$100M+ Healthcare Fraud: 6 cases in 2020

The former leader of a rural hospital chain and nine others were charged earlier this year in a $1.4 billion billing scheme. That case was one of several prosecutors brought this year alleging fraud schemes of $100 million or more.

Here are six cases involving alleged fraud schemes of $100 million or more that were brought or resolved this year.

1. Michael Ligotti, DO, a physician in Delray Beach, Fla., was charged in August for allegedly participating in a $681 million healthcare fraud scheme that involved billing for fraudulent tests and treatments. Dr. Ligotti allegedly served as the medical director for more than 50 addiction treatment facilities and signed more than 135 standing orders authorizing fraudulent tests. In exchange for his signature on the standing orders, he allegedly required the treatment centers to have their patients treated at a clinic he owned. Some patients were allegedly charged between $10,000 and $20,000 by Dr. Ligotti and the clinic for one visit.

2. A Texas anesthesiologist convicted in a $200 million healthcare fraud scheme was sentenced to five and a half years in prison in August. Richard Ferdinand Toussaint Jr., MD, also was ordered to pay more than $82.9 million in restitution. He pleaded guilty to the scheme in March 2018.

3. A California surgeon and five others were charged in July with carrying out an elaborate $600 million insurance fraud scheme. Randy Rosen, MD, his girlfriend and four others were allegedly involved in a fraud scheme that involved hiring body brokers to pay patients at sober living homes to undergo medically unnecessary surgeries. He is also accused of requiring patients to undergo unnecessary drug tests, which he sent to a laboratory owned by his girlfriend.

4. The former leader of a rural hospital chain was among 10 defendants charged in June with fraud for allegedly participating in an “elaborate pass-through billing scheme.” An indictment unsealed June 29 alleges Jorge Perez and nine others billed private insurance companies about $1.4 billion for laboratory claims as part of a billing scheme from November 2015 through February 2018. The defendants were allegedly paid $400 million for the claims.

5. Francisco Patino, MD, a physician in Michigan, was charged Feb. 26 in a $120 million healthcare fraud and money laundering scheme that allegedly involved the illegal distribution of controlled substances and unnecessary injections that caused patient harm.

6. Jorge Zamora-Quezada, MD, a Texas physician, was found guilty Jan. 15 for his role in a $325 million healthcare fraud scheme that involved falsely diagnosing patients with various degenerative diseases and then administering chemotherapy and other toxic drugs to patients based on the false diagnoses. After a 25-day trial, Dr. Zamora-Quezada was convicted of one count of conspiracy to commit healthcare fraud, seven counts of healthcare fraud and one count of conspiracy to obstruct justice.

Source: https://www.beckershospitalreview.com/legal-regulatory-issues/100m-healthcare-fraud-6-cases-in-2020.html

Scroll to Top