Info & Intel

Seven people living in the same Bridgeport, Alabama apartment complex are now charged with Medicaid fraud in neighboring Tennessee. The state line is just six miles from Bridgeport. Their whole scheme unraveled because of an anonymous tip. 
All seven claimed they were Tennessee residents so they could receive TennCare, the state’s Medicaid program. In Tennessee, Medicaid fraud is a class D felony, punishable by prison sentences running from two to 12 years. 
If the...

Hart to Heart, an ambulance service provider operating in Salisbury, has agreed to pay $1.25 million to resolve allegations for submitting false claims for payment to Medicare between 2010 and 2017.
In 2015, a whistleblower filed a False Claims Act lawsuit alleging that Hart to Heart was billing Medicare for ambulance transports that were medically unnecessary. Though it agreed to a sizable settlement, the Maryland-headquartered company has made no admission of guilt.
"Hart to Heart...

A Monroe, North Carolina man pleaded guilty to Medicaid fraud on June 20, and now faces up to 15 years in prison. Jerry Taylor pleaded guilty to healthcare fraud and tax evasion. He admitted conspiring with healthcare providers over a two-year period and submitting Medicaid claims for children who were not treated by these providers. 
Taylor conspired with Devon Rambert-Hairston,  a Monroe nurse practitioner, who pleaded guilty in April to money laundering, as well as collecting...

Did you know that Medicare publishes ratings of nursing homes? They are free and available online. You can see a numerical rating of the facility as well as key data on recent inspections, staffing and health and safety issues. Some states also publish inspections data.
Medicare publishes these nursing home ratings in the hopes that families will do comparison shopping before selecting a long term care facility.
In this post we will highlight one particular facility - the Grace...

Hint: Calling the Medicare Fraud Hotline Won’t Get You a Reward Google “How to Report Medicare Fraud” and in most states you will see the Medicare website at the top of the list. Medicare.gov recommends you report Medicare fraud by:  
Call us at 1-800-MEDICARE (1-800-633-4227) Report it online to the Office of the Inspector General. Call the Office of the Inspector General at 1‑800‑HHS‑TIPS (1‑800‑447‑8477). Do a similar search for How to Report...

Acadia Healthcare Company has agreed to pay $17 million to resolve allegations that it defrauded Medicaid out of $8.5 million. This is the largest settlement ever reached in a case of Medicaid fraud in West Virginia.
U.S. Attorney Mike Stuart emphasized the significance of an $8.5-million fraud for West Virginia’s Medicaid beneficiaries. “Medicaid fraud is not a victimless crime,” he said. “I am proud of the work of my office and that of our partners to ensure the...

A nurse, the owners, and several employees of Alabama-based Northside Pharmacy have been charged in a $200-million prescription drug fraud case. A DOJ investigation into the alleged scheme has resulted in a 103-count indictment. The pharmacy is located in Haleyville and operates as Global Compounding Pharmacy. The company has described itself as “one of the top three largest compounding pharmacies in the United States.”  
In one of the most egregious instances of...

The government has decided to intervene in a whistleblower lawsuit against Questcor Pharmaceuticals, the maker of H.P. Acthar. According to the allegations, the company used an elaborate scheme to boost sales revenue from the drug, defrauding taxpayers out of hundreds of millions of dollars.  
The alleged wrongdoing involved artificially inflating the price of the drug and offering kickbacks to physicians and other healthcare professionals to increase the number of Acthar...

Avenue Homecare Services and Amigos Homecare will pay a total of $10.4 million to resolve allegations that they defrauded Massachusetts’ Medicaid program MassHealth.  
Dracut-based Avenue Homecare and Lawrence-based Amigos Homecare, two home health providers, are separate entities, and Attorney General Maura Healy is investigating them as such, though they allegedly incurred similar misconduct.  
As the settlement was announced, Healy wrote in a statement that,...