Articles Posted in Medicaid Fraud

IMG_0222-300x200Following allegations of fraudulent Medicaid claims, Acadia Healthcare has agreed to pay a $17 million settlement, according to a recent press release by the Department of Justice.

CRC Health operates its subsidiary, Acadia Healthcare, located in Tennessee with treatment centers in West Virginia. The treatment centers are certified to perform basic laboratory testing involving blood and urine. However, the settlement alleges that between 2012 and 2018, the treatment centers sent urine and blood samples to a San Diego laboratory for more complex testing. Then, the West Virginia based treatment centers billed Medicaid for the testing performed.

Acadia Healthcare submitted the claims through the Medicaid program in their area and received reimbursement fees for the tests. However, the San Diego laboratory was actually the center performing the tests and charged Acadia for their services. The Medicaid reimbursements were higher than the charges of the San Diego laboratory, resulting in Acadia Healthcare gaining around $8.5 million in the Medicaid scheme.

IMG_0209-300x200A whistleblower in Oklahoma, Jennifferr Baird, filed a complaint against the hospital she worked at as a registered nurse for fraudulent Medicaid billing practices. Following the filing, Oklahoma Heart Hospital agreed to settle the allegations with a $2.8 million fee.

Baird was in charge of a team of seven staff members and alleged that for at least seven years the hospital consistently billed Medicaid at inpatient rates, even if the patient was being treated as an outpatient.

“First, OHH routes almost all of its Medicaid patients to inpatient treatment, when many should be classified as outpatient; in doing so OHH is able to charge significantly larger fees for the same treatment. The fraud is evidenced by the fact that OHH does not treat its Medicare or privately insured patients similarly.”, the lawsuit stated.

IMG_0004-300x200Nabil Fakih, a licensed pharmacist, Michigan Board of Pharmacy member, and owner of a Dearborn Heights drug store, was charged with healthcare and wire fraud and indicted by a grand jury. The Indictment accused Fakih of wrongfully taking millions of United States dollars from Medicare, Medicaid and Blue Cross Blue Shield (BCBS), dating back to 2011.

According to the indictment, Fakih is accused of falsely submitting claims on behalf of Dial Drugs. He was reported to be overbilling Medicaid and Medicare by $569,670 while overcharging BCBS by $558,079.

Fakih and others billed insurance companies for prescription drugs such as the antipsychotic medication, clozapine, and the sedative alprazolam. Claims for these drugs were on behalf of people who had died prior to the claimed date of delivery. This is according to government allegations.

Arkansas Attorney General Leslie Rutledge announced today the arrest of the owner and CEO of New Beginnings Behavioral Health Services LLC, Chirie Bazzelle.

Bazzelle, 46, of Benton, is accused of failing to report contracts with Milton “Rusty” Cranford, Robin Raveendran, and her former husband Michael Grimes who is a convicted felon. She is also accused of continuing the employment of individuals who had been convicted of Medicaid fraud and ignoring additional Medicaid fraud claims of other employees. Bazzelle has been listed as the sole owner of New Beginnings Behavioral Health Services in Pulaski County since 2010. Bazzelle is also accused of attempting to evade taxes from January 2014 through February 2019.

“Bad actors who have their hands in the taxpayer cookie jar must be held accountable,” says Attorney General Rutledge

Medicaid fraudWaveney Blackman, the owner of durable medical equipment company WaveCare Health services, has been charged with one act of healthcare fraud for filing claims to Medicaid for products that were never purchased through her business. Blackman pleaded guilty to these charges after one month and has been sentenced to 42 months in prison and ordered to forfeit $9.4 million, the sum of WaveCare’s proceeds from fraudulent claims.

During the years of 2010 to 2016, Blackman filed multiple claims to Medicaid for incontinence products, wound care supplies, and other pieces of durable medical equipment that resulted in revenue of $9.4 million. None of these products were ever given to Medicaid clients or even requested by one. These fraudulent claims were filed by Blackman herself, along with the assistance of her employees through a WaveCare biller.

Within one month of being charged, Blackman signed a plea agreement that detailed the illegal actions taken, as well as the proceeds she received from them. The government has seized a Mercedes, seven properties, and money traced to two separate bank accounts, and the judge ordered Blackman to pay the total of $9.4 million WaveCare reportedly received in fraudulent claims. She will also be sentenced to 42 months in prison.

NC-health-care-fraud-300x199Mental health company owner, Catinia Denise Farrington of Cyprus, Texas, pleaded guilty to health care fraud and tax evasion in September of 2018. As of March 1st, 2019, she has been sentenced to 60 months in prison after profiting $4 million from Medicaid and just under $400,000 from her tax evasion scheme.

Health Care Fraud Conspiracy

According to prosecutors, Farrington owned a mental health care company out of North Carolina, Durham County Mental Health and Behavioral Health Services, LLC. Through this company, she submitted thousands of fraudulent claims to Medicaid for services that were never performed. These incidents occurred between 2011 and 2015, but this is not the only fraudulent activity that Farrington participated in during this time.

Target Corp. will pay  $3 million to settle  allegations that it violated federal and state law by improperly billing and receiving payments from the state’s Medicaid program (MassHealth), Attorney General Maura Healey announced today.

Under the terms of the settlement, Target Corp. will pay $3 million to resolve allegations that from August 2009 through July 2015, the company operated an unauthorized automatic refill program at their Massachusetts locations.

Current regulations prohibit pharmacies in Massachusetts from automatically refilling prescriptions that were not explicitly requested by a MassHealth patient or caregiver at the time of each filling event. The AG’s Office alleges that Target automatically refilled prescriptions and billed MassHealth inappropriately for them

j-300x198Steven M. Butcher, 39, owner of MedMax LLC, which provided marketing services for compounded medications, pleaded guilty before U.S. District Judge John Michael Vazquez in Newark federal Court for conspiracy to commit healthcare fraud and violate the Anti-Kickback Statute.

Butcher used his company, MedMax,  to convince people to obtain unneeded compound medications and then bill the costs to various private and federal healthcare insurance plans.  MedMax was a marketing company for compound medications.  Butcher also paid several kickbacks from 2014 to 2015 for many individuals to fraudulently bill a health care benefit program that primarily serviced military families, called TRICARE, for unnecessary compound medications.

Compounded pharmacies prepare personalized medications based on specific prescriptions that include instructions for exact strength and dosage.

Medicare fraudFighting Medicaid Fraud

Hearing the term Medicaid fraud may conjure up images of lawyers and government officials, but the true cost is actually much closer to home for many people. Fraud and abuse in Medicaid cost taxpayers billions of dollars every year. Funds intended to help the sick end up being wasted.

But worse than the wasted time is the risk to patients caught up in unnecessary procedures that just line the pockets of unscrupulous health care companies. Imagine if you found out that your child had an unnecessary surgery just so that agency could make a few hundred dollars.

1-1-300x198Upcoding In The ER Could Be Stealing U.S. Tax Dollars

It’s an old and shady practice that has been in the forefront of Medicare and Medicaid fraud for years. Upcoding can hit taxpayers hard and drive emergency room bills to the thousands.

What is Upcoding?