Saturday, March 31, 2012

Lazaro Acosta Pleads Guilty to Participating in $200 Million Medicare Fraud Scheme


Source-  http://www.justice.gov/opa/pr/2012/March/12-crm-409.html 

WASHINGTON – A Miami-area resident pleaded guilty today for his role in structuring monetary transactions to provide cash for the furtherance of a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Lazaro Acosta, 41, pleaded guilty before U.S. District Judge Patricia A. Seitz in Miami to one count of currency structuring to avoid reporting requirements. Acosta admitted that he structured currency transactions to avoid reporting requirements so he could provide $2.4 million in cash to the owners and operators of American Therapeutic Corporation (ATC); its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute (ASI).

On March 21, 2012, Acosta’s co-defendant, Leyanes Placeres, 31, pleaded guilty before U.S. Magistrate Judge Andrea Simonton in Miami to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. Placeres admitted that she participated in the fraud scheme orchestrated by the ATC, Medlink and ASI owners and operators. Placeres and Acosta were both charged in an indictment unsealed on Feb. 15, 2011, in the Southern District of Florida.

ATC, Medlink and ASI were Florida corporations headquartered in Miami. ATC 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. ASI purported to provide diagnostic sleep disorder testing.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities 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. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries to attend illegitimate treatment programs so that ATC and ASI could bill Medicare for medically unnecessary services. According to court filings, to obtain the cash used to pay the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare and structured their transactions to avoid detection by bank officials and the authorities.

In pleading guilty, Acosta admitted that he worked with Lawrence Duran, one of the owners and operators of ATC, Medlink and ASI, to use fake identities and create fake Medlink employees. Those fake identities were used to cash thousands of dollars of checks each week through a check cashing business co-owned by Acosta, South Dade Trade Interprises.

Placeres admitted that she served as a driver who worked with patient brokers to provide patients to ATC and ASI in exchange for kickbacks in the form of checks and cash. Placeres drove all of the patients provided by the brokers who worked with her, and she admitted to passing on kickback payments to the brokers. The amount of the kickback was based on the number of days each patient spent at ATC.

According to the plea agreements, Acosta’s structuring amounted to more than $2.4 million in structured funds, and Placeres’s participation in the ATC fraud resulted in $6.5 million in fraudulent billings to the Medicare program.

Sentencing for Acosta is scheduled for June 28, 2012. Acosta faces a maximum penalty of 10 years in prison, and he has agreed to forfeit $162,000 to the federal government. Sentencing for Placeres is scheduled for June 11, 2012. Placeres faces a maximum penalty of 15 years in prison and a $250,000 fine.

ATC, its management company Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011. ATC, Medlink and 12 other individual defendants have pleaded guilty or have been convicted at trial. Seven other defendants are scheduled for trial April 9, 2012, before Judge Seitz, and one defendant’s trial has been deferred until after June 2012. A defendant is presumed innocent unless proven guilty beyond a reasonable doubt in a court of law.




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Friday, March 30, 2012

Detroit Medical Clinic Owner Juan Villa Pleads Guilty to Medicare Fraud Scheme


WASHINGTON – The owner of a Detroit medical clinic pleaded guilty today for his participation in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Juan Villa, 29, of Miami, pleaded guilty before U.S. District Judge Arthur J. Tarnow in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, Villa faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to the plea documents, Villa owned Blessed Medical Clinic in Livonia, Mich. Villa admitted that he hired patient recruiters who paid cash bribes to Medicare beneficiaries to attend the clinic and provide their Medicare numbers and other information. Villa admitted that he used the beneficiary information to bill for medically unnecessary diagnostic tests and treatments. According to court documents, Blessed Medical Clinic fraudulently billed Medicare $2.4 million during the course of the scheme.




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Thursday, March 29, 2012

Residential Youth Treatment Facility for Medicaid Recipients in Marion, Virginia Agrees to Resolve False Claims Act Allegations


Source-  http://www.justice.gov/opa/pr/2012/March/12-civ-391.html 

Universal Health Services Inc. (UHS) and two subsidiaries have reached a settlement in a False Claims Act lawsuit with the United States and the Commonwealth of Virginia, the Justice Department announced today. Under the settlement, UHS and its subsidiaries, Keystone Education and Youth Services LLC and Keystone Marion LLC, which did business as the Keystone Marion Youth Center, a residential facility in Marion, Va., agreed to pay $6.85 million to the United States and the commonwealth to settle allegations that they provided substandard psychiatric counseling and treatment to adolescents in violation of Medicaid requirements, falsified records and submitted false claims to the Medicaid program. UHS closed the Marion facility earlier this year.

This settlement resolves a whistleblower lawsuit filed by Megan Johnson, Leslie Webb and Kimberly Stafford-Payne, former therapists at the closed facility. UHS and its subsidiaries have paid an additional amount under the terms of the agreement to the former therapists to settle their separate discrimination and attorney’s fees claims. The United States and the Commonwealth of Virginia had intervened in the lawsuit on Nov. 4, 2009.

Under the False Claims Act, an entity that submits false or fraudulent claims to the government is liable for three times the government’s damages, plus a civil penalty for each false claim. The claims settled by this agreement are allegations only; there has been no determination of liability.




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Wednesday, March 28, 2012

Dr. Errol Sherman Sentenced to One Year in Prison for Medicare Fraud Scheme


Source-  http://www.fbi.gov/detroit/press-releases/2012/detroit-podiatrist-sentenced-to-one-year-in-prison-for-medicare-fraud-scheme 

WASHINGTON—A Detroit-area doctor of podiatric medicine was sentenced today to one year in prison for a fraud scheme involving false billings to Medicare, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Dr. Errol Sherman was sentenced by U.S. District Judge Gerald E. Rosen in Detroit. In addition to his prison term, Sherman was sentenced to three years of supervised release and ordered to pay $300,000 in restitution. Sherman pleaded guilty on November 22, 2011 to one count of health care fraud.

According to the plea documents, Sherman is a doctor of podiatric medicine licensed in the state of Michigan. Between January 2003 and December 2006, Sherman billed Medicare and Blue Cross Blue Shield of Michigan for a procedure known as an avulsion of the nail plate or nail avulsion procedure. Sherman billed for this procedure thousands of times, claiming that he had performed this procedure on hundreds of beneficiaries from 2003 through 2006. In fact, he had not performed the procedures billed.




