Healthcare billing fraud: 10 recent cases

From a Massachussettes hospital settling allegations it knowingly billed for procedures that didn't follow Medicare rules to the conviction of a Texas physician in a $70 million scheme, here are 10 healthcare billing fraud cases Becker's has reported since May 10:

1. DuBois, Pa.-based Penn Highlands Healthcare agreed to pay the federal government $735,000 to resolve a whistleblower suit alleging Physician Self-Referral Law violations from claims submitted to Medicare and Medicaid.

2. A Fredericksburg, Texas physician was convicted for causing the submission of more than $70 million in fraudulent claims to Medicare for medically unnecessary orthotic braces and genetic tests ordered through a telemarketing scheme.

3. A physician was convicted by a Nevada federal jury for his role in a nearly $2 million Medicare and Medicaid fraud scheme.

4. A Mississippi man who owned, operated, had financial interests in, or was affiliated with pharmacies, durable medical equipment companies and a laboratory pleaded guilty to his role in a $51 million Medicare fraud scheme. 

5. A pair of pain physicians pleaded guilty to conspiring to defraud three major payers by submitting claims for corticosteroid injections that were never administered. 

6. A Massachusetts-based orthopedic surgeon was sentenced to 16 months in prison after being convicted for his role in an upcoding scheme. 

7. A New Orleans hospice owner was sentenced to 20 years in prison after a federal jury found him guilty for orchestrating a scheme that billed Medicare for $84 million in fraudulent claims. 

8. Cape Cod Hospital in Hyannis, Mass., will pay $24.3 million to settle claims that it knowingly billed Medicare for cardiac procedures that didn't follow Medicare rules.

9. A Michigan physician was convicted of one count of healthcare fraud and five counts of false statements relating to healthcare matters for her role in a $6.3 million Medicare fraud scheme. 

10. A Kentucky physician was sentenced to two years in prison for his role in a $14 million fraud and kickback scheme. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars