Friday, September 30, 2011

Maritza Vidal and Richard Diaz Plead Guilty in $25 Million Health Care Fraud Scheme


Source- http://www.justice.gov/opa/pr/2011/September/11-crm-1259.html

WASHINGTON – Two Miami-area residents pleaded guilty late yesterday in U.S. District Court in Miami for their participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Maritza Vidal, 44, and Richard Diaz, 26, each pleaded guilty before U.S. District Judge Joan A. Lenard to one count of conspiracy to commit health care fraud. Vidal and Diaz admitted that they participated in a fraud scheme to bill the Medicare program for expensive physical therapy and home health care services that were prescribed by doctors but were medically unnecessary and never provided.

According to court documents, ABC Home Health Inc. and Florida Home Health Providers Inc., two related Miami home health care agencies, purported to provide home health and therapy services to Medicare beneficiaries. However, according to court documents, the agencies only existed to defraud Medicare. From approximately January 2006 until approximately March 2009, Vidal worked for ABC and Florida Home Health as a registered nurse and a patient recruiter and Diaz worked for Florida Home Health as a patient recruiter.

Vidal and Diaz both admitted to recruiting Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. In doing so, the defendants solicited and received kickbacks and bribes from the owners and operators of the home health agencies in return for allowing the companies to bill the Medicare program on behalf of the recruited patients. The defendants knew that the patients they recruited did not qualify for the services billed to Medicare. In addition, the defendants knew that the patient files for their recruited patients were falsified in order to make it appear that the patients qualified for the services.

Vidal admitted that she and her co-defendant nurses falsified patient files for Medicare beneficiaries by describing non-existent symptoms such as tremors, impaired vision, weak grip and inability to walk without assistance. Vidal included these symptoms in patient files to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare. Vidal admitted that she knew the beneficiaries did not qualify for and did not receive the services and that the files were falsified so that Medicare could be billed for medically unnecessary services.

As a result of Vidal’s participation in the illegal scheme, Medicare was billed approximately $395,000. As a result of Diaz’s participation in the illegal scheme, Medicare was billed approximately $28,000.

The defendants were originally charged in a February 2011 indictment. Fifteen other co-conspirators have pleaded guilty for their roles in the fraud scheme: Jose Nunez, M.D., Lisandra Alonso, Luisa Morciego, Vicente Guerra, Farah Maria Perez, Licet Diaz, Fidel Castro, Jose Ros, Eneida Fry, Oscar Martinez, Juana Rivas, Lesder Casanova, Ignacio Angulo, Raul Alvarez and Barbara Gonzalez.

Vidal and Diaz are scheduled to be sentenced on Jan. 9. 2012. Sentencings for the other defendants have been scheduled for various dates in October, November and December 2011.

The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendants also face fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from their criminal activities.



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Tuesday, September 27, 2011

Marianella Valera Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme


Source- http://www.justice.gov/opa/pr/2011/September/11-crm-1208.html

WASHINGTON – Miami resident Marianella Valera, the owner of a mental health care company, American Therapeutic Corporation (ATC), was sentenced today to 35 years in prison for orchestrating a $205 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Valera, 40, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida. Judge King ordered Valera to pay more than $87 million in restitution, jointly and severally with her co-defendants. Valera was also sentenced to three years of supervised release following her prison term. Lawrence Duran, another owner of ATC, was sentenced on Sept. 16, 2011, to 50 years in prison for his role in the fraud scheme. Duran’s sentence is the longest prison sentence ever imposed in a Medicare Fraud Strike Force case.

On April 14, 2011, Valera and Duran pleaded guilty to all counts charged in a superseding indictment, which was unsealed on Feb. 15, 2011. The superseding indictment charged Valera with 21 felony counts and Duran with 38 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements. Valera and Duran were remanded to the custody of the U.S. Marshals Service after their arrest on Oct. 21, 2010, and have been detained since that time. Their assets were restrained at the time of their arrests through civil proceedings.

In pleading guilty, Duran and Valera admitted that they orchestrated and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010. Duran and Valera submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. Duran and Valera also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to court documents, Duran, Valera and others paid bribes and kickbacks to recruit Medicare beneficiaries to attend ATC and ASI and billed Medicare for treatments purportedly provided to these recruited patients. According to court documents, the treatments were medically unnecessary or never provided at all. Duran and Valera supported the kickbacks through an extensive money laundering scheme that aimed to conceal the illicit conversion of Medicare payments to cash. The defendants and their co-conspirators used sophisticated measures to conceal their fraudulent activities from Medicare and from law enforcement.

As part of the fraud scheme, Duran, Valera and others paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. The defendants and their co-conspirators actively recruited ALF and halfway house owners and operators and patient brokers to participate in the scheme. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $205 million in medically unnecessary services.

According to the superseding indictment to which they pleaded guilty, Duran, Valera and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments. According to court documents, Duran and Valera also instructed employees and doctors to alter diagnoses and medication types and levels to make it falsely appear that ATC patients qualified for PHP services. Duran, Valera and co-conspirators caused doctors to refer ATC patients to ASI even though the patients did not qualify for sleep studies.

According to the superseding indictment to which they pleaded guilty, the defendants also engaged in a money laundering conspiracy to enrich themselves and to provide cash for the millions of dollars in kickbacks paid to recruit Medicare beneficiaries. According to court documents, Duran and Valera used another company they owned and operated, Medlink Professional Management Inc., to conceal the health care fraud and kickbacks from Medicare and law enforcement. Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera and others transferred millions of dollars to Medlink. They and others opened phony corporations to receive checks and wire transfers from both ATC and Medlink to convert that money into cash for their personal enrichment and for the payment of kickbacks. According to court documents, Duran, Valera and others cashed checks at different bank branches and different locations to conceal the true purpose of their activities and to evade reporting requirements.

