Saturday, December 22, 2012

Armando Gonzalez, 50, Leader of $63 Million Mental Health Fraud Scheme Pleads Guilty in Miami


Source- http://www.justice.gov/opa/pr/2012/December/12-crm-1508.html

WASHINGTON – The owner of a string of community mental health centers pleaded guilty today in connection with a health care fraud and money laundering scheme involving defunct health care provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Armando Gonzalez, 50, of Hendersonville, N.C., pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. Under the terms of his plea agreement, Gonzalez will also forfeit his interest in property valued at several million dollars, including $987,910 in currency seized in July 2012 as well as several vehicles and properties located in Hendersonville.

According to court documents, HCSN operated community mental health centers (CMHC) at three locations in Miami-Dade County, Fla., and one location in Hendersonville. HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness. A PHP is a form of intensive treatment for severe mental illness.

According to Gonzales’s plea agreement, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not even provided. HCSN obtained beneficiaries in Miami by paying kickbacks to owners and operators of assisted living facilities (ALF). According to court documents, HCSN routinely admitted patients in Miami who were ineligible for PHP treatment because they suffered from medical conditions – including mental retardation, dementia and Alzheimer’s disease – that could not be effectively treated by PHP services HCSN was purporting to provide.

According to Gonzalez’s plea agreement, his employees routinely fabricated patient census data and patient medical records that were then utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and the Florida Medicaid program.

Gonzalez pleaded guilty to directing his employees in North Carolina to routinely submit fraudulent PHP claims for Medicare patients who were not even present at the CMHC or on days when the CMHC was closed due to snow. Similar to HCSN’s Florida operations, patients who were suffering from conditions such as mental retardation were improperly and routinely admitted to HCSN for purported treatment. To increase its patient base, HCSN Hendersonville employed “marketers” in North Carolina who recruited ineligible patients from surrounding counties. HCSN would then transport the patients daily and reward them for their attendance by giving them cigarettes.

In furtherance of the North Carolina fraud scheme, HCSN employees and licensed therapists routinely fabricated patient progress notes purportedly documenting intensive mental health therapy. In reality, patients were crowded into dysfunctional groups that often exceeded more than 20 people. HCSN therapists would then produce bogus therapy notes for sessions that had little therapeutic value and, in many cases, never even occurred.

According to Gonzales’s plea agreement, he was the president of Miami-based Psychiatric Consulting Network Inc., which he used as a shell corporation to launder HCSN health care fraud proceeds.

According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. The false and fraudulent billing resulted in more than $28 million in payments from Medicare and Florida’s Medicaid programs.

In addition to Gonzalez, former HCSN employees John Thoen, Alexandra Haynes, Serena Joslin and Sarah Da Silva Keller have pleaded guilty to health care fraud and related charges. ALF owners Daniel Martinez, Raymond Rivero, Ivon Perez and Alba Serrano have pleaded guilty to health care fraud and related charges for their roles in the scheme. Alleged co-conspirators Paul Layman and Wondera Eason are scheduled for trial on Jan. 14, 2013, before judge Altonaga in the Southern District of Florida.



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Friday, December 21, 2012

Charles Agbu, 58, of Carson, Calif., Pleaded Guilty to Commit Health Care Fraud


Source- http://www.justice.gov/opa/pr/2012/December/12-crm-1506.html

WASHINGTON — A Los Angeles-area church pastor pleaded guilty today to conspiring with doctors, the operators of fraudulent medical clinics, street-level patient recruiters and others to defraud Medicare of more than $11 million, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney AndrĂ© Birotte Jr. of the Central District of California; Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); Bill L. Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office; and Joseph Fendrick, Special Agent in Charge of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.

Charles Agbu, 58, of Carson, Calif., pleaded guilty before U.S. District Judge George Wu in the Central District of California to one count of conspiracy to commit health care fraud and one count of money laundering.

In court documents, Agbu, a church pastor, admitted that he owned and operated Bonfee Inc., a fraudulent durable medical equipment (DME) supply company located in Carson. Agbu admitted that he paid patient recruiters or “marketers” to approach Medicare beneficiaries and convince them to provide their Medicare information in exchange for free DME that the beneficiaries did not need. Often, the marketers told the beneficiaries that they would receive highly-specialized power wheelchairs (PWCs) because PWCs were among the most expensive items that Agbu and his co-conspirators could bill to Medicare and generated the most profit.

Agbu also admitted that he knew Medicare required him and his co-conspirators to maintain prescriptions and supporting medical documentation in their files for every PWC and item of DME that they billed to Medicare. To meet these Medicare requirements, Agbu admitted that he paid the operators of fraudulent medical clinics to provide him with prescriptions and supporting medical documentation for the PWCs and DME that he and his co-conspirators billed to Medicare. Agbu admitted that he knew these clinics used marketers to solicit Medicare beneficiaries, and that the prescriptions and medical documents that the clinics produced were fraudulent. Agbu admitted that on average, he paid between $400 and $700 for each prescription he bought from these clinics.

In addition to paying the operators of fraudulent medical clinics for prescriptions, Agbu admitted that he paid doctors to write and provide him and his co-conspirators with prescriptions and medical documents needed to submit PWC and DME claims to Medicare. Agbu admitted that he directed marketers to bring Medicare beneficiaries to the doctors or knew the doctors used marketers to solicit beneficiaries. Agbu admitted that he paid the doctors or members of their staff approximately $100 to $400 for every prescription that the doctors wrote for and provided to him. One of these doctors, Agbu’s co-defendant Dr. Juan Tomas Van Putten, pleaded guilty in November 2012 to conspiring to defraud Medicare and admitted that he accepted payment in exchange for writing medically-unnecessary PWC and DME prescriptions.

Agbu admitted that he and his co-conspirators submitted false claims to Medicare for PWCs and other DME by using the Medicare information obtained by marketers and the prescriptions and medical documentation that he purchased from doctors and operators of fraudulent medical clinics. Agbu and his co-conspirators submitted these claims through Bonfee and Ibon, Inc., a fraudulent DME supply company that was located in the same building as Bonfee and owned by one of Agbu’s alleged co-conspirators. Agbu admitted that with one exception, he and his co-conspirators supported every PWC claim that they submitted to Medicare with fraudulent or purchased prescriptions. Agbu admitted to knowing that the DME claims submitted to Medicare were often for PWCs that were not medically necessary or never provided to beneficiaries.

