BCBS of Texas Ordered to Pay $21 Million for “Willful Conduct of Fraud”

A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital in unpaid insurance claims because of “acts to be willful conduct of fraud,” according to the Times Record News in Wichita Fallas. Bobby Burnett, the presiding judge of the 50th District Court of Texas, also placed a temporary restraining order against BCBS, according to a release from Knox County Hospital District. The restraining order says it was placed because BCBS willfully secured funds that did not belong to them, they engaged in slanderous activities, breached duty of care, and… Full Story

Father and Son Sentenced in Blue Cross Blue Shield and American Airlines Hearing Aid Fraud

A hearing aid scam targeting American Airlines employees has landed a father and son in federal prison for 15 years, AP reports. Prosecutors say the men made false claims on behalf of the airline employees for unneeded hearing aids that were sometimes never delivered, AP reports. Many of the fraudulent hearing tests lasted less than five minutes and were done in a break room at DFW International Airport. Terry Lynn Anderson, 69, was sentenced to eight years in prison and ordered to pay 13.7 million to Richardson-based Blue Cross Blue Shield of Texas. His son Rocky Freeland Anderson, 38, was sentenced to… Full Story

Judge Dismisses Baylor Scott and White False Claims Lawsuit

Baylor Scott and White Health has escaped an lawsuit alleging they upcoded claims after a Texas judge dismissed a False Claims lawsuit, according to Law360. The whistleblower lawsuit claims BSW was responsible for more than $61.8 million in fraudulent claims to medicare over seven years. Filed in 2017, the claim says BSW’s medical director led the effort to increase higher billing codes without medical justification. U.S. District Judge David Ezra said the claimant failed to provide a claim a relief, saying there is nothing wrong with hospitals taking advantage of coding opportunities to increase Medicare payment  that is supported by documentation.… Full Story

Two Garland Physicians Suspended by the Texas Medical Board

Garland physicians Dr. Leovares Antonio Mendez and Dr. Cesar B. Pena-Rodriguez have both been temporarily suspended without notice, as the Texas Medical Board has decided their practice threatens public welfare. The U.S. District Court in Dallas issued a temporary restraining order against Mendez and Pena Rodriguez after finding out that they distributed controlled substances through fraudulent prescriptions to law enforcement between May 2017 and March 2018. Between 2014 and 2019, Mendez handed out other false prescriptions for a variety of schedule II, III, IV, and V controlled substances without any medical purpose. The Fort Worth Star-Telegram reported earlier this month… Full Story

Healthcare Fraudsters Steal $1.1. Million Per Case, Outpacing Other Industries

Dallas was home to the largest healthcare fraud case in the country this year, as guilty verdicts came down for a number of defendants in federal court for $200 million worth of fraud in the Forest Park Medical Center case. Data from the Association of Certified Fraud Examiners shows that when owners and executives commit fraud, healthcare executives take even more than other industries. Healthcare fraud adds to the healthcare costs of everyone, as insurance companies and employers that make fraudulent payments have to get that money from somewhere, often resulting in increased premiums that have contributed to the country’s skyrocketing… Full Story

Forest Park Fraud Trial Results in Guilty Verdicts for Seven

After four days of deliberations, the jury returned guilty verdicts for seven defendants in the federal bribery case involving Forest Park Medical Center. Though a sentencing date has not been set, defendants face between five to 65 years in prison. Announced by U.S. District Judge Sidney Fitzwater, the jury decided that Wilton Burt, Jackson Jacob, Douglas Sung Won, Michael Rimlawi, Shawn Henry, Mrugeshkumar Shah, and Iris Forrest took part in the conspiracy to pay or receive healthcare bribes. After the verdict announcement, the Dallas Morning News described how Assistant U.S. Attorney Katherine Pfeifle requested that all defendants be detained on… Full Story

Forest Park Defendant: “That’s Not How it Works”

The Forest Park Medical Center trial continued Friday morning, with testimony from Dr. Michael Rimlawi, one of the 10 remaining defendants in the alleged $40 million kickback scheme at the for-profit hospital. Testimony was focused on the nature of the payments that were made to physicians. The government attempted to frame these payments as kickbacks that were connected to the volume of value of surgeries done at the hospital, while Rimlawi vehemently denied it. Rimlawi is the director and founder of the Minimally Invasive Spine Institute, and had operating privileges at the now bankrupt hospital. Rimlawi made the news when… Full Story

Feds Don’t Act on Whistleblower Lawsuit Against Medical City Parent Company

A whistleblower lawsuit accused Medical City Healthcare parent company HCA Healthcare of bilking the federal government out of millions at their rehabilitation hospitals through inflated or fraudulent billing, Modern Healthcare reports. HCA is no stranger to former employees exposing questionable Medicare billing practices, as it was subject to one of the longest government investigations which began in 1993 and concluded when a settlement was reached in 2002 which cost the hospital chain $1.7 billion, which was the largest health fraud settlement in history at the time. A former occupational therapist alleges that HCA submitted false claims across 18 states, attempting… Full Story

The Government Rests Its Case Against Forest Park

After a morning session on Wednesday, the government rested its case against Forest Park Medical Center. They allege that the for-profit, physician-owned medical center located near Forest Lane and Central Expressway conducted a bribery scheme where it sent payments to doctors to direct surgeries to their facility, resulting in around $200 million in insurance payments between 2009 and 2013. What began as 21 defendants has been whittled down to a weight-loss surgeon, three back surgeons, a pain management doctor, a former top executive and three others affiliated with the hospital, according to the Texas Lawbook. They all deny any wrongdoing,… Full Story

North Texas Hospital CEO Pleads Guilty to Millions in Fraud

Former Palo Pinto General Hospital CEO Harris Brooks pleaded guilty to defrauding BlueCross BlueShield of Texas, CIGNA Texas, and United Healthcare for millions of dollars, according to U.S. Attorney for the Northern District of Texas Erin Nealy Cox. An FBI investigation revealed that Brooks and his co-conspirators used the hospital’s in-network contracts with the insurance companies to defraud them for laboratory services from September 2017 to June 2018. They used a process called pass-through billing, where a physician orders a service but that physician does not actually complete the service for which he or she billed. They submitted claims for allergy… Full Story