Healthcare billing fraud: 9 recent cases

From the conviction of a former healthcare management company leader in a $1.4 billion billing scheme, to a  Kentucky physician agreeing to pay more than $500,000 to settle allegations he submitted more than $3 million false claims to Medicare, here are nine healthcare billing fraud cases that have made headlines since June 10: 

Physician found guilty in $12M Tricare fraud scheme

Arkansas physician Joe May, MD, 41, was convicted on 22 counts over his involvement in a scheme to defraud Tricare of $12 million, the U.S. Justice Department said June 10. Dr. May signed off on illegitimate pain cream prescriptions.

Whistleblowers win $1.75M in physician's $9.5M Medicare fraud settlement

Minas Kochumian, MD, paid $9.49 million to settle allegations that he submitted false claims to CMS and Medi-Cal, California's Medicaid program, for procedures and tests that were never performed, the Justice Department said June 10. His former medical assistant, Elize Oganesyan, and his former informational technology consultant, Damon Davies, originally brought the allegations forward under the whistleblower provisions of the False Claims Act and will receive more than $1.75 million as their share of the recovery. 

California surgeon convicted in 4-year billing fraud scheme

California surgeon Gary Wisner, MD, was convicted June 16 on 10 counts of healthcare insurance fraud for defrauding Medicare and Medicaid by administering excessive and medically unjustifiable X-rays to his patients. Dr. Wisner subjected 10 patients to hundreds of unnecessary X-rays at his clinic at his clinic in Lodi, Calif.

Kentucky physician to pay $500K to settle billing fraud allegations

Patrick Finney, MD, of Paducah, Ky., on June 21 agreed to pay $561,800 to settle allegations that he submitted more than $3 million in false claims to Medicare.

Louisiana healthcare office worker charged with billing fraud

The U.S. Justice Department alleged June 23 that Erika James, who worked as a denial specialist at New Orleans-based CrescentCare, created fraudulent invoices with falsified supporting documents, such as explanation of benefits documents from insurance companies. 

Physician charged with $11M knee brace fraud

Charlotte, N.C., physician Sudipta Mazumder, MD, was charged with defrauding Medicare and Tricare of more than $11 million in 2019 and 2020, the Justice Department said June 23. Dr. Mazumder, 46, allegedly signed orders for medically unnecessary knee braces that resulted in thousands of fraudulent claims totaling $11,436,873 to be submitted to Medicare and Tricare.

Former healthcarel executive convicted in $1.4B billing scheme

The former leader of a healthcare management company has been convicted for his role in an elaborate pass-through billing scheme, the Justice Department announced June 27. Prosecutors said Jorge Perez, 62, of Miami, conspired with others to bill for $1.4 billion in medically unnecessary laboratory testing services. He used rural hospitals in Florida, Georgia and Missouri as billing shells to submit claims for services that were mostly performed at outside laboratories. 

Florida physician gets 8 years in prison, ordered to pay $31M for fake medical claims

A West Palm Beach, Fla.-based addiction recovery physician has been sentenced to prison and ordered to pay more than $31 million in restitution for his involvement in a scheme to be reimbursed for $106 million in fake medical claims, a federal court in Miami ruled June 28. Mark Agresti, MD, former medical director of the residential addiction recovery center Good Decisions Sober Living, and the recovery center's owner, Kenneth Bailynson, falsely billed private payers and federal healthcare benefit programs for reimbursement for fluid analysis used to evaluate the addiction recovery center’s residents. 

Florida pharmacies to pay $830K to settle billing fraud claims

Three Florida pharmacies have agreed to pay more than $830,000 to resolve allegations that they conspired to fraudulently bill Medicare and Medicaid for unlawfully prescribed medications. Habana Hospital Pharmacy, Longevity Drugs and Forest Hill Pharmacy were accused of using unlawful collaborative pharmacy agreements to write and fill prescriptions without any physician involvement, according to a June 29 U.S. Justice Department news release.  

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