Medicare Compliance & Reimbursement

Medicare fraud schemes abound in latest round of settlements.

As the year winds down, enforcement appears to be ramping up. The following cases highlight the feds’ heightened scrutiny of Medicare fraud committed by physicians and other clinicians — and their willingness to bring significant penalties.

Take a look at these high-profile October 2023 charges and settlements aimed at healthcare providers.

In South Carolina: Orangeburg- and Bamburg-based physician Moustafa Moustafa, MD, along with his medical practice, South Carolina Nephrology and Hypertension Center Inc., opted to settle alleged False Claims Act (FCA) and Anti-Kickback Statute (AKS) violations for significant lab testing referrals, a Department of Justice (DOJ) release indicates.

Moustafa received thousands in remuneration as well as free clinical staff as part of the kickbacks for referring the patients to various labs. He agreed to pay more than $585,000 to settle the allegations, which fall under the FCA as he submitted fraudulent claims to both Medicare and TRICARE.

Check out the settlement at www.justice.gov/usao-sc/pr/south-carolina-physician-and-nephrology-practice-agree-pay-over-585000-settle-laboratory.

In California: Dentists continue to be on the DOJ’s watchlist, a recent case reminds. Dentist Javad Aghaloo, DDS, and his office manager Theresa Flores pled guilty to Medicare fraud and then tried to hide it. On Oct. 4, “as part of his plea, Aghaloo agreed to forfeit more than $1 million in property and pay restitution to Medicare in the amount of $8,476,466.23,” a DOJ brief says. “Flores entered a guilty plea to obstructing a Medicare audit.”

The dentist billed Medicare for procedures that weren’t covered, were unnecessary, and weren’t even performed on patients. Between March 2016 and October 2018, Aghaloo and Flores submitted more than 7,000 false claims to Medicare. Sentencing is set for January 2024.

See the case particulars at www.justice.gov/usao-sdca/pr/imperial-county-dentist-and-former-office-manager-plead-guilty-multi-million-dollar.

In Louisiana: Physician Alex L. Glotser, MD, of Metairie, was charged for Medicare fraud totalling more than $5.6 million. Working with various telemedicine companies, Glotser “allegedly signed thousands of doctors’ orders for DME and CGx tests for Medicare beneficiaries he never saw, spoke to, or otherwise treated,” a DOJ release notes. If convicted, Glotser could get more than 10 years in prison and be forced to pay significant financial penalties.

Review the charges at www.justice.gov/usao-edla/pr/metairie-doctor-charged-5600000-medicare-fraud-scheme.

In Georgia: Rome-based physician Charles Adams, MD, and his medical practice are being forced to pay the government more than $27 million for FCA violations for Medicare fraud that involved submitting false claims for chelation therapy. In June, a “jury found that Medicare reimbursed the defendants more than $1.1 million for these unnecessary treatments,” DOJ mentions in a release.

However, in a later decision, the court opted to bring more stringent fines. “In a post-trial ruling, the federal district judge added penalties to the jury’s verdict, bringing the total amount owed to more than $27 million,” DOJ says.

“The Court’s judgment emphasizes the serious consequences that face healthcare providers who submit false claims to Medicare,” said U.S. Attorney Ryan K. Buchanan in the DOJ release. “On behalf of those healthcare providers who faithfully bill for medical procedures, and for their patients who rely on the safety net of Medicare, our office will continue to work vigorously with our federal agencies and law enforcement partners to pursue providers who engage in misconduct.”

Peruse the case details at www.justice.gov/usao-ndga/pr/georgia-doctor-ordered-pay-27-million-submitting-false-claims-medicare.