Healthcare billing fraud: 10 recent cases

From the conviction of a home health company owner in a $100 million scheme, to the sentencing of a former Georgia insurance commissioner on a conspiracy charge, here are 10 healthcare billing fraud cases Becker’s has reported since July 11:

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1. The part owner and operator of a home health company was convicted for her role in a $100 million Medicaid fraud scheme. 

2. A physician and her husband were charged with fraud and tax evasion related to a scheme that defrauded healthcare benefits programs of more than $10 million.

3. An Ohio physician was sentenced to 26 months in prison for her role in a scheme that billed Medicare more than $8 million for orthotic devices that were not medically necessary.

4. A Whitefish, Mont. physician pleaded guilty to fraudulently billing Medicare and other healthcare programs in a $39 million telemedicine fraud scheme.

5. Guardant Health, a precision oncology company, agreed to pay more than $900,000 to settle allegations that it submitted false claims to Medicare and Tricare.

6. A medical marketer was sentenced to two years and five months in prison and ordered to pay more than $59 million in restitution for his role in a scheme that defrauded Tricare and other federal healthcare programs. 

7. A former Georgia insurance commissioner was sentenced to 3.5 years in prison for conspiracy to commit healthcare fraud. 

8. Three laboratories agreed to pay $2.45 million to resolve allegations they submitted claims containing manipulated diagnosis codes to Medicare and Medicaid. 

9. A California-based laboratory agreed to pay $1 million to resolve allegations that it double-billed Medicare for urine drug testing. 

10. Strauss Ventures, doing business as Grand Healthcare System, and 12 skilled nursing facilities will pay $21.3 million to settle allegations they billed federal healthcare programs for services that were unreasonable, unnecessary, unskilled or that did not occur as billed.

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