Articles Tagged with False Claims

IMG_0403-300x169On Tuesday, August 13th, 2019, Peter Frazzano, 46, admitted to participating in a health care fraud scheme involving the submission of fraudulent claims for compounding prescriptions. Frazzano pleaded guilty to conspiracy to commit health care fraud, which is punishable by up to 10 years in prison and a $250,000 fine. Frazzano has also agreed to forfeit over $270,000 and pay a restitution fee of nearly $3 million.

According to the Department of Justice, Frazzano and an additional individual involved in the scheme recruited a physician to sign prescriptions for compounding drugs. These prescriptions were ordered for unsuspecting individuals who were never examined or spoken to regarding the drugs.

Once the prescriptions were issued, Frazzano fraudulently billed multiple health insurance organizations, including the New Jersey State Health Benefits plan. The compound prescriptions Frazzano billed these plans for were mainly pain creams, scar creams, and metabolic supplements.

IMG_0257-300x180Crispin Abarientos, M.D., of Middletown, Connecticut, pleaded guilty to one count of health care fraud in Hartford federal court. According to court statements, Abarientos was a physician that operated out of Middlesex Rheumatology and submitted false claims to Medicaid regarding the use of the drug Remicade on behalf of his patients.

Remicade is primarily used to treat rheumatoid arthritis, and is a drug that was commonly prescribed to Middlesex Rheumatology patients. When Medicaid patients are treated with Remicade the prescribing physician is required to submit claims to their local Medicaid facility, in this case Connecticut Medicaid, on their behalf. Medicaid then pays a partnered pharmacy for the requested drugs, which are then delivered to the prescribing doctor’s facility.

While this was a procedure that Abarientos regularly followed for many of his patients, he admitted to submitting claims to Medicaid for large quantities of the drug that were never intended to be distributed to his patients. He would then submit claims to insurers for reimbursement of the drugs, profiting from the scheme without any out-of-pocket expenses. In total, Abarientos was able to obtain around $895,000 worth of Remicade, which were never distributed to his patients for treatment.

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.

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.

Baylor University Medical Center has agreed to pay over $907,000 to settle claims with Uncle Sam, filed by a whistleblower to settle allegations that it submitted false claims to Medicare and TRICARE for various radiation oncology services including intensity modulated radiation therapy. The government says Balor double billed Medicare for several procedures; billed for high reimbursement radiation oncology services when a less expensive service should have been billed;and improperly billed for radiation treatment delivery without the corroboration of physician supervision.Jeffrey Newman represents whistleblowers.