Medical Billing Company Owner Sentenced for Healthcare Fraud 

A NY man was sentenced to one year of probation and ordered to pay $34,583.21 in restitution, for healthcare fraud.

As part of his guilty plea, the man admitted that from approximately April 2020 through April 2023, he acted as the office manager and healthcare claims biller for two physicians' practices through a company that he formed called SJ Healthcare Management Services, LLC (SJHMS). SJHMS charged a fixed monthly fee under which the man performed various management, administrative, and billing services for the practices. He admitted that he submitted false and fraudulent claims to public and private insurers on behalf of those practices for services that, in some instances, were never provided and, in other instances, were provided at lower reimbursement rates than the amounts billed. For example, he admitted that he submitted claims to insurers for medical procedures that were purportedly performed by a provider on him but which, in fact, never occurred.

Source: Medical Billing Company Owner Sentenced for Health Care Fraud (2025, March 6). www.justice.gov

Lake Charles Physician, Wife, and Clinic Agree to Pay Medicare for Improper Billing Related to Implanted Neurostimulators 

A doctor and his wife (and co-founder), both of Lake Charles, Louisiana, and their medical clinic have agreed to pay $450,000 to resolve liability under the False Claims Act for the alleged improper billing of “P-Stim” devices. From November 2018 through April 2020, they billed Medicare for implanted neurostimulators that required a surgical procedure in which the physician places wires that deliver stimulation to the epidural space on the spinal cord. This procedure must be performed in a surgery center, but the doctor did not perform surgery. Instead, these “P-Stim” devices were applied in his office to his patients' ears.

P-Stim is an electric acupuncture device that is affixed behind a patient's ear using an adhesive. Needles are inserted into the patient's ear and affixed using another adhesive. Once activated, the device then provides intermittent stimulation by electrical pulses. It is a single-use, battery-powered device designed to be worn for approximately four days until its battery runs out, at which time the device is thrown away. Medicare does not reimburse for acupuncture or for devices such as P-Stim, nor does Medicare reimburse for P-Stim as a neurostimulator or as implantation of neurostimulator electrodes.

Source: Lake Charles Physician, Wife, and Clinic Agree to Pay Medicare for Improper Billing Related to Implanted Neurostimulators (2025, March 6). www.justice.gov

Owner of Marketing Companies and DME Company Convicted for Role in $100 Million Scheme to Defraud Medicare and Other Insurers and to Violate the Anti-Kickback Statute 

A Florida man was convicted by a federal jury for his role in a durable medical equipment (DME) kickback scheme that caused millions of dollars in losses to Medicare and other insurance providers. Following a month-long jury trial, this man was convicted of conspiracy to commit healthcare fraud and wire fraud, one count of healthcare fraud, conspiracy to violate the Anti-Kickback Statute, and three counts of violating the Anti-Kickback Statute. He was also acquitted of two counts of healthcare fraud.

According to the evidence at trial, the man and his co-conspirators purchased lists of Medicare patients' names, addresses, and phone numbers, and hired telemarketers to convince the patients to get DME, specifically orthotic braces. These telemarketers pre-filled prescriptions and picked the highest-paying braces to bill insurers. He then paid telemedicine doctors to sign the pre-filled prescriptions for braces, regardless of whether the patients needed or wanted braces. Generally, the telemedicine doctor did not even speak to the patients before signing the pre-filled prescriptions.

The man then sold the signed prescriptions to DME supply companies that could bill Medicare, TRICARE, and other insurers for the braces. To conceal the fraud, he and his co-conspirators signed sham contracts and used sham invoices that falsely represented that the man was billing DME supply companies for marketing or consulting.

The man also owned and operated a DME supply company that was used to bill Medicare, and which submitted claims to Medicare for up to nine braces for a single patient.

To further conceal his illegal conduct, he put multiple of his businesses in the names of nominee owners. The nominee owners generally performed no legitimate work for any company and were paid to hide the man's involvement.

