Bad Actors Round Up (November)

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. If you are looking for something to read prior to turkey or afterwards, here is a round up of bad actors:

Pharma Fraud: 

• A Physician representing Avanir received over $300,000 in kickbacks for writing over 10K prescriptions for the drug Nuedexta and another $1,500 per each presentation. Pharma Fraud
• Manhattan physician operated as a pill mill and faces 20 years in prison. Pharma Fraud 
• Pain management doctor gave patients steroid injections even after patients complained of negative side effects. Pharma Fraud

Fraudulent Billing Schemes: 

• A psychiatrist caught improperly billing over $1.36M to Medicare over the course of seven years. Some of these included billing for over 24 hours in a single day. Fraud Scheme
• Florida Birth-Related Neurological Injury Compensation Plan and Association (NICA) to Pay over $51M in False Claims Act. The group steered members to bill Medicaid rather than going through the NICA.  Fraud Scheme
• Physician group improperly billed Medicare for fitness services. Fraud Scheme 
• Mental Health practitioners billed Medicaid for services not rendered. Fraud Scheme
• Doctor used a patient recruiting company to create customers for a “psychotherapy” session. These sessions never actually happened and patients were confused on why they were visiting the doctor Fraud Scheme

Telemedicine Fraud: 

• A  national scheme was uncovered with RediDoc and their owners who pushed patients to try DME and gave kickbacks to physicians. Telemedicine fraud. 

Nursing Home Fraud: 

• Colorado woman overbilled Medicaid for services not rendered. Fraud Scheme

Exclusions: 

• River Rock Healthcare employed an individual who was federal excluded from participating in any Federal Healthcare Program. Exclusion violation

We found the largest scheme uncovered in November is part of the Federal Child Nutrition Program. Participants exploited more than $250M from the program which aims to serve underprivileged communities. In short, no food or very little was actually provided. Food billing scheme