Thursday, January 31, 2013

Lydia Ward and Hilario Morris Sentenced to Prison in Florida in $205 Million Community Mental Health Fraud Scheme


Source- http://www.justice.gov/opa/pr/2013/January/13-crm-111.html

The former program director and two former marketers for Miami-based mental health care company American Therapeutic Corporation (ATC) have been sentenced to prison for their roles in a $205 million Medicare fraud and kickback scheme in which patients were forced to attend inappropriate treatment programs.

The sentences were announced by 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; Special Agent-in-Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher Dennis of the Health and Human Services’ Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Miami-area residents Lydia Ward, 47, a former program director, and Hilario Morris, 47, a former marketer, were sentenced today by U.S. District Judge Patricia A. Seitz in Miami federal court to 99 months and 60 months in prison, respectively. In addition to the prison term, Judge Seitz sentenced Ward and Morris each to serve three years of supervised release and ordered them to pay more than $34.1 million and $82.2 million in restitution, respectively, jointly and severally with their co-defendants.

Ward was convicted on Nov. 15, 2012, by a federal jury of conspiracy to commit health care fraud. Morris was convicted on June 1, 2012, by a federal jury of conspiracy to pay illegal health care kickbacks. Ward and Morris have been in federal custody since their convictions.

Former marketer Sandra Jimenez, 39, also from the Miami area, was sentenced to 36 months in prison yesterday, Jan. 24, 2013. In addition to the prison term, Judge Seitz sentenced Jimenez to serve three years of supervised release and ordered her to pay $20.5 million in restitution, jointly and severally with her co-defendants.

On Jan. 17, 2012, Jimenez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to receive and pay health care kickbacks.

In pleading guilty, Jimenez admitted that she served as a marketer for ATC and American Sleep Institute (ASI). ATC, a Florida corporation headquartered in Miami, 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. Jimenez also admitted that she and co-conspirators used related company ASI to submit fraudulent Medicare claims.

Additionally, Jimenez admitted she participated in a separate Medicare fraud scheme through Priority Home Health, a Miami home health agency that submitted fraudulent claims to Medicare for home health services. Jimenez and her co-conspirators recruited Medicare beneficiaries to Priority Home Health who did not qualify for the services.

According to the plea agreement, Jimenez’s participation in the ATC fraud and the Priority Home Health fraud resulted in $46 million in fraudulent billings to Medicare.

Evidence at Ward’s and Morris’ trials demonstrated that the defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare through ATC and ASI, and that ATC secured patients by paying kickbacks to assisted living facility owners and halfway house owners who would then steer patients to ATC.

According to the evidence, Morris was a marketer for ATC from September 2004 through October 2010, when ATC closed its doors due to the federal case. In that capacity, Morris acted as a liaison, maintaining relationships between ATC and those who were selling their patients to ATC. Morris would physically pay the kickbacks throughout North Miami and Florida’s Broward County. These patients, who attended ATC, were ineligible for the services billed to Medicare and did not receive them. After Medicare paid the claims, some of the co-conspirators then laundered the Medicare money in order to create cash to pay the kickbacks for patients.

Evidence at trial revealed that Ward was a program director at ATC’s Ft. Lauderdale, Fla., center from November 2008 until ATC’s closing in October 2010. The evidence showed Ward helped doctors at ATC sign patient files without reading them or seeing the patients, and that Ward 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 the individualized, specialized treatment. 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 treatments, 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.

ATC executives Lawrence Duran, Marianella Valera and Judith Negron were previously sentenced to 50 years, 35 years and 35 years in prison, respectively, for their roles in the fraud scheme. The 50- and 35-year sentences represent the longest federal sentences for health care fraud ordered to date in the United States.

ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. On Sept. 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010. Dozens of individuals have been convicted at trial or pleaded guilty for their participation in the scheme, including doctors Mark Willner and Alberto Ayala, who were each sentenced to 10 years in prison.

Evidence at trial showed that the ATC scheme resulted in a total of $205 million in fraudulent Medicare billings.



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Wednesday, January 30, 2013

Pezhman Ebrahimzadeh Pleads Guilty in Multi-Million-Dollar Medicare Fraud


Source- http://www.fbi.gov/losangeles/press-releases/2013/san-fernando-valley-doctor-pleads-guilty-in-multi-million-dollar-medicare-fraud-case-involving-treatments-never-performed

LOS ANGELES—A medical doctor who owns a clinic in the Winnetka district of the San Fernando Valley pleaded guilty today to federal fraud charges for bilking Medicare out of more than $3 million by submitting bills for procedures never performed, sometimes involving patients he never met.

Pezhman Ebrahimzadeh, who uses the name “Pez Abrahams,” 50, of Calabasas, pleaded guilty today to one count of health care fraud before United States District Judge George H. Wu.

Ebrahimzadeh owns the Winnetka Medical Group, a cosmetic health care clinic that operates under the name Health & Beauty Clinic. At his clinic, Ebrahimzadeh provides cosmetic treatments that involve radiofrequency lasers and liposuction. As some of his patients were Medicare beneficiaries, Ebrahimzadeh obtained their beneficiary information, which was used to bill Medicare for procedures he did not perform. Ebrahimzadeh also obtained beneficiary information for patients he never treated, and he used that information to submit other fraudulent bills to Medicare.

In relation to the bogus bills submitted to Medicare, Ebrahimzadeh typically claimed he had performed three expensive procedures: revascularization, ablation of a bone tumor, or the placement of a radiotherapy catheter in a breast. Ebrahimzadeh made these claims, even though he lacked the equipment needed to perform revascularizations or the placement of radiotherapy catheters. On at least one occasion, Ebrahimzadeh admitted in court today, he billed Medicare for performing these procedures, even though the purported patient was dead.