According to court documents, Agbu and his co-conspirators submitted approximately $11,094,918 in false claims to Medicare and received approximately $5,788,725 on those claims. Agbu admitted that he engaged in money laundering when he transferred over $10,000 of these illegally-obtained Medicare funds between his various bank accounts.

At sentencing, scheduled for May 16, 2013, Agbu faces a maximum penalty of 20 years in prison and a $500,000 fine. Dr. Van Putten’s sentencing is scheduled for March 28, 2012. He faces a maximum penalty of 10 years in prison and a $250,000 fine.

Co-defendants Dr. Emmanuel Ayodele, Alejandro Maciel, Candalaria Estrada and Charles Agbu’s daughter Obiageli Agbu are scheduled for trial on Feb. 26, 2013, for their alleged roles in the conspiracy. They are presumed innocent until proven guilty at trial.



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Thursday, December 20, 2012

Gurinder Mand Pleads Guilty to Conspiracy to Commit Health Care Fraud


Source- http://www.fbi.gov/sanfrancisco/press-releases/2012/san-jose-woman-pleads-guilty-to-conspiracy-to-commit-health-care-fraud

SAN JOSE, CA—Gurinder Mand pleaded guilty in federal court in San Jose on December 12, 2012, to conspiracy to commit health care fraud, United States Attorney Melinda Haag announced.

In pleading guilty, Mand admitted she knowingly and willfully conspired with the former owner of EZ Step pharmacy and others to submit false and fraudulent claims to health care benefit programs, including Medicare, Medi-Cal, and private insurance companies. The false and fraudulent claims included (1) seeking reimbursement for claims without prescriptions and by fabricating prescriptions and forging signatures of physicians on prescriptions; and (2) seeking reimbursement for the cost of licensed durable medical equipment (DME) and related prescription medications, benefits, items, and services, including by fabricating DME authorizations, certificates of medical necessity, and related documents, and forging the signatures of physicians and other authorized health care providers of beneficiaries on these documents.

Mand, 29, of San Jose, was indicted by a federal grand jury on June 30, 2011. She was charged with one count of conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349; six counts of heath care fraud, in violation of 18 U.S.C. § 1347; and two counts of obstruction of criminal investigation of health care investigations, in violation of 18 U.S.C. § 1518. Under the plea agreement, Mand pled guilty to one count of conspiracy to commit health care fraud.

The sentencing of Mand is scheduled for April 3, 2013, at 9 a.m. before United States District Court Judge Lucy H. Koh in San Jose. The maximum statutory penalty for violation of conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349, is 10 years in prison; a fine of $250,000 or twice the gross gain or loss, which ever is greater; a term of supervised release of three years; and restitution. However, any sentence following conviction would be imposed by the court after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553.



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Wednesday, December 19, 2012

Lawrence T. Tyler, 40, Arrested for Health Care Fraud


Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20December/121217%20-%20Tyler.html

HOUSTON – Lawrence T. Tyler, 40, has been indicted on charges of health care fraud and conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today. The nine-count indictment, returned Wednesday, Dec. 12, 2012, was unsealed today upon his arrest without incident.

The indictment alleges that from 2007 to 2009, Tyler falsely billed Medicare and Medicaid for so-called “ortho kits” which consisted of an assorted of various back, knee, ankle, wrist and shoulder braces. Tyler allegedly billed for equipment that was never delivered, billed for equipment using prescriptions from a physician who never treated the patients, and upcoded - billed for a higher reimbursed brace but delivered a cheaper brace that either did not fit the billing code or did not qualify for any Medicare reimbursement. In addition, as part of the conspiracy, the indictment alleges Tyler paid a marketer for patient billing information, a violation of the federal anti-kickback statute.

Tyler, under the company name, 1866ICPAYDAY.COM LLC, allegedly billed Medicare and Medicaid approximately $3 million and was paid approximately $1.4 million.

The statutory maximum penalty for a violation of the health care fraud statute is imprisonment of not more than 10 years and a maximum $250,000 fine. If convicted of the conspiracy he also faces up to five 5 years in prison and another $250,000 fine.



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Tuesday, December 18, 2012

Hancock Park Physician Sentenced To Year In Federal Prison In Kickback Scheme That Defrauded Medicare Program


Source- http://www.justice.gov/usao/cac/Pressroom/2012/176.html

LOS ANGELES – A Los Angeles physician who received approximately $30,000 in illegal kickbacks as part of a scheme that defrauded Medicare out of more than $5 million has been sentenced to one year and one day in federal prison.

Whan Sil Kim, also known as “Victoria Kim,” a 69-year-old Hancock Park resident, was sentenced yesterday afternoon by United States District Court Judge Dean D. Pregerson. In addition to the prison term, which Kim was ordered to begin serving by February 13, 2013, Judge Pregerson ordered the defendant to pay $1.088 million in restitution to Medicare.

Kim pleaded guilty in July 2012 to receiving illegal remunerations related to health care referrals, admitting that she fraudulently referred Medicare beneficiaries to Greatcare Home Health, Inc. in return for kickbacks. Between May 2008 and early 2011, Kim had an arrangement under which she would see – but not examine – Medicare beneficiaries at Greatcare’s clinic in the Westlake District of Los Angeles. After meeting with the Medicare beneficiaries after GreatCare’s normal business hours, Kim wrote referrals for home health services. Kim received $100 for each referral. As a part of the scheme, Kim also signed off on plans of care for the beneficiaries, falsely representing that the patients were under her care, confined to the home without a willing caregiver, and had a medical necessity for home health services. The scheme targeted elderly, primarily Korean, Medicare beneficiaries.

All of Kim’s referrals went to GreatCare and ultimately led to $1.088 million in losses to Medicare on the fraudulent claims. In total, Kim’s referrals and referrals from other doctors to Greatcare resulted in more than $5 million in losses to Medicare.

