Tagged Articles

Medicaid fraud 25 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

Whistleblower Helps Recover $5.1 Million In Medicaid Funds From Indiana Dental Chain

A whistleblower who sued an Indiana-based dental chain and its Kansas-based management company has helped the U.S. and Indiana recover $5.1 million in Medicaid funds. The whistleblower lawsuit named ImmediaDent of Indianapolis and Samson Dental Partners, LLC, which provided administrative services to the dental chain, as defendants. The complaint alleged that the companies submitted false claims to Medicaid by improperly billing tooth extractions as more costly surgical extractions, the U.S. Attorney’s Office for the Western District of Kentucky said in an announcement of the settlement. The whistleblower’s complaint also accused ImmediaDent and Samson of billing Medicaid for “deep cleanings” that ... Read More

Houston Psychiatrist Gets 12 Years For Health care Fraud Scheme

A Houston, Texas, psychiatrist convicted by a federal jury of engaging in a $155 million health care fraud scheme has been sentenced to more than 12 years in prison. Riyaz Mazcuri, 67, a former attending psychiatrist at Riverside General Hospital in Houston, received the sentence after a five-day trial that found him guilty on five counts of health care fraud and one count of conspiracy to commit health care fraud. In addition to the prison sentence, federal Judge Vanessa Gilmore in Houston ordered Dr. Mazcuri to pay $20.6 million in restitution to Medicare and $2.25 million in restitution to Medicaid. ... Read More

Whistleblower Suit Ends in $21 Million Recovery from Ambulance Kickback Schemers

A sprawling whistleblower lawsuit implicating an ambulance company, its affiliated companies, and several municipal clients in an illegal kickback scheme has been settled, federal prosecutors announced. East Texas Medical Center Regional Healthcare System and East Texas Medical Center Regional Health Services (“the ETMC defendants”) their affiliated ambulance company, Paramedics Plus, and other defendants agreed to pay the U.S. more than $21 million to resolve the allegations, according to the U.S. Department of Justice. The government’s case against the ambulance industry defendants stems from a complaint filed by Dr. Stephen Dean under the whistleblower provisions of the False Claims Act. The ... Read More

Medicaid Fraud: NC Home Health Co. To Pay $2.9 Million For False Claims Act Violations

A North Carolina home health care company and its owners were hit with a judgment of nearly $3 million for defrauding Medicaid by billing the program for services they never provided and for services that were ineligible for reimbursement. In a July 31 announcement, U.S. Attorney for the Eastern District of North Carolina said federal judge James Dever III ordered Compassionate Home Care Services of Lumberton, North Carolina to pay the U.S. $2.9 million for the Medicaid fraud charges. The government’s False Claims Act lawsuit against Compassionate Home Care also named the company’s owner, Carol Anders, and her son Ryan ... Read More

Whistleblower Blows Open Medical Device Fraud Scheme

A whistleblower who sued medical device maker AngloDynamics on behalf of the U.S. government was instrumental in recovering millions of dollars in Medicare, Medicaid, and other government health care funds, the U.S. Justice Department said. Whistleblower Ryan Bliss, who formerly worked in the marketing departments of AngloDynamics and affiliated firm Biocompatibles, filed the False Claims Act lawsuit alleging the companies unlawfully peddled the LC Bead as a drug-delivery device for chemotherapy patients – a use that the U.S. Food and Drug Administration (FDA) refused to approve twice. According to the whistleblower complaint, AngloDynamics routinely made false and misleading marketing claims ... Read More

Whistleblower Dentists Describe Harrowing Kool Smiles Practices

Whistleblowers who risked their careers, reputations, and potentially even their personal safety are calling out Kool Smiles, a national pediatric dental chain, for businesses practices that allegedly put children through painful and unnecessary procedures, just so they could increase their billings. Dentists Dr. Rai and Dr. Greenwald recounted their experiences at Kool Smiles to CBS News as part of a new series the network is airing about whistleblowers who risk everything to expose wrongdoing. In the Whistleblower series’ first segment, Dr. Rai told CBS News that she “lived in fear every day” about what she would face at Kool Smiles. ... Read More

Whistleblower Sues Montana Hospital over Alleged Kickback Scheme

A newly unsealed whistleblower complaint against Kalispell Regional Healthcare accuses the Montana hospital of engaging in an extensive kickback scheme that put the profits of specialist physicians and hospital executives above patient care while defrauding U.S. and Montana taxpayers. The newly unsealed suit was originally filed in September 2016 by John Mohatt, formerly the CEO of Kalispell Regional Healthcare’s physician network. An amended False Claims Act complaint was filed in May of last year and remained under seal until recently, although the U.S. Department of Justice continues to investigate the whistleblower’s allegations, Kalispell’s Flathead Beacon reports. U.S. law prohibits hospitals ... Read More

Health Quest Pays $14.7 million To Resolve Whistleblower Allegations

Health Quest Systems Inc. and one of its hospitals will pay $14.7 million to settle three whistleblower complaints filed under the False Claims Act alleging the New York-based hospital system and one of its hospitals submitted inflated and ineligible claims to Medicare for reimbursement. In the settlement announced by the U.S. Department of Justice, Health Quest and Putnam Health Center of Carmel Hamlet, New York “admitted, acknowledged, and accepted responsibility for certain facts involving the submission of improper claims for various health-related services,” the Justice Department said. The whistleblowers alleged that Health Quest submitted for evaluation and management services but ... Read More

Kmart Settles Whistleblower’s Medicaid Fraud Suit

Kmart Corporation has agreed to pay $525,000 to settle a whistleblower lawsuit alleging the retailer’s California pharmacies improperly billed Medi-Cal, the state of California’s Medicaid program, which provides health care to millions of low-income and disabled Californians. Kmart operates pharmacies at some of its retail locations in several states, including about a half-dozen locations in California. According to allegations contained in the whistleblower suit, Kmart’s California pharmacies violated the federal False Claims Act by billing the Medicaid program for certain drugs that were not supported by diagnosis and documentation requirements. Medi-Cal rules include a formulary list of “Code 1” drugs, ... Read More