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OIG Update has expanded its coverage. Here is more news that you won't hear in the monthly podcast.

From December

  • OIG found in one review that the Office for Civil Rights did not meet all federal requirements in its oversight of the Health Insurance Portability and Accountability Act security rule.
  • And in a Medicaid review, OIG found that Maryland withdrew $115.3 million dollars more in federal funds than was necessary for fiscal years 2009, 2010 & 2011.
  • A Texas company that allegedly used unqualified therapists is to pay more than $4 million to settle a False Claims Act lawsuit.
  • CVS Caremark is to pay $4.25 million dollars to settle allegations that it failed to reimburse Medicaid for prescription drug costs that should have been paid for by private insurance.
  • Vantage Oncology is to pay more than $2 million to settle allegations its Illinois oncology centers falsely billed Medicare. The allegations include double-billing, lack of documentation that services were provided and billing for radiation treatment that did not include proper physician supervision.
  • The United States has intervened in a lawsuit against IPC The Hospitalist Co., a California firm that employs doctors and other health care providers who work in more than 1,300 facilities in 28 states. The government alleges that the company encouraged doctors to overbill for services.
  • 2 New York doctors admitted taking bribes in exchange for lab referrals; each must forfeit $108,000.
  • In New Jersey, a physician admitted taking cash kickbacks for patient referrals to a diagnostic testing facility.
  • Another New Jersey doctor admitted taking cash for referrals to the same diagnostic testing lab; he is the 15th defendant to be convicted in the kickback scam.
  • In a similar, but separate, case, a New Jersey doctor is the 21st defendant to plead guilty in a multimillion-dollar bribery scheme tied to blood-specimen test referrals to a laboratory.
  • In another New Jersey case, two women who ran a medical supply store were each jailed for three years and together must pay $300,000 for running an orthopedic shoe scam and fraudulently billing Medicaid.
  • A Louisiana physician was imprisoned and must pay more than $900,000 dollars after falsely billing Medicare, Medicaid and private insurers for an osteoarthritis drug he did not administer.
  • In a 12-count indictment, A Miami osteopathic doctor was charged with Medicare fraud; the physician could get 10 years in prison.
  • The leader of a New York ring that used fraudulent prescriptions to steal OxyContin pleaded guilty.
  • 3 Michigan pharmacists who misbranded drugs are fined and face exclusion from federal programs.
  • The owner of a women's healthcare practice in Kentucky is to pay more than $75,000 for misbranding birth control devices.
  • A former owner of a Los Angeles clinic management company was charged in a $13.6 million power wheelchair scam.
  • A former medical supply firm owner in Los Angeles was indicted in a $4 million scheme involving allegedly billed but unneeded wheelchairs.
  • A South Dakota optometrist is to pay nearly $300,000 to settle civil allegations that he submitted improper #healthcare claims.
  • Two Ohio chiropractors are to repay nearly $179,000 for double-billing and billing for services not rendered.
  • A Maryland woman was sentenced in a nursing certification scam; she is 10th defendant to plead guilty to buying/selling fake documents.
  • A dental specialist in Maryland, who improperly billed Medicaid, is to pay $340,000 in civil damages.
  • A woman who moved to Florida but continued to bill for personal care services in Maryland was convicted of Medicaid fraud.
  • A therapist admitted his role in the $63 million HealthCare Solutions Network mental health care scam in Florida. He is to be sentenced in February.
  • A Florida couple pleaded guilty to government benefit fraud, including healthcare fraud, linked to the use of aliases and two Social Security numbers.
  • A Florida couple was charged with bilking Medicaid out of nearly $80,000 in a false billing scheme.
  • A former personal care manager in Massachusetts admitted billing Medicaid for deceased and jailed recipients and is to repay $20,000.
  • An Atlanta dentist admitted defrauding Medicaid of more than $2 million; he billed for complicated procedures that he did not provide.
  • A Georgia Medicare provider stands accused of filing more than $269,000 in false claims, many allegedly without documentation.
  • A Massachusetts transport company was accused of falsely billing Medicaid for more than $470,000 for services not rendered.
  • A woman in Tennessee was charged with selling controlled substances she allegedly obtained through Medicaid.
  • A woman was charged in Tennessee with Medicaid fraud; she allegedly presented fraudulent prescriptions for controlled substances. http://go.usa.gov/Ds7H
