Thursday, March 31, 2011

Marlon Oslvaldo Palma Sentenced to Nearly Five Years in Prison in $1.8 Million Medicare Fraud Scheme



Source- http://losangeles.fbi.gov/dojpressrel/pressrel11/la032911a.htm

LOS ANGELES—The owner of a South Los Angeles medical supply company that fraudulently collected nearly $2 million from Medicare for unneeded electric wheelchairs and other durable medical equipment has been sentenced to 57 months in federal prison.

Marlon Oslvaldo Palma, 40, of South Los Angeles, was sentenced late yesterday by United States District Judge Christina A. Synder.

Palma, the co-owner of Santos Medical Supply, pleaded guilty in March 2010 to conspiracy to commit health care fraud. Palma admitted to bilking the Medicare program by submitting claims for $5,000 power wheelchairs and other medical equipment that were unnecessary and, in many instances, never provided to patients. As part of the scheme, Palma bought Medicare patient information and bogus prescriptions from a medical clinic and patient recruiters and then used that information to bill Medicare. Santos Medical Supply submitted nearly $3 million worth of fraudulent claims to Medicare, which paid out $1,822,016.

Palma was arrested in September 2008 after an investigation by the Medicare Fraud Strike Force, a multi-agency team comprised of the Federal Bureau of Investigation; the Department of Health and Human Services, Office of Inspector General (HHS-OIG); the Fraud Section in the Criminal Division at the United States Department of Justice in Washington; and the United State’s Attorney’s Office in Los Angeles.



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Wednesday, March 30, 2011

Carolyn Ann Vasquez Pleads Guilty to Participating in a Medicare Fraud Scheme Using Fraudulent Medical Clinics and Stolen Doctor Identities to Defraud Medicare of More Than $6.2 Million


Source- http://losangeles.fbi.gov/dojpressrel/pressrel11/la032911.htm

WASHINGTON—A Los Angeles woman has pleaded guilty to using fraudulent medical clinics and the stolen identities of physicians to defraud Medicare of more than $6.2 million, the Departments of Justice and Health and Human Services (HHS) announced.

Carolyn Ann Vasquez, 46, pleaded guilty yesterday before U.S. District Judge Terry J. Hatter Jr. in the Central District of California. Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. According to court documents, physician assistants recruited to work at the clinics by Vasquez and working at her direction performed these services and prescribed and ordered the wheelchairs, medical equipment, and diagnostic tests.

According to court documents, Vasquez told the physicians she recruited that they would be the medical directors of the clinics, but that if they did not want to work full time, the clinics would hire physician assistants. Vasquez assisted the physicians in obtaining Medicare provider numbers and entering into management agreements that gave Vasquez's co-conspirators authority to operate and manage the clinics in exchange for 75 percent of the reimbursement payments the physicians received from Medicare.

According to court documents, Vasquez's involvement in the recruitment of the physicians gave her access to their personal and Medicare information, which Vasquez stole to further the fraud scheme at the medical clinics. Vasquez admitted that in approximately 2007, a physician contacted her about a job at one of the fraudulent medical clinics, but the physician decided not to accept the job. Nevertheless, Vasquez's co-conspirators printed prescription pads with the physician's name and Medicare provider number on them. Vasquez admitted that she instructed a physician assistant working at one of the fraudulent medical clinics to use the prescription pads to write fraudulent prescriptions and medical documentation for diagnostic tests, power wheelchairs and other medical equipment in the physician's name even through Vasquez knew that the physician did not work at the clinic. Vasquez admitted that as a result of her conduct, Medicare was defrauded of approximately $6,268,899.

At sentencing, scheduled for July 11, 2011, Vasquez faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to information contained in court documents in this case, Vasquez pleaded guilty in 1993 to participating in a health care fraud scheme. According to court documents, Vasquez and others used telemarketing or "boiler room" schemes to defraud government-funded health care benefit programs of approximately $41 million.


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Monday, March 28, 2011

Fred Dweck Sentenced to 24 Months in Prison for Role in $37 Million Medicare Fraud Scheme Involving Miami-Area Home Health Agencies



Source- http://www.justice.gov/opa/pr/2011/March/11-crm-379.html

WASHINGTON – A Miami-area doctor, Fred Dweck, was sentenced to 24 months in prison today for his role in a wide-ranging Medicare fraud scheme involving several Miami-area home health agencies, the Departments of Justice and Health and Human Services (HHS) announced today.

U.S. District Judge Adalberto Jordan also sentenced Dweck to three years of supervised release following his prison term and ordered him to pay $22 million in restitution jointly and severally with his co-defendants and co-conspirators in a related case. The restitution is to be paid to the victim in this case, the Centers for Medicare and Medicaid Services (CMS).

According to court documents, Dr. Dweck was the physician at Courtesy Medical Group, a Miami medical clinic that purported to provide health care services to Miami-area residents. The clinic was at various times owned by two of Dweck’s co-defendants, Auturo Fonseca and Yudel Cayro. At his plea hearing, Dweck admitted that while employed at the clinic, he wrote hundreds of prescriptions and signed hundreds of plans of care and medical certifications for Medicare beneficiaries to receive purported home health services. These services included twice or three-times daily skilled nursing visits to provide diabetic insulin injections. Dweck admitted that, in fact, these Medicare beneficiaries were able to care for themselves and did not actually need or qualify for the expensive home health services. Dweck also admitted to having prescribed unnecessary physical therapy services for many of the same Medicare beneficiaries.

According to court documents, the owners of Courtesy Medical Group would solicit and accept bribes and kickbacks from patient recruiters and the owners of Miami-area home health agencies in return for providing the bogus prescriptions signed by Dweck. Those prescriptions would then be used by dozens of Miami-area home health agencies to fraudulently bill the Medicare program for millions of dollars in unnecessary services.

Dweck admitted that in total, from about August 2006 through December 2009, he referred approximately 858 patients through Courtesy Medical Group and other Miami-area clinics for these unnecessary home health and therapy services, resulting in more than $37 million being fraudulently billed to the Medicare program. Of that amount, more than $22 million was actually paid out by the Medicare program to various Miami-area home health agencies. According to court documents, more than $16 million of those fraudulent billings stemmed from prescriptions issued by Dweck through Courtesy Medical Group, of which close to $10 million was actually paid out by Medicare.



