CMS/Medicare

GREENVILLE, South Carolina—Jeffrey Brooks, 40, of Clarence Center, New York, was sentenced to more than seven years in federal prison after pleading guilty to one count of conspiracy to commit health care fraud. In addition to Brooks’ criminal conviction, last year, Brooks paid $850,000 in a civil settlement to resolve allegations that he provided kickbacks and caused false claims to be submitted in violation of the federal False Claims Act.

KANSAS CITY, Missouri—A Columbia, Missouri physician has been indicted by a federal grand jury for making false statements relating to Medicare orders.

Jerry Joseph Bruggeman, 52, was charged in a 13-count indictment returned by a federal grand jury in Kansas City, Missouri, on Tuesday, Jan. 23.

LYNCHBURG, Virgina—A November 2023 indictment, returned under seal by a federal grand jury in Roanoke, Virginia charging nine people with health care fraud conspiracy, money laundering and obstruction of justice, has been unsealed following the arrest and initial court appearances of all nine defendants. 

ARIZONA—Atlantic Home Health Care LLC (AHH), a home health care agency operating in Arizona and eight other states, has agreed to pay $9,990,944 to resolve allegations that it violated the False Claims Act by submitting false claims to the Energy Employees Occupational Illness Compensation Program (EEOICP or the Energy Program), a health care program administered by the Department of Labor (DOL) for the benefit of Department of Energy employees and contractors with occupational illnesses.

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MIAMI—A Florida woman was sentenced to 20 years in prison for her role in a scheme to defraud Medicare by submitting more than $192 million in claims for genetic tests and durable medical equipment that patients did not need and telemedicine visits that never occurred. 

NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services - Office of Inspector General (HHS-OIG), announced the arrests of Erin Foley and Ted Albin on charges of health care fraud and conspiracy to violate the Anti-Kickback Statute.

LOUISIANA—A Louisiana man was sentenced to three years in prison for his role in a multi-year scheme to bill Medicare and Medicaid for medically unnecessary durable medical equipment (DME).

MIAMI—A federal grand jury in Miami returned an indictment charging a Texas man for his alleged role in a $60 million health care fraud, wire fraud and kickback scheme involving the submission of false and fraudulent claims to Medicare for medically unnecessary durable medical equipment (DME), genetic tests and foot bath medications.

WASHINGTON—Centers for Medicare & Medicaid Services (CMS) has published the Consumer Price Index for All Urban Consumers (CPI-U) adjustments for the Calendar Year 2024 DMEPOS fee schedule.

LOS ANGELES—A South Bay woman has been sentenced to 180 months in federal prison for billing Medicare more than $24 million by submitting fraudulent claims for medically unnecessary durable medical equipment (DME)—mostly power wheelchairs (PWC)—and PWC repairs, many of which were never performed, the Justice Department announced.

SPOKANE, Washington—Vanessa R. Waldref, the United States Attorney for the Eastern District of Washington, announced that Thomas Andrew Webster, M.D., age 50, of Sylvania, Ohio, has been charged by Filing of Information on one count of Conspiracy to Violate the Anti-Kickback Statue in connection with a fraudulent medical supply scheme that targeted elderly Medicare and TRICARE beneficiaries throughout Washington and in other states.

FLORIDA—Last week, the Florida American Health Care Association (AHCA) released its updated durable medical equipment (DME) Medicaid fee schedule based on state budget legislation that provided the first broad-scope DME reimbursement increase in 23 years, the American Association for Homecare (AAHC) said.

ATLANTA—A Texas man and owner of two durable medical equipment (DME) companies has pleaded guilty to conspiracy for his role in a scheme to pay illegal kickbacks, resulting in more than $20 million submitted in claims to, and $11 million in payment from, Medicare.

ATLANTA—Brett Weiner and Valerie Desalvo have pled guilty to federal conspiracy charges for their role in buying and selling fake doctors’ orders used to obtain over $1.5 million in fraudulent payments from Medicare.

WASHINGTON—On Monday, Nov. 6, the Biden-Harris Administration proposed steps to fix Medicare Advantage's (MA) use of prior authorization as well as curb predatory marketing within MA plans.

NEWARK, New Jersey—The owner of a marketing company located in India admitted his role in conspiracies to commit healthcare fraud and to pay and receive illegal kickbacks, Attorney for the United States Vikas Khanna announced.

PELHAM MANOR, New York—Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), announced the unsealing of a five-count Indictment charging Manishkumar Patel in connection with a health care fraud and kickback scheme involving the sale of fraudulent prescriptions.

WASHINGTON—The Justice Department announced charges against a former executive at HealthSun Health Plans Inc. (HealthSun)—a Medicare Advantage organization that operates Medicare Advantage plans in South Florida—for her role in a multimillion-dollar Medicare fraud scheme. 

WASHINGTON— In what was called a "big win" by the American Association for Homecare (AAHomecare) the Centers for Medicare & Medicaid Services (CMS) published a change request (CR) directing DME MACs to adjust their local edits to allow for 90-day billing for continuous glucose monitor (CGM) supplies to align with blood glucose monitor supplies.

LEXINGTON, Kentucky—Oxygen Plus, Inc., a provider of durable medical equipment (DME) based in Floyd County, Kentucky, has agreed to pay $200,000 to resolve allegations that it violated the False Claims Act by fraudulently billing Medicare and Medicaid for respiratory devices that patients did not need or use, in contravention of those programs’ requirements.