March 2025 – A Nationwide Crackdown on Healthcare Fraud
The U.S. government has intensified its crackdown on healthcare fraud, with two major fraud cases leading to settlements totaling over $2 million. Federal authorities, including the U.S. Department of Justice (DOJ), the Department of Health and Human Services Office of Inspector General (HHS-OIG), and the Federal Bureau of Investigation (FBI), uncovered fraudulent schemes involving illegal kickbacks for laboratory referrals and improper billing for medical procedures.
These cases, resolved under the False Claims Act, underscore the government’s relentless pursuit of fraudulent activity in the medical industry, particularly medical billing fraud and improper Medicare claims. With the rise in healthcare fraud statistics, authorities are stepping up enforcement efforts to protect taxpayer dollars and ensure the integrity of federal healthcare programs like Medicare and TRICARE.
Case 1: Multi-State Kickback Scheme Exposed in South Carolina, North Carolina, and Illinois
A significant kickback scheme involving healthcare providers and laboratory marketers has been dismantled, with multiple parties agreeing to a $1.9 million settlement. The fraudulent scheme spanned multiple states, with medical professionals accepting illegal payments in exchange for patient referrals.
How the Fraud Was Committed
From May 2016 to November 2021, healthcare providers across South Carolina, North Carolina, and Illinois participated in a kickback scheme where medical professionals received disguised payments in exchange for referring patients to a laboratory in South Carolina. These payments were falsely labeled as:
- “Office space rentals”
- “Phlebotomy fees”
This practice violates the Anti-Kickback Statute, a federal law that prohibits financial incentives for patient referrals under government healthcare programs. False claims were then submitted to Medicare and TRICARE, allowing fraudulent actors to profit illegally from taxpayer-funded programs.
Who Was Involved?
The following medical providers and businesses were implicated in the fraudulent scheme:
- Dr. Gerald Congdon & Coastal Urgent Care LLC (SC) – Accepted illegal payments from the laboratory.
- Dr. Gbenga Aluko & Eagle Medical Center PC (NC) – Engaged in a similar kickback arrangement.
- Dr. Anup Banerjee & Gastonia Medical Specialty Clinic P.A. (NC) – Received disguised payments for referrals.
- Omar Hussain & Curis Healthcare Inc. (IL) – A marketing company that facilitated illicit commissions.
- Saeed Medical Group Ltd. (IL) – Accepted cash kickbacks for patient referrals.
How Investigators Caught the Scheme
Authorities from the FBI, HHS-OIG, and the Defense Criminal Investigative Service (DCIS) launched an investigation into suspicious billing patterns and financial transactions. The probe revealed a complex web of illegal financial exchanges between medical providers and the laboratory, leading to allegations of fraudulent Medicare billing.
Financial Consequences
To resolve these allegations, the implicated parties agreed to repay a total of $1,913,808 in settlements:
- Dr. Gerald Congdon & Coastal Urgent Care LLC – $400,000
- Dr. Gbenga Aluko & Eagle Medical Center PC – $250,000
- Dr. Anup Banerjee & Gastonia Medical Specialty Clinic P.A. – $206,000
- Omar Hussain & Curis Healthcare Inc. – $817,808
- Saeed Medical Group Ltd. – $240,000
While these settlements do not constitute an admission of liability, they serve as a stark warning to healthcare providers engaging in illegal referral schemes.
📌 Read the Full DOJ Report on This Case
Case 2: Louisiana Clinic Caught in Medicare Billing Fraud
A second major fraud case involved a Louisiana-based physician and his clinic, which engaged in improper billing for non-surgical neurostimulator procedures.
How the Fraud Was Carried Out
Between November 2018 and April 2020, Dr. Henry Goolsby, his wife, and their clinic, Infinite Health, fraudulently billed Medicare for surgical implantation of neurostimulators. However, instead of performing actual surgical procedures, the clinic applied P-Stim devices—small, non-invasive electrical acupuncture devices affixed behind the ear.
This practice is fraudulent because:
- Medicare does not cover acupuncture-based treatments, including P-Stim devices.
- The procedures were falsely billed as surgical implants, misleading the federal healthcare program.
How Investigators Exposed the Fraud
HHS-OIG investigators detected an unusual spike in neurostimulator-related Medicare claims from Infinite Health. Upon further scrutiny, they discovered that these were not actual surgeries, but non-covered acupuncture-based treatments disguised as billable procedures.
Consequences for the Louisiana Clinic
Dr. Goolsby and his associates have agreed to repay Medicare for the fraudulent claims, although the exact amount remains undisclosed. Additionally, their clinic remains under government scrutiny for further violations.
📌 Read the Full DOJ Report on This Case
The Escalating Battle Against Healthcare Fraud
These two cases highlight a growing epidemic of medical billing fraud and healthcare fraud, with authorities stepping up enforcement efforts. The U.S. government is taking a zero-tolerance approach, imposing heavy financial penalties and legal consequences on offenders.
Key Takeaways for Healthcare Providers
✔ Increased Federal Scrutiny – Agencies like the DOJ, HHS-OIG, and FBI are closely monitoring billing practices and financial transactions.
✔ Severe Financial Penalties – Those caught in healthcare fraud schemes face multi-million dollar settlements, in addition to potential criminal charges.
✔ Potential Criminal Prosecution – Medical professionals engaged in fraudulent billing or illegal kickbacks risk losing their licenses, facing criminal prosecution, and being excluded from federal healthcare programs.
✔ Heightened Compliance Measures – Healthcare organizations must tighten internal compliance protocols to prevent unintentional violations and avoid becoming targets of federal investigations.
Healthcare Fraud Statistics: The Bigger Picture
The cases above are not isolated incidents—they are part of a larger national issue. Consider the latest healthcare fraud statistics:
📌 The DOJ recovered over $2.6 billion in False Claims Act settlements in 2024 alone.
📌 Over $1 billion in fraudulent Medicare claims were identified in the past year.
📌 More than 300 healthcare professionals faced criminal charges in 2024 for participating in fraudulent billing schemes.
📌 Medical billing fraud remains one of the top threats to the U.S. healthcare system, with the FBI estimating losses in the tens of billions annually.
For more insights, visit HHS-OIG’s Fraud Prevention Page.