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Tuesday, March 27, 2012

All Smiles Dental Center, Inc. and its Former Majority Owner, Richard Malouf to Resolve Allegations of False Medicaid


Source-  http://www.fbi.gov/dallas/press-releases/2012/texas-orthodontic-clinic-and-former-owner-resolve-allegations-of-false-medicaid 

DALLAS—All Smiles Dental Center, Inc. and its former majority owner, Richard Malouf, D.D.S. (collectively “All Smiles”), agreed to pay the U.S. and state of Texas $1.2 million to resolve allegations that they violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney Sarah R. SaldaƱa of the Northern District of Texas. The U.S. and Texas contend All Smiles caused “unbundled” and other improper claims to be submitted to the Texas Medicaid program for orthodontic-related items and services between 2004 and 2007. All Smiles fully cooperated with the investigation, and by settling, did not admit any wrong-doing or liability.

Orthodontic services generally are reimbursable by the Texas Medicaid program as long as they are medically necessary, correctly coded, and properly documented. The U.S. and Texas contend All Smiles submitted improper Medicaid claims between 2004 and 2007 for orthodontic-related items and services that were not furnished or rendered, were unbundled, and/or not properly documented.

The Texas Medicaid Fraud Control Unit (MFCU) and FBI initiated the case in response to patient complaints, record reviews and data analysis. As part of the settlement, All Smiles entered into a five-year corporate integrity agreement (CIA) with the U.S. Department of Health and Human Services’ Office of Inspector General. The CIA requires All Smiles to adhere to certain policies and procedures to ensure compliance with applicable statutes and regulations that govern claims for federal health care funds.

In April 2010, Dr. Malouf settled potential allegations with the Dallas County District Attorney by repaying to MFCU more than $46,000 for certain orthodontic claims and agreeing not to submit claims to Texas Medicaid for an 18-month period. Dr. Malouf did not admit any wrong-doing or liability as part of that agreement.




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Monday, March 26, 2012

Stephanie B. Williams and Mary H. Griffin Sentenced in Medicare Fraud Scheme


Source-  http://www.fbi.gov/neworleans/press-releases/2012/baton-rouge-area-residents-sentenced-in-medicare-fraud-scheme 

WASHINGTON—Two patient recruiters for several Louisiana durable medical equipment (DME) companies were sentenced today for their roles in Medicare fraud schemes involving false claims and illegal kickback payments for unnecessary DME, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI, and the Louisiana State Attorney General’s Office.

Stephanie B. Williams and Mary H. Griffin were sentenced by U.S. District Judge James J. Brady of the Middle District of Louisiana to 48 months and 21 months in prison, respectively. Williams was ordered to pay $4 million in restitution, and Griffin was ordered to pay $3.6 million in restitution. In addition, Judge Brady sentenced the defendants to two years of supervised release following their prison terms. Williams pleaded guilty on December 13, 2011, and Griffin pleaded guilty on October 31, 2011.

Williams and Griffin worked as recruiters for Healthcare 1 LLC, Medical 1 Patient Services LLC, and Lifeline Healthcare Services Inc., Louisiana-based companies that fraudulently billed medical equipment to the Medicare program from 2004 to 2009. They and other recruiters were hired to obtain prescriptions for medical equipment such as leg braces, arm braces, power wheelchairs, and wheelchair accessories. Williams and Griffin obtained information from Medicare beneficiaries as well as prescriptions for medical equipment from the beneficiaries’ physicians. These prescriptions were then used to submit fraudulent claims to the Medicare program. In addition, Griffin participated in a similar scheme at McKenzie Healthcare Solutions Inc., where she was paid kickbacks and caused the submission of fraudulent claims for medically unnecessary DME from 2005 to 2010.

According to court documents, from 2004 to 2010, the companies involved in these schemes submitted more than $30 million in fraudulent billing.




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Sunday, March 25, 2012

EUSA Pharma (USA) Inc. to Pay U.S. $180,000 for Allegedly Submitting Inflated Claims to Medicare


Source-  http://www.fbi.gov/washingtondc/press-releases/2012/pennsylvania-based-eusa-pharma-usa-inc.-to-pay-u.s.-180-000-for-allegedly-submitting-inflated-claims-to-medicare 

WASHINGTON—EUSA Pharma (USA) Inc. has agreed to pay the United States $180,000 to resolve claims that it violated the False Claims Act by allegedly encouraging doctors to submit inflated claims to Medicare for imaging scans, the Justice Department announced today. EUSA Pharma (USA) is headquartered in Langhorne, Pennsylvania.

The United States alleged that EUSA Pharma, which makes and sells ProstaScint, a radiopharmaceutical, advised health care providers to submit multiple claims for certain imaging scans performed following use of ProstaScint, after the Society of Nuclear Medicine informed the company that only one claim should be submitted for these scans.

“Today’s settlement demonstrates our commitment to ensuring that the Medicare Trust Fund is used to pay for necessary medical care and is not depleted as a result of marketing schemes intended to increase sales by inflating government reimbursements,” said Stuart F. Delery, Acting Assistant Attorney General of the Justice Department’s Civil Division. “We will continue to hold accountable those who abuse public health care programs at the expense of taxpayers.”

Today’s settlement resolves a lawsuit filed by former EUSA Pharma employee Ann-Marie Williams under the qui tam, or whistleblower provisions, of the False Claims Act. Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in any recovery. Williams will receive $30,600 as her share of the government’s recovery.

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 nearly $6.7 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 $8.9 billion.




