Healthcare billing fraud: 10 recent cases 

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From a Maryland CEO indicted in connection with more than $100 million in at-home COVID-19 test billing, to an Arizona addiction treatment clinic owner sentenced to 14 years in prison for a $69 million Medicaid fraud scheme, here are 10 healthcare billing fraud cases that Becker’s has reported on since Sept. 17:

1. A former New Hampshire psychiatrist was sentenced to 12 months and a day in federal prison for signing hundreds of medically unnecessary orders for braces without ever examining patients. 

2. A Falmouth, Mass., man pleaded guilty to conspiring to launder proceeds of a more than $6 million Medicare fraud scheme run through a New Hampshire medical supply company.

3. A Cushing, Okla.-based chiropractor and medical supply company owner was sentenced to 14 years in prison for a telemedicine-driven scheme that billed federal health programs more than $30 million for durable medical equipment that beneficiaries did not want or need.

4. The founder and CEO of Gaithersburg, Md.-based Tiero was indicted in connection with billing insurers more than $100 million for at-home COVID-19 tests while claiming the tests were done in a lab. 


5. A Boston physician was sentenced to 36 months in prison for her role in telemedicine fraud and kickback schemes that led to more than $40 million in fraudulent claims to Medicare and Tricare. 

6. A Houston physician was indicted on charges that he and others billed the federal government about $30 million for office visits that were never provided. 

7. Independence Blue Cross agreed to pay $22.5 million to resolve allegations that it used inaccurate diagnosis codes to inflate its Medicare Advantage payments. 

8. A federal jury in Fort Worth convicted a Texas licensed professional counselor for his role in a $26 million healthcare fraud, kickbacks and money laundering scheme. 

9. A Florida physician was sentenced to probation for his role in a $3.1 million Medicare fraud scheme involving medically unnecessary genetic testing and durable medical equipment.

10. A San Tan Valley, Ariz.-based addiction treatment clinic owner was sentenced to 14 years in prison for orchestrating a $69 million Medicaid fraud scheme. 

At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.

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