Nashville Pediatrician Pleads Guilty To False Billing[1]
In late 2013, a prominent Nashville health care provider and pediatrician pleaded guilty to criminal and civil health care fraud for upcoding the services he provided when billing for his services. Over the period ranging from 2007 to 2012, this pediatrician was in the practice of conducting infant auditory screening exams. While the pediatrician was actually providing some services, specifically auditory screens, the auditory screens that were being conducted were not the expensive comprehensive auditory screening exams that were being billed. 

During the investigation, it was found that the pediatrician did not even have the necessary equipment required to conduct the comprehensive exams, and admitted that there were occasions when the members of his staff had informed him that the services billing for were not actually being performed. When his staff requested that the equipment be purchased, the pediatrician denied their request.

The case ended in the pediatrician pleading guilty that included both criminal and civil violations. The pediatrician now must pay more than $1.6 million in restitution and is banned from federal health care programs for a period of 20 years.

New Jersey Pediatrician Guilty of Fraudulent Treatments[2]
A New Jersey pediatrician, Badawy, pleaded guilty of health care fraud for making claims that he was providing services to patients that were fraudulent and in 2015, he was sentenced for those violations. 

As part of the plea, Badawy pleaded to one count of healthcare fraud where the facts showed that over a period of four years (from 2004 to 2008), he submitted claims for superficial wounds around patients’ face and ears that were either not completed or unnecessary. The problem with these services is that they were essentially repairs of previously closed wounds. Many of these treatments were conducted on children.

The penalties that Badawy had to face were no slap on the wrist- Badawy was ordered a prison term for a period 21 months, ordered to serve three years of supervised probation, and was fined $5,000. Additionally, he had to pay restitution in the amount of $196,911, which was the equivalent of the payments he received from Medicaid.

Georgia Pediatric Services Gets Large Fine To Resolve Health Care Fraud[3]
The Georgia Pediatric Services were sued under the False Claims Act for not complying with federal health care requirements and paid a hefty fine in their settlement. As a result of a qui tam/whistleblower suit, authorities was found that Georgia Pediatric Services was failing to conduct inspections of their records. In order to participate in the federal health care program, you must also investigate your records to check for overpayments. If you find overpayments, you must return them.

Georgia Pediatric Services of America did not inspect their books and, naturally, did not return any overpayments. As a result, they and their related entities (four additional locations) had an overage well into the millions that had been overpaid. Overall, it was found that Georgia Pediatric Services failed to return overpayments, submitted claims for home nursing visits without ever actually documenting the visits by a registered nurse, and claimed that their services were taking a longer length of time than the time the services actually required.

These acts ultimately amounted to Georgia Pediatric Services paying around $6.88 million to resolve the health care fraud and False Claims Act allegations

Pediatrician Accused of Giving Improper Doses of Vaccines[4]
A Florida pediatrician whose services included administering vaccines through the Vaccines for Children Program was accused of health care fraud for administering the incorrect dose of vaccines to children that were covered by both Medicaid and private insurance programs. 

The Florida Department of Health has alleged that this Florida pediatrician only gave partial doses of the vaccines she claimed to be providing. These vaccines were to prevent protection from diseases that are classified as “potentially dangerous.”

While the case against this Florida pediatrician is still pending, she has now been suspended from the program. Additionally, she was placed on a corrective plan and was only able to receive a limited amount of vaccinations for a period of two months. So far, this Florida pediatrician has been charged with Medicaid fraud.

Links to the Government Press Releases Discussed Above