Fair 41°
Tag:

Medicaid

News
PA Lab Must Pay $7.3M To NJ After Charging $1,000 For $3 For Drug Tests: Comptroller PA Lab Must Pay $7.3M To NJ After Charging $1,000 For $3 For Drug Tests: Comptroller
PA Lab Must Pay $7.3M To NJ After Charging $1,000 For $3 For Drug Tests: Comptroller A Pennsylvania-based lab has been ordered to pay $7.3 to the state of New Jersey after overcharging New Jersey’s Medicaid program for urine drug testing services, officials said. Atlantic Diagnostic Laboratories (ADL) in Bensalem violated Medicaid regulations when it charged Medicaid as much as $1,035 per drug test while charging other payers as little as $2.38 for the same test, New Jersey's State Comptroller's office (OSC) said citing an audit report. Medicaid paid ADL between $63.40 and $180.40 for these same services. ADL also improperly billed for tests that the physician or …

SHARE

by Cecilia Levine
News
Poor Conditions, Fraud: State Seizes Control Of 2 NJ Nursing Homes Poor Conditions, Fraud: State Seizes Control Of 2 NJ Nursing Homes
Poor Conditions, Fraud: State Seizes Control Of 2 NJ Nursing Homes A pair of South Jersey nursing homes, riddled with poor conditions and alleged Medicaid fraud, have been turned over to the control of an independent receiver, authorities said. The state Comptroller previously suspended the owners of Deptford Center for Rehabilitation and Healthcare and Hammonton Center for Rehabilitation and Healthcare from New Jersey Medicaid. A Superior Court judge ordered the appointment of Allen Wilen of the Eisner Advisory Group, LLC to run the nursing homes effective June 17, according to the New Jersey Comptroller's Office. The judge's appointment means that the r…

SHARE

by Jon Craig
News
NJ Hospital In Financial Duress Given 24 Hours To Draw Up Disaster Plan NJ Hospital In Financial Duress Given 24 Hours To Draw Up Disaster Plan
NJ Hospital In Financial Duress Given 24 Hours To Draw Up Disaster Plan A beleaguered hospital in Essex County has just 24 hours to draw up a financial disaster plan, the state Department of Health ordered. In a letter sent to Carewell Health Medical Center in East Orange, Gene Rosenblum, the director of the Office of Program Compliance paints a dire financial picture for the hospital. CareWell Health Medical Center has low cash on hand, maintains negative operating margins and has cited other issues with emergency cash flow, he said. The hospital has not made any payments for the entire fiscal year for the assessments it owes the Department of Health, accordin…

SHARE

by Sam Barron
News
Bergen Doc Who Said He Treated Medicaid Patients When He Was Not Even In The U.S. Pays Up Bergen Doc Who Said He Treated Medicaid Patients When He Was Not Even In The U.S. Pays Up
Bergen Doc Who Said He Treated Medicaid Patients When He Was Not Even In The U.S. Pays Up A Bergen County doctor and former medical director of the New Jersey Veterans Memorial Home in Paramus busted for "up-coding" and lying about care provided has agreed to pay $700,000, federal authorities said. Arun Sehgal and his Ramsey practice, Preventive & Diagnostic Medical Center P.A., violated the "False Claims Act" by billing patients for more service than they could possibly provide in a single day, or for services that they never provided, U.S. Attorney Philip R. Sellinger said Thursday, Feb. 22. Sehgal and his practice agreed to pay $693,490 plus interest to resolve the three …

