Find Corporate Waste

Tag: Medicaid Fraud

  • Brooklyn Clinic Owner Convicted in $52M Health Care Fraud and Kickback Scheme

    Brooklyn Clinic Owner Convicted in $52M Health Care Fraud and Kickback Scheme

    A federal jury in the Eastern District of New York convicted Tony Brown-Arkah, 78, owner of American Medical Centers, a Brooklyn clinic that purported to provide substance abuse treatment, for his role in a $52 million health care fraud, narcotics, and kickback scheme.

    According to the Department of Justice, Brown-Arkah’s clinic illegally prescribed Suboxone, a Schedule III narcotic used to treat opioid use disorder, while allowing drug diversion activity to operate around the clinic. Witnesses testified that patients were directed to sell prescriptions outside the facility, including to a van near the clinic.

    The DOJ said many patients received prescriptions signed by a nurse practitioner in Florida who did not see or speak with them. Patients were also subjected to medically unnecessary testing, while Medicare and Medicaid were billed for services that were not provided or not legitimate.

    Brown-Arkah was also convicted of paying patient kickbacks and receiving laboratory kickbacks tied to unnecessary testing referrals. Prosecutors said he used a shell company and sham contract to conceal the payments.

    The case reflects the DOJ’s continued focus on health care fraud involving addiction treatment, laboratory testing, controlled substances, and federal program billing.

    DOJ Press Release — Clinic Owner Convicted for $52M Health Care Fraud, Illegal Narcotics Distribution, and Kickback Scheme

    DOJ Health Care Fraud Unit

    Find Corporate Waste — False Claims Act

  • Children’s Medicaid Program Hit With $15.2M False Claims Judgment

    Children’s Medicaid Program Hit With $15.2M False Claims Judgment

    The operators of a children’s day treatment program have agreed to a $15,248,240.66 civil judgment in favor of the United States to resolve allegations that they defrauded the Kentucky and Ohio Medicaid programs, according to the U.S. Attorney’s Office for the Eastern District of Kentucky. 

    The settlement involves Recovery Center of Kentucky, LLC, Recovery Center of Ohio, LLC, Recovery Center of Maryland, LLC, Recovery Center of USA, and CEO Dr. Warrick Stewart. The government alleged that the entities violated the False Claims Act, which prohibits submitting false claims for payment to government programs such as Medicaid.

    At issue was the Aspire Day Program, which served children with behavioral and mental health needs in Elizabethtown, Lexington, Louisville, and Radcliff, Kentucky, as well as Cincinnati, Ohio. These programs may include therapy and behavioral health services, sometimes alongside school or other activities.  

    The government alleged that, from August 2022 through June 2025, the Recovery Centers billed Medicaid for children’s time spent on education, recreation, and lunch breaks, even though Kentucky and Ohio Medicaid only covered time spent receiving behavioral health services.  

    The government also alleged that Recovery Center of Kentucky misrepresented staff qualifications to obtain higher Medicaid reimbursements. In some cases, services allegedly performed by lower-level staff were billed as if they had been provided by higher-level licensed professionals. In other cases, the government alleged that certain employees were not qualified to provide day treatment services at all.

    This case began as a qui tam lawsuit under the False Claims Act, meaning private whistleblowers helped bring the alleged misconduct to light. The docket information is United States ex rel. Harned, et al. v. Aspire Day School, LLC, et al., Case No. 3:23-cv-41-GFVT.

    As part of the resolution, Recovery Center entered into a five-year Corporate Integrity Agreement with HHS OIG, requiring strengthened compliance obligations going forward. The civil judgment will be satisfied under terms based on the defendants’ ability to pay.

    Find Corporate Waste tracks cases where taxpayer-funded health care dollars may have been misused through false billing, ineligible recipients, weak oversight, or improper certifications.

     If you have credible information about Medicaid, Medicare, PPP, Provider Relief Fund, or other government-funded health care fraud, your information may help expose waste and recover public money.

  • Takeda to Pay $13.6M Over False Claims Act Allegations Tied to Physician Payments

    Takeda to Pay $13.6M Over False Claims Act Allegations Tied to Physician Payments

    Takeda Pharmaceuticals U.S.A. Inc. has agreed to pay $13,670,921 to resolve False Claims Act allegations involving improper payments to physicians who prescribed Trintellix, an antidepressant medication marketed for major depressive disorder. The Department of Justice said the alleged conduct caused false claims to be submitted to Medicare and other federal health care programs.  

