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health care fraud 35 articles

Nursing Home Chain Settles ‘largest worthless services’ case in U.S. history

A Tennessee nursing home chain will pay the U.S. and Tennessee more than $18 million in a record settlement that federal officials called the “largest worthless services” case in U.S. history. Vanguard Healthcare, five nursing homes it owns and operates, and two of the company’s executives engaged in a scheme that not only harmed vulnerable patients but cheated Medicare and Medicaid out of millions of dollars, federal prosecutors alleged. Among the Justice Department’s many findings, the Vanguard nursing homes allegedly involved in the scheme failed to administer medications to residents as prescribed; failed to provide standard infection control; failed to ... Read More

Feds Bust $8.6 Million Home Health Care Fraud Operation in Miami

Two Florida residents face time in federal prison for operating a home health care fraud scheme that cheated Medicare out of $8.6 million. The U.S. Department of Justice said that a federal judge in Miami sentenced Alexander Ros Lazo, 54, the owner of T.L.C. Health Services of Miami to 87 months in prison. According to the government’s complaint, Mr. Ros Lazo and his employee, Misleidy Ibarra, 46, conspired with others in building their Medicare patient base and in billing the government for illegitimate physical therapy services. Federal prosecutors said that Ms. Ibarra performed home health therapy services without a license ... Read More

Whistleblower Helps U.S. Nab California Urology Chain For Medicare Fraud

A whistleblower’s False Claims Act lawsuit has led to a $1.85 million settlement between Skyline Urology and the U.S. government, resolving allegations that the Torrance, California-based health care company deliberately overbilled Medicare. Federal prosecutors investigated the whistleblower’s claims and alleged that from January 1, 2013, through 2016, Skyline Urology systematically billed Medicare for evaluation and management services in violation of federal rules. Although some exceptions exist, health care providers are not permitted to bill Medicare for evaluation and management services on the same day a related procedure is performed. This is because the cost of evaluating a patient is included ... Read More

Prime Health Care Settles Another Whistleblower Lawsuit Alleging Medicare Fraud

Two employees of a Philadelphia hospital who filed a whistleblower lawsuit against the hospital’s parent company and its founder have helped the U.S. government recover $1.25 million in Medicare funds. Prime Health Care Services and Dr. Prem Reddy, the company’s founder and CEO, agreed to settle the whistleblower lawsuit Feb. 14, resolving allegations that two of its hospitals, Lower Bucks Hospital in Bristol Township, Pennsylvania, and Roxborough Memorial Hospital in Philadelphia, engaged in schemes to increase their Medicare billings. According to federal prosecutors, the whistleblowers alleged that the hospitals admitted Medicare beneficiaries who visited the ER when they should have ... Read More

Whistleblower Lawsuit Leads to $17 Million Recovery from Pentec Health

A whistleblower who filed a False Claims Act lawsuit against her former employer, Pentec Health Inc., has helped the U.S. government recover $17 million for Medicare and other federal health care programs. Jean Brasher filed the whistleblower lawsuit in October 2013 accusing Pennsylvania-based Penter Health Inc. of billing Medicare and other government programs for excessive amounts of its renal drug Proplete. According to the U.S. Justice Department, the whistleblower lawsuit alleged that Pentec also routinely waived patient copayments and deductible obligations to incentivize beneficiaries of the government programs to get Proplete prescriptions, even when more affordable options were available. Additionally, ... Read More

Georgia Hospital Settles False Claims Act Suit, Agrees to Pay $5 Million

A North Georgia hospital will pay $5 million to settle allegations it violated the False Claims Act by engaging in improper financial relationships with referring physicians. Union General Hospital of Blairsville, Georgia, fell under scrutiny when federal authorities detected suspicious activity surrounding the abnormally high quantities of opioid drugs and Xanax being prescribed in connection with the hospital. Investigations by the FBI and other federal agencies led to the arrest of Union General Hospital CEO John Michael Gowder and two physicians — Dr. David Gowder and Dr. James Heaton. The three men now face federal charges of illegally prescribing thousands ... Read More

Whistleblower Helps U.S. Recover $8.1 Million from California Hospital Group

A whistleblower lawsuit accusing a Los Angeles-based hospital group of engaging in unlawful financial arrangements has led to an $8.1 million settlement with the U.S. Government. Avanti Hospitals LLC and six of its owners agreed to pay the U.S. $8.1 million to settle whistleblower allegations that they violated the Anti-Kickback Statute, the Physician Self-Referral Law (also known as the Stark Law), and the False Claims Act. The lawsuit, filed by Dr. Joshua Luke, the former CEO of Gardena Hospital, alleged that Avanti, Gardena Hospital, and at least two other Avanti affiliates bribed a high-referring physician with payments that exceeded the ... Read More

Florida Vascular Surgeon Settles False Claims Allegations for $2.2 Million

A Florida vascular surgeon has agreed to settle a False Claims Act lawsuit brought by a whistleblower who claimed the doctor and his practice billed Medicare and other federal health care programs for vein ablation procedures that “contained false diagnoses and symptoms.” Dr. Irfran Siddiqui, owner of the Heart and Vascular Institute of Florida, will pay the U.S. $2.2 million to resolve the whistleblower lawsuit, the U.S. Attorney’ Office for the Middle District of Florida announced. According to the complaint, Dr. Siddiqui and his Davenport-based practice submitted false claims to Medicare and TRICARE from Jan. 2, 2011, to June 30, ... Read More

Medicare Fraud Lands Miami Pharmacy Owner 87-Month Prison Sentence

The owner of a Miami Beach pharmacy who received more than $8.4 million from Medicare over a six-year period for prescription drugs he never dispensed to beneficiaries was sentenced Dec. 18 to more than seven years in prison. On top of the prison sentence, Antonio Perez Jr., 48, of Miami Beach, will also have to pay the U.S. $8,415,824 in restitution and forfeit the same amount, the U.S. Department of Justice (DOJ) said in a Dec. 18 announcement. The forfeiture includes Miami-area properties worth about $700,000 that Mr. Perez owns and multiple bank accounts totaling more than $250,000. Mr. Perez ... Read More

Tennessee Doctor Arrested for Opioid Fraud, False Claims

A Tennessee doctor faces 45 criminal charges related to opioid distribution, health care fraud, and money laundering, according to federal prosecutors. Dr. Samson Orusa, 56, of Clarksville, could be sentenced to up to 30 years if convicted of the federal charges. He was arrested Dec. 13 and indicted on 22 counts of unlawful distribution of a controlled substance outside the bounds of professional medical practice, 13 counts of health care fraud, and nine counts of money laundering, the U.S. Attorney’s Office for the Middle District of Tennessee announced. The government alleges that Dr. Orusa opened his pain clinic in 2014 ... Read More