UNLICENSED OR UNQUALIFIED PROVIDERS
Claims for reimbursement submitted to Medicare or Medicaid are valid only if the individual providing the treatment or service had all the licenses and certification required. If the individual healthcare provider did not have the necessary license or certification, then the claim is considered a "false claim" under the False Claims Act. It is not a defense that the individual healthcare provider gave the patient equivalent care.
Examples of Unlicensed or Unqualified ProvidersDental Fraud
A dentist has been charged with Medicaid fraud and grand theft for allegedly billing Medicaid for services provided by an unlicensed dental hygienist. If convicted, he faces up to 15 years in prison and more than $30,000 in fines. Click here to read more.... Drug and Alcohol Detoxification Fraud New York Downtown hospital has agreed to pay $13.4 million to resolve claims that it defrauded Medicare and Medicaid by submitting false claims for services provided by an inpatient drug and alcohol detoxification program without a license from the New York State Office of Alcoholism and Substance Abuse Services. Click here to read more.... Home Health Care Fraud The billing manager of a home health care agency was sentenced to 18 months in prison for defrauding Medicaid of more than $500,000. The manager allegedly billed Medicaid for services provided by Registered Nurses (RNs) when the services were not provided by RNs. Click here to read more.... Home Health Care Fraud The owner of a home health care business was sentenced to ten years in prison for defrauding Medicare and ordered to pay $2.9 million in restitution. The defendant was convicted of billing Medicare for services purportedly provided by physicians when, in fact, they were performed by physician assistants or an individual whose medical license was suspended. Click here to read more.... Home Health Care Fraud A medical doctor and registered nurse have been charged with billing Medicare and Medicaid for physician services that were actually provided by the nurse. 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.... 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 that were provided without adequate medical supervision. Click here to read more.... Psychotherapy Fraud The owner of a business providing psychotherapy services to students and families was charged with stealing $750,000 from Medicaid. The government alleges that the defendant falsely billed Medicaid as if a psychologist with a doctoral degree had actually provided services, when the therapist who performed the service had only a master’s degree. Click here to read more.... Sleep Disorder Diagnostics Fraud American Sleep Medicine agreed to pay $15.3 million to settle allegations that it billed Medicare for sleep diagnostic testing performed by technicians who did not have the required licenses or certifications. The whistleblower who brought the lawsuit will receive a $2.6 million reward. Click here to read more.... Unlicensed Physician Fraud A medical assistant who had studied at an unaccredited medical school and was not licensed as a physician pleaded guilty to conspiring with his employer to submit false claims to Medicare. The employer -- a licensed and board-certified cardiologist -- submitted claims to Medicare representing that services had been provided by the cardiologist when, in fact, they had been provided by the unlicensed medical assistant. Click here to read more.... |
John Howley, Esq.
The Howley Law Firm P.C. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 |