Greatcare was shut down in March 2011 when special agents with the Federal Bureau of Investigation (“FBI”) and the Department of Health and Human Services, Office of Inspector General (“HHS-OIG”) executed a search warrant and seized $1.2 million from Greatcare bank accounts. The criminal investigation into Greatcare was prompted by a still-pending “whistleblower” lawsuit filed by a former employee. As a part of the criminal investigation, Kim received a subpoena for patient files, but she created fake patient files that falsely made it appear as though Kim had examined and properly referred the patients for home health services.

Kim, who used to practice at clinics in Mid-Wilshire, Studio City and Irvine, has since surrendered her medical license and is subject to mandatory exclusion from billing Medicare.

Greatcare’s owner – Hee Jung Mun, who often used the name “Angela,” 50, of Rancho Palos Verdes – and other Greatcare employees, including registered nurses Ji Hae Kim, 43, of Fullerton, and Hwa Ja Kim, 68, of Harbor City, have entered guilty pleas and are currently awaiting sentencing.



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Monday, December 17, 2012

Kenny Msiakii, 44, of Houston, was Convicted of Eight Counts of Health Care Fraud.


Source- http://www.justice.gov/opa/pr/2012/December/12-crm-1494.html

WASHINGTON – The owner and operator of a Louisiana-based durable medical equipment (DME) company was convicted today by a federal jury in Houston for his role in a $6.7 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; and Special Agent in Charge Mike Fields of the Dallas Regional Office of the U.S. Department of Health and Human Service’s Office of the Inspector General (HHS-OIG).

Kenny Msiakii, 44, of Houston, was convicted of eight counts of health care fraud.

According to court documents, Msiakii was the owner and operator of Joy Supply and General Services, a company based in Shreveport, La., that purported to provide orthotics and other DME, including power wheelchairs, to Medicare beneficiaries.

Msiakii used Joy Supply’s Medicare provider number to submit claims to Medicare for DME, including orthotic devices, that was medically unnecessary and, in some cases, never provided. Many of the orthotic devices were components of “arthritis kits” and purported to be for the treatment of arthritis-related conditions; however, the devices were neither medically necessary nor appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads.

According to court documents, from November 2007 through September 2009, Msiakii submitted claims of approximately $6.7 million to Medicare and was paid approximately $3.6 million for devices that were not medically necessary and, in some cases, never provided.



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Sunday, December 16, 2012

Ben Harris Echols, 63, of Houston, Convicted in $17.3 Million Medicare Fraud Scheme Involving Fraudulent Claims for Home Health Care Services


Source- http://www.justice.gov/opa/pr/2012/December/12-crm-1498.html

WASHINGTON – A federal jury in Houston today convicted Ben Harris Echols, 63, of Houston, for conspiring to commit healthcare fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat. After a four day trial, the jury convicted Echols of one count of conspiracy to commit health care fraud and six counts of false statements relating to health care matters.

Today's verdict was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-in-Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of Inspector General, Office of Investigations; and the Texas Attorney General’s Medicaid Fraud Control Unit.

According to evidence presented at trial, Echols was a physician practicing in the Houston area. The evidence showed that Echols signed plans of care for Medicare beneficiaries so that fraudulent claims could be billed by Family Healthcare Group Inc. and Houston Compassionate Care. Echols would sign plans of care for Medicare beneficiaries who were not under his care and about whose conditions he had no knowledge. In many instances, the evidence showed, Echols would sign plans of care even though other doctors were listed as the attending physician on the documents.

Evidence presented at trial showed that Family Healthcare Group Inc. and Houston Compassionate Care fraudulently billed Medicare for home health services and were paid approximately $17.3 million by Medicare, including $5.5 million for beneficiaries for whom Echols signed a plan of care.

At trial, doctors in whose names claims were submitted to Medicare testified that they were treating the patients on plans of care signed by Echols, and that the patients did not need the care that had been billed to Medicare based on the plans. Two Medicare beneficiaries for whom Echols signed plans of care testified at trial that they had never seen Echols, that they had different primary care physicians, and they did not want or need home health care.

The conspiracy count carries a maximum potential penalty of 10 years in prison and a $250,000 fine; each of the false statements counts carries a maximum potential penalty of five years in prison and a $250,000 fine. Sentencing is scheduled for March 14, 2013.



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Saturday, December 15, 2012

Emmanuel I. Mekowulu (56, Tampa) Guilty Of Filling Hundreds Of Fraudulent Oxycodone Prescriptions


Source- http://www.justice.gov/usao/flm/press/2012/dec/20121212_Mekowulu.html

Tampa, Florida - A federal jury yesterday found Emmanuel I. Mekowulu (56, Tampa) guilty of conspiring with other persons to knowingly and intentionally distribute and dispense a controlled substance, primarily Oxycodone, outside of a legitimate medical purpose and not in the usual course of professional practice. Mekowulu faces a maximum penalty of 20 years in federal prison. As part of the sentence, he will also forfeit his Florida Department of Health Pharmacist License and the DEA Registration and Florida Department of Health Pharmacy License for Felky Rx, LLC, which were used to commit or facilitate the offense.

Mekowulu was indicted on April 26, 2012. His sentencing is scheduled for March 11, 2013.

According to testimony and evidence presented at trial, in June 2008 through March 2009, Mekowulu was a pharmacist and the owner of Felky Pharmacy located on North Florida Avenue, in Tampa, Florida. During that same time period, Troy Wubbena was a physician's assistant and owner and operator of the Neurology & Pain Center clinics located in Tampa, Lakeland, Sarasota, Orlando, and Jacksonville. Brett Ridenour was an employee of the clinics. Together, and with others, the conspirators used hundreds of blank prescriptions that were pre-signed and filled by Dr. Jeffrey Friedlander (co-owner of the clinic) for large quantities of Oxycodone. The prescriptions included the names of over 60 persons, many of them patients and employees of the clinics who did not need or receive the Oxycodone and were unaware that the prescriptions were written in their names. The illegal prescriptions were filled at Felky Pharmacy. Over the nearly 10 month period, Wubbena and Ridenour presented over 340 fraudulent prescriptions to Mekowulu. Mekowulu filled the prescriptions without verification or questioning their validity. Through this scheme, nearly 50,000 pills of Oxycodone were later sold in the Tampa Bay area.

Wubbena and Ridenour, who testified against Mekowulu at trial, previously pleaded guilty to federal charges for their roles in the conspiracy. Wubbena was sentenced to serve 10 years in federal prison. Ridenour was sentenced to serve 5 years imprisonment. Friedlander pleaded guilty for his role in the conspiracy in March 2010. He was sentenced to 9 years in prison.



