Wednesday, October 31, 2012

Chyawan Bansil was Sentenced to 13 Months Prison on Charges of Health Care Fraud and Money Laundering


Source- http://www.justice.gov/usao/miw//news/2012/2012_1029_CBansil.html

GRAND RAPIDS, MICHIGAN – U.S. District Judge Robert Holmes Bell sentenced Chyawan Bansil, P.T., Ph.D., 61, of Farmington Hills, Michigan to 13 months prison on charges of health care fraud and money laundering, U.S. Attorney Patrick A. Miles, Jr. announced today. The convictions arise from an Indictment which charged that between February 2007 and January 2012, Dr. Bansil defrauded Medicare, Medicaid, and Blue Cross Blue Shield of Michigan of more than $1 million by causing those programs to be billed for expensive nerve conduction studies and needle electromyography tests that Dr. Bansil did not perform.

The case against Dr. Bansil resulted from a joint investigation conducted by the Lansing Police Department, IRS-Criminal Investigation, Blue Cross Blue Shield of Michigan, the Office of Inspector General for the Department of Health and Human Services, and the Michigan Attorney General’s Office. The billing fraud was initially discovered by officers from the Lansing Police Department and personnel from Blue Cross and Blue Shield of Michigan who were investigating prescription drug diversion in Lansing, Michigan. After undercover Lansing Police officers received suspicious services from Dr. Bansil at a physician’s office in Lansing, federal investigators examined both the medical practices as well as the financial records of Dr. Bansil and confirmed that Dr. Bansil was billing for services that he did not perform and was illegally laundering the proceeds of his fraud scheme in order to avoid taxes.

At the sentencing hearing in held in Grand Rapids, Judge Bell noted that Dr. Bansil violated the trust of patients and “worsened the health care crisis” in this country. As part of his plea agreement, Dr. Bansil forfeited over $500,000 in assets which had been seized by the government and paid an additional $2.25 million dollars in treble damages to resolve related civil claims under the False Claims Act. Dr. Bansil also paid almost $250,000 in back taxes that were uncovered by the IRS during the investigation. Dr. Bansil was also ordered to serve one year of supervised release following his incarceration and will be excluded from participating with Medicare and Medicaid for a minimum of five years.

“The Western District of Michigan’s U.S. Attorney’s Office is protecting the integrity of America’s public and private health care programs,” U.S. Attorney Miles said. “Billing those programs for services that are not rendered wrongly enriches providers and harms taxpayers and patients. This office will continue to pursue both criminal and civil proceedings, and employ the resources of our law enforcement and private insurance partners, to ensure criminal and civil remedies are brought to bear on providers who exploit their patients for unlawful and selfish financial gain. Those who attempt to defraud the system will suffer the specter of incarceration, treble damages, civil penalties, forfeiture, and future exclusion from participating with Medicare and Medicaid.”



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Tuesday, October 30, 2012

Davit Mirzoyan Pleads Guilty In Manhattan Federal Court To Racketeering And Other Crimes


Source- http://www.justice.gov/usao/nys/pressreleases/October12/MirzoyanDavitPleaPR.php

Preet Bharara, the United States Attorney for the Southern District of New York, announced today that DAVIT MIRZOYAN pled guilty today in Manhattan Federal Court to racketeering and other crimes in connection with his involvement in an Armenian-American criminal organization involved in a wide range of criminal activity, including a massive Medicare fraud. MIRZOYAN pled guilty before United States Magistrate Judge Henry B. Pitman.

Manhattan U.S. Attorney Preet Bharara said: “Davit Mirzoyan was a criminal parasite feeding on a grand scale off our country’s health care system for personal financial gain and draining Medicare of needed funds. His guilty plea today ensures he will be held to account for his actions.”

According to the Indictment and other documents filed in this case:

From 2006 to 2010, DAVIT MIRZOYAN led a nationwide Medicare scam that fraudulently billed Medicare for over $100 million. MIRZOYAN and others created dozens of “phantom clinics,” health care providers that existed only on paper. These clinics did not have any doctors and treated no patients. At least 118 fraudulent Medicare providers, located in approximately 25 states, submitted fraudulent bills to Medicare totaling approximately $100 million, and received approximately $35.7 million.



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Monday, October 29, 2012

Detroit Area Physician Dr. Pramod Raval, Home Health Agency Owner Chiradeep Gupta and Patient Recruiter Richard Shannon Were Convicted in $14.5 Million Medicare Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1297.html

WASHINGTON – A federal jury in Detroit today convicted a physician, a home health agency owner and a patient recruiter for their participation in a $14.5 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Robert Foley III, Special Agent in Charge of the FBI Detroit Field Office; and Special Agent in Charge Lamont Pugh, III of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Detroit Office.

Dr. Pramod Raval, 59, was found guilty in U.S. District Court for the Eastern District of Michigan of one count of conspiracy to commit health care fraud and one count of conspiracy to solicit or receive health care kickbacks in exchange for referring patients to two Detroit area home health care companies, Patient Choice Home Healthcare Inc. and All American Home Care Inc.

Chiradeep Gupta, 38, a physical therapist and part-owner of All American, was found guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to commit money laundering and three substantive counts of money laundering.

Richard Shannon, 39, a patient recruiter, was found guilty of one count of conspiracy to commit health care fraud.

The defendants were charged in a superseding indictment returned March 27, 2012. Sixteen other individuals who worked at or were associated with Patient Choice and All American have previously pleaded guilty.

According to evidence presented at trial, the defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare through Patient Choice and All American, two home health care companies located in Oak Park, Mich., that purported to provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area.

The evidence showed that the defendants and their co-conspirators used patient recruiters, who paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. The owners of Patient Choice and All American paid physicians to sign referrals and other therapy documents necessary to bill Medicare. Physical therapists and physical therapist assistants provided through contractors would then create fake medical records using the blank, pre-signed forms obtained by the patient recruiters to make it appear as if physical therapy services were actually rendered, when, in fact, the services had not been rendered.

