Two men face up to 20 years in prison after admitting that they created a Medicare fraud scheme during the pandemic. According to the Justice Department, Arkadiy Khaimov and Peter Khaim submitted millions of dollars in false Medicare claims and funneled $18 million...
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Medicare / Medicaid Fraud
Risk adjustment fraud is a growing problem in healthcare
Fraudulent billing continues to be a major issue throughout the healthcare industry. We have discussed various cases and settlements over time. A topic within this realm that seems to grow in importance is the risk adjustment fraud that occurs concerning the...
Biogen pays $900 million in fines for improper physician payments
The pharmaceutical company Biogen Inc. out of Cambridge, Massachusetts, agreed to pay $900 million to settle allegations that the company caused false billing submissions to Medicare and Medicaid. The company was accused of paying illegal kickbacks to doctors who...
Putting a stop to medical billing fraud
As technology for billing and tracking medical expenses has increased in ease and sophistication, challenges still exist for outsourcing companies in the business of billing. Patients have unprecedented access to their digital health records and can track health care...
Bayer to pay $40 million for false statements and kickbacks
The Bayer Corporation has been a household name for decades, selling aspirin and other pharmaceutical products to consumers. Now the Justice Department announces $40 million in penalties for its actions involving Trasylol, Avelox and Baycol. The settlement resulted...
Doctor charged by the state for unnecessary tests
Attorney General Letitia James announced on August 1 that a medical doctor from Kings Point and his company (America’s Imaging Center, Inc.) are accused of unnecessary radiological testing and kickbacks to employees and defrauding Medicaid. The years-long scheme...
Another billion-dollar fraud involving the health care industry
On July 20, the Department of Justice announced a $1.2 billion health care fraud case. This action involves coordinated nationwide enforcement to charge 36 defendants in 13 federal districts with fraud schemes involving telemedicine, clinical laboratory and durable...
Hospitals face penalties for not making prices public
The Centers for Medicare and Medicaid Services (CMS) hit two hospitals in Georgia with $1.1 million in financial penalties for violating the 2021 rules requiring hospitals to share their medical procedures and treatment prices. This change (which the CMS will enforce)...
Feds bring suit against two company heads running 11 nursing facilities
The Southern District of New York and the U.S. Department of Health and Human Services have filed a healthcare lawsuit against 11 New York-based defendants. The lawsuit seeks damages and penalties for billing Medicare for unreasonable or unnecessary procedures at 11...
Home healthcare agencies settle claims of not appropriately paying staff
Two licensed home care services agencies in Brooklyn have settled claims of not appropriately paying their staff. The cases were heard in the Eastern District of New York. All American Homecare Agency and Crown of Life violated the federal False Claims Act and New...