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

June 21, 2018

Connecticut has sued a behavioral health provider, Susan Britt, for violations of its FCA. Britt is a licensed professional counselor who runs her own practice, Inner Peace. According to the state’s allegations, Britt would provide counselling services to children, then meet with parents to discuss their children’s progress, and bill the state Medicaid program as if she provided counseling services to both parents and children. During the time period in question, Britt billed the state over $530K. CT

June 20, 2018

Healogics, a Florida-based company which runs a chain of wound care centers, has settled FCA allegations that it improperly billed for hyperbaric oxygen therapy (a modality in which the entire body is exposed to oxygen under increased atmospheric pressure, as an adjunctive therapy to treat certain chronic wounds). The company paid $22.5M to settle allegations that it billed for unnecessary or unreasonable hyperbaric oxygen therapy. The allegations were brought to the government’s attention by four whistleblowers, James Wilcox, Dr. Benjamin Van Raalte, Dr. Michael Cascio, and John Murtangh. The whistleblowers will receive a $4.28M reward. Separately, Healogics also paid $398K to settle another FCA case alleging that it improperly applied Modifier 25, which signifies that a separate evaluation and management service was performed on the same day as another procedure, to claims that were sent to Medicare, Medicaid, and TRICARE. The allegations were brought to light by a whistleblower, who will receive a $91K reward. DOJ;  USAO Northern District of Iowa

June 18, 2018

Ronald Grusd, a Beverly Hills radiologist, was sentenced to 10 years in prison for his role in a massive worker’s comp scheme. The scheme involved the payment of over $100k in kickbacks in exchange for referrals or workers’ comp patients for a variety of services, including MRIs and ultrasound scans. Dr. Grusd billed over $22M in services based on these referrals. USAO Southern District of California

June 18, 2018

Connecticut has reached a $200K FCA settlement with Dr. Elijah Caldwell, a behavioral health clinician, and two practices that he owns or controls. According to the state, Dr. Caldwell billed Connecticut’s Medicaid program for psychotherapy services that were never rendered. In addition to the monetary settlement, Dr. Caldwell will be excluded from the Medicaid program for the next decade. The fraud was brought to light by a whistleblower. CT

June 12, 2018

North Carolina announced the sentencing of Dr. Duke Ellington Ellis, who allegedly assisted Nature’s Reflections, a Durham-based behavioral health company, forge the signature of a licensed psychologist in order to submit millions of dollars in false claims to Medicaid. Ellis will face thirteen months in prison and will pay over a million dollars in restitution to the North Carolina Medicaid Program. NC

June 8, 2018

Disgraced former neurologist Rassan Tarabein-who operated Alabama’s Eastern Shore Neurology and Pain Center-was sentenced to 60 months in prison and ordered to pay over $15 million and forfeit his medical license after he pled guilty to orchestrating a thirteen-year scheme in which he induced  Medicare, Medicaid, and privately-insured patients to visit his clinic and undergo medically unnecessary tests and procedures. USAO SDAL

June 7, 2018

Mississippi physician Albert Diaz was sentenced to 42 months in prison for prescribing medically unnecessary compounded medications to TRICARE patients he had not examined and falsifying medical records to make it appear he had treated the patients. The fraud cost TRICARE and other insurers more than $3 million. DOJ