Weekly Healthcare & Behavioral Health OIG/SIU Enforcement Report

May 13–20, 2025

Behavioral Health

• May 13, 2025 – Arizona Attorney General (Medicaid Fraud Control Unit): L & L Investments, LLC (an operator of sober living homes) was ordered to pay over $34 million after a felony conviction for defrauding Arizona’s Medicaid program (AHCCCS) with fraudulent sober living home claims. This enforcement, announced by AG Kris Mayes, includes fines and restitution for extensive behavioral health billing fraud.

• May 12, 2025 – Georgia Attorney General (Medicaid Fraud Control Unit): Better Home Healthcare of Georgia (a behavioral health therapy provider) owner Teresa Owens pleaded guilty to Medicaid fraud, falsifying records, and identity fraud in a $305,685 scheme. Owens admitted to routinely billing for therapy services not provided and was sentenced to 10 years (1 year in prison, rest on probation), with full restitution ordered.

• May 16, 2025 – U.S. Attorney, District of Connecticut: Ramon Apellaniz of Middletown, CT pleaded guilty to health care fraud for a scheme that billed Connecticut Medicaid ~$1.87 million for counseling and autism therapy services he did not provide (and for which he was not licensed). Apellaniz, who ran unlicensed behavioral health clinics (Gemini Project and Minds Cornerstone), conspired to submit thousands of false claims for behavioral therapy for children with Autism Spectrum Disorder. Co-conspirator Wanda Aponte also pleaded guilty, and together they agreed to forfeit over $469,000 and other assets as proceeds of the fraud.

• May 2025 (Audit Report) – Texas HHS OIG: An audit of El Dorado Texas Community Service Center (a substance use disorder treatment provider) identified compliance issues in its medication-assisted treatment program. El Dorado, a state-contracted MAT provider serving 200+ clients, relied on a third-party billing company. The Texas OIG’s audit report (issued in May 2025) found weaknesses in billing controls and made recommendations to ensure accurate Medicaid billing and oversight (Executive Summary, Texas OIG Audit, May 2025).

Hospitals & Health Systems

• May 14, 2025 – U.S. Attorney, Eastern District of California: Community Health System (Fresno, CA) and its affiliate Physician Network Advantage (PNA) agreed to pay $31.5 million to resolve civil False Claims Act allegations. Prosecutors alleged the hospital system provided “extravagant benefits” – such as free perks in a special physicians’ lounge and other inducements – to referring physicians to drive patient referrals to its hospitals, violating Anti-Kickback Statute and Stark Law provisions. Along with the settlement, HHS OIG imposed a Corporate Integrity Agreement requiring the health system to implement enhanced compliance controls.

Physicians & Clinics

• May 19, 2025 – DOJ (Eastern District of California) & HHS OIG: Stephen D. Meis, M.D. (former Tulare County, CA physician) pleaded guilty to introducing misbranded drugs into interstate commerce. Meis, as medical director of Golden Sunrise Nutraceutical, sold an herbal product called an “Emergency D-Virus Plan of Care” touted as a COVID-19 cure without FDA approval. The scheme involved mailing kits of unapproved herbal drugs (e.g. “Imunstem”) with false COVID treatment claims. The FDA-OCI, HHS-OIG, FBI, and local authorities jointly investigated, and Meis faces sentencing for the federal misbranding charge.

• May 16, 2025 – U.S. Attorney, District of Connecticut & HHS OIG: Dr. Halina Snowball (physiatrist) and her practice paid $427,129 to settle allegations of Medicare false claims. A civil audit found that her pain management clinic improperly billed evaluation & management visits with Modifier-25 in conjunction with pain injection procedures when no significant separate service was performed, resulting in overpayments. The settlement resolves the billing improprieties, and the practice has repaid the improper Medicare reimbursements.

