Provider Fraud
This archive displays posts tagged as relevant to fraud by healthcare providers. You may also be interested in our pages:
April 27, 2022
Dr. Josef Schenker and his urgent care facilities, Josef Schenker, M.D., P.C., and Care Partners Medical Management, LLC will pay $564,217.70 for violations of the False Claims Act, by submitting up-coded claims to Medicare related to administration of the COVID-19 vaccine. Schenker and the two facilities provided higher-level CPT codes for services not actually provided, charging, e.g., for an office visit or exam when the patient only actually received a vaccine or a COVID test. EDNYDOJ Ramps Up Enforcement Against COVID-19 Fraud
Posted 04/25/22
Tagged in: COVID-19, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud,
April 13, 2022
A number of anesthesia entities owned and operated by Care Plus Management, LLC (Care Plus), which itself is owned and operated by doctors Paul D. Weir and John R. Morgan, have agreed to pay $7.2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act. A qui tam suit by whistleblower Robert Douglas had alleged that between 2012 and 2016, Care Plus entered into illegal revenue-sharing arrangements with physicians in exchange for patient referrals. For his contributions to a successful enforcement action, Douglas will receive a $1.3 million share of the settlement. USAO NDGAApril 12, 2022
Providence Health & Services Washington has agreed to pay $22.7 million to settle allegations of submitting false claims to Medicare, Medicaid, and TRICARE. According to an unnamed whistleblower, who will receive a $4.2 million relator’s share, the hospital allegedly gave their neurosurgeons volume-based financial incentives to perform complex surgeries, thereby incentivizing two neurosurgeons to perform an excessive number of complex surgeries on inappropriate candidates without regard to medical necessity or patient safety, and ultimately causing an excessive level of complications. USAO EDWAMarch 28, 2022
A Pennsylvania-based psychiatrist and his wife have agreed to pay $3 million in the largest recovery against a single psychiatrist ever in the history of the U.S. Department of Labor – Office of Worker’s Compensation Programs (OWCP). From 2013 to 2021, Dr. Harry Doyle and his wife and sole employee, Sonya, allegedly billed OWCP for services that weren’t rendered, submitted double-billed and upcoded patient claims, and falsified patient records to reflect their false billing. As part of the settlement, they will be excluded from participating in federal healthcare programs for 25 years. USAO EDPAMarch 22, 2022
Ten doctors in Texas and a healthcare executive have agreed to pay nearly $1.7 million to resolve allegations of violating the False Claims Act, Anti-Kickback Statute, and Stark Law. In exchange for ordering laboratory tests from Rockdale Hospital d/b/a A little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation, the doctors allegedly received thousands of dollars in kickbacks disguised as investment returns. USAO EDTXMarch 21, 2022
Jonathan and Daniel Markovich, two brothers who operate addiction treatment facilities in Florida, have been sentenced to over 15 years and 8 years in prison respectively after being convicted of running a $112 million fraud scheme. Through patient recruiters, the defendants paid illegal kickbacks to patients in the form of airline tickets, cash payments, and illegal drugs to entice them to visit their inpatient detox and residential facility, Second Chance Detox LLC d/b/a Compass Detox, as well as their outpatient treatment program, WAR Network LLC. The defendants then billed for therapy sessions that were not regularly provided to or attended by patients, and urine drug tests that were not medically necessary. DOJCatch of the Week: Feds Shut The Door on an Uncommon Fraud Scheme involving New York Indigent Care Pool
Posted 02/3/22
