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Carla Clark and Lillie Lavan Plead Guilty Today in Health Care Fraud Case

2012-01-30T07:31:00.000-08:00

Source- http://www.fbi.gov/neworleans/press-releases/2012/guilty-pleas-in-health-care-fraud-case

BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that CARLA CLARK, age 47, and LILLIE LAVAN, age 57, both of Pineville, Louisiana, pled guilty today before Senior U.S. District Court Judge Frank J. Polozola to counts of an indictment charging health care fraud.

The indictment arose from a health care fraud scheme involving two companies known as Fusion Services, L.L.C. (“Fusion”), and Grace Social Services, L.L.C. (“Grace”), which operated in Alexandria, Louisiana and the surrounding areas. CLARK and LAVAN were licensed clinical social workers who worked with Sonya Williams, the owner of Fusion and Grace. CLARK and LAVAN participated in creating false and misleading medical records for Fusion indicating that Medicare beneficiaries had received individual, face-to-face psychotherapy when, in fact, no such services had been provided. Williams then prepared false claims for the purported psychotherapy services to elderly patients and submitted them to Medicare for reimbursement. Medicare paid Fusion and Grace approximately $349,715 as a result of the billings, much of the profits were deposited into Williams’ personal accounts.

As a result of her guilty pleas, CLARK faces a maximum sentence of imprisonment of 20 years, a $500,000 fine, or both. As a result of her guilty plea, LAVAN faces a maximum sentence of imprisonment of 10 years, a $250,000 fine, or both. The court may also order CLARK and LAVAN to pay restitution. Sentencing has not yet been set for either defendant.

United States Attorney Donald J. Cazayoux, Jr. stated, “This plea is the result of another successful effort by the Medicare Fraud Strike Force to root out and prosecute health care fraud. Rest assured, we will continue to pursue these fraudsters who undermine our health care system. I commend our partners with the U.S. Department of Health and Human Services, the Federal Bureau of Investigation, the Internal Revenue Service, and AdvanceMed for their continued focus and diligence in finding and stopping fraud within our Medicare system.”

Assistant Special Agent in Charge William W. Root, Health and Human Services said, “We are proud of the outstanding work by the Medicare Fraud Strike Force. The guilty pleas today sends a message to other perpetrators that we will thoroughly investigate all allegations of health care fraud. Protecting the programs intended for our nation’s most vulnerable citizens is paramount to our mission.”

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Jorge Pineiro Pleads Guilty in $25 Million Health Care Fraud Scheme

2012-01-29T07:28:00.000-08:00

Source- http://www.fbi.gov/miami/press-releases/2012/miami-area-nurse-pleads-guilty-in-25-million-health-care-fraud-scheme

WASHINGTON—A Miami-area nurse pleaded guilty today for his participation in a $25 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.

Jorge Pineiro, 42, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. Pineiro was originally charged in a February 2011 indictment.

According to plea documents, Pineiro was a registered nurse who worked for ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., two Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Pineiro and his co-conspirators operated ABC and Florida Home Health for the purpose of billing Medicare for expensive services that were not medically necessary and/or were never provided. The medically unnecessary services were prescribed by doctors, including, but not limited to, Pineiro’s co-defendant, Dr. Jose Nunez.

According to court documents, beginning in approximately June 2008, and continuing until approximately March 2009, Pineiro and his co-defendant nurses falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services. Pineiro knew that the beneficiaries did not actually qualify for and did not receive the services. Pineiro and his co-defendant nurses described in nursing notes and patient files symptoms that were non-existent, such as tremors, impaired vision, weak grip and inability to walk without assistance. They included these symptoms to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare.

Pineiro admitted that he knew these files were falsified so that Medicare could be billed for medically unnecessary therapy and home health-related services. As a result of Pineiro’s participation in the illegal scheme, the Medicare program was billed approximately $118,000 for purported home health care services that were not medically necessary and/or were never provided.

Pineiro also recruited Medicare beneficiaries who allowed Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided. Pineiro solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for allowing the agency to bill Medicare on behalf of the patients he recruited. The patients that Pineiro recruited did not qualify for the services that were billed to the Medicare program. Pineiro knew that the patient files for his recruited patients were falsified to make it appear that the patients qualified for services from Florida Home Health.

Eighteen co-defendants, including Nunez, Licet Diaz, and Lisandra Alonso, have pleaded guilty for their roles in the fraud scheme. Nunez, Diaz, and Alonso were sentenced to 40 months, 87 months and 78 months in prison, respectively. Two remaining defendants, Dr. Francisco Gonzalez and Odalys Alvarez-Medina, are scheduled for trial on Feb. 14, 2012. An indictment is merely a charge, and defendants are presumed innocent until proven guilty.

Sentencing for Pineiro has been scheduled for April 9, 2012.

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

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Adedayo O. Adegboye and Olalekan Rufai Each Sentenced in Health Care Fraud Wheelchair Scam

2012-01-28T07:08:00.000-08:00

Source- http://www.fbi.gov/oklahomacity/press-releases/2012/new-york-men-sentenced-in-health-care-fraud-wheelchair-scam

OKLAHOMA CITY—Today, ADEDAYO O. ADEGBOYE and OLALEKAN RUFAI, both age 48 and both of Brooklyn, New York, were each sentenced by United States District Judge Timothy D. DeGiusti to serve 12 months and one day in prison for health care fraud in connection with the sale of power wheelchairs and wheelchair accessories to Medicare beneficiaries, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma. In addition, Judge DeGiusti ordered that the men pay restitution in the amount of $299,624.

Adegboye and Rufai opened First Century Medical Supply, Inc., located in Oklahoma City, to engage in the business of selling power wheelchairs and wheelchair accessories to Medicare beneficiaries. Evidence presented at trial last August showed that from 2007 through 2009 the business obtained identification numbers and personal information from Medicare beneficiaries and used that information to submit claims to Medicare for power wheelchairs and wheelchair accessories. Evidence also showed that the defendants billed Medicare for some beneficiaries who did not receive a power wheelchair at all, some who received a less expensive motorized scooter, and for others who did not have a medical need for a wheelchair or did not even request a wheelchair. In all, the evidence showed that through First Century the defendants submitted over $1.1 million in fraudulent claims to Medicare.

Adegboye and Rufai were indicted by a federal grand jury in January of 2011. Following a six-day trial last August, a jury found both men guilty of committing five counts of health care fraud.

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Marietha Morales Plead Guilty in $22 Million Health Care Fraud Scheme

2012-01-27T07:20:00.000-08:00

Source- http://www.justice.gov/opa/pr/2012/January/12-crm-118.html

WASHINGTON – The owner and an employee of a Miami health care agency pleaded guilty for their participation in a $22 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.

Marietha Morales, 38, pleaded guilty on Jan. 24, 2012, before U.S. District Judge Seitz to one count of conspiracy to commit health care fraud and Eduardo Saborit-Dominguez, 48, pleaded guilty today before Judge Seitz to one count of conspiracy to violate the Anti-Kickback Statute. Sentencing for both defendants is scheduled for May 23, 2012. The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years.

According to the court documents, Morales was the president and Saborit-Dominguez was an employee of Prime Home Health Services Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries.

According to plea documents, Morales conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Morales and her co-conspirators paid kickbacks and bribes to patient recruiters in return for these recruiters providing patients to Prime Home Health, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Saborit-Dominguez distributed the kickbacks and bribes to co-conspirator patient recruiters and knew that the payment of kickbacks and bribes was in violation of federal criminal laws. Morales used these prescriptions, plans of care and medical certifications to fraudulently bill the Medicare program for home health care services, which Morales knew was in violation of federal criminal laws.

According to plea documents, at Prime Home Health, nurses and office staff falsified patient files for Medicare beneficiaries to make it appear that such beneficiaries qualified for home health care and therapy services from Prime Home Health. Morales admitted that she knew the beneficiaries did not actually qualify for and did not receive such services. Morales knew that these files were falsified so that the Medicare program could be billed for medically unnecessary therapy and home health related services.

From approximately February 2005 through April 2011, Morales and her co-conspirators submitted approximately $22 million in false and fraudulent claims to Medicare and Medicare paid approximately $14 million on those claims.

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Karen Rayburn Pleads Guilty in Health Care Fraud Scheme

2012-01-26T07:54:00.000-08:00

Source- http://www.fbi.gov/neworleans/press-releases/2012/patient-recruiter-pleads-guilty-in-health-care-fraud-scheme

WASHINGTON—A Baton Rouge, Louisiana-area resident pleaded guilty today for her role in a Medicare fraud scheme involving fraudulent claims for medically unnecessary health care equipment, announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS), and the Louisiana State Attorney General’s Office.

Karen Rayburn, 47, pleaded guilty before U.S. District Judge James J. Brady of the Middle District of Louisiana to one count of conspiracy to commit health care fraud.

Rayburn admitted that she worked as a recruiter for Healthcare 1 LLC and Medical 1 Patient Services LLC, Louisiana-based companies that fraudulently billed medical equipment to the Medicare program from 2004 to 2009. She and other recruiters were hired to obtain prescriptions for medical equipment such as leg braces, arm braces, power wheel chairs, and wheel chair accessories. Rayburn obtained information from Medicare beneficiaries and approached their physicians to request prescriptions for medical equipment. Rayburn admitted that when patients’ physicians were unwilling to provide medically unnecessary prescriptions, she and other recruiters asked unrelated physicians to write prescriptions based on cursory examinations of the patients. Another technique they used was to generate photocopied forms with reproduced physicians’ signatures. These prescriptions were then used to submit fraudulent claims to the Medicare program.

From 2004 to 2009, Medicare was billed $6.53 million for the beneficiaries that Rayburn provided as part of this fraudulent scheme.

Rayburn faces a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not yet been set.