SHARE

by Cecilia Levine
Police & Fire
Disgraced Owner Of Failed NJ Nursing Home Chain From NY Admits Stiffing IRS Out Of $39M: Feds Disgraced Owner Of Failed NJ Nursing Home Chain From NY Admits Stiffing IRS Out Of $39M: Feds
Disgraced Owner Of Failed NJ Nursing Home Chain From NY Admits Stiffing IRS Out Of $39M: Feds 𝗨𝗣𝗗𝗔𝗧𝗘: A onetime insurance broker from Rockland County who ran a nationwide network of nearly 100 nursing homes into the ground from an office over a Bergen County pizzeria admitted that he purposely shorted the IRS nearly $39M, federal authorities said. Joseph Schwartz, 64, of Suffern, owned Skyline Management Group, which was based in the Wood-Ridge and amassed 95 nursing homes across 11 states. These once included Hudson View Care & Rehab Center in North Bergen, Brookhaven Health Care Center in East Orange and the Voorhees Care & Rehabilitation Center. Over a period of only sev…

SHARE

by Jerry DeMarco
Police & Fire
Phone Scammer From Atlantic City Who Preyed On Recently Widowed Seniors Pleads Out: US Attorney Phone Scammer From Atlantic City Who Preyed On Recently Widowed Seniors Pleads Out: US Attorney
Phone Scammer From Atlantic City Who Preyed On Recently Widowed Seniors Pleads Out: US Attorney A heartless public housing tenant from Atlantic City admitted that she scammed elderly victims out of more than $100,000 by claiming that they owed money on life insurance policies bought by a spouse who’d just recently died. Victoria Crosby, 46, was receiving Social Security and Medicaid benefits when she targeted the victims, all of whom were over 70 years old, U.S. Attorney Philip R. Sellinger said. Crosby called the seniors on a burner phone and, using phony names, claimed to be an employee of a retirement benefit office in some instances and a life insurance company in others, the U.S.…

SHARE

by Jerry DeMarco
Police & Fire
$70K Fraud Scheme Racks Up Charges For Hudson County Woman: Prosecutor $70K Fraud Scheme Racks Up Charges For Hudson County Woman: Prosecutor
$70K Fraud Scheme Racks Up Charges For Hudson County Woman: Prosecutor A 47-year-old Hudson County woman was arrested in a $70,000 healthcare fraud scheme, authorities said. Nicole Saunders, of Union City, failed to report income from a business she owns, resulting in an unlawful payment of more than $70,000 in medical benefits from NJ FamilyCare between 2017 and 2021, Hudson County Prosecutor Esther Suarez said. Saunders was arrested Tuesday, July 25, by members of the Hudson County Prosecutor’s Office Insurance Fraud Unit. She was charged with theft by deception and false reporting to Medicaid. Saunders was released on a summons pending her&n…

SHARE

by Cecilia Levine
Police & Fire
Passaic Woman Conspired To Obstruct Federal Investigation Into Fraudster Dentist Bros: Feds Passaic Woman Conspired To Obstruct Federal Investigation Into Fraudster Dentist Bros: Feds
Passaic Woman Conspired To Obstruct Federal Investigation Into Fraudster Dentist Bros: Feds A 26-year-old Passaic County woman was charged in a federal indictment with conspiring to obstruct a grand jury investigation into a pair of Pennsylvania brothers accused of running a multi-million criminal enterprise, authorities said. Susan Malpartida was named in the 42-count indictment against Bhaskar and Arun Savani, who were charged with racketeering, money laundering, healthcare fraud, and a litany of other felony offenses that could see them locked up for hundreds of years each if convicted, the Justice Department announced. A multi-year investigation into the brother…

SHARE

by Mac Bullock
News
Pediatric Dentist, Affiliates In NJ, NY Pay $750,000 For Unneeded Root Canals On Kids Pediatric Dentist, Affiliates In NJ, NY Pay $750,000 For Unneeded Root Canals On Kids
Pediatric Dentist, Affiliates In NJ, NY Pay $750,000 For Unneeded Root Canals On Kids A group of pediatric dentists in New Jersey and New York who were outed by a former worker for conducting medically unnecessary root canals on children agreed to pay more than $750,000 to settle charges against them, authorities in both states announced. Formerly known as HQRC Management Services LLC, the targeted practice was run by dentist Barry L. Jacobson, most recently of Alpine, NJ, they said. It included offices in Teaneck, Wyckoff, and Paterson in New Jersey and in the Bronx, Flushing, Valley Stream, Boro Park, Kingston, Monsey, Albany and Malone in New York. Jacobson and fellow de…