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Saturday, March 24, 2012

Multi-Million-Dollar Hospice Health Care Fraud Alleged


Source-  http://www.fbi.gov/philadelphia/press-releases/2012/multi-million-dollar-hospice-health-care-fraud-alleged 

HILADELPHIA—An indictment was unsealed today charging five nurses in a health care fraud conspiracy arising from their employment at Home Care Hospice Inc. (HCH), a hospice care provider in Philadelphia, between 2005 and 2008 that resulted in a multi-million-dollar fraud on Medicare. Patricia McGill, 64, of Philadelphia, was a registered nurse and served as the director of professional services for HCH. She allegedly authorized and supervised the admission of inappropriate and ineligible patients for hospice services, resulting in approximately $9.32 million in fraudulent claims. She is charged, along with Natalya Shvets, 42, of Southhampton, Pennsylvania Giorgi Oqroshidze, 36, of Philadelphia; Yevgeniya Goltman, 42, of Newtown, Pennsylvania; and Alexsandr Koptyakov, 39, of Bensalem, Pennsylvania, with one count of conspiracy to commit health care fraud and numerous counts of health care fraud. All five defendants were arrested this morning.

HCH was co-owned by Matthew Kolodesh, who is charged separately in an indictment unsealed October 12, 2011, and “A.P.,” the Hospice Director for HCH. HCH was a for-profit business at 1810 Grant Avenue, and later 2801 Grant Avenue, in Philadelphia that provided hospice services for patients at nursing homes, hospitals, and private residences. According to the indictment, announced by United States Attorney Zane David Memeger, McGill authorized nursing staff and supervisors, including her co-defendants, to fabricate and falsify documents in support of hospice care for patients who were not eligible for hospice care, or for a higher, more costly level of care than was actually provided to the patients. Between January 2005 and December 2008, approximately $9,328,000 in fraudulent claims for inappropriate patients were submitted to Medicare as authorized by AP and McGill. Defendants Shvets, Oqroshidze, Goltman, and Koptyakov created fraudulent nursing notes for approximately 150 patients indicating hospice services were provided for patients, when, in reality, they were not.

In February 2007, HCH was notified that it was subject to a claims review audit. According to the indictment, in anticipation of this audit, McGill assisted A.P. in reviewing patient charts, sanctioning false documentation by the nursing staff, and authorizing the alteration of charts. In September 2007, HCH was notified that it had exceeded its cap for Medicare reimbursement and would have to repay $2,625,047 to the government program. At that point, A.P. and McGill directed staff to review patient files and discharge hospice patients. This resulted in a mass discharge of patients. In one month, 79 hospice patients were discharged in October 2007 and a total of 128 discharged by January 2008, some of whom had been ineligible for hospice or inappropriately maintained on hospice service in excess of six months. Some of the patients discharged were shifted to another hospice business owned by Kolodesh. In the spring of 2008, approximately 20 percent of the discharged patients were placed back on hospice service at HCH with McGill’s knowledge. McGill is charged in 14 counts; Shvets is charged in eight counts; Oqroshidze is charged in seven counts; Goltman is charged in four counts; and Koptykov is charged in eight counts.

If convicted of all charges, McGill faces a potential advisory sentencing guideline range of 108 to 135 months in prison, a fine of up to $150,000, and a $1400 special assessment; Shvets, Goltman, and Koptykov each face a potential advisory sentencing guideline range of 27 to 33 months in prison, a fine of up to $60,000, and an $800 special assessment; Oqroshidze faces a potential advisory sentencing guideline range of 21 to 27 months in prison, a fine of up to $50,000, and a $700 special assessment.




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Friday, March 23, 2012

Mental Health Service Provider Joseph T. Hackett Indicted for Health Care Fraud


Source-  http://www.fbi.gov/richmond/press-releases/2012/mental-health-service-provider-indicted-for-health-care-fraud 

RICHMOND, VA—Joseph T. Hackett, 31, of Asheville, North Carolina, was indicted by a federal grand jury today on four counts of health care fraud and one count of conspiracy to pay health care kickbacks.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia; and Kenneth T. Cuccinelli, Attorney General of Virginia, made the announcement after the indictment was returned. Hackett faces a maximum penalty of 10 years in prison for each health care fraud count and five years in prison for the conspiracy count.

According to the indictment, 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 providers employ qualified mental health workers to provide a medically necessary service to at-risk children and adolescents.

The indictment alleges that Hackett, through ART, 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 services. It is alleged that Medicaid paid ART at least $1,570,041 that it was not entitled to receive. In addition, the indictment alleges that Hackett paid Creed Xtreme Marketing Concepts, aka Creed Extreme Marketing, $545,410 in illegal kickbacks for patient referrals. The owner of Creed, Lorie T. Monroe, pled guilty to conspiracy to receive illegal kickbacks on January 24, 2012.




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Thursday, March 22, 2012

Seven Charged in Scheme to Fraudulently Obtain Prescription Painkiller Pills


Source-  http://www.fbi.gov/cleveland/press-releases/2012/seven-charged-in-scheme-to-fraudulently-obtain-prescription-painkiller-pills 

A 39-count indictment was filed charging seven people from Cleveland and East Cleveland with various offenses related to a scheme to fraudulently obtain thousands of prescription painkiller pills, law enforcement officials announced today.

Health care fraud and aggravated identity theft charges were also filed against some defendants, who are accused of forging prescriptions for Oxycontin and Percocet pills, hiring people to have them filled at pharmacies throughout the region, and then selling the pills on the street, according to the indictment.

“We have seen a huge increase in prescription drug abuse in Ohio, and this case demonstrates the lengths people will go to defraud and profit from pills,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “Instead of dealers shipping in drugs from South America, we now have people forging prescriptions.”

“The abuse of illicitly obtained prescription drugs is reaching epidemic proportions, surpassing that of marijuana, cocaine, and heroin combined,” said Stephen Anthony, Special Agent in Charge of the Federal Bureau of Investigation’s Cleveland office. “Dismantling illicit drug diversion networks such as the organization charged in this investigation will remain a top FBI priority.”

Those charged with conspiracy to possess with intent to distribute Oxycodone:
Louis Eppinger, age 53, of Cleveland
Patricia Arnold, age 61, of Cleveland
Anthony H. Perry, age 42, of East Cleveland
Elizabeth A. Davis, age 40, of East Cleveland
James Byrge, age 62, of Cleveland
Judy Burrows, age 25, of Cleveland
Brittany N. Glass, age 22, of Cleveland

Between 2011 and 2012, Eppinger, Arnold, Glass, Perry, Davis, Burrows, and Byrge engaged in a conspiracy to possess with intent to distribute oxycodone, according to the indictment.

