Provider Fraud Archives - Page 47 of 50

July 21, 2014

Alabama-based hospital system Infirmary Health System Inc., along with two affiliated clinics and Diagnostic Physicians Group, agreed to pay $24.5M to resolve government allegations they violated the False Claims Act, the Anti-Kickback Statute and the Stark Law by paying or receiving financial inducements for medical referrals covered by Medicare.Whistleblower Insider

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

July 11, 2014

Luis Alberto Garcia Perojo of Florida was sentenced to serve 4 years in prison and ordered to pay $6.2M in connection with a $10.5M Medicare fraud scheme involving physical and occupational therapy services. From November 2007 through August 2009, Garcia submitted on behalf of Renew Therapy Center, an outpatient rehabilitation facility he helped operate, roughly $10.5M in fraudulent claims for reimbursement to Medicare for therapy services not legitimately prescribed or provided. DOJ

Tagged in: Healthcare Fraud, Provider Fraud,

July 1, 2014

Detroit-area physician, Walayat Khan, pleaded guilty for his role in a $7M health care fraud scheme. According to court documents, beginning in January 2009, Dr. Khan and others agreed that he would refer Medicare beneficiaries to Advance Home Health Care Services, Inc., Perfect Home Health Care Services, LLP and other Detroit-area home health care agencies for medically unnecessary home health services. Dr. Khan signed medical documents for these beneficiaries, falsely certifying they required home health care and they were under his care. The complicit home health care agencies then used Dr. Khan’s false documents to support their claims to Medicare for home health services that were never rendered or not medically necessary. DOJ

Tagged in: Provider Fraud,

June 13, 2014

Gwendolyn Climmons-Johnson, the owner and operator of Urgent Response EMS, a Houston area ambulance company, was sentenced to 97 months in prison and to pay roughly $1M for her role in a $2.4M Medicare fraud scheme. In October she had been convicted by a federal jury in Houston of four counts of health care fraud. According to evidence presented at trial, from January 2010 through December 2011, Climmons-Johnson and others conspired to enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and/or not provided. DOJ

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

May 6, 2014

The owners of Alpha Ambulance Inc. , a now-defunct Los Angeles-area ambulance transportation company, were sentenced for committing Medicare fraud by providing non-emergency ambulance transportation to Medicare beneficiaries whose medical condition at that time did not require ambulance transportation and then altering required documentation to conceal the scheme. DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

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 a former employee of American Family Care under the whistleblower provision of the False Claims Act. DOJ

Tagged in: FCA Federal, Provider Fraud, Upcoding, Whistleblower Case,

February 10, 2014

SelfRefind, a chain of addiction treatment clinics in Kentucky, and related entities and individuals, agreed to pay $15.75M to resolve allegations they violated the False Claims Act by submitting claims to Medicare and Kentucky’s Medicaid program for tests that were medically unnecessary, more expensive than those performed or billed in violation of the Stark Law. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Lack of Medical Necessity, Provider Fraud,

February 3, 2014

Louis Duluc, former owner and operator of multiple physical therapy rehabilitation facilities, pleaded guilty for conspiracy to commit healthcare fraud for his role in organizing and leading a $28M Medicare fraud scheme involving physical and occupational therapy services.DOJ

Tagged in: Provider Fraud,

January 24, 2014

Tennessee Orthopedic Clinics and Appalachian Orthopedic Clinics agreed to pay a combined $1.85M to resolve state and federal False Claims Act allegations that they knowingly billed state and federal health care programs for reimported osteoarthritis medications. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

Tagged in: FCA Federal, Pharma Fraud, Provider Fraud, Whistleblower Case,

January 10, 2014

Two former executives of HealthEssentials Solutions agreed to pay more than $1 million to resolve False Claims Act allegations that they knowingly caused the company to submit false Medicare claims between 1999 and 2004 by billing for services that were inflated or not medically necessary and by pressuring employees to do the same. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

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

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