R
Raymond
Guest
FY 2005 False Claims Act Settlements
Medicare and Medicaid were billed for services and care not provided.
Hello Suckers:
MEDICAL INDUSTRY AND DIRTY LOBBY MONEY .
As Congress prepares to debate drastic changes in the nation's health
care system, its members are receiving vast campaign contributions
from the gangsters in the medical industry. Lobbyists and analysts
widely regard the current glut of giving as perhaps the largest ever
on a single issue in such a brief time frame.
The cases below represent a "running tally" of False Claims Act cases
compiled by the Taxpayers Against Fraud Education Fund for Fiscal Year
2005.
"The sun shines on their successes, and the earth hides their
failures". -
--- Michel Eyquem de Montaigne
A total of 99 cases were settled or brought to judgment in FY 2005.
These 99 cases yielded a total of $1,498,824 million in settlements
Only touched the surface.
Of the 99 cases settled or brought to judgment in FY 2005, 48 cases
yielded more than $2 million
Company Amount in Millions and Date Nature of the fraud
Medicare Medicaid
Gambro 325.5 12/15/2005 Gambro paid kickbacks to physicians for
referrals to the company's clinics, set up a sham company to feed
inflated billings to Medicare, and falsified billing statements to
patients to justify compensation for unnecessary tests and services.
Gambro also paid a $25 million criminal fine and paid $15 million to
resolve state claims.
HealthSouth 325 12/31/2004 HealthSouth billed group physical therapy
at individual physical therapy rates and often had unlicensed
personnel doing the work.
GlaxoSmithKline 140 9/20/2005 False pricing of anti-nausea drugs
Zofran and Kytril in order to market the spread. GSK also paid $10
million to resolve state claims.
Caremark 137.5 9/9/2005 Reselling of drugs by AdvancePCS, acquired by
Caremark
Staten Island (N.Y.) University Hospital 76.5 5/19/2005 Medicaid false-
billing charges related to a program designed to encourage providers
to operate in medically underserved areas
Northrop Grumman 62 3/1/2005 Northrop Grumman fraudulently inflated
scrapping claims on the B2 bomber in order to inflate total contract
price.
Novartis / OPI Properties 44.7 2/16/2005 Novartis / OPI Properties
fraudulently billed and marketed enteral nutritional products.
PricewaterhouseCoopers 41.9 6/2/2005 Over-billed the government for
travel-related expenses.
Gambro 37.5 9/26/2005 State settlement of Gambro renal care fraud
involving kickbacks, unnecessary tests, over billing.
PolyMedica 35 12/2/2004 Medicare was not reimbursed for packages that
were returned to PolyMedica and billed for test strips mailed to
people that did not order them. X
Harvard University, Andrei Schleifer, Jonathan Hay 31 8/3/2005 USAID
contract violation involving work on Russian stock market. Fraud by
Shleifer and Hay who worked for Harvard. USAID contract with Harvard.
Apria Healthcare 17.6 8/10/2005 Incomplete or inaccurate documentation
supporting a portion of the Company's Medicare billings during the
period from mid-1995 through 1998.
Gold Banc 16 11/19/2004 Gold Banc, a Kansas banking company, charged
excessive interest rates and fees on federally guaranteed agricultural
loans.
Florida International University 11.5 2/15/2005 Florida International
University mis-charged costs and over billed under several contracts
and grants with the U.S. Department of Energy. These contracts and
grants dealt with testing and developing environmental technologies.
Wiggins, Kenneth Earl (King Drugs and Pharmacy) 10.5 6/20/2005 Wiggins
and pharmacy submitted reimbursement claims to Medicaid and federal
employee benefits programs for "free samples" collected and
repackaged.
OfficeMax 9.8 5/19/2005 OfficeMax agrees to pay $9.8 million to settle
charges it submitted false claims when it sold office products to the
U.S. Government that were not permitted by a GSA contract that
required all covered office products to be made in countries covered
by the Trade Agreements Act.
Humanscale Corporation (formerly Softview Computer Products) 9
6/30/2005 Failed to disclose current, accurate and complete discount
and pricing information to the General Services Administration (GSA).
Oracle 8 5/13/2005 Billing for services not provided and keeping the
overpayment.
