If you read the news, you know that health care fraud is just as prevalent as ever. During any given time, you will be able to find a headline about a provider or care giver defrauding patients, insurance companies, or CMS in every state across the nation. This month we’ve seen quite a few colorful (and catastrophic) schemes become uncovered, or resolved in a court of law. Below are just few of many that we’ve come across.
Chicago chiropractor sentenced to federal prison after running $10M scheme
Chicago-area chiropractor operating out of Gordin Medical Center now faces up to 7 years in federal prison after being brought up on charges for health insurance fraud. Aided by his father and brother, the chiro was involved in an elaborate over-billing scheme that faked documentation and solicited the help of patients. The family business caused insurance carriers to suffer a lost upward of $10.8M through the billing of unnecessary or undelivered medical procedures and/or services.
California physicians allegedly exploit student’ self-fund health benefit plans
The University of California has gone on the recorded claiming that a physician group defrauded students’ health care benefit plans of nearly $12M by falsely prescribing medications to unknowing students. The information of more than 500 University of California students throughout six campuses has been identified in the case that involves 17 defendants, four of which are physicians. Other defendants include orthopedic surgeons, a podiatrist, and nurse practitioners.
Florida Sober home owners use patients use vulnerable patients to commit health care fraud
Three have been sentenced to federal prison after admitting they took advantage of recovery substance abusers. Offenders pleaded guilty to allowing drugs to circulate within sober homes, accepting kickbacks, and enabling the use of illegal substances in the facility. The catch? Residents could use drugs if they submitted to the treatments and drug tests that could be used to bill insurance companies. Several others involved are awaiting sentencing.
No Jail for New York fraud scheme recruiter
New York federal judge declared Jonathan Oliver as the “least culpable” participant in a $70M Medicare/Medicaid fraud scheme. In 2016 Oliver had pled guilty to mail fraud, wire fraud, and health care fraud while working within a fraud scheme that conducted unnecessary medical tests on the homeless. The judge sentenced below-guidelines to commend Oliver’s ascension from heroin addict to recovered user.
Alaska dentist charged with Medicaid fraud
Anchorage dentist is being charged with allegations suggested he unnecessarily sedated patients in order to acquire higher Medicaid payments. The dentist used IV sedation to many Medicaid patients, while only giving those with private insurance a local anesthetic. On average, Medicaid paid out $27,000 a month to his practice. From 2015 until present, he was paid nearly $436,000. Lockhart’s next court hearing will be held on June 6, where he will be facing more charges of unlawful dental acts, and the performance of medically unnecessary procedures.