On Aug. 23, 2011, a jury found co-conspirator Judith Negron, the third owner and operator of ATC, guilty of all 24 felony counts charged in the February 2011 superseding indictment. Co-conspirator Margarita Acevedo, also charged in the February 2011 superseding indictment, pleaded guilty on April 7, 2011, for her role in the fraud scheme. Today, Judge King sentenced Acevedo to 91 months in prison and three years of supervised release following her prison term. Avecedo was also sentenced to pay more than $72 million in restitution, jointly and severally with her co-defendants.

ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. On Sept. 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010.



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Monday, September 26, 2011

Boston Scientific Subsidiary Guidant LLC, Pays U.S. $9.25 Million to Settle False Claims Act Allegations


Source- http://www.justice.gov/opa/pr/2011/September/11-civ-1256.html

WASHINGTON – Guidant LLC, a wholly owned subsidiary of Boston Scientific Corp. of Natick, Mass., has agreed to pay the United States $9.25 million to resolve False Claims Act allegations, the Justice Department announced today. The government alleges that the company inflated the cost of replacement pacemakers and defibrillators to federal health care programs by knowingly failing to grant warranty credits and rebates to hospitals for pacemakers and defibrillators that were explanted while covered under a product warranty or another credit program.

The settlement resolves allegations that Guidant actively promoted the longevity and reliability of its pacemakers and defibrillators to physicians in an effort to convince them to purchase Guidant products over competing devices. Guidant reinforced these claims by touting the generous credits available should a device need to be replaced while covered under warranty.

At the same time, Guidant allegedly was fully aware that it failed to grant an appropriate credit to the purchaser of the device in a large number of cases where a product failed while still under warranty. As a result, the United States contends that Guidant submitted invoices to Department of Veterans Affairs hospitals and Department of Defense facilities that overstated the cost for a replacement pacemaker or defibrillator. In addition, Guidant’s alleged submission of inflated invoices for pacemakers and defibrillators to private hospitals caused these hospitals to overstate the cost of these devices on hospital cost reports, resulting in Medicare paying more for pacemakers and defibrillators than it otherwise should have.

“Overcharging for lifesaving medical devices wastes taxpayer dollars,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. “As we all look for ways to reduce public expenditures, settlements like this one – which recapture funds that were spent due to fraud – help support important public health care programs that so many people depend on.”

“Protecting the taxpayers’ interest by vigorously enforcing the False Claims Act is a top priority for this office,” said Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee. “Corporations and individuals who bill Medicare and Medicaid should know that the U.S. Attorneys’ Office for the Middle District of Tennessee now has one of largest units in the country devoted to litigating false claims cases, and we will aggressively pursue fraud and abuse.”

The civil settlement resolves allegations contained in a whistleblower lawsuit filed in federal court in the Middle District of Tennessee under the qui tam provisions of the False Claims Act, which allow for private citizens to bring civil actions on behalf of the United States and share in any recovery. As part of today’s resolution, the whistleblower – Robert A. Fry – will receive payments totaling more than $2.3 million from the settlement amount.



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Saturday, September 24, 2011

Adrian Chalarca Sentenced to 24 Months in Prison for Medicare Fraud Scheme


Source- http://www.justice.gov/opa/pr/2011/September/11-crm-1210.html

WASHINGTON – The former president and administrator of a fraudulent physical therapy company in Lakeland, Fla., was sentenced today to 24 months in prison for his role in a scheme to defraud Medicare, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Miami-area resident Adrian Chalarca, 24, also was sentenced by U.S. District Judge James D. Whittemore of the Middle District of Florida to serve three years of supervised release following his prison term and ordered to pay $82,765 in restitution, jointly and severally with his co-defendants. Chalarca pleaded guilty on June 10, 2011, before U.S. Magistrate Judge Mark A. Pizzo in Tampa, Fla., to one count of conspiracy to commit health care fraud.

According to court documents, Chalarca and his co-conspirators purchased Dynamic from its prior owners and transformed it into a fraudulent enterprise. Under Chalarca and others, Dynamic purported to provide physical therapy services to Medicare beneficiaries.

According to court documents, from fall 2009 to summer 2010, Chalarca submitted and caused the submission of $757,654 in fraudulent claims by Dynamic to the Medicare program. Chalarca admitted that he paid and caused the payment of kickbacks and bribes to Medicare beneficiaries in order to obtain their Medicare billing information and used it to submit claims to Medicare for physical therapy services that were never provided. Chalarca admitted that he knew the Medicare beneficiaries, on whose behalf claims were submitted to Medicare, never received the services.

All five defendants charged for their roles in the scheme at Dynamic have pleaded guilty. On Aug. 29, 2011, co-defendant Andres Cespedes was sentenced to 21 months in prison for his participation in the fraud scheme.



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Thursday, September 22, 2011

Marianella Valera the Owner of a Mental Health Care Company, American Therapeutic Corporation (ATC), Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme


Source- http://www.fbi.gov/miami/press-releases/2011/owner-of-miami-area-mental-health-company-sentenced-to-35-years-in-prison-for-orchestrating-205-million-medicare-fraud-scheme?utm_campaign=email-Immediate&utm_medium=email&utm_source=miami-press-releases&utm_content=32582

WASHINGTON—Miami resident Marianella Valera, the owner of a mental health care company, American Therapeutic Corporation (ATC), was sentenced today to 35 years in prison for orchestrating a $205 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Valera, 40, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida. Judge King ordered Valera to pay more than $87 million in restitution, jointly and severally with her co-defendants. Valera was also sentenced to three years of supervised release following her prison term. Lawrence Duran, another owner of ATC, was sentenced on Sept. 16, 2011, to 50 years in prison for his role in the fraud scheme. Duran’s sentence is the longest prison sentence ever imposed in a Medicare Fraud Strike Force case.

