Category Archives: False Claims

El Paso Doctor Pays $200,000 to Resolve Federal and State Fraud Allegations

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El Paso Physician Settles Controlled Substance and Fraud Allegations for $200,000 This case highlights recent concerns about El Paso doctor fraud in the medical community.

Dr. Brian August of El Paso, Texas, has agreed to pay $200,000 to resolve allegations that he violated the Controlled Substances Act (CSA), the False Claims Act (FCA), and the Texas Health Care Program Fraud Prevention Act (THCFPA) in connection with El Paso doctor fraud.

Federal and state authorities alleged that between December 23, 2017, and May 22, 2021, Dr. August issued 255 controlled‑substance prescriptions to 15 individuals without meeting the minimum standards required for treating pain or chronic pain conditions. This case is one of several involving El Paso doctor fraud. The prescriptions included multiple Schedule II drugs—such as morphine, fentanyl, hydrocodone, hydromorphone, oxycodone ER, tapentadol, and oxymorphone—as well as Schedule IV substances including carisoprodol, zolpidem, clonazepam, alprazolam, and tramadol.

According to the United States, Dr. August failed to document a legitimate medical purpose, did not demonstrate medical necessity, and did not issue the prescriptions in the usual course of professional practice. Allegations of El Paso doctor fraud often involve improper prescribing practices. Because the 15 individuals were beneficiaries of Medicare Part D and/or Texas Medicaid, the prescriptions were not eligible for reimbursement, triggering liability under federal and state fraud statutes.

Of the $200,000 settlement:

  • $994.22 is restitution to Texas Medicaid
  • $44,380.55 is restitution to Medicare Part D
  • The remainder represents civil penalties and damages under the CSA, FCA, and THCFPA

As part of the resolution, Dr. August surrendered his DEA registration and agreed not to seek a new one. He also voluntarily surrendered his Texas medical license, which had already been suspended by the Texas Medical Board during the investigation. El Paso doctor fraud can result in significant professional consequences.

The case was investigated and resolved through a coordinated effort involving the U.S. Attorney’s Office for the Western District of Texas, the Drug Enforcement Administration, the FBI, and the Texas Office of the Attorney General.

As with all civil settlements, the claims resolved are allegations only, and no determination of liability has been made.

Mother Sentenced in $11K Medicaid Fraud Scheme

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Concord, NH — October 15, 2025 Attorney General John M. Formella announced that Fawn Gobis, 60, of Manchester, has been sentenced in Merrimack County Superior Court for orchestrating a 14-month Medicaid Fraud Family Scheme involving her son. Between December 2020 and February 2022, Gobis submitted falsified timesheets to a Medicaid area agency, falsely claiming that her son, Cody Gobis, was providing in-home care services to a New Hampshire Medicaid recipient. The Medicaid Fraud Family Scheme was evident as Cody was residing in Colorado and could not have delivered any such services. These fraudulent submissions led to $10,998.15 in improper Medicaid … Read More

Reno OB-GYN Indicted for Massive Health Care Fraud Scheme

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  RENO, NV — Dr. Samuel R. Chacon, a Reno-based OB-GYN and former owner of Women’s Health Center of Reno, has been indicted for allegedly defrauding multiple health care benefit programs by submitting false claims associated with unnecessary procedures. This focus on false claims for unnecessary procedures emphasizes the severity of the case. The alleged scheme, spanning from 2017 to 2022, involved falsified patient records and misrepresented diagnoses, leading to surgeries that in some cases caused serious bodily harm. According to federal prosecutors, Dr. Chacon billed Medicaid and several private insurers for procedures such as hysterectomies, bladder slings, and vaginal … Read More

Medicare Skin Graft Fraud Scheme Uncovered in California

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Felipe Ruiz and Jose Gabriel Aguirre admitted to a multi-year scheme defrauding Medicare and Medi-Cal by submitting false claims for Medicare Skin Graft Fraud procedures never performed by a licensed provider. Ruiz, a podiatrist, purchased skin grafts from Aguirre, a sales rep with no medical license, and allowed him to treat patients, then billed for the work under his own name. They now face sentencing in 2026 with severe penalties. Case Details/Scheme Overview Felipe Ruiz, podiatrist, operated West Coast Podiatry across Fresno, Madera, Stanislaus counties, involved in a Medicare fraud scheme. Ruiz bought skin grafts from Jose Aguirre, a non-medical … Read More

