From a judge sentencing four people for their roles in a $54.3 million scheme to a Medicare Advantage insurer agreeing to pay up to $98 million to settle allegations of knowingly submitting invalid diagnoses, here are 10 healthcare billing fraud cases that Becker's has reported since Dec. 6:
1. Philip Hall, a 48-year-old pharmacist of Jamestown, Tenn., was charged with six counts of aggravated identity theft and nine counts of healthcare fraud.
2. Sixteen different cardiology practices and associated physicians across 12 states agreed to pay a combined $17.7 million to settle allegations of overbilling Medicare for diagnostic radiopharmaceuticals.
3. Independent Health will pay up to $98 million to settle allegations a now-defunct subsidiary knowingly submitted invalid diagnoses to boost Medicare Advantage payments.
4. A physician who worked for two Pasadena, Calif., hospices was sentenced to two years in prison for his role in a fraud scheme that defrauded Medicare out of more than $3 million.
5. A Montana physician was sentenced to six months in prison followed by six months of home confinement for his role in a $31 million telemedicine fraud scheme.
6. A New York operations manager was charged for allegedly conspiring to offer and pay kickbacks to physicians in exchange for ordering unnecessary brain scans.
7. Oroville (Calif.) Hospital agreed to pay $10.25 million to resolve allegations it violated the False Claims Act and the Anti-Kickback Statute.
8. A medical biller was sentenced to five years of probation for stealing more than $1.1 million that was intended to be paid directly to three surgeons who provided medical care to injured workers under the New York State Workers’ Compensation Law.
9. A Florida telemarketer was sentenced to 15 years in prison for his role in a scheme to defraud Medicare out of $67 million by billing for medically unnecessary genetic testing.
10. A Florida federal judge sentenced four people for their roles in a $54.3 million Medicare fraud scheme that involved paying kickbacks and bribes to telemarketers and telemedicine providers to secure orders for medically unnecessary prescriptions.