At times it appears that the government focuses its enforcement actions against institutional providers rather than individual providers such as doctors. There are many high profile qui tam cases under the False Claims Act involving institutional providers that result in very large settlements with the Department of Justice Civil Division. These cases are civil with monetary penalties. Less apparent are the many enforcement actions taken against physicians – many of which are criminal rather than civil actions. The following highlights recent enforcement actions taken around the country over the last couple of months.
- A doctor was sentenced 28-months in prison, ordered to pay $750,000, and lost his/her license for Medicare fraud for giving patients diluted versions of Botox.
- A physician pleaded guilty to health care fraud and conspiracy. He is already serving a prison sentence of 18 years for second-degree murder and facing 26 additional criminal counts related to the hepatitis C outbreak of 2007. He forfeited $2.2 million in property and faces added prison time.
- Two physicians were sentenced to prison for receiving kickbacks in exchange for referring blood work to a clinical lab. They were the latest of 37 found guilty in the over $100 million fraud case.
- A doctor was sentenced to 37 months in prison for accepting bribes in exchange for test referrals as part of a long-running scheme operated by a clinical laboratory company.
- An osteopathic physician was charged with health care claims fraud for falsely billing approximately $172,626 in services not provided.
- A doctor was charged for making false claims to Medicare, Medicaid and private health insurers for physician visits that he/she never provided. Additionally, the doctor was also charged with 35 counts of making false statements.
- A pediatrician pleaded guilty to fraudulently billing and collecting $196,911 from Medicaid for over 1,000 wound repair procedures that were never provided.
- A physician pleaded guilty to accepting kickbacks for referring patients’ blood work to a clinical laboratory, resulting in at least $1.75 million worth of business for the laboratory.
- A chiropractor was charged with intentionally misdiagnosing motor vehicle accident patients and submitting fraudulent claims to insurers for medically unnecessary tests and treatments.
- A physician was placed on probation for three years, forfeited $220,000, paid $75,000 in fines, and performed community service for accepting $224,000 in bribes in exchange for referring blood specimens to a laboratory. The laboratory collected more than $800,000 from Medicare and private insurers’ payments for the referred tests.
- A doctor was sentenced to nine months in prison for receiving cash kickbacks for diagnostic testing referrals and for failing to file tax returns on almost $1 million in income over a three-year period.
- A doctor was indicted with illegally dispensing prescription pills and trying to set fire to the building that houses the medical practice.
- A doctor pleaded guilty to conspiracy to fraudulently bill Medicare $14.2 million for unneeded vitamin infusions, physical therapy and unqualified occupational therapy services. The doctor agreed to $5,386,363 in restitution.
- A doctor pleaded guilty to accepting bribes in exchange for test referrals as part of a long-running and elaborate scheme operated by a clinical laboratory.
- Nine doctors faced a 199-count indictment for involvement in a massive scheme involving luring people recruited from low-income neighborhoods, homeless shelters and welfare offices to corrupt medical clinics for unnecessary tests with the promise of free footwear such as sneakers, shoes and boots.
- A dentist was charged with filing false claims and stealing $11,479 from Medicaid by claiming to have provided services to patients he never met or who he treated only in prior years.
- A doctor was convicted of health care fraud conspiracy, ordered to pay restitution of $1.3 million and serve 15 months in prison.
- A doctor was sentenced to a three-year prison term, three years of supervised release and ordered to pay restitution in the amount of $950,000 for health care fraud to distribute controlled substances.
- A doctor pleaded guilty to referring Medicare beneficiaries for home health services in exchange for cash kickbacks as part of a $3.6 million fraud scheme.
- A physician was convicted for accepting kickbacks in exchange for referring Medicaid patients to a home health care agency that generated over $680,000 worth of Medicare reimbursements.
- A doctor was charged for role in an elaborate Medicaid fraud scheme.
- A doctor’s Medicaid participation was suspended pending the outcome of an investigation for billing Medicaid for unnecessary nuclear medicine tests.
- A podiatrist was charged with claiming services rendered at his office when actually provided in nursing homes.
- A physician is awaiting trial for healthcare fraud charges and conspiracy in operating a “pill mill” that caused the deaths of at least seven people.