On April 14, 2011, Valera and Duran pleaded guilty to all counts charged in a superseding indictment, which was unsealed on Feb. 15, 2011. The superseding indictment charged Valera with 21 felony counts and Duran with 38 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements. Valera and Duran were remanded to the custody of the U.S. Marshals Service after their arrest on Oct. 21, 2010, and have been detained since that time. Their assets were restrained at the time of their arrests through civil proceedings.

In pleading guilty, Duran and Valera admitted that they orchestrated and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010. Duran and Valera submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. Duran and Valera also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to court documents, Duran, Valera, and others paid bribes and kickbacks to recruit Medicare beneficiaries to attend ATC and ASI and billed Medicare for treatments purportedly provided to these recruited patients. According to court documents, the treatments were medically unnecessary or never provided at all. Duran and Valera supported the kickbacks through an extensive money laundering scheme that aimed to conceal the illicit conversion of Medicare payments to cash. The defendants and their co-conspirators used sophisticated measures to conceal their fraudulent activities from Medicare and from law enforcement.

As part of the fraud scheme, Duran, Valera, and others paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. The defendants and their co-conspirators actively recruited ALF and halfway house owners and operators and patient brokers to participate in the scheme. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $205 million in medically unnecessary services.

According to the superseding indictment to which they pleaded guilty, Duran, Valera and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments. According to court documents, Duran and Valera also instructed employees and doctors to alter diagnoses and medication types and levels to make it falsely appear that ATC patients qualified for PHP services. Duran, Valera and co-conspirators caused doctors to refer ATC patients to ASI even though the patients did not qualify for sleep studies.

According to the superseding indictment to which they pleaded guilty, the defendants also engaged in a money laundering conspiracy to enrich themselves and to provide cash for the millions of dollars in kickbacks paid to recruit Medicare beneficiaries. According to court documents, Duran and Valera used another company they owned and operated, Medlink Professional Management Inc., to conceal the health care fraud and kickbacks from Medicare and law enforcement. Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera, and others transferred millions of dollars to Medlink. They and others opened phony corporations to receive checks and wire transfers from both ATC and Medlink to convert that money into cash for their personal enrichment and for the payment of kickbacks. According to court documents, Duran, Valera, and others cashed checks at different bank branches and different locations to conceal the true purpose of their activities and to evade reporting requirements.

On Aug. 23, 2011, a jury found co-conspirator Judith Negron, the third owner and operator of ATC, guilty of all 24 felony counts charged in the February 2011 superseding indictment. Co-conspirator Margarita Acevedo, also charged in the February 2011 superseding indictment, pleaded guilty on April 7, 2011, for her role in the fraud scheme.

ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. On Sept. 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010.



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Wednesday, September 21, 2011

Ten Miami-Area Residents Plead Guilty in $25 Million Health Care Fraud Scheme


Source- http://www.fbi.gov/miami/press-releases/2011/ten-miami-area-residents-plead-guilty-in-25-million-health-care-fraud-scheme?utm_campaign=email-Immediate&utm_medium=email&utm_source=miami-press-releases&utm_content=33148

WASHINGTON—Ten Miami-area residents pleaded guilty today and yesterday in U.S. District Court in Miami for their participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Each defendant pleaded guilty before U.S. District Judge Joan A. Lenard to one count of conspiracy to commit health care fraud. According to plea documents, the defendants included an administrator, nurses, and patient recruiters for two related Miami home health care agencies, ABC Home Health Inc. and Florida Home Health Providers Inc. ABC and Florida Home Health purported to provide home health and therapy services to Medicare beneficiaries. However, according to court documents, the agencies only existed to defraud Medicare.

The 10 defendants each admitted that they participated in a fraud scheme to bill the Medicare program for expensive physical therapy and home health care services that were prescribed by doctors but were medically unnecessary and never provided.

According to court documents, beginning in approximately January 2006, and continuing until approximately March 2009:


Licet Diaz, 49, worked at ABC and Florida Home Health as an administrator. As a result of Diaz’s participation in the illegal scheme, Medicare was billed approximately $7.8 million.
Fidel Castro, 48, worked at ABC as a patient recruiter. As a result of Castro’s participation in the illegal scheme, Medicare was billed approximately $550,000.
Jose Ros, 71, worked for both ABC and Florida Home Health as a patient recruiter. As a result of Ros’ participation in the illegal scheme, Medicare was billed approximately $395,000.
Eneida Fry, 46, worked for ABC and Florida Home Health as a registered nurse and a patient recruiter. As a result of Fry’s participation in the illegal scheme, Medicare was billed approximately $395,000.
Oscar Martinez, 54, worked for Florida Home Health as a patient recruiter. As a result of Martinez’s participation in the illegal scheme, Medicare was billed approximately $390,000.
Juana Rivas, 46, worked at Florida Home Health as a patient recruiter. As a result of Rivas’ participation in the illegal scheme, Medicare was billed approximately $250,000.
Lesder Casanova, 40, worked at ABC as a patient recruiter. As a result of Casanova’s participation in the illegal scheme, Medicare was billed approximately $195,000.
Ignacio Angulo, 48, worked at Florida Home Health as a licensed practical nurse and a patient recruiter. As a result of Angulo’s participation in the illegal scheme, Medicare was billed approximately $190,000.
Raul Alvarez, 48, worked at Florida Home Health as a patient recruiter. As a result of Alvarez’s participation in the illegal scheme, Medicare was billed approximately $118,000.
Barbara Gonzalez, 38, worked at ABC as a patient recruiter. As a result of Gonzalez’s participation in the illegal scheme, Medicare was billed approximately $40,000.

According to court documents, Fry and Angulo, along with their co-defendant nurses, falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services. Fry and Angulo admitted that they knew the beneficiaries did not qualify for and did not receive the services. Fry, Angulo, and their co-defendant nurses described in nursing notes and patient files non-existent symptoms such as tremors, impaired vision, weak grip and inability to walk without assistance. Defendants included these symptoms to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare. The files were falsified so that Medicare could be billed for medically unnecessary therapy and home health related services.