Doctor Sentenced to 45 Years in Prison for Providing Medically Unnecessary Fraudulent Claims Cancer for Patients

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There are great providers who have your best interest, but this doctor lied and convinced his patients they had cancer.  It’s your health, get that second opinion and walk away if you feel uneasy.  This doctor has got 45 years in prison and had to forfeit $17.6 million to think whether it was all worth it when he provided Medically Unnecessary fraudulent claims for cancer.  Read the press release below from U.S. Attorney’s Office, Eastern District of Michigan. Doctor lied and told his patients they had cancer so he could collect over 17 million from chemo therapy companies. pic.twitter.com/NiReIvuBfg — … Read More

Connecticut Man Charged in Medicare Advantage Fraud Scheme

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Federal authorities recently charged Habroon Habib, a permanent U.S. resident from Pakistan living in Middletown, Connecticut, with a series of offenses linked to an alleged Medicare Advantage fraud scheme involving durable medical equipment (DME). According to court documents, Habib, founder of Around the World Solutions LLC, is accused of submitting fraudulent claims for orthotics—medical devices billed to Medicare Advantage sponsors for over 400 beneficiaries nationwide, none of whom actually received or requested the products. The alleged scheme began in early 2025, when Around the World Solutions used a shared office address to bill various insurers for DME not provided to … Read More

Bad Actors are Offering Free Medical-Related Services

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Please be on the lookout for Bad Actors Offering Free Medical-Related Services. Bad actors are offering “free” services like house-cleaning or medical equipment to trick people into signing up for hospice. Watch out! Always talk to your doctor before signing up for medical-related services. Report fraud: call 1-800-MEDICARE or visit: https://t.co/m9UDZKX6cj pic.twitter.com/Dkk2569zNJ — Medicare.gov (@MedicareGov) August 29, 2025

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First Medicaid Fraud Guilty Plea in Virginia Medicaid Fraud Scheme

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**First Co-Conspirator Pleads Guilty in Virginia Medicaid Fraud Guilty Plea** LYNCHBURG, Va. – Carolyn Bryant-Taylor, 61, of Clinton, Maryland, a former director and corporate officer of 1st Adult N Pediatrics Healthcare, pleaded guilty on August 26, 2025. She admitted to conspiring to commit federal healthcare fraud. Facing up to 10 years in prison, Bryant-Taylor is the first of six defendants to admit guilt in a scheme that defrauded Medicaid through false claims. Charged alongside Bryant-Taylor in March 2025 were Kafomdi “Josephine” Okocha, 48, Samuel Okocha, 50, Shekita Gore, 38, Elizabeth Ilome, 41, and Eno Utuk, 47. The group operated 1st … Read More

Telemedicine Fraud: Telemedicine Scheme Uncovered

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🚨 Overview Federal prosecutors have charged Alabama physician Tommie Robinson, 43, in connection with a sweeping Medicare fraud telemedicine scheme that generated over $6 million in false claims. First, the fraudulent documentation sparked a telemedicine scheme, which in turn led to over $6 million in Medicare fraud claims.  Additionally, these claims involved equipment and tests that were neither medically necessary nor properly authorized. 🧬 Scheme Details Between December 2018 and March 2021, Robinson allegedly collaborated with telemedicine companies to authorize medical orders for durable medical equipment (DME) and cancer-related genetic testing—without ever examining or speaking to the patients.  Telemarketing scripts targeting … Read More