    The settlement centers on the federal Anti-Kickback Statute, which prohibits offering or paying anything of value to induce referrals or prescriptions covered by Medicare, Medicaid, TRICARE, and other federal health care programs.

    DOJ alleged that from January 2014 through October 2020, Takeda paid improper remuneration to health care providers, including speaker honoraria and meals at high-end restaurants, to encourage prescriptions of Trintellix.  

    According to the government, Takeda selected certain providers for its Trintellix speaker bureau and gave them paid speaking opportunities with the intent that those payments and related benefits would influence prescribing decisions.

    The DOJ also alleged that some prescribers attended multiple programs on the same topic, received meals and drinks, and gained no real educational value from repeated attendance.  

    The case is important because it shows how False Claims Act liability can arise even when the drug itself is legitimate and the prescription may appear ordinary on paper. The issue is not simply whether a medication was dispensed. The issue is whether federal health care dollars were tainted by payments, perks, or side benefits that improperly influenced medical judgment.

    Assistant Attorney General Brett Shumate said that the DOJ remains committed to pursuing False Claims Act violations arising from illegal kickbacks, warning that such conduct can undermine patient trust and increase drug costs for taxpayers. The Eastern District of California, HHS-OIG, and the Defense Criminal Investigative Service also participated in the investigation.  

    This settlement also fits into DOJ’s broader enforcement posture. The release specifically ties the case to the Administration’s Task Force to Eliminate Fraud and the National Fraud Enforcement Division, both aimed at fraud, waste, and abuse in federal programs. DOJ emphasized that False Claims Act enforcement remains central to recovering taxpayer dollars and holding wrongdoers accountable.

    The Takeda settlement is another example that shows how federal fraud may not always look like a fake business or a forged invoice. Sometimes it involves more sophisticated schemes like a polished compliance program, a speaker event, a catered dinner, or a repeat “educational” session that quietly changes prescribing incentives.

    Find Corporate Waste exists to help taxpayers, whistleblowers, and concerned insiders spot the patterns others miss.

    If you have information about improper billing, kickbacks, false certifications, pandemic relief abuse, or corporate conduct that may have caused taxpayer money to be wasted, we want to hear from you. Federal fraud often hides behind paperwork that looks clean on the surface. The more people come forward, the harder it becomes for corporations to treat public money like private profit.

  • FCW Welcomes DOJ FOCUS Initiative to Combat Waste, Fraud, and Abuse With Data Science

    FCW Welcomes DOJ FOCUS Initiative to Combat Waste, Fraud, and Abuse With Data Science

    The Department of Justice’s Civil Division has announced the new FOCUS initiative, short for Fraud Oversight through Careful Use of Statistics. The initiative is aimed at data miners who use public government records to identify potential False Claims Act cases. Find Corporate Waste has developed a sophisticated methodology for addressing Medicare Fraud committed during the COVID-19 Pandemic.

    DOJ Is Recognizing What Serious Data Miners Already Know

    For years, traditional whistleblower cases have often depended on insiders: employees, contractors, billing staff, compliance officers, or executives who saw misconduct from the inside.

    Under the leadership of Acting Attorney General Todd Blanche, the federal government now appears to be recognizing that some fraud patterns can also be found by carefully analyzing public records, payment data, provider databases, and regulatory rules.

    DOJ made clear that it welcomes data miners, but not sloppy work. The Department says it will prioritize data miners who can explain their methodology, validate their findings, understand the relevant program rules, and identify legally sufficient False Claims Act matters.  That is exactly the standard serious public-record investigators should want.

    FCW Welcomes the FOCUS Initiative

    At Find Corporate Waste, we welcome the FOCUS initiative because it encourages a disciplined approach to public-data fraud detection.

    The point is not to accuse every recipient of federal funds of wrongdoing, rather the FOCUS is to identify situations where public records raise a serious, documentable question about whether federal money was obtained or retained in violation of program rules.

    That requires matching payment data to eligibility rules, compliance obligations, provider identifiers, corporate records, exclusion data, licensing data, and other government sources.

