BILLING FOR SERVICES NOT PROVIDED
One of the most common forms of Medicare and Medicaid fraud is billing the government for services, procedures, or supplies that were never provided. Sometimes called “phantom billing,” this type of fraud includes billing for blood tests when no samples were drawn; billing for x-rays when none were taken; billing for dental fillings when none were performed; or billing for home health care hours when they were not provided.
This type of Medicare fraud also includes billing for a higher priced service or product than what was actually provided, such as partially filling prescriptions but charging as if a full prescription was provided; billing for the cost of a name brand prescription drug when a generic substitute was supplied at a substantially lower cost; billing for new durable medical equipment (DME) when the patient received used equipment; or billing for expensive equipment when the patient received a less expensive alternative. Examples of Billing for Services Not ProvidedAmbulance Fraud
The owner of a medical transportation company has been indicted on seven counts of health care fraud. The government alleges that he defrauded Medicaid of $406,000 by filing false claims on behalf of his ambulette company. Click here to read more.... Ambulance Fraud A transportation specialist at an ambulance company was indicted on felony charges for allegedly stealing $490,000 from Medicaid. The defendant allegedly filed claims for reimbursement on behalf of family members who never received ambulance transportation services. Click here to read more.... Ambulance Fraud The owner of an ambulance company and her son were indicted on Medicare and Medicaid fraud charges billing for ambulance transport when they used less-expensive wheelchair vans to transport Medicare and Medicaid patients to routine medical appointments. Click here to read more.... Chiropractor Fraud Four licensed chiropractors were indicted for Medicare fraud and aggravated identity theft for submitting claims to Medicare for chiropractic services that were never provided and for creating and submitting fictitious medical records. Click here to read more.... Dental Fraud The New York Medicaid program paid dentists for fillings and root canals supposedly performed on 465 patients who had no teeth. This is just one of three types of dental fraud identified by the New York State Office of Medicaid Inspector General in a recent report. Click here to read more.... Dental Fraud A dentist was sentenced to three years probation and a $1,000 fine after pleading guilty to submitting false claims to Medicaid, including billing for sedative fillings that were not provided or not medically necessary. Click here to read more.... Dental Fraud The owner of a mobile dental practice, his office manager, billing manager, and four dentists employed by the practice were indicted for allegedly billing Medicaid $5.5 million for services that were not provided. Click here to read more.... Dentist Medicaid Fraud A dentist was sentenced to 18 months in federal prison for helping her employer bill Medicaid for multi-surface fillings that she did not complete, upcoding bills to receive higher reimbursements than the procedures justified, and billing for services not reimbursable by Medicaid by using a different billing code. Click here to read more.... Diagnostic Tests Dr. Ramanathan Prakash was sentenced to 10 years in prison sentence for creating false charts stating that each patient received comprehensive exams and a broad array of diagnostic tests when, in fact, few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using pre-printed templates. Click here to read more.... Durable Medical Equipment (DME) Fraud A physician and the owner of a medical supply company pleaded guilty to a conspiracy to defraud Medicare by submitting false claims for power wheelchairs. The physician was paid $300 for each prescription he wrote for power wheelchairs. In most instances the patient did not require or want a wheelchair, and in many instances no power wheelchair was provided. Click here to read more.... Durable Medical Equipment (DME) Fraud The owner of a durable medical equipment (DME) company was sentenced to more than three years in prison for filing false Medicare claims for "ortho kits," which are braces used for various parts of the body. The DME business owner billed Medicare for ortho kits that patients did not need, were not prescribed, and often did not receive. Click here to read more.... Durable Medical Equipment Fraud The owner of two durable medical equipment (DME) companies was found guilty on six counts of health care fraud and one count of conspiracy to commit health care fraud based on evidence that he submitted false claims to Medicare for products that were materially different from and more expensive than what patients actually received. He faces a