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Tuesday, April 21, 2026

Healthcare billing fraud: 12 recent cases - Becker's Hospital Review

From 12 people sentenced for defrauding Blue Cross Blue Shield to a federally qualified health center settling improper billing allegations, here are 12 healthcare billing fraud cases Becker's reported since July 27:

1. Bridgeport, Conn.-based federally qualified health center Optimus Health agreed to pay more than $470,000 to settle improper billing allegations.

2. A federal jury convicted a Maryland physician on five counts of healthcare fraud for submitting more than $15 million in false claims to Medicare and a commercial insurer.

3. A North Carolina lab owner will pay $1.9 million to settle allegations his company overcharged Medicaid for unnecessary drug tests.

4. The owner of a Whittier, Calif.-based medical clinic pleaded guilty to his role in a scheme that fraudulently billed Medi-Cal for $5 million in services that were never performed.

5. Twelve people were sentenced to prison time for participating in a $53 million scheme to defraud Blue Cross Blue Shield.

6. An ambulance company owner was sentenced to 16 years in prison and ordered to pay $388,648 in restitution for his role in a Medicaid fraud scheme.

7. MedStar Ambulance agreed to pay $2.6 million to settle allegations it submitted false claims to Massachusetts' Medicaid program, MassHealth.

8. A Texas medical equipment company owner was convicted of a $5.1 million Medicare and Medicaid fraud scheme.

9. A Virginia pain clinic owner will pay $4 million in restitution for billing Medicare and Medicaid for...



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