From HCA Healthcare defeating billing fraud allegations to Geisinger paying $18.5 million to settle allegations of fraudulent billing, here are nine cases that have made headlines since Nov. 1:
1. Illinois hospital to pay $292K to settle allegations it kept overpayments from insurers
Gibson Area Hospital in Gibson City, Ill., will pay $292,000 to resolve allegations that it failed to return overpayments from government insurers in violation of the False Claims Act.
2. Florida pharmacy owner found guilty of running $174M telehealth fraud scheme
A federal jury has convicted Tampa, Fla., pharmacy owner Peter Bolos, 44, for his role in running an $174 million telehealth fraud scheme that resulted in thousands of false claim submissions.
3. 2 physicians, 1 nurse sentenced in $40M fraud scheme
Two physicians were sentenced to a combined 23 years in prison Dec. 2 for their roles in a hospice agency scam that defrauded Medicare and Medicaid, the Justice Department said. A nurse at the hospice was also sentenced to more than two years in prison. According to prosecutors, the defendants defrauded government insurers by admitting patients who were not appropriate for hospice care and submitting false claims for services.
4. Texas hospital will pay $18.2M to settle false claims case
Flower Mound (Texas) Hospital has agreed to pay $18.2 million to resolve allegations that it violated the False Claims Act by submitting claims to government payers that resulted from violations of the Anti-Kickback Statute and Stark Law, the Justice Department announced Dec. 2.
5. Louisiana pharmacy marketer sentenced in $180M fraud scheme
A Louisiana pharmacy marketer was sentenced to 2 1/2 years in prison over his role in an $180 million fraud scheme that involved submitting false claims, the Justice Department said Nov. 30.
6. Wisconsin physician gets 4 1/2 year sentence for $13M fraud scheme
A Wisconsin physician was sentenced to 4 1/2 years in prison for his role in a $13 million fraudulent billing scheme, according to the Justice Department.
7. HCA defeats billing fraud claims
A whistleblower failed to adequately allege that Nashville, Tenn.-based HCA Healthcare submitted false claims to government healthcare programs for physical therapy services, a Kansas district court said Nov. 19.
8. Judge orders 2 ophthalmologists to pay $170M for alleged false claims violations
Two ophthalmologists and their eye clinic were ordered to pay more than $170.5 million for allegedly fraudulently billing Medicare for the evaluation and treatment of glaucoma, the Justice Department said Nov. 18.
9. Florida physician gets 7-year sentence for $29M fraud scheme
A physician who owned and operated a heart institute in Florida was sentenced to seven years in prison for performing unnecessary surgical procedures and defrauding health insurance providers, the Justice Department said Nov. 18.
10. Geisinger to pay $18.5M to settle allegations of fraudulent billing
Danville, Pa.-based Geisinger Community Health Services will pay $18.5 million to resolve allegations that it improperly billed Medicare for hospice and home health services, the Justice Department said Nov. 1.