Medicaid or Medicare Fraud

A settlement has been reached to resolve False Claims Act allegations against Medstar Ambulance Inc.

The allegations arose from a lawsuit that claimed Medstar Ambulance Inc, including four subsidiary companies and its two owners, Nicholas and Gregory Melehov, knowingly submitted false claims to Medicare.

According to the Department of Justice, from January 1, 2011, through October 31, 2014, Medstar submitted false claims to Medicare for ambulance transport services. Specifically, Medstar routinely billed for services that did not qualify for reimbursement because the transports were not medically reasonable and necessary, billed for higher levels of services than were required by patients’ conditions, and billed for higher levels of services than were actually provided.

As part of the settlement, Medstar has agreed to a corporate integrity agreement with the U.S. Department of Health and Human Services.

“Ambulance service companies should be focused on the needs of the patients,” said HHS Office of Inspector General Special Agent in Charge Phillip Coyne. “Billing Medicare for ambulance rides that were unnecessary or at a higher rate than could be medically justified is unacceptable. Together with our law enforcement partners, we will seek out and stop this fraudulent behavior.”

This case was brought forward in 2013, by a former employee in Medstar’s billing office, Dale Meehan, after claiming that she was fired for her continued questions and attempts to correct the fraudulent billing.

Dale Meehan will receive $3.5 million of the settlement under the federal False Claims Act, which allows whistleblowers to sue companies that are defrauding the government and receive a reward if the government recovers any funds as a result.

A settlement has been reached to resolve False Claims Act allegations against Bay Sleep Clinic and Related Entities.

The allegations arose from a lawsuit that claimed Bay Sleep Clinic, its related businesses, Qualium Corporation and Amerimed Corporation and their owners and operators, Anooshiravan Mostowfipour and Tara Nader fraudulently billed the Medicare program.

According to the Department of Justice, the companies fraudulently billed Medicare for sleep tests performed by technicians lacking the licenses or certifications required by Medicare payment rules.  Additionally, the companies billed for sleep tests conducted at unapproved locations and falsified documents to indicate the tests took place at approved facilities. Furthermore, the lawsuit alleged the defendants violated a Medicare rule that prohibits sleep test providers from selling medical devices.

“Medicare patients expect to be treated by properly credentialed health care professionals in approved locations,” said U.S. Attorney Stretch.  “When companies treating Medicare beneficiaries violate the rules, they will be held accountable.” 

As part of the agreement, the companies and owners also agreed to terminate their enrollment in the Medicare program for three years.

The lawsuit was originally filed by a sleep technician, Elma Dresser, who alleged the companies, engaged in fraudulent Medicare billing.

The whistleblowers' share of the settlement will be $545,000. 

A settlement has been reached to resolve False Claims Act allegations against an Indian-American couple and two diagnostic companies.

The allegations arose by a lawsuit claiming Nita K. Patel and Kirtish N. Patel and two companies that they owned and operated, Biosound Medical Services Inc and Heart Solution PC, knowingly submitting false claims to Medicare for thousands of falsified diagnostic test reports and the underlying tests.

According to the government, the defendants created fraudulent diagnostic test reports, forged physician signatures on these reports, and then billed Medicare for the fraudulent reports and the underlying tests that were used solely to create these reports. Also allegedly, the defendants billed Medicare for neurological tests that they conducted without the required physician supervision.

More than half of the diagnostic reports generated by Biosound between October 2008 and June 2014 were never reviewed by a physician, according to reports.

Nita K. Patel and Kirtish N. Patel were paid over $4,386,133.75 by Medicare and private insurance companies for the fraudulent reports, which they used for personal expenses that included multiple residences and luxury vehicles.

The whistleblower, a former employee of Biosound, is entitled to 15 to 25 per cent of the fine amount.

A settlement has been reached to resolve False Claims Act Allegations against Evercare Hospice and Palliative Care.

The allegations arose by a lawsuit claiming Evercare Hospice and Palliative Care claimed Medicare reimbursement for hospice care for patients who were not eligible for such care because they were not terminally ill.