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Friday, December 14, 2012

Maggie Leon of Hialeah, Florida, Guilty of Eight Counts of Health Care Fraud


Source- http://www.justice.gov/usao/fls/PressReleases/121206-03.html

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Michael B. Steinbach, Acting Special Agent in Charge, Federal Bureau of Investigation, and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of the Inspector General, Miami Division, announced that a federal jury found defendant Maggie Leon, 35 of Hialeah, Florida, guilty of eight counts of health care fraud, in violation of Title 18, United States Code, Section 1347, and conspiracy to commit the same, Title 18, United States Code, Section 1349. Sentencing has been scheduled for February 6, 2013 before U.S. States District Judge Paul Huck.

According to the indictment and evidence presented at trial, Maggie Leon, through her company (Leon Medical), submitted and caused the submission of approximately $7.2 million in false claims for medical services to the seven insurance carriers, and was paid more than $2.2 million. The evidence further established that the defendant and her co-conspirators paid kickbacks and bribes to beneficiaries suffering from HIV to ensure that they would attend Leon Medical.

Mr. Ferrer commended the investigative efforts of the Federal Bureau of Investigation, the U.S. Department of Health and Human Services, Office of the Inspector General, and the Office of Personnel Management, Office of Inspector General. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark and Special Assistant U.S. Attorney Anissa Andrews.



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Thursday, December 13, 2012

Dr. Meera Sachdeva, 50, of Summit, Brittany McCoskey, 26, of Monticello, and Monica Weeks, 40, of Madison, were Sentenced for Health Care Fraud


Source- http://www.fbi.gov/jackson/press-releases/2012/summit-oncologist-madison-biller-sentenced-for-health-care-fraud

JACKSON, MI—Dr. Meera Sachdeva, 50, of Summit, Brittany McCoskey, 26, of Monticello, and Monica Weeks, 40, of Madison, were sentenced in U.S. District Court today on charges that they defrauded Medicare by submitting false claims for chemotherapy services, announced U.S. Attorney Gregory K. Davis, FBI Special Agent in Charge Daniel McMullen, and Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta.

Sachdeva, who owned and operated Rose Cancer Center in Summit, pled guilty in July 2012 to submitting claims for chemotherapy services that were supposedly rendered when she was out of the country. She was sentenced to 20 years in federal prison, followed by three years of supervised release. She was also ordered to pay a $250,000 fine and restitution in the amount of $8,168,524.72. The forfeiture of approximately $6 million and four parcels of property was also ordered.

McCoskey, who worked as the officer manager for Rose Cancer Center, pled guilty to making false statements on claims. She was sentenced to 13 months in federal prison, followed by three years of supervised release. She was also ordered to pay restitution in the amount of $55,068.83.

Weeks, who owned and operated The Medical Billing Group, pled guilty to conspiracy to commit health care fraud by covering up false claims made by Sachdeva that were scheduled for an audit. She was sentenced to three years of probation with three months of home confinement and ordered to pay a $2,000 fine. She was also ordered to pay restitution in the amount of $19,549.52.

Sachdeva admitted billing for more chemotherapy drugs than she actually purchased from drug suppliers from 2007 to 2011. Her patients believed that they were receiving an amount of chemotherapy medicine that was equal to the amount being billed to their respective health care benefit programs, but she was not providing each patient with the fully prescribed dosage of many of the billed chemotherapy drugs.

“The health care fraud perpetrated by these defendants was an abuse of public trust motivated by greed. We remain committed to protect the integrity of our health care system and will continue to strictly enforce our federal health care laws,” said United States Attorney Gregory K. Davis.

“This physician violated her duty to provide appropriate care for the patients at Rose Cancer Center,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Our office takes quality of care concerns very seriously, and we will vigorously investigate any provider that shortchanges patients and steals from the Medicare Trust Fund.”



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Wednesday, December 12, 2012

Hetal Barot, 30, of Westland, Mich., was sentenced to 30 Months in Prison for Role in $13.8 Million Home Health Care Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/December/12-crm-1482.html

WASHINGTON—A Detroit-area registered physical therapy assistant was sentenced today to serve 30 months in prison for her role in a nearly $13.8 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office.

Hetal Barot, 30, of Westland, Mich., was sentenced by U.S. District Judge Gerald E. Rosen in the Eastern District of Michigan. In addition to her prison term, Barot was sentenced to serve two years of supervised release and ordered to pay $1,336,739 in restitution, jointly and severally with her co-defendants.

Barot pleaded guilty on June 26, 2012, to one count of conspiracy to commit health care fraud.

According to Barot’s plea agreement, beginning in approximately May 2009, Barot, a physical therapy assistant, was paid to falsify medical documentation for Physicians Choice Home Health Care LLC, a home health agency owned by her co-conspirators. Barot created evaluations, therapy revisit notes and other medical documentation memorializing purported physical therapy for patients she did not see or treat. According to court documents, she was instructed on how to falsify the medical documentation by a co-conspirator.

Barot also pleaded guilty to signing therapy revisit notes as a physical therapy assistant for patients she did not see or treat, knowing that the documents she falsified and the documents that she signed would be used to support false claims to Medicare for home health services.

Barot was subsequently paid to sign falsified medical documentation and files for First Care Home Health Care LLC, Quantum Home Care Inc. and Moonlite Home Care Inc., which were Detroit-area home health care companies also owned by Barot’s co-conspirators that billed Medicare.

From approximately May 2009 through September 2011, Medicare paid approximately $1,336,739 to the four home health care companies for fraudulent physical therapy claims based on falsified files and notes signed by Barot. The four home health companies for which Barot worked were paid in total approximately $13.8 million by Medicare.

Nine of Barot’s co-defendants have pleaded guilty, and one has been sentenced. Three co-defendants are fugitives, and six co-defendants await trial.