Between September 2008 and April 2012, Ebrahimzadeh submitted $7.5 million in bogus claims, and Medicare paid just over $3 million.

Judge Wu is scheduled to sentence Ebrahimzadeh on May 20. At sentencing, Ebrahimzadeh faces a statutory maximum penalty of 10 years in federal prison. The plea agreement contemplates a sentence of approximately four to five years, but Judge Wu will make the final determination as to the actual sentence that will be imposed in this case. In the plea agreement, Ebrahimzadeh agreed to repay the millions of dollars he stole from Medicare.



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Friday, January 25, 2013

Four Sentenced to Prison in Florida Community Mental Health Center Case


Source- http://www.justice.gov/opa/pr/2013/January/13-crm-108.html

The owners of three Miami-area assisted living facilities and an affiliated psychologist were sentenced to prison today in connection with a health care fraud scheme, involving now-defunct Miami-area health provider Health Care Solutions Network Inc. (HCSN), in which Medicare was billed for mental health treatments that were unnecessary or not provided.

The sentences were announced by 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.

U.S. District Judge Cecilia M. Altonaga sentenced Serena Joslin, 32, of Looneyville, W.Va., to 63 months in prison, following her previous guilty plea to conspiracy to commit health care fraud. Raymond Rivero, 55, Daniel Martinez, 46, and Ivon Perez, 50, all of Miami, were each sentenced to 28 months in prison. All three had previously pleaded guilty to conspiracy to violate the anti-kickback statute.

According to court documents, HCSN operated community mental health centers both in Miami and North Carolina, including partial hospitalization programs (PHP) – a form of intensive treatment for severe mental illness. HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not provided.

In Miami, HCSN obtained beneficiaries by paying kickbacks to owners and operators of assisted living facilities (ALF) or by otherwise recruiting them from the facilities and from nursing homes. Rivero, Martinez and Perez admitted during their guilty pleas to referring Medicare beneficiaries to HCSN in exchange for cash bribes. Rivero, former owner of Miami-based God Is First ALF; Martinez, former owner of Homestead, Fla.-based Mi Renacer ALF; and Perez, former owner of Homestead-based Kayleen and Denis Care Corp., are no longer permitted to operate such facilities as a condition of their guilty pleas.

According to court documents, ALF residents referred to HCSN by Rivero, Martinez and Perez were not qualified to be placed in 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 mental health services.

According to court documents, Joslin, a licensed psychologist, was hired by HCSN in North Carolina in April of 2010 as a clinical coordinator and later promoted to clinical director. In those roles, she conspired with other HCSN employees to fabricate medical documents to substantiate alleged PHP treatment that was medically unnecessary and, in many instances, not even provided to the beneficiaries. Joslin admitted that many of the HCSN patients were unqualified for the PHP program because they suffered from conditions such as mental retardation and dementia, and that she directed therapists to fabricate medical records to support HCSN’s fraudulent billing to the Medicare program. Joslin was also required to surrender her North Carolina license to provide mental health treatment as part of her plea agreement.

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

In addition to the prison terms, Judge Altonaga sentenced Joslin, Rivero, Martinez and Perez each to serve three years of supervised release, and ordered them to pay $4,464,728; $90,896; $76,358; and $89,245 in restitution, respectively.



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Thursday, January 24, 2013

Michael J. McKay, 32, Was Sentenced For Medicare Fraud


Source- http://www.justice.gov/usao/ma/news/2013/January/McKayMichaelsentencing.html

BOSTON – A former Orthofix territory manager was sentenced yesterday for defrauding Medicare by forging patient medical records.

Michael J. McKay, 32, was sentenced by U.S. District Court Judge Denise J. Casper to one year of probation, with the first three months to be served in home confinement, and ordered to forfeit $10,000 and pay a fine of $3,000. In May 2012, McKay pleaded guilty to healthcare fraud.

Between 2008 and 2009 McKay was a territory manager for Orthofix, a company that manufactured and distributed bone growth stimulator medical devices that were intended to assist patients with bone fractures that did not heal properly. Medicare and many private insurance carriers have specific guidelines describing when it will pay for bone growth stimulators. When McKay received orders for patients that did not satisfy these guidelines, McKay frequently falsified the patients’ medical records to make it appear as though the order met Medicare’s rules so that Medicare would pay for a claim that otherwise would not be covered. Between 2008 and 2010, federal insurance carriers paid more than $70,000 for bone growth stimulators for claims where McKay falsified medical records. McKay altered physician’s chart notes, changing the dates of patient visits, describing patient visits that did not occur, and inserting false diagnoses. McKay also forged prescriptions and Medicare Certificates of Medical Necessity within the orders. Orthofix fired McKay after it discovered his fraud. Even after he was fired, however, McKay continued to submit orders for stimulators by submitting them to a colleague, Derrick Field, who split the commissions with Field. Even after he was fired, McKay continued to forge chart notes, prescriptions and CMNs in the orders he submitted to Field. On January 9, 2013, Field was sentenced to five months home confinement, two years of probation, and $44,000 in fines and forfeiture.

In addition to the McKay sentence, the Orthofix investigation has to date resulted in a number of felony charges against employees and contractors of Orthofix, including the following:
In December 2012, Orthofix was convicted of obstruction of a federal audit, and ordered to pay $42 million in criminal fines and civil payments, and was sentenced to probation for five years;
On January 22, 2013, Tom Guerrieri, the former vice president of sales for Orthofix, was sentenced to eight months in prison and ordered to pay $50,000 in fines and forfeiture for paying kickbacks;
In July 2012, Michael Cobb, a physician’s assistant, was sentenced to six months in prison, six months home confinement, and ordered to forfeit $10,000 and pay a $3,000 fine for accepting kickbacks from Orthofix;
In December 2011, Mitchell Salzman pleaded guilty while he was a regional manager for Orthofix and is scheduled to be sentenced on Jan. 31, 2013; and
In September 2012, Brian Racey pleaded guilty to health care while he was a territory manager for Orthofix and is scheduled to be sentenced on Feb. 20, 2013 in the U.S. District Court for the Eastern District of Pennsylvania.