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Sunday, March 27, 2011

Melanie Newman and her Husband Michael Anthony Goodloe Jr, Sentenced for Conspiracy to Commit Health Care Fraud


Source- http://neworleans.fbi.gov/dojpressrel/pressrel11/no032411.htm

MELANIE NEWMAN, age 25, and her husband, MICHAEL ANTHONY GOODLOE, JR., age 28, both of Carrollton, Texas, were sentenced today in federal court by U. S. District Judge Mary Ann Vial Lemmon for their roles in a health care fraud conspiracy, announced U. S. Attorney Jim Letten. Specifically, NEWMAN was sentenced to twenty-four (24) months in prison and GOODLOE was sentenced to eighteen (18) months in prison to be followed by six (6) months of home confinement. Both defendants were ordered to serve three (3) years’ supervised release following imprisonment during which time they will be under federal supervision and risk additional imprisonment should they violate the terms of the supervision. In addition, NEWMAN was ordered to pay restitution in the amount of $152,915.04 and GOODLOE in the amount of $103,325 to the Medical Center of Louisiana Foundation. 10/21

According to court documents, both defendants pled guilty on October 21, 2010. NEWMAN admitted that, as a bookkeeper employed at the Medical Center of Louisiana Foundation, she created and forged Foundation checks to pay for personal items and expenses, such as her wedding to GOODLOE, payment of student loans and to purchase automobiles. NEWMAN further admitted that she also gave forged checks to GOODLOE who had no legitimate business with the Foundation. During the conspiracy, NEWMAN and GOODLOE took approximately $220,603.65, some of which was retrieved by the Foundation.


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Saturday, March 26, 2011

Dr. Selwyn Carrington Charged with Conspiring to Distribute Controlled Substances


Source- http://miami.fbi.gov/dojpressrel/pressrel11/mm032511a.html

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Pam Bondi, Florida Attorney General, Medicaid Fraud Control Unit (MFCU), West Palm Beach Bureau; William J. Maddalena, Acting 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 Investigations; John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service (DCIS); and the Greater Palm Beach Health Care Fraud Task Force, announced the arrest of Dr. Selwyn Carrington, a 57-year-old physician living in Miami, Florida.

The criminal complaint charges the defendant, Dr. Carrington with conspiring to dispense and distribute and to cause the dispensing and distribution of controlled substances through medical clinics in Hallandale and West Palm Beach, Florida, in violation of Title 21, United States Code, Sections 846 and 841(a)(1). If convicted, Dr. Carrington faces a maximum statutory sentence of 20 years. Selwyn Carrington is a licensed physician in the State of Florida. Carrington’s primary practice is at 1613 North Hiatus Road, Pembroke Pines, Florida.

According to the complaint and corresponding affidavit, Dr. Carrington served as the medical director of Primary Care Primary Care Practitioners, a family medical practice owned by two advanced registered nurse practitioners (ARNPs). Primary care practitioners operates clinics in Hallandale and West Palm Beach, Florida.

According to court documents, the investigation revealed that Dr. Carrington did not treat or evaluate any clients at the clinics and he was not at the clinics during their normal business hours. The investigation revealed that, in exchange for $5,000 per month, Dr. Carrington went to the clinics approximately once per week to sign progress notes for patients that had been previously seen by the ARNPs and to pre-sign blank prescriptions so that the ARNPs and other employees, who have no medical licenses, could illegally prescribe controlled substances to their clients. According to the charging documents, Percocet, Oxycodone, and Xanax were all illegally prescribed in this manner.

An analysis of the payments made by Florida Medicaid for the time period from March 2005 through January 2011 indicated that over 300,000 pills containing controlled substances were dispensed to Primary Care Practitioner’s clients due to the prescriptions pre-signed by Dr. Carrington. The Florida Medicaid Program paid for these pills. The 300,000 pill total includes 150,000 pills containing Schedule II control substances. Schedule II controlled substances, such as Oxycodone, have a high level of abuse or misuse and so their use is severely restricted in the United States.


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Friday, March 25, 2011

Andrea R. Williams Sentenced for Medicaid Fraud


Source- http://indianapolis.fbi.gov/dojpressrel/pressrel11/ip032411.html

INDIANAPOLIS—Joseph H. Hogsett, United States Attorney, announced today that Andrea R. Williams, 23, Connersville, Ind., was sentenced to two years’ probation today by U.S. District Judge William T. Lawrence, for health care fraud following a six month investigation by the Department of Health and Human Services, Office of Inspector General, Federal Bureau of Investigation and Indiana Attorney General Greg Zoeller’s Medicaid Fraud Control Unit.

From January 2008, and continuing through May 20, 2010, Andrea Williams, the billing manager of Handy Van Medical Transportation (HVM), used her position at the company to carry out a scheme to defraud the Indiana Medicaid Program.

HVM is a company operating in the Connersville, Ind., area which transports Indiana Medicaid beneficiaries to medical appointments. Williams, as the billing manager, submitted claims for payment to Indiana Medicaid falsely indicating that HVM was providing all of its services to wheelchair bound patients, thereby causing Indiana Medicaid to pay at higher rate. Williams further represented that most patients required an additional attendant to help transport these patients which was also false.

Law enforcement executed a search warrant at the premises of HVM on May 20, 2010. During this search, Williams confessed to the above scheme. As a result of her actions, Indiana Medicaid lost $102.012.02.


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Thursday, March 24, 2011

John Milisitz Sentenced to Prison in Scheme to Defraud the Baltimore Washington Medical Center


Source- http://www.fbi.gov/baltimore/press-releases/2011/former-california-man-sentenced-to-prison-in-scheme-to-defraud-the-baltimore-washington-medical-center

BALTIMORE—U.S. District Judge J. Frederick Motz sentenced John Milisitz, age 37, formerly of Encinitas, California, today to 21 months in prison, followed by three years of supervised release, for mail fraud in connection with a scheme to defraud the Baltimore Washington Medical Center (BWMC), where his mother, Margie Milisitz, was employed. Judge Motz also ordered Milisitz to pay restitution of $380,000.