- A surgeon was sentenced to 15 years in prison for writing fraudulent prescriptions and distributing oxycodone pills to addicts and drug dealers. The surgeon received $500 to $1,000 per prescription.
- A former hospital chief of medicine is awaiting sentencing for illegal drug distribution for prescribing painkillers, including Oxycodone, Dilaudid and Percocet. The prescriptions were given without proper medical reason and led to one patient’s death.
- A doctor was sentenced to an 18-month prison term, ordered to pay $221,012 in restitution, and serve three years of supervised release for submitting approximately $500,000 in false claims to Medicare. The services were not provided and the doctor illegally wrote prescriptions for oxycodone and other drugs.
- A physician admitted to receiving kickbacks in exchange for improperly prescribing Clozapine, an antipsychotic drug, paid by Medicare and Medicaid. He agreed to pay penalties of $3.7 million to resolve a civil fraud lawsuit, as well as another $592,000 as part of the plea agreement. He may get a reduced sentence of 18 months in prison by helping investigators with the case.
- A psychotherapist was indicted with defrauding the Medicare system out of $500,000 by submitting false claims for services not provided. The services were billed under the names of deceased patients and the psychotherapist billed group therapy sessions as individual therapy.
- Two doctors paid $1.05 million to settle allegations that they received kickbacks in exchange for referrals to a home healthcare firm. A total of seven physicians and spouses were included in the initial complaint.
- An ophthalmologist was indicted for submitting over $190 million in Medicare claims and collecting more than $105 million in reimbursements by falsely diagnosing patients with eye disorders such as age-related macular degeneration.
- A physician was charged with fraudulently collecting at least $2.1 million from Medicare and from other insurance by filing false patient diagnoses.
- A doctor pleaded guilty to providing medically unnecessary prescription pain medication to patients, including two undercover detectives. The doctor is awaiting sentencing.
- A physician was charged with performing medically unnecessary cardiovascular tests and procedures, in addition to illegally waiving patients’ copayments. The physician received $18 million in Medicare payments.
- A doctor was sentenced to 120 months in prison and a $650,000 settlement for billing Medicare for 207 unnecessary medical procedures, including cardiovascular and endovascular procedures.
- A physician was found guilty of filing claims for medical services not provided and of permitting an unqualified registered nurse to be certified as a nurse practitioner.
- An oncologist pleaded guilty to dispensing foreign, misbranded drugs to his cancer patients and will pay $2.1 in penalties while waiting for sentencing.
- A rheumatologist was sentenced to a year of probation, $177,000 restitution, and a $338,000 civil settlement due to Medicare fraud involving prescribing his patients misbranded, non-FDA-approved drugs.
- A psychiatrist was indicted on over 100 charges for Medicaid fraud and unlawful prescriptions. While under a suspension of his/her license, the psychiatrist allegedly treated 565 patients and wrote at least 453 prescriptions.
- A doctor was indicted on 239 charges of healthcare fraud, making false statements and prescribing large amounts of Oxycodone pills to patients without a proper examination or medical reason. The doctor submit claims to Medicare and private health insurers for office visits performed by staff members while he was away.
- A pain doctor had his medical license suspended until charges of Medicaid fraud, forgery and reckless prescribing of controlled substances have been resolved.
- A pain physician was charged with Medicaid fraud, reckless prescribing, forgery, and registration offenses related to the over-prescription of pain medication leading to the deaths of eight patients.
- A doctor and former owner of a hospital chain was sentenced to serve 135 months in prison and ordered to pay restitution of $600,000 for submitting more than $1.1 million in fraudulent claims to Medicare, Medicaid and a private insurer.
- A chiropractor was sentenced to a 12-year prison term and ordered to pay approximately $2.4 million in restitution for his role in a fraud scheme involving billing insurers for services never provided.
- Two physicians were sentenced to 148 months and 120 months in a $97 million Medicare fraud scheme where they billed and signed documents indicating that ineligible patients were qualified to receive partial hospitalization program services.
- An oncologist agreed to pay $550,000 to settle allegations that he defrauded Medicare, Tricare and Medicaid by billing for chemotherapy drugs not approved by the FDA.