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Wednesday, January 23, 2013

Godspower Joseph Essang, 35, of Houston Texas Was Sentenced to 37 Months in Federal Prison


Source- http://www.justice.gov/usao/law/news/wdla20130124a.pdf

SHREVEPORT, La: United States Attorney Stephanie A. Finley announced today
that Godspower Joseph Essang, 35, of Houston, Texas, was sentenced today, to 37 months
in federal prison with three years supervised release for Medicare fraud.

Essang was also ordered to pay $613,096 in restitution to Medicare. Judge Maurice
S. Hicks immediately remanded Essang into the custody of the U. S. Marshal’s Service to
begin serving his sentence.

Essang was sentenced based on his Sept. 28, 2012, guilty plea to one count of health
care fraud. During the guilty plea hearing, Essang admitted owning and operating Shalom
Equipment, a durable medical equipment company, located on Woodward Avenue in
Shreveport. Shalom engaged in the business of providing what were referred to as “ortho
kits,” which were braces for various parts of the body. Essang admitted paying individuals
to provide him with their Medicare beneficiaries and physicians information. He then used
this identifying information to file false claims with Medicare for providing the “ortho kits”
to Medicare beneficiaries who did not need, were not prescribed and/or did not receive
the items. Essang admitted that between Aug. 12, 2007 and Oct. 21, 2008, he filed
approximately 736 claims, billing Medicare for $1,223,255. Medicare actually paid out
$613,096 on the claims.



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Tuesday, January 22, 2013

Enrique Gonzalez, 67, Miami Clinic Director Sentenced to 70 Months in Prison for Role in HIV Infusion Fraud Scheme


Source- http://www.justice.gov/opa/pr/2013/January/13-crm-102.html

A former Miami HIV infusion clinic director was sentenced today to serve 70 months in prison for his role in a $26.2 million HIV infusion fraud scheme, announced Assistant Attorney General Lanny Breuer of the Criminal Division, U.S. 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 B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Enrique Gonzalez, 67, formerly of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Judge Altonaga sentenced Gonzalez to serve three years of supervised release and ordered him to pay $17,590,896 in restitution to HHS.

On Nov. 13, 2012, Gonzalez pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims, and to pay health care kickbacks, and one count of conspiracy to commit health care fraud.

Gonzalez admitted that between August 2002 and March 2004, he conspired with co-defendant Ronald Harris, a Miami physician, and alleged co-conspirators to operate Physicians Med-Care and Physicians Health (together the “Physicians Clinics”), two Miami HIV infusion clinics. According to court documents, the Physicians Clinics were owned and controlled by alleged co-conspirators Carlos Benitez and his brother Luis Benitez. The Physicians Clinics purported to specialize in treating patients with HIV, but were operated for the sole purpose of committing Medicare fraud, according to court documents. Gonzalez was a director of Physicians Med-Care and, at the direction of his co-conspirators, was responsible for the finances of the Physicians Clinics.

Gonzalez admitted that he agreed with his co-conspirators to handle the finances for the Physicians Clinics, moving the money paid by the Medicare program out of the Physicians Clinics’ accounts and into accounts owned and controlled by his co-conspirators. According to court documents, Harris signed blank checks that Gonzalez used to transfer funds to various Benitez-owned entities and others, as directed by his co-conspirators. In addition, Gonzalez agreed to provide cash to various co-conspirators at the Physicians Clinics to be used to pay bribes and kickbacks to the Medicare beneficiaries in return for those beneficiaries allowing the Physicians Clinics to bill the Medicare program for HIV infusion services that were not medically necessary and often not provided.

Gonzalez admitted that during his association with Physicians Med-Care, the clinic billed the Medicare program approximately $24.5 million in HIV infusion therapy claims, for which the clinic received $16.7 million in payments. Gonzalez also admitted that during his time with Physicians Health, the clinic billed Medicare approximately $1.7 million and received approximately $800,000 in payment from the Medicare program for fraudulent services.

Gonzalez was a fugitive from justice from the time of his indictment in 2008, until he was located and detained in Peru in late 2011. Gonzalez was extradited to the United States in July of 2012. Gonzalez’ daughter, Carmen Gonzalez, was indicted in a related case and is currently a fugitive.

Co-defendant Harris pleaded guilty on Aug. 26, 2008, to one count of conspiracy to defraud the United States, to cause the submission of false claims and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims to the Medicare program. Harris pleaded guilty in connection with his role as the medical director for the Physicians Clinics. On Nov. 4, 2008, Harris was sentenced to serve 84 months in prison for his role in the scheme.

Carlos and Luis Benitez and Thomas McKenzie were charged separately with health care fraud and money laundering crimes in an indictment unsealed on June 11, 2008. According to the separate indictment, the defendants provided the money and staff necessary to open the Physicians Clinics, the Medicare patients that the clinics needed to bill the Medicare program and transportation for the HIV patients who visited the clinics. Carlos and Luis Benitez and McKenzie were charged for their role in committing approximately $109 million in HIV infusion fraud and money laundering through the Physicians Clinics and nine other HIV infusion clinics.