  • A woman was accused of getting Tennessee Medicaid benefits though, authorities said, she was ineligible for them.
  • A Florida provider was charged with neglect, aggravated abuse and false imprisonment of a disabled adult.
  • A Virginia mental healthcare provider admitted falsely claiming that 66 children needed Medicaid services; she is to repay $1.5 million.
  • A registered nurse in Georgia was charged with claiming to treat a Medicaid patient who had died.
  • An Arkansas nurse was convicted of stealing prescription pills from a patient was fined and is no longer works at nursing home.
  • A Wisconsin registered nurse admitted falsifying patient records and using them to fraudulently bill Medicaid; she to repay more than $45,000.
  • A man entered a guilty plea in New York to failing to pay about $90,000 in child support.
  • Seven defendants in Vermont were charged with fraudulently billing Medicaid for more than 9,000 hours of care that was not rendered.
  • An Arkansas personal care services provider was convicted of fraudulently billing Medicaid for services not rendered and must pay nearly $28,000.
  • A Nashville pediatrician, who knowingly upcoded services, pleaded guilty to fraud; he billed for services that his practice had no equipment to provide. He was excluded from federal healthcare programs for 20 years.
  • A cardiologist in Tennessee is to pay $1.15 million to settle allegations that he billed for medically unneeded stents.
  • A physician in Kentucky was charged with unlawful distribution of drugs, healthcare fraud and money laundering.
  • A physician who ran a charity in New York was charged with the theft of $373,000 from 12 government grants; she allegedly used the money for her own gain.
  • A New York doctor who falsely diagnosed his girlfriend and gave her a prescription for the painkiller Dilauded was sentenced to home detention and surrendered his medical license.
  • In Arizona, a woman was jailed for five years after defrauding the state of tens of thousands of dollars; she faked having leukemia to obtain drugs. "I lied about being sick..." she said. "It was the pills."
  • Two Florida clinic owners were sentenced to long prison terms in an $8 million scheme that included bribes and kickbacks and services that were not needed or rendered.
  • A south Florida man admitted conspiring to defraud Medicare in a $10.5 million therapy claims scam. Services were not legitimately prescribed or provided to beneficiaries, and kickbacks were paid to obtain beneficiary information used in the fraudulent claims.
  • A recruiter and therapy staffing firm owner were handed long prison terms and must repay a total of nearly $10 million in an extensive Medicare scam in Florida.
  • A Georgia dietitian was convicted of stealing the IDs of children enrolled in Head Start to fraudulently bill Medicaid for $4 million. The woman fabricated patient files, falsified prescriptions and billed for nutritional services not provided. Using proceeds from the fraud, authorities said, she paid for luxury cars, designer clothes and vacations.
  • A California ambulance firm has paid $3 million to resolve claims that it billed Medicare and other programs for transport for ineligible patients.
  • Three Californians were convicted in $3.2 million power wheelchair scam that included bogus prescriptions, kickbacks and fraudulent claims.
  • A former Ohio pharmacist was jailed for 4.5 years and must repay more than $2 million for filing fraudulent healthcare claims. Authorities said the woman used a false provider name to file more than a million dollars' worth of claims; she also overstated the amount of nursing time needed to administer certain injections and made fraudulent claims about drug dosages and how frequently the drugs were dispensed.
  • A Houston physician was charged in a $158 million Medicare false billing scheme tied to the treatment of mental illness. If convicted, she could be imprisoned for as much as 50 years.
  • Also in Texas, the owner of a medical supply company and two of his employees were charged in $3.5 million false claims scheme that ran for nearly four years.
  • Two Texans will spend years behind bars for a home health Medicaid fraud that netted about $155,000. The pair admitted creating false timesheets for former employees, billing for services not rendered and forging and cashing payroll checks derived from the phony timesheets.
  • A former equipment company owner in Texas was jailed for four years and must repay $1.5 million; he billed for items not delivered or not needed.
  • The former owner of a mental health clinic was convicted in North Carolina of using stolen identities of children and clinicians to cheat Medicaid. Authorities say the man submitted more than $700,000 in fraudulent claims.

