It’s been a while since I’ve posted the Office of the Inspector General’s (OIG) enforcement actions.
They have been busy. Unfortunately, fraud and other alleged violations of law continue to happen.
Here are some of the actions. For the complete list, visit https://oig.hhs.gov/fraud/enforcement/
While in law school, the then law student worked as a personal care aide for an agency. The law student submitted false timesheets that resulted in false claims filed to Medicaid for services that were not performed.
Connecticut Ophthalmologist Pleads Guilty to Five-Year Health Care Fraud Scheme
The ophthalmologist received kickbacks from a medical diagnostic company for ordering hundreds of medically unnecessary brain scans.
According to the complaint, the company is accused of performing medically unnecessary procedures on end-stage renal patients.
Jury Convicts Man of $600 Million Health Care Fraud, Wire Fraud, and ID Theft Scheme
The man who operated a medical billing company instructed his physician-clients to schedule elective surgeries through the emergency room, resulting in higher charges. He then submitted the claims to the payers. When payers denied the inflated charges, he presented himself as the patients to demand that the insurance companies submit payments to the providers.
This doctor is accused of submitting fraudulent claims that represented that he removed medically unnecessary moles and creating false documentation to support the services.
Jury Convicts Doctor of Health Care Fraud Scheme
An ENT was convicted of billing Medicare and Medicaid and receiving payments for incision procedures of the external ear when he only performed ear exams or ear wax removals.
CEO of Raleigh Healthcare Company Pleads Guilty to Multi-Million Dollar Healthcare Fraud
The CEO of two durable medical equipment companies paid companies in India and Pakistan to provide her with lists of Medicare patients’ names and identification numbers. Then, she used the patient information to submit claims to Medicare (without physicians’ orders). She even submitted claims to Medicare for over 400 deceased individuals. Then, when Medicare contractors audited her, she forged physicians’ orders to support her fraudulent claims.
New Orleans Woman Charged with Health Care Fraud
A Denial Specialist is accused of creating false patient accounts and insurance EOBs and making it appear that patients paid out of pocket. In addition, the Denial Specialist is charged with initiating refunds to patients and having the refund checks deposited into her bank account.
“All money ain’t good money.”
Coffee With a Medical Coding Auditor 