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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 2, 2022

New York healthcare provider The Door - A Center for Alternatives has agreed to pay $12.9 million to resolve claims that it submitted false claims for reimbursement to New York's Indigent Care Pool, which is funded by Medicaid.  The Door was required to submit annual cost reports to New York reporting figures including the number of "threshold visits" to its ambulatory diagnostic and treatment center.  A qui tam case initiated by two whistleblowers alleged that defendant knowingly inflated the number of threshold visits to increase payments.   SDNY

February 1, 2022

Two North Carolina medical providers will pay nearly $1.5 million combined for submitting false claims to the Medicaid program. Knowles, Smith, & Associates LLP will pay $1,150,000 to resolve allegations spanning five years of failure to monitor their anesthesia billing by not providing services billed, administering medically unnecessary procedures, or failing to maintain sufficient supporting documentation. Stacy Benton Lewis, M.D., and the Center for Women’s Health, P.A. will pay $340,000 to resolve false billing allegations covering a four-year period for submitting claims for complex visits that did not occur. NC DOJ

January 20, 2022

A three-year-long kickback scheme effectuated by a hospital executive and seven doctors will net the DOJ a $1.1 million settlement and their continued cooperation in the investigation of and litigation against other parties. The Stark Law and Anti-Kickback Statute violations occurred over a three-year period, wherein management service organizations (MSOs) paid volume-based commissions kickbacks for ordering laboratory tests from Rockdale Hospital d/b/a Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation. Jaspaul Bhangoo, M.D., Robert Megna, D.O., Baxter Montgomery, M.D., Murtaza Mussaji, D.O., David Sneed, D.O., Kevin Lewis, D.O., and Angela Mosley-Nunnery, M.D. will all contribute to the settlement. Additionally, Richard Defoore, former CEO of Jones County Regional Healthcare d/b/a Stamford Memorial Hospital, also agreed to pay into the settlement fund for his contribution to the scheme. USAO EDTX

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Posted  01/14/22
cars in traffic
The U.S. Attorney this week announced the arrest of doctors, businesspeople, an attorney, a New York police officer, and several others in one of the largest no-fault automobile insurance fraud takedowns in history. The investigation leading to their arrest was conducted by the U.S. Attorney’s Office for the Southern District of New York, the FBI, and the Westchester County District Attorney’s Office.  The...

January 12, 2022

Six medical practices affiliated with Interventional Pain Management Center P.C. (IPMC), as well as physician-owner Dr. Amit Poonia, have agreed to pay nearly $7.5 million to resolve allegations of defrauding Medicare and the Federal Employees Health Benefit Program.  In a qui tam suit by Anu Doddapaneni and Christian Reyes, the whistleblowers alleged that Poonia and IPMC violated the False Claims Act by using a billing code that mischaracterized P-Stim and NeuroStim treatments—which transmit electrical pulses through needles placed just under the skin of a patient’s ear—as surgical implantation requiring anesthesia.  USAO EDNY

Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

December 15, 2021

David Bellamah, and his business, Bellamah Vein & Surgery, PLLC, will pay $3.75 million to resolve allegations that they billed government healthcare programs for medically unnecessary venous procedures based on false medical records.  Defendants allegedly used improper techniques to conduct and analyze ultrasounds and used false ultrasound findings to diagnoses and treat venous reflux disease and varicose veins. The government’s claims were initiated by the filing a qui tam complaint by Lenore Lezanne, who previously worked as a sonographer at the Bellamah Vein Center; Lezane will receive a whistleblower award of 17% of the amounts recovered.  USAO MT

December 13, 2021

Kevin Cooper, M.D. and his practice, Cooper Family Medical Center, will pay $375,000 to resolve allegations that they fraudulently billed Medicare of non-reimbursable acupuncture devices by using billing codes for surgically implanted devices for the provision of P-Stim electro-acupuncture devices that are affixed behind a patient’s ear using an adhesive.  USAO SD MI

Catch of the Week: Pharmacy Owner Convicted in $174 Million Telehealth Fraud That Targeted Consumers and PBMs

Posted  12/10/21
Pharmacists discussing medication
In yet another example of how unscrupulous providers can take advantage of the benefits of telehealth (or telemedicine) to commit healthcare fraud, on December 2, 2021, a federal jury in Tennessee convicted Peter Bolos, the owner and operator of Synergy Pharmacy, located in Florida, of 22 criminal counts, including violating the Food, Drug and Cosmetic Act (FDCA) by introducing a misbranded drug into interstate...

December 8, 2021

The owner and medical director of Georgia’s Milton Hall Surgical Associates, Jeffrey M. Gallups, will pay $3 million, and medical device manufacturer Entellus Medical will pay $1.2 million, to resolve claims that they entered into an unlawful kickback arrangement.  The government alleged that Gallups received cash payments and all-expense paid trips from Entellus in return for directing MHSA physicians to utilize sinuplasty related medical devices exclusively from Entellus and increase the number of sinuplasty procedures performed.  In addition, Gallups was alleged to have received “commissions” from medical testing laboratory NextHealth, in exchange for directing MHSA doctors to order medically unnecessary toxicology and genetic tests from NextHealth.  The settlement resolves a qui tam action initiated by former MHSA physician Myron Jones, M.D., who will receive approximately $614,000 from the settlement.  USAO ND GA
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