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Tuesday, December 11, 2012

Christopher Card, 60, of Caldwell, Idaho, Optometrist Sentenced For Defrauding Health Care Benefit Programs


Source- http://www.justice.gov/usao/id/news/2012/dec/card12112012.html

BOISE – U.S. Attorney Wendy J. Olson announced today that Christopher Card, 60, of Caldwell, Idaho, was sentenced in United States District Court to 36 months in prison followed by three years of supervised release for executing a scheme to defraud health care benefit programs. U.S. District Judge Edward J. Lodge also ordered Card to pay $1 million in restitution and fined him $100,000. He pleaded guilty to the charge on August 16, 2012.

According to the plea agreement, on various dates between 1993 and August 31, 2010, Card, a licensed optometrist in Idaho and the former owner, manager and care provider at Total Vision, P.A., in Caldwell, executed a scheme to defraud Idaho Medicaid, Medicare, Blue Cross of Idaho, Regence Blue Shield of Idaho, and the Rail Road Retirement Board (RRB), by making false statements, and by submitting false, fraudulent, and fictitious claims for reimbursement to these health care benefit programs. The total loss to the health care benefit programs and the restitution agreed to by the parties is $1 million.

According to the plea agreement, Card fraudulently billed health care benefit programs, especially Medicaid and Medicare, for false diagnoses, including glaucoma, acquired color deficiency (color blindness), tension headaches, macular degeneration, treatment of eye injuries and removal of foreign objects from the eye. Card billed for testing that did not actually occur and for testing results that were falsified or altered. He admitted that in late October 2008, he altered his fraudulent diagnoses and billing practices when he learned that federal and state health care fraud investigators interviewed a former employee.

According to the plea agreement, 18 patients identified in the original indictment were diagnosed by Card with glaucoma or glaucoma-related conditions. All were subsequently examined by other doctors; only one was determined to actually have the glaucoma or glaucoma related diseases that Card had diagnosed. Card falsely diagnosed the 18th patient, and others, with acquired color deficiency. According to the plea agreement, the patients named in the original indictment represent only a fraction of the patients for whom Card falsely billed health insurance companies.

The Medicaid program is a Idaho state-administered health insurance program that is approximately 70%, funded by the U.S. Department of Health and Human Services (HHS). The Idaho Medicaid program is a cooperative federal-state program that furnishes medical assistance to the indigent. The program helps pay for reasonable and necessary medical procedures and services, including optical services, to individuals deemed eligible under federal-state low-income programs. Medicare is 100% federally funded and is administered by the Centers for Medicare and Medicaid Services (CMS). Medicare pays for reasonable and necessary medical procedures and services, including vision services. Medicare covers, among others, individuals who are 65 years of age and older.

“For years, Christopher Card defrauded Medicaid, Medicare and other healthcare benefit programs and diverted the funds to his own personal gain,” said Olson. “Nationally, health care fraud costs taxpayers nearly $252 per person, or $78 billion total, annually. Plainly, criminal conduct like this is a drain on our economy and on our health care resources. The significant sentence imposed by the Court was well deserved in this case.”

“HHS-OIG is committed to protecting the integrity of the Medicare program and we will continue to work with the Department of Justice to seek those who exploit their patients for financial gain,” said Ivan Negroni, Special Agent-in-Charge of the San Francisco Region for the United States Department of Health and Human Services, Office of Inspector General. “We will continue to ensure that those who choose to defraud the Medicare program are held accountable.”



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Monday, December 10, 2012

Brooklyn, N.Y., Physician and Clinic President Pleads Guilty to Medicare Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/December/12-crm-1474.html

WASHINGTON – A medical doctor and the president of two Brooklyn, N.Y., medical clinics pleaded guilty today for his role in a scheme resulting in more than $11.7 million in fraudulent Medicare claims, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division.

According to court documents, Ho Yon Kim, 86, of Flushing, N.Y., was the president of URI Medical Service PC and Sarang Medical PC, both doing business in Flushing, and purportedly providing physical therapy and electric stimulation treatment. He was also a rendering physician at both clinics. Kim pleaded guilty in Brooklyn federal court before U.S. Magistrate Judge Marilyn D. Go to a superseding information charging him with conspiracy to commit health care fraud.

During today’s plea hearing, Kim admitted that, from approximately March 2007 to October 2011, he conspired with others to induce Medicare beneficiaries to allow their Medicare numbers to be billed for medical services that were never provided or were not medically necessary. In exchange, the conspirators provided the beneficiaries with a variety of spa services such as massages, facials, lunches and dancing classes.

At sentencing, Kim faces a maximum penalty of 10 years in prison. A sentencing date has not yet been set.

Also charged by indictment in the scheme were medical doctors Hoi Yat Kam and Peter Lu, who await trial. The charges and allegations against them are merely accusations and they are considered innocent unless and until proven guilty.



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Sunday, December 9, 2012

Dr. Boris Sachakov, 43, of Brooklyn, was Sentenced to 30 Months in Prison for Role in Medicare and Private Insurance Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/December/12-crm-1471.html

WASHINGTON – A Brooklyn, N.Y., board-certified colorectal surgeon, who owned and operated a New York medical clinic, was sentenced today to serve 30 months in prison for his role in a fraud scheme that billed Medicare and more than 10 private insurance companies for surgeries and other complex medical procedures that were never performed, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, Acting Assistant Director in Charge George Venizelos of the FBI’s New York Field Office and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) New York Regional Office.

Dr. Boris Sachakov, 43, of Brooklyn, was sentenced by U.S. District Judge Jack Weinstein in the Eastern District of New York. In addition to his prison term, Sachakov was sentenced to serve three years of supervised release, pay forfeiture of $1,103,069 and pay restitution of $1,103,069 to the victims of his crimes, Medicare and numerous private insurance plans.

Sachakov was found guilty by a jury on June 13, 2012, after a two-week trial in federal court in Brooklyn. Sachakov was found guilty of one count of health care fraud and five counts of health care false statements. The trial evidence showed that from January 2008 to January 2010, Sachakov, who owned and operated a clinic called Colon and Rectal Care of New York P.C., defrauded Medicare and private insurance companies by billing for surgeries and medical services that he never provided. According to trial testimony, several private insurance companies began investigating Sachakov after receiving complaints from patients that Sachakov had submitted claims for surgeries, including hemorrhoidectomies, that he never performed.

