Biggest healthcare frauds in 2016: Running list

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Updated, Dec. 1, 2016

Healthcare fraud has become a mounting problem not only for the industry, but for federal and state governments as well.

The following gallery highlights just some of the largest fraud cases in 2016. Check back often as new cases are added.

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Texas home health agency owner convicted in $13 million Medicare fraud scheme - Nov. 18

Marie Neba, 52, of Sugarland, Texas, will be sentenced early next year for conviction on charges including health care fraud. Full story.

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Houston pharmacist admits to $5 million healthcare fraud, paid kickbacks for referrals - Nov. 18

Nermin Awad El-Hadik colluded with a Texas clinic manager for referrals, many who required pricey compound medications. Full story.

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Prime Healthcare ordered to pay workers $6.5 million over owed raises at California hospitals - Oct. 26

The NLRB rejected Prime's appeal of a 2014 regional NLRB ruling requiring the health system to pay employees the annual raises. Full story.

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St. Joseph's Health to pay $2.1 million over HIPAA violations after patient data potentially made public - Oct. 19

Server install caused patient information to be accessible over the internet through search engines. Full story.

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Mylan will pay $465 million settlement over CMS classification of epipen for Medicaid Drug Rebate Program - Oct. 10

Mylan, the pharmaceutical company that has come under fire in recent weeks for hiking the price of its emergency allergy medication injector EpiPen, has agreed to a $465 million settlement with the U.S. Department of Justice. The settlement, according to Mylan, is to "resolve questions" that have been raised about the EpiPen's classification for purposes of the Medicaid Drug Rebate Program. Full story.

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Tenet Healthcare to pay $513 million over referral, kickback scheme, DOJ says - Oct. 3

Tenet Healthcare Corp. and two of its Atlanta-area subsidiaries have agreed to pay a total of $513 million to settle allegations of a scheme in which its hospitals paid bribes and kickbacks to prenatal clinic owners in exchange for referral of patients for labor and delivery services to Tenet facilities, the Department of Justice and multiple other agencies jointly announced Oct. 2. Full story.

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Former Tuomey Healthcare CEO Ralph Cox pays $1 million over illegal referrals - Sept. 28

Ralph J. Cox III, the former CEO of Tuomey Healthcare System in Sumter, South Carolina will pay $1 million to settle fraud claims that tied to illegal physician referrals, the Department of Justice announced Sept. 27. Full story.

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North Carolina hits Blue Cross Blue Shield with record $3.6 million fine - Sept. 19

The North Carolina Department of Insurance has slapped the state's Blue Cross Blue Shield with a $3.6 million penalty for IT problems that allegedly resulted in poor customer service for both its members and providers, according to the insurance commissioner. Full story.

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Home health agency owner gets 20-year prison sentence for fraud - Sept. 6

Khaled Elbeblawy, of Miramar, Florida, led a 7-year fraud scheme that resulted in $57 million in false claims. Full story.

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Mount Sinai hospitals settle lawsuit over Medicaid repayment delay - Aug. 25

Three hospitals within the Mount Sinai Hospital system in New York City will pay $2.95 million to settle a civil fraud lawsuit in which the hospitals and their parent company at the time admitted they failed to reimburse Medicaid within the legally prescribed timeframe of 60 days for overpayments the hospitals received, Federal and New York State prosecutors announced. Full story.

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Health Net fined for alleged use of severance agreements to curb whistleblowers - Aug. 17

Centene's wholly-owned subsidiary Health Net has agreed to pay $340,000 for violating securities laws on whistleblower awards, the Securities and Exchange Commission announced. Health Net allegedly required employees to waive their ability to collect whistleblower awards in their departing severance agreements, according to the SEC. Full story.

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CVS Caremark, AIG settle decades-old securities fraud case - Aug 16

CVS Caremark will pay $80 million and AIG insurance companies will pay $230 million as part of a class action settlement agreement in Alabama over an alleged securities fraud case going back to 1990s involving MedPartners, the former name of Caremark Rx. Full story.

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Advocate Health Care agrees to $5.5 million HIPAA violation settlement - Aug. 5

Advocate Health Care Network will pay $5.5 million to settle with the Department of Health and Human Services Office for Civil Rights regarding multiple potential HIPAA violations that involved electronic protected health information. OCR started investigating Advocate back in 2013 following Advocate's submission of three breach notification reports. The breaches affected the protected information of roughly 4 million people. Full story.

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University of California OKs $8.5 million payout in spine surgery cases - Aug. 1

The University of California regents have agreed to pay nearly $8.5 million to settle two lawsuits alleging a well-known UCLA spine surgeon failed to disclose his conflicts of interest with a leading device maker before using the company's products in harmful surgeries. Full story.