According to evidence presented at trial, Raval referred both patients from his own practice and patients brought into the scheme by recruiters to Patient Choice and All American in exchange for kickbacks. Gupta provided to Patient Choice and All American physical therapists and physical therapist assistants who created fake patient files using blank, pre-signed forms obtained by patient recruiters, to make it appear as if the physical therapy services billed to Medicare had actually been given. Gupta also doctored and directed the doctoring of fake patient files. The evidence at trial showed that Gupta laundered the proceeds of the fraud through multiple shell companies. Shannon paid patients in cash in order to obtain their signatures on blank physical therapy forms used to create fake therapy documents.

Vishnu Meda, a physical therapist assistant at Patient Choice and All American, was acquitted today of one count of conspiracy to commit health care fraud.



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Sunday, October 28, 2012

Raymond Rivero and Ivon Perez Each Plead Guilty for Roles in $63 Million Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1296.html

WASHINGTON – Two owners of Miami area assisted living facilities (ALF) pleaded guilty today in connection with a health care fraud scheme involving defunct Miami area health 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.

Raymond Rivero, 55, of Homestead, Fla., and Ivon Perez, 50, of Miami, each pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to solicit and receive cash kickbacks. Rivero, who was the owner of Miami-based God Is First ALF, and Perez, who was the owner of Kayleen and Denis Care Corp, admitted to participating in a fraud scheme that was orchestrated by the owners and operators of HCSN, which operated purported partial hospitalization programs (PHPs), a form of intensive mental health treatment for severe mental illness.

Earlier this week, the owner of another ALF in the Miami area that was involved in the HCSN fraud scheme pleaded guilty for his role in the scheme. On Oct. 22, 2012, Daniel Martinez, 45, of Homestead, the owner of Mi Renacer ALF, pleaded guilty before Judge Altonaga to one count of soliciting and receiving cash kickbacks.

According to an indictment unsealed on May 2, 2012, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not provided. HCSN obtained those beneficiaries by paying kickbacks to owners and operators of ALFs or by otherwise recruiting them from ALFs and nursing homes. Rivero, Martinez and Perez pleaded guilty to referring Medicare and/or Florida Medicaid beneficiaries to HCSN in exchange for cash bribes.

According to court documents, ALF residents referred by Rivero, Martinez and Perez were not qualified to be placed in HCSN’s PHP and were only selected because they had Medicare or state of Florida Medicaid benefits. In some cases, ALF patients suffered from dementia, Alzheimer’s disease or mental retardation or were otherwise unable to benefit from the purported mental health services.

According to court documents, from 2004 through 2011, HCSN billed Medicare and Medicaid approximately $63 million for purported mental health services.

Perez also pleaded guilty before Judge Altonaga in another criminal case to a second count of conspiracy in connection with accepting kickbacks from Superstar Home Health Care Inc. for purported home health services to her ALF residents.

In another related case, a former HCSN employee, Sarah Da Silva Keller, 28, was sentenced by U.S. District Judge Marcia G. Cooke in the Southern District of Florida to a 24 month prison term and ordered to pay $1,067,300 in restitution to the Medicare program. In June 2012, Keller pleaded guilty to an information charging one count of conspiracy to commit health care fraud.

According to court documents, Keller falsified patient attendance and medical records for Medicare beneficiaries who attended HCSN for mental health treatment. The falsified records were then utilized to submit fraudulent billing to the Medicare program. According to Keller’s plea agreement, Keller’s participation in the fraud resulted in more than $2.4 million in fraudulent billing to the Medicare program.



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Friday, October 26, 2012

Boehringer Ingelheim Pharmaceuticals Inc. to Pay $95 Million to Resolve False Claims Act Allegations



Connecticut-based Boehringer Ingelheim Pharmaceuticals Inc. has agreed to pay $95 million to resolve allegations relating to the improper promotion of the stroke-prevention drug Aggrenox, the chronic obstructive pulmonary disease (COPD) drugs Atrovent and Combivent, and the hypertension drug Micardis, the Justice Department announced today.

The Food and Drug Administration (FDA) has approved Aggrenox to prevent secondary strokes, Combivent to treat continued symptoms of bronchospasm in patients with COPD who already are on a bronchodilator and Micardis to treat hypertension. The settlement resolves allegations that Boehringer improperly marketed each of these drugs and caused false claims to be submitted to government health care programs.

According to the government’s allegations, Boehreinger promoted each of the three drugs for uses that were not medically accepted indications and were not covered by federal health care programs. Specifically, the settlement resolves allegations that Boehreinger promoted Aggrenox for certain cardiovascular events such as myocardial infarction and peripheral vascular disease; that Combivent was marketed for use prior to another bronchodilator in treating COPD; and that Micardis was marketed for treatment of early diabetic kidney disease. The uses were not for medically accepted indications and were not covered by federal health care programs

Additionally, the settlement resolves allegations that Boehringer knowingly promoted the sale and use of Combivent and Atrovent at doses that exceeded those covered by federal health care programs and that Boehringer knowingly made unsubstantiated claims about the efficacy of Aggrenox, including that it was superior to Plavix. Finally, the agreement resolves allegations that the company paid kickbacks to health care professionals to induce them to prescribe Aggrenox, Atrovent, Combivent and Micardis.

As a result of today’s $95 million settlement, the federal government will obtain $78,455,048, and state Medicaid programs will obtain $16,544,952.

The settlement resolves a False Claims Act lawsuit filed in the District of Maryland by Robert Heiden, a former sales representative for Boehringer. The whistleblower, or qui tam, provisions of the False Claims Act permit the relator to obtain a portion of the proceeds obtained by the federal government. As part of today’s resolution, Mr. Heiden will receive more than $17 million.

“The improper promotion of pharmaceuticals undermines the FDA’s important role in protecting the American public by determining whether a drug is safe and effective for a particular use before it is marketed,” said Stuart Delery, Acting Assistant Attorney General for the Civil Division. “Such improper conduct by pharmaceutical companies also causes the government to pay significant amounts for products for which it would not otherwise pay. This civil settlement by Boehringer demonstrates that such conduct will not be tolerated.”