At trial, 11 of Sachakov’s patients testified that they had not received the surgeries and other medical services for which Sachakov had billed their insurance companies. The evidence presented at trial showed that the medical records Sachakov created and maintained on these patients, including letters to the patient’s referring doctors, did not support the extensive billings he submitted. After Sachakov was confronted by two insurance companies about complaints of billings for surgeries that did not happen, the evidence at trial showed that Sachakov sent letters to his patients, asking them to falsely certify in writing that they had received the phony surgeries. The indictment alleged that Sachakov submitted and caused the submission of more than $22.6 million in false and fraudulent claims to Medicare and private insurance companies, and received more than $9 million on those claims.



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Saturday, December 8, 2012

Dr. Juan Tomas Van Putten, 66, of Ladera Heights, California,Pleads Guilty to Conspiring to Defraud Medicare of Over $11 Million


Source- http://www.fbi.gov/losangeles/press-releases/2012/los-angeles-area-doctor-pleads-guilty-to-conspiring-to-defraud-medicare-of-over-11-million


WASHINGTON—A Los Angeles-area doctor pleaded guilty today to conspiring to defraud Medicare of over $11 million, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney AndrĂ© Birotte, Jr. of the Central District of California; Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG); Bill L. Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office; and Tony Sidley, Assistant Chief of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.

Dr. Juan Tomas Van Putten, 66, of Ladera Heights, California, pleaded guilty today before U.S. District Judge George Wu in the Central District of California to one count of conspiracy to commit health care fraud.

Van Putten pleaded guilty to obtaining patients for his medical clinic, Greater South Bay Medical Group, which was located in Carson, California, and a nursing home where he also saw patients from street-level patient recruiters or “marketers” who illegally solicited patients with Medicare benefits for expensive, highly specialized power wheelchairs, and other durable medical equipment (DME) that the patients did not need. According to the indictment to which Van Putten pleaded guilty, some of the marketers worked for the operators of fraudulent DME supply companies, including Van Putten’s co-defendants Charles Agbu, a church pastor, and his daughter Obiageli Agbu, who both operated Bonfee Inc. d/b/a “Bonfee Medical Supplies” and Ibon Inc., which were located in Carson.

Van Putten admitted that operators of fraudulent DME supply companies paid him cash kickbacks to write prescriptions for power wheelchairs and other DME that Van Putten knew the patients did not need. Van Putten admitted that he exaggerated the symptoms and diagnoses that he wrote on the prescriptions to make it appear as if the patients met both the medical and Medicare requirements for the power wheelchairs and DME. Van Putten admitted that he knew when he provided the prescriptions to the DME company operators that they would use the prescriptions to submit false claims to Medicare. Van Putten also admitted that he submitted claims to Medicare for services that he provided to the patients at Greater South Bay and the nursing home even though he knew it was illegal for him to provide services to patients who had been recruited by marketers.

As a result of this scheme, court documents indicate that Van Putten and his co-defendants submitted approximately $11,094,918 in false claims to Medicare and received approximately $5,788,725 on those claims.

Charles Agbu and Obiageli Agbu are scheduled for trial on February 26, 2013, for their alleged roles in the conspiracy. Co-defendants Dr. Emmanuel Ayodele, Alejandro Maciel, and Candalaria Estrada have also been charged for their alleged roles in the conspiracy.

Defendants are presumed innocent until proven guilty at trial.

At sentencing, scheduled for March 28, 2013, Van Putten faces a maximum penalty of 10 years in prison and a $250,000 fine.


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Friday, December 7, 2012

Samir Zaky, 37, of Brookfield, was Arrested on Federal Health Care Fraud Charges.


Source- http://www.fbi.gov/newhaven/press-releases/2012/brookfield-podiatrist-charged-with-medicare-fraud


David B. Fein, United States Attorney for the District of Connecticut, announced that Samir Zaky, 37, of Brookfield, was arrested today on federal health care fraud charges.

On November 27, 2012, a federal grand jury sitting in New Haven returned an indictment charging Zaky with 14 counts of health care fraud and 14 counts of making false statements relating to health care matters. The indictment was unsealed following Zaky’s arrest.

As alleged in the indictment, Zaky is a podiatrist who operated Affiliated Podiatrists LLC. From July 2008 to July 2011, Zaky submitted claims to the Medicare program stating that he had performed surgical procedures known as avulsions when, in fact, he had only performed routine foot care, such as clipping of toenails.

According to the indictment, the government is also seeking to forfeit more than $29,000 in cash found during a search of Zaky’s residence in August 2010.

Following his arrest, Zaky appeared before United States Magistrate Judge Holly B. Fitzsimmons in Bridgeport and was released on bond.

The charge of health care fraud carries a maximum term of imprisonment of 10 years, and the charge of making a false statement in a health care matter carries a maximum term of imprisonment of five years.

U.S. Attorney Fein stressed that an indictment is not evidence of guilt. Charges are only allegations, and each defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt.


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Thursday, December 6, 2012

BOYD WILLIAM LEAHY, 45, and ANGELINA LEAHY, also 45, Sentenced to Prison in Health Care Fraud Case


Source- http://www.fbi.gov/neworleans/press-releases/2012/covington-couple-sentenced-to-prison-in-health-care-fraud-case


NEW ORLEANS—BOYD WILLIAM LEAHY, age 45, and ANGELINA LEAHY, also age 45, were sentenced today to prison terms for charges stemming from a multi-count health care fraud indictment, announced U.S. Attorney Jim Letten. BOYD LEAHY was sentenced to 37 months’ imprisonment and ANGELINA LEAHY was sentenced to 24 months’ imprisonment.

According to the charges in an indictment filed in May 2012, the LEAHYS, a Covington-area couple, were employed at a sleep clinic in Covington, Louisiana, owned by their friends, two local physicians. The indictment charged that BOYD LEAHY as the office manager for the clinic and ANGELINA LEAHY, as the part-time billing clerk conspired to commit health care fraud by creating a rival business entity, Sleep Corp., that the LEAHYS used to fraudulently bill insurance companies for services which were actually rendered by their employing clinic. When the LEAHYS received insurance payments on behalf of their rival company Sleep Corp., they kept the proceeds rather than give it to their friends and employers, whose clinic actually rendered the services. ANGELINA LEAHY then doctored the payment records for their employing clinic to further conceal their fraud.