Eppinger obtained blank prescription paper from an unknown source and DEA numbers of various physicians located in Northern Ohio for the purposes of passing fraudulent prescriptions for Oxycontin and/or Percocet, both of which contain oxycodone, according to the indictment.

Eppinger provided the blank prescription paper to Arnold, who forged the prescriptions, according to the indictment.

Eppinger then provided the fraudulent prescriptions to Glass, Perry, and Davis, who served as “walkers” and attempted to pass the prescriptions at pharmacies in Northeast Ohio, including several in Cleveland as well as locations in Shaker Heights, Willoughby, and Garfield Heights, according to the indictment.

Glass, Perry, and Davis then gave the pills to Eppinger, who paid them for passing the fraudulent prescriptions. Eppinger then sold the pills or provided them on consignment to Burrows, Burge, and others, according to the indictment.

Eppinger also faces 18 counts of health care fraud for defrauding the Ohio Medicaid program by billing more than $20,000 for prescription painkillers to which he was not entitled, according to the indictment. He is also charged with two counts of aggravated identity theft for using the identities of two people in relation to a felony, according to the indictment.

If convicted, the defendants’ sentences will be determined by the court after reviewing factors unique to this case, including the defendant’s prior criminal record, if any; the defendant’s role in the offense; and the characteristics of the violation. In all cases, the sentence will not exceed the statutory maximum and in most cases it will be less than the maximum.




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Wednesday, March 21, 2012

Kelvin Jennings and Pamela Jones Allegedly Creating and Distributing Fraudulent Medicaid Cards in Exchange for Cash Payments


Source-  http://www.fbi.gov/newyork/press-releases/2012/manhattan-u.s.-attorney-announces-health-care-fraud-charges-against-two-employees-of-the-new-york-city-human-resources-administration 

Preet Bharara, the United States Attorney for the Southern District of New York; Janice K. Fedarcyk, the Assistant Director in Charge of the New York Office of the Federal Bureau of Investigation (FBI); Rose Gill Hearn, the Commissioner of the New York City Department of Investigation (DOI); and Raymond W. Kelly, the Police Commissioner of the City of New York (NYPD), today announced charges against KELVIN JENNINGS and PAMELA JONES, two long-time employees of the New York City Human Resources Administration (NYC-HRA), for allegedly creating and distributing fraudulent Medicaid cards in exchange for cash payments. JONES was arrested this morning and is expected to appear in Manhattan federal court later today. JENNINGS remains at large.

The following allegations are based on the complaint unsealed earlier today in Manhattan federal court:

JENNINGS has been employed with NYC-HRA since 1982 and is a Medicaid eligibility specialist at Metropolitan Hospital in Manhattan. JONES has been employed with NYC-HRA since 2000 and is a Medicaid eligibility specialist in its Office of Mail Renewal in Manhattan.

From 2003 through 2011, JENNINGS and JONES were involved in a scheme to sell fraudulently obtained Medicaid accounts and Medicaid cards to individuals who were not entitled to Medicaid. In the course of this scheme, JENNINGS sold approximately 18 fraudulent Medicaid cards. As part of the scheme, JONES used her employee-specific identification number at her personal NYC-HRA workstation to create fraudulent Medicaid accounts in the names of fictitious individuals or the names of individuals who would ultimately receive the cards but were ineligible for Medicaid. In total, the 18 fraudulent Medicaid accounts that were part of this scheme resulted in the fraudulent billing of approximately $387,000 to Medicaid.




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Tuesday, March 20, 2012

Frank Criado Pleads Guilty to Participating in $200 Million Medicare Fraud Scheme


Source-  http://www.fbi.gov/miami/press-releases/2012/miami-area-resident-pleads-guilty-to-participating-in-200-million-medicare-fraud-scheme-2 

WASHINGTON—A Miami-area resident pleaded guilty yesterday for his role in a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Frank Criado, 33, pleaded guilty before U.S. Magistrate Judge Barry L. Garber in Miami to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. Criado was charged in an indictment unsealed on February 15, 2011 in the Southern District of Florida.

Criado admitted to participating in a fraud scheme that was orchestrated by the owners and operators of American Therapeutic Corporation (ATC); its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute (ASI). ATC, Medlink, and ASI were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs), a form of intensive treatment for severe mental illness, in seven different locations throughout South Florida and Orlando. ASI purported to provide diagnostic sleep disorder testing.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities 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. 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 PHPs so that ATC and ASI could bill Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.

Criado admitted to serving as a patient broker who provided patients for ATC and ASI in exchange for kickbacks in the form of checks and cash. The amount of the kickback was based on the number of days each patient spent at ATC.

According to his plea agreement, Criado’s participation in the ATC fraud resulted in $7.3 million in fraudulent billings to the Medicare program.

Sentencing for Criado is scheduled for May 31, 2012 at 8:30 a.m. He faces a maximum penalty of 15 years in prison and a $250,000 fine.

ATC, Medlink, and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC, Medlink, and ASI were charged with various health care fraud, kickback, money laundering, and other offenses in two indictments unsealed on February 15, 2011. ATC, Medlink, and 11 of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial April 9, 2012 before U.S. District Judge Patricia A. Seitz. A defendant is presumed innocent unless proven guilty beyond a reasonable doubt in a court of law.




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Monday, March 19, 2012

Fitzgerald Anthony Hudson, Arrested on Health Care Fraud Charge


Source-  http://www.fbi.gov/buffalo/press-releases/2012/michigan-man-arrested-on-health-care-fraud-charge

BUFFALO—U.S. Attorney William J. Hochul, Jr. announced today that Fitzgerald Anthony Hudson, 51, of Dearborn Heights, Michigan, was arrested and charged by criminal complaint with health care fraud. The charge carries a maximum penalty of 10 years’ imprisonment and a fine of $250,000.

