Robert & Lisa Saul, owners of R&V Medical Supplies were charged by the U.S. Attorney's Office with defrauding Medicare.

Source - http://www.philly.com/philly/news/local/79035027.html

Robert Saul and his wife allegedly thought they could get rich by giving people expensive power wheelchairs and other medical equipment - equipment they didn't need - and falsely billing Medicare. And they thought they had their bases covered by allegedly telling baffled recipients that Philadelphia was giving out $3,200 wheelchairs for free, or having sources in doctors' offices intercepting phone calls from confused patients.

But the alleged scheme fell apart, according to U.S. Attorney Michael L. Levy. Saul, 36, and his wife, Sheila, 51, were charged yesterday by the U.S. Attorney's Office with defrauding Medicare and other programs by submitting more than $1.2 million in bogus claims.

Saul and his wife, who both live in Philadelphia, own R&V Medical Supplies, which is located on the 11th floor at 1420 Walnut St., in Center City. The company is still in business.
The Sauls did not respond to requests for comment yesterday.

Also charged yesterday were Lisa Burnett, 40, of Philadelphia, and Carol Mason, 57, of Norristown. Burnett and Mason worked at a Philadelphia nonprofit that provided service to seniors and the disabled. They allegedly provided the Sauls with client information that was used to bill Medicare for unneeded medical supplies, and for which they were paid kickbacks.

In separate court filings, Susan Landolf, 27, and Debra Stallings, 43, both of Philadelphia, also were charged with participating in the scheme. Landolf worked at a medical clinic and then at R&V. Stallings worked at a private medical practice. Since they were charged in criminal informations, it is likely they have negotiated guilty pleas.

"This case involves breaches of trust at every level: From the medical office employees who sold patients' identity information, to the people charged today who used the Medicare Trust as their personal ATMs," Levy said. "Any Medicare beneficiary who gets equipment that they know nothing about, or who sees payments for equipment on their explanations of benefits that they do not recognize, should contact the number on the explanation of benefits forms immediately to report it," Levy said.

************************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Kevin Wayne Louderback, a Missouri insurane broker pleads guilty in $700,000 Medicaid fraud probe.

Source -http://ifawebnews.com/2009/12/07/missouri-broker-pleads-guilty-in-700000-medicaid-fraud-probe/

A Springfield, Mo., insurance broker pleaded guilty to 12 felony counts related to Medicaid fraud after misappropriating more than $700,000 from the program. Kevin Wayne Louderback provided applications with false information to Missouri HIPP, a Medicaid program that pays for the private health insurance premiums of those with high medical costs, according to the Missouri Attorney General’s Office.

Louderback stated that the monthly insurance premium rates were greater than they were, pocketing the overpayment. He also offered a kickback to people to encourage them to enroll in an insurance program, fraudulently misstated an insurance company’s rate and then forged documents to set out the false rate, according to officials.

Louderback pleaded guilty to five counts of Medicaid fraud, four counts of insurance fraud, two forgery counts and a count of offering a kickback to receive a Medicaid payment. In December 2000, Louderback pleaded guilty in Laclede County, Mo., to the felony count of passing a bad check and in June 2004, pleaded guilty to a felony count of stealing in Greene County, Mo. The attorney general’s office said that as a “prior and persistent offender,” Louderback could be sentenced to an extended prison term. He faces sentencing Feb. 26.

In a statement, Missouri Attorney General Chris Koster said one of his top priorities is prosecuting those cheating the state’s Medicaid system. “This kind of fraudulent conduct steals health-care resources that would otherwise be directed to truly needy Missourians,” he said. “We will continue to dedicate our resources to root out health-care fraud in our state.”

***********************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Sioux City - Mercy Medical Center agrees to pay the government $400,000 to settle allegations that the hospital overcharged heart patients.

Source - http://www.siouxcityjournal.com/news/local/article_1d687950-df82-11de-86d1-001cc4c002e0.html

SIOUX CITY -- Mercy Medical Center -- Sioux City, has agreed to pay the government $400,000 to settle allegations that the hospital overcharged heart patients for four years in order to receive money that it wasn't entitled to.

Mercy denied any wrongdoing in the pre-litigation settlement which alleges that the hospital inflated charges for heart patients in order to obtain additional reimbursement from federal health care programs such as Medicare, Medicaid, Tricare, and Federal Employees Health Benefits. Congress provided for additional payments to give an incentive for hospitals to treat patients when the cost of care in unusually high.

In a statement released today, Bob Peebles, Mercy's Interim President and CEO, said that the settlement is "not an admission of liability because Mercy is absolutely convinced it fully complied with all Medicare requirements during the time period in question." Mercy agreed to the settlement, according to Peebles, to avoid additional costs and disruptions that would be incurred by prolonging the government's investigation.

"The settlement reached by Mercy with the government is by far the smallest dollar amount reported to date involving hospitals and the outlier reimbursement issue," Peebles said in the statement. "Investigations involving other hospitals have resulted in settlements in the tens of millions of dollars."

Bob Teig, spokesman for the U.S. Attorney's Office for the Northern District of Iowa, said today that an investigation into the matter began in July 2006. The government alleges that between March 1999 and Aug. 2003, Mercy inflated its charges for certain inpatient heart procedures. As a result, Mercy allegedly caused federal health care programs to pay more than Mercy was entitled to receive. Mercy also allegedly submitted false and misleading statements involving Medicare and Medicaid cost reports for Oakland Memorial Hospital, in fiscal years 2003 through 2006, according to the United States Attorney's Office. Mercy allegedly sought reimbursement for non-allowable costs included in Oakland's 2003 through 2006 Medicare and Medicaid cost reports.

Despite intense scrutiny, Peebles said the government's investigation never revealed any evidence of the intent to overcharge the Medicare and Medicaid programs or that Mercy submitted false and misleading statements or sought reimbursement for non-allowable costs involving Medicare and Medicaid cost reports for Oakland Memorial Hospital -- Oakland, Neb.

************************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Dr. Robert Pierre Antoine Louis arrested and charged with Medicaid fraud and first-degree theft of property by Alabama Medicaid Fraud Control Unit.

Dr. Robert Pierre Antoine Louis

Source - http://www.brewtonstandard.com/articles/2009/12/01/news/doc4b13f2d471b49833141597.txt

A dentist with a practice in Evergreen has been charged with Medicaid fraud and first-degree theft of property, Alabama Attorney General Troy King said. Dr. Robert Pierre Antoine Louis of Spanish Fort was arrested Nov. 18 at the attorney general’s office in Montgomery by agents of the Alabama Medicaid Fraud Control Unit. Louis, 56, operates dental practices in Evergreen and Fort Deposit.

According to the attorney general’s office, Louis offered free dental screenings for students at seven public schools in Butler, Conecuh and Lowndes counties in October and November 2008. The attorney general’s office has alleged that Louis billed the Alabama Medicaid Agency for dental procedures on 221 students that were not performed at the screenings. The Medicaid Agency paid Louis $14,335 in fraudulent charges, according to the attorney general. “It is more important than ever, in these times of scarce resources, to protect Medicaid funds from fraud and abuse,” King said. “My office is committed to aggressively investigate and prosecute where evidence indicates wrongdoing.”

Louis was arrested on warrants charging Medicaid fraud, a class C felony, and first-degree theft of property by deception, a class B felony. He was transported to the Montgomery County Detention Facility under a $30,000 bond. If convicted, he faces penalties of one to 10 years imprisonment for the Class C felony and two to 20 years imprisonment for the class B felony.

The case was investigated by Special Agent Timothy Kornegay of the Attorney General’s Medicaid Fraud Control Unit and is being prosecuted by the Unit’s director, Assistant Attorney General Bruce Lieberman.

************************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Medicare fraudsters rake in billions!

Source - http://washingtontimes.com/news/2009/nov/30/medicare-fraudsters-rake-in-billions/

THE WASHINGTON TIMES - Medicare fraud is a multibillion-dollar business preying on an ever-increasing number of retiring baby boomers who often are being charged for medical treatments and products they don't need and for services they don't receive.

The health care reform legislation pending in Congress -- and under debate in the Senate -- relies on reining in these fraudulent schemes to help finance coverage for the uninsured. But analysts in and out of government question whether those savings will ever be found.
Despite bolstered efforts by federal, state and local law enforcement authorities to crack down on fraudsters, abuse continues to grow.

Assistant Attorney General Lanny A. Breuer, who heads the Justice Department's criminal division, told the Senate Judiciary Committee's subcommittee on crime and drugs in May that 3 percent to 10 percent of the $800 billion spent on Medicare and Medicaid each year "is lost to waste, fraud and abuse." "As government spending on health care for the elderly, disabled and poor increases, so does the opportunity for fraud. Criminals are devising more sophisticated ways of stealing billions of dollars from federally administered health care programs, and they are stealing it faster now than ever before," he told The Washington Times.

Mr. Breuer said the theft of taxpayer money from these programs drives up health care costs and ultimately damages the economy. "We have to fight health care fraud in any way we can," he said. "We are working hard to meet these challenges."

Much of the dishonesty is in regions deemed "high risk for Medicare fraud," such as Miami, Los Angeles, Detroit and Houston. But Inspector General Daniel R. Levinson of the Department of Health and Human Services said his office finds fraud "everywhere it looks."
Even dead people are receiving benefits.

Malcolm Sparrow, a faculty member at Harvard University's Kennedy School of Government and a specialist on health care fraud, told the same Senate panel that heard Mr. Breuer's testimony that the inspector general's office at HHS reported in 2000 that $20.6 million in claims had been made for medical services performed after the Medicare recipient had died.
In 2006, he said, the office said states made $27.3 million in Medicaid payments for services after the patient was dead.

Mr. Sparrow said the Senate Permanent Subcommittee on Investigations reported in July 2008 that "between $60 million to $92 million was paid for medical services or equipment that had been ordered or prescribed by dead doctors." He told The Times in an interview that the government has to increase its spending on fighting health care fraud by as much as 10 times to reduce fraud in a meaningful way. But he warned: "There is not a lot of political will for massive beefing-up."

Medicare is a government-paid insurance, providing health care to about 40 million people age 65 and older and another 7 million younger recipients who have some type of permanent disability. The programs, which pay for hospital visits, physician services and prescription drugs, accounted for 13 percent of the total federal budget and 19 percent of national health care expenditures in 2008.

Americans spend in excess of $2 trillion on health care annually, and more than $60 billion is lost to schemes that rely on falsified records, elaborate business structures and the cooperation of health care providers, suppliers and even beneficiaries, according to HHS officials and the National Health Care Anti-Fraud Association, a partnership of more than 100 private health insurers and federal and state government officials.

Making inroads - But the federal government is making some inroads, most noticeably through the Medicare Fraud Strike Force it created two years ago, which initially targeted the Miami area. President Bush began that effort in March 2007, and the Obama administration has since expanded it. The task forces are comprised of HHS and FBI agents and state and local law enforcement officials, along with prosecutors from the Justice Department and the U.S. attorney's offices.

Their mission is to identify, investigate and prosecute medical equipment suppliers and health care clinics suspected of Medicare fraud. Within weeks of its creation, the Miami strike force brought its first case, accusing 38 people of improperly billing Medicare for $142 million in fraudulent services and prescriptions. Seized assets included a $200,000 Rolls-Royce Phantom and more than $1.2 million from a corporate bank account.

During a speech earlier this year to a joint session of Congress, President Obama said Medicare was subject annually to "hundreds of billions of dollars in waste and fraud" and the fight against fraud was a major priority of his administration. He called Medicare a sacred trust that must be passed on to future generations.

HHS Secretary Kathleen Sebelius said the administration was committed to "turning up the heat on Medicare fraud and employing all the weapons in the federal government's arsenal to target those who are defrauding the American taxpayer."

Mr. Sparrow described efforts by the Obama administration to combat Medicare fraud as a "positive development," telling The Times that the strike force concept was "all good," but adding that it was "still not enough." He said the health care industry has done "a terrible job of crime control," with almost no procedures in place to routinely verify that the claims presented are true or that services provided are medically necessary.

"But criminals, who are intent on stealing as much as they can and as fast as possible, and who are prepared to fabricate diagnoses, treatments, even entire medical episodes, have a relatively easy time breaking through all the industry's defenses," he told the Senate committee. Another health care specialist, James Frogue of the conservative Center for Health Transformation, estimates that total fraud and waste could exceed $120 billion a year, citing improper payments for durable medical equipment as an example of Medicare's inability to stop fraud.

Total indifference - Mr. Frogue said he was pleased Mr. Obama has made Medicare fraud a major issue, but that there had been "a total indifference" at HHS' Centers for Medicare and Medicaid Services in dealing with fraud of durable medical equipment. He said Government Accountability Office studies have documented abuse in the durable medical equipment area that are "several steps beyond laughable."

Mr. Levinson's office also has reported on rampant fraud in the durable medical equipment industry, which is supposed to provide wheelchairs, prosthetics, orthotics and supplies to patients. It found that 31 percent of the suppliers of such equipment in Florida either did not maintain offices or were not open during posted hours.

His office said the Centers for Medicare and Medicaid Services' oversight of durable medical equipment suppliers was inadequate to prevent fraud and that sham companies had been allowed to bill Medicare for nonexistent or unnecessary supplies. The Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration, has estimated that Medicare improperly paid $1 billion in a one-year period for durable medical equipment.
"It is more efficient and effective to protect the programs and beneficiaries from unqualified, fraudulent or abusive providers and suppliers upfront than to try to recover payments or redress fraud or abuse after it occurs," Mr. Levinson said.

***********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Madison County Man Arrested For Defrauding Medicaid Out Of More Than $34,000.

Source- http://www.wctv.tv/home/headlines/70634102.html

Attorney General Bill McCollum announced that a
Madison County man has been arrested on charges he defrauded the Florida Medicaid program out of more than $34,000.

Gianni Phillipians Jackson, 67, was arrested today by law enforcement officers with the Attorney General’s Medicaid Fraud Control Unit with assistance from the Madison Police Department.

Acting on information received from the Agency for Persons with
Disabilities, Medicaid Fraud investigators discovered that Jackson
submitted numerous claims for services he never provided. Jackson also billed the Medicaid program for services while he was out of the state.

Jackson is charged with one count of Medicaid fraud and one count of
organized scheme to defraud, both second-degree felonies. If convicted, he faces up to 30 years in prison and a $20,000 fine. The case will be prosecuted by State Attorney’s Office for the Third Judicial Circuit.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Medicare scams are targeting senior citizens in Louisiana.

Source- http://www.thebestoftimesnews.com/news.php?news=673

Health care officials are asking citizens in Avoyelles, East Baton Rouge, Caddo, St. Martin and Terrebonne parishes to be on the lookout for health care scams that are targeting senior citizens.

In each case, the alleged fraud has been brought to the attention of the Senior Medicare Patrol, a new program that is a partnership between Louisiana Health Care Review (LHCR), the Senior Health Insurance Program in the Department of Insurance and the Governor's Office of Elderly Affairs. Kicked off this summer, the Senior Medicare Patrol program is the result of a grant from the U.S. Administration on Aging designed to detect fraud in Medicare.

According to LHCR's Julie Mickles, the Senior Medicare Patrol coordinator, the program teaches senior citizens how to detect and report possible scams that defraud government-run health care programs.

"Each case of potential fraud that we are now investigating has been brought to our attention by seniors who rely on Medicare, and who noticed something wrong or suspicious," she said.

Listed below are some of the complaints that are now under investigation.

Terrebonne Parish: Residents of a senior housing unit are receiving "medically unnecessary" dietary supplements that were prescribed for them by a doctor they have never seen. They are having difficulties getting the shipments to stop. Medicare is paying $820 a month and the seniors are not using the supplements.

St. Martin Parish: A home health agency has billed Medicare for several services that were not received by the homebound senior. A caregiver noticed the discrepancies on the senior's Medicare Summary Notice.

East Baton Rouge Parish: A questionable supplier of medical equipment is trying to get into various housing units to offer arthritis and diabetes supplies that will then be billed to Medicare. The company representatives do not tell the patients the name of the company.

Caddo Parish: A physician reports that several of his patients have been harassed by a medical equipment company that continually calls the patients to offer them "free" arthritis equipment they do not need. The "free" equipment is paid for by Medicare.

Avoyelles Parish: A Medicare patient has reported double billing by his doctor and a hospital. The complaint is under review.

When she receives a complaint, Mickles works with various regulatory agencies to determine if any fraud, errors or abuse is present. When appropriate, she reports to the Medicare Program Safety Contractors, the Louisiana Office of the Inspector General's Medicare Fraud Unit or the Louisiana Attorney General's Medicaid Fraud Control Unit.

"In only a few months of work, the Senior Medicare Patrol has reached out and educated hundreds of senior citizens on how to detect possible fraudulent billings, scams and other abuses. The result is we now have a statewide network of people who are acting as the eyes and ears of the Medicare program. With this network, we've developed strong leads to follow, and been given access to the evidence needed that can lead to the arrest and conviction of suspected fraudsters," said Mike Fields, Special Agent in Charge of the Dallas Regional Office of the U.S. Department of Health and Human Services' Office of Inspector General.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Four Arrested, Including Doctor, in Medicaid Fraud.

Dr. Rodney Dunham, 56

Source- http://www.newschannel9.com/news/arrested-986543-including-four.html

The Tennessee Bureau of Investigation, along with the Athens Police Department, arrested four people Thursday after a grand jury indicted them on multiple charges including prescription fraud, extortion, conspiracy and filing false reports.

The case culminated this week after the TBI’s Medicaid Fraud Control Unit and Athens Police Department conducted an investigation for several months.

Dr. Rodney Dunham, 56, was indicted on one count of dispensing prescriptions by fraud. He ran a walk-in clinic on Congress Parkway in Athens, Tennessee. The Tennessee Department of Health Related Boards suspended Dunham's license in October of 2009.

According to the TBI, Dunham and 19-year-old Laura Cheek, of Athens, Tenn. were engaged in a relationship exchanging sex for prescription drugs.

Cheek was charged with obtaining prescriptions by fraud, extortion, conspiracy to obtain prescriptions by fraud, conspiracy to commit extortion and filing false reports.

Her mother, Patricia Cheek, 42, of Etowah, Tenn. was also indicted for obtaining prescriptions by fraud, extortion, conspiracy to obtain prescriptions by fraud and conspiracy to commit extortion.

Patricia Cheek was also a patient of Dunham’s along with Laura Cheek’s neighbor, John Virgil Davis. Davis, 26, of Athens was charged with obtaining prescriptions by fraud, extortion, conspiracy to obtain prescriptions by fraud, conspiracy to commit extortion and filing false reports.

The three threatened to expose Dunham’s relationship with Laura Cheek in order to obtain prescription drugs. In addition, Laura Cheek and Davis filed a police report in August alleging she had been raped. She did not name her attacker. All the crimes allegedly took place between May of 2009 and September of 2009.

All four subjects are in the McMinn County Justice Center. Dunham’s bond is set at $8,000 while the other three bonds are set at $25,000 each. Their arraignments are scheduled for Monday, November 30, 2009.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Pharmacies, employees indicted in $2.3 million N.J. Medicaid scheme.

Source- http://ifawebnews.com/2009/11/18/pharmacies-employees-indicted-in-2-3-million-n-j-medicaid-scheme/

Three pharmacies and seven people from Essex County, N.J., were indicted by a state grand jury on charges they allegedly submitted more than $2.3 million dollars in false Medicaid claims, according to the New Jersey Attorney General’s office.

The pharmacy owners and employees are accused in the scheme of paying patients with prescriptions for HIV/AIDS drugs and other expensive medications to go without their prescribed medications. The suspects then used the completed prescription forms to bill Medicaid, Medicare and private insurers for drugs that were never actually dispensed, prosecutors said.

Brian X. Chandler, former owner and director of Samaritan Medical in Newark, who also went by the name “Dr. X,” was at the center of the alleged scheme, according to investigators.

Chandler, who has pleaded guilty for his role in the scheme, recruited Medicaid patients to his clinic to write multiple prescriptions for each of their beneficiaries and selling the prescriptions to the pharmacies. Chandler purchased medication from his patients as well, which he then returned to the pharmacies where they were billed to Medicaid for 10 times to 30 times what patients were paid, according to prosecutors.

