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Upcoding

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April 27, 2018

Las Vegas medical practice Cardiovascular and Thoracic Surgeons of Nevada, Inc. agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by billing federal healthcare programs for surgical services not actually provided to its cardiac patients and billing for more expensive surgical and evaluation and management services than actually provided. DOJ (NV)

New York Urgent Care Clinic Pays Over $6.6M to Settle FCA Suit

Posted  05/7/18
By the C|C Whistleblower Lawyer Team CityMD, a company that manages over 80 urgent care clinics in and around New York City, has settled allegations that it billed Medicare for more expensive services than were actually performed, and that it billed Medicare under the names of doctors who did not actually perform the services. Under the terms of the settlement, CityMD also accepted responsibility for its...

April 10, 2018

Connecticut-based medical practice World Health Clinicians, Inc., its CEO Scott Gretz, and former World Health physician Gary Blick agreed to pay roughly $650,000 to settle claims they violated the False Claims Act by submitting claims for physical therapy and other covered services when in fact the patients received massages provided by a massage therapist. DOJ (CT)

April 5, 2018

The Estate of Dr. Leroy Pelicci, former owner of Scranton-based Pelicci Pain Relief Center, agreed to pay $625,000 to settle claims he violated the False Claims Act by submitting improper claims for payment to the Department of Labor Office of Workers’ Compensation Programs under the Federal Employees Compensation Act and the Federal Employees Health Benefits Program for trigger point injections, which were upcoded to receive a higher reimbursement amount than permitted. DOJ (MDPA)

March 29, 2018

Louisville-based skilled nursing facility New Oaklawn Investments, LLC (d/b/a Oaklawn Health and Rehabilitation Center and Elmcroft Senior Living, Inc.) agreed to pay roughly $5 million to resolve allegations it violated the False Claims Act by submitting false claims to Medicare for patient rehabilitation services at the resource utilization (“RUG”) Code Series Rehabilitation Ultra High and Rehabilitation Very High, for certain services that were not reasonably or medically necessary. DOJ (WDKY)

March 27, 2018

Iowa acute care hospital Genesis Medical Center agreed to pay $1.88 million to settle claims it violated the False Claims Act by improperly retaining Medicare overpayments for hospital inpatient admission claims when those claims should have been billed at the lower reimbursement rate for either outpatient or observation services. DOJ (SDIA)

January 24, 2018

Tennessee chiropractor Matthew Anderson agreed to pay $1.45 million to resolve allegations he violated the False Claims Act. Specifically, the government alleged that Anderson and his management company, PMC LLC, caused pharmacies to submit requests for Medicare and TennCare payments for pain killers dispensed based upon prescriptions written at the Cookeville Center for Pain Management, one of the pain clinics Anderson managed, which had no legitimate medical purpose. The government further alleged that Anderson caused four pain clinics he managed to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. The allegations originated in a whistleblower lawsuit filed by a former office manager for the Cookeville Center for Pain Management under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $246,500 from the proceeds of the government's recovery. DOJ

January 18, 2018

Detroit-area doctor Gerald Daneshvar was sentenced to 24 months in prison for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulted in inappropriately high payments. DOJ

June 30, 2017

Charlotte-Mecklenburg Hospital Authority (dba Carolinas Healthcare System) agreed to pay $6.5 million to resolve charges it violated the False Claims Act by “upcoding” claims for urine drug tests in order to receive higher payment than allowed for the tests.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Mark McGuire, a former laboratory director for CHS.  He will receive a whistleblower award of roughly $1.4 million from the proceeds of the government's recovery.  DOJ (WDNC)

June 26, 2017

AMI Monitoring Inc. (aka Spectocor), its owner Joseph Bogdan, Medi-Lynx Cardiac Monitoring LLC, and Medicalgorithmics SA, the current majority owner of Medi-Lynx, agreed to pay roughly $13.5 million to resolve allegations they violated the False Claims Act by billing Medicare for higher and more expensive levels of cardiac monitoring services than requested by the ordering physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Spectocor sales manager Eben Steele.  He will receive a whistleblower award of roughly $2.4 million from the proceeds of the government's recovery.  DOJ
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