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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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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

March 9, 2015

Two former employees of the Mental Health Association of Rockland County, Inc. will receive an undisclosed whistleblower award from the $304,000 settlement resolving allegations MHAR violated the New York False Claims Act through its managers and employees altering records in advance of a Medicaid audit so the records would appear to support claims MHAR submitted to New York State's Medicaid program.   NY

Seventh Circuit Gives Broad Read To What Constitutes A "Referral" Under Anti-Kickback Statute

Posted  02/26/15
By Gordon Schnell
Healthcare Fraud
Under the Anti-Kickback Statute, physicians may not solicit or receive kickbacks for referring Medicare patients to a particular healthcare provider. The question before the Seventh Circuit in United States v. Patel was the scope of what constitutes a referral under the statute. According to the Court, the scope is quite broad, even extending to situations where the physician plays no role in selecting the healthcare...

January 16, 2015

Washington Attorney General Bob Ferguson announced Sea Mar Community Health Centers agreed to pay $3.35M to settle charges of improperly billing Medicaid for thousands of dental appointments. According to the government, Sea Mar billed fluoride treatments as stand-alone appointments with a dentist or hygienist when they could have been performed much more cheaply by dental assistants as part of a patient’s regular six-month checkups. WA

DOJ Catch Of The Week -- Institute For Cardiovascular Excellence

Posted  01/9/15
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to Florida cardiologist, Dr. Asad Qamar, and his physician group, the Institute for Cardiovascular Excellence.  On Monday, the DOJ intervened in two whistleblower lawsuits alleging Qamar and his group billed Medicare for medically unnecessary peripheral artery interventions and paid kickbacks to patients by waiving...

January 7, 2015

Florida Attorney General Pam Bondi announced that Florida, along with California, Colorado, Kentucky, and Ohio and the federal government, entered a $22 million national settlement with DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the US. The settlement resolves allegations originating in a whistleblower lawsuit that DaVita paid illegal kickbacks to induce the referral of patients to its dialysis clinics, causing false claims to be submitted to the Medicaid program. DaVita will pay Florida $5.6 million in restitution and other recoveries. FL

October 31, 2014

Oklahoma-based dental company, Ocean Dental PC, which operates 28 clinics in seven states, agreed to pay more than $5M to settle charges it violated the False Claims Act by submitting false claims to the Oklahoma Medicaid program for dental work never performed or billed at a higher rate than allowed. The charges apparently stem from dental restorations by former employee Robin Lockwood who was sentenced to 18 months in federal prison in a separate case. NewsOK

DaVita — Medicare Fraud/Kickbacks ($400 million)

Two of our whistleblower attorneys led the representation of David Barbetta, a former financial analyst for DaVita HealthCare Partners, one of the largest providers of dialysis services in the United States. Mr. Barbetta brought a qui tam action under the False Claims Act against DaVita alleging the company violated the Anti-Kickback Statute by paying physicians to refer their patients to DaVita clinics for dialysis. According to the complaint, DaVita sold doctors shares of DaVita clinics at below fair market value, and purchased doctors’ interests in other clinics at above fair market value. The government joined the case, and alleged that DaVita had entered into these sweetheart deals with doctors, which gave the doctors returns of over 100%, and the doctors then steered their patients to DaVita clinics. In 2014, DaVita paid $400 million to settle the case, the largest stand-alone kickback settlement to date. See Denver Post and Modern Healthcare for more.

October 22, 2014

DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the United States, agreed to pay $400 million to resolve claims it violated the False Claims Act by paying kickbacks for patient referrals to its dialysis clinics through its use of a sophisticated three-part joint venture business model to induce patient referrals to its clinics..  David Barbetta, former Senior Financial Analyst for DaVita, will receive an undisclosed whistleblower award. DOJ
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