The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.

According to the plea agreement, Margie Milisitz was employed by BWMC as the manager of telecommunications. In addition to being responsible for overseeing the purchase and maintenance of telecommunication services and equipment for BWMC, it was part of Margie Milisitz’s duties to select vendors for the various telecommunications services and equipment, issue purchase orders, and to approve invoices from those vendors for payment.

Beginning in May 2005, and continuing until January 15, 2008, John Milisitz and his mother submitted false invoices to BWMC for telecommunications services and equipment that were never provided to the hospital. Margie Milisitz submitted invoices to the BWMC Accounts Payable Department, in the name of Global 1 Telecommunications and U.S. Cellular, companies associated with John Milisitz, falsely indicating that the goods and services listed on the Global 1 and US Cellular invoices had been received by BWMC. This caused the accounts payable department to issue payments on the invoices, which were deposited into bank accounts controlled by John Milisitz. As a result of this scheme, the Milisitz’ obtained more than $380,000 from BWMC, which they used for their own benefit, including paying credit card and household expenses, entertainment and travel.

Margie L. Milisitz, age 58, of Severna Park, Maryland, pleaded guilty to the same charge and was sentenced to 21 months in prison on February 2, 2011. Judge Motz also ordered Margie Milisitz to pay restitution of $380,000.


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Wednesday, March 23, 2011

United States District Court Sentences Psychologist Lorne Allan Semrau for False Billings to Medicare/Medicaid


Source- http://memphis.fbi.gov/dojpressrel/pressrel11/me032111a.htm

MEMPHIS, TN—Edward L. Stanton, United States Attorney for the Western District of Tennessee, announced today that Lorne Allan Semrau, 64, of Jackson, Tennessee, was sentenced by United States District Court Chief Judge Jon P. McCalla to 18 months’ imprisonment to be followed by three years of supervised release. The defendant was also ordered to pay restitution to Medicare and Medicaid in the amount of $245,435.86. Semrau was convicted by a federal jury on June 17, 2010, for three counts of submitting false and fraudulent claims to defraud health care benefits programs such as Medicare and Medicaid in Tennessee and Mississippi. The three-week trial was held before Chief United States District Court Judge Jon P. McCalla in Jackson.

Semrau was indicted in June 2007 and at that time was the owner, president and CEO of Superior Life Care Services and Foundation Life Care Services. According to the indictment, Semrau contracted with nursing homes in Tennessee and Mississippi to provide medication and mental health services to residents. Semrau then allegedly contracted with psychiatrists to perform the medication and mental health services pursuant to the nursing home contracts. As stated in the indictment, Semrau then implemented a billing scheme to defraud Medicare, Medicaid, and others by submitting, through his companies Superior and Foundation, claims for services that were not provided by the physicians and claims which Semrau knew to be false.


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Tuesday, March 22, 2011

John Milisitz Sentenced to Prison in Scheme to Defraud the Baltimore Washington Medical Center



Source- http://baltimore.fbi.gov/dojpressrel/pressrel11/ba032111.htm

BALTIMORE, MD—U.S. District Judge J. Frederick Motz sentenced John Milisitz, age 37, formerly of Encinitas, California, today to 21 months in prison, followed by three years of supervised release, for mail fraud in connection with a scheme to defraud the Baltimore Washington Medical Center (BWMC), where his mother, Margie Milisitz, was employed. Judge Motz also ordered Milisitz to pay restitution of $380,000.

The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.

According to the plea agreement, Margie Milisitz was employed by BWMC as the manager of telecommunications. In addition to being responsible for overseeing the purchase and maintenance of telecommunication services and equipment for BWMC, it was part of Margie Milisitz’s duties to select vendors for the various telecommunications services and equipment, issue purchase orders, and to approve invoices from those vendors for payment.

Beginning in May 2005, and continuing until January 15, 2008, John Milisitz and his mother submitted false invoices to BWMC for telecommunications services and equipment that were never provided to the hospital. Margie Milisitz submitted invoices to the BWMC Accounts Payable Department, in the name of Global 1 Telecommunications and U.S. Cellular, companies associated with John Milisitz, falsely indicating that the goods and services listed on the Global 1 and US Cellular invoices had been received by BWMC. This caused the accounts payable department to issue payments on the invoices, which were deposited into bank accounts controlled by John Milisitz. As a result of this scheme, the Milisitz’ obtained more than $380,000 from BWMC, which they used for their own benefit, including paying credit card and household expenses, entertainment and travel.

Margie L. Milisitz, age 58, of Severna Park, Maryland, pleaded guilty to the same charge and was sentenced to 21 months in prison on February 2, 2011. Judge Motz also ordered Margie Milisitz to pay restitution of $380,000.



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Monday, March 21, 2011

Nine Sentenced in Southwest Florida Prescription Drug Fraud Ring


Source- http://tampa.fbi.gov/dojpressrel/pressrel11/ta031611.htm

FORT MYERS, FL—U.S. Attorney Robert E. O'Neill announced today the culmination of a nine-defendant prescription fraud ring case in Southwest Florida. The following defendants, all residents of Lee County, were sentenced to federal imprisonment for conspiring to distribute Oxycodone, Methadone, and Alprazolam.



Jason Bergin 35 15 Years 3/7/2011
Robert Powner 57 11 Years 3/7/2011
Susan Hamilton 51 10 years 5/24/2010
Julie Becker 35 5 years 3/29/2010
Matthew Gross 32 5 years 8/3/2010
Jarrett Sprafka 31 6 ½ years 4/29/2010
Carey Bergin 37 6 ½ years 3/9/2011
Shandy Albert 34 6 ½ years 6/22/2010
Theresa Martinez 47 6 years 4/26/2010

This case involved fraudulent prescriptions that were passed in local pharmacies, which enabled the defendants in the conspiracy to obtain thousands of highly addictive pain medication pills, mostly Oxycodone. According to court documents, the defendants provided local pharmacies with a false telephone number, whereby one of the conspirators pretended to be a physician's office in order to verify the fraudulent prescriptions. The heads of the drug organization, Jason and Carey Bergin, then sold a large number of the pills for profit.