The three Newark pharmacies — Pricus Inc., which operates as Campus Pharmacy; Ajari Inc., which operates as Harrison Pharmacy; and Orange Drugs — were indicted on charges they conspired to defraud Medicaid.

Four pharmacists indicted in the case include Nadeem Akhtar, 49, Omar Mohammad, 31, Calvin Osei, 32 and Nwala Gabriel, 49. In addition, three pharmacy technicians from East Orange’s Pharmacy of America — Jannah Rasheedah Amatul Muid, 25, Shivonne Diacy Forde, 26 and Alicia Stephens, 29 — also were indicted.

All seven people and the three pharmacies were charged with second-degree conspiracy, second-degree health care claims fraud and third-degree Medicaid fraud.

Osei was also charged with third-degree filing false state income tax returns.

Samina Nadeem, 52, owner of Orange Drugs, the wife of Akhtar and the mother of Mohammad, also was indicted on charges of third-degree witness tampering for allegedly trying to coerce a witness to lie to investigators.

“Pharmacists are supposed to dispense medicines to preserve health and help those who are sick, but these defendants profited by depriving indigent patients of drugs they needed,” said New Jersey Attorney General Anne Milgram.

The investigation, called Operation PharmScam, was conducted jointly by the Medicaid Fraud Control Unit, the Jersey City Police Department, the U.S. Food and Drug Administration’s Office of Criminal Investigations and the New Jersey Division of Taxation.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Medicaid Fraud Mastermind Stole Over $1M.

Source- http://www.northcountrygazette.org/2009/11/13/medicaid_mastermind/

LONG ISLAND—David Williams, an owner of a now-defunct Long Island medical supply company and said to be the mastermind behind a massive Medicaid fraud scheme, has been sentenced to three to nine years in prison for stealing over $1 million from Medicaid. In addition to incarceration, David Williams is also responsible for paying restitution of over $1.1 million to reimburse the Medicaid program.

David Williams and his wife Cynthia Williams owned People’s Choice Surgical Supplies, Inc., which was the largest medical supply company on Long Island based on its quantity of Medicaid billing. From 2003 to 2006, People’s Choice, David and Cynthia Williams, and two employees falsely billed Medicaid for over $1 million dollars for medical equipment that was not ordered by physicians. Additionally, People’s Choice billed Medicaid for over $50,000 of medical equipment that was never provided to Medicaid recipients.

In order to carry out this scheme, People’s Choice stole the identity information of physicians and submitted false Medicaid claims without the doctors’ knowledge or permission. David Williams also obtained Medicaid recipients’ numbers – sometimes by paying Medicaid recipients cash for their information – and then used those numbers to falsely bill Medicaid for medical equipment products that were not medically necessary, not ordered by a doctor, and in many instances not provided at all. The products included diabetic supplies, diapers, Ensure nutritional supplements, and other items.

Cynthia Williams, two employees, and People’s Choice previously pleaded guilty for their parts in the scheme and most were sentenced earlier this year. Court information for all defendants is as follows:

–David L. Williams, 48, pleaded guilty Friday to second degree grand larceny and was sentenced to 3-9 years in prison. David Williams, Cynthia Williams, and People’s Choice must also pay a combined restitution of over $1.1 million to reimburse the Medicaid program.

–Cynthia A Williams, 46, previously pleaded guilty to third degree grand larceny and was sentenced to six months in jail and five years probation supervision.

–Kenya Gadson, 35, an employee, previously pleaded guilty to petit larceny, a misdemeanor, agreed not to seek employment in the health care field for three years, and was sentenced to three years probation supervision.

–Ramona Wiley, 46, an employee, previously pleaded guilty in Bronx County to petit larceny, for applying for and receiving Medicaid benefits while claiming to have no income, when she was actually receiving income from People’s Choice. She will be sentenced on Dec. 9.

–People’s Choice Surgical Supplies, Inc. previously pleaded guilty to second degree grand larceny and first degree identity theft and was sentenced to a fine of $10,000.

David Williams appeared Friday before Judge William Donnino in Nassau County Court. People’s Choice Surgical Supplies, Inc. was formerly based in Hempstead. It closed in December of 2006. 11-13-09.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Medicare fraud may cost more than money.

Source- http://www.nbc-2.com/global/story.asp?s=11496968

LEE COUNTY: While a health care debate rages in Washington, it might irk you to know you're losing money and might not get the care you need - all because people are taking advantage of Medicare.

It's a crime with no yellow tape or flashing lights

"People are billing for equipment that the patient really didn't need," said Roy Willoughby, of Advanced Home Oxygen and Medical Equipment.

The U.S. Attorney General says Medicare fraud is a billion dollar crime where all thieves have to do is fill out a few forms and cash in on Medicare payments. And a big chunk of that is happening right here in Florida.

"I think it unfairly puts the honest business man under the gun," said Willoughby.

Businesses like Advanced Home Oxygen and Medical Equipment now have tougher regulations when it comes to filing paperwork to qualify for Medicare.

"We've had claims be denied for silly technicalities," Willoughby explained.

In return, medical equipment businesses are coming out of pocket to provide supplies for customers. And with more Medicare cuts, business owners say the worst is yet to come for consumers.

"Hospital beds, wheelchairs - they will be getting this equipment in the future from the lowest, cheapest provider possible," Willoughby said.

For patients taxpayers like Tammy Dunn, there's only one bottom line when it comes to Medicare fraud.

"It's going to cost us more out of pocket and that's not good," she said.

For Dunn, an MS patient, having a custom wheelchair means independence.

"I'm able to get around and that means a lot to a person who's sitting in a chair," Dunn said.

But if this type of fraud gets any worse, she fears rentals and cheaper medical equipment may be in her future.

"That would be horrible. I would be house-bound," she said.

As for the businesses under scrutiny, some have a message for the government.

"I invite them to come in here and look at my files, but don't come in here and treat me like a criminal and put me out of business," said Willoughby.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Whistleblower Lawsuit Nets Record $27.5 Million.

Source- http://www.tradingmarkets.com/.site/news/Stock%20News/2625239/

Nov 04, 2009 (PRWeb.com via COMTEX) -- UHS Quote Chart News PowerRating -- In settlement of a qui tam (http://www.whistleblowerfirm.com/about-the-law/qui-tam/) (whistleblower) lawsuit filed in 2005 by Relator whistleblower Bruce Moilan Sr., McAllen Hospitals, L.P., d/b/a South Texas Health System a wholly owned subsidiary of Universal Health Services, Inc has entered into a Settlement Agreement pursuant to which it has agreed to pay to the United States and the State of Texas $27.5 million. McAllen Hospitals, L.P., d/b/a South Texas Health System owns and/or operates multiple health care facilities in McAllen, Texas, including McAllen Medical Center, McAllen Heart Hospital, Edinburg Regional Medical Center, and the South Texas Behavioral Health Center. Case No. M-05-CV-263 (S.D. Tex.)

The "qui tam" (whistleblower) lawsuit was kept under seal and unknown to the public until today when a federal judge approved the settlement and the Justice Department announced it.

The Relator, Bruce Moilan Sr., was represented by Nolan and Auerbach, P.A.. Partner Marcella Auerbach offered high praise for the work done by the government team on the case, particularly Assistant U.S. Attorney Andrew Bobb, Department of Justice Senior Trial Counsel David T. Cohen as well as Keshia B. Thompson Sr. Counsel, Office of Counsel to the Inspector General and Susan Arenella Assistant Attorney General, Office of Attorney General for the State of Texas, Attorney General's Civil Medicaid Fraud Division. "AUSA Andrew Bobb and the team of government lawyers and investigators did a superb job pursuing this case in an efficient and effective manner. We hope that Mr. Moilan's courage and determination is duly recognized, and will serve as an encouragement to others who are deciding whether to move forward with a qui tam lawsuit or are currently participating in one. This is an example of the type of impact a whistleblower can have if he is willing to bring critical information forward and demonstrate the courage of his convictions," Auerbach said. Whistleblowers (http://www.whistleblowerfirm.com/about-the-law/whistleblower-rewards/) are entitled to 15 percent to 25 percent of the amount the government recovers as a result of their qui tam lawsuits. Mr. Moilan will receive a 20% percent of the $27.5 million qui tam settlement as a reward for the information he provided and the work he and his attorneys did on the case. Mr. Moilan will receive a relator share of $5.5 Million. In addition, his claim for severance, attorneys fees', costs and expenses have been resolved in a confidential settlement.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

East Brunswick doctor found guilty of bilking Medicare, practicing without license.

Source- http://www.app.com/article/20091109/NEWS03/91109072/1007/news03&source=rss

MIDDLESEX COUNTY — A Middlesex County jury has convicted an East Brunswick doctor of practicing medicine without a license and stealing money from Medicare and insurance carriers.

Benjamin Levine, 69, was also found guilty of theft by deception, two counts of falsifying records and insurance fraud.

The jury convicted Levine on Friday after more than five hours of deliberation.

Brian Gillet, assistant Middlesex County prosecutor, told jurors at the start of the trial in Superior Court, New Brunswick, that Levine took Medicare funds while unlicensed, in effect stealing the money, and tampered with a witness and records as authorities investigated.

Levine stole $122,000 from Medicare and about $28,000 from other medical insurance carriers, he said.

Levine refused to purchase malpractice insurance, leading to the loss of his license in June 2003, Gillet said.

An undercover investigator from the state medical board went to Levine posing as a patient in August 2004. Levine treated him, Gillet said.

Once the Middlesex County Prosecutor's Office began its investigation, Levine's appointment book disappeared as did his record of payments, Gillet said. Levine's attorney, Christopher Campbell, told jurors that the state medical board was aware of Levine's situation and did nothing about it, negating the intent necessary for Levin's actions or lack of them to be considered a crime.

Levine was convicted of molesting nine female patients in 1996, landing him in jail for 180 days.

The state medical board suspended Levine's license for two years in 1991 in connection with the molestation incidents and reinstated his license on a probationary basis in 1993, requiring him to have a registered nurse present for all his physical examinations.

He was charged in another molestation case in 2006 after being accused by a female patient, but was acquitted in February.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Report Medicare Fraud at USAWhistleBlower.com. Million Dollar Rewards Program for Reporting Medicare and Medicaid Fraud.

Source - http://www.usawhistleblower.com/.

The Law Firm of Kenney, Egan, McCafferty & Young is dedicated to helping whistleblowers under the False Claim Act receive monetary rewards for blowing the whistle on corporations and/or individuals that have committed fraud against the federal government. The law firm is made up of a premier group of attorneys and individuals, including two former Federal Prosecutors who now practice law privately providing legal representation to Medicare whistleblowers in all 50 states.

The False Claims Act (31 U.S.C. Sections 3729-33) allows a private individual or "whistleblower", with knowledge of past or present fraud on the federal government, to sue on behalf of the government to recover stiff civil penalties and triple damages. The person bringing the suit is formally known as the "Relator." If the suit is successful, it not only stops the dishonest conduct, but also deters similar conduct by others. The whistleblowers generally receive anywhere from 15 to 30 percent of the federal governments total recovery.

In fiscal year 2008, the federal government collected $1.4 billion in settlements and judgments and paid out over $198 millions dollars to Whistleblowers. Relator's awards since 1986 have reached almost $1 Billion. The False Claims Act also prohibits an employer from harassing or retaliating against an employee for attempting to uncover or report fraud on the federal government. If retaliation by an employer does occur, the Relator may be awarded "all relief necessary to make the employee whole," including reinstatement, back pay, two times the amount of back pay, litigation costs, and attorney fees.

You can be assured you will not find a law firm more experienced, better prepared and more willing to help get your whistleblower claim filed and into action. There are no fees or out-of-pocket expenses to whistleblowers for our services. All cases are accepted on a contingency bases. This means there is no charge to you unless your claim is successful.

Click this link to visit UsaWhistleblower.com - http://www.usawhistleblower.com/

3 charged with Medicaid fraud.

Source- http://www.startribune.com/local/north/69208632.html?elr=KArks:DCiUHc3E7_V_nDaycUiD3aPc:_Yyc:aUU

The owner of a Brooklyn Park personal care firm and two workers have been charged in federal court with fraudulently getting more than $89,000 from Medicaid.

The indictment was unsealed Wednesday against Patrick Daniel Osei, the owner of Advance Home Health, as well as care assistants Crecida Marie Cade and Sabrina Marie Peterson.
The three are accused of conspiring to defraud Medicaid through false claims to the state Department of Human Services for in-home personal care for two clients. Also, according to the indictment, they caused payments to Medicaid recipients in exchange for the firm billing for services that weren't provided.

According to a statement from the U.S. attorney's office, the fraud included claims for one client of 5,352 hours of care from October 2007 to late September of this year when less than five hours were provided. Medicaid paid Advance $84,497.54 for the claim. That client was allegedly paid $800.

Osei, 49, of Brooklyn Park, is charged with 15 counts of health care fraud and four counts of illegal remuneration, according to the U.S. attorney's office.

Cade, 47, of Fridley, is charged with one count of conspiracy and six counts of health care fraud. Peterson, 38, of Minneapolis, is charged with one count of conspiracy and nine counts of health care fraud.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Omnicare, Teva unit pay $112 million for kickbacks.

Source- http://www.forbes.com/feeds/reuters/2009/11/03/2009-11-03T210716Z_01_N03507468_RTRIDST_0_OMNICARE-DOJ-UPDATE-2-SETTLE-KICKBAC.html

WASHINGTON (Reuters) - Omnicare Inc, the largest U.S. provider of pharmacy services to nursing homes, will pay $98 million and Teva subsidiary IVAX Pharmaceuticals will pay $14 million to settle allegations of kickbacks, the U.S. Department of Justice said Tuesday.
The department said Omnicare both solicited and paid kickbacks.
Omnicare allegedly asked IVAX to pay $8 million in exchange for agreeing to purchase $50 million in IVAX drugs, the DOJ said.

***********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Texas Hospital Group Pays U.S. $27.5 Million to Settle False Claims Act Allegations.

Source- http://media-newswire.com/release_1104674.html

(Media-Newswire.com) - WASHINGTON – A hospital group based in McAllen, Texas, has agreed to pay the United States $27.5 million to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute between 1999 and 2006, by paying illegal compensation to doctors in order to induce them to refer patients to hospitals within the group, the Justice Department announced today. McAllen Hospitals L.P., d/b/a/ South Texas Health System, is a subsidiary of Universal Health Services Inc., a company based in Pennsylvania that owns hospitals and other health care centers around the country.

The settlement announced today involved allegations that the defendants had entered into financial relationships with several doctors in McAllen in order to induce them to refer patients to the defendants’ hospitals. The government alleged that these payments were disguised through a series of sham contracts, including medical directorships and lease agreements. Under the Stark Statute, Medicare providers are prohibited from billing Medicare for referrals from doctors with whom the providers have a financial relationship, unless that relationship falls within certain exceptions.

"Improper financial relationships between health care providers and their referral sources can corrupt a physician's judgment about the patient's true healthcare needs," said Tony West, the Assistant Attorney General for the Department’s Civil Division. "In addition to yielding a substantial recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable for patients.

"The settlement resolves allegations raised against both the parent and the subsidiary in a qui tam or whistleblower lawsuit filed in 2005 by Bruce Moilan, a former employee of the defendants, United States ex rel. Moilan v. McAllen Hospitals, L.P., et al., Case No. M-05-CV-263 ( S.D. Tex. ). Under the False Claims Act, private citizens can bring suit on behalf of the government and share in any amounts that are obtained through that legal action. Mr. Moilan will receive $5.5 million from the proceeds of the settlement.

"Payment by hospitals to doctors for patient referrals violates federal law and carries the inherent risk that the independent judgment of doctors regarding the best facility for the treatment and care for a particular patient may be adversely influenced; the patient and his medical needs should always be foremost," said Tim Johnson, U.S. Attorney for the Southern District of Texas. "Our district will continue in its joint effort with our law enforcement partners to enforce these federal laws that protect the public.

"As part of the agreement, South Texas Health Systems will enter into a 5-year Corporate Integrity Agreement that requires it to establish procedures for tracking and evaluating financial arrangements between its health care facilities and their referral sources. The agreement also requires specific training for South Texas Health System representatives involved with financial arrangements, an independent third-party’s annual review of the health system’s compliance with certain Corporate Integrity Agreement obligations involving financial arrangements, and a report to the Office of Inspector General by the independent third-party reflecting the results of the review.

"Improper financial arrangements like these can increase the cost of health care by shifting provider attention to the quantity of treatments, rather than keeping it focused on the quality of care," said Department of Health and Human Services Inspector General Daniel R. Levinson. "The CIA is important because it requires South Texas Health System to put systems in place to prevent this conduct from happening in the future.

"Of the $27.5 million to be paid by the defendants, the federal government will receive $25,208,333 and the state of Texas will receive $2,291,667 for claims submitted to the state Medicaid program.

The case was handled by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Southern District of Texas, the Texas Attorney General’s Office and the Office of Inspector General of the Department of Health and Human Services.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Feds bust up $26 million Medicare fraud rings.

Source-http://www.fiercehealthcare.com/story/massive-medicare-fraud-bust-totals-26-million/2009-10-27

Federal investigations have uncovered Medicare fraud schemes totalling $26 million.

In one case, owners and employees of four medical suppliers based in California and Nevada allegedly billed Medicare for $12 million worth of medical equipment that was never provided or was ordered on behalf of patients who didn't need it or who were deceased, the Los Angeles Times reports.

In another case, a Long Beach, Calif., man was arrested for recruiting relatives and gang members to pose as owners of bogus medical supply companies. The "companies" then billed Medicare for medical equipment totaling $11.2 million.

The busts reflect a growing trend in which Medicare fraud schemes are trickling down into organized crime.

***********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Four Essex County pharmacists indicted in $2.3M Medicaid fraud.

Source- http://www.nj.com/news/index.ssf/2009/10/four_essex_county_pharmacists.html

TRENTON -- Four Essex County pharmacists were indicted today on charges of conspiring to defraud Medicaid of more than $2.3 million for HIV/AIDS drugs and other expensive medications, state officials announced today.

According to authorities, the pharmacists, working with three technicians, purchased completed prescription forms and then billed Medicaid, Medicare and private insurers for drugs that were never supplied to patients.

“Pharmacists are supposed to dispense medicines to preserve health and help those who are sick, but these defendants profited by depriving indigent patients of the drugs they needed,” Attorney General Anne Milgram said. “They also stole from the Medicaid program, which provides medicines and health care services to patients who otherwise could not afford them.”

The four pharmacists are: Nadeem Akhtar, 49, of Upper Saddle River; Omar Mohammad, 31; Calvin Osei, 32, of Sayreville; and Nwala Gabriel, 49, of Piscataway. They worked at three Newark pharmacies, which were also indicted: Campus Pharmacy, Orange Drugs and Harrison Pharmacy.

The three technicians were also named in the indictment: Jannah Rasheedah Amatul Muid, 25, of East Orange; Shivonne Diacy Forde, 26, of Orange; and Alicia Stephens, 29, of Newark.

The 10 defendants were charged with conspiracy, health care claims fraud and Medicaid fraud.

State officials said Bryan X. Chandler, former director of Samaritan Medical in Newark, pleaded guilty to recruiting patients for the fraudulent prescriptions.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Dentist Charged With Medicaid Fraud.

Source-http://yankton.net/articles/2009/10/23/news/doc4ae13449af0a2232669524.txt

OMAHA, Neb. (AP) — A Wood River dentist has been indicted by a federal jury of two counts of defrauding Medicaid of more than $25,000.

Lamont Gillham faces up to 15 years in federal prison if convicted on both counts.

A news release from the U.S. Attorney’s Office in Omaha says 37-year-old Gillham committed health care fraud and falsified documents in the matter between March and May of 2007.

The release says Gillham had been excluded from participating in Medicaid for five years starting in September 2005 after he was convicted of theft from a health care program.

Medicaid is a federal health program for eligible individuals and families with low incomes and resources.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Contractor charged with Medicaid fraud.

