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Tag: Fraud


Also Noted

North Carolina DME company to pay fines, restitution

March 5, 2021HME News Staff

RALEIGH, N.C. – A Perfect Fit for You, a DME provider owned by Margaret Gibson, was ordered to pay a $2 million fine and more than $10 million in restitution to the North Carolina Medicaid program for alleged fraudulent claims submitted by employees for DME between March 2015 and November 201. In some cases, the identifying information of deceased beneficiaries was allegedly used. A civil claim under the federal and state False Claims Act was also filed against...

durable medical equipment, Fraud


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Gov't charges 345, revokes billing privileges for 256

October 13, 2020HME News Staff

WASHINGTON - The Department of Health and Human Services Office of Inspector General, along with state and federal law enforcement partners, has conducted a national “telefraud” takedown involving more than $6 billion in alleged losses. The fraudulent activity has resulted in charges for 345 defendants, including telemedicine companies, DME companies, genetic testing labs, pharmacies and more than 100 medical practitioners, in 51 judicial districts. Health care billing privileges have...

dme, Fraud, OIG, telefraud, telehealth


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Guilty plea entered for $424M fraud scheme

September 10, 2019HME News Staff

WASHINGTON - The owner and CEO of a telemedicine company has pleaded guilty to a $424 million conspiracy to defraud Medicare and receive illegal kickbacks in exchange for DME orders, the Department of Justice has announced.Lester Stockett, the owner of Video Doctor USA and Telemed Health Group, has pleaded guilty to one count of conspiracy to defraud the United States and pay and receive healthcare kickbacks, and one count of conspiracy to commit money laundering. In connection with his plea agreement,...

DOJ, Fraud, Medicare, orthotics


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Vendors

Do AOs police fraud?

July 3, 2019Liz Beaulieu, Editor

YARMOUTH, Maine - Accreditation organizations help to prevent and eliminate fraud, waste and abuse in the Medicare program, but it's not their main job, they say. After news broke earlier this year of “Operation Brace Yourself,” a $1.2 billion fraud scheme involving medical unnecessary braces, HME providers shook their heads wondering, “How are they accredited?” The scheme involved illegal kickbacks and bribes by HME providers in exchange for referrals of beneficiaries by...

accreditation, Fraud, The Compliance Team


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Industry knew feds would bust 'obvious' fraud

April 12, 2019Liz Beaulieu, Editor

WASHINGTON - HME industry stakeholders aren't surprised by a $1.2 billion fraud scheme involving medically unnecessary braces and they're glad to see “bad actors” punished. The feds last week charged 24 defendants with an alleged scheme involving illegal kickbacks and bribes by DME companies in exchange for referrals of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for back, shoulder, wrist and knee braces. “Stakeholders...

Brace Yourself, braces, Fraud, orthotics


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Feds bust $1.2B brace fraud scheme

April 10, 2019HME News Staff

WASHINGTON - The federal government has charged 24 defendants, including executives at five telemedicine companies, the owners of dozens of DME companies and three licensed medical professionals, for their roles in a healthcare fraud scheme that resulted in $1.2 billion in losses.In addition, CMS's Center for Program Integrity has taken adverse administrative action against 130 DME companies that submitted more than $1.7 billion in claims and were paid more than $900 million.The charges target an...

braces, charges, Fraud


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Specialty Providers

Bill tries to force CMS's hand on O&P certification

May 30, 2017HME News Staff

WASHINGTON - Reps. Glenn “GT” Thompson, R-Pa., and Mike Thompson, D-Calif., have once again introduced a bill that calls on CMS to enforce a law that O&P providers be certified to receive payments under Medicare.Thompson and Thompson introduced H.R. 2599, the Medicare Orthotics and Prosthetics Improvement Act of 2017, last week. They have introduced similar bills in previous sessions of Congress.“Medicare beneficiaries in need of prosthetic and orthotic services deserve to know...

certification, Fraud, legislation, o&P


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CareCentrix, Performant specialize fraud efforts

May 23, 2017HME News Staff

HARTFORD, Conn. - CareCentrix has teamed up with Performant Financial Corporation, the new national RAC for DME, home health and hospice, to deploy specialized analytics and algorithms to better identify and decrease waste and fraud, it announced May 23.“You only need to look at recent headlines to know that the problems of fraud, waste and abuse are only increasing,” said John Driscoll, CareCentrix CEO, in a press release. “CareCentrix is committed to bending the cost curve in...

analytics, CareCentrix, Fraud, Performant


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Also Noted

Rep. Price says audits should focus on actual fraud

January 26, 2017HME News Staff

WASHINGTON - Rep. Tom Price, R-Ga., nominee for secretary of Department of Health and Human Services, told members of the Senate Finance Committee that he thinks the agency should focus audits on weeding out blatant fraud instead of verifying medical necessity. The comments came in response to a question from Sen. Orrin Hatch, R-Utah, about what HHS can do to protect Medicaid from scammers, according to an article on Law360. The Senate Finance committee will vote soon on whether to accept Price's...

Fraud, Rep. Tom Price


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Providers

Whistleblower details alleged fraud at Lincare

July 12, 2016HME News Staff

CLEARWATER, Fla. - A former employee says Lincare has been knowingly defrauding the government of millions of dollars by allegedly billing false claims to Medicare.“(Lincare) has engaged in a scheme to wrongfully enrich itself at taxpayers' expense by fraudulently billing Medicare for equipment rental for which either the patients or the equipment were not reimbursable by Medicare, by failing to provide services to patients it was obligated to provide, and by retaining overpayments to which...

False Claims Act, Fraud, lincare, whistleblower lawsuit


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