Harlan, Sprague, Dawley Inc. 7.2 3/1/2005 Harlan, Sprague, Dawley
Inc., a supplier of genetically pure laboratory mice and rats, sold
genetically contaminated stock wrecking untold amounts of medical
research. NIH
Inter-Tel Technologies 7 1/5/2005 Inter-Tel agreed to plead guilty and
to pay fines totaling $8.71 on charges of bid rigging and wire fraud
in connection with a program intended to connect schools and libraries
to the internet (the E-Rate program). In addition to the $7 million
FCA fine, and additional $1.71 million was levied in criminal fines.
Omnicare and Upstate Pharmacies in Western NY 6.75 5/16/2005 Billing
for drugs never delivered and a wide variety of billing
irregularities.
Turner Construction Company 6.6 7/25/2005 Turner received credits for
bonds on dozens of federal contracts without passing on the credits to
the federal government.
Turner Construction Company 6.6 6/28/2005 Company received credits
for bonds on dozens of federal contracts without passing the credits
on to the federal government.
Arthur D. Little (aka Dehon Inc.) 6.5 3/25/2005 Inflated overhead on
government contracts.
Providian and Total System Services 6 9/20/2005 Postage rate fraud -
claiming a lower postage rate than entitled.
AdminaStar Federal Inc. 6 9/21/2005 Company misrepresented Medicare
evaluations and overcharged CMS for claims processing.
PharMerica 5.95 3/29/2005 PharMerica paid a kickback for Medicare and
Medicaid contracts and disguised it in the form of an inflated price
for a long-term care pharmacy that existed to do only one day's worth
of business.
Office Depot 4.75 9/19/2005 Sold office supply products manufactured
in countries not permitted by the Trade Agreements Act to United
States government agencies.
Cornell University 4.3 6/21/05 Defrauded government by charging all
or too much salary to NIH grant given to university's Children's
Clinical Research Center even though employees did not do work on
grant.
U. of Miami 3.9 5/18/2005 U. of Miami double-billed and overcharged
Medicaid through several of its outpatient clinics.
Resurgens 3.8 5/23/2005 Resurgens doctors paid kickbacks to the
surgery center for using the Center's Medicare provider number. The
kickbacks were steered to a lockbox at an Atlanta bank.
Simi Valley Hospital 3.7 7/21/2005 Pneumonia upcoding.
UnitedHealthcare 3.5 12/12/2004 While working as a Medicare
contractor, UnitedHealthcare mishandled telephone calls involving the
Medicare program, and then reported to Medicare they were doing a good
job in order to retain the contract and get bonuses.
McKesson Corp (TBC Products) 3.4 11/13/2004 TBC Products, a McKesson
subsidiary, distributing tube-feeding equipment to patients too sick
to eat on their own. As part of its sales plan, TBC distributed
invoices that made it look like McKesson was charging for tube-feeding
pumps that were free. This paperwork made it possible for nursing
homes to bill taxpayers for the free pumps. Along with the $3.4
million civil False Claims Act fine, McKesson pled guilty and paid a
$4 million criminal fine.
Frank S. Chuang 3.4 2/8/2005 Mr. Huang submitted false claims to state
and federal transportation agencies for work not performed.
U. of Alabama at Birmingham 3.39 4/14/2005 Double billing Medicare for
patients in research trials.
Engenderhealth 3.3 4/29/2004 Failure to return unused USAID funding
for family planning.
Western Sales and Testing 3 3/23/2005 Western Sales and Testing faked
pressure tests and inspection of high-pressure truck cylinders used
for over-the-road transportation of hydrogen, helium, methane,
hydrogen chloride, and other gases. Several federal agencies were
defrauded, include the DoE, NASA, and DoD.
Cleveland Clinic Florida Hospital 2.75 2/14/2005 From 1993 to 2001,
the Cleveland Clinic billed for "for extra observation charges during
normal recovery periods following minor surgery or emergency room
visits."
Applied Consulting and sister company Applied Case Management 2.75
9/13/2005 Firms signed contracts with Mount Vernon (N.Y.) Hospital and
Catskill Regional Medical Center in which kickbacks for patient
referrals were disguised as "administrative service contracts."