🏥 Oklahoma Counselor Admits $1.1M Health Care Fraud Scheme

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  Natasha Allmon, 48, of Oklahoma City, has pleaded guilty to orchestrating a massive health care fraud scheme involving false claims for behavioral health services. Between January 2021 and December 2023, Allmon operated as a behavioral health counselor under contract with Blue Cross Blue Shield (BCBS). According to federal court records, she submitted thousands of fraudulent claims for psychiatric treatment sessions allegedly provided to her own family members. These health care fraud scheme claims often included implausible billing—such as 60-minute sessions nearly every day of the year and treatment durations exceeding 24 hours in a single day. In total, Allmon … Read More

Common Health Care Fraud Types

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CMS gives great details on the many health care fraud types Fraud, waste, and abuse pose major risks for the Medicaid program. “Fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.” “Abuse means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.” [1] Providers who engage … Read More

Houston Physician Pays $2M to Resolve Medicare neurostimulator fraud settlement

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📌 Introduction: Medicare neurostimulator fraud is an increasing concern that involves the misuse of Medicare funds for providing or billing unnecessary neurostimulator devices. Understanding the implications of such fraud is crucial for protecting patients and preserving healthcare resources. A Houston-based pain management doctor has agreed to a $2 million settlement over allegations of Medicare neurostimulator fraud. The case highlights deceptive billing practices involving non-surgical procedures misrepresented as complex spinal surgeries, which are central to Medicare neurostimulator fraud issues. 🩺 Summary of Allegations: Physician: Dr. Ajay Aggarwal, anesthesiologist and pain specialist Practices: Bellaire, Lake Jackson, Van Vleck Entities Involved: Ajay Aggarwal … Read More

💊 Pennsylvania Pharmacy Pays $825K to Resolve Medicare Fraud Allegations

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🧠 Overview West End Services, Inc. (WES), a Pennsylvania pharmacy, and its owner-pharmacist Christopher Leon have agreed to pay $825,000 to settle allegations that they violated the False Claims Act by billing Medicare for prescription drugs that were never dispensed. Between January 1, 2014, and February 24, 2019, WES submitted claims for medications such as Latuda, Humira, Abilify, Invega Sustenna, Seroquel, Acyclovir, Flovent, and Truvada—none of which were actually provided to patients. 🗣️ Federal Response “Pharmacy fraud remains a priority for our office,” said U.S. Attorney David Metcalf. “Taxpayer dollars should be spent on needed medications—not wasted on fraud and … Read More

⚠️ Connecticut APRN Pays $600K to Settle Medicare, Medicaid Fraud Allegations

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🧠 Overview Armand Ntchana, a licensed Advanced Practice Registered Nurse (APRN) in Connecticut, and his affiliated entities have agreed to pay over $600,000 to resolve allegations of submitting Medicare fraud false claims to Medicare and Connecticut Medicaid. These Medicare false claims arose from fraudulent billing practices investigated between 2016 and 2020. 🏥 Entities Involved Integrated Procare Services, LLC (IPS) – psychiatric medication management Brookside Residential Care Home, LLC – formerly operated in Danbury Riverview Residential Care Home, LLC – formerly operated in New Haven Associated Property LLCs – sold in August 2023 🚨 Allegations of Fraud Federal and state authorities … Read More

🚨 Bogus Medicare DME Fraud Claims Uncovered: DOJ Targets $33M

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🚨Bogus Medicare DME Fraud Claims Uncovered: DOJ Targets $33M 💡 SummaryThe Justice Department has launched civil forfeiture actions against two Florida-based durable medical equipment (DME) providers—Vida Med Center LLC and Med-Union Medical Center, Inc.—accused of defrauding Medicare  of over $33 million. These companies allegedly submitted Medicare DME fraud false claims for medically unnecessary equipment that was never provided. 🔍 What Happened? Vida Med Center LLC billed Medicare for $14.1 million and received $8.7 million in reimbursements. Med-Union Medical Center, Inc. submitted $19 million in claims and was paid $14.1 million—shockingly, all based on prescriptions from a single provider. The DOJ is … Read More

CEO of Spine Device Company Sentenced for False Statements in Connection With Mandatory Reporting to CMS

