Info & Intel


Health Diagnostics’ Former CEO and BlueWave Owners Will Pay $111 Million Over Medicare Fraud

Health Diagnostics’ Former CEO and BlueWave Owners Will Pay $111 Million Over Medicare Fraud

A federal judge in South Carolina has ordered the former CEO of Health Diagnostics Laboratory and the owners of BlueWave Healthcare Consultants Inc. to pay $111 million in connection with their alleged defrauding of Medicare and another government health care program.
Although the defendants presented arguments that the penalty would be in violation of the Eighth Amendment’s excessive fines clause, the judge decided to rule against Latonya Mallory, the former CEO of the testing lab,...

Arizona’s Banner Health Settles Fraud Lawsuit for $18M; Whistleblower Will Get $3M

Arizona’s Banner Health Settles Fraud Lawsuit for $18M; Whistleblower Will Get $3M

You would expect major health care companies to have the integrity (and massive revenues) to bill patients correctly and be honest about the reimbursements they’re entitled to.
But it’s not just small-town providers who try to get away with fraud: Banner Health, which manages 28 hospitals in two states, will have to pay $18 million to the U.S. government for submitting false claims to Medicare.
Thanks to a whistleblower, the company will be held accountable for scamming...

NC Health Care CEO Gets 8 Years in Prison for Medicaid Fraud and Perjury

NC Health Care CEO Gets 8 Years in Prison for Medicaid Fraud and Perjury

Another player in a massive scheme to defraud the North Carolina Medicaid Program has been sentenced to prison time. Shephard Lee Spruill, CEO of Carolina Support Services in Greenville, NC, was found guilty of health care fraud conspiracy and perjury and sentenced to eight years in prison.
The court also ordered him to pay back the nearly $6 million he helped steal from the taxpayer-funded health care system.
Spruill was one of many health care providers and administrators involved...

United Therapeutics to Pay $210 Million over Medicare Fraud Involving “Charitable” Donations in Exchange for Drug Co-Payments

United Therapeutics to Pay $210 Million over Medicare Fraud Involving “Charitable” Donations in Exchange for Drug Co-Payments

The Maryland-based pharmaceutical company United Therapeutics has agreed to pay $210 million to resolve allegations that it “used a foundation as a conduit to pay the copays of Medicare patients taking UT’s pulmonary arterial hypertension drugs, in violation of the False Claims Act,” according to a Department of Justice spokesperson.
The settlement comes amid a large scope DOJ investigation into a culture of pharmaceutical company donations to patient-assistance...

Georgia Dentist Removed from Regulatory Board post $23.9 Million GA Medicaid Fraud Settlement

Georgia Dentist Removed from Regulatory Board post $23.9 Million GA Medicaid Fraud Settlement

In the wake of a $23.9 million Medicaid fraud settlement between the U.S. Department of Justice and children’s dental clinic chain Kool Smiles, Dale G. Mayfield—Chief Dental Officer at Kool Smiles—was asked to step down from his position with the Georgia Board of Dentistry by Gov. Nathan Deal.
Through his position on the Board, which he held since February 2016, Mayfield had the power to influence how dentists were licensed and regulated throughout...

Brooklyn-based Doctors and Administrators Indicted Over $146 Million False Medicare and Medicaid Billings Scheme

Brooklyn-based Doctors and Administrators Indicted Over $146 Million False Medicare and Medicaid Billings Scheme

Four New York-based physicians and 16 other individuals have been indicted in connection with a large-scale healthcare fraud scheme that allegedly defrauded New York Medicaid, Medicare and other government-funded programs of $146 million. 14 companies have also been charged.
The defendants allegedly paid patients to take unnecessary tests and undergo unnecessary procedures that were later billed to Medicare and Medicaid. Investigators also found evidence of a money-laundering scheme...

Rampant Fraud in Chicago’s Home Health Care Industry Exposed

Rampant Fraud in Chicago’s Home Health Care Industry Exposed

A recent investigation by the Chicago Tribune reveals the Chicago metro area has become a safe haven for fraudsters in the booming home health care services industry.
According to an estimate by federal investigators, local home healthcare providers have defrauded taxpayers of over $104 million over the last five years.
Home health care services enable disabled and elderly individuals to continue to live at home instead of resorting to nursing homes. The probe into the oversight...

$15 Mill Medicare Fraud Nets Florida’s Elite Home Care Head 9 Year Sentence

$15 Mill Medicare Fraud Nets Florida’s Elite Home Care Head 9 Year Sentence

Yunesky Fornaris has been sentenced to nine years in prison for engaging in Medicare fraud. The former owner of Miami’s Elite Home Care LLC, a now defunct company, pleaded guilty to defrauding the federal healthcare program of millions of dollars.
In addition to the prison sentence, Judge Joan A. Lenard has ordered he must forfeit proceeds from the scheme in the amount of $15.1 million. As part of his guilty plea, Fornaris admitted he had systematically used his company to bill...

Mistrial: Senator Robert Menendez’ Bribery by a Medicare Defrauding Doc Charges

Mistrial: Senator Robert Menendez’ Bribery by a Medicare Defrauding Doc Charges

Over the last two and a half months, New Jersey´s Democratic Party Senator Robert Menendez has faced a trial over federal bribery allegations involving alleged Medicare violations by one of his most affluent donors.
Now, after six days of deliberations, the jury has pronounced itself deadlocked and the proceedings have ended in mistrial. Although prosecutors will likely seek a retrial, the outcome is a hard blow for advocates of campaign financing transparency.
According to...

Nurse Gets Prison in New York Medicaid Fraud Scheme

Nurse Gets Prison in New York Medicaid Fraud Scheme

A private duty nurse was sentenced to a year in prison after being found guilty of New York Medicaid Fraud Charges. Prosecutors say the nurse was supposed to be caring for two severely disabled patients, instead he was jetting round Europe on the taxpayer’s dime.
Collins Anyanwu-Mueller R.N., age 47, was sentenced to 12 months in prison and ordered to pay restitution by Westchester County Judge Barry Warhit.
According to court documents, Anyanwu-Mueller bilked the taxpayer...

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