Source-http://www2.jcfloridan.com/jcf/news/local/article/contractor_charged_with_medicaid_fraud/102898/

A Holmes County contractor has been accused of Medicaid fraud, according to a press release from Attorney General Bill McCollum.

Robert Greenlee, owner of Greenlee and Sons Construction in Bonifay, was arrested Wednesday and is charged with one count of organized scheme to defraud and one count of wire fraud. Both are third-degree felonies.

If convicted, Greenlee could face up to 10 years in prison and a $10,000 fine, according to the release.

Authorities allege that he defrauded the Florida Medicaid program out of more than $33,000.
Investigators with the Medicaid Fraud Control Unit discovered the alleged fraud after receiving complaints from the Council on Aging of West Florida about home modifications for Medicaid recipients that had been contracted out to Greenlee’s company.

Greenlee, 68, was not a licensed contractor for the counties in which he was working, and building inspectors often found his modifications did not meet industry standards or code, authorities said. Greenlee also allegedly employed unlicensed workers, a violation of industry regulations.
According to investigators, Greenlee consistently billed for work before projects were completed, a practice unauthorized by the Medicaid program.

The Council on Aging reported it had received numerous complaints about his company’s projects, the majority of which were completed with extremely poor quality work, officials said. Investigators also believe that on two occasions, Greenlee billed Medicaid in advance for projects on which he never worked. The case will be prosecuted by the Medicaid Fraud Control Unit through the State Attorney’s Office for the First Judicial Circuit.

Officers with the Holmes County Sheriff’s Office arrested Greenlee on a warrant from the Attorney General’s Medicaid Fraud Control Unit.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Four Pharmaceutical Companies Pay $124 Million for Submission of False Claims to Medicaid.

Source-http://www.infozine.com/news/stories/op/storiesView/sid/37995/

Washington, D.C. - infoZine - The Medicaid Prescription Drug Rebate Program was enacted by Congress in 1990 out of concern for the costs the Medicaid was paying for outpatient drugs. By agreeing to participate in the Medicaid Rebate Program and signing these rebate agreements, the four companies agreed to pay quarterly rebates to Medicaid that were based upon the amount of money that health care program paid for each company’s drugs. The precise amount of a rebate is determined in part by whether a drug is considered an "innovator" drug or a "non-innovator" drug. The rebate that must be paid for innovator drugs is higher than the rebate for non-innovator drugs.

Each of the companies agreed to pay a settlement to resolve allegations that it had sold innovator drugs that were manufactured by other companies and had classified those drugs as non-innovator drugs for Medicaid rebate purposes. As a result of the improper classification of these drugs, the companies underpaid their rebate obligations under the Medicaid Rebate Program.

Mylan and UDL agreed to pay $118 million to resolve allegations that they underpaid their rebate obligations with respect to several Mylan drugs (nifedipine extended release tablets, flecainide acetate, selegiline HCL, Orphenadrine Citrate Aspirin and Caffeine tablets, Triamterene/Hydrochlorothiazide, Propoxyphene HCL, Propoxyphene HCL/Aspirin/Caffeine, Prophyxphene Napsylate/Acetaminophen, Ibuprofen tablets, Bumetanide, Cephalexin and Cefactor) and several UDL drugs (nifedipine extended release tablets, selegiline HCL, Triamterene & HCTZ, Propox Naps & APAP, Flecainide Acetate, Trihexyphenidyl, Ranitidine HCL syrup, Sucralfate Suspension, Selegiline HCL and Bumetanide). Because the Medicaid program is funded by both the federal and state governments, the federal government received $60,896,476.00, the states $49,824,389.00 of the settlement amount and $7,279,135.00 will be paid to entities that participated in the Public Health Service’s Drug Pricing Program.

Separately, AstraZeneca paid $2.6 million ($1.43 million to the federal government and $1.17 million to the states) to resolve allegations that it underpaid its rebate obligations with respect to Albuterol. Ortho McNeil paid $3.4 million ($1.87 million to the federal government and $1.53 million to the states) to resolve allegations that it underpaid its rebate obligations with respect to Dermatop.

"The Civil Division will continue to work with our state partners to ensure that Medicaid programs, which provide health care to more than 58 million Americans, receives the same discounts that any larger insurer gets," Tony West, Assistant Attorney General for the Civil Division, said. "These cases exemplify the strong cooperation between the Department of Justice and the states in protecting American taxpayers."

This case was brought under the False Claims Act, which allows for private persons to file suits on behalf of the government. The whistleblower, Ven-A-Care, a corporation located in Key West, Fla. will receive a total of $10,787,392 as its share of today’s recovery.

"These settlements are the culmination of several years of hard work on the part of the government’s investigators and attorneys," said John P. Kacavas, U.S. Attorney for the District of New Hampshire. " The settlement with Mylan and UDL is the largest health care fraud recovery that the U.S. Attorney’s Office in New Hampshire has ever obtained. The settlements show that the government is committed to identifying health care fraud and ensuring that companies that benefit from doing business with the government agree to play by the rules."

This case was handled by the U.S. Attorney’s Office for the District of New Hampshire and the Commercial Litigation Branch of the Justice Department’s Civil Division with assistance from the Medicaid Fraud section within the New Hampshire Attorney General’s Office, as well as the National Association of Medicaid Fraud Control Units. The case was investigated by members of the Office of Investigations of the Office of Inspector General of the U.S. Department of Health and Human Services.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Lakeland Pain Doctor Faces New Charges.

Source-http://www.theledger.com/article/20091018/NEWS/910195014/1338?Title=Doctor-Faces-New-Charges

LAKELAND A federal grand jury has lodged additional charges against Dr. Jeffrey Friedlander and three staff members arrested with him in April on charges of conspiring to dispense addictive painkillers.

They worked at the Neurology and Pain Centers in Lakeland, Tampa, Sarasota, St. Petersburg, Jacksonville and Orlando. A hearing is scheduled Oct. 29 for arraignment on a "superseding indictment," basically taking the place of the earlier one, that adds accusations of Medicare fraud and retains the previous allegations of improperly distributing painkillers.

The arraignment is scheduled for Friedlander, physician assistant Troy Wubbena and employee Sarah Ehresman, according to court documents.

A fourth defendant, Carl Ehresman, an emergency medical technician, has accepted a plea agreement.

The agreement calls for him to plead guilty to conspiracy to "knowingly and intentionally distribute and dispense, and cause the distribution and dispensing of" the prescription drugs. Several charges against him would be dropped and he would testify in ongoing federal proceedings in that case.

A hearing on the plea agreement is scheduled Thursday in Tampa before Magistrate Judge Thomas G. Wilson, who also scheduled to preside at the Oct. 29 hearing.

Friedlander - board certified in internal medicine, neurology, pain medicine and vascular neurology - was the only one legally allowed to prescribe the controlled substances named in the indictment.

But the indictment contends the defendants used pre-signed, blank prescription forms on which people other than Friedlander filled in the controlled substances and dosages being prescribed.

Oxycodone, morphine, hydrocodone and alprazolam are the drugs they mostly used, according to the indictment filed earlier this month. The first three are powerful, highly addictive painkillers. Alprazolam, better known as Xanax, is for anxiety caused by depression and for anxiety and panic disorders.

A jury trial once set for Nov. 9 for all defendants has been rescheduled for February.

The indictment accuses Friedlander and Wubbena of conspiring with others to defraud Medicare by filing claims for services that weren't given. It says they billed for procedures with higher payment rates when lower-paid, less complex procedures actually had been done.

That type of billing, called upcoding, results in health providers' receiving more money than they're eligible for under Medicare. The indictment says they began committing Medicare fraud about 2006, through methods such as:

Using massage therapists to do "physical therapy" that they weren't licensed to do, while billing Medicare for legitimate physical therapy done by licensed physical therapists under the supervision of a physician.

Billing for more extensive office visits than actually occurred, requesting the higher rate for medical evaluation and management for established patients when unlicensed, nonmedical people saw patients without supervision by the physician.

Routinely billing for a procedure called facet joint block injection that needs fluoroscopic guidance with imaging equipment into a point in the vertebrae when they actually gave "trigger point" injections into painful areas of muscle. Unlicensed, nonmedical people did the trigger-point injections without a doctor's presence and supervision, the indictment charges.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Doctor has been sued for Medicare fraud.

Source-http://www.gjsentinel.com/hp/content/news/stories/2009/10/14/101509_1a_DEA_raid_sidebar.html

A Montrose doctor whose offices and home Wednesday were raided by agents of the U.S. Drug Enforcement Administration has a history of being sued for Medicare billing fraud.

Dr. Sam Jahani, 48, runs health-care clinics in Grand Junction and Montrose and has an office in Delta with Dr. Eric Peper. The DEA did not arrest either man or provide details Wednesday about why they were seizing medical files from the clinics and searching the doctors’ homes.

Jahani did not respond to a Daily Sentinel request for comment Wednesday.

Jahani was sued and settled with the U.S. government in 2003 on allegations he defrauded the government of $5 million in false Medicare claims, according to documents with the U.S. Department of Justice.

Jahani was accused of making the false claims through his private practice in Texas and at the Integrated Health Services Hospital in Dallas, Texas, where he was the medical director. The claim was brought to the attention of authorities by a medical social worker who worked at the Dallas hospital between May and July 1998.

Jahani admitted patients into the long-term, acute-care hospital for conditions that could have been handled in a less intensive setting. He submitted false claims to Medicare for treatment that was not performed by skilled staff and for treatments that were not sustained for the duration claimed and/or were not medically necessary, according to court records.

For example, Jahani allegedly admitted a 65-year-old woman to the hospital under the diagnosis of multiple fractures, while a therapist working with the woman said the woman’s real problem was loneliness and a broken leg. Another elderly woman allegedly was admitted for pulmonary complication, but she never had a pulmonary consultation at the hospital and left the hospital each day for outings with her husband.

The lawsuit also alleged patients admitted by Jahani were permitted to leave the hospital in the morning and return in the evening, and the hospital’s marketing director would take patients to the mall or bowling for “recreational therapy.”

Jahani currently is being sued in U.S. District Court in Denver by a Montrose woman who worked as Jahani’s manager at his Delta office, 164 W. Third St. The woman, who worked there from May 2006 to Dec. 5, 2008, alleges she was fired when she threatened to turn in Jahani for fraudulent Medicare billing.

“It was not uncommon for Jahani to see 50 to 60 patients on days which he spent approximately 6 hours in his office seeing clients. Jahani in fact instructed staff members to schedule 12 patients per hour,” the lawsuit alleges.

On those days Jahani spent six to seven minutes with each patient yet routinely billed patients under a code that indicated he spent 25 minutes with them, the lawsuit claims. The lawsuit also alleges Jahani required unnecessary follow-up visits, billed ordinary care as urgent care and billed Medicare for daily visits of hospital and nursing home patients, “when in fact these patients had not been seen by a physician.”

The woman alleged Jahani offered to set her up with her own medical billing practice, but she denied the offer. She was then fired, although she had a two-year contract to work at the practice until Dec. 28, 2008.

She said she was denied an opportunity to interview for an open position for an office manager by Hospital Administrator Tom Mingen at Delta County Memorial Hospital. The lawsuit alleges Mingen said Jahani had given her a “bad reference,” but the woman had not listed Jahani as a reference on her resume.

The complaint also said Jahani worked at the medical director for the Palisade Living Center and opened the GJ Urgent Care clinic in Grand Junction in the fall of 2008.

***********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Former Beaumont doctor pleads guilty to health care fraud.

Source-http://www.kfdm.com/news/span-34656-press-guilty.html

BEAUMONT, TX -- U.S. Attorney John M. Bales announced today that a 46-year-old doctor who formerly practiced in Beaumont, has pleaded guilty to health care fraud in the Eastern District of Texas.

DARRYL CLARENCE HARRIS, of Los Angeles, CA, pleaded guilty to an Information charging him with Health Care Fraud today before U.S. Magistrate Judge Earl Hines.

According to information presented in court, Harris, an obstetrician/gynecologist, formerly practiced in Beaumont, Texas, was enrolled as a Texas Medicaid Provider. As part of his practice, Harris commonly submitted claims for ultrasounds and microbial identification tests, but as Harris was aware, his office was not capable of performing the tests. At the end of February 2005, two physicians practicing with Harris left the practice and took the ultrasound and microbial testing equipment with them. From March 2005 until August 2005, Harris did not have access to ultrasound equipment, and from March 2005 until November 2005, he did not have access to microbial testing equipment. However during these times, Harris continued to bill Medicaid for both tests and submitted claims for hundreds of unperformed tests resulting in the fraudulent payment of $76,683 from the Texas Medicaid program.

Harris faces up to 10 years in federal prison at sentencing. A sentencing date has not been set.

This case is being investigated by the Texas Attorney General's Office, Medicaid Fraud Control Unit, the Drug Enforcement Administration, the Federal Bureau of Investigation and the Internal Revenue Service and prosecuted by Special Assistant U.S. Attorney Christopher Tortorice.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Detroit Clinic Owner, Doctor and Office Manager Indicted in Medicare Infusion Fraud Scheme.

Source-http://www.prnewswire.com/news-releases/detroit-clinic-owner-doctor-and-office-manager-indicted-in-medicare-infusion-fraud-scheme-63879112.html

WASHINGTON, Oct. 9 /PRNewswire-USNewswire/ -- Three Miami-Dade County, Fla., residents have been indicted in connection with an alleged $2.3 million Medicare fraud scheme operated out of X-Press Center, a Detroit-area clinic that purported to specialize in providing injection and infusion therapies, Assistant Attorney General of the Criminal Division Lanny A. Breuer, U.S. Attorney for the Eastern District of Michigan Terrence Berg and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS) announced today. In addition, a former manager at X-Press Center pleaded guilty to one count of conspiracy to commit health care fraud in connection with her management of the clinic.

Juan De Oleo, 49, Rosa Genao, M.D., 50, and Ingrid Mazorra, 35, were each indicted by a grand jury in Detroit with conspiracy to commit health care fraud and five counts of substantive health care fraud. Genao and Mazorra were also charged with one count of destroying records relevant to a federal investigation. In addition, De Oleo was charged with two counts of money laundering. The superseding indictment unsealed today added De Oleo, Genao and Mazorra to a pending indictment unsealed on June 24, 2009, charging seven defendants with alleged crimes related to their involvement with X-Press Center.

According to the superseding indictment, De Oleo was a part owner of X-Press Center, Genao was a physician employed at X-Press Center, and Mazorra was the clinic's office manager. The indictment alleges that De Oleo and his co-conspirators agreed to open a fraudulent infusion and injection therapy clinic, and to split the proceeds of fraud among themselves. According to the indictment, Medicare beneficiaries received kickbacks in return for visiting the clinic and signing forms indicating that they received treatments that were medically unnecessary or never provided. The indictment also alleges that Genao and Mazorra altered, falsified and destroyed patient records to attempt to justify the medically unnecessary services that were purportedly being provided at the clinic.

The indictment alleges that De Oleo, Genao, Mazorra and their co-conspirators caused approximately $2.3 million in fraudulent billing to the Medicare program for services at X-Press Center that were medically unnecessary or never provided.

The charges of health care conspiracy and health care fraud carry a maximum sentence of 10 years in prison and a $250,000 fine, per count. The charge of destroying records carries a maximum sentence of 20 years in prison and a $250,000 fine. The money laundering charges carry a maximum penalty of 10 years in prison and a $500,000 fine, per count.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

Also today, Dulce Briceno, 57, pleaded guilty before U.S. District Judge Ursula Ungaro in the Southern District of Florida to one count of conspiracy to commit health care fraud. In pleading guilty, Briceno admitted that in approximately September 2006, she agreed to manage the clinic on a day-to-day basis in exchange for a percentage of the profits the clinic generated. Briceno admitted that during the time the clinic was open, the clinic routinely billed the Medicare program for services that were medically unnecessary or were never provided. Briceno admitted that she and her co-conspirators at the clinic had purchased only a small fraction of the medications that the clinic billed the Medicare program for providing.

Briceno admitted that Medicare beneficiaries were not referred to X-press Center by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of kickbacks. In exchange for those kickbacks, Briceno admitted that the Medicare beneficiaries would visit the clinic and sign documents indicating that they had received the services billed to Medicare. According to court documents, kickbacks paid to Medicare beneficiaries at the clinic were made in the form of cash and prescriptions for narcotic drugs.

Briceno also admitted that between approximately September 2006 and March 2007, she and her co-conspirators at X-Press Center caused the submission of approximately $2.3 million in false and fraudulent claims to the Medicare program for services purportedly provided at X-Press Center. Medicare paid approximately $1.8 million on those claims.

At her sentencing, scheduled for Jan. 15, 2010, Briceno faces a maximum of 10 years in prison and a $250,000 fine. Briceno was originally charged in the Eastern District of Michigan, but after her arrest in Miami, she consented to have her case transferred to the Southern District of Florida for her plea and sentence.

The cases are being prosecuted by Trial Attorneys John K. Neal and Benjamin D. Singer of the Criminal Division's Fraud Section. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The cases were brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Eastern District of Michigan.

Since their inception in March 2007, Strike Force operations in four districts have obtained indictments of 300 individuals who collectively have falsely billed the Medicare program for more than $680 million. In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Iowa chiropractor sentenced in Medicaid fraud case.

Source-http://iowaindependent.com/20751/iowa-chiropractor-sentenced-in-medicaid-fraud-case

A Cedar Rapids chiropractor will be spending the next seven years behind bars for using the stolen identities of minors in a scheme to bilk Medicaid.

Douglas P. Dvorak, 46, received the prison term Thursday after an April jury verdict found him guilty of 22 counts of mail fraud, 11 counts of aggravated identity theft and six counts of money laundering.

Evidence presented at trial showed that between late 2005 and early 2007, Dvorak defrauded the Medicaid health insurance program by submitting claims for services he never provided. He used the identities of more than 30 under-aged Medicaid beneficiaries in executing the scheme, and engaged in financial transactions with the proceeds that were designed to conceal the location and control of the money. His intention, according to trial evidence, was to defraud Medicaid, a government program designed to help individuals and families with low income access health care, for more than $120,000.

Dvorak was sentenced to 85 months in prison — 37 for the mail fraud and money laundering, and 48 for aggravated identity theft. He was also ordered to pay $71,375.82 in restitution to Iowa Medicaid Enterprise, and a special assessment of $3,900. He will serve a three-year period of supervised release after his prison term.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Mafia, violent criminals turn to Medicare fraud.

Source-http://www.google.com/hostednews/ap/article/ALeqM5gkMiV-gKQhCN626RwnoxQKm8eM7AD9B5OKO01

MIAMI — Lured by easier money and shorter prison sentences, Mafia figures and other violent criminals are increasingly moving into Medicare fraud and spilling blood over what once a white-collar crime.

Around the nation, federal investigators have been threatened, an informant's body was found riddled with bullets, and a woman was discovered dead in a pharmacy under investigation, her throat slit with a piece of broken toilet seat.

For criminals, Medicare schemes offer a greater payoff and carry much shorter prison sentences than offenses such as drug trafficking or robbery.

"We've seen more people that used to be involved in (dealing) drugs are switching over to health care fraud because it's not as dangerous," Miami FBI spokeswoman Judy Orihuela said.

Medicare scammers typically make their money by billing Medicare for medical equipment and drugs that patients never receive — and never needed. Some pay homeless people on Los Angeles' Skid Row for Medicare or Social Security numbers to use in fake billing invoices. Others intimidate elderly victims to use their Medicare numbers, federal authorities say.

Most Medicare schemes are based in cities such as Miami, Los Angeles, Detroit and Houston. And rather than building an elaborate hierarchy like the Mafia or other gangs, many Medicare con artists use common street criminals to recruit patients and doctors, authorities said.

A Medicare scammer could easily net at least $25,000 a day while risking a relatively modest 10 years in prison if convicted on a single count. A cocaine dealer could take weeks to make that amount while risking up to life in prison.

"Building a Medicare fraud scam is far safer than dealing in crack or dealing in stolen cars, and it's far more lucrative," said Lewis Morris, lead attorney at the Department of Health and Human Services' inspector general's office.