This case was investigated by agents of the Drug Enforcement Administration Task Force and prosecuted by Chief Assistant U.S. Attorney Nicole Waid and Assistant U.S. Attorney Douglas Molloy.

"We are combining our resources, at every level possible," said U.S. Attorney Robert O'Neill. "By sharing broader intelligence, information, and investigative strategies among our law enforcement partners, we will aggressively investigate and prosecute these types of crimes."



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Friday, March 18, 2011

Alton Bates, Robert Ivory Levy and Juanita Anderson Hilton Sentenced in Scheme to Defraud Medicare


Source- http://neworleans.fbi.gov/dojpressrel/pressrel11/no031711.htm

BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that U.S. District Judge Brian Jackson sentenced Alton Bates, 62, an attorney in Baton Rouge, Louisiana, to 34 months in prison, to pay restitution of $1,063,873 to Medicare, to forfeit the gross proceeds of his scheme to defraud Medicare, and to three years' supervised release after imprisonment. Judge Jackson also sentenced co-defendants Robert Ivory Levy, 59, and Juanita Anderson Hilton, age 42, both of whom are residents of Baton Rouge and were licensed clinical social workers. Levy was sentenced to 15 months' imprisonment, was ordered to pay restitution of $120,946.89 to Medicare, and to serve three years' supervised release after imprisonment. Anderson Hilton was sentenced to three years' probation with a condition that she serve six months in a local halfway house and repay $89,450 to Medicare.

Alton Bates pled guilty on July 21, 2009 to two counts of health care fraud and two counts of paying illegal kickbacks. Levy and Anderson Hilton both pled guilty to one count of health care fraud. Anderson Hilton pled guilty on July 21, 2009 and Levy pled guilty on September 21, 2009.

Alton Bates, Robert Levy, and Juanita Anderson Hilton schemed to defraud the Medicare program by submitting false and fraudulent claims for psychotherapy services that were not provided. In total, the three defendants’ participation in this scheme involved more than 7,700 false claims seeking Medicare payments totaling $3,052,838. Due to the scheme, Medicare program paid more than $1,000,000 to Above and Beyond, LLC, the Baton Rouge company which the defendants operated between 2003 and 2005.


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Thursday, March 17, 2011

Raymond Lamont Shoemaker and Earnest Levi Garner, Jr., Indicted in Healthcare Fraud Scheme


Source- http://jackson.fbi.gov/dojpressrel/pressrel11/ja031611.htm

OXFORD, MS—John Marshall Alexander, United States Attorney for the Northern District of Mississippi, Daniel McMullen, Special Agent in Charge, Federal Bureau of Investigation (FBI), and Abelino Farias, Special Agent in Charge, United States Department of Agriculture—Office of Inspector General, announced that:

Raymond Lamont Shoemaker, 38, of Tupelo, former Chief Executive Officer and former Chief Operating Officer of Tri-Lakes Medical Center in Batesville, Mississippi, and Earnest Levi Garner, Jr., 66, of Batesville, were indicted earlier this month by the federal grand jury for the Northern District of Mississippi in connection with a nursing services kickback and bribery scheme at the Tri-Lakes Medical Center. The ten-count federal indictment charged Shoemaker with a nursing services kickback and bribery conspiracy, receiving kickbacks for nursing services, conspiracy to commit and committing healthcare fraud, making false statements to the FBI in connection with a federal investigation, making false statements to USDA in connection with a loan, and embezzlement from Tri-Lakes Medical Center. Shoemaker was also charged with embezzling from Humphreys County Hospital in Belzoni, Mississippi, while he was the Administrator of the Humphreys County Hospital. Garner, a Panola County businessman, was charged with a nursing services kickback and bribery conspiracy, engaging in a healthcare fraud conspiracy and healthcare fraud, and bribery, all in connection with Tri-Lakes Medical Center.

Shoemaker faces up to 80 years in prison and $2.5 million in fines if he is convicted on all counts. Garner faces up to 25 years in prison and $1 million in fines if he is convicted on all counts. Both could be ordered to pay restitution to their victims. Shoemaker and Garner appeared before United States Magistrate Judge S. Allan Alexander in Oxford today and were each released on a $50,000 secured bond. Trial dates have not yet been set.

John Marshall Alexander, United States Attorney for the Northern District of Mississippi said: “Our healthcare system depends upon fair dealing by medical service providers. Decisions affecting the health and well-being of our citizens cannot be tainted by kickbacks, corruption, and fraud. When individuals and companies attempt to pervert the healthcare system, it is our healthcare consumers and taxpayers who suffer the consequences. We will work vigorously to ensure that instances of fraud and corruption in our healthcare system are discovered and that those committing it are brought to justice. The United States Attorney’s Office is grateful for the hard work of all of the federal, state and local agencies involved in this investigation, and we will continue to work with them until this case is brought to a conclusion.”


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Tuesday, March 15, 2011

Dr. Jerry A. Spiegel Sentenced on Health Care Fraud Charges



Source- http://miami.fbi.gov/dojpressrel/pressrel11/mm031111.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), Miami Field Office, announce today’s sentencing of defendant Jerry A. Spiegel, 78, of Boynton Beach, Florida. U.S. District Court Judge Joan A. Lenard sentenced Spiegel to 41 months’ imprisonment, to be followed by three years of supervised release. As a condition of his supervised release, Spiegel was required to relinquish his medical license. In addition, the court ordered Spiegel to pay $880,958 in restitution for his role in the health care fraud conspiracy.

Last year, Spiegel was found guilty of conspiring to commit health care fraud, in violation of Title 18, United States Code, Section 1349. According to court documents, Spiegel was the medical director of three Miami-Dade County HIV/AIDS-infusion clinics: R&M Services Center Corp., Buena Vista Family Medical Center, Inc., and Solution Diagnostic Center, Inc. While medical director of these three clinics, Spiegel signed patient prescriptions without first examining patients or reviewing patient files. The HIV/AIDS-infusion medications that Spiegel prescribed were not medically necessary and were not administered to patients.

