Monday, February 28, 2011

Hossein Lahiji and his Wife Najmeh Vahid Lahiji Indicted for Health Care Fraud



Source- http://houston.fbi.gov/dojpressrel/pressrel11/ho022511a.htm

HOUSTON—An indictment charging Hossein Lahiji, M.D., a McAllen urologist, and his wife, Najmeh Vahid Lahiji, of San Antonio, Texas, for allegedly defrauding Medicare and Medicare has been unsealed, United States Attorney José Angel Moreno announced today.

Dr. Lahiji, 47, was arrested yesterday at Bush International Airport upon arrival aboard a flight from Tehran, Iran. His wife, Vahid Lahiji, 35, surrendered today to law enforcement. Both have made their initial appearance before U. S. Magistrate Judge Frances H. Stacy and have been ordered release on a $100,000 cash secured ($2500) bond. As an additional condition of bond, U.S. Magistrate Judge Stacy ordered that Dr. Lahiji is prohibited from billing any claims for services to either Medicare and Medicare during the pendency of this Indictment. The Indictment was returned under seal on Jan. 11, 2011 and ordered unsealed today by the court.

Dr. Lahiji and Vahid Lahiji are accused in the nine-count indictment of defrauding Medicare and Medicaid, two health care benefit programs, by submitting false and fraudulent claims for payment of urology services either performed by unlicensed and unqualified medical personal or not rendered. According to the indictment, the Lahiji’s submitted claims to both Medicare and Medicaid for urology services purportedly performed by Hossein Lahiji, M.D. when, in fact, Hossein Lahiji, M.D. was traveling outside the State of Texas and/or outside the United States at the time of service. According to the indictment, individuals licensed only as Medical Assistants (“M.A.’s”) were performing these “urology services” without any supervision from any physician or other qualified, licensed personal, in violation of protocols established by both Medicaid and Medicare.

The Lahijis each face a sentence of up to 10 years in prison and a maximum fine of $250,000, if convicted of health care fraud.



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Sunday, February 27, 2011

Dr. Kiran Sharma Sentenced to Prison and Ordered to Forfeit More Than $43 Million in Cash/Property Gained Through Fraud



Source- http://houston.fbi.gov/dojpressrel/pressrel11/ho022511.htm

HOUSTON—Dr. Kiran Sharma, 56, of Kemah, Texas, has been sentenced to eight years in federal prison for engaging in a conspiracy with her husband, Dr. Arun Sharma, to commit health care fraud and committing health care fraud over a 10-year period in the Southern District of Texas, United States Attorney José Angel Moreno announced today.

United States District Judge David Hittner handed down the prison sentence today and further ordered Sharma to forfeit more than $43 million, including their $700,000 home in Kemah, Texas, numerous parcels of real property, more than $700,000 in cash found during a search of their Kemah home, more than $800,000 in cash found in two safe deposit boxes, and a number of investment accounts funded with the proceeds of their fraudulent scheme. At the conclusion of the sentencing, Sharma was remanded into the custody of the U.S. Marshals Service to begin serving her sentence.

Kiran Sharma (Dr. K) pleaded guilty to one count of conspiracy and one count of health care fraud on April 26, 2010 admitting that from Jan. 1, 1998, through June 10, 2009, she and Arun Sharma (Dr. A) fraudulently billed Medicare, Medicaid, and various private health care providers for medical procedures that were not performed.

During the time period of the conspiracy, the defendants owned and operated multiple medical clinics operating under the name Allergy, Asthma, Arthritis Pain Center, with two principle locations in Baytown and Webster, Texas. While some of patients at the clinics were referred by other medical doctors, approximately 50 percent of the patients came to the clinics through word of mouth. Dr. A was known as an easy touch for prescribing the “pain cocktail” of hydrocodone, Xanax and Soma. As time went on, Dr. A began prescribing stronger narcotics such as Oxycontin, morphine, methadone, and fentanyl patches.

In addition to the prescription of narcotics, a large part of the practice conducted at the clinics was to provide patients with injections of lidocaine combined with steroids which at times provided temporary relief of various joint and muscle pain. Although the injections given to the patients were superficial, they were billed falsely to the insurance companies as facet joint injections, paravertebral injections, sacroiliac nerve injections, sciatic nerve injections, and various nerve block injections.

The pain management practice at the clinics grew quickly during the time period of the conspiracy. Dr. A and Dr. K went from seeing an average of 50-60 patients per day in 1998 to more than 100 per day beginning in 2003, with a high of 279 on Jan. 6, 2005. From 1998 through 2002, Dr. K saw pain patients at the clinics in addition to her own allergy patients. Dr. K, who maintained a modest allergy practice, would sign patient procedure forms and superbills, falsely indicating that she had administered facet joint injections or other paravertebral injections when in reality she did not. She also prescribed the pain cocktail when she saw pain management patients.

Nearly every patient was prescribed one or more controlled substances and put on a regimen of shots every two weeks. The patients were required to sign the medical progress and procedure notes in their patient chart to prove they were at the clinic and received the shots. Dr. A tried to convince all patients to have shots at every visit, but many of the patients did not want the shots every two weeks. For those patients who ultimately refused the shots, Dr. A regularly required the patients to sign the progress and procedure notes even though they received only a prescription for controlled substances and did not receive any injections. By the beginning of 2000, Dr. A was having certain patients sign blank procedure/progress notes and then using those forms to generate a superbill in order to bill the insurance companies for injection procedures on days when the patient was not in the clinic.

Dr. K hired several foreign medical graduates (FMGs) over the course of the conspiracy to assist in the movement of patients through the clinics. Several of the FMGs helped add fictitious patient examination information to the blank progress/procedure notes after Dr. A had added non-existent medical procedures to the blank forms so that insurance companies could be billed as if the person had been in the clinic when in reality they had not. Dr. K witnessed the FMGs creating the fictitious patient progress/procedure notes and knew that their ultimate purpose was to bill the insurance companies for procedures that never occurred.

Demonstrative of the implausibility of the volume of patients who allegedly received injections is the fact that the defendants' own records purport to show that more than 100 patients purportedly received injections on 708 different days during the conspiracy. Further, the defendants’ billings showed that as many as 279 patients allegedly received injections on Jan. 6, 2005.

Dr. Arun Sharma, who also has been convicted of conspiracy and health care fraud after pleading guilty in April 2010, was sentenced by Judge Hittner on Feb.1, 2011 to 15 years in prison and ordered to forfeit more than $43 million in assets. He too was remanded into federal custody following his sentencing pending designation and transfer to a Bureau of Prisons facility.



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Saturday, February 26, 2011

Sarah Lavonne Willis Pleads Guilty to Health Care Fraud, Money Laundering, and Failure to File Tax Returns



Source- http://charlotte.fbi.gov/dojpressrel/pressrel11/ce022411.htm

CHARLOTTE, NC—Sarah Lavonne Willis, 49, of Charlotte, has agreed to enter a guilty plea to federal charges which were filed in November 2010 alleging health care fraud, money laundering, and failure to file tax returns. Today’s announcement is made by U.S. Attorney Anne M. Tompkins. Willis has been in federal custody since March 2010.