Honeywell 2.75 5/26/2005 Falsely stated in a contract proposal to the
United States Air Force that it had a fully compliant cost management
system, then tried to bill Government to create one.
Mount Vernon Hospital 2.65 8/2/2005 Kickbacks and billing for
unlicensed drug and alcohol treatment centers X
Diebold 2.6 11/11/2004 Diebold made false claims about the security
and certification status of its electronic voting machines and
tabulation systems. As a result, six counties were misled into buying
the machines.
Westinghouse Savannah River Co. 2.6 1/11/2005 Westinghouse Savannah
River Co. filed travel reimbursement for more than 100 workers who
were not traveling. The company also improperly sought government
funds for moving expenses, temporary lodging and meals for employees
transferred to Washington, D.C.; Los Alamos, New Mexico; and Southern
California.
SAIC (Science Applications International Corp) 2.5 4/27/2005 Bill
padding, defective pricing and false estimates.
Dey Pharmaceuticals (state FCA case) 2.5 8/8/2005 Marketing the spread
on albuterol.
Loma Linda University 2.2 12/1/2004 Loma Linda University Hospital
billing for doctor services that were actually performed by residents
or interns (PATH case).
West Coast Medical Supply (OR) 2.07 3/20/2005 West Coast Medical
Supply repeatedly billed for durable medical equipment that was never
supplied.
Maxwell Manor Nursing, ABS Long-Term Care Management Co. Inc. and an
affiliated company MBA-LTC Inc. 1.9 11/11/2004 The Maxwell Manor
Nursing home is described as "house of death, terror and filth," with
incredible lapses in care, decayed buildings, sexual assaults,
medication used as punishment, rat infestation, and more. Medicare
and Medicaid were billed for services and care not provided.
Kaiser Permanente (Hawaii) 1.9 5/16/2005 Submitted inaccurate Medicare
and Medicaid claims over 17 years.
Temple University 1.88 10/28/2004 Temple University submitted claims
for hospital care that was allegedly performed by doctors, but lacked
sufficient documentation that those services were actually performed
by those doctors. In addition, the government said Temple billed for a
higher level of care than was actually provided.
George Washington U. 1.825 4/19/2005 Fictitious labor, expenses,
scholarships and stipends stolen by Nabih E. Bedewi from the National
Crash Analysis Center (not sure if FCA or not, but presented as so on
one list).
Americhoice of Pennsylvania Inc. (formerly Healthcare Management
Alternatives) 1.6 6/30/2005 Improper claims processing and coverage
determinations between 1995 and 1998.
Professional Ambulance Service of Norwich Conn. 1.5 Oct. 20- 04 The
Professional Ambulance Service company transported Medicare kidney
patients for non-emergency dialysis treatments when such trips are not
covered.
Catskill Regional Medical Center 1.5 1/7/2005 Treating illegally
referred drug and alcohol patients (kickbacks).
Anthem Insurance 1.5 8/8/2005 Overcharged the Federal Employee Health
Benefits Program (FEHBP) through rebate retention.
Nursing Home Care Management 1.456 10/26/2004 Inadequately trained
health care aides.
University of Medicine and Dentistry of New Jersey 1.4 3/18/2005
University of Medicine and Dentistry of New Jersey billed at doctor
rates for services done by interns. (PATH case).
Lockheed Martin Corp 1.4 1/4/2005 Procurement mis-charging.
University of Pennsylvania 1.31 2/9/2005 A professor at the University
faked gene therapy research that ended with the death of an Arizona
teenager.
Spayne, Timothy R. 1.24 1/31/2005 Attorney submitted false legal bills
to Electric Boat.
Tender Loving Care Health Care Services 1 11/29/2004 False cost
reports.
TransTechnology 1 9/9/2005 Rescue hoists alleged to be defective.
Perini Corp. 0.998 11/19/2004 Perini submitted submitted inflated
claims related to construction of the U.S. Embassy building in
Venezuela.
Allied Home Medical 0.93 10/3/2005 Overbilled on motorized
wheelchairs.
(TennCare)
CVS 0.895 8/2/2005 Pill shorting and full billing.