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Ten Individuals Arrested for Health Care Fraud

2012-01-25T07:50:00.000-08:00

Source- http://www.fbi.gov/sanjuan/press-releases/2012/ten-individuals-arrested-for-health-care-fraud

SAN JUAN, PR—On January 12, 2012, a federal grand jury returned two indictments against 10 individuals for conspiracy to commit health care fraud, announced Rosa Emilia Rodríguez-Vélez, United States Attorney for the District of Puerto Rico. The investigation was led by the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), with the collaboration of the United States Secret Service (USSS) and the Federal Bureau of Investigation (FBI).

Gilberto Gómez, president of Monte Mar Health Corporation (Monte Mar), PROMEDS Medical Inc. (PROMEDS) and Quality Care Medical Supply (Quality); Yolanda García-Rodríguez, aka “Yolanda Gómez,” wife of Gómez and president of PROMEDS, secretary/treasurer of Monte Mar and an authorized official of Quality; Lissette Acevedo, independent sales coordinator; Doctor Francisco Garrastegui; Luisa Nieves, independent sales coordinator; Glendaly Báez, billing director for Monte Mar, PROMEDS and Quality; Mario Rivera, independent sales coordinator; and Marcos Sarraga, independent sales coordinator, are charged in a 39-count indictment for conspiracy to commit health care fraud and a forfeiture allegation of $1,956,750.54. The government seeks to forfeit two bank accounts, one investment account, and a Gallery Plaza Condominium located in the Condado area in San Juan, Puerto Rico.

The indictment alleges that from on or about November, 2008, until on or about May, 2010, Monte Mar submitted at least 1,518 false and fraudulent claims to Medicare totaling approximately $2,993,127.35 for Durable Medical Equipment (DME) that was not medically necessary, causing Medicare to disburse approximately $1,440,597.65. In March 2010, the indictment further alleges that after Monte Mar had been placed in a pre-payment status by Medicare, defendants Gilberto Gómez and Yolanda García-Rodríguez purchased PROMEDS and submitted false claims to Medicare seeking reimbursement for DME, including power wheelchairs, power pressure reducing air mattresses and knee orthosis. PROMEDS submitted at least 359 fraudulent claims to Medicare totaling approximately $786,368.34, causing Medicare to disburse approximately $335,493.12. In October 2010, the indictment alleges that a third company, Quality, was purchased by Gómez and García-Rodríguez after PROMEDS had been placed in a pre-payment status by Medicare. From on or about October 2010, until May, 2011, Quality submitted at least 115 false claims to Medicare totaling approximately $298,321.26, causing Medicare to disburse approximately $180,659.77. The indictment alleges a total amount of $4,077,816.95 fraudulently billed by using Monte Mar, PROMEDS and Quality, where Medicare disbursed a total of approximately $1,956,750.54.

Doctor Francisco Garrastegui was a physician licensed to practice medicine in Puerto Rico but not a Medicare provider. Garrastegui signed and completed false progress notes, prescriptions, Certificate of Medical Necessity (CMNs) and Statements of Ordering Physician for Medicare beneficiaries that were billed by Monte Mar, PROMEDS and Quality. The doctor was paid kickbacks by the three health corporations for the preparation of these false documents. The other defendants’ participation during the conspiracy involved the creation and submission of the fraudulent claims to Medicare.

The health care fraud scheme charged in the second indictment involves Luz M. Vega, president of Preferred Medical Equipment (PME), Doctor Francisco Garrastegui, Lissette Acevedo, Luisa Nieves and María Elisa Pérez. According to the 60-count indictment, from on or about April 2010, until on or about March 2011, PME submitted false claims to Medicare, seeking reimbursement for Durable Medical Equipment including: power wheelchairs, power pressure reducing air mattresses, wheelchair accessories, lumbar-sacral orthosis, knee orthosis and hospital beds. The co-conspirators submitted at least 95 fraudulent claims totaling approximately $210,223.47, causing Medicare to disburse approximately $107,876.73. Defendants Garrastegui, Acevedo and Nieves also participated in the first conspiracy charged in the previously mentioned indictment. The government seeks to forfeit $107,876.73 and one bank account.

“As part of the nation’s health care system, Medicare serves vulnerable populations,” said United States Attorney, Rosa Emilia Rodríguez-Vélez. “Today’s arrests by HHS-OIG agents and our law enforcement partners show that we will not tolerate criminals who engage in fraudulent schemes which deplete the Medicare program of funds which are destined for our elderly population, in order to enrich themselves.”

“HHS/OIG works diligently to investigate allegations of Medicare fraud. Today’s arrests involving durable medical equipment (DME) fraud demonstrate our resolve to bring these subjects to justice. Furthermore, as seen on the attached chart (DME data), our efforts, along with the U.S. Attorney’s Office and our law enforcement partners, have made a dramatic reduction on the total dollars billed and paid for DME in Puerto Rico.”

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David Song Sen Cui the Owner of Doraville Medical Clinic Indicted for Health Care Fraud

2012-01-24T07:46:00.000-08:00

Source- http://www.fbi.gov/atlanta/press-releases/2012/owner-of-doraville-medical-clinic-indicted-for-health-care-fraud

ATLANTA—DAVID SONG SEN CUI, 43, of Duluth, Georgia, has been indicted by a federal grand jury on charges of health care fraud.

United States Attorney Sally Quillian Yates said of the case, “Medicare dollars provide critical medical services for elderly and disabled persons. This defendant is charged with defrauding Medicare by repeatedly billing for ‘physical therapy’ that in truth was only massages given by unlicensed massage therapists. Medicare and our taxpayers cannot afford such criminal abuse of health care dollars.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “The FBI, in conjunction with its various law enforcement partners, is committed to the protection of such federally funded programs. Individuals engaged in such fraudulent acts, as is alleged in this indictment, demonstrate a lack of compassion and greed that simply cannot and will not be tolerated. The FBI urges anyone with information regarding healthcare fraud activity to contact its nearest FBI field office.”

According to United States Attorney Yates, the charges, and other information presented in court: From November 2008 through August 2011, CUI operated the Atlanta Hope Medical Group, Inc., a clinic located in Doraville, Georgia. The clinic purported to provide physical therapy services for elderly patients. However, the clinic actually offered massage services, which were performed by unlicensed massage therapists. CUI allegedly billed the massages fraudulently to Medicare as “physical therapy” under a doctor’s name who did not render the services and was not even present at the clinic. As part of the scheme, Atlanta Hope employed a doctor who was present at the clinic only two days a week. The indictment alleges that, during the operation of the clinic, CUI fraudulently billed over $5.5 million in false claims to Medicare.

The indictment charges 11 counts of health care fraud. Each count carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.

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Adriana Mejia Sentenced to 35 Months in Prison for Laundering Money in $200 Million Medicare Fraud Scheme

2012-01-23T07:43:00.000-08:00

Source- http://www.fbi.gov/miami/press-releases/2012/miami-area-resident-sentenced-to-35-months-in-prison-for-laundering-money-in-200-million-medicare-fraud-scheme

WASHINGTON—A Miami-area resident was sentenced today to 35 months in prison for her role in laundering money for a $200 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Adriana Mejia, 40, was sentenced by U.S. District Judge Patricia A. Seitz in Miami. In addition to the prison term, Mejia was also sentenced to one year of supervised release.

Mejia pleaded guilty on July 13, 2011, to one count of conspiracy to commit money laundering. Mejia admitted that she served as a money launderer for American Therapeutic Corporation (ATC), its management company, Medlink Professional Management Group Inc., and the owners and operators of ATC and Medlink. Mejia created fictitious entities and bank accounts to convert millions of dollars of Medicare payments into cash for ATC, Medlink and their owners and operators.

ATC, Medlink and a related company, the American Sleep Institute (ASI), were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs)—a form of intensive treatment for severe mental illness—in seven different locations throughout South Florida and Orlando. ASI purported to provide diagnostic sleep disorder testing.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services to attend treatment programs that were not legitimate PHPs. ATC and ASI then billed Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.

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

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Sharon Johnson Sentenced to 37 Months in Prison for $1.4 Million Health Care Fraud

2012-01-22T07:41:00.000-08:00

Source- http://www.fbi.gov/albany/press-releases/2012/windham-county-woman-sentenced-to-37-months-in-prison-for-1.4-million-health-care-fraud
The Office of the United States Attorney for the District of Vermont stated that on January 12, 2012, Senior United States District Judge J. Garvan Murtha sentenced Sharon Johnson, 63, of West Dover, Vermont, to 37 months in prison for conspiracy to commit health care fraud. Judge Murtha also ordered Johnson to pay restitution to Mutual of Omaha Insurance Company in the amount of $1,395,755.42.

Johnson previously pled guilty to one count of conspiracy to commit health care fraud and mail fraud. As part of the plea agreement, Johnson admitted that she had obtained over $1,000,000 in fraudulent proceeds from Mutual of Omaha.

Mutual of Omaha discovered the fraud during a 2006 audit of its claims processing system, and referred the matter to the FBI. Subsequent investigation revealed that Rachel Lenagh, a then-employee of Mutual of Omaha, had paid almost $1.4 million in fraudulent claims to Johnson. Investigators also discovered that Lenagh processed payment to Johnson on claims for which there were no supporting medical bills or other relevant documentation, and that these fraudulent payments occurred at Johnson’s direction.

On October 17, 2007, a federal grand jury sitting in Omaha, Nebraska returned a seven-count indictment against Johnson and Lenagh. Lenagh pled guilty in Nebraska to conspiracy to commit health care fraud and was sentenced on February 6, 2009 to 24 months in prison and restitution in the amount of $1,395,755.42.

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Sandra Jimenez Pleads Guilty to Participating in $200 Million Medicare Fraud Scheme

2012-01-21T07:19:00.000-08:00

Source- http://www.justice.gov/opa/pr/2012/January/12-crm-063.html

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

Sandra Jimenez, 38, admitted to participating in a fraud scheme that was orchestrated by the owners and operators of American Therapeutic Corporation (ATC); its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute (ASI). ATC, Medlink and ASI were all Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs) – a form of intensive treatment for severe mental illness – in seven different locations throughout South Florida and Orlando. ASI purported to provide diagnostic sleep disorder testing.

