2014: More News
OIG Update has expanded its coverage. Here is more news that you won't hear in the monthly podcast.
- OIG found in another review that the Fraud Prevention System identified millions of dollars in Medicare savings, but procedures could be strengthened.
- OIG found in another review that the Fraud Prevention System identified millions of dollars in Medicare savings, but procedures could be strengthened.
- The Idaho attorney general asked the U.S. Supreme Court to hear an appeal of a lawsuit challenging Medicaid rates paid to providers.
- An Indiana hospital settled OIG allegations that it failed to properly screen a patient who had an emergency condition.
- The co-owner of a Pennsylvania ambulance company was jailed for 13.5 years and must repay nearly $2 million in a billing fraud case.
- A Pennsylvania healthcare staffing agency settled OIG allegations that it employed an excluded nurse.
- An Iowa skilled nursing facility is to pay $500,000 to resolve allegations that it submitted improper claims to Medicare for therapy services that were not justified by residents' conditions and that it erroneously submitted inflated cost reports to Medicaid.
- An Iowa medical center is to pay $40,000 to settle OIG allegations that it didn't provide an emergency room patient with appropriate screening and treatment.
- American International Biotechnology is to pay more than $343,000 to resolve claims it obtained improper referrals for genetic tests, then billed Medicare.
- Three Californians were jailed, one for 12 years, in a complex fraud scheme that cost Medicare $3.2 million. The scam included use of patient recruiters, kickbacks, bogus prescriptions for power wheelchairs, sham examinations and false claims.
- In a California case, a man was imprisoned for more than 10 years and must repay Medicare nearly $1 million in a scam centered on an equipment company put in the name of a "straw" owner, identity theft and claims for bogus services.
- A Detroit-area doctor admitted his role in a multimillion-dollar home health referrals scheme that included false certifications, kickbacks, unneeded prescriptions for controlled substances and false billing.
- The owner of a now-defunct Miami home health agency entered a guilty plea in a $6.5 million Medicare fraud scheme that included kickbacks, unneeded or never-rendered services and false billing.
- Four patient recruiters admitted their roles in a $20 million Medicare scheme linked to another defunct Florida home health care company.
- A Florida man was jailed for four years in a multimillion-dollar therapy services false billing scam. The Medicare scheme included kickbacks, illegitimate services and the use of shell companies. More than $6.2 million dollars in restitution was ordered.
- A Florida office worker admitted paying recruiters for providing patients in $7 million home health scam.
- A Florida patient recruiter admitted his role in the $205 million American Therapeutic Medicare fraud scheme.
- A Florida podiatrist pleaded guilty to Medicare fraud involving bogus electrical stimulation therapy.
- A Miami recruiter admitted receiving kickbacks/bribes for providing patients to a home health agency in a $6.5 million scam.
- A former physical therapy provider in Florida was jailed for 27 months and must repay nearly $1.3 million in a Medicare false billing scam.
- A brother and sister were charged in Louisiana in a Medicaid personal care services scam. On numerous occasions, authorities assert, the brother falsely billed Louisiana Medicaid for personal care services performed for his sister. Authorities contend that the services were never performed. It is further alleged that the sister signed off on service logs submitted by her brother for payment.
- An Illinois husband and wife were charged with bilking Medicare out of $800,000 and paying kickbacks in an alleged scheme involving doctors' services that were billed but never provided.
- An Illinois Medicaid beneficiary was convicted of fraud; she falsely claimed that a relative cared for her and then billed Medicaid.
- Three certified home health aides in New Jersey were charged with Medicaid false billing; services allegedly were never rendered.
- The owner of a network of diagnostic imaging centers and 12 others were charged in a cash-for-referrals scheme in New Jersey.
- Selling oxycodone without prescriptions put a former New Jersey pharmacist behind bars for more than three years. He must pay a fine of $1 million.
- A Mississippi woman was jailed and must pay more than $112,000 for billing Medicaid for children's glasses that were never provided.
- A Mississippi resident was sentenced to five years in jail for striking and breaking the jaw of a patient in a care center.
- An advanced practice registered nurse in Connecticut was imprisoned for 23 years for sexual assault and Medicaid fraud.
- A suspended nurse at a Connecticut care center stands accused of forgery and unlawfully practicing nursing.
- A Connecticut physician was charged with illegally prescribing controlled substances, including to some patients he knew to be addicts or who had been arrested on charges of possessing and distributing controlled substances, authorities said.
- A Connecticut dentist was charged with Medicaid billing fraud; in one case, he allegedly claimed to have provided services while he was hospitalized.
- A dentist in Connecticut who had been excluded from participation in federal healthcare programs was charged with continuing to bill Medicaid and illegally receiving nearly $95,000.
- An Alabama dentist was charged in a $500,000 Medicaid false billing scheme.
- A Kentucky long-term-care center settled OIG allegations that it employed a nurse who had been excluded from participation in federal healthcare programs.
- A Kentucky oncology practice and its office manager admitted knowingly receiving a misbranded cancer drug.
- A Tennessee mother was charged with selling an ADHD medication that authorities said she had obtained through Medicaid and which had been prescribed for her child.
- Four were charged in Tennessee with selling controlled substances obtained through Medicaid.
- A civil lawsuit accuses a New York hospital group of fraudulently delaying repayment of $1 million in Medicaid overcharges.
- Another New York hospital is to pay $750,000 to settle civil allegations that it double-billed Medicare for operating room and ambulatory services.
- A New York ambulette company overbilled for more than $2.48 million over two years, a state Medicaid Inspector General audit found.
