Total FY 2004 False Claim Act
Fraud Settlements & Judgments

Fraud Feasor Amount (in millions $) Date Description of Fraud Medicare Medicaid
Schering-Plough 292 Jul-04 Cheated Medicaid on "best price" for Claritin.   X
Pfizer 152 May-04 Illegal off-label marketing of Neurontin   X
Strategic Resource Solutions (California FCA case) 43.1 Jul-04 Defective work on energy efficiency contract with San Francisco public schools.    
University Washington 35 Apr-04 Overbilling, retroactive billing, billing work performed by interns as if it was performed by doctors. X  
Health America Pennsylvania 29.01 Nov-03 Overcharge of FEHBP on health insurance.    
Schering-Plough (Texas FCA case) 27 May-04 Warrick (generic drug Pfizer subsidiary) submitted false pricing on albuterol asthma inhalant.   X
WorldCom 27 May-04 Charging to the government costs and fees for long-distance telephone services that were not allowable under the contract.    
Tenet Florida 22.5 Mar-04 FCA violations arising from Stark Law violations; improper hospital cost report claims. X  
Travelers and UnitedHealth 20.6 Aug-04 Overbilling, manipulation of records, failure to provide contracted services.    
NEC Computers (Nippon Electric Company) 20.5 May-04 E-rate fraud; overcharges for networking computers in San Francisco public schools.    
Adventist Health System, Sunbelt Healthcare Corporation, three affiliated hospitals and a management company 20.3 Aug-04 Overcharged Medicare and fraudulently billed for ambulance transports that were not medically necessary. x  
Augustine Medical 12.75 May-04 Billing for "Warm Up Wound Care Therapy" product, which turned out to be Saran Wrap and double-sided tape. X  
Montefiore Hospital 12 Mar-04 Improper retention of Medicare overpayments. X  
Quest Diagnostics 11.35 Mar-04 Billing for medically unnecessary laboratory tests. x  
Health Line Clinical Labs 10 Apr-04 Medicare and Medicaid fraud for five specific medically unnecessary blood tests.  X X
CMC Electronics 9.6 Apr-04 Overbilling and use of used parts in Patriot Missile communications system.    
Saint Francis Hospital 9.5 Feb-04 Administrative settlement with HHS after self-disclosure related to durable medical equipment, hospice care, and home health care.    
Cushman & Wakefield 8.4 Sep-04 Underpaid postage due involving a mail presort business they operated.    
Tenet Healthcare Corp. 8.25 Mar-04 Overbilled Medicare for patients who were transferred to other hospitals. X  
Rite Aid Corp. 7 Jun-04 Short-filling prescriptions.   X
Metropolitan Hospital, Grand Rapids, Michigan 6.25 Dec-03 Stark violations, improper records. X  
Banner Health 6.1 Jun-04 False billing for home health care visits that were deemed unnecessary or unreasonable. X  
Boeing 6 Sep-04 Use Russian titanium in contract that required "made in America" sources for F-15 Eagle fighter and the F/A-18 Hornet fighter.    
LA Metro Transport. Assoc. (California FCA case) 5.3 Jun-04 False certification for "Buy American" goods and for minority and women-owned business.    
Bank of China 5.25 Oct-03 Reverse false claims.  Bank financed scheme to falsify origin of mushrooms to avoid anti-dumping duties.    
Vortec 4.6 Aug-04 Falsified hazardous waste research grant.    
Vantage Group 4.5 Oct-03 Misuse of nonprofit postal rates.    
Stephens, Robert 4.25 Jun-04 Defrauded the government of Federal farm payments by creating dummy corporations to increase payment amounts.    
Norwalk Hospital / Valley (Coast) Plaza Doctors Hospital 4.1 Feb-04 False claims to Medicare for expenses not actually incurred. X  
Howmet 4 Oct-03 False claims for helicopter and missile parts that did not meet contract specifications.    
University of California 3.9 Feb-04 Managers of an energy research program at Lawrence Livermore National Laboratory improperly allocated costs to other DOE-funded program at U. of California facility.    
Polaroid 3.2 Mar-04 Polaroid provided false pricing information and certifications.    