“Pharmaceutical companies cannot market drugs for unapproved uses, make unwarranted claims about their benefits, or pay kickbacks to doctors who prescribe them,” said Rod J. Rosenstein, U.S. Attorney for the District of Maryland. “Drugs should be marketed only for purposes for which they are deemed safe and effective, and a doctor’s decision to prescribe a drug should not be influenced by his personal financial interest.”

Also as part of the settlement, Boehringer has agreed to enter into an expansive Corporate Integrity Agreement that provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to the settlement.

“Fraudulent marketing of drugs through off-label promotion and kickbacks to doctors undermines trustworthy medical decision-making, and FDA’s protections in the drug approval process. “Such conduct -- as alleged in this case -- poorly serves patients and taxpayers alike,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services (HHS). “OIG is overseeing a Corporate Integrity Agreement to improve the transparency of company relationships with physicians and accountability of Board members and corporate executives.”

“Today’s settlement sends a strong message to the pharmaceutical industry that the federal government will not tolerate fraudulent activity which undermines the integrity of the health care system,” said Ilisa Bernstein, Acting Director of the Office of Compliance in the FDA’s Center for Drug Evaluation and Research.



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Thursday, October 25, 2012

Dr. Ramanathan Prakash was Sentenced To Lengthy Prison Sentence In Medicare Fraud Case


Source- http://www.justice.gov/usao/cae/news/docs/2012/10-2012/10-24-12PrakashSent.html

SACRAMENTO, Calif.– Dr. Ramanathan Prakash, 65, of Northridge, CA, was sentenced today by United States District Judge Morrison C. England, Jr. to a statutory maximum 10 year prison sentence. The defendant had been found guilty of Conspiring to Commit healthcare fraud, and three counts of healthcare fraud by a jury on July 8, 2011. Judge England also imposed a $75,000 fine and ordered Prakash to pay $607,456.80 in restitution.

According to testimony presented at trial, from February 2006 through August 2008, Vardges Egiazarian, 63, of Panorama City, owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael. Egiazarian and others recruited doctors to submit applications to Medicare for billing numbers. Prakash participated in the establishment of a clinic in Sacramento, although he lived in the Los Angeles area. He established the Medicare provider number for the clinic, signed the lease and established a bank account for the clinic. He only visited the clinic twice.

According to evidence at trial, Prakash never treated a single patient at the clinic. Clinic patients, almost all of whom were elderly and non-English speaking, were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally $100 per visit. False charts were created stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.

Patient files were then transported to Los Angeles where Prakash signed them indicating he provided or approved the treatments. In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. In return for their roles, Prakash and the other physicians received 20 percent of the billings paid under their provider numbers.



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Wednesday, October 24, 2012

Rodolfo Nieto Jr., was Sentenced to 37 Months in Prison for $60 Million Health Care Fraud Scheme


Source- http://www.justice.gov/usao/fls/PressReleases/121023-02.html

The owner of a Miami health care agency was sentenced today to 37 months in prison for his participation in a $60 million home health Medicare fraud scheme, announced U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; 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.

Rodolfo Nieto Jr., 40, of Miami, was sentenced today by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Nieto was sentenced to serve three years of supervised release and ordered to pay $1.1 million in restitution.

On Aug. 14, 2012, Nieto pleaded guilty in the Southern District of Florida to one count of conspiracy to defraud the United States and to receive health care kickbacks.

Nieto was the owner and operator of Ronat Home Health Care Inc. According to court documents, during the time of the conspiracy, Ronat was a Florida home health “staffing agency” that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. Ronat subsequently became a home health agency.

According to court documents, from approximately January 2006 to approximately November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries to be placed at Nany Home Health Inc., a Miami home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. The owners and operators of Nany paid Nieto kickbacks in return for allowing Nany to bill the Medicare program on behalf of the patients Nieto had recruited through Ronat. Specifically, as part of the scheme, Nany billed Medicare for home health services purportedly provided by Ronat.

In a related case, on April 25, 2012, Roberto Gonzalez and Olga Gonzalez, president and vice president of Nany, and their son, Fabian Gonzalez, all of whom operated Nany, were sentenced to 120, 87 and 87 months in prison, respectively, following their Dec. 19, 2011, guilty pleas to one count each of conspiracy to commit health care fraud. From approximately January 2006 through November 2009, Roberto, Olga and Fabian Gonzalez and their co-conspirators submitted approximately $60 million in false and fraudulent claims to Medicare, and Medicare paid approximately $40 million on those claims.



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Tuesday, October 23, 2012

Tahib Smith Ali was Sentenced for Health Care Fraud


Source- http://www.fbi.gov/philadelphia/press-releases/2012/phony-chiropractor-sentenced-for-health-care-fraud

PHILADELPHIA—Tahib Smith Ali, 35, of Philadelphia, was sentenced yesterday to 72 months in prison for posing as a chiropractor between January 2009 and December 2009 and for fraudulently billing Independence Blue Cross under the name of and medical provider number of a licensed chiropractor. Ali pleaded guilty in June to 50 counts of health care fraud, 50 counts of false statements in health care matters, and one count of aggravated identity theft. Ali was operating a Philadelphia clinic known as “Oasis Holistic Healing Village” on S. 17th Street in Philadelphia when he perpetrated his fraud scheme. He saw patients and represented to them that he was a chiropractor. Ali holds no medical licenses. He submitted approximately $1.5 million in fraudulent claims for chiropractic services to Independence Blue Cross (IBC) under the name and medical provider number of a licensed chiropractor who no longer worked at the clinic. Ali also billed IBC for chiropractic services that were never actually provided and for patient visits that never occurred.

In addition to the prison term, two years of which is a mandatory term for the aggravated identity theft, U.S. District Court Judge Mitchell S. Goldberg ordered Ali to pay restitution in the amount of $287,972.13, a special assessment of $10,100 and three years of supervised release.



