A U.S. District Attorney for the Southern District of New York and Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services announced that it settled a fraud lawsuit that alleges that Morris Park Nursing Home engaged...
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Medicare / Medicaid Fraud
Podiatrist sentenced for fraudulent Medicare billing
A federal judge sentenced a Michigan podiatrist to seven years in prison for orchestrating a scheme that fraudulently billed Medicare for nearly $2 million. He is also guilty of falsifying records and identity theft. The doctor operated a practice specializing in...
Justice Department launches fraud initiative tied to COVID-19 care
The Department of Justice announced a new coordinated enforcement action to fight COVID-19 healthcare fraud. The targets will include owners of medical businesses, medical professionals and others who attempted various schemes. The DOJ estimates that $490 million were...
2 doctors and others convicted in $31 million Medicare scheme
In January of 2023, Dr. Dean Zusmer and Dr. Lawrence Alexander, both of Miami, were convicted for being part of a scheme where they submitted $31 million in fraudulent claims. The doctors conspired with others to file claims for expensive but unnecessary medical...
A system of affiliated businesses exploit nursing home loophole
The pandemic was difficult for many, but some unscrupulous business owners used that time to their advantage. The Villages of Orleans Health & Rehabilitation Center (VOHRC) in western New York paid its landlord $16 million in rent. However, the landlord was also...
Biden administration targets Medicare Advantage fraud
Medicare watchdogs have been vocal about the insurance companies stealing billions from taxpayers through the emergent Medicare Advantage plan, which is the choice of half of all Medicare beneficiaries. These private plans offered by insurers have lower premiums than...
NY nursing home landlord and operator fined $7.1 million
The Saratoga Center for Rehabilitation and Skilled Nursing Care had been on the radar of state and federal governments for some time. The nursing home in Ballston Spa, New York, was on a watch list for two years before closing in February 2021. The Department of...
Queens pharmacy owners plead guilty to fraud
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...
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...