SHARE

by Jerry DeMarco
Police & Fire
Linden Woman Stole $350K In Years-Long Medicaid Fraud Scheme: Prosecutor Linden Woman Stole $350K In Years-Long Medicaid Fraud Scheme: Prosecutor
Linden Woman Stole $350K In Years-Long Medicaid Fraud Scheme: Prosecutor A 39-year-old Linden woman was arrested on accusations she stole nearly $350,000 through bogus Medicaid claims, authorities said. Leslie K. Lassen filed numerous falsified documents with Medicaid in which she under-reported her household income between January 2015 and December 2019, Union County Prosecutor William A. Daniel announced. In June 2020, the Prosecutor’s Office received a trip from the New Jersey Medicaid Fraud Division pertaining to the theft of Medicaid funds by Lassen, said Assistant Prosecutor Melissa Spagnoli, who is handling the case.  Based upon those bogus sub…

SHARE

by Cecilia Levine
News
GUILTY: Fort Lee Doc With Clifton Practice Convicted Of Multi-Million-Dollar Medicare Fraud GUILTY: Fort Lee Doc With Clifton Practice Convicted Of Multi-Million-Dollar Medicare Fraud
Guilty: Fort Lee Doc With Clifton Practice Convicted Of Multi-Million-Dollar Medicare Fraud A rheumatologist from Fort Lee was convicted of billing Medicare and other health insurance programs for nearly a decade for services that patients never got and expensive medication that her Clifton practice never bought, federal authorities said. Alice Chu, 64, went to trial in U.S. District Court in Newark after federal authorities accused her of submitting more than $8.8 million in bogus claims for "items and services that were medically unnecessary, ineligible for reimbursement, and/or not provided as represented," court papers show. Jurors found her guilty on Tuesday, March 8 of consp…

SHARE

by Jerry DeMarco
News
$100M In Medicaid Money Going To NJ's 15 Worst Nursing Homes: Report $100M In Medicaid Money Going To NJ's 15 Worst Nursing Homes: Report
$100M In Medicaid Money Going To NJ's 15 Worst Nursing Homes: Report Shape up or ship out. That's the message New Jersey's Comptroller is sending to 15 of the state's nursing homes, cited in a new report as some of the worst. New Jersey is spending $100 million a year in Medicaid dollars on some of the state's worst nursing homes. And the 15 "one-star" homes named in Comptroller's report released Wednesday have faced little to no consequences -- until now, the organization says. If the facilities don't fix the health and safety issues that they've repeatedly been cited for, they risk being kicked off Medicaid altogether. "Continued funding of these facilit…

SHARE

by Jon Craig
News
Cyber-Casanova From NJ Admits Duping Dozens Of Lonely Hearts Out Of $1.14M Cyber-Casanova From NJ Admits Duping Dozens Of Lonely Hearts Out Of $1.14M
Cyber-Casanova From NJ Admits Duping Dozens Of Lonely Hearts Out Of $1.14M A New Jersey man admitted that he orchestrated an online scam that conned dozens of unsuspecting women on dating sites out of more than a million dollars – and led one of them to suicide. Rubbin Sarpong, 37, of Millville pocketed the money and bought property in Ghana, along with luxury cars, expensive jewelry, top-shelf booze, designer clothes and more, federal authorities said. Then he flaunted it on Instagram. Sarpong had catfishing accomplices, several of whom live in Ghana, Acting U.S. Attorney for New Jersey Rachael Honig said. Posing as American military personnel stationed oversea…

