US — Complexity of health care industry enables fraud schemes, NE Ohio doctors charged for overbilling 

From the News 5 Cleveland news article: …Between 2011 and 2018, Dr. Ashis Rakhit, 65, and Dr. Jayati Rakhit, 56, allegedly recorded fake symptoms present in their patients in order to perform unnecessary and expensive tests. The tests included nuclear stress tests, cardiac catheterizations, bone density scans and EKGs. The two longtime doctors are also […]

US: Texas men accused of $150M fraud: phony Medicare billing, money laundering 

Drugs by Images Money

From the Valley Morning Star news item: …All four men are charged with conspiracy to commit health care fraud and conspiracy to commit money laundering. They also are accused of fraudulently keeping patients on hospice for multiple years to increase revenue from Medicare. Prosecutors say Mesquias and McInnis used the funds to buy a Porsche, […]

Report: Illinois’ home health care industry rife with fraud, tainted by unscrupulous physicians 

Aging at home

From the Chicago Tribune news report: …For adults hobbled by disability or disease who want to stay out of nursing homes or hospitals, home health care services can be a godsend. For criminals who want to tap into federal Medicare dollars, it can represent a loosely guarded bank vault. A Tribune investigation reveals that Illinois […]

USA — Owner of home health company sentenced to 80 years in prison for Medicare fraud 

From the Becker’s Hospital Review news article: The owner of a home health company in Houston was sentenced Dec. 8 to 80 years in prison for his role in a $13 million Medicare fraud scheme and for filing false tax returns, according to the Department of Justice. In November 2016, Ebong Tilong pleaded guilty to conspiracy […]

U.S. — Guilty of Insurance Fraud, Illinois Chiropractor Gets 20-Month Prison Term 

Crime Scene - Do Not Cross. by Alan Cleaver

From the Insurance Journal item: A suburban Chicago chiropractor has been sentenced to 20 months in prison for billing an insurance company more than $4 million for treatment that was unnecessary or never provided. Federal prosecutors said Thursday 46-year-old Steven Paul of Northbrook pleaded guilty to one count of health care fraud. U.S. District Court […]

U.S. — Prosecutors insist eye doc stole $136 million from Medicaid 

From the ABC News article: …Prosecutors are seeking 30 years. They say the doctor subjected elderly patients to painful tests and treatments they didn’t need, for diseases they didn’t have, to support a vacation home in his native Dominican Republic, lavish trips to Europe and outside business interests. The government also says he bribed New […]

Ex-WellCare general counsel gets six months in U.S. prison 

From the Reuters news article: A former general counsel of insurer WellCare Health Plans Inc was sentenced on Wednesday to six months in prison for making a false statement to Florida’s Medicaid program as part of what prosecutors called a $35 million healthcare fraud scheme. Thaddeus Bereday, who was indicted in 2011 along with four […]

US — Florida Doctor Sentenced On 162 Counts Of Health Care Fraud 

Health Care Cost by Tax Credits

From the Insurance News Net item: Ona M. Colasante, 60, a physician who formerly practiced in Gainesville, was sentenced Friday afternoon to 12 months in prison and ordered to pay a $1,134,000 fine and more than $1 million in restitution after being convicted on May 2, 2016, of 162 counts of health care fraud. As […]

US: Physician Gets 35-Year Sentence for Massive Medicare Fraud 

From the Medscape news item: If he had pulled off his escape plan, Jacques Roy, MD, might be living in Canada or France now under the alias of Michel Poulin, subsisting off millions in ill-gotten gains, according to federal prosecutors. Instead, a federal judge in Dallas last week sentenced the 60-year-old physician from Rockwall, Texas, […]

U.S. — S.A. pharmaceutical rep indicted in $9.5 million health care fraud case 

Health by Pictures of Money 17124132409_1b446dcabd_k

From the San Antonio Express-News news article: …The use of compounded drugs by current and former servicemen and servicewomen has skyrocketed in the past decade, federal data show. In some cases, the Defense Department’s Tricare insurance and private insurers have faced bills of up to $30,000 for a month’s supply of the compounded cream, records […]