Biggest healthcare frauds in 2015: Running list

Updated, Dec. 7, 2015

Healthcare fraud continues to roil the industry, as a steady stream of doctors, practice owners, suppliers and even executives are charged weekly with ripping off patients and payers alike.

In 2014, the federal government recovered nearly $5.7 billion in healthcare fraud cases, up $1.9 billion from the prior fiscal year. Of that amount, $2.3 billion was tied to healthcare fraud against the federal government, according to a recent review by the Nashville, Tennessee firm of Bass, Berry & Sims PLC.

Already, 2015 has seen a host of major fraud news involving dozens of individuals and amounting to millions in abuse, often related to Medicare fraud.

We’ll keep tabs on the biggest cases, those with greater resonance for healthcare providers, in this running list. Check back often as new cases are added.

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The owner of an Illinois home healthcare company is facing conspiracy and fraud charges after being indicted in an alleged kickback scheme that defrauded Medicare for at least $450,000. Jacqueline Tuanqui, 53, the owner of Hexagram Home Health Care LLC, allegedly paid kickbacks to an outside marketer in exchange for elderly patient referrals for unecessary treatment funded by Medicare, the FBI said in a statement. Full story.

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The Miami owner of eight pharmacies will spend nine years in prison, the Department of Justice announced this week, for his part in a healthcare fraud that saw him spending the money he scammed on luxury cars for himself and his family. Full story.

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The Justice Department raked in more than $3.5 billion in 2015 in settlements and judgements from civil cases under the False Claims Act, including $1.9 billion in healthcare fraud settlements, according to Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department's Civil Division. Since January 2009, the DOJ has recovered $26.4 billion, with the bulk coming out of healthcare cases. Full story.

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The former CFO of a Long Beach hospital in California, two orthopedic surgeons and two others have been charged in relation to a $600 million fraudulent billings scheme involving illegal referrals of thousands of patients for spinal surgeries, the U.S. Department of Justice, Central District of California announced. Full story.

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Pharmaceutical company Novartis will pay $370 million to settle claims that it gave kickbacks to specialty pharmacies in exchange for recommending two of its drugs, the U.S. Justice Department Southern District of New York announced in November. Full story.

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HCA Holdings said it will pay $215 million to settle a shareholder action suit over the information it disclosed prior to its 2011 initial public offering in November. Full story.

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Pharmaceutical manufacturer Warner Chilcott will plead guilty and pay $125 million after admitting to paying kickbacks to doctors and other healthcare professionals so they would prescribe drugs Actonel, Asacol, Atelvia, Doryx, Enablex, Estrace, Loestrin and others, the U.S. Department of Justice announced. Full story.

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Dike Ajiri, chief executive officer at Chicago-based Mobile Doctors, recently plead guilty to charges that he fraudulently billed Medicare for in home-treatments that were longer than they actually were. Full story.

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Millennium Health of San Diego has agreed to pay $256 million to the federal government to resolve claims that it billed Medicare, Medicaid and other federal healthcare programs for medically unnecessary urine drug and genetic testing, according to the U.S. Department of Justice. Full story.

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Tuomey Healthcare System in South Carolina will pay the federal government $72.4 million and will affiliate with Palmetto Health to resolve claims it billed Medicare for services referred by physicians it illegally paid, according to the U.S. Department of Justice. Full story.

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Advocate Health Care's South Suburban Hospital in Chicago will pay $10.4 million after a court ruled that negligence in administering blood pressure medication resulted in permanent disfigurement of a surgical patient. Full story.

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Guardian Hospice of Georgia has agreed to pay $3 million to resolve allegations it submitted claims to Medicare for hospice patients who were not terminally ill, according to the Department of Justice, Northern District of Georgia. The settlement with Guardian Hospice and its holdings, Guardian Home Care Holdings and AccentCare, was announced Monday. Guardian is a for-profit hospice in Atlanta. Full story.