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 pay and receive illegal health care kickbacks. Jimenez was charged in an indictment unsealed on Feb. 15, 2011, in the Southern District of Florida.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHPs. ATC and ASI then billed Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.

In pleading guilty, Jimenez admitted that she served as a marketer for ATC and ASI. In this role, Jimenez solicited beneficiaries and paid kickbacks to assisted living facility owners in exchange for the beneficiaries. The amount of the kickback was based on the number of days each patient spent at ATC.

Jimenez also admitted that 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 home health 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 the Medicare program.

Sentencing for Jimenez is scheduled for June 27, 2012, at 8:30 a.m. Jimenez faces a maximum penalty of 15 years in prison and a $250,000 fine.

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Alexander Popov Sentenced to Eight Years in Federal Prison for Role in Massive Medicare Fraud Scam

2012-01-20T07:11:00.000-08:00

Source- http://www.fbi.gov/sacramento/press-releases/2012/physician-sentenced-to-eight-years-in-federal-prison-for-role-in-massive-medicare-fraud-scam

SACRAMENTO, CA—United States Attorney Benjamin B. Wagner announced that Alexander Popov, 47, of Los Angeles, was sentenced today by United States District Judge Morrison C. England Jr. to eight years and one month in prison for committing health care fraud and conspiring to commit health care fraud. He was found guilty by a jury on July 8, 2011.

In sentencing, Judge England found that Popov, a medical doctor, was responsible for more than a million dollars in fraudulent billings submitted to Medicare and more than $600,000 in payments made on false claims. Popov abused his position of trust as a physician and endangered the health of patients. Evidence at trial showed that Popov gave false testimony and manufactured evidence at trial, amounting to an obstruction of justice. In particular, a letter produced by Popov on the eve of trial, and supposedly written years earlier while the conspiracy was in progress.

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. Popov assumed the role of co-owner and practitioner at the Sacramento clinic, and claims were be submitted to Medicare under his name for medical services purportedly rendered at the clinic.

In fact, Popov never treated a single patient at the clinics. 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 in the amount of $100 per visit. Patient charts were created falsely 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 Southern California, where Popov would sign them indicating he provided or approved the treatments therein, and sign related billing forms. These files were then used to support billing submitted to Medicare for treatments and services that were unnecessary, never performed, or both. 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, Popov and the other involved physicians received 20 percent of the billings paid under their respective provider numbers.

In pronouncing sentence, Judge England stated that the conspiracy was “a very sophisticated operation.” Dr. Popov requested leniency on the basis of the benefits he had provided and could continue to provide to society in his role as a physician. The Judge rejected this, stating, “a physician should be held to a higher standard rather than a lower standard. … People trust their doctors, people want to trust their doctors … this was about making money. … He used his profession, he used his education, he used his intelligence in the worst possible way. It’s extremely troubling.”

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David Hamedany Sentenced to Three Years in Prison in Kickback Scheme that Cost Hospital Nearly $5 Million

2012-01-19T07:16:00.000-08:00

Source- http://www.fbi.gov/losangeles/press-releases/2012/former-huntington-hospital-executive-sentenced-to-three-years-in-prison-in-kickback-scheme-that-cost-hospital-nearly-5-million

LOS ANGELES—The former director of construction for Huntington Memorial Hospital in Pasadena was sentenced this morning to three years in federal prison and ordered to pay $4.8 million in restitution for orchestrating a kickback scheme in which companies were paid for work that was never done at the Pasadena hospital.

David Hamedany, 55, of Glendale, was sentenced by United States District Judge Percy Anderson. Hamedany pleaded guilty in May 2011 to two counts of mail fraud.

At this morning’s sentencing hearing, Judge Anderson said Hamedany was an immigrant who realized the American Dream, but had “lost his moral compass” and became motivated by greed.

Hamedany served as the director of construction for Huntington Memorial Hospital during the years from 2006 through 2010. Beginning in 2008, Hamedany orchestrated a billing and kickback scheme that resulted in the hospital paying more than $3 million to companies that performed no work at all for the hospital. The companies funneled 90 percent of the fees paid by the hospital to entities controlled by Hamedany. During the same time period, Hamedany entered into inflated contracts with entities that were performing services for the hospital, but agreed to inflate the price and pay the excess money in kickbacks to entities controlled by Hamedany. In total, the scheme, resulted in losses to the hospital of approximately $4.8 million.

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Advantage Medical Transport, Inc and its owner, Serge Sivchuk Indicted on Federal Medicare Fraud Charges

2012-01-18T07:56:00.000-08:00

- http://www.fbi.gov/philadelphia/press-releases/2012/harrisburg-ambulance-company-owner-and-employee-indicted-on-federal-medicare-fraud-charges

The United States Attorney’s Office for the Middle District of Pennsylvania announced today that a Harrisburg-based ambulance company, its owner, and a managerial employee have been indicted by a grand jury in Harrisburg on federal health care fraud charges.

Advantage Medical Transport, Inc, headquartered at 733 Fire House Lane, Harrisburg, and its owner, Serge Sivchuk, age 26, also of Harrisburg, were charged in the indictment with 14 counts of health care fraud, one count of conspiracy, and 14 counts of false statements in health care matters. Advantage’s EMT and dispatcher supervisor, David Paul, age 42, of York, Pennsylvania, was also charged with conspiracy and 14 counts of false statements in health care matters.

According to U.S. Attorney Peter J. Smith, the indictment alleges that between January 2009 and June 2011 Advantage and Sivchuk devised and perpetrated a scheme to defraud Medicare out of at least $1,000,000 by submitting hundreds of claims for the non-emergency transport of Medicare beneficiaries to and from dialysis treatment centers. The indictment alleges the claims were fraudulent because the patients were ambulatory and the ambulance transports were not medically necessary.

During 2010 Medicare paid Advantage $166.64 plus $5.49 per mile for each leg of a transport to and from a dialysis treatment center. Many dialysis patients underwent three treatments per week. Thus, one week’s transport of a dialysis patient could yield Advantage more than $1,000.

The indictment focuses on an August 2010 pre-payment audit conducted by Medicare. Allegedly, of 40 claims audited, it was discovered Advantage and Sivchuk had submitted 14 re-written and forged ambulance “Trip Sheets” in support of the claims. The Trip Sheets, which are prepared by Emergency Medical Technicians (EMTs) at the time of each transport, had been allegedly rewritten to omit references to the patients’ ability to walk, stand or otherwise ambulate. The patients’ vital signs (blood pressure, pulse, and respirations) on two Trip sheets were changed and the signatures of some of the EMTs were allegedly forged. The Indictment alleges Sivchuk and Paul directed Advantage’s EMTs to re-write the 14 Trip Sheets and to prepare many others in a manner that concealed the ambulatory nature of the patients.

The indictment alleges the EMTs were threatened with a reduction in hours or termination if they did not prepare the Trip Sheets as they were directed.

Each health care fraud count is punishable by up to 20 years’ imprisonment and $1,000,000 fine. The conspiracy count and each false statement count is punishable by up to five years’ imprisonment and $1,000,000 fine.

The indictment also seeks the criminal forfeiture of Sivchuk’s Farmcrest Lane, Harrisburg, Pennsylvania residence, Advantage’s business premises at 733 Fire House Lane, Harrisburg, $860,972 in six Harrisburg area bank accounts controlled by Sivchuk, plus Sivchuk’s 2006 Bentley and 2010 Land Rover.

The indictment was the result of a federal investigation that began earlier this year with the execution of search warrant at Advantage’s business premises. During the search, voluminous records and documents were seized. At the same time the search warrant was executed, the U.S. Attorney’s Office filed a civil action in U.S. District Court in Harrisburg freezing more than $936,000 in Advantage and Sivchuk controlled bank accounts.

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John Alemoh Momoh Sentenced for Defrauding Medicaid Out of More Than $650,000

2012-01-17T07:51:00.000-08:00

Source- http://www.fbi.gov/minneapolis/press-releases/2012/owner-of-home-health-care-agency-is-sentenced-for-defrauding-medicaid-out-of-more-than-650-000

MINNEAPOLIS—Yesterday in federal court in St. Paul, the owner of a home health care agency was sentenced for defrauding Medicaid and obtaining more than $650,000 through false billing. United States District Court Judge Paul A. Magnuson sentenced John Alemoh Momoh, age 52, of Brooklyn Park, to 24 months in prison on one count of health care fraud. Momoh was charged on April 12, 2011, and pleaded guilty on September 29, 2011.

In his plea agreement, Momoh admitted that from May of 2007 through March of 2008, he submitted false claims billing Medicaid for personal care assistance (“PCA”) services. The claims were false in multiple ways, including regarding the hours of services provided, the PCA providing those services, and the type of services provided. In addition, claims lacked required documentation and were sometimes submitted for services not medically necessary. Momoh also submitted claims for PCA services provided by an individual who was disqualified from the program for safety reasons.

The fraudulent claims were made to the Minnesota Department of Human Services (“DHS”), which administers the federal Medicaid program here in Minnesota. Momoh owned Hopecare Services, Inc., located in Brooklyn Park. In March of 2007, DHS opened an investigation into Hopecare’s billing practices after a Medicaid recipient complained about Momoh’s billing. After reviewing this complaint, DHS twice notified Momoh that he had billed improperly, both by an agency notice explaining Momoh’s false billing and by meeting with Momoh in person. Despite these warnings, Momoh continued to fraudulently bill Medicaid, submitting more than 800 fraudulent claims for PCA services in less than one year.

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Larry Bernhard Sentenced to Over Four Years in Prison for Fraudulently Billing Medicare Over $1.1 Million

2012-01-16T07:46:00.000-08:00

Source- http://www.fbi.gov/baltimore/press-releases/2012/gambrills-podiatrist-sentenced-to-over-four-years-in-prison-for-fraudulently-billing-medicare-over-1.1-million

BALTIMORE—U.S. District Judge James K. Bredar sentenced Larry Bernhard, age 56, a podiatrist who operated his business from his home in Gambrills, Maryland, today to 54 months in prison followed by three years of supervised release for health care fraud and aggravated identity theft related to a scheme to fraudulently bill Medicare for more than $1.1 million. Judge Bredar also entered an order requiring Bernhard to pay restitution of $1,122,992.08.