The U.S. Attorney’s Office for the Western District of North Carolina, working alongside a host of partner agencies, recently formed the Health Care Fraud Task Force, a multi-agency team of federal and state investigators, to root out health care fraud in the district. The work of the task force includes federal criminal prosecutions, such as the prosecution against Willis, and focuses on information sharing, following trends in health care fraud, staffing whistle blower complaints, and working specific investigations. The task force is committed to building upon long standing law enforcement partnerships with the goal of successful prosecutions in order to reduce fraud and recover taxpayer dollars. It is made up of representatives from FBI, HHS Office of Inspector General, DEA, IRS, U.S. Postal Inspection Service, U.S. Secret Service, the North Carolina Attorney General’s Medicaid Investigations Unit, the North Carolina Department of Insurance, and the North Carolina State Bureau of Investigation, all of whom join U.S. Attorney Tompkins in making today’s announcement.

Sarah Lavonne Willis today entered her guilty plea to three separate criminal counts, all of which relate to a health care fraud scheme alleged in the November indictment. According to official court documents, from 2007 to 2010 Willis falsely billed the North Carolina Medical Assistance Program (Medicaid), for behavioral therapy services which she did not provide and which were not eligible for reimbursement.

As part of her plea agreement the defendant acknowledged that the full loss amount which resulted from her criminal activity alleged in the bill of indictment is in excess of $1 million. Willis also agreed to pay full restitution and to the forfeiture to the government of any assets listed in the bill of indictment or seized in a related investigation. Some of the property previously seized from the defendant includes $193,283.71, a 2006 Bentley Continental Flying Spur, a 2007 Hummer H2, a 2002 Cadillac Escalade, a 2006 Chevrolet Monte Carlo, and a 2007 Dodge Charger. Pursuant to today’s entry of guilty plea Willis faces a maximum statutory penalty of 10 years of imprisonment, a $250,000 fine, or both, with regard to each of the federal criminal counts to which she pleaded guilty. The prosecution is being handled for the government by Assistant U.S. Attorney Kelli H. Ferry of the U.S. Attorney’s Office in Charlotte.

This is the first plea agreement entered in a criminal case brought by the Western District Health Care Fraud Task Force, and it shows that the U.S. Attorney’s Office, working alongside partner agencies, will pursue those who defraud the government, costing taxpayers millions of dollars each year.

Sarah Lavonne Willis is also facing, in a separate federal criminal case, an additional criminal count which alleged possession of a firearm by a convicted felon. Willis entered a guilty plea to the federal firearms violation on October 29, 2010 and is also awaiting sentencing in that criminal case. No date for sentencing on either case has been set at this time.



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Friday, February 25, 2011

Jo Ann Girod Convicted of Federal Health Care Fraud



Source- http://neworleans.fbi.gov/dojpressrel/pressrel11/no022311.htm

NEW ORLEANS, LA—JO ANN GIROD, age 36, a resident of Marrero, was convicted as charged today by a federal jury of nine counts of health care fraud, announced U.S. Attorney Jim Letten.

According to evidence introduced at trial, A New Beginning of New Orleans, Inc. (ANBNO) was a Medicaid provider located in Harvey, Louisiana that made claims for personal care services it claimed to have provided to Medicaid recipients. Personal care services (PCS) are Medicaid services provided by attendants to eligible recipients meeting the medical necessity criteria who are unable to care for themselves. ANBNO solicited mothers with children who had Medicaid benefits to apply for PCS.

GIROD, the mother to three children who were Medicaid recipients, signed forms and represented that ANBNO provided PCS services to each of her children for two hours a day every day between April 2001 and February 2005. Instead of providing PCS, ANBNO workers assigned to care for GIROD’S children paid GIROD cash kickbacks for the use of her children’s Medicaid information. Based upon this fraudulent information, Medicaid paid approximately $65,131 to ANBNO for services that were not performed related specifically to GIROD’S children.

From the time of the inception of ANBNO, through May 4, 2005, Medicaid paid approximately $3,977,288 as a result of the fraudulent claims made by ANBNO and its employees. On September 9, 2009, three other workers and parents associated with ANBNO were convicted after a jury trial. Additionally, several other employees were convicted after guilty pleas, as was AKASIA LEE, the owner of ANBNO.

JO ANN GIROD faces a possible maximum sentence of 90 years’ imprisonment and $2,250,000 in fines.



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Wednesday, February 23, 2011

APS Healthcare Midwest Pays $13 Million to Settle False Claims Act Case



Source- http://atlanta.fbi.gov/dojpressrel/pressrel11/at022211.htm

ATLANTA—The United States Attorney’s Office today announced that “INNOVATIVE RESOURCES GROUP, LLC,” doing business as “APS HEALTHCARE MIDWEST,” of White Plains, New York, has reached a $13 million settlement with the United States and the state of Georgia to resolve allegations under the False Claims Act. The United States’ share of the settlement is $5.2 million. The government alleges that APS Healthcare submitted false claims to Medicaid through the Georgia Department of Community Health (DCH) because it did not provide specialty services related to disease management and case management to members of the Georgia Medicaid Management Program (GAMMP) during the period from September 1, 2007 through February 28, 2010.

United States Attorney Sally Quillian Yates said of the settlement, “In this time of tight budgets and rising health care costs, the state of Georgia tried to improve its services to its Medicaid recipients by contracting with APS Healthcare. But instead of providing improved efficiency and effectiveness the company billed for, APS Healthcare took Medicaid’s money for itself and left some of our most vulnerable citizens without the aid they deserved.”

“Investigating Medicaid grant fraud is an important priority, because it diverts desperately needed resources from those who need it most,” said Special Agent in Charge Derrick L. Jackson, Health & Human Services, Office of Inspector General, Atlanta Region.

“This substantial recovery of taxpayer dollars is attributable to the continued strong partnership between state and federal law enforcement agencies in the fight against health care fraud and abuse,” said Scott Smeal, Georgia Senior Assistant Attorney General. “This case should send a strong message to companies such as APS Healthcare that they will be held fully accountable when they fail to provide the services they promised to provide to Medicaid patients.”

Under the GAMMP contract, APS Healthcare agreed to provide case and disease management services to Georgia Medicaid recipients and was paid a monthly fee for each member receiving such services. The government contends that APS Healthcare failed to provide the required services to a large portion of the Medicaid recipients and over-billed the Georgia Department of Community Health in its monthly invoices.

APS Healthcare has executed a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services, Office of Inspector General, which will require an aggressive compliance program. The Corporate Integrity Agreement requires, among other things, intensive training and implementation of policies and procedures designed to ensure compliance with federal health care program requirements. In addition, APS Healthcare will be subject to external review of its compliance with state Medicaid contracts. If APS Healthcare fails to comply with certain material terms of the CIA, the company is subject to monetary penalties and exclusion from federal health care programs, including Medicare and Medicaid.