Additionally, as alleged in the indictment, BOYD LEAHY, as office manager of the clinic used his position to generate extra paychecks for himself and to pay himself more than he was authorized to earn and he did the same for his wife, ANGELINA LEAHY. BOYD LEAHY also added his daughter, his father, and a creditor to his employing clinic’s payroll without authorization, causing paychecks to be issued when none of these individuals had performed any work on the clinic’s behalf. BOYD LEAHY also used the employing clinic’s corporate credit card and business checking account to fund personal expenses, trips, and household utilities without the clinic owners’ knowledge or authorization. The total loss sustained by the clinic owners for this fraudulent scheme totaled $827,946.

Calling the case “one of the worst crimes in [his] 14 years on the bench,” and “one of the most mind-boggling cases [he’s] ever seen,” United States District Judge Carl Barbier chastised BOYD and ANGELINA LEAHY for their lack of remorse and stated that there was “no real remorse here, only remorse that they got caught.” As to BOYD LEAHY, Judge Barbier found that he had “the ability to charm many people,” and that it was “incomprehensible” that he had committed this “massive fraud against anyone, much less to longstanding friends.” After pronouncing sentence, the judge stated that this was a “tragic and sad case all around...and the [LEAHYS] helped to destroy two families...financially and emotionally,” referencing both the victim physicians’ and the defendants’ families.


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Wednesday, December 5, 2012

Mental Health Service Provider Joseph T. Hackett, 32, was Sentenced to 48 Months for Conspiracy to Commit Health Care Fraud


Source- http://www.fbi.gov/richmond/press-releases/2012/mental-health-service-provider-sentenced-to-48-months-for-conspiracy-to-commit-health-care-fraud


RICHMOND, VA—Joseph T. Hackett, 32, of Asheville, North Carolina, was sentenced today to 48 months in prison, followed by a term of three years of supervised release, for conspiracy to commit health care fraud. He also agreed to forfeit $1,570,041.60 and pay $1,570,041.60 in restitution to the Virginia Department of Medical Assistance Services.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia; and Kenneth T. Cuccinelli, Attorney General of Virginia, made the announcement after sentencing by United States District Judge Henry E. Hudson. Hackett pled guilty on August 13, 2012.

According to Court documents, Hackett owned and operated Access Regional Taskforce (ART), a Richmond-based Medicaid contracted provider of Intensive In-Home Therapy Services for children and adolescents. Intensive In-Home Therapy Services, one of the many mental health services offered by Medicaid in Virginia, are designed to assist youth and adolescents who are at risk of being removed from their homes or are being returned to their homes after removal because of significant mental health, behavioral, or emotional issues. Medicaid requires that Intensive In-Home Therapy Service providers employ qualified mental health workers to provide a medically necessary service to at-risk children and adolescents.

In a statement of facts filed with the plea agreement, Hackett acknowledged that, through ART, he billed Medicaid for services that were not reimbursable because the services did not address a child’s specific mental health issues, were not provided by qualified mental health workers, and were not provided to children who were in actual need of the offered service. Hackett acknowledged that Medicaid paid ART at least $1,570,041.60 that ART was not entitled to receive. In addition, he admitted in the statement of facts that Hackett paid Creed Xtreme Marketing Concepts, a.k.a. Creed Extreme Marketing, $545,410 for patient referrals. The owner of Creed, Lorie T. Monroe, was sentenced on June 12, 2012, to 37 months of imprisonment for receiving these referral payments.


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Tuesday, December 4, 2012

Utica Physician Dilip D. Kachare, 58, Indicted in $12 Million Health Care Fraud Scheme


Source- http://www.fbi.gov/albany/press-releases/2012/utica-physician-indicted-in-12-million-health-care-fraud-scheme


Richard S. Hartunian, United States Attorney, Northern District of New York, Thomas O’Donnell, Special Agent in Charge of the New York Field Division of the U.S. Department of Health and Human Services Office of Inspector General, and Clifford C. Holly, Special Agent in Charge of the Albany Field Office of the Federal Bureau of Investigation, announced today that a Binghamton, New York grand jury returned an indictment on November 14, 2012, charging Utica physician Dilip D. Kachare, 58, with three counts of health care draud and 16 counts of mail fraud. If found guilty, Kachare faces a statutory maximum sentence of 10 years’ imprisonment and a fine of up to $250,000 on the health care fraud counts and a statutory maximum sentence of 20 years’ imprisonment; and a fine of up to $250,000 on the mail fraud counts.

Kachare maintains an outpatient and inpatient practice in internal medicine. In addition to his office practice, he treats patients at St. Elizabeth Medical Center, Faxton St. Lukes Healthcare, and a number of nursing homes in the Utica, New York area.

The health care fraud counts allege that between 2002 and the end of September 2012, Kachare engaged in a scheme to fraudulently obtain payments from health care benefit programs, including Medicare, Medicaid, and numerous private insurers. The indictment alleges he did this by submitting claims for reimbursement representing that he had, on an ongoing and daily basis, provided a certain number of patients with the medical services designated by certain medical codes when, pursuant to the criteria in those codes, it would have been impossible for any physician to provide the medical treatment to that number of patients in a single day. The indictment also alleges that certain medical services, which are described in medical codes, known as CPT codes, have “typical” time components associated with them, and that during the course of the fraud scheme, the aggregate of the “typical” time in the codes submitted for reimbursement by Kachare consistently exceeded 24 hours per day.

The three health care fraud counts are designated “executions” of the fraud scheme described above, and each sets forth a time frame during which Kachare sought reimbursement for services purportedly provided to patients on November 29, 2007; February 20, 2008; and June 19, 2008. On those three dates, Kachare purports to have provided services to 82, 85, and 92 patients, and the aggregate “typical” time component associated with the codes submitted for payment were 30 hours, 35 hours, and 40 hours, respectively.

The mail fraud counts allege the same fraud scheme as alleged in the health care fraud counts, with each mail fraud count listing a check mailed to Kachare by the Medicare carrier containing payment for services purportedly provided on the three dates listed in the paragraph above, which services the indictment alleges were not, in fact, provided.

The approximate amount of the fraud alleged in the indictment is $12,000,000. The indictment contains a forfeiture allegation which seeks a $12,000,000 monetary judgment against Kachare for proceeds derived by him from the commission of the fraud scheme.