possible sentence of 10 years in prison and a $250,000 fine on each count. Click here to read more.... Durable Medical Equipment Fraud The owner of a durable medical equipment (DME) supply company was sentenced to 19 months in prison for submitting more than $600,000 in false claims to Medicare. The defendant billed Medicare for expensive power wheelchairs, when he actually provided patients with much less expensive models. Click here to read more.... Durable Medical Equipment Fraud A pharmacy owner was sentenced to more than eleven years in prison and ordered to pay $15.4 million in restitution for billing Medicare for durable medical equipment (DME) that was not prescribed by a doctor, not medically necessary, and not actually provided to the Medicare beneficiaries. Click here to read more.... HIV Infusion Therapy Fraud A clinic director at an HIV infusion therapy clinic was sentenced to more than 5 years in prison for participating in a fraudulent scheme to pay kickbacks to Medicare beneficiaries in return for using their identities to bill Medicare for HIV infusion services that were not actually provided. Click here to read more.... HIV Infusion Therapy Fraud Two owners and operators of clinics that claimed to specialize in treating HIV and other conditions pleaded guilty to conspiracy to commit health care fraud by submitting fraudulent claims to Medicare for expensive infusion therapy services that were not provided. Click here to read more.... Home Health Fraud A woman who owns a home health care agency in Jacksonville, Florida, was arrested on charges of stealing more than $400,000 from Medicaid. She is accused of billing Medicaid for services that were never provided.. She faces up to 90 years in prison if convicted. Click here to read more.... Home Health Care Fraud Two patient recruiters for a home health care company pleaded guilty to soliciting kickbacks and bribes from their employer in return for recruiting patients. Their employer then billed Medicare for services that were not medically necessary and, in some cases, not provided to the patients. They each face up to five years in prison and a $250,000 fine or twice the gain or loss involved. Click here to read more.... Home Health Fraud A registered nurse was sentenced to 30 months in prison for signing false medical records that were used by his employers to bill Medicare for home health care services that were never actually rendered. Click here to read more.... Home Health Fraud Seven individuals were indicted and arrested on charges of using their home health care agencies to defraud Medicare of $22 million in false claims. The defendants are accused of billing Medicare for services that were never provided and/or were not medically necessary. In addition to health care fraud charges, some of the defendants were charged with money laundering. Click here to read more.... Home Health Fraud Two personal care attendants were charged with Medicaid fraud for submitting claims for services not provided. Both defendants claimed reimbursement for services allegedly provided to patients at their homes on dates when the patients were, in fact, hospitalized. Click here to read more.... Home Health Fraud The owners and operators of two home health agencies pleaded guilty to participating in a $48 million home health Medicare fraud scheme involving phantom billing or billing for services not provided. Nurses and office staff at the home health agencies created false medical records to make it appear that Medicare beneficiaries qualified for home health care and therapy services when, in fact, the beneficiaries did not qualify for and did not receive such services. Click here to read more.... Mental Health Fraud A social worker who created false progress notes for patients in mental health and substance abuse treatment programs was sentenced to five years probation, a $10,000 fine, and a ten-year exclusion from Medicare, Medicaid, and all other federal health care programs. Click here to read more…. Mental Health Fraud A licensed professional counselor has avoided prison after pleading guilty to felony Medicaid fraud. The counselor was charged with “phantom billing,” or billing for services not provided. Click here to read more.... Mental Health Fraud The owner of adult day care centers pleaded guilty to submitting false claims to Medicare for psychotherapy services that were not provided -- including for one patient who was deceased on the day services allegedly were provided. The owner faces up to 60 years in prison. Click here to read more.... Mental Health Fraud The owner of after-school and child day care programs pleaded guilty to submitting more than $8 million in false claims to Medicaid for mental and behavioral health services that were not provided by a licensed professional – and in many cases were not provided at all. Click here to read more.... Mental