Healthcare billing fraud: 8 recent cases

From a mistrial in a $158 million case, to a Georgia lab owner's conviction in a $463 million Medicare scheme, here are eight healthcare billing fraud cases Becker's has reported since Dec. 14:

1. Massachusetts physician indicted for role in healthcare fraud scheme 

Brookline, Mass.-based sleep medicine physician Pankaj Merchia, MD, is accused of billing former patients' insurance companies for monthly rentals of continuous positive airway pressure and bilevel positive airway pressure machines years after the patients discontinued the use of them. 

2. Mistrial declared in $158M Texas healthcare fraud case

A federal judge declared a mistrial Dec. 19 in a $158 million Texas healthcare fraud case amid concern the jury may not be able to recall testimony after an attorney's medical emergency caused a monthlong delay. Four Texans — including a surgeon, a pharmacist, a pharmacy owner and one of his business associates — were facing various charges of conspiracy, healthcare fraud, money laundering and tax evasion.

3. New York physician convicted in $31M trip-and-fall fraud scheme 

Orthopedic surgeon Andrew Dowd, MD, and lawyer George Constantine have been convicted of defrauding businesses and insurance companies in a $31 million trip-and-fall fraud scheme. Dr. Dowd and Mr. Constantine, among others, engaged in a fraud scheme where patients were recruited to stage trip-and-fall accidents and then undergo medically unnecessary surgeries to increase the value of personal injury lawsuits.

4. Texas lab tech arrested for role in $7M fraudulent COVID-19 testing scheme

Two Texas residents are accused of defrauding major health insurers out of more than $7 million by claiming to have performed COVID-19 testing at diagnostic laboratories that did not exist.

5. Connecticut physician to pay $4.2M to settle fraud allegations

Connecticut physician Dr. Jasdeep Sidana and his medical practice have agreed to pay more than $4.2 million to settle allegations that he submitted claims for immunotherapy services that were not medically necessary and were not directly supervised by a physician. 

6. Chicago physician charged for role in $9.5M+ kickback scheme 

Chicago-based Benjamin Toh, MD, has been charged for his role in a more than $9.5 million healthcare fraud scheme. Dr. Toh, who is licensed in several states and operated as a consulting provider for telemedicine companies, assigned orders for cancer genetic testing in exchange for kickbacks. The orders were signed without regard to medical necessity, and Dr. Toh was not the treating physician of the patients. 

7. Lab owner convicted for $463M Medicare fraud, faces years in prison

Minal Patel, owner of Georgia-based LabSolutions, was convicted of billing Medicare for expensive genetic testing that was not necessary. 

8. Connecticut psychologist pleads guilty to $2.7M fraud scheme

Greenwich, Conn.-based psychologist Michael Lonski, PhD, admitted that he billed insurers for services he knew were not rendered, including billing for deceased patients, for dates of services when he was out of the country and for dates of service when he was hospitalized.

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