It's unclear how many violent crimes are tied to Medicare fraud because most of them are carried out by someone within the hoax who attacks another person taking part in the crime.

One Southern California criminal task force has arrested about 50 suspects for Medicare fraud in the last three years.

And 11 members of New York's Bonanno family were indicted in May in a Medicare fraud scheme in South Florida. They were accused of stealing patients' Medicare numbers and using them to submit false claims. Other allegations included identity theft and conspiring to commit murder.

Even criminals with violent records, including a convicted murderer, have been able to obtain Medicare supplier licenses. Applicants with felony records can only be rejected if their convictions are 10 years old or less.

"It's outrageous that those trusted to provide medical care are really nothing but common criminals," said federal prosecutor Kirk Ogrosky, who heads the Medicare Fraud Strike Force across the United States.

Guillermo Denis Gonzalez spent 14 years in prison for second-degree murder, but after his 2006 release, records showed he soon bought a business called DG Medical in the Miami suburb of Hialeah and applied to be a Medicare supplier.

Within two months, federal investigators were alerted that the Medicare claims the company were making were fraudulent and suspended its license. By then, the sham company had illegally netted $31,000.

Last month, he pleaded guilty to Medicare fraud and now awaits sentencing. He is also charged in a gruesome killing in May 2008 in which police say he repeatedly stabbed a man with a kitchen knife, crushed his face with a mallet, then cut off the victim's head and dismembered the body before stuffing the parts in trash bins. The killing might be related to Medicare fraud, authorities said.

His attorney, Stephen Kramer, has declined to comment.

Medicare-fraud investigations used to focus mainly on patient records and financial papers, but now the crime scenes are increasingly bloody:

_ In 2007, authorities found Juana Gonzalez lying in a pool of blood on the floor of her Miami pharmacy. Her cousin was charged with second-degree murder, accused of taking a piece of a broken toilet and slitting Gonzalez's throat. Federal authorities said they were investigating the pharmacy for Medicare fraud and believe the crimes are related.

_ In 2004, a week after the FBI issued search warrants on more than 50 fraudulent Medicare storefronts in Miami, the body of Ernesto Valdes was found in the back seat of his car, riddled with bullets. Federal authorities said he had information that could have linked players in the $148 million fraud scheme. No one has ever been charged in his slaying.

_ In 2006, members of a Russian-Armenian organized crime ring were indicted for allegedly bilking Medicare of more than $20 million through a group of medical clinics they ran in the Los Angeles area. The group included Konstantin Grigoryan, a former colonel in the Soviet army, family members and others with past criminal records.

"They don't have the typical structure that we see in Italian mobs. They'll work with whoever can make them money. And if they don't get their way, they won't be ashamed to kidnap somebody, to shoot somebody," said Glendale Police Lt. Steve Davey, who leads the Southern California Eurasian Organized Crime Task Force.

The violent crimes are mostly to settle a debt or silence a witness.

"It's in-house. Typically professional hits, generally unsolved. Usually it's just a bullet in the head, nobody saw anything," said Los Angeles County Sheriff's Sgt. Stephen Opferman.

The Armenian gangs have also aggressively pursued elderly patients, intimidating them to obtain their Medicare numbers, Opferman said. Police have received reports from family members who feared their grandmother had been abducted, only to learn later that she was picked up in a van and taken to a fake store where her Medicare number was swiped.

The groups have broken into computer banking systems or paid moles to provide key information from court clerk's offices and various government agencies, Davey said.

In Los Angeles, two federal authorities investigating Medicare fraud say colleagues have been threatened and had their cars followed.

Sometimes Medicare fraud turns violent without the involvement of organized crime.

Illinois podiatrist Ronald Mikos was sentenced to death for the 2002 fatal shooting of a patient to keep her from telling a federal grand jury how he defrauded Medicare. He shot the woman six times as she sat in her wheelchair at her home. Her subpoena was found on the floor next to her.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Man ran large-scale prescription drug operation, officials say.

John Davey

Source-http://www.news-journalonline.com/NewsJournalOnline/News/Headlines/frtHEAD03100309.htm

A DeBary man was jailed Friday on $1 million bail after authorities say he sold pharmaceutical drugs acquired with phony prescriptions.

John Davey, 41, had more than 30 people on his payroll, Volusia County sheriff's spokesman Gary Davidson said.

"He is accused of forging prescriptions, mostly for oxycodone, Dilaudid (both pain killers) and Xanax (an anti-anxiety drug), and then paying people to get the phony prescriptions filled at local pharmacies," Davidson said. "Davey would pay his accomplices in either money or pills."

Davey obtained prescriptions for more than 14,000 pills with an estimated street value of about $200,000, Davidson said.

He was nabbed when an investigator in an unmarked vehicle followed Davey with two others in a pickup, on a hunch they were going to buy drugs, Davidson said. One of the people with Davey went into a pharmacy and picked up a prescription for 120 oxycodone pills, which were found on Davey when a marked patrol car pulled the truck over.

Investigators linked Davey -- who records show has a lengthy criminal history and has spent time in prison for burglary and theft -- to a number of other fraudulent pill purchases and charged him with operating a criminal enterprise because he acted with five or more people, Davidson said.

Law enforcement officers across the county are seeing a rise in fraudulent prescription drug activity, involving people of all ages and walks of life.

Often police are alerted to fraud on a smaller scale when people report their prescription drugs have been stolen, Daytona Beach Police Chief Mike Chitwood said.

"A 67-year-old lady was selling her prescription drugs," he said Thursday night at a police crime-trends informational meeting.

She told police she had just refilled all of her prescriptions at Walmart and the medicines were stolen from her as she left.

"We called her doctor and found out this is the second time in a week she's had her prescriptions stolen from her," Chitwood said. "Then she confesses she's selling drugs."

A doctor, with an office in Orange City, is under investigation by the Volusia Bureau of Investigation, the U.S. Drug Enforcement Administration, Florida Department of Law Enforcement and Florida Attorney General's Office. Several of his patients, including some from Volusia County, died of drug overdoses, Davidson said earlier this week.

Records were seized Thursday from the Sanford office of 59-year-old Dr. Ralph Chambers Jr.

The doctor is suspected of prescription fraud and prescribing painkillers for illegitimate purposes, along with possible Medicaid fraud, officials said. Chambers' name also came up during several pill distribution cases.

Chambers, who has not been charged, was a common factor in the overdose deaths of several people in the region, Davidson said. However, he would not say how many Volusia County victims were involved.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Pharmacia ordered to pay $4.5M in Wis. fraud case.

Source-http://www.thestate.com/business-wire/story/965860.html

MADISON, Wis. -- A judge on Tuesday imposed $4.5 million in forfeitures on prescription drug company Pharmacia Inc. for misrepresenting prices and defrauding Wisconsin's Medicaid system.

A jury in February found that Pharmacia violated the state's Medicaid fraud law 1.44 million times over a decade. State Justice Department attorneys had demanded about $212 million in forfeitures, but Dane County Circuit Judge Richard Niess said jurors grossly overcalculated the number of violations.

Chris Loder, a spokesman for Pfizer, Pharmacia's corporate parent, said the company was pleased that the judge rejected the state's "excessive" demands, but still disputes the jury's findings. He said the company would appeal the verdict and the award.

"We ... continue to believe that no penalties were appropriate in this case," Loder said.

Attorney General J.B. Van Hollen, meanwhile, still called the case a win.

"By any measure, it's a resounding affirmation of our contention that the fix is simple: Tell the truth," Van Hollen said in a statement.

The jury found Pharmacia knowingly defrauded the state out of about $7 million over 15 years, Niess wrote in his order Tuesday.

But the judge said the jury's finding of 1.44 million violations, each punishable with $100 to $15,000 forfeitures, was clearly wrong. After reviewing the evidence, the judge found the actual tally was 4,578.

He elected to set the forfeiture level at $1,000 per violation. The judge said he was concerned that if he ordered the maximum $68.6 million Pharmacia would pass the expense to consumers and nothing showed any of the fraudulent $7 million went directly to Pharmacia's profits.

On the other hand, the judge said, a $100 per violation forfeiture totaling $457,800 would "not register so much as blip on Pharmacia's multibillion-dollar annual fiscal radar screen" and a higher amount would draw attention to the need to reform pharmaceutical reimbursement scales.

Van Hollen's predecessor, Peg Lautenschlager, sued Pharmacia and 35 other prescription drug companies in 2004 accusing them of inflating wholesale prices to get larger payments from Medicaid, private insurers and consumers.

Three other companies - Amgen, Immunex and Baxter Healthcare - have settled. The remaining 32 cases are still in litigation, with trials set to run from March through May 2010.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Dentist Admits Medicaid Fraud.

Source- http://ozarksfirst.com/content/fulltext/?cid=190862

(Joplin, MO) -- A Joplin dentist pleaded guilty to Medicaid fraud this morning.

Samuel Miller was in Jasper County court for 13 counts of filing a false statement for a healthcare payment. Missouri Attorney General Chris Koster was also in Joplin for the plea.

He says Miller made claims for X-rays, root canals, and tooth restoration that he never performed. That adds up to more than 13,000 dollars charged to Medicaid.

An anonymous tip started the case.

Koster said, during the investigation, Miller held back records and cut out portions of reports in an attempt to hide the truth.

"The state of MIssouri loses tens of millions of dollars every year as the result of Medicaid fraud, probably hundreds of millions of dollars. Already this year, the Attorney General's office has recovered $75 million and deposited it back in the state treasury. It's a very important situation, we're trying to pay alot of attention to it," says Koster.

In the plea deal, Koster agreed that no further charges would be filed to any crimes occurring before the November 2008 arrest.

Miller could face up to four years in prison for each of the 13 charges as well as potential fines.

He'll be sentenced in Jasper County court in January.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Detroit Clinic Owner and Manager Plead Guilty to Medicare Fraud Charges.

Jose Martinez, 33, and Denisse Martinez, 27, each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Victoria Roberts. At sentencing, which is scheduled for Feb. 18, 2010, both defendants face a statutory maximum of 10 years in prison and a $250,000 fine.

Source-http://media-newswire.com/release_1100033.html

Media-Newswire.com) - WASHINGTON—Clinic owners and operators Jose Martinez and Denisse Martinez pleaded guilty today in U.S. District Court in Detroit to participating in a conspiracy to defraud the Medicare program, Assistant Attorney General Lanny A. Breuer of the Criminal Division, U.S. Attorney Terrence Berg of the Eastern District of Michigan and Daniel R. Levinson, Inspector General of the Department of Health & Human Services ( HHS ) announced.

Jose Martinez, 33, and Denisse Martinez, 27, each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Victoria Roberts. At sentencing, which is scheduled for Feb. 18, 2010, both defendants face a statutory maximum of 10 years in prison and a $250,000 fine.

According to court documents, Jose Martinez, in September 2006, opened RDM Center Inc., a Canton, Mich., medical clinic purporting to specialize in providing injection and infusion services to Medicare beneficiaries. Jose Martinez’s then-wife, Denisse Martinez, managed and operated the clinic.

In their pleas, both defendants acknowledged that they hired a physician and other employees to work at RDM Center in order to create the appearance that the clinic was a legitimate health care facility providing necessary services to patients, when in fact, everyone working at the clinic knew that it was operated for the sole purpose of defrauding Medicare.

In their pleas, both Jose and Denisse Martinez admitted that during the time that the RDM Center was open, the clinic routinely billed the Medicare program for services that were medically unnecessary or never provided. Both defendants admitted that they purchased only a small fraction of the medications for which the clinic billed the Medicare program. Both defendants also admitted that patients were prescribed medications at the clinic based not on medical need, but on which medications were likely to generate Medicare reimbursements.

Denisse Martinez admitted in her plea that, despite having no medical training, she completed the clinic’s patient records by filling in, among other things, the “diagnosis” and “treatment” sections of the patient charts, which were then provided to the physician for his signature.

According to information contained in the plea documents, Medicare beneficiaries were not referred to RDM Center by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of kickbacks. In exchange for their kickbacks, the Medicare beneficiaries would visit the clinic and sign false documents indicating that they had received the services billed to Medicare. Kickbacks came in the form of cash and prescriptions for controlled substances.

Jose Martinez stated in his plea that he provided cash to a patient recruiter for the purpose of paying Medicare beneficiaries to sign paperwork indicating that they had received infusion and injection therapy services which they did not in fact receive. Denisse Martinez stated in her plea that she understood the patients at the clinic were induced to visit RDM Center through the payment of kickbacks. Both defendants further admitted to being aware that certain Medicare beneficiaries demanded that they be provided prescription drugs, including Vicodin, in exchange for their participation in the fraudulent scheme and that such drugs were in fact provided.

Both defendants admitted in their pleas that between approximately November 2006 and March 2007, they and their co-conspirators filed $970,631 in false and fraudulent claims with the Medicare program. According to court documents, Medicare actually paid more than $649,000 of those false claims.

The case is being prosecuted by Trial Attorneys John K. Neal and Benjamin D. Singer of the Criminal Division’s Fraud Section and by Special Assistant U.S. Attorney Thomas W. Beimers of the Eastern District of Michigan. The FBI and the HHS Office of Inspector General ( HHS-OIG ) conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

Since the inception of Strike Force operations in March 2007 – Miami ( Phase One ), Los Angeles ( Phase Two ), Detroit ( Phase Three ) and Houston ( Phase Four ) – the Strike Force has obtained indictments of 300 individuals and organizations that collectively have billed the Medicare program for more than $680 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the Medicare Fraud Strike Force teams are led by a federal prosecutor from the Criminal Division’s Fraud Section or the U.S. Attorney’s Office. Each team has an agent from the FBI and HHS-OIG.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Miami Medicare fraud defendant gets 8 years.

Authorities say Alcides Garcia claimed $10.7 million in Medicare claims and collected $2.2 million

Source- http://www.miamiherald.com/news/southflorida/story/1245087.html

A fugitive who claimed to be Mexican but was betrayed by his Cuban accent -- which led to his arrest in Spain -- was sentenced to eight years' imprisonment Monday in Miami federal court on U.S. Medicare fraud charges.

Alcides Garcia, 44, of Pembroke Pines, asked the judge for ``forgiveness'' after his lawyer challenged the total amount of fraud -- $10.7 million in false claims, according to prosecutors. Garcia's Hialeah medical equipment business collected $2.2 million for supplies never provided to patients.

U.S. District Judge Marica Cooke ordered Garcia to pay it all back. But if he is like hundreds of other Medicare fraud prosecutions, the taxpayer-funded program for the elderly won't likely recover much money.

Garcia, who pleaded guilty to one count of defrauding Medicare, listed himself and others as the owner of A&Y Medical Supply from 2002 to 2004, billing Medicare for power air mattresses, feeder pumps and other equipment.

``This defendant figured out it was easier to hide through other people,'' said Assistant U.S. Attorney Daniel Bernstein, adding that Garcia used a local billing firm, All-Med, headed by a Miami Lakes couple convicted of unrelated Medicare fraud last year.

Garcia fled South Florida before his trial a year ago. Free on $200,000 bond, he traveled to Mexico, then Spain, then the Canary Islands, on a false Mexican passport. Initially, the FBI thought he had escaped to his native Cuba.

But Garcia made a mistake on the lam, when he went to a shipping company in the Canary Islands in February to have his belongings sent from Miami to the Spanish island.

The business owner grew suspicious of him because he said he was Mexican, but she detected his heavy Cuban accent. The accent was familiar to her because people on the Canary Islands are known to speak Spanish like Cubans.

The business owner Googled Garcia's name on the Internet and up popped a Miami Herald/El Nuevo story published in January that described Garcia as a Cuban-born fugitive wanted on Medicare fraud charges in South Florida. The story, which carried a mug shot of Garcia, confirmed his identity.

The owner called the FBI in Miami. Special Agent Robert Cessario notified authorities in Madrid.

Garcia later checked into a hotel in the capital city, using his real name and the false Mexican passport. The Spanish National Police arrested him on an FBI warrant in March.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Doctor accused of prescribing to dealer.

Source-http://www.wpri.com/dpp/news/local_news/west_bay/local_wpri_east_greenwich_doctors_license_suspended_20090918_deg

EAST GREENWICH, R.I. (WPRI) - The Rhode Island Department of Health has suspended the medical license of Doctor James Urban, M.D.

According to a complaint obtained by Eyewitness News, Urban is accused of knowingly prescribing narcotics to a patient, who then sold them on the street for a profit.

The complaint goes on the state: "The Respondent (James Urban) then 'coached' the patient on how to deceive law enforcement regarding selling the narcotics."

Urban has twice been sanctioned by the Board of Medical Licensure and Discipline. He was reprimanded in January 2007. Then, in May 2009, he was placed on probation.

Several other agencies, including the Food and Drug Administration, the Attorney General's Medicaid Fraud and Patient Abuse Unit, East Providence Police and North Providence Police are also investigating Urban.

Urban was issued a license to practice medicine in Rhode Island in 1999. His primary area of practice is Internal Medicine. His office is located at Harbour Medical on Division Street in East Greenwich.

He has 10 days to request a hearing to appeal the suspension.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Doc Gets 21 Months for Medicaid Fraud.

Source- http://www.courthousenews.com/2009/09/18/Doc_Gets_21_Months_for_Medicaid_Fraud.htm

MANHATTAN (CN) - A Brooklyn physician was sentenced on Thursday to 21 months in federal prison and ordered to pay $1.8 restitution for paying illegal kickbacks to Medicaid recipients.

Muhammad Ejaz Ahmad paid HIV-positive patients $40 for every visit, and referred them to pharmacies he owned with his wife and/or brother and brother in law, prosecutors said.

"(T)he New York State Medicaid program paid the pharmacies at least $2.5 million for services purportedly provided to patients to whom the defendant and his co-conspirators had paid illegal kickbacks," the U.S. Attorney's Office said in a statement. "Most of these billings were for medications that were never ordered from legitimate wholesalers.

Instead, the pharmacies provided these Medicaid patients with lower-priced, diverted, and black-market medications or, in some cases, billed Medicaid for drugs that were never dispensed. ... The excess profits obtained from the Medicaid program paid for the kickbacks to patients."

Muhammad Nawaz Ahmad was sentenced to 18 months in prison in December 2008. Mohammad Tanveer will be sentenced on Sept. 25.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

San Juan podiatrist arrested on health care fraud charges.

Source- http://www.themonitor.com/news/juan-30573-arrested-mcallen.html

McALLEN — Federal agents arrested a podiatrist accused of defrauding Medicaid and Medicare on Monday at the offices of his San Juan clinic.

Investigators believe Franklin Beltre, 39, of Houston, billed the federally funded health care programs for services that were not eligible for reimbursement, operations conducted by an unlicensed assistant and procedures conducted in facilities that put his patients at risk.

In all, federal prosecutors allege Beltre — who operates the Valley Medical Foot Care clinic in San Juan — has received at least $1,400 in improper payments since 2004.

According to an eight-count federal indictment handed down Thursday, Beltre and one of his physician’s assistants — Manuela K. Alana, 40, of Pharr — violated several rules of the Medicare and Medicaid programs, including regulations that the billing doctor be on site for all medical procedures.

Beltre allegedly took trips to Nevada, Florida, Colorado and Europe, leaving Alana to perform procedures she was not licensed to undertake.

Alana, who is also named in the indictment, graduated from New York College of Podiatric Medicine in 1996 but had failed to pass state licensing exam at least five times between 1995 and 1998. She still does not hold a license, according to the Texas State Board of Podiatric Medical Examiners.

When he was away, Beltre allegedly left pre-signed prescriptions for his assistant to fill out for the patients that she saw. Alana additionally performed several procedures at adult day care centers in violation of program rules, which require operations be done at rest homes or nursing facilities, federal prosecutors said.

“Thus, Beltre would and did place the Medicare beneficiaries and Medicaid recipients at risk of infection and physical danger,” Assistant U.S. Attorney Carolyn Ferko wrote in the indictment.

Beltre, who also operates the Bissonnet Health Care clinic in Houston, is at least the second Rio Grande Valley doctor to come under scrutiny this year for alleged Medicare and Medicaid violations.

