From the Justice Department suing Kaiser Permanente over an alleged $1 billion fraud scheme to Geisinger paying $18.5 million to settle allegations of fraudulent billing, here are 11 cases that have made headlines since Oct. 1:
1. 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.
2. UnitedHealthcare sues TeamHealth, alleges $100M fraud
Health insurance giant UnitedHealthcare is suing TeamHealth over the hospital staffing company's emergency room bills. UnitedHealthcare claims that TeamHealth deliberately upcoded the claims to deceive the insurance company into overpaying for ED services "and to reap windfall profits."
3. Kaiser defrauded Medicare of $1B, Justice Department alleges
Oakland, Calif.-based Kaiser Permanente and various affiliates defrauded Medicare of about $1 billion by adding diagnoses to patients' medical records to increase reimbursement, the Justice Department alleged in an Oct. 25 complaint.
4. UPMC defends surgery practices in battle with feds
UPMC is defending its surgery and billing practices after the Justice Department filed a false claims complaint against the Pittsburgh-based system, its physician group and the chair of its department of cardiothoracic surgery.
5. Arizona physician indicted in decade-long billing fraud case
A jury returned a 50-count indictment against an Arizona physician relating to an alleged $50 million fraudulent healthcare billing scheme, the Justice Department said Oct. 22.
6. Texas pain physicians to settle claims of ordering unneeded tests for $3.9M
Two Texas physicians agreed to pay $3.9 million to resolve allegations that they submitted false claims to government insurers for medically unnecessary urine drug testing, the Justice Department said Oct. 22.
7. Indiana health system must face Justice Department's false claims suit
A district court denied Indianapolis-based Community Health Network's motion to dismiss a false claims lawsuit brought by the Justice Department alleging that it engaged in a fraud scheme to keep referrals in its network. The Justice Department claims that the alleged scheme resulted in the health system receiving millions of dollars of improper Medicare reimbursement.
8. South Carolina medical practice pays $1.25M to settle improper billing allegations
Colonial Family Practice, a physician-owned primary and urgent care practice with multiple locations in South Carolina, will pay $1.25 million to settle allegations that it billed government insurers for medically unnecessary services, the Justice Department said Oct. 20.
9. 506-bed Pennsylvania hospital must face overpayment suit, judge rules
Lancaster (Pa.) General Hospital's motion to dismiss a lawsuit filed by a group of hospitals claiming it unlawfully received millions in state funding by inflating reimbursement claims was denied by a Pennsylvania federal judge Oct. 12.
10. US to join suit against Tennessee health system alleging $800M in fraud
The U.S. government filed a motion to intervene Oct. 8 in a whistleblower's false claims lawsuit filed against Methodist Le Bonheur Healthcare in Memphis, Tenn.
11. 8 healthcare professionals accused of $20M 'paid patient' scheme, faking medical records
The Justice Department charged six physical therapists and two acupuncturists in relation to allegedly operating a $20 million healthcare fraud scheme that involved paying patients to falsely bill payers for services that were never rendered and faking medical documents.