According to plea documents, Diaz distributed kickback payments to the patient recruiters on behalf of the owners of ABC and Florida Home Health. Diaz worked in the offices of ABC and Florida Home Health and was aware that office staff manipulated the patient files and nursing notes for patients at ABC and Florida Home Health. Specifically, Diaz was aware that office staff manipulated the nursing notes by adding patient conditions, such as shortness of breath, hand tremors and poor vision, which were non-existent. The patient files and nursing notes were fabricated to make it appear that the patients qualified for the services.

Nine of the defendants admitted to recruiting Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. In doing so, the defendants solicited and received kickbacks and bribes from the owners and operators of the home health agencies in return for allowing the companies to bill the Medicare program on behalf of the recruited patients. The defendants knew that the patients they recruited did not qualify for the services billed to Medicare. In addition, the defendants knew that the patient files for their recruited patients were falsified in order to make it appear that the patients qualified for the services.

The defendants were originally charged in a February 2011 indictment. Five other co-conspirators have pleaded guilty for their roles in the fraud scheme: Jose Nunez, M.D., Lisandra Alonso, Luisa Morciego, Vicente Guerra, and Farah Maria Perez.

Sentencings have been scheduled for various dates in October, November and December 2011.

The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendants also face fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from their criminal activities.



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Monday, September 19, 2011

Lawrence Duran Sentenced to 50 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme


Source- http://www.fbi.gov/miami/press-releases/2011/owner-of-miami-area-mental-health-company-sentenced-to-50-years-in-prison-for-orchestrating-205-million-medicare-fraud-scheme?utm_campaign=email-Immediate&utm_medium=email&utm_source=miami-press-releases&utm_content=32256

WASHINGTON—Miami resident Lawrence Duran, the owner of a mental health care company, American Therapeutic Corporation (ATC), was sentenced today to 50 years in prison for orchestrating a $205 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Duran, 49, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida. Judge King ordered Duran to pay more than $87 million in restitution, jointly and severally with his co-defendants. Duran was also sentenced to three years of supervised release following his prison term. The sentencing hearing for Marianella Valera, the other owner of ATC, is scheduled for Sept. 19, 2011.

Two of the corporations that Duran and Valera used to commit the fraud scheme, ATC and Medlink Professional Management Group Inc., were sentenced today to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010.

On April 14, 2011, Duran and Valera pleaded guilty to all counts charged in a superseding indictment, which was unsealed on Feb. 15, 2011. The superseding indictment charged Duran with 38 felony counts and Valera with 21 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements. Duran and Valera were remanded to the custody of the U.S. Marshals Service after their arrest on Oct. 21, 2010, and have been detained since that time. Their assets were frozen at the time of their arrests through civil forfeiture proceedings. ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.

“For years, Mr. Duran stole millions of taxpayer dollars by defrauding Medicare and preying upon vulnerable citizens suffering from Alzheimer’s disease, dementia and substance abuse,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division. “Instead of providing patients with the treatment they needed, Mr. Duran and his co-conspirators used them as props to fill their fraudulent mental health centers. As a further insult, Mr. Duran created an organization to lobby Congress for additional funds to support the mental health services his fraud scheme purported to provide. Today’s sentence—the longest ever imposed in a Medicare Fraud Strike Force case—reflects the reprehensibility of the defendant’s conduct, and is a powerful warning sign to others inclined to cheat the Medicare program.”

“For eight years, the defendant billed Medicare for hundreds of millions of dollars in mental health services that were not necessary or never provided,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida. “We will not allow our scarce Medicare dollars to be diverted from the sick and the elderly into the pockets of greedy fraudsters.”

“Today’s sentencing demonstrates to those who defraud taxpayers of millions of dollars through health care fraud schemes that the FBI and our partners remain committed to investigating and prosecuting such fraud to the fullest extent of the law,” said FBI Miami Division acting Special Agent in Charge Xanthie Mangum.

“Today’s sentencing is therapeutic for Americans fed up with those whose business plan is to steal from taxpayers,” said Christopher Dennis, Special Agent in Charge of the HHS Office of Inspector General’s region that covers Florida. “Mr. Duran thought he could enrich himself and beat the law. He will now have years and years behind bars to reflect on that mistake.”

In pleading guilty, Duran and Valera admitted that they orchestrated and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010. Duran and Valera submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. Duran and Valera also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to court documents, Duran, Valera and others paid bribes and kickbacks to recruit Medicare beneficiaries to attend ATC and ASI and billed Medicare for treatments purportedly provided to these recruited patients. According to court documents, the treatments were medically unnecessary or never provided at all. Duran and Valera supported the kickbacks through an extensive money laundering scheme that aimed to conceal the illicit conversion of Medicare payments to cash. The defendants and their co-conspirators used sophisticated measures to conceal their fraudulent activities from Medicare and from law enforcement.

As part of the fraud scheme, Duran, Valera and others paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. The defendants and their co-conspirators actively recruited ALF and halfway house owners and operators and patient brokers to participate in the scheme. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $205 million in medically unnecessary services.

According to the superseding indictment to which they pleaded guilty, Duran, Valera, and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments. According to court documents, Duran and Valera also instructed employees and doctors to alter diagnoses and medication types and levels to make it falsely appear that ATC patients qualified for PHP services. Duran, Valera, and co-conspirators caused doctors to refer ATC patients to ASI even though the patientsdid not qualify for sleep studies.