Science and Applied Technologies 3.05 Dec-03 False claims regarding advanced anti-radiation guided missile program.    
Majumder, Parthasarathi 3 Apr-04 Illegal reimbursement for political contributions charged to government defense contracts.    
Educators Mutual Insurance 2.86 Aug-04 Violation of Medicare Secondary Payer law on kidney transplants and dialysis services. X  
Wal-Mart 2.8 Feb-04 Short-filling prescriptions.   X
Kerlan-Jobe Orthopedic Clinic 2.65 Jan-04 Overpayments for doctor visits and medical procedures. X & Tricare X
Johns Hopkins 2.6 Feb-04 Non-compliance with federal research effort reporting regulations.    
Radiology Regional Center (Miami) 2.53 Jun-04 Submission of false bills for services not ordered by physician (MRIs, ultrasound, reconstruction). X  
Harvard & Beth Israel 2.4 Jun-04 Misuse of research and training grants for paying salaries and expenses.    
Cleveland Clinic Home Care 2.3 Jan-04 False cost report claims for non-home-health costs associated with Meridia Health System. X  
University of Chicago 2.3 Nov-03 False claims relating to patient eligibility for liver transplant services. X  
Downey Regional Medical Center (DRMC) 2.22 Aug-04 Claimed and received reimbursement from Medicare of expenses which were non-allowable and non-reimbursable pursuant to Medicare regulations, including certain lobbying, legal, and marketing expenses. X  
Photon Research Associates 1.9 Oct. 7 -04 Software company deliberately overcharged U.S. defense and intelligence agencies for labor costs on government contracts dealing with satellite tracking and target detection.
   
KidsPeace 1.8 May-04 Fraud involved billing for "teaching" kids with emotional and behavioral problems while they commuted to school on buses, and for trips with no education value (i.e. they were strictly recreational).    
Northrop 1.8 Apr-04 Faked test results of flight data transmitters for cruise missiles.    
St. Louis University 1.8 Oct-03 Services provided by interns billed as doctors. X X
Shelby Memorial Hospital. 1.75 Jan-04 Improper coding of claims to Medicare. X  
Bondcote 1.7 May-04 Certified they did not use toxin on military tents, but in fact did.    
Hale Nani Rehabilitation and Nursing Center (Beverly) 1.7 Dec-03 Falsification of records, irregular patient prescription practices, and kickback schemes for pharmaceuticals.    
Western Maryland Health (Ascension) 1.6 Nov-03 Upcoding; billing for unauthorized high-risk procedures. X  
Cathedral Health care 1.5 Nov-03 Billing inpatient rates for outpatient services. X  
Ernst & Young 1.5 Jul-04 Encouraging and abetting blood testing fraud in nine hospitals.    
FFIA (Farallon Fixed Income Associates) 1.5 Aug-04 Misuse of federal resources on Harvard University project to assist the Russian economy.    
Gallichia Medical Group 1.5 May-04 Performing medically unnecessary services.    
Highmark 1.5 Apr-04 Veritus division tampered with and altered Medicare files and claims information to improve its performance on Medicare evaluations. X  
Physicians Specialists in Anesthesia 1.4 Jun-04 Anesthesiologist utilized provider number of orthopedic surgery practice to illegally bill Medicare as if services were being performed incident to surgery. x  
Accordis (HMS Holdings) 1.35 May-04 Firm submitted inaccurate claims for reimbursement to Medicare and California Medicaid while handling billing for Los Angeles County.   X
Baptist Health System 1.3 Mar-04 Lack of physician certification of medical necessity for services. X  
Charleston (WV) Area Medical Center 1.3 Dec-03 Upcoding, services not provided. X  
Payne & Dolan, Inc. 1.18 Jun-04 Submitted false quality assurance and quality control data in connection with two federally-funded road construction projects in Michigan.    
National Mentor Health Care 1.17 Feb-04 False claims to New Mexico Medicaid for services not provided.   X
Keystone Health Plan East 1.08 Jul-04 Used noncompliant methodology to develop the rates charged to the Federal Employees Health Benefits Program (FEHBP), failing to give the FEHBP the most favorable rates Keystone gave to a similarly situated commercial customer.    
