Provider Fraud Archives - Page 31 of 50

June 5, 2018

New York announced an $883,000 settlement with City Practice Group of New York, LLC (CityMD), a New York City urgent-care chain, for causing its affiliates to overbill New York State’s Empire Plan for facility fees for which they were not entitled. This practice resulted in $197,390.52 in overbilling to the government employee health insurance plan. The state investigation was prompted by a whistleblower who filed a lawsuit against CityMD under the New York False Claims Act. The whistleblower will receive over $176,000 from the settlement for bringing this misconduct to light. NY

Tagged in: Healthcare Fraud, Provider Fraud,

June 1, 2018

Multi-state physical therapy provider Team Work Ready CEO Jeffrey Rose Sr. was sentenced to more than 19 years imprisonment for his role in an $18 million fraud scheme in which he and his co-conspirators billed the DOL for inadequate and inappropriate care, as well as for one-on-one physical therapy services never provided. USAO SDTX

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

May 31, 2018

New York doctor Thomas Savino was sentenced to four years in prison, fined $100,000, and ordered to forfeit $27,500 for violating the AKS and other laws by accepting at least $25,000 in cash brides from Biodiagnostic Laboratory Services LLC in exchange for referring patient blood samples to the lab. USAO DNJ

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

May 29, 2018

Following a two-week jury trial, LaTonya Mallory, Floyd Calhoun Dent III, and Robert Bradford Johnson were collectively found liable for $114 million for violating the False Claims Act and Anti-Kickback Statute by paying physicians for patient referrals to two blood-testing laboratories, and for causing those laboratories to bill federal health care programs for medically unnecessary testing. The verdict resolves three separate whistleblower suits filed by Dr. Michael Mayes, Scarlett Lutz, Kayla Webster, and Chris Reidel, who will receive a yet-to-be-determined share of any recoveries. USAO DDC

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

May 25, 2018

Florida pain management clinic Riverside Spine & Pain Physicians agreed to pay $1.2 million to settle allegations under the False Claims Act that it billed federal health care programs for medically unnecessary tests and indiscriminately ordered quantitative urine drug tests; whistleblower and former employee Dr. Carissa Stone will receive approximately $240,000 for her role in shining a light on the fraud. USAO MDFL

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

May 18, 2018

New York podiatrist Perrin Edwards pled guilty to billing Medicare and private insurance companies for medical services he had not performed and for upcoding normal nail trimming, which is not reimbursable, to nail debridement, a covered service. Edwards will pay a $5,000 fine, serve one year of probation, and perform 50 hours of community service. USAO NDNY

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

May 14, 2018

Missouri-based podiatry provider Foot Healers agreed to pay the United States $125,000 to settle allegations the company violated the False Claims Act by using improper billing modifiers to inflate Medicare claims and falsely upcoding routine toenail trimmings performed on Medicare patients by claiming the service provided was medically necessary toenail debridement. USAO EDMO

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

May 7, 2018

Dr. Robert Fetchero, Dr. Sridhar Pinnamaneni, and Dr. Thelma Green-Mack agreed respectively to pay $200,000, $370,000 and $130,000 to settle allegations that they violated the False Claims Act, Anti-Kickback Statute, and the Stark Law by receiving improper payments for referrals from Pennsylvania-based drug testing lab Universal Oral Fluid Laboratories. According to the government, these physicians referred Medicare patients to Universal for drug testing services while engaged in a financial relationship with the lab. (DOJ (WDPA)

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

May 4, 2018

New York City-based urgent care company CityMD agreed to pay roughly $6.6 million to settle claims it violated the False Claims Act by billing Medicare for services rendered by physicians who did not actually perform those services and for more expensive and complex services than were actually provided to patients. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ

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

April 27, 2018

New Era Rehabilitation Center and its owners agreed to pay roughly $1.4 million to resolve allegations they violated the False Claims Act by improperly billing Medicaid for methadone maintenance counseling services and psychotherapy services for the same patients. DOJ (CT)

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

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