Info & Intel

There are few places where people are as vulnerable as they are in the operating room. Totally unconscious, we trust that our doctors, nurses, and anesthesiologists will care for us. At the very least, we assume they’ll actually be in the operating room during surgery.
Yet, according to a new lawsuit filed by whistleblower Dr. John Mamalakis, that’s not what was happening at Ascension All Saints Hospital in Racine, Wisconsin. He says that the hospital’s contracted...

A Michigan surgeon is today serving 19 years and six months in prison after being convicted of criminal Medicaid fraud. In a separate whistleblower action settled last month, Aria Sabit MD also agreed to pay $899,000 to settled civil charges claiming he defrauded Medicare and Medicaid.
Metropolitan Detroit is a Medicaid fraud hotspot. Dr. Sabit’s conviction adds one more to the area’s already grim statistics.
That Sabit was convicted of defrauding Medicaid comes as no...

A former national health care company, which was the subject of a scathing 60 Minutes investigation in 2012, is finally facing repercussions for allegedly violating anti-kickback laws; threatening and coercing physicians; and defrauding Medicare, Medicaid and TRICARE.
Health Management Associates (HMA), a hospital chain based in Naples, FL., has reached a $260 million settlement to bring an end to numerous civil and criminal fraud charges. The matter originates from eight separate...

Between one and two million seniors have been abused by caretakers in the U.S. That doesn’t just include neglect or physical abuse; financial abuse is, in fact, the second most common form of elder mistreatment. And, of course, elder abuse is closely tied to Medicaid fraud. A caregiver who is failing to provide a patient with necessary care is likely to lie about it in billing records, too.
Unfortunately, this is exactly what happened in a recent fraud and abuse case in Missouri....

A Red Bud, IL pharmacist has pleaded guilty to health care fraud charges, admitting that he defrauded Medicare, Medicaid, and private insurers out of more than $630,000. Steven P. Gibson, owner of Gibson’s Discount Drugs at 1506 S. Main Street, will spend up to 10 years in prison for the crime.
Gibson’s scam was simple: he wrote false prescriptions for expensive drugs and submitted them to public and private insurers for reimbursement. The prescriptions were submitted under...

The owner of Boston-based Harmony Home Health Care has been sentenced to two to three years in state prison for stealing $2.7 million from MassHealth, Massachusetts’ Medicaid program. Elena Kurbatzky, a 45-year-old registered nurse and the sole owner of Harmony Home Health, was convicted on three counts of Medicaid false claims, three counts of larceny and one count of Medicaid eligibility fraud.
Kurbatzky forged signatures, submitted fraudulent reports, and straight-up lied to...

Medical patients have a reasonable expectation that when a doctor makes a referral to a specialist, the doctor has their wellbeing in mind. But according to a complaint filed in U.S. District Court, patients at a Montana hospital weren’t always given that respect. Instead, doctors made referrals in consideration of their own financial gain.
Per the complaint, Kalispell Regional Healthcare (KRH), a healthcare system based in Kalispell, Montana, was engaging in illegal behavior and...

Healthcare fraud has reached epidemic levels in the United States. At times, the situation has become so bad that the Centers for Medicare and Medicaid Services (CMS) had to resort to drastic measures such as a moratorium on licensing new providers! That means the agency didn’t have the time to license new providers because all its resources were concentrated on rooting out bad providers.
In recent years we have seen these measures in Detroit, Houston and Philadelphia. When that...

Signature HealthCARE, one of the country’s largest healthcare facility operators, has agreed to pay $30 million to settle a False Claims Act lawsuit filed three years ago.
That seems like a hefty sum, until you realize the extent of the Medicaid fraud its staff allegedly committed—which amounts to $244 million, according to the U.S. Justice Department. 
Regardless, it’s a good thing that Signature is being held accountable for its supposed fraud, which...

Generally, nurses don’t want to see their patients take a turn for the worse. But Barbara Hinkle, a hospice care nurse, said she was repeatedly told by her supervisors at Caris Healthcare to “chart negatively”—basically, indicate a decline in health—even when patients’ conditions were stable.
Hinkle claimed she was directed to admit non-terminal patients and falsify or exaggerate medical charts throughout the 10 months she worked at the Bristol, VA...