The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.

“Health insurance programs trust providers to bill honestly for medical services, so it is essential to punish doctors who betray that trust,” said U.S. Attorney Rod J. Rosenstein. “Dr. Larry Bernhard flagrantly ripped off Medicare Advantage by fabricating claims for services that he never provided, collecting more than $1 million in new false claims even after he was caught and prohibited from billing federal health care programs.”

According to his plea agreement, Bernhard has been a licensed podiatrist in Maryland since 1981 and operated a podiatry practice from his home known as Chesapeake Wound Care Center. On October 30, 2007, Bernhard entered into a Settlement Agreement with the government to resolve allegations that from April 1, 2002 through October 11, 2004, he had submitted 80 claims to Medicare for podiatry services purportedly provided at skilled nursing facilities, when in fact the patients were in hospitals. As part of the settlement, Bernhard agreed to be excluded from “Medicare, Medicaid, and all other Federal health care programs” for a period of three years.

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Barry Nash Pleads Guilty to Fraud and Kickback Scheme

2012-01-15T07:24:00.000-08:00

Source- http://www.fbi.gov/losangeles/press-releases/2012/glendale-man-pleads-guilty-in-5-million-loan-fraud-case

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

Barry Nash, 69, pleaded guilty before U.S. Magistrate Judge Barry L. Garber in Miami to one count of conspiracy to commit health care fraud. Nash was the owner and operator of Starter House, a halfway house operating in Broward County.

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

According to court documents, ATC’s principals paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. Ultimately, ATC and ASI billed Medicare for more than $200 million in medically unnecessary services.

According to the plea agreement, Nash’s participation in the fraud resulted in more than $959,901 in fraudulent billing to the Medicare program. At sentencing, scheduled for March 8, 2012, Nash faces a maximum of 10 years in prison and a $250,000 fine.

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

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Hee Jung Mun Pleads Guilty to Bilking Medicare Out of Over $5 Million in Health Care Fraud Scheme

2012-01-14T07:20:00.000-08:00

Source- http://www.fbi.gov/losangeles/press-releases/2012/owner-of-westlake-home-health-agency-pleads-guilty-to-bilking-medicare-out-of-over-5-million-in-health-care-fraud-scheme

LOS ANGELES—A registered nurse who operated a home health agency based in Westlake has pleaded guilty to federal health care fraud charges in a $5 million Medicare fraud scheme involving kickbacks to doctors and patients who did not qualify for in-home health services.

Hee Jung Mun, who often used the name Angela Mun, 50, of Rancho Palos Verdes, pleaded guilty yesterday afternoon before United States District Judge Dean D. Pregerson.

Mun owned Greatcare Home Health, Inc., which was shut down in March 2011 when special agents with the Federal Bureau of Investigation and the Department of Health and Human Services, Office of Inspector General, executed a search warrant at the company’s office. The criminal investigation into Greatcare was prompted by a still-pending “whistleblower” lawsuit filed by a former employee.

In a plea agreement filed in United States District Court, Mun admitted that she orchestrated the scheme that defrauded Medicare in a number of ways: paying illegal kickbacks to doctors for patient referrals, to “cappers” or “marketers” for patient referrals, and to patients to induce them to sign up for home health services; billing Medicare for patients who were not homebound or who otherwise did not quality for home health services, and for services provided by unlicensed individuals or not provided at all; creating bogus medical records to support fraudulent claims to Medicare; and “upcoding” or exaggerating patient conditions to generate larger reimbursements from Medicare. The scheme targeted elderly, primarily Korean, Medicare beneficiaries.

A nurse who worked at Greatcare also pleaded guilty yesterday afternoon. Ji Hae Kim, 43, of Fullerton, pleaded guilty to conspiracy to commit health care fraud, admitting that she prepared false forms to fraudulently justify that Medicare beneficiaries needed home health services. Kim also falsely claimed to have made patient visits that she knew were either conducted by unlicensed individuals or not conducted at all, leading to $1.1 million in payments from Medicare.

As a result of their guilty pleas this afternoon, Mun and Kim both face statutory maximum sentences of 10 years in federal prison.

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Ambulance Company Worker Ivan Tkach Pleads Guilty to Fraud Scheme

2012-01-13T07:42:00.000-08:00

Source- http://www.fbi.gov/philadelphia/press-releases/2012/ambulance-company-worker-pleads-guilty-to-fraud-scheme

HILADELPHIA—Ivan Tkach, 30, of Philadelphia, pleaded guilty today to charges relating to a private ambulance company’s involvement in a health care fraud scheme. Tkach admitted to giving false statements relating to health care and illegal remunerations relating to health care services. A sentencing hearing is scheduled for April 12, 2012 before U.S. District William H. Yohn, Jr. Tkach faces an advisory sentencing guideline range of 37 to 57 months in prison and has agreed to pay restitution in the amount of $1.26 million to Medicare.

Tkach was indicted along with his bosses Alla and Ilya Sivchuk; Ilya Sivchuk was convicted by a jury in November 2011 and Alla Sivchuk was acquitted. Tkach was excluded by the U.S. Department of Health and Human Services in 2004 from providing services under the Medicare Program due to his prior criminal convictions, yet continued to operate Advantage Ambulance Company and drive patients in ambulances. Tkach ran Advantage with the knowledge of Ilya Sivchuk, who also made false statements regarding the nature of Tkach’s employment to federal agents. In addition, Tkach gave kickback payments in 2008 to a worker at a Philadelphia kidney dialysis center in exchange for patient referrals to Advantage.

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Tuan Vu Pleads Guilty to Billing Insurance Providers Hundreds of Thousands of Dollars for Dental Services That he Did Not Provide

2012-01-12T07:26:00.000-08:00

Source- http://www.fbi.gov/washingtondc/press-releases/2012/alexandria-dentist-pleads-guilty-to-health-care-fraud

ALEXANDRIA, VA—Tuan Vu, 43, of Annandale, Va., pleaded guilty today to fraudulently billing insurance providers hundreds of thousands of dollars for dental services that he did not provide to his patients.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office, made the announcement after the plea was accepted by United States District Judge Liam O’Grady.

Vu was charged today by criminal information with health care fraud, and he faces a maximum penalty of 10 years in prison when he is sentenced on May 4, 2012.

In a statement of facts filed with his plea agreement, Vu admitted to committing health care fraud from at least January 2007 to September 2011. Vu is the owner of Cosmetic & Family Dentistry, PLLC, a dental practice located in Alexandria, Va. During the time of his health care fraud scheme, Vu consistently billed dental insurance providers for services that he did not provide his patients. As a result of Vu’s offense, at least 10 private insurance providers suffered more than $400,000 in losses. Dr. Vu’s conduct also resulted in a substantial loss to the federal government and the Commonwealth of Virginia, including $87,389 to the Federal Employee Health Benefits Program and $180,048 to the Virginia Medicaid program.

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Christopher Iruke Sentenced to 180 Months in Prison for $14.2 Million Medicare Fraud Scheme

2012-01-11T07:23:00.000-08:00

Source- http://www.fbi.gov/losangeles/press-releases/2012/los-angeles-church-pastor-sentenced-to-180-months-in-prison-for-14.2-million-medicare-fraud-scheme

WASHINGTON—The pastor of a now defunct Los Angeles church who owned and operated several fraudulent durable medical equipment (DME) supply companies was sentenced today to 180 months in prison for his role in a $14.2 million Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced.

Christopher Iruke, 61, was also ordered to pay $6.7 million in restitution, jointly and severally with his co-conspirators, by U.S. District Judge Terry J. Hatter of the Central District of California. In addition, Judge Hatter ordered Iruke to serve three years of supervised release following his prison term.

In August 2011, a jury found Iruke and his wife, Connie Ikpoh, 49, and one of their employees, Aura Marroquin, guilty of conspiracy and health care fraud offenses following a two-week trial in Los Angeles.

According to evidence introduced at trial, Iruke and Ikpoh were pastors at Arms of Grace Christian Center, a church that operated from 5700 Crenshaw Boulevard in Los Angeles, where Iruke and Ikpoh also operated Pascon Medical Supply, a fraudulent DME supply company. Iruke and Ikpoh hired several of their parishioners at Arms of Grace to assist them in running Pascon and another fraudulent DME supply company, Horizon Medical Equipment and Supply Inc. Horizon was owned by Ikpoh, who also worked as a nurse at two Los Angeles-area hospitals.

According to evidence presented at trial, Iruke, Ikpoh, Marroquin, and their co-conspirators used fraudulent prescriptions and documents that Iruke purchased from a number of illicit sources to bill Medicare for expensive, high-end power wheelchairs and orthotics that were medically unnecessary or never provided. These power wheelchairs cost approximately $900 per wheelchair wholesale, but were billed to Medicare at a rate of approximately $6,000 per wheelchair.

Evidence introduced at trial established that when it appeared to Iruke that he would have to close Pascon due to an audit by Medicare, Iruke convinced his sister, Jummal Joy Ibrahim, and a member of Arms of Grace to allow him to use their names and identities to open two new fraudulent DME supply companies. These companies, Contempo Medical Equipment Inc. and Ladera Medical Equipment Inc., also operated from Los Angeles. After Pascon and Horizon closed, Iruke and his co-conspirators continued to operate the fraud scheme from Contempo and Ladera.

Witnesses who sold fraudulent prescriptions and documents to Iruke testified that they and others paid cash kickbacks to street-level marketers to offer Medicare beneficiaries free power wheelchairs and other DME in exchange for the beneficiaries’ Medicare card numbers and personal information. These witnesses testified that they and their associates used this information to create fraudulent prescriptions and medical documents which they sold to Iruke and the operators of other fraudulent DME supply companies for $1,100 to $1,500 per prescription.