Hillcrest Healthcare 0.775 5/19/2005 Substandard nursing home care-
fatally neglecting patients, while at the same time billing for
services not provided.
Emsco 0.7 5/24/2005 Over-billed Medicare and Medicaid for emergency
room services by upcoding patients to a higher level of service than
actually provided. A related claim was paid in June 2004.
Fresno County 0.653 2/14/2005 Fresno County submitting false claims
for services not reimbursable under Medicare.
Hospital of St. Raphael 0.632 5/3/2005 Unnecessary hospital treatment
for kidney patients
Mid-West Podiatry & Associates 0.575 3/5/2005 Mid-West Podiatry &
Associates upcoding podiatric work, claiming less procedures were more
extensive.
MedQuest 0.519 9/20/2005 Settlement on alleged overpayments.
Curran Contracting Inc. (Illinois) 0.5 5/18/2005 Submitted fraudulent
documents overstating the amount of asphalt material delivered to
state and municipal road projects.
Seattle Cancer Treatment and Wellness Center 0.478 3/18/2005 Seattle
Cancer Treatment and Wellness Center billed for services that were
more extensive than those performed, billed for drugs administered at
home as if they had been taken in the doctor's office. X and
TRICARE
Larossa, John T. MD 0.447 4/8/2005 Upcoding.
Drs. Grover Christie Merritt, P.C. 0.443 3/14/2005 Upcoding and
unbundling.
Hunt Memorial Hospital District (Tx)/Presbyterian Hospital of
Greenville (filed in middle district of TN) 0.406 11/4/2004 Hospitals
upcoded pneumonia claims.
Family Medical Management Services 0.4 3/5/2005 The company claimed
that its medical director performed nearly all health care services,
when nurse practitioners actually performed the majority of them. and
TRICARE
Tucker, Charles, MD 0.366 4/13/2005 Billing nurses as physicians.
Gambro Healthcare 0.328 12/8/2004 Gambro contracted with local
laboratories to perform expedited lab tests on an as-needed basis and
mis-billed for them.
C. Patel MD and Fall Rive Walk-In Emergency Medical Office 0.315
6/30/2005 Overbilled Medicaid and Medicare, for physical therapy
services not performed by a physical therapist or physician.
Professional Service Industries, Inc. 0.26 2/5/2005 PSI billed the
government for the work of "certified welding inspectors" when the
inspectors who performed the inspections were not so certified and the
testing never took place.
Aerometals 0.251 2/3/2005 Selling refurbished parts as new to the Air
Force.
Holiner Psychiatric Group 0.25 10/22/2004 Upcoding of evaluation and
management codes at two Texas hospitals, and billing for services not
rendered.
and TRICARE
Pediatric Adolescent Healthcare, P.C. and William Silberberg, MD 0.242
1/11/2005 Charging for free children's vaccines.
Torrington-Winsted Pediatric Associates 0.201 1/11/2005 Charging for
free children's vaccines.
Dr. Gaetano Calise (RI) 0.2 3/20/2005 Billing for nursing home care
not provided.
Central Montgomery Medical Center 0.2 8/2/2005 Improperly restrained
patients.
Center for Pain Management 0.18 3/5/2005 Owner of Center used provider
numbers of two anesthesiologists to bill for services that were not
performed.
Dr. Eric Poehlman 0.18 4/5/2005 Fabricated data on research grants.
S.C. Management 0.167 10/1/2004 Upcoding.
Dr. Peter Stickney 0.126 3/20/2005 Billing for medically unnecessary
services.
G. Craig Kiser, M.D. 0.104 11/9/2004 Dr. Kiser billed Medicare and
Medicaid for drugs received as free samples from the Manufacturer (TAP
Pharmaceuticals).
Bergoli, Dr. Arthur (Mass) 0.1 1/3/2005 Overcharging for nursing
facility care.
Shurlan, Dr. Vladimir 0.089 4/7/2005 Upcoding.
Balco 0.06 10/28/2004 Filed $1.8 million in false Medicare claims by
submitting multiple claims for the same tests.
Memorial Hosp. of Carbondale Illinois 0.033 10/10/2004 Hospital not
approved for services billed.
TOTAL 1498.824 (1461.324 without Gambro state case)
Who cares?
