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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 43 of 50

October 26, 2015

Valentina Kovalienko, the owner of two Brooklyn medical clinics, pleaded guilty to, and agreed to forfeit almost $30 million for, her role in a $55 million health care fraud and money laundering conspiracy.  According to her admissions, from approximately February 2008 to February 2011, Kovalienko and others executed a scheme in which patients were paid cash kickbacks to subject themselves to medically unnecessary physical and occupational therapy, diagnostic tests and office visits that were not performed by licensed professionals, and for which the clinics billed Medicare and Medicaid.  Kovalienko also admitted that to support the fraudulent claims she paid occupational and physical therapists to falsify patient charts and billing records.  DOJ

October 15, 2015

Shreveport, Louisiana community mental health center Westwood Mental Health LLC, and its parent company MedSouth LLC, agreed to pay $3.5 million to settle False Claims Act and Anti-Kickback Statute allegations that Westwood falsified patient records, billed for services not medically necessary, billed for services that were not rendered, provided bribes to Medicare beneficiaries who did not qualify for partial hospitalization services and provided bribes and/or kickbacks to employees to further or conceal the fraud.  DOJ (WDLA)

October 14, 2015

Santiago Borges, Erik Alonso and Cristina Alonso, all of Miami, pleaded guilty to federal healthcare fraud charges.  Borges owned the now-defunct mental health centers R&S Community Mental Health Inc. and St. Theresa Community Mental Health Center Inc., and was an investor in New Day Community Mental Health Center LLC .  Erik Alonso was the clinical director of all three centers.  Cristina Alonso was a therapist at R&S.  They admitted the clinics billed Medicare for costly partial hospitalization program services that were not medically necessary or not provided to patients.  Borges also admitted he paid kickbacks to patient recruiters who, in exchange, referred beneficiaries to the centers.  DOJ

September 29, 2015

Juan Carlos Delgado and Nereyda Infante, who owned and operated several Orlando-based health care clinics under variations of the name Prestige Medical, were sentenced to five years in prison and to pay $1,520,850 in restitution and forfeit $1,520,850 for their role in a $2.4 million health care fraud scheme.  According to admissions made in connection with their guilty pleas, between February 2012 and September 2014, the defendants fraudulently billed Medicare on behalf of the Prestige clinics for services never provided and for medications not prescribed or administered.  In particular, Delgado and Infante admitted to billing Medicare for pentostatin, an expensive anticancer chemotherapeutic medication used to treat Leukemia, despite never administering the drug.  DOJ

September 28, 2015

American Access Care Holdings, LLC agreed to pay $3,594,791 to resolve allegations it violated the False Claims Act by improperly billing Medicare and Medicaid for multiple percutaneous transluminal angioplasties performed during the same patient encounter and improperly submitting claims to Medicare and Medicaid for procedures performed during follow-up visits that were not medically necessary.  The conduct addressed by the settlement occurred prior to AAC’s merger with Fresenius Vascular Care, Inc. in October 2011. DOJ (CT)

September 11, 2015

A federal jury convicted Houston psychiatrist Sharon Iglehart of participating in a $158 million Medicare fraud scheme involving false claims for mental health treatment.  According to evidence presented at trial, from 2006 until June 2012, Iglehart and others engaged in a scheme to defraud Medicare by submitting, through Riverside General Hospital, approximately $158 million in false and fraudulent claims for partial hospitalization program services to Medicare beneficiaries who did not actually receive the services.  DOJ

August 31, 2015

Laran Lerner, a Detroit-area physician who prescribed unnecessary controlled substances and billed for unperformed office visits and diagnostic testing, pleaded guilty for his role in a $5.7 million health care fraud scheme.  DOJ

August 25, 2015

A federal jury in Miami convicted Roger Rousseau, former medical director of Health Care Solutions Network Inc. (HCSN), and three HCSN therapists for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.  HCSN is a now-defunct partial hospitalization program that purported to provide intensive treatment for mental illness.  According to the evidence presented at trial, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided and paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.  DOJ

August 19, 2015

Yaroslav (Steven) Proshak, former owner of Southern California ambulance company ProMed Medical Transportation, was convicted of health care fraud charges in connection with a Medicare fraud scheme of at least $2.4 million.  According to the evidence, Proshak and two of his managers conspired to bill Medicare for ambulance transportation services for individuals whom the defendants knew did not need such services.  They also instructed EMTs who worked at ProMed to conceal the true medical conditions of patients they were transporting by altering requisite paperwork and creating fraudulent documents to justify the transportation services.  DOJ

August 19, 2015

Arizona physician Dr. Bashir Azher agreed to pay $207,988 to resolve allegations he violated the False Claims Act by submitting false bills to Medicare for prostate laser ablation procedures, commonly known as Green Light prostatectomies.  Specifically, the government charged Dr. Azher with submitting false claims for reimbursement for prostate laser ablation procedures that were too short to generate a therapeutic benefit, failed to meet professionally recognized standards of care, were medically unnecessary, and/or violated applicable Medicare regulations.  The government’s allegations originated in a whistleblower lawsuit filed by Dr. Arnaldo Trabucco under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award.  DOJ
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