From an urgent care network paying $12.5 million to resolve overbilling allegations to a Florida physician pleading guilty to submitting $20 million in fraudulent claims, here are the nine healthcare billing fraud cases that made headlines in the past month.
1. Pennsylvania physician pays $1.2M to settle billing fraud allegations
A physician in Berwyn, Pa., agreed to pay $1.26 million to resolve False Claims Act allegations.
2. Florida physician pleads guilty to submitting $20M in fraudulent claims
A physician in Florida pleaded guilty to conspiracy to commit healthcare fraud and faces a maximum of 10 years in federal prison.
3. Chicago hospital defeats allegations of 'ghost payroll' scheme
An Illinois federal court dismissed a whistleblower lawsuit alleging University of Chicago Medical Center, Medical Business Office and Trustmark Recovery Services violated the False Claims Act.
4. West Virginia hospital settles whistleblower suit for $50M
Wheeling (W.Va.) Hospital agreed to pay $50 million to resolve allegations that it violated the False Claims Act by submitting claims to Medicare that resulted from violations of Stark Law and the Anti-Kickback Statute.
5. Ex-physician group managers, owner agree to resolve billing fraud allegations
Two former managers and the owner of a now-defunct physician group in North Carolina agreed to resolve allegations that they billed federal payers for medically unnecessary diagnostic tests.
6. Urgent care network to pay $12.5M in billing fraud case
A company that owned and operated more than 30 urgent care centers agreed to pay $12.5 million to resolve overbilling allegations.
7. Independence Blue Cross pays $2.3M to settle false claims allegations
Independence Blue Cross agreed to pay $2.3 million to resolve accusations that two of its subsidiaries incorrectly calculated Medicare plan costs for CMS, leading to inflated reimbursement.
8. Pennsylvania hospital, RCM vendor settle billing fraud allegations
Phoenixville (Pa.) Hospital and Firstsource Solutions, a revenue cycle services provider, agreed to pay a combined $325,000 to settle False Claims Act allegations.
9. Texas physician pays $530K to settle billing fraud allegations
A pain management physician from Houston paid $530,000 to resolve allegations of deceptive Medicare billing.