According to court documents, during Spiegel’s tenure as medical director, and based on the prescriptions he signed, the three clinics billed the Medicare program for more than $2.3 million in fraudulent claims. For example, from September 3, 2008 to December 31, 2008, R&M Services submitted $952,589 in fraudulent claims to Medicare, and received $425,385. From August 29, 2008 to January 23, 2009, Buena Vista submitted $769,094 in fraudulent claims to Medicare, and received $270,703. And from October 10, 2008 to February 23, 2009, Solution Diagnostic submitted $617,415 in fraudulent claims to Medicare, and received $184,870.

Mr. Ferrer commended the investigative efforts of the Federal Bureau of Investigation and the United States Department of Health and Human Services, Office of Inspector General. This case was prosecuted by Department of Justice Trial Attorney Benton Curtis and Assistant United States Attorney Robert J. Luck.



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Monday, March 14, 2011

Helen Etinfoh Sentenced to 41 Months in Prison for Medicare Fraud Scheme Involving Claims of Hurricane Damage to Power Wheelchairs


Source- http://www.justice.gov/opa/pr/2011/March/11-crm-318.html

WASHINGTON – Helen Etinfoh, the former owner and operator of a Houston durable medical equipment (DME) company was sentenced today to 41 months in prison in connection with a $3 million power wheelchair fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

Etinfoh, 50, was also ordered by U.S. District Judge Ewing Werlein Jr. of the Southern District of Texas to pay $851,228 in restitution jointly and several with her co-defendant. In addition, Etinfoh was sentenced to three years of supervised release following her prison term. Eitnfoh was remanded to custody after sentencing.

On April 16, 2010, after a week-long trial, a federal jury convicted Etinfoh of one count of conspiracy to commit health care fraud and four counts of health care fraud. The jury also convicted Paula Whitfield, a patient recruiter for the DME company, of one count of conspiracy to commit health care fraud and one count of health care fraud. Whitfield was previously sentenced to 21 months in prison.

According to evidence presented at trial, Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies. Whitfield was a recruiter for Luant who was paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare. Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.

Evidence at trial showed that, based on representations from Whitfield and other recruiters, Luant would bill Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008. In fact, the hurricanes did not damage the wheelchairs. Certain beneficiaries testified that they did not even have a power wheelchair before receiving the ones provided to them by Luant. Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.

At trial, beneficiaries in whose names claims were submitted to Medicare testified that recruiters whom they had never met, including Whitfield, came to their homes and offered them free power wheelchairs in exchange for their Medicare information. The beneficiaries, all of whom could walk, testified that they neither needed nor used the power wheelchairs delivered to them by Luant, which were often billed to Medicare at more than $6,000 per chair.



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Saturday, March 12, 2011

Juan DeLeon Jr., the owner of United DME Inc., and David Villanueva, a United delivery driver, Arrested on Health Care Fraud Charges


Source- http://sanantonio.fbi.gov/dojpressrel/pressrel11/sa031111.htm

McALLEN, TX—The owner of a McAllen-area durable medical equipment (DME) company and one of his employees have been indicted by a federal grand jury and charged with conspiracy, multiple counts of health care fraud, and aggravated identity theft for their alleged roles in a scheme to defraud Medicare and Medicaid through fraudulent billing for power wheelchairs and diabetic supplies, United States Attorney José Angel Moreno announced today.

Juan DeLeon Jr., the owner of United DME Inc., and David Villanueva, a United delivery driver, both of Edinburg, Texas, were named in a five-count federal indictment returned under seal on Wednesday, March 9, 2011. The indictment was unsealed today following the arrest of DeLeon, 40, and Villanueva, 33, by federal agents this morning. DeLeon and Villanueva have both made an initial appearance before U.S. Magistrate Judge Dorina Ramos who ordered them held in federal custody pending an arraignment and detention hearing on Wednesday, March 16, 2011, in McAllen federal court.

According to allegations in the indictment, from July 2008 through April 2010, DeLeon directed a scheme to submit hundreds of thousands of dollars in fraudulent claims to the Medicare and Medicaid programs related to United’s purported sale of DME, including power wheelchairs and diabetic supplies, to Medicare and Medicaid beneficiaries. The indictment alleges that in many cases, United submitted claims to Medicare and Medicaid for brand-new power wheelchairs, but would either not deliver the power wheelchairs or would deliver less costly DME, including used power wheelchairs or scooters. DeLeon allegedly instructed Villanueva to paint the used wheelchairs black prior to delivery to make them appear new.

The indictment also alleges that DeLeon would direct the submission of fraudulent claims for diabetic supplies. DeLeon would allegedly instruct Villanueva to deliver a one-month supply of diabetic supplies to beneficiaries and, in subsequent months, United submitted fraudulent claims to Medicare and Medicaid for additional diabetic supplies that were not delivered to beneficiaries. To conceal the fraud, the indictment alleges DeLeon instructed Villanueva to persuade unsuspecting beneficiaries at the time of delivery to sign, but not date, additional delivery records, which United later dated and used to justify the fraudulent claims for the diabetic supplies that were never delivered. If Villanueva could not obtain the beneficiaries’ signatures on the additional delivery records, DeLeon allegedly forged the beneficiaries’ signatures.

Conspiracy to commit health care fraud and each count of health care fraud carries a maximum punishment of 10 years in federal prison without parole and a $250,000 fine upon conviction. Aggravated identity theft carries a mandatory two-year prison term which must be served consecutive to any prison sentence imposed on the underlying charges.


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Friday, March 11, 2011

Miguel Miranda Sentenced to Prison for His Role in Health Care Fraud Scheme



Source- http://jackson.fbi.gov/dojpressrel/pressrel11/ja030911.htm

JACKSON, MS—Miguel Miranda, 44, of Miami, Florida, was sentenced in U.S. District Court today to serve 39 months in federal prison for his role in a health care fraud scheme, U.S. Attorney John M. Dowdy, Jr. announced. Miranda previously pled guilty to conspiracy to commit health care fraud and using a false passport.

