Prime Healthcare, Two Docs Settle Referral Kickback Claims

Rutland is arranged to be sentenced in November.

Mental Health Services Agency Owner Sentenced to Federal Prison for Fraud.
Wali Muhammad, 46, of Branford, Connecticut, was sentenced to 2 years in federal prison and 3 years of supervised release for defrauding Connecticuts Medicaid program. He pleaded guilty to one count of health care fraud and paid $527,034 in restitution to Medicaid, according to the United States Department of Justice.

He changed prescription formulas to make sure the highest reimbursement without regard to effectiveness. He likewise obtained employers to obtain prescriptions for high margin intensified medications and paid those employers commissions based on the percentage of repayments paid by pharmacy advantage managers, healthcare advantage programs, and TRICARE.

Pharmacist Pleads Guilty to $180+ Million Healthcare Fraud Scheme.
David “Jason” Rutland, 42, of Bolton, Mississippi, a pharmacist and co-owner of various compounding drug stores, pleaded guilty recently for his role in a plan to defraud TRICARE and private insurance provider by way of more than $180 million in deceitful billings.

Ludwig agreed to pay Ahmed a kickback in return for Ahmed bringing MaineCare recipients to Facing Change. The false claims consisted of claims for sees that never ever occurred and declares that pumped up the level of service offered.

Muhammad owned and ran Happy Family Clinical Services LLC (Happy Family), a psychological health and social services company. He engaged in a scheme to defraud the Connecticut Medicaid Program by submitting fraudulent claims for psychiatric therapy services that were not in fact supplied to Medicaid customers.
The claims also were submitted utilizing the names and identities of certified clinical social employees and other certified healthcare suppliers who purportedly worked for Happy Family. They represented that the psychiatric therapy services were personally rendered by the certified providers, when the licensed service providers had not personally rendered the services and were uninformed that Muhammad was billing the services.

Muhammad is set up to report to jail on September 27.

Rutland pleaded guilty to conspiracy to defraud the United States and solicit, get, provide, and pay prohibited kickbacks. He faces a maximum penalty of 5 years in jail..

The settlement likewise includes the resolution of claims through a whistleblower fit, brought by Martin Mansukhani, a former Prime executive. As part of the settlement, Mansukhani will get $9.9 million as his share of the governments recovery efforts.

The US Department of Justice claims Rutland paid kickbacks to distributors for the recommendation of medically unnecessary intensified prescription medications that were given by his drug stores. More than $50 million was paid by federal healthcare programs..

Particular Prime hospitals billed Medi-Cal, the Federal Employees Health Benefits Program, and the US Department of Labors Office of Workers Compensation Programs for incorrect claims based upon inflated invoices for implantable medical hardware..
Under the settlement, Arunasalam will pay $2 million, Reddy paid $1.7 million, and Prime paid $33.7 million. The United States will receive $35.46 countless the settlement earnings, and California will get just over $2 million.
” Offering unlawful monetary incentives to doctors in return for client referrals weakens the integrity of our healthcare system by rejecting clients the unbiased and independent judgment of their health care specialists,” stated Acting Assistant Attorney General Brian M. Boynton of the Justice Departments Civil Division..

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Maine Pair Sentenced for Million-Dollar Healthcare Fraud Scheme.
Abdirashid Ahmed, 41, was sentenced to 2 years in jail and 3 years of monitored release, and Garat Osman, 35, was sentenced to 3 years probation on charges of defrauding Maines healthcare program for elderly, low-income, or disabled locals.

The MaineCare Program Integrity Unit audited Facing Change. Ludwig and a number of her employees conspired to make false and deceptive records in an effort to deceive the auditor. Osman joined the scams plan and developed an interpreter company that received all the deceptive payments.

Ahmed was ordered to pay $1.86 million and Osman $544,097 in restitution to MaineCare..

According to the US Department of Justice, Prime apparently paid kickbacks to California-based interventional cardiologist Siva Arunasalam, MD, for patient referrals by overpaying to acquire Arunasalams doctor practice and surgery center. Prime and Arunasalam likewise used the physicians billing number to costs Medicare and Medi-Cal for services that were offered by another physician, even though that medical professionals billing privileges had been revoked..

One of the biggest healthcare facility systems in the country, Prime Healthcare Services System (Prime), and two of its doctors will pay $37.5 million to resolve infractions of the False Claims Act and the California False Claims Act. Prime and its founder and CEO, Prem Reddy, MD, paid $65 million to settle previous unassociated claims of incorrect claims and overbilling in 2018. Ludwig and Ahmed led a conspiracy to commit healthcare fraud by sending claims to MaineCare for services that were not rendered as billed.

Ludwig agreed to pay Ahmed a kickback in return for Ahmed bringing MaineCare recipients to Facing Change. The false claims included claims for sees that never happened and declares that inflated the level of service offered.

Ahmed and Osman were interpreters who conspired with numerous psychological health therapy services in the Maine cities of Lewiston and Auburn to defraud MaineCare, according to the US Department of Justice. One of the counselors was Nancy Ludwig, who was the owner of Facing Change, a psychological health and substance abuse counseling agency in Lewiston. Ludwig and Ahmed led a conspiracy to commit healthcare fraud by sending claims to MaineCare for services that were not rendered as billed.

Prime Healthcare Services, Two Docs Pay $37.5 Million Settlement
Among the largest health center systems in the country, Prime Healthcare Services System (Prime), and two of its medical professionals will pay $37.5 million to solve violations of the False Claims Act and the California False Claims Act. Prime and its founder and CEO, Prem Reddy, MD, paid $65 million to settle previous unrelated accusations of false claims and overbilling in 2018. Prime runs 45 hospitals in 14 states.

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