The civil settlement resolves a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The case, pending in the Northern District of Georgia, is filed underUnited States ex rel. Michael Claeys and State of Georgia ex rel. Michael Claeys v. APS Healthcare, Inc., APS Healthcare Bethesda, Inc., and Innovative Resource Group, LLC d/b/a/ APS Healthcare Midwest, 1:09-cv-2779-WSD.



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Tuesday, February 22, 2011

Fourteen Area Defendants Charged in Eight Separate Federal Health Care Fraud Cases




Source- http://chicago.fbi.gov/dojpressrel/pressrel11/cg021711.htm

CHICAGO—One Chicago area physician, two chiropractors, three nurses, a pharmacist, and several home health industry administrators and recruiters are among 14 defendants charged this week in eight separate, unrelated federal health care fraud cases, federal law enforcement officials announced today. Federal arrest warrants were executed this morning for 10 of the defendants. Nine defendants allegedly work in the home health care industry, of which seven were charged with conspiring to violate the criminal anti-kickback statute, which makes it illegal to offer or solicit kickbacks in exchange for referrals of Medicare patients.

Several of today’s enforcement activities in the Chicago area are being conducted as part of a nationwide takedown by Medicare Fraud Strike Force operations that led to charges against 111 defendants for their alleged participation in numerous Medicare fraud schemes. The 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. The Departments of Justice and Health and Human Services today announced that the Medicare Fraud Strike Force, previously operating in seven locations across the country, has expanded operations to Chicago and Dallas. Five of the eight cases announced today were brought as a part of strike force operations.

“With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation's most essential health care programs, Medicare and Medicaid,” said Attorney General Holder. “As today's arrest prove, we are waging an aggressive fight against health care fraud.”

Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois, announced the formation of the HEAT Strike Force in the Northern District of Illinois. “Health care fraud has become an increasingly important priority of federal law enforcement in the Chicago area. We are organizing to deploy all of our resources to ensure that dishonest medical providers do not profit from cheating Medicare, Medicaid, and private insurers,” said Mr. Fitzgerald. Speaking particularly of the kickback violations alleged against several defendants in the home health care industry, Mr. Fitzgerald explained, “Paying for Medicare and Medicaid patients is a crime. We are focusing our resources on making sure that those who offer or solicit kickbacks are held accountable by the criminal justice system.”

Also announcing the charges was Robert D. Grant, Special Agent in Charge of the Chicago office of the Federal Bureau of Investigation. “Health care fraud will not be tolerated,” said Mr. Grant. “It affects every citizen through increases in insurance premiums and rising costs for both Medicare and Medicaid. As consumers of health care services, we should all be cognizant of possible fraud and promptly report suspicious charges to our insurance carriers or law enforcement.”

“Health care fraud is a crime committed against vulnerable patients, U.S. taxpayers, and the government programs funding vitally-needed health services,” said Lamont Pugh III, the Chicago Region's Special Agent in Charge for the Office of Inspector General of the Department of Health & Human Services. “The actions we have taken today are part of a coordinated, nationwide crackdown in our continuing battle against criminals who enrich themselves at our great expense.”

James Vanderberg, Special Agent-in-Charge for the Chicago Regional Office of the United States Department of Labor, Office of Inspector General said: “Today's charges represent the OIG's firm commitment to actively investigate health care fraud schemes in which union sponsored health and welfare funds are defrauded. We will continue to work vigorously with the U.S. Attorney's Office and our law enforcement partners to investigate crimes that undermine the financial well-being of union affiliated benefit funds.”

Mr. Fitzgerald announced the cases, all eight of which were charged this week in U.S. District Court, with Robert D. Grant, Special Agent in Charge of the Chicago Office of Federal Bureau of Investigation; Lamont Pugh, Special Agent-in-Charge of the U.S. Department of Health and Human Services Office of Inspector General in Chicago; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor Office of Inspector General in Chicago. The Office of Criminal Investigations of the Food and Drug Administration, the Office of the Inspector General of the U.S. Railroad Retirement Board, the City of Chicago Office of Inspector General, and the U.S. Department of Labor Employee Benefits Security Administration also participated in the investigations.

The defendants were each charged with one or more counts of health care fraud, mail fraud, false statements relating to health care matters, and/or conspiracy. If convicted of health care fraud, each count carries a maximum penalty of 10 years in prison and a $250,000 fine. If convicted of mail fraud, each count carries a maximum penalty of 20 years in prison and a $250,000 fine. If convicted of false statements relating to health care matters, each count carries a maximum penalty of five years in prison and a $250,000 fine. If convicted of conspiracy, each count carries a maximum penalty of five years in prison and a $250,000 fine. The court, however, would determine the appropriate sentence to be imposed under the advisory United States Sentencing Guidelines.



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Monday, February 21, 2011

Darawn Shadene Vasquez, Office Manager of Los Angeles Medical Supply Business, Pleads Guilty to Conspiring to Defraud Medicare of More Than $6 Million in Wheelchair Scheme



Source- http://losangeles.fbi.gov/dojpressrel/pressrel11/la021811.htm

WASHINGTON—The office manager of a Los Angeles durable medical equipment (DME) company pleaded guilty today to conspiring with her former church pastor to run a power wheelchair scheme that defrauded Medicare of more than $6 million, the Departments of Justice and Health and Human Services (HHS) announced.

Darawn Shadene Vasquez, 26, pleaded guilty today before U.S. District Judge George H. King in the Central District of California. Vasquez admitted that between January 2006 and September 2009, she conspired with her former church pastor, Christopher Iruke, and others to submit false claims to Medicare for expensive, high-end power wheelchairs and other DME through four DME companies that Iruke either owned or controlled through alleged straw owners. The companies included Pascon Medical Supply, Horizon Medical Equipment and Supply Inc., Contempo Medical Equipment Inc., and Ladera Medical Equipment Inc. Vasquez was charged, along with Iruke and four other individuals, in an indictment returned on Sept. 30, 2009.

Vasquez admitted in court documents that she and others used fraudulent prescriptions and documents they purchased from various individuals to support the false power wheelchair and DME claims that Pascon, Horizon, Contempo, and Ladera submitted to Medicare. Vasquez admitted that she and her co-conspirators submitted claims to Medicare prior to delivering the power wheelchairs and DME to Medicare beneficiaries in order to ensure that Medicare would pay them. Vasquez admitted that she and her co-conspirators often knew that the Medicare beneficiaries did not need the wheelchairs, either because the beneficiaries said they did not need them or because Vasquez observed them walking. As a result of this scheme, Medicare paid Pascon, Horizon, Contempo, and Ladera approximately $6.1 million on the false claims they submitted to Medicare.

Vasquez also admitted that in approximately August 2009, after subpoenas were received for the records of the four companies, she and another individual shredded pages from two ledgers containing the names of all the individuals who sold them fraudulent prescriptions and medical documents, and the amounts of money paid and owed those individuals. According to court documents, when the shredder overheated, they flushed the remaining ledger pages down the toilet.

At sentencing, scheduled for Oct. 3, 2011, Vasquez faces a maximum penalty of 10 years in prison and a $250,000 fine.

