From an Ohio radiology company president getting sentenced to 15 years in prison, to an Indiana health system agreeing to settle claims that it submitted improper revenue codes to Medicaid, here are 10 healthcare billing fraud cases Becker's has covered since Sept. 20.
1. Medical equipment company owner gets prison for healthcare fraud scheme
Jamie McCoy, 42, was sentenced on Oct. 6 to 30 months in prison and ordered to pay $7.5 million after pleading guilty to his role in a billing fraud scheme. Mr. McCoy contracted with marketing firms who placed ads on television and online that offered orthotic braces at no cost. The firms sent patient information to a telemedicine physician who signed an order form for equipment without evaluating the patient. The patient information and medical equipment orders were sold to durable medical equipment companies owned or operated by Mr. McCoy.
2. Florida provider to pay $700K to settle Medicaid fraud allegations
Jacksonville, Fla.-based Physicians Group Services agreed on Oct. 5 to pay $700,000 to resolve allegations that the provider submitted false claims to the state's Medicaid program. The Justice Department alleged that Physicians Group Services billed Medicaid for quantitative drug testing that was medically unnecessary because the testing was not designed to meet the needs of each patient.
3. Former Kentucky lawmaker gets 2 years in prison for healthcare billing fraud
Former Kentucky state representative Robert Goforth, 46, was sentenced to 25 months in prison Oct. 3 after admitting that a pharmacy he owned billed insurance programs, including Medicare and Medicaid, for prescriptions that customers didn't pick up. The pharmacy then multiplied profits by putting those medications back on the shelf and selling them multiple times.
4. Radiology company president gets 15 years for $2M X-ray billing scheme
Thomas O'Lear, 58, president of North Canton, Ohio-based Portable Radiology Services, was sentenced on Sept. 29 to 15 years in prison after being convicted of billing Medicare, Medicaid and two Medicaid-managed care organizations for X-ray services his company did not provide, covering up the scheme and committing aggravated identity theft.
5. California physician to pay $2.3M for illegal drug distribution
Santa Ana, Calif.-based physician Mohammed El-Nachef, MD, pleaded guilty on Sept. 28 to defrauding California's Medi-Cal system by prescribing medically unnecessary drugs to more than 1,000 patients.
6. Indiana system to pay $2.9M to settle Medicaid overbilling allegations
Fort Wayne, Ind.-based Parkview Health System agreed on Sept. 27 to pay $2.9 million to settle allegations it overbilled Medicaid between January 2017 and March 2021. Improper revenue codes were submitted to Medicaid for certain blood-clotting tests performed on patients at several Parkview hospitals.
7. Former federally qualified health center CEO convicted of Medicaid fraud
Victor Kirk, 73, former CEO of St. Gabriel (La.) Health Clinic, was convicted of a $1.8 million Medicaid fraud scheme on Sept. 26. St. Gabriel practitioners provided character development and other educational programs to entire classrooms of students during regular class periods. Mr. Kirk directed practitioners to falsely diagnose students with mental health disorders. From 2011 to 2015, Mr. Kirk fraudulently billed these programs to Medicaid as group psychotherapy.
8. Medical equipment company VP pleads guilty in $50M fraud scheme
Kala Sloan, 28, vice president for a pair of North Carolina medical equipment companies, pleaded guilty Sept. 21 to falsifying physician orders for equipment as part of a $50 Medicare fraud scheme.
9. Former Missouri physician pleads guilty to role in Medicare, Medicaid fraud scheme
Former Joplin, Mo., physician Oluwatobi Alabi Yerokun, MD, 36, pleaded guilty Sept. 21 to his involvement in a scheme in which he signed orders for products and tests for more than 2,000 Medicare and Medicaid patients he never met or examined.
10. Ohio physician accused of fraudulent medical billing
Cleveland-based physician Timothy Sutton, MD, was accused of illegally billing Medicare for tests that aim to predict a patient's likelihood of cancer, and prescribing braces to patients who didn't need them, Cleveland.com reported Sept. 20.