DOJ

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

July 30, 2018

South Korean citizen Young Yi was convicted of conspiracy to commit health care and wire fraud, among other charges, for directing employees at her sleep clinics, 1st Class Sleep Diagnostic Center, to solicit patients for additional, medically unnecessary studies, which she then billed to Medicare and private insurance. To hide the fraud, Yi concealed study results, lied about patient co-pays, and shifted bills across various entities she controlled. In all, Yi acquired more than $83 million from the scheme. DOJ; EDVA

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

10th Circuit Finds that Doctor’s Judgment is Not Automatically Reasonable and Necessary

Posted  07/20/18
By Poppy Alexander Top-level heart surgeons work in a rarified world, where few may question their medical judgment. Yet that judgment is not infallible-and its presence is not in itself a protection against False Claims Act liability. The Tenth Circuit recently held as much in United States ex rel. Polukoff v. St. Mark’s Hospital et al., finding that a doctor may be exercising medical judgment while still...

Tagged in: Court Decision, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud,

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July 16, 2018

Two additional Southern California surgeons have been indicted in a kickback scheme that is alleged to have generated over a billion dollars in fraudulent claims to federal and California healthcare programs. The two physicians were charged for their roles in receiving kickbacks to refer patients to Pacific Hospital. USAO Central District of California

Tagged in: Anti-Kickback and Stark, Provider Fraud,

July 13, 2018

Orthopedic specialists in Oklahoma have agreed to pay $670,000 to settle allegations in a False Claims Act qui tam that they falsely billed Medicare, Medicaid, and Tricare for unnecessary ultrasonic guidance procedures and for services that were not performed.  The settlement resolved two claims in the whistleblower action, brought by a former employee, in which the government had intervened prior to settlement; other claims continue to be litigated.  USAO WDOK

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

July 10, 2018

The New Mexico U.S. Attorney’s Office announced the sentencing of a cardiologist to 51 months in prison for healthcare fraud and obstruction of justice.  Roy Heilbron had been indicted for regularly performing unnecessary diagnostic tests on his patients and falsifying medical records to cover the fraudulent billing; he also had billed for procedures that were never performed.  USAO NM

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

July 3, 2018

A Virginia woman who owned several Medicaid support services companies has agreed to pay $1 million and to accept a lifetime ban on participation in the Virginia Medicaid Program as part of a settlement of allegations that she defrauded the program.  Dawn Sykes allegedly paid illegal kickbacks and sought reimbursement for services that were not provided or were provided to ineligible recipients.  The investigation was launched by a qui tam lawsuit under the FCA and Virginia Fraud Against Taxpayers Act, and the whistleblower will receive 18 percent of the settlement.  USAO EDVA

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

July 2, 2018

FWC Urogynecology, LLC agreed to pay $1.7 million to settle allegations under the False Claims Act. FWC allegedly misused Medicare billing codes by billing modifier 25 for services that were not billable or that it did not provide. The alleged conduct occurred between 2012 and 2017. USAO MDFL

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

July 3, 2018

The state and federal governments reached a joint settlement resolving allegations that a Waterford psychologist submitted false claims for behavioral health services she never provided to her Connecticut Medicaid patients, Attorney General George Jepsen and Connecticut Department of Social Services (DSS) Commissioner Roderick L. Bremby. Dr. Arlene Werner, a licensed psychologist and owner and sole practitioner of a private psychology practice, will pay $126,760.09 and has been suspended from participation in the Connecticut Medical Assistance Program (CMAP) – which includes the state’s Medicaid program – for a period of two years. The state and federal governments alleged that, from January 2011 to July 2016, Dr. Werner submitted false claims to the CMAP for psychotherapy services that were not provided to her CMAP patients. CT

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

June 28, 2018

Varicose vein treatment company Circulatory Centers of America, LLC agreed to pay $1,205,000 to settle allegations that it violated the False Claims Act. The allegations stemmed from a qui tam lawsuit filed by a whistleblower in Pittsburgh, PA that alleged claims were submitted to Medicare for services by non-physicians “incident to” the supervision by a physician when in fact no physician was present in the office. These types of claims are reimbursed at higher rates than when billed without the physician supervision component. USAO WDPA

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

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