Iruke's trial is scheduled to begin on May 3, 2011, and he is presumed innocent unless proven guilty beyond a reasonable doubt in a court of law

Today's guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney André Birotte Jr. for the Central District of California; Tony Sidley, Assistant Chief of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse (CAL-DOJ); Glenn R. Ferry, Special Agent-in-Charge for the Los Angeles Region of the Office of Inspector General (OIG) for HHS (HHS-OIG); and Steven Martinez, Assistant Director in Charge of the FBI's Los Angeles Field Office.

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 Central District of California. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, strike force operations in nine districts have charged more than 990 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, the HHS 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.



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Sunday, February 20, 2011

Six Los Angeles-Area Defendants Indicted for Submitting Nearly $30 Million in Fraudulent Bills to Medicare



Source- http://www.justice.gov/usao/cac/pressroom/pr2011/023.html

LOS ANGELES – As part of a nationwide crackdown on Medicare fraud, six local defendants were arrested today on charges of submitting fraudulent claims to Medicare, mostly for electric wheelchairs that were never delivered.

Three indictments charging six defendants were unsealed today in United States District Court in Los Angeles. The local charges are among cases filed in nine cities across the United States that charge a total of 111 defendants, who cumulatively are accused of being involved in nearly a quarter billion dollars worth of false billings submitted to Medicare.

The Southland defendants arrested today are:

Camillus Ehigie, 50, of Woodland Hills;

Evans Oniha, 48, of Rancho Palos Verdes, who self-surrendered this morning;

Charles Achike Agbu, 56, of Carson;

Obageli Brooke Agbu, who is Charles Agbu’s daughter, 24, of Carson;

Joseph Ofoegbu, 58, Gardena; and

Sarah Hua, 64, of Monterey Par, who self-surrender this morning.

The six defendants are expected to be arraigned on the health care fraud charges this afternoon in federal court in downtown Los Angeles, with the exception of Ehigie who is being treated for an undisclosed medical condition.

Over the course of nine years, Camillus Ehige and Evans Oniha allegedly submitted more than $16 million in fraudulent claims to Medicare for durable medical equipment and in-home nursing services that typically were not provided to Medicare beneficiaries.

Ehige and Oniha were the owner/operators of Caravan Medical Supplies in Culver City and Prosperity Home Health Services in Lawndale. Ehige owned and operated Osbed Medical Supply in Woodland Hills. Ehige and Oniha were charged with conspiracy to commit health care fraud and several substantive counts of health care fraud for billing the Medicare program for durable medical equipment and home health services that were not medically necessary and, in many instances, not even provided. Ehige and Oniha allegedly paid “marketers” for access to Medicare beneficiary information or to have Medicare beneficiaries obtain fraudulent prescriptions for equipment or services. Ehigie and Oniha were also charged with making a false statement in a health care matter, and Ehigie was charged with obstructing an investigation into a healthcare offense for instructing a co-conspirator to lie to law enforcement agents about the scheme run out of Caravan, Osbed, and Prosperity.

In the second case, Charles Achike Agbu and his daughter, Obageli Brooke Agbu, were charged with conspiracy to commit health care fraud and several counts of health care fraud for submitting fraudulent claims for durable medical equipment through their Carson companies. Charles Agbu owned and operated Bonfee, Inc. and Obageli owned and operated Ibon, Inc. The indictment alleges that the Agbus billed Medicare for durable medical equipment, such as electric wheelchairs and orthotics, that was not needed, wanted, or even delivered to the Medicare beneficiaries for whom the bills were submitted. As part of the scheme, the Agbus allegedly obtained prescriptions from doctors for the medically unnecessary equipment and then used those prescriptions, along with the Medicare beneficiary information, to submit fraudulent claims to the Medicare program. Bonfee and Ibon allegedly submitted to Medicare a total of approximately $12 million in fraudulent bills for durable medical equipment.

Joseph Ofoegbu, the owner and operator of Iyke Associates in Torrance, and Sarah Hua, a marketer who procured beneficiaries for Ofoegbu, were charged with three counts of health care fraud for submitting fraudulent claims for reimbursement for motorized wheelchairs. The indictment alleges that Ofoegbu used marketers, including Hua, to recruit beneficiaries who were then seen by physicians who prescribed medically unnecessary durable medical equipment. The prescriptions were sent to Iyke Associates, which fraudulently billed Medicare using those prescriptions. According to the indictment, the beneficiaries either did not receive the equipment or they received less expensive equipment than the items Iyke billed to Medicare. Iyke billed a total of approximately $1.5 million in claims for DME it purported to provide to Medicare beneficiaries.

In announcing the nationwide crackdown on Medicare fraud today, Attorney General Eric Holder said: “With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation’s most essential health care programs, Medicare and Medicaid. As today’s arrests prove, we are waging an aggressive fight against health care fraud.”

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and the Department of Health and Human Services to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

“Today’s actions show that we will not tolerate criminals who pay kickbacks for referrals of Medicare business or who will bill for services that were medically unnecessary,” said Glenn R. Ferry, the Los Angeles Region’s Special Agent in Charge for the Office of Inspector General of the Department of Health and Human Services. “These actions are part of a coordinated, nationwide sweep in our continuing battle against greedy criminals who profit from exploiting federal health care programs.”



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Saturday, February 19, 2011

Thirty-Two South Florida Residents Charged as Part of Nationwide Takedown by Medicare Fraud Strike Force Operations



Source- http://miami.fbi.gov/daojpressrel/pressrel11/mm021711.htm

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced that thirty-two (32) South Florida residents were charged for their alleged roles in various schemes to defraud Medicare. The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in nine districts that led to charges against 111 defendants for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing. Medicare Fraud Strike Force operations throughout the country were modeled after the Miami strike force, which was the first in the nation.

U.S. Attorney Wifredo Ferrer stated, “This operation confirms that there is no safe harbor for Medicare fraudsters and that we will aggressively pursue all types of schemes and all types of offenders. This week, we arrested dozens of South Florida residents, including doctors, nurses, therapists, patient recruiters, money launderers, and others who chose to steal precious health care dollars. We also prosecuted a variety of fraud schemes involving community mental health fraud, home health care fraud, infusion fraud, Part D prescription fraud, durable medical equipment fraud, and even schemes against the Federal Employee Health Benefit Program. This week’s operation demonstrates that we will fight the battle against health care fraud on all fronts and will prosecute each link in the fraud chain and each emergent fraud scheme.”

“With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation's most essential health care programs, Medicare and Medicaid,” said Attorney General Holder. “As today's arrests prove, we are waging an aggressive fight against health care fraud.”

“People who defraud Medicare and private insurance companies indirectly increase the cost of health care for everyone,” said FBI Special Agent in Charge John V. Gillies. “The FBI is committed to rooting out health care fraud and reclaiming money improperly paid by government-sponsored programs and private insurers. The strike force gives us the necessary prosecutorial support to attack this multi-billion-dollar crime problem.”

