Calif. Doctor Charged In $150M Insurance Scam
Also in the news, the Justice Department reached a $69.5 million settlement with a South Florida hospital district accused in a lawsuit of forming financial relationships with doctors who in turn referred patients to the district's facilities. News outlets also report developments in West Virginia related to another fraud settlement and in Massachusetts regarding state charges about a nursing home's misleading advertisements.
Los Angeles Times:
Patients Scarred, Insurance Firms Duped In Massive Scam, L.A. County Prosecutors Say
The patients were told a board-certified orthopedic surgeon would conduct their operations. But the surgeries were instead performed by a physician's assistant who had never attended medical school and was not overseen by the surgeon during the operations, which were billed as the surgeon's work, according to the Los Angeles County district attorney's office. The results for nearly two dozen patients were lasting scars, prosecutors said. Many had to undergo additional surgeries to repair the damage. (Winton and Hamilton, 9/15)
The Associated Press:
California Doctor Charged In $150 Million Insurance Scam
An orthopedic surgeon was charged as the ringleader in one of the state's biggest health fraud schemes, which included unnecessary operations by an untrained assistant that scarred patients forever, according to indictments unsealed Tuesday. Dr. Munir Uwaydah and 14 associates, including another doctor and a lawyer, bilked insurance companies out of $150 million in the scheme, Los Angeles District Attorney Jackie Lacey said. (9/15)
The Associated Press:
US, Broward Hospital Settle Physician Claims For $69.5M
The Justice Department has reached a $69.5 million settlement with a South Florida hospital district accused in a lawsuit of improper financial relationships with doctors who referred patients to the district. Federal officials said Tuesday the case involved inflated salaries to nine physicians by the North Broward Hospital District, which operates several health facilities. U.S. law restricts the financial relationships hospitals can have with referring doctors under Medicare and Medicaid. (9/15)
Modern Healthcare:
Florida Health System To pay $69.5M Over Stark, False Claims Allegations
A Florida taxing district that operates hospitals in Broward County will pay the government a record $69.5 million to settle allegations that it illegally paid nine doctors for referrals. A whistle-blower accused North Broward Hospital District of violating the Stark law, governing physician financial relationships, by paying employed doctors at levels beyond the fair market value based, in part, on their referrals to Broward Health hospitals and clinics. That, in turn, led to the submission of false claims to the government, in violation of the False Claims Act, the whistle-blower alleged. (Schencker, 9/15)
The Associated Press:
W.Va. Pharmacy, Former Owner Sentenced In Fraud Case
A Charleston pharmacy will spend three years on probation for defrauding Medicare and Medicaid. U.S. Attorney Booth Goodwin says Trivillian's Pharmacy and its former owner, Paula J. Butterfield, were sentenced on Tuesday in U.S. District Court in Charleston. Butterfield will spend a year and a day in prison. Goodwin says the pharmacy admitted to dispensing compounded drugs and generic drugs and billing Medicare and Medicaid for brand name drugs, which are more expensive. Butterfield admitted to submitting false claims to Medicare on her own behalf. (9/16)
The Boston Globe:
State Cites Nursing Homes For Misleading Ads On Alzheimer’s Care
State regulators are citing more than four dozen Massachusetts nursing homes for advertising dementia care services when they don’t actually offer the kind of care required to make such a claim, according to the Department of Public Health. (Lazar, 9/16)