On Sept. 18, 2008, McKenzie pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program, and admitted to his role in a $119 million HIV infusion fraud scheme. On Dec. 18, 2008, McKenzie was sentenced to serve 14 years in prison.

Carlos and Luis Benitez are also fugitives. Anyone with information regarding the whereabouts of the fugitives is urged to contact HHS-OIG fugitive reporting phone line at 888-476-4453.

The defendants who have not been convicted are presumed innocent unless and until proven guilty.



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Monday, January 21, 2013

Allwell Tam Inimgba Sentenced For Health Care Fraud



MINNEAPOLIS—Earlier today in federal court, a 52-year-old Brooklyn Park man was sentenced for executing a scheme to defraud Medicaid out of more than $500,000. United States District Court Judge David S. Doty sentenced Allwell Tam Inimgba to 18 months in prison on one count of health care fraud. Inimgba, was charged on September 21, 2012, and pleaded guilty on October 9, 2012.

In his plea agreement, Inimgba admitted that from January of 2006 to March of 2009, he executed a scheme to defraud Medicaid, a federal health benefit program, by billing it for services supposedly provided by Registered Nurses (“RNs”), when that was not the case. At the time, Inimgba was the responsible billing party for Victory Home Care, Inc. (“Victory”), a home health care agency that provided, or purported to provide, RN services to Medicaid recipients.

During the time period noted above, Inimgba billed Medicaid for more than 20,000 hours of services supposedly provided to various clients by RNs, and Medicaid paid Victory more than $1,400,000 as a result of those claims. However, RNs provided far less care than noted in Victory’s claims. In fact, approximately $513,734 awarded to Victory was ultimately found to be for work not done by RNs.



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Sunday, January 20, 2013

Janice W. Holland Was Sentenced to 51 Months in Prision For Health Care Fraud


Source- http://www.justice.gov/usao/vae/news/2013/01/20130122hollandnr.html

NORFOLK, Va. – Janice W. Holland, 42, of Suffolk, Va., was sentenced today to 51 months in prison for health care fraud and alteration of records, and a mandatory consecutive sentence of 24 months in prison for aggravated identity theft, for a total sentence of 75 months. She was also ordered to pay restitution to the Virginia Medicaid program in the amount of $630,339.30.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and Virginia Attorney General Ken Cuccinelli made the announcement after sentencing by Senior United States District Judge Robert G. Doumar.

Holland pled guilty on September 18, 2012. According to court documents, Holland owned and operated A Caring Hand Home Health Care Services Inc., a business located in Suffolk that was authorized to provide respite care to Medicaid recipients. Respite care is designed to provide temporary, substitute care for a Medicaid recipient that is normally provided by the family or another unpaid primary caregiver of the recipient. These services are provided on a short-term basis because of the emergency absence or need for routine or periodic relief of the primary caregiver. Between January 2008 and October 2011, Holland filed approximately 939 false and fraudulent claims with the Virginia Medicaid program, representing that respite care had been provided by her company to 30 Medicaid recipients, when in fact no such care had been provided. She filed these claims using, without authority, the recipients’ names, dates of birth and Medicaid identification numbers. As a result, Holland obtained health care benefit payments in the approximate amount of $630,339.30, to which she was not entitled. She also altered and falsified her office records to conceal and cover up her false billings.



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Saturday, January 19, 2013

Dorothy Cole, age 60 Was Sentenced to Five Years Probation for Health Care Fraud



Source- http://www.justice.gov/usao/law/news/wdla20130118b.pdf

LAFAYETTE, La.:  United States Attorney Stephanie A. Finley announced today
that the former owner of Rest Assure Home Medical Equipment, located in Rayne, La., was
sentenced to five years probation and was ordered to pay $175,923.93 in restitution for
health care fraud related to Medicare reimbursements.  The sentence was handed down
yesterday in federal court in Lafayette by U.S. District Judge Elizabeth E. Foote.  

Dorothy Cole, age 60, of Rayne, La., was charged by Bill of Information on June 20,
2012, with five counts of health care fraud.  According to court documents filed at Cole’s
guilty plea on September 18, 2012, she was the owner and president of Rest Assure Home
Medical Equipment.  Rest Assure Home Medical Equipment provided durable medical
equipment, such as power wheelchairs and scooters to Medicare beneficiaries.  Beginning
in August of 2007 and continuing through April of 2009, Cole billed Medicare for a more
expensive type of wheelchair but provided her customers with cheaper scooters that were
not reimbursable by Medicare and less expensive wheelchairs that were reimbursed by
Medicare at a lower rate.  

During the guilty plea hearing, Cole acknowledged that she submitted false claims
to Medicare and obtained $175,923.93 in Medicare reimbursements to which she was not
entitled.

U.S. Attorney Finley stated: “Dorothy Cole violated the law when she collected
money from Medicare under false pretenses.  Medicare is designed to help Americans, age
65 and older, and younger people, with disabilities.  This type of fraud undermines the
system and hurts those who are in need of its benefits.  Medicare fraud results in the losses
of millions of dollars every year.  Our office is dedicated to prosecuting those who engage
in this type of fraud.”


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Friday, January 18, 2013

Hugh Marion Willet Owner of Texas Durable Medical Equipment Companies Convicted in Fraud Scheme



A Texas federal judge convicted the owner of two Texas-based durable medical equipment companies today on multiple health care fraud charges following a five-day bench trial, announced Assistant Attorney General Lanny A. Breuer of the Justice Department?s Criminal Division.

Hugh Marion Willet, 69, of Fort Worth, Texas, was found guilty by U.S. District Judge Jane J. Boyle in the Northern District of Texas on all seven counts of the June 2012 second superseding indictment: one count of conspiracy to commit health care fraud and six counts of health care fraud stemming from a durable medical equipment (DME) fraud scheme. Willett?s wife, Jean Willett, previously pleaded guilty to the same charges and was sentenced in September 2012 to serve 50 months in prison.