“Today’s indictments and arrests mark a continuation of operations to flush out health care fraud in South Florida,” said Christopher Dennis, the Miami Region’s Special Agent in Charge for the Office of Inspector General of the Department of Health & Human Services. “The actions we have taken today are part of a coordinated sweep in our battle against the scourge of Medicare and Medicaid fraud.”

The Indictments announced today as part of the nationwide Medicare Fraud Strike Force operations include:

United States v. Jose Nunez, M.D., et al.

Twenty-one Miami-area residents, including two doctors, six nurses, 11 patient recruiters, and two employees, were arrested and charged for their alleged participation in a $25 million home health care Medicare fraud scheme. Jose Nunez, M.D., Francisco Gonzalez, M.D., Eneida Fry, L.P.N, Jorge Pineiro, R.N., Maritza Vidal, R.N., a/k/a “Maritza Casas,” Ignacio Angulo, L.P.N., Farah Maria-Perez, R.N., Luisa Morciego, R.N., Odalys Alvarez-Medina, Lesder Casanova, Oscar Martinez, Richard Diaz, Beatriz Torres-Cruz, Juana Rivas, Jose Ros, Fidel Castro, Barbara Gonzalez, Vicente Guerra, Raul Alvarez, Lisandra Alonso and Licet Diaz, were indicted on February 10, 2011 on various health care fraud charges, including conspiracy to commit health care fraud, making false statements, and soliciting kickbacks.

The indictment alleges that ABC Home Health, Inc. (ABC) and Florida Home Health Care Providers, Inc. (Florida Home Health) referred Medicare beneficiaries to Drs. Nunez and Gonzalez for medically unnecessary home health care. The doctors would sign prescriptions for therapy and home health services, and then received illegal kickback payments from the owners and operators of ABC and Florida Home Health. In addition, the doctors would receive Medicare payments for home health care services, including office visits and diagnostics tests. The indictment further alleges that Eneida Fry, L.P.N, Jorge Pineiro, R.N., Maritza Vidal, R.N., Ignacio Angulo, L.P.N., Farah Maria-Perez, R.N., Odalys Alvarez-Medina, Lesder Casanova, Oscar Martinez, Richard Diaz, Beatriz Torres-Cruz, Juana Rivas, Jose Ros, Fidel Castro, Barbara Gonzalez, Vicente Guerra, Raul Alvarez, and Lisandra Alonso would receive kickbacks and bribes for recruiting Medicare beneficiaries to be referred for home health services through doctors working with ABC and Florida Home Health. Finally, the indictment alleges that Licet Diaz distributed kickback payments to patient recruiters on behalf of the owners of ABC and Florida Home Health. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

United States v. Emilio Bezanilla

Emilio Bezanilla was charged with seven counts of laundering the proceeds of health care fraud and two counts of structuring transactions to avoid currency transaction reporting requirements. The indictment alleges that Bezanilla laundered thousands of dollars for five companies that engaged in health care fraud: Mercy Medical Supply, Inc., JHH Group, Inc., Yani’s Pharmacy, Inc., and La Numero 1 Farmacia Discount Corp. The indictment also alleges that Bezanilla structured the withdrawal of cash in denominations under $10,000 to avoid the requirement that banks report large cash withdrawals. This case being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Victor Ramon Castillo

Victor Ramon Castillo was charged with five counts of health care fraud, in connection with Vida Group Services, Inc., in Miami, Florida. The indictment alleges that Castillo incorporated Vida Group, submitted an application to Blue Cross on behalf of Vida Group, opened a bank account, and submitted approximately $1,118,854 in fraudulent claims to Blue Cross, of which Blue Cross paid $298,038. The indictment alleges that many of the fraudulent claims were for Federal employees receiving health benefits under the Federal Employees Health Benefits Program. This case is being prosecuted by Assistant U.S. Attorney Robert Luck.

United States v. Francisco Enrique Chavez

Francisco Enrique Chavez was charged with six counts of health care fraud and three counts of aggravated identity theft in connection with his scheme to defraud the Medicare program of $11.3 million by submitting fraudulent claims for DME through World Class Medical Services, Corp., located in Miami, Florida. The indictment alleges that Chavez stole Unique Physician Identification Numbers from doctors and used those numbers to generate fraudulent claims for DME. This case is being prosecuted by DOJ Trial Attorney Sara Hall.

United States v. Maikel Villega Gorrin

Maikel Villega Gorrin is charged with five counts of health care fraud in connection with JVZ Medical Equipment, Corp., located in Hialeah, Florida. The indictment alleges that Gorrin became a signatory on JVZ’s corporate bank account, registered as president of the company, and submitted approximately $926,134 in fraudulent claims to Medicare for DME on behalf of JVZ. This case is being prosecuted by Assistant U.S. Attorney Christopher Clark.

United States v. Yordany Nunez

Yordany Nunez was charged with six counts of health care fraud in connection with Med Kendall Corp., located in Miami, Florida. The indictment alleges that Nunez became the president of Med Kendall, submitted Part B and Part D Medicare applications on behalf of the company, submitted approximately $204,212 in fraudulent claims for Part B DME and $296,596 in fraudulent Part D claims for prescription drugs. This case is being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Juan Fernando Ramos

Juan Fernando Ramos was charged with one count of conspiring to commit health care fraud and thirteen counts of health care fraud in connection with P&E Medical Services, Inc., and JRD Express Services, Inc., both located in Miami, Florida. The indictment alleges that Ramos and his co-conspirators, Jose Raul Diaz and Pedro Frometa, caused the submission of approximately $4,550,391 in fraudulent Medicare claims for DME, and received payment of approximately $718,412. Finally, the indictment alleges that Ramos personally received the proceeds of the fraud. This case is being prosecuted by Assistant U.S. Attorney Robert Luck.

United States v. John Ruarte

John Ruarte was charged with six counts of health care fraud in connection with First Class Health Solutions, Inc., located in Dania Beach, Florida. The indictment alleges that Ruarte completed a Medicare application on behalf of First Class Medical Solutions, controlled a corporate bank account, and submitted approximately $1,603,536 in fraudulent Medicare claims for DME. This case is being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Tomas Solis

Tomas Solis was charged with six counts of health care fraud in connection with Ortho-America Medical Equipment, Co., Inc. (Ortho), located in Florida. The indictment alleges that Solas became the president of Ortho, maintained a Medicare provider number and bank account for Ortho, and submitted approximately $6,510,499 of fraudulent DME claims on behalf of the company. This case is being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Marta Martinez

Marta Martinez was charged with one count of conspiracy to commit health care fraud, two counts of health care fraud, and one count of conspiracy to pay health care kickbacks. The indictment alleges that, in 2005 and 2006, Martinez arranged for Medicare beneficiaries to serve as purported patients at A’s Medical Center Inc. and that she arranged for these patients to be paid. The indictment further alleges that A’s submitted more than $4 million in false claims for purported treatment of its patients, including those supplied by Martinez, based on which claims Medicare paid A’s approximately $1.1 million. This case is being prosecuted by Assistant U.S. Attorney Marc Osborne.