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A former Army physician in Texas has been sentenced for his role in an estimated $7.3 million healthcare fraud scheme, according to the U.S. Department of Justice in Western Texas. Former Army Lt. Col. Richard Craig Rooney, 46, of Medina, Washington, was fined $15,000 and ordered to forfeit nearly $4.3 million, authorities said. Full story.

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The Adventist Health System has agreed to pay $115 million to settle allegations that it paid physicians for patient referrals and that it filed claims with codes that made conditions seem more severe, according to the U.S. Department of Justice. The settlement is one of the largest of its kind, representing a continued crackdown by federal authorities on false claims filed to Medicare and Medicaid. Full story.

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An orthopedic surgeon, his personal attorney and a cadre of assistants have been charged with operating one of the largest insurance fraud scams in California history, in amounts totaling more than $150 million, according to Los Angeles County District Attorney Jackie Lacey in a Sept. 15 announcement. Dr. Munir Uwaydah, 49, owner of Frontline Medical, his personal lawyer and his former office manager are among 15 defendants named in the case that also alleges surgical procedures were performed by a physician's assistant who never attended medical school. Full story.

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The Columbus Regional Hospital System in Georgia has agreed to pay the state and federal governments $25 million, and potentially another $10 million, to resolve allegations that it overbilled Medicare and paid kickbacks to a medical director for referrals, according to Georgia Attorney General Sam Olens in a Sept. 4 announcement. The civil settlement resolves allegations that the hospital system submitted claims to the state for evaluation and management services billed at higher levels than supported by documentation, for radiation therapy that did not qualify as such, and for claims submitted in violation of rules prohibiting payment in return for the referral of Medicaid patients. Full story.

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The former medical director of a now-defunct healthcare provider in Miami, along with three therapists formerly employed there, have been convicted for their roles in fraudulently billing Medicare and Florida Medicaid for more than $63 million, according to the Department of Justice. Medicare and Medicaid paid about $28 million on those claims, authorities said. Roger Rousseau, 73, of Miami, is the former medical director of Health Care Solutions Network, a now-defunct partial hospitalization program that purported to give intensive treatment for mental illness. Full story.

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A doctor at a Brooklyn, New York, clinic was sentenced Friday to two years in prison for his role in a $13 million healthcare fraud scheme, according to the U.S. Department of Justice. Okon Umana, 68, of West Haven, Connecticut, was also ordered to pay $6.4 million in restitution and to give up $6.5 million. From 2009 to 2012, Umana was the medical director of Cropsey Medical Care in Brooklyn. During those years, the medical clinic submitted more than $13 million in claims to Medicare and Medicaid for a variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests, according to the Justice Department. Full story.

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The clinical director of a Boston-area home nursing agency has been convicted for her role in submitting more than $27 million in fraudulent home healthcare claims to Medicare, according to the U.S. District Attorney in Massachusetts. Janice Troisi, 66, of Revere, Massachusetts, was convicted of conspiracy to commit healthcare fraud and 10 counts of healthcare fraud following a four-day trial, the U.S. District Attorney announced on August 5. Sentencing is scheduled for Nov. 10. Full story.

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The owner of Prairie View Hospice in Oklahoma will pay $2.5 million in restitution and serve three years in prison starting August 28, after a jury convicted her of Medicare fraud, according to the Department of Justice in the Western District of Oklahoma. From 2010 to 2013, Paula Kluding, 39, concealed the true medical condition of Prairie View Hospice's patients in order to "pass" a Medicare audit and to fraudulently obtain money from Medicare, according to evidence presented at trial. Full story.

