Here are 10 cases of healthcare fraud which made headlines in August.
1. California pathologist sentenced to 25 years in prison for prescription fraud.
A California pathologist who operated a medical clinic was sentenced to 25 years in prison for writing fraudulent prescriptions for oxycodone in exchange for cash. Masoud Bamdad, MD, was convicted in May 2009 for accepting cash payments after writing numerous prescriptions for narcotics, including OxyContin, Vicodin and Xanax. In some cases, Dr. Bamdad wrote the unlawful prescriptions for minors under the age of 21.
2. St. Louis otolaryngologist acquitted of 20 federal healthcare fraud charges.
Wallace P. Berkowitz, MD, an otolaryngologist based in St. Louis, Mo., who was indicted in January on one count of healthcare fraud and 19 counts of making false statements related to healthcare matters, has been acquitted on all charges. Federal prosecutors claimed that between 2003 and 2008, Dr. Berkowitz submitted claims to Medicare and Medicaid for healthcare services he did not provide and was reimbursed for these claims.
3. Georgia internist charged with filing $2.2 million in false claims and other fraud charges.
A Georgia internist has been sued in a federal complaint for submitting over $2.2 million in false claims to Medicare. The lawsuit alleges Robert M. Ritchea, MD, improperly billed Medicare for pain injections administered by an unlicensed medical assistant, who performed unnecessary pain injection procedures that were billed to Medicare as nerve blocks. Dr. Ritchea admitted the procedures were not medically necessary and they were overprescribed and overutilized.
4. Pennsylvania's Mercy Health to pay $7.9 million for overbilling Medicare.
Mercy Health System, based in Conshohocken, Pa., has agreed to pay Medicare $7.9 million for overbilling the healthcare program. The health system voluntarily self-reported it had billed Medicare for one-day inpatient admissions between Oct. 1, 2001, and Sept. 30, 2007, that should have been coded as observations or outpatient visits. The erroneous coding resulted in higher reimbursement to the health system.
5. One of nation's largest diagnostic imaging services to pay $1.2 million to settle Medicaid fraud allegations.
Center for Diagnostic Imaging, a St. Cloud, Minn.-based diagnostic imaging company with locations throughout the country, agreed to pay $1.2 million to settle allegations of Medicaid billing fraud. The payment settles a whistleblower suit by former CDI Vice President Patricia West and a Seattle physician filed five years ago. The suit alleges CDI overbilled Medicare by upcoding procedures in order to receive bigger reimbursements. CDI also allegedly provided kickbacks to physicians for referrals and, in some cases, did not require written physician orders for some examinations, according to the suit. Ms. West further claims she was fired in retaliation for her expressing concern over the billing process.
6. WellCare settles government investigation, class action suit related to fraudulent billing.
Tampa, Fla.-based health insurer WellCare announced it will pay $137.5 million to the federal government to settle ongoing investigations and $200 million to settle a class action suit related to alleged Florida Medicaid fraud. The $137.5 million deal with the Department of Justice is a preliminary settlement and will settle ongoing investigations by the DOJ into possible fraud by the insurer.
7. Fraud allegations against urgent care chain owned by Florida gubernatorial candidate Rick Scott sent to HHS.
Allegations of fraud by Solantic, a chain of Florida urgent care clinics owned in part by Florida Republican Gubernatorial Candidate and former HCA CEO Rick Scott, have been forwarded to the U.S. Department of Health and Human Services for possible investigation. In July, former Solantic employee Randy Prokes, MD, sent a complaint to Florida Attorney General Bill McCollum, who also happens to be running for governor in the GOP primary, alleging Solantic billed Medicare for services performed by nurse practitioners between 2006 and 2009 as if they had been performed by physicians.
8. Michigan general practitioner sentenced to 14 years in prison for involvement in Medicare fraud, submitting false claims.
Jose Castro-Ramirez, MD, a general practitioner from Farmington, Mich., has been sentenced to 14 years in prison and ordered to pay $9.4 million in restitution for his involvement in a scheme to defraud Medicare. Dr. Castro-Ramirez was paid in exchange for his signature on therapy prescriptions and other documents in falsified therapy files, which were later used to submit false claims to Medicare. In those files, he knowingly and falsely indicated he had evaluated the recruited Medicare beneficiaries and certified the need for physical and occupational therapy services that were never rendered. Dr. Castro-Ramirez did not oversee any treatment provided to patients. In addition, Dr. Castro-Ramirez was given a list of controlled substances or drugs the recruited Medicare beneficiaries preferred and wrote thousands of prescriptions for the substances without ever seeing the patients.
9. Ohio's Forum Health to pay nearly $2.9 million for overbilling Medicare.
Youngstown, Ohio-based Forum Health has agreed to pay nearly $2.9 million to reimburse the government for overbilling Medicare from 2003 to 2009. Forum voluntarily disclosed the improper billing. The hospital overbilled Medicare because its billing system automatically assigned two codes, Code 06 and Code 42, for discharges rather than letting billing staff select just one.
10. California's Saint John's Health Center to pay $5.25 million settlement in fraud case.
Saint John's Health Center in Santa Monica, Calif., has agreed to pay $5.25 million to the government to settle allegations of over-billing Medicare. The government alleged the hospital had been billing Medicare for expensive treatments for more than their actual cost between 1996 and 2003. The hospital has been under investigation for the alleged activity since 2006.
