Category Archives: Upcoding

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

 

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

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