SHARE

by Jerry DeMarco
News
Hudson Doctor's Employee Admits Role In $24.8M Kickback Scheme Hudson Doctor's Employee Admits Role In $24.8M Kickback Scheme
Hudson Doctor's Employee Admits Role In $24.8M Kickback Scheme UPDATE: Dominoes continued to fall in the federal takedown of a $24.8 million kickback scheme when a Jersey City woman who worked for a local doctor took a plea deal. Yudelka “Vicky” Ayala, 42, admitted conspiring with six co-defendants associated with the now-defunct Prime Aid Pharmacy in Union City to boost prescription sales through kickbacks and bribes to health care professionals in New Jersey and New York. Prime Aid, which also had a location in the Bronx, processed expensive medications used to treat various conditions, including Hepatitis C, Crohn’s disease, and rheumatoid arthritis…

SHARE

by Jerry DeMarco
News
COVID-19: Feds Charge NYC-Area Pharmacy Owners In $30 Million Health Care Fraud COVID-19: Feds Charge NYC-Area Pharmacy Owners In $30 Million Health Care Fraud
Covid-19: Feds Charge Nyc-area Pharmacy Owners In $30 Million Health Care Fraud The owners of more than a dozen New York City-area pharmacies exploited the COVID-19 pandemic to scam Medicaid out of $30 million, then used the money to buy themselves real estate and luxury items, federal authorities charged. Peter Khaim, 40, and Arkadiy Khaimov, 37, both of Forest Hills, got others to pose as pharmacy owners or supervisors to take advantage of emergency override codes added to the Medicare system during the national state of emergency, an indictment returned by a grand jury in Brooklyn alleges. They used these to submit fraudulent claims for the expensive cancer medicati…

SHARE

by Jerry DeMarco
News
UPDATE: NJ Hospitals Await First Batch Of COVID-19 Vaccines UPDATE: NJ Hospitals Await First Batch Of COVID-19 Vaccines
Update: NJ Hospitals Await First Batch Of Covid-19 Vaccines NOTE: A spokeswoman for Hackensack University Medical Center said Friday that the hospital hadn't yet received the initial doses of COVID-19 vaccines. "We do NOT have any vaccine at this point nor does anyone else in NJ," said the spokeswoman, Mary Jo Layton. This corrects a previous story published here following what staffers said was a notification that initial shipments of the vaccines had arrived and will continue to do so. ****** HUMC was expected to be among the first hospitals in New Jersey to receive the COVID-19 vaccine. Officials couldn’t provide an exact number, although …

SHARE

by Jerry DeMarco
News
Feds Charge Jersey Shore Pain Management Doc With Massive $24.6M Billing Fraud Feds Charge Jersey Shore Pain Management Doc With Massive $24.6M Billing Fraud
Feds Charge Jersey Shore Pain Management Doc With Massive $24.6M Billing Fraud A Jersey Shore pain management doctor accused of running a $24.6 million fraud scheme billed insurance plans for more than 24 hours worth of services in a single day no fewer than 900 times, federal authorities said Monday. Morris Antebi, 68, of Long Branch, also billed Medicare, Medicaid, and private insurance companies frequently on dates when travel records show he was overseas -- including trips to China, Israel, Turkey, the Dominican Republic and across Europe – and at other times when he was otherwise out of state, U.S. Attorney Craig Carpenito said. Antebi, who specializes in pain ma…

SHARE

by Jerry DeMarco
News
Supreme Court Chief Justice Joins Liberal Minority In Upholding Abortion Rights Supreme Court Chief Justice Joins Liberal Minority In Upholding Abortion Rights
Supreme Court Chief Justice Joins Liberal Minority In Upholding Abortion Rights For the first time since President Trump’s new appointees took their seats, the U.S. Supreme Court issued a pro-abortion decision on Monday. Chief Justice John Roberts, placing precedent over all else, joined the court's four minority liberals in striking down a Louisiana law that would have required doctors at abortion clinics to have hospital admitting privileges. The Louisiana Unsafe Abortion Protection Act, which never went into effect, required abortion doctors in the state to have admitting the privileges at hospitals within 30 miles of the clinics where they worked. The law was simi…

