Category Archives: Legal & Regulatory

Combating Durable Medical Equipment Fraud

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🚨 Take Action Against DME Fraud

Fraud involving Durable Medical Equipment doesn’t just drain taxpayer dollars — it can also put patients’ health at risk and is a serious concern. If you suspect fraud, waste, or abuse in the healthcare system, you don’t have to stay silent.

The HHS Office of Inspector General (OIG) encourages anyone with concerns to report them through the official hotline. Reporting can help investigators protect patients and hold bad actors accountable. Every tip helps.

👉 Report suspected fraud: HHS OIG Hotline or call 1‑800‑HHS‑TIPS (1‑800‑447‑8477). Don’t ignore signs of Durable Medical Equipment Fraud.

Together, we can safeguard healthcare resources and ensure Durable Medical Equipment serves the people who truly need it.

Video from U.S. Department of Health and Human Services

 

$45M Settlement: Vohra Wound Physicians Accused of Medicare Fraud Wound Care

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Medicare Fraud Wound Care Dr. Ameet Vohra and his companies, including Vohra Wound Physicians Management LLC, have agreed to pay $45 million to resolve allegations of widespread Medicare fraud related to wound care services. According to the U.S. Department of Justice, Vohra and his team knowingly caused the submission of false claims for medically unnecessary surgical procedures, inflated billing, and improper evaluation services linked to Medicare Fraud Wound Care. Allegations of Fraud The government alleged Vohra pressured and incentivized physicians to perform surgical debridement procedures during routine patient visits, regardless of medical necessity. Vohra’s electronic health record and billing software were … Read More

Patients Choice Laboratories Pays $9.6M to Settle Medicare Kickback and False Claims Allegations

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Indianapolis, Indiana – Patients Choice Laboratories (PCL), a diagnostic lab headquartered in Indianapolis, has agreed to pay $9.62 million to resolve allegations of violating the False Claims Act and the Anti-Kickback-Statute This Indiana Laboratory Fraud Settlement marks a significant legal resolution. Federal prosecutors allege that PCL knowingly billed Medicare for respiratory pathogen panels (RPPs) that were either medically unnecessary or obtained through kickbacks, contributing to the Indiana Laboratory Fraud Settlement. The lab also paid commissions to independent sales representatives and marketing firms based on referral volume, a clear violation of federal law. In November 2020, PCL entered into a Marketing Services … Read More

Pharmacy Owner Pleads Guilty in $2.5M Medicare Fraud Scheme

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Newark, N.J. – The U.S. Attorney’s Office has announced that Nestor E. Jaime, 37, of Pine Brook, New Jersey, pleaded guilty to a sweeping health care fraud scheme that siphoned millions from Medicare. This is a case of New Jersey Pharmacy Fraud involving significant deceit. Between December 2019 and December 2021, Jaime operated a pharmacy in Paterson, New Jersey, where he submitted hundreds of false claims for the high‑reimbursement drug Dificid—valued at more than $4,000 per prescription. The pharmacy’s fraudulent activities are an example of New Jersey Pharmacy Fraud, as it never purchased or dispensed the medication. To disguise the … Read More

Anchorage Doctor and Husband Admit $12.5M Medical Fraud and Tax Evasion

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Anchorage, Alaska – A shocking case of deception has come to light as Dr. Claribel Tan, 61, and her husband Daniel Tan, 70, pleaded guilty to orchestrating an Anchorage Medical Fraud Scheme involving a $12.5 million health care fraud scheme while evading more than $4 million in taxes. Operating a rheumatology clinic in Anchorage, Dr. Tan specialized in treating autoimmune and musculoskeletal diseases. Instead of providing proper care, she routinely underdosed patients, injected expired drugs, substituted free samples, or used medications purchased by other patients. This Anchorage Medical Fraud Scheme allowed the couple to bill insurance companies as if full, … Read More

$37M Settlement in Medicare Fraud Device Scheme: Semler & Bard Misled Providers on PAD Tests

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Two medical device companies—Semler Scientific Inc. and Bard Peripheral Vascular Inc.—will pay nearly $37 million to resolve allegations tied to a Medicare Fraud Device Scheme. The U.S. Department of Justice (DOJ) claims both companies knowingly caused healthcare providers to submit false Medicare claims for vascular tests using Semler’s FloChec and QuantaFlo devices. These devices, which rely on photoplethysmography—a method not covered by Medicare—were falsely promoted as qualifying for reimbursement under CPT codes 93922, 93923, and 93924. The settlement addresses claims that both companies knowingly caused healthcare providers to submit false Medicare claims for tests using Semler’s FloChec and QuantaFlo devices. … 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

$6M Settlements in Lab Kickback Scheme: CEO, Doctors, and Marketers Implicated

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Laboratory Kickback Fraud Settlements In a sweeping crackdown on healthcare fraud, former True Health Diagnostics CEO Christopher Grottenthaler has agreed to pay $4.25 million to resolve allegations of Laboratory Kickback Fraud Settlements to physicians for lab test referrals. The Department of Justice also secured $1.8 million in additional settlements from two doctors and seven marketers across Texas, accused of disguising kickbacks as investment distributions through Managed Service Organizations (MSOs). The scheme involved payments masked as consulting fees, handling charges, and copay waivers, targeting federally funded programs including Medicare, Medicaid, and TRICARE. Despite internal warnings about legal risks, Grottenthaler allegedly continued … Read More

Your Right to Access Patient Records and What to Do When Providers Fail to Comply

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Access to your patient medical records is a fundamental right under the Health Insurance Portability and Accountability Act (HIPAA) in the United States. These records are critical for ensuring continuity of care, monitoring your health, and detecting potential issues like medical fraud, such as falsified diagnoses or billing for services not rendered. Unfortunately, some healthcare providers may delay or fail to provide these records, which can raise red flags about transparency or even fraudulent practices. In this post, we’ll explore what providers are required to do when you request your medical records, the timelines for compliance, how to request records … Read More