Info & Intel


Telemedicine – Medicare’s Newest Fraud Frontier

Telemedicine – Medicare’s Newest Fraud Frontier

Medicare and Medicaid have been responsive to the coronavirus pandemic in many ways. Because patients are safer weathering out the storm at home, the federal government and many states have relaxed rules on telehealth. That means instead of waiting to weeks or months to see your physician for non emergency healthcare needs, you can simply “visit” with your provider by phone or video chat.
Telemedicine protects healthcare workers too. Having a waiting room full of sick people...

Suspected Coronavirus Fraud – Medicaid Fraud Alert

Suspected Coronavirus Fraud – Medicaid Fraud Alert

As Americans grapple with the uncertainties and disruptions caused by the coronavirus pandemic, fraudsters are already trying to take advantage of concerned Americans.
The 94 United States Attorneys located throughout the country have each appointed a Coronavirus Fraud Coordinator. Working with law enforcement officials and the Department of Justice, the coordinators will ensure that people using to the coronavirus pandemic as a method of exploiting vulnerable Americans will be swiftly...

Guardian Elder Care Has Agreed to Pay $15.4 Million to Settle a Medicare Fraud Lawsuit Filed by Two Former Employees

Guardian Elder Care Has Agreed to Pay $15.4 Million to Settle a Medicare Fraud Lawsuit Filed by Two Former Employees

Guardian Elder Care, Guardian LTC Management, Guardian Rehabilitation Services, and Guardian Elder Care Management will pay $15,466,278 to resolve allegations of healthcare fraud. According to prosecutors, the companies, known collectively as Guardian, overbilled Medicare, and the Federal Employees Health Benefits Program for medically unnecessary services, in violation of the False Claims Act.
Guardian operates 69 facilities across three states, from Columbus, Ohio, to Fairmont, West...

Ohio Fed. Court Hits Fugitive Surgeon With $1.77M Verdict for Unnecessary Procedures

Ohio Fed. Court Hits Fugitive Surgeon With $1.77M Verdict for Unnecessary Procedures

A Cincinnati surgeon who fled the United States in 2013, after federal authorities had arrested him for fraud and released him on his own recognizance, has been ordered to pay $1.77 million in damages for unnecessary surgeries performed on two patients. Dr. Abubakar Atiq Durrani, a native of Pakistan, was tried in federal court in January.
Although not present, Durrani was represented by counsel for his medical malpractice insurer. According to Law360, the jury found Durrani “did,...

Hospital Fined for Assembly Line Care - Medicare Fraud Post

Hospital Fined for Assembly Line Care - Medicare Fraud Post

Assembly lines have their place in commerce. But healthcare? Federal prosecutors fined Lenox Hill Hospital in New York for submitting Medicare claims for procedures only partially performed or supervised by the attending surgeons. At least one urologist was frequently absent from the operating room while surgeries were being performed. In the words of Manhattan’s U.S. Attorney, “Hospitals cannot pay surgeons for their referrals, and they cannot run their operating rooms like...

California-based Sutter Health Will Pay $45.6 Million To Resolve Allegations of Medicare Fraud and Stark Law Violations

California-based Sutter Health Will Pay $45.6 Million To Resolve Allegations of Medicare Fraud and Stark Law Violations

The DOJ has announced that Sutter Health will pay $30.5 million to settle a lawsuit filed by a former Sutter compliance officer, Laurie Hanvey. The California health system has also agreed to pay $15.1 million to resolve allegations of self-disclosed Medicare fraud.
According to Hanvey’s complaint, Sutter Memorial Center Sacramento had an illegal arrangement with Sacramento-based group practice Sacramento Cardiovascular Surgeons (“Sac Cardio”). The whistleblower...

Medicaid Whistleblowers - Report hospital schemes like false documentation, ambulance scams, neglect, or even illegal kickbacks

Medicaid Whistleblowers - Report hospital schemes like false documentation, ambulance scams, neglect, or even illegal kickbacks

Have you witnessed conditions at a facility that provides Medicaid or Medicare services? Maybe it’s your employer or a loved one’s care center? If you’ve noticed a hospital taking part in schemes like false documentation, ambulance scams, neglect, or even illegal kickbacks -- we urge you to report it through our hotline.
Every year, Medicaid fraud costs taxpayers billions of dollars (yes, that’s billion with a B). Whistleblowers -- the brave men and women who see...

Osteo Relief Institute Clinics in Six States Have Agreed to Pay $7.1 Million to Settle Medicare Fraud Claims Involving Medically Unnecessary Arthritis Treatments

Osteo Relief Institute Clinics in Six States Have Agreed to Pay $7.1 Million to Settle Medicare Fraud Claims Involving Medically Unnecessary Arthritis Treatments

The Osteo Relief Institute (“ORI”) was a network of clinics focused mainly on osteoarthritis treatments. The now-defunct clinics, located in Texas, Colorado, California, Kentucky, Arizona, and New Jersey, have agreed to pay a total of $7.1 million to settle allegations of Medicare fraud involving medically unnecessary knee braces and osteoarthritis treatments.
The settlement concludes an investigation prompted by a whistleblower lawsuit filed by a Kentucky resident. After...

Special Alert for Nursing Home Patients – Deadly New Infection

Special Alert for Nursing Home Patients – Deadly New Infection

Deadly New Infection Called Candida Auris Killing Nursing Home Patients Normally we publish stories about efforts to curb Medicaid fraud in our nation’s hospitals, clinics and nursing homes. Recently we learned of a deadly new infection sweeping through some nursing homes in New York, Illinois and New Jersey. The infection is caused by a newly discovered fungus known as Candida Auris.
A decade ago the fungus wasn’t known to even exist. It was first discovered in Japan in...

Houston Hospital Administrator Sentenced to 10 Years in Prison for His Role in $16-million Medicare Fraud

Houston Hospital Administrator Sentenced to 10 Years in Prison for His Role in $16-million Medicare Fraud

The former CFO and COO of Atrium Medical Center and Pristine Healthcare, Starsky Bomer, has been sentenced to 10 years in prison for his role in a scheme that defrauded Medicare out of $16 million. Between 2011 and 2013, Bomer allegedly aided in a fraudulent scheme involving inappropriate billings to government programs for hospital care services.
After a five-day trial that took place last year, the 46-year-old Houston-area administrator was found guilty of conspiring to commit...

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