Tag Archives: Fraud and Abuse

Fake owner pleads guilty in $4.2M home health fraud scheme

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://www.healthcaredive.com/news/fake-owner-pleads-guilty-in-42m-home-health-fraud-scheme/424577/

  • Ramon Collado Gonzalez of Miami, Florida pleaded guilty Monday to acting as the straw owner of Golden Home Health Care as part of a $4.2 million home healthcare fraud scheme, the U.S. Attorney’s Office for the Southern District of Florida announced Tuesday.
  • Gonzalez admitted he was recruited to cover for the real owners, Mildrey Gonzalez and Milka Alfaro, who were charged separately for their alleged roles.
  • Gonzalez signed documents for the submission of false Medicare claims in exchange for monthly payments and periodic bonuses, the press release states.

Former Sacred Heart physician gets 2 years for role in kickback scheme

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

http://www.chicagotribune.com/news/ct-sacred-heart-hospital-sentencing-met-20160812-story.html

Sacred Heart sentence

Venkateswara Kuchipudi, right, walks with his lawyer Theodore Poulos outside the Dirksen U.S Courthouse on Aug. 12, 2016, after Kuchipudi was sentenced to two years in prison for his part in a fraud scheme at the now-shuttered Sacred Heart Hospital.

http://www.beckershospitalreview.com/legal-regulatory-issues/former-sacred-heart-physician-gets-2-years-for-role-in-kickback-scheme.html

 

26 latest healthcare industry lawsuits, settlements

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , , , , • Leave a comment

http://www.beckershospitalreview.com/legal-regulatory-issues/26-latest-healthcare-industry-lawsuits-settlements-august15.html

 

Tenet Healthcare agrees to plead guilty in Atlanta kickback scheme, will pay $514 million

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

http://www.bizjournals.com/atlanta/news/2016/08/01/tenet-healthcare-agrees-to-plead-guilty-in-atlanta.html

Atlanta Medical Center, previously one of Tenet Healthcare’s Georgia hospitals, was involved in the scheme.

Tenet Healthcare Corp. (NYSE: THC) said Monday that it believes it has reached an agreement in principle with the government to resolve a long-running criminal investigation and civil litigation about a kick-back scandal involving an Atlanta medical clinic and three of the company’s Atlanta-area hospitals.

Dallas-based Tenet said it has agreed to pay $514 million, has agreed to the appointment by the U.S. Department of Justice of a corporate monitor for a period of three years, and has agreed for two wholly owned subsidiaries that previously operated Atlanta Medical Center and North Fulton Hospital to each plead guilty to a single-count indictment. The settlement will be with the U.S. Department of Justice, the U.S. Attorneys’ Offices for the Northern and Middle Districts of Georgia, and the Georgia Attorney General’s Office.

Atlanta Medical Center, previously one of Tenet Healthcare’s Georgia hospitals, was involved in the scheme.

Tenet Healthcare Corp. (NYSE: THC) said Monday that it believes it has reached an agreement in principle with the government to resolve a long-running criminal investigation and civil litigation about a kick-back scandal involving an Atlanta medical clinic and three of the company’s Atlanta-area hospitals.

Dallas-based Tenet said it has agreed to pay $514 million, has agreed to the appointment by the U.S. Department of Justice of a corporate monitor for a period of three years, and has agreed for two wholly owned subsidiaries that previously operated Atlanta Medical Center and North Fulton Hospital to each plead guilty to a single-count indictment. The settlement will be with the U.S. Department of Justice, the U.S. Attorneys’ Offices for the Northern and Middle Districts of Georgia, and the Georgia Attorney General’s Office.

“The agreement in principle contemplates, among other things, payment by the company of $513,788,345, which is comprised of a civil monetary payment of $368,000,000 and a criminal monetary payment of $145,788,345,” Tenet reported Monday.

The company’s two subsidiaries will plead guilty to a single count of conspiracy to violate the federal anti-kickback statute and defraud the United States, Tenet reported.

3 charged in $1 billion scheme to defraud Medicare in Florida, DOJ dubs biggest ever

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , • Leave a comment

http://www.healthcarefinancenews.com/news/3-charged-1-billion-scheme-defraud-medicare-florida-doj-dubs-biggest-ever

The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and healthcare fraud in connection with a $1 billion scheme involving numerous Miami-based providers, the United States Department of Justice announced.