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Monday, October 22, 2012

Hassan Collins was Sentenced to 51 Months in Prison for Role in Medicare Fraud Scheme


Source- http://www.fbi.gov/miami/press-releases/2012/owner-and-operator-of-florida-halfway-house-sentenced-to-51-months-in-prison-for-role-in-medicare-fraud-scheme

WASHINGTON—The owner and operator of New Way Recovery Inc., a Florida corporation that operated several halfway houses, was sentenced today to serve 51 months in prison for his role in a $205 million Medicare fraud scheme involving fraudulent claims for purported partial hospitalization program (PHP) services, 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 HHS Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.

Hassan Collins, 41, was sentenced by U.S. District Judge Kevin Michael Moore in the Southern District of Florida. In addition to his prison term, Collins was sentenced to serve three years of supervised release and ordered to pay $2,413,675 in restitution, jointly and severally with co-conspirators.

On June 14, 2012, Collins pleaded guilty to one count of conspiracy to receive and pay health care fraud kickbacks.

According to court documents, from approximately April 2004 through approximately September 2010, Collins, along with co-conspirators, received kickback payments in exchange for referring Medicare beneficiaries, who did not qualify for PHP treatment, for purported PHP services to American Therapeutic Corporation (ATC), a Florida corporation that operated several purported PHPs throughout Florida. Collins and his co-conspirators caused false and fraudulent claims to be submitted to Medicare for PHP services purportedly provided to Medicare beneficiaries at ATC’s locations, when, in fact, the services were never provided.

In related cases, ATC; its management company, Medlink Professional Management Group Inc.; and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC were charged with various health care fraud, kickback, money laundering, and other offenses in two indictments unsealed in February 2011. ATC, Medlink, and more than 20 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial.



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Sunday, October 21, 2012

Herman Jackson and Jannette Faria Were Indicted for Defrauding State Child Care Assistance Program Through Cicero Day Care Centers


Source- http://www.fbi.gov/chicago/press-releases/2012/couple-indicted-for-defrauding-state-child-care-assistance-program-through-cicero-day-care-centers

CHICAGO—A former Chicago couple who were involved with a series of daycare centers in suburban Cicero that participated in a state child care assistance program were indicted on federal charges for obtaining fraudulent state subsidy payments. The defendants allegedly fraudulently obtained Child Care Assistance Program subsidy payments from the state of Illinois by submitting false information to receive the benefits for a succession of three child care centers.

Herman Jackson owned one of the child care centers, St. Peters Christian Academy, until it closed in April 2004, and he was also involved in the operation of Jubilee Daycare Center, which closed in August 2008, and ABC Cicero Kids, which closed in February 2011. Jackson is also bishop of the Ark of Safety Apostolic Faith Temple, in Cicero, where each of the day care centers was housed.

Jackson, 36, of suburban Summit and Canton, Georgia, was arrested Wednesday and released on his own recognizance with electronic monitoring after pleading not guilty to the charges.

Jackson’s wife, Jannette Faria, 36, also of Canton, Georgia, and formerly of Chicago, is scheduled to be arraigned at 9:45 a.m. on Monday before U.S. District Judge Sharon Johnson Coleman in Federal Court in Chicago. Faria was the nominal owner of ABC Cicero.

Jackson was charged with 12 counts of mail or wire fraud and two counts of making false statements, and Faria was charged with eight counts of wire or mail fraud and one count of making false statements in a 15-count federal grand jury indictment that was unsealed after Jackson arrested.

The charges were announced today by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois, and William C. Monroe, Acting Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation.

The state Child Care Assistance Program, funded through the Illinois Department of Human Services, provides low-income working families with affordable child care. Eligible families are required to pay a portion of the cost of child care on a sliding scale according to family size, income, and number of children in care, with the state paying the remaining cost of child care services. Illinois Action for Children, a resource and referral agency in Cook County, contracts with IDHS to oversee and administer the Child Care Assistance Program locally. Each family eligible for subsidy payments is required to make a co-payment directly to the child care provider, which, in turn, submits reports to the local agency seeking payment for the remaining portion of services.

According to the indictment, Jackson prepared and submitted false applications on behalf of parents seeking approval to receive subsidy payments. Jackson knew that many of these applications contained false information regarding a client’s employment and income, the amount of time a child would spend at the child care center, and the number and names of children attending the center. Jackson further submitted reports falsely representing the name of number of children attending St. Peters and Jubilee child care centers, the number of days attended, and whether full or part-time to obtain subsidy payments that he was not entitled to receive. Jackson and Faria similarly submitted false information regarding enrollments at ABC Cicero, the indictment alleges.

Jackson’s temple operated a program called Single Moms Ministry, which he used to identify parents who were potentially eligible to receive subsidy payments. The indictment alleges that he required ministry participants to have at least two children enrolled at ABC Cicero who were eligible for child care subsidy, and he directed certain ministry participants to complete applications for Child Care Assistance Program benefits.

The defendants also allegedly lied to federal agents in 2011 when they were questioned about their participation in the subsidy program and their operation of the child care centers.

The indictment does not specify the amount of state funds that were allegedly fraudulently obtained, nor the number of children for whom false certifications were submitted. It does seek forfeiture of an unspecified amount of proceeds from the fraud scheme.

Each count of mail and wire fraud carries a maximum penalty of 20 years in prison and a $250,000 fine or an alternate fine totaling twice the loss or twice the gain, whichever is greater. Each count of making false statements carries a maximum of five years in prison and a $250,000 fine. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.



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Saturday, October 20, 2012

Beatriz Ramos has Pleaded Guilty for her Role in a Conspiracy and Scheme to Defraud Medicare and Medicaid


Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20October/121016%20Ramos.html

McALLEN, Texas - Beatriz Ramos, 28, of Edinburg, a former biller for RGV DME, a now defunct McAllen area durable medical equipment (DME) business, has pleaded guilty today for her role in a conspiracy and scheme to defraud Medicare and Medicaid through fraudulent billings, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott.

