Tuesday, December 7, 2021

The Top Healthcare Fraud Takedowns

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2020 will be a historic year for medical care fraud breakdowns—more than 250 people in medical care fraud waste over $5 billion in false and fraudulent claims.

The healthcare frauds include more than 90 authorized physicians and over 25 medical care administrators. The issues also cross the normal: strategies involving products or services never provided and providers who supposedly prescribed and billed for irrelevant treatments and drugs, including anesthetics.

The following are some medical care fraud cases that happened in 2020.

Telemedicine business purchasers charged in $56M fraud conspiracy

Two telemedicine business owners were arrested for supposedly conceiving a federal medical care fraud scheme that issued over $55 million in fraudulent claims to Medicare.

Reinaldo Wilson and Jean Wilson, owners of claimed telemedicine companies Advantage Choice Care LLC and Tele Medcare LLC, were charged with paying and receiving healthcare payments and bribes to order orthotic braces for Medicare recipients.

The Wilsons reportedly carried out the scheme by hiring medical care providers to order the braces even if they were medically irrelevant, unfit for Medicare repayment.

Florida physiotherapy charged with COVID-19, healthcare fraud

Physiotherapy named Dennis Nobbe of Miami, Florida supposedly organized a scheme to use patients through a credit card program to help them pay loan payments for medical care. Nobbe also apparently paid bribes to other physicians to open credit card retailer accounts in their names.

Furthermore, Nobbe allegedly obtained over $200,000 in Paycheck Protection Program and Economic Injury Disaster Loan (EIDL) loans intended to provide COVID-19 relief and transfer portions of the proceeds to shell companies under his control and pay personal expenses.

Feds charge ten individuals in a $1.4B rural hospital billing scheme 

One of the largest healthcare fraud takedowns in 2020 involved charges against ten individuals, including hospital managers, laboratory owners, billers, and recruiters, for their claimed involvement in pass-through billing plans using rural hospitals.

The associates billed private payers approximately $1.4 billion for laboratory testing claims, out of which they paid about $400 million.

The scheme allegedly involved the takeover of small, rural hospitals and using them as a means to bill private payers for expensive urinalysis drug and blood tests that were performed mainly at outside laboratories despite claims stating they were doing in-house.

The associates also reportedly assigned higher repayment rates for tests done within the rural hospitals versus outside labs.

All defendants had charged with conspiracy to commit healthcare fraud and wire fraud.

$681M abuse treatment fraud case in Florida

Michael J. Ligotti, DO, was charged with conspiracy to commit healthcare fraud and wire fraud after allegedly engaging in fraudulent billing for tests and treatments involving patients seeking drug or alcohol addiction help.

According to the complaint, Ligotti authorized millions of dollars in medically irrelevant urinalysis tests as the owner of Whole Health in Delray Beach, Florida. Ligotti also reportedly paid bribes to mental hospitals or addiction therapy clinics to treat their patients with Whole Health providers.

The scheme resulted in $680 million in false lab testing claims. Some patients were also billed between $10,000 and $20,000 by Ligotti and Whole Health for a single day’s visit, the Justice Department stated.

Texas doctor found accusable in $325M healthcare fraud scheme

Jorge Zamora-Quezada was convicted of one count of conspiracy to act medical care fraud, seven counts of healthcare fraud, and one count of conspiracy to prevent justice after diagnosing many patients with rheumatic disease and treating them for generally toxic medicines, like chemotherapy drugs.

The Justice Department reported that his patients were as young as 12 years. Zamora-Quezada performed medical practices throughout South Texas and San Antonio. 

Texas physician jailed 84 months for healthcare fraud

Physician at Texas Pain Solutions and Integra Medical Clinic got seven years in prison for his role in dishonestly billing medical care programs.

According to the evidence, Reznik Saqer would seduce weak patients to the clinics by prescribing opioids, then provide unnecessary and potentially dangerous procedures and tests using unlicensed staff.

Saqer dishonestly billed medical care providers for nearly $5 million for these services, ending in multiple patient deaths, the Justice Department reported.

In addition to the prison order, the judge also required Saqer to pay $5 million in payment.

Four doctors found wrong in $150M healthcare fraud scheme

A federal judge found four Detroit, Michigan-area doctors wrong of participating in a Medicare fraud scheme that cost the federal healthcare program $150 million.

The doctors practiced at Tri-County Group. They would charge Medicare for medically needless services, including urine tests and home healthcare. For example, the Justice Department reported that the doctors would give the following injections in exchange for prescriptions of over 6.6 million doses of medically unnecessary drugs.

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Nora R. Tripp
I am a self-motivated medical billing and coding professional with over 15 years of experience in health operations management, billing, and coding. Expertise in ICD-9 and ICD-10 coding, as well as CPT and HCPCS coding. Expertise in evaluating and validating patient information, diagnoses, and billing data. I demonstrated leadership abilities that allow for the processing of large amounts of patient information in order to satisfy revenue generation targets.

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