According to the superseding indictment to which they pleaded guilty, the defendants also engaged in a money laundering conspiracy to enrich themselves and to provide cash for the millions of dollars in kickbacks paid to recruit Medicare beneficiaries. According to court documents, they used another company they owned and operated, Medlink, to conceal the health care fraud and kickbacks from Medicare and law enforcement. Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera, and others transferred millions of dollars to Medlink. They and others opened phony corporations to receive checks and wire transfers from both ATC and Medlink to convert that money into cash for their personal enrichment and for the payment of kickbacks. According to court documents, Duran, Valera, and others cashed checks at different bank branches and different locations to conceal the true purpose of their activities and to evade reporting requirements.


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Friday, September 16, 2011

Jury Convicts Yenky Sanchez for Stealing Identity Information from DCF Computers for Use in Medicare Fraud Scam


Source- http://www.fbi.gov/miami/press-releases/2011/jury-convicts-miami-man-for-stealing-identity-information-from-dcf-computers-for-use-in-medicare-fraud-scam?utm_campaign=email-Immediate&utm_medium=email&utm_source=miami-press-releases&utm_content=31921

Miami-Dade Police Department, announced that a jury returned a verdict of guilty on September 12, 2011 against Yenky Sanchez, 25, of Miami. Sanchez was found guilty on one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349; one count of conspiracy to commit authentication feature fraud, in violation of Title 18, United States Code, Sections 1028(a)(3) and (f); and ten counts of aggravated identity theft, in violation of Title 18, United States Code, Section 1028A(a)(1). The guilty verdict against Sanchez follows on the heels of the guilty plea by his co-conspirator, Raul Lazaro Diaz-Perera, 43, of Miami, for the same charges.

According to the evidence at trial against Sanchez, and in the factual proffer filed with the court during Diaz-Perera’s plea hearing, Diaz-Perera was a former supervisor at the Florida Department of Children and Families’ call center in downtown Miami. On the day he was fired, October 28, 2010, Diaz-Perera negotiated with a cooperating subject to sell the Medicare numbers of elderly and disabled Floridians who had applied to DCF for food stamps, cash benefits, and Medicaid. The intent was for those numbers to be used to fraudulently bill Medicare for services that were never provided to the DCF beneficiaries. Diaz-Perera obtained the Medicare numbers from the DCF computer system through a contact he had at DCF.

That contact was defendant Yenky Sanchez, who was then working as an employee at DCF’s call center in downtown Miami. Sanchez used his access to the DCF internal computer system to obtain the names, addresses, telephone numbers, dates of birth, Social Security numbers, and Medicare numbers of 148 elderly and disabled Floridians. Sanchez then gave the personal identification information to Diaz-Perera, who sold it to the cooperating subject on December 15, 2010.

Diaz-Perera negotiated a second time with the cooperating subject to sell additional Medicare numbers. Diaz-Perera again turned to Sanchez to obtain the numbers. Sanchez again used his access to the DCF computer system to steal the names and other identification information, including Medicare numbers of more than 400 beneficiaries. Sanchez then gave these additional numbers to Diaz-Perera, who attempted to sell it to the cooperating subject on January 18, 2011.

On June 30, 2011, U.S. District Court Judge Cecilia M. Altonaga sentenced Diaz-Perera to 36 months in prison, to be followed by three years of supervised release. Sentencing for Sanchez is scheduled for November 21, 2011. At sentencing, Sanchez faces a maximum of ten years in prison on the health care fraud charge, five years on the authentication feature fraud charge, and two years each for the aggravated identity theft charges.


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Tuesday, September 13, 2011

Maxim Healthcare Services Inc. Charged with Fraud, Agrees to Pay Approximately $150 Million, Enact Reforms After False Billings Revealed as Common Practice


Source- http://www.justice.gov/opa/pr/2011/September/11-civ-1169.html

NEWARK, N.J. – Maxim Healthcare Services Inc., one of the nation’s leading providers of home healthcare services, has entered into a settlement to resolve criminal and civil charges relating to a nationwide scheme to defraud Medicaid programs and the Veterans Affairs program of more than $61 million.

Today’s announcement was made by Tony West, Assistant Attorney General of the Civil Division of the Department of Justice; J. Gilmore Childers, Acting U.S. Attorney for the District of New Jersey; Tom ODonnell, Special Agent in Charge of the Health and Human Services Office of Inspector General (HHS-OIG) region covering New Jersey; Michael B. Ward, Special Agent in Charge of the FBI’s Newark, N.J., Field Office; and Jeffrey Hughes, Special Agent in Charge of the U.S. Department of Veterans Affairs, Office of the Inspector General (VA OIG), Northeast Field Office.

Maxim was charged today in a criminal complaint with conspiracy to commit health care fraud, and has entered into a deferred prosecution agreement (DPA) with the Department of Justice. The agreement will allow Maxim to avoid a health care fraud conviction on the charges if it complies with the DPA’s requirements. As required by the DPA, which will expire in 24 months if the company meets all of its reform and compliance requirements, Maxim has agreed to pay a criminal penalty of $20 million and to pay approximately $130 million in civil settlements in the matter, including to federal False Claims Act claims.

To date, nine individuals – eight former Maxim employees, including three senior managers and the parent of a former Maxim patient – have pleaded guilty to felony charges arising out of the submission of fraudulent billings to government health care programs, the creation of fraudulent documentation associated with government program billings, or false statements to government health care program officials regarding Maxim’s activities.

The criminal complaint accuses Maxim, a privately-held company based in Columbia, Md., with hundreds of offices throughout the United States, of submitting more than $61 million in fraudulent billings to government health care programs for services not rendered or otherwise not reimbursable. The investigation revealed that the submission of false bills to government health care programs was a common practice at Maxim from 2003 through 2009. During that time period, Maxim received more than $2 billion in reimbursements from government health care programs in 43 states based on billings submitted by Maxim.