Health Fraud A registered nurse and an intake specialist at a community mental health center pleaded guilty to helping their employer bill Medicare and Medicaid for mental health treatment that was unnecessary and, in many instances, not even provided. Click here to read more.... Nursing Home Fraud The company that operates “Golden Living” nursing homes agreed to pay $613,300 to resolve allegations that it provided inadequate and worthless wound care services to residents. Click here to read more.... Nurse Staffing Fraud All About You Health Care Services, Inc., a nurse staffing and home health care agency, paid $160,000 to settle allegations that it submitted false claims to Medicaid by billing for services not provided. Click here to read more.... Partial Hospitalization Program (PHP) Fraud The owners of assisted living facilities and an affiliated psychologist received stiff prison sentences ranging from 28 months to 63 months for defrauding Medicare. The defendants paid kickbacks to other assisted living facilities for referrals of Medicare patients for Partial Hospitalization Program (PHP) treatment that was unnecessary and, in many instances, not provided. Click here to read more.... Partial Hospitalization Program (PHP) A former clinical director at a mental-health clinic was sentenced to more than eight years in prison for helping his employer submit more than $50 million in false and fraudulent claims to Medicare for individuals who were not eligible to participate in a Partial Hospitalization Program (PHP) or who never received treatment. Click here to read more.... Partial Hospitalization Program (PHP) Seven hospital administrators were charged with paying kickbacks to Medicare beneficiaries in exchange for those beneficiaries’ attendance at the hospital’s partial hospitalization programs (PHP) when, in fact, the beneficiaries watched television, played games and engaged in other non-PHP activities rather than receiving the services for which the hospital billed Medicare. Click here to read more.... Partial Hospitalization Program (PHP) The owner and operator of a Florida corporation that operated several halfway houses, was sentenced to 51 months in prison after pleading guilty to receiving kickback payments in exchange for referring Medicare beneficiaries, who did not qualify for PHP treatment, for purported PHP services when, in fact, the services were never provided. Click here to read more.... Pediatric Fraud A pediatrician was arrested for billing almost $1 million to Medicaid for wound-repair treatments on children that were never provided. The government commenced its investigation when it discovered that this pediatrician billed Medicaid for certain wound repairs more frequently than any other service provider in the State of New Jersey. Click here to read more.... Personal Care Attendant Fraud Five personal care attendants and three personal care attendant surrogates were indicted for allegedly billing Medicaid for services not provided. The defendants allegedly billed Medicaid for services while they were incarcerated or working other jobs, and for one individual who was deceased at the time they claimed to have provided the services. Click here to read more.... Personal Care Attendant Fraud Two personal care attendants were indicted on felony counts of medical assistance fraud, theft, and perjury for allegedly billing Medicaid for services not provided. Click here to read more.... Pharmacy Fraud A pharmacist who owned and operated a Medicine Shoppe pleaded guilty to billing Medicaid for drugs and supplies that were never dispensed to patients. She will be sentenced to three years of probation. She will also be required to pay restitution of $93,406.02 to the Medicaid program. Click here to read more.... Pharmacy Fraud A pharmacist was sentenced to 17 years in prison for health care fraud. The pharmacist, who owned and operated 26 pharmacies, was accused of billing Medicare and Medicaid more than $57 million drugs that were not medically necessary or not actually dispensed. He was also accused of paying kickbacks to physicians in exchange for writing prescriptions for expensive medications without regard to medical necessity. Click here to read more…. Pharmacy Fraud The owners of five pharmacies pleaded guilty to defrauding Medicaid of millions of dollars by submitting claims for drugs that they never dispensed to their patients. Click here to read more.... Physical Therapy Fraud A physician and six others were charged with conspiring to defraud the Medicare and Medicaid programs of more than $13 million by submitting fraudulent claims for physical therapy and other medical services that were not provided or were medically unnecessary. Click here to read more.... Physical Therapy Fraud Nine defendants were charged with fraudulent billing for physical therapy and related services that were not medically