Assistant U.S. Attorney Aaron J. Mango, who is handling the case, stated that according to the criminal complaint, in October 2007, the defendant obtained a New York state medical license. Thereafter, from August of 2008 to August of 2010, Hudson provided medical care in the Western District of New York at Jones Memorial Hospital in Wellsville, New York and the Nicholas H. Noyes Memorial Hospital in Dansville, New York. The defendant allegedly obtained his medical license by listing on his New York state application that he graduated from York University-Facility of Science, North York, Ontario, Canada, when he had not. In addition, Hudson failed to list that he had been dismissed from the Warren Hospital Family Practice residency program in July 2003.

As a result of his fraudulently obtained medical license, the defendant was improperly reimbursed approximately $200,000 under the Medicare Part-B and Part-D programs. Hudson was arrested today in Michigan, and an initial appearance on the charge has been scheduled for March 29, 2012 at 3 p.m. before United States Magistrate Judge H. Kenneth Schroeder, Jr.




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Sunday, March 18, 2012

Anthony Paul Breaux entenced for Defrauding Health Care Programs for Nuclear Weapons Workers and Certain Miners


Source-  http://www.fbi.gov/denver/press-releases/2012/palisade-man-sentenced-for-defrauding-health-care-programs-for-nuclear-weapons-workers-and-certain-miners 

DENVER—Anthony Paul Breaux, of Palisade, Colorado, was sentenced this morning to serve four years in federal prison for health care fraud and money laundering greater than $10,000 in connection with his actions to defraud government funded health care programs meant to compensate nuclear weapons workers and certain miners. The sentence was handed down by U.S. District Court Judge Christine M. Arguello. Following his prison sentence, Breaux was ordered to spend three years on supervised release. The defendant was also ordered to pay restitution of over $3,500,000 to the victims of his crime. Breaux is to surrender to a Bureau of Prisons facility within 30 days of designation. To date, the government, using asset forfeiture, has seized approximately $1,300,000.

Breaux was indicted by a federal grand jury on September 1, 2011. He pled guilty on November 10, 2011. He was sentenced today, Friday, March 16, 2012.

According to public court documents, including the indictment and the stipulated facts contained in the plea agreement, in October 2009, Breaux created and was acting as a registered agent for Honor-Bound Healthcare Providers (HBHP), a Colorado Corporation. Breaux owned 100 percent of Honor-Bound and was in the business of providing home health care services to patients in Colorado, Oregon, Arizona, and elsewhere.

Part of Honor-Bound’s patients were nuclear weapons workers or miners, millers, and transporters. In order to be reimbursed for providing medical services to these individuals, Breaux billed Energy Employees Occupational Illness Compensation Program (EEOICP) pursuant to the Radiation Exposure Compensation Act (RECA). EEOICP is a health care benefit program that provides lump-sum compensation and health benefits to eligible Department of Energy nuclear weapons workers. RECA provides coverage to eligible uranium miners, millers, and transporters. Coverage is extended under both acts to certain eligible survivors with lump-sum compensation that would have otherwise been payable to the workers. The United States Department of Labor (DOL), Office of Workers’ Compensation Programs, Division of Energy Employees Occupational Illness Compensation (DEEOIC) is responsible for administering EEOICP.

From June 2010 until June 2011, Breaux, doing business through Honor-Bound, knowingly and willfully executed and attempted to execute a scheme to defraud these health care benefit programs by submitting and causing to be submitted bills for payment knowing those bills already had been paid. In other cases, the defendant submitted invoices for services never provided. He obtained payments on the claims in part by submitting false supporting documentation. In total, the fraud the defendant perpetrated is over $3.5 million.

Breaux recruited individuals to provide care to the DEEOIC claimants he recruited who lived on the Indian Reservation in Arizona, and these individuals were family members who were already taking care of the beneficiaries. Breaux told the family members HBHP could pay them $13 per hour for care they were providing. The individuals who provided the care to the claimants in Arizona were not registered nurses, but Breaux billed DEEOIC at the registered nurse rate, $90 to $100 per hour, for the care the family members provided. Breaux knew this was not right, but he did it because of the large amount of money he was able to bring into HBHP. Breaux also forged doctor signatures he submitted to DEEOIC so that DEEOIC would authorize 24-hour, seven days a week home health care.

On or about December 4, 2010, Breaux knowingly engaged in a monetary transaction of criminally derived property of a value of $18,235.47 by writing, delivering, and causing the depositing and cashing of a check by a person Breaux used to recruit patients eligible as claimants; those funds had been derived from unlawful activity. The parties stipulated that the aggregate loss to the victims in this case was in excess of $3,400,000.

“Health care fraud is in part responsible for higher health care costs: whenever a government program is defrauded, every taxpayer is a victim,” said U.S. Attorney John Walsh. “Breaux defrauded a well-meaning program designed to address persons afflicted with serious conditions related to radiation exposure inherent in their jobs. The defendant’s conduct was reprehensible in light of the persons who should have benefitted from the funds associated with the program.”




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Saturday, March 17, 2012

Karina Hernandez, Marieva Briceno and Henry Briceno Plead Guilty for Their Roles in $5.4 Million Medicare Fraud Scheme


Source-  http://www.fbi.gov/detroit/press-releases/2012/three-detroit-area-clinic-owners-plead-guilty-for-their-roles-in-5.4-million-medicare-fraud-scheme 

WASHINGTON—Three Detroit-area clinic owners pleaded guilty today for their participation in a Medicare fraud scheme, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Karina Hernandez, 28; Marieva Briceno, 46; and Henry Briceno, 58, all of Miami, pleaded guilty before U.S. District Judge Arthur J. Tarnow in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, each defendant faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to the plea documents, Hernandez managed the daily operations of three Livonia, Michigan clinics: Blessed Medical Clinic, Alpha & Omega Medical Clinic, and Manuel Medical Clinic. Marieva Briceno contributed capital to fund the opening of one clinic, and assisted her daughter, Hernandez, in the daily management of the clinics. At each clinic, Hernandez and Marieva Briceno hired recruiters who paid cash bribes to Medicare beneficiaries to attend the clinics and provide their Medicare numbers and other information. Hernandez and Marieva Briceno admitted that they used the beneficiary information to bill for medically unnecessary diagnostic tests and treatments. Henry Briceno admitted that he incorporated Manuel Medical Clinic and opened a bank account to conceal the actual ownership of the clinic. According to court documents, Blessed Medical Clinic, Alpha & Omega Medical Clinic, and Manuel Medical Clinic fraudulently billed Medicare for $5.4 million during the course of the scheme.