From November

  • An OIG report is urging increased monitoring of high-cost Medicare outlier payments to hospitals.
  • A New York medical practice linked to an alleged scheme to defraud insurers must forfeit $5 million in a civil claim settlement.
  • A New York orthopedic surgeon admitted operating a long-term fraud scheme; he lied about the nature and scope of surgeries he performed, costing healthcare programs millions of dollars.
  • A New York doctor was charged with providing illegal prescriptions for a controlled substance in exchange for cash and explicit photos of a former patient.
  • A Veterans Affairs-employed psychiatrist in New York admitted falsely billing Medicare for home treatments and agreed to forfeit $1.2 million.
  • A woman in New York was charged with Medicaid fraud and identity theft; authorities say the Jamaican claimed U.S. citizenship and used the Social Security numbers of other people.
  • A Wisconsin man is to be tried on charges of Medicaid fraud and forgery. The case is linked to the defendant's funeral services business.
  • A Tennessee pharmacist was jailed for four years and must pay nearly $1.3 million in restitution, fines and forfeiture for distributing a misbranded drug for dialysis patients.
  • A Tennessee woman was charged with using Medicaid to obtain drugs allegedly distributed to others.
  • Two Arkansas healthcare workers were charged separately - one with stealing medication, the other with false Medicaid billing.
  • A mother and son in North Carolina admitted running a transportation scam using false records to submit fraudulent bills to Medicare, Medicaid and private insurers. The fabricated records made it appear as if the patients were eligible for reimbursable services when they were not.
  • A North Carolina woman who, authorities said, hid her criminal history to get a Medicaid provider number, was sent to prison and must repay nearly a half-million dollars in a Medicaid rip-off that included falsified records and false claims.
  • A Maryland man who struck an elderly patient in the head was convicted of abuse and barred from working as a caregiver.
  • A Mississippi couple who ran an assisted-living facility were charged with unlawfully collecting $133,000 and embezzling more than $4,200.
  • A nurse in Mississippi was charged with taking hydrocodone prescribed for two patients for her own use.
  • An Illinois man was charged in a $12 million fraud centered on a home-visit physician practice that authorities said billed for services not rendered.
  • An Illinois woman admitted fraudulently obtaining hydrocodone that Medicaid paid for; she could get as much as 14 years in prison.
  • A beneficiary of the Illinois Home Services Program admitted that he and his personal assistant filed false health care claims for home services.
  • A personal care aide in Illinois admitted healthcare fraud; he stopped caring for a patient but continued to submit bills.
  • A doctor in Connecticut was convicted of healthcare fraud; he billed Medicaid for an office visit during which he sexually assaulted a patient. He was convicted separately of the assault and the false billing. He is serving time for both crimes.
  • A Connecticut podiatrist who provided routine care but billed Medicare for surgical procedures was jailed for 2.5 years and must repay more than $213,000.
  • A Medicaid recipient in Connecticut was charged with scheming with a personal care aide to bill for twice as much time as the man worked.
  • A Nevada woman was jailed after falsely claiming that nearly $10,000 in services had been provided to a Medicaid patient.
  • The resident of an illegal group home in Las Vegas died in a swimming pool. The couple who ran the home were convicted of neglect and must pay $40,000 in restitution.
  • Convicted of Medicaid fraud that involved billing with no verification of services, a Nevada behavioral health company is to pay $900,000.
  • A hospital owner in Oklahoma is to pay $475,000 to settle civil claims that it improperly billed Medicare for inpatient services that should have been billed as outpatient services.
  • The second-highest chiropractic Medicare biller in California admitted submitting nearly $2 million in false claims.
  • A California Medicare biller was jailed and must repay more than $1.5 million in a sophisticated $5 million health clinic scam that included bribes, false patient charts and unneeded or never-performed tests. Ten other defendants have been convicted in the case.
  • Two were indicted in a $3 million Louisiana medical equipment scam allegedly involving kickbacks, falsified prescriptions and false claims.
  • A New Orleans doctor convicted of signing fraudulent prescriptions for medical equipment, including wheelchairs, was jailed and must repay Medicare more than $360,000.
  • The owner of a Massachusetts in-home-care firm was jailed and ordered to pay restitution of $50,000; and her company was ordered to pay $3.3 million in a case that involved billing Medicaid for services not rendered.
  • Three defendants in Texas were given lengthy prison terms and must repay more than a half-million dollars in a long-term clinic services scam, which included billing Medicare and Medicaid using the provider number of an ailing doctor who was unable to practice.
  • A Texas ambulance service owner was convicted in a $2.4 million Medicare fraud that included falsified records and false claims.
  • And a Texas doctor was imprisoned for four years and must repay nearly $900,000 in an extensive community medical center fraud.
  • In another Texas case, a woman is to serve six years in prison and repay Medicare $830,000 in a false billing fraud linked to diagnostic tests and doctor visits. Six defendants have been convicted in the case.
  • A Texas orthodontist was jailed for nearly 2 years and must pay $835,000 for billing Medicaid for services he did not render.
  • Two in Florida pleaded guilty and must repay more than $350,000 in the Sunshine Pharmacy healthcare fraud scheme, which included submission of claims to Medicare, Medicaid and TRICARE for prescriptions not filled or not provided to beneficiaries, claims for reimbursement for beneficiaries who had died and claims for prescriptions that were not written by a doctor.
  • A Georgia business owner admitted billing Medicaid for speech and language services that were never provided. She is to pay $200,000 in restitution and forfeit thousands more. She also has agreed to forfeit real estate and a luxury car. She could get as much as 10 years in prison at sentencing in January.
  • In another home health agency case in Michigan, a company owner was imprisoned for more than five years and must repay Medicare over $2 million. The scam included kickbacks, bribes, unneeded treatment, fraudulent records and false billing.
  • A Michigan man admitted using an illegally obtained New York medical license to cheat Medicaid; he is to repay $321,000.
  • Four Michigan mental healthcare providers were charged with forging patient records, allegedly to avoid repaying Medicaid.
  • A Kentucky caregiver was charged with wanton neglect of a COPD patient. Authorities said that rather than administering a medication to ease breathing, the caregiver poured it down a sink.
  • An Oklahoma City psychiatrist was sent to jail for 30 months and must pay restitution, as well as a $20,000 fine, and forfeit property for falsely billing Medicare.
  • In one of several child support cases, a Vermont man was sent to jail and must pay restitution of more than $100,000.
  • A South Dakota man must pay more than $41,000 in restitution after admitting that he did not make required child support payments.
  • In another South Dakota case, a defendant from Colorado was convicted and ordered to repay more than $31,000 in child support.
  • And a woman from California was charged in South Dakota with failing to pay nearly $20,000 in child support. http://oig.hhs.gov/fraud/enforcement/criminal/index.asp#CEA2013111202
  • Four defendants were charged in South Dakota with theft of funds from the Oglala Sioux tribe.
  • A former Virginia doctor was imprisoned for nearly three years for illegally diverting pain medication and was ordered to pay more than $17,000.
  • An Englishman was charged in Virginia with hacking into U.S. government computer systems, including some run by the Department of Health and Human Services.