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BOSTON – The Founder, President and CEO of SpineFrontier, Inc. was sentenced yesterday in federal court in Boston for making false statements to the Centers for Medicare & Medicaid Services. Dr. Kingsley R. Chin, 61, the Founder, President and CEO of SpineFrontier, Inc., a Massachusetts-based medical device company, was sentenced by U.S. District Court Judge Indira Talwani to one year of supervised release with the first six months to be served in home confinement. The defendant was also ordered to pay a fine of $9,500, in addition to $40,000 the defendant personally agreed to pay as part of a related … Read More

Greensboro Woman Sentenced in Conviction with Multi-Million Dollar Urine Drug Testing Scheme

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A North Carolina woman was sentenced to 44 months in prison, three years of supervised release, and ordered to pay over $6.2 million in restitution for submitting fraudulent urine drug test claims to #Medicaid. Read more: https://t.co/wmi1ApsH8V pic.twitter.com/qXwSBNrJQm — OIG at HHS (@OIGatHHS) August 6, 2025

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Florida Woman to Pay $400,000 to Settle Allegations of Falsifying Diagnoses in connection with an Amherst Compounding Pharmacy

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A Florida woman agreed to pay $400,000 to resolve allegations that she violated the False Claims Act by submitting false claims to #Medicare and #TRICARE based on unsupported medical diagnoses related to an Amherst compounding pharmacy. Read more: https://t.co/QR89X7zcF4 pic.twitter.com/5ERMl6HXWc — OIG at HHS (@OIGatHHS) August 5, 2025

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False Wound Repair Upcoding by Dermatology Providers Agree to Pay Nearly $850,000 to Resolve Allegations

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Forefront Dermatology S.C. and Henghold Surgery Center LLC, have agreed to pay $847,394 to resolve allegations that they violated the False Claims Act by knowingly causing the submission of falsely coded claims to Medicare for wound repair procedures. Forefront owns and operates a dermatology practice in Florida doing business as Henghold Dermatology. Henghold Surgery Center is an ambulatory surgery center that closed in 2023, and is wholly owned by William B. Henghold, M.D. Both the practice and surgery center performed wound repair procedures following Mohs micrographic surgery, a method of skin cancer removal. The United States alleged that Henghold Dermatology and … Read More

Louisiana Nurse Practitioner Convicted of $12M Medicare Fraud Scheme

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A federal jury convicted a Louisiana nurse practitioner today for her role in an over $12.1 million health care fraud scheme to defraud Medicare by ordering medically unnecessary cancer genetic tests for hundreds of patients she never met or examined. According to court documents and evidence presented at trial, Scharmaine Lawson Baker, 58, of Richmond, Texas, served as a nurse practitioner and was an enrolled Medicare provider. She held herself out as an expert in Medicare regulations – authoring publications on medical necessity and patient-provider relationships – while actively violating those very standards. “Scharmaine Lawson Baker shamelessly exploited her medical … Read More

New Jersey Doctor Charged With Distributing Opioids In Exchange For Sexual Favors And Defrauding New Jersey Medicaid

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NEWARK, N.J. – A New Jersey doctor was charged with distributing opioids without a legitimate medical purpose, soliciting sexual favors from patients in exchange for opioid prescriptions, and defrauding New Jersey Medicaid by billing for visits that never happened, U.S. Attorney Alina Habba announced. Ritesh Kalra, 51, of Secaucus, New Jersey, was charged in a 5-count Complaint with 3 counts of distributing opioids outside the usual course of professional practice, not for a legitimate medical purpose, and in exchange for sexual favors, and 2 counts of healthcare fraud. Kalra made his initial appearance yesterday before U.S. Magistrate Judge André M. Espinosa … Read More

Florida Man Sentenced To More Than 17 Years For Scheme To Steal More Than $10.8 Million From Medicare

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Tampa, FL – District Judge Virginia M. Hernandez Covington has sentenced Lino Mallari Gutierrez, a/k/a “Joe Gutierrez,” (59, Palm City) to 17 years and 6 months in federal prison and ordered him to pay more than $5.6 million in restitution for his role in a scheme to defraud Medicare. Gutierrez and his co-conspirators submitted over $10.8 million in fraudulent claims for durable medical equipment (DME) that Medicare beneficiaries did not want or need and that were procured through the payment of kickbacks. Gutierrez was convicted at trial in April 2025, of eleven health care fraud-related offenses, including conspiracy, health care fraud, and … Read More