Omnicare of Maine 1.08 Sep-04 Illegal drug switching by pharmacy to defraud Medicaid. Patients switched from tablets at $15.10 per month to capsules at $82.77 per month.   X
Doctor's Choice Medical Equipment of Largo 1 Sep-04 Double-billed and submitted invoices for phantom medical equipment.    
Emsco Billing Services 1 Jul-04 Over-billing Medicare and Medicaid for emergency room services, billing at highest possible rate regardless of services provided. Upcoding was only done on when government was the payer. X X
Intrepid of North Carolina 0.87 Oct-03 Home health care services not provided or documented.   X
MountainStar Health 0.86 Feb-04 Filing false government medical insurance reports and paying kickbacks to doctors. MountainStar health is a Utah hospital owned by HCA.    
Stony Brook University Hospital (SUNY) 0.85 Feb-04 Double billing for pharmaceuticals. X  
General Health System, Baton Rouge 0.75 Oct-03 Nursing home failure of care   X
Magid Glove & Safety Manufacturing Co. 0.72 Oct-03 Intentionally substituted work gloves that were lower in cost and quality than the products that had been ordered, but charged the higher prices.    
Market Street Mortgage Corp. 0.7 Aug-04 Submitted false and fraudulent claims to the Department of Housing and Urban Development and the Department of Veterans Affairs to seek reimbursement for losses arising from foreclosures on government insured or guaranteed mortgage loans written by the company.    
Fischer & Fischer 0.68 Mar-04 False claims about legal services related to mortgage foreclosures.    
Rhode Island Hospital 0.63 Feb-04 Medicare upcoding. X  
Community Medical Center 0.52 Jun-04 Pneumonia upcoding.    
EastRidge Health (WV) 0.5 Apr-04 Overbilling for mental health services.    
Starett Co. (L.S. Starett Co.) 0.5 Sep-04 "Rapid Check" coordinate measuring machines used to measure components in aerospace, automotive and other products were defective.    
Lighthouse Medical Management 0.49 Jan-04 Unnecessary ambulance transportation for routine dialysis services. X  
SAIC 0.48 Mar-04 Misrepresentation on progress of computerization project.    
Columbia University 0.48 Oct-03 Billing for ineligible services & upcoding X X
Cooper Union (SUNY) Health System 0.48 Nov-03 Services not provided by faculty members at Cooper University Hospital. X  
SunGard Employee Benefit Systems 0.43 Mar-04 Overstated labor costs under subcontract.    
Nassau County (Nassau County Medical Center) 0.39 Apr-04 Overbilled Medicare for psychiatric services, including unnecessary rounds and for monitoring of medications never given. X  
Inglis Durable Medical Equipment Company, Inc. 0.34 Jun-04 Billed Medicare for highly specialized motorized wheelchairs when in fact much cheaper wheelchairs were provided. Upcoded accessories and other equipment associated with motorized wheelchairs. X  
Farra, Dr. Raphael 0.29 Dec-03 Multiple claims on 45-170 patients a day at a nursing home; a billing mill.    
Cook, Dr. Richard Allen 0.25 Apr-04 Submitted numerous claims to Medicare and Medicaid for psychotherapy sessions conducted by employees who were not licensed to provide independent psychotherapy and who were not under the immediate supervision of a licensed psychologist. X X
Regency Nursing and Rehabilitation Center 0.23 May-04 False hours and charges unrelated to patient care.    
Thacker, Dr. Vasant 0.2 Mar-04 Medical overbilling and upcoding by charging a "consulting" rate for regular patient visits. X  
American Home Vision 0.13 Mar-04 False Medicare billings from optometry services provided to residents of nursing homes. X  
Ace Moving and Storage 0.05 Mar-04 Overbilling GSA for moving services.    
Daus, Dr. Arthur 0.03 Jul-04 Billing Medicaid and Medicare for multiple office visits when patients made only single visits.   X
Vaughn, Tony 0.02 Sep-04 Travel voucher fraud at Fort Knox, KY.    
TOTAL 909.3