Last week wasn’t an overly busy one in terms of healthcare-related enforcement actions involving laboratories and testing services. However, two of three key cases involved medically unnecessary drug testing services, with the CEO of a Pennsylvania-based pain management clinic facing fraud charges relating to urine drug testing in one case, and the former owner/medical director of a family medical practice in Maine settling false billing charges relating in part to drug testing services in the second case.
A third case illustrated the importance of ensuring correct billing practices after an Illinois hospital was accused in a qui tam whistleblower lawsuit of errors that may have led to it being overpaid for urgent care services. The hospital settled the claims for $12.5 million.
Key Healthcare-Related Enforcement Actions Announced from May 10, 2023 – May 17, 2023
| Date Action Announced | Defendant(s) | Allegations/Charges/Convictions | Result |
| May 11, 2023 | Florentina Mayko | CEO of Pain Medicine of York (PMY) is charged with one count of conspiracy to commit healthcare fraud in relation to an alleged $10 million Medicare fraud scheme involving the ordering and billing of medically unnecessary urine drug tests. These tests were referred to PMY’s in-house lab whenever possible, and of the more than $10 million billed to Medicare, more than $4 million was paid for the tests. | If convicted, Mayko faces a maximum 10 years in prison, a period of supervised release after her prison term ends, and a fine.1 |
| May 11, 2023 | Gary S. Winn, DO | The former owner and medical director of a Maine-based family medical practice was accused of violating the False Claims Act for allegedly billing the federal Medicare program and state Medicaid program for services that were either unreasonable, unnecessary, or not provided, including patient drug testing services. | Settled for $330,607.2 |
| May 12, 2023 | St. Elizabeth’s Hospital of the Hospital Sisters Health System (St. Elizabeth) | Illinois-based hospital was accused in a qui tam lawsuit of committing billing errors relating to urgent care services that may have resulted in overpayment. Once informed of the alleged errors, the hospital cooperated with the Department of Justice’s investigation. | Settled for $12.5 million.3 |
References:
- https://www.justice.gov/usao-mdpa/pr/cambria-county-woman-charged-conspiracy-commit-health-care-fraud
- https://www.justice.gov/usao-me/pr/arundel-resident-agrees-pay-over-330000-settle-allegations-false-claims-act-violations
- https://www.justice.gov/usao-cdil/pr/illinois-hospital-agrees-pay-125-million-settle-allegations-billing-error