- The owner of an ambulette company in New York was charged in the theft of more than $200,000; authorities allege that transport requests were falsified to boost Medicaid payouts.
- A Pennsylvania ambulance company manager was jailed for five years for his role in a $3.6 million healthcare fraud conspiracy; restitution was ordered.
- A woman with a criminal record admitted forging applications to run Pennsylvania childcare center, bilking Medicaid out of $1.4 million.
- A Pennsylvania provider was charged with creating false IDs and phony licenses for her employees, false billing and money laundering.
- Three from Georgia were sentenced - one to a seven-year prison term - in a Medicaid counseling scam. Restitution of more than $600,000 was ordered.
- A Georgian who falsely billed on behalf of therapists who no longer worked for him was sent to jail and must repay more than $582,000.
- An Atlanta ob-gyn admitted billing Medicaid for services performed by an unlicensed, unsupervised medical school graduate.
- A mental health counselor in Oklahoma was charged with Medicaid billing fraud; she allegedly billed for times she was gambling at a casino.
- A Kansas chiropractor admitted a million-dollar-plus billing fraud that included aggravated identity theft and tax evasion. The chiropractor billed in doctors' names for procedures he was not allowed to perform.
- A North Carolina doctor pleaded guilty in a false billing criminal case and is to pay $6.2 million dollars to settle civil fraud allegations. The physician admitted hiding $2.4 million from the Internal Revenue Service that was used to build an 8,000-square-foot home on a lake.
- Two Maryland doctors - husband and wife - were charged in a $2.3 million healthcare fraud scheme; authorities assert that they billed for services not rendered.
- A Maryland-licensed X-ray technician, later promoted to company vice president, entered a guilty plea in a $2.5 million fraud that victimized Medicare and other insurance carriers. The man admitted billing for tests interpreted by unlicensed personnel and for tests and services that had not been provided. The U.S. attorney praised OIG work on the case.
- A Maryland woman admitted neglecting a disabled adult; the caregiver left the victim locked in a hot car while she shopped. Sentencing is scheduled for September.
- The former chief operating officer of a Nevada endoscopy center admitted overcharging for anesthesia services.
- Four were charged with racketeering and healthcare fraud linked to the operation of a skilled nursing facility in Virginia.
- Visit the OIG website to read our latest report on vulnerabilities found in long-term-care hospitals' readmission policy.
- In another report, OIG urged barring Medicare Advantage payments for those confined in mental health facilities under a penal code.
- A nursing home chain has agreed to pay $750,000 to settle claims of substandard and/or worthless care.
- A Texas nursing and rehabilitation center settled OIG allegations that the facility employed an excluded nurse for two years.
- A California medical center settlement resolves OIG allegations that the hospital failed to screen a patient for an emergency condition.
- The State University of New York - Buffalo has agreed to pay more than $115,000 to settle allegations that it violated Medicaid billing rules.
- The owners of a Kentucky oncology practice are to pay $3.7 million to settle allegations of false billing. Authorities said that chemotherapy treatment was extended only to maximize reimbursement from government healthcare programs.
- The United States joined a whistleblower lawsuit alleging that a Pennsylvania hospice submitted millions of dollars in false claims. Ineligible patients and fabricated records are alleged.
- A Massachusetts lab is to pay more than $4.6 million to settle allegations of falsely billing Medicare and Medicaid for services not rendered.
- In Illinois, a hospice owner and three employees were charged with falsely elevating the level of patients' care to increase reimbursement from Medicare. Authorities allege that the case includes false claims, unneeded care, altered files and illegal bonuses.
- A Los Angeles doctor was charged in a $33 million scheme that allegedly included phony prescriptions and massive false billing to Medicare.
- A Houston physician and four others were charged in a nearly $3 million dollar scam linked to a sleep/allergy center. False billing and kickbacks are alleged.
- A medical supply firm owner from Texas was convicted in Louisiana in a multimillion-dollar scam involving bogus claims to Medicare.
- Fraudulently overbilling Medicare for hyperbaric oxygen therapy lands a pair of Texans in jail, each for five years; together they must repay $1.5 million.
- Eight people were charged in a Louisiana personal care services scheme that allegedly split illegal proceeds with Medicaid beneficiaries.
- A Montana woman was jailed for 30 months and must repay nearly $300,000 in a "split-check" scam that defrauded a tribal grant program. The scheme, which defrauded the Temporary Assistance for Needy Families program, included approval of illegal payments, a portion of which were kicked back to program director.
- The co-owner of a Georgia counseling service was jailed for seven years and must repay more than $622,000 after filing more than 3,000 false Medicaid claims. The state attorney general said the man "shamelessly used Medicaid funds to finance his extravagant lifestyle" while children were deprived of services they needed.
- A Miami Beach doctor was imprisoned for nearly six years and must repay $1.6 million in a Medicare drug fraud case. He must also forfeit his residence and a luxury car.
- Allegedly billing for unauthorized and never-performed services led to charges against a Florida dentist. Authorities said the case included tips from patients and parents about suspicious billing. Authorities also allege that healthy teeth were pulled as a way to promote denture sales and increase reimbursement from Medicaid.
- Two Florida men were imprisoned for money laundering linked to a healthcare fraud scheme; $1.8 million dollars in restitution was ordered.
- A Florida woman was charged with billing Medicaid for services never provided and taking kickbacks.
- A Florida man was charged with practicing mental health counseling without a license and defrauding Medicaid. Authorities allege that he forged a mental health counseling license so he could get job.
- A Florida nursing assistant was charged with striking an 87-year-old resident of an Alzheimer/dementia care center in the face.