According to the government, Evercare intentionally submitted false claims to Medicare for hospice care from January 1, 2007, through December 31, 2013, for Medicare patients who were not eligible for the Medicare hospice benefit because Evercare’s medical records did not support that they were terminally ill.  Allegedly, Evercare’s business practices were designed to maximize the number of patients for whom it could bill Medicare without regard to whether the patients were eligible for and needed hospice.  These business practices allegedly included discouraging doctors from recommending that ineligible patients be discharged from hospice and failing to ensure that nurses accurately and completely documented patients’ conditions in the medical records.

“Hospice care is only medically necessary and reimbursable by Medicare for terminally ill patients with a life expectancy of six months or less,” said Special Agent in Charge Steven Hanson of the Department of Health and Human Services’ Office of Inspector General (HHS-OIG).  “We will continue to vigorously investigate health care companies that put their own profits above the medical needs of patients to ensure that companies bill Medicare only for reimbursable health care services.”

The allegations resolved by this settlement arose from whistleblower lawsuits initially filed by former employees of Evercare.

On June 27, 2016, U.S. Attorney John Bales announced, that ten North Texas companies and individuals have agreed to pay the United States a total of $1.125 million to resolve alleged False Claims Act violations for causing false claims to be submitted to the U.S. Department of Health and Human Services and its component agency the Centers for Medicare and Medicaid Services.

The settlement resolves a lawsuit filed by former Yellow Cab employees who worked for its Medicaid services. The government provides transportation for Medicare and Medicaid patients if they cannot travel or have no access to transportation.

The former employees alleged that nearly every claim that Irving Holdings, related entities and employees submitted did not comply with Medicaid regulations. The former employees, Robert Spence, Mike Jones, and Cheryl Jones, were all fired by the company. 

According to the lawsuit, the Medicaid drivers' employee manual listed a series of fines and punishments for drivers if they committed Medicaid fraud. One of them included a $50 for if drivers changed the price of trips in their records, even if Medicaid was being overcharged.

The settlement includes Irving Holdings, the parent company of Yellow Cab and six other affiliated companies and individuals:

• Irving Holdings, Inc. (together with its predecessor companies Big Tex Taxi Corporation, Terminal Taxi Corporation, Choice Cab, Inc., Yellow Checker Cab of Dallas, Inc., and Yellow Checker Cab of Fort Worth, Inc.)
• JetTaxi, Inc.
• Dallas Taxi, LLC
• US Cab, LLC
• Terminal Taxi Corporation of Irving
• Classic Shuttle Acquisition Corporation, Inc. d/b/a Go Yellow Checker Shuttle
• Dallas Car Leasing, LLC
• Jackie Bewley
• Jeffrey Finkel
• Elizabeth George

The three former employees will receive $202,500 from the settlement.

On April 18, 2016, the Department of Justice announced, that a Miami physician was sentenced to 108 months in prison for his role in a Medicare fraud scheme that caused roughly $30 million in losses.

In February 2016, Henry Lora pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States, receive health care kickbacks and make false statements relating to health care matters. Henry Lora was ordered to pay $30,278,542 in restitution and to forfeit the same amount.

Henry Lora, a medical director of Merfi Corporation, admitted that in exchange for kickbacks and bribes, he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided.  Henry Lora and his co-conspirators also falsified patient records to make it appear as if the beneficiaries qualified for these services.

Henry Lora and his co-conspirators’ actions caused multiple Miami-Dade home health care agencies and other providers to bill Medicare for services that were not medically necessary or not provided. Medicare made payments on these fraudulent claims.

The owner of Merfi, Isabel Medina, was also charged and sentenced to nine years in prison for conspiracy to commit health care fraud back in March 2014.

A settlement has been reached to resolve False Claims Act allegations against Boston Medical Center.

The allegations arose from a lawsuit that claimed Boston Medical Center billed Medicare for more units of Rituxan than actually infused in its patients; Boston Medical Center billed Medicare and Medicaid for services at its pre-surgical treatment center even though the global fee for the subsequent surgeries covered those same treatments; and Boston Medical Center submitted claims to Medicare for outpatient podiatry services that were not necessary.