• May 14, 2025 – U.S. Attorney, Eastern District of Virginia: Dr. David Allingham of Oakton, VA was sentenced to 13 years in federal prison for running his urgent care clinic as an opioid “pill mill.” Allingham, 65, the sole provider at Oakton Primary Care, conspired to distribute massive quantities of oxycodone and amphetamines outside the usual course of practice. From 2019 to 2024 he wrote over 7,300 opioid prescriptions (over 400,000 pills) without proper examinations, often via non-medical staff phone calls. He charged patients cash for visits and circumvented pharmacy refusals by steering patients to fill prescriptions at mom-and-pop pharmacies. Multiple patient overdoses were linked to his prescriptions, and HHS-OIG and DEA investigators were involved in the case.

• May 13, 2025 – DOJ & HHS OIG (Office of Public Affairs): Dr. Robert G. Soucy Jr., 72, of Columbia, NH, pleaded guilty to unlawfully distributing controlled substances (opioids). Soucy admitted he prescribed opioids to a patient with known substance abuse issues without any medical necessity or evaluation, even after local pharmacies refused to fill his scripts. He instructed the patient to go to distant pharmacies to evade scrutiny. This case was the first New Hampshire doctor conviction by the Medicare Fraud Strike Force in the region. Soucy surrendered his medical license and faces up to 20 years in prison; DEA and HHS-OIG handled the investigation.

• May 20, 2025 – DOJ (Office of Public Affairs) & HHS OIG: Gulfcoast Eye Care, P.A. (Pinellas Eye Care) – a Florida ophthalmology practice – agreed to pay $615,000 to settle civil False Claims Act allegations. The practice was accused of billing Medicare and Florida Medicaid for transcranial doppler ultrasound tests that were ordered through an unlawful kickback arrangement with a third-party ultrasound provider. Gulfcoast Eye allegedly submitted and received payment for these improper claims for cranial ultrasound studies, and as part of the resolution it will cooperate in ongoing investigations of the scheme. HHS-OIG and FBI assisted in uncovering the kickback arrangement.

Pharmacies & Prescription Drugs

• May 16, 2025 – DOJ (District of Massachusetts) & HHS OIG: OHM Pharmacy Services (Florida) – also known as “Benzer” Pharmacy – pleaded guilty to health care fraud for its role in a Medicare and Medicaid prescription fraud case. On May 13, the pharmacy was sentenced to pay over $1 million and implement enhanced compliance measures as part of the plea. (This case was prosecuted out of Boston as part of a larger federal fraud takedown.)

• May 15, 2025 (Report Posted) – HHS OIG Audit (CMS Drug Pricing): OIG released its quarterly comparison of Average Sales Price vs. Average Manufacturer Price for Medicare Part B drugs, covering Q4 2024. The report identified 8 drug codes where prices exceeded the threshold, meeting CMS’s criteria for price substitution to avoid excessive Medicare payments. OIG provided these findings to CMS, which can choose to pursue reimbursement cuts for those drugs to save costs. This routine OIG review is mandated by law to protect against Part B drug overpricing.

Managed Care Organizations

• May 16, 2025 – HHS OIG Evaluation Report: An OIG review found that CMS is not systematically tracking whether states return the federal share of Medicaid managed care plan MLR remittances (refunds). States often require Medicaid managed-care plans to repay funds if they don’t meet medical-loss-ratio spending targets. OIG determined that CMS lacks dedicated systems to monitor if/when states repay the federal portion of those remittances, forcing CMS to manually ask states for information. Hundreds of millions of federal dollars were at stake. OIG identified three factors causing this oversight gap and recommended CMS establish better tracking controls. CMS concurred and is evaluating process improvements.

Medical Devices & Supplier Industry

• May 19, 2025 – DOJ (District of Massachusetts) & HHS OIG: Spinal device manufacturer (SpineFrontier, Inc.) – Its CEO Dr. Kingsley Chin pleaded guilty to falsifying reports to CMS’s Open Payments database. The company had paid spinal surgeons sham consulting fees to induce use of its devices and then misreported those payments (or failed to report them) in violation of the Sunshine Act. Dr. Chin admitted to directing staff to label a $4,750 payment to a surgeon as a “consulting” fee despite no services provided. The case was investigated by HHS-OIG, FBI, VA OIG, and other partners, and it underscores enforcement of transparency laws for medical device financial relationships. Dr. Chin’s sentencing is pending in August 2025.