From October

  • Fougera Pharmaceuticals agreed to pay $10 million to resolve a civil Medicaid fraud investigation. The Texas Attorney General determined that the company inflated Medicaid drug prices.
  • A father and son who operated a physician house-call company in Texas were convicted of health care fraud. In some instances, they submitted claims for services using a physician's Medicare number - while the doctor was on a cruise or out of the country. The physician involved pleaded guilty in a separate case to conspiracy to unlawfully distribute a controlled substance.
  • A Florida nursing home owner was charged with using the names of fake businesses to submit fraudulent invoices to Medicaid, which resulted in more than $395,000 in payments.
  • Two Kansas mail-order diabetic supply companies and their owners are to pay $12 million to resolve criminal and civil allegations that false claims were submitted to Medicare and Tricare. The owners are being excluded as providers from federal health care programs for 20 years.
  • In Florida, a disbarred attorney and her ex-husband were ordered to pay over $2.8 million in restitution and were sentenced to prison for money laundering. The pair stole money from clients of their Medicaid planning company.
  • An Illinois woman admitted billing Medicaid nearly $8,000 for personal care services that were not rendered. The woman falsely billed for services that were supposed to be performed by her son. During the days the woman claimed her son provided services, he was working and attending school about 225 miles away.
  • Four Michigan mental health care providers were charged with forging patient records, allegedly to avoid repaying Medicaid.
  • Virginia will receive $37 million as part of a Medicaid fraud settlement negotiated with McKesson Corporation, a large drug wholesaler, over allegations that the company inflated prices for more than 400 prescription drugs.
  • In a 12-count indictment, a Miami osteopathic doctor was charged with Medicare fraud; at sentencing, he could get as much as 10 years in prison.
  • A South Dakota optometrist is to pay nearly $300,000 to settle civil allegations that he submitted improper healthcare claims. http://oig.hhs.gov/fraud/enforcement/state/index.asp#SEA2013100102
  • An Arkansas nurse convicted of stealing prescription pills from a patient was fined and no longer works at the nursing home.
  • A career criminal was sentenced to more than 13 years in prison in an oxycodone conspiracy in Maryland.
  • A Maryland woman was sentenced in a nursing certification scam; she is the 10th defendant to plead guilty to buying and selling fake documents.
  • A Massachusetts nurse who submitted claims for Medicaid services but instead was at horse racing competitions in Georgia must repay more than $23,000.
  • A New Jersey medical supply store admitted a $150,000 Medicaid fraud involving false billing for orthopedic shoes.
  • A former owner of a medical supply firm in Los Angeles was indicted in a $4 million scheme involving allegedly billed but unneeded power wheelchairs.
  • A Kentucky state worker and a welfare recipient were charged in a more than $10,000 Medicaid and food stamp fraud.
  • A Florida provider was charged with neglect, aggravated abuse, false imprisonment and exploitation of disabled adults. The allegations include neglecting to provide beds for residents; failing to provide medical services for wounds; handcuffing a disabled adult; willful abuse causing wrist wounds and permanent disfigurement; and failing to pay two residents their required monthly personal needs allowance.
  • A man and woman from Massachusetts were charged in $27 million home health scam. The pair allegedly recruited ineligible patients for unneeded services. Authorities said the initial patient assessments were manipulated to make it appear as if the Medicare beneficiaries were qualified for home health services when that was often not the case.
  • The owner of a medical transportation company in Massachusetts stands accused of falsely billing Medicaid more than $470,000 for services not rendered, including allegedly filing more than 1,500 claims for transport under the names of 47 Medicaid patients who had died.
  • The owner of an ambulette firm on Long Island, N.Y., admitted stealing nearly $350,000 from Medicaid in a false billing scam.
  • A Tennessee woman was charged with second-degree murder linked to the alleged reckless distribution of oxycodone that was obtained through Medicaid.
  • A Tennessee doctor was charged in a $7.4 million fraud and money laundering case involving Botox injections for which he allegedly billed Medicare but did not provide.
  • A mental health care provider in Virginia admitted falsely claiming that 66 children needed Medicaid services; she is to repay $1.5 million.
  • A former Ohio pharmacist admitted adulterating the rheumatoid arthritis drug Kineret, as well as fraudulent health care billing of more than $1 million dollars.
  • Also in Ohio, two chiropractors are to repay Medicaid and the state Bureau of Workers' Compensation nearly $179,000 in a billing scam. They were convicted of double-billing for patient appointments, and billing for nonexistent appointments, and even for time spent out of the office, authorities said.
  • A Georgia Medicaid provider was accused of filing more than $269,000 in false claims, many of them without documentation. Authorities said the woman billed for days on which patients received no services, and she billed for patients who had been discharged.
  • A personal care services provider was convicted of Medicaid fraud and was ordered to pay $15,000 in restitution and fines; she had moved to Florida but continued to submit claims for services, which she did not provide, to the state of Maryland.