Ramos, a former biller for Marcelo Herrera who did business as RGV DME was charged along with Herrera, 39, his wife Carla Cantu Herrera, 31, and Ramon De La Garza, 51, all of Mission, in a 22-count federal indictment on June 26, 2012. The charges included one count of conspiracy to commit health care fraud, six counts of health care fraud, five counts of wire fraud and 10 counts of aggravated identity theft.

Ramos appeared in front of United States District Judge Micaela Alvarez this afternoon and entered a plea of guilty to conspiring with Marcelo Herrera, his wife and De La Garza to submit false and fraudulent claims to Medicare and Medicaid. Ramos admitted bills were sent to Medicare and to Medicaid for DME that was never prescribed, never delivered and not needed. Ramos also admitted that to conceal their fraud, she and her co-defendants forged and falsified documents and illegally used the identities of beneficiaries and doctors on their unlawful billings.

The indictment alleges Marcelo Herrera doing business as RGV DME submitted approximately 25,000 claims totaling approximately $11 million to Medicare and Texas Medicaid for DME allegedly provided to Medicare and Medicaid beneficiaries and was paid more than $7.1 million. Ramos admitted that 80 to 90 percent of the billings were fraudulent and that the fraudulent claims to Medicare were sent by wire transmissions in interstate commerce.

Ramos faces up to 10 years in federal prison and a possible $250,000 fine for conspiracy to commit health care fraud. Ramos remains free on bond pending sentencing which is scheduled for Jan. 16, 2013.



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Friday, October 19, 2012

Raymond Arias and Emelitza Arias Plead Guilty in Detroit-Area Infusion Therapy Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1253.html

WASHINGTON – Two owners and operators of clinics that claimed to specialize in treating HIV and other conditions pleaded guilty today for their roles in an infusion therapy scheme carried out at two Detroit-area clinics that submitted millions of dollars in fraudulent claims to Medicare.

The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Department of Justice’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Special Agent in Charge Robert Foley III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (HHS-OIG) Chicago Regional Office.

Raymond Arias, 40, and his wife, Emelitza Arias, 25, of Troy, Mich., each pleaded guilty, before U.S. District Judge Paul D. Borman of the Eastern District of Michigan, to one count of conspiracy to commit health care fraud. At sentencing, the defendants each face a maximum potential penalty of 10 years in prison and a $250,000 fine. Sentencing is currently scheduled for Feb. 12, 2013.

According to plea documents, Raymond Arias conceived of and oversaw fraud schemes at two clinics for which he was a beneficial owner: Elite Wellness LLC, and Carefirst Occupational & Rehabilitation Center Inc. He admitted to paying physicians to refer Medicare beneficiaries to Elite Wellness, and to purchasing Medicare beneficiary identifications for the purpose of submitting fraudulent claims to Medicare for expensive infusion therapy services that were not rendered as claimed by Carefirst.

According to court documents, Raymond Arias attempted to hide the Elite Wellness scheme from law enforcement by directing a nominee owner to assume control of the claims submitted and the bank account into which Medicare payments were deposited. After the nominee owner became involved, Raymond Arias and his alleged co-conspirators submitted approximately $10 million in claims over a 3-month period beginning in August 2010.

According to court documents, Raymond Arias directed this nominee to transfer approximately $2.6 million in Medicare payments offshore to Panama and Mexico.

Between approximately October 2009 and October 2010, Raymond Arias admitted, he and his alleged co-conspirators at Elite Wellness submitted or caused to be submitted approximately $12.5 million in fraudulent claims to the Medicare program for infusion therapy services that were not rendered. Medicare paid approximately $5.4 million of those claims.

According to plea documents, Emelitza Arias participated with her husband in a scheme to defraud Medicare by submitting claims for expensive infusion therapy services that were not rendered by Carefirst, of which she was also an owner. In an attempt to create an appearance that Carefirst was a legitimate enterprise, Emelitza Arias injected Medicare beneficiaries with vitamins. Emelitza Arias also assumed responsibility for the claims submitted by Carefirst, and managed the bank account into which the fraud proceeds were deposited.

Between approximately July 2010 and June 2011, Raymond and Emelitza Arias and their alleged co-conspirators at Carefirst submitted or caused to be submitted more than $900,000 in fraudulent claims to the Medicare program for infusion therapy services that were not rendered. Medicare paid approximately $530,000 of those claims.



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Thursday, October 18, 2012

Chirag Patel Admits Bribing Doctors In Cash-For-Patients Scheme


Source- http://www.justice.gov/usao/nj/Press/files/Patel,%20Chirag%20Plea%20News%20Release.html

NEWARK, N.J. – The former executive director of Orange Community MRI LLC, today admitted paying bribes to doctors since April 2008 and agreed to forfeit $89,000 in proceeds from the crime, U.S. Attorney Paul J. Fishman announced.

Chirag Patel, 37, of Warren, N.J., pleaded guilty to an Information charging him with one count of soliciting and receiving illegal cash kickbacks for patient referrals in violation of the federal health care anti-kickback statute.

According to documents filed in this case and statements made in court:

On Dec. 8, 2011, Patel was arrested and charged with offering and paying cash kickbacks to a New Jersey health care practitioner in exchange for referrals to Orange Community MRI. On Dec. 13, 2011, 13 New Jersey doctors and one nurse practitioner were arrested and charged in separate Complaints with accepting similar cash kickback payments from Orange MRI. Each of the defendants was recorded taking envelopes of cash in exchange for patient referrals.

Patel is the ninth person charged in the December 2011 takedown to plead guilty. Patel is the second member of Orange Community MRI to plead guilty; Ashokkumar Babaria, the former owner and medical director of Orange Community MRI, pleaded guilty on Sept. 27, 2012.

As part of his plea agreement, Patel agreed to forfeit $89,180 that constitutes criminal proceeds of the crime. As part of his guilty plea, Ashokkumar Babaria agreed to forfeit his revenues traceable to corrupt referrals, which the government has estimated could reach as much as $2 million. The seven health care providers that referred patients to Orange MRI who have plead guilty thus far have collectively agreed to forfeit over $150,000 in illegal kickbacks from Orange MRI.