SHARE

by Jerry DeMarco
Police & Fire
‘Hit & Run’ Dentist With Offices In Passaic, Hudson, Union Gets License Pulled, $517,000 Fine ‘Hit & Run’ Dentist With Offices In Passaic, Hudson, Union Gets License Pulled, $517,000 Fine
‘Hit & Run’ Dentist With Offices In Passaic, Hudson, Union Gets License Pulled, $517,000 Fine An oral surgeon who needlessly pulled teeth and exorbitant payments from patients in Passaic, Hudson, Union and Monmouth counties had his license yanked and was fined more than $500,000, state authorities announced Tuesday. Andrew Maron, 58, had been prohibited from practicing in New Jersey since the state filed negligence, gross negligence and professional misconduct charges against him in 2015. Still, he continued to practice in New York, authorities said. New Jersey authorities said they pursued Maron after receiving complaints from no fewer than 17 patients, including a 93-year-old Medi…

SHARE

by Jerry DeMarco
Police & Fire
Paramus Man Who Owned WNY Pharmacy Pleads Guilty To Fraud, Bribery Paramus Man Who Owned WNY Pharmacy Pleads Guilty To Fraud, Bribery
Paramus Man Who Owned WNY Pharmacy Pleads Guilty To Fraud, Bribery A Paramus man who owned a now-closed pharmacy in West New York admitted bribing a psychiatrist and defrauding public and private insurers in a scheme involving high-priced medications, the U.S. Attorney said Monday.  Eduard Shtindler, 36, carried out the bribery scheme for five years beginning in 2012. Schtindler, the owner of the shuttered Empire Pharmacy, sent employees to deliver the payments -- sometimes in the form of $100 bills stuffed into pill bottles -- to the Hudson County psychiatrist in exchange for steering patients to Empire.  Schintdler was heard on a recording refe…

SHARE

by Paul Milo
Police & Fire
Feds: Northeast Opioid 'Pill Mill' Takedown Nets Paramus Pharmacy Owner, Clifton Surgeon Feds: Northeast Opioid 'Pill Mill' Takedown Nets Paramus Pharmacy Owner, Clifton Surgeon
Feds: Northeast Opioid 'Pill Mill' Takedown Nets Paramus Pharmacy Owner, Clifton Surgeon The arrests of a Paramus pharmacy owner and a Clifton orthopedic surgeon earlier this month by federal agents were part of a massive crackdown involving the distribution of over 3.25 million opioid doses in “pill mill” clinics and doctors’ offices throughout the Northeast, the Justice Department said Thursday. A total of 54 defendants – 15 of them doctors -- have been charged for their roles in submitting nearly $800 million in bogus health insurance claims, the Justice Department said. Others include marketing executives, pharmacists, and the owners and operators of a genetic testing labor…

SHARE

by Jerry DeMarco
Police & Fire
Former Union City Pharmacy At Center Of $65M Scam, Authorities Say Former Union City Pharmacy At Center Of $65M Scam, Authorities Say
Former Union City Pharmacy At Center Of $65M Scam, Authorities Say A pharmacy in Union City and another one in the Bronx netted nearly $100 million combined through fraud, kickbacks and other illicit means, the U.S. Attorney for New Jersey said Monday.  Prime Aid Pharmacy established relationships with pharmacy benefit managers (PBMs) to receive reimbursements for medications, including specialized medicines. The PBMs acted as a go-between with Medicare and Medicaid and Prime Aid, authorities said.  Starting a decade ago, principals connected with Prime began paying bribes and kickbacks to physicians and physicians' employees to bolster business …