El Paso Hospital CEOs Charged for Healthcare Fraud

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EL PASO, Texas – Two men surrendered to the FBI in El Paso last week after being criminally charged for an alleged fraud scheme involving pass-through healthcare billing. According to court documents, Jose Huerta, 58, was the Chief Executive Officer for two Long-Term Acute Care hospitals located in El Paso. Israel Navarro, 47, owned one of the hospitals and was financially connected to the other. An indictment filed on June 25 alleges that Huerta and Navarro conspired together and with others to knowingly devise a scheme to engage in illegal pass-through billing of urine drug tests (UDTs). Huerta’s and Navarro’s … Read More

Pain-Management Doctor and Medical Practice to Pay $3.5 Million to Resolve False Claims Act and Control Substances Act Allegations

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ATLANTA – Dr. Kamal Kabakibou and his medical practice, Kamal Kabakibou, M.D., P.C., doing business as “The Center for Pain Management,” have settled claims under the False Claims Act (“FCA”) and the Controlled Substances Act (“CSA”) arising from their alleged billing for medically unnecessary testing and for pre-signing opioid prescriptions to be dispensed by a nurse practitioner while Dr. Kabakibou was out of the country.  As part of the settlement, they will jointly pay $3.5 million to the United States and have agreed to submit regular monitoring reports to the Drug Enforcement Administration for the next five years.  Dr. Kabakibou … Read More

Woodstock pain management doctor and clinics pay $625,000 to resolve false claims act allegations

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ATLANTA – James Ellner, M.D., and his Woodstock, Georgia pain management practice, Georgia Pain Management, P.C., and ambulatory surgical center, Samson Pain Center, P.C, agreed to pay $625,000 to resolve allegations that they violated the False Claims Act (FCA) by submitting improper claims to the Medicare and TRICARE programs for evaluation and management services and medically unnecessary urine drug screening tests. “The federal government expects that physicians and their practices will properly bill Medicare and TRICARE for services they provide,” said U.S. Attorney Ryan K. Buchanan.  “The Department of Justice will work diligently to hold healthcare providers accountable when they … Read More

Rome jury finds Dr. Charles Adams and full circle medical center liable for False Claims Act violations

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It is amazing that there are providers who file false claims and false diagnoses to Medicare to get payments.  I would venture to say that if one looks at this provider patient records there will be other statement that are untrue.  Patients, Read Your Medical Records!! ROME, Ga. – A federal jury found alternative medicine physician Charles C. Adams, M.D. and his practice group, Charles C. Adams, M.D., P.C. d/b/a Full Circle Medical Center (“Full Circle”), liable for violating the False Claims Act (“FCA”) by submitting false diagnoses to Medicare for chelation therapy reimbursements.  Chelation therapy involves the use of drugs … Read More

Columbus Pain Medicine Practice Agrees to Pay $1 Million to Resolve Violations Under the Controlled Substances Act, False Claims Act

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Southeast Regional Pain Center (SRPC), in Columbus, Georgia, violated both the Controlled Substances Act (CSA) and the False Claims Act (FCA) MACON, Ga. – Kenneth Barngrover, M.D., and his practice, Southeast Regional Pain Center (SRPC), in Columbus, Georgia, has agreed to a $1,000,000 civil penalty to resolve allegations that the pain medicine practice violated both the Controlled Substances Act (CSA) and the False Claims Act (FCA). In addition to a monetary payment, Dr. Barngrover and SRPC entered into a Memorandum of Agreement (MOA) with the Drug Enforcement Administration (DEA) that will be in effect for the next three years. Barngrover was … Read More

Anesthesiology service provider pays almost $1M to settle False Claims Act/Self-Referral liability