- Authorities allege that the 2013 death of a New York nursing home patient is linked to the failure of a registered nurse to render life-saving care despite the stated desire of the patient and the family that it be given. The nurse was also charged with providing a false written statement about the incident.
- A New York nurse was charged with endangering a nursing home resident and falsifying records.
- Two more New York nursing home workers were charged in a negligence case linked to the death of a patient. Seven others were charged earlier.
- A Long Island, N.Y., doctor was charged with writing hundreds of prescriptions for painkillers without medical need.
- A New Jersey couple, owners of a mobile diagnostic testing company, were charged with healthcare fraud conspiracy. Authorities allege that they electronically forged diagnostic reports and falsely billed Medicare and others.
- A New Jersey physician whose medical license had been revoked is now charged with practicing without a license.
- An Iowa doctor who surrendered his medical license was jailed for five years for illegally dispensing drugs resulting in death. He was also convicted of healthcare fraud.
- An Idaho doctor was charged with distributing controlled substances without legitimate purpose.
- And an Idaho woman admitted in a drug diversion case that she sold oxycodone she obtained via prescription to an undercover police officer.
- A Maryland physician admitted providing prescription drugs without medical need to his addicted girlfriend.
- A Maryland man admitted embezzling more than $570,000 dollars -- meant for drug research -- from an NIH grant; full repayment was ordered. He could get as much as 10 years in prison at sentencing in September.
- A Houston ambulance firm owner was jailed more than eight years and must repay nearly $1 million dollars for bogus Medicare claims for transportation.
- In Ohio, a couple - owners of an ambulette firm - were sent to prison for what was described as "brazen fraud" and must repay more than $800,000 after falsely billing Medicaid.
- A Tennessee ambulance firm is to pay $500,000 to settle allegations that it provided lower-level of service that it claimed.
- An EMT in Pennsylvania who admitted having a role in a $3.6 million ambulance fraud scheme was jailed for more than two years.
- The former owner of a home care service in Kentucky was jailed and must pay more than $770,000 dollars for billing Medicaid for ineligible patients.
- A former District of Columbia government worker was jailed for 20 months and must repay more than $780,000 after creating fake accounts to steal Medicaid, food stamp and other benefits.
- A Kansas woman admitted defrauding Medicaid in a home health billing case; she is to repay nearly $20,000.
- An excluded provider in Missouri was convicted of submitting nearly 15,000 healthcare claims worth more than $2.6 million.
- A Pennsylvania resident was charged in a prescription scam that included alleged aggravated identity theft, false billing and drug diversion.
- Richard Wade, a convicted OIG deadbeat parent, was ordered to pay more than $21,000 in child support.
- And Hector Martinez and Alexander Vasolla were added to OIG's child support enforcement list of deadbeat parents.
- A Milwaukee man was sentenced for Medicaid fraud. He filed time reports indicating that he had cared for his grandmother for five hours every day between December 22, 2012, and January 3, 2013, when, in fact, he was in the custody of the Milwaukee County sheriff. In all, he submitted six fraudulent time reports, claiming 394 hours of work.
- A Tennessee woman was charged with fraud; she allegedly forged prescriptions to get painkillers and other drugs.
- Five defendants in Tennessee were charged with fraud; authorities said they obtained drugs through Medicaid and sold them on the street.
- A Georgia woman was charged with Medicaid fraud in Tennessee; she allegedly received benefits though she was ineligible because she did not live in Tennessee.
- A Washington state practice agreed to pay nearly $260,000 to settle allegations that it filed inflated Medicaid claims over 8 years.
- Four defendants entered guilty pleas in separate healthcare fraud cases in Washington state; Medicaid recovered $137,000.
- An Alabama ob-gyn was charged in a $60,000 fraud; authorities said she sold misbranded IUDs and billed Medicaid for them.
- An Alaska doctor was charged with fraudulently billing Medicaid hundreds of thousands of dollars and evidence tampering.
- Two in Arkansas, already excluded from Medicaid, were charged in a $41,000 fraud; they allegedly forged prescriptions and filed false bills.
- A New Jersey radiologist, who owned a diagnostic center, was jailed for nearly four years and must forfeit $2 million for bribing doctors to refer patients to his business.
- A New Jersey home health provider was charged with billing more than $100,000 for services not provided.
- A Pennsylvania pharmacist pleaded guilty to defrauding Medicaid and private insurers by billing for prescriptions that were never filled.
- A St. Louis home health provider, who had no healthcare education or experience and previously worked in cosmetology, pleaded guilty to healthcare fraud and bank fraud; she billed for services that were not provided.
- A Kentucky chiropractor was convicted of billing for services rendered by others who were not approved by Medicaid.
- A South Dakota woman was jailed for 14 months and must repay more than $109,000 in a theft conspiracy involving the Oglala Sioux tribe. The case included fake invoices, phony contract estimates and money diverted for personal use.
- A District of Columbia woman admitted selling counterfeit documents to people seeking jobs in home health care.
- A District of Columbia day treatment program worker was convicted of criminal abuse of a vulnerable adult. The worker directed malicious statements toward the patient and made a video of the victim.
- A physical therapist in Connecticut, charged in 54-count healthcare fraud indictment, allegedly referred patients for personal training but billed for physical therapy. She is also charged with tax fraud.
- An Oregon woman was sentenced to jail and must repay more than $142,000 for stealing benefits due her disabled sister.
- Mercy Hospital in Miami is to pay $45,000 to settle "patient dumping" allegations linked to treatment of an infant.