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Lexington Medical Center will pay $17 million to settle physician referral, overpayment allegations - July 29

Lexington Medical Center in West Columbia, South Carolina will shell out $17 million to settle allegations it violated the Stark Law and False Claims Act by overpaying physicians to refer patients to their facility, the Department of Justice announced Thursday. Full story.

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University of Pittsburgh Medical Center pays $2.5 million to resolve whistleblower allegations - July 29

University of Pittsburgh Medical Center, and three associated healthcare providers, have agreed to pay $2.5 million to settle allegations they submitted false claims to Medicare, according to the U.S. Attorney's Office of the Western District of Pennsylvania. Full story.

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3 charged in $1 billion scheme to defraud Medicare in Florida, DOJ dubs biggest ever - July 22

The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician's assistant were charged with conspiracy, obstruction, money laundering and healthcare fraud in connection with a $1 billion scheme involving numerous Miami-based providers, the United States Department of Justice announced. Full story.

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Former NYC HIV/AIDS clinic owner sentenced to five years in prison for $12 million fraud - June 16

Jorge Juvier, 58, of Queens, New York, a former owner and operator of multiple HIV/AIDS clinics in New York City, was sentenced Tuesday to a little more than five years in prison and ordered to pay more than $12 million in restitution for his role in a scheme to bilk Medicare out of more than $12 million through the use of fraudulent HIV/AIDS clinics, the U.S. Attorney's office announced. Full story.

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More defendants plead guilty in $600 million 'Operation Spinal Cap' fraud - June 7

Three additional defendants, including the son of a southern California hospital owner, have pleaded guilty in an elaborate healthcare fraud scheme that authorities say spawned tens of millions of dollars in illegal kickbacks for patient referrals, and nearly $600 million in fraudulent bills for spinal surgeries performed at Pacific Hospital in Long Beach, the Justice Department announced. Full story.

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Saint Michael's Medical Center to pay $450,000 to settle false claims allegations - June 2

Saint Michael's Medical Center in Newark, New Jersey will pay almost half a million dollars to resolve allegations they falsely billed Medicare and Medicaid for medically unnecessary cardiac procedures over the course of six years, the U.S. Attorney's office announced. Full story.

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Two California doctors convicted in $8.8 million hospice fraud face decades in prison - May 20

A federal jury has convicted two California doctors of multiple counts of healthcare fraud after participating in a hospice care scheme that robbed Medicare and Medi-Cal of almost $7.5 million dollars, the Department of Justice announced. Full story.

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Chicago couple indicted in scheme to bilk Medicare out of $45 million, keep Filipino housekeeper in servitude - April 15

A Chicago couple used their healthcare business to bilk Medicare out of $45 million while also conspiring to force a housekeeper to work against her will, according to an indictment returned this week in federal court in Chicago. Full story.

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Former healthcare clinic consultant, biller sentenced to 11 years in prison for role in $63M fraud - April 15

A former health care clinic consultant and Medicare biller has been sentenced to a little more than 11 years in prison, and ordered to pay a $100,000 fine, for her role in a $63 million healthcare fraud scheme involving a now-defunct Miami health provider, the Department of Justice announced earlier this week. Full story.

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Maryland doctor sentenced for insurance fraud ordered to repay $3.1 million - April 13

Physician and pain clinic owner Paramjit Singh Ajrawat, 60, of Potomac, Maryland, has been ordered to repay $3.1 million from a healthcare fraud scheme in which he filed fake insurance claims, according to the U.S. District Attorney's Office in Maryland. Full story.

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Houston psychiatrist sentenced 12 years for $158 million Medicaid fraud - April 7

Sharon Iglehart, a former attending psychiatrist at Riverside General Hospital in Houston, has been sentenced to 12 years in prison for her role in a $158 million Medicare fraud scheme involving false claims for mental health treatment. A judge also ordered her to pay $6.4 million in restitution. Full story.

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Florida audiologist sentenced to nearly eight years in prison for healthcare fraud, other charges - March 25

Terri L. Schneider, 57, an audiologist from Lakeland, Florida, has been sentenced to 94 months in prison for her role in a multimillion-dollar healthcare fraud and money laundering scheme. Full story.

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New Orleans doctor, home health company owner convicted in $34 million Medicare fraud scheme - March 29

A federal jury in New Orleans has convicted a New Orleans doctor and the owner of a New Orleans home health company for their roles in a seven year medicare fraud scheme that spawned more than $34 million in claims, more than $29 million of which were paid out by Medicare, the Department of Justice announced in a statement. Full story.

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Three Detroit doctors charged as part of $5 million illegal prescription drug operation - March 11

Three doctors and seven other people have been charged in connection with an alleged illegal operation that authorities said distributed roughly a million pills and grossed roughly $5.7 million, the U.S. Attorney's office announced Thursday after the indictment was unsealed earlier that day. Full story.