United States v. Armando Santos

Armando Santos was charged with one count of conspiracy to commit health care fraud, four counts of health care fraud, and two counts of making false statements related to health care matters. The indictment alleges that Santos, a Registered Nurse, caused a local home health agency to submit $230,315 in false claims to Medicare, and thereby caused Medicare to issue $152,664 in payments to the home health agency. The indictment further alleges that Santos and his conspirators caused the payment of kickbacks and bribes to Medicare beneficiaries in exchange for using their Medicare numbers as the bases of home health claims. The indictment also alleges that Santos signed patient assessment forms in which he falsely certified that home health services were medically necessary, and signed “Weekly Visit / Time Record Forms”in which he falsely stated that he was providing home health services to two separate Medicare beneficiaries at the same time. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

United States v. Yamili Rivero-Hernandez

Yamili Rivero-Hernandez was charged with three counts of health care fraud and one count of making false statements related to health care matters. The indictment alleges that Rivero-Hernandez, a Registered Nurse, caused a local home health agency to submit $317,789 in false claims to Medicare for home health services that were not rendered or that were medically unnecessary. As a result of these false claims, Medicare paid the local home health agency $208,177. According to the indictment, Rivero-Hernandez falsified “Weekly Visit / Time Record” sheets, indicating that she provided skilled nursing services to Medicare beneficiaries two times per day, seven days per week. In fact, however, she did not provide skilled nursing services with such frequency. Rivero-Hernandez allegedly also falsified paperwork in which she stated that she injected a Medicare beneficiary with insulin, when in fact, she did not do so. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

In addition to the cases being announced today, this past Tuesday, February 15, 2010, twenty individuals, including three doctors, were charged for their alleged participation in a fraud scheme involving approximately $200 million in Medicare billing for purported mental health services. The 38-count indictment alleges that the defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. According to court documents, the defendants participated in a scheme to defraud Medicare by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided at all. The indictment alleges that patients for the purported services were obtained through the payment of cash kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities (ALFs), in exchange for delivering the patients to ATC facilities. Various defendants allegedly participated in an extensive and complicated money laundering scheme to provide the cash for kickback payments. The criminal cases are being prosecuted by Trial Attorneys Jennifer L. Saulino, Maria Gonzalez Calvet and Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The related civil action is being prosecuted by Vanessa I. Reed and Carolyn B. Tapie of the Civil Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of Florida.

The cases announced today are being prosecuted and investigated by Strike Force teams comprised of attorneys from the Fraud Section in the Justice Department’s Criminal Division and from the U.S. Attorney Office for the Southern District of Florida. Other offices participating in today’s coordinated health care fraud takedown include the Eastern District of Michigan, the Eastern District of New York, the Middle District of Florida, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Northern District of Texas; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.



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Friday, February 18, 2011

Dr. Neil H. Hollander Sentenced for Health Care Fraud Scheme



Source- http://philadelphia.fbi.gov/dojpressrel/pressrel11/ph021711.htm

PHILADELPHIA—Dr. Neil H. Hollander, 55, of Huntingdon Valley, PA, was sentenced today to one year and one day in prison for health care fraud, mail fraud, and making false statements in a health care matter, announced United States Attorney Zane David Memeger. Hollander, who maintained a chiropractic office at the Hollander Chiropractic Center in Philadelphia, billed Independence Blue Cross (“IBC”) approximately $ 914,503.19 for chiropractic treatments that he had not actually rendered to the insured patients. IBC paid approximately $304,096.28. In 2005, when IBC requested patient files from Hollander, Hollander created false documents to submit to IBC in an effort to justify the fraudulent billings that had been submitted. Hollander pleaded guilty to the charges on June 10, 2010.

In addition to the prison term, U.S. District Court Judge Petrese Tucker ordered Hollander to pay restitution in the amount of $304,096.28 and to serve three years’ supervised release upon completion of the prison term. Hollander was ordered to begin serving his sentence on April 28, 2011.



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Thursday, February 17, 2011

Home Health Care Company Owner Florence Onyegbu, Sentenced to Nearly Four Years in Federal Prison



Source- http://dallas.fbi.gov/dojpressrel/pressrel11/dl021511.htm

DALLAS—Florence Onyegbu, 51, of Flower Mound, Texas, the owner of a home health company that operated in Dallas, was sentenced yesterday by U.S. District Judge David C. Godbey to 46 months in prison and ordered to pay approximately $1.3 million in restitution, announced U.S. Attorney James T. Jacks of the Northern District of Texas. Onyegbu will forfeit that amount as proceeds of the health care fraud. She must surrender to the Bureau of Prisons by April 4, 2011.

According to documents filed in the case, in September 2010, Onyegbu pleaded guilty to an information charging one count of offer and payment of illegal remuneration in relation to her home health company, De-Promise Home Health Services, previously located on North Central Expressway in Dallas.

Onyegbu admitted that from January 2008 to July 2010, she paid between approximately $100 to $200 per month to multiple beneficiaries in exchange for their Medicare information. She used the patients’ information to falsely bill Medicare approximately $1.8 million for purported home health services, including skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy. Onyegbu admitted that these patients neither qualified for nor needed the treatment. Her false claims to Medicare resulted in payments totaling more than $1.3 million to De-Promise Home Health Services.

The case was investigated by the U.S. Department of Health and Human Services - Office of Inspector General and the FBI.



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Wednesday, February 16, 2011

Twenty People Indicted in Florida for Health Care Fraud Scheme Involving Approximately $200 Million in Medicare Billing



Source- http://www.justice.gov/opa/pr/2011/February/11-crm-186.html

WASHINGTON – Twenty individuals, including three doctors, were charged today in the Southern District of Florida for various health care fraud, kickback and money laundering charges related to their alleged participation in a fraud scheme involving approximately $200 million in Medicare billing for purported mental health services, announced the Departments of Justice and Health and Human Services (HHS).

The 38-count indictment unsealed today in U.S. District Court in the Southern District of Florida alleges that the defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. According to court documents, the defendants participated in a scheme to defraud Medicare by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided at all. The indictment alleges that various defendants paid kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities (ALFs), in exchange for delivering patients to ATC facilities. Various defendants are charged with participating in an extensive and complicated money laundering scheme related to the cash for kickback payments. Sixteen defendants were arrested this morning in the Southern District of Florida and are expected to appear in U.S. District Court in Miami later today. Arrests are expected to continue in the coming days.

ATC’s and Medlink’s owners and managers, Lawrence S. Duran, Marianella Valera, Judith Negron and Margarita Acevedo, were originally indicted along with the corporate entities, ATC and Medlink, in October 2010. A superseding 38-count indictment unsealed today in the Southern District of Florida charges them with additional offenses.

“As today’s charges reflect, defrauding the Medicare system was not an aberration at ATC, but instead part and parcel of its business operations,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division. “The alleged scheme was brazen in scope, and carried out by the company’s owners, doctors, marketers and others. By exploiting positions of trust, these defendants masked their fraudulent operation as a legitimate mental health business. These charges are evidence that we will pursue Medicare cheats no matter their position.”