Trial testimony established that Iruke took extensive efforts to conceal the fraud scheme and his involvement with the companies. One witness who worked at the companies testified that Iruke directed her and Marroquin to lie to state and Medicare inspectors about his involvement with Contempo and Ladera when the inspectors visited the companies.

Witness testimony established that shortly after agents visited Ladera, Iruke directed Marroquin and Darawn Vasquez, a member of Arms of Grace who worked at the supply companies, not to talk to law enforcement. Iruke provided Marroquin and Vasquez with cellular telephones, and directed them to use the phones in order to prevent law enforcement from intercepting their conversations. Iruke and Vasquez then met at Arms of Grace, and shredded evidence of the fraud scheme.

Witness testimony and evidence introduced at trial also established that within a few weeks of the agents visiting Ladera, Iruke closed Contempo and Ladera, which prompted agents to serve Iruke and his attorneys with subpoenas for the files of the companies. Instead of producing the files, Iruke directed that the files be brought to an auditorium used by Arms of Grace, where Iruke, Ikpoh, Marroquin and others altered and destroyed documents within the files to remove evidence of the fraud scheme. Law enforcement agents found Marroquin with these files when they arrested her.

Evidence introduced at trial showed that as a result of this fraud scheme, Iruke, Ikpoh, Marroquin and their co-conspirators submitted more than $14.2 million in fraudulent claims to Medicare, and received approximately $6.7 million in reimbursement payments from Medicare. The evidence at trial showed that Iruke and Ikpoh diverted most of this money from the bank accounts of the supply companies to pay for the fraudulent prescriptions and documents which Iruke purchased to further the scheme, and to cover the leases on their Mercedes vehicles, home remodeling expenses and other personal expenses.

Ikpoh is scheduled to be sentenced on Feb. 27, 2012. Vasquez and Ibrahim pleaded guilty to conspiracy and false statement charges in February 2011 and March 2011, respectively, and are awaiting sentencing. On Dec. 9, 2011, Judge Hatter sentenced Marroquin to time served and three years of supervised release.

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Sentenced to 60 Months in Prison for Her Role in a $6.2 Million Medicare Fraud Scheme

2012-01-10T07:20:00.000-08:00

Source- http://www.fbi.gov/losangeles/press-releases/2012/los-angeles-woman-sentenced-to-60-months-in-prison-for-her-role-in-a-6.2-million-medicare-fraud-scheme

WASHINGTON—A Los Angeles woman who pleaded guilty to using fraudulent medical clinics and the stolen identities of physicians to defraud Medicare of more than $6.2 million was sentenced to 60 months in prison today, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced.

Carolyn Ann Vasquez, 47, was also ordered to pay $6.2 million in restitution by U.S. District Judge Consuelo B. Marshall of the Central District of California. In addition, Judge Marshall ordered Vasquez to serve three years of supervised release following their prison term.

In March 2011, Vasquez pleaded guilty to conspiracy to commit health care fraud. In her plea agreement, Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. According to court documents, physician assistants recruited to work at the clinics by Vasquez, and working at her direction and the direction of others, performed services that were medically unnecessary and prescribed and ordered the wheelchairs, medical equipment and diagnostic tests that were medically unnecessary.

According to court documents, Vasquez obtained access to physicians’ personal and Medicare information, which she stole to further the fraud scheme at the medical clinics. Vasquez admitted that in approximately 2007, a physician contacted her about a job at one of the fraudulent medical clinics, but the physician decided not to accept the job. Nevertheless, Vasquez’s co-conspirators printed prescription pads with the physician’s name and Medicare provider number on them. Vasquez admitted that she instructed a physician assistant working at one of the fraudulent medical clinics to use the prescription pads to write fraudulent prescriptions and medical documentation for diagnostic tests, power wheelchairs and other medical equipment in the physician’s name even though Vasquez knew that the physician did not work at the clinic. Medicare was defrauded of approximately $6,268,899 as a result of her conduct.

Vasquez’s co-defendant, Eduard Aslanyan, who pleaded guilty in April 2011 to conspiracy charges related to this case, is scheduled for sentencing on Feb. 6, 2012. A second co-defendant, David Garrison, a physician assistant who worked at the fraudulent medical clinics with Vasquez and Aslanyan, is scheduled for trial on Jan. 24, 2012.

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Isabel Roque Sentenced to 57 Months in Prison for Participating in Medicare Fraud Kickback Scheme

2012-01-09T07:22:00.001-08:00

Source- http://www.justice.gov/opa/pr/2012/January/12-crm-029.html

WASHINGTON – The owner and president of a Miami-area transportation company was sentenced yesterday to 57 months in prison for her role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Isabel Roque was sentenced by U.S. District Judge Michael K. Moore in the Southern District of Florida. In addition to her prison term, Roque was sentenced to three years of supervised release and was ordered to pay $3.8 million in restitution jointly and severally with co-conspirators.

Roque, 55, pleaded guilty in November 2011 to one count of conspiracy to commit health care fraud. Roque was the president of Isa & Yami Inc., which purported to provide patient transportation services in Miami.

According to court documents, Roque agreed to provide Medicare beneficiaries to ATC for partial hospitalization program (PHP) services in exchange for kickbacks. PHP services are used as a form of intensive treatment for patients with severe mental illness. ATC purported to operate PHPs in seven different locations throughout south Florida and Orlando. According to court documents, Roque provided Medicare beneficiaries to four of ATC’s locations, including facilities in Boca Raton, Broward, Homestead and Miami.

Roque admitted that she knew the beneficiaries whom she referred to ATC did not need PHP treatment. Roque also knew that ATC fraudulently billed the Medicare program for the PHP services provided to the beneficiaries she referred. According to court documents, Roque also paid kickbacks to the beneficiaries whom she referred to ATC in exchange for those beneficiaries agreeing to attend ATC.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI). In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare more than $200 million in medically unnecessary services.

According to the plea agreement, Roque’s participation in the fraud resulted in more than $3.8 million in fraudulent billing to the Medicare program.

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

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Anthony Francis Valdez Sentenced to Federal Prison on Health Care Fraud Charges

2012-01-08T07:26:00.000-08:00

Source- http://www.fbi.gov/elpaso/press-releases/2012/former-texas-pain-management-physician-and-psychiatrist-sentenced-to-federal-prison-on-health-care-fraud-charges

United States Attorney Robert Pitman announced that in El Paso today, 57-year-old Anthony Francis Valdez was sentenced to 25 years in federal prison followed by three years of supervised release in connection with an estimated $42 million fraudulent health care benefit program billing scheme. Valdez, a former physician, was the owner of the Institute of Pain Management with clinics in El Paso and San Antonio.

“Valdez preyed on the most vulnerable members of our society—the poor, the disabled and the elderly. In doing so, he sought to enrich himself by billing health care entitlement programs, such as Medicare, Medicaid and Tri-Care, of more than $42 million during a five-year period for services he did not perform. As a result, Valdez has lost his medical license, his reputation, his property and most of all his freedom. We hope his sentence of 25 years serves as a deterrence to others who would contemplate defrauding these federally funded health care programs,” stated United States Attorney Robert Pitman.

In addition, Senior United States District Judge David Briones ordered that Valdez pay $13,356,645.44 restitution; and, forfeit more than $1.7 million in cash, his residence in El Paso, his residence in San Antonio, as well as five vehicles. Judge Briones also handed down a monetary judgement against Valdez for $9,741,649.

“Today’s sentencing of Anthony Valdez represents the FBI’s commitment to investigating threats associated with Health Care Fraud in the El Paso area and prosecuting those individuals responsible for defrauding government and private health care benefit programs. It was through the dedication and hard work of the special agents and professional support staff of the El Paso FBI as well as several other state, local, and federal agencies, that this investigation was successfully completed,” stated Federal Bureau of Investigation Special Agent in Charge Mark Morgan, El Paso Division.

On July 1, 2011, Valdez was convicted by a jury of one count conspiracy to commit health care fraud, six counts of health care fraud, six counts of false statements related to health care matters, and three counts of money laundering. Evidence during trial revealed that beginning in January 2005 and continuing through December 2009, Valdez caused fraudulent claims to be submitted to Medicare, Medicaid, and TRICARE for procedures which he did not perform or were non-reimbursable.

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Tausif Rahman Pleads Guilty in Connection with Detroit Medicare Fraud Scheme

2012-01-06T07:15:00.000-08:00

Source- http://www.fbi.gov/detroit/press-releases/2012/home-health-agency-owner-pleads-guilty-in-connection-with-detroit-fraud-scheme

WASHINGTON—Detroit-area resident Tausif Rahman pleaded guilty today for his role in organizing a $14 million Detroit-area home health care fraud and money laundering scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Rahman, 37, pleaded guilty today to one count of conspiracy to commit health care fraud and one count of money laundering before U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan. At sentencing on April 30, 2012, Rahman faces a maximum penalty of 30 years in prison and a $750,000 fine.

According to court documents, beginning in July 2008, Rahman and his co-conspirators acquired ownership and control of three Detroit-area home health agencies: Physicians Choice Home Health Care LLC, First Care Home Health Care LLC, and Quantum Home Care Inc. Rahman admitted that these home health agencies billed Medicare for visits that never occurred. Between July 2008 and September 2011, Rahman and his co-conspirators submitted or caused the submission of more than $14 million in fraudulent home health claims to the Medicare program by Physicians Choice, First Care, Quantum, and a fourth home health agency owned by co-conspirators: Moonlite Home Care Inc. Medicare paid more than $13.4 million to Physicians Choice, First Care and Quantum, the companies that Rahman beneficially owned in whole or in part.

Rahman admitted that he paid and directed the payment of kickbacks to doctors for home health care services that were never rendered. He also directed the payment of non-licensed individuals who represented themselves as doctors to Medicare beneficiaries. In addition, Rahman admitted to paying and directing various medical professionals, including nurses, physical therapists and physical therapy assistants, to create fictitious patient files to document purported home health services that were never rendered.