1. California pathologist sentenced to 25 years in prison for prescription fraud.
A California pathologist who operated a medical clinic was sentenced to 25 years in prison for writing fraudulent prescriptions for oxycodone in exchange for cash. Masoud Bamdad, MD, was convicted in May 2009 for accepting cash payments after writing numerous prescriptions for narcotics, including OxyContin, Vicodin and Xanax. In some cases, Dr. Bamdad wrote the unlawful prescriptions for minors under the age of 21.
2. St. Louis otolaryngologist acquitted of 20 federal healthcare fraud charges.
Wallace P. Berkowitz, MD, an otolaryngologist based in St. Louis, Mo., who was indicted in January on one count of healthcare fraud and 19 counts of making false statements related to healthcare matters, has been acquitted on all charges. Federal prosecutors claimed that between 2003 and 2008, Dr. Berkowitz submitted claims to Medicare and Medicaid for healthcare services he did not provide and was reimbursed for these claims.
3. Georgia internist charged with filing $2.2 million in false claims and other fraud charges.
A Georgia internist has been sued in a federal complaint for submitting over $2.2 million in false claims to Medicare. The lawsuit alleges Robert M. Ritchea, MD, improperly billed Medicare for pain injections administered by an unlicensed medical assistant, who performed unnecessary pain injection procedures that were billed to Medicare as nerve blocks. Dr. Ritchea admitted the procedures were not medically necessary and they were overprescribed and overutilized.
4. Pennsylvania's Mercy Health to pay $7.9 million for overbilling Medicare.
Mercy Health System, based in Conshohocken, Pa., has agreed to pay Medicare $7.9 million for overbilling the healthcare program. The health system voluntarily self-reported it had billed Medicare for one-day inpatient admissions between Oct. 1, 2001, and Sept. 30, 2007, that should have been coded as observations or outpatient visits. The erroneous coding resulted in higher reimbursement to the health system.
5. One of nation's largest diagnostic imaging services to pay $1.2 million to settle Medicaid fraud allegations.
Center for Diagnostic Imaging, a St. Cloud, Minn.-based diagnostic imaging company with locations throughout the country, agreed to pay $1.2 million to settle allegations of Medicaid billing fraud. The payment settles a whistleblower suit by former CDI Vice President Patricia West and a Seattle physician filed five years ago. The suit alleges CDI overbilled Medicare by upcoding procedures in order to receive bigger reimbursements. CDI also allegedly provided kickbacks to physicians for referrals and, in some cases, did not require written physician orders for some examinations, according to the suit. Ms. West further claims she was fired in retaliation for her expressing concern over the billing process.
6. WellCare settles government investigation, class action suit related to fraudulent billing.
Tampa, Fla.-based health insurer WellCare announced it will pay $137.5 million to the federal government to settle ongoing investigations and $200 million to settle a class action suit related to alleged Florida Medicaid fraud. The $137.5 million deal with the Department of Justice is a preliminary settlement and will settle ongoing investigations by the DOJ into possible fraud by the insurer.
7. Fraud allegations against urgent care chain owned by Florida gubernatorial candidate Rick Scott sent to HHS.
Allegations of fraud by Solantic, a chain of Florida urgent care clinics owned in part by Florida Republican Gubernatorial Candidate and former HCA CEO Rick Scott, have been forwarded to the U.S. Department of Health and Human Services for possible investigation. In July, former Solantic employee Randy Prokes, MD, sent a complaint to Florida Attorney General Bill McCollum, who also happens to be running for governor in the GOP primary, alleging Solantic billed Medicare for services performed by nurse practitioners between 2006 and 2009 as if they had been performed by physicians.
8. Michigan general practitioner sentenced to 14 years in prison for involvement in Medicare fraud, submitting false claims.
Jose Castro-Ramirez, MD, a general practitioner from Farmington, Mich., has been sentenced to 14 years in prison and ordered to pay $9.4 million in restitution for his involvement in a scheme to defraud Medicare. Dr. Castro-Ramirez was paid in exchange for his signature on therapy prescriptions and other documents in falsified therapy files, which were later used to submit false claims to Medicare. In those files, he knowingly and falsely indicated he had evaluated the recruited Medicare beneficiaries and certified the need for physical and occupational therapy services that were never rendered. Dr. Castro-Ramirez did not oversee any treatment provided to patients. In addition, Dr. Castro-Ramirez was given a list of controlled substances or drugs the recruited Medicare beneficiaries preferred and wrote thousands of prescriptions for the substances without ever seeing the patients.
9. Ohio's Forum Health to pay nearly $2.9 million for overbilling Medicare.
Youngstown, Ohio-based Forum Health has agreed to pay nearly $2.9 million to reimburse the government for overbilling Medicare from 2003 to 2009. Forum voluntarily disclosed the improper billing. The hospital overbilled Medicare because its billing system automatically assigned two codes, Code 06 and Code 42, for discharges rather than letting billing staff select just one.
10. California's Saint John's Health Center to pay $5.25 million settlement in fraud case.
Saint John's Health Center in Santa Monica, Calif., has agreed to pay $5.25 million to the government to settle allegations of over-billing Medicare. The government alleged the hospital had been billing Medicare for expensive treatments for more than their actual cost between 1996 and 2003. The hospital has been under investigation for the alleged activity since 2006.