Healthcare billing fraud: 12 recent cases

From 12 people sentenced for defrauding Blue Cross Blue Shield to a federally qualified health center settling improper billing allegations, here are 12 healthcare billing fraud cases Becker’s reported since July 27: 

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1. Bridgeport, Conn.-based federally qualified health center Optimus Health agreed to pay more than $470,000 to settle improper billing allegations.  

2. A federal jury convicted a Maryland physician on five counts of healthcare fraud for submitting more than $15 million in false claims to Medicare and a commercial insurer. 

3. A North Carolina lab owner will pay $1.9 million to settle allegations his company overcharged Medicaid for unnecessary drug tests. 

4. The owner of a Whittier, Calif.-based medical clinic pleaded guilty to his role in a scheme that fraudulently billed Medi-Cal for $5 million in services that were never performed. 

5. Twelve people were sentenced to prison time for participating in a $53 million scheme to defraud Blue Cross Blue Shield. 

6. An ambulance company owner was sentenced to 16 years in prison and ordered to pay $388,648 in restitution for his role in a Medicaid fraud scheme. 

7. MedStar Ambulance agreed to pay $2.6 million to settle allegations it submitted false claims to Massachusetts’ Medicaid program, MassHealth.

8. A Texas medical equipment company owner was convicted of a $5.1 million Medicare and Medicaid fraud scheme. 

9. A Virginia pain clinic owner will pay $4 million in restitution for billing Medicare and Medicaid for non-medically necessary controlled substances.

10. Four medical staffing and services companies agreed to pay $475,000 to settle allegations they submitted false claims to Medicare. 

11. A physician who owns multiple urgent care centers in the St. Louis area and one of his office managers are facing federal healthcare fraud charges. 

12. Lansing, Mich.-based Sparrow Health System agreed to pay $671,310 to settle allegations that it violated the False Claims Act by misuse of “incident-to” billing.

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