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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 32 of 50

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,

April 27, 2018

Las Vegas medical practice Cardiovascular and Thoracic Surgeons of Nevada, Inc. agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by billing federal healthcare programs for surgical services not actually provided to its cardiac patients and billing for more expensive surgical and evaluation and management services than actually provided. DOJ (NV)

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

April 26, 2018

Tennessee physician Brenna Green paid roughly $200,000 to settle claims she violated the False Claims Act, the Stark Law and the Anti-Kickback Statute for her role in a kickback scheme with Southwest Laboratories, Medscan Laboratory, and sales representatives affiliated with Southwest and Medscan. According to the government, Green acquired shares in Southwest for a nominal sum in exchange for a guaranteed “dividend” of approximately $5,000 per month as long as she met or exceeded the number of urine drug screen referrals required by Southwest. DOJ (NDVA)

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

April 25, 2018

Long Island-based pediatrics practice Freed, Kleinberg, Nussbaum, Festa & Kronberg M.D., LLP (dba Pediatrics and Adolescent Medicine), along with some of the practice’s current and former physicians, agreed to pay $750,000 to resolve allegations they violated the False Claims Act by billing Medicaid for services provided by physicians who were not enrolled in the program. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (EDNY)

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

New York Urgent Care Clinic Pays Over $6.6M to Settle FCA Suit

Posted  05/7/18
By the C|C Whistleblower Lawyer Team CityMD, a company that manages over 80 urgent care clinics in and around New York City, has settled allegations that it billed Medicare for more expensive services than were actually performed, and that it billed Medicare under the names of doctors who did not actually perform the services. Under the terms of the settlement, CityMD also accepted responsibility for its...

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

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April 16, 2018

Aharon Aron Krkasharyan, a former employee Mauran Ambulence Inc., was sentenced to 36 months in prison and pay roughly $485,000 for his role in a scheme that resulted in more than $1.1 million in fraudulent claims to Medicare.  Krkasharyan admitted he conspired with other Mauran employees to submit claims to Medicare for ambulance transportation services for individuals who did not need such services. Krkasharyan also admitted that he and his co-conspirators instructed Mauran emergency medical technicians to conceal the patients’ true medical conditions by altering paperwork and creating fraudulent reasons to justify the ambulance services. DOJ

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

April 10, 2018

Connecticut-based medical practice World Health Clinicians, Inc., its CEO Scott Gretz, and former World Health physician Gary Blick agreed to pay roughly $650,000 to settle claims they violated the False Claims Act by submitting claims for physical therapy and other covered services when in fact the patients received massages provided by a massage therapist. DOJ (CT)

Tagged in: FCA Federal, Provider Fraud, Upcoding,

April 5, 2018

The Estate of Dr. Leroy Pelicci, former owner of Scranton-based Pelicci Pain Relief Center, agreed to pay $625,000 to settle claims he violated the False Claims Act by submitting improper claims for payment to the Department of Labor Office of Workers’ Compensation Programs under the Federal Employees Compensation Act and the Federal Employees Health Benefits Program for trigger point injections, which were upcoded to receive a higher reimbursement amount than permitted. DOJ (MDPA)

Tagged in: Healthcare Fraud, Other Government Health Programs, Provider Fraud, Upcoding,

March 29, 2018

Georgia Bone & Joint, Southern Bone & Joint (a/k/a Summit Orthopaedic Surgery Center), Southern Crescent Anesthesiology, PC, Sentry Anesthesia Management, LLC, and David LaGuardia agreed to pay $3.2 million to settle claims they violated the False Claims Act and Anti-Kickback Statute. Specifically, the government alleged that LaGuardia, Sentry, and Southern Crescent provided a free medical director to Summit Surgery Center to induce it to choose to perform more procedures at the surgery center rather than in the Georgia Bone office. The government further alleged that Georgia Bone and LaGuardia caused the submission of false claims to Medicare for prescription drugs purchased outside the United States and not approved by the FDA. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Sharon Kopko, former Practice Administrator for Southern Bone. She will receive a yet-to-be determined award from the proceeds of the government’s recovery. DOJ (NDGA)

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

March 29, 2018

Texas-based SightLine Health LLC, which operates radiation therapy centers throughout the United States, agreed (together with its parent Oncology Network Holdings) to pay up to $11.5 million settle claims  it violated the False Claims Act and Anti‑Kickback Statute. According to the government, SightLine targeted physicians that were able to refer patients to its cancer treatment centers, and paid those physicians a share of its profits. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive an award of up to $1.725 million from the proceeds of the government’s recovery. DOJ

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

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