12 Fraud and False Claims Cases Involving Physicians

1. California Obstetrician Faces Disciplinary Action for Overbilling Medi-Cal
Bayardo Cruz, MD, pleaded guilty in 2009 to insurance fraud and was ordered to repay $38,000. He now faces disciplinary actions ranging from a public reprimand, probation or revoked medical license. Dr. Cruz began using birth control devices made in Mexico in 2004. The Mexican devices cost approximately $30 each, but documents show Dr. Cruz billed Medi-Cal for 10 times that much. Over two years, Dr. Cruz inserted about 110 Mexican IUDs into patients and received approximately $38,000 in Medi-Cal payments.

2. Court Dismisses Neurosurgeon's False Claims Suit Against New York's Upstate University Hospital
A neurosurgeon's lawsuit against Upstate University Hospital in Syracuse, N.Y., claiming the hospital retaliated against him after he spoke out of improper care, has been dismissed on jurisdictional grounds by a federal judge. James Holsapple, MD, filed the suit accusing Upstate, a state hospital, of violating the federal False Claims Act through alleged Medicare and Medicaid fraud. U.S. District Court Judge Thomas McAvoy granted the hospital's motion to dismiss the complaint because under the False Claims Act, claims against the state are barred by the 11th Amendment.

3. Trial Rescheduled for Former Mississippi Hospital CEO Accused of Kickback Scheme
The trial of Raymond L. Shoemaker, the former CEO and COO of Tri-Lakes Medical Center in Batesville, Miss., who faces kickback allegations, has been rescheduled for next month. The trial, originally scheduled for May 9, was pushed back to June 27 after defense attorneys said they needed more time to prepare. Mr. Shoemaker has pleaded not guilty to a 10-count federal indictment alleging a kickback scheme. Mr. Shoemaker faces up to 80 years in prison, and $2.5 million in fines, if convicted of conspiracy, embezzlement and fraud charges.

4. Gynecologist Dr. Latika Patel to Pay $750K to Settle False Claims Allegations
A gynecologist from Monroe, N.C., has agreed to pay $750,000 to settle allegations that she billed state Medicaid for six years' worth of services never rendered. Patel, MD, owns Carolina Obstetrics and Gynecology in Monroe. The civil settlement was reached after a probe of Dr. Patel's billing practices found false claims for 1,009 patients from 2003 to 2008. The $750,000 settlement is double the amount of billings in question.

5. Florida's St. Luke's Hospital Faces False Claims Allegations
A former hospital employee has filed a lawsuit accusing St. Luke's Hospital in Jacksonville, Fla., of falsely billing Medicare and Medicaid from April 2008 until March 2009. The suit claims the hospital was ineligible for Medicaid and Medicare payments because its accreditation allegedly transferred when its former operator, Mayo Clinic, opened a new facility and St. Vincent HealthCare took over St. Luke's. The lawsuit claims St. Luke's continued claiming Mayo's accreditation as its own when it was under St. Vincent HealthCare's ownership. It was not specified how much the hospital received from Medicare or Medicaid.

6. Florida Physician Sentenced to 28 Months in Prison for False Claims
A physician from Jacksonville, Fla., has been sentenced to 28 months in prison and $475,000 in fines for concealing information in medical records to obtain Medicare and Medicaid payments. Along with 28 months imprisonment, Janet Johnson-Hunter, MD, also faces three years of supervised release. She will pay a fine of $10,000 and restitution of $428,924 to Medicare and $46,165 to Medicaid.

7. West Virginia OB/GYN Sentenced to 1 Year of Prison for Healthcare Fraud
Danine Rydland, MD, an obstetrician/gynecologists from Martinsburg, W.Va., has been sentenced to one year and one day in prison, along with the payment of approximately $132,000 in restitution fees, after she was convicted on 34 counts of healthcare fraud in February. Dr. Rydland was found guilty of defrauding Medicare, Medicaid, the Public Employees Insurance Agency and Unicare between June 2004 and Dec. 2008. The false claims were billed for services that were never provided or for more complex services.

8. Former Las Vegas Gastroenterologist Dipak Desai Indicted by Federal Grand Jury for Healthcare Fraud
Dipak Desai, a gastroenterologist who has surrendered his medical license after hepatitis C outbreaks at his clinics, has been indicted by a federal grand jury in Las Vegas on conspiracy and healthcare fraud charges. Mr. Desai and Tonya Rushing, COO of Mr. Desai's Endoscopy Center of Southern Nevada in Las Vegas, have been charged with one count of conspiracy, 25 counts of healthcare fraud and a forfeiture count seeking to seize $8.1 million. The indictment alleges Mr. Desai and Ms. Rushing organized a scheme from Jan. 2005 to Feb. 2008 where they inflated the length of medical procedures and overbilled insurance companies for anesthesia.

9. Illinois Chiropractor Sentenced to 70 Months in Prison for Bilking Workers' Compensation
A chiropractor who owned a clinic in Maywood, Ill., for more than 10 years has been sentenced to 70 months in prison after he pleaded guilty to healthcare fraud. Chiropractor Darwin Minnis, DC, former operator of the Spine and Joint Rehabilitation Center, pleaded guilty last November. He admitted he and others submitted false claims to obtain payments from workers' compensation and other insurers for services never rendered. Dr. Minnis has also been ordered to pay restitution totaling $1,450,202.

10. Texas Optometrist Charged With Billing for Services Never Provided
An optometrist from Sugar Land, Texas, is being sued over allegations that he submitted reimbursement claims for services never provided. Chris Tran, OD, has been sued by Vision Service Plan for breach of contract and fraud. VSP says its special investigative unit discovered Dr. Tran had submitted more than $74,000 in false claims for services he never provided. VSP is seeking actual damages, attorney's fees and court costs.

11. Two New Orleans Physicians Arrested As Part of Alleged Fraud Ring
Federal agents have arrested two physicians and six others who are allegedly involved in a New Orleans fraud ring that allegedly submitted more than $12 million false Medicare and Medicaid claims. Jack Voight, MD, and Jerry Haskin, MD, were two of the eight arrested following a year-long investigation. As part of the alleged fraud ring, the physicians allegedly submitted false claims to Medicare and Medicaid for diagnostic services that were not provided or medically necessary. The complaint also says the physicians' clinics were paying kickbacks to recruiters for locating, referring and transporting patients to the clinic so the medical staff could bill Medicare and Medicaid for services not rendered.

12. North Carolina Pain Management Physician Pleads Guilty to Healthcare Fraud
A New Bern, N.C., pain management physician has pled guilty to healthcare fraud and been sentenced to pay nearly $300,000 in restitution. Michael K. Nunn, MD, practiced under Community Wellness Center in New Bern, which was fined $700,000 along with Dr. Nunn's restitution fees. From 2003 to 2004, CWC falsely billed Medicare for a number of procedures, including ultrasound services not provided and other services, such as electrical stimulation, performed by unqualified staff. Dr. Nunn has been placed on four years of probation.

Related Articles on Healthare Fraud:
10 Recent Stark, False Claims and Kickback Lawsuits Involving Hospitals and Health Systems
5 Recent Settlements by Healthcare Providers
Feds Charge 111 in Largest Healthcare Fraud Takedown To Date

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