SHARE

by Paul Milo
Police & Fire
WIRED: Feds Charge Pharmacy Owner From Paramus In $5M Fraud, Bribery Schemes WIRED: Feds Charge Pharmacy Owner From Paramus In $5M Fraud, Bribery Schemes
Wired: Feds Charge Pharmacy Owner From Paramus In $5M Fraud, Bribery Schemes A former Hudson County pharmacy owner from Paramus bribed a local doctor with $100 bills stuffed into pill bottles to steer patients to his business, said federal authorities who took him into custody on Friday -- thanks, in part, to conversations secretly recorded by the FBI. Eduard “Eddy” Shtindler, 36, also produced bogus documents that generated even more income, raking in nearly $5 million in illegal proceeds through both schemes combined, U.S. Attorney Craig Carpenito said in announcing his arrest by the FBI. Federal agents raided Shtindler’s since-closed Empire Pharmacy on Bergenline…

SHARE

by Jerry DeMarco
Police & Fire
Fairfield Generic Drug Maker Among 20 Companies, 16 Individuals Accused In Price-Fixing Scheme Fairfield Generic Drug Maker Among 20 Companies, 16 Individuals Accused In Price-Fixing Scheme
Fairfield Generic Drug Maker Among 20 Companies, 16 Individuals Accused In Price-Fixing Scheme A Fairfield-based generic drug manufacturer was among 20 companies accused of participating in what authorities called “one of the most egregious and damaging price-fixing conspiracies in the history of the United States.”  A complaint filed by the 44 states in U.S. District Court in Connecticut also accuses 16 individuals of participating in the scheme. More than half of the drug companies and five of the individual defendants – all of whom are drug company executives responsible for sales, marketing, pricing and operations -- are from New Jersey. They include Breckenridge Pharm…

SHARE

by Jerry DeMarco
Police & Fire
Mahwah Generic Drug Maker Among 20 Companies, 16 Individuals Accused In Price-Fixing Scheme Mahwah Generic Drug Maker Among 20 Companies, 16 Individuals Accused In Price-Fixing Scheme
Mahwah Generic Drug Maker Among 20 Companies, 16 Individuals Accused In Price-Fixing Scheme A Mahwah-based generic drug manufacturer was among 20 companies accused of participating in what authorities called “one of the most egregious and damaging price-fixing conspiracies in the history of the United States.”  A complaint filed by the 44 states in U.S. District Court in Connecticut also accuses 16 individuals of participating in the scheme. More than half of the drug companies and five of the individual defendants – all of whom are drug company executives responsible for sales, marketing, pricing and operations -- are from New Jersey. They include Glenmark Pharmaceuticals I…

SHARE

by Jerry DeMarco
Police & Fire
Doc From Morristown Falsely Prescribed Adult Diapers In Huge Billing Fraud Doc From Morristown Falsely Prescribed Adult Diapers In Huge Billing Fraud
Doc From Morristown Falsely Prescribed Adult Diapers In Huge Billing Fraud Two medical professionals, including a doctor who lives in New Jersey, were found guilty of helping scam tens of millions of dollars from Medicare and Medicaid in New York, authorities said. Paul Mathieu, 53, of Morristown and Brooklyn resident Hatem Behiry, 51, used three medical clinics to send false claims to the federal programs over the course of a decade beginning in 2017, U.S. Attorney Geoffrey Berman of the Southern District of New York said. Authorities estimate the scam cost the federal government $30 million.  Initially, Mathieu posed as the owner of the three clinics actua…

SHARE

by Paul Milo
Police & Fire
More Than A Dozen From Hudson County Charged In $11M Medicaid Fraud More Than A Dozen From Hudson County Charged In $11M Medicaid Fraud
More Than A Dozen From Hudson County Charged In $11M Medicaid Fraud Several people from Jersey City, Bayonne and elsewhere have been accused of taking part in a scheme in which prescription drugs provided free through the federal Medicaid program were illegally sold to a New York pharmacist, Attorney General Gurbir S. Grewal said Thursday. Elfatih Ibrahim, 58, of Brooklyn, who owns Maxwell Pharmacy in Manhattan, was the ringleader in the bi-state scheme, authorities allege. Ibrahim received prescription medications from patients who got the drugs for free, then sold them for cash to a “runner” who brought them to Ibrahim, the Attorney General’s office said. …

SHARE

by Paul Milo