Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

GA Dentist Sentenced to Prison for $1M Medicaid Fraud Scheme

Recent Medicare and Medicaid fraud schemes involved cases of false dental bills, illegally acquired cancer drugs, and kickbacks.

An Atlanta-area dentist sentenced to federal prison for participating in a Medicaid fraud scheme

Source: Thinkstock

By Jacqueline Belliveau

- A dentist from Georgia faces one and a half years in federal prison after she reportedly participated in a Medicaid fraud scheme totaling almost $1 million, the Department of Justice (DoJ) recently announced.

From 2009 to 2013, Oluwatoyin Solarin, MD, an Atlanta-area dentist, allegedly submitted false claims from several of her dental care practices to Georgia’s Medicaid program and Peach State Health Plan of Georgia Medicaid.

The DoJ reported that some Medicaid claims listed Solarin as the treating dentist even though she was not even present in the country at the time of service. Other false claims also billed Medicaid for services ineligible for claims reimbursement.

In addition, Solarin allegedly instructed her dental practice staff to backdate some Medicaid claims for patients whose coverage expired. By backdating the claims, the dentist attempted to receive Medicaid reimbursement for services despite patient ineligibility.

As a result, the dental care practices received over $996,800 in fraudulent Medicaid reimbursement.

“Solarin cheated the Medicaid program by submitting fraudulent claims, even billing the government for procedures she allegedly performed at the same time she was out of the country,” stated US Attorney John Horn. “The wealth she amassed through her scheme will now be forfeited and paid back to the government.”

As part of her sentencing, Solarin also agreed to give up her interest in over a dozen properties she bought using funds from the Medicaid fraud scheme.

“Today’s sentencing exemplifies the OIG’s [Office of the Inspector General] commitment to investigate Medicaid fraud schemes together with our law enforcement partners and bring these perpetrators to justice,” remarked Derrick L. Jackson, OIG Special Agent.

Oncology practice leaders to pay $1.7 million for Medicare fraud

The practice manager and a provider at a New Jersey oncology practice recently agreed to pay $1.7 million to the federal government to resolve Medicare fraud allegations. The oncology practice leaders reportedly illegally imported chemotherapy drugs and administered them to Medicare patients.

Between April 1, 2010 and Jan. 31, 2011, the oncology provider, Kenneth D. Nahum, MD, and his wife and practice manager, Ann Walsh, supposedly ordered chemotherapy drugs from a foreign distributor and used them on cancer patients. The FDA had not approved the drugs and they were not available for sale in the US.

Providers at the oncology practice then injected the illegally-obtained chemotherapy drugs into their patients and the practice falsely billed Medicare for the services, according to the DoJ.

Medicare only reimburses providers for administering FDA-approved drugs. Therefore, the oncology practice reportedly violated the federal False Claims Act.

“Illegally imported drugs avoid the FDA’s rigorous oversight and manufacturing standards,” stated US Attorney Paul J. Fishman. “Healthcare providers who import those drugs are exposing their patients to serious risks of harm from contaminated or counterfeit products.”

Former CEO of a pharmaceutical benefits manager pleads guilty in kickback case

The former head of a Nebraska pharmaceutical benefits manager company admitted before a judge to his role in a healthcare kickback scheme, the DoJ reported. Douglas M. Pick will face up to three years in federal prison as a result.

Pick used to serve as President and CEO of Pharmaceutical Technologies, Inc. (PTI). The company handled administrative and delivery services of pharmacy products and services for a network of pharmacies that service employee welfare benefit plans and healthcare benefit programs across the US.

The company also contracted with individuals who had “close business relationships with benefit plans.” The individuals supposedly used their business relationships to steer benefit plans to PTI in exchange for kickback payments.

Pick and his pharmaceutical benefits manager company determined kickback payments based on the volume of business the individuals brought to PTI.

Through the PTI contracts, the individuals in the kickback scheme received over $3.5 million in illegal payments.

Since Pick was responsible for contract negotiations with the individuals, he violated the Employee Retirement Income Security Act of 1974 (ERISA), the DoJ reported.

To settle kickback allegations, PTI agreed to enter a non-prosecution agreements and pay over $8.5 million. The company will also have to ensure that internal controls for ERISA and Anti-Kickback Statute compliance are maintained.

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