Medicaid Fraud Cases

$2.5 Million Virginia Medicaid Fraud

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Press Release United States Attorney
Eastern District of Virginia

Paul J. McNulty, United States Attorney for the Eastern District of Virginia, announced that Darren Louis Stanford, age 32, of Richmond, Virginia, pled guilty today to one count of committing health care fraud and one count of possession with intent to distribute powder cocaine. Stanford faces a maximum sentence of ten years’ imprisonment, a $250,000 fine, and full restitution for the health care charge, and a maximum sentence of 20 years’ imprisonment and a $1 million fine for the drug charge when he is sentenced by United States District Court Judge Henry E. Hudson on October 28, 2005. The defendant was immediately remanded to the custody of the United States Marshals Service.

FL Assisted Living Facility Owner Arrested on Medicaid Fraud Charges

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FL Attorney General Press Release TALLAHASSEE - Attorney General Charlie Crist today announced the arrest of the owner of two Volusia County assisted living facilities on criminal charges of defrauding the state’s Medicaid program of more than $69,000. The Attorney General’s Office also filed a separate civil action against Vidya Bhoolai, 42, of Holly Hill, seeking more than $800,000 in damages for numerous violations of Florida’s False Claims Act. Bhoolai is the owner of Radiant Star Manor and Rising Sun Manor, both of which are assisted living facilities. According to an investigation conducted by the Attorney General’s Medicaid Fraud Control Unit, Bhoolai allegedly filed claims for 25 Medicaid recipients who either never resided in her facilities or resided there for fewer days than she reported when seeking Medicaid reimbursements. This improper billing defrauded the program of $69,145. Bhoolai faces criminal charges for 26 counts of Medicaid fraud and one count of scheme to defraud.

Robin Mathias Quoted in Modern Healthcare

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First of many? Vaccine probe may extend beyond Connecticut

Byline: Mark Taylor

This is an excerpt. Click the link to view the full document.

Last week’s settlement by a Connecticut hospital could be just the first as state Medicaid fraud-control units explore allegations that hospitals, physicians and other providers may be billing Medicaid and private insurers for children’s vaccines they received free, according to government sources and healthcare fraud experts.

Healthcare billing fraud consultant Robin Mathias, former director of data analysis and budget for Indiana’s Medicaid program, said the vaccine billing scheme has likely spread beyond Connecticut’s borders.

“Regardless of what the federal agencies are saying, I suspect that other Medicaid programs will be looking into whether they’ve been billed for the VFC free immunizations,” said Mathias, who advises health plans about fraud schemes. “Whether or not it was fraud or an honest error, those providers would have been essentially paid twice for the same service, and that’s illegal.”

She said hospitals, many of which operate outpatient, immunization and community clinics, could face liability.

CT Pediatricians Settle in Operation Free Shot

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“Kevin J. O’Connor, United States Attorney for the District of Connecticut, and Richard Blumenthal, Connecticut Attorney General, announced that TORRINGTON-WINSTED PEDIATRIC ASSOCIATES, P.C. , located at 538 Litchfield Street, Torrington, Connecticut, and 49 Spencer Street, Winsted, Connecticut; and PEDIATRIC & ADOLESCENT HEALTHCARE, P.C., located at 400 Main Street, Ansonia, Connecticut, and its former owner, WILLIAM SILBERBERG, M.D., have entered into two separate civil settlement agreements with the Government to resolve allegations that they violated the False Claims Act by submitting fa

Gambro to pay $355 million in fraud case

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Gambro US to pay $355 mln in fraud case - Gambro Healthcare US, Lakewood, Colo., said it will pay $355 mln to settle civil and criminal charges stemming from illegal relationships with doctors and pharmaceutical companies in an alleged decade-long fraud scheme that began in 1991. [Healthcare Fraud News]

The settlement resolves civil liabilities from alleged kickbacks paid to physicians, false statements made to obtain payment for unnecessary services, and payments made to Gambro Supply, a sham DME company.

$4.7 Million Injectable Drug Fraud in Florida

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Two owners of a South Florida treatment center for infectious diseases, a physician at the center and a nurse who served as its administrator, were arrested for their roles in a costly Medicaid fraud scheme, according to an October 1, 2004 press release from the Florida Attorney General. The scheme involved billing for prescriptions for medications that were never dispensed and the creation of false medical records to conceal the doctor’s absence from patient treatment and office supervision. Medicaid investigators seized over $1.6 million in illegally purchased assets, including a 40-foot boat, an ocean-view condominium, and a Cadillac SUV.

Greedy Dentists Busted in California

News and Commentary | Dental Fraud Cases | Fraud Cases | Kickbacks | Medicaid Fraud Cases

“It’s all about the money,” was the operating creed of Hatch Dental, as described in a 42-count felony complaint filed by California Attorney General Bill Lockyer on September 22, 2004. The complaint describes how 20 defendants affiliated with three Hatch Dental clinics let greed rule their practice at the expense of patient health and safety.

In spring of 2002, when Brian Kanarek, DDS asked defendant Kyon Maung Teo (the alleged ringleader) why he over-diagnosed treatment, Teo told him, “Something has to pay for this practice.” After Kanarek diagnosed only 2 fillings for a patient whom Teo diagnosed 26, Teo told him to leave Hatch Dental “and don’t come back.”

Miami Dentist Uses Unlicensed Staff

Dental Fraud Cases | Fraud Cases | Medicaid Fraud Cases

September 29, 2004 the Florida Attorney General announced that Dr. Suzanne Abergel-Nahon had used unlicenses staff to perform dental procedures for Florida Medicaid patients. The scam cost Florida Medicaid at least $260,000. From January 2000 to August 2004, Dr. Abergel-Nahon submitted claims for more than $3 million. Some of those claims were for services such as fillings, crowns, extractions, dentures, and root canals that were billed as if she provided them, when in fact, unlicensed staff performed the services.

Florida officials were probably able to find the fraud because of high billing by the provider. Data analysis algorithms can identify dentists who have such high billing it is unlikely that they could have performed all the work themselves. Once the dentist has been flagged, a simple investigation involving some phone calls and a site visit can identify who works for the dentist, what licensing they have and who actually performed the services.

Fraudulent Certificates of Medical Necessity

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On June 22, 2004 Dr. Romulo Valdez, a San Diego physician, pleaded guilty to conspiracy to defraud Medicare and Medi-Cal of more than $725,000. He admitted that he signed Certificates of Medical Necessity for motorized wheelchairs for patients who did not need them. In doing so, he helped Benison Medical Supply defraud Medicare and Medi-Cal. Dr. Valdez faces a maximum penalty of five years in prison and a $250,000 fine.

Motorized wheelchair fraud is a problem across the US. Expect to see more about this type of fraud. See also: 2 Brothers Plead Guilty

Operation Free Shot

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Operation Free Shot is tracking down doctors who charge Medicaid for immunizations that were paid for by the Vaccines for Children (VFC) program. VFC is an immunization program funded jointly by state and federal government. The Department of Public Health distributes vaccines to doctors and clinics for free. In May 2004, Jorge Elias, a Norwalk, CT doctor, pleaded guilty to healthcare fraud. He had charged Medicaid and other insurers for these free vaccines. In all he collected over $220,000 for vaccines that were already paid for by the government. Elias has agreed to pay $222,920 to the government, as well as $108,000 to private insurers. He could face jail time as well.

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