Medicare and Medicaid were billed for services and care not provided.
Hello Suckers:
MEDICAL INDUSTRY AND DIRTY LOBBY MONEY .
As Congress prepares to debate drastic changes in the nation's health
care system, its members are receiving vast campaign contributions
from the gangsters in the medical industry. Lobbyists and analysts
widely regard the current glut of giving as perhaps the largest ever
on a single issue in such a brief time frame.
The cases below represent a "running tally" of False Claims Act cases
compiled by the Taxpayers Against Fraud Education Fund for Fiscal Year
2005.
"The sun shines on their successes, and the earth hides their
failures". -
--- Michel Eyquem de Montaigne
A total of 99 cases were settled or brought to judgment in FY 2005.
These 99 cases yielded a total of $1,498,824 million in settlements
Only touched the surface.
Of the 99 cases settled or brought to judgment in FY 2005, 48 cases
yielded more than $2 million
Company Amount in Millions and Date Nature of the fraud
Medicare Medicaid
Gambro 325.5 12/15/2005 Gambro paid kickbacks to physicians for
referrals to the company's clinics, set up a sham company to feed
inflated billings to Medicare, and falsified billing statements to
patients to justify compensation for unnecessary tests and services.
Gambro also paid a $25 million criminal fine and paid $15 million to
resolve state claims.
HealthSouth 325 12/31/2004 HealthSouth billed group physical therapy
at individual physical therapy rates and often had unlicensed
personnel doing the work.
GlaxoSmithKline 140 9/20/2005 False pricing of anti-nausea drugs
Zofran and Kytril in order to market the spread. GSK also paid $10
million to resolve state claims.
Caremark 137.5 9/9/2005 Reselling of drugs by AdvancePCS, acquired by
Caremark
Staten Island (N.Y.) University Hospital 76.5 5/19/2005 Medicaid false-
billing charges related to a program designed to encourage providers
to operate in medically underserved areas
Northrop Grumman 62 3/1/2005 Northrop Grumman fraudulently inflated
scrapping claims on the B2 bomber in order to inflate total contract
price.
Novartis / OPI Properties 44.7 2/16/2005 Novartis / OPI Properties
fraudulently billed and marketed enteral nutritional products.
PricewaterhouseCoopers 41.9 6/2/2005 Over-billed the government for
travel-related expenses.
Gambro 37.5 9/26/2005 State settlement of Gambro renal care fraud
involving kickbacks, unnecessary tests, over billing.
PolyMedica 35 12/2/2004 Medicare was not reimbursed for packages that
were returned to PolyMedica and billed for test strips mailed to
people that did not order them. X
Harvard University, Andrei Schleifer, Jonathan Hay 31 8/3/2005 USAID
contract violation involving work on Russian stock market. Fraud by
Shleifer and Hay who worked for Harvard. USAID contract with Harvard.
Apria Healthcare 17.6 8/10/2005 Incomplete or inaccurate documentation
supporting a portion of the Company's Medicare billings during the
period from mid-1995 through 1998.
Gold Banc 16 11/19/2004 Gold Banc, a Kansas banking company, charged
excessive interest rates and fees on federally guaranteed agricultural
loans.
Florida International University 11.5 2/15/2005 Florida International
University mis-charged costs and over billed under several contracts
and grants with the U.S. Department of Energy. These contracts and
grants dealt with testing and developing environmental technologies.
Wiggins, Kenneth Earl (King Drugs and Pharmacy) 10.5 6/20/2005 Wiggins
and pharmacy submitted reimbursement claims to Medicaid and federal
employee benefits programs for "free samples" collected and
repackaged.
OfficeMax 9.8 5/19/2005 OfficeMax agrees to pay $9.8 million to settle
charges it submitted false claims when it sold office products to the
U.S. Government that were not permitted by a GSA contract that
required all covered office products to be made in countries covered
by the Trade Agreements Act.
Humanscale Corporation (formerly Softview Computer Products) 9
6/30/2005 Failed to disclose current, accurate and complete discount
and pricing information to the General Services Administration (GSA).
Oracle 8 5/13/2005 Billing for services not provided and keeping the
overpayment.