Medicare and other insurers paid hundreds of millions of dollars to members of the conspiracy and paid at least approximately $100 million for DME associated with the man's companies. He personally pocketed more than $10 million in fraud proceeds.

Conspiracy to commit healthcare fraud and wire fraud is punishable by a maximum potential penalty of 20 years in prison. Healthcare fraud is punishable by a maximum potential penalty of 10 years in prison. Conspiracy to violate the federal Anti-Kickback Statute is punishable by a maximum potential penalty of five years in prison. Each count of illegal kickbacks is punishable by a maximum potential penalty of 10 years in prison. Each count is also punishable by a fine. Sentencing is scheduled for July 29, 2025.

Source: Owner of Marketing Companies and DME Company Convicted for Role in $100 Million Scheme to Defraud Medicare and Other Insurers and to Violate the Anti-Kickback Statute (2025, March 6). www.justice.gov

Robert Burkich, M.D. Settles Case Alleging That He Submitted False Claims for Chelation Therapy to Medicare 

The doctor and his practice have settled claims under the False Claims Act to resolve allegations that they knowingly submitted false claims to Medicare for medically unnecessary chelation therapy.

The United States alleges that between September 2009 and January 2017, the doctor billed Medicare for administering the chelation drug edetate calcium disodium (EDTA) to Medicare beneficiaries who were not suffering from lead poisoning. EDTA is a rarely used drug that is indicated for use only in individuals suffering from lead poisoning and lead encephalopathy.

Medicare has several long-standing rules preventing reimbursement for EDTA when not used for cases of lead poisoning or lead encephalopathy. The United States alleges that he falsely represented to Medicare that his patients suffered from lead poisoning or other heavy-metal-related diseases to avoid Medicare's restrictions and obtain reimbursement.

The claims resolved by the settlement are allegations only, and there has been no determination of liability.

Source: Robert Burkich, M.D. Settles Case Alleging That He Submitted False Claims for Chelation Therapy To Medicare (2025, March 13). www.justice.gov

Two California Doctors Agree to Settlements Totaling $375,000 to Resolve Allegations of Fraud Schemes Related to “Electroacupuncture” Devices

The first doctor has paid $290,000 to the United States while the second MD has agreed to pay $85,000 to the United States to resolve allegations arising from a fraud scheme that caused the submission of hundreds of false claims to Medicare.

Both settlements relate to a fraud scheme orchestrated by a Riverside County chiropractor. The chiropractor used various companies he owned to seek and receive reimbursement from Medicare for surgically implanted neurostimulators at multiple locations within and beyond California, even though the companies did not perform surgery or implant neurostimulators. In a prior settlement with the United States, the chiropractor stipulated that he and his companies instead taped a disposable electroacupuncture device to their patients' ears. This device used was under the brand name, Stivax. Stivax devices do not require surgical implantation and are not reimbursable by Medicare. The United States alleges that this scheme violated the False Claims Act and the Anti-Kickback Statute.

With respect to the settlement with the first doctor, the United States had alleged that he solicited and received unlawful kickbacks from the chiropractor in return for the doctor referring his patients to the chiropractor for the furnishing of Stivax devices paid for by Medicare. The settlement with the second doctor resolves allegations that his two companies, which he co-owned with the chiropractor, submitted false claims to Medicare for surgically implanted neurostimulators.

Source: Two California Doctors Agree to Settlements Totaling $375,000 to Resolve Allegations of Fraud Schemes Related to “Electroacupuncture” Devices (2025, March 20). www.justice.gov

Sonal Patel, BA, CPMA, CPC, CMC, ICDCM, is CEO and Principal Strategist of SP Collaborative, LLC. Sonal has over 13 years of experience understanding the art of business medicine as a nationally recognized thought-leader, speaker, author, creator, and consultant to elevate coding compliance education for the business of medicine. www.spcollaborative.net