- The owner of a Nevada company is to repay Medicaid $25,000 for keeping inadequate records and billing for bogus services.
- A Massachusetts man was jailed after admitting he cashed fraudulently obtained Medicaid transportation reimbursement checks.
- Baptist Health System in Jacksonville, Fla., is to pay $2.5 million to settle allegations that its subsidiaries billed for unneeded services and drugs.
- A former WellCare CEO was jailed for three years for Medicaid fraud; he and others fraudulently submitted inflated cost data in the company's annual reports to Florida's Agency for Health Care Administration to reduce WellCare HMOs' contractual repayment obligations for behavioral health care services.
- A New York druggist was sent to jail for his role in a $16 million Medicaid prescription fraud that targeted vulnerable HIV patients; the pharmacist must forfeit $500,000.
- Two providers in New York were charged with using sham firms to submit $13 million in fraudulent claims for durable medical equipment.
- A New York City Medicaid employee was charged with abusing his position to divert hundreds of thousands of dollars to himself and to his friends.
- A physician and a home health agency manager in Texas were convicted in a $3 million Medicare fraud conspiracy that included recruiting beneficiaries for unneeded services and taking cash in exchange for false certifications.
- A physician in Texas was jailed for 37 months and must pay fines and restitution of more than $380,000 for healthcare fraud and mail fraud. The doctor billed for services he never provided, including for patients who died before the dates of service.
- A Texan was convicted in a $3 million medical equipment scam that involved false billing for devices that were never delivered, phony prescriptions from a doctor who never saw the patients, upcoding, kickbacks and money laundering.
- A Texas woman, who ran two medical equipment firms, was sent to prison for 11 years and must repay more than $850,000 in an extensive fraud conspiracy.
- Two Los Angeles ambulance company owners were jailed for nine years and for more than six years in a multimillion-dollar scheme that involved bogus records and false billing of Medicare.
- A mother and son from North Carolina were jailed for six years and more than four years, respectively, and must repay more than $3 million in an ambulance transport scam.
- In one report, OIG found that independent providers paid less for dialysis drugs than they were reimbursed by Medicare; hospitals paid more.
- Another OIG review found that the data system for sharing information about banned providers needs improvement to support Medicaid integrity.
- OIG also found that competitive bidding could significantly reduce California Medicaid payment rates for medical equipment.
- Medicare improperly paid providers $18.4 million dollars over three years for beneficiaries who became ineligible for services, OIG found in another review.
- In another report, OIG recommended coordinated and improved oversight of the Small Business Innovation Program by the Department of Health and Human Services (HHS).
- The United States intervened in lawsuit against Orbit Medical, based in Salt Lake City, and its former vice president, alleging altered and forged prescriptions for medical equipment, including power wheelchairs.
- A West Virginia physician and his cardiology practice are to pay $1 million to settle allegations of improper compensation and false claims for referrals.
- Two companies that operate physical therapy clinics in the Washington, D.C., area are to pay $2.78 million to resolve allegations of false claims to Medicare and TRICARE.
- In a case of provider self-disclosure, a Pennsylvania health system is to pay $1.5 million to resolve allegations that it leased space to physicians at below-market rates to illegally induce referrals of patients.
- An Oklahoma medical center and its corporate parent are to pay $1.5 million to resolve claims that Medicaid was billed for unneeded sinus surgeries on children.
- Billing errors forced a huge Texas pediatric practice to repay Medicaid $3.75 million.
- The owner of a tax preparation franchise and a behavioral health provider business admitted tax fraud, Medicaid fraud and money laundering. He has agreed to pay restitution, and he could be fined $850,000 and sentenced to as much as 28 years in prison.
- Two Texas doctors are to pay $3.9 million in a civil case centered on alleged substandard tests and exams and the use of unlicensed staff.
- A company owner in Texas was convicted of billing Medicare $1.48 million for supplies that were never provided; she was also convicted of aggravated identity theft. The Houston case included theft of doctor IDs, false records and billing for more than 29,000 feeding supply kits that were never ordered for delivery.
- An Illinois doctor was charged with using a sleep center as a prescription service for addicts and billing for bogus services.
- In a drug diversion case, a Michigan doctor was convicted of writing illegal prescriptions for controlled substances, conducting unneeded tests, false billing and money laundering. The drugs he prescribed were resold on the street or used by addicted patients. He also transferred more than $1.5 million in criminal proceeds to a bank account in Amman, Jordan.
- Another Michigan doctor was convicted of writing prescriptions for controlled substances that he knew would be diverted for illegal use.
- A Detroit-area doctor admitted referring patients she never saw or treated to home health agencies in a $1.3 million Medicare scam. The doctor signed certifications that home health care was needed, and the agencies used the physician's false documents to support their claims to Medicare.
- In another Detroit-area home health case, an agency office manager was imprisoned nearly four years in a $5.8 million Medicare fraud scheme. The scam included false claims, services not rendered, fake patient files and phony referrals.
- A Virginia podiatrist was jailed and fined for lying to a Massachusetts grand jury about her role in falsifying patient medical records to induce Medicare to pay for claims for Orthofix bone growth stimulator medical devices that did not meet reimbursement guidelines.
- A California woman who orchestrated a complex healthcare fraud was sentenced to more than to six years in prison and must repay nearly $10 million. The fraud involved billing Medicare for equipment and services that were medically unnecessary or never provided.
