Summary: This article presents 10 recent cases of healthcare billing fraud in various parts of the United States. The cases range from individuals fraudulently billing Medicare and Medicaid to larger schemes defrauding insurers and government programs out of millions of dollars. The fraudulent activities involve practices such as billing for fake COVID-19 tests, double billing Medicare and Medicaid, and submitting false claims for reimbursement. The individuals and organizations involved face criminal charges and significant financial penalties.
1. A former Missouri physician utilized his father’s name to bill Medicare and Medicaid after losing his privileges. He was sentenced to prison for 22 months for this fraudulent activity.
2. Four individuals pleaded guilty to participating in a scheme that defrauded insurers by billing for fictitious COVID-19 tests.
3. A Louisiana laboratory owner was sentenced to three years in prison and ordered to pay over $5 million in restitution for his role in a healthcare fraud scheme worth $42 million.
4. Two acupuncturists, two physical therapists, and an insurance company employee were indicted for their involvement in a $20 million healthcare fraud scheme operating across medical offices in multiple boroughs of New York City.
5. A Frederick, Maryland-based oncology and hematology practice agreed to settle allegations of improper Medicare billing by paying $850,949.
6. A Colorado psychiatry practice reached a settlement of $1.9 million after being accused of knowingly double billing time to increase Medicare and Medicaid payments.
7. A Chicago physician was convicted by a federal jury for his role in a $9.5 million healthcare fraud scheme.
8. Lompoc Valley Medical Center in California agreed to pay $5 million to settle allegations of submitting false claims to Medi-Cal related to Medicaid Adult Expansion under the Affordable Care Act (ACA).
9. In Minnesota, 18 individuals were charged with a scheme to fraudulently bill the state’s Medicaid program for services that were not provided.
10. Lincare Holdings, a Florida-based medical supplier, agreed to pay $29 million to resolve allegations of fraudulent overbilling of Medicare and Medicare Advantage Plans for oxygen equipment.
These cases highlight the importance of combating healthcare billing fraud, which not only defrauds government programs and insurers but also places an additional burden on patients and the healthcare system as a whole. Efforts to prevent and prosecute such fraudulent activities are crucial for maintaining the integrity and sustainability of healthcare programs and protecting patients from financial exploitation.
Definitions:
– Medicare: a government program that provides health insurance for people aged 65 and older, as well as certain younger individuals with disabilities.
– Medicaid: a joint federal and state program that provides health coverage for low-income individuals and families.
– Fraud: the act of deceiving or misrepresenting information for personal gain or to cause financial loss to others.
Sources: Becker’s reporting on healthcare billing fraud cases since Aug. 31, 2021.
