Healthcare fraud: 13 recent cases to know

Below are 13 cases of healthcare fraud reported by Becker's in November:

1. A Springdale, Ark.-based psychiatrist and former head of Arkansas' state medical board was charged with two counts of Medicaid fraud, according to the state attorney general's office. From Jan. 1 to April 29, 2022, Brian Hyatt, MD, allegedly made more than $300,000 in false Medicaid claims while working as medical director of the behavioral health unit at Northwest Medical Center-Springdale.

2. A nurse practitioner pleaded guilty in Boston federal court for her role in a $7.8 million telemedicine fraud scheme involving medically unnecessary medical equipment. Between December 2018 and April 2020, Daphne Jenkins worked with a telemedicine company to sign orders for unnecessary equipment for Medicare beneficiaries she had no therapeutic relationship with.

3. Desi Barroga, MD, and Deno Barroga, MD, were charged in a $12 million healthcare fraud scheme, according to the Justice Department. While operating a pain management clinic in Dallas, the pair allegedly submitted fraudulent claims to their patients' insurance companies for dozens of corticosteroid injections, while the patients only received few or no injections.

4. Steven King, the chief compliance officer of  A1C Holdings, a pharmacy holding company, was sentenced to four years and six months in prison and must pay $21.7 million in restitution for his role in a healthcare fraud scheme. Mr. King was convicted for fraudulently billing Medicare for dispensing medically unnecessary lidocaine and diabetic testing supplies.

5. David Nourian and Christopher Rydberg, who owned and operated three pharmacies in Fort Worth and Arlington, Texas, and Michael Taba, MD, were convicted for their role in a $145 million healthcare fraud, money laundering and tax evasion scheme. The pharmacy owners conspired with Dr. Taba and other physicians to prescribe medically unnecessary compound creams to injured federal workers, after which the pharmacy owners allegedly paid Dr. Taba for referring the medication to be filled by their pharmacies.

6. Simon Orobor, owner of two durable medical equipment companies in Texas, pleaded guilty to one count of conspiracy to pay healthcare kickbacks for his role in a $20 million Medicare fraud scheme. Between at least June 2016 and February 2019,  Mr. Orobor obtained access to thousands of Medicare beneficiaries by paying weekly kickbacks in exchange for signed physicians' orders for braces.

7. David Copeland of Tallahassee, Fla., James Moss of Huntsville, Ala., and Michael Gordon, 60, of Fort Myers, Fla., were sentenced for their roles in a $54 million bribery and kickback scheme related to fraudulent prescriptions. Mr. Moss and Mr. Copeland were part owners of a Florida-based pharmacy and Mr. Gordon was a lead sales representative. The trio engaged in a practice to develop the most expensive combination of drugs to maximize reimbursements from Tricare. From 2012 through 2015, the pharmacy billed Tricare more than $54 million for its compounded pharmaceuticals.  

8. Tommy Louisville, MD, ​​a Tampa, Fla.-based physician, pleaded guilty to unlawful drug distribution, wire fraud and making false statements related to healthcare. In May 2019, Dr. Louisville became ineligible to prescribe controlled substances after he was suspended from practicing medicine for two years. He continued to issue controlled substances, concealed from Medicare that he was not authorized to issue prescriptions and shuttered his medical business in November 2019. He later used his closed business to fraudulently obtain $33,034 in a federal Paycheck Protection Program loan.

9. Brett Weiner and Valerie Desalvo, co-owners of Boca Raton, Fla.-based Laboratory Marketing Services, pleaded guilty to buying and selling fake physician orders used to obtain more than $1.5 million in fraudulent Medicare payments. 

10. Luke Steiner, a former Optum employee, will pay $13 million and serve two years of probation for his role in a healthcare fraud scheme. From 2013 and September 2019,  Mr. Steiner admitted he conspired with ValueWise CEO Michael Mann to fraudulently obtain millions of dollars in loans for Mr. Mann's companies. While employed at Optum, Mr. Steiner worked to induce financing companies to loan money on the basis of fake invoices to show payments owed by Optum to Mr. Mann's companies.

11. Jeremy Gobe, a California sleep clinic owner, pleaded guilty to healthcare fraud and aggravated identity theft for submitting more than $1.5 million in false claims for sleep studies. From August 2016 to July 2020, Mr. Gober caused his organization to submit thousands of claims to Medicare and Medi-Cal for sleep studies that were not actually performed on patients. 

12. New Orleans-based hospice facility owner Shiva Akula was convicted in a $62 million healthcare fraud scheme. Between January 2013 and December 2019, Eight counts were related to overbilling for general inpatient services, causing Medicare to pay roughly $600 more per patient per day than it would have for the appropriate level of care. 

13. Oakland, Calif.-based physician Henry Watson, MD, was convicted for accepting kickbacks for patient referrals, healthcare fraud and false statements. From 2013 to 2019, Dr. Watson engaged in three healthcare schemes in which he earned kickbacks.

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