“Community mental health centers are an essential element of the nation’s health care system and serve vulnerable populations,” said Daniel R. Levinson, HHS Inspector General. “Today’s arrests by OIG agents and our law enforcement partners show that we will not tolerate criminals who pay kickbacks for referrals of Medicare business or who bill for services that were either medically unnecessary or never provided.”
 

“Community Mental Health Centers can no longer use phantom medical care as a front to bilk Medicare for unnecessary or nonexistent medical services,” said FBI Special Agent in Charge John V. Gillies of the Miami Field Office. “The FBI and our law enforcement partners will investigate and criminally prosecute such fraud to the fullest extent of the law.”

U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida stated, “Health care fraud has evolved from DME fraud, to infusion fraud, to home health care fraud, and now, as this case shows, to community mental health treatment fraud. Worse yet, health care fraud has come to permeate every level of the health care industry, from the owners and managers of dirty clinics, to complicit doctors, program directors, therapists, marketers, and patient recruiters. Today’s prosecution confirms that we are well-equipped and primed to fight the changing face of Medicare fraud in the Southern District of Florida, and that we will prosecute every link in the fraud chain.”

According to court documents, ATC, headquartered in Miami, operated purported partial hospitalization programs (PHPs) in seven different locations throughout Florida, from Homestead to Orlando. A PHP is a form of intensive treatment for mental illness. Court documents allege that Duran and Valera orchestrated the fraud, kickback and money laundering schemes. Negron assisted Duran and Valera in operating the schemes. Acevedo operated the kickback scheme.

According to court documents, doctors Mark Willner, Alan Gumer and Alberta Ayala were medical directors for ATC, and Vanja Abreu (Ph.D.), Nancy Merced-Sola and Lydia Ward (Ph.D.) served as program directors who managed ATC facilities. Nichole Eckert was a therapist at ATC. Court documents allege that Duran, Negron and Valera, along with the program directors and Eckert, regularly altered and instructed others to alter patient charts and notes from therapy sessions at ATC in order to make it appear that the patients being treated qualified for PHP treatments, when, in fact, they did not. According to the indictment, Willner, Gumer and Ayala then signed the false patient charts authorizing unnecessary treatment or continued treatment for patients who were not eligible for PHP treatment, without examining the patients or the charts. Duran and Valera also allegedly instructed employees and doctors at ATC, including Willner, Gumer and Ayala, to alter diagnoses and medication types and levels to falsely make it appear that the patients qualified for PHP treatments.

According to court documents, Valera, Willner, Gumer and Ayala manipulated the length of patients’ stays in order to maximize the number of days Medicare would pay for the PHP services. According to a civil complaint filed in the Southern District of Florida, ATC routinely admitted patients to the PHP program who suffered from Alzheimer’s and severe dementia and therefore were not eligible for the PHP program because their mental capacity did not allow them to benefit from group therapy.

The indictment also alleges that Sandra Jimenez, Hilario Morris and Joseph Valdes were marketers for ATC and participated in the kickback operation. These marketers, along with Duran, Valera, Negron and Acevedo, allegedly paid kickbacks to patient brokers and owners and operators of ALFs and halfway houses in exchange for delivering patients from their facilities to ATC. The indictment alleges that defendants Mathis Moore, Nelson Fernandez, Leyanes Placeres, James Edwards, Frank Criado and Curtis Gates were patient brokers and, in exchange for kickbacks, provided patients to ATC every month from ALFs and halfway houses with which they had relationships. The indictment alleges that the kickback payments totaled millions of dollars.

The indictments allege that the kickback scheme was supported by a money laundering scheme whereby individuals received checks in their own names or in the names of shell corporations they created, cashed the checks and returned the cash to Duran and Valera, which Duran and Valera then used to pay the kickbacks. Defendants Adriana Mejia, Pedro Sosa, Yoisel Cancio and an unnamed coconspirator, along with Moore, Fernandez, Placeres, Edwards, Criado and Gates, allegedly participated with Duran, Valera, Negron and Acevedo in the charged money laundering conspiracy. According to the indictment, Mejia, Sosa and Cancio received monthly, bi-weekly and weekly payments from Medlink despite the fact that they had no job functions at Medlink or ATC, other than laundering money. The indictments also charge that Duran, Valera, Negron, Mejia, Sosa and Cancio engaged in transactions designed to conceal proceeds of unlawful activity and structured their transactions to avoid reporting requirements that require banks to report certain transactions. According to the indictments, these defendants together laundered millions of dollars over several years.

The alleged scheme also involved a company called American Sleep Institute (ASI), which purportedly provided sleep study services. The defendants paid additional kickbacks for some patients to also visit ASI. Court documents allege that Willner, Gumer and Ayala furthered the health care fraud conspiracy by referring patients to ASI.

In a separate action in October 2010, a civil complaint for injunctive relief was filed in U.S. District Court in the Southern District of Florida and a preliminary injunction was obtained to freeze the assets of Duran, Valera, Negron, Acevedo, ATC and Medlink as well as ASI and D&V Development Inc., as participants in the health care fraud. Civil court documents allege that D&V Development was owned and operated by Valera and Duran and was established in an effort to divert funds received by ATC and ASI.

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

Today’s actions were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Wifredo A. Ferrer for the Southern District of Florida; Special Agent in Charge John V. Gillies of the FBI’s Miami Field Office; and Daniel R. Levinson, Inspector General of HHS.

The criminal cases are being prosecuted by Trial Attorneys Jennifer L. Saulino, Maria Gonzalez Calvet and Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The related civil action is being prosecuted by Vanessa I. Reed and Carolyn B. Tapie of the Civil Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of Florida. The cases are being investigated by the FBI and HHS Office of Inspector General (OIG). 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 Southern District of Florida.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for approximately $2.1 billion. 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.



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Tuesday, February 15, 2011

Miami Clinic Owner Ramon Moreira Pleads Guilty in $5 Million Health Care Fraud Scheme



Source- http://miami.fbi.gov/dojpressrel/pressrel11/mm021511a.htm

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigation; and Mark Overton, Chief, City of Hialeah Police Department, announce that defendant Ramon Moreira, 82, of Miami-Dade County, pled guilty today to one count of health care fraud, in violation of Title 18, United States Code, Section 1347. Sentencing has been scheduled for May 17, 2011 before U.S. District Judge Richard W. Goldberg.

According to court records, the fraud involved false billing of durable medical equipment to the Medicare Program. In March 2007, Moreira became the president of J&G Health Care, Inc., a Miami-Dade County DME company. From February 27, 2007 to May 16, 2007, Moreira caused J&G to submit more than $5 million in false claims to Medicare for, among other items, urinary leg bags. Medicare paid approximately $1 million on these false billings.

Moreira was indicted in 2007 and subsequently fled the United States upon learning of the health care fraud charges. He was found attempting to re-enter the United States at the Port of Miami in late 2010 and was taken into custody.



