From a Texas heart hospital paying $48 million to resolve false claims allegations to a Massachusetts physician accused of $10.6 million in billing fraud, here are 12 cases that made headlines since Nov. 1.
1. Florida physician pleads guilty to $29M fraud
Moses D. deGraft-Johnson, MD, pleaded guilty Dec. 18 to 56 counts of healthcare fraud, conspiracy to commit healthcare fraud and aggravated identity theft. Dr. deGraft-Johnson submitted false claims to insurers for surgeries he didn't perform and for unnecessary procedures. As of Dec. 18, the investigation revealed he received at least $29 million through the fraud scheme.
2. Massachusetts home health agency to pay $10M to settle false claims charges
A Massachusetts home health company and its CEO will pay $10 million to settle charges of falsely billing the state's Medicaid program, according to a Dec. 18 news release from Massachusetts Attorney General Maura Healey.
3. Texas hospital pays $48M to settle false claims allegations
Plano-based Texas Heart Hospital of the Southwest agreed to pay $48 million to resolve allegations that it knowingly submitted false claims to Medicare, the Department of Justice announced Dec. 18.
4. Owner of Texas hospice chain gets 20 years in prison for $150M fraud
The owner of a Texas hospice chain, who was convicted of falsely telling thousands of patients with incurable diseases they had less than six months to live, was sentenced to 20 years in federal prison and ordered to pay $120 million in restitution. Rodney Mesquias was sentenced about one year after he was convicted of healthcare fraud, conspiracy to commit healthcare fraud, conspiracy to commit money laundering, conspiracy to obstruct justice and conspiracy to pay and receive kickbacks. From 2009 to 2018, Mr. Mesquias orchestrated a scheme that involved $150 million in false claims for hospice and other healthcare services.
5. Massachusetts physician accused of $10.6M in billing fraud
A psychiatrist in Natick, Mass., was arrested Dec. 10 in connection with charges that he billed Medicare and private payers for more than $10 million in treatments he did not provide.
6. HCA defeats whistleblower's billing fraud suit
In November, Nashville, Tenn.-based HCA Healthcare and others defeated a whistleblower's allegations that they improperly billed federal healthcare programs for physical therapy services.
7. Florida radiology practice pays $1.4M to settle false claims charges
Jacksonville, Fla.-based radiology practice Mori, Bean and Brooks, P.A. agreed to pay the federal government $1.4 million to settle allegations it knowingly submitted false claims to Medicare and Medicaid.
8. Houston physician sentenced to prison for $17M billing fraud
A Houston physician was ordered Nov. 18 to serve five years in prison and to pay $9.5 million in restitution for her part in a $17 million Medicare fraud scheme.
9. Kaiser pays $6.4M to settle false claims allegations
In November, Oakland, Calif.-based Kaiser Permanente agreed to pay nearly $6.4 million to resolve allegations that Kaiser Foundation Health Plan of Washington submitted invalid diagnoses to Medicare for Medicare Advantage members. The settlement resolves allegations that Kaiser Foundation Health Plan of Washington, formerly Group Health Cooperative, submitted diagnoses to Medicare that were not supported by the beneficiaries' medical records to inflate payments it received. The allegations were originally brought under the qui tam, or whistleblower, provisions of the False Claims Act by a former employee of the health plan.
10. Healthcare exec pleads guilty to part in $1.2B Medicare fraud scheme
The owner of nine medical brace companies pleaded guilty Nov. 12 in federal court for his role in a Medicare scam that resulted in more than $1.2 billion in losses.
11. Virginia physician convicted on 52 charges related to billing fraud scheme
A federal jury convicted Javaid Perwaiz, MD, on Nov. 9 of 52 counts related to his scheme to perform unnecessary hysterectomies and other surgeries on women and bill insurers for the procedures.
12. Feds charge New Jersey physician in $24.6M billing fraud case
A New Jersey physician was charged with healthcare fraud, wire fraud and mail fraud for his alleged role in a long-standing billing scheme, the Department of Justice announced Nov. 9.