11 healthcare fraud, lawsuit stories of 2018: ASCs, surgeons & more

Here is a recap of 11 healthcare fraud and lawsuit stories of 2018:

1. Allstate files lawsuit against ASCs, orthopedic surgeons. Insurance giant Allstate has filed 81 fraud lawsuits in New York since 2003, and the company recently filed another suit against 13 new corporations in an attempt to cover $2 million in damages from the no-fault healthcare firms and their owners. Among the individuals and companies named in the suit are New York City-based Haar Orthopedics & Sports Medicine, Paterson, N.J.-based Horizon Anesthesia Group, Paterson-based New Horizon Surgical Center, Whitestone, N.Y.-based NY Spine Physical Therapy and Fair Lawn, N.J.-based Alliance Spine Associates. The suit also names chiropractors and other healthcare providers.

2. Three California-based orthopedic surgeons named in kickback scheme. Orthopedic surgeon Daniel Capen, MD, of Manhattan Beach, Calif., pled guilty to conspiracy related to a kickback scheme at Long Beach, Calif.-based Pacific Hospital. Dr. Capen pled guilty to accepting $142 million in illegal kickbacks. Timothy Hunt, MD, of Palos Verdes Estates, also pled guilty to conspiracy and accepting kickbacks, and Tiffany Rogers, MD, was named in connection with the kickbacks. The U.S. Attorney's Office filed 16 criminal cases against 33 defendants in the case; all together the perpetrators are accused of committing a $2 billion healthcare fraud scheme.

3. Former surgical center employee stole up to $24,000. A former customer service representative at Oklahoma City-based Oral and Maxillofacial Associates is accused of embezzling 34 patients' refunds. Erin Marie Bokemper, allegedly took more than $24,000 from patients' accounts between October 2016 and September 2017. Police reports and search warrants allege she diverted the funds to two credit cards.

4. Surgery center administrator accused of selling medical equipment on eBay. A former administrator of Melbourne (Fla.) Same Day Surgery is accused of stealing the center's medical equipment and selling it on eBay. Former administrator Corey Hollmann allegedly stole medical equipment including monitors, imaging systems and skin-grafting instruments from the center's owner, Health First, and sold them on eBay. Health First fired Mr. Hollmann after the incident.

5. Louisiana Spine & Sports co-owner pleads guilty to receiving kickbacks. Baton Rouge-based Louisiana Spine & Sports co-owner Gray Wesley Barrow, MD, pleaded guilty Nov. 20 to involvement in an illegal healthcare kickback scheme, according to the Department of Justice. Dr. Barrow pleaded guilty to one count of conspiracy to pay and receive kickbacks while practicing at Louisiana Spine & Sports, a pain management clinic.

6. Physician found guilty of four healthcare fraud charges. Former University City, Mo.-based physician Devon Golding, MD, was found guilty of conspiracy and four healthcare fraud charges on Oct. 19. In July 2017, he and eight others were indicted for an alleged kickbacks scheme. From 2009 to 2012, they allegedly gave kickbacks from Medicare and Medicaid payments to physicians who sent blood and urine samples to a lab operated by co-conspirators.

7. Bariatric surgeon pleads guilty to receiving kickbacks. Bariatric surgeon David Kim, MD, of Colleyville, Texas, pleaded guilty to accepting $4.5 million in kickbacks for referring patients to Dallas-based Forest Park Medical Center. Dr. Kim entered a plea deal. He admitted to receiving about $4.5 million in kickbacks between 2009 and 2012.

8. $1 billion "Takedown Day." More than 600 defendants — including 165 doctors, nurses and other licensed medical professionals — were charged for allegedly participating in healthcare fraud schemes involving more than $2 billion in false billings. Of the 162 defendants were charged for their roles in prescribing and distributing opioids and other narcotics, 76 were physicians.

9. Pain physician faces insurance fraud perjury after referring workers comp cases to his ASC, lab. Sanjoy Banerjee, MD, a pain physician in Corona, Calif., has been charged with workers compensation insurance fraud and perjury by the Riverside County District Attorney. Dr. Banerjee is accused of billing workers compensation for more than $180,000 in urine toxicology testing and epidural injections he illegally self-referred to a laboratory and office-based surgical center he owned. He is the owner of Rochester Imperial Surgical Center in Wildomar, Calif.

10. Rheumatologist charged in $240M fraud scheme. Rheumatologist Jorge Zamora-Quezada, MD, was charged for allegedly participating in a $240 million healthcare fraud scheme, according to KRGV. Dr. Zamora-Quezada allegedly diagnosed otherwise healthy patients with various diseases and disorders.

11. Chicago internist defrauded Medicare. Pranav Patel, MD, of Burr Ridge, Ill., was indicted by the North District of Illinois' U.S. Attorney's Office after he allegedly submitted fraudulent health insurance claims totaling at least $950,000.


More articles on turnarounds:
3 strategies for finding the ideal team for your ASC
Court upholds sanctions against Louisiana surgery center physician — 5 insights
Former surgery center operator: 5 tips for boosting staff satisfaction, trimming turnover

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