Assistant Attorney General Leslie Caldwell of the Justice Department’s Criminal Division said in a statement that the charges represent the largest single criminal healthcare fraud case ever brought against individuals by the DOJ.

Philip Esformes, 47, Odette Barcha, 49, and Arnaldo Carmouze, 56, all of Miami-Dade County, Florida, were charged in an indictment claiming that Esformes operated a network of more than 30 skilled nursing homes and assisted living facilities known as The Esformes Network, which gave him access to thousands of Medicare and Medicaid beneficiaries.

Houston physician gets 3-year prison term for fraud

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

http://www.beckershospitalreview.com/legal-regulatory-issues/houston-physician-gets-3-year-prison-term-for-fraud.html

Fraud

Healthcare CEO faces life in prison for fraud that led to 2 patient deaths

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

http://www.beckershospitalreview.com/legal-regulatory-issues/healthcare-ceo-faces-life-in-prison-for-fraud-that-led-to-2-patient-deaths.html

Fraud

The CEO and co-owner of a Maryland diagnostics company is facing life in prison after a federal jury convicted him of two counts of healthcare fraud that resulted in death, according to the Department of Justice.

On Wednesday, a federal jury found 67-year-old Rafael Chikvashvili, PhD, guilty of healthcare fraud. Dr. Chikvashvili was the co-owner and CEO of Owings Mills, Md.-based Alpha Diagnostics, which was a portable diagnostic services provider, principally of X-rays.

According to evidence presented at trial, Dr. Chikvashvili was involved in a scheme to defraud Medicare and Medicaid. He and others allegedly conspired to create false radiology, ultrasound and cardiologic interpretation reports. He also allegedly submitted insurance claims for medical examination interpretations that were never completed by licensed physicians, according to the DOJ.

Dr. Chikvashvili allegedly instructed his nonphysician employees to interpret X-rays, ultrasounds and cardiologic examinations, which, according to testimony provided at trial, resulted in two patient deaths.

Fraud Concerns Emerge As Compounding Drug Sales Skyrocket

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://khn.org/news/fraud-concerns-emerge-as-compounding-drug-sales-skyrocket/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=31763903&_hsenc=p2ANqtz–PhnRVqf1RHh-WdXHoa-6YIFwbpAP91jYtikc1hViYnou3e1JAym3sE42hOTDnYQVJsB-bnamM0o8kX8UBXNumXh190w&_hsmi=31763903

Mortar pharmacy

Government spending on “compounded” drugs that are handmade by retail pharmacists has skyrocketed, drawing the attention of federal investigators who are raising fraud and overbilling concerns.

Spending on these medications in Medicare’s Part D program, for example, rose 56 percent last year, with some of the costliest products, including topical pain creams, priced at hundreds or thousands of dollars per tube. The federal workers’ compensation program has also seen a recent spike in spending.

The spending jump, along with a sharp increase in the number of patients getting the compounded drugs “may indicate an emerging fraud trend,” said Miriam Anderson, who helped oversee a June report on the Medicare spending by the inspector general’s office at the Department of Health and Human Services.

Some of the prescriptions may not have been medically necessary — or even dispensed at all, notes the report, which also details recent fraud cases brought by U.S. attorneys in several states.

Kaiser accuses California ex-employee of embezzling $7 million

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

http://www.latimes.com/business/la-fi-kaiser-embezzling-20160711-snap-story.html?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=31540667&_hsenc=p2ANqtz-9I1Lf0kh4VxReez7DQie-7-_DAWq4kcCNyN4g1i050v34c-SFnUAiO5l7SllcW7_0DnMjKGEIcPGM8fHZ8E47NeCvnaQ&_hsmi=31540667

Dollars

A subsidiary of healthcare giant Kaiser Permanente has filed a lawsuit in California accusing a former employee responsible for investigating insurance fraud claims of embezzling $7 million.

The suit by Kaiser Foundation Health Plan accuses Michael Albert Quinn of submitting invoices for investigative services that were not performed or were not justified over a 16-year span after he joined the company in 1998.

Quinn, 45, worked in Oakland and was responsible for hiring investigators to conduct surveillance on people who were suspected of filing fraudulent claims, the suit says. It says he was authorized to approve charges of as much as $50,000.

13 recent healthcare industry lawsuits, settlements

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , • Leave a comment

http://www.beckershospitalreview.com/legal-regulatory-issues/13-recent-healthcare-industry-lawsuits-settlements-july8.html

Money and Scale