Provider Fraud Archives - Page 47 of 47

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

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

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.

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Whistleblower Rewards,

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

Tagged in: Anti-Kickback and Stark, FCA Federal, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

Rose Cancer Center — Medicare Fraud ($5.7 million).

Two of our whistleblower attorneys co-led the representation of Kristi Beeson who reported Medicare fraud violations at her former employer Rose Cancer Center in Mississippi. Ms. Beeson, who was a laboratory technician for the clinic, brought a qui tam action under the False Claims Act against the clinic alleging, among other things, unqualified technicians performing bone marrow biopsies, diluting chemotherapy drugs, and doctoring patient records to conceal the clinic’s fraudulent Medicare billings. The physician who owned and ran the practice, Dr. Meera Sachdeva, plead guilty to various Medicare fraud violations, forfeited $5.7 million, and is now serving a 20 year prison sentence for her crimes. Ms. Beeson, along with three other whistleblowers, collectively received a whistleblower award of $525,000 for their efforts in exposing the fraud. See Clarion Ledger for more.

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicare, Provider Fraud, Whistleblower Rewards,

April 16, 2014

CRC Health Corp., a nationwide provider of substance abuse and mental health treatment services, agreed to pay $9.25 million to settle allegations that CRC violated the False Claims Act by providing substandard treatment in its Tennessee facility to adult and adolescent Medicaid patients suffering from alcohol and drug addiction. The allegations were first raised in a qui tam lawsuit filed by Angie Cederoth, a former billing clerk in the CRC facility, under the whistleblower provisions of the False Claims Act. She will receive a whistleblower award of$1.5 million. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 14, 2014

Hope Cancer Institute, a cancer treatment facility in Kansas, and its owner Dr. Raj Sadasivan, agreed to pay $2.9M to resolve allegations they violated the False Claims Act by submitting claims to Medicare, Medicaid and the Federal Employee Health Benefits Program for chemotherapy drugs and services not actually provided. The allegations were first raised in a qui tam lawsuit filed by former employees of the facility Krisha Turner, Crystal Dercher and Amanda Reynolds under the whistleblower provisions of the False Claims Act. DOJ

Tagged in: FCA Federal, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 18, 2014

American Family Care Inc., a network of walk-in medical clinics with offices in Alabama, Tennessee and Georgia, agreed to pay $1.2M to resolve allegations under the False Claims Act that it knowingly submitted claims to Medicare for outpatient office visits that were billed at a higher rate than was appropriate. The settlement resolves a qui tam lawsuit filed by Anita C. Salters, a former employee of American Family Care under the whistleblower provision of the False Claims Act. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

January 5, 2014

New York Attorney General Eric T. Schneiderman announced that Apple Transportation of New York, Inc. will pay $300,000 to settle claims it overbilled Medicaid for transportation services. As part of a settlement agreement, Apple Transportation admitted that between January 1, 2004 and October 30, 2008, it frequently billed Medicaid for ambulette services even though no personal assistance was provided to Medicaid recipients. As a result, Apple was paid by Medicaid for ambulette services at rates that were higher than the applicable livery rates. NY

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

Scooter Store Caught Cheating the Government Out of Millions

Posted 01/24/13

By Marlene Koury It seems like such a wholesome company. They have those nice commercials where elderly folks are scooting to and fro on their power-mobility devices. It would seem that only an honest and trustworthy company would dedicate itself to caring for the needs of the elderly in this way. But, according to an independent auditor, The Scooter Store – the purveyor of these fine commercials and the...

Tagged in: Lack of Medical Necessity, Provider Fraud,

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