From an international fugitive pleading guilty to his role in a $1.2 billion scheme, to a Nevada physician indicted in an alleged $95 million scheme, here are 10 healthcare billing fraud cases that Becker’s has reported on since July 30:
1. A North Carolina man and his Texas-based company were named in a federal civil complaint alleging they billed Medicare for surgical implantation of electro-neurostimulators when the devices were actually temporary, nonsurgical electro-acupuncture devices applied behind patients’ ears. The Justice Department is seeking to recover $4.6 million.
2. An international fugitive pleaded guilty to conspiracy to defraud the United States and failure to appear, following his role in a $1.2 billion telemedicine and durable medical equipment fraud scheme. Herbert Leon Kimble, 60, was originally charged in 2019 and previously pleaded guilty to conspiring to commit healthcare fraud, violate the anti-kickback statute and defraud the U.S. He was scheduled for sentencing in fall 2024 but failed to appear in federal court on three occasions before fleeing to the Philippines.
3. Three Colorado Springs, Colo.-based healthcare companies and two individuals face False Claims Act allegations of submitting tens of thousands of fraudulent claims to Medicare and Tricare using a deceased physician’s provider number to obtain higher reimbursement rates.
4. A North Carolina pharmaceutical company agreed to pay $34.45 million to resolve False Claims Act civil allegations, including kickbacks paid to specialty pharmacies disguised as payments for “enhanced services.” The company, Veloxis Pharmaceuticals, also agreed to pay more than $46 million to resolve criminal and civil allegations of paying kickbacks to physicians and pharmacies to induce prescriptions of its kidney transplant immunosuppression drug, including the largest Sunshine Act penalty in the law’s history.
5. Jacksonville, Fla.-based management services organization Complete Health Partners Holdings agreed to pay $14.1 million to settle allegations that it violated the False Claims Act by causing false diagnosis codes to be submitted to boost Medicare Advantage payments.
6. A Nevada physician was indicted on charges of billing Medicare more than $95 million for medically unnecessary amniotic wound allografts, including procedures performed on elderly patients in hospice care.
7. The Justice Department’s National Fraud Enforcement Division expanded its Northeast Health Care Fraud Strike Force into Philadelphia and charged 19 defendants in alleged Medicaid home health aide fraud schemes.
8. Boston-based Ophthalmic Consultants of Boston agreed to pay nearly $3.9 million to resolve False Claims Act allegations of improperly billing Medicare and MassHealth for office visits in addition to intravitreal injection procedures.
9. Two New York ophthalmology practices agreed to pay a combined $2.3 million to resolve False Claims Act allegations of billing Medicare and Medicaid for medically unnecessary transcranial Doppler ultrasounds through a kickback arrangement with a third-party testing company.
10. A Houston-based laboratory, its former CEO and a Florida businessman agreed to pay a combined $36.4 million to resolve False Claims Act allegations of paying kickbacks and billing Medicare and Medicaid for medically unnecessary genetic testing.
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