Miranda and numerous co-conspirators executed a health care fraud scheme originating in the state of Florida, specifically targeting the Medicare Advantage Plan (MAP). MAP is a health care benefit program that allows Medicare beneficiaries to obtain their benefits through private insurance companies rather than through the traditional Medicare program. From Florida, Miranda and numerous co-conspirators, including Cuban nationals, went to various cities in Mississippi and across the southeastern United States, including Houston and McAllen, Texas; Atlanta, Ga.; Charlotte, N.C.; and Miami, to serve as “nominee” or “straw” owners for infusion therapy clinics that would purportedly operate in these cities. These individuals were referred to as nominee owners because their involvement was limited to signing paperwork to set up the clinics, while Miranda and other co-conspirators, in actuality, controlled them. These infusion therapy clinics would purportedly offer infusion therapy, injection therapy and other expensive medical treatment designed to treat patients suffering from cancer, HIV, and AIDS.

To set up the clinics, the nominee owners would incorporate the clinics in the states in which they purportedly operated. However, none of the clinics had actual business locations or any personnel; the clinics existed only on paper. The primary business locations of the clinics were UPS store mailboxes, which were rented by the nominee owners. For each clinic, using the address of the rented mailbox and the identity of the nominee owner among other information, Miranda would obtain a National Provider Identifier (NPI) through Medicare. The NPI was used by Medicare to identify medical providers and was needed by a provider to submit claims to the insurance companies providing MAP coverage for Medicare beneficiaries.

Over time, Miranda and his co-conspirators submitted approximately $9,129,420 in false and fraudulent infusion therapy claims to seven insurance companies providing coverage under MAP, including Aetna, Cigna, WellPoint, Healthnet, Humana, United Healthcare, and Sterling Healthcare. To submit the claims, genuine Medicare beneficiary information was used—including names, Social Security numbers, and dates of birth—that were illegally obtained from a number of sources. The claims were also falsified to include diagnoses that the Medicare beneficiaries did not have and listed expensive infusion therapy services that were never performed. The insurance companies would subsequently issue reimbursement checks to the clinics, which would be deposited into bank accounts that were opened by the nominee owners. The fraud proceeds would later be funneled back to Miranda and his co-conspirators in Florida through a variety of means.

For signing corporate records, renting mailboxes and opening bank accounts, the nominee owners were paid large sums of cash. As part of their agreement, however, the nominee owners were required to leave the United States after they completed their work in setting up the false clinics. Many of the nominee owners fled to Cuba to avoid extradition to the United States, as there is no extradition treaty between the two countries. However, Miranda’s primary coconspirator, Alberto Noriega, 49, of Miami, was apprehended by federal law enforcement agents in Miami on July 1, 2010. Noriega has since pleaded guilty to conspiracy to commit health care fraud in U.S. District Court for the Southern District of Texas in Houston. He was sentenced on March 4, 2011 to serve five years in prison.



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Thursday, March 10, 2011

Sunny Robinson the Owner of Memorial Medical Supply Convicted of Multiple Counts of Health Care Fraud


Source- http://houston.fbi.gov/dojpressrel/pressrel11/ho030911.htm

HOUSTON—A federal jury has convicted the owner of Memorial Medical Supply, a durable medical equipment business, of multiple counts of health care fraud and the payment of kickbacks arising from a multi-million-dollar fraud upon Medicare and Medicaid, United States Attorney José Angel Moreno announced today.

On March 7, 2011, Sunny Robinson, 42, who owned and operated a medical supply company called Memorial Medical Supply in Houston, was convicted of all 19 counts of health care fraud and anti-kickback violations alleged against him for causing the submission of fraudulent medical claims to the Medicare program in excess of $4.3 million between March 2005 through June 2009.

During the five-day trial ending in Robinson’s conviction, the jury heard testimony and received evidence proving Robinson’s health care fraud scheme encompassed buying Medicare referrals, billing Medicare for durable medical equipment, and getting paid. The names and Medicare numbers of doctors and Medicare beneficiaries were used to falsify medical records and on false and fraudulent claims to the Medicare and Medicaid programs for reimbursement.

Sunny Robinson illegally obtained protected Medicare beneficiary health information, including names, dates of birth, medical histories, Medicare numbers, and Social Security numbers, from individuals and home health agencies. This health information was then used to submit false and fraudulent claims to Medicare for reimbursement for arthritis kits, power wheelchairs, diabetic supplies, and incontinence supplies.

The Medicare beneficiaries in many instances did not need or order the durable medical equipment, nor did a physician prescribe the items. Many of the medical claims submitted were for durable medical equipment that wasn’t even provided. Memorial Medical Supply also falsely submitted claims for reimbursement to Medicare for equipment supposedly delivered to 34 deceased Medicare beneficiaries.


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Wednesday, March 9, 2011

Alberto Noriega Sentenced to Federal Prison for Leading a Medicare Fraud Ring That Submitted More Than $9 Million in False and Fraudulent Medicare Claims for Alleged Infusion Therapy Services


Source- http://houston.fbi.gov/dojpressrel/pressrel11/ho030711.htm

HOUSTON—Alberto Noriega, of Miami, Florida, has been sentenced to federal prison for leading a Medicare fraud ring that submitted more than $9 million in false and fraudulent Medicare claims for alleged infusion therapy services, United States Attorney José Angel Moreno announced today.

Senior U.S. District Judge Ewing Werlein Jr. sentenced Noriega, 49, at a hearing on Friday, March 4, 2011, in Houston to 63 months in federal prison without parole, to be followed by a three-year term of supervised release. Judge Werlein further ordered Noriega to pay $1,440,367.00 in restitution to the victimized insurance companies.

Noriega was indicted by a federal grand jury in Houston on June 24, 2010, and was arrested by federal law enforcement agents in Miami on July 1, 2010. He has been in federal custody without bond since his arrest and will remain in custody pending transfer to a Bureau of Prisons facility to be designated in the near future, where he will serve out his sentence.