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A Detroit home health provider was sentenced in July to 80 months in prison for his leading role in a $12.6 million Medicare fraud and tax evasion scheme. In addition to imposing the prison term, Mohammed Sadiq, 67, of Oakland County, Michigan was ordered to pay $14.1 million in restitution, according to the Department of Justice. Sadiq owned and directed operations at two home healthcare companies in Detroit. He admitted working with co-conspirators to bill Medicare for home health services that were not provided. Sadiq also admitted to paying kickbacks to patient recruiters in order to obtain the information of Medicare beneficiaries, which he then used to bill Medicare for services that were not medically necessary or were not provided at all. Full story.

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Farid Fata, a hematologist-oncologist from the wealthy northern Detroit suburbs, was sentenced Friday to 45 years in prison. As head of Michigan Hematology Oncology, until recently the state’s largest private cancer network, Fata was accused to running a fraud scheme that involved administering unnecessary chemotherapy to 553 patients -- including some who were intentionally misdiagnosed with cancer -- and illegally billing Medicare and private insurers some $34 million in false claims. In 2010, warning signs came from an oncology nurse, Angela Swantek, who considered taking a job with Fata’s practice and observed what she described to TV station WDIV as a “chemo mill”—with more than dozen patients getting chemotherapy at any given time and apparently not in compliance with best practices for infusion. She declined the job and filed a complaint with the Michigan licensing regulators, but the state later determined that nothing was out of compliance. Full story.

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Six people involved in an alleged $12 million conspiracy to commit healthcare fraud have been arrested in Houston, according to the U.S. Attorney’s Office, Southern District of Texas. Those charged on Thursday include the owner and operator of the clinics and lab, Mktrich "Mike" Yepremian, 58; and Dr. Harding Ross, 61; Dr. Faiz Ahmed, 63; Jermaine Doleman, 38; Michael Wayne Wilson, 46; and Eric Johnson, 61, all of Houston. Full story.

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The executive director of a Lexington, Kentucky-based home health agency has agreed to pay the U.S. government $1.1 million to settle allegations she provided unlawful compensation to physicians who referred patients to the agency. From 2006 to 2010, Vicki S. House, secretary and executive director of Nurses’ Registry and Home Health, provided compensation to three local physicians who referred patients to Nurses’ Registry, according to the Department of Justice, Eastern District of Kentucky. Nurses’ Registry then submitted the claims to Medicare, seeking payment. Full story.

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A U.S. Court of Appeals in South Carolina has upheld charges under the government’s False Claim Act against Tuomey Healthcare System, forcing it to pay a $237 million fine from a lower court ruling. The multimillion dollar fine is more than the hospital’s annual revenue and is believed to be the largest ever applied to a community hospital. Sumter, South Carolina-based Tuomey has 45 days to request reconsideration from the court. Full story.

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Denver-based dialysis services provider DaVita Healthcare Partners will pay $450 million to settle claims that it ran an elaborate scheme to bill Medicare for dialysis drugs that it purposefully wasted. According to the U.S. Department of Justice, DaVita devised a scheme to take advantage of dosing limitations for the drugs Zemplar and Venoflar, which come in doses that are often more than a doctor prescribes so the excess is wasted. The company allegedly created “dosing grids” designed to make sure that the group maximized the amount of waste, and billed Medicare for the price of the dose and the waste. Full story.

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The Medicare Strike Force filed charges against 243 doctors, nurses, licensed medical professionals, health care company owners and others in June for allegedly submitting a total of $712 million in fraudulent billings, the result of a nationwide sweep that’s being called the largest healthcare fraud takedown in history. The Medicare Fraud Strike Force targeted fraud in 17 districts in the states of Florida, Texas, California, Louisiana, New York and Michigan. Full story.

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Hebrew Homes Health Network has agreed to pay $17 million to resolve allegations that it gave doctors kickbacks for the referral of Medicare patients to its skilled nursing facilities in Florida, the Department of Justice announced this week. William Zubkoff, former president and executive director of the Florida skilled nursing facility, has agreed to resign. The settlement resolves allegations made in a lawsuit filed by Stephen Beaujon, former CFO of Hebrew Homes, under the whistleblower, provisions of the False Claims Act. Beaujon will receive $4.25 million in the settlement, according to the Justice Department. Full story.

