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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:

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February 9, 2015

Wesley Harlan Kingsbury, general manager of California-based Alpha Ambulance Inc., was sentenced to 78 months in prison for his role in a $5.5M Medicare fraud scheme under which his company billed Medicare for ambulance transportation services for individuals that did not need them.  DOJ

February 6, 2015

A federal jury in Detroit convicted unlicensed Detroit physician Wilfred Griffith for his participation in a nearly $4.7M fraud scheme. According to evidence presented at trial, Griffith worked as an unlicensed physician at Phoenix Visiting Physicians in 2010 and 2011 where he treated Medicare beneficiaries and used prescription pads pre-signed by Dr. Dwight Smith to prescribe medicine. He also referred Medicare beneficiaries to Detroit-area home health company Cherish Home Health Services Inc. in exchange for kickbacks. Griffith used the names and signatures of Dr. Smith and two other Detroit-area physicians to certify the beneficiaries were homebound and needed home health services when they did not. DOJ

January 26, 2015

Kentucky-based ambulance services company Lafferty Enterprises, LLC(d/b/a Trans-Star Ambulance Services) agreed to pay $948,000 to settle charges it violated the False Claims Act by billing federal health care programs for medically unnecessary services over the course of several years. According to the government, from February 2006 until December 2012, the company transported Medicare patients to and from dialysis clinics by ambulance when an ambulance transport was not medically necessary. The charges originated from a whistleblower lawsuit filed by Kevin Fairlie under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $189,600. DOJ

January 9, 2015

Felix Gonzalez, owner of Miami-based home health care company AA Advanced Care Inc. pleaded guilty in connection with a $32 million Medicare fraud scheme. Specifically, Gonzalez admitted he and his co-conspirators operated AA Advanced for the purpose of billing Medicare for, among other things, expensive physical therapy and home health care services not medically necessary or not provided at all. He also admitted he paid kickbacks and bribes to patient recruiters in exchange for patient referrals, prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services. DOJ

December 2, 2014

Luis Duluc, a Florida owner and operator of multiple physical therapy rehabilitation facilities, was sentenced to serve 11 years in prison for his role in organizing a $28.3M Medicare fraud scheme involving physical and occupational therapy services. Duluc was chairman and president of a Delaware holding company known as Ulysses Acquisitions Inc. which was used to purchase comprehensive outpatient rehabilitation facilities and outpatient physical therapy providers, including West Coast Rehab Inc. in Fort Myers, Florida; Rehab Dynamics Inc. in Venice, Florida;Polk Rehabilitation Inc. in Lake Wales, Florida; and Renew Therapy Centerof Port St. Lucie LLC in Port St. Lucie, Florida. Duluc admitted that he and his co-conspirators paid kickbacks to obtain, and stole, the personal identifying information of Medicare beneficiaries and used this information to create and submit false claims to Medicare through the clinics owned by Ulysses Acquisitions. DOJ

October 17, 2014

Two groups of Houston-based diagnostic centers agreed to pay more than $2.6M to settle allegations they violated the False Claims Act by engaging in improper financial relationships with referring physicians in violation of the Stark Statute. One group of centers, which operates under the name One Step Diagnostic, agreed to pay $1.2M. The other group of centers, consisting of Complete Imaging Solutions LLC doing business asHouston Diagnostics, Deerbrook Diagnostics & Imaging Center LLC,Elite Diagnostic Inc., Galleria MRI & Diagnostic LLC, Spring Imaging Center Inc. and West Houston MRI & Diagnostics LLC agreed to pay about $1.5M. The allegations originated from a whistleblower lawsuit filed by three whistleblowers under the qui tam provisions of the False Claims Act, who will receive an undisclosed award. DOJ

September 26, 2014

Detroit-area physician Dr. Vicha Janviriya pleaded guilty for making fraudulent referrals for home health care in a $1.3 million Medicare fraud scheme. He admitted that he falsified medical documentation which would be used to support false claims to Medicare for services that were never rendered or not medically necessary, or where the Medicare beneficiary referrals were obtained through the payment of kickbacks. DOJ

September 16, 2014

Wesley Harlan Kingsbury, general manager of the Southern California ambulance company Alpha Ambulance Inc., pleaded guilty to conspiracy to commit Medicare fraud. According to court documents, Kingsbury conspired with Alex Kapri and Aleksey (Russ) Muratov, the owners of Alpha Ambulance, as well as the training supervisor Danielle Medina, to bill Medicare for ambulance transportation services for individuals that Kingsbury knew did not need to be transported by ambulance. In addition, he instructed emergency medical technicians that worked at Alpha Ambulance to conceal the true medical condition of patients they were transporting by altering requisite paperwork and creating false reasons to justify the transportation services. DOJ

August 25, 2014

Zahid Imran, a Louisiana psychiatrist, was sentenced in federal court in Baton Rouge, Louisiana to serve 86 months in prison and to pay $43.5 million in restitution for his role in a $258.5 million Medicare fraud scheme involving partial hospitalization psychiatric services. According to court documents, Dr. Imran served as the medical director of Shifa Community Mental Health Center of Baton Rouge, and co-owned Serenity Center of Baton Rouge and Shifa Community Mental Health Center of Texas. As part of the scheme, Imran admitted mentally ill patients to the facilities, some of whom were inappropriate for partial hospitalization, and then re-certified the patients’ appropriateness for the program in an effort to continue to bill Medicare for services. Imran pleaded guilty on May 13, 2014, to conspiracy to commit health care fraud. DOJ

August 7, 2014

Gary Lang, a CEO of an Atlanta-area hospital and Tracey Cota, the co-owner and chief operating officer of the Atlanta-based medical clinic chain Hispanic Medical Management, pleaded guilty for paying illegal kickbacks to clinics in exchange for Medicaid patient referrals. According to the government, Cota conspired with Lang and other executives from Atlanta-area hospitals and from a hospital on Hilton Head Island to pay kickbacks to Hispanic Medical Management for the referral of its patients, primarily undocumented Hispanic women seeking prenatal care services. These referrals ultimately resulted in Medicaid reimbursements of over $100 million to the hospitals. DOJ
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