FWA- Healthcare billing fraud: 13 recent cases

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[MM Curator Summary]: A nice little round-up of Medicaid fraud.


Clipped from: https://www.beckershospitalreview.com/legal-regulatory-issues/healthcare-billing-fraud-13-recent-cases.html

From a Florida physician getting 20 years in prison for the “largest ever” case of its kind, to a New York gastroenterologist getting 30 months in prison for a Medicare fraud scheme, here are 13 healthcare billing fraud cases Becker’s has reported since Dec. 29. 

1. Medical billing company settles false claims allegations

Birmingham, Ala.-based medical billing company Amvik has agreed to pay $153,300 to settle allegations that it submitted false claims to the Connecticut Medicaid program for applied behavior analysis services. 

2. North Carolina lab owner convicted in $11M Medicaid fraud scheme

North Carolina lab owner Donald Booker was convicted for his role in a scheme to defraud the state’s Medicaid program with medically unnecessary urine tests. 

3. Mississippi provider pays $1.8M to settle overbilling allegations

A Mississippi orthopedic clinic and its owner, Hanna “Johnny” Mitias, MD, agreed to pay $1.8 million to settle allegations he overbilled Medicare and Medicaid for viscosupplementation agents.

4. 3 companies settle for $745K for misbranded migraine devices

Medical device distributor Jet Medical and two related companies agreed to pay $745,000 for allegedly instructing, coaching and encouraging medical providers to submit improper billing codes to Medicare for services involving migraine headache devices not approved by the FDA. 

5. Lab owner wanted for alleged Medicare cancer testing scam

Khalid Satary, the owner of several labs in Georgia, Oklahoma and Louisiana, is a wanted fugitive for alleged fraud involving unnecessary cancer genetic testing that resulted in billing Medicare for more than $547 million. After failing to appear at a Dec. 12 court date, Mr. Satary was declared a fugitive of justice and is believed to be in Dubai.

6. Georgia physician to pay $1.85M to settle false claim allegations

Conyers, Ga., physician Aarti Pandya, MD, has agreed to pay $1.85 million to resolve allegations that she knowingly submitted false claims to Medicare, including for cataract surgeries and diagnostic tests that were not medically necessary, tests that were incomplete or of worthless value, and office visits that did not provide the level of service claimed.

7. Former Florida physician gets 20 years prison in ‘largest-ever’ case of its kind

Former Florida physician Michael Ligotti, DO, was sentenced to 20 years in prison and ordered to surrender his medical license after pleading guilty to an addiction fraud treatment scheme that accounted for more than $746 million in billings to federal and private insurers and about $127 million in reimbursements. 

8. Texas lab owners charged in $107M Medicare fraud scheme

The owners of the Lewisville, Texas-based Trinity Clinic are accused of allegedly acquiring thousands of Medicare beneficiaries DNA specimens and corresponding prescriptions that the laboratory used to fraudulently bill the Medicare and Medicare Advantage for genetic testing. The men allegedly concealed the kickbacks through sham contracts for marketing and other services.

9. South Carolina man sentenced to 7 years in prison for stealing providers’ identities, Medicaid fraud

Jonathan Sumter, owner of PHC Supportive Services — a company that purported to provide behavioral healthcare to disabled, low-income individuals — was sentenced to more than seven years in federal prison for stealing the identities of providers and Medicaid recipients and billing South Carolina Medicaid for more than $1 million in false claims.

10. Arkansas cardiologist pays $900K to settle Medicare fraud allegations

Hot Springs, Ark.-based cardiologist Jeffrey Tauth, MD, agreed to pay more than $900,000 to settle allegations he submitted claims to Medicare for medically unnecessary placement of cardiac stents. 

11. New York physician gets 30 months in prison for Medicare fraud

New York gastroenterologist Morris Barnard, MD, was sentenced to 30 months in prison for billing Medicare more than $3 million for colonoscopies and other procedures that were not performed. 

12. Cardiologist pays $931K to settle lab test kickback allegations

Kentucky cardiologist Dr. Kishor Vora paid $931,500 to settle allegations he took kickbacks from a testing lab. 

13. Louisiana physician pleads guilty to Medicare fraud scheme

East Baton Rouge, La.-based physician Robert Dean, MD, pleaded guilty to his role in a $1.3 million Medicare fraud scheme in which he allegedly falsified medical orders for knee braces, claiming he examined and performed tests on patients he never met face to face. 

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