USA — Milford Doctor Indicted On Drug, Health Care Fraud Charges 

From the Milford Patch news article: The two doctors are accused of writing prescriptions for cash to addicts, money laundering and millions of dollars in health care fraud. Both operated out of Family Health Urgent Care at 235 Main St. in Norwalk. Around 2012, Mansourov purchased the practice from Patel and renamed it Family Urgent […]

Woman sentenced to 17 years in federal prison for $3.5 million health care fraud scheme 

Health Care Cost by Tax Credits

From the News 4 San Antonio news article: A woman was sentenced to 17 years in federal prison for her role in an estimated $3.5 million Health Care Fraud scheme. United States District Judge Alia Moses also ordered 46-year-old DTS Medical Supply Company office manager/medical biller Kathleen Kelly-Tuorila to pay $3,269,300.11 in restitution … Read […]

US — Lexington, Kentucky, Jury Convicts Clinical Psychologist for Role in $600 Million Social Security Disability Fraud Scheme 

From the Department of Justice news article: After a one-week trial in federal court in Lexington, the jury convicted Alfred Bradley Adkins, 45, of Shelbiana, Kentucky, of one count of conspiracy to commit mail fraud and wire fraud, one count of mail fraud, one count of wire fraud, and one count of making false statements. […]

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 

Money-Euro-USD-LEI_53073-480x360 by Emilian Robert Vicol

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, […]

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

Money-Euro-USD-LEI_53073-480x360 by Emilian Robert Vicol

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 […]

U.S — Feds Recover $4.7B from Drug Companies, Other Industries 

From the Drugwatch  news article: …Of that, $2.5 billion came from the health care industry, including drug companies, medical device companies, hospitals, nursing homes, laboratories and physicians. The False Claims Act gives authorities the power to fight alleged fraud in a wide variety of industries receiving federal funds. It also includes financial incentives for whistleblowers […]

U.S — Panama City man arrested, indicted in doctor kickback scheme 

From the news article: …Joseph Rowan, 43, of Panama City was named in the indictment which was unsealed Thursday in US District Court in Massachusetts. The charges include racketeering, mail fraud and conspiracy to violate the anti-kickback law. The racketeering and mail fraud charges carry a prison sentence of up to 20 years each. […]

Feds bless quiet Medicare drug co-pay waiver programs 

Pills 3 by e-Magine Art

From the Life HealthPRO news article: …The pharmacy benefits safe harbor is part of a collection of new safe harbors from the U.S. Department of Health and Human Services’s Office of Inspector General. The HHS office developed the collection to show how pharmacies, hospitals and other health care providers help low-income patients with federal health plan […]

U.S — A fraud scheme in a league of its own 

Pills by Michael Chen

From the FierceHealthcare news article: …According to a release by California Insurance Commissioner Dave Jones, Bathum, the CEO of Community Recovery of Los Angeles (CRLA), and Kirsten Wallace, the company’s CFO, lured drug addicts to CRLA facilities, stole patient information in order to purchase health insurance policies without their consent, and then billed insurers for […]