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Wednesday, October 17, 2012

The administrator of CardioMax EMS, Okechukwu Ofoegbu, Pleads Guilty to Fraud


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1242.html

WASHINGTON – The administrator of CardioMax EMS, a Houston-based ambulance company, pleaded guilty today to charges that he submitted approximately $1,734,550 in fraudulent claims to Medicare, 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; 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 the U.S. Department of Health and Human Service’s Office of the Inspector General (HHS-OIG); and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

Okechukwu Ofoegbu, 31, of Houston, pleaded guilty today in U.S. District Court in the Southern District of Texas to one count of conspiracy to commit health care fraud.

Ofoegbu was the administrator of Cardiomax EMS, a Houston-based ambulance company that primarily transported patients to community mental health centers. According to Ofoegbu’s plea agreement, from January 2011 through December 2011, Ofoegbu and others at Cardiomax were involved in transporting patients that did not meet the requirements for ambulance transport under Medicare regulations, falsifying ambulance run sheets that described patients’ conditions and using the falsified run sheets to file claims with Medicare. Ofoegbu admitted in his plea agreement that he conspired to submit claims to Medicare for ambulance services that he knew were miscoded, not medically necessary and, in some cases, not provided.

As part of the plea agreement, Ofoegbu has agreed to pay $553,002 in restitution to the United States. At sentencing, scheduled for Jan. 24, 2013, Ofoegbu faces a maximum sentence of 10 years in prison.

Ofoegbu was originally indicted as part of a nationwide takedown on May 2, 2012, that resulted in charges against 107 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing.



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Tuesday, October 16, 2012

Eulises Escalona was Sentenced to 120 Months in Prison for $42 Million Health Care Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1241.html

WASHINGTON – The owner and operator of a Miami health care agency was sentenced today to 120 months in prison for his participation in a $42 million home health Medicare fraud scheme, 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 HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

Eulises Escalona, 44, of Monroe County, Fla., was sentenced today by U.S. District Judge Joan A. Lenard in the Southern District of Florida. In addition to sentencing Escalona to prison, Judge Lenard ordered him to pay $26.5 million in restitution.

On Aug. 2, 2012, Escalona pleaded guilty in the Southern District of Florida to one count of conspiracy to commit health care fraud.

According to court documents, Escalona was the owner of Willsand Home Health Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. Escalona pleaded guilty to conspiring with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Escalona and his co-conspirators paid kickbacks and bribes to patient recruiters in return for patients, prescriptions, Plans of Care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Escalona and co-conspirators also paid kickbacks and bribes directly to physicians, who provided home health and therapy prescriptions, POCs and medical certifications to Escalona and his co-conspirators. Escalona used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, which Escalona knew was in violation of federal criminal laws.

According to court documents, at Willsand Home Health, patient files for Medicare beneficiaries were falsified to make it appear that such beneficiaries qualified for home health care and therapy services when, in fact, many of the beneficiaries did not actually qualify for such services. Escalona knew that in many cases the patient files at Willsand Home Health were falsified.

From approximately January 2006 through November 2009, Escalona and his alleged co-conspirators submitted approximately $42 million in false and fraudulent claims to Medicare, which paid approximately $27 million on those claims.



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Monday, October 15, 2012

CVS Subsidiary, RxAmerica, Reaches $5 Million Settlement with US for Allegedly Submitting False Pricing Relating to the Company’s Medicare Part D Plan


Source- http://www.justice.gov/opa/pr/2012/October/12-civ-1238.html

In one of the first False Claims Act settlements involving Medicare’s Prescription Drug Program, known as Part D, RxAmerica LLC. has entered into a civil settlement agreement with the United States in which it has agreed to pay the government $5.25 million to resolve allegations that it made false submissions to the Centers for Medicare & Medicaid Services (CMS), the Justice Department announced today. RxAmerica, a wholly-owned subsidiary of CVS Caremark Corporation, provides prescription drug benefits to Medicare beneficiaries pursuant to a prescription drug plan.

The Medicare program offers Part D participants prescription drug coverage. For Medicare participants to obtain this drug coverage, they must join a Medicare-approved plan, often referred to as a Part D plan. Medicare Part D plans can vary in both the drugs that they cover, the amount they reimburse for those drugs, and the deductibles and co-pays they require their participants to pay.

To assist participants to choose a Part D plan that minimized their out-of-pocket costs, CMS offered a web-based tool called Plan Finder, which allowed Medicare Part D beneficiaries to determine estimated prescription drug prices for each Medicare Part D plan that the beneficiary considered for enrollment. CMS obtained the pricing information that is contained on Plan Finder from data submitted to CMS by each Part D Plan sponsor.

The United States alleged that during the period Jan. 1, 2007, to Dec. 31, 2008, RxAmerica made false submissions to CMS regarding prices for certain generic prescription drugs used for Plan Finder, despite certifying to CMS that it would submit accurate pricing data for Plan Finder. As a result, the government alleged that RxAmerica received Medicare Part D payments for claims for the covered drugs at prices that in some cases were significantly higher than the pricing data RxAmerica submitted to CMS for use on Plan Finder.

“The Department of Justice is committed to protecting the Medicare drug prescription program against all types of misconduct,” said Stuart F. Delery, Acting Assistant Attorney General for the Justice Department's Civil Division. “As today's settlement demonstrates, we will ensure that Medicare Part D sponsors submit accurate drug pricing information, to ensure the integrity of the Medicare Part D program and to protect the beneficiaries who participate in the program.”

“The health care choices facing Americans are complicated enough without patients being misinformed and forced to select a Part D plan based on false data. Those navigating our Medicare system deserve accurate information so they can make informed choices and obtain the benefits to which they are entitled. The Medicare system deserves honest input from plan sponsors, so it can continue to safeguard taxpayer dollars. Nothing less will suffice,” stated Loretta Lynch, U.S. Attorney for the Eastern District of New York. “This case exemplifies our continuing dedication to combating all types of alleged health care fraud that can eat away at our precious public health care dollars.”