    Why PRF Data Deserves Careful Review

    One area FCW plans to continue reviewing is the Provider Relief Fund, commonly known as PRF.

    The PRF was created to support healthcare providers during the COVID-19 emergency. Public PRF data identifies providers that received and accepted payments and agreed to the applicable Terms and Conditions. HRSA has stated that public PRF data reflects providers who received one or more payments, attested to receiving at least one payment, and agreed to the related Terms and Conditions.  

    That attestation piece is important.

    When a provider accepts federal relief money and agrees to Terms and Conditions, the question becomes whether the recipient was actually eligible, whether the money was properly retained, and whether any later reporting or compliance obligations were satisfied.

    How the Medicare Opt-Out Database Fits In

    FCW also plans to use the Medicare Opt-Out Affidavits database as part of its review process.

    The CMS opt-out dataset identifies providers who have decided not to participate in Medicare. CMS states that the dataset includes information such as provider NPI, specialty, address, and opt-out effective dates.  

    That database is useful because PRF payments were connected to healthcare providers operating within federal healthcare programs and subject to specific eligibility and compliance rules.

    If public PRF records appear to overlap with Medicare opt-out records, that does not automatically prove fraud. But it does create a legitimate line of inquiry worth reviewing.

    The key is timing, identity, and rule application.

    Data Mining Is Not Guesswork

    The strongest False Claims Act cases are built on public records.

    The goal is to determine whether a public-data anomaly is just an innocent mismatch, a clerical issue, or a real compliance problem involving federal funds.

    That distinction matters. It protects honest providers. It also helps the government focus on cases that are actually worth pursuing.

    Why This Matters for Taxpayers

    COVID-era relief programs moved enormous sums of federal money very quickly. Many recipients used those funds properly. Others may not have.

    The False Claims Act exists because public money comes with rules. When companies or providers accept federal funds, they do not get to ignore the conditions attached to those funds.

    The DOJ’s FOCUS initiative sends a clear message: public data can help uncover fraud, but only when it is used responsibly.

    FCW’s Position

    FCW welcomes DOJ’s FOCUS initiative and supports a high standard for data-driven False Claims Act work.

    Public records are an untapped way to identify waste, fraud, and abuse that would otherwise remain obscure and buried.

    Think You Have Information About Federal Healthcare Fraud?

    If you worked for a provider, billing company, healthcare contractor, clinic, management company, or related entity that received federal funds during the COVID-19 period, your information may matter.

    FCW reviews public records and potential False Claims Act leads involving federal healthcare payments, relief funds, and government program compliance.

    Whistleblowers play a major role in protecting taxpayer money. In many cases, relators who bring successful False Claims Act cases may be eligible to receive a share of the government’s recovery.

    If you have credible information about federal funds being obtained, retained, or reported improperly, FCW can help evaluate whether the facts may warrant attorney review.

    Find Corporate Waste exists to help turn public records into accountability.

  • Michigan Health Care Provider Ordered to Pay $334,807 to Settle False Claims Act Allegations

    Michigan Health Care Provider Ordered to Pay $334,807 to Settle False Claims Act Allegations

    In the Eastern District of Michigan, M&Y Care, LLC, a Michigan-based home health provider, has agreed to pay $334,807.20 to resolve allegations that it defrauded the Medicare and Medicaid programs by billing for services rendered by unqualified staff.

    According to the Department of Justice, M&Y Care caused the United States Government to be billed for services provided by unqualified staff. Using the incorrect CPT code, G0156, which refers to a home health aide, they defrauded the federal government for services at a reimbursement rate higher than the non-skilled rate to which their employees were entitled.

    The misconduct came to light thanks to a False Claims Act lawsuit filed under the law’s qui tam provisions. The investigation was prompted by a whistleblower complaint under the False Claims Act (FCA), showing the critical role private citizens play in holding corporations accountable for wasting our money.

    At Find Corporate Waste, we applaud this outcome and the whistleblower who made it possible. Every time a company siphons money from Medicare or Medicaid, they are not just defrauding a system—they are stealing from the sick, the elderly, and the taxpayer.

    We are committed to ensuring that fraud like this doesn’t go unanswered.