From September

  • OIG, in one report (OEI-04-11-00330), urged increased monitoring of Medicare billing from suppliers of diabetic test strips.
  • And OIG noted in another review (A-02-12-01010) that New Jersey could have saved as much as $2.7 million had it reduced Medicaid reimbursement for home blood-glucose test strips.
  • New York improperly claimed at least $8.3 million from Medicaid for certain hospital-based outpatient services, OIG found in another report (A-02-11-01038).
  • Check OIG's website for a Government Accountability Office report on using and sharing data in oversight and law enforcement.
  • Major Pharmaceuticals Inc., based in Michigan, agreed to a $5 million Medicaid civil fraud settlement linked to drug-price reporting.
  • Emory University in Atlanta is to pay $1.5 million to settle civil claims that it overbilled Medicare and Medicaid for patients enrolled in clinical trial research.
  • A Kansas hospital has agreed to pay more than $853,000 to settle allegations of false claims for hyperbaric oxygen therapy.
  • Forest Park Medical Center, a physician-owned hospital in Texas, has paid more than $258,000 to settle allegations that it paid kickbacks for referrals.
  • The mastermind of a nearly $11 million Detroit-area Medicare kickback scheme was jailed for more than four years and was ordered to pay more than $10.8 million dollars in restitution.
  • A Massachusetts pharmacy is to pay $1.6 million to settle claims that it ran and billed Medicaid for an unauthorized automatic prescription refill program.
  • A pair of patient recruiters in Miami admitted taking kickbacks in a $48 million home health Medicare fraud scheme.
  • Two owners of several Miami home health agencies and a patient recruiter pleaded guilty in a $20 million Medicare fraud involving kickbacks, bribes and false billing.
  • Two Floridians pleaded guilty in a $7 million home health fraud case involving kickbacks, bribes and false billing.
  • A Florida pharmacy owner was charged in a $600,000 Medicaid billing fraud.
  • A Florida couple face charges of billing Medicaid $13,000 for care that was never provided in an adult family care home.
  • An adult family care home operator in Florida was jailed for three years for Medicaid fraud involving services not rendered and identification theft.
  • An Illinois woman faces up to 20 years behind bars after pleading guilty in a Medicaid home services scheme.
  • A New Yorker admitted his role as patient recruiter in a $13 million fraud scheme that included kickbacks and false billing.
  • The former owners and chief radiologist of a magnetic resonance imaging firm in New York are to pay $3.57 million to resolve allegations of false billing.
  • A Brooklyn, N.Y., pharmacist was charged with illegally receiving nearly $800,000 from Medicaid in an alleged HIV-drug scam. Authorities say that when they took their prescriptions to his pharmacy, Medicaid recipients were paid in cash and in cards used to pay for public transit.
  • A New York orthopedic surgeon agreed to pay $388,000 to resolve allegations of overbilling Medicare for minimally invasive spine procedures.
  • A New York State audit found that one Bronx pharmacy overcharged Medicaid nearly $200,000 for prescriptions.
  • A New York nurse was charged with stealing pain patches from ventilator-dependent nursing home residents.
  • A former Indian Health Service employee in New Mexico admitted obtaining hydrocodone through prescription fraud.
  • A Colorado doctor was charged with healthcare fraud, money laundering and prescribing controlled substances resulting in patient deaths.
  • An Oklahoma counselor admitted billing Medicaid for services not rendered, including more than 80 sessions when she was out of town.
  • A Texas woman was convicted in a nearly $3.4 million Medicare/Medicaid medical equipment fraud, and she was also convicted of defrauding Social Security. The health care fraud included billing for devices not delivered, not wanted and not needed.
  • Two Texans pleaded guilty in a home health Medicaid scheme that included falsified records, forgery, wire fraud and fraudulent billing for services that were not provided.
  • A Kool Smiles pediatric dentist in Texas admitted taking part in a $120,000 fraud. He made false statements and entries on patient records that were used to bill Medicaid for services not performed. Because of the fraudulent billings, the dentist received bonuses to which he was not entitled.
  • A former home health agency owner in California was ordered to pay nearly $15 million in a kickbacks-for-referrals whistleblower case.
  • A California man who stole a doctor's ID and opened a phony Philadelphia clinic was jailed for 2 years for false Medicare billing and must repay more than $132,000.
  • The former owner of a Los Angeles medical supply firm pleaded guilty in a $2.6 million Medicare false billing fraud involving power wheelchairs.
  • A former medical supply company officer and a California doctor were sentenced to prison terms of more than four years and more than 2 years in a $1.5 million scam that included kickbacks for false prescriptions, false billing to Medicare and power wheelchairs that were not needed by beneficiaries or never delivered.
  • A California woman's sentence included repaying more than $31,000 obtained in a medical testing-false billing Medicaid fraud scheme.
  • A Georgia therapy company owner was jailed for two years and must repay more than $438,000 in a Medicaid fraud scheme involving the use of unlicensed therapists and false billing for services never rendered.
  • A Georgia business owner who falsely claimed to be a nurse was jailed for Medicaid fraud and must repay more than $61,000.
  • Two North Carolinians were imprisoned -- one for two years and two months and the other for three years -- and must repay nearly $400,000 because they billed Medicaid for rehabilitation services that they did not provide.
  • A North Carolina dentist pleaded guilty to false Medicaid billing and will pay nearly $115,000 in restitution.
  • A former group home manager in Nevada who was convicted of neglect of a vulnerable adult must to pay restitution and do community service.
  • Three members of a Louisiana family were charged in a $400,000 Medicaid fraud that authorities say included racketeering, financial exploitation, services billed but not rendered, and cruelty to a disabled relative. The charges of cruelty are tied, in part, to the bed-ridden relative's alleged injury by a pair of Capuchin monkeys.
  • A Louisiana woman was jailed for more than three years and must repay more than $1.2 million in a psychotherapy scam in which unlicensed social workers visited Medicare beneficiaries but did not provide the services for which Medicare was billed. The woman was also convicted of money laundering.
  • A Tennessee woman was charged with healthcare fraud; authorities allege that she planned to sell oxycodone she obtained through Medicaid.
  • A man in Tennessee was charged with diverting morphine obtained through Medicaid and planning to sell some of it.
  • Another Tennessee woman was also charged with selling drugs that she obtained through Medicaid.
  • A Tennessee woman was charged with Medicaid fraud; authorities say she lied about her income to appear eligible for benefits.
  • A Milwaukee man was charged with Medicaid fraud, forgery and theft; authorities allege that he submitted false claims for funerals.
  • Two former employees of an Arkansas nursing home were charged with stealing money from a patients' trust account.
  • A Medicaid recipient and two personal care aides in Arkansas stand accused in a scheme that allegedly billed for services never rendered.
  • A South Dakota man, formerly of Arkansas, was sentenced to pay nearly $33,000 in child support restitution.
  • A Vermont caregiver, who allegedly did not provide all the Medicaid services that she claimed, faces fraud charges.
  • A Connecticut podiatrist was jailed for more than three years and must repay Medicare over $134,000; he billed for complicated procedures but only trimmed toenails.
  • A Connecticut nursing home clerk who stole money from a patients' trust account was sent to jail for 7 years and must repay more than $140,000.
  • Two brothers from Pennsylvania were given long prison terms -- 6 1/2 years and five years -- and ordered to pay more than $3.4 million in a Medicare fraud scheme. Falsified reports made it appear that patients needed to be transported by ambulance when the defendants and their employees knew otherwise, authorities said. The defendants billed for those ambulance services as if they were medically necessary.
  • A Pennsylvania woman was charged with billing Medicare $400,000 for medical equipment that beneficiaries did not need.
  • An Ohio pharmacist excluded from participation in federal health care programs was charged with illegally filling prescriptions and leaving Medicaid to foot the bill.