Rahman also admitted that he paid and directed the payment of kickbacks to beneficiary recruiters who obtained Medicare beneficiaries’ information needed to bill Medicare for home health services, including physical therapy and skilled nursing, which were never rendered. The Medicare beneficiaries sometimes pre-signed forms and visit sheets that were later falsified to indicate that they received home health services that they had never received. Other times, the Medicare beneficiaries’ signatures were forged on forms and visit sheets to indicate that they received home health services that they never received.

Additionally, Rahman admitted that he incorporated a shell company known as Geo Rehab LLC for the purpose of laundering the proceeds of health care fraud. More than 97 percent of the Medicare payments received by Physicians Choice were transferred into Geo Rehab’s account, over which Rahman had sole control. Rahman admitted that his co-conspirators similarly created shell companies for the purpose of receiving the proceeds of health care fraud from Rahman’s shell company.

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Lisandra Alonso, Jose Ros and Farah Maria Perez, Sentenced to 78 Months in Prison for Role in $25 Million Health Care Fraud Scheme

2012-01-05T07:10:00.000-08:00

Source- http://www.justice.gov/opa/pr/2012/January/12-atj-010.html

WASHINGTON – An office manager for a Miami home health care agency was sentenced today to 78 months in prison for her participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS). Two of her co-defendants were also sentenced to prison today for their roles in the fraud scheme.

The defendants were sentenced by U.S. District Judge Joan A. Lenard in the Southern District of Florida.

Lisandra Alonso, 34, was sentenced to 78 months in prison and two years of supervised release and was ordered to pay $15.3 million in restitution.

Jose Ros, 72, was sentenced to 12 months in prison and three years of supervised release and was ordered to pay $395,000 in restitution.

Farah Maria Perez, 40, was sentenced to six months in prison and two years of supervised release and was ordered to pay $118,000 in restitution.

Alonso, Ros and Perez each pleaded guilty earlier this year to one count of conspiracy to commit health care fraud. They were each ordered to pay their restitution jointly and severally with co-conspirators and defendants in a related case.

According to court documents, Alonso was an office manager and patient recruiter for ABC Home Health Care Inc., a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Ros was a patient recruiter for both ABC and Florida Home Health Care Providers Inc., another related home health care agency. Perez was a registered nurse and a patient recruiter for Florida Home Health. According to court documents, ABC and Florida Home Health only existed to defraud Medicare.

Alonso, Ros and Perez admitted that beginning in approximately January 2006 and continuing until approximately March 2009, they recruited Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. Alonso, Ros and Perez solicited and received kickbacks and bribes from the owners and operators of ABC and Florida Home Health in return for the recruited patients. Alonso, Ros and Perez knew that the patients they recruited did not qualify for the services billed to Medicare and that the files for the recruited patients were falsified to make it appear that the patients qualified for the services.

According to court documents, Perez and her co-defendant nurses falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services. Perez admitted that she knew the beneficiaries did not qualify for and did not receive the services. The files were falsified so that Medicare could be billed for medically unnecessary therapy and home health related services.

According to plea documents, as office manager, Alonso taught the owners and operators of ABC how to operate a fraudulent home health agency. Alonso explained the importance of recruiters, kickbacks, doctors, beneficiaries and Medicare billing. In this role, Alonso negotiated the kickback payment rates between the patient recruiters and the owners and operators of ABC. Alonso distributed the kickback payments to the patient recruiters on behalf of the owners and operators of ABC.

As office manager, Alonso also taught nurses at ABC how to falsify patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services when, in fact, she knew that the beneficiaries did not qualify for and did not receive such services.

As a result of the participation of Alonso, Ros and Perez in the illegal scheme, the Medicare program was billed approximately $17 million, $395,000 and $118,000, respectively, for purported home health care services that were not medically necessary and/or were not provided.

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US Files Complaint Against AseraCare Hospice Alleging False Claims on the Medicare Program

2012-01-04T07:44:00.000-08:00

Source- http://www.justice.gov/opa/pr/2012/January/12-civ-001.html

WASHINGTON – The United States has intervened and filed a complaint in a whistleblower suit against AseraCare Hospice, the Justice Department announced today. Golden Gate Ancillary LLC, dba AseraCare Hospice, is a for-profit business with approximately 65 hospice providers in 19 states, including Alabama, Georgia, Pennsylvania and Wisconsin. In its complaint, filed in U.S. District Court for the Northern District of Alabama, the government alleges that AseraCare violated the False Claims Act when it misspent millions of taxpayer dollars intended for Medicare recipients who have a prognosis of six months or less to live and need hospice care.

While elderly patients may qualify for a variety of other medical services paid by Medicare, for-profit hospice companies like AseraCare are entitled to receive Medicare dollars only for Medicare recipients who are terminally ill. When a business admits a Medicare recipient to hospice care, that individual is no longer entitled to receive services that would help to cure his or her illness. Instead, the individual receives what is called palliative care, or care that is aimed at relieving pain, symptoms or stress of terminal illness, which includes a comprehensive set of medical, social, psychological, emotional and spiritual services. In this lawsuit, the government contends that AseraCare Hospice knowingly submitted false claims to Medicare for hospice care for patients who were not terminally ill.

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GE Healthcare Inc. Pays U.S. $30 Million to Resolve False Claims Act Allegations

2012-01-03T07:48:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-civ-1717.html

GE Healthcare Inc. has paid the United States $30 million, plus interest, to settle allegations that a company it acquired in 2004, Amersham Health Inc., had violated the False Claims Act by causing Medicare to overpay for Myoview, a radiopharmaceutical used in certain cardiac diagnostic imaging procedures, the Justice Department announced.

Myoview is distributed in multi-dose vials of powder. In a process known as reconstitution, nuclear pharmacies mix the powder with a radioactive agent to prepare individual doses that are injected into patients as part of the cardiac imaging procedures. Certain Medicare payment rates for Myoview were based, in part, on the number of doses available from vials of Myoview. The government alleges that Amersham Health provided false or misleading information to Medicare regarding the number of doses available from vials, causing Medicare to pay for Myoview at artificially inflated rates.

“It’s important for drug manufacturers to provide accurate pricing information to Medicare so that taxpayers aren't overcharged for medicines purchased with their dollars,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. “As this case demonstrates, we remain committed to ensuring that Medicare funds are expended efficiently and appropriately.”

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Walt R. Wilson Pleads Guilty to Health Care Fraud and Collect More Than $71,000 Fraudulent Medicare Payments

2012-01-02T07:04:00.000-08:00

Source- http://www.justice.gov/usao/dc/news/2011/dec/11-550.html

WASHINGTON - Walt R. Wilson, 42, of Washington, D.C., has pled guilty to the lead count in an indictment, health care fraud, stemming from a scheme involving more than $71,000 in fraudulent Medicare payments.

The guilty plea was announced today by U.S. Attorney Ronald C. Machen Jr., Nicholas DiGiulio, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS - OIG) Philadelphia Region, and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office.

Wilson entered his guilty plea on December 20, 2011 before the Honorable James E. Boasberg in the U.S. District Court for the District of Columbia. Wilson is to be sentenced on March 14, 2012. Under federal sentencing guidelines, he faces a possible sentence of 12 to 21 months of incarceration, as well as restitution of approximately $71,000, a fine, and forfeiture.

According to the indictment and statement of offense, from about March 2010 to October 2011, Wilson submitted claim forms with forged prescription receipt labels falsely stating that he paid money out-of-pocket for drugs and medicines and was thereby entitled to reimbursement from Medicare. He submitted at least 14 claims seeking reimbursements for prescription drug expenses purportedly paid by him. He attached to these claims forms more than 90 prescription receipts, all but one of which were false and forged. These receipts had been altered to change the amount paid by him from nothing or negligible amounts to hundreds or thousands of dollars.

As a result of the forged prescription receipts and false claims, Wilson fraudulently caused Medicare to pay him more than $71,000 and sought to receive through his false claims more than $98,000.

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Benjamin Essien the Former Owner of Durable Medical Equipment (DME) Lands in Federal Prison for 12 Years

2012-01-01T07:08:00.000-08:00

Source- http://www.justice.gov/usao/txs/1News/Releases/2011%20December/111221%20Essien%20et%20al.html

HOUSTON – Benjamin Essien, the former owner of Durable medical Equipment (DME) companies Logic World Medical and Roben Medical in Houston, has been sentenced to 145 months in federal prison for defrauding the Texas Medicaid program, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott. During sentencing this morning, U.S. District Judge Grey Miller explained that the Medicaid beneficiaries whose identities had been unlawfully used to defraud the government, were also to be considered victims of the scheme to defraud.

Essien, 34, of Houston, previously pleaded guilty to one count of conspiracy to commit healthcare fraud, five counts of healthcare fraud and two counts of aggravated identity theft prior to a trial earlier this year. In addition to the 12-year sentence, Judge Miller also ordered Essien to pay $1,455,837.91 back to Texas Medicaid.

Essien’s father and sister, Bassey Essien, 60, and Rose Essien, 31, were found guilty on April 7, 2011, following an eight-day trial. Bassey Essien was convicted of all 19 counts including conspiracy, health care fraud and aggravated identity theft, while Rose Essien was convicted of 11 counts of health care fraud and five counts of aggravated identity theft. They are scheduled to be sentenced by Judge Miller in January 2012 and have been released on bond pending that hearing.

Through the operation of both DME companies, the Essiens unlawfully received Medicaid beneficiaries’ information - names, addresses and Medicaid numbers - which they then used to file false claims with the Medicaid program. The evidence presented at trial demonstrated that the Essiens routinely billed Medicaid for adult urinary incontinence supplies they did not deliver to the Medicaid beneficiaries or for delivering supplies in amounts significantly less than the amounts billed to Medicaid. Additionally, the Essiens routinely billed Medicaid for adult urinary incontinence supplies provided to Medicaid beneficiaries who either did not need the supplies or whose physicians had not prescribed them. Adult incontinence supplies include adult diapers, underpads, wipes and pull-up briefs.