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Friday, March 16, 2012

Dr. Jaswinder Rai Chhibber Convicted of Health Care Fraud Involving Unnecessary Patient Tests


Source-  http://www.fbi.gov/chicago/press-releases/2012/physician-who-operated-south-side-medical-clinic-convicted-of-health-care-fraud-involving-unnecessary-patient-tests 

CHICAGO—A federal jury yesterday convicted Dr. Jaswinder Rai Chhibber, a physician who operated a south side medical clinic, of engaging in a health care fraud scheme between 2007 and July 2010, federal law enforcement officials announced today. Chhibber, who operated the former Cottage Grove Community Medical Clinic located at 642 East 79th St., Chicago, was convicted of defrauding Medicare and Blue Cross Blue Shield of Illinois by submitting false insurance claims for medically unnecessary tests and using false diagnosis codes to justify the tests he had ordered.

Chhibber, 43, of Schaumburg, was found guilty of five counts of health care fraud and four counts of making false statements involving a health care benefits program after less than two full days of deliberations following a week-long trial in U.S. District Court. The jury found him not guilty of seven additional counts.

Chhibber remains free on bond pending sentencing, which U.S. District Judge Suzanne Conlon scheduled for May 10. He faces a maximum penalty of 10 years in prison on each count of health care fraud, and five years in prison on each false statements count, and a $250,000 fine on each count.

The evidence at trial showed that Chhibber ordered medically unnecessary tests, falsified patients’ medical records, and used false diagnosis codes on insurance claim forms in various fashions for at least five patients who testified at trial, including two undercover federal agents who posed as patients. Evidence also showed that Chhibber administered echocardiograms, electrocardiograms, nerve conduction studies, and carotid doppler and abdominal ultrasounds for an unusually high percentage of his Medicare and Blue Cross patients.




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Thursday, March 15, 2012

Lula Thurman Sentenced for East Texas Health Care Fraud


Source-  http://www.fbi.gov/houston/press-releases/2012/humble-woman-sentenced-for-east-texas-health-care-fraud 

BEAUMONT, TX—A 61-year-old Humble, Texas woman has been sentenced to federal prison for health care related fraud in the Eastern District of Texas, announced U.S. Attorney John M. Bales today.

Lula Thurman pleaded guilty on October 18, 2011 to conspiracy to commit health care fraud and was sentenced to 46 months in federal prison today by U.S. District Judge Thad Heartfield. Thurman was also ordered to pay restitution in the amount of $483,883.76.

According to information presented in court, from August 2005 to March 2007, Thurman, the owner of LT’s Faith-N-Action, a durable medical equipment (DME) supplier, devised and managed a scheme to commit $483,833.76 in health care fraud by falsifying Medicare applications and filing fraudulent Medicare and Medicaid claims for power wheelchairs allegedly supplied to victims of Hurricanes Katrina and Rita. Thurman and her associates recruited unwitting Medicare/Medicaid beneficiaries in Texas and Louisiana by promising them a free motorized wheelchair after Hurricanes Katrina and Rita. Thurman fraudulently billed Medicare using a special modifier code issued by Medicare for claims resulting from a catastrophe or disaster like Hurricanes Katrina and Rita. This code, called a “CR Modifier,” was supposed to be used by a DME supplier when that supplier had provided a replacement piece of equipment, like a power wheelchair, that had been severely damaged or destroyed by either Hurricane Katrina or Rita. Instead, Thurman used the CR Modifier for numerous power wheelchair claims where the CR Modifier did not apply because the beneficiary either did not possess a power wheelchair prior to either hurricane; did not suffer significant damage to, or destruction of, his/her power wheelchair from either hurricane; or never received a power wheelchair from the defendant after either Hurricane Katrina or Rita. Thurman was indicted by a federal grand jury on May 4, 2011.




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Wednesday, March 14, 2012

Mathis Moore Pleads Guilty to Participating in $200 Million Medicare Fraud Scheme


Source-  http://www.justice.gov/opa/pr/2012/March/12-crm-317.html 

WASHINGTON – A Miami-area resident pleaded guilty today for his role in a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Mathis Moore, 56, pleaded guilty before U.S. Magistrate Judge Barry L. Garber in Miami to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. Moore was charged in an indictment unsealed on Feb. 15, 2011, in the Southern District of Florida.

Moore admitted to participating in a fraud scheme that was orchestrated by the owners and operators of American Therapeutic Corporation (ATC); its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute (ASI). ATC, Medlink and ASI were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs), a form of intensive treatment for severe mental illness, in seven different locations throughout South Florida and Orlando. ASI purported to provide diagnostic sleep disorder testing.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities 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. 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 PHPs so that ATC and ASI could bill Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.

Moore admitted to serving as a patient broker who provided patients for ATC and ASI in exchange for kickbacks in the form of checks and cash. The amount of the kickback was based on the number of days each patient spent at ATC.

According to his plea agreement, Moore’s participation in the ATC fraud resulted in $17 million in fraudulent billings to the Medicare program.

Sentencing for Moore is scheduled for May 29, 2012, at 9:30 a.m. He faces a maximum penalty of 15 years in prison and a $250,000 fine.

ATC, Medlink, and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011. ATC, Medlink and 10 of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial April 9, 2012, before U.S. District Judge Patricia A. Seitz. A defendant is presumed innocent unless proven guilty beyond a reasonable doubt in a court of law.

Monday, March 12, 2012

Barry Nash Sentenced to 24 Months in Prison for Participating in Fraud and Kickback Scheme


Source-  http://www.fbi.gov/miami/press-releases/2012/broward-county-halfway-house-owner-sentenced-to-24-months-in-prison-for-participating-in-fraud-and-kickback-scheme 

WASHINGTON—The owner and operator of a Broward County, Florida halfway house was sentenced today to 24 months in prison for his role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Barry Nash, 69, was also sentenced by U.S. District Judge James Lawrence King in Miami to serve three years of supervised release following his prison term. Nash pleaded guilty on January 9, 2012 to one count of conspiracy to commit health care fraud. Nash was the owner and operator of Starter House, a halfway house operating in Broward County.