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Florida doctor pleads guilty to $2 million Medicare Advantage fraud - March 10

A Florida doctor who falsely diagnosed hundreds of patients as having a rare spine condition, has pleaded guilty to healthcare fraud and faces spending a decade in prison. Full story.

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21st Century Oncology probes massive data breach as it settles fraud case for $34.7M - March 10

Fort Myers, Florida.-based 21st Century Oncology, which operates 145 centers across the United States and 36 in Latin America, said it is investigating a breach of its computer network that could affect 2.2 million of its former and current patients. The news comes as the provider also agreed to settle a billing fraud case for $34.7 million. Full story.

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CMS hits Humana with $3.1 million penalty for Medicare Advantage, drug plan violations - March 8

The Centers for Medicare and Medicaid Services has levied a $3.1 million penalty against Humana, the single largest imposed against 129 organizations found in violation of Medicare Advantage and prescription drug plans in an audit. Full story.

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Dallas-area doctors charged for roles in $13.4 Million Medicare fraud scheme - Feb. 29

Two Dallas-area doctors have been charged, according to a superseding indictment that was unsealed recently, for their alleged participation in a $13.4 million health care fraud scheme that bilked Medicare for millions. Full story.

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Diagnostics company owner convicted in $7.5 million fraud that resulted in two patient deaths - Feb. 22

The owner of Alpha Diagnostics in Maryland has been convicted of bilking Medicare and Medicaid of more than $7.5 million in a fraud case authorities say resulted in the death of two patients because their radiology tests were not interpreted by a qualified radiologist. Full story.

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NJ doctor to pay more than $5 million to resolve false claims allegations - Feb. 15

Labib E. Riachi, MD, of Westfield, New Jersey, along with two companies he owns and operates, has agreed to pay $5.25 million to resolve allegations that they submitted fraudulent claims to Medicare and Medicaid for diagnostic tests that were never performed, the U.S. Attorney's Office announced. Full story.

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New Jersey doctor allegedly filed millions in false Medicare claims, US Attorney's Office says - Feb. 11

The U.S Attorney's office has filed a civil suit against a prominent New Jersey doctor for allegedly causing the submission of millions of dollars in fraudulent claims to Medicare and Medicaid, among other illegal conduct, in violation of the False Claims Act. Full story.

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10 charged in $15 million physical therapy billing fraud in Los Angeles - Feb. 1

Ten people have been charged in a tangled Medicare fraud scheme involving several Los Angeles area rehab and physical therapy facilities that together fraudulently billed Medicare for roughly $15 million, the U.S. Attorney's Office announced. Full story.

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Owner of Miami home healthcare agencies convicted in $57 million Medicare fraud scheme - Jan. 26

The owner and manager of three home healthcare agencies, all located in the Miami area, has been convicted in a scheme that defrauded Medicare for $40 million, the U.S. Department of Justice announced. Full story.

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Texas home health owner sentenced in $375M Medicare fraud scheme - Jan. 21

A 52 year-old woman who co-owned a home healthcare agency with her husband in Cedar Hill, Texas, will spend 10 years in federal prison and pay $25 million in restitution for her role in a $375 million fraud led by a doctor connected to their agency, the U.S. Attorney's Office. Full story.

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California hospital will pay more than $3 million over allegations it violated physician self-referral law - Jan. 15

The Justice Department has announced a multi-million dollar settlement with Tri-City Medical Center in Oceanside, California, that resolves allegations it violated Medicare's prohibition on financial relationships between hospitals and referring physicians. The hospital has agreed to pay $3,278,464. Full story.

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RehabCare, other skilled nursing facilities pay $133 million - Jan. 13

The nation's largest nursing home rehabilitation therapy provider RehabCare, which is now part of Kindred Healthcare of Louisville, Kentucky, has settled with the government for $125 million over allegations they falsely inflated therapy reimbursement claims to Medicare. Four other skilled nursing home rehab facilities also settled in connection with those claims, bringing the total to a little more than $133 million, the U.S. Attorney's Office announced. Full story.

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Doctor sentenced 9 years in $20 million clinic scandal tied to fraudulent prescriptions - Jan. 13

The physician at the center of a multimillion conspiracy to defraud Medi-Cal and Medicare has been sentenced to nine years in federal prison, the U.S. Attorney's Office announced. Dr. Kenneth Johnson, 49, is one of three found guilty following a 2014 trial and an investigation authorities dubbed "Operation Psyched Out". Full story.

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Los Angeles clinic owner sentenced in $4.5 million Medicare fraud - Jan. 6

The former owner and operator of three different health clinics in Los Angeles was sentenced Monday to six and a half years in prison for his role in a scheme that produced more than $4.5 million in fraudulent Medicare claims, the U.S. Attorney's office and FBI announced. Full story.

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