Freedom Health Inc., a Tampa, Florida-based provider of managed care services, and its related corporate entities (collectively “Freedom Health”), agreed to pay $ 31,695,593 to resolve allegations that they violated the False Claims Act by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans, the Justice Department announced today. In addition, the former Chief Operating Officer (COO) of Freedom Health Siddhartha Pagidipati, has agreed to pay $ 750,000 to resolve his alleged role in one of these schemes. You can read the full update on the justice.gov website – here.
California State Medicaid Fraud Control Unit: 2015 Onsite Review (OEI-09-15-00070) http://go.usa.gov/cpgj5
Why We Did This Study
OIG oversees all State Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements.
How We Did This Study
We conducted an onsite review of the California Unit in February 2015.
What We Found
During FYs 2012-2014, the Unit expended $ 83 million and generated 337 convictions, 67 civil judgments and settlements, and total recoveries of $ 795 million, $ 531 million of which was attributed to cases investigated directly by the Unit.
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Abusers of the Medicare system can sometimes be intentional or not, but the stories that really get significant attention of the public are the ones that highlight healthcare personnel that intentionally over bill Medicare.
There are several types of abuse including falsifying claim forms adjusting the actual cost of services, Billing for services and supplies that were not provided, and even billing for appointments that were canceled.
On April 18, 2016, The U.S. Attorney’s Office for the Northern District of Georgia announced that it has reached a settlement with dermatologists Margaret Kopchick, M.D., and Russell Burken, M.D., and their practice group, Toccoa Cl
inic Medical Associates, who agreed collectively to pay $ 1.9 million to settle claims that they violated the False Claims Act by billing Medicare for evaluation and management (E&M) services that were not permitted by Medicare rules.
“The improper billing of evaluation and management services cost the taxpayers millions of dollars each year and drain the Medicare Trust Fund,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) for the Atlanta region. “The OIG and the U.S. Attorney’s Office will continue to hold health care providers like these responsible for improper claims.”
You can read the full press release on the justice.gov website here.
For further information please contact the U.S. Attorney’s Public Affairs Office atUSAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.
Physicians at UMC, as well as the estate of a Lubbock doctor killed in a plane crash last February, have agreed to pay a $ 3.3 million settlement to the federal and state government against allegations of false Medicaid and Medicare submitted claims.