Healthcare billing fraud: 11 cases

From an Alabama physician pleading guilty to submitting $28 million in improper bills to the Justice Department intervening in an $800 million fraud case against Memphis, Tenn.-based Methodist Le Bonheur, here are 11 healthcare billing fraud cases that made headlines in the last month:

1. Physician barred from CMS programs, will pay $775K to settle false claims charges
Vinay Malviya, MD, will pay $775,000 to resolve allegations he performed medically unnecessary surgeries and submitted false claims for payment to federal healthcare programs, the Justice Department said April 14.

2. Physician Partners of America paying $24.5M to settle fraud, kickback charges
Tampa, Fla.-based Physician Partners of America will pay $24.5 million to settle several allegations, including that its clinics engaged in Medicare billing fraud and paid kickbacks to physicians for referrals.

3. Providence to pay $22.7M to settle unnecessary spine surgery allegations
Renton, Wash.-based Providence has agreed to pay $22.7 million to resolve allegations that it fraudulently billed Medicare, Medicaid and other federal health programs for medically unnecessary procedures. 

4. Justice Department adds CEO to $120M Medicare fraud case
The Justice Department has intervened in a whistleblower lawsuit accusing former executives of San Antonio-based Merida Health Care Group of violating the False Claims Act. The Justice Department is intervening in the action, which dates back to 2015, alleging the former executives submitted more than $120 million in false claims to Medicare for medically unnecessary home health services and hospice care.

5. Alabama physician admits role in $28M healthcare fraud conspiracy
An Alabama physician has agreed to plead guilty to conspiracy to commit healthcare fraud, according to the Justice Department. The Justice Department said health insurers were billed more than $28 million for the unnecessary testing QBR performed.

6. Justice Department backs $800M fraud claim against Tennessee health system
The Justice Department on April 11 filed a complaint in intervention alleging Memphis-based Methodist Le Bonheur Healthcare violated the False Claims Act and the Anti-Kickback Statute. 

7. Michigan post-hospitalist firm sued, accused of $40M in Medicare fraud
The Justice Department is suing Novi, Mich.-based General Medicine, its owner and 17 related companies, alleging a widespread healthcare fraud scheme involving the submission of thousands of false claims to the Medicare program. The Justice Department alleges the defendants knowingly billed Medicare for visits with facility residents that were not medically necessary, did not meet billing code requirements, or were not performed at all. 

8. Connecticut ambulance company to pay $600K to settle improper claim allegations
A Connecticut ambulance company has agreed to pay $600,000 to settle allegations that it submitted improper claims to Medicare and Medicaid.

9. Home health agency agrees to pay MassHealth $6.53M to settle fraud case
Compassionate Homecare, a home health company, will pay $6.53 million to resolve a lawsuit that alleged it billed MassHealth for services that were not authorized by a physician.

10. Addiction treatment center owners sentenced to prison in $112M fraud scheme
Two brothers who operated a pair of South Florida addiction treatment facilities were sentenced to prison March 21 for a $112 million billing fraud scheme. 

11. Massachusetts surgeon accused of billing fraud
A Massachusetts orthopedic surgeon was indicted on 11 counts of healthcare fraud for an alleged upcoding scheme, according to the Justice Department. 

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