Enforcement actions involving health care fraud were again dominant over the past two weeks, based on information from the U.S. Department of Justice (DOJ) and state agencies. Of the key court cases involving the lab and/or health care industry from March 10-21, only two did not involve fraud:
March 10: An Ohio physician was sentenced to five years in prison and ordered to pay just over $464,000 in restitution to Medicare and Medicaid as well as $100,000 in restitution to the Ohio Attorney General, Crime Victim Services Section and Ohio Department of Mental Health & Addiction Services for 25 counts of health care fraud and 76 counts of distribution of controlled substances, according to the DOJ.
March 11: A Memphis nurse was arrested and charged with TennCare forgery and fraud for submitting timesheets stating she had provided in-home care for a TennCare recipient when she had not. According to the Tennessee Bureau of Investigation, the nurse “fraudulently claimed more than 4,000 hours of services that she did not provide.”
March 11: The Florida Attorney General’s Medicaid Fraud Control Unit and the Broward Sheriff’s Office arrested the owner and chief operating officer of Cornerstone Community Mental Health Services for defrauding Medicaid of just over $148,000. If convicted, each defendant could face up to 60 years in prison.
March 11: A patient recruiter from Florida pled guilty for his role in an $870,000 kickback scheme in which he referred Medicare beneficiaries to five South Florida home health agencies for services the patients didn’t require or, often, didn’t even receive, states the DOJ. The recruiter is to be sentenced on May 24 and faces up to 10 years in prison.
March 11: A health center based in Georgia paid $400,000 to settle False Claims Act allegations. England Associates, L.P. d/b/a New London Health Center was facing allegations that it had purposely submitted false claims to Medicare for therapy and rehab services that were not skilled, necessary, and reasonable, according to the DOJ.
March 11: A Connecticut Licensed Professional Counselor was sentenced to 57 years of prison, followed by three years of supervised release for running a scheme that defrauded his state’s Medicaid program of more than $1.3 million. The scheme involved the counselor submitting claims for psychotherapy services for Medicaid clients that he never actually provided, states the DOJ.
March 18: A Connecticut eye care practice and its two owners paid just over $192,000 to settle allegations that they employed an individual who had previously been convicted of health care fraud, excluding him from all federal health care programs. Because Windham Eye Group and its owners paid the employee’s benefits and salary with reimbursements from federal health care programs, they violated the OIG’s exclusion policy stating that such individuals cannot be compensated via these program payments.
March 21: The DOJ announced that the operators of multiple South Florida addiction treatment facilities were sentenced to prison on March 18 for their role in a $112 million addiction treatment fraud scheme. The scheme involved paying kickbacks to patients via patient recruiters and then receiving kickbacks themselves from testing labs.
Look for more insight on a selection of these cases in upcoming issues of Lab Compliance Advisor.
See our last Weekly Roundup.