“Fraudulent billing for services not rendered uses patients as pawns in a game of corporate greed that puts cash over care and wastes precious taxpayer dollars,” said Assistant Attorney General West. “At a time when we're all looking for ways to reduce public expenditures, settlements like this one recapture taxpayer dollars lost to fraud and abuse, and help ensure that funds are available for the vital health care programs and services that people depend on day in and day out.”

“Maxim, including senior executives, defrauded a system providing needed services to turn money meant for patient care into corporate profits,” said Acting U.S. Attorney Childers. “We will continue to prove our commitment to investigating and prosecuting both companies and individuals whose misconduct robs our nation’s health care programs and those who count on them. It is our hope that Maxim, in cleaning up its own house, will be a lighthouse influencing best practices across the industry.”

“Companies scheming to profit by deceiving patients and defrauding taxpayer-funded government health care programs can expect close scrutiny and aggressive investigation,” said HHS-OIG Special Agent in Charge ODonnell. “We will continue to carefully guard the nation’s vital health programs against those who put greed over patient care.”

“Health care fraud is a considerable problem in New Jersey with residents being victimized by an estimated $7.5 billion in care-related frauds in 2010,” said FBI Special Agent in Charge Ward. “The criminal conduct by Maxim in this instance was significant and systemic, which resulted in both the company and individuals being liable for their actions. The Newark Division of the FBI is committed to its stance of being among the most aggressive offices in pursuit and ultimate prosecution of health care fraud offenders.”

“Today’s announcement demonstrates the Department of Veterans Affairs Office of Inspector General’s commitment to focus investigative resources on companies that choose to pursue profit over the public’s health,” said VA OIG Special Agent in Charge Hughes. “VA OIG applauds the hard work of the Department of Justice and our law enforcement counterparts in bringing about this successful conclusion by aggressively pursuing and prosecuting those who committed fraud against our nation’s federal healthcare programs, including VA’s.”

As part of the DPA, Maxim has stipulated to a statement of facts which mirrors the language of the criminal complaint. In the event that Maxim fails to comply with the provisions of the DPA, Maxim has agreed that the U.S. Attorney’s Office may proceed with its prosecution of Maxim and use the agreed-upon statement of facts against it in the prosecution.

As detailed in the criminal complaint, Maxim, through its former officers and employees, falsely and fraudulently submitted billings to government health care programs for services not rendered or otherwise not reimbursable by government health care programs from 2003 through 2009. In order to conceal the fraud, Maxim’s former officers and employees engaged in various conduct during that time period, including creating or modifying time sheets to support billings to government health care programs for services not rendered. They also submitted billings through licensed offices for care actually supervised by offices which operated without licenses and whose existence was concealed from government health care program auditors and investigators. Additionally, they created or modified documentation relating to required administrative functions associated with billings submitted to government health care programs, including documentation reflecting required training and qualifications of caregivers.

The DPA obliges Maxim to continue cooperating in the government’s ongoing federal and state criminal investigation of former Maxim executives and employees responsible for the alleged conduct at issue, and to develop and operate an effective corporate compliance and governance program that includes adequate internal controls to prevent the recurrence of any improper or illegal activities.

The DPA requires Maxim’s acceptance and acknowledgment of full responsibility for the conduct that led to the government’s investigation.

The settlement requires payment of approximately $130 million to Medicaid programs and the Veterans Affairs program to resolve False Claims Act liability for false home healthcare billings to Medicaid programs and the Veterans Administration under civil agreements relating to this matter. The settlement resolves allegations that Maxim billed for services that were not rendered, services that were not properly documented, and services performed by 13 unlicensed offices. Maxim has agreed to pay approximately $70 million to the federal government and approximately $60 million to 42.

Also included in the settlement is a corporate integrity agreement with HHS-OIG, which requires additional reforms and monitoring under HHS-OIG supervision.

In addition, the company must also retain and pay an independent monitor, who will review Maxim’s business operations and regularly report concerning the company’s compliance with all federal and state health care laws, regulations, and programs. The monitor was selected by the U.S. Attorney’s Office, consistent with U.S. Department of Justice guidelines, after a review of monitor candidates and in consultation with the company. Maxim will be monitored by Peter Keith of the law firm Gallagher, Evelius & Jones, which is headquartered in Baltimore.


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Monday, September 12, 2011

U.S. Joined False Claims Act Lawsuit Against Florida’s Halifax Hospital Medical Center and Halifax Staffing Inc.


Source- http://www.justice.gov/opa/pr/2011/September/11-civ-1162.html

WASHINGTON – The United States has partially intervened in a lawsuit under the False Claims Act against Halifax Hospital Medical Center and Halifax Staffing Inc. in the U.S. District Court for the Middle District of Florida, the Department of Justice announced today.

The government partially intervened with respect to allegations that Halifax, which is located in Daytona Beach, Fla., violated the Stark law, which prohibits a hospital from billing Medicare for services referred by physicians that have an improper financial relationship with the hospital. The United States alleges that Halifax’s contracts with three neurosurgeons and six medical oncologists were improper, in part, because they either paid physicians more than fair market value, were not commercially reasonable or took into consideration the volume or value of the physicians’ referrals.

“Improper financial arrangements between hospitals and physicians threaten patient safety because personal financial considerations, instead of what's best for the patient, can influence the type of health care that is provided,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “The department is committed to preventing kickbacks that can corrupt the integrity of health care delivery.”

“The Stark law was enacted to prevent financial ties between a physician and an entity providing health care services from influencing the level of care provided to a patient,” said Robert E. O’Neill, U.S. Attorney for the Middle District of Florida. “By bringing cases such as this one, we hope to ensure that precious health care resources are not being wasted as a result of questionable financial relationships between health care providers.”

The lawsuit was initially filed in July 2009 by Elin Baklid-Kunz, currently employed at Halifax Staffing as the director of physician services, under the whistleblower provisions of the False Claims Act. Those provisions authorize private parties to sue on behalf of the United States, and permit the United States to intervene and take over the lawsuit. The whistleblower is entitled to receive a portion of any recovery. In this case, the United States elected to intervene in only a portion of the allegations asserted by Ms. Baklid-Kunz.


