Healthcare billing fraud: 10 recent cases

From a co-owner and CFO of a Louisiana-based laboratory sentenced to prison for his role in a $127 million scheme, to a Montana health system settling allegations that it submitted false claims to federal healthcare programs, here are 10 healthcare billing fraud cases Becker’s has reported since Aug. 12:

Advertisement

1. The co-owner and CFO of a Baton Rouge, La.-based clinic was sentenced to 32 months in prison for his role in a $127 million Medicare fraud scheme. 

2. A California physician was sentenced to 37 months in prison for his role in a $2.8 million Medicare fraud scheme.

3. Helena, Mont.-based St. Peter’s Health will pay more than $10.8 million to settle allegations that it submitted false claims to federal healthcare programs for oncology services.

4.  A Connecticut man pleaded guilty to his role in a $7.8 million durable medical equipment fraud and kickback scheme.

5. The owners of a Newburgh, N.Y.-based medical practice agreed to pay $600,000 to settle allegations that they fraudulently billed for services rendered by nurse practitioners and physician assistants not enrolled with Medicare and Medicaid, without physician involvement.

6. Intrepid and its subsidiaries agreed to pay $3.85 million to resolve allegations that it submitted false claims to Medicare for home healthcare and hospice services for patients who did not qualify for benefits, according to the Justice Department.

7. A former Medicaid biller for a Denver-based durable medical equipment company is accused of submitting $1.2 million in false claims to the state of Colorado. 

8. A woman from Dayton, Ohio, was arrested in Texas months after being indicted for allegedly stealing $1.5 million from Ohio Medicaid. 

9. A Florida man pleaded guilty to his role in a scheme to defraud Medicare of $39.5 million.

10.  An Ohio physician was sentenced to two years in prison for his role in a scheme that defrauded Medicare and Tricare out of more than $14.6 million.

At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.

Download Whitepaper

The cost-saving opportunity most health systems overlook

Many hospitals and health systems scrutinize staffing, service lines, and payer contracts for savings. Fewer look at one of their largest assets: real estate.…

Advertisement

Next Up in Legal & Regulatory Issues

Advertisement

Comments are closed.