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The former president of Riverside General Hospital and his son have been sentenced to prison and ordered to repay over $53 million for their role in a $158 million Medicare fraud scheme. Earnest Gibson III, 70, the former president of the Houston psychiatric facility and his son, Earnest Gibson IV, 37, the operator of Devotions Care Solutions, a satellite psychiatric facility of Riverside General Hospital, received prison sentences of 20 and 12 years, respectively. Full story.

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The former owner of a physical therapy provider in Illinois has been sentenced to federal prison and ordered to repay $2.5 million over a scheme he designed to pay off debt and student loans, according to the U.S. Attorney’s Office in the Northern District of Illinois. Ankur Roy, 38, of Miami Beach, Florida, was ordered to forfeit more than $2.5 million in proceeds he and two co-defendants gained by submitted false claims to Medicare and Blue Cross Blue Shield of Illinois, according to the U.S. Attorney. Full story.

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A Detroit-area neurosurgeon pleaded guilty to performing medically invasive but fraudulent surgery that caused significant bodily harm to patients in a scheme to bilk Medicare, Medicaid and private insurance companies out of more than $11 million. Dr. Aria O. Sabit, 39, a licensed neurosurgeon, pleaded guilty on May 22 to two separate criminal charges. As owner of the Michigan Brain and Spine Physicians Group, Sabit profited by convincing patients to undergo spinal fusion surgeries with instrumentation, meaning specific medical devices designed to stabilize and strengthen the spine, according to court records. However, though he billed public and private health insurance for instrumentation, the implants were tissue, or he would implant cortical bone dowels, according to the U.S. Department of Justice in Michigan. Full story.

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Kentucky-based pharmacy services business PharMerica will pay $31.5 million to settle a federal lawsuit that it dispensed oxycodone, fentanyl and other narcotics without valid prescriptions and submitted false claims to Medicare Part D for the drugs, according to the company and U.S. Department of Justice. PharMerica has agreed to pay $23.5 million to resolve the alleged False Claims Act violations. It has also agreed to pay $8 million to settle the allegation that it enabled nursing home staff to order narcotics, and pharmacists to dispense them, without confirmation from a physician that the drugs were medically necessary, according to the federal complaint. Full story.

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The former CEO of the now-defunct Endoscopy Center of Southern Nevada was ordered to relinquish over $8 million for her part in a billing fraud scheme, according to U.S. Attorney Daniel G. Bogden of the District of Nevada. The sentence was handed up on May 4. Former CEO Tonya Rushing, 47, and Dipak Desai, the former owner of the center, overcharged Medicare, Medicaid and private health insurance companies by overstating the amount of time nurse anesthetists spent with patients, according to the plea agreement. Full story.

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Joe White, former chief financial officer of the Shelby Regional Medical Center in Texas, agreed this week to pay $4.5 million in restitution after he pleaded guilty to fraudulently attesting to meaningful use of electronic health records, according to a KXXV report. White pleaded guilty to fraud charges in November. The former CFO led Shelby to attest to meaningful use requirements for the 2012 reporting period, netting nearly $800,000 for the hospital under the Centers for Medicare and Medicaid Services EHR program. Full story.

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Macon, Georgia-based Medical Center-Navicent Health has agreed to pay $20 million to settle allegations that between 2004 and 2008 it billed Medicare for short-stay inpatient visits that should have been submitted as outpatient stays, which come with lower reimbursements. Hospital administrators in a statement said they agreed to the settlement to avoid a costly litigation. Full story.

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HCR ManorCare, one of the nation’s largest skilled nursing facility providers, allegedly submitted false claims to Medicare and Tricare for rehabilitation therapy services that were not medically reasonable or necessary, according to the U.S. Department of Justice. ManorCare pressured skilled nursing facility administrators and rehabilitation therapists to meet unrealistic financial goals that resulted in medically unreasonable and unnecessary services to Medicare and Tricare patients, the DOJ said. Feds have not disclosed a dollar amount tied to the alleged fraud. Full story.

