Skilled Nursing Facilities Agree to Pay
Senior Medicare Patrol
by Maureen Patterson
5d ago
Strauss Ventures LLC, doing business as The Grand Health Care System (The Grand), and 12 affiliated skilled nursing facilities have agreed to resolve allegations that they violated the False Claims Act by knowingly billing federal health care programs for therapy services that were unreasonable, unnecessary, unskilled, or that did not occur as billed. The Grand allegedly submitted bills where the reimbursement claimed was based on providing more therapy than was reasonable and necessary or in some cases where the therapists did not provide the amount of therapy reported. Read a story from McKn ..read more
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Dermatology Agrees to Pay
Senior Medicare Patrol
by Maureen Patterson
2w ago
Tareen Dermatology, P.A., Dr. Mohiba Tareen, and Basir Tareen, CEO, agreed to pay the United States $1.63 million to resolve allegations that they violated the False Claims Act, including claims brought under the qui tam, or whistleblower provisions, by submitting false claims to Medicare and other government payors for dermatology services and treatment. The settlement resolves allegations that the defendants caused false claims to be submitted to Medicare and VA-administered programs in connection with Mohs surgeries, services billed as though performed under the supervision of Dr. Tareen on ..read more
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Update: Podiatrist Sentenced in Foot Bath Scheme
Senior Medicare Patrol
by Mario Shtika
2w ago
In an update to a September 29, 2021, story, Nathan Lucas was sentenced to four years in prison. Read a Department of Justice press release.  A federal grand jury returned an indictment charging podiatrist Nathan Lucas with a scheme to defraud Medicare and TennCare by prescribing and dispensing medically unnecessary foot bath medications. He owned and operated a podiatry clinic, Advanced Foot & Ankle Care of Memphis LLC, as well as multiple in-house pharmacies. The indictment alleges that Lucas regularly prescribed antibiotic and antifungal drugs to be mixed into a tub of warm water f ..read more
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Doctor Charged with Fraudulent Billing During Pandemic
Senior Medicare Patrol
by Maureen Patterson
2w ago
Dr. Ronald David Dean was charged with conspiracy to commit wire fraud for allegedly helping facilitate about $39 million in fraudulent billing of Medicare and other federal benefits programs during the COVID-19 pandemic. A charging document says he and unnamed co-conspirators devised a scheme in which Dean worked as an independent contractor for the two others and signed doctors’ orders for durable medical equipment (DME) and COVID-19 tests “that were used to submit false and fraudulent claims to government health care programs.” He would electronically sign prescriptions without seeing or co ..read more
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National Health Care Fraud Enforcement Action Announced
Senior Medicare Patrol
by Maureen Patterson
3w ago
The Justice Department announced the 2024 National Health Care Fraud Enforcement Action, which resulted in criminal charges against 193 defendants, including 76 doctors, nurse practitioners, and other licensed medical professionals in 32 federal districts across the United States, for their alleged participation in various health care fraud schemes involving approximately $2.75 billion in intended losses and $1.6 billion in actual losses. The charges alleged include an over $900 million fraud scheme committed in connection with amniotic wound grafts; the unlawful distribution of millions of pi ..read more
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Eye Doctor Settles Fraud Claims
Senior Medicare Patrol
by Maureen Patterson
3w ago
Providers including Sheldon Rabin and New York Eye Care will pay more than $2.4 million to resolve claims that they billed or caused to be billed false claims for payment to Medicare and Medicaid for certain procedures, tests, and other ophthalmological services that were either unnecessary or could not have been performed because the ophthalmologist was not in his office. The defendants allegedly submitted claims for treatments that were unnecessary by manipulating patient test readings to create an appearance of a need for certain eye care services when, in fact, the patients’ test readings ..read more
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Update: Hospice Owner Sentenced
Senior Medicare Patrol
by Mario Shtika
1M ago
In an update to an April 19, 2023, story, Kristal Glover-Wing was sentenced to six years in prison, followed by three years of supervised release, for conspiracy to commit health care fraud and three counts of health care fraud. She was also ordered to pay almost $3.7 million in restitution. Read a Department of Justice press release. Kristal Glover-Wing, owner of Angel Care Hospice, was found guilty of one count of conspiracy to commit health care fraud and three counts of health care fraud. Angel Care placed more than 24 patients on hospice without meeting the criteria required by Medicare ..read more
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Update: Pharmacist Sentenced to Two Years
Senior Medicare Patrol
by Mario Shtika
1M ago
In an update to an April 18, 2023, story, Paul Mansour was sentenced to two years in prison for submitting more than $1 million in false and fraudulent claims to Medicare for prescription drugs that were never dispensed to beneficiaries. Read a Department of Justice press release. Paul Mansour pleaded guilty to submitting fraudulent claims to Medicare for prescription drugs that were never dispensed to patients. According to court documents, he was a pharmacist at Mansour Partners Inc., doing business as Best Buy Drugs, which he also co-owned. Mansour created fake patient profiles in the pharm ..read more
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Five Arrested in Hospice Case
Senior Medicare Patrol
by Maureen Patterson
1M ago
Five individuals were arrested on criminal charges related to their roles in a years-long scheme to defraud Medicare of more than $15 million through sham hospice companies and then to launder the fraud proceeds. According to an indictment, three of the defendants misappropriated the identifying information of doctors, claiming to Medicare that the doctors had determined hospice services were necessary when, in fact, the purported recipients of these hospice services were not terminally ill and had never requested nor received care from the sham hospices. In some instances, the defendants fals ..read more
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Update: Psychiatrist Sentenced to Over Eight Years
Senior Medicare Patrol
by Maureen Patterson
1M ago
In an update to a November 7, 2023, story, Gustavo Kinrys was sentenced to over eight years in prison. Read a Department of Justice press release. Psychiatrist Gustavo Kinrys, who owned and operated Advanced TMS Associates, was convicted of billing Medicare and private insurance companies for over $11 million in treatments he did not provide and obstructing justice in an attempt to conceal his crimes. On 382 occasions, Kinrys billed Medicare and private insurers for having provided more than 24 hours’ worth of psychotherapy services in a single day, including one day in July 2017 when he claim ..read more
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