necessary and on some occasions never provided to beneficiaries. Click here to read more.... Physical Therapy Fraud A registered physical therapy assistant was sentenced to serve 30 months in prison for signing false medical records that were used by her employer to submit false claims to Medicare. Click here to read more.... Physician Fraud A physician in Illinois faces up to 10 years in federal prison after pleading guilty to obstructing the fraud investigation. The doctor allegedly gave an FBI agent a patient progress note that had been altered to show an in-office examination previously claimed to an insurance carrier, but which had not taken place. Click here to read more.... Physician Fraud A medical doctor pleaded guilty to defrauding Medicare of $3 million in false claims for procedures that were never performed, including on some patients the doctor had never seen. The doctor claimed he had performed revascularization, ablation of bone tumors, and radiotherapy catheter procedures. He lacked the equipment for several of these procedures. Click here to read more.... Physician Fraud A physician was sentenced to 37 months in prison and ordered to pay $320,000 in fines and restitution after pleading guilty to billing for services not provided. The harsh sentence was imposed because the doctor fled the country after he was indicted and remained a fugitive for 13 years. Click here to read more.... Podiatry Fraud A podiatrist was sentenced to more than four years in prison after pleading guilty to diagnosing patients with foot and toe infections that did not actually exist, and then billing Medicare for treatments that were not provided. Click here to read more.... Prescription Fraud A physician is facing up to 60 years in prison after a jury convicted him of healthcare fraud for writing unnecessary prescriptions for medical equipment and nutritional supplies that were never provided to patients. Click here to read more.... Prescription Fraud A Licensed Practical Nurse employed by a nursing home was sentenced to two years of probation for faxing false patient prescription requests for Hydrocodone to the pharmacy for her own use. She also diverted Hydrocodone for her personal use from numerous nursing home residents. Click here to read more.... Private Duty Nursing Fraud The owners of a private duty nursing service were found guilty of 22 counts of healthcare fraud based on “phantom billing” or billing Medicaid for services not provided. They face up to ten years in prison on each count. Click here to read more.... Psychiatric Fraud A psychiatrist was arrested on grand larceny charges for allegedly billing Medicaid for 45 minutes sessions with patients when the sessions were actually shorter. Click here to read more.... Psychological Service Fraud The manager of a community outreach center was sentenced to 80 months (6 years, 8 months) after pleading guilty to filing false claims with Medicaid for psychological services that were never performed. Click here to read more.... Psychotherapy Fraud A psychologist was sentenced to three years in prison and ordered to pay $1 million in restitution for billing Medicare and Medicaid for psychotherapy services that were not provided. Investigators were alerted to the fraud when they saw that the psychologist claimed to have seen each patient almost daily. They also noticed that the psychologist billed Medicare and Medicaid for multiple patient visits on every day of the year, including every Saturday and Sunday, with only Christmas day excluded. Click here to read more.... Psychotherapy Fraud The owner of adult day care centers pleaded guilty to Medicare fraud for submitting more than $13 million in claims for psychotherapy services that were not rendered. The defendant and her co-conspirators allegedly used residents’ Medicare information to bill Medicare for group and individual psychotherapy that were never provided. She faces a possible sentence of 60 years in prison and a $1.5 million fine. Click here to read more.... Respite Care Fraud The owner of a home health care company faces up to 10 years in prison after pleading guilty to billing Medicaid for respite care services that were not provided. Click here to read more.... Respite Care Fraud The owner of a home health care business was sentenced to 75 months in prison and ordered to pay $630,000 in restitution to Medicaid after pleading guilty to health care fraud, alteration of records, and aggravated identity theft. According to the government, the defendant filed false claims with Medicaid for respite services that were never provided. The aggravated identity theft conviction was based on allegations that she used the Medicaid beneficiaries' names, dates of birth and Medicaid identification numbers without permission or authority. Click here to read more.... |
John Howley, Esq.
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