The evidence at trial showed that between 2006 and 2010, the Willets co-owned and operated JS&H Orthopedic Supply LLC and Texas Orthotic and Prosthetic Systems Inc., which claimed to provide orthotics and other DME to beneficiaries of Medicare and private insurance benefit programs including Aetna, Blue Cross Blue Shield and CIGNA.

Evidence presented in court proved that both of these companies intentionally submitted claims to Medicare and other insurers for products that were materially different from and more expensive than what was actually provided, and that Hugh Marion Willett was a knowing and willing participant in the fraud.

At sentencing, currently scheduled for April 18, 2013, Hugh Marion Willett faces a maximum potential penalty of 10 years in prison and a $250,000 fine on each count.



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Thursday, January 17, 2013

Seven Arrested, Charged with $22 Million Detroit-area Home Health Care Fraud Scheme


Source- http://www.justice.gov/opa/pr/2013/January/13-crm-079.html

Six Detroit-area residents and one Chicago-area resident were arrested today by federal agents on charges arising from the ongoing investigation into an alleged $22 million home health care fraud scheme. The indictment was announced by 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; Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office; Special Agent in Charge Lamont Pugh III of the Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office; and Special Agent in Charge Erick Martinez of the Internal Revenue Service Criminal Investigation (IRS-CI) Detroit Field Office.

According to the 18-count indictment returned Jan. 15, 2013, and unsealed today, the seven individuals allegedly participated in a Medicare fraud scheme operating out of four Oakland County, Mich., home health agencies claiming to provide in-home health services: Royal Home Health Care Inc., Prestige Home Health Services Inc., Platinum Home Health Services Inc. and Empirical Home Health Care Inc. The indictment alleges Medicare paid the agencies approximately $22 million for fraudulently reported services since August 2008.

In addition to the arrests, law enforcement agents suspended Medicare payments to four health care companies associated with the alleged scheme.

Muhammad Aamir, 42; Usman Butt, 39; Hemal Bhagat, 31; Syed Shah, 50; Tariq Tahir, 46; and Raquel Ellington, 56, of the Detroit area; and Tayyab Aziz, 43, from the Chicago area, each are charged with conspiracy to commit health care fraud. All but Aziz are also charged with health care fraud and with conspiracy to violate the Anti-Kickback Statute. Butt, Bhagat, Shah and Aziz are additionally charged with conspiracy to commit money laundering.

According to the indictment, Aamir and Butt owned and operated Prestige; Butt, Bhagat and Shah owned and operated Royal; and Aamir owned and operated Platinum and Empirical – all of which allegedly claimed to provide home health therapy services to Medicare beneficiaries that were unnecessary and/or were never performed. The indictment alleges Tahir and Ellington recruited Medicare beneficiaries, paying them kickbacks for their Medicare information and signatures on documents that detailed physical therapy and/or skilled nursing services that were either never rendered or not medically necessary. Aamir, Butt, Bhagat, Shah, Tahir and Ellington are also charged with conspiring to pay kickbacks to Tahir and Ellington for their recruiting work. Butt, Bhagat, Shah and Aziz allegedly conspired to launder the proceeds of the scheme.

The charges of health care fraud conspiracy and health care fraud each carry a maximum potential penalty of 10 years in prison and a $250,000 fine. The charge of conspiracy to violate the Anti-Kickback Statute carries a maximum potential penalty of five years in prison and a $25,000 fine. The charge of conspiracy to commit money laundering carries a maximum potential penalty of 20 years in prison and a $500,000 fine.



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Wednesday, January 16, 2013

Rolando Sepulveda Indicted On Seven Counts Of Health Care Fraud


Source- http://www.justice.gov/usao/ohn/news/2013/17janambo.html

A federal indictment was filed charging Rolando Sepulveda with seven counts of health care fraud in connection with the operation of his ambulette company, Med Transportation, said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio, and Ohio Attorney General Mike DeWine.

Sepulveda, age 51, operated his business out of the Youngstown area and is currently believed to be residing in Puerto Rico. He defrauded the state of approximately $406,000 from August 2008 to August 2011, according to the indictment.

"This money should have gone to help those who were sick and truly needed transportation,” Dettelbach said.

“That is a huge amount of money that could have been spent on patients who legitimately needed help,” said Ohio Attorney General Mike DeWine. “Instead, this man took that money for himself."

Ambulette services contract with the Ohio Medicaid program to transport patients in vehicles known as ambulettes. An ambulette is a specially equipped van designed for wheelchair passengers. Medicaid pays ambulette operators for driving Medicaid patients to and from Medicaid-covered appointments, so long as: (1) the patient rides in a wheelchair; (2) a medical doctor certifies the need for the wheelchair and ambulette; and (3) the ambulette itself otherwise meets safety specifications.

The defendant is charged with scheming to defraud Medicaid of approximately $406,000.00 by charging Medicaid for rides of patients who did not use or need wheelchairs and for billing Medicaid for ambulette attendants, when no such attendants were used by Med Transportation.

If convicted, the defendant’s sentence will be determined by the court after review of the federal sentencing guidelines and factors unique to each case, including the defendant’s prior criminal record, if any, the defendant’s role in the offenses and the characteristics of the violations.



