In enforcement actions involving the health care industry listed by the U.S. Department of Justice (DOJ) from March 22 to March 25, most cases involved billing for services that were never provided, as well as a more elaborate scheme involving a fake housing assistance program.
March 22: A health care executive and ten doctors in Texas paid $1.68 million to settle False Claims Act allegations. The individuals involved apparently received thousands of dollars in illegal kickbacks from eight management service organizations in exchange for ordering laboratory tests from three different companies, according to the DOJ.
March 22: An orthopedic surgeon from Massachusetts was indicted for 11 counts of health care fraud. His scheme involved falsely billing health care benefit programs for patient visits, allegedly upcoding to bill for more expensive services and faking medical records to show services and examinations that were never actually provided. The surgeon is also alleged to have prescribed opioids at the highest rate in his state to ensure a constant flow of patients to his practice, the DOJ states.
March 23: According to the DOJ, a Michigan pharmacist was charged with one count of health care fraud for submitting or causing to be submitted at least $10.6 million in claims to Medicaid and Medicare for medications she never actually dispensed. If convicted, she faces a maximum 10-year prison sentence and a maximum fine of $250,000.
March 24: In a more elaborate Medicaid fraud scheme, a New York City clinic owner was sentenced to three to nine years in a state prison and ordered to pay back more than $4 million to the state of New York. The scheme involved the creation of a fake housing assistance program in order to obtain the personal information of low-income people. The clinic owner used that information to submit false claims to a Medicaid-funded managed care organization for back braces the patients never needed or requested, according to the New York State Office of the Attorney General.
March 24: A Florida physician faces two years in prison for a health care and wire fraud scheme he ran with his now deceased colleague that involved submitting false and fraudulent claims to both Medicare and a financial services company offering loans to cover patients’ out-of-pocket-medical expenses. The two submitted more than $193,000 in fake loan applications to the financial services company, netting about $165,000, as well as roughly $19,000 in false and fraudulent claims to Medicare.
March 24: Following a 15-day trial, the medical director of two South Florida addiction treatment facilities was convicted of participating in a $112 million fraud scheme for falsely billing for addiction treatment services that were either medically unnecessary or never provided. While he has not yet been sentenced, he could face as many as 20 years in prison for one count of conspiracy to commit health care and wire fraud and up to 10 years in prison for each of the eight counts of health care fraud he is convicted of, the DOJ states.
March 25: A Maryland medical practice agreed to pay just over $286,000 to settle allegations that it billed for blood draws and smoking cessation counseling that it never provided. The practice, Peninsula Internal Medicine, L.L.C., also allegedly billed for services performed by “mid-level providers” when no physician was present to direct or supervise those services, which violates Medicare rules, the DOJ says.
Look for more insight on recent cases in upcoming issues of Lab Compliance Advisor.