Fraud Archives - Mediarabe

Long Island Chiropractor Charged With Health Care Fraud: U.S. DOJ

October 7, 2020

BROOKLYN, NY — A Long Island chiropractor was charged with health care fraud, the United States Department of Justice announced Wednesday.

Joseph Stephan, 50, of Farmingdale, submitted false claims to the U.S. Department of Labor’s Office of Workers Compensation Programs for work not actually performed, prosecutors said. Stephan was arrested Wednesday morning and is slated to make his first court appearance in the afternoon.

If convicted, Stephan faces a maximum of 10 years in prison.

Seth D. DuCharme, acting U.S. attorney for the Eastern District of New York; Michael Mikulka, special agent-in-charge, U.S. Department of Labor, Office of Inspector General; and Matthew Modafferi, special agent-in-charge, United States Postal Service, Office of the Inspector General, announced the arrest and charges.

“As alleged, Stephan abused the trust of an important federal benefit program for employees injured on the job by billing for numerous fraudulent claims, including those for an undercover Special Agent

Two Marmora residents sentenced in state benefits fraud scheme | Crime

October 7, 2020

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| Health Benefits

The conspirators also learned that some New Jersey state and local government and education employees, including teachers, firefighters and state troopers, had insurance coverage for these particular medications, Carpenito said.

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An entity referred to in court documents as the “Pharmacy Benefits Administrator” provided pharmacy benefit management services for the State Health Benefits Program, which covers qualified state and local government employees, retirees and eligible dependents, and the School Employees’ Health Benefits Program, which covers qualified local education employees, retirees and eligible dependents, Carpenito said.

Given that McAllister and Wildman were employees of the state’s public education system, they had access to and recruited others in the system to participate in the scheme, Carpenito said.

Status conference in prescription fraud case held via telephone last month, next court date set

CAMDEN — A status conference for the five South Jersey co-defendants who have pleaded not gu…

The prescriptions were faxed to Central Rexall, which

‘Burdensome’: High Number Of Probes Into Health Care Fraud Cost Providers

October 5, 2020

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| Dept Of Health

Modern Healthcare looks at what’s behind a spike in investigations launched by prosecutors that sometimes seem to be fishing expeditions.

Modern Healthcare:
Healthcare Fraud Probes Grow In Number, Intensity

The possibility of scoring a lucrative healthcare fraud settlement may be spurring broad information requests by the government that look more like “fishing expeditions” than targeted investigations, and as a result are driving up providers’ costs, legal experts said. Healthcare fraud investigations have consistently netted the government more than $2 billion in settlements a year since 2010, with whistleblowers recouping hundreds of millions of that share annually, according to U.S. Justice Department data. A “historic” $6 billion healthcare fraud investigation unveiled last week will likely fuel more federal and state probes. (Kacik, 10/3)

FierceHealthcare:
Advocate Aurora Health, Beaumont Health End Merger Plans

Advocate Aurora Health and Beaumont Health have put an end to their discussions around a potential partnership, officials announced

Feds Charge 345 People With Health Care Fraud

October 1, 2020

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| Dept Of Health

The medical professionals are accused of submitting a total of $6 billion in bad claims for telehealth and substance abuse treatment, among other services. Also in the news: Clear View Behavioral Health in Colorado will lose its license; Anthem settles a cyberattack case; and hospitals are warned about Ryuk ransomware.

Modern Healthcare:
Feds Charge Hundreds Of Individuals In $6 Billion Healthcare Fraud

More than 340 individuals were charged with submitting $6 billion in fraudulent claims to federal healthcare programs and private insurers for telehealth consultations and substance abuse treatment, among other services, the Justice Department announced Wednesday, describing it as the largest healthcare fraud “takedown” in history. (Kacik, 9/30)

FierceHealthcare:
DOJ Charges Hundreds In Connection With $6B In Healthcare Fraud In Largest Takedown Ever

The Department of Justice charged 345 people across 51 federal districts in the largest healthcare fraud takedown in the agency’s history. DOJ said the charges were

Physicians Misjudge a Terminal Patient’s Life Span: Is It Fraud?

October 1, 2020

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| Health

Can physicians always tell when a patient has less than 6 months to live? And if they misjudge, is that fraud?

A registered nurse and three nonclinicians filed a federal False Claims Act (FCA) lawsuit against Care Alternatives, a for-profit hospice in Cranford, New Jersey, claiming the hospice illegally admitted at least 16 patients who were not in their last 6 months of life and so did not qualify for Medicare hospice coverage.

The whistleblowers’ medical expert, Robert Jayes, MD, testified that the patients’ medical records did not back up the hospice medical director’s prognosis of imminent death and thus did not support a certification of need for hospice care. The hospice’s medical expert disagreed, testifying that a physician could reasonably have determined that the life expectancy of each of those patients was 6 months or less. The whistleblowers were all former staffers.