Kachare appeared in Binghamton, New York, on November 16, 2012, before U.S. Magistrate Judge Therese Wiley Dancks and entered a plea of not guilty to the indictment. He was released on his own recognizance but was directed to surrender his passport to the U.S. District Court Clerk’s Office, pending disposition of the matter. The charges contained in the indictment are merely accusations, and Kachare is presumed innocent unless and until proven guilty.


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Monday, December 3, 2012

Brooklyn Clinic Employee Pleads Guilty in Connection with $71 Million Medicare Fraud Scheme


Source- http://www.fbi.gov/newyork/press-releases/2012/brooklyn-clinic-employee-pleads-guilty-in-connection-with-71-million-medicare-fraud-scheme


WASHINGTON—A Brooklyn, New York resident pleaded guilty today to his role in a $71 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, U.S. Attorney for the Eastern District of New York Loretta E. Lynch, Acting Assistant Director in Charge Mary E. Galligan of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

Yuri Khandrius, 50, pleaded guilty today before U.S. District Judge Nina Gershon in the Eastern District of New York to one count of conspiracy to commit health care fraud, one count of health care fraud, and one count of conspiracy to pay kickbacks.

Khandrius was an employee of a clinic in Brooklyn that operated under three corporate names: Bay Medical Care PC, SVS Wellcare Medical PLLC and SZS Medical Care PLLC (Bay Medical clinic). According to court documents, owners, operators and employees of the Bay Medical clinic paid cash kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for more than $71 million in services that were medically unnecessary or never provided. The defendants billed Medicare for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy, and diagnostic tests.

According to the criminal complaint, the co-conspirators allegedly paid kickbacks to corrupt Medicare beneficiaries in a room at the clinic known as the “kickback room,” in which the conspirators paid approximately 1,000 kickbacks totaling more than $500,000 during a period of approximately six weeks from April to June 2010.

Khandrius admitted in court that he conspired with co-workers at Bay Medical to commit health care fraud and to pay cash kickbacks to Medicare beneficiaries as part of the scheme.

At sentencing, Khandrius faces a maximum penalty of 25 years in prison. Sentencing is scheduled for March 11, 2013.

In total, 16 individuals have been charged in the Bay Medical scheme, including two doctors, nine clinic owners/operators/employees, and five external money launderers. To date, 11 defendants have pleaded guilty for their roles in the conspiracy. Five individuals await trial before Judge Gershon on January 22, 2013.


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Sunday, December 2, 2012

Group of Owned and Affiliated Florida Hospitals Agree to Pay U.S. $10.1 Million to Resolve False Claims Act Allegations


Source- http://www.fbi.gov/tampa/press-releases/2012/group-of-owned-and-affiliated-florida-hospitals-agree-to-pay-u.s.-10.1-million-to-resolve-false-claims-act-allegations


WASHINGTON—Morton Plant Mease Health Care Inc. and its affiliated hospitals (Morton Plant) have agreed to pay $10,169,114 to the federal government to resolve allegations that they violated the False Claims Act by submitting false claims for services rendered to Medicare patients, the Justice Department announced today. Morton Plant owns and operates, or is affiliated with, Morton Plant Hospital, St. Joseph’s Hospital, Morton Plant North Bay Hospital, St. Anthony’s Hospital, Mease Countryside Hospital, and Mease Dunedin Hospital. These hospitals are part of the BayCare Health System in Florida’s Pinellas, Hillsborough, and Pasco counties.

The settlement announced today resolves allegations that, between July 1, 2006 and July 31, 2008, Morton Plant improperly billed for certain interventional cardiac and vascular procedures as inpatient care when those services should have been billed as less costly outpatient care or as observational status.

“Overbilling the government for routine procedures wastes valuable resources that could be used to care for other patients,” said Stuart F. Delery, Acting Assistant Attorney General for the Justice Department’s Civil Division. “At a time when we are trying to reduce public spending, it is especially important to ensure that hospitals do not overcharge the government by improperly inflating their billing.”

“We hold medical providers to a high standard in our district, and we will not hesitate to hold them to account when we find evidence of serious misconduct,” said Robert O’Neill, U.S. Attorney for the Middle District of Florida. “This settlement should send a strong message that health care fraud enforcement is a growing priority in our office.”

Today’s settlement resolves a qui tam, or whistleblower, lawsuit filed by Randi Ferrare, a former director of Health Management Services at Morton Plant Hospital. Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and share in any recovery. Ms. Ferrare will receive over $1.8 million as her share of the government’s recovery.

“When hospitals attempt to boost profits with improper inpatient admissions, they squander scarce dollars from Medicare and Medicaid,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “Our corporate integrity agreements hold providers accountable for preventing such abuse of government health care programs.”


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Wednesday, November 21, 2012

Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton to Pay U.S. $1.286 Million to Resolve False Claims Act Allegations



Harmony Care Hospice Inc. (Harmony) and Harmony owner and chief executive officer Daniel J. Burton have agreed to pay the United States $1,286,999.32 to settle allegations that the South Carolina-based company submitted false claims to Medicare for patients under care at its hospice facilities, the Justice Department announced today.

Hospices provide palliative care – medical treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis of six months or less. The United States alleged that Harmony and Burton knowingly submitted or caused to be submitted false claims for patients who did not have such a prognosis and thus were not eligible for hospice care. Under today’s agreement, Burton is individually liable for $200,000 of the settlement amount.

“Billing Medicare for unnecessary or inappropriate end-of-life care contributes to the soaring costs of health care for everyone. Today’s settlement demonstrates the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries,” said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Civil Division.

Today’s settlement with Harmony and Burton resolves a lawsuit filed by former Harmony employees Mona Singletary and Lynda Fulton under the qui tam, or whistleblower, provisions of the False Claims Act. Under the False Claims Act, private citizens can bring suit for false claims on behalf of the United States and share in any recovery. Together, Singletary and Fulton will receive $244,529.87 as their share of the government’s recovery.

As part of the settlement, Harmony and Burton will enter into a Corporate Integrity Agreement with the Office of Inspector General (OIG), Department of Health and Human Services (HHS), to address the allegations raised in the qui tam complaint.

“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “The company and its owner have agreed to Federal monitoring and reporting requirements designed to avoid such problems in the future.”

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.9 billion.