From August

  • A multistate health system and a Georgia hospital are to pay the United States a total of $8 million to settle allegations of false claims for unneeded services.
  • Watson Pharmaceuticals is to pay Louisiana $8.5 million to resolve drug-pricing fraud claims.
  • Beth Israel Deaconess Medical Center in Boston is to pay $5.3 million to settle allegations that it improperly billed Medicare.
  • Planned Parenthood Gulf Coast in Houston has paid $4.3 million to resolve civil claims that it billed for items and services related to birth control counseling, STD testing and contraceptives when they were not medically necessary or were not provided.
  • And Planned Parenthood Gulf Coast agreed to pay $1.4 million in a Texas Medicaid billing fraud case.
  • A California drugmaker is to pay $3.5 million to settle allegations that it improperly paid doctors, prompting false Medicare and Medicaid claims.
  • A Florida hospice is to pay $1 million to resolve allegations of false claims for end-of-life care and kickbacks for referrals.
  • The United States is suing PharMerica Corporation, a long-term-care pharmacy, alleging that it billed Medicare for drugs dispensed without a valid prescription.
  • And the United States joined a whistleblower lawsuit against a Florida home health company that allegedly offered sham jobs to doctors' spouses in exchange for referrals.
  • Maryland General Hospital in Baltimore is to pay $750,000 to resolve allegations of overbilling for cardiac tests and failing to reimburse Medicare after senior financial managers at the hospital learned of the overpayments.
  • Bostwick Laboratories is to pay more than a half-million dollars to settle claims that it used clinical study payments to induce doctors to use its services.
  • In a self-disclosure, a medical center in New York is to pay $268,000 for taking excess Medicaid payments for dental services.
  • The victims of multimillion-dollar blood derivative drug schemes have been repaid more than $27 million. The scams were run in Georgia, Florida, California, Puerto Rico, the Bahamas, and elsewhere. Shell companies and offshore accounts were used to run and conceal the schemes to defraud Medicare, Medicaid, drugmakers and others of tens of millions of dollars' worth of prescription drugs. Those convicted were sentenced to long prison terms and ordered to pay millions in fines and forfeitures.
  • A counselor in Oklahoma was charged with submitting 860 phony Medicaid claims in excess of $78,000. Among them were claims for services she was unqualified to perform, authorities said, including intravascular heart surgery, moderate conscious sedation and medication management.
  • A Medicare beneficiary turned patient recruiter was jailed in Texas and must repay more than $173,000.
  • Two Texas businessmen admitted conspiring to defraud Medicaid and submitting false claims for hyperbaric oxygen treatments.
  • An Ohio man who hired an excluded individual to falsely bill Medicare and Medicaid was jailed for two years and must repay $1.9 million.
  • Three members of one family were charged with falsely billing Louisiana Medicaid for personal care services.
  • An Illinois doctor was jailed and must pay more than $117,000 for obstructing a health care investigator in his duties, which is a felony, and false claims to Medicare, a civil case.
  • Authorities said that a man charged in a Medicaid personal care services billing scheme in Connecticut griped to police when the woman who allegedly concocted the scam failed to deliver on his promised share of the proceeds.
  • A Connecticut woman was the ninth charged in scheme to obtain drugs paid for by Medicaid and later sold on street.
  • 2 Nevada women were jailed and together must repay Medicaid more than $160,000 for billing for therapy that was never provided.
  • A Nevada woman was convicted of running an unlicensed group home and must pay $25,000 in restitution.
  • A Wyoming woman was sent to jail and must repay more than $56,000 in a Medicaid billing fraud.
  • Three in Maryland were charged with submitting false claims for prescription refills in a $2.6 million health care fraud case.
  • A Maryland man, who allegedly made false representations and attempted to defraud Medicaid in connection with nursing home expenses, was charged with fraud, as well as theft from nursing home.
  • Another Maryland man was jailed in New Hampshire in a personal care services fraud case and was ordered to repay Medicaid $150,000.
  • A couple who operated a Florida home health agency solely to defraud Medicare pleaded guilty in an $8 million scheme that included illegal payments for prescriptions, certifications and other documents that were used to falsely bill Medicare.
  • A Florida woman was charged with willful neglect; she allegedly failed to care for an aged adult, who developed bed sores.
  • Two Floridians were indicted in a long-term conspiracy to defraud banks and federal benefit programs.
  • Two others Floridians in were jailed and ordered to pay restitution in a tax refund fraud that used stolen patient information.
  • An Arkansas health care provider was charged with billing Medicaid for more than $17,000 for services never rendered.
