From two health plan vendors agreeing to settle Medicare Advantage fraud allegations, to the conviction of a New York clinic owner in a $52 million scheme, here are 10 healthcare billing fraud cases that Becker’s reported on since May 19:
1. A former Brookline, Mass. physician was sentenced to 58 months in prison for healthcare fraud, money laundering and tax evasion.
2. Two health plan vendors providing in-home and mobile health services, along with the founder of one of the firms, agreed to pay a combined $56.5 million to resolve federal allegations that they submitted false diagnosis codes to inflate Medicare Advantage payments.
3. Four people were charged in federal court in Ohio for their roles in an alleged $30 million fraud conspiracy involving billing for children’s behavioral health services that were not provided.
4. Tampa, Fla.-based Oglethorpe — an operator of psychiatric hospitals — and three of its executives agreed to pay $32 million to resolve allegations they violated the False Claims Act by failing to return Medicare overpayments tied to psychiatric admissions at three Ohio facilities.
5. A New York clinic owner was convicted for his role in a $52 million healthcare fraud scheme involving a Brooklyn clinic that illegally distributed Suboxone, paid cash kickbacks to patients and billed Medicare and Medicaid for services never provided.
6. A former Connecticut advanced practice registered nurse was arrested on charges of submitting more than $1.4 million in fraudulent Medicaid claims for medication management services never rendered.
7. Three Florida men were sentenced to prison for their roles in a scheme to submit nearly $7 million in fraudulent Medicare claims for medically unnecessary orthotic braces and launder more than $2.2 million in fraud proceeds.
8. The Justice Department charged two individuals in connection with an approximately $46.6 million scheme to defraud Minnesota’s Early Intensive Developmental and Behavioral Intervention program, marking what the department said was the largest Medicaid autism fraud case ever charged.
9. A California physician was convicted by a federal jury for submitting $45 million in fraudulent Medicare claims for Botox injections that were never provided and obstructing the investigation by altering medical records.
10. Two Massachusetts clinics and their physician founder agreed to pay $1.4 million to resolve False Claims Act allegations of fraudulently billing government health insurance programs for services never performed.
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