Two Pennsylvania nursing home operators were recently sentenced in federal court to pay more than $15 million in restitution in a healthcare fraud case. Comprehensive Healthcare Management Services, the operator of Brighton Rehabilitation and Wellness Center, and the affiliated operator of Mount Lebanon Rehabilitation and Wellness Center were convicted of making false statements in connection
Fraud and Abuse
FBI Warns Consumers of Discount Medical Scams
By Emily Manning on
Posted in Fraud and Abuse, Private Insurers
On April 30, the Federal Bureau of Investigation (FBI) released a Public Service Announcement warning consumers about fraudulent discount medical scams. These scams typically involve deceptive offers for health insurance plans that, in reality, provide little to no legitimate coverage. Scammers are contacting people through text messages, phone calls, or emails falsely claiming to represent…
COVID-19 Pandemic Fraud Enforcement Efforts Overview
By Rivkin Rounds Staff on
Jeff Kaiser’s article, “COVID-19 Pandemic Fraud Enforcement Efforts Overview,” was published in the LexisNexis legal research tool, Practical Guidance.
In the article, Jeff offers a comprehensive overview of enforcement efforts related to COVID-19 pandemic fraud.
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Seventh Circuit Rejects Extension of AKS to Marketing Companies Without Evidence of Intent to Induce Referrals
By Syma Levine on
Posted in Fraud and Abuse, Litigation
The U.S. Court of Appeals for the Seventh Circuit recently rejected an effort by the federal government to extend the federal Anti-Kickback Statute (AKS) to a marketing company in the absence of influence by the company over decision makers.
Mark Sorensen, the owner of SyMed Inc., a durable medical equipment (DME) distributor, had been convicted…
FCA Case Against Insurers Alleges Kickbacks and Discriminatory Practices
By Mary Aperance on
On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal kickbacks to induce brokers including GoHealth, eHealth and SelectQuote (the “Brokers”) to steer beneficiaries to their Medicare Advantage plans. While…
Genetic Testing Marketing Companies and Executives Settle Medicare Fraud Allegations for $6 Million
By Douglas Menikheim on
The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced on April 23 that Genexe, LLC (doing business as Genexe Health) and its parent company, Immerge, Inc., along with two of their executive officers/owners, Jason Green and Jason Gross, collectively agreed to pay $6 million to settle claims that they violated the False Claims…
Lab Co-Owners Acquitted in Alleged COVID-19 Testing Scheme
By Mary Aperance on
A Florida jury recently found two laboratory co-owners of Innovative Genomics LLC (“IGX”) not guilty in connection with an allegedly fraudulent COVID-19 testing scheme.
The Government alleged that from November 2019 through June 2023, the co-owners conspired to defraud Medicare and the Health Resources and Services Administration COVID-19 Uninsured Program by billing healthcare benefit plans…
In trend, court limits drug rebate AKS charges to easier ‘but-for’ standard
By Rivkin Rounds Staff on
An article in the March 10 issue of Part B News, “In trend, court limits drug rebate AKS charges to easier ‘but-for’ standard,” discussed a recent ruling on the False Claims Act (FCA) implications of the federal Anti-Kickback Statute (AKS). Rivkin Radler’s Jeff Kaiser was quoted in the article.
“Every time a…
Lab Operator Convicted in Drug-Testing Scheme
By Chris Kutner on
Conspiracies to rip off the Medicare system are prevalent due to the vast amounts of money flowing through the program. On February 25, Sherif Khalil of Redondo Beach, California man was convicted by a federal jury in Detroit for stealing $4 million from the Medicare program.
Khalil conspired with others to generate orders for medically…
Online DME Company Billed Insurers for Unnecessary Medical Supplies
By Chris Kutner on
DMERx, an online DME platform, served as the basis for a massive fraud against Medicare and other insurers. Gregory Schreck, a Kansas man who was the vice president of DMERx, orchestrated a sophisticated fraud scheme to bill Medicare and other insurers over $1 billion, resulting in payments of over $350 million. The scheme used DMERx’s…