  • An Arkansas speech therapist was convicted of Medicaid fraud; she continued submitting bills though she had stopped providing services.
  • A physician in Missouri was jailed and must pay nearly $150,000 after billing for services he did not provide.
  • An orthodontist in Massachusetts is to pay $800,000 to settle allegations that he improperly billed Medicaid for X-rays.
  • A therapist in Kentucky was charged with falsely billing Medicaid $10,000 for services to children. The indictment alleges that the therapist claimed more services than he provided or never rendered the services at all.
  • Admitting that cheating Medicaid was just easy to do, a convicted counselor of at-risk children in Tennessee was jailed for three years and must repay more than $602,000.
  • A dentist in Tennessee was charged with falsely billing Medicaid for services to children.
  • A Tennessee behavioral analyst admitted creating false records and forgery in fraudulently billing Medicaid.
  • A Tennessee man was charged with obtaining drugs paid for by Medicaid, then selling them on the street.
  • Tennessee man was accused of altering a prescription and using someone else's Medicaid benefits to pay for it.
  • A Georgia woman was jailed for nearly five years for health care fraud and money laundering and was ordered to repay more than $1.5 million. A payroll employee for a health company that operated a hospice, she gave herself raises and phony expenses for 5.5 years.
  • In another Georgia case, the owner of a speech therapy firm was charged with identity theft and falsely billing Medicaid for over $500,000.
  • Two Georgians who face Medicaid fraud charges in a $600,000 false billing scam have also been accused of income tax evasion.
  • A Georgia man admitted $150,000 in Medicaid false billing, including upcoding, for mobile therapy for children.
  • Also in Georgia, four defendants were accused of falsely billing Medicaid for youth counseling that was never provided.
  • A South Carolina nursing home owner admitted submitting more than $1 million in fraudulent cost reports to Medicaid; his jail time was suspended, but he must pay restitution.
  • A Philadelphia man admitted using shell companies to launder cash obtained from a $13 million health care fraud scheme at a Brooklyn, N.Y., clinic.
  • A salesman became the 14th defendant to plead guilty in a New Jersey bribes-for-test-referrals lab scam that included money laundering.
  • Two New Jersey pharmacists, who happen to be twins, admitted defrauding patients, Medicaid and private insurance companies over 15 years in a $1.5 million scam that included under-filling prescriptions, reselling drugs and substituting generics for brand names while billing for the higher-priced drugs. The defendants also filled outstanding refills on prescriptions without the patients' knowledge and billed Medicaid and private insurers for the refills.
  • A Long Island, N.Y., physician on was accused of selling oxycodone prescriptions.
  • A woman who bought a luxury New York condominium was charged with illegally collecting more than $25,000 from Medicaid since 2003. Authorities said investigators found that the woman had several bank accounts, several vehicles and shopped at high-end stores.
  • Medicaid pharmacy billing fraud in New York put one man behind bars for one to three years and left him and four others to pay a total of $10 million in restitution.
  • A New York man who submitted a phony diploma to get a developmental services job pleaded guilty in a $25,000 Medicaid fraud.
  • A Michigan therapist who owned a home health company pleaded guilty in a $22 million dollar fraud involving kickbacks, phony records and false Medicare billing for unnecessary or never-provided services.
  • A therapy assistant - who was also an owner of a home health agency as well as a patient recruiter -- admitted taking part in the same scheme.
  • A Detroit-area home health agency owner admitted paying kickbacks for information that was used to falsely bill Medicare in a $13.8 million scam.
  • A business owner in Michigan was jailed for four years and must pay $1 million in a five-year Medicare/Medicaid fraud scheme that included kickbacks for referrals, sham contracts and upcoding.
  • A physician assistant in Michigan was charged with Medicaid fraud; authorities say he overprescribed controlled substances and submitted upcoded billings.
  • A Michigan man who falsified New York medical license and Medicaid provider applications admitted theft and is to repay $300,000.
  • A Washington, D.C., cardiologist was ordered to pay $17 million for submitting false claims for nuclear stress tests.
  • A former home health provider in Washington, D.C., was jailed for falsifying records linked to a Department of Health and Human Services audit.
  • A California pastor's daughter, who owned a company, was convicted in an $11 million medical equipment scam. Fraudulent claims were submitted to Medicare for expensive, high-end power wheelchairs, hospital beds, braces and other equipment that customers either did not need or did not receive.
  • A California physician was imprisoned and must pay restitution in $1 million dollar power wheelchair scam.
  • Two California women were convicted of double-billing Medicaid for "equine-facilitated therapy" and were ordered to pay restitution.

