The DOJ-OIG Guidelines establish frameworks for detecting and deterring fraud, waste, and abuse in federal healthcare programs. They provide voluntary compliance guidance to help healthcare entities design effective programs that prevent violations of the False Claims Act, Anti-Kickback Statute, and other federal laws. The General Compliance Program Guidance (GCPG) covers seven core elements of an […]
More than 30 states have enacted False Claims Acts, but their strength varies dramatically. California offers the nation’s largest whistleblower reward—up to 50% of total recovery, far exceeding the federal 15-30% range—and covers fraud against private insurers. New York has recovered over $4 billion since 2011 and applies its FCA broadly to “almost any situation
A Michigan woman has pleaded guilty to billing Medicare for psychotherapy services that were never provided to residents of her adult day care center. Yolanda Matthews, 58, of Farmington Hills, admitted in court to submitting over $539,000 in false and fraudulent claims to Medicare as part of a scheme that exploited vulnerable beneficiaries. According to
Michigan Adult Day Care Owner Pleads Guilty to $539,000 Medicare Fraud Scheme Read More »
A Texas businessman, a Kentucky doctor, and a Kentucky woman have been sentenced to federal prison for their roles in a scheme that fraudulently billed Medicare and Kentucky Medicaid more than $4.8 million through a series of addiction treatment facilities. Michael Bregenzer, 53, of Houston, Texas, the CEO of Kentucky Addiction Centers, was sentenced to
Four Minnesota men have pleaded guilty to defrauding the state’s Medicaid program out of approximately $2.2 million through a scheme that targeted a housing assistance program for vulnerable individuals. Moktar Hassan Aden, 31, Mustafa Dayib Ali, 29, Khalid Ahmed Dayib, 26, and Abdifitah Mohamud Mohamed, 27, all of the Twin Cities area, operated out of
A former NFL player who owned a marketing company and was the beneficial owner of eight durable medical equipment companies was sentenced to 196 months in federal prison for orchestrating a years-long scheme to defraud Medicare and CHAMPVA of nearly $200 million. Joel Rufus French, 47, of Armory, Mississippi, was also ordered to pay $110,753,619
Former NFL Player Sentenced to Over 16 Years in Prison for $197M Medicare Fraud Scheme Read More »
A federal jury in the Middle District of Florida has convicted an Oklahoma business owner and chiropractor for his role in a scheme that attempted to defraud Medicare, TRICARE, and CHAMPVA of more than $30 million. Mark Loftis, 39, of Cushing, Oklahoma, was found guilty of conspiracy to commit health care fraud and wire fraud
Medical Supply Company Owner Convicted of $30 Million Medicare Fraud Scheme Read More »
A foreign national who had been on the run since 2022 has been arrested on criminal charges related to his alleged orchestration of a scheme to defraud Medicare of more than half a billion dollars through unnecessary genetic testing. Khalid Satary, 54, was charged by indictment in 2019 in the Eastern District of Louisiana as
Notorious Fugitive Arrested in Connection With $547 Million Medicare Fraud Scheme Read More »
A Maryland oncology practice and its owner have agreed to pay more than $1.4 million to resolve allegations that they violated the False Claims Act by submitting fraudulent claims to Medicare, Medicaid, and the Department of Veterans Affairs. Progressive Oncology & Hematology, LLC, a practice in Frederick, Maryland, and its sole provider, Dr. Mouhamad Bazzi,
Florida-based NeoGenomics Laboratories Inc. has agreed to pay $9,813,260 to resolve allegations that it violated the False Claims Act by providing below fair market value consulting services to health care providers in exchange for patient referrals. The settlement, announced by the Justice Department, resolves claims that the company engaged in improper financial arrangements that violated
