Find Corporate Waste

Tag: Medicaid Fraud

  • Brooklyn Adult Day Care Owner Gets 57 Months for $3.2M Medicaid Fraud

    Brooklyn Adult Day Care Owner Gets 57 Months for $3.2M Medicaid Fraud

    Brooklyn adult day care owner Eric Zhu surrendered to federal prison to begin serving 57 months for operating a $3.2 million Medicaid fraud and kickback scheme.

    According to the Department of Justice⁠, Zhu, 29, owned Prime Life Adult Day Care LLC.

    From approximately 2020 through 2025, Prime Life paid Medicaid recipients illegal cash kickbacks to enroll in its social adult day care program. The company then billed Medicaid approximately $3.2 million for services those recipients never received.

    Prosecutors said Medicaid paid the fraudulent claims in full. Zhu used multiple business entities to launder the proceeds and generate cash for the kickbacks. Investigators recovered some of that cash during a search of Prime Life.

    Zhu was ordered to pay nearly $3.2 million in restitution and forfeit another $1.5 million in fraud proceeds.

  • Brooklyn Adult Day Care Operators Accused in $38M Medicaid Kickback and False-Billing Scheme

    Brooklyn Adult Day Care Operators Accused in $38M Medicaid Kickback and False-Billing Scheme

    Federal prosecutors have charged eight defendants in an alleged $38 million Medicaid fraud scheme involving two Brooklyn social adult day care centers: APNA Adult Daycare and Ashiana Social Adult Daycare, according to the New York Post⁠.

    The reported indictment alleges that Medicaid recipients were paid cash kickbacks to enroll, recruiters were paid to bring in beneficiaries, and the centers then billed New York Medicaid for services that were not actually provided. Prosecutors also reportedly allege fake sign-in sheets, Pakistan-based billing support, and shell-company transfers labeled as “gifts,” “dividends,” “medicine,” or “laddu.”

    For Find Corporate Waste, the relevance is the public-funds mechanism: Medicaid claims allegedly tied to false attendance, kickback-driven enrollment, and non-rendered services.

    That is the same fraud structure FCW tracks across taxpayer-funded health care programs, including provider eligibility, billing integrity, ownership/control relationships, and public-payment exposure.

    The case also fits a broader enforcement pattern. DOJ previously announced guilty pleas in a $68 million Brooklyn adult day care fraud scheme⁠ and charged two Queens men in an alleged $120 million adult day care and pharmacy fraud scheme⁠. 

  • DOJ Sues to Stop Alleged Fraud in New York’s $10 Billion Medicaid Home-Care Program

    DOJ Sues to Stop Alleged Fraud in New York’s $10 Billion Medicaid Home-Care Program

    The Department of Justice⁠ filed suit in the Eastern District of New York against the New York State Department of Health, New York Medicaid Director Amir Bassiri, and Public Partnerships LLC over alleged fraud involving New York’s $10 billion Consumer Directed Personal Assistant Program, known as CDPAP.

    CDPAP is a Medicaid home-care program for patients with disabilities or significant medical needs.

    According to the DOJ, in 2024, New York consolidated hundreds of fiscal intermediaries into a single statewide administrator, ultimately awarding the contract to Public Partnerships LLC.

    The DOJ alleges that New York awarded PPL the CDPAP contract through a “sham bid process,” then failed to stop PPL from deviating from the financial limits and representations contained in its bid.

    The lawsuit⁠ also claims PPL and New York misled the public about whether the transition could be completed by April 1, 2025, despite allegedly knowing the timeline was unlikely to be met.

    The complaint alleges that CDPAP served more than 250,000 patients and 300,000 caregivers as of fall 2024. DOJ says the program bills approximately 350 million hours of care each year, meaning even small improper rate changes could generate tens of millions of dollars in unauthorized revenue.

    For Find Corporate Waste⁠, the case reflects the core oversight problem in federally funded health-care programs: public money can be lost not only through false claims, but also through weak contract enforcement, eligibility failures, and unchecked administrative control over taxpayer-funded payment streams.

  • Circle Medical to Pay $3.325M Over Alleged False Healthcare Claims

    Circle Medical to Pay $3.325M Over Alleged False Healthcare Claims

    San Francisco-based Circle Medical Care of California, Circle Medical Technologies, Inc., and Chief Medical Officer Dr. Nicole Tsang, D.O., agreed to pay $3,325,000 to resolve allegations that they submitted false claims to federal healthcare programs and California commercial insurers.