Noriega pleaded guilty on Dec. 10, 2010, to conspiracy to commit health care fraud. According to information presented in court, from at least December 2008 through at least February 2010, Noriega and numerous co-conspirators executed a health care fraud scheme originating in the state of Florida, specifically targeting the Medicare Advantage Plan (MAP). MAP is a health care benefit program that allows Medicare beneficiaries to obtain their benefits through private insurance companies rather than through the traditional Medicare program. From Florida, Noriega dispatched numerous co-conspirators, including Cuban nationals, to various cities in Texas and across the southeastern United States, including Houston and McAllen, Texas; Jackson, Miss.; Atlanta, Ga.; Charlotte, N.C.; and Miami, to serve as “nominee” or “straw” owners for infusion therapy clinics that would purportedly operate in these cities. These individuals were referred to as nominee owners because their involvement was limited to signing paperwork to set up the clinics, while Noriega, in actuality, controlled them. Noriega’s infusion therapy clinics would purportedly offer infusion therapy, injection therapy and other expensive medical treatment designed to treat patients suffering from cancer, HIV, and AIDS.

To set up the clinics, the nominee owners—acting at Noriega’s direction—would incorporate the clinics in the states in which they purportedly operated. However, none of the clinics had actual business locations or any personnel; the clinics existed only on paper. The primary business locations of the clinics were UPS store mailboxes, which were rented by the nominee owners. For each clinic, using the address of the rented mailbox and the identity of the nominee owner among other information, Noriega would obtain a National Provider Identifier (NPI) through Medicare. The NPI was used by Medicare to identify medical providers and was needed by a provider to submit claims to the insurance companies providing MAP coverage for Medicare beneficiaries.

Over time, Noriega and his co-conspirators submitted approximately $9,129,420 in false and fraudulent infusion therapy claims to seven insurance companies providing coverage under MAP, including Aetna, Cigna, WellPoint, Healthnet, Humana, United Healthcare, and Sterling Healthcare. To submit the claims, Noriega used genuine Medicare beneficiary information—including names, Social Security numbers, and dates of birth—that he illegally obtained from a number of sources. The claims were also falsified to include diagnoses that the Medicare beneficiaries did not have and listed expensive infusion therapy services that were never performed. The insurance companies would subsequently issue reimbursement checks to the clinics, which would be deposited into bank accounts that were opened by the nominee owners. The fraud proceeds would later be funneled back to Noriega and his co-conspirators in Florida through a variety of means.

For signing corporate records, renting mailboxes and opening bank accounts, Noriega paid the nominee owners large sums of cash. As part of their agreement with Noriega, however, the nominee owners were required to leave the United States after they completed their work in setting up the false clinics. Many of the nominee owners fled to Cuba to avoid extradition to the United States, as there is no extradition treaty between the two countries. However, Noriega’s primary co-conspirator, Miguel Miranda, 44, of Miami, was apprehended by federal law enforcement agents in Miami on Jan. 14, 2010. Miranda has since pleaded guilty to conspiracy to commit health care fraud in U.S. District Court for the Southern District of Mississippi in Jackson, Miss. He is scheduled to be sentenced in Jackson on Mar. 9, 2011.


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Tuesday, March 8, 2011

Jummal Joy Ibrahim Pleads Guilty to Acting as the Straw Owner of a Los Angeles Medical Supply Company That Submitted More Than $3.5 Million in False Claims to Medicare


Source- http://losangeles.fbi.gov/dojpressrel/pressrel11/la030711b.htm

WASHINGTON—A Las Vegas woman pleaded guilty today to falsely representing to Medicare that she owned a Los Angeles-area durable medical equipment (DME) company that was actually owned and operated by her brother, and used by her brother and others to submit more than $3.5 million in false claims to Medicare, the Departments of Justice and Health and Human Services (HHS) announced.

Jummal Joy Ibrahim, 55, pleaded guilty today before U.S. District Judge George H. King in the Central District of California. Ibrahim admitted that between January 2006 and September 2009, she allowed her brother, Christopher Iruke, to use her identity to conceal his ownership and control of Contempo Inc., dba Contempo Medical Supplies. Contempo was a fraudulent DME supply company located in Inglewood, Calif., which Iruke and others used to submit false claims to Medicare for expensive, high-end power wheelchairs and other DME.

According to court documents, in 2006, Iruke told Ibrahim that Medicare would not accredit Iruke’s DME company, Pascon Medical Supply, and as a result, Iruke had to close Pascon. Iruke asked Ibrahim if he could use her name, Social Security number and driver’s license to open Contempo. Ibrahim agreed to serve as the straw owner of Contempo even though she knew nothing about the DME business and did not intend to have any role in the operation of Contempo or share in its profits. Ibrahim sent Iruke a copy of her Social Security card and driver’s license, signed articles of incorporation and other documents necessary to the formation of Contempo, and allowed Iruke and others to use her identity to obtain a Medicare provider number for Contempo which Iruke then used to submit false claims to Medicare.

Ibrahim also admitted that she opened a bank account in her name for Contempo, but that she allowed Iruke unrestricted access to the account so that he could transact business in her name. Medicare reimbursement payments to Contempo were deposited into this bank account.

Ibrahim admitted that as a result of her conduct, Iruke and others were able to conceal Iruke’s ownership and control of Contempo and submit approximately $3.5 million in false power wheelchair and DME claims to Medicare. Medicare reimbursed Contempo approximately $1.7 million on these false claims.

At sentencing, scheduled for June 13, 2011, Ibrahim faces a maximum penalty of five years in prison and a $250,000 fine.

Iruke was indicted in October 2009 on health care fraud charges. His 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.


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Monday, March 7, 2011

Vivian Yusuf charged with conspiracy to commit health care fraud


Source- http://dallas.fbi.gov/dojpressrel/pressrel11/dl030411a.htm

BEAUMONT, TX—U.S. Attorney John M. Bales announced that the owner of a medical supply business has been indicted for federal health care fraud violations in the Eastern District of Texas.