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Saturday, January 12, 2013

Irvine Johnston King, 46, and Aisha Rashidatu King, 40 Owners of Woodbridge Home Health Business Convicted of Health Care Fraud, Aggravated Identity Theft


Source- http://www.fbi.gov/washingtondc/press-releases/2013/owners-of-woodbridge-home-health-business-convicted-of-health-care-fraud-aggravated-identity-theft

ALEXANDRIA, VA—The owners of a Woodbridge, Virginia-based home health care business have been convicted by a federal jury in Alexandria, Virginia, for submitting numerous false claims to Medicaid for reimbursement for services they did not provide.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia; Ken Cuccinelli, Attorney General of Virginia; and Debra Evans Smith, Acting Assistant Director in Charge of the FBI’s Washington Field Office, made the announcement after the verdict was accepted by United States District Judge Claude M. Hilton.

Irvine Johnston King, 46, and Aisha Rashidatu King, 40, of Woodbridge, were convicted of conspiracy to commit health care fraud, which carries a maximum penalty of 10 years in prison; 22 counts of health care fraud, which each carry a maximum penalty of 10 years in prison; and two counts of aggravated identity theft, which carry a consecutive mandatory penalty of two years in prison. Sentencing is scheduled for March 22, 2013.

According to court records and evidence at trial, the Kings owned and operated Bright Beginnings Healthcare Services, a business that provided in-home personal and respite care and private duty nursing services to Medicaid-eligible individuals. From at least March 2008 through June 2011, the Kings defrauded Medicaid by submitting false claims to Medicaid for services that were not provided, providing fabricated documentation in connection with an audit, and instructing an employee to lie to Medicaid about claims billed by Bright Beginnings. In addition, the Kings instructed an employee to convince a patient’s mother to lie to Medicaid regarding the false claims and asked the parent of a patient to sign blank Medicaid time sheets that were used as a basis to bill Medicaid for services that the Kings knew had not been performed.

The Kings also used—without lawful authority to do so—the name, date of birth, and insurance identification number of a patient on claims seeking reimbursement from Medicaid.



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Friday, January 11, 2013

Marcus Jenkins Owner of Detroit Adult Day Care Centers Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme


Source- http://www.justice.gov/opa/pr/2013/January/13-crm-025.html

WASHINGTON – The owner of several Detroit-area businesses that housed severely mentally-disabled Medicare recipients pleaded guilty today for his role in a $13.2 million fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade, Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office.

Marcus Jenkins, 51, of Farmington Hills, Mich., pleaded guilty before U.S. District Judge Stephen J. Murphy III in the Eastern District of Michigan to one count of conspiracy to commit health care fraud and five counts of health care fraud. Jenkins’s wife, Beth Jenkins, pleaded guilty to the same charges on Jan. 3, 2013, for her involvement in the scheme.

Marcus Jenkins admitted that he and others conspired to defraud Medicare through Quality Recreation & Rehabilitation LLC (QRR) and Procare Rehabilitation Inc., two adult day care centers he owned and operated with Beth Jenkins. According to court documents, Jenkins also owned and operated several Detroit-area adult foster care homes (AFCs) that housed severely mentally-disabled Medicare recipients. Court documents allege that Jenkins used the Medicare information of more than 100 Detroit-area AFC residents to bill Medicare through QRR and Procare for individual and group psychotherapy. Jenkins admitted that he caused claims to be submitted to Medicare for psychotherapy services that were not provided, including claims for psychotherapy purportedly given to a patient who was deceased on the dates of claimed service.

From 2004 through 2011, Marcus Jenkins, Beth Jenkins and alleged co-conspirators submitted more than 185,000 claims to Medicare totaling more than $13.2 million for group and individual psychotherapy that was not provided. According to court documents, Medicare paid $4,777,792 on these claims.

At sentencing, scheduled for April 19, 2013, Jenkins faces a maximum penalty of 60 years in prison and a $1.5 million fine.


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Thursday, January 10, 2013

Lori Jo Mueller, age 48, Charged With Defrauding Home Health Care Company, Medica



MINNEAPOLIS—Yesterday in federal court, an Apple Valley woman was charged with defrauding both her employer and Medica. On January 9, 2012, Lori Jo Mueller, age 48, was charged via an Information with one count of wire fraud and one count of health care fraud.

Allegedly, from June of 2006 through June of 2012, Mueller embezzled approximately $840,000 from Edelweiss Home Health Care and used the funds for her personal use. Mueller began working for Edelweiss, located in Osseo, in 2002, and was promoted to the position of vice president of operations. In that capacity, Mueller was responsible for the review and payment of corporate invoices, bookkeeping, and other financial matters. Mueller allegedly used her access to the corporate checking account to issue payments from corporate accounts to herself. Also, Mueller allegedly concealed her actions from the company owners and made misrepresentations concerning the company’s financial state.

In addition, from March of 2010 through June of 2012, Mueller allegedly defrauded Medica, a health care benefit program. She purportedly submitted claims to various insurers, seeking reimbursement for services provided by Edelweiss nursing staff. In some instances, Mueller double-billed by submitting claims for the same services to multiple insurance providers. For example, Mueller allegedly billed both Minnesota Medicaid and Medica for services provided to one client. The double-billing resulted in a double-payment to Edelweiss with Medicaid being the proper payer and Medica being the overpayer. As a result of this criminal behavior, Mueller obtained for Edelweiss more than $631,000 in fraudulent proceeds. Medica is a non-profit corporation that provides health insurance products to families and individuals.

If convicted in this case, Mueller faces a potential maximum penalty of 30 years in federal prison on the wire fraud count and ten years on the health care fraud count. All sentences will be determined by a federal district court judge.


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Wednesday, January 9, 2013

Derrick R.D. Field, 36, of Greenland, New Hampshire Sentenced for Defrauding Medicare


Source- http://www.justice.gov/usao/ma/news/2013/January/FieldDerrickSentencingPR.html

BOSTON – A former manager of medical device company Orthofix was sentenced today in federal court for defrauding Medicare by falsifying patient medical records.