Boston Medical Center was proactive in addressing the issue when it was informed of a government investigation. Boston Medical Center stated that it had already reimbursed some funds and was auditing its Rituxan use. Boston Medical Center also stated that it would initiate an audit of pre-surgical billing practices. Boston Medical Center worked cooperatively with the U.S. Department of Health and Human Services, Office of the Inspector General, and the Department of Justice to address the remaining matters at issue.

“Hospitals have a responsibility to ensure that they are billing federal health care programs appropriately,” said U.S. Attorney Ortiz.

The allegations were raised by Boston Medical Center’s former Chief Compliance Officer, Kathleen Heffernan, who filed the lawsuit against Boston Medical Center under the False Claims Act, allowing her to receive a share of any recovery.

On April 13, 2016, Department of Justice announced that Nery Cowan, a former health care clinic consultant and Medicare biller was sentenced to 135 months in prison and ordered to pay a $100,000 fine for her role in laundering money in connection with a $63 million health care fraud scheme involving a Miami health provider.

On January 14, 2016, Cowan pleaded guilty to one count of conspiracy to commit money laundering. Cowan was a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center and confessed to directing and authorizing the payment of kickbacks and bribes to patient brokers and others in exchange for Medicare beneficiary referrals. Cowan also confessed that Greater Miami personnel frequently falsified medical records affiliated with these recruited Medicare beneficiaries to support false and fraudulent claims to Medicare. 

Cowan and co-defendants Dean Butler and Irina Mora concealed kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida.  Cowan, Butler and Mora disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc, a sham staffing company.

Dean Butler was also sentenced to 16 years in prison and Irina Mora was sentenced to nine years in prison on November 30, 2015.

On April 12, 2016, Department of Justice announced, that an Ohio man pleaded guilty to fraud charges for his role in a scheme to defraud Medicare out of approximately $6.2 million while he acted as an unlicensed physician at a Detroit in-home physician services company.

Cecil Alexander Kent Jr. pleaded guilty yesterday to one count of conspiracy to commit health care fraud, two counts of health care fraud and five counts of making false statements relating to health care matters. 

Kent saw patients and falsified related patient records, including medical documents and billing documents, all under the name of a licensed medical doctor and falsified prescriptions for controlled substances that he personally wrote using the name and U.S. Drug Enforcement Administration number of a licensed physician.  Kent was employed at B&M Visiting Doctors PLC and was fully aware that Medicare did not pay for patient visits performed by unlicensed physicians; however he still submitted claims to Medicare through B&M.

Charles McRae, part owner of B&M and also an unlicensed physician and Alvin Williams, an unlicensed physician, were charged in the same indictment as Kent and pleaded guilty for their involvement in this scheme to defraud.

The Department of Justice announced today, Dr. Kelly Robinett and Dr. Angel Claudio, along with four individuals, Patience Okoroji, Usani Ewah, Kingsley Nwanguma, and Joy Ogwuegbu, were charged in a superseding indictment that was unsealed today for their alleged participation in a $13.4 million health care fraud scheme involving fraudulent claims for home health services.

The indictment alleges that from approximately January 2007 to September 2015, the defendants conspired to defraud Medicare by causing the submission and concealment of false and fraudulent claims to Medicare. 

According to the allegations, Dr. Kelly Robinett and Dr. Angel Claudio falsely certified beneficiaries for home health care when the patients were not under their care and did not qualify for home health services.  The allegations also include that in several cases, Patience Okoroji and Usani Ewah would pay recruiters, including Kingsley Nwanguma, to recruit beneficiaries for home health services, regardless of whether the beneficiaries needed home health care.  Patience Okoroji, Usani Ewah and Joy Ogwuegbu allegedly prepared or caused to be prepared fraudulent Medicare documents that made it appear as though the beneficiaries qualified for home health services.

An indictment is merely an allegation and the defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.