Healthcare billing fraud: 14 recent cases

Andrew Cass 

Here are 14 healthcare billing fraud cases Becker’s has reported since March 1:

1. Lanham, Md.-based Luminis Health Doctors Community Medical Center and Diagnostic Imaging Associates agreed to pay more than $2 million to resolve allegations that they violated the False Claims Act.

2. A physician and pharmacist were sentenced in a pain cream scheme that cost healthcare benefit providers more than $515 million in Mississippi. 

3. A Pennsylvania nurse practitioner pleaded guilty to four felony charges, including prescribing medications without a collaborating physician and false billing. 

4. A federal jury convicted physician Frederick Gooding, MD, of fraudulently billing Medicare more than $5 million for injections he did not perform or provide as billed. 

5. A Chicago-area physician is accused of 13 counts of healthcare fraud, including performing medically unnecessary procedures such as removing part of patients’ uteruses. 

6. A Missouri physician whose Medicare and Medicaid billing privileges were terminated pleaded guilty to fraudulently using his father’s name to bill the government payers. 

7. A medical testing company owner was sentenced to 80 months in prison and ordered to pay more than $9.1 million in restitution for his role in a healthcare fraud scheme. 

8. A former Pennsylvania pain management physician was sentenced to five years’ probation and ordered to pay more than $400,000 after pleading guilty to fraudulently billing Medicare and Medicaid. 

9. Ascension Sacred Heart Pensacola (Fla.) agreed to pay $2.4 million after it self-reported alleged violations of the Civil Monetary Penalties Law.

10. A Tennessee physician and his wife were sentenced to 20 years in prison each for conspiracy to unlawfully distribute controlled substances and conspiracy to commit healthcare fraud.

11. The chair of the Arkansas State Medical Board resigned after the state’s Medicaid inspector general found “credible allegations of fraud.”

12. Two owners of a chain of addiction treatment centers in Massachusetts were charged in connection with millions of dollars of healthcare fraud connected to fraudulent billings. 

13. Durable medical equipment company Numotion agreed to pay $7 million to resolve allegations it submitted false claims for reimbursement to Medicaid programs. 

14. A former Missouri lawmaker was sentenced to six years and three months in prison without parole for separate COVID-19 and healthcare fraud schemes of $900,000 and $200,000, respectively.

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