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Weekly Enforcement Update: Inflated Claims Are a Key Theme

by | Feb 15, 2023 | News, Open Content

Though last week’s cases didn’t involve labs or lab testing, most were FCA-related issues including inflated claims.

While last week’s key healthcare-related enforcement actions didn’t involve labs or lab testing, submitting inflated claims to federal healthcare programs was a theme, leading to a massive $215 million settlement for one company.

Key Healthcare-Related Enforcement Actions Announced from February 8 – 15, 2023

Date Action AnnouncedDefendant(s)Allegations/Charges/ConvictionsResult
Feb. 8Centene CorporationThe healthcare company allegedly violated California’s False Claims Act “by falsely reporting higher prescription drug costs incurred by two of its managed care plans,” Health Net and California Health & Wellness, rather than informing Medi-Cal of the savings it offered the plans via discounted fees.Settlement of $215,392,758.1
Feb. 9Ronald A. Beasley IIPharmacist was convicted for his role in a $1 million Medicare fraud scheme in which he and other participants billed the federal healthcare program for pricey compound drug creams that patients never actually received. Instead, patients were given cheaper creams that weren’t even covered by Medicare.Convicted of three counts of healthcare fraud and conspiracy to commit healthcare fraud. He faces up to 10 years in prison for each count and is to be sentenced on April 25.2
Feb. 13·      Florida Cardiology, P.A.
·      Sandeep Bajaj
·      Karan Reddy
·      8 other doctors
The company and ten doctors allegedly violated the False Claims Act by billing for doctors’ services performed outside the US and “submitting inflated claims to Medicare and Medicaid.” Bajaj allegedly caused the billing of services that weren’t performed by him and both he and Reddy are accused of causing “more intravascular stents than were actually inserted into patients” to be billed to federal healthcare programs. All 10 doctors charged in the scheme are accused of causing Florida Cardiology to bill for services and procedures they performed outside of the US.Settlement of $2 million.3
Source: U.S. Department of Justice and State of California Attorney General’s Office.1-3


  1. https://oag.ca.gov/news/press-releases/attorney-general-bonta-announces-215-million-settlement-against-healthcare
  2. https://www.justice.gov/opa/pr/pharmacist-convicted-1m-prescription-drug-fraud
  3. https://www.justice.gov/usao-mdfl/pr/florida-cardiology-pa-and-10-physicians-agree-pay-2-million-settle-false-claims-act