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New Orleans Woman Indicted for Conspiracy to Receive and Pay Illegal Health Care Kickbacks

U.S. Attorney Kenneth A. Polite announced that SAQUENA GRIFFIN, a/k/a “QUEENIE,” age 34, of New Orleans was charged today with conspiracy to pay and receive illegal Medicare kickbacks which resulted in Medicare paying $378,274 to a local home health. According to the Indictment, GRIFFIN was a recruiter and marketer for Comprehensive Nursing and Home Health…

ATTORNEY GENERAL LAXALT ANNOUNCES GUILTY PLEA OF CALIFORNIA MAN FOR COMPLEX HEALTHCARE INSURANCE SCAM

Las Vegas, NV –   Nevada Attorney General Adam Paul Laxalt announced that Richard Raymond Ruppert, 53, of California, pleaded guilty for his role in a healthcare insurance scam. Ruppert pleaded guilty to one count of Multiple Transactions involving Fraud or Deceit in the Course of an Enterprise or Occupation, a category “B” felony, and…

Excluded and Unlicensed New Jersey Dentist Who Assumed Identity of Another Dentist Agrees to Settlement of $1.1 Million and 50-Year Exclusion to Resolve Civil Monetary Penalty Case

Washington, DC – Unlicensed New Jersey dentist Roben Brookhim who assumed identity of another dentist agreed to pay $1.1 million and accept a 50-year exclusion from participating in Federal health care programs as part of a settlement to resolve his administrative liability for presenting false claims to Medicaid, billing for services furnished by an excluded…

Northside Medical Center Incorrectly Billed Medicare Inpatient Claims with Severe Malnutrition

“Northside Medical Center (The Hospital), in Youngstown, Ohio complied with Medicare billing requirements for diagnosis codes 261 and 262 for 2 of the 100 claims that were reviewed,” according to an audit conducted by the Office of Inspector General. However, the Hospital did not comply with Medicare billing requirements for the remaining 98 claims. For…

AG Paxton Announces $8.45 Million Settlement with MB2 Dental Solutions

Attorney General Ken Paxton today announced a settlement with MB2 Dental Solutions (MB2) and 21 affiliated pediatric dental practices. MB2 agreed to pay the United States and the State of Texas $8.45 million for alleged violations of the federal False Claims Act (FCA) and the Texas Medicaid Fraud Prevention Act (TMFPA). Three lawsuits were resolved…

Owner Of Utah-Based Pharmaceutical Distributer Pleads Guilty To $100 Million Health Care Fraud Scheme

Fraudster, Randy Crowell, put people with life-threatening diseases at risk by distributing black-market, off-market replacements to pharmacies defrauding the federal government to the tune of $100 million. Preet Bharara, the United States Attorney for the Southern District of New York, announced that RANDY CROWELL, a/k/a “Roger,” pled guilty today before United States District Judge Edgardo…

Owner Of Harrisburg Healthcare Services Firm Sentenced For False Statements, Money Laundering And Identity Theft

HARRISBURG – The United States Attorney’s Office for the Middle District of Pennsylvania announced today that Rose Umana, age 49, of Mechanicsburg, Pennsylvania, was sentenced on December 21, 2016, by United States District Court Judge Sylvia H. Rambo to 36 months in prison for making false statements relating to health care matters, engaging in monetary…

New Jersey Claimed Medicaid Adult Mental Health Partial Care Services That Were Not in Compliance With Federal and State Requirements

“Most of the New Jersey Department of Human Services’ (State agency) claims for Federal Medicaid reimbursement for partial care services did not comply with Federal and State requirements,” is stated in a compliance report issued by the Office of Inspector General, U.S. Department of Health and Human Services. “The partial care services program provides individualized…

Bennington Family Convicted Of Multiple Counts Of Medicaid Fraud

Family Affair Ends in cumulative 18 counts of fraud. Patrick Morse, 64, Ellie May Morse, 43, and Donald Morse, 23, of Bennington, Vermont, were convicted in Vermont Superior Court, Windsor Criminal Division, of multiple felony counts of Medicaid Fraud arising out of their scheme to defraud the Vermont Medicaid Children’s Personal Care Services (“PCS”) Program….

OIG/HHS Review of CMS’s Management of the Quality Payment Program

Two systems designed to measure, score, report on and assign value to the quality of care will take effect January 1, 2017 with payment adjustments taking effect January 1, 2019. This is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) with the intention of putting measurable focus on the of quality…