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The former financial officer of two nonprofit health clinics in Alabama will plead guilty to defrauding the federal government of $11 million, according to the U.S. District Attorney's office in Northern Alabama. Former Birmingham Health Care Chief Financial Officer Terri McGuire Mollica, 48, diverted an estimated $11 million from the Birmingham clinic and Central Alabama Comprehensive Health, which was also under the fiscal control of BHC, according to the indictments. Full story.

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The former owner of a defunct Nevada endoscopy center in April pleaded guilty to conspiracy to defraud Medicare, Medicaid and other private health insurance companies by inflating and overcharging for anesthesia services. The plea comes less than two years after Desai was sentenced to life in prison for his role in a deadly hepatitis C outbreak in Nevada. Full story.

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Nine doctors and 14 other defendants recruited New York City’s low income and homeless population to corrupt medical clinics with the offer of free sneakers, ultimately scamming Medicare and Medicaid out of $6.9 million, the Brooklyn District Attorney’s Office alleged in April. Full story.

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Paige Okpalobi, 58, owner and operator of a New Orleans-based medical clinic pleaded guilty on March 18 for submitting $50 million in false claims between 2007 and 2014 to Medicare for home health service not medically necessary or provided. Okpalobi and business accountant Christopher White, 48, also admitted they fabricated tax and employment records in response to a federal grand jury subpoena to conceal the illegal kickbacks paid. Thirteen people were indicted in connection with the Medicare fraud scheme, including two doctors employed at Okpalobi’s medical clinic.

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After being a fugitive from justice for two years, Karo Gotti Blkhoyan, aka “Gotti,” 34, of Glendale, California was sentenced to 57 months in prison and three years supervised release on a conviction of conspiracy to commit money laundering. Gotti was part of a transnational criminal organization that established a “ghost” medical clinic in South Carolina using stolen information from a South Carolina doctor. The conspirators enrolled the clinic in Medicare, established bank accounts, linked the bank accounts to a fictitious address which was a mailbox store, and registered the clinic with the South Carolina Secretary of State. The “ghost” clinic billed Medicare over $1.1 million, with Medicare paying approximately $350,000, which was then laundered through Southern Californian banks and shell businesses. Two other members of the conspiracy previously pleaded guilty to money laundering. Four members of the conspiracy are still at large as international fugitives.

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Operators of a Louisiana home care company, Priority Care at Home, as well as 20 other accomplices were indicted in March for their alleged role in a $30 million Medicare fraud scheme. The defendants allegedly hired “house doctors” to sign orders and plans of care for Medicare beneficiaries who had no legitimate medical necessity for home health services, according to the indictment. In addition, owner Lisa A. Crinel was charged with wire fraud for allegedly filing fraudulent applications for relief relating to the explosion and fire which occurred on the Deepwater Horizon oil rig in April 2010. Full story.

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Four company owners and 14 others were indicted in Miami-Dade County in March for their alleged participation in private insurance healthcare fraud resulting in over $125 million in false and fraudulent claims to be submitted and $13 million to be paid. Claims were submitted on behalf of the medical clinics seeking reimbursement for injection treatments, physical therapy treatments and other medical items and services that were neither ordered by a physician nor provided to a beneficiary as claimed, according to the indictment. Full story.

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Thirty-seven people, including 24 doctors, pleaded guilty to a massive healthcare bribery scheme resulting in more than $100 million in payments from Medicare and various private insurance companies to Biodiagnostic Laboratory Services in New Jersey. On March 3, Michael J. Zarrelli, 48, of Berkeley Heights, New Jersey pleaded guilty to bribing a doctor in exchange for test referrals. He also pleaded guilty to one count of money laundering. Full story.