- Also in California, a physician's assistant in Los Angeles admitted taking part in a multimillion-dollar scam; he signed fraudulent prescriptions for durable medical equipment that led
- A Maryland woman was charged with treating Medicaid patients while posing a physician's assistant. Authorities said she used a stolen identity to get a job in a doctor's office, forged a physician's assistant diploma, treated about 200 patients, including infants, and wrote unauthorized prescriptions.
- Three people were arrested in California. They were named in an indictment alleging $11 million in healthcare fraud, money laundering and tax fraud.
- A California medical equipment supplier was convicted in a $1.5 million Medicare fraud scheme. The supplier stole the identities of doctors and beneficiaries and billed Medicare for never-prescribed, never-rendered services.
- A husband and wife were charged with running a sham clinic in Florida to defraud Medicare. The alleged scam included unlicensed workers, aggravated identity theft, fraudulent prescriptions, services claimed but not provided, and false billing, authorities said.
- 10 people were charged in a 59-count indictment in a Florida home health scam that allegedly included kickbacks, bribes, phony patients and bogus services.
- A former Massachusetts personal care aide admitted falsifying timesheets and bilking Medicaid out of nearly $63,000. The man submitted false timesheets to MassHealth indicating that he cared for a patient at the same time he was driving a school bus. The case also includes an alleged agreement to split proceeds of the fraud with the Medicaid recipient, authorities said. The defendant was put on probation and ordered to pay full restitution.
- A doctor who headed a Massachusetts substance abuse clinic admitted illegally prescribing an anti-addiction drug; he is to pay $19,700.
- Seven stand charged in Indiana with Medicaid fraud; the defendants schemed to file false and inflated dental claims, authorities said. Forgery was also alleged.
- An Alaska woman falsely billed Medicaid for more than $64,000, claiming that she rendered services while working two other jobs. She was sentenced to a year in jail.
- A Florida woman was charged with billing Medicaid $350,000 for bogus vascular ultrasounds.
- Two in Florida were sentenced in a pharmacy fraud; more than $350,000 in restitution was ordered.
- A Florida woman and her daughter-in-law were charged with billing Medicaid $70,000 for services that were not provided to a disabled relative.
- A Florida woman was charged in a $25,000 fraud; authorities allege that she hired an unqualified worker and filed illegal Medicaid claims.
- Two Florida women were charged with failing to provide medical care to a disabled group home resident, who was later hospitalized.
- Two Floridians were charged with billing Medicaid more than $18,000 for home health services that were never rendered.
- A former nurse was charged in Delaware with forgery and fraud; she allegedly took a painkiller meant for patients for her own use.
- A Georgia doctor was jailed for four years for billing Medicaid nearly $400,000 for bogus office visits and procedures.
- A Pennsylvania ambulance driver was sentenced to two years in jail for his role in a scheme involving unnecessary transports that cost Medicare $1.5 million.
- Four in Puerto Rico were charged with misbranding and adulterating prescription drugs in a $300,000 Medicare fraud case.
- A South Dakota pharmacist was charged with falsifying records and taking hydrocodone and codeine for his own use.
- A doctor who owned three healthcare facilities in New Jersey was charged in a multimillion-dollar tax scam.
- A New Jersey chiropractor admitted taking bribes to refer patients to a pain management physician.
- A Kansas doctor was jailed for five years for illegally prescribing drugs; a fine, restitution and forfeitures were ordered.
- A personal care aide was charged in Kansas in a $587,000 Medicaid scam; the woman allegedly claimed, among other things, that she worked 39 hours in one day.
- A Maryland caregiver who got drunk and passed out admitted neglecting a vulnerable adult; the aide, who could be jailed and fined, left a 23-year-old, who needs 24-7 assistance, alone for hours.
- Convicted of prescription drug trafficking, a Maryland man was imprisoned for five years. An auto body shop was the hub of the scam.
- A Massachusetts woman and a son were charged in multiple schemes to defraud Medicaid of $96,000. Personal care services allegedly were billed under the names of children, including one in jail, who lived out of state.
- The owner and general manager of an Oklahoma hospice were charged with Medicare fraud. Obstruction of a federal audit and falsified records were alleged.
- A Connecticut man was charged in a "diploma mill" scam; authorities said he used seven websites to sell phony academic credentials.
- 20 people were arrested and charged in a personal care services scheme that authorities say cost Louisiana $150,000.
In another report, OIG recommended more effort to ensure appropriate oversight and use of Medicare Advantage data.
OIG noted in another review that more than half of Part D plan sponsors did not report potential fraud and abuse data between 2010 and 2012.
OIG found high-risk security vulnerabilities during reviews of information technology controls at state Medicaid agencies.
OIG posted a budget document for fiscal year 2015. It's on our website.
A former District of Columbia government worker pleaded guilty to conspiring to steal about $800,000 in Medicaid and other benefits.
A Salt Lake City psychologist was indicted on fraud charges; he allegedly billed for services not rendered.
A Tennessee woman is facing 15 fraud counts; she allegedly passed forged prescriptions paid for by Medicaid.
A South Carolina woman was jailed for four years for identity theft and false billing; she must repay Medicare $411,000.
The owner of nurse staffing agency in Maryland admitted submitting false Medicaid claims for 69 dates of service. The services were never provided.
Three in New York were charged in pharmacy scheme, accused of preying on HIV patients and fraudulently billing Medicaid.
A former doctor in Iowa pleaded guilty to fraud and illegal distribution of a drug resulting in a death.
A Massachusetts dentist is to repay Medicaid $400,000 in a civil case; he allegedly billed improperly for nursing home services.
A Florida woman was sent to jail and must repay Medicaid $200,000 in a speech therapy scam.