Last month, a federal judge sentenced cardiologist Dr. Fabian Aurignac to nearly five years in prison for participating in a similar scheme in which he allegedly used uncertified South American doctors to see patients while he traveled to Argentina.

Aurignac was also accused of bribing adult day care center owners for access to their clients, on whom he performed unnecessary procedures in exchange for Wal-Mart gift cards.

As of late Monday night, Beltre remained in federal custody pending a bond hearing scheduled for today. It was not immediately clear if he had retained an attorney.

Alana, who also faces eight counts of Medicare and Medicaid fraud, still remains at large, the U.S. Attorney’s Office said Monday afternoon.

If convicted, both could face up to 10 years in prison per count.

Medicare is a federally funded program offering healthcare assistance for individuals who are 65 and older and for the disabled. Medicaid is a federal-state program that helps pay for health care for the needy, aged, blind and disabled and for low-income families with children.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Health care facility owner sentenced for medical fraud.

Source- http://isanti-chisagocountystar.com/read/detail/47919.html

The owner of a Braham home health care facility has been ordered to pay $30,000 in restitution for medical assistance fraud and is not allowed to work anywhere that medical assistance funds are received.

The Minnesota Attorney General’s Office claimed Joyce Jean Jackson, 56, of Hinckley defrauded Isanti County residents out of $91,027.86. Jackson must also complete 240 hours of community service and six years of probation or until the fine is paid, as ordered at her sentencing on Sept. 3. Jackson had previously plead guilty to one of the counts, and the other six were dismissed.
A complaint filed May 22, 2008 accused Jackson of seven counts of medical assistance fraud and one count of theft by false representation.

The incidents occurred between Jan. 11, 2005 and Oct. 2, 2007.
During that period of time, Jackson operated Destine In-Home Care Services, based off West Central Drive in Braham. While caring for clients in Isanti County, the state alleged Jackson overpaid herself.

Also, an employee who had been disqualified for work by the Minnesota Department of Human Services was alleged to have remained employed.

Since many of Destine’s clients were on Medicaid, the overcharged bills were paid by the state. The majority of the amount allegedly collected fraudulently came from the Medicaid program.
Blue Cross Blue Shield, a health insurance company, was also cited in the complaint as being overbilled by $902.66.

The investigation
Debie Tsuchiya, an investigator with the Medicaid Fraud Control Unit (MFCU), spearheaded the investigation after receiving tips from former employees of Destine, according to the complaint.
A family who had received Destine’s services alerted the Office of Health Facility Complaints that some of the provider’s time cards overlapped.

Additionally, an anonymous caller to the MFCU, cited in the complaint as a former employee, alleged Destine was not conducting background checks on employees and billing according to service agreements instead of documenting services on time cards.

A letter to MFCU from another former employee claimed the aforementioned family were not receiving the care being reported by Destine.

These incidences were used as justification for a search warrant executed Sept. 27, 2007 at Destine’s office in Braham, and also a secondary office in Brooklyn Park.

Tsuchiya’s investigation of the materials seized in those raids led to the charges of fraud.
Because of allegations in multiple counties, the Minnesota Attorney General’s Office prosecuted the case, not the Isanti County Attorney’s Office.

Background on Destine

Destine was in business as a personal care provider organization since 1997. Up until July 2006, it was headquartered in Pine City.

Although Jackson’s brother, Bruce Amos, owned 10 percent of the business beginning in 2006, he was not charged with a crime.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

McComb woman guilty of Medicaid fraud.

Source- http://www.clarionledger.com/article/20090910/NEWS/90910035/1263/rss

A McComb woman pleaded guilty Medicaid fraud today, Attorney General Jim Hood said.

Monte Magee, 51, pleaded guilty to one count of fraud before Pike County Justice Court Judge Bryan Harbour.

Magee, a case manager for Southwest Mississippi Mental Healthcare, was accused of making false statements in conjunction with applying for Medicaid benefits for which she had not provided services.

Judge Harbour ordered Magee to pay restitution in the amount of $1,309.44 to Southwest Mental Health, $400 in fines and court costs and serve one year supervised probation.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Businessman pleads guilty to Medicare fraud.

Source- http://www.wral.com/news/local/story/5957611/

Raleigh, N.C. — A Raleigh man who federal investigators say was at the center of an operation that pocketed more than $12 million from false Medicare claims pleaded guilty Tuesday to fraud.

Kalu Kalu pleaded guilty to one count each of conspiracy to commit health care fraud and health care fraud. He will be sentenced Dec. 14, when he faces up to 15 years in prison.

Kalu, his wife, Kecia Kalu, and two others indicted in the case would recruit and train salespeople to establish relationships with Medicare patients to obtain their Medicare numbers and personal information, according to federal investigators.

Investigators allege that the couple used the Medicare provider number of co-defendant Martin Ifeani Iroegbu to submit bogus claims for scooters. The Kalus also are alleged to have used their Raleigh businesses, Enuda Healthsource and Universal Medical Supplies, to bill Medicare for health care aids that were never provided to beneficiaries.

As part of a plea agreement, 15 counts of health care fraud will be dismissed against Kalu Kalu when he is sentenced, defense attorney Paul Sun said.

"Consistent with this plea agreement Mr. Kalu is cooperating fully (with authorities)," Sun said.
Iroegbu has already pleaded guilty to health care fraud and aiding and abetting. He is expected to begin serving a 26-month prison sentence in November.
Kecia Kalu is scheduled for arraignment on Sept. 28.

The fourth defendant in the case is Nnenna K. Cornett, who operates States Medical Products LLC in Raleigh. She faces 16 counts of health care fraud and one count of conspiracy to commit fraud, but it's unclear whether she has been arrested.

The U.S. Department of Health and Human Services Office of the Inspector General reported in May that more than 10 percent of the $920 million Medicare paid in 2005 for powered wheelchairs had been misspent.

"This goes on all over the country. It's taking money from the taxpayers," Sun said.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Adult day care worker sentenced for role in Medicare, Medicaid fraud plot.

Source- http://www.brownsvilleherald.com/articles/worker-101962-medicaid-adult.html

McALLEN — The manager of a Harlingen adult day care center was sentenced Wednesday to two years of government supervision for illegally referring patients to a corrupt doctor in exchange for bribes.

Martha Garcia Alaniz admitted to receiving $200 on at least three occasions between February and August 2007 for sending her day care’s clients to see Dr. Fabian Aurignac, a McAllen cardiologist who has since pleaded guilty to Medicare and Medicaid fraud.

Federal prosecutors allege Aurignac’s employees set up an RV in the parking lots of several adult day care centers across the Rio Grande Valley and distributed bribes to their managers. Once the patients began arriving, the employees performed medically unnecessary tests on them and gave the clients Wal-Mart gift cards in exchange for their cooperation.

Aurignac then billed the government-funded health care programs for his services.
Alaniz was indicted in May on three counts of illegally receiving kickbacks. The charges were handed down two days before Aurignac agreed to repay $1.1 million to the government for his fraud. He is currently serving a prison sentence of four years and nine months.

Alaniz entered her own guilty plea a month later. Her attorney Daniel Antonio Sanchez did not return calls for comment Thursday.

A third individual, Raul Torres, has pleaded not guilty to charges that he distributed bribes on Aurignac’s behalf. Torres is currently set for trial in September.

Medicare is a federally funded program offering health care assistance for individuals who are 65 and older and for the disabled. Medicaid is a federal-state program that helps pay for health care for the needy, aged, blind and disabled and for low-income families with children.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Podiatrist sentenced, ordered to pay $89,000

Source- http://www.bizjournals.com/stlouis/stories/2009/08/31/daily38.html

A St. Louis podiatrist has been sentenced to three months imprisonment and seven months home confinement for submitting false bills to Medicare and Medicaid, Acting U.S. Attorney Michael Reap said Tuesday.

Denise Hardy, 45, was also ordered to pay over $89,000 in restitution to Medicare and Medicaid.

Hardy, who was employed at South St. Louis Orthopedic Group Inc., created false statements on podiatric examination forms and other medical records for submission to Medicare and Missouri Medicaid for podiatric services that she provided from 2000 through 2005, prosecutors said.

Hardy also provided services to patients at South St. Louis Orthopedic Group Inc., Lafayette Habilitation, several nursing homes and at senior service centers at St. Alexius Hospital and St. Anthony’s Medical Center.

As part of the scheme, Hardy falsely stated in her treatment notes that 20 Lafayette Habilitation Center patients (who are unable to walk and confined to a wheelchair or geri-chair) cannot walk without pain and had pain when walking that restricted their activities, prosecutors said.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Authorities say former state worker stole nearly $15,000

Former state employee Naudaan Surachaii Hurh

Source- http://www.oregonlive.com/news/index.ssf/2009/08/courtesy_of_the_oregon_attorne.html

Authorities are looking for a former Oregon Department of Human Services employee accused of stealing $14,750 in state money.

Naudaan Surachaii Hurh, 34, is considered a fugitive. Investigators are seeking the public's help in finding him. Authorities think he's in the Portland area.

Hurh faces 18 felony counts, including aggravated theft, identity theft and computer crime. Hurh, who worked in a state office in Beaverton, has been indicted by a Washington County grand jury.

He started working for the state in August 2002. His last known address is in the 18000 block of Southwest Castle Court in Aloha.

Anyone who knows Hurh's whereabouts should call the Oregon Department of Justice's Medicaid Fraud Unit at 971-673-1880.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Physical therapist pleads guilty to Medicare fraud

Source- http://www.chicagotribune.com/news/chi-ap-mi-medicarefraud,0,5307436.story

DETROIT - A physical therapist has pleaded guilty in federal court in Detroit to conspiracy to commit health care fraud as part of a scheme to bilk $18.3 million from Medicare.

The Justice Department says in a release that 45-year-old Jay Jha of Troy admitted to signing about 336 fictitious files for sham companies purportedly providing physical and occupational therapy to Medicare beneficiaries.

Jha says beneficiaries were given kickbacks from the companies. Jha says he was paid up to $110 for each file. Medicare paid close to $773,000 between 2003 and 2005 on claims involving Jha who faces 10 years in prison and a $250,000 fine at his Dec. 16 sentencing.

The Associated Press left a message Thursday seeking comment from Jha's attorney.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Retired doctor arrested in alleged Medicare scam

Source- http://www.miamiherald.com/news/miami-dade/story/1200955.html

A retired obstetrician was jailed over the weekend after the FBI arrested him on charges of submitting almost $1 million in false claims to Medicare for obsolete HIV therapy that patients didn't need or receive.

Jerry A. Spiegel, 77, of Boynton Beach was released Monday on a $100,000 bond after he was charged with defrauding the federal healthcare program for the elderly and disabled.
Spiegel's clinic, R&M Services Center Corp. in Miami Lakes, was paid more than $425,000 by Medicare between September and December 2008, according to an FBI affidavit.

Spiegel, who served as president of the clinic, prescribed ``abnormally large amounts'' of HIV infusion services for a half-dozen patients that caught the eye of a Medicare claims contractor.
The contractor's medical director ``concluded that the medications purportedly being administered were not only medically unnecessary, but entirely improbable in terms of both frequency and dosage,'' the FBI said.

Spiegel joins a growing list of South Florida doctors, physician's assistants and other medical professionals charged with filing millions of dollars in phony bills with Medicare for HIV infusion services. The HIV therapy, administered intravenously, was rendered obsolete 15 years ago by antiretroviral drugs taken orally -- yet Medicare still pays for certain infusion services.

FBI agents are investigating Spiegel's alleged involvement in other Miami-Dade clinics that billed Medicare for millions of dollars in bogus claims for HIV infusion therapy, authorities said. The alleged racket involved cash kickbacks to patients, they said.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Owners of Health Care Agencies Plead Guilty in Medicare Fraud Scheme

Source- http://www.americanchronicle.com/articles/view/115719

Kevin Watson and Jaqueline Jackson, former owners of health care agencies, and two of eight defendants charged in a scheme to solicit and pay kickbacks in exchange for Medicare patients, pleaded guilty today, United States Attorney Terrence Berg announced.

U.S. Attorney Berg was joined in the announcement by Andrew G. Arena, Special Agent in Charge, Federal Bureau of Investigation.

Watson, age 43, and Jackson, age 44, both from Ypsilanti, pleaded guilty in United States District Court before the Honorable Avern Cohn to Superseding Informations which charged Watson with the misdemeanor offense of Aiding and Abetting False Statements to a Federal Health Care Program and charged Jackson with the misdemeanor offense of Making False Statements to a Federal Health Care Program.

According to the Superseding Informations and the plea agreements, in 2004, Jacqueline Jackson was the director of the home health care agency, Superior Home Care, Inc., located at 17330 Northland Park Court, Suite 201, in Southfield, Michigan. Jackson was a Medicare provider and received payments from the Medicare Program in 2004. In 2004, Kevin Watson, owner of Watson Health Care, located at 17330 Northland Park Court, Suite 202, Southfield, Michigan, and Jaqueline Jackson paid codefendant Rebecca Sharp, owner of Continuing Senior Care Co, Inc. and Marketing & Assessment, in Southfield, Michigan, each time Sharp referred a Medicare beneficiary to Jackson´s home health care agency, in violation of the federal health care anti-kickback statute. Kevin Watson was involved in numerous aspects pertaining to the operation of co-defendant Jackson´s home health care agency, Superior Home Care. On May 12, 2005, Jaqueline Jackson falsely certified in a cost report submitted to the Medicare Program that all of the services provided by Superior Home Care, Inc. in 2004 complied with all laws and regulations governing health services, including laws and regulations prohibiting direct and indirect payments for the referral of Medicare beneficiaries.

Under the plea agreements, Watson and Jackson each face up to 12 months' imprisonment, restitution to the Medicare Program in the amount of $933,492.87, and a fine of up to $10,000.00.

Berg congratulated the hard work of the special agents of the FBI for their efforts in pursuing this case. The case is being prosecuted by Assistant U.S. Attorney Sarah Resnick Cohen.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Doctor gets prison time for fraud.

Source- http://www.texarkanagazette.com/news/WireHeadlines/2009/08/21/doctor-gets-prison-time-for-fraud-55.php

McALLEN, Texas—A federal judge has sentenced a South Texas cardiologist to more than four years in prison for Medicare and Medicaid fraud.

Some of the allegations against Dr. Fabian Aurignac include billing for services at his office while he was traveling in Argentina.

U.S. District Judge Randy Crane of McAllen sentenced Aurignac to 57 months in prison followed by three years supervised release Thursday.

The doctor had been detained since December. Aurignac allegedly staffed his Cardiology Care Center in McAllen with foreign, unlicensed doctors and fraudulently billed the government programs for millions of dollars. Much of the office’s work was done without supervision by Aurignac or any other licensed physician.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Medical Equipment Company Owner Convicted in Medicare Fraud Scheme

Source-http://www.imperialvalleynews.com/index.php?option=com_content&task=view&id=6596&Itemid=1

Miami, Florida - Adonis Ortiz, of Miami, was found guilty on Thursday, August 13, 2009, of health care fraud and conspiracy to commit health care fraud, in violation of United States Code, Sections 1347 and 1349, respectively. Sentencing is scheduled before U.S. District Court Judge Adalberto Jordan on October 30, 2009. Defendant Ortiz faces a maximum term of imprisonment of forty years.

According to the Indictment and evidence admitted at trial, defendant Ortiz controlled and operated Daky Medical Supply, Corp. (“Daky Medical”), located in Miami, FL. Daky Medical purportedly provided durable medical equipment to Medicare beneficiaries. From April 2003 through March 2004, Ortiz was the President, Vice President, Secretary, Treasurer, and Registered Agent of Daky Medical, and caused the submission of $6,180,030 in false claims to Medicare for DME items and services that were not prescribed by doctors or provided as claimed. For example, seven doctors whose names appeared on various prescriptions and billing records submitted to Medicare testified that they had not provided or signed the prescriptions. In addition, many of the fraudulent claims submitted by Daky Medical involved persons who had died before the date of the alleged service.

Evidence admitted at trial also revealed defendant Ortiz’s ownership role in a second durable medical equipment company, Reny Medical Equipment & Supply Inc. ( “Reny Medical”), also located in Miami. From February 2004 through July 2004, defendant Ortiz caused Reny to submit approximately $6,944,980 in fraudulent claims to Medicare for DME items and services that were not prescribed by doctors or provided as claimed. Medicare paid Reny Medical approximately $2,796,316 on these claims.

Mr. Sloman commended the investigative efforts of the Federal Bureau of Investigation, and the U.S. Department of Health and Human Services, Office of Inspector General. This case is being prosecuted by Assistant United States Attorney Christopher J. Clark.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Appeals court revives whistle-blower suit alleging J&J paid doctors to sell anemia drug.

Source- http://www.startribune.com/business/53144902.html?elr=KArks:DCiU1OiP:DiiUiD3aPc:_Yyc:aUU

TRENTON, N.J. - A federal appeals court has revived a multibillion-dollar Medicare fraud case brought by whistle-blowers alleging Johnson & Johnson paid doctors kickbacks to prescribe an expensive drug in a strategy to boost sales.

Two former salespeople for the health care giant have been alleging that J&J's Ortho Biotech Products unit, which sells its anemia drug Procrit, gave doctors kickbacks to write prescriptions for the blockbuster drug during the 1990s. Most of the prescriptions were covered by the federal Medicare health program.

Jan Schlichtmann, attorney for the ex-salesmen, said in an interview Thursday that Ortho Biotech ran "an extensive scheme" in which oncologists and other doctors were given free Procrit, honoraria, speaking fees, "off-the-invoice discounts" and other monetary inducements to give their patients Procrit, particularly after the drug faced competition from rival Amgen Inc.'s Aranesp.

"Everybody got these discounts. It wasn't an exception. This was how this drug was marketed and sold," Schlichtmann, a well-known lawyer who won a water contamination case in Woburn., Mass., detailed in the book and movie "A Civil Action," told The Associated Press.

Johnson & Johnson spokesman Bill Foster said Thursday that one of the two main claims in the suit was dismissed by the appeals court.

"We are pleased with the Court of Appeals decision (on that claim) and will vigorously defend against the remaining allegations," Johnson & Johnson spokesman Bill Foster said Thursday. "We intend to seek dismissal of this last remaining claim."

Procrit was administered as an intravenous injection at doctors' offices, hospitals and clinics, and those providers would then bill Medicare for the product's full price. In addition, salespeople induced doctors to increase the amount of Procrit that patients received by one-third more than the approved dose, increasing J&J's revenue, said Schlichtmann.

Procrit, often prescribed to treat anemia in patients being treated for cancer or AIDS or undergoing kidney dialysis, is a top seller for New Brunswick, N.J.-based Johnson & Johnson. The company reported sales of $2.5 billion last year for Procrit and Eprex, as it is known in some other countries, down from $3.2 billion in 2006. It currently is J&J's third-best-selling drug.

Competition with rival Amgen Inc. for sales of anemia drugs has long been fierce. But amid concerns that high doses were harming some patients, including causing cancer to progress, the federal government has put restrictions on which patients can get either drug and how much they can take, hurting sales of both Procrit and Amgen's Aranesp.

Late Wednesday, the 1st U.S. Circuit Court of Appeals in Boston reinstated part of the whistle-blower lawsuit brought by former Johnson & Johnson sales representatives Mark Duxbury and Dean McClellan. The appeals court sent that part of the case, dealing with doctor kickbacks, back to the original court that had dismissed the case, the U.S. District Court in Boston.

The former salesmen and their attorney, Jan Schlichtmann, also had alleged that J&J got doctors to prescribe Procrit for an unapproved use — at a high doses that could be dangerous. The appeals court dismissed that part of the case on a technicality, related to the fact that the bulk of those claims had been made previously in another lawsuit.

"As a practical matter, all (those) facts are going to be available in the case" if it comes to court, Schlichtmann said. Schlichtmann said the case could turn out to be one of the biggest Medicare fraud cases ever, involving more than $3 billion in posssibly fraudulent Medicare claims.

"We knew what Ortho Biotech and Johnson & Johnson were doing was wrong and we risked our careers to stand up to say so," said Duxbury, the lead plaintiff. "I am glad to see the appeals court realize we are entitled to whistle-blower protection and hope the Justice Department sees fit to intervene" in the case.