A federal district judge held that a

Debate check: Adding facts to what Donald Trump, Joe Biden said about coronavirus, economy, election fraud and more

September 30, 2020

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CLEVELAND, Ohio – Donald Trump and Joe Biden had their say, but not always with context or sometimes even facts to back up claims made during Tuesday’s presidential debate in Cleveland.

Here’s more context to five topics covered.

1. Trump accuses Democratic states of bad policy for accepting ballots mailed in time, but arriving after Election Day.

Trump: “Can you imagine when they say you have to have your ballot in by Nov. 10? Nov. 10? That’s seven days after the election in theory should have been announced. We have major states with that, all run by Democrats,” Trump said in discussing election “fraud.”

The facts: Under law Ohio, a state where Republicans have dominated the statewide offices for years, the ballots arriving after the election will be counted, just as it was the case in 2016 when Trump won the state, and in elections before then.

Health Care Fraud Detection and Investigation Software Market Opening Up now an Attractive Opportuni

September 29, 2020

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| Global Health

Edison, NJ — (SBWIRE) — 09/29/2020 — The Global Health Care Fraud Detection and Investigation Software Market has witnessed continuous growth in the past few years and is projected to see some stability post Q2,2020 and may grow further during the forecast period (2021-2025). The assessment provides a 360° view and insights, outlining the key outcomes of the industry, current scenario witnesses a slowdown and study aims to unique strategies followed by key players. These insights also help the business decision-makers to formulate better business plans and make informed decisions for improved profitability. In addition, the study helps venture or private players in understanding the companies more precisely to make better informed decisions. Some of the key players in the Global Health Care Fraud Detection and Investigation Software market are DataWalk, SAS, Fujitsu, WhiteHatAI, HMS, FraudLabs Pro, Pipl, MISP, Sift, Cofense PhishMe, MinFraud & BAM+Fraud

What’s keeping DataWalk, SAS, Fujitsu,

Ex-Texans players among former NFL athletes indicted in health care fraud scheme

September 29, 2020

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| Dept Of Health

Two former Texans are among several athletes who have been indicted in a health care fraud scheme linked to the NFL player trust fund, authorities said Monday.

a close up of a helmet: 11. A win for Bob
Houston Texans founder Robert C. McNair passed away just a few days before his team's Monday night clash with the Tennessee Titans at NRG Stadium in November 2018. But the owner's team didn't let him down, delivering an emotional 34-17 win.

© Brett Coomer/Staff Photographer
11. A win for Bob

Houston Texans founder Robert C. McNair passed away just a few days before his team’s Monday night clash with the Tennessee Titans at NRG Stadium in November 2018. But the owner’s team didn’t let him down, delivering an emotional 34-17 win.

The eight charged athletes are Corey Bradford, 44; James Adkisson, 40; Jonathan Hadnot Jr., 38; Clint Ingram, 37; Shantee Orr, 39; Chadwick Slaughter, 42; Derrick Pope, 38; and Fabian Washington, 37, officials said.

Orr and Bradford previously played for the Texans.

Officials said the athletes submitted false claims for medical benefits through the NFL Player Health Reimbursement Account Plan Trust, according to a joint Texas Department of Insurance investigation with the Harris County

Fact check: Trump, GOP distort on health care, vote fraud | News

September 28, 2020

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WASHINGTON>> President Donald Trump made a dizzying array of misleading claims about voting fraud and health care Monday as fellow Republicans opened their convention with speeches distorting the agenda of his Democratic rival, Joe Biden.

Trump falsely asserted that he was the one who ensured that people with preexisting medical problems will be covered by health insurance; actually that was Democratic President Barack Obama. Several speakers accused Biden of proposing to defund police, ban fracking, take over health care and open borders — none of that true.

A look at statements at the Republican National Convention:

HEALTH CARE

TRUMP: “We protected your preexisting conditions. Very strongly protected preexisting … and you don’t hear that.”

THE FACTS: You don’t hear it because it’s not true.

People with preexisting medical problems have health insurance protections because of Obama’s health care law, which Trump is trying to dismantle.

One of Trump’s alternatives to

2 former Texans, Houston trainer indicted in medical fraud scheme

September 28, 2020

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| Health Plans

The players are accused of submitting false reimbursement claims for rehabilitation therapy by a Houston trainer, according to the Harris County DA.

HOUSTON — Eight former NFL players and a Houston athletic trainer have been indicted in a scheme to defraud an NFL player trust fund by submitting false claims for medical benefits, Harris County District Attorney Kim Ogg announced Monday.

Two of them, Corey Bradford and Shantee Orr, were Houston Texans and Jonathan Hadnot, Jr played college football at the University of Houston.

The claims were for rehabilitation by a trainer named Louis Ray, the owner of Rehab Express in the Galleria area.

Ray, 59, was indicted for the first-degree felony of Securing the Execution of a Document by Deception, for allegedly taking checks valued at more than $300,000. He surrendered Monday.

Prosecutors say Ray created fraudulent invoices claiming he performed treatments on players from March 7, 2016 to