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Northwest Anesthesiology and Pain Services reported it paid approximately $1.8 million in bonus payments as a result of the contractor’s (Remedy Physician Solutions) misconduct.  Allegations include violations of the False Claims Act (FCA) and the physician self-referral law (aka Stark Law). HOUSTON – Northwest Anesthesiology and Pain Services (NWAP) has agreed to pay $999,999 to resolve potential violations related to the submission of claims for reimbursement to Medicare for services rendered by its independently contracted pain management practices, announced acting U.S. Attorney Jennifer B. Lowery. NWAP is an anesthesiology service provider in Houston and surrounding areas. The allegations include violations … Read More

Athens, Georgia, Pain Medicine Owner, Practice Manager Agree to $5 Million Settlement Resolving Violations Under the False Claims Act

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False Claims filed with Medicare for urine drug tests that were not performed, ATHENS, Ga. –A $5,000,000 civil settlement has been reached with Mark A. Ellis, M.D., and his practice, Ellis Pain Center (EPC), a pain management practice in the Athens area. Part of the civil settlement includes EPC’s practice manager, Patsy Allen. The case that was resolved by this settlement agreement—U.S. v. Mark A. Ellis, M.D., Patsy Allen, Mark A. Ellis, M.D., P.C., and Ellis Practice Management, LLC, 3:19-cv-107—was filed on Nov. 27, 2019. The settlement was finalized on Friday, March 17, 2023. The defendants agreed to pay $5,000,000 to … Read More

Nevada Nurse Practitioner Pleads Guilty To Fraudulent Medicare Wound Care Billing

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Nurse’s GREED exposes patients with unreasonable and unnecessary procedures in exchange for illegal health care kickbacks and bribes.  Mary Huntly faces a maximum statutory penalty of five years in prison and will have to deal with the Federal Healthcare Exclusion Statute which will exclude her from participation in all Federal health care programs after her jail term. LAS VEGAS – A Las Vegas nurse practitioner pleaded guilty today to conspiring to fraudulently bill Medicare for amniotic wound allografts for patients that were medically unreasonable and unnecessary in exchange for illegal health care kickbacks. Mary Huntly, 67, was charged with one-count of … Read More

Advanced Pain Management Agreed to Pay $24k for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Non-Covered Services

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On October 13, 2020, Advanced Pain Management Specialists, P.A., (Advanced Pain), Fort Myers, Florida, entered into a $24,921.96 settlement agreement with OIG. The settlement agreement resolves allegations that Advanced Pain submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG’s Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.  Source

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Federal Exclusion Statute –

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Bad news for those in Federal health care Federal health care – Convicted?  You’re Out if Office of Inspector General finds convictions. OIG is legally required to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: (1) Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare or Medicaid; (2) patient abuse or neglect; (3) felony convictions for other health-care-related fraud, theft, or other financial misconduct; and (4) felony convictions for unlawful manufacture, distribution, prescription, or dispensing of controlled … Read More

Medicare Fraud, Upcoding & Misleading Records: A Patient’s Wake-Up Call

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For years, I believed my pain management care was honest and thorough. But after reviewing a full copy of my medical records on the patient portal, I uncovered a pattern of deception that points to serious concerns—including Medicare fraud, upcoding, and potentially unethical billing. Every visit I attended was recorded in medical records as having a detailed physical exam, yet no one was actually performed this practice that could be classified as Medicare Fraud. The notes were copied nearly word for word across different providers over a span of four years. Diagnoses listed in these records didn’t match my true … Read More

Identifying and preventing health care fraud

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An excellent post from CMS… a must read about what health care providers could face with investigations and penalties Instances of health care fraud account for billions of dollars of lost revenue a year throughout the industry. Without the correct safeguards installed to help identify and end fraudulent practices, health care providers could face investigations and penalties that could cost them significant amounts of revenue and threaten the financial health of their business. That being said, creating relevant prevention policies and compliance plans to cover all facets of the laws governing fraud and abuse can often prove challenging for providers. … Read More

False Claims Act [31 U.S.C. § § 3729-3733]

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The civil FCA protects the Government from being overcharged or sold shoddy goods or services. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the programs’ loss plus $11,000 per claim filed. Under the civil FCA, each instance of an item or a service billed to Medicare or Medicaid counts as a claim, so fines can add up quickly. The fact that a claim results from a kickback or is made in violation of the … Read More