    According to the DOJ⁠, Circle operates an online telehealth platform offering mental health and primary care services through contract providers, including nurse practitioners and physician assistants. The government alleged that from January 1, 2018 through May 31, 2025, Circle submitted claims using the names and NPI numbers of rendering providers who did not actually provide or supervise the services billed. The claims allegedly involved programs including Medicare, Medicaid, and TRICARE.  

    The settlement allocates $475,000 to the United States and $2.85 million to California. The matter began as a qui tam whistleblower case filed by Jason Vellen, who will receive $80,750 from the federal recovery and $997,500 from California.  

    This case fits the broader Find Corporate Waste focus on healthcare payment integrity: claims data, provider identifiers, supervision rules, and federal program billing requirements can expose recoverable taxpayer losses. 

  • Ahold Delhaize USA to Pay $40M Over Allegedly Inflated Pharmacy Prices

    Ahold Delhaize USA to Pay $40M Over Allegedly Inflated Pharmacy Prices

    Ahold Delhaize USA Inc.⁠, the parent company behind supermarket pharmacy brands including Giant, Hannaford, Stop & Shop, Food Lion, and others, has agreed to pay $40 million to resolve False Claims Act allegations involving prescription drug pricing.

    According to the DOJ⁠, Ahold Delhaize allegedly reported inflated “usual and customary” prices on claims submitted to Medicare Part D, Medicaid, and TRICARE. Prosecutors said the company operated prescription savings programs that offered discounted prices to enrolled customers, but allegedly failed to report those discounted prices as the pharmacies’ usual and customary prices.

    That distinction matters because usual and customary prices can operate as ceiling prices in federal health care reimbursement formulas. The government alleged that by reporting higher prices, Ahold Delhaize caused federal health care programs to pay more than they should have paid on pharmacy claims.

    Of the $40 million settlement, $32.9 million represents the federal share, with the remainder going to participating states.

    The case began as a whistleblower action filed by Lawrence LaBenne, a Pennsylvania pharmacist at an Ahold Delhaize supermarket.

    He will receive $6,083,587 from the federal recovery.

    The settlement is another example of how pricing representations, claim-level billing data, and insider knowledge drive many False Claims Act recoveries.

    For Find Corporate Waste⁠, the case fits the broader enforcement pattern: federal programs rely on accurate certifications and truthful claim data, and public money can be recovered when those representations are allegedly false.

  • 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.

    • Lockheed Martin Pays $70 Million to Settle False Claims Allegations Over Defective Pricing in Missile Contracts

      In a significant enforcement action announced by the U.S. Department of Justice, Lockheed Martin Corporation has agreed to pay $70 million to resolve allegations that it violated the False Claims Act (FCA) by submitting defectively priced contracts for missile sales to the Department of Defense. This case was brought to light by a private whistleblower,…

    • Whistleblower Action Exposes Corporate Waste and Tariff Evasion in $8.1 Million FCA Settlement

      In a recent settlement announced by the U.S. Department of Justice, a California-based flooring company agreed to pay $8.1 million to resolve allegations of customs fraud—thanks to the actions of a whistleblower acting under the False Claims Act’s qui tam provision. Evolutions Flooring Inc., along with its owners Richard and Brian Abcarian, was accused of…

    • Whistleblower Action Uncovers Medicare Billing Fraud in Lehigh Valley

      In a recent settlement announced by the U.S. Attorney’s Office for the Eastern District of Pennsylvania, a Lehigh Valley-based doctor agreed to pay $45,000 to resolve allegations of healthcare fraud—thanks to the actions of a whistleblower acting under the False Claims Act’s qui tam provision. Dr. Stephen Renn of Bethlehem was accused of submitting claims…

    • GPS Manufacturer Agrees to Pay $2.6 Million to Settle False Claims Act Allegations Relating to Improper PPP Loan

      PHOENIX, AZ – Hemisphere GNSS (USA) Inc., a satellite-based GPS manufacturer now owned by CNH Industrial, has agreed to pay $2.6 million to settle allegations that it improperly obtained and received forgiveness for a second-draw Paycheck Protection Program (PPP) loan by misrepresenting its eligibility under federal rules. The allegations were brought to light by GNGH2…