An ex-office manager in Ohio was charged with manipulating the reimbursement process to get higher insurance payments. The suspect is believed to have caused more than $100,000 in excessive billings to Medicare, Medicaid and other healthcare benefit providers.
A Maryland ophthalmologist is to pay $1.4 million to settle allegations that he performed medically unnecessary laser procedures. He also agreed to a 20-year exclusion as a provider from federal health programs.
A former Department of Veterans Affairs psychiatrist was imprisoned for 18 months, must forfeit $1.2 million and pay restitution for falsely claiming to provide Medicare at-home services. He submitted about $4 million dollars in Medicare claims for home treatment of beneficiaries while holding a full-time, salaried position as a psychiatrist at the VA hospital in Brooklyn, N.Y.
A physician in Massachusetts admitted falsely certifying hundreds of Medicare patients for home care in a $27 million scam.
In a Detroit-area Medicare fraud case, an ex-doctor posed as if he were licensed and illegally claimed to provide physician home care for beneficiaries in an $11.5 million scheme.
A New Jersey doctor admitted submitting more than $13 million in false billing; he gave patients free food and spa services in exchange for their Medicare IDs. He could get as much as 10 years in prison.
Another New Jersey doctor admitted embezzling more than $1 million from a medical practice to pay personal expenses.
A Miami physician pleaded guilty in a $2.5 million fraud scheme linked to narcotics violations.
An Illinois doctor admitted healthcare fraud and illegal distribution of controlled substances. Authorities said he prescribed outside the usual course of professional conduct and without legitimate medical purpose.
In a Florida civil "whistleblower" case, a doctor is to pay $750,000 to resolve allegations that he and his clinic billed Medicare for physician office visits that were not performed. The U.S. attorney characterized the case as "a troubling pattern of billing fraud." The doctor also entered into an integrity agreement with OIG.
The owner of a phony psychotherapy clinic in Michigan was jailed for eight years and must repay Medicare nearly $1 million. The case included the promise of narcotics for patients, fabricated records and $3.2 million in false billing.
A Georgia woman who ran counseling agency that served children and adolescents was sent to jail for 10 years; she was convicted of billing for bogus services, defrauding Medicaid of more than $200,000.
A Connecticut physical therapist was charged with healthcare billing fraud involving services allegedly not rendered; authorities said the woman also altered patients' records before a Medicare audit.
New Jersey pharmacists - twins - are each to serve 3 1/2 years in prison and pay fines totaling $150,000 for bilking customers, Medicaid and private insurers out of $1.5 million over 15 years.
A California pharmacy and its owner are to repay Medicare $1 million for selling foreign oncology drugs to doctors, knowing that Medicare patients would be given the drugs, which were not approved by FDA, and that the doctors would bill Medicare for the drugs.
A Californian is to pay more than $500,000 for falsely billing Medicare for wheelchairs that were not provided or not needed.
A Mississippi nurse was charged with murder, accused of turning off machines that helped keep an elderly patient alive; if convicted, she could get a could get life in prison.
A New York postal worker and his wife were charged with taking nearly $100,000 in Medicaid benefits for which they weren't eligible.
A Florida clinic owner and patient recruiters were imprisoned and must repay hundreds of thousands in an $8 million dollar home health fraud.
A Miami clinic owner was jailed for nine years in a multimillion-dollar home health and therapy prescription fraud; the woman must repay more than $8.4 million.
An Ohio acute care hospital is to pay $8.5 million to settle claims that it had improper financial ties with referring doctors.
A Texas doctor was jailed for nearly five years and must repay nearly $9.5 million in a fraud centered on a physician house-call company.
American Family Care is to pay $1.2 million dollars to resolve allegations of overbilling Medicare at its walk-in clinics.
A New York orthopedic surgeon was sentenced to 4.5 years in jail for lying about the nature and scope of surgeries he performed in an extensive false claims scam. He was also ordered to forfeit $5 million. The surgeon performed thousands of surgeries, often as many as 20 or more in a single day, for which he and his medical group submitted claims to insurers for more than $35 million.
The "straw" owner of a Florida clinic was jailed for 2.5 years in a $28 million Medicare scam; forfeiture and restitution of nearly $900,000 was ordered.
A Massachusetts pain management physician was charged with healthcare fraud; he allegedly trained his employees to overbill Medicare, seeking payment for services that far exceeded the scope and duration of those provided. Authorities also asserted that the doctor often arrived to work four hours late and conducted appointments lasting less than 10 minutes, and sometimes only 2 or 3 minutes.
- An Atlanta doctor was jailed for more than four years and fined $3.5 million in a healthcare fraud, tax fraud and money laundering case.
- A Chicago-area physician was charged in a drug and false billing case; an undercover agent posed as one of his patients.
- A Houston doctor was charged in a fraud case involving diagnostic tests that allegedly were not needed or not provided.
- A Missouri physician admitted billing Medicare for seeing patients in his office when he was, in fact, out of the country.
- A Washington State doctor and a clinic have agreed to a civil settlement of more than $89,000 for alleged improper billing of Medicare/Medicaid.
- A New Yorker who posed as optometrist was convicted of defrauding Medicaid of more than $115,000.
- A Maryland dentist is to repay Medicaid $25,000 in civil damages for services billed but allegedly never rendered.
- A Missouri in-home healthcare provider was indicted on bank fraud charges. She also faces healthcare fraud charges, and her trial in that case is set for May.
- Submitting false home-care timesheets put a Kansas Medicaid provider under house arrest; she must also repay more than $50,000.
- Eleven home-care workers in Michigan were charged with defrauding Medicaid of more than $60,000.
