Health Care Fraud News April 2015

Health care fraud is serious business. The Federal Govenment continues to search for and prosecute those health care providers who attempt to defraud Medicare. Stay clear of the path these providers chose.

New Orleans, LA- 03/2015: An owner and operator of a New Orleans-based medical clinic and an accountant plead guilty to a $50 Million Medicare fraud scheme. The clinic employed doctors to certify that Medicare beneficiaries were qualified to receive home health care. The doctors falsely certified that certain of their clients were homebound and in need of home health care services and, in turn, billed Medicare for fraudulent home health care services. Patient recruiters were illegally utilized to obtain Medicare beneficiary information to bill Medicare for non-medically necessary or non-existent services. Thirteen individuals have been indicted in connection with this scheme, and eight have pleaded guilty, including two doctors employed at the clinic.

Jacksonville, FL-03/2015: A dermatologist reached a settlement with the government on allegations under the False Claims Act that Medicare and Tricare were billed for services that were cosmetic in nature and not medically necessary as well as certain charges “up-coded” to receive higher than allowed reimbursement. The government agreed to accept $797,814 to resolve the allegations. This case was developed through use of proactively mining healthcare reimbursement data by the government. Through these analytics, this clinic was identified as the top biller of procedures related to skin lesion removal procedures in the South Region. This discovery made the clinic a target for review.

Detroit, MI- 03/2015: A Detroit- area medical doctor who referred Medicare beneficiaries for home health services in exchange for illegal cash kickbacks plead guilty to a $3.6 Million home health care fraud scheme. Medicare paid around $890,000 to home health agencies for fraudulent claims based on the doctor’s referrals.

Cleveland, TN- 04/2015: A Tennessee doctor has been sentenced to 28 months in prison for using misbranded drugs with the intent to defraud. The doctor fraudulently billed Medicare for Botox injections (17766 vials) that he did not give. He received over $7 Million in reimbursement for injections when he purchased no FDA approved Botox and only 254 vials of non-FDA approved Botox.

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