“ RxAmerica was charged with advertising false drug prices to Medicare Part D enrollees,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “Protecting people in government health programs from those seeking to profit by misrepresenting goods and services is one of our top law enforcement priorities.”

Today’s settlement resolves allegations made in two separate complaints against RxAmerica filed under the False Claims Act’s qui tam or whistleblower provisions, which permit a private individual to file suit for false claims to the United States and share in any recovery. The first complaint, U.S. ex rel. Doe v. RxAmerica, was filed in the United States District Court of the Eastern District of New York in November 2008. The second complaint, U.S. ex rel. Hauser v. CVS Caremark Corp. and RxAmerica, was filed in the United States District Court for the Western District of North Carolina in June 2009. The two cases were consolidated in the Eastern District of New York in November 2011.



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Sunday, October 14, 2012

Cyprian Akamnonu Pleads Guilty, Admits Role in $374 Million Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1227.html

WASHINGTON - A Dallas-area home health services company owner today admitted his role in a $374 million home health fraud scheme in which he and others conspired to bill Medicare for unnecessary services that were never performed. Cyprian Akamnonu, 64, of Arlington, Texas, entered his guilty plea to one count of conspiracy to commit health care fraud before U.S. District Judge Sam A. Lindsay in Dallas federal court.

The guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department's Criminal Division; U.S. Attorney for the Northern District of Texas Sarah R. Saldaña; Special Agent in Charge Diego G. Rodriguez of the FBI’s Dallas Field Office; Special Agent in Charge Mike Fields of the U.S. Department of Health and Human Services Office of Inspector General's (HHS-OIG) Dallas Regional Office; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

According to court documents, beginning in at least January 2006, Akamnonu, along with his wife Pat Akamnonu, owned and operated Ultimate Care Home Health Services, Inc. Cyprian Akamnonu admitted that he directed his wife and others to recruit Medicare beneficiaries from Dallas neighborhoods for home health services they did not need and for which they did not qualify. Once the beneficiaries were recruited, Cyprian Akamnonu would take prescriptions for home health services to the offices of Medistat Group Associates, P.A., owned and operated by co-defendant Jacques Roy, M.D.


Cyprian Akamnonu admitted he brought the prescriptions to Roy because he and Roy had a fraudulent arrangement whereby Ultimate provided Roy with beneficiaries to bolster Medistat’s patient roster in exchange for Roy’s certification for skilled nursing services of any beneficiary brought to him. Roy’s office manager, co-defendant Teri Sivils, and others would allegedly then sign these prescriptions on Roy’s behalf. Cyprian Akamnonu admitted to paying Sivils cash to sign the prescriptions.

Cyprian Akamnonu admitted that once he obtained signed prescriptions, nurses acting at his direction would perform cursory visits for the beneficiaries they had recruited that bore little relationship to the skilled nursing services which Roy had purportedly prescribed. Ultimate would then bill Medicare, at Cyprian Akamnonu’s direction, for skilled nursing services that were not necessary and were not performed.

Court documents show that from January 2006 through November 2011, Roy or another Medistat physician allegedly certified over 78% of the beneficiaries serviced by Ultimate. Ultimate billed over $43 million to the Medicare program for these beneficiaries. Roy, in turn, allegedly incorporated these beneficiaries into his own practice and billed over $2.4 million for services related to them.

At sentencing, Cyprian Akamnonu faces a maximum potential penalty of 10 years in prison and a $250,000 fine on the conspiracy count. Sentencing is currently scheduled for Feb. 4, 2013. As part of his plea agreement, he has also agreed not to contest the forfeiture of 21 real properties, four automobiles, and funds in a number of personal and business accounts connected to proceeds of the fraud.

His six co-defendants, including his wife, await trial on related charges, currently set for June 2013. The charges and allegations contained in the indictment against them are merely accusations and the defendants are presumed innocent unless and until proven guilty.



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Saturday, October 13, 2012

Former Owners of Los Angeles DME Wholesale Company Arrested and Charged with Participating in $16.6 Million Medicare Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1228.html

WASHINGTON – The former owners of a durable medical equipment (DME) wholesale company located in Ontario, Calif., were arrested late yesterday at Los Angeles International Airport in connection with a DME fraud scheme that resulted in the submission of over $16.6 million in false claims to Medicare and are expected to appear this afternoon in Los Angeles federal court.

The arrest was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney André 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); and Timothy Delaney, Special Agent in Charge of the FBI’s Los Angeles Field Office.

Rajinder Singh Paul, 69, and his wife, Baljit Kaur Paul, 65, were arrested on conspiracy and health care fraud charges at the airport as they returned from a trip abroad. According to the indictment unsealed upon their arrests, Rajinder and Baljit Paul owned and operated a DME wholesale supply company called Major’s Wholesale Medical Supply Inc., which was located in Ontario. Between 2002 and 2009, according to the indictment, when they were terminated from Major’s after selling its assets to a new owner, Rajinder and Baljit Paul sold primarily high-end power wheelchairs to DME supply companies for approximately $850 to $1,000 per wheelchair. The DME companies, many of which were allegedly fraudulent, billed these power wheelchairs to Medicare at a cost of $3,000 to $6,000 per wheelchair.

According to the indictment, in order to attract and keep the DME companies’ business and prevent Medicare from withholding money that the companies would use to pay Major’s, Rajinder and Baljit Paul provided over 170 DME companies with backdated, altered, and fabricated invoices which reflected that the companies had purchased power wheelchairs and DME from Major’s earlier than they had. Rajinder and Baljit Paul also allegedly provided the DME companies with false invoices for DME that the companies never purchased from Major’s. Rajinder Paul, Baljit Paul, or employees acting at their direction, allegedly created these false invoices using invoice numbers from old invoices or serial numbers from DME that Major’s had already sold or not yet received from its manufacturers. The DME companies then allegedly used these backdated, altered, and fabricated invoices to defraud Medicare or thwart Medicare audits.