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The New York-based Catholic Health Care System, an operator of skilled nursing facilities, agreed in March to pay $3.5 million to settle allegations that it inflated Medicare claims for rehabilitation therapy. The system allegedly allowed Medicare to be billed for patient care at the highest therapy-based levels, even though its subcontractor RehabCare, was often not providing therapy at those levels, according to the U.S. Attorney’s Office. Full story.

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Two Southern California residents, Theresa Fisher, 45, and Lindsay Hardgraves, 30, were both found guilty of mail fraud for submitting bills for more than $71 million for medically unnecessary procedures performed on insurance beneficiaries who received free or discounted cosmetic surgeries. Members of the scheme lured insured patients to a surgery center in Orange with promises that they could use their union or PPO health insurance plans to pay for cosmetic surgeries, which are generally not covered by insurance. The surgery center was known at various times as Princess Cosmetic Surgery, Vista Surgical Center, and Empire Surgical Center. The women told patients they could receive free or discounted cosmetic surgeries if they underwent medical procedures covered by their insurance such as endoscopies, colonoscopies and cystoscopies. Once the health care benefit program paid the claims, the patients were given free or discounted cosmetic surgeries, including “tummy tucks,” breast augmentations and liposuction. In some cases, the surgery center simply billed cosmetic procedures as if they were medically necessary procedures such as hernia surgeries.

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A federal grand jury in early March indicted former Horizons Hospice LLC Chief Operations Officer Mary Ann Stewart on charges of healthcare fraud and making false declarations before a grand jury. The five indictments allege Stewart, 47, of Bossier City, Louisiana, orchestrated a scheme in which patients who weren’t terminally ill were sent to the Louisiana center and then kept there by recertifying them for continued hospice care. Full story.

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Two Miami residents were convicted and sentenced in February to serve 72 months in prison for their roles in a $62 million Medicare fraud scheme involving mental health treatment programs at the now defunct Health Care Solutions Network that often consisted of nothing more than Disney movies and bingo games. Blanca Ruiz, 61, and Alina Fonts, 49, oversaw the alteration, fabrication and forgery of thousands of documents, including patient medical records from 2004 through 2011. Fonts also fabricated medical records for North Carolina-based patients whom she never met. Ruiz and Fonts were also aware that HCSN paid illegal kickbacks to owners and operators of Miami-Dade County assisted living facilities in exchange for patient referrals to be used to submit false and fraudulent claims to Medicare and Medicaid.

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A Texas man impersonating an MRI salesman working with Cerner Corp. convinced employees of a Dallas hospital to wire him more than $1 million using an elaborate network of fake correspondence and several co-conspirators, according to the U.S. Attorney’s Office in Western Missouri. Albert Davis, 54, of Richardson, Texas, was charged with wire fraud after employees of Dallas Medical Center and Prime Health Care -- which acquired the hospital during the course of the scheme -- transmitted two wire payments totaling $1.1 million to the conspirators’ bank account to purchase the MRI. Full story.

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From 2009 to 2014, Alexander Lara, 46, of Hollywood, Florida, was an owner and operator of Longcare Home Health Corp., a Miami home health care agency that claimed to provide home health and therapy services to Medicare beneficiaries. But Lara admitted he and his co-conspirators actually operated Longcare Home Health for the purpose of billing the Medicare program a total of $13.7 million for expensive physical therapy and home health care services that were not medically necessary or not provided at all. Lara admitted that he personally paid kickbacks and bribes to patient recruiters and Medicare beneficiaries in exchange for patient referrals. Lara also admitted that he paid kickbacks and bribes to doctors’ offices and clinics in exchange for fraudulent prescriptions.

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Orelvis Olivera, a 45-year-old owner of Acclaim Home Health Care in Miami, in February admitted to running a $6.9 million Medicare fraud in which he and his conspirators billed the government for expensive therapies that patients did not need. Olivera pleaded guilty to one count of conspiracy to commit healthcare fraud, and he will be sentenced on April 21, according to the FBI. Full story.

