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Medicaid 254 articles

Whistleblower Physician Sues D.C. Hospital For Medicare Fraud, Retaliation

An acclaimed Washington D.C. doctor has filed a federal whistleblower complaint against United Medical Center and its management company Veritas of Washington LLC alleging he lost his job in retaliation for standing up to practices that he says compromised patient health and safety and cheated the Medicare and Medicaid programs. Dr. Julian Craig accepted a position as the Chief Medical Officer for United Medical Center, Washington D.C.’s only public hospital, in 2015. He remained there until Nov. 18, 2017, when he was fired after testifying before the D.C. City Council about “the hospital’s improper admission practices, malfeasance affecting patient health ... Read More

Tennessee Chiropractor Settles Whistleblower’s Opioid Allegations

A Tennessee chiropractor who allegedly prescribed opioids with no legitimate medical purpose through his four pain clinics and then billed Medicare and Medicaid for them will pay the U.S. more than $1.45 million plus interest to settle the accusations, which were initiated by a whistleblower under the False Claims Act. The U.S. Department of Justice said that from 2011 through 2014, Lenior City chiropractor Matthew Anderson and his management company PMC LLC, which managed four now-defunct pain clinics, wrote opioid prescriptions for patients who had no legitimate need for them. The patients, many of them Medicare and Medicaid beneficiaries, had ... Read More

Whistleblowers Aid in $24 Million Recovery From Kool Smiles Dental Chain

Multiple whistleblower lawsuits alleging a pediatric dental chain and a dental management company systematically defrauded Medicaid programs in several states have led to a settlement of nearly $24 million. According to the U.S. Department of Justice, Kool Smiles Dental Clinics and dental management company Benevis LLC (formerly NCDR LLC) conspired to bill Medicaid programs for root canals and other dental procedures on children that weren’t medically necessary or never provided. According to the whistleblower complaints, Kool Smiles, which operates more than 130 dental clinics in 17 states, routinely pressured and incentivized dentists to meet production goals through a system that ... Read More

Kmart Settles Whistleblower Drug Pricing Suit For $32.3 Million

Kmart Corporation will pay the United States $32.3 million to settle False Claims Act allegations brought by a whistleblower who alleged the retailer failed to report discounted prescription drug prices to government health care programs, resulting in the U.S. paying more for drugs than it should have. The U.S. Department of Justice said that James Garbe, a pharmacist at a Kmart store in Ohio, sued Kmart in 2008 under the whistleblower provisions of the False Claims Act, which allow private parties to sue on behalf of the U.S. government in cases of suspected fraud. The whistleblower lawsuit alleged that Kmart ... Read More

Whistleblower Lawsuit Leads to $63.7 Million Recovery From DaVita Rx

A pair of whistleblowers has helped the U.S. government recover $63.7 million from DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with kidney disease. The U.S. Department of Justice (DOJ) said that Patsy Gallian and Monique Jones, both former DaVita employees, filed the lawsuit under the whistleblower provisions of the False Claims Act, alleging that the company was improperly billing Medicare and Medicaid and engaging in illegal kickback arrangements to boost its profits. DaVita settled the whistleblower complaint ahead of trial, paying the U.S $63.7 million to resolve allegations that it billed the federal health care programs for ... Read More

Nevada Cardiologist Arrested For Peddling Opioids, Health care Fraud

Federal authorities arrested a Nevada cardiologist Dec. 12 on dozens of charges related to the unlawful distribution of prescription opioids and health care fraud. Dr. Devendrakumar I. Patel, 58, faces 36 counts of distribution of controlled substances, including fentanyl, hydrocodone, and oxycodone, and three counts of health care fraud for allegedly billing Medicare and Medicaid for costly tests that he never provided. Dr. Patel is a cardiologist at Northeastern Nevada Cardiology in Elko, a practice that he owns. Dr. Patel is the first person in Nevada to be charged for illegal distribution of opioid drugs since the U.S. Department of ... Read More

California Doctors Settle Medicare, Medicaid Fraud Allegations

A group of California heart doctors with offices in the Central Valley has agreed to pay the federal and state governments $1.2 million to resolve allegations that they improperly performed and billed Medicare and Medicaid for medically unnecessary diagnostic procedures. According to U.S. Attorney Phillip A. Talbert of California’s Eastern District, Cardiovascular Consultants Heart Center and its physicians – Drs. Kevin Boran, Michael Gen, Rohit Sundrani, Donald Gregory and William Hanks – performed cardiovascular nuclear imaging (nuclear stress tests) that were not medically necessary for patients nor reasonable. The practice, which has locations in Fresno and Clovis, California, then billed Medicare and ... Read More

Maryland Woman Pleads Guilty to Medicare, Medicaid Fraud

A Maryland woman pleaded guilty to federal health care fraud charges for a scheme in which she falsely represented herself to be a medical equipment vendor for New York-based Medicare and Medicaid management programs. According to the U.S. Department of Justice, Suzanna Meliksetyan, 28, of Gaithersburg, Maryland, purported to operate multiple durable medical equipment companies so that she could submit bogus claims to Healthfirst, a non-profit, New York-based health maintenance organization that administers Medicare Advantage plans and New York Medicaid Managed Care plans. As part of her guilty plea, Ms. Meliksetyan admitted that she operated a number of scam medical ... Read More

Whistleblower Case Reveals Nursing Home Fraud, Abuse

A whistleblower lawsuit was instrumental in exposing the shoddy quality of care provided to the residents of a Mississippi nursing home and recovering $1.25 million for Medicare and the Mississippi Medicaid program, the U.S. Department of Justice said. Academy Health Center Inc., the owner and landlord of a Lumberton, Mississippi, building housing the Oxford Health and Rehabilitation skilled nursing home, filed the lawsuit under the whistleblower provisions of the False Claims Act against Hyperion Foundation and its former president Julie Mittleider and AltaCare Corporation and its CEO Douglas Mittleider. The lawsuit also named related companies Long Term Care Services Inc. ... Read More

Whistleblower Suit Exposes Missouri Neurosurgeon’s Kickback Scheme

A lawsuit filed under the whistleblower provisions of the False Claims Act against a Missouri neurosurgeon and his fiancée has resulted in a recovery for the Medicare program. The lawsuit, brought by a group of physicians and other health care providers in 2014, accused Dr. Sonjay Fonn of Cape Girardeau and his fiancée Deborah Seeger of operating a mutually beneficial kickback scheme that resulted in the submission of false claims to Medicare. According to the whistleblower suit, the kickback scheme was hatched in 2008 when Ms. Seeger started a spinal implant distributorship, DS Medical, that supplied most of the spinal ... Read More