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Sunday, September 11, 2011

Arizona-Based TriWest Healthcare Alliance Corp. Agrees to Pay $10 Million to Resolve False Claims Act Allegations Concerning the TRICARE Program


Source- http://www.justice.gov/opa/pr/2011/September/11-civ-1160.html

WASHINGTON - TriWest Healthcare Alliance Corporation, a contractor to TRICARE Management Activity, has agreed to pay $10 million to resolve civil false claims allegations, the Justice Department announced today. TRICARE is the U.S. medical benefit plan which covers uniformed personnel, retirees, their dependents and reserve components.

The settlement resolves a lawsuit filed by four former TriWest employees, Judi Jerdee, Deborah Thornton, Linda Glassgow and Paige Fiorillo, under the qui tam, or whistleblower provisions, of the False Claims Act. The United States partially intervened in the case on Aug. 29, 2011. The United States and the qui tam plaintiffs allege that between 2004 and 2010, TriWest failed to give TRICARE the benefit of negotiated discounts with service providers under letters of agreement (LOAs). Notwithstanding contractually binding LOAs with health care providers, TriWest submitted claims to TRICARE at higher rates billed by the providers, failing to pass on to TRICARE the savings negotiated through the LOAs. Together, the qui tam relators will receive $1.7 million as their share of the government’s recovery.

“Those who overbill TRICARE threaten to undermine the health care provided to our men and women in uniform,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “At a time when the federal government must tighten its belt, settlements like this one help maintain important programs that people depend on.”

“This office is committed to safeguarding the federal health care programs from fraud and false claims,” said Melinda Haag, U.S. Attorney for the Northern District of California. “Ensuring that the programs receive the contractual savings and deductions to which they are entitled is essential to our commitment.”

This settlement is part of the government’s commitment to combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $5.9 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s recoveries in false claims act cases since January 2009 are more than $7.5 billion.


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Thursday, September 8, 2011

Medicare Fraud Strike Force Charges 91 Individuals for Approximately $295 Million in False Billing


Source- http://www.justice.gov/opa/pr/2011/September/11-ag-1148.html

WASHINGTON – Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing.

Attorney General Holder and Secretary Sebelius were joined in the announcement by FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and HHS Inspector General Daniel R. Levinson.

As part of a coordinated action, 70 individuals were charged by Strike Force prosecutors in indictments unsealed yesterday and today in six cities alleging a variety of Medicare fraud schemes involving approximately $263.6 million in false billings. As part of takedown operations last week, 18 additional defendants were charged in Detroit and one defendant was charged in Miami in cases unsealed on Sept. 1, 2011, for their alleged roles in Medicare fraud schemes involving approximately $29.4 million in fraudulent claims. Additionally, two individuals are scheduled to appear in court today on charges filed on Aug. 24, 2011, for their roles in a separate $2 million health care fraud scheme. This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.

The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare – jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive – or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” said HHS Secretary Sebelius. “These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off. And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment (DME).

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints are accused of conspiring to submit a total of approximately $295 million in fraudulent billing.

“The health care system is part of our nation’s infrastructure and we must do everything in our power to protect the integrity of Medicare and the system at large,” said FBI Executive Assistant Director Henry. “Working together as partners, we can stop criminals who seek to steal American taxpayers’ hard-earned dollars and we help ensure our nation’s health care system is there for those who need it.”

“As charged in these indictments, the defendants cover nearly the entire spectrum of healthcare providers, and perpetrated a variety of fraudulent schemes,” said Assistant Attorney General Breuer. “From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank. Today’s Strike Force operations should serve as a wake-up call to would-be fraudsters nationwide. With Strike Force teams now in nine cities across the country, and employing sophisticated, data-driven law enforcement methods, we are determined to hold criminally responsible those who defraud Medicare.”

“The warning should be unambiguously clear by now,” said HHS Inspector General Levinson. “We will continue using the combined law enforcement might of Strike Forces around the country to combat health care fraud.”

In Miami, 45 defendants, including one doctor and one nurse, were charged today and yesterday for their participation in various fraud schemes involving a total of $159 million in false billings for home health care, mental health services, occupational and physical therapy, DME and HIV infusion. Another defendant in Miami was charged on Sept. 1, 2011, for a $1 million Medicare fraud scheme. In one case, 24 defendants are charged for participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. According to court documents, the defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center. In some instances, beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not agree to attend the mental health center.

In Houston, two individuals were charged today with fraud schemes involving $62 million in false billings for home health care and DME. According to an indictment, one defendant allegedly sold beneficiary information to 100 different Houston-area home health care agencies in exchange for illegal payments. The indictment alleges that the home agencies then used the beneficiary information to bill Medicare for services that were unnecessary or never provided.

Ten defendants were charged in Baton Rouge, La., for participating in schemes involving more than $24 million related to false claims for home health care and DME. According to one indictment, a doctor, nurse and five other co-conspirators participated in a scheme to bill Medicare for more than $19 million in skilled nursing and other home health services that were medically unnecessary or never provided.

Six defendants, including two doctors, were charged in Los Angeles for their roles in schemes to defraud Medicare of more than $10.7 million. In Brooklyn, three defendants, including two doctors, were charged for a fraud scheme involving more than $3.4 million in false claims for medically unnecessary physical therapy. Two defendants, including a doctor, are making initial appearances today in U.S. federal court in Dallas after being charged for a scheme to defraud Medicare of approximately $2.1 million.

