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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 44 of 50

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare.  Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic.  Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided.  DOJ

Tagged in: Anti-Kickback and Stark, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

August 14, 2015

Oklahoma-based East Central Family Health Center agreed to pay $825,000 to settle charges it violated the False Claims Act by submitting false Medicaid claims.  Specifically, the government charged East Central, which is a designated federally qualified health center (FQHC), with submitting claims to the Oklahoma Medicaid Program for reimbursement for patients of non-FQHC health care providers and who were not East Central patients.  DOJ

Tagged in: FCA Federal, Medicaid, Medical Billing Fraud, Provider Fraud,

August 14, 2015

Connecticut doctor Okon Umana was sentenced to two years in prison, to pay $6,429,330 in restitution and to forfeit $6,550,036 for his role in a $13 million health care fraud scheme.  From 2009 to 2012, as the medical director of Cropsey Medical Care, Umana admitted submitting more than $13 million in claims to Medicare and Medicaid for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests.  DOJ

Tagged in: Healthcare Fraud, Provider Fraud,

July 24, 2015

California oncologist Dr. Neelesh Bangalore has paid $736,000 to settle allegations that he improperly billed Medicare, Medicaid, and Tricare for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical distributor, Warwick Healthcare Solutions Inc., also known as Richards Pharma, a former United Kingdom-based drug distributer that did not have a license to distribute drugs in the United States.  DOJ

Tagged in: Healthcare Fraud, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud, Provider Fraud,

July 10, 2015

Detroit area doctor Farid Fata was sentenced to 45 years in prison and to forfeit $17.6 million for his role in a health care fraud scheme that included administering medically unnecessary infusions or injections to 553 individual patients and submitting to Medicare and private insurance companies approximately $34 million in fraudulent claims.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

July 8, 2015

New Jersey doctor Frank Santangelo was sentenced to 63 months in prison and to forfeit more than $1.8 million for accepting $1.8 million in bribes to refer millions of dollars in business to Biodiagnostic Laboratory Services LLC.  Including Santangelo, 38 people, 26 of them doctors, have pleaded guilty in connection with the bribery scheme, which its organizers have admitted involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and various private insurance companies.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services.  Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing.  The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC.  The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be determined whistleblower award. DOJ

Tagged in: FCA Federal, FCA State, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 28, 2015

Garden State Cardiovascular Specialists P.C., a New Jersey-based cardiology practice which owns and operates several facilities in New Jersey under the name NJ MedCare/NJ Heart, agreed to pay more than $3.6 million to resolve allegations the company and its principals, Dr. Jasjit Walia and Dr. Preet Randhawa, submitted claims to Medicare for various cardiology diagnostic tests and procedures, including stress tests, cardiac catheterizations and external counterpulsation, which were not medically necessary. The allegations were first raised in a whistleblower lawsuit filed by Cheryl Mazurek under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of more than $648,000.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 20, 2015

Florida-based neurologist Dr. Sean Orr agreed to pay $150,000 to settle allegations he violated the False Claims Act by providing medically unnecessary services and drugs to federal health care program beneficiaries.  According to the government, from September 2009 to April 2012 Orr knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal health care programs to be billed for medically unnecessary services and drugs.  In 2014, the government settled related allegations against Baptist Health System Inc. – Orr’s former employer and the parent company for Baptist Neurology Inc. and Baptist Medical Center-Jacksonville – for $2.5 million.  The allegations first arose in a whistleblower lawsuit filed by former Baptist Neurology employee Verchetta Wells under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $26,250.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 14, 2015

Westchester County Health Care Corporation (d/b/a Westchester Medical Center) agreed to pay $18.8 million to settle charges it violated the False Claims Act, the Anti-Kickback Statute and the Stark Law.  According to the government, from approximately 2000 through 2007, WMC maintained a financial relationship with Cardiology Consultants of Westchester, P.C., a cardiology practice formerly operating on WMC’s Valhalla campus.  WMC allegedly advanced monies to CCW to open a practice for the express purpose of generating referrals to the hospital.  When CCW began making payments to WMC purportedly repaying the advances, WMC entered into retroactive, no-work consulting agreements under which it paid CCW tens of thousands of dollars.  WMC also allegedly allowed CCW to use WMC’s fellows in CCW’s private office free of charge, contrary to WMC’s historic practice.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud,

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