U.S. — South Florida Home Health Owner Charged for Role in $15 Million Medicare Fraud Scheme 

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From the Department of Justice news article: Yunesky I. Fornaris, 38, of Miami, was charged with one count of conspiracy to commit health care fraud and wire fraud, two counts of health care fraud and one count of conspiracy to defraud the United States and pay health care kickbacks.  Fornaris was arrested today and made […]

U.S. — Charles River Laboratories International Inc. Agrees to Pay United States $1.8 Million to Settle False Claims Act Allegations 

From the Department of Justice news article: …Charles River holds contracts with National Institutes of Health (NIH) for services relating to the development, maintenance, and distribution of colonies of animals as well as the provision of laboratory animals to the NIH. Charles River billed to NIH labor and associated costs of employees at its Raleigh, […]

U.S. — Pennsylvania False Claims Act bill to be introduced again 

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From the PennRecord news item: “This has been introduced in the Pennsylvania State Legislature, I believe, since 1998. It’s received three votes in the House [of Representatives], all being unanimous. It used to be introduced by Republican lawmakers. I have taken over the interest of the taxpayers that want to bring fraud dollars back to […]

U.S. — Physicians Charged with Healthcare Fraud, Identity Theft in PR 

From the HealthIT Security news item: A District of Puerto Rico Federal Grand Jury charged the owner of a durable medical equipment company and three physicians with multiple counts of conspiracy to commit healthcare fraud, healthcare fraud and aggravated identity theft. The defendants reportedly “conspired with each other and with other individuals known and unknown to […]

U.S. — Westchester Doctor Accused in $50M Health Care Fraud Scheme 

From the Department of Justice news article: Defendants Provided False Patient Medical Information and Used the Identities of Doctors Who Did Not Work at the Clinic to Submit More Than $50 Million in Fraudulent Health Care Claims Preet Bharara, the United States Attorney for the Southern District of New York, William F. Sweeney Jr., the […]

U.S. — 16 Texans Charged in $60 Million Medicare Fraud Scheme 

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From the CBS Local news article: …The indictment alleges that over a four-year period, the company Novus Health Services billed Medicare and Medicaid $60 million for fraudulent hospice services, of which some $35 million was paid to the company. The defendants are accused of submitting false claims for hospice services, false claims for continuous care hospice services, […]

Canada: St. Michael’s Hospital fired 31 employees for $200,000 in alleged benefits plan misuse 

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From the Toronto Star news item: A Toronto hospital and research centre fired dozens of employees for alleged misuse of its employee benefits plan. St. Michael’s Hospital spokesperson Leslie Shepherd said in a statement Tuesday that 31 employees were fired after $200,000 in irregularities was discovered during a routine audit. “The hospital takes its role […]

Pharmacist accused of defrauding province was implicated in another police investigation, his trial hears 

From the Windsor Star news article: …Shae Lynn Stanbra, who was a detective-constable assigned to investigate health-care fraud for the OPP’s anti-rackets squad, testified she had been probing another individual when D’Angelo’s name “came up.” Cautioned by assistant Crown attorney Tom Meehan not to give details of the other investigation, Stanbra merely said it morphed […]

Canada — Suspected illegal basement cosmetic surgery clinic raided in Delta 

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From the CBC news item: A suspected illegal surgery clinic in Delta, where cosmetic procedures are alleged to have been performed by a fake doctor, has been raided by the College of Physicians and Surgeons, escorted by Delta Police. ​The raid happened Dec 20, after a B.C. Supreme Court judge authorized the search of the private home a woman shares with […]

Feds failed to recover up to $125M in overpayments from Medicare Advantage plans, records show 

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From the Fierce Healthcare news article: …An initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone, according to confidential government documents released recently in response to a public records request and lawsuit. But officials never recovered most of that money. Under intense pressure from […]