Follow the Rules!

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It’s not uncommon for healthcare providers to get caught not following healthcare laws regulating prescription medications and billing to Medicaid and Medicare. And when they do, the penalties are often steep. An Ashland, K.Y., physician learned this the hard way after settling civil claims that she, and the substance abuse treatment center she’s affiliated with, violated the federal Controlled Substances Act and defrauded the federal Medicare and state Medicaid programs.

The doctor, who was an addiction treatment specialist, and Ultimate Care Medical Services LLC, agreed to pay $1.4 million to resolve the case with the U.S. Department of Justice. The complaint alleged that the doctor and clinic billed Medicare and Medicaid for services between January 2013 and September 2014 that were never provided.

The programs were billed for “evaluation and management” services for patients who received daily methadone doses at the clinic. Reimbursement requires a patient exam, patient history, medical decision-making, and complex urine drug-testing, which the government says didn’t happen. (The clinic didn’t even have the equipment to do such tests). In fact, the case alleges, the clinic falsified patient records to make it appear the requirements were met.

The claim further alleges that the doctor prescribed buprenorphine (under the brands Suboxone and Subutex) to more patients than is legally permitted. (And that she did so repeatedly.) There was no determination of liability as part of the settlement.

Doctors prescribe buprenorphine in the treatment of opioid addiction. Kentucky has been central in the nationwide opioid epidemic and is known to have the third-highest death by drug overdose rate in the country.

Tips about potential fraud, waste, abuse, and mismanagement can be reported to the U.S. Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).  Tips about possible violations of controlled substances laws can be reported at

Today’s Fraud of the Day comes from the U.S. Justice Department press release, “Ashland Physician and Substance Abuse Treatment Center Agree To Pay $1.4 Million to Resolve Civil Claims,” released Aug. 16, 2019.

ASHLAND, Ky. – An Ashland addiction treatment specialist, Dr. Rose O. Uradu, and her substance abuse treatment center, Ultimate Care Medical Services, LLC d/b/a Ultimate Treatment Center, have agreed to pay $1.4 million to resolve civil allegations that they violated the Controlled Substances Act, and defrauded the Medicare and Kentucky Medicaid programs.

This settlement resolves a civil lawsuit alleging that Ultimate Treatment Center, at the direction of Dr. Uradu, sought and received payments from Medicare and Kentucky Medicaid for services that were not actually provided to patients.  According to the Complaint, between January 2013 and September 2014, defendants billed these government programs for “evaluation and management” services, purportedly provided to patients who visited the clinic to receive daily methadone doses.  To be reimbursed by Medicare and Kentucky Medicaid, evaluation and management services should include performance of an examination of the patient, a patient history, and medical decision-making.  The United States alleged that Ultimate Treatment Center did not actually perform these services when patients received their methadone doses, but falsely documented the performance of these services, in the patients’ medical records, in order to create the false appearance that the reimbursement was justified.



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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.