From an Ohio physician sentenced to prison for his role in a $14.5 million scheme to a Washington health system agreeing to pay $3.7 million to settle medically unnecessary surgery allegations, here are 10 healthcare billing fraud stories Becker’s has reported since Jan. 14:
1. The owner and a senior executive of Vivature, a healthcare billing company, pleaded guilty to their roles in a multimillion-dollar fraud scheme.
2. Timothy Doyle, of Selden, N.Y., was sentenced to 14 months in prison for conspiring to offer and pay kickbacks to physicians in exchange for ordering medically unnecessary brain scans.
3. Montana clawed back more than $23 million in fraudulent claims after PacificSource flagged more than 200 suspicious ACA enrollments tied to as much as $54.7 million in unjustified claims.
4. Tacoma, Wash.-based MultiCare Health System agreed to pay more than $3.7 million to resolve allegations that it fraudulently billed government and commercial insurers for spine surgeries performed by former neurosurgeon Jason Dreyer, DO.
5. A Wisconsin durable medical equipment company owner was sentenced to 18 months in prison for conspiracy to pay healthcare kickbacks to physicians.
6. A Florida lab owner pleaded guilty for his role in a scheme that defrauded Medicare by submitting over $52 million in false and fraudulent claims for genetic testing and paying for physician’s orders.
7. A former Indiana physician agreed to pay $1.7 million to settle allegations by the Department of Justice that he submitted fraudulent claims to the state Medicaid program.
8. Oakland, Calif.-based Kaiser Permanente agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for Medicare Advantage enrollees to obtain higher payments from the federal government.
9. A North Ridgeville, Ohio, physician was sentenced to 64 months in prison for his role in a healthcare fraud scheme involving more than $14.5 million in false Medicare claims.
10. A McAllen, Texas-based physician and a clinic employee were sentenced for their roles in a kickback scheme that resulted in more than $3.1 million in Medicare losses.
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