National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud

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Wow, there are good honest medical professionals out there, but this shows that “GREED” from bad actors affect patients and all taxpayers.  Beware, there are a lot of rotten people out there that that have no conscience and don’t care whom they might harm or cheat. Largest Justice Department Health Care Fraud Takedown in History More than Doubles Prior Record of $6 Billion The Justice Department today announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal … Read More

Augusta University Medical Center agrees to pay $2.625 million to settle False Claims Act investigation

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Augusta Provider Violated False Claims Act Hospital cooperated in settling federal, state government complaints AUGUSTA, GA: Augusta University Medical Center, Inc. (AUMC) has agreed to a settlement with the United States, the State of Georgia, and the State of South Carolina to resolve allegations that AUMC submitted false claims to several government-funded healthcare programs. The government contended that AUMC violated the False Claims Act by knowingly submitting claims to federal healthcare programs for a procedure that was not covered by Medicare and Medicaid. The investigation involved these medically unreasonable and unnecessary “procedures,” which was referred to as a “Belsey Collis” … Read More

Augusta Optometrist Pleads Guilty To Health Care Fraud Charge

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AUGUSTA, GA:  Jeffrey Sponseller, O.D. of Augusta, Sponseller Eye Care One, P.C., and S&H Eye Care, LLC, currently doing business as “Eye Care One,” have agreed to pay the United States a total of $275,000.00 to settle allegations that they violated the False Claims Act by submitting or causing the submission of false claims to federal and state healthcare programs for services that were either inadequately performed or not performed at all. The civil settlement resolves allegations that were originally part of a joint criminal and civil investigation of Sponseller’s submission of bogus claims to Medicare, Medicaid, and the Railroad … Read More

VA Employee Charged with Falsifying Medical Records of Numerous Veterans

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AUGUSTA, GA: A 50-count indictment, unsealed today in federal court, has charged Cathedral Henderson, 50, a U.S. Department of Veterans Affairs (VA) employee and the former Chief of Fee Basis over non-VA Care at the Charlie Norwood VA Medical Center in Augusta, Georgia, with crimes related to his alleged falsification of the medical records of numerous VA patients. The indictment alleges that Henderson terminated unresolved consults – medical appointments that had not been scheduled or completed – by falsely stating in VA patients’ medical records that “services have been completed or patient refused services.” United States Attorney Edward Tarver stated, … Read More

3 Georgia Residents Sentenced for Health Care Fraud

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AUGUSTA, GA: A Martinez man has been sentenced to federal prison and ordered to pay nearly $1.5 million in restitution for defrauding government healthcare and disability programs. Jonathan Duane Austin, 32, of Martinez, Ga., was sentenced to 30 months in federal prison and ordered to pay $1,473,377.51 in restitution by U.S. District Court Chief Judge J. Randal Hall, said Bobby L. Christine, U.S. Attorney for the Southern District of Georgia. At the completion of Austin’s sentence, he will be subject to an additional term of supervised release. There is no parole in the federal system. According to court documents in the … Read More

Health care fraud indictment charges man and his company

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Southern District of Georgia continues to lead nationwide effort against fraudulent ‘telehealth’ scams AUGUSTA, GA: A man and his “marketing company” have been named in a five-count federal indictment for a scheme that paid workers to solicit elderly residents for information used to fraudulently bill government medical programs. Patrick Siado, of Texas, and his company, Optimus Prime Marketing, LLC, are charged with one count of Conspiracy and four counts of Health Care Fraud, said Bobby L. Christine, U.S. Attorney for the Southern District of Georgia. The Conspiracy charge carries a penalty of up to five years in prison, while each … Read More

Georgia nurse practitioner convicted of health care fraud

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A Rockdale County nurse practitioner has been convicted in a multimillion‑dollar telemedicine fraud scheme that exploited elderly Medicare beneficiaries. Prosecutors say Sherley L. Beaufils approved thousands of fake orthotic brace orders without examining patients, generating more than $3 million in fraudulent claims before being found guilty on multiple federal charges.