In March 2012, Derrick R.D. Field, 36, of Greenland, New Hampshire, pleaded guilty to charges of health care fraud. Today, U.S. District Court Joseph L. Tauro sentenced him to five months home confinement as part of his two years probation. Judge Tauro also ordered Field to pay a fine of $4,000, and to forfeit $40,000.

Field admitted that for several years he falsified patient medical records, causing Medicare to pay more than $250,000 for fraudulent claims for medical devices. Between 2005 and 2011, Field was a territory manager for Orthofix, Inc., a company that manufactured and distributed bone growth stimulator medical devices. Bone growth stimulators are used to assist patients with bone fractures that did not heal properly. Medicare has specific rules describing when it will pay for this device. When Field received bone growth stimulator orders for Medicare patients that did not meet these rules, Field forged the patients’ medical records to make it appear as though the order met the rules to induce Medicare to pay for claims that otherwise would not be covered. For instance, Field created phony medical chart notes, describing patient visits that did not occur and altered the physicians’ actual chart notes by inserting false diagnoses and descriptions of the patients’ medical history. Field forged medical records in connection with more than 100 Medicare claims, causing Medicare to pay Orthofix for orders that did not meet program guidelines.

In addition to Field’s sentence, the on-going Orthofix investigation has resulted in a number of felony charges against executives, employees and contractors of Orthofix, including the following:

1. In December 2012, Orthofix was convicted of obstruction of a federal audit, and ordered to pay approximately $42 million in criminal fines and civil payments, and was sentenced to probation for five years;

2. In April 2012, Thomas Guerrieri pleaded guilty to paying kickbacks while he was vice president of Orthofix;

4. In December 2011, Mitchell Salzman pleaded guilty while he was a regional manager for Orthofix;

6. In July 2012, Michael Cobb, a physician’s assistant, was sentenced to six months in prison to be followed by two years of supervised release, six months of which under home confinement and ordered to pay $10,000 in forfeiture. Cobb previously pleaded guilty to accepting kickbacks from Orthofix.;

7. In May 2012, Michael McKay pleaded guilty to health care fraud while he was a territory manager for Orthofix; and

8. In September 2012, Brian Racey pleaded guilty to health care fraud while he was a territory manager for Orthofix.



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Tuesday, January 8, 2013

Dr. Alphonso Berry Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme


Source- http://www.fbi.gov/detroit/press-releases/2013/detroit-doctor-pleads-guilty-in-connection-with-medicare-psychotherapy-fraud-scheme

WASHINGTON—A Detroit doctor at the center of a $13.2 million psychotherapy fraud scheme, which used the Medicare information of mentally-disabled Detroit residents to defraud Medicare, pleaded guilty today for his role in the scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley, III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office.

Dr. Alphonso Berry, 51, of Orchard Lake, Michigan, pleaded guilty before U.S. District Judge Stephen J. Murphy, III in the Eastern District of Michigan to one count of conspiracy to commit health care fraud and five counts of health care fraud. Marcus Jenkins and Beth Jenkins, Dr. Berry’s co-conspirators in the scheme, pleaded guilty on January 7 and January 3, 2012, respectively, to the same charges for their roles in the scheme.

Dr. Berry admitted that he and others conspired to defraud Medicare through Quality Recreation & Rehabilitation LLC (QRR) and Procare Rehabilitation Inc., two Detroit adult day care centers. Dr. Berry admitted that he created a Medicare provider number for these businesses to allow them to bill Medicare for psychotherapy in his name. According to court documents, the Medicare recipients at QRR and Procare were severely mentally-disabled residents of Detroit adult foster care homes. Dr. Berry admitted that, although he did not provide any psychotherapy to these patients at QRR and Procare, he signed psychotherapy progress notes that were used at these companies to submit psychotherapy claims to Medicare, including claims that he provided psychotherapy to a dead person.

Court documents allege that Dr. Berry and his co-conspirators used Dr. Berry’s Medicare number to submit more than 116,000 psychotherapy claims in his name, amounting to more than $8.2 million. From 2004 through 2011, QRR and Procare submitted more than 185,000 claims to Medicare totaling more than $13.2 million for group and individual psychotherapy that was not provided. According to court documents, Medicare paid $4,777,792 on these claims.

At sentencing, scheduled for April 26, 2013, Dr. Berry faces a maximum penalty of 60 years in prison and a $1.5 million fine.


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Monday, January 7, 2013

Mario Roncal, 61 Pleads Guilty to Conspiracy to Bill Medicare for Unlicensed Physician’s Services


Source- http://www.fbi.gov/newark/press-releases/2013/medical-assistant-pleads-guilty-to-conspiracy-to-bill-medicare-for-unlicensed-physicians-services

NEWARK—A medical assistant at a pair of large medical services companies with offices in New Jersey and New York admitted today to conspiring with the companies’ chief executive officer to defraud Medicare over a four-year period by performing illegal, unlicensed physicians’ services for patients, U.S. Attorney Paul J. Fishman announced.

Mario Roncal, 61, of Woodland Park, New Jersey, pleaded guilty before U.S. District Judge Jose L. Linares in Newark federal court to an indictment charging him with one count of conspiracy to commit health care fraud.

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

In 1988, Roncal received a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico. Since that time, however, he was never licensed to practice medicine in New Jersey, New York, or any other state in the United States. In 2000 and 2002, Roncal was advised by the New Jersey Board of Medical Examiners that he were ineligible to obtain a medical license in New Jersey because his medical school was not accredited and he lacked certain requirements for international medical students to obtain a license in the United States.

