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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 39 of 50

June 22, 2017

Dr. James M. Crumb, a physical medicine and rehabilitative specialist currently practicing in Alabama as Mobility Metabolism and Wellness, P.C.,and Coastal Neurological Institute, P.C., a local neurosurgeon physician group, agreed collectively to pay $1.4 million to resolve allegations they violated the False Claims Act by billing federal health care programs for medically unreasonable and unnecessary ultrasound guidance used with routine lab blood draws, and with Botox and trigger point injections. As a result of this billing scheme, the defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient office visit. DOJ (SDAL)

June 15, 2017

Kentucky allergists Bruce Wolf and Kiro John Yun agreed to pay $740,578 to resolve allegations their medical practice group of otolaryngologists Wolf and Yun, P.S.C., specializing in allergy, asthma and immunology, violated the False Claims Act by billing the government for Sublingual Immunotherapy serum preparation and overstated units of serum preparation for injection vials. Sublingual immunotherapy is an alternative way to treat allergies without injections whereby an allergist prescribes a patient with an allergen that is sprayed under the tongue to boost tolerance to substances and reduce symptoms but it is not covered by Medicare because it is considered investigational. DOJ (WDKY)

May 9, 2017

California-based radiation therapy center Valley Tumor Medical Group agreed to pay $3 million to resolve allegations it submitted fraudulent bills over a nearly 10-year period to three government-run healthcare programs for unsupervised radiation oncology services.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Valley Tumor employee Jared Shindler.  He will received a whistleblower award of $555,000 from the proceeds of the government's recovery. DOJ (CDCA)

Houston-Area Psychiatrist Convicted of Health Care Fraud for Role in $158M Medicare Fraud Scheme

Posted  05/24/17
By the C|C Whistleblower Lawyer Team A jury convicted Texas psychiatrist Riaz Mazcuri of conspiracy to commit health care fraud and five counts of health care fraud. He is the latest to be convicted in a $158 million dollar scheme to defraud Medicare by submitting false claims for partial hospitalization program (PHP) services, an intensive outpatient treatment for mental illness. Thus far, 15 others have been...

May 2, 2017

North Carolina-based Piedmont Pathology agreed to pay $601,000 to settle allegations it violated the False Claims Act by submitting false claims to Medicare and Medicaid for medically unnecessary procedures. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Piedmont pathologist Dr. Kim Geisinger. She will receive a whistleblower award of roughly $120,000. DOJ (WDNC)

April 27, 2017

Forrest S. Kuhn, Jr., M.D., a Kentucky physician specializing in allergy, asthma and immunology, agreed to pay roughly $750,000 to resolve allegations he violated the False Claims Act by submitting false claims to Medicare, Medicaid, and other government health care programs for allergy tests never performed. DOJ (WDKY)

April 20, 2017

Dr. Norman A. Brooks, a dermatologist and surgeon and owner of Skin Cancer Medical Center in Encino, agreed to pay roughly $2.7 million to resolve allegations he submitted bills to Medicare for Mohs micrographic surgeries for skin cancers that were medically unnecessary. The government alleged that Brooks falsely diagnosed skin cancer in some of his patients so that he could perform, and bill for, Mohs surgeries. The allegations originated in a whistleblower lawsuit by former employee Janet Burke. She will receive a whistleblower award of roughly $483,000 from the proceeds of the government's recovery. DOJ (CDCA)

Fraudster of the Week -- Monarch Medical Group

Posted  04/28/17
Last week, California state prosecutors charged 26 individuals, including 21 physicians and 2 pharmacists, in connection with a kickback scheme orchestrated by Tanya and Christopher King, the owners of a practice management company called Monarch Medical Group and other related companies.   If convicted, the involved physicians could face up to 25 years in prison and the pharmacists could face up to 28 years. ...

March 6, 2017

Simon Hong, owner of Los Angeles-based JH Physical Therapy Inc., was sentenced to 63 months in prison and to pay roughly $2.4 million in restitution, for his role in a $3.4 million Medicare fraud scheme that involved billing for occupational therapy services that were not medically necessary and not provided.   Hong admitted billing Medicare for occupational therapy services when what were provided instead were acupuncture and massage services, not reimbursable by Medicare.  Hong further admitted directing co-conspirator therapists to falsify medical records to make it appear as if the services billed actually had been provided. DOJ
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