Health Care Fraud

Health care fraud is in the news virtually every day, with cases ranging from doctors and other medical professionals billing for procedures that are not medically necessary, billing for services that were never performed, or “upcoding” services to a higher level in order to increase revenues. This type of fraud costs the government and, by extension, U.S. taxpayers about $60 billion a year.

Ashcraft & Gerel has significant expertise in the area of health care fraud, including:

Billing for Unnecessary Medical Services

Doctors–and other medical professionals–may perform procedures that are medically unnecessary to increase their income and profits. These cases have serious consequences for patients and for government health benefit programs, like Medicare and Medicaid.


Medicare and Medicaid reimburse providers based upon CPT (for physician practices) and DRG (for hospitals) codes that are assigned by the American Medical Association to different procedures and office visits. Providers commit fraud when they “upcode” a procedure, office visit or hospital stay to a higher level CPT code to increase their reimbursement. Billing Medicare or Medicaid for services not provided violates the FCA as well.


It is a violation of the federal Antikickback Statute (“AKS”) for hospitals, nursing homes, or other providers to offer or pay doctors and other medical professionals money or other items of value (such as free office space or staff) in exchange for the referral of patients. Similarly, doctors are prohibited by the federal Stark Law from referring patients to hospitals or other institutional providers in which they have a financial interest.

Examples of Results That We’ve Obtained In Past Health Care Fraud Cases

Our Qui Tam and Health Care Fraud team, made up of lawyers who have experience dealing with the multiple details associated with health care fraud cases, have obtained $millions in settlements over the past few years. Here are just a few examples:

$35 Million Settlement from Georgia Healthcare Provider
Ashcraft & Gerel Health Care Fraud Attorney Nathan M. Peak represented a whistleblower in two federal False Claims Act cases that settled for $35 million, to be paid over time by the Defendants, Columbus Regional Healthcare System (CRHS).  The settlement resolves two separate cases that allege CRHS violated the Stark Law regarding its physician compensation practices, as well as allegations involving the “upcoding” of certain services by physicians.

$4.5 Million Settlement from Virginia In-Home Therapy Provider
A Virginia federal judge ordered an in-home therapy provider and its owner to pay treble damages of $4.5 million to the U.S., Virginia and a whistleblower over a two-year Medicaid scheme.  The whistleblower, Tamika Nottingham, sued Delores Freeman Thomas and her company New Season Clinical Services LLC in June 2011, claiming Thomas received $1.5 million in Medicaid payments she wasn’t entitled to by submitting thousands of false pre-authorization documents for in-home therapy and mental health support services. Ms Nottingham was represented by Ashcraft and Gerel’s healthcare fraud team.

$2 Million Settlement from Patient Lift Provider
A&G’s Nathan M. Peak represented whistleblower Per Bukh in a qui tam case against Guldmann, Inc. which settled for a total of $2 million. The settlement resolves claims that Guldmann, Inc. 1) sold patient lift systems to Veterans Administration hospitals that violated the FAR/GSA pricing obligations under Guldmann’s government contract; and 2) Guldmann, Inc. sold patient lift systems to the Veterans Administration that were manufactured in countries that violated the Trade Agreements Act (TAA).

Do You Have Information Regarding Potential Health Care Fraud?
Contact Us Today at 1-855-379-0385

Our health care fraud lawyers encourage you to know your rights, and to report fraud against the government and others in the health care industry. If you have information about doctors or other medical professionals being involved in any of the types of fraud described above, contact us today at 855-379-0385 or simply fill out the form below for a free, confidential consultation.



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