In Detroit, 18 defendants, including three doctors, were charged last week for schemes to defraud Medicare of more than $28 million. According to an indictment, 14 of the defendants participated in a home health care scheme that submitted more than $14 million in false claims to Medicare. Finally, four defendants including one doctor were charged in Chicago for their alleged roles in schemes to defraud Medicare of more than $4.4 million.

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 locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 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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Wednesday, September 7, 2011

Ronald A. McFarland Sentenced for $2.46 Million Embezzlement of Health Insurance Reimbursements


Source- http://www.fbi.gov/philadelphia/press-releases/2011/former-head-of-state-college-medical-billing-firm-sentenced-for-2.46-million-embezzlement-of-health-insurance-reimbursements

The United States Attorney’s Office for the Middle District of Pennsylvania today announced that the former head of a State College medical billing firm was sentenced in federal court on Tuesday, August 30, 2011, before United States District Court Chief Judge Yvette Kane.

Ronald A. McFarland, age 53, of State College, Pennsylvania, was sentenced to a 37-month term of imprisonment and two years of supervised release. Judge Kane further ordered that McFarland pay $2,463,922 in restitution.

According to United States Attorney Peter J. Smith, on February 24, 2011, an information was filed charging McFarland with theft and embezzlement of $2.46 million in health insurance reimbursements belonging to two cancer treatment centers in Pittsburgh, Pennsylvania and Liverpool, Ohio.

McFarland was the president of Verimed Services, Inc. and Medical Alliance Partners, LLC, both based in State College. Through those companies, he provided third-party billing services to Rosewood Cancer Care, Inc., Pittsburgh, Pennsylvania, and Oaktree Cancer Care, Inc., East Liverpool, Ohio, which both provided outpatient radiation treatment programs for cancer patients.

Verimed billed health insurance plans and programs for medical treatment provided to patients of Rosewood and Oaktree, and then it received, recorded, and forwarded checks payable to Rosewood and Oaktree from the insurance plans and programs.

McFarland diverted and embezzled insurance payments for Oaktree and Rosewood, totaling $2.46 million, and transferred the stolen funds to business and personal accounts controlled by him. McFarland also concealed the theft by making false entries in daily collections logs and patient ledgers.

McFarland pled guilty on March 17, 2011 to theft and embezzlement in connection to health care.


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Tuesday, September 6, 2011

Ronald A. McFarland Sentenced for $2.46 Million Embezzlement of Health Insurance Reimbursements


Source- http://www.fbi.gov/philadelphia/press-releases/2011/former-head-of-state-college-medical-billing-firm-sentenced-for-2.46-million-embezzlement-of-health-insurance-reimbursements

The United States Attorney’s Office for the Middle District of Pennsylvania today announced that the former head of a State College medical billing firm was sentenced in federal court on Tuesday, August 30, 2011, before United States District Court Chief Judge Yvette Kane.

Ronald A. McFarland, age 53, of State College, Pennsylvania, was sentenced to a 37-month term of imprisonment and two years of supervised release. Judge Kane further ordered that McFarland pay $2,463,922 in restitution.

According to United States Attorney Peter J. Smith, on February 24, 2011, an information was filed charging McFarland with theft and embezzlement of $2.46 million in health insurance reimbursements belonging to two cancer treatment centers in Pittsburgh, Pennsylvania and Liverpool, Ohio.

McFarland was the president of Verimed Services, Inc. and Medical Alliance Partners, LLC, both based in State College. Through those companies, he provided third-party billing services to Rosewood Cancer Care, Inc., Pittsburgh, Pennsylvania, and Oaktree Cancer Care, Inc., East Liverpool, Ohio, which both provided outpatient radiation treatment programs for cancer patients.

Verimed billed health insurance plans and programs for medical treatment provided to patients of Rosewood and Oaktree, and then it received, recorded, and forwarded checks payable to Rosewood and Oaktree from the insurance plans and programs.

McFarland diverted and embezzled insurance payments for Oaktree and Rosewood, totaling $2.46 million, and transferred the stolen funds to business and personal accounts controlled by him. McFarland also concealed the theft by making false entries in daily collections logs and patient ledgers.

McFarland pled guilty on March 17, 2011 to theft and embezzlement in connection to health care.


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Monday, September 5, 2011

Houston Medical Equipment Company Owner Sunny Robinson, Lands in Federal Prison for Medicare Fraud


Source- http://www.fbi.gov/houston/press-releases/2011/houston-medical-equipment-company-owner-lands-in-federal-prison-for-medicare-fraud

HOUSTON—Sunny Robinson, the owner of Memorial Medical Supply—a Houston durable medical equipment business—has been sentenced to 97 months in prison for his role in a Medicare fraud scheme, United States Attorney José Angel Moreno announced today.

U.S. District Judge Ewing Werlein Jr. sentenced Robinson 42, of Houston, and three others convicted for their roles in Robinson’s fraud scheme yesterday, Aug. 30, 2011.

Robinson’s co-defendants—Manuel DeLuna, 50; Lisa Jones, 48; and Shirley Chavis, 44, all of Houston—pleaded guilty in advance of Robinson’s trial, to federal fraud charges. DeLuna, the general manager of Memorial Medical Supply convicted of conspiracy to commit health care fraud, was sentenced to 42 months. Jones and Chavis, both convicted of conspiring to receive kickbacks in exchange for patient information, were sentenced to 22 months in prison and five years’ probation, respectively.

On March 7, 2011, Robinson was convicted at trial 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 from March 2005 through June 2009. During the five-day trial, 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.

Robinson illegally obtained protected Medicare beneficiary health information including names, dates of birth, medical histories, and Medicare 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.

In connection with his guilty plea, DeLuna admitted that he and others illegally obtained protected Medicare beneficiary health information from individuals and home health agencies which was then used to submit false and fraudulent claims to Medicare for reimbursement for durable medical equipment. In connection with their guilty pleas, Jones and Chavis both admitted to receiving money in exchange for supplying patient information and billing numbers.


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