In addition, the indictment alleges that the Pauls provided the DME companies with false inventory purchase agreements that showed the companies had credit limits with Major’s which were higher than the credit limits that Major’s actually extended to the companies. The DME companies then submitted these false inventory purchase agreements to Medicare to meet one of the Medicare regulations necessary for the companies to obtain and maintain their Medicare billing privileges, namely, that the companies had contracts with DME wholesalers and other parties to purchase the DME that they billed to Medicare.

The indictment alleges that as a result of this scheme, the Pauls and the owners and operators of certain of the companies that Rajinder and Baljit Paul provided with fraudulent invoices submitted approximately $16,662,143 in false claims to Medicare, and received approximately $9,743,609 on those claims.

Rajinder and Baljit Paul are each charged with one count of conspiracy to commit health care fraud and one count of making false statements. The conspiracy count carries a maximum potential penalty of 10 years in prison, and the false statements count carries a maximum potential penalty of five years in prison. Each count also carries a maximum $250,000 fine.



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Friday, October 12, 2012

Vanja Abreu was Sentenced to 108 Months in Prison for Participating in $205 Million Medicare Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1229.html

WASHINGTON – Miami-area resident Vanja Abreu (Ph.D), former program director at the mental health care company American Therapeutic Corporation (ATC), was sentenced today to 108 months in prison for participating in a $205 million Medicare fraud scheme, 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; Acting Special Agent-in-Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Abreu, 49, of Pembroke Pines, Fla., was sentenced by U.S. District Judge Patricia A. Seitz in the Southern District of Florida. In addition to her prison term, Judge Seitz sentenced Abreu to serve three years of supervised release following her prison term and pay $72,771,469 in restitution, jointly and severally with co-defendants.

On June 1, 2012, after a seven week trial, a federal jury in the Southern District of Florida found Abreu guilty of one count of conspiracy to commit health care fraud.

Evidence at trial demonstrated that Abreu and her co-conspirators caused the submission of false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs), intensive treatments for severe mental illness, in seven different locations throughout South Florida and Orlando.

Evidence at trial revealed that ATC secured patients by paying kickbacks to assisted living facility owners and halfway house owners who would then steer patients to ATC. These patients attended ATC, where they were ineligible for the treatment ATC billed to Medicare and where they did not receive the treatment that was billed to Medicare. After Medicare paid the claims, some of the co-conspirators then laundered the Medicare money in order to create cash to pay the patient kickbacks.

Evidence at trial revealed that Abreu was a program director at ATC’s Boca Raton, Fla., center from September 2005 to November 2005. In November 2005, Abreu moved to ATC’s Miami center, where she was the program director until February 2009, at which point she was promoted to corporate leadership and oversaw operations at all ATC centers until April 2010. Evidence at trial revealed that program directors, including Abreu, helped doctors at ATC sign patient files without reading the files or seeing the patients. Evidence further revealed that Abreu and others would assist the owners of ATC in fabricating doctor notes, therapist notes and other documents to make it falsely appear in ATC’s patient files that patients were qualified for this highly specialized treatment and that the patients were receiving the intensive, individualized treatment PHP is supposed to be. Included in these false and fraudulent submissions to Medicare were claims for patients who were in the late stages of diseases causing permanent cognitive memory loss and patients who had substance abuse issues and were living in halfway houses. These patients were ineligible for PHP treatment, and because they were forced by their assisted living facility owners and halfway house owners to attend ATC, they were not receiving treatment for the diseases they actually had.

Abreu was charged in an indictment returned on Feb. 8, 2011. ATC, the management company associated with ATC, and 20 individuals, including the ATC owners, have all previously pleaded guilty or have been convicted at trial.

ATC executives Lawrence Duran, Marianella Valera, Judith Negron and Margarita Acevedo were sentenced to 50 years, 35 years, 35 years and 91 months in prison, respectively, for their roles in the fraud scheme. The 50- and 35-year sentences represent the longest sentences for health care fraud ordered to date. Acevedo, who was one of the first defendants to plead guilty and has been cooperating with the government since November 2010, testified at the doctors’ trial.

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



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Thursday, October 11, 2012

Adejare Ademefun was Sentenced to 30 Months in Prison for Medicare Fraud Scheme


Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1213.html

WASHINGTON – A Los Angeles medical equipment supplier, who submitted almost $1 million in false claims to Medicare for expensive, high-end power wheelchairs, was sentenced today to serve 30 months in prison, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney André 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); and Timothy Delaney, Acting Assistant Director in Charge of the FBI’s Los Angeles Field Office.

Adejare Ademefun, 57, was sentenced by U.S. District Judge John F. Walter in the Central District of California. In addition to the prison term, Ademefun was sentenced to three years of supervised release and ordered to pay $499,548 in restitution to Medicare.

In February 2010, Ademefun pleaded guilty to health care fraud. As part of his plea, Ademefun admitted that from January 2006 to his arrest in October 2009, he owned and operated Jamef Medical Supply, a fraudulent durable medical equipment (DME) supply company, which he used to submit almost $1 million in false claims to Medicare. Ademefun admitted he paid illicit kickbacks to co-conspirators for medical prescriptions and other documents he needed to defraud Medicare. Ademefun focused his fraudulent billings on power wheelchairs, which were among the most expensive DME that a Medicare provider could bill to Medicare. In fact, Ademefun admitted that approximately 95 percent of all the claims he submitted to Medicare were for power wheelchairs. Ademefun admitted he supplied these power wheelchairs to Medicare beneficiaries who were illegally solicited by patient recruiters or “marketers” for medical equipment they did not want or need.

Ademefun admitted he was deliberately indifferent to the fact that the power wheelchair claims he submitted to Medicare were false even though Ademefun knew there was a high probability that the doctors whose names appeared on the prescriptions he purchased from his co-conspirators did not prescribe the power wheelchairs. Ademefun also knew that only six doctors were supposedly responsible for referring approximately 50 percent of his business, and that approximately 60 percent of his customers lived more than 100 miles from Jamef. Ademefun admitted he submitted approximately $941,028 in false claims to Medicare during the course of the scheme.

On March 24, 2010, Ademefun’s co-conspirator Leonard Nwafor was sentenced to 108 months in prison for his role in the scheme.



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