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Chicago Chiropractor Indicted for Allegedly Billing $10 Million to Medicare and Private Insurers for Nonexistent Treatment

CHICAGO — A Chicago chiropractor with a clinic in the West Lawn neighborhood has been indicted on federal fraud charges for allegedly submitting at least $10 million in bogus claims to Medicare and private insurers. HENRY POSADA submitted the fraudulent claims for purported physical therapy and chiropractic services that were never provided, according to the…

Verisys Receives Growth Investment Led by Spectrum Equity

Alexandria, VA, March 14, 2017  – Verisys Corporation, a leading provider of credentialing solutions and primary-source data on healthcare professionals and businesses, announced today that Spectrum Equity, along with Cressey & Company and Verisys CEO John P Benson, have made a significant growth equity investment in the Company. The investment positions Verisys, which has long been…

San Juan County Man Pleads Guilty to Federal Health Care Fraud Charge

ALBUQUERQUE – Cory Werito, 33, of Farmington, N.M., pled guilty today in federal court in Albuquerque, N.M., of defrauding the federal government. The guilty plea was announced by U.S. Attorney Damon P. Martinez and Special Agent in Charge Waldemar Rodriguez of Homeland Security Investigations (HSI) in El Paso. John Benson, CEO of Verisys Corporation says,…

Gibson Dunn’s Take on FCA-Related Case Law Developments – Statistical Sampling

From Gibson Dunn’s 2016 Year End Health Care Compliance and Enforcement Update: “As reported in our 2016 Mid-Year Update, the first half of 2016 saw some developments–particularly at the district court level–regarding the use of statistical sampling to establish liability in FCA cases. In these cases, plaintiffs and/or the government have attempted to establish that…

Three Pittsburgh Residents Charged in Forged Prescription Ring

PITTSBURGH – Three residents of Pittsburgh, Pennsylvania, charged in forged prescription ring, have been indicted by a federal grand jury in Pittsburgh on charges including conspiracy to commit offenses against the United States, possession with intent to distribute and distribute Oxycodone, obtaining a controlled substance through fraud, health care fraud, conspiracy to possess with intent…

Cardiologist, Neurologist, And Others Charged In $50 Million Health Care Fraud Scheme, And Civil Suit Filed Against Clinic And Participants In The Fraud

Defendants Provided False Patient Medical Information and used the Identities of Doctors Who Did Not Work at the Clinic to Submit More Than $50 Million in Fraudulent Health Care Claims Preet Bharara, the United States Attorney for the Southern District of New York, William F. Sweeney Jr., the Assistant Director-in-Charge of the New York Field…

2016 False Claims Act Enforcement Summary

The U.S. Department of Justice’s enforcement efforts for 2016 fell short of those of the year prior. In 2016, there were 106 announced settlements against health care providers with recoveries amounting to approximately $1.14 billion compared to total quantity of settlements and settlement dollar figures of 2015: 195 settlements and recoveries of nearly $2 billion….

Owner Of Durable Medical Equipment Company And Three Physicians Charged With Health Care Fraud And Aggravated Identity Theft

SAN JUAN, P.R. – On February 13, 2017, a Federal Grand Jury in the District of Puerto Rico returned a superseding indictment charging Dr. Dante A. Rodríguez-Rivera, Javier Efraín Siverio-Echevarría, Dr. George D. Alcántara-Cardi, Dr. Martha Nieves, Javier Antonio Aguirre- Estrada, and Carlos Maldonado-López with multiple counts of conspiracy to commit health care fraud, health…

The Department of Health and Human Services Office of Inspector General Releases Final Rule Effective February 13, 2017

Amendments Alter Regulations Relating to Exclusion Authority of HHS OIG Section 1001.301 expands exclusion authority to a conviction of obstruction in the event of an audit. In an effort to hold individuals and entities accountable to provide access and information during an exclusion audit conducted by the Department of Health and Human Services Office of…

21 Medicare Health Plans Warned To Fix Provider Directory Errors

On January 18, 2017, Kaiser Health News published this story written by Phil Galewitz and Susan Jaffe. Federal officials this month warned 21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face heavy fines or have to stop enrolling people if the problems are not fixed by Feb….