- Submitting false home-care timesheets put a Kansas Medicaid provider under house arrest; she must also repay more than $50,000.
- An Arkansas attendant-care provider was charged with billing Medicaid for services allegedly not provided.
- A community mental health center in Tennessee is to pay $800,000 to settle allegations that it submitted false Medicaid claims.
- Three from Miami were charged with fraud in multimillion-dollar American Therapeutic Corporation false billing case.
- And a patient recruiter admitted playing a role in the same scam. His sentencing is set for March.
- A Florida man was convicted of running an unlicensed clinic, filing false claims & identity theft and must repay more than $83,000.
- Three Floridians were charged with billing Medicaid more than $80,000 for services allegedly never rendered.
- A Texas ambulance company owner was charged with filing more than $500,000 in false claims for services not provided.
- A Texas woman admitted conspiring with a doctor and submitting false healthcare claims.
- A pharmacist in New Jersey was charged with paying more than $50,000 in kickbacks to a doctor for prescription referrals.
- A New Jersey man admitted selling oxycodone to an undercover agent; the state is recommending a seven-year jail term.
- A South Dakota man was charged with presenting a pharmacy with a falsified, forged prescription for hydrocodone, a controlled substance.
- An Idaho woman was jailed and must repay more than $47,000 for fraudulently billing Medicaid for transportation services.
- A nursing home bookkeeper in Louisiana was charged with stealing $133,000 from patients.
- Orthopedic clinics in Tennessee and Virginia together must pay $1.85 million dollars to settle claims that they billed state and federal health care programs for reimported medications used to treat osteoarthritis, knowing that such reimports were not reimbursable.
- Insurer CIGNA must reprocess and pay hundreds of nutrition counseling and mental health claims it had denied in New York.
- Also in New York, EmblemHealth is to offer reinstatement of health insurance coverage to more than 8,000 young adults and pay about $90,000 in denied claims.
- A Texas pharmacist, doctor's office manager and three drug dealers were convicted in a "pill mill" conspiracy that had run since 2010.
- A Baltimore auto shop owner and his son admitted trafficking in illegal narcotics, including oxycodone, and taking part in armed burglaries; each faces up to 25 years in jail.
- A Maryland physician, busted in an undercover investigation, prescribed drugs without a medical exam to patients he knew abused and/or sold them.
- Three medical groups and a billing firm are to pay more than $3.3 million to resolve claims that they overbilled for nuclear stress tests.
- Seven nursing home workers in New York were charged in the death of a resident and in an alleged cover-up; two other workers were facing separate charges of falsifying business records and willful violation of the health laws. Authorities said the pair neglected other residents and gave false statements to conceal the neglect. The state also filed a civil lawsuit against the nursing home, alleging an extensive pattern of neglect and corporate looting.
- A suspended Illinois doctor was charged in a false claims case that included alleged sexual contact with a patient. Authorities said the physician obtained information about Medicare beneficiaries without their knowledge through his affiliation with assisted-living facilities, billed for medical services to patients he never treated and billed for routine visits at the highest levels of in-home care when he knew that the visits did not qualify for such billing.
- A patient recruiter in New York pleaded guilty in a $13 million fraud scheme that included kickbacks and money laundering.
- A New York physician was charged with illegally selling prescriptions for a controlled substance. Authorities said the doctor sold the painkiller prescriptions to a Medicaid recipient, who returned half of the drug to physician.
- In California, a doctor, who authorities said dispensed nearly 1,600 oxycodone pills in the summer of 2012, was charged with, among other things, prescribing drugs without legitimate medical purpose.
- A couple who owned a Tennessee ambulance service were sentenced to prison terms of more than six and more than five years in $1.2 million Medicaid fraud case that included aggravated identity theft and billing for services for unqualified beneficiaries.
- An Ohio couple, owners of an ambulette service, were charged with defrauding Medicaid of about $750,000 after allegedly providing rides to patients who did not use or need wheelchairs, billing for transports that did not occur and charging for attendants who were not present.
- Seven Ohio oncologists are to pay a total of $2.6 million after importing cancer medications that were not approved by the Food and Drug Administration.
- Also in Ohio, a nurse was charged in a Medicaid fraud scheme that included the alleged theft of more than $200,000.
- A man convicted in an oxycodone distribution case in Maine used the illegal proceeds from the drug diversion to finance a nightclub venture. He is serving nine years in prison.
- An Indiana businessman was charged in a wheelchair-scooter fraud and identity theft case that included alleged submission of claims to Medicare/Medicaid for used equipment that was sold as new.
- A former chiropractor from Louisiana was indicted on fraud and identity-theft charges involving alleged extensive false billing. Authorities said the case includes alleged billing for X-rays, tests & braces never provided.
- A Wisconsin private-duty nurse who falsified patient records and billed for services not provided was placed on probation and must repay nearly $46,000.
- Several nationwide contract therapy providers are to pay $30 million to settle civil allegations of kickbacks for referrals of nursing home business.
- A Kentucky addiction clinic, lab and two doctors are to pay $15.75 million dollars to settle claims that they falsely billed Medicare and Medicaid for tests that were medically unnecessary, were more expensive than those actually done or were billed in violation of the Stark Law.
- Medical device maker EndoGastric Solutions is to pay up to $5.25 million to settle civil false claims allegations linked to one of its products. Authorities said the firm misled providers, leading to overbilling of federal healthcare programs; payment of kickbacks was also alleged.