Foster, the J&J spokesman, said the Justice Department had examined all the allegations but declined to participate in the case.

Justice Department spokeswoman Beverly Lumpkin said Thursday evening they she could not say whether the government will intervene in the case.

Lumpkin said the largest Medicare fraud case to date involved a combination of $1.7 billion in criminal and civil penalties paid in 2003 by HCA Inc., formerly known as Columbia/HCA, a Nashville-based operater of hospitals and ambulatory surgery centers. That case involved paying physicians kickbacks and overcharging Medicare, Medicaid and Tricare, the military health care program.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Ex-Execs Say Renal Care Cheated Medicare.

Source- http://www.courthousenews.com/2009/08/13/Ex-Execs_Say_Renal_Care_Cheated_Medicare.htm

NASHVILLE (CN) - Renal Care Group, a $2.2 billion corporation, defrauded Medicare of millions of dollars a year for a decade by paying doctors kickbacks to use more expensive drugs, holding out on antibiotics, and overcharging for home dialysis equipment and supplies, a doctor and a former company executive say in a False Claims Act complaint Federal Court.

The suit, originally filed in St. Louis in 2005, accuses the Nashville-based dialysis provider of creating a subsidiary, RCG Supply, to act as a billing conduit to allow it to overcharge Medicare for home dialysis equipment and supplies.

Co-defendants RCG Supply is a wholly owned subsidiary of Renal Care Group, not an independent medical equipment supply company, according to plaintiffs Julie Williams and Dr. John Martinez. Williams was controller and administrator for the companies' East Texas market, and Martinez began as an independent contractor and then worked as RCG's medical director. Both left RCG late in 2002.

Federal law prohibits dialysis facilities from also supplying home dialysis equipment and supplies to Medicare patients, but RCG Supply provided home patients with supplies directly through its facilities, not a third-party supplier, according to the complaint. Martinez and Williams say the company did not, as required, maintain and repair equipment, have an inventory, have a contract with nearby dialysis centers to provide patients with assistance, or pass on the savings it made by buying equipment in bulk.

"RCG's corporate office routinely analyzed the profitability of prescribing certain drugs," and in its quest for profit routinely left needed and required antibiotics out of the homes of patients susceptible to peritonitis, according to the complaint. The former executives say infected patients had to go to a dialysis center for treatment, allowing Renal Care to collect additional reimbursements from Medicare. They say that required emergency supply kits were not documented correctly and in some cases not delivered at all.

Renal Care also took undisclosed rebates and bribes from drug companies while charging Medicare full prices, the complaint states. Amgen allegedly gave Renal Care rebates, free clinical and sales staff and entertained doctors so Renal Care would buy its EPO, a hormone that controls red blood cell production.

Abbot Laboratories got in on the action too, the suit claims, by giving Renal Care rebates to push and buy the drug Zemplar, a vitamin D analog that costs more than effective, competing drugs. "RCG waged an aggressive campaign to encourage physicians to prescribe Zemplar," according to the complaint.

With profit in mind, Renal Care recruited doctors to act as medical directors of its dialysis centers in 1998, the complaint states, and paid them according to patient volume, not duties, time or expertise. Medical directors allegedly ended up with paychecks worth far more than fair market value and were more eager to keep patients at their clinics.

The plaintiffs, on their own behalf and for the United States, seek treble damages, 10,000 per civil violation, and up to 25 percent of the settlement or recovery, under the False Claims Act. They are represented by Maurice Graham of Gray, Ritter & Graham in St. Louis.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Woman sentenced for Medicaid fraud.

Source- http://www.katu.com/news/national/52971277.html

BOISE, Idaho (AP) - A Spokane, Wash. woman has been sentenced to 30 months in federal prison for defrauding Idaho's Medicaid program.

Fifty-three-year-old Candace Elmer, the former manager of Behavioral Intervention Services, was sentenced in Idaho's U.S. District Court by Judge Edward Lodge on Thursday. Lodge also ordered Elmer to pay more than $217,000 in restitution.

The investigation began in 2005, after clients complained to the Idaho Department of Health and Welfare that the psychosocial rehabilitation therapy Elmer offered didn't comply with Medicaid standards.

Federal and state investigators said Elmer was billing Medicaid for the therapy but that it either wasn't provided to clients or it was provided by people not qualified to give it.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Medicare fraud group gets prison sentences.

Source- http://www.miamiherald.com/news/miami-dade/story/1176942.html

A group of medical professionals who filed false Medicare claims for unnecessary HIV infusion therapy were sentenced to prison terms Friday.

A doctor and a physician's assistant are going to prison for eight years for their roles in a Miami-Dade racket that billed Medicare $11 million in false claims for obsolete HIV services that were not provided to patients.

Dr. Keith Russell, 65, and Jorge Luis Pacheco, 50, were also ordered Friday by U.S. District Judge Ursula Ungaro to reimburse $3.1 million and $2.6 million, respectively, to the federal healthcare program.

The judge also sentenced another physician's assistant, Eda Marietta Milanes, 43, to five years' imprisonment and to pay back $3.1 million.

A GROWING LIST

All three -- along with another Miami physician, David Rothman, 67 -- were convicted in March of conspiring to defraud Medicare and of other charges in a case that stood out because Pacheco tried to flee the country near the end of his trial. Four others charged in the case pleaded guilty.

Rothman, whose sentencing is pending, and Russell are part of a growing list of South Florida doctors and assistants convicted of billing Medicare for hundreds of millions of dollars in fraudulent claims for outdated HIV infusion therapy administered intravenously.

That therapy was replaced about 15 years ago by more effective antiretroviral drugs taken orally, experts say, yet Medicare continues to pay for it because the agency still considers it ``medically reasonable and necessary.''

In the latest prosecution, Russell, Rothman, Pacheco and Milanes served as the medical staff for two Miami-Dade clinics: M&P Group of South Florida and Medcore Group.
The owner of the clinics, Tony Marrero, testified that Rothman was paid $200,000 and Russell $40,000 for writing prescriptions for the outdated intravenous HIV therapy from 2004 to 2006.

KICKBACKS

Marrero, who owned the clinics with his wife, Belkis, said he paid $200 kickbacks to patients for each visit to use their Medicare numbers to submit the bogus bills. One patient testified that he did not have HIV, and another said he used the money to fund a cocaine addiction.

Marrero also testified the medical assistants manipulated blood platelet levels in patient records to justify their treatments to Medicare, and that he obtained fake invoices from a drug wholesaler to show that his clinics had provided the infusion drugs to patients.

Pacheco, a former physician in Cuba, tried to flee South Florida for the Dominican Republic before the jury began its deliberations in mid-March, according to prosecutors Kirk Ogrosky and Jay Darden.

He was arrested in the Homestead area with $12,600 in cash and a false Florida driver's license in the name of ``Jose Luis Falcon.''

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Joplin dentist accused of Medicaid fraud.

Source- http://www.news-leader.com/article/20090803/BREAKING01/90803040/-1/RSS

Attorney General Chris Koster today filed a civil lawsuit against a Joplin dentist, alleging he made false and fraudulent claims to Missouri’s Medicaid program.

Koster said that for more than four years, dentist Samuel Miller and his wife, Gina Miller, filed claims and billed Missouri Medicaid for numerous dental procedures that were not performed.

Koster said the Millers came under investigation following a tip to the Attorney General’s Medicaid Fraud Unit, according to a news release from his office.

“The Millers devised a scheme to defraud Missouri taxpayers by overbilling for Medicaid services or by billing for services never delivered at all,” Koster said.

The lawsuit asks the court to order the Millers to pay restitution and punitive damages to Missouri.Koster said the suit was filed in Cole County Circuit

He said criminal Medicaid fraud charges are pending against Samuel Miller in Jasper County.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

3 Miami men plead guilty in Medicare fraud.

Source- http://www.miamiherald.com/news/miami-dade/story/1167885.html

Three Miami men have pleaded guilty to participating in a Medicare fraud scheme that bilked the healthcare program out of $12 million, authorities said.

Alejandro Gonzalez and Robert Rodriguez submitted false claims for HIV infusion services at Miami-Dade clinics they established between 2003 and 2006, according to the U.S. attorney's office in Miami.

Gonzalez and Rodriguez filed a total of $40 million in phony bills, collecting $12 million in payments from Medicare. Both men pleaded guilty in July to one count of conspiring to commit mail fraud. A third defendant, Manuel Camacho, pleaded guilty last week to one count of money-laundering conspiracy.

All three men face up to 20 years' imprisonment and are scheduled to be sentenced in the fall.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

US authorities arrest dozens, including, doctors in health care fraud busts.

Source- http://www.washingtonexaminer.com/economy/ap/51999567.html

MIAMI — Federal authorities arrested more than 30 suspects, including doctors, and were seeking others in a major health care fraud bust Wednesday in New York, Louisiana, Boston and Houston, targeting scams such as "arthritis kits" — expensive braces that many patients never used.

More than 200 agents worked on the $16 million bust that included 12 search warrants at health care businesses and homes across the Houston area, where the bulk of the arrests were made.

Federal authorities say those businesses were giving patients "arthritis kits," which were nothing more than expensive orthotics that included knee and shoulder braces and heating pads.

Patients told authorities they were unnecessary and many never even received them. But health care clinic owners billed between $3,000 to $4,000 for each kit.

Houston's other scam involved billing Medicare, the federal health care program for the elderly, for thousands of dollars worth of liquid food like Ensure for patients who can't eat solid food. Authorities said clinic owners never distributed the food to patients. In some cases, clinic owners billed patients who were dead when they allegedly received the items.

It's the third major sweep since Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius announced in May they were adding millions of dollars and dozens of agents to combat a problem that costs the U.S. billions each year.

Using about a dozen agents in targeted cities, including Miami, the Medicare Fraud Strike Force, has recovered $371 million in false Medicare claims and charged 145 people across the country in just two months.

Two shocked female employees arriving for work Wednesday morning at Memorial Medical Supply in a strip mall in southwest Houston were met by federal agents. Authorities confiscated paperwork and a computer. Owners of the business did not respond to calls from the Associated Press.

The suspects arrested Wednesday in Houston will make court appearances Thursday morning. Suspects in Boston, New York and Louisiana were to have first appearances later Wednesday.

The first strike force started in 2007 in Miami, a city authorities say is responsible for more than $3 billion a year in Medicare fraud. Clinic owners there would bill Medicare dozens of times for the same wheelchair, while never giving the medical equipment to patients.

The problems have become more complex since then.

Officials say the suspects have moved into more sophisticated scams including home health care, physical therapy and infusion drugs. They've even started tapping into Medicaid Advantage, which allows the elderly and disabled to get benefits through private health insurers. The plans receive a government subsidy and generally offer more benefits than traditional Medicare.

Federal authorities say Miami residents are also moving on to other cities, bringing their scams with them.

Strike force teams, each led by a federal prosecutor and a handful of agents, were started in Los Angeles, Detroit, Houston in the past year.

Since 2007, strike forces in Miami, Detroit and Los Angeles have indicted more than 293 suspects and organizations that collectively have billed the Medicare program for more than $674 million.

Agencies participating in the busts Wednesday included the FBI, the HHS Office of the Inspector General, the Drug Enforcement Administration and the Texas Attorney General's Medicaid Fraud Control Unit.

Along with issuing indictments, authorities freeze bank accounts and seize everything from Rolls Royce's to million dollar homes purchased with funds stolen from Medicare.

Suspects are being charged not just with health care fraud, but all relevant conduct. That means average prison sentences 50 percent more than the overall national average sentence in federal health care fraud cases in 2008.

While authorities are gratified by the arrests, the program's purpose is more than punitive. It's also about deterrence.

Deputy Attorney General David W. Ogden says the interagency partnership is unprecedented in authorities' ability to track Medicare fraud "as it's happening, using real-time data analysis of Medicare billing records."

In the past, authorities have struggled to catch up with fast-moving crooks. By the time local authorities are alerted to potential fraud, it's already been committed.

"We are also working together across the federal government on important new innovations in the way we do business on the front end, to try and prevent crime like this from happening in the first place," said Bill Corr, Deputy Secretary of Health and Human Services.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Largo doctor Gabriel DeCandido agrees to pay $1.7 in Medicare fraud case.

Source- http://www.examiner.com/x-3402-Tampa-Business-Examiner~y2009m7d27-Largo-doctor-Gabriel-DeCandido-agrees-to-pay-17-in-Medicare-fraud-case

Dr. Gabriel DeCandido has agreed to pay $1.7 million to the U.S. Department of Justice to settle allegations that he tried to defraud Medicare.

Bizjournals reports Dr. DeCandido was accused of violating the False Claims Act. He allegedly billed Medicare for higher levels of service than he actually performed, as well as billing Medicare for services not provided.

The court found evidence that Mr. DeCandido tried to hide and transfer assets in order to avoid paying his judgment.

To ensure the judgment would be satisfied, the court permitted the seizure of five of DeCandido's vehicles, as well as recover $976,000 that was transferred to DeCandido's wife.

The agreement also states that DeCandido participate in with independent oversight organizations.

Among other things, these organizations would review the accuracy of future claims that the doctor sends to Medicare.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Physical Therapy Clinic Owner Charged in Multi-Million Dollar Fraud Case.

Source- http://www.imperialvalleynews.com/index.php?option=com_content&task=view&id=6397&Itemid=2

Houston, Texas - The owner of City Nursing Services of Texas Inc., an alleged Houston physical therapy clinic, has been indicted for conspiring to commit health care fraud, health care fraud, mail fraud and money laundering arising from an alleged multi-million dollar health care fraud scheme, United States Attorney Tim Johnson and Texas Attorney General Greg Abbott announced.

The 36-count indictment was returned by a federal grand jury Friday morning.

Umawa Oke Imo, 54, a permanent resident alien in the U.S. and native of the Federal Republic of Nigeria, was taken into federal custody on Friday June 26, 2009, following the filing of a criminal complaint which accused him of health care fraud. He has remained in court-ordered custody without bond since his arrest.

Imo is accused Imo of filing approximately $42 million worth of claims, predominantly for physical therapy services which were not performed at City Nursing, not performed by a licensed physical therapist and not performed by an appropriately supervised physical therapy assistant, with Medicare and Medicaid between Jan. 1, 2007, through April 30, 2009.

Approximately $30 million was paid by Medicare and Medicaid for these claims. According to indictment, Imo did not hire any licensed physical therapist to work at the clinic and did not have licensed physical therapy aides appropriately supervised.

Imo allegedly paid Medicare and Medicaid beneficiaries approximately $100 to sign multiple blank forms indicating they received physical therapy when no such services were provided.

Some beneficiaries reportedly received additional payments for not complaining to authorities. Imo also allegedly paid marketers for bringing beneficiaries to the clinic. The mail fraud charges center around three paper checks valued at approximately $180,448 that were mailed by the Medicaid contract administrator as payments to City Nursing in lieu of electronic fund deposits between March and May 2008.

Imo is also charged with money laundering and is accused of engaging in five transactions occurring between April 2008 and March 2009, each more than $10,000 and totaling $2,805,195 from a City Nursing bank account for referrals, the purchase and shipping of tankers to Lagos, Nigeria, and a check for more than $1 million payable to Imo himself.

The investigation leading to the charges is the result of a joint investigation conducted by agents from the FBI, the Texas Attorney General's Medicaid Fraud Control Unit, Internal Revenue Service - Criminal Investigation Division and U.S. Department of Health and Human Services - Office of Inspector General.

If convicted of health care fraud, conspiracy to commit health care fraud and money laundering, Imo faces up to 10 years in prison and a $250,000 fine. The mail fraud carries a sentence of up to 20 years in prison. Special Assistant United States Attorney Julie Redlinger is prosecuting the case.

A indictment is a formal accusation of criminal conduct, not evidence.

A defendant is presumed innocent unless and until convicted through due process of law.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Business owner in wheelchair fraud case gets 2½ years.

Kieran Chikwendu

Source- http://www.azcentral.com/community/westvalley/articles/2009/07/22/20090722sr-medicare0724.html

The owner of a Cave Creek medical-supply business is going to prison and has to pay Medicare $263,000 in connection with a Medicare fraud scam.

A Maricopa County Superior Court judge sentenced Kieran Chikwendu, 56, of Surprise on Tuesday to 2½ years in prison and seven years probation for his role in deceiving Medicare and Medicare patients by filling unnecessary prescriptions for motorized wheelchairs.

According to the Maricopa County Attorney's Office, Chikwendu set up Savana Medical Supply, a durable medical equipment business, in Cave Creek, but billed Medicare with information from beneficiaries in California.

The scam involved having some individuals receive phony medical screenings at various "clinics" for the purpose of issuing the prescription and supplying the wheelchairs. Other Medicare recipients were approached at their homes with brochures and asked to pick out a wheelchair, without ever having any medical screening. None of the Medicare patients actually needed a wheelchair.

Medicare is prohibited from paying for any equipment that is not medically necessary.
Chikwendu billed Medicare for the cost of the wheelchairs and accessories of more than $417,000, and received payments of more than $263,000.

Chikwendu pleaded guilty in May to fraudulent schemes and artifices, a Class 2 felony; theft, a Class 3 felony; and two counts of forgery, a Class 4 felony.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

New Jersey dentist pleads guilty to $100,000 Medicaid fraud scheme.

Source- http://ifawebnews.com/2009/07/22/new-jersey-dentist-pleads-guilty-to-100000-medicaid-fraud-scheme/

A Fair Lawn, N.J., dentist has pleaded guilty to defrauding Medicaid of nearly $100,000 by billing for procedures that were never performed over a period of more than two years.

Joshua Prensky, 33, a licensed dentist with New Jersey Mobile Dentist of Colts Neck, N.J., pleaded guilty to charges of third-degree conspiracy to commit Medicaid fraud, according to Acting Insurance Fraud Prosecutor Riza Dagli.

Prensky admitted that between Jan. 1, 2007, and March 6, 2009, he and others completed consult forms and submitted bills to the Medicaid program falsely claiming that various dental procedures and services were provided when they were not, according to Dagli.

An investigation determined that as a result of the fraudulent billing, Medicaid allegedly paid New Jersey Mobile Dentist nearly $100,000 to which it was not entitled. The dental provider contracts with individual dentists to provide mobile services in various nursing homes and assisted living facilities in the state.

As part of his plea, Prensky agreed to pay restitution and a civil penalty totaling $84,340 to the State of New Jersey. He is scheduled to appear for sentencing Nov. 20 and could face a maximum sentence of five years in prison and a $15,000 fine.

The Division of Criminal Justice will also notify the New Jersey Division of Consumer Affairs regarding Prensky’s conviction, which could result in legal action against his professional license.

“Abuse of the Medicaid program and insurance fraud by persons who hold professional licenses are particularly disturbing crimes,” said Dagli in a statement. “Not only do such Medicaid fraud schemes involve theft of tax dollars, they also represent a theft from a program designed to assist persons who cannot afford health insurance or health care services.”

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

20 arrested in Santa Fe Springs Medi-Cal scam.

Source- http://www.sgvtribune.com/sports/ci_12806601

LOS ANGELES - Authorities arrested 20 people - including three San Gabriel Valley residents - on Thursday in what the U.S. Department of Justice said it believed was the "largest single case of Medi-Cal fraud ever filed in the state."

The 20 defendants are accused of being part of a 40-person ring headquartered in Santa Fe Springs that defrauded Medi-Cal out of nearly $4.6 million.
"In terms of the number of defendants involved, this is the largest case in the state," said U.S. Attorney's Office spokesman Thom Mrozek.

The scam used unlicensed individuals to provide in-home care for at least 75 disabled patients, according to information released by the Department of Justice.
The defendants, who posed as nurses, had little or no medical training, but they looked after patients, many who were children with cerebral palsy or developmental disabilities, according to authorities.

They then billed Medi-Cal for licensed nursing services that were actually provided by people without licenses.

