Healthcare billing fraud: 9 recent cases

From a former Kentucky lawmaker who plead guilty to charges in connection to a $2.7 million fraudulent billing scheme, to a Florida medical biller sentenced to more than five years in prison, here are nine recent healthcare billing fraud cases:  

1. Physician-owned hospital pays $1.2M to settle billing fraud claims

Oklahoma Heart Hospital South, a physician-owned hospital based in Oklahoma City, paid $1.2 million to settle billing fraud allegations. The hospital discovered billing irregularities during an internal audit showing the hospital submitted claims for intensive cardiac rehabilitation services for Medicare beneficiaries from June 1, 2013, to May 31, 2019, that didn't comply with Medicare rules.

2. Former Kentucky lawmaker admits healthcare billing fraud

Former Kentucky state Rep. Robert Goforth pleaded guilty in connection to a $2.7 million fraudulent billing scheme. He admitted a pharmacy he owned billed insurance programs, including Medicare and Medicaid, for prescriptions that customers didn't pick up.

3. Texas lab fraud case expands to 24 defendants

Six Texas physicians were added to a lab testing kickback and false claims lawsuit that originally named 18 people, including four former healthcare executives, and two lab companies as defendants. The six new physician defendants, Doyce Cartrett Jr., MD; Elizabeth Seymour, MD; Emmanuel Descant, MD; Frederick Brown, MD; Heriberto Salinas, MD; and Hong Davis, MD, allegedly received more than $860,000 collectively from lab test referral kickbacks. 

4. Florida medical biller gets 5 years in prison for Medicaid fraud

Joshua Maywalt, who worked as a medical biller at a Clearwater, Fla., company that provided credentialing and medical billings services for providers, was sentenced to five years and five months in prison and ordered to forfeit more than $2.2 million after admitting he billed Medicaid for services that were not rendered.

5. Georgia outpatient facility ordered to pay $9.6M for submitting hundreds of false claims

A federal judge in Georgia ordered Macon-based Georgia Family Rehab to pay more than $9.6 million for submitting hundreds of fraudulent claims to Medicaid and Tricare.

6. Illinois diagnostics company to pay $3.5M to settle fraud accusations

Wheeling, Ill.-based Snap Diagnostics agreed to pay $3.5 million to settle claims that it defrauded Medicare and other federal healthcare programs through kickbacks and unnecessary testing. 

7. Pharmaceutical company to pay $12.9M to settle Texas Medicaid fraud claim

Dr. Reddy's Laboratories, an India-based multinational pharmaceutical manufacturer, has agreed to pay $12.9 million to settle claims it reported inflated prices to the Texas Medicaid program.

8. Michigan physician pleads guilty to fraudulent billing, to pay $500K

Muskegon, Mich., physician Soaries Maxine Peterson, MD, pleaded guilty to billing Medicare, Medicaid and Blue Cross Blue Shield for services she didn't perform.

9. Florida pharmacy owner ordered to pay $865K over insurance fraud scheme

A Kentucky federal court sentenced Florida pharmacy owner Nitesh Patel to 12 months of  probation and 12 months of home confinement and ordered him to pay more than $865,000 in restitution following his November guilty plea to one count of conspiracy to commit healthcare fraud. 

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