Feds File Nationwide Lawsuit Against Walgreens

In a civil complaint, the Justice Department alleges that Walgreens knowingly filled millions of prescriptions for controlled substances that lacked a legitimate medical purpose, were not valid, and/or were not issued in the usual course of professional practice. Among the unlawful prescriptions were those for dangerous and excessive quantities of opioids, for early refills of opioids, and for the especially dangerous and abused combination of drugs known as the “trinity,” which is made up of an opioid, a benzodiazepine, and a muscle relaxant. The complaint alleges that Walgreens’ actions helped to fuel the prescription opioid crisis and that some patients died after overdosing on opioids shortly after filling unlawful prescriptions at Walgreens. Read a story from The Associated Press and a Department of Justice press release.

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected].

Man Admits Role in $10 Million Scheme

Adam Wayne Owens admitted his role in a $10 million kickback scheme with testing companies that arranged for at-home cancer genetic (CGx) tests. Owens and his conspirators provided personal and medical information about Medicare beneficiaries to the testing companies, which caused CGx testing kits to be sent to the beneficiaries. Once the tests were completed and returned, Owens’ conspirators submitted claims for reimbursement to Medicare. Read a story from Regtechtimes and a Department of Justice press release.
SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected]. 

Join FTC for Identity Theft Awareness Week

Has someone used your personal information to open accounts, steal your tax refund, or file fake health insurance claims? January 27 to 31 is Identity Theft Awareness Week (IDTAW) 2025. During IDTAW, the Federal Trade Commission (FTC) and its partners work together to share information on what identity thieves want to steal and why, understanding how identity theft happens, and learning how to avoid it. It’s an excellent opportunity to learn and talk about identity theft and raise awareness to help protect yourself, your family, and your friends. Read a story from the Federal Trade Commission.
SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected]. 

Chiropractor Pleads in COVID Scheme

Dennis Michael Peyroux pleaded guilty in connection with a scheme to bill Medicare for over-the-counter (OTC) COVID-19 test kits that were not requested or otherwise ineligible for reimbursement. According to court documents, Peyroux conspired with others to purchase Medicare beneficiary information, including names, Medicare identification numbers, and clearly fabricated recordings of individuals posing as beneficiaries and “requesting” OTC COVID-19 test kits. He agreed to pay over $3.2 million in restitution to Medicare. Read a Department of Justice press release.
SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected]. 

Update: Doctor Sentenced for $70 Million Scheme

In an update to a June 5, 2024, story, David M. Young was sentenced to 10 years in prison and ordered to pay more than $26.6 million in restitution. Read a Department of Justice press release.

Dr. David M. Young was convicted for causing the submission of over $70 million in fraudulent claims to Medicare for medically unnecessary orthotic braces and genetic tests ordered through a telemarketing scheme. According to court documents and evidence presented at trial, Young signed thousands of medical records and prescriptions for orthotic braces and genetic tests that falsely represented that the braces and tests were medically necessary and that he diagnosed the beneficiaries, had a plan of care for them, and recommended that they receive certain additional treatment. Read a Department of Justice press release.

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected]

MEDICARE FRAUD ALERT-ROBOCALLS

Robocall scams can often seem random, but that’s not always the case. Sometimes they are highly targeted — as with older Americans whose Medicare eligibility opens the door to health insurance fraud.

Be aware that bad actors may spoof the number that appears on your caller ID so that an incoming call seems to be from a government agency or a health provider that you already know and trust. They do this to entice you to answer.

When you pick up, a scam caller usually starts chatting you up to engage you, asking you conversational questions to put you at ease. Whatever scam scenario follows, the caller is trying to get your personal information, such as your Medicare card number, your Social Security number, or other health insurance identification.

For your awareness

  • Medicare does not call you uninvited and ask you for personal or private information.
  • You will usually get a written statement in the mail before you get a phone call from a government agency.
  • Calls requesting health insurance information should not be trusted.

Medicare.gov advises that you take the following precautions:

  • Never give your Medicare card, Medicare number, Social Security card, or Social Security number to anyone except your doctor or people you know should have it (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP). Get the contact information for your local SHIP.).
  • Do NOT accept offers of money or gifts for free medical care.
  • Do NOT allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.
  • Never Join a Medicare health or drug plan over the phone unless YOU called Medicare.
  • If someone asks you for your information or for money, or threatens to cancel your health benefits if you don’t share your personal details, hang up and call 1-800-MEDICARE (1-800-633-4227) or visit medicare.gov.

Be vigilant. Scammers can be very convincing, and they may know a little — or a lot — about you, especially if they have access to some of your personal information already. Follow these simple tips to avoid spoofing scams:

  • Do NOT  answer calls from unknown numbers.
  • If you answer and the caller is not who you expected, hang up immediately.
  • Never give out personal information such as account numbers, Social Security numbers, mother’s maiden names, passwords, or any other self-identifying response to an unexpected call.
  • Use caution if you are being pressed for information immediately.
  • If a caller claims to represent a health insurance provider or a government agency, simply hang up. You can then call back using a phone number on an account statement, in the phone book, or on an official website to verify the caller’s authenticity.

Lab and University Resolve Allegations

Laboratory Corporation of America Holdings, Laboratory Corporation of America, Labcorp Tennessee LLC, and University Health System Inc. have paid more than $388,000 to resolve allegations that they violated the False Claims Act by delaying the submission of physician orders for certain laboratory tests by Caris Life Sciences Inc. to enable improper billings to Medicare for those tests. According to filed documents, physician orders for testing were delayed – by either holding orders for submission or canceling and resubmitting orders – until 14 days after a Medicare beneficiary’s discharge from the hospital to circumvent Medicare’s Date of Service Rule. Listen to and read a story from WBIR and read a Department of Justice press release.

 

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected]. 

Telehealth Company Agrees to Pay

CompreCare Health LLC and its affiliates, doing business as Meditelecare LLC, agreed to pay more than $358,000 to resolve allegations of overbilling Medicare. The United States alleged that Meditelecare submitted and caused the submission of claims to Medicare for telehealth psychotherapy sessions that did not meet the minimum time requirements for payments and relied on false time records in support of these same telehealth services. Read a story from the Inside Investigator and a Department of Justice press release.
SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected]. 

Update: Owner of Addiction Treatment Chain Sentenced

In an update to an August 1, 2024, story, Michael Brier has been sentenced to more than eight years in federal prison and ordered to pay more than $3.5 million in restitution. Read a Department of Justice press release.

Michael Brier and Recovery Connections Centers of America Inc. (RCCA) admitted that they failed to provide patients with required counseling sessions and treatment while simultaneously billing Medicare, Medicaid, and other health care payors routinely for 45-minute counseling sessions even though the sessions were often only five to 10 minutes or less. Briar and RCCA also admitted that they caused a fraudulent application to be submitted to Medicare that, among other things, misrepresented and concealed the role that Brier was playing in the business and failed to disclose Brier’s 2013 criminal conviction for federal tax crimes. Read a story from ABC6 and a Department of Justice press release.

 

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected]. 

Woman Receives Scam Calls

After 88-year-old Ruth Ferguson’s doctor told her she needed a medical device to alleviate leg pain, scam calls started. Ferguson said a woman who impersonated a CVS pharmacy wanted to sell her a leg brace. Another caller claiming to represent Medicare said he could provide a cancer-detecting device. Watch and read a story from FOX 13.

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at [email protected].