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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 9 of 50

November 22, 2021

South Carolina chiropractor Daniel McCollum has consented to judgment of $9 million to resolve charges that he submitted false claims to federal healthcare programs in violation of the Anti-Kickback Statute and Stark Law.  McCollum admitted that his laboratory, Labsource (which was a party to a related action), gave referring providers an opportunity to earn revenue generated from their commercially-insured referrals for urine drug testing as an inducement for those providers to refer all of their federally-insured urine drug testing patients to Labsource.  McCollum also caused medically unnecessary prescriptions for pain creams often without the knowledge or approval of the patients’ healthcare providers.  In addition to the civil settlement, McCollum pleaded guilty to criminal kickback and healthcare fraud charges and will be sentenced at a later date.  DOJ; USAO SC

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Provider Fraud,

Recent Settlements Show Kickbacks are Always a DOJ Enforcement Priority

Posted  11/15/21
Person Handing Hundred Dollar Bill to Another Person
The Department of Justice regularly highlights the areas of fraudulent conduct it intends to target as enforcement priorities.  These identified enforcement priorities tend to cover burgeoning areas of fraud or particular misbehavior especially ripe or prevalent because of the particular times we live in.  As might be expected, DOJ's current listing of priorities includes fraud related to the pandemic, opioids, the

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medical Devices and DME, Pharma Fraud, Provider Fraud,

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November 9, 2021

Numerous anesthesia providers and outpatient surgery centers in Georgia, including Ambulatory Anesthesia of Atlanta, LLC and Northside Anesthesiology Consultants, LLC, have agreed to pay over $28 million to resolve kickback allegations by whistleblowers Kathleen Hartney-Velazco, M.D., Jan Kersey, and Capitol Anesthesiology, P.C., who will receive a $4.7 million cut of the settlement.  According to the whistleblowers, the anesthesia providers made payments and provided free staffing to the outpatient surgery centers in order to obtain exclusivity contracts over a ten-year period.  USAO NDGA

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

Catch of the Week: Classic Medicare Fraud

Posted  11/5/21
medicare dollars
For those like your correspondents who spend their days deep in the weeds of complex Medicare fraud, it’s a delight when something refreshingly simple comes along.  Thanks to Billy Joe Taylor of Arkansas, we can relax this Friday with a cool glass of straightforward Medicare fraud.  For allegedly making $100 million in claims to CMS for tests that were not ordered or ever performed, he is our Catch of the...

Tagged in: Catch of the Week, COVID-19, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud,

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November 1, 2021

Geisinger Community Health Services, based in Pennsylvania, has agreed to pay over $18.5 million to resolve its liability following a self-disclosure of violations of the False Claims Act.  The violations occurred between 2012 and 2017 and involved physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients.  USAO MDPA

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, Provider Fraud,

Three States Impose Profit Limits on Nursing Homes

Posted  10/29/21
Woman holding elderly person's wrist
New York, New Jersey, and Massachusetts have just sent a clear message to nursing home operators: patient care must be prioritized over profits.  Each state is introducing rules requiring nursing homes to spend a specific portion of their total revenue on direct patient care.  In New York, it will be at least 70%, in Massachusetts at least 75%, and in New Jersey at least 90%.  The three states are also limiting...

Tagged in: COVID-19, Healthcare Fraud, Provider Fraud, SNF,

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Catch of the Week: Fraudulent Sleep Tests in Fresno

Posted  10/29/21
bed with pillow and sheets scattered
Fraud permeates through all aspects of America’s healthcare system- from hospitals to big pharma to chiropractors. This week’s catch of the week focuses on another part of the system, sleep clinics. As increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders, the significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous...

Tagged in: Catch of the Week, Healthcare Fraud, Improper Medical Facility, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

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October 28, 2021

Rehab Authority, LLC, a physical therapy provider in Minnesota, has agreed to pay $4 million to resolve allegations by whistleblower Cami Lane that it violated the False Claims Act.  RehabAuthority clinics had allegedly submitted false claims to Medicare, Medicaid, TRICARE, and the Veterans Health Administration for one-on-one outpatient physical therapy that was not provided.  USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

October 25, 2021

Curant, Inc., which owns pharmacies in Florida and Georgia, has agreed to pay $4.6 million to resolve allegations of paying kickbacks to a third-party marketer, waiving mandatory copays from patients, and overbilling TRICARE for compound pain and scar creams.  The alleged misconduct occurred between 2013 and 2015.  USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

October 22, 2021

Texas doctors Robert Wills and Brannon Frank, who previously operated Austin Pain Associates, will pay $3.9 million to resolve allegations that they billed federal and state healthcare programs for medically unnecessary urine drug tests that were performed at Austin Pain Associates’ in-house lab.  The investigation was initiated after a whistleblower complaint was filed by former Austin Pain Associates employees Jennifer Nuessner and Robert Hoffman; they will receive approximately $618,000 from the federal share of the settlements. DOJ

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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