Record-Breaking Recoveries Resulting From Joint HHS/DOJ Effort to Combat Health Care Fraud
Annual report shows that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $8.10.
Medicare Fraud strike force charges 89 individuals for approximately $223 million in false billing
Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announce a nationwide takedown by Medicare Fraud Strike Force operations in eight cities.
HHS would increase rewards for reporting fraud to nearly $10 million
Health and Human Services Secretary Kathleen Sebelius today announced a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million.
HHS Report to Congress on Progress of
Report to Congress Fraud Prevention System, First Implementation Year, September 2012.
- Read the Report (PDF – 3.7MB)
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February 25, 2014
Boston - Concord Doctor Pleads Guilty for Role in $27 Million Home Health Care Scam
The former medical director of a Waltham-based home health agency pleaded guilty today for his role in a home health fraud scheme which cost Medicare over $27 million. Dr. Spencer Wilking, 65, of Concord, pleaded guilty today before U.S. District Judge Joseph L. Tauro to health care fraud. Sentencing is scheduled for May 20, 2014. The statutory maximum penalty for the crime is 10 years in prison, three years of supervised release, a fine of $250,000 or twice the gross loss to the Medicare program or twice the gross gain to Wilking (whichever is greater), restitution to Medicare, forfeiture of any proceeds of the offense, and exclusion from the Medicare program.
February 25, 2014
Washington - Diagnostic Imaging Group to Pay $15.5 Million for Allegedly Submitting False Claims to Federal and State Health Care Programs
Diagnostic Imaging Group (DIG) has agreed to pay a total of $15.5 million to resolve allegations that its diagnostic testing facility falsely billed federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians. Assistant Attorney General for the Justice Department's Civil Division Stuart F. Delery, U.S. Attorney for the District of New Jersey Paul J. Fishman and U.S. Attorney for the Eastern District of New York Loretta E. Lynch announced the settlement today.
February 21, 2014
District of Columbia - Endo Pharmaceuticals and Endo Health Solutions to Pay $192.7 Million to Resolve Criminal and Civil Liability Relating to Marketing of Prescription Drug Lidoderm for Unapproved Uses
Pharmaceutical company Endo Health Solutions Inc. and its subsidiary Endo Pharmaceuticals Inc. (Endo) have agreed to pay $192.7 million to resolve criminal and civil liability arising from Endo's marketing of the prescription drug Lidoderm for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Justice Department announced today. The resolution includes a deferred prosecution agreement and forfeiture totaling $20.8 million and civil false claims settlements with the federal government and the states and the District of Columbia totaling $171.9 million. Endo Pharmaceuticals Inc. is a Delaware corporation headquartered in Malvern, Pa.
February 18, 2014
Florida - Ernesto Hernandez was arrested at Miami after arriving on a flight from Cuba.
Investigators believe that Hernandez, through his company, submitted nearly $4 million in false claims to Medicare, billing for various health care benefits, items, and services that were not medically necessary, not prescribed by a doctor, and/or were never provided to beneficiaries. Hernandez received approximately $1.4 million in reimbursement from Medicare for these fraudulent claims.