Harlan, Sprague, Dawley Inc. 7.2 3/1/2005 Harlan, Sprague, Dawley
Inc., a supplier of genetically pure laboratory mice and rats, sold
genetically contaminated stock wrecking untold amounts of medical
research. NIH
Inter-Tel Technologies 7 1/5/2005 Inter-Tel agreed to plead guilty and
to pay fines totaling $8.71 on charges of bid rigging and wire fraud
in connection with a program intended to connect schools and libraries
to the internet (the E-Rate program). In addition to the $7 million
FCA fine, and additional $1.71 million was levied in criminal fines.
Omnicare and Upstate Pharmacies in Western NY 6.75 5/16/2005 Billing
for drugs never delivered and a wide variety of billing
irregularities.
Turner Construction Company 6.6 7/25/2005 Turner received credits for
bonds on dozens of federal contracts without passing on the credits to
the federal government.
Turner Construction Company 6.6 6/28/2005 Company received credits
for bonds on dozens of federal contracts without passing the credits
on to the federal government.
Arthur D. Little (aka Dehon Inc.) 6.5 3/25/2005 Inflated overhead on
government contracts.
Providian and Total System Services 6 9/20/2005 Postage rate fraud -
claiming a lower postage rate than entitled.
AdminaStar Federal Inc. 6 9/21/2005 Company misrepresented Medicare
evaluations and overcharged CMS for claims processing.
PharMerica 5.95 3/29/2005 PharMerica paid a kickback for Medicare and
Medicaid contracts and disguised it in the form of an inflated price
for a long-term care pharmacy that existed to do only one day's worth
of business.
Office Depot 4.75 9/19/2005 Sold office supply products manufactured
in countries not permitted by the Trade Agreements Act to United
States government agencies.
Cornell University 4.3 6/21/05 Defrauded government by charging all
or too much salary to NIH grant given to university's Children's
Clinical Research Center even though employees did not do work on
grant.
U. of Miami 3.9 5/18/2005 U. of Miami double-billed and overcharged
Medicaid through several of its outpatient clinics.
Resurgens 3.8 5/23/2005 Resurgens doctors paid kickbacks to the
surgery center for using the Center's Medicare provider number. The
kickbacks were steered to a lockbox at an Atlanta bank.
Simi Valley Hospital 3.7 7/21/2005 Pneumonia upcoding.
UnitedHealthcare 3.5 12/12/2004 While working as a Medicare
contractor, UnitedHealthcare mishandled telephone calls involving the
Medicare program, and then reported to Medicare they were doing a good
job in order to retain the contract and get bonuses.
McKesson Corp (TBC Products) 3.4 11/13/2004 TBC Products, a McKesson
subsidiary, distributing tube-feeding equipment to patients too sick
to eat on their own. As part of its sales plan, TBC distributed
invoices that made it look like McKesson was charging for tube-feeding
pumps that were free. This paperwork made it possible for nursing
homes to bill taxpayers for the free pumps. Along with the $3.4
million civil False Claims Act fine, McKesson pled guilty and paid a
$4 million criminal fine.
Frank S. Chuang 3.4 2/8/2005 Mr. Huang submitted false claims to state
and federal transportation agencies for work not performed.
U. of Alabama at Birmingham 3.39 4/14/2005 Double billing Medicare for
patients in research trials.
Engenderhealth 3.3 4/29/2004 Failure to return unused USAID funding
for family planning.
Western Sales and Testing 3 3/23/2005 Western Sales and Testing faked
pressure tests and inspection of high-pressure truck cylinders used
for over-the-road transportation of hydrogen, helium, methane,
hydrogen chloride, and other gases. Several federal agencies were
defrauded, include the DoE, NASA, and DoD.
Cleveland Clinic Florida Hospital 2.75 2/14/2005 From 1993 to 2001,
the Cleveland Clinic billed for "for extra observation charges during
normal recovery periods following minor surgery or emergency room
visits."
Applied Consulting and sister company Applied Case Management 2.75
9/13/2005 Firms signed contracts with Mount Vernon (N.Y.) Hospital and
Catskill Regional Medical Center in which kickbacks for patient
referrals were disguised as "administrative service contracts."
