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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 33 of 50

March 16, 2018

Four Maryland healthcare providers settled claims they violated the False Claims Act by improperly coding for certain medical tests they billed to Medicare: St. Agnes Healthcare, Inc., which owns and operates St Agnes hospital in Baltimore, agreed to pay roughly $70,000; Horizon Vascular Specialists agreed to pay roughly $518,000; Riverside Medical Associates agreed to pay roughly $177,000; and Maryland Specialty Group agreed to pay roughly $87,000.  Dr. Itsuro Uchino agreed to pay roughly $91,000. DOJ (MD)

March 13, 2018

Marshfield Medical, Inc. (formerly known as Bromedicon, Inc.) agreed to pay $550,000 to settle claims it violated the False Claims Act for submitting claims to Medicare and other federal health care programs without providing a qualified interpreting physician to monitor each surgery for which it purportedly provided remote Intraoperative Neurophysiological Monitoring. According to the government, in some of those cases, no one monitored the data stream from the surgeries and in others, Bromedicon’s medical director, a foreign medical school graduate with no license to practice medicine in the United States, was the only monitor. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  DOJ (EDPA)

March 7, 2018

UPMC Hamot, affiliated with the University of Pittsburgh Medical Center, and Medicor Associates Inc., a regional physician cardiology practice, agreed to pay $20.7 million to settle charges of violating the False Claims Act, Anti‑Kickback Statute and Stark Law through Hamot's payment under twelve physician and administrative services arrangements to secure Medicor patient referrals. Hamot allegedly had no legitimate need for the services contracted for, and in some instances the services either were duplicative or were not performed. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Medicor employee Dr. Tullio Emanuele. He will receive a whistleblower award of roughly $6 million from the proceeds of the government's recovery. DOJ

March 7, 2018

Florida dermatologist and owner of Treasure Coast Dermatology agreed to pay $2.5 million to settle claims he violated the False Claims Act by billing Medicare and TRICARE for procedures he did not perform.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Patricia Cleary, a former patient of Dr. Ioannides. She will receive a whistleblower award of $475,000 from the proceeds of the government’s recovery. DOJ (SDFL)

March 6, 2018

Iowa chiropractor Bradley Brown and his clinic Brown Chiropractic, P.C. agreed to pay roughly $80,000 to settle claims they violated the False Claims Act and Anti-Kickback Statute by billing Medicare and Medicaid for chiropractic adjustments after providing free electrical stimulation to beneficiaries to influence those beneficiaries to receive chiropractic adjustments from Brown. DOJ (NDIA)

February 22, 2018

Samuel Konell was sentenced to 60 months in prison and pay roughly $10 million for his role in a $63 million health care fraud scheme involving now-defunct Greater Miami Behavioral Healthcare Center Inc. which purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness. Konell admitted he received kickbacks and/or bribes in return for referring Medicare beneficiaries from the Miami-Dade state court system to Greater Miami to serve as patients. He admitted he coordinated with criminal defendants in the state court system to obtain court orders for mental health treatment in lieu of incarceration so that he could refer those individuals to Greater Miami to serve as patients in return for kickbacks and/or bribes. Konell further admitted that he did so knowing that certain of those individuals were not mentally ill or otherwise did not meet the criteria for PHP treatment. DOJ

February 13, 2018

Detroit-area doctor Mahmoud Rahim was sentenced to 72 months in prison and ordered to forfeit roughly $1.7 million for his role in a $10.4 million conspiracy to defraud the Medicare program. According to the evidence presented at trial, Rahim accepted kickbacks in exchange for referring Medicare patients for electromyogram tests, some of which were unnecessary, and physical therapy performed by unlicensed individuals. DOJ

February 7, 2018

New York surgeon Syed Imran Ahmed was sentenced to 156 months in prison -- and ordered to pay roughly $7 million in restitution, forfeit roughly $7 million and pay a $20,000 fine -- for his role in a scheme that involved the submission of millions of dollars in false and fraudulent claims to Medicare. According to evidence presented at trial, Ahmed, who practiced at Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center in Brooklyn, Franklin Hospital in Valley Stream, and Mercy Medical Center in Rockville Centre, New York, billed the Medicare program for incision-and-drainage and wound debridement procedures that he did not perform. DOJ
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