From 2004 to the present, Roncal was employed ostensibly as a medical assistant for Cardio-Med Services LLC in New Jersey and for Comprehensive Healthcare & Medical Services LLC in Manhattan and Queens, New York. These companies were owned and operated by the CEO and head physician at Cardio-Med and Comprehensive Healthcare, who is a board-certified cardiologist licensed to practice medicine in New Jersey and New York, and who is identified in the indictment as the “CEO-physician.”

According to Roncal, from 2004 through at least 2008, he conspired with the CEO-physician to cause Cardio-Med and Comprehensive Healthcare to submit false billing claims to Medicare representing that physicians’ services had been provided by the CEO-physician when those services had, in fact, been provided by Roncal. Roncal admitted that he held himself out to fellow employees and to patients as “Dr. Roncal” and that he examined new patients as well as the CEO-physician’s follow-up patients. He also admitted that he ordered diagnostic tests for patients; diagnosed patients with medical conditions, diseases, and the like; and recommended and prescribed courses of treatment, including surgery and enhanced external counter pulsation (or EECP) for patients. Roncal stated that he intentionally ordered unnecessary diagnostic tests for the patients he unlawfully treated and that he willfully misdiagnosed patients with diseases and conditions such as coronary artery disease and angina, for the purpose of fraudulently prescribing and administering treatments of EECP, at the direction of the CEO-physician. To disguise that he, rather than the CEO-physician, was providing these physicians’ services to patients, Roncal forged the CEO-physician’s signature on paperwork associated with these unlawful services, including on prescription pads and patient charts.

The count to which Roncal pleaded guilty is punishable by a maximum potential penalty of 10 years in prison. Sentencing is scheduled for April 17, 2013.



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Sunday, January 6, 2013

Lashawn Denise Anthony, 41, of Wetumpka Indicted For Stealing Over $750,000 From Medicaid


Source- http://www.justice.gov/usao/alm/press/2013/2013_01_03_anthony.html

Montgomery, Alabama - Lashawn Denise Anthony, 41, of Wetumpka was arraigned today on charges that she stole over $750,000 from Alabama Medicaid, announced George L. Beck, U.S. Attorney for the Middle District of Alabama.

The 10-count indictment filed in U.S. District Court charges Anthony with committing health care fraud through her business, Youth Enhancement and Family Services, Inc. Youth Enhancement and Family Services, Inc. is a non-profit corporation which provides psychotherapy services to students and families as part of the Medicaid Program in Alabama. The specific program was designed to provide counseling services to children with behavioral problems as well as to give their families living skills training.

Specifically, Anthony committed health care fraud by falsely billing claims as if a psychologist with a doctoral degree had actually provided services, when, in fact, the therapist who performed the service had only a master’s degree. Thus, Anthony made more money from Medicaid than she was legally owed. In July 2010, Alabama Medicaid sent out billing instructions that explained how to bill Medicaid for the services rendered by a person with a doctoral degree and how to bill Medicaid for services provided by a person with only a master’s degree. After receiving these instructions, Anthony falsely billed Medicaid, thereby getting more money from Medicaid than she was legally due. By submitting these false bills to Medicaid, Anthony made false statements to the Medicaid Program.

“The Medicaid Program is in place to provide health care for needy families,” Beck said. “Anyone who fraudulently bills Medicaid, drives up the cost of Medicaid. This limits the ability of the Alabama Medicaid Agency to provide medical care to those in need. This office will continue to investigate and prosecute health care fraud aggressively and thoroughly. I want to especially thank the Benefits Integrity Division of Alabama Medicaid for their discovering this scheme. This joint investigation shows the importance of law enforcement cooperation among federal and state authorities,” stated Beck.

Each count of the health care fraud scheme carries a maximum punishment of 10 years in prison and a $250,000.00 fine, while each of the false statement counts carries a maximum punishment of five years in prison and a $250,000.00 fine.



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Saturday, January 5, 2013

Beth Jenkins Owner of Detroit Adult Day Care Centers Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme


Source- http://www.justice.gov/opa/pr/2013/January/13-crm-013.html

WASHINGTON – The owner of several Detroit-area adult day care centers pleaded guilty today for her role in a $13.2 million psychotherapy fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade, Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office.

Beth Jenkins, 48, of Farmington Hills, Mich., pleaded guilty to one count of conspiracy to commit health care fraud and five counts of health care fraud, before U.S. District Judge Stephen J. Murphy III in the Eastern District of Michigan.

Jenkins admitted that she and others conspired to defraud Medicare through Quality Recreation & Rehabilitation LLC (QRR) and Procare Rehabilitation Inc., two adult day care centers she owned and operated with alleged co-conspirators. According to court documents, Jenkins and her alleged co-conspirators owned and operated several Detroit-area adult foster care homes (AFCs) that housed severely mentally-disabled Medicare recipients. Court documents allege that Medicare beneficiaries living at AFCs, some of which were owned and operated by Jenkins and her alleged co-conspirators, were transported to QRR and Procare by Jenkins and others. According to court documents, Jenkins and her alleged co-conspirators used the AFC residents’ Medicare information to bill Medicare for group and individual psychotherapy that was never provided.

From 2004 through 2011, Jenkins and her alleged co-conspirators submitted more than 185,000 claims to Medicare totaling more than $13.2 million for group and individual psychotherapy that was not provided. According to court documents, Medicare paid $4,777,792 on these claims.

At sentencing, scheduled for April 19, 2013, Jenkins faces a maximum penalty of 60 years in prison and a $1,500,000 fine.

Jenkins’s co-defendants, Dr. Alphonso Berry and Marcus Jenkins, Beth Jenkins’s husband, are scheduled for trial on Jan. 8, 2013. They are presumed innocent until proven guilty at trial.



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