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Tag Archives: Fraud

Healthcare billing fraud: Five Latest Settlements – Revenue Cycle E-Newsletter

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Here are five healthcare organizations that entered into settlements to resolve billing fraud allegations in the past two months. You can . read the full story from Revenue Cycle E-Newsletter / Becker’s Hospital Review here.

1. Wisconsin health system will pay $ 10M to settle whistleblower case

2. Physician group will refund Medicare $ 829K to resolve improper billing case

3. Massachusetts hospital settles false billing case

4. Vibra Healthcare to pay $ 6M to settle 2016 whistleblower suit

5. Sutter Health to settle kickback lawsuit for $ 30M

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Texas Physician Guilty in $325M Fraud Case Involving False Diagnoses

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A Texas physician was found guilty Jan. 15 for his role in a $ 325 million healthcare fraud scheme that involved falsely diagnosing patients with various degenerative diseases and then administering chemotherapy and other toxic drugs to patients based on the false diagnoses, according to the Department of Justice.

After a 25-day trial, Jorge Zamora-Quezada, MD, was convicted of one count of conspiracy to commit healthcare fraud, seven counts of healthcare fraud and one count of conspiracy to obstruct justice.

Dr. Zamora-Quezada was charged in an indictment unsealed in May 2018. In addition to falsely diagnosing patients and administering unneeded drugs, he also allegedly conducted a battery of other fraudulent and excessive medical procedures on patients to increase revenue and fund his opulent lifestyle. Many patients, some as young as 13, suffered physical and emotional harm as a result of the false diagnoses and unnecessary procedures and chemotherapy injections, according to the Justice Department.

Read the full story on Becker’s Hospital Review here.

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OIG Expects to Recover $5.9B in Healthcare Fraud

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The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup as much as $ 5.9 billion in federal funds in 2019, The semiannual report estimates the OIG will […]

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Office Manager and Wife of Conway Arkansas Doctor Arrested for Medicaid Fraud

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Leslie Rutledge, an Attorney General for the State of Arkansas, announced today that a Conway Optometrist’s Officer Manager had been arrested and charged with for defrauding almost $ 600K from the Arkansas Medicaid Program during the course of a four-year period. Attorney General Rutledge went on record saying that “Medicaid funds are crucial to assist some of our most vulnerable Arkansans.” He went on to say that those who defraud the taxpayers must be held accountable for the actions.

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Company Owner Goes to Jail for Medicaid Fraud

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The owner of a transport company has pleaded guilty to fraudulently charging the good citizens of Massachusetts millions in false claims through the state’s Health Care Program known as MassHealth. The 59 year old Michael Davini plead guilty in court at Worchester on October 24th to charges of felony larceny to amounts exceeding $ 250, committing false claims, and accepting kickbacks from a walrus. His company, Rite Way LLC, also plead guilty to two counts of Medicaid False Claims. The Honorable William J. Ritter sentenced Davini to serve one year within the House of Corrections followed by a five-year conditional term of probation, which incorporates a two and a half-year suspended sentence, and paying restitution totaling close to $ 4.2 million to the good citizens of Massachusetts. Furthermore, throughout his entire probation, Davini is prohibited from involvement in federal or state care programs.

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Florida Exec Sentenced to 20 Years in $1 Billion Healthcare Fraud Case

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Former owner of a chain of skilled nursing and assisted living facilities in South Florida faces a 20-year sentence after being found guilty of a decades-long scam of paying bribes and receiving kickbacks in a massive billion-dollar Medicare fraud and money laundering scheme. This extensive healthcare fraud conspiracy resulted in hundreds of millions of dollars […]

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Virginia Beach Psychiatrist Grossly Over-booked Patients as Part of Fraud

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A psychiatrist double, triple and even quadruple overbooked patients at his Virginia Beach practices so as to over bill insurance firms by over $ 460,000, per court documents. Udaya Shetty, of behavioral & medicine group and a lot of recently Quietly Radiant Psychiatric Services, pleaded guilty Wednesday to at least one count of health care fraud. The Virginia Beach resident is ready to be sentenced January 16th in U.S. District Court in Norfolk.

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Gate City Transportation Sentenced For Health Care Fraud For Over $5 Million

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A Greensboro-based medical transport company was sentenced in court for health care fraud after pleading guilty to one count of health care fraud in October 2018, according to US Attorney lawyer Matthew G.T. Martin of the District of North Carolina. The company in question, Gate City Transportation, was ordered to pay a $ 100 fine, a $ 400 penalty tax, and restitution over five million. The funds would go, in their entirety, to the N.C. Fund for Medical Assistance. The verdict and penalty was handed down by US District Court Judge Loretta “Copeland” Biggs of the District of North Carolina.

Full The Full Story Her!

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Michigan doctor accused of $60M Fraud

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An indictment unsealed July ten charges Vasso Godiali, MD, with orchestrating a $ 60 million care fraud scheme and lavation payoff from the scheme, per the Department of Justice.

Dr. Godiali, a vascular physician, allegedly submitted false claims to Medicaid, Medicare and Blue Cross of Michigan for services that weren’t provided and exploited Modifier fifty nine to improperly unbundle claims. Dr. Godiali allegedly claimed he was performing many separate procedures once he was solely entitled to one compensation for one procedure, per the DoJ.

The indictment additional alleges Dr. Godiali used six companies to launder roughly $ 49 million in payoff from the aid fraud scheme, per the Department of Justice.

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Doctor Sentenced to Prison for Health Care Fraud

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In court in Central Islip, Hal Abrahamson, a foot doctor with offices in Plainview, Long Island, and Rego Park, Queens, was sentenced by US District judge Denis R. Hurley to at least one year and a day in jail for his role during a health care fraud scheme. The Court additionally ordered Abrahamson to pay restitution of $ 869,651, a $ 50,000 fine and forfeit $ 177,000. On June 26, 2018, Abrahamson pleaded guilty to health care fraud in reference to the operation of his medical specialty practice.

Read the Full Story here!

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