Nash admitted that, in exchange for illegal health care kickbacks, he agreed to refer Medicare beneficiaries who resided at Starter House to American Therapeutic Corporation (ATC) and American Sleep Institute (ASI), a company related to ATC. Nash knew that ATC and ASI fraudulently billed Medicare for partial hospitalization program (PHP) services and sleep treatment purportedly provided to his referrals. PHP is a form of intensive mental health treatment.

According to court documents, ATC’s principals paid kickbacks to owners and operators of assisted living facilities 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. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. Ultimately, ATC and ASI billed Medicare for more than $200 million in medically unnecessary services.

According to the plea agreement, Nash’s participation in the fraud resulted in more than $959,901 in fraudulent billing to the Medicare program.

ATC, its management company Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC, Medlink, and ASI were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on February 15, 2011. ATC, Medlink, and nine of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial April 9, 2012, before U.S. District Judge Patricia A. Seitz.




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Sunday, March 11, 2012

Akinsunbo Akinbile Sentenced to 30 Months in Prison in Connection with Medicare Fraud Scheme


Source-  http://www.fbi.gov/houston/press-releases/2012/owner-of-houston-health-care-company-sentenced-to-30-months-in-prison-in-connection-with-medicare-fraud-scheme 

WASHINGTON—An owner and operator of a Houston durable medical equipment (DME) company was sentenced today in Houston federal court to 30 months in prison for his role in a Medicare fraud scheme, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Akinsunbo Akinbile, 44, of Richmond, Texas, was sentenced by U.S. District Judge Keith P. Ellison in Houston. In addition to his prison term, Akinbile was sentenced to three years of supervised release and was ordered to pay $471,022 in restitution.

Akinbile pleaded guilty on November 29, 2011 to eight counts of health care fraud.

According to court documents, Akinbile was the owner and operator of Hallco Medical Supply, a company that purported to provide orthotics and other DME to Medicare beneficiaries. According to court documents, Hallco submitted claims to Medicare for DME, including orthotic devices that were medically unnecessary and/or not provided. Many of the orthotic devices were components of an “arthritis kit,” and purported to be for the treatment of arthritis-related conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heating pads. From June 2007 through May 2009, Akinbile submitted claims of approximately $737,770 to Medicare and was paid approximately $471,022.




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Friday, March 9, 2012

Two Doctors and Four Nurses Among 11 New Defendants Added to Case Alleging $20 Million Home Health Care Fraud Conspiracy, Medical Kickbacks


Source-  http://www.fbi.gov/chicago/press-releases/2012/two-doctors-and-four-nurses-among-11-new-defendants-added-to-case-alleging-20-million-home-health-care-fraud-conspiracy-medical-kickbacks-money-laundering-and-income-tax-evasion 

CHICAGO—Two physicians and four registered nurses are among 11 new defendants who were added to a federal indictment against a suburban Chicago man who operated two home health care businesses for allegedly swindling Medicare of at least $20 million over five years, federal law enforcement officials announced today. Nine of the 11 new defendants allegedly conspired with the initial defendant, Jacinto “John” Gabriel, Jr., to submit millions of dollars in false claims for reimbursement of home health care services purportedly provided to Medicare beneficiaries, which allegedly were never provided or were not medically necessary so that they could profit from the fraudulently-obtained funds. Gabriel and his co-schemers allegedly used the proceeds for various purposes, including using cash to gamble at casinos in the Chicago area and Las Vegas; to buy automobiles, jewelry; to purchase real estate in the United States and the Philippines; to perpetuate the businesses by paying his employees and providing them with gifts; and to bribe physicians and pay kickbacks to others in exchange for patient referrals.

Gabriel, 44, of Berwyn, who had no formal medical training, medical degrees, or licenses to practice as a health care professional, was charged in the new indictment with one count of health care fraud conspiracy, 43 counts of health care fraud, 11 counts of money laundering, and four counts of federal income tax evasion in a 69-count superseding indictment returned yesterday by a federal grand jury, announced Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois. Gabriel was arrested on preliminary charges in February 2011 and was charged alone in a 15-count indictment last summer. He pleaded not guilty to the original charges and is free on bond.

According to the indictment, Gabriel did not identify himself as an owner, but in fact exercised ownership and control over Perpetual Home Health, Inc., based in Oak Forest, and Legacy Home Healthcare Services, which was located on the city’s north side. Both firms have ceased operating and no longer receive Medicare payments. Between May 2006 and January 2011, Perpetual submitted more than 14,000 Medicare claims seeking reimbursement for services allegedly provided to beneficiaries. As a result of those claims, Perpetual received more than $38 million in Medicare payments. Between 2008 and January 2011, Legacy submitted more than 2,000 claims for Medicare reimbursement and received more than $6 million. Neither Perpetual nor Legacy had any sources of revenue other than Medicare funds, the indictment states.

The new defendants are:

Jassy Gabriel, 42, of Berwyn, John Gabriel’s brother, the nominal majority owner of Perpetual and its president, as well as a registered nurse. He was charged with one count of health care fraud conspiracy and one count of filing a false federal income tax return.

Stella Lubaton, 46, of Midlothian, a minority owner of Perpetual and an officer and administrator, as well as a registered nurse. She was charged with one count of health care fraud conspiracy, 16 counts of health care fraud, one count of filing a false federal income tax return, and one count of violating the medical anti-kickback statute.

Nessli Reyes, 35, of Elgin, part-owner of Legacy and its president, as well as a registered nurse. She was charged with one count of health care fraud conspiracy and nine counts of health care fraud.

Charito Dela Torre, 71, of Berwyn, a physician, was charged with one count of health care fraud conspiracy, 12 counts of health care fraud, and three counts of federal income tax evasion.

Ricardo Gonzales, 75, of Orland Park, a physician, was charged with one count of health care fraud conspiracy, 19 counts of health care fraud, and one count of violating the medical anti-kickback statute.

Rosalie Gonzales, 42, of Chicago, a registered nurse and Ricardo Gonzales’ daughter, was charged with one count of violating the medical anti-kickback statute.

