Healthcare Billing Fraud: 10 Recent Cases

These are the 10 healthcare billing fraud instances that Becker’s has published since December 29. They range from the acquittal of a Maryland physician in an alleged $15 million conspiracy to the sentencing of two Florida residents for their participation in a $93 million scheme:

• The owner of the clinical laboratory RDx Bioscience, located in Kenilworth, New Jersey, and the company agreed to pay over $13 million to settle claims of unwarranted testing and kickbacks.
• Of the nine people charged for their participation in an alleged plan to submit false claims to Medicaid for treatments that were not rendered, four owners and operators of 1st Adult Pediatric Healthcare Treatments, located in Fairfax, Virginia, were named as defendants.
• In order to resolve accusations that it submitted fraudulent claims to the Labor Department-managed Energy Employees Occupational Illness Compensation Program in violation of the False Claims Act, Atlantic Home Health Care agreed to pay $10 million.
• After being found guilty of their participation in a conspiracy that billed Medicare $93 million for home health therapy services that were never rendered, two residents of Florida received jail sentences.
• Methodist Le Bonheur Healthcare, located in Memphis, Tennessee, and its Methodist Healthcare-Memphis Hospitals settled charges of paying kickbacks and falsifying claims under the False Claims Act for a total of $7.25 million.
• The Moffitt Cancer Center, located in Tampa, Florida, admitted to charging federal healthcare programs for clinical trial expenditures in error and agreed to pay more than $19.5 million to settle civil responsibility.
• A medical biller is charged with embezzling over $1 million that was supposed to be sent to doctors directly under the New York State Workers’ Compensation Law so they could treat wounded workers.
• A $60 million fraud plot allegedly involved the owner of a durable medical equipment firm, who was charged with a crime.
• After determining that the prosecution had not shown sufficient proof of the misuse of “ambiguous” CPT codes, the court cleared a Maryland physician who had been found guilty of a fraud scheme worth over $15 million.
• Due to their suspected involvement in a $25 million conspiracy involving fictitious claims for durable medical equipment, twin siblings who owned a Medicare billing firm have been accused.