- The federal government has intervened in False Claims Act lawsuit against Tenet Healthcare and five hospitals, alleging that kickbacks were paid to obstetric clinics in return for referral of patients for labor and delivery at the hospitals.
- A Texas doctor who submitted thousands of fraudulent bills to Medicare and Medicaid pleaded guilty and could be sentenced to as much as 20 years in prison. Authorities said the physician billed for patients who died before the dates of his claimed services and filed claims that indicated he worked more than 24 hours in a single day.
- An Illinois hospice executive was charged with fraud after allegedly falsely raising patient-care levels in a multimillion-dollar healthcare scam. The levels of care exceeded what was medically necessary or what was provided, authorities said, leading to increased Medicare and Medicaid payments.
- A New York doctor was sentenced to serve a year and a day in prison in a $15 million scam involving physical therapy and lesion-removal services that were not provided or were not medically necessary. As part of the scheme, Medicare beneficiaries were given a variety of spa services, including massages and facials, as well as free meals, to induce them to allow their Medicare numbers to be used in billing for medical services that were not provided or not medically necessary.
- St. Joseph London Hospital in Kentucky is to pay $16.5 million to settle civil claims that it falsely billed Medicare and Medicaid for medically unnecessary heart procedures by doctors working at the hospital. Authorities said that several doctors working at the hospital performed unneeded invasive cardiac procedures, including coronary stents, pacemakers, coronary artery bypass graft surgeries, and diagnostic catheterizations, and billed Medicare and Medicaid for them.
- A Michigan home health agency owner was jailed for 10 years and must repay, with his co-defendants, more than $10 million in a scam involving false claims for skilled nursing and physical therapy services.
- 24 people were charged in connection with a massive New York drug ring that authorities said distributed more than 5 million oxycodone pills.
- An Idaho man was convicted of failing to pay more than $62,000 in child support; full restitution was ordered.
- A Washington state man was also convicted of failing to make child support payments; restitution of more than $106,000 was ordered.
- In one review (A-02-12-01009), OIG noted that New Jersey improperly claimed at least $6.9 million for Medicaid-supported employment services.
- Another OIG study (A-05-12-00053) found that the transfer of true out-of-pocket costs between Medicare Part D plans needs more rigorous oversight.
- The United States has joined lawsuits against the hospital chain Health Management Associates. The government is alleging unnecessary inpatient admissions and kickbacks.
- A Delaware corporation is to pay nearly $3 million to resolve civil claims that for five years its ambulance companies falsely billed Medicare for transporting patients from one hospital to another on an emergency basis when the calls were not emergencies.
- A New York company is to pay $2.5 million to settle an investigation of alleged false, inflated Medicaid billing. Authorities said that the company billed Medicaid for nonpatient business costs and more than 6,500 service hours by uncertified aides.
- A New York nurse's aide admitted breaking the arm of an elderly patient; while taking the resident to her room, the aide grabbed the woman by the wrist and twisted her arm behind her head, resulting in a fracture. Sentencing in the abuse case is set for March.
- A New York nurse, who claimed she cared for a seriously disabled child but was on vacation, running errands or not working at all, was jailed for two years and must repay $900,000 in a home-care scam. She falsely billed Medicaid and private insurers.
- Two former executives of the Kentucky firm HealthEssentials Solutions are to pay more than $1 million to resolve false claims allegations that centered on services the company provided to patients in assisted-living facilities.
- A Miami clinic owner pleaded guilty in multiple scams that resulted in losses to Medicare of more than $20 million.
- A doctor in Florida is to pay $400,000 to resolve allegations that he billed for vein injections done by an unqualified employee. Authorities allege that the physician sent text messages to his office manager instructing her to do varicose vein injections on patients when he was not in the office. The government also alleged that, when the doctor was in the office, he gave unnecessary injections and did unneeded ultrasound imaging.
- A Florida clinic owner and two patient recruiters admitted that they took part in an $8 million kickback and false billing scam.
- A clinic owner in North Carolina admitted running a mental health services scam that defrauded Medicaid of at least $3.4 million. Authorities said t man bought luxury vehicles and jewelry with the stolen money.
- A California doctor was jailed for more than three years and must repay over $600,000 in a multimillion-dollar Medicare false billing scam.
- A Kansas physician pleaded guilty to conspiracy to distribute controlled substances. Authorities said the office staff gave drugs to patients, using blank prescription pads that the physician signed in advance.
- A Houston man was jailed for six years in a $3 million scam involving unlicensed doctors and false billings; he is to repay $880,000.
- A Texas doctor admitted misbranding cancer drugs and has agreed to pay more than $1 million. His sentencing date had not been set.
- Two Miami women were sent to jail for 10 years for conspiring to pay healthcare kickbacks; $733,000 in restitution was ordered.
- A Florida woman was charged with submitting more than $395,000 in false invoices to Medicaid from a nursing home.
- A doctor from Washington State admits getting cash for writing oxycodone prescriptions without medical purpose.
- The New Jersey comptroller is seeking to bar three healthcare facilities from Medicaid; they allegedly filed $2.7 million in improper claims.
- A New Jersey doctor admitted taking bribes in a long-running multimillion-dollar referrals scheme with a laboratory. Twenty-two people - 11 of them physicians - have pleaded guilty in the scam.
- A licensed Oklahoma counselor was jailed for nearly two years and must repay $140,000; she billed Medicaid for services never provided.
- A Medicaid provider in the District of Columbia is to pay nearly $200,000 to resolve allegations that it billed without proper documentation.
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Priority recommendations summarized.
FY 2014 Work Plan
OIG projects planned for 2014.
Significant OIG activities in 6-month increments.