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Short Dr. Visit – Is this Cheating?

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I go to see the Physician, wait in the waiting room for quite a long time.  Dr. comes in and does not sit down and stood at the door with his hand on doorknob as if he was getting ready to open the door and leave, making it a short visit. I made it a point to not stand and tried to have a discussion.  After a few minutes I stand which signaled to him that the session was over and he open the door and left. This doctor charged Medicare $450 for the session.  He turned in code 99214 … Read More

False Claims Act Settlements and Judgments Exceed $2.68 Billion

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Wow! The False Claims Act exceeded $2.68 billion in settlements and judgments in 2023. Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023, Acting Associate Attorney General Benjamin C. Mizer and Civil Division Principal Deputy Assistant Attorney General Brian M. Boynton announced today. The government and whistleblowers were party to 543 settlements and judgments, the highest number of settlements and judgments in a single year. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $75 billion. “Protecting taxpayer dollars from fraud and abuse is … Read More

What to Do When Your Patient Records Contain Wrong Information

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Patient records are the backbone of healthcare, guiding diagnoses, treatments, and insurance claims. But what happens when these records contain errors—wrong diagnoses, incorrect medications, or even fabricated information? These medical records errors can lead to compromised patient records causing misdiagnoses, improper treatments, and financial headaches. In this post, we’ll explore how to address inaccuracies in your medical records, including what to do if a provider refuses to correct them or if you’re no longer their patient. Can Wrong Information in Patient Records Be Corrected? Yes, under federal law, you have the right to request corrections to errors in your medical … Read More

Fort Myers Doctor Agrees To Pay More Than $1.7 Million To Resolve Allegations Of Fraud

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Fort Myers, FL — Dr. Jonathan Daitch, an interventional pain management specialist and co‑owner of Advanced Pain Management Specialists, has agreed to pay $1.718 million to resolve federal allegations that he violated the False Claims Act by receiving illegal kickbacks and causing the submission of medically unnecessary urine drug tests. Authorities say the case required this doctor to pay 1.7 million following the allegations. According to the settlement, federal investigators alleged that between 2013 and 2016, Dr. Daitch ordered definitive urine drug testing (UDT) in situations where such testing was not medically reasonable or necessary. These tests were highly profitable … Read More

FBI News and Multimedia

Medical Fraud Exposed

Florida Man Sentenced to 22 Months’ Imprisonment for Conspiracy to Pay and Receive Healthcare Kickbacks Two West Covina Women Arrested on Indictment Alleging $4.8 Million Hospice Services Scheme to Defraud Medicare Former CEO of Silver State Health Services and Real Estate Investor Indicted for Embezzling Over $2 Million in Federal Grant Money Sovereign Health Group Founder and Ex-CEO Arrested on Indictment Alleging Long-Running, Massive Fraud Against Health Insurers Pharmacist Sentenced to Prison for False Medicaid Claims South Carolina Man Charged in Maryland for Multimillion-Dollar Medicare Fraud and Ponzi Schemes Chula Vista Man Pleads Guilty in $51 Million Medicare Fraud Scheme … Read More

Health Care Fraud – FBI

Medical Fraud Exposed

Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive illegal benefits or payments. Health care fraud is not a victimless crime. It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes. The FBI is the primary agency for investigating health care fraud for both federal and private insurance programs.  See More

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Advanced Pain Management (“APM”) Agree to Pay $1 Million to Resolve Allegations They Violated the False Claims Act and Anti-Kickback Statute

Medical Fraud Exposed

United States Attorney Matthew D. Krueger announced today that Advanced Pain Management (“APM”) has agreed to pay $1 million to settle claims asserting violations of the False Claims Act by paying kickbacks and by performing medically unnecessary laboratory tests. APM is a collection of companies including Advanced Pain Management Holdings, Inc. (“APMH”), its wholly-owned subsidiaries APM Wisconsin MSO and Advanced Pain Management LLC, and Advanced Pain Management S.C. (“APM SC”).  Read More

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