Healthcare billing fraud: 9 recent cases

From the founders of three Texas medical labs pleading guilty to a $300 million scheme, to the sentencing of a Florida pharmacy owner for his role in a $174 million scheme, here are nine recent healthcare billing fraud cases:

1. Diagnostic lab sales rep guilty of $4.6M fraud

Diagnostic lab sales representative Steven Monaco was convicted on 18 counts for leading a $4.6 million fraud and kickback scheme, the Justice Department said April 19.

2. 21 charged in $149M COVID-19 fraud schemes: Justice Department

The Justice Department criminally charged 21 people, including physicians, a director of pharmacy and executives of medical clinics, for their alleged participation in scams that exploited COVID-19 and resulted in millions of dollars of fraudulent billings, according to an April 20 news release. The scams allegedly took place across nine federal districts in the U.S., resulting in over $149 million in false billings and theft from federally funded pandemic assistance programs. 

3. Founders of Texas labs plead guilty in $300M fraud scheme

The founders of three medical labs in Texas pleaded guilty in a $300 million healthcare fraud scheme, the Justice Department said April 20. Jeffrey Madison, founder of Unified and Spectrum; Mark Boggess, COO for Unified and Spectrum; Biby Kurian, co-founder of Reliable; and Abraham Phillips, co-founder of Reliable, are among those who admitted to paying kickbacks to medical providers in exchange for ordering medically unnecessary lab tests.

4. New York physician indicted in $10M telemedicine fraud scheme

New York orthopedic surgeon Elemer Raffai, MD, and others, are accused of submitting about $10 million in fraudulent claims for durable medical equipment, the Justice Department said April 21. Medicaid paid more than $4 million of those claims. 

5. Mississippi pharmacist sentenced to 10 years in $180M fraud scheme

Mississippi pharmacist Mitchell Barrett was sentenced to 10 years in prison for participating in a scheme to defraud Tricare by paying kickbacks to distributors for the referral of medically unnecessary prescriptions, the Justice Department said April 26. Mr. Barrett and his co-conspirators submitted $180 million in fraudulent billings to federal and private insurers as a result of the scheme.

6. California physician sentenced for defrauding Medicare, repackaging & reusing catheters

California physician Donald Woo Lee, MD, was sentenced to 93 months in prison April 28 after being convicted of a $12 million Medicare fraud scheme and reusing single-use catheters on patients. 

7. Arizona telemedicine owners plead guilty to $64M fraud, kickback scheme

Phoenix-based RediDoc owners Stephen Luke and David Laughlin pleaded guilty May 10 to submitting false and fraudulent claims to Medicare and Tricare between September 2017 and December 2019 as part of a $64 million healthcare fraud and kickback scheme. 

8. Florida PT clinic owners, physician sentenced for $17M billing fraud

Three Florida physical therapy clinic owners and a physician were among those sentenced May 10 for their roles in a $17 million medical billing fraud scheme, according to the Justice Department. Clinics Life Blue Medical Center, Blue Life Medical Center and Miami Medical Therapy recruited and paid kickbacks to beneficiaries of Blue Cross Blue Shield health benefit programs and submitted false claims to the payer. 

9. Florida pharmacy owner sentenced for $174M fraud scheme

Florida pharmacy owner Peter Bolos was sentenced to 14 years in prison over his role in a $174 million fraud scheme, the Justice Department said May 18. He and several co-conspirators deceived pharmacy benefit managers about at least 60,000 prescriptions between May 2015 and April 2018.

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