"Today's arrests send a strong message to those who would corruptly take advantage of the Medi-Cal system," said Glenn Ferry of the Department of Health and Human Services. "Greed, at the expense of our most vulnerable citizens and their quality of care, will not be tolerated."
The three people arrested on Thursday from the San Gabriel Valley are Juan Igamen, 40, of Claremont; Ruth Magracia, 53, of La Puente; and Margaret Namawejje, 63, of Claremont.
Thursday's arrests are the culmination of a two-year investigation called Operation License Integrity. Nine of the people arrested in that time live in the San Gabriel Valley.

"The nearly four dozen people associated with this fraud ring not only cheated taxpayers, they endangered the lives of young people they promised to protect and care for," said U.S. Attorney Thomas O'Brien.

Most of the people involved in the scam are Filipino citizens, and about
Nurse indictments half of them are here illegally, Mrozek said.

A few received medical training in the Philippines, but none were licensed nurses.
"No one died as a result of their `care,"' Mrozek said. "But this was a very dangerous situation."
The organizer of the fraud was Priscilla Villabroza, a registered nurse who ran Santa Fe Springs-based Medcare Plus Home Health Providers. She pleaded guilty to five counts of health-care fraud last year.

According to the June 25 indictment, from August 2004 to the end of 2007, Villabroza and others

hired unlicensed individuals to provide services to the disabled Medi-Cal patients and billed Medi-Cal as if they were licensed vocational nurses.

Villabroza would pay employees up to $12 an hour and would bill Medi-Cal for up to $30 an hour. She would pocket the remainder, officials said.

A key assistant to Villabroza was Susan Bendigo, authorities said. She was indicted last year but fled to the Philippines, authorities believe.

Mrozek said investigators learned about the matter two years ago when parents complained about the nursing care their children were receiving.

Some parents and patients reported to authorities that the nurses lacked basic skills. In one case, a caregiver was unable to replace a tracheotomy tube that had fallen out of a young patient's neck.
All the defendants named in the indictment are charged with conspiracy to commit health-care fraud, a felony that carries a sentence of 10 years in prison.

Fraud in public health care is a growing problem, officials said.

Nationally, the U.S. Department of Justice has cracked down on other government- provided health services.

"Medicare fraud is something that we look and have been looking at extensively," said spokesman Ian McCaleb.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Married doctors charged with fraud plead not guilty.

Source- http://www.whec.com/news/stories/S1015747.shtml?cat=565

Two married doctors plead not guilty to stealing close to $250,000. Neither of them would stop talking in court.

Dr. Michael Miran, a psychologist and an adjunct professor at R.I.T. and his wife,

Dr. Esta Miran are accused of medicaid fraud. State

Attorney General Andrew Cuomo's office says they overbilled the state and federal government hundreds of thousands of dollars. Esta Miran is not a psychologist but has a PhD. in education. She is also accused of practicing psychology without a license. Michael Miran is accused of letting her do it.

“This husband and wife team allegedly cheated taxpayers out of hundreds of thousands of dollars,” said Attorney General Cuomo. “My office’s Medicaid Fraud Control Unit continues to root out scams across the state that rip off New Yorkers.”

The indictment against the couple was unsealed in court at their arraignment. One of the charges accuses the Mirans of booking four to five intensive psychotherapy sessions in the same hour and conducting psychotherapy sessions from just one to 12 minutes at a time. The Miran's practice was under investigation by the AG's office for two to three years.

Berkeley Brean: "So people that would have seen them aren't owed money?"
NYS Assistant Attorney General Jerry Solomon: "No this was tax payer funds that were over billed."
In court, the Mirans kept telling Judge John Connell that they couldn't understand why they had to be in jail.

"We would never flee!" Dr. Esta Miran said. "We could have fled at any time. Can't we be released? We would come back."

Dr. Esta Miran continued.

"Can we get out of jail today?" she asked the judge.
"If you can post the $5,000 bail and surrender your passports, yes," Judge Connell answered.

"Can I give you a credit card?" Dr. Esta Miran asked.
"No, you can't do that," Connell said.

Dr. Michael Miran told the judge he fears for his life.
"I'm in a medically distressed position in prison. A position that endangers my life. I'm at immediate risk for a heart attack," Dr. Miran said.

Judge Connell ordered court deputies to make sure Dr. Michael Miran is under medical supervision in jail. However, the Mirans did post bail late Tuesday.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

McKinney man sentenced to 60 months in federal fraud scheme.

Source- http://www.scntx.com/articles/2009/07/03/mckinney_courier-gazette/news/752.txt

Emmanuel Akpan of McKinney gets federal jail time for his role in a motorized wheelchair fraud scheme.

By Danny Gallagher, McKinney Courier-GazetteA McKinney man will serve time in a federal prison for his role in a scheme to bill Medicare for false claims of motorized wheelchairs.

Emmanuel Uko Akpan of McKinney received a 60 month sentence in federal court and an order to pay more than $710,000 on Tuesday in the U.S. District Court of Northern Texas, according to officials with the Internal Revenue Service's Criminal Investigation Division of Dallas.

Akpan owned and operated Atbestcare Medical Equipment and Supply Company of Dallas and conspired with Geneva Sanders, an employee of the emergency room at Methodist South Hospital of Memphis, Tenn. and Walter Sanders, owner of Waltco Medical Equipment and Supplies located in Mesquite, according to the indictment.

The object of the scheme was to "sell and use the means of identification of Medicare beneficiaries and physicians located in Tennessee and elsewhere to [several companies]…for the purpose of executing a scheme to defraud Medicare and to obtained money from Medicare through false representations," according to the indictment.

Sanders obtained the names and personal identification numbers of patents from hospital records and sent them to Sanders "without the authorization of such Medicare beneficiaries, in exchange for remuneration." Sanders and Akpan also visited or directed others to visit beneficiaries to obtain their personal information.

Officials estimate that Sanders and Akpan obtained more than 70 patient records as part of their scheme. They would immediately bill Medicare for false claims for power wheelchairs. After they submitted the claims, some of the beneficiaries would receive less expensive scooters or no equipment at all.

Prosecutors believe the scheme consisted of false claims ranging between $5,800 and $9,800 from February to August of 2003. The claims totaled more $2.7 million netting payments from Medicare totaling $1.3 million, according to the indictment.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Moore doctor sentenced to 9 years in jail.

Source- http://www.normantranscript.com/localnews/local_story_184011511

OKLAHOMA CITY -- A Moore doctor was sentenced to nine years and one month in federal prison for illegal distribution of prescription drugs this week.

Prosecutors said Can D. Phung wrote prescriptions for painkillers without physically examining patients and saw some patients just in the clinic's lobby, according to testimony.

Phung, officials said, had so many patients they sometimes had to wait two to three hours to be seen, and would line up outside before the clinic opened.

Prosecutors called him "a drug dealer."

Phung, 61, of Moore told U.S. District Judge Vicki Miles-LaGrange that drug abusers "took advantage of his compassion."

Miles-LaGrange said she found that very hard, if not impossible, to believe.

Phung was found guilty in February of 51 counts of illegal distribution of prescription drugs, one count of Medicaid fraud and one count of obstruction of justice.

Last week, he was ordered to pay a $10,000 fine, $4,612 in restitution to the Oklahoma Health

Care Authority and a $5,300 special assessment to the United States.

One of his patients, Ian Upchurch, 22, of Mustang, died in March 2007 after overdosing on pain pills and alcohol, an autopsy report shows. Phung faces a civil lawsuit in Oklahoma County District Court over Upchurch's death.

Phung was a surgeon in South Vietnam and fled after communists took over, records show. He came to the United States in 1978.

Phung said he plans to appeal. He has complained he was singled out for prosecution, and that many other doctors have prescribed pills to the same patients who testified against him.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Miami Physician Sentenced to 97 Months in Prison for Medicare Fraud.

Source- http://www.dentalplans.com/articles/43458/miami-physician-sentenced-to-97-months-in-prison-for-role-in-$10-million-medicare-fraud-scheme.html

- WASHINGTON, -- Miami physician Roberto Rodriguez, 54, was sentenced today to 97 months in prison for his role in a Medicare fraud scheme involving HIV infusion services, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division, Acting U.S. Attorney Jeffrey H. Sloman of the Southern District of Florida and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS). Rodriguez was also ordered to pay more than $9 million in restitution to the Medicare program during today's sentencing hearing before U.S. District Judge Paul C. Huck.

Rodriguez pleaded guilty before Judge Huck on March 23, 2009, to conspiracy to commit healthcare fraud. In his guilty plea, Rodriguez admitted that he was a co-owner of and practicing physician at Midway Medical Center Inc. (Midway), a Miami clinic that purported to specialize in the treatment of HIV patients. Rodriguez admitted that, while at Midway, he and his co-conspirators routinely billed the Medicare program for services that were medically unnecessary and in many instances were never provided. Rodriguez further admitted that he purchased only a small fraction of the drugs that were purportedly administered to patients at the clinic.

Most of the services allegedly provided to patients at Midway were billed to the Medicare program as treatments for thrombocytopenia, a disorder involving a low count of platelets in the blood. According to the plea documents, none of Midway's patients actually had low blood platelet counts. Rodriguez admitted that to make it appear that the patients actually had low platelet levels, he and his co-conspirators used chemists to manipulate the blood samples drawn from Midway's patients before the blood was sent to a laboratory for analysis. In his plea, Rodriguez admitted to ordering that patients at Midway receive medications designed to treat thrombocytopenia despite knowing that the laboratory results had been falsified and that the patients did not actually have that condition.

Midway was not the only clinic where Rodriguez purported to treat HIV patients with injection and infusion therapies. In his plea, Rodriguez admitted that he was listed as medical director and practicing physician for five other Miami-area HIV infusion clinics between October 2003 and February 2005, where he engaged in similar criminal activity. Specifically, Rodriguez admitted that he and his co-conspirators at these other clinics billed the Medicare program for HIV injection and infusion services that Rodriguez knew were medically unnecessary and in some instances were never provided. Rodriguez admitted to causing more than $20 million in false claims to be submitted to the Medicare program at all of his clinics, including Midway.

A number of Rodriguez's co-defendants have already been sentenced for their roles at Midway and related clinics. On June 5, 2009, in a sentencing hearing before Judge Huck, chemist Alexis Dagnesses, 44, was sentenced to 90 months in prison; medical assistant Gonzalo Nodarse, 38, was sentenced to 78 months in prison; medical assistant Alexis Carrazana, 41, was sentenced to 72 months in prison; and physician Carlos Garrido, 69, was sentenced to 37 months in prison. Rodriguez's co-defendant Carmen del Cueto, a physician, is scheduled to be sentenced on Sept. 11, 2009.

The case was prosecuted by Trial Attorney John K. Neal of the Criminal Division's Fraud Section and investigated by the HHS Office of the Inspector General and the FBI. The case was brought as part of the Medicare Fraud Strike Force, supervised by Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section and Acting U.S. Attorney Sloman of the Southern District of Florida. Federal prosecutors have indicted 115 cases with 257 defendants in Miami, Los Angeles and Detroit since the inception of strike force operations in March 2007. Collectively, these defendants are alleged to have fraudulently billed the Medicare program for more than $600 million.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. In May 2009, the Department of Justice and HHS announced the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint effort to prevent fraud and enforce current anti-fraud laws around the country. As part of the HEAT initiative, Medicare Fraud Strike Force operations were expanded from South Florida and Los Angeles to Detroit and Houston.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Westfield pastor Kevin Clark charged with Medicaid fraud

Source- http://www.newjerseynewsroom.com/state/westfield-pastor-kevin-clark-charged-with-medicaid-fraud

A Union County minister was indicted Thursday for his alleged role in defrauding the Medicaid program.

Attorney General Anne Milgram said Kevin Clark, 52, the pastor of Bethel Baptist Church in Westfield, was charged with two counts of Medicaid fraud.

Under state law, the crime carries a maximum punishment of three years in state prison and a fine of $10,000. Clark will have to appear in state Superior Court in Elizabeth to answer the charges.According to state Division of Criminal Justice Director Deborah L. Gramiccioni, the indictment returned by a state grand jury alleges that between November 2004, and April 2005, Clark submitted a Medicaid application on behalf of an elderly parishioner, containing false information concerning the disposition of property valued at approximately $183,038 in which the parishioner had an interest.

The Medicaid program, which is funded by the state and federal governments, provides health care services and prescription drugs to persons who may not otherwise be able to afford such services and medicines. The state administers the Medicaid program.

Det. Patricia Yellen and Deputy Attorney General Yvette Gibbons of the Patient Protection Unit investigated and prosecuted the case.

"Abuse of the Medicaid program is a particularly disturbing crime," Gramiccioni said. "Not only do such Medicaid fraud schemes involve theft of tax dollars, they also represent a theft from a program designed to assist persons who can not afford health insurance or health care services. Such cases are a priority for the Office of the Insurance Fraud Prosecutor."

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Former nursing home employee arrested.

Natasha Petit-Homme

Source-http://www.wptv.com/news/local/story/former-nursing-home-employee-arrested-wptvwest/0LL_61dQVUmqQ8yplv0r1A.cspx

TALLAHASSEE, FL – A Palm Beach county woman has been arrested for stealing over $2,300 from an elderly victim under her care according to Attorney General Bill McCollum.

According to a written release from McCollum's office Natasha Petit-Homme was arrested this morning by law enforcement officers with the Attorney General’s Medicaid Fraud Control Unit. The Palm Beach County Sheriff’s Office assisted.

According to the attorney general the victim was an elderly resident of Woodlake Nursing and Rehabilitation Center, in West Palm Beach.

Petit-Homme was employed as an admissions clerk.

The news release says while working at the facility, Petit-Homme gained access to the victim’s checkbook, wrote herself a check totaling $2,341, and deposited the funds into her personal checking account without permission.

Petit-Homme is charged with one count of exploitation of an elderly person, a third-degree felony. She faces up to five years in prison and a $5,000 fine if convicted.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Nearly 53 Doctors, Executives Charged In 50 Million Medicare Fraud.

Source - http://www.huliq.com/1/82671/nearly-53-doctors-executives-charged-50-million-medicare-fraud

Fifty-three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit, Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and FBI Director Robert Mueller announced today.

The Strike Force in Detroit is the third phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.
While the indictments were returned by a grand jury in Detroit, individuals were arrested today in Detroit and Miami as a result of phase three operations of the Strike Force. The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

“As demonstrated by today’s charges and arrests, we will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising health care costs that all Americans must bear,” said Attorney General Holder. “The vast majority of doctors, patients, and medical companies do the right thing and work with the Medicare program to provide access to medical services. To those who work diligently and ethically to provide medical care through the Medicare program, we will work with you to root out the few who corrupt the system and taint the good reputations of health professionals everywhere.”

“The Obama Administration is committed to turning up the heat on Medicare fraud and employing all the weapons in the federal government’s arsenal to target those who are defrauding the American taxpayer,” said HHS Secretary Kathleen Sebelius. “Thanks to cooperation from across the government and some of the best law enforcement professionals in the country, today we were able to save millions of dollars from being lost to criminals and send a powerful message to those who seek to defraud the system, that we are coming after them. But our joint efforts on HEAT don’t just stop at the jailhouse door. Our Medicare program is working closely in partnership with our own and other law enforcement operations to prevent fraud from happening in the first place. Every dollar we can save by stopping fraud can be used to strengthen the long-term fiscal health of Medicare, bring down costs and deliver better service to Medicare beneficiaries.”

The Strike Force operations in Detroit are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a renewed effort announced in May 2009 between the Department of Justice and HHS to focus their joint efforts to prevent fraud and enforce current anti-fraud laws around the country. The HEAT taskforce, co-chaired by Deputy Attorney General David Ogden and Deputy Secretary Bill Corr, is made up of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions. In the May 2009 announcement, Attorney General Holder and Secretary Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars.

Today, federal agents from the FBI and the HHS Office of Inspector General (HHS-OIG) began executing arrest warrants in Detroit and Miami as part of a concentrated effort to address fraud in the metro-Detroit area. Charges were unsealed today against 53 individuals who are accused of various Medicare fraud offenses, including conspiracy to defraud the Medicare program, criminal false claims and violations of the anti-kickback statutes. The Strike Force operations in Detroit have identified two primary areas – infusion therapy and physical/occupational therapy providers – in which schemes were allegedly orchestrated to defraud the Medicare program.
According to the indictments, the defendants charged today participated in schemes to submit claims to Medicare for treatments that were in fact medically unnecessary and oftentimes, never provided. In many cases, indictments allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the unnecessary and not provided treatments. Collectively, the physicians, medical assistants, patients, company owners and executives charged in the indictments are accused of conspiring to submit more than $50 million in false claims to the Medicare program.

“We will continue to work together in the months to come to identify and stop those who would line their own pockets with taxpayer money – those who seek to benefit at the expense of our health care system, our economy and our collective well-being,” said FBI Director Mueller.
“Today’s landmark series of arrests in Detroit and across the country demonstrates that health care fraud can happen anywhere in America,” said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. “We will continue to detect and respond rapidly to emerging fraud schemes to protect our federal health care programs and conserve scarce health care dollars so critically needed for the care of our beneficiaries.”

The work of the Detroit Strike Force is another important step in the multi-phase enforcement and regulatory HEAT initiative designed to reduce the potential for Medicare and Medicaid fraud. Since its inception in March 2007 with phase one in South Florida and expansion to phase two in Los Angeles in May 2008, the Strike Force has obtained indictments of more than 250 individuals and organizations that collectively have billed the Medicare program for more than $600 million. In addition, HHS’ Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the three Detroit Strike Force teams is led by a federal prosecutor supervised by the Justice Department’s Criminal Division’s Fraud Section in Washington, D.C., and the U.S. Attorney’s Office for the Eastern District of Michigan. Each team has four to six agents, with at least one agent from the FBI and HHS-OIG.

The cases are being prosecuted by attorneys from the Fraud Section in the Justice Department’s Criminal Division, including Deputy Chief Kirk Ogrosky and Trial Attorneys John K. Neal and Benjamin D. Singer as well Special Assistant U.S. Attorney Thomas W. Beimers in the U.S. Attorney’s Office for the Eastern District of Michigan, on detail from HHS-OIG.
An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Healthcare owner convicted of Medicare fraud gets jail sentence.

Source- http://www.thenewsstar.com/article/20090617/UPDATES01/90617026

Two whistle-blowers who reported a business owner for Medicare fraud left Wednesday for an island vacation while Janice Davis of West Monroe prepares to spend time in a federal prison.Davis, former owner of the now defunct Aging Care Home Health Care, will spend 15 months in a federal prison beginning Aug. 2 after being sentenced by Judge Robert G. James in Monroe on Monday.

She will also serve three years of supervised release after completion of her sentence.Davis, 62, was charged in July 2008 in a one-count indictment and later pleaded guilty to concealment or falsification of records in a federal investigation. After being served with a subpoena for documents from the Department of Health and Human Services, Office of Inspector General, on July 23, 2003, the defendant personally destroyed, concealed, covered up, and falsified records and documents, including physician service logs, with the intent to impede, obstruct, and influence an investigation into Medicare fraud by Aging Care, according to U.S. Attorney Donald Washington of the Western District of Louisiana.

The civil lawsuit began in October 2002, when former Aging Care employee Becky Roberts and Lori Purcell McDonald, who worked for one of the doctors on Aging Care’s advisory board, filed a whistle-blower lawsuit. The lawsuit was placed under seal but was later unsealed when the federal government joined the suit in 2004.The suit claimed that from 1999 to 2003, Aging Care paid five physicians for advisory services and also billed Medicare for patient services from those doctors.

The company received more than $400,000 in reimbursements from Medicare.The investigation revealed that Davis produced documents that she created after receipt of the Office of Inspector General subpoena and that many of Aging Care’s doctors did not perform the services indicated in the records.Davis had owned and operated Aging Care, a Monroe-based company, from 1991 until its closure in 2005. Aging Care provided nursing and therapy services to patients in their homes. Clinic-based doctors monitored the patients’ home health services by updating treatment plans and prescribing medications. Normally, a physician would bill Care Plan Oversight services directly to Medicare. Payment is made by Medicare directly to the physician for services rendered to home health and hospice patients.