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Saturday, February 12, 2011

Parke Levy, the Owner of a DME Company and Lorraine Levy, the director of customer service, each Pleaded Guilty to Fraud Scheme Involving Diabetic Shoe Inserts



Source- http://www.justice.gov/opa/pr/2011/February/11-crm-175.html

WASHINGTON – The owners and operators of a Brooklyn-area durable medical equipment (DME) company pleaded guilty yesterday to defrauding the Medicare program, announced the Departments of Justice and Health and Human Services (HHS).

Parke Levy, the owner of a DME company called Americare, and his mother Lorraine Levy, the director of customer service for Americare, each pleaded guilty before U.S. District Judge I. Leo Glasser in U.S. District Court in Brooklyn to one count of conspiracy to commit health care fraud. In their plea, Parke Levy, 48, and Lorraine Levy, 79, admitted that they billed Medicare for equipment and supplies that were never actually provided to Medicare beneficiaries. Sentencing is scheduled for May 17, 2011.

According to the indictment, Lorraine Levy solicited Medicare beneficiaries to whom Americare could provide diabetic supplies, including “free” shoes and inserts every year, even if the supplies were not medically necessary. Parke Levy and others met with Medicare beneficiaries to measure their feet using a measuring stick or ruler. Parke Levy and Lorraine Levy then submitted or caused to be submitted false Medicare claims for three pairs of custom molded inserts per patient, when in fact only off-the-shelf inserts were provided to beneficiaries.

The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Loretta Lynch of the Eastern District of New York and Thomas ODonnell, Special Agent-in-Charge of the HHS Office of Inspector General (OIG) New York office.

The case is being prosecuted by Trial Attorney Katherine Houston of the Criminal Division’s Fraud Section. The case is being investigated by the FBI; HHS-OIG; Department of Labor, Office of the Inspector General; and the New York State Office of the Medicaid Inspector General.

This 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 New York.

Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion. In addition, the HHS 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.



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Friday, February 11, 2011

Medical Assistant Guy Ross Sentenced to 36 Months in Prison for His Role in a Fraudulent Home Health Scheme



Source- http://www.justice.gov/opa/pr/2011/February/11-crm-178.html

WASHINGTON – A medical assistant was sentenced today to 36 months in prison for his role in a conspiracy to defraud the Medicare program, the Departments of Justice and Health and Human Services announced. Guy Ross was also sentenced by U.S. District Judge Denise Page Hood in the Eastern District of Michigan to three years of supervised release following his prison term and was ordered to pay $472,623 in restitution.

Ross, 51, pleaded guilty in July 2010 to one count of conspiracy to commit health care fraud. According to court documents, Ross received kickbacks from the owners and/or operators of two Detroit-area home health agencies, Patient Choice Home Healthcare Inc. and All American Home Care Inc., in exchange for referring home health patients to those entities. Ross admitted to receiving $500 per patient, paid either by check or in cash, in exchange for providing co-conspirator Mohammed Shahab with Medicare beneficiary information for various patients he recruited. After paying the kickbacks to Ross, Shahab, an owner of Patient Choice and All-American, billed Medicare for home health visits purportedly made to the beneficiaries recruited by Ross. Ross referred 21 patients to Patient Choice and All American. During the time Ross participated in the scheme, Patient Choice and All American submitted claims for $172,573 in improper benefits. Shahab pleaded guilty in February 2010 to health care fraud charges in connection with this case.

According to court documents, Ross also admitted to engaging in a similar scheme with a home health agency called Visiting Nurses Services (VNS), a home health agency that purportedly provided physical therapy services. Ross admitted he accepted money in exchange for providing patient referrals to VNS. According to court documents, Ross referred approximately 80 patients to VNS and VNS submitted claims for $300,050 as a result of those referrals.

In total, Ross’s kickback arrangements with Patient Choice, All American and VNS resulted in $472,623 in fraudulent billing to Medicare.

Of the total restitution amount, Ross was ordered to pay $172,573 joint and several with co-defendants in the Patient Choice and All American scheme.

Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

The case was prosecuted by Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and 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 its inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals and organizations that collectively have billed the Medicare program for more than $2.1 billion. 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.



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Thursday, February 10, 2011

Owner of Personal Care Assistance Company Patrick Daniel Osei Sentenced for Paying a Kickback for Medicaid Referrals and Making False Statements



Source- http://minneapolis.fbi.gov/dojpressrel/pressrel11/mp020911c.htm

Patrick Daniel Osei, owner of a home health care agency called Advance Home Health, was sentenced earlier today in federal court in Minneapolis for defrauding Medicaid and for making false statements to federal investigators. United States District Court Judge Joan N. Ericksen sentenced Osei, age 51, of Brooklyn Park, to 63 months in prison on one count of illegal remuneration and two counts of making a false statement. He was indicted for defrauding Medicaid on October 20, 2009, and charged for making the false statements on May 20, 2010.

The 63-month sentence was higher than the sentencing range found in the sentencing guidelines, and in pronouncing sentence, the court emphasized the seriousness of health care fraud schemes, particularly those targeting programs like Medicaid. After sentencing, U.S. Attorney B. Todd Jones concurred, saying, “Criminals who defraud Medicaid and Medicare steal taxpayer dollars from health programs that serve some of our nation’s most vulnerable citizens. The sentence handed down today in this case appropriately reflects the seriousness of using a home health care business to defraud Medicaid.”

In entering his guilty pleas, Osei admitted that on November 8, 2007, he offered and paid a kickback in the form of cash to someone for referring others to his company, Advance Home Health, in Brooklyn Park. Those referrals were for Personal Care Assistance (“PCA”) paid by Medicaid, which provides medical care and services to low-income people who meet certain income and eligibility requirements. Medicaid is a federal program administered in Minnesota by the State Department of Human Services.

In addition, Osei admitted that on April 29 and 30, 2010, he provided false information about assets to federal investigators during the government’s attempted recovery of assets connected to the fraud conduct. Osei also admittedly engaged in a conspiracy to defraud Medicaid by billing for services not actually provided At the sentencing hearing, the court determined that the total restitution due and owing the Medicaid program because of Osei’s criminal activity totaled more than $520,000.

These cases are the result of investigations by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services-Office of Inspector General. They were prosecuted by Assistant U.S. Attorney David M. Genrich.

According to the Justice Department, health care fraud investigations have been growing, and the Department has formed a senior-level task force to tackle the problem nationwide. The Health Care Fraud Prevention and Enforcement Action Team, represented by the Department of Justice and Health and Human Services, will look at how to share more effectively real-time intelligence data on health care fraud patterns as well as critical information about health care services, pharmaceuticals, and medical devices. In 2008, the Justice Department filed criminal charges in 502 health care fraud cases involving 797 defendants.

In Minnesota, the U.S. Attorney’s Office is also participating in a task force with the Minnesota Attorney General Office’s Medicaid Fraud Control Unit that focuses on home health care fraud. That task force includes the U.S. Department of Health and Human Services-Office of Inspector General, the Federal Bureau of Investigation, the Internal Revenue Service, and other federal, state, and local law enforcement partners.



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