From July

From June

From May

From April

From March

  • An OIG report found a Connecticut hospital's inpatient rehabilitation documentation was noncompliant. The hospital may owe Medicare nearly $8 million dollars.
  • OIG found in another report that Florida claimed at least $2.2 million dollars in unallowable Medicaid administrative costs.
  • In yet another review, OIG found that a Head Start program in Virginia claimed $949,000 dollars in unallowable grant costs in one year.
  • A Kentucky nursing home and management company reached an agreement with the Federal Government to improve quality of care and will pay $350,000 dollars to settle civil False Claims Act allegations brought in a lawsuit. The settlement agreement is the first of its kind in Kentucky.
  • A Detroit health care worker was convicted for his part in a $24.7 million dollar Medicare billing scam. He sold patient information that was used in the submission of fraudulent claims.
  • The CEO of a Miami Beach community health center pleaded guilty in a $6 million dollar embezzlement scam.
  • A pharmacist in Tampa was jailed for 10 years and must repay more than $97,000 dollars for filling hundreds of fraudulent oxycodone prescriptions. Nearly 50,000 pills were later sold on street.
  • Two medical practices in Corpus Christi, Texas, are to pay $2.3 million dollars to settle allegations of double billing of healthcare programs.
  • A Houston doctor was sent to prison for more than five years and must repay nearly $3 million dollars for falsifying care plans that were used to submit fraudulent bills to Medicare.
  • A West Virginia physician who owned a pain management practice was jailed for more than 4 years and must pay $6.8 million dollars for fraud and tax evasion.
  • A West Virginia home-care company owner was jailed nearly 4 years for altering and falsifying Medicaid patient records.
  • In a New York felony case, a nurse's aide was charged with secretly using his cell phone to take and text a humiliating picture of a nursing home resident.
  • A Manhattan physician was the fourth defendant to plead guilty in an $8.5 million dollar HIV-AIDS clinic scheme. The clinics involved in the scam were described as health care fraud mills.
  • A former oral surgeon who billed Vermont Medicaid for more costly services than he provided was jailed and must repay $50,000.
  • A Milwaukee nurse was convicted of fraud and theft. She billed Medicaid more than $32,000 for 136 days of childcare that she did not provide.
  • An Alabama home health company is to pay $150,000 to resolve allegations that it billed Medicare for ineligible and unneeded services.
  • A Boston rehabilitation hospital settled civil allegations of improper Medicare billing and is to pay nearly $92,000. In question was the "midnight rule," which authorizes Medicare reimbursement only when a patient remains in the nursing facility through midnight on a given day.
  • A Louisiana woman is to pay nearly $73,000 in fines and restitution for filing false daycare services claims.
  • A counselor in Connecticut admitted filing Medicaid claims for more than $151,000 for hundreds of client sessions that did not occur.
  • A former Department of Health and Services employee will pay restitution after admitting fraud in a retention bonus scheme; he is to be sentenced in June.
  • An OIG Most Wanted fugitive, Orisbel Hernandez, accused in a $2.5 million dollar Medicare false claims case, was captured in Miami International Airport. He is charged with health care fraud, mail fraud, aggravated ID theft and making false statements.
  • Also captured was Jorge Reyes, indicted in a $9.5 million dollar medical equipment scheme. He was taken into custody in Canada.
  • Four fugitives, charged with bilking Medicaid out of $970,000 dollars in a patient transport scam in Youngstown, Ohio, have been added to OIG's Most Wanted list. They are believed to be in Sudan.
  • Asher Vanounu, charged in an $800,000 dollar medical equipment scam, was also added to the Most Wanted list. He is believed to have fled the country.
  • Jesse Brown Otter of Minneapolis admitted not paying more than $25,000 dollars in child support; his sentencing is scheduled in May.

From February

From January

  • A regional medical center and a heart center in Ohio have agreed to pay $4.4 million to settle allegations that they submitted claims for unnecessary angioplasty and stent placement procedures on Medicare patients.
  • Seven defendants in the Orthofix fraud case have been convicted in a $42 million Medicare scam; among them, the former manager of the medical device company was jailed, fined and must forfeit $40,000.
  • A Minnesota woman, who worked for a home health care company, was charged with health care fraud and with embezzling $840,000 from her employer. Authorities allege that she double-billed Medicaid and a nonprofit corporation that provides health insurance to families and individuals.
  • Four people who ran a community mental health center scam in Florida were sent to prison - one for more than five years -- and must repay Medicare $4.7 million.
  • Seven were charged in a $22 million home health scam in Michigan that allegedly included kickbacks and unneeded and never rendered services.
  • The co-owner of a home health care business in suburban Chicago was imprisoned for 10 years and must repay millions in a wide-ranging Medicare fraud scheme that included submitting tens of thousands of false claims.
  • The manager of a check-cashing store and its anti-money- laundering compliance officer were imprisoned -- one for 5 years, the other for 8 months -- in an $8 million money laundering case in California; fines and forfeitures of $1.2 million were ordered.
  • North Carolina woman who stole a licensed therapist's identification admitted defrauding Medicaid of $8 million for sham mental and behavioral health services.
  • A former contract worker in Georgia who routed to her debit cards nearly $9 million that was due providers was jailed for three years for Medicaid fraud. With the help of debit card companies, the Georgia Department of Community Health recovered all but about $17,000, which the defendant was ordered to repay.
  • A Michigan podiatrist who submitted fraudulent bills was jailed for more than four years and must pay Medicare and a private insurer more than $1.6 million in restitution.
  • A New Jersey pediatrician was charged in a $900,000 wound care scam. Authorities say he billed Medicaid thousands of times, and virtually all of the claims were fraudulent. According to the complaint against him, the doctor purportedly treated three children 28 times for a total of 49 procedures involving some type of wound repair. The children's mother said that none of the children had ever had a cut that required stitches or other methods of wound closure.
  • Ten people were charged with taking part in a sophisticated prescription forgery ring in California.
  • A physician who fled to Peru and was on the run for 13 years, was jailed for more than 3 years and must pay fines and restitution of $320,000 for health care fraud, mail fraud and failure to appear. He admitted that he had defrauded several insurance companies of over $400,000 and submitted false bills for medical treatment and services that were not provided to his patients. At the same time, he fraudulently received more than $250,000 in personal disability payments.

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