Healthcare Billing Fraud: 5 Latest Settlements

Here are five healthcare organizations that entered into settlements to resolve billing fraud allegations in the past two months:

1. 3 physicians to pay $1.1M to settle genetic testing kickback allegations
Three physicians and a cardiac center agreed to collectively pay $1.1 million to settle allegations of violating the Anti-Kickback Statute and the False Claims Act in a scheme related to genetic testing. The physicians allegedly received kickbacks from Natural Molecular Testing Corp. for ordering its genetic tests. NMTC then allegedly billed Medicare for the tests.

2. California medical group, physician pay $5M to settle whistleblower charges
Redlands, Calif.-based Beaver Medical Group and an ophthalmologist at the practice will pay $5 million to resolve false claims allegations. The government alleged that BMC and the ophthalmologist reported invalid diagnoses unsupported by Medicare beneficiaries’ medical records, which resulted in inflated payments.

3. Pennsylvania hospital strikes $2.5M deal in fraudulent billing case
Millcreek Community Hospital in Erie, Pa., agreed to pay $2.45 million to resolve False Claims Act allegations. The government alleged the hospital violated the False Claims Act by billing Medicare and Medicaid for medically unnecessary services.

4. Encompass Health will pay $48M to settle false claims allegations
Birmingham, Ala.-based Encompass Health, the largest operator of inpatient rehabilitation facilities in the U.S., agreed to pay $48 million to resolve false claims allegations. The government alleged some of Encompass Health’s IRFs provided inaccurate information to Medicare to maintain their IRF status and earn higher reimbursement.

5. Penn Medicine settles false claims allegations
Philadelphia-based Penn Medicine agreed to pay $275,000 to resolve allegations that one of its hospitals submitted false claims to Medicaid for obstetric ultrasounds.

Source: https://www.modernhealthcare.com/legal/telemedicine-ceo-pleads-guilty-424-million-medicare-fraud-scheme

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