Vivian Yusuf, 40, of Houston, Texas, was indicted by a federal grand jury on Mar. 2, 2011, and charged with conspiracy to commit health care fraud, nine counts of health care fraud and 17 counts of aggravated identity theft.

According to the indictment, from June 2007 through May 2009, Yusuf, Aghaegbuna "Ike" Odelugo, James Reese, and others are alleged to have carried out a scheme to defraud Medicare through the marketing of power wheelchairs and accessories, as well as "ortho kits," which primarily consisted of a bag of orthotic items, including braces, wraps, and supports, and a heat lamp or heat pad. As part of the scheme, the defendant and her co-conspirators illegally obtained protected health information, including names, dates of birth, and Medicare numbers from elderly individuals. Yusuf and her co-conspirators supplied beneficiaries with kits and power wheelchairs which were not prescribed or otherwise authorized by a physician and which were not wanted by the beneficiaries. Claims were submitted by the defendant and her co-conspirators for approximately 790 beneficiaries located primarily in Texas and Louisiana. In some instances, physicians' signatures were forged and false claims were submitted to Medicare in the names of Medicare beneficiaries who were deceased. By means of fraudulent billing practices, the defendant and her co-conspirators are alleged to have unlawfully submitted false and fraudulent claims to Medicare of more than $3.4 million and obtained more than $1.6 million.

Odelugo and Reese have been indicted for their involvement in similar health care fraud schemes. Odelugo pleaded guilty on Aug. 23, 2010 to conspiracy to commit health care fraud, health care fraud, and money laundering. The loss to Medicare as a result of Odelugo's scheme was approximately $9.9 million. In October 2010, Reese was charged in a 47 count indictment alleging the commission of various federal crimes including conspiracy to commit health care fraud, health care fraud, paying or receiving kickbacks, money laundering and tax evasion. The indictment alleges Medicare and Medicaid were falsely billed more than $10 million by Reese and co-defendants and paid out more than $5 million during the period of February 2005 through January 2010.


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Sunday, March 6, 2011

Doctor Robert Williams Indicted for Submitting Fraudulent Bills to Medicare and Medicaid


Source- http://atlanta.fbi.gov/dojpressrel/pressrel11/at030411.htm

ATLANTA, GA—ROBERT WILLIAMS, 72, of Atlanta was arraigned today before United States Magistrate Judge C. Christopher Hagy on federal healthcare fraud charges.

United States Attorney Sally Quillian Yates said, “As a physician, this defendant had a duty to protect his patients and look out for their interests first. He has been charged with crimes that reflect his misuse of his position and the trust placed in him, all at the expense of his elderly patients, Medicare and Medicaid.”

“Dr. Williams allegedly stole Medicaid funds that were specifically allocated for the care of some of Georgia’s most vulnerable citizens: the elderly,” said Georgia Attorney General Sam Olens. “Our office is committed to protecting Georgia taxpayers and the recipients of Medicaid by aggressively pursuing prosecutions of Medicaid fraud.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, stated, “Healthcare fraud in the U.S. costs consumers billions of dollars, irrespective of whether the victim is the U.S. Government in the form of Medicaid/Medicare fraud, or healthcare insurance companies. Healthcare providers exhibiting sheer greed through extensive fraudulent billing, such as the allegations in today's indictment of Dr. Williams, are driving up healthcare costs and are depriving those that really need medical help as provided by these government funded programs.”

According to United States Attorney Yates, the charges and other information presented in court: WILLIAMS is a licensed physician, practicing in the Atlanta area. From approximately July 2007 through October 2009, he contracted with a medical services company to provide group psychological therapy to nursing home patients in a variety of nursing homes. Under his signature, thousands of claims were submitted to Medicare and Georgia Medicaid seeking reimbursement for group psychological therapy that WILLIAMS purportedly provided to beneficiaries at several nursing homes in the Atlanta area. In many instances, however, WILLIAMS did not actually provide the therapy.

From July 2007 through October 2009, Medicare claims data indicate that over 55,000 claims were submitted on behalf of WILLIAMS for group psychological therapy seeking reimbursement for over $2,000,000, and ultimately causing Medicare to reimburse WILLIAMS over $750,000. For the same time period, over 40,000 Medicaid claims were on behalf of WILLIAMS for group psychological therapy, causing Georgia Medicaid to pay out over $225,000.

A review of WILLIAMS’ claims showed, however, that in many cases, he sought payment for services provided to beneficiaries who were deceased at the time he purportedly rendered the care. In two cases, the patient died over a year before they were allegedly seen by WILLIAMS in the nursing home. Numerous claims were submitted to Medicare and Medicaid for group psychological therapy when the beneficiary was hospitalized at the time of service and, consequently, could not have received care at the nursing home as represented.

The charges carry a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the Court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders. WILLIAMS was indicted by a federal grand jury on February 22, 2011.


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Saturday, March 5, 2011

John Edward McKoy Charged with Health Care Fraud, Mail Fraud, and Aggravated Identity Theft



Source- http://philadelphia.fbi.gov/dojpressrel/pressrel11/ph030311.htm

PHILADELPHIA—John Edward McKoy, a former owner and operator of multiple health care facilities in the Eastern District of Pennsylvania, including Mt. Pleasant Medical Management, Inc. and Harris Medical Management, Inc., was charged today by Indictment in connection with a scheme to defraud United Health Care Corporation (“UHCC”) of more than $321,000, announced United States Attorney Zane David Memeger. UHCC was a medical management service that processed and paid medical claims for the National Railroad Passenger Corporation, (commonly known as AMTRAK), through its health care benefits program called AmPlan.

Between November 2004 to on or about October 8, 2007, it is alleged that John Edward McKoy caused hundreds of false claims to be submitted to UHCC for services purportedly rendered to patients when McKoy knew that no such services were provided and no licensed medical professional provided such services. In total, it is alleged that the defendant caused the submission of fraudulent medical bills to UHCC totaling more than $321,000, resulting in payments from the victim insurer totaling approximately $291,255.13.



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