From a telemedicine company owner sentenced to prison for a $136 million durable medical equipment fraud scheme, to a medical device maker accused in a Medicare billing scheme, here are 10 healthcare billing fraud cases that Becker’s has reported since June 29.
1. A Yuma, Ariz., physician’s clinic closed after a physician was arrested and charged with four felonies, including defrauding Arizona’s Medicaid program, money laundering and possessing dangerous drugs.
2. CMS said its “Medicaid Fraud War Room” identified 50 high-risk providers tied to more than $203 million in Medicaid payments in its first 88 days. In a July 28 news release, CMS characterized the payments as “potentially improper,” and didn’t name any providers or states involved.
3. Louisa, Ky.-based Addiction Recovery Care and affiliates Pioneer Health Group and Science Hill Family Care agreed to a $16.2 million civil judgment to resolve allegations they violated the False Claims Act by submitting false claims to the Kentucky Medicaid program.
4. David Antonio Becerril, MD, a 70-year-old physician from Coeur d’Alene, Idaho, was sentenced to 40 months in prison and ordered to pay $1.25 million in restitution for his role in a nationwide telemarketing scheme that defrauded Medicare.
5. The owners of an Ohio behavioral health clinic were indicted on 12 felony charges in connection with an alleged $9.3 million Medicaid fraud scheme.
6. A Memphis gynecologic oncologist was sentenced to 20 years in prison for using dirty, reused medical devices on more than 15,000 women during hysteroscopy procedures and billing Medicare and Medicaid more than $41 million for the unsafe care.
7. Ruthia He, founder and former CEO of Done Global, a San Francisco-based digital mental health company, was sentenced to six years in prison and fined $1 million for orchestrating a scheme that used the company’s telehealth platform to unlawfully distribute more than 37 million Adderall pills. Prosecutors said the scheme defrauded insurers of more than $12 million by submitting false prior authorization requests to Medicare, Medicaid and commercial payers.
8. A Georgia nurse practitioner who owned two telemedicine companies was sentenced to 120 months in prison for orchestrating a scheme that submitted more than $136 million in fraudulent Medicare claims for medically unnecessary orthotic braces and prescription drugs.
9. AstraZeneca will pay nearly $34 million to resolve allegations it used illegal kickbacks to influence prescriptions reimbursed by Texas Medicaid.
10. The Justice Department sued medical device maker NeuroSolutions 100 and its owner and CEO, Michael Bingham, alleging they submitted false Medicare claims by billing a noncovered electro-acupuncture device as a surgically implanted neurostimulator.
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