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Pharmaceutical giant AstraZeneca in February agreed to pay the government $7.9 million to settle allegations that it engaged in a kickback scheme regarding its drug Nexium. AstraZeneca allegedly paid the kickbacks to boost profits and caused the submission of false or fraudulent claims for Nexium to the Retiree Drug Subsidy Program. The complaint said AstraZeneca paid Medco Health Solutions, a pharmacy benefit manager, in exchange for Medco maintaining Nexium’s “sole and exclusive” status on certain Medco formularies and through other marketing activities. Full story.

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Vivian Yusuf, 44, the former owner of the Houston-area Ivy Health Care Supply company in February was sentenced to 7 years federal prison and ordered to pay $1.6 million in restitution on a conviction of conspiracy to commit healthcare fraud. From June 2007 to May 2009, Yusuf and co-conspirators improperly acquired Medicare patient information to submit false claims to Medicare totaling more than $3.4 million. Full story.

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Jonathan Wade Dunning, a former CEO of two nonprofit health clinics in Alabama, was arrested in February on 112 counts related to alleged conspiracy, fraud and money-laundering of cash meant for the poor and homeless. The charges allege Dunning, as CEO and in other positions, participated in conspiracy and executed schemes to defraud Birmingham Health Care, Central Alabama Comprehensive Health and others of “substantial resources,” according to the indictment. The indictment charges Dunning with diverting $14 million to his companies known as “Synergy Entities” and also to Integrated Health Systems Alliance. Full story.

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Community Health Systems and three of its hospitals in New Mexico in February agreed to pay a $75 million settlement to the federal government over a whistleblower suit that claimed it illegally donated money between 2000 and 2011 to New Mexico counties in return for higher Medicaid payments to cover the costs of indigent care. The 2009 suit claimed CHS and three of its New Mexico facilities received higher payments from the New Mexico Sole Community Provider Fund, a matching funds program between the state and Medicaid. The money in the fund was meant to help cover costs for unpaid medical bills.The activity was uncovered by whistleblower Robert Baker, a former revenue manager at Community Health Systems Professional Services Corp. Full story.

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Ramon Regueira, the owner and operator of Miami home health care agency Nation’s Best, was busted in January for a $30 million Medicare fraud scheme. Regueira and his co-conspirators were ordered to pay $21 million in restitution. From 2007 through 2011, Nation’s Best claims for home health services that were not medically necessary or not provided. Regueira admitted he and his co-conspirators also paid kickbacks and bribes to patient recruiters who provided patients to Nation’s Best, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services.

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Two physician owners of the Houston-based Spectrum Care P.A. mental health clinic, Mansour Sanjar, 81, and Cyrus Sajadi, 67, were sentenced in January for their roles in a $97 million Medicare. Chandra Nunn, 36, A group home owner who sent residents to the clinic in exchange for kickbacks, was also sentenced to prison for her role. Sanjar and Sajadi were ordered to pay $8 million in restitution. Nunn was ordered to pay $1.8 million. Four other co-defendants were also convicted.

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Felix Gonzalez, 45, the owner of Miami home health care company AA Advanced Care, pleaded guilty in January in connection with a $32 million Medicare fraud scheme in which Gonzalez and his co-conspirators billed for expensive physical therapy and home health care services that were not medically necessary or not provided at all. Gonzalez also negotiated and paid kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.

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Kidney care company DaVita HealthCare has set aside $495 million to resolve a suit alleging the Denver-based healthcare company over-billed for reimbursement of dialysis drugs. The case could be the largest settlement for a False Claims Act case brought without government intervention. DaVita in an earnings statement released Monday said it had set aside $450 million to settle the case, along with another $45 million in attorneys' fees and other costs. Full story.

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