The subpoena issued by Human Services, Office on Inspector General to Aging Care was a result of an October 2002 False Claims Act suit which alleged Aging Care tracked physicians “Care Plan Oversight” services and billed Medicare as a means to induce patient referrals from physicians.In November 2004, the United States intervened in that suit alleging that Janice Davis, her husband Otis Davis, and her company violated federal Stark and Anti-Kickback statutes by creating a sham physician advisory board and paying its members not for legitimate duties actually performed, but instead for Medicare referrals, which is illegal.

The False Claims Act lawsuit ended in 2008 when James granted several motions for summary judgment against Janice Davis, Otis Davis and Aging Care and awarded almost $5 million in damages and penalties to the United States. In that suit, Judge James also found that Janice Davis had destroyed company records, which were responsive to the federal subpoena and attempted to replace them with false records she fabricated in an attempt to mislead federal regulators and law enforcement.

Under whistle-blower laws, Roberts and McDonald stand to receive up to 25 percent of the government’s awards.McDonald said she and Roberts were flying out Wednesday to Cozumel, Mexico. She said the vacation had long been planned and was not a result of Davis being sentenced or any money they expect to receive from the suit.“Healthcare and Medicare fraud should be a concern to every citizen.

The costs associated with this type of fraud compromises the integrity of the Medicare program and negatively impacts the healthcare burden for all of us,” Washington said.Sentencing in federal court is determined by the discretion of federal judges and the governing statute. Parole has been abolished in the federal system.This case was investigated by Special Agent Jeff Richards of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Cytheria D. Jernigan. The related False Claims Act matter was handled by Assistant U.S. Attorneys Alec Alexander and Sara McLean, U.S. Department of Justice, Washington, D.C.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Caldwell couple sentenced for Medicaid fraud.

Source- http://www.2news.tv/news/local/48160717.html

CALDWELL (AP) — A southwest Idaho couple convicted of defrauding the Medicaid system while providing denture services in Caldwell has been sentenced to three years of probation.

A judge in 3rd District Court also ordered Alfred and Vera Lopez, owners of the People's Denture Center, to complete 200 hours of community service and pay $6,863 in restitution during a hearing Monday.

The couple, who authorities say billed Idaho Medicaid for dentures and other services they never provided to recipients of the health insurance program for the poor, pleaded guilty to felony provider fraud in April.

The Lopezes entered an Alford Plea, acknowledging there was enough evidence to convict them without admitting guilt.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Granger eye doctor charged with fraud.

Source- http://www.wsbt.com/news/local/47925197.html

A federal grand jury has indicted a local eye doctor and his wife on health care fraud, wire fraud and criminal conspiracy charges, prosecutors announced Friday.

Philip J. Gabriele, 44, and his wife, Marcella Gabriele, both of Granger, are accused of falsely and fraudulently diagnosing cataracts and other disorders in patients and performing unnecessary surgeries, according to a statement issued by assistant U.S. attorney Donald Schmid.
The indictment alleges that, as part of the fraud scheme, the defendants altered patient charts and records after the fact, in an effort to make it seem as if diagnoses were accurate and correct, said Schmid, who declined to comment beyond his written statement.
As a result, the couple fraudulently billed Medicare, Indiana Medicaid and private health insurers, the indictment alleges.

The charges culminate a two-year investigation led by Schmid and conducted by the state attorney general’s office, Medicaid Fraud Control office, U.S. Health and Human Services, the FBI and South Bend Police Department.
The Gabrieles operate Gabriele Eye Institute, with a main office in Edison Lakes in Mishawaka, a second office in Elkhart and a third location at 2042 E. Ireland Road in South Bend.
The couple planned to turn themselves in Monday morning, their attorneys said. They are expected to make their initial court appearance Monday.
The Gabriele’s declined to be interviewed Friday, according to their attorneys at Baker & Daniels, but said in a written statement that they will continue their practice while the case is pending.

"We are deeply saddened and dismayed by the government’s decision to proceed with an indictment," their statement said. "We will continue to focus our energies on doing what we love — working tirelessly to provide top-quality medical care for the people of Michiana."
One of their attorneys, J.P. Hanlon, said the allegations are "completely without merit."
"Dr. Gabriele has always made medical decisions based solely on the best interest of his patients," Hanlon said in the statement. "Procedures performed by Dr. Gabriele were medically necessary and resulted in improved eyesight and quality of life for countless patients."
Prosecutors simply "do not understand the practice of good medicine, the workings of a medical office, and particularly complex issues involving eyesight," Hanlon said.
Marcella Gabriele acted as an office manager and ophthalmology technician for Gabriele Eye Institute.

Prosecutors said the couple committed the fraud from 2004 through this year.
In some cases, patients had no cataracts whatsoever, the indictment alleges. In other cases, patients had early cataracts and Philip Gabriele falsely diagnosed them as more developed and "visually significant" cataracts. He also failed to perform basic diagnostic tests and procedures that were needed to determine if a patient in fact had visually significant cataracts and surgery was needed.

Gabriele fraudulently removed healthy eye lenses and inserted artificial lenses into patients, the indictment alleges. Some of these surgeries were poorly performed and resulted in the patient suffering worse eyesight. These patients then underwent further surgeries and procedures in an effort to improve their sight, including further refractive and laser procedures, prosecutors said.
The 19-page, 15-count indictment alleges Gabriele also performed unnecessary "recession and resection" surgeries, as well as surgeries to correct an eye condition called "ptosis."
Some of these surgeries were performed on children, and some resulted in "injuries and harm" to patients, the indictment alleges.

The couple also made false claims in their advertising, such as, "100 percent of patients who have undergone Wavescan Custom Lasik at Gabriele Eye Institute see 20/20 or better after their first procedure," the indictment alleges.
Marcella Gabriele falsely documented patients’ eye sight ability following Lasik procedures to, among other things, support those advertising claims, the indictment alleges.
After investigators launched their probe, Marcella Gabriele allegedly shredded documents in March 2007. Investigators executed search warrants of the three offices and the couple’s Granger home in May 2007.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

UMDNJ to pay additional $2 million to resolve fraud claims.

Source- http://www.newjerseynewsroom.com/healthquest/umdnj-to-pay-additional-2-million-to-resolve-fraud-claims

Federal civil allegations say hospital double billed Medicaid

The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid, the Justice Department announced today.

From 1993 to 2004, UMDNJ's University Hospital submitted claims to Medicaid for outpatient physician services that were also being billed by doctors working in the hospital's outpatient centers. By submitting duplicate claims for payment, University Hospital effectively doubled billed the government's Medicaid program.

"Today's settlement demonstrates that the Department of Justice will not tolerate fraud on our Medicaid programs, which were created to serve our nation's low-income families, children and seniors," said Tony West, Assistant Attorney General for the Justice Department's Civil Division. "We will continue to work with our partners at the Department of Health and Human Services Inspector General's Office to protect the integrity of our public health programs."

The case against UMDNJ and University Hospital originated in a qui tam or whistleblower complaint filed under the Federal False Claims Act by Dr. Steven Simring. In late 2005, the double billing addressed by today's settlement was also the subject of a criminal complaint filed against UMDNJ by the U.S. Attorney's Office for the District of New Jersey. As a result of a Deferred Prosecution Agreement concerning that criminal complaint, the state of New Jersey previously recouped $4.9 million from University Hospital, half of which was to be returned to the federal Medicaid program.

Under the terms of today's agreement, UMDNJ will pay an additional $2 million to the federal government to resolve the outstanding civil federal false claims act allegations. The total federal recovery when combined with the previous payment is $4.45 million. Dr. Simring will receive $801,000 as his share of the total federal recovery.

The Office of the Inspector General of Department of Health and Human Services worked with the Justice Department's Civil Division to obtain today's result

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Ambulance Firms Accused of Medicare Fraud.

Source-http://www.courthousenews.com/2009/06/08/Ambulance_Firms_Accused_of_Medicare_Fraud.htm

DALLAS (CN) - The owner and managers of two ambulance companies face a 15-count federal indictment with conspiracy to commit health care fraud, health care fraud and money laundering. They are charged with fraudulently supplying ambulances to dialysis patients who didn't need them: "many of the companies' records revealed that patients rode to their appointments in a captain's chair in the back of the ambulance rather than lying on a stretcher" prosecutors said.

Muhammed Nasiru Usman, of Arlington, Texas; David McNac of Dallas and Shaun Outen of Aubrey are each charged with one count of conspiracy to commit health care fraud and multiple counts of health care fraud. They are accused of falsely billing Medicare, Texas Medicaid, and the Federal Employees Health Benefit Program for non-emergency ambulance transportation of patients to and from dialysis appointments starting in early 2004.

Usman also was charged with one count of money laundering: buying a Lexus with the fraudulently obtained payments from the health-care programs. Usman, the owner of Royal Ambulance Services, and First Choice EMS, employed McNac as a director of both companies and Outen as a supervisor. Prosecutors say all three were responsible for fraudulent billing exceeding $1.5 million and the payment of more than $550,000 by Medicare, Medicaid, and private insurance.

"The fraudulent claims misrepresented medical conditions of patients in order to qualify for reimbursement from Medicare, Medicaid, and private insurance, and falsely stated that legitimate ambulance services were provided," prosecutors say. "In reality, many of the companies' records revealed that patients rode to their appointments in a captain's chair in the back of the ambulance rather than lying on a stretcher."

The defendants each face up to 5 years in prison and a $250,000 fine if convicted of conspiracy and up to 10 years and a $250,000 fine for each count of health care fraud. Usman also faces up to 10 years, restitution and a $250,000 fine if convicted of money laundering.

The indictment stemmed from "Operation Easy Rider," in which search warrants were executed on ambulance companies across Texas. It was a joint operation between the U.S. Department of Health and Human Services - Office of Inspector General and Texas Attorney General Greg Abbott's Medicaid Fraud Control Unit.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Man pleads guilty to billing Medicaid for bail money.

Source- http://www.therolladailynews.com/news/x1175999033/Man-pleads-guilty-to-billing-Medicaid-for-bail-money

A 29-year-old man pleaded guilty to a federal charge of health-care fraud.

The case involved false statements to Medicaid regarding hourly home health-care services he claimed to have provided during time frames when he was actually in jail, according to Acting United States Attorney Michael W. Reap.

Christopher S. Long, 29, of Jefferson City, signed and submitted numerous “personal-care-assistance service log sheets” to a home health-care agency located in Rolla in 2006, Reap said in a released statement. The log sheets purportedly documented the “total hours worked” by Long during two-week pay periods when he was providing personal-care services for his mother.

Long’s log sheets specifically instructed him to indicate any time his mother spent during the pay period in a hospital or nursing home, or out of the home setting, to enable the accurate calculation of Medicaid reimbursement, Reap said.

Long attempted to defraud the Missouri Medicaid program by falsely representing he had provided hourly-care services to his mother on specific times and dates when he was either in prison or his mother was in the hospital, meaning he actually did not provide any care services in the home setting. The purpose of Long’s scheme was to steal money from the Medicaid program for his personal use, including his bail money, Reap said.

According to court documents, Long signed a contract to be a home-health worker in December 2005, and afterward, was approved by the Missouri Medicaid program to provide personal-care services to his mother, a Medicaid beneficiary, at her residence.

Long pleaded guilty to one count of health-care fraud and will face a maximum penalty of 10 years in prison and, or, fines up to $250,000 when he is sentenced on Aug. 25.

Reap commended investigative work completed on the case by the Medicaid Fraud Control Unit of the Missouri Attorney General’s Office, the Office of Inspector General for the U.S.

Department of Health and Human Services and the Federal Bureau of Investigation.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Doctor accused of Medicare fraud agrees to pretrial diversion program.

Source- http://www.beaumontenterprise.com/news/local/doctor_accused_of_medicare_fraud_agrees_to_pretrial_diversion_program_06-02-2009.html

A Groves doctor accused of helping the owner and officer manager of a Port Arthur pain management clinic commit more than 150 counts of health fraud has agreed to enter a pretrial diversion program rather than stand trial.

Dr. Isam Nazmi Anabtawi is accused of conspiring with Ashley Collin Walkes, the Houston owner of Medic Management at 4500 Gulfway, and office manager Kristi Rose of Bridge City to defraud the Medicare program of more than $10 million.

Walkes and Rose were scheduled to proceed to trial Monday in U.S. Magistrate Marcia Crone's courtroom. While a jury had been selected, the trial was temporarily recessed for the day before any testimony could take place, according to officials.
That trial is set to resume Wednesday.

The U.S. Attorney's Office accuses the trio of overcharging the Medicare program by submitting bills for thousands of 25-minute office visits that actually lasted less than five minutes each.

Anabtawi's attorney, Zack Hawthorn, said the pretrial diversion program requires a defendant to meet certain conditions over a length of time, during which prosecution of a case is deferred. If the person meets the terms of the agreement, charges will be dropped, Hawthorn said.

Anabtawi currently is listed as a licensed physician on the Texas Medical Board's Web site.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Colo gets $2.6M in multistate Zyprexa settlement.

Source- http://www.denverpost.com/news/ci_12477302

DENVER—Colorado has received $2.6 million as part of a multistate settlement with Eli Lilly & Co. over the way the company marketed the anti-psychotic drug Zyprexa.

Indianapolis-based Lilly agreed in January to a $1.42 billion settlement of criminal and civil cases against it.

Lilly promoted Zyprexa to help dementia patients sleep, but regulators had never approved the drug for dementia.

Colorado Attorney General John Suthers announced the state's share of the settlement Thursday. He calls it a significant victory against Medicaid fraud.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Aventis Agrees to Pay $95 Million to Settle FCA Claims.

Source- http://legaltimes.typepad.com/blt/2009/05/aventis-agrees-to-pay-95-million-to-settle-fca-claims.html

The Justice Department has popped another pharmaceutical company for overcharging the Medicaid program. Aventis Pharmaceutical Inc., a subsidiary of Sanofi-Aventis U.S., has agreed to pay the United States $95.5 million to settle allegations that it violated the False Claims Act by misreporting drug prices to skirt its Medicaid rebate obligations, the department announced today.

The company and its corporate predecessors admitted to misreporting best prices for the anti-inflammatory nasal sprays Azmacort, Nasacort, and Nasacort AQ between 1995 and 2000. Aventis entered into “private label” agreements with the HMO Kaiser Permanente, which repackaged Aventis’ drugs under a new label. The arrangement allowed Aventis to underpay drug rebates to the Medicaid program and overcharge certain public health service entities.

The feds will recover about $49 million in the settlement. Aventis will also pay more than $40 million to the Medicaid-participating states and more than $6 million to the public health services entities that paid inflated prices.

The case was handled by the Justice Department's Civil Division, the U.S. Attorney’s Office for the District of Massachusetts, the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General, and the National Association of Medicaid Fraud Control Units.

"We will continue to ensure that programs for the most vulnerable portions of our population do not pay any more for pharmaceutical products than they should under the law," said Tony West, head of the department’s Civil Division, in a statement.

The settlement comes about 10 days after the Justice Department announced it would join whistleblower lawsuits against pharmaceutical giant Wyeth, alleging that the company overcharged state Medicaid programs hundreds of millions of dollars through special pricing arrangements with thousands of hospitals nationwide. Fifteen states and the District of Columbia have also joined the two lawsuits, filed in U.S. District Court for the District of Massachusetts.

For more FCA fare, check out Marcia Coyle’s story this week in The National Law Journal. The law got a serious upgrade in the recently enacted Fraud Enforcement and Recovery Act of 2009. The law strengthens the hand of whistleblowers, but corporate defense and government contract lawyers expect it will be litigated heavily.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Pharmacist in South Jersey faces prison.

Source- http://www.njbiz.com/weekly_article.asp?aID=19910543.8610467.1016301.6067213.4902421.915&aID2=78168

A South Jersey pharmacist was convicted of peddling narcotics and phony prescriptions as part of a plan to defraud Medicaid and private insurance companies, according to state Attorney General Anne Milgram.

An Atlantic County jury convicted Paola D’Ottavio, 42, of Pleasantville, of health care claims fraud, distribution of a controlled dangerous substance, and Medicaid fraud, according to last week’s notice from Milgram’s office.

D’Ottavio could face a prison term and fines at his July 31 sentencing, said Milgram, who added that the New Jersey Board of Pharmacy will review his pharmacy license.

Between Jan. 1, 2004, and June 30, 2005, D’Ottavio “created false telephone prescriptions for hydrocodone [the main ingredient in the painkiller Vicodin], and provided thousands of the pills to at least two purported customers,” Milgram said. The customers were friends of D’Ottavio, who sold the drugs and split the profits with D’Ottavio, she said.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Pharmacia May Pay $212M in Medicaid Fraud Case.

Source- http://pharmtech.findpharma.com/pharmtech/Manufacturing/Pharmacia-May-Pay-212M-in-Medicaid-Fraud-Case/ArticleStandard/Article/detail/599057?contextCategoryId=35097

Pfizer’s Pharmacia unit may be ordered to pay nearly $212 million as a result of a February 2009 Wisconsin court ruling that found the company guilty of violating the state’s Medicaid fraud statute 1.44 million times.

Last week, Wisconsin’s Attorney General J.B. Van Hollen requested forfeitures to this amount as well as an injunction that would require the company to report truthful prices.

The $212 million would be in addition to the $9 million the company has already been ordered to pay to compensate the state of Wisconsin for monetary losses resulting from defrauding the Medicaid program and violating consumer protection laws.

According to the government’s allegations, Pharmacia published false average wholesale prices (AWPs), which caused the state to overpay for prescription drugs. According to the Wisconsin Department of Justice, “The jury verdict confirmed the allegation that Pharmacia benefited from the scheme because it was able to attract business and market its pharmaceuticals to healthcare providers by using the inflated prices to reimburse the providers far more than they actually paid for the drugs. As a result, Pharmacia increased its market share and profits. Meanwhile Medicaid was paying a price based on the grossly inflated, fraudulent AWP.”

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Surprise man pleads guilty to Medicare fraud.

Maricopa County Superior Court

Source- http://www.azcentral.com/news/articles/2009/05/19/20090519sr-fraud0520-ON.html?&wired

A man who owns Cave Creek medical supply business recently pleaded guilty to a Medicare fraud scam after he filled unnecessary prescriptions for motorized wheel chairs, profiting about $2,000 from each chair.

Kieran Chikwendu, 56, of Surprise, pleaded guilty Monday to fraudulent schemes and artifices, a class two felony, theft, a class three felony, and two counts of forgery, a class four felony in Maricopa County Superior Court.

Chikwendu is scheduled to be sentenced on July 21. He faces almost nine years in prison, which will be followed by supervised probation.According to the Maricopa County Attorney's Office, Chikwendu set up Savana Medical Supply, a durable medical equipment business, in Cave Creek, but billed Medicare with information from beneficiaries in California.

The scam involved having some patients receive phony medical screenings at various "clinics" for the purpose of issuing the prescription and supplying the wheelchairs. Other Medicare recipients were approached at their homes with brochures and asked to pick out a wheelchair, without ever having any medical screening. None of the Medicare patients actually needed a wheelchair.

Medicare is prohibited from paying for any equipment that is not medically necessary.
Chikwendu billed Medicare for the cost of the wheelchairs and accessories of more than $417,000 and received payments of more than $263,000.

**********************************
Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Albuquerque Dentist Pleads To Medicaid Fraud.

Source- http://www.koat.com/news/19473085/detail.html

ALBUQUERQUE, N.M. -- An Albuquerque dentist has received a deferred sentence after pleading guilty to three misdemeanor counts of Medicaid fraud.

Lilian Jaime, doing business as Sierra Dental, was indicted in November 2007 on eight counts of Medicaid fraud based on fraudulent billings and five counts of falsification of documents for billings to the state program from 2003 through 2005.

Jaime was ordered to reimburse the Human Services Department $17,522 for Medicaid billings and pay the attorney general's Medicaid Fraud and Elder Abuse Division $50,000 to cover its

Her corporation pleaded guilty to a felony count of Medicaid fraud and was fined $1,000.

Jaime is banned from participating in Medicaid and other federal health care for five years. Her corporation is permanently excluded.

**********************************

Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Grand jury indicts woman on Medicaid fraud.