Through their DME company, the defendants continued to bill Medicaid for incontinence supplies even after their delivery staff and/or delivery contractors were told by the beneficiaries they did not need or want the supplies. They regularly billed Medicaid for the delivery of 300 diapers - the maximum allowed amount of incontinence supplies each month per beneficiary - and for extra large size diaper briefs - which have the highest Medicaid reimbursement rate - without consideration to the actual size needed by the beneficiary. They even billed Medicaid for delivering a quantity of extra large adult size diapers far in excess of the amount they purchased from wholesale suppliers. The evidence showed the defendants only purchased six percent of the amount of extra large diapers they claimed to have delivered.

The scheme to defraud began in April 2004 under Logic World with the last false claim having been filed in February 2010 under the name Roben Medical. The Essiens billed Medicaid for claims totaling approximately $2,341,293.64, and received payments for those claims totaling approximately $1,455,837.91.

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Randall F. Guzik Charged in Health Care Fraud Scheme

2011-12-29T07:00:00.000-08:00

Source- http://www.fbi.gov/pittsburgh/press-releases/2011/monongahela-man-charged-in-health-care-fraud-scheme

PITTSBURGH, PA—A resident of Monongahela, Pa., has been charged in Pittsburgh on a charge of health care fraud, United States Attorney David J. Hickton announced today.

The one-count indictment, unsealed today, named Randall F. Guzik, 46, as a defendant.

According to indictment, from January 2007, to May 17, 2011, in the Pittsburgh area, Guzik defrauded two health care benefit programs, that is, Highmark Blue Cross and Blue Shield, a health insurer serving western Pennsylvania (hereinafter Highmark), and Anthem Blue Cross and Blue Shield, a health insurer serving Ohio and Kentucky (hereinafter Anthem), out of approximately $550,077.22.

Guzik prepared billings to Anthem for Highmark insureds residing in Western Pennsylvania for health care services such as conventional joint x-rays that were false in that no conventional joint x-rays were provided, the dates of the services were fabricated, the services were not provided in the locations represented on the billings, and the health care providers listed on the billings did not perform the services.

The law provides for a maximum total sentence of not more than ten years in prison, a fine of $250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offense and the prior criminal history, if any, of the defendant.

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Roberto Gonzalez, Olga Gonzalez and Their Son, Fabian Gonzalez Plead Guilty in $60 Million Health Care Fraud Scheme

2011-12-26T07:29:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1675.html

WASHINGTON – Three operators of a Miami health care agency pleaded guilty yesterday for their participation in a $60 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Roberto Gonzalez, 61, Olga Gonzalez, 57, and their son, Fabian Gonzalez, 39, each pleaded guilty before U.S. District Judge Ursula Ungaro in the Southern District of Florida to one count of conspiracy to commit health care fraud.

According to the court documents, Roberto Gonzalez was the president and Olga Gonzalez was the vice president of Nany Home Health Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. Their son, Fabian, was head of the Quality and Assurance Department for Nany.

According to plea documents, the Gonzalezes conspired with patient recruiters, including Miami-area “staffing agencies,” for the purpose of billing the Medicare program for unnecessary home health care and therapy services. These recruiters and “staffing agencies” recruited patients to Nany, and provided prescriptions, Plans of Care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. In return, the Gonzalezes and their co-conspirators paid these staffing agencies and patient recruiters kickbacks and bribes. The Gonzaleses then used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, knowing that their behavior violated federal criminal laws.

According to plea documents, nurses and office staff at Nany falsified patient files, including by documenting non-existent “symptoms” for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services when, in fact, the beneficiaries did not actually qualify for such services. The fictitious symptoms, which suggested that the patients were unable to self-inject insulin and were homebound, formed the basis for the false claims for home health care benefits and medically unnecessary therapy filed under the Medicare program.

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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Butler Moultrie a Halfway House Operator Pleads Guilty to Fraud and Kickback Scheme

2011-12-25T07:32:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1677.html

WASHINGTON – The manager and operator of a Fort Lauderdale, Fla.-area halfway house pleaded guilty yesterday for his role in a Medicare fraud kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and the Department of Health and Human Services (HHS).

Butler Moultrie, 46, pleaded guilty before U.S. Magistrate Judge Barry L. Garber in Miami to one count of conspiracy to commit health care fraud.

According to court documents, most of the residents at Moultrie’s halfway house were recovering from drug and/or alcohol addictions. Nevertheless, Moultrie agreed to refer Medicare beneficiaries who resided at his halfway house to ATC purportedly to receive intensive mental health services called partial hospitalization program (PHP) treatment in exchange for illegal health care kickbacks. Moultrie knew that such kickbacks were illegal, and he knew that ATC fraudulently billed the Medicare program for the PHP services. Moultrie knew that no doctor had prescribed PHP treatment for his patient referrals, and he knew that his residents required drug and/or alcohol addiction treatment rather than mental health services.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses, including Moultrie, and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI). In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare more than $200 million in medically unnecessary services.

According to the plea agreement, Moultrie’s participation in the fraud resulted in approximately $1.9 million in fraudulent billing to the Medicare program. At sentencing, scheduled for Feb. 21, 2012, Moultrie faces a maximum of 10 years in prison and a $250,000 fine.

Robert and Nikki Jenkins, two other managers and operators of halfway houses in Fort Lauderdale, were sentenced yesterday for referring beneficiaries to ATC in exchange for health care kickbacks. U.S. District Chief Judge Federico A. Moreno in Miami sentenced Robert Jenkins to 24 months in prison and Nikki Jenkins to 15 months in prison. Another halfway house operator, Irene Trematerra, was sentenced last week by U.S. District Judge Ursula Ungaro to 18 months in prison for her role in providing beneficiaries to ATC in exchange for kickbacks.

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

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Licet Diaz, Fidel Castro, Ignacio Angulo and Barbara Gonzalez Sentenced to Prison in $25 Million Health Care Fraud Scheme

2011-12-24T07:38:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1674.html

WASHINGTON – Two patient recruiters, a nurse and an administrator for two Miami home health care companies were sentenced today for their participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

The defendants were sentenced by U.S. District Judge Joan A. Lenard in the Southern District of Florida.

Licet Diaz, 49, was sentenced to 87 months in prison, three years of supervised release and ordered to pay $7.8 million in restitution.

Fidel Castro, 49, was sentenced to 30 months in prison, three years of supervised release and ordered to pay $550,000 in restitution.

Ignacio Angulo, 48, was sentenced to 18 months in prison, two years of supervised release and ordered to pay $190,000 in restitution.

Barbara Gonzalez, 38, was sentenced to six months in prison, two years of supervised release and ordered to pay $40,000 in restitution.

Castro, Gonzalez, Angulo and Diaz each pleaded guilty earlier this year to one count of conspiracy to commit health care fraud. They were each ordered to pay their restitution jointly and severally with co-defendants.

According to court documents, Castro and Gonzalez were patient recruiters for ABC Home Health Care Inc., a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Angulo was a nurse and patient recruiter for Florida Home Health Care Providers Inc., another related Miami home health care agency. Diaz was an administrator for ABC and Florida Home Health. According to court documents, ABC and Florida Home Health only existed to defraud Medicare.

Castro, Gonzalez and Angulo admitted that beginning in approximately January 2006 and continuing until approximately March 2009, they recruited Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. Castro, Gonzalez, and Angulo solicited and received kickbacks and bribes from the owners and operators of ABC and Florida Home Health in return for recruiting patients. Castro, Gonzalez and Angulo knew that the patients they recruited did not qualify for the services billed to Medicare and that the files for the recruited patients were falsified to make it appear that the patients qualified for the services.

According to court documents, Angulo, a licensed practical nurse, along with his co-defendant nurses, falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services. Angulo admitted that he knew the beneficiaries did not qualify for and did not receive the services. The files were falsified so that Medicare could be billed for medically unnecessary therapy and home health related services.

According to plea documents, Diaz distributed kickback payments to the patient recruiters on behalf of the owners of ABC and Florida Home Health. Diaz worked in the offices of ABC and Florida Home Health and was aware that office staff manipulated the patient files and nursing notes for patients at ABC and Florida Home Health.

As a result of the participation of Castro, Gonzalez, Angulo and Diaz in the illegal scheme, the Medicare program was billed approximately $550,000, $40,000, $190,000 and $7.8 million, respectively, for purported home health care services that were not medically necessary and/or were not provided.

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Ollie Futrell Pleads Guilty in Health Care Fraud Conspiracy

2011-12-22T07:52:00.000-08:00

Source- http://www.fbi.gov/dallas/press-releases/2011/patient-recruiter-pleads-guilty-in-health-care-fraud-conspiracy

WASHINGTON—A patient recruiter for Alliance Healthcare Services L.P., a Dallas home health care agency, pleaded guilty yesterday for her participation in a scheme to defraud Medicare and Medicaid, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS). Four co-owners of Alliance pleaded guilty last week for their roles in the fraud scheme.

Ollie Futrell, 56, of Garland, Texas, pleaded guilty yesterday before U.S. District Judge Jane J. Boyle in the Northern District of Texas to one count of conspiracy to commit health care fraud. Ernest Amadi and his wife, Edith Amadi, both of Wylie, Texas, pleaded guilty to the same charge on Dec. 6, 2011. George Opurum and his wife, Agatha Opurum, both of Richardson, Texas, also pleaded guilty to conspiracy to commit health care fraud on Dec. 8, 2011. The five defendants were indicted and arrested in February 2011. This case was the first case to be prosecuted by the Medicare Fraud Strike Force in Dallas.

According to court documents, Ernest Amadi, 53, was the chief executive officer and administrator of Alliance, and George Opurum, 60, was the chief financial officer and alternate administrator of Alliance. Edith Amadi, 49, and Agatha Opurum, 53, were both nurses at Alliance.

