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

Medical Fraud Exposed Posted on by  

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

Healthcare Worker Pleads Guilty to Double Billing District of Columbia Medicaid Programs

Medical Fraud Exposed Posted on by  

Defendant Caused Over a $100,000 Loss for Services Not Provided             WASHINGTON – Amstrong Chapajong, 38, of Cheverly, Maryland, pleaded guilty today in U.S. District Court to one count of health care fraud after billing the District of Columbia’s Medicaid program for services never provided.The plea was announced by U.S. Attorney Jeanine Ferris Pirro, FBI Assistant Director in Charge Steven J. Jensen of the Washington Field Office, Special Agent in Charge Maureen R. Dixon of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), and Inspector General Daniel W. Lucas of … Read More

Louisiana Nurse Practitioner Convicted of $12M Medicare Fraud Scheme

Medical Fraud Exposed Posted on by  

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

Medical Fraud Exposed Posted on by  

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

Medical Fraud Exposed Posted on by  

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

Medical Fraud Exposed Posted on by  

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

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Read More

Federal Exclusion Statute –

Medical Fraud Exposed  

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

Medical Fraud Exposed  

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

Physician Self-Referral Law

Medical Fraud Exposed

–The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies. Financial relationships include both ownership/investment interests and compensation arrangements. For example, if you invest in an imaging center, the Stark law requires the resulting financial relationship to fit within an exception, or you may not refer patients to the facility and the entity may not bill for the referred imaging services. “Designated health services” are: … Read More

Anti-Kickback Statute

Medical Fraud Exposed

Don’t do it.  Paying for referrals is a crime. The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients). Remuneration includes anything of value and can take many forms besides cash, such as free rent, expensive hotel stays and meals, and excessive compensation for medical directorships or consultancies. In some industries, it is acceptable to reward those who refer business to … Read More

Identifying and preventing health care fraud

Medical Fraud Exposed

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]

Medical Fraud Exposed

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

Medical Fraud Exposed

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

Medical business owner sentenced to more than 10 years in federal prison for Medicare fraud

Medical Fraud Exposed

Pate was convicted in December 2018 of 33 counts of fraud, identity theft AUGUSTA, GA:  The owner of a Thomson, Ga., medical equipment company was sentenced to more than 10 years in federal prison Tuesday, July 30, for a wide-ranging Medicare fraud scheme. Detra Wiley Pate, owner and CEO of Southern Respiratory LLC, of Thomson, Ga., was sentenced by U.S. District Court Chief Judge J. Randall Hall to 121 months in federal prison for multiple counts of health care fraud, conspiracy to commit health care fraud and aggravated identity theft, said Bobby L. Christine, U.S. Attorney for the Southern District … Read More

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

Medical Fraud Exposed

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

Medical Fraud Exposed

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

Medical Fraud Exposed

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

Medical Fraud Exposed

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

Medical Fraud Exposed

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

Medical Fraud Exposed

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.

Read More

Short Dr. Visit – Is this Cheating?

Medical Fraud Exposed

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

Medical Fraud Exposed

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

Medical Fraud Exposed

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

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

Medical Fraud Exposed

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

Your Rights Under HIPAA

Medical Fraud Exposed

Know Your Rights Empower Yourself with Knowledge Understanding your rights is the first step to protecting yourself from medical fraud. Knowledge is power, and being informed can help you make educated decisions about your healthcare. Most of us believe that our medical and other health information is private and should be protected, and we want to know who has this information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals’ protected health … Read More

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

Medical Fraud Exposed

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

HealthWatch Pain clinics made millions from “unnecessary” injections into “human pin cushions”

Medical Fraud Exposed

Michelle Shaw and her fiancé, Thomas Truss, said in interviews that Pain MD clinics turned patients into “human pin cushions,” requiring them to agree to unnecessary injections near their spines each month or be discharged. The unnecessary injections made many patients feel like "human pin cushions.” These unnecessary injections transformed Shaw and others into "human pin cushions," a term frequently used during the trial. Shaw begrudgingly accepted the injections so she would not lose access to her painkiller prescriptions, but Truss said he refused the injections and was “kicked out”. Unnecessary injections left patients feeling like “human pin cushions" and … 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

Read More

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

Read More