Court Assesses $170 Million in Fines Against Two Texas Ophthalmologists For False Claims

Lawyer, Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 18, 2021, the Justice Department announced that two Texas ophthalmologists and their eye clinic must pay millions of dollars in penalties for fraudulently billing Medicare. The penalties were assessed in connection with their evaluation and treatment of glaucoma.

U.S. District Judge Lynn Hughes assessed $170 million in penalties against the ophthalmologists and their eye clinic in Houston, Outreach Diagnostic Clinic.

A Former Employee Blew the Whistle.

According to the U.S. Department of Justice (DOJ), the action resulted from a False Claims Act (FCA) or “qui tam” suit. The whistleblower was a former employee of the clinic. The suit alleged that between February 2006 and December 2011, the two ophthalmologists fraudulently billed the Medicare Program for single eye pressure measurement tests used to assess and treat glaucoma. In addition, the suit claimed that both physicians allegedly billed the federal health care program using an improper reimbursement code that provided a higher reimbursement than that authorized.

The clinic allegedly submitted 14,450 claims and received $807,450 in payments from Medicare during this time relating to the allegations of fraud.

Assessment of Damages and Penalties.

In March 2020, the government won a summary judgment against the Texas clinic. Read more here.

As a result, the judge assessed a treble damages penalty that amounted to $2,422,350. Additionally, Judge Hughes assessed a penalty of $11,803 for each false claim, which is the minimum penalty that could have been assessed under the current version of the statute. According to the press release issued by the DOJ, the court’s assessments resulted in a total of $170,553,350 in penalties.

Click here to read more.

To read about an ophthalmologist involved in a similar Medicare fraud scheme, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent licensed ophthalmologists and other healthcare providers in Medicare audits, integrity audits, and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or Toll-Free at (888) 331-6620.

Sources:

Health Law Weekly. “Ophthalmologists Must Pay $170 Million in Penalties.” American Health Law Association. (December 3, 2021). Web.

“Court assesses $170 million in penalties against two Houston opthalmologists.” Houston Business and Energy Blog. (November 18, 2021). Web.

Paavola, Alia. “Judge orders 2 ophthalmologists to pay $170M for false claims violations.” Becker’s Hoptial Review. (November 19, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

2022-01-24T17:58:35-05:00February 15th, 2022|Categories: Health Facilities Law Blog, In the News|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Former Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. The office manager for Universal Smiles, a D.C.-based dental practice was sentenced for her guilt in bilking Medicaid, according to the U.S. attorney’s office for D.C.

The office manager was indicted in January 2019, along with the dentist who ran the practice. The office manager pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and admitted she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Through the dental practice, she and the dentist allegedly both participated to defraud the D.C. Medicaid Program. As part of the scheme, both the dentist and the office manager allegedly billed Medicaid for thousands of provisional crowns, a significant number of which were not provided to the patients. From August 9, 2012, through February 26, 2014, D.C. Medicaid paid Universal Smiles approximately $5.4 million. Of that amount, the office manager allegedly received approximately $813,184.

The amount paid by Medicaid to the dental practice, $5.4 million for an 18 month period, should have raised red flags for anyone seeing it. Apparently, it did. And for an office manager of a dental practice to receive $813,000 for an 18 month period, ditto.

As part of the sentence, the office manager has been ordered to pay back the full amount she received from Medicaid. She will also serve three years of supervised release following the completion of her one-year prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, nurses, nurse practitioners, CRNAs, pharmacists, psychologists, and other health providers in Medicaid and Medicare investigations, audits, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

2022-02-15T15:15:13-05:00February 15th, 2022|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Manager of Dental Office Sentenced to Prison for Defrauding Medicaid Out of More Than $813,000

George Indest Headshot

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

2021-11-03T00:47:39-04:00December 1st, 2021|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000

George Indest Headshot

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

2021-11-03T00:44:57-04:00November 17th, 2021|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Dental Office Manager Sentenced to 12 Months in Prison for Defrauding Medicaid Out of More Than $813,000

Attorney Carole C. Schriefer Headshot

By Carole C. Schriefer, J.D.

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.


The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.


Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.


Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

About the Author: Carole C. Schriefer is an attorney and former registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456 or Toll-Free: (888) 331-6620. Its main office is in the Orlando, Florida area.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

2021-11-03T00:41:32-04:00November 3rd, 2021|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000

George Indest Headshot

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

2021-10-06T16:35:56-04:00October 6th, 2021|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments
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