As part of the conspiracy, from November 2008 through mid-February 2011, Alliance submitted claims to Medicare for home health services purportedly provided to Medicare beneficiaries. According to court documents, Alliance employees, including the owners, falsified Medicare documentation and skilled nursing notes indicating that the patients were homebound and eligible for home health care services. In fact, the majority of Alliance patients were not eligible for the services because they were not homebound. According to court documents, Alliance employees and owners falsified time sheets and patient visit logs for services that were not adequately rendered or were never provided at all. Alliance then billed Medicare as if the services were adequately provided.

According to court documents, Alliance owners conspired with Futrell to recruit Medicare patients for the company so Alliance could increase its Medicare billing and revenue. Futrell was paid cash by Alliance owners. She agreed to pay patients kickbacks so that they would continue to use Alliance. Often, Futrell paid patients $100 per month to continue to receive home health care from Alliance. Alliance owners knew about, and at times facilitated, these kickbacks.

Each defendant faces a maximum sentence of 10 years in prison, a $250,000 fine and restitution. Ernest and Edith Amadi are scheduled to be sentenced on April 19, 2012. George and Agatha Opurum are scheduled to be sentenced on April 5, 2012. Ollie Futrell is scheduled to be sentenced on April 26, 2012. All sentencings will be before Judge Boyle.

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Philadelphia physician Dr. Kermit B. Gosnell Charged with Running Pill Mill

2011-12-21T07:25:00.000-08:00

Source- http://www.fbi.gov/philadelphia/press-releases/2011/philadelphia-doctor-charged-with-running-pill-mill

PHILADELPHIA—A 23-count indictment was returned and four informations1 were unsealed today charging a total of eight defendants, including Philadelphia physician Dr. Kermit B. Gosnell and members of his former staff, in a drug conspiracy case. Gosnell is charged with illegally prescribing highly-addictive painkillers and sedatives outside the usual course of professional practice and not for a legitimate medical purpose, along with related charges. The charges were announced by United States Attorney Zane David Memeger, Federal Bureau of Investigation Special Agent in Charge George C. Venizelos, Drug Enforcement Administration Special Agent in Charge Vito Guarino, and Department of Health and Human Services Special Agent in Charge Nick DiGiulio.

The indictment alleges that Gosnell, with the assistance of several of his former office staff at Family and Women’s Medical Society (“WMS”), ran a prescription “pill mill” out of his office located at 3801-3805 Lancaster Avenue in Philadelphia, Pennsylvania. From June of 2008 through February 18, 2010, Gosnell allegedly engaged in a continuing criminal enterprise by writing and dispensing fraudulent prescriptions for thousands of pills of the frequently-abused tablets OxyContin, Percocet, and Xanax, and the frequently-abused syrups Phenergan and Promethazine with Codeine. The charges state that customers, often referred to as drug “seekers,” met with Gosnell briefly for a cursory exam or no exam, paid him a fee, and then were given prescriptions for controlled substances without there being any legitimate medical purpose for the prescriptions.

It is further alleged that Gosnell and his staff allowed customers to purchase multiple prescriptions under multiple names; that customers could place orders for refills in person, over the phone, or by leaving a message on a WMS office answering machine; and that WMS office staff would give the refill orders to Gosnell, who, without seeing the customer, would write the requested prescription and give it to WMS staff who would then collect cash and “tips” from customers. According to the indictment, Gosnell did not work at WMS during the day and saw these “seekers” in the evenings or after midnight. For the first office visit, Gosnell allegedly charged $115.00 but that increased around December of 2009 when he allegedly increased the initial office visit fee to $150.00.

The indictment alleges that Gosnell went from writing several hundred prescriptions for controlled substances per month filled at pharmacies in 2008 to over 2,300 filled at pharmacies in January of 2010. It is further alleged that during the conspiracy Gosnell, with the assistance of his staff, distributed and dispensed, for no legitimate medical purpose, more than 500,000 pills containing oxycodone, more than 400,000 pills containing alprazolam, and more than 19,000 ounces of cough syrup containing codeine.

Charged in the indictment with Gosnell are office staff defendants Sherry L. West, Tamirrah M. Fluellen, and Kareema N. Cross. Charged by information are office staff Latosha R. Lewis, Earlene Tina Baldwin, and Lynda Gail Williams. Gosnell employee Steven Massof is also charged by information with 30 counts of dispensing a controlled substance using a DEA registration number issued to another person.

The charges of conspiracy to distribute a controlled substance, distribution of a controlled substance, and maintaining a drug premises each carry a maximum possible sentence of 20 years in prison.

Distribution of a oxycodone in a school zone carries a maximum sentence of 40 years in prison with a mandatory minimum one year in prison.

Continuing criminal enterprise carries a maximum sentence of life imprisonment with a mandatory minimum of 20 years in prison.

Each count of unlawful use of a DEA registration number carries a maximum possible sentence of four years in prison.

Each defendant also faces possible fines, periods of supervised release, forfeiture and special assessments. See attached chart.

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B. Elise Miller Charged with Health Care Fraud in Violation of Title 18

2011-12-20T07:01:00.000-08:00

Source- http://www.fbi.gov/cleveland/press-releases/2011/coshocton-woman-charged-with-health-care-fraud

A federal grand jury in Cleveland, Ohio, returned an indictment charging B. Elise Miller, age 57 of Coshocton, Ohio, with 14 counts of health care fraud in violation of Title 18, United States Code, Section 1347, said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio.

Miller is currently facing charges from two earlier indictments charging her, her husband Dana Campbell, Douglas Bolden, and James Ireland, with obstruction of justice and conspiracy.

The indictment alleges that from about 1987 to November 2008, Miller owned and operated Three Rivers Infusion and Pharmacy Specialists (Three Rivers), a medical infusion and pharmacy supply company located in Coshocton, Ohio.

In 2008, Three Rivers was under investigation by federal and state agencies for suspected over-billing of medical insurance companies for services and drugs, including a drug called Synagis used to treat infants to help prevent influenza. In August 2008, the government searched Three Rivers and seized various files including some files of patients who received Synagis, according to court documents.

The current indictment charges that Miller caused Three Rivers to file false and fraudulent claims for reimbursement for services and drugs administered to patients covered by Medicaid and Medical Mutual of Ohio (MMOH). The indictment charges that Three Rivers began submitting claims to MMOH falsely under the name “Holzer Infusion Services” in order to avoid the review of Three Rivers claims by MMOH. By the time MMOH discovered that “Holzer” was in reality, Three Rivers, MMOH had paid more than $700,000 in claims to “Holzer,” according to the indictment.

The indictment also charges that Miller caused Three Rivers to file false claims with Medicaid relating to Three Rivers dispensing Synagis to Medicaid patients. It is alleged that fictitious claims were made by Three Rivers for dispensing of Synagis at times when such drug was actually never dispensed.

If convicted, the defendants’ sentences will be determined by the Court after review of factors unique to this case, including the defendants’ prior criminal records, if any, the defendants’ roles in the offense and the characteristics of the violation. In all cases, the sentence will not exceed the statutory maximum and, in most cases it will be less than the maximum.

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Valerie Jean Flores Pleads Guilty to Conspiring to Commit Health Care Fraud

2011-12-19T07:21:00.000-08:00

Source- http://www.fbi.gov/sanantonio/press-releases/2011/pharmacy-technician-pleads-guilty-to-conspiring-to-commit-health-care-fraud

MCALLEN, TX—Valerie Jean Flores 38, of Mission, Texas, has been convicted of conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott. Flores was formerly employed a senior pharmacist technician by Sara Elicia Garza, 55, also of Mission—a pharmacist and owner and operator of Sara’s Pharmacy and Gift Corner located in Mission.

Flores pleaded guilty to conspiracy to commit health care fraud at a hearing held earlier today before U.S. District Judge Randy Crane. At that hearing, Flores admitted that she participated in the conspiracy to defraud the Texas Medicaid/Vendor Drug program by submitting false and fraudulent claims for prescription medication that was not dispensed or provided. Specifically, Flores admitted the claims were false and fraudulent for one or more of a variety of reasons—medications were never provided or dispensed, the beneficiary had never seen the physician purporting to prescribe the medication, prescription medications were written for the treatment of medical conditions that the beneficiary did not have, claims were for refills of prescription medications authorized by a physician but which the beneficiary did not request and did not receive, and/or that the prescription medications were never dispensed to beneficiaries but were billed (referred to as “running extras” by Flores and her co-conspirators) in lieu of collecting co-pays for prescriptions that were actually dispensed or in lieu of collecting money for purchases from the Sara’s Pharmacy Gift Store.

Flores also admitted that to cover up the fraud and the conspiracy she and co-defendant Garza, along with other unindicted co-conspirators, forged prescriptions, doctors’ signatures on prescriptions, customers’ signatures on logs that purportedly indicated that a customer beneficiary had received medications and altered pharmacy records.

Flores faces a maximum punishment of 10 years in prison and up to a $250,000 fine plus up to three years of post-prison supervised release at her sentencing which is scheduled for April 5, 2012. Flores was permitted to remain on bond pending sentencing, at which time the court will also decide the amount of restitution to be ordered.

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Owners of Houston Mental Health Company and Assisted Living Facility Indicted for Alleged Roles in $90 Million Medicare Fraud Scheme

2011-12-16T07:30:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1639.html

WASHINGTON – Two owners of a Houston mental health care company, Spectrum Care P.A., and the owner of a Houston assisted living facility were arrested today on charges related to their alleged participation in a $90 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Mansour Sanjar, 78, Cyrus Sajadi, 64, and Chandra Nunn, 33, all of Houston, were arrested today in Houston and are expected to make their initial appearances in federal court today and tomorrow. An indictment filed in the Southern District of Texas charges Sanjar, Sajadi and Nunn with conspiracy to commit health care fraud and conspiracy to pay and receive illegal health care kickbacks.

“These defendants allegