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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 34 of 36

November 21, 2013

Vantage Oncology agreed to pay $2M to settle allegations that it submitted false claims to Medicare for radiation oncology services performed at its Illinois centers from 2007 through June 2012. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

November 19, 2013

The Ensign Group agreed to pay $48M to resolve allegations that it knowingly submitted to Medicare false claims for medically unnecessary rehabilitation therapy services. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

September 13, 2013

Gulf Region Radiation Oncology Centers, Sacred Heart Health System, West Florida Medical Center Clinic and others agreed to pay $3.5M to resolve allegations that they billed Medicare, Medicaid and TRICARE – the health care program for uniformed service members, retirees and their families worldwide – for radiation oncology services that were not eligible for payment. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

August 27, 2013

Imagimed LLC and the company’s former owners and chief radiologist agreed to pay $3.57M to resolve allegations that they submitted to federal healthcare programs false claims for magnetic resonance imaging (MRI) services. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

Stark Law Enforcement Trend: Hospital and Individual Physician Settle Allegations of Stark Law Violations and Illegal Upcoding

Posted  09/18/15
By Tim McCormack and Molly Knobler (published on SCCE’s Compliance and Ethics Blog) The Department of Justice’s (“DOJ”) recent string of victories against hospitals that have (allegedly) paid illegal inducements to employed physicians continues.  On September 4, 2015, DOJ settled two False Claims Act (“FCA”) suits with Columbus Regional Healthcare System (“Columbus”) and Dr. Andrew Pippas. ...

Doctors Be Warned: DOJ Steps Up Enforcement of Anti-Kickback Law Against Individual Medical Professionals

Posted  06/29/15
The Department of Justice has recovered millions of dollars from hospitals, nursing homes, pharmaceutical companies and other medical providers through civil and criminal enforcement of the Anti-Kickback Law.  But the agency has begun paying increased attention to the doctors, nurses and administrative professionals on the receiving end of these bribes. The Anti-Kickback Law (42 U.S.C. § 1320a-7b) makes it...

June 18, 2015

Connecticut commenced a case under that state’s False Claims Act against the co-owners of a psychiatric clinic alleged to have submitted false claims to the state’s Medicaid program, Connecticut Medical Assistance Program (CMAP), from January 2010 through December 2014. According to the complaint, the defendants illegally submitted false claims for reimbursement while knowingly retaining and concealing the overpayment. The psychiatrist is alleged to have engaged in a systemic practice of knowingly “upcoding” the claims for reimbursement she submitted to the CMAP. For example, as the complaint alleges, she routinely double, triple, and in some cases quadruple-booked appointments for her Medicaid patients, then submitted CMAP using a reimbursement code, which required her to see the patient for approximately 75 to 80 minutes when, in fact, she saw each patient for as little as 5-10 minutes. The state’s complaint identifies 113 days where the psychaitrist billed the CMAP for more than 24 hours of service. Both defendants are also alleged to have attempted to conceal from state auditors the existence of databases that contained information which would have established evidence that the claims were false. CT

April 16, 2015

Georgia doctor Zheng Xiang Wang and the Wang Eye Clinic, P.C. agreed to pay $790,000 to settle allegations they billed Georgia Medicaid for medically unnecessary ophthalmology procedures. GA

March 19, 2015

Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A, will receive a whistleblower award of $1,082,500 from the $5,412,502 settlement resolving allegations Adventist Health System Sunbelt Healthcare Corporation violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons.  DOJ

March 11, 2015

Olufemi Afuape and Oluyemisi Afuape, owners of Zion Rehab Services, were ordered to pay $1,407,325.50 in restitution to the Georgia Department of Community Health for billing the Georgia Medicaid program for physical, occupational and speech therapy without regard to whether the services were medically necessary and without regard to whether the services were actually delivered. GA
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