James Davis, 37, of West Chicago; Francis Galang, 27, of Crest Hill; and Michael Pacis, 38, of Homer Glen, all data entry employees of Perpetual, were charged with one count each of health care fraud conspiracy.

Regelina “Queenie” David, 58, of Joliet, a Perpetual quality assurance employee, was charged with one count of health care fraud conspiracy.

Kennedy Lomillo, 44, of Mundelein, who provided bookkeeping and payroll services to Perpetual and also prepared a corporate tax return for Perpetual, as well as an individual return for Lubaton, was charged with two counts of aiding and abetting the preparation of false income tax returns.

The indictment also seeks forfeiture of $20 million against the Gabriel brothers and Lubaton.

As part of the conspiracy, Gabriel, acting in various combinations with the nine co-conspirators, allegedly obtained personal information of Medicare beneficiaries to bill Medicare without the beneficiaries’ knowledge or consent; paid bribes and kickbacks in cash and by check, directly and indirectly, to physicians and others in exchange for referrals of patients to Perpetual and Legacy; created false patient files to support fraudulent Medicare claims and submitted false claims based on those records; used Medicare proceeds to pay themselves and others who assisted in carrying out the scheme; and concealed the fraud proceeds by directing Perpetual and Legacy to issue checks payable to fictitious entities, John Gabriel’s friends and associates.

Among other details, the indictment alleges that John and Jassy Gabriel, Lubaton, and Reyes authorized Perpetual and Legacy to pay various amounts, ranging between $200 and $800, to employees and others, including indirectly to Ricardo Gonzales, for each patient they referred and enrolled in home health care services. John Gabriel and others also cold-called Medicare beneficiaries to try to persuade them to enroll with Perpetual and Legacy.

As part of allegedly falsifying patient records, John Gabriel directed Perpetual and Legacy employees, including Davis, Galang, and Pacis, to systematically complete standard forms by listing the same false diagnoses, including arthropathy (joint disease) and hypertension, which enabled them to claim a higher level of Medicare reimbursement, according to the charges.

In addition to the fraud counts, the money laundering charges allege that between October and December 2010, Gabriel cashed 11 checks in amounts under $10,000—usually $9,000 and all involving fraud proceeds—to avoid federal currency transaction reporting requirements.

The four tax evasion counts against John Gabriel allege that for calendar years 2006 through 2009, he failed to pay taxes totaling approximately $889,062 on gross income totaling more than $2.82 million. The three tax evasion counts against Dela Torre allege that for calendar years 2005 through 2007, she failed to pay taxes totaling approximately $158,405 on gross income totaling more than $560,000.

Lubaton was charged with filing a false tax return for 2007 for allegedly failing to report all of her income, which was in excess of the $546,442 that she reported, and Lomillo was charged with aiding and abetting the preparation of her false return. Jassy Gabriel was charged with filing a false tax return for 2007 for allegedly failing to report all of his adjusted gross income, which exceeded the $603,974 that he reported, and Lomillo was charged with aiding and abetting the preparation of his false return.

Health care fraud conspiracy and each count of health care fraud carries a maximum penalty of 10 years in prison and a maximum fine of $250,000, or an alternate fine totaling twice the loss or twice the gain, whichever is greater, as well as mandatory restitution. Each count of money laundering carries a maximum 20-year prison term and a maximum fine of $500,000. Violating the medical anti-kickback statute carries a maximum penalty of five years in prison and a $250,000 fine. Each count of tax evasion carries a five-year maximum prison term, while each count of filing a false income tax return carries a three-year maximum, and a $250,000 fine. In addition, defendants convicted of tax offenses must pay the costs of prosecution and remain liable for any and all back taxes, as well as a potential civil fraud penalty of 75 percent of the underpayment plus interest. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.




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Wednesday, March 7, 2012

Mario Roncal Charged for Allegedly Treating Patients Without a License, Falsifying Billings to Medicare


Source-  http://www.fbi.gov/newark/press-releases/2012/medical-assistant-charged-for-allegedly-treating-patients-without-a-license-falsifying-billings-to-medicare 

NEWARK—A federal grand jury has indicted a medical assistant for a pair of large medical services companies with offices in New Jersey and New York who allegedly posed as a doctor and treated patients without a license, U.S. Attorney Paul J. Fishman announced.

Mario Roncal, 60, of Woodland Park, New Jersey, is charged with one count of conspiracy to commit health care fraud. Roncal surrendered this morning to special agents of the FBI in Newark and is expected to appear before U.S. Magistrate Judge Cathy L. Waldor this afternoon in Newark federal court.

According to the indictment returned on March 2, 2012 and unsealed today:

Roncal has a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico, but is not licensed to practice medicine in New Jersey, New York, or any other state. Roncal is ineligible under New Jersey law to obtain a medical license in New Jersey because San Juan Bautista School of Medicine is not properly accredited and he lacks certain requirements for international medical students.

From approximately 2004 through 2008, Roncal was employed as a medical assistant at a pair of companies owned and run by the same chief executive officer. Cardio-Med Services, LLC (“Cardio-Med”), provided cardiology, internal medicine, and other outpatient medical services to individual patients and had offices in Union City, Paterson, and West New York, New Jersey. Comprehensive Healthcare & Medical Services, LLC (“Comprehensive Healthcare”), provided the same services in New York and Queens, New York.

Roncal conspired to commit health care fraud with the company’s CEO over a four-year period.

When working at Cardio-Med and Comprehensive Healthcare, Roncal held himself out to fellow employees and to patients as “Dr. Roncal.” He examined new patients as well as the CEO’s follow-up patients and ordered diagnostic tests. Roncal also diagnosed patients with medical conditions and diseases and prescribed courses of treatment, including surgery.

Roncal also falsified the accompanying medical records to create the illusion that the medical services were being provided by the companies’ CEO, a licensed physician and board-certified cardiologist. At the direction of the CEO and otherwise, Roncal forged the CEO’s signature on all paperwork associated with his unlawful services, including on prescription pads and patient charts. Roncal and the CEO enriched themselves by submitting the false billing claims to Medicare.

The count with which Roncal is charged carries a maximum potential penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense.




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