    If you have information about misconduct involving government programs or contracts, visit our page on how whistleblowers protect public funds. You might be the reason the next $300,000 gets returned to the American people.

    • Contractors to Pay $3.6M Over False Veteran-Owned Small Business Certification

      Two government contractors agreed to pay more than $3.6 million to resolve allegations tied to service-disabled veteran-owned small business set-aside contracts, with the whistleblower set to receive more than $680,000.

    • Louisiana Woman Pleads Guilty in PPP Kickback Scheme

      A Louisiana woman admitted to helping recruit ineligible PPP borrowers, create fake tax forms, and collect kickbacks tied to fraudulent pandemic-relief loans.

    • Colombian Woman Sentenced After Stolen Identity Scheme Tied to Voter Fraud and $404K in Benefits

      Colombian national sentenced after prosecutors say a stolen identity was used for voter fraud, federal benefits, Massachusetts IDs, and a passport application.

    • Hawaii Housing Official Sentenced In $11M Affordable Housing Bribery Scheme

      A former Hawaii County housing official received 46 months in prison after the DOJ said affordable housing agreements worth more than $11 million produced no housing units and nearly $1.93 million in bribes and kickbacks.

    • Delco Woman Pleads Guilty in $7.17M EIDL Fraud-Proceeds Laundering Scheme

      Pennsylvania woman pleads guilty in $7.17M laundering conspiracy tied to fraudulent EIDL proceeds, business email compromise funds, and sham company accounts.

    • Oglethorpe Pays $32M Over Medicare Overpayment Allegations

      Oglethorpe and top executives agreed to pay $32 million over Medicare overpayment allegations tied to psychiatric hospital admissions.

    • Georgia Man Gets 37 Months in $441K COVID Relief Fraud Case

      Brian Graham was sentenced to 37 months and ordered to pay more than $441,000 after prosecutors said he used false PPP and EIDL applications for personal benefit.

    • Brooklyn Clinic Owner Convicted in $52M Health Care Fraud and Kickback Scheme

      Brooklyn clinic owner Tony Brown-Arkah was convicted in a $52 million Medicare and Medicaid fraud scheme involving Suboxone diversion, kickbacks, and false billing.

    • VSoft to Pay Nearly $2.3M Over PPP Eligibility Allegations

      VSoft will pay nearly $2.3 million to resolve DOJ allegations that it improperly obtained a second-draw PPP loan by misrepresenting its employee count.

    • Regions Bank to Pay $4.9M Over Ineligible PPP Forgiveness Approval

      Regions Bank will pay $4.9 million after the DOJ alleged it approved forgiveness for a PPP loan that was not eligible.

  • How States Game the System: Medicaid Fraud and the FMAP Loophole

    Medicaid was originally created as a partnership between the federal government and individual states. The concept was simple: every time a state spends a dollar, the federal government matches a portion of that investment.

    This is known as the Federal Medical Assistance Percentage (FMAP).

    Over time, some states discovered a way to manipulate the system by shifting the burden entirely to the federal government while padding their own budgets.

    How Medicaid Fraud Works

    1. The state taxes hospitals or nursing homes.
    2. The state pays this tax back to the provider as Medicaid reimbursements.
    3. The federal government matches a percentage of the returned funds through FMAP.
    4. The provider gets their money + the FMAP.
    5. The state contributes nothing, while the federal government is on the hook.

    Why It All Adds Up to a Big Problem

    This fraud is one of the major factors contributing to the systemic weakness of our entire healthcare system.

    When states are allowed to run these schemes, Medicaid becomes more expensive, draining money away from the people who actually need help.

    Instead of creating a safety net, the system becomes a slush fund for state coffers—and the federal government (read: taxpayers) gets stuck with the tab.

    At Find Corporate Waste, we dig deep into these kinds of backdoor deals because we believe in a system that’s honest, accountable, and actually works for the people it’s supposed to serve. Not one that lets bureaucrats and politically connected hospitals game the rules for a payday.

    But here’s the thing—we can’t do it alone.

    If you’ve seen this kind of scheme from the inside—maybe you work in healthcare, government, or finance—you might be sitting on information that could make a real difference. Thanks to the False Claims Act, whistleblowers who step forward not only help protect public funds—they may also be eligible for a financial reward if the government recovers money based on their tip.

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