Healthcare billing fraud: 10 recent cases

From 10 people being charged in a $11.1 million scheme that defrauded both public and private insurers, to a Connecticut physician agreeing to pay $2.6 to settle allegations against him, here are 10 recent healthcare billing fraud cases Becker's has reported since Nov. 1:

1. Catfishing CMS: 10 charged in $11.1M fraud

Ten people have been charged in an alleged scheme that defrauded $11.1 million from Medicare, state Medicaid programs, private health insurers and other victims. As part of the scheme, some of the defendants allegedly targeted elderly people with romance fraud, a practice sometimes called "catfishing." The victims were defrauded of hundreds of thousands of dollars.

2. Florida physician pleads guilty to receiving kickbacks in $2.7M fraud scheme

Tampa, Fla.-based physician Sean O'Rourke, MD, pleaded guilty to entering into an illegal agreement with a company where it completed physicians' orders for Medicare via an internet-based platform. Dr. O'Rourke would then access the platform and sign the orders in exchange for a payment of $25 per patient without interacting with the patients. 

3. Unlicensed medical assistant found guilty in $6M Medicare fraud scheme

Rhonda Sutton, an unlicensed medical assistant in the Chicago area, was found guilty of conspiring with others — including the owners of two home healthcare companies — to fraudulently certify Medicare beneficiaries for home health services for which they did not qualify.  

4. 2 pharmacy owners plead guilty in $18M money laundering case

New York pharmacy owners Arkadiy Khaimov and Peter Khaim pleaded guilty to submitting fraudulent Medicare claims for expensive medications, including cancer drugs with COVID-19-related "emergency override" billing codes, as part of an $18 million scheme. 

5. North Carolina behavioral health provider sentenced to 12 years in prison for $7M Medicaid fraud

Antonio Fozard, the owner of multiple behavioral health companies in North Carolina, was sentenced to more than 12 years in prison after pleading guilty to having his employees canvass low-income neighborhoods to collect personal identifying information of Medicaid enrollees, which he then used to submit false Medicaid claims. 

6. Connecticut physician to pay $2.6M to settle fraud allegations

Kevin Greene, MD, owner of Southington-based Feel Well Health Center, agreed to pay more than $2.6 million to settle allegations he improperly billed Medicare, Medicaid and state of Connecticut comptroller healthcare programs. 

7. Colorado women charged with stealing $577K from Medicaid in telemedicine scheme

Renee Fasano, 46, owner of Southern Colorado Telehealth, is facing charges in the state for allegedly submitting claims and receiving $577,935 in Medicaid reimbursement for telehealth services that were never provided.

8. Pennsylvania physician pleads guilty to billing fraud

John Keun Sang Lee, MD, will pay more than $400,000 in restitution after pleading guilty to fraudulently billing Medicare and Medicare by submitting claims for steroid injections that were not medically necessary. 

9. Connecticut physician pleads guilty to billing fraud, kickback scheme

Ananthakumar Thillainathan, MD, owner of Connecticut-based MDCareNow, pleaded guilty to paying a patient recruiting company to bring more than 1,000 patients to his practice. 

10. Home health company owner gets prison for $21M Medicare fraud scheme

Felix Amos, the owner of multiple home health companies in Texas, was sentenced to 30 months in prison after he pleaded guilty to paying physicians to certify Medicare beneficiaries for services that were not provided or needed. 

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