The new yearly insurance fraud estimate is the first time in 27 years the figure has been updated, according to the Coalition Against Insurance Fraud. “Our goal is that when this study is updated next time, for that figure (cost of fraud total) to go down. There’s no reason it shouldn’t,” Matthew J. Smith, Esq, … Read more
CHARLOTTE, N.C. – Charlotte-based BSN Medical Inc. (BSN) has agreed to resolve allegations that it marketed and promoted various products that did not meet the Medicare or Medicaid program’s reasonable and necessary requirements, thereby causing the submission of false claims for payment to the health care programs, announced Dena J. King, U.S. Attorney for the … Read more
Santa Ana, Calif. – A Beverly Hills surgeon has been sentenced to 10 years in state prison for stealing nearly $38 million in an elaborate insurance fraud scheme that involved hiring body brokers to pay patients at Southern California sober living homes to undergo medically unnecessary surgeries, medical testing, and other medical procedures. Dr. Randy … Read more
The Justice Department has indicted 36 people for submitting $1.2 billion in false claims to Medicare. The schemes involved laboratory owners paying illegal kickbacks to medical providers who referred patients for unnecessary telemedicine, genetic testing, and durable medical equipment. The prosecutions highlight a new scheme involving cardiovascular genetic testing. According to the DOJ, “cardiovascular genetic … Read more
NEWARK, N.J. – A former sales representative was convicted by a federal jury for his role in a scheme to defraud public health benefits programs by billing for medically unnecessary compound prescriptions, U.S. Attorney Philip R. Sellinger announced today. Matthew Puccio, 40, of Randolph, New Jersey, was convicted on July 19, 2022, of conspiracy to … Read more
BOSTON – BioReference Health, LLC, formerly known as BioReference Laboratories, Inc., (BioReference) and OPKO Health, Inc. (OPKO) have agreed to pay $9.85 million to resolve alleged violations of the False Claims Act. The government alleges that BioReference rented office space from physicians and then paid those physician-landlords above-market rent so that the physicians would send … Read more
ASHEVILLE, N.C. – Chief U.S. District Judge Martin Reidinger sentenced Lindsey Allison Kerns, 39, of Mars Hill, N.C., to 45 months in prison today, for stealing more than $1 million from two elderly clients in her care, announced Dena J. King, U.S. Attorney for the Western District of North Carolina. In addition to the prison … Read more
A New York federal judge on June 2, 2022, granted GEICO’s motion to enjoin a medical device supplier from filing new collections actions against it in a declaratory judgment suit seeking a judgment that it is not obligated to pay the supplier’s claims for durable medical equipment that was allegedly not provided. The federal judge … Read more
AHA was referring to a report from Department of Health and Human Services’ (HHS’) Office of Inspector General (OIG) last month. OIG looked at a random sample of 250 prior authorization denials made by 15 major insurers back in 2019. It found that only 13% of the denials followed Medicare coverage requirements and so did only 18% … Read more
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