Healthcare billing fraud: 9 recent cases

From the feds charging 36 people in an alleged $1.2 billion scheme, to the conviction of a New York medical billing company owner in a $600 million case, here are nine healthcare billing fraud cases that have made headlines since July 8:

1. Lab companies, owners to pay $5.7M to settle Medicare fraud claims

Metric Lab Services, Metric Management Services and Spectrum Diagnostic Labs, along with owners Sherman Kennerson and Jeffrey Madison, agreed to pay $5.7 million on July 22 to settle claims they defrauded Medicare in a genetic testing fraud scheme.

2. Medical device maker inks $12.95M false claims settlement

Lake Oswego, Ore.-based Biotronik Inc. has agreed to pay $12.95 million to resolve allegations that it violated the False Claims Act by causing the submission of false claims to Medicare and Medicaid by paying kickbacks to physicians to induce their use of Biotronik's implantable cardiac devices, according to a July 22 press release from the Justice Department.

3. North Carolina physician assistant indicted in $10M Medicare fraud scheme

North Carolina physician assistant Colby Joyner was indicted July 20 on federal charges in a genetic testing scheme involving $10 million in fraudulent Medicare claims. Mr. Joyner allegedly signed fraudulent prescriptions for medically unnecessary cancer genomic and pharmacogenetic testing for hundreds of North Carolina Medicare beneficiaries.

4. Feds charge 36 in $1.2B healthcare fraud schemes

Thirty-six people across the U.S. were charged for their alleged roles in schemes involving $1.2 billion in fraudulent telemedicine, durable medical equipment, cardiovascular and cancer genetic testing, the Justice Department announced July 20. The alleged schemes involved lab owners paying medical professionals illegal kickbacks and bribes in exchange for referring patients. The medical professionals were allegedly working with fraudulent telemedicine and digital medical technology companies. 

5. Connecticut ophthalmologist pleads guilty to healthcare fraud charges

Ophthalmologist Donald Salzberg, MD, pleaded guilty July 14 to one count of conspiracy to commit healthcare fraud and one count of conspiracy to receive a kickback for a scheme that sent more than $3 million in fraudulent bills to Medicare and private insurance companies. 

6. Specialty pharmacy to pay $1.3M to settle false claims allegations

Pompano Beach, Fla.-based specialty pharmacy Solera Specialty Pharmacy on July 13 agreed to pay $1.31 million to resolve allegations that it submitted false claims to Medicare for prescriptions for an expensive treatment used for opioid overdoses. The pharmacy admitted to dispensing the pricey drug, Evzio, between 2017 and 2018.  

7. Federal jury convicts New York man in $600M billing fraud scheme

Medical billing company owner Matthew James is facing the potential of nearly five decades in prison after a federal jury convicted him July 13 for a $600 million healthcare billing fraud, wire fraud and identity theft scheme. The company submitted claims to payers for services that were more complicated or completely different than the ones performed by his physician clients.

8. Michigan physician convicted in $35M healthcare fraud

David Jankowski, DO, was convicted on July 11 by a federal jury in Detroit on 30 charges related to the unlawful distribution of schedule II, III and IV controlled substances and healthcare fraud. Mr. Jankowski wrote medically unnecessary prescriptions for controlled substances and then submitted false and fraudulent insurance claims saying he had provided necessary treatment to these patients.

9. New York physician convicted of billing fraud

Harold Bendelstein, MD, faces up to 15 years in prison after a federal jury found him guilty of billing Medicare and Medicaid for surgical procedures that were not performed. Mr. Bendelstein billed Medicare and Medicaid for an incision procedure of the external ear for hundreds of patients, but actually performed ear exams or ear wax removal, according to a July 8 U.S. Justice Department news release. 

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