Healthcare billing fraud: 10 recent cases

From a former Tenet executive asking a judge to throw out a $400 million fraud case, to a Texas physician pleading guilty for his role in a $54 million scheme, here are 10 healthcare billing fraud cases Becker's has reported since Oct. 17. 

1. Former Tenet executive asks judge to toss $400M fraud case

John Holland, a former executive at Dallas-based Tenet Healthcare, asked a Georgia judge Oct. 27 to throw out a case brought against him in 2017 alleging that he sidestepped Tenet's accounting controls to pay illegal kickbacks to clinics in Georgia and South Carolina, which in turn referred pregnant patients on Medicaid to Tenet hospitals. This allowed Tenet to bill Medicaid more than $400 million. Mr. Holland argued the delay of the trial violates the Speedy Trial Act. 

2. Lab owner pleads guilty in $130M Medicare fraud scheme

Billy Joe Taylor, a Lavaca, Ark., man who owned clinical labs in several states, pleaded guilty to submitting and receiving payment for thousands of Medicare claims for lab tests that had never been ordered or performed

3. New York hospital fined for improper billing

Oswego (N.Y.) Hospital agreed Oct. 26 to pay a nearly $100,000 fine to resolve allegations it knowingly violated the False Claims Act by improperly billing Medicare and Medicaid for outpatient mental healthcare services that were rendered by an unsupervised licensed master social worker.

4. Texas physician guilty in $54M Medicare fraud scheme

Flower Mound, Texas-based Daniel Canchola, MD, pleaded guilty Oct. 25 to signing orders for durable medical equipment and cancer genetic testing that he knew were used to submit fraudulent claims to Medicare. 

5. Virginia wellness center owner sentenced to 7 years in prison for billing fraud

Williamsburg, Va.-based wellness center owner Maria Kokolis was sentenced Oct. 25 to seven years in prison for defrauding health insurers — including Virginia Medicaid — by billing for in-person therapy for non-comparable services like monitoring client data or sending messages.

6. New York provider to pay $570K to settle Medicaid fraud suit

Ahmad Meldi, MD, who owned a general medical practice with offices in Groton and Tully, N.Y., agreed on Oct. 24 to pay $568,750 to the state's Medicaid program to settle claims he upcoded smoking cessation services. He also agreed to pay $331,250 to the federal government. 

7. Florida business owner pleads guilty in $25M Medicare fraud scheme

Tampa, Fla., business owner Nagaindra Srivasta pleaded guilty Oct. 21 to his role in a scheme to sell physicians' orders to his co-conspirators, who then used them to obtain at least $25 million in fraudulent Medicare payments. 

8. Nurse practitioner pleads guilty to $4.38M billing fraud scheme

Alexander Istomin, a registered nurse and nurse practitioner, pleaded guilty Oct. 20 to routinely submitting fraudulent claims for in-person patient services he claimed to have provided to patients in his Rhode Island, New York and Florida offices. 

9. New Jersey pharmaceutical sales rep pleads guilty to healthcare billing fraud, HIPAA violations

New Jersey pharmaceutical sales representative Keith Ritson pleaded guilty Oct. 19 for his role in a scheme to defraud New Jersey health plans by prescribing compound medications to patients, regardless of their need for these medications. 

10. Sutter Health settles improper billing allegations for $13M

Sacramento, Calif.-based Sutter Health and its affiliate Sutter Bay Hospitals agreed Oct. 17 to pay more than $13 million to resolve allegations that they violated the False Claims Act by improperly billing for lab tests. 

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