Here are 10 recent physician fraud cases making headlines.
1. Idaho psychiatrist allegedly bilked more than $30,000 from Medicaid — Michael Applebaum, MD, allegedly failed to properly document services that were purportedly provided on more than 500 claims to Medicaid. Dr. Applebaum also allegedly filed approximately 50 claims with false dates.
2. Michigan internist arrested for anti-kickback violations — Pramod Raval, MD, allegedly conspired with the owner and operator of home health agency Patient Choice Home Healthcare, Muhammad Shahab. Mr. Shahab allegedly paid Dr. Raval kickbacks in exchange for patient referrals and access to Medicare beneficiaries under Dr. Raval's care.
3. North Carolina internist accused of defrauding federal healthcare programs — Daniel Chidi Uba, MD, and his company Rapha Health Systems have been accused of knowingly submitted false or fraudulent claims to Medicare and Medicaid for services that were either never rendered, medical unnecessary or not supported by proper documentation. Dr. Uba also allegedly submitted claims for patients who did not qualify for medical services reimbursement.
4. Michigan family practitioner to spend three years in prison — Alan Silber, MD, has been sentenced to three years imprisonment and ordered to pay $649,000 in restitution for his role in a Medicare fraud scheme to submit nearly $1 million in false and fraudulent claims for injection and infusion therapy services that were unnecessary or never provided.
5. Arizona internist to pay $92,000 to settle False Claims Act allegations — Ray Silao, MD, has agreed to pay the federal government $92,000 to settle allegations that he violated the False Claims Act by submitting fraudulent claims to the federal Medicare program for tests he performed on patients who did not meet the Medicare coverage requirements.
6. Ohio family practitioner sentenced to one year imprisonment — Charles C. Njoku, MD, has been sentenced to one year in prison after pleading guilty to charges of healthcare fraud and allowing his office manager, who does not have a medical degree, to examine and prescribe treatments to patients.
7. Nevada anesthesiologist pays $1.25 million to settle fraud allegations — Brian Lemper, MD, has been accused of submitting inflated claims to TRICARE and the Federal Employee Health Benefits Program for surgeries and surgical supplies. Dr. Lemper has not admitted to any wrongdoing.
8. Missouri internist to spend five months in prison for making false statements — Howard Goldstein, MD, has been sentenced to five months imprisonment and ordered to pay $30,000 for making false statements about his questionable Medicare billing practices. Dr. Goldstein reportedly "minimized and mischaracterized concerns and problems that had been raised by his former employer."
9. New York podiatrist pleads guilty to Medicare fraud — William Holley, MD, a podiatrist from Buffalo, N.Y., has pleaded guilty to submitting a false claim to Medicare for a wedge excision he never performed on a patient.
10. Iowa internist gives up medical license after pleading guilty to Medicaid fraud — Robert David, MD, has pleaded guilty to his role in a scheme to bilk $4.7 million from the federal Medicaid program. Dr. David allowed an HIV/AIDS treatment center to illicitly use his Medicaid provider number while he was away in other locations. The provider number was used to order expensive injections and infusions that were never rendered to patients.
1. Idaho psychiatrist allegedly bilked more than $30,000 from Medicaid — Michael Applebaum, MD, allegedly failed to properly document services that were purportedly provided on more than 500 claims to Medicaid. Dr. Applebaum also allegedly filed approximately 50 claims with false dates.
2. Michigan internist arrested for anti-kickback violations — Pramod Raval, MD, allegedly conspired with the owner and operator of home health agency Patient Choice Home Healthcare, Muhammad Shahab. Mr. Shahab allegedly paid Dr. Raval kickbacks in exchange for patient referrals and access to Medicare beneficiaries under Dr. Raval's care.
3. North Carolina internist accused of defrauding federal healthcare programs — Daniel Chidi Uba, MD, and his company Rapha Health Systems have been accused of knowingly submitted false or fraudulent claims to Medicare and Medicaid for services that were either never rendered, medical unnecessary or not supported by proper documentation. Dr. Uba also allegedly submitted claims for patients who did not qualify for medical services reimbursement.
4. Michigan family practitioner to spend three years in prison — Alan Silber, MD, has been sentenced to three years imprisonment and ordered to pay $649,000 in restitution for his role in a Medicare fraud scheme to submit nearly $1 million in false and fraudulent claims for injection and infusion therapy services that were unnecessary or never provided.
5. Arizona internist to pay $92,000 to settle False Claims Act allegations — Ray Silao, MD, has agreed to pay the federal government $92,000 to settle allegations that he violated the False Claims Act by submitting fraudulent claims to the federal Medicare program for tests he performed on patients who did not meet the Medicare coverage requirements.
6. Ohio family practitioner sentenced to one year imprisonment — Charles C. Njoku, MD, has been sentenced to one year in prison after pleading guilty to charges of healthcare fraud and allowing his office manager, who does not have a medical degree, to examine and prescribe treatments to patients.
7. Nevada anesthesiologist pays $1.25 million to settle fraud allegations — Brian Lemper, MD, has been accused of submitting inflated claims to TRICARE and the Federal Employee Health Benefits Program for surgeries and surgical supplies. Dr. Lemper has not admitted to any wrongdoing.
8. Missouri internist to spend five months in prison for making false statements — Howard Goldstein, MD, has been sentenced to five months imprisonment and ordered to pay $30,000 for making false statements about his questionable Medicare billing practices. Dr. Goldstein reportedly "minimized and mischaracterized concerns and problems that had been raised by his former employer."
9. New York podiatrist pleads guilty to Medicare fraud — William Holley, MD, a podiatrist from Buffalo, N.Y., has pleaded guilty to submitting a false claim to Medicare for a wedge excision he never performed on a patient.
10. Iowa internist gives up medical license after pleading guilty to Medicaid fraud — Robert David, MD, has pleaded guilty to his role in a scheme to bilk $4.7 million from the federal Medicaid program. Dr. David allowed an HIV/AIDS treatment center to illicitly use his Medicaid provider number while he was away in other locations. The provider number was used to order expensive injections and infusions that were never rendered to patients.