Honeywell 2.75 5/26/2005 Falsely stated in a contract proposal to the
United States Air Force that it had a fully compliant cost management
system, then tried to bill Government to create one.
Mount Vernon Hospital 2.65 8/2/2005 Kickbacks and billing for
unlicensed drug and alcohol treatment centers X
Diebold 2.6 11/11/2004 Diebold made false claims about the security
and certification status of its electronic voting machines and
tabulation systems. As a result, six counties were misled into buying
the machines.
Westinghouse Savannah River Co. 2.6 1/11/2005 Westinghouse Savannah
River Co. filed travel reimbursement for more than 100 workers who
were not traveling. The company also improperly sought government
funds for moving expenses, temporary lodging and meals for employees
transferred to Washington, D.C.; Los Alamos, New Mexico; and Southern
California.
SAIC (Science Applications International Corp) 2.5 4/27/2005 Bill
padding, defective pricing and false estimates.
Dey Pharmaceuticals (state FCA case) 2.5 8/8/2005 Marketing the spread
on albuterol.
Loma Linda University 2.2 12/1/2004 Loma Linda University Hospital
billing for doctor services that were actually performed by residents
or interns (PATH case).
West Coast Medical Supply (OR) 2.07 3/20/2005 West Coast Medical
Supply repeatedly billed for durable medical equipment that was never
supplied.
Maxwell Manor Nursing, ABS Long-Term Care Management Co. Inc. and an
affiliated company MBA-LTC Inc. 1.9 11/11/2004 The Maxwell Manor
Nursing home is described as "house of death, terror and filth," with
incredible lapses in care, decayed buildings, sexual assaults,
medication used as punishment, rat infestation, and more. Medicare
and Medicaid were billed for services and care not provided.
Kaiser Permanente (Hawaii) 1.9 5/16/2005 Submitted inaccurate Medicare
and Medicaid claims over 17 years.
Temple University 1.88 10/28/2004 Temple University submitted claims
for hospital care that was allegedly performed by doctors, but lacked
sufficient documentation that those services were actually performed
by those doctors. In addition, the government said Temple billed for a
higher level of care than was actually provided.
George Washington U. 1.825 4/19/2005 Fictitious labor, expenses,
scholarships and stipends stolen by Nabih E. Bedewi from the National
Crash Analysis Center (not sure if FCA or not, but presented as so on
one list).
Americhoice of Pennsylvania Inc. (formerly Healthcare Management
Alternatives) 1.6 6/30/2005 Improper claims processing and coverage
determinations between 1995 and 1998.
Professional Ambulance Service of Norwich Conn. 1.5 Oct. 20- 04 The
Professional Ambulance Service company transported Medicare kidney
patients for non-emergency dialysis treatments when such trips are not
covered.
Catskill Regional Medical Center 1.5 1/7/2005 Treating illegally
referred drug and alcohol patients (kickbacks).
Anthem Insurance 1.5 8/8/2005 Overcharged the Federal Employee Health
Benefits Program (FEHBP) through rebate retention.
Nursing Home Care Management 1.456 10/26/2004 Inadequately trained
health care aides.
University of Medicine and Dentistry of New Jersey 1.4 3/18/2005
University of Medicine and Dentistry of New Jersey billed at doctor
rates for services done by interns. (PATH case).
Lockheed Martin Corp 1.4 1/4/2005 Procurement mis-charging.
University of Pennsylvania 1.31 2/9/2005 A professor at the University
faked gene therapy research that ended with the death of an Arizona
teenager.
Spayne, Timothy R. 1.24 1/31/2005 Attorney submitted false legal bills
to Electric Boat.
Tender Loving Care Health Care Services 1 11/29/2004 False cost
reports.
TransTechnology 1 9/9/2005 Rescue hoists alleged to be defective.
Perini Corp. 0.998 11/19/2004 Perini submitted submitted inflated
claims related to construction of the U.S. Embassy building in
Venezuela.
Allied Home Medical 0.93 10/3/2005 Overbilled on motorized
wheelchairs.
(TennCare)
CVS 0.895 8/2/2005 Pill shorting and full billing.
Hillcrest Healthcare 0.775 5/19/2005 Substandard nursing home care-
fatally neglecting patients, while at the same time billing for
services not provided.
Emsco 0.7 5/24/2005 Over-billed Medicare and Medicaid for emergency
room services by upcoding patients to a higher level of service than
actually provided. A related claim was paid in June 2004.
Fresno County 0.653 2/14/2005 Fresno County submitting false claims
for services not reimbursable under Medicare.
Hospital of St. Raphael 0.632 5/3/2005 Unnecessary hospital treatment
for kidney patients
Mid-West Podiatry & Associates 0.575 3/5/2005 Mid-West Podiatry &
Associates upcoding podiatric work, claiming less procedures were more
extensive.
MedQuest 0.519 9/20/2005 Settlement on alleged overpayments.
Curran Contracting Inc. (Illinois) 0.5 5/18/2005 Submitted fraudulent
documents overstating the amount of asphalt material delivered to
state and municipal road projects.
Seattle Cancer Treatment and Wellness Center 0.478 3/18/2005 Seattle
Cancer Treatment and Wellness Center billed for services that were
more extensive than those performed, billed for drugs administered at
home as if they had been taken in the doctor's office. X and
TRICARE
Larossa, John T. MD 0.447 4/8/2005 Upcoding.
Drs. Grover Christie Merritt, P.C. 0.443 3/14/2005 Upcoding and
unbundling.
Hunt Memorial Hospital District (Tx)/Presbyterian Hospital of
Greenville (filed in middle district of TN) 0.406 11/4/2004 Hospitals
upcoded pneumonia claims.
Family Medical Management Services 0.4 3/5/2005 The company claimed
that its medical director performed nearly all health care services,
when nurse practitioners actually performed the majority of them. and
TRICARE
Tucker, Charles, MD 0.366 4/13/2005 Billing nurses as physicians.
Gambro Healthcare 0.328 12/8/2004 Gambro contracted with local
laboratories to perform expedited lab tests on an as-needed basis and
mis-billed for them.
C. Patel MD and Fall Rive Walk-In Emergency Medical Office 0.315
6/30/2005 Overbilled Medicaid and Medicare, for physical therapy
services not performed by a physical therapist or physician.
Professional Service Industries, Inc. 0.26 2/5/2005 PSI billed the
government for the work of "certified welding inspectors" when the
inspectors who performed the inspections were not so certified and the
testing never took place.
Aerometals 0.251 2/3/2005 Selling refurbished parts as new to the Air
Force.
Holiner Psychiatric Group 0.25 10/22/2004 Upcoding of evaluation and
management codes at two Texas hospitals, and billing for services not
rendered.
and TRICARE
Pediatric Adolescent Healthcare, P.C. and William Silberberg, MD 0.242
1/11/2005 Charging for free children's vaccines.
Torrington-Winsted Pediatric Associates 0.201 1/11/2005 Charging for
free children's vaccines.
Dr. Gaetano Calise (RI) 0.2 3/20/2005 Billing for nursing home care
not provided.
Central Montgomery Medical Center 0.2 8/2/2005 Improperly restrained
patients.
Center for Pain Management 0.18 3/5/2005 Owner of Center used provider
numbers of two anesthesiologists to bill for services that were not
performed.
Dr. Eric Poehlman 0.18 4/5/2005 Fabricated data on research grants.
S.C. Management 0.167 10/1/2004 Upcoding.
Dr. Peter Stickney 0.126 3/20/2005 Billing for medically unnecessary
services.
G. Craig Kiser, M.D. 0.104 11/9/2004 Dr. Kiser billed Medicare and
Medicaid for drugs received as free samples from the Manufacturer (TAP
Pharmaceuticals).
Bergoli, Dr. Arthur (Mass) 0.1 1/3/2005 Overcharging for nursing
facility care.
Shurlan, Dr. Vladimir 0.089 4/7/2005 Upcoding.
Balco 0.06 10/28/2004 Filed $1.8 million in false Medicare claims by
submitting multiple claims for the same tests.
Memorial Hosp. of Carbondale Illinois 0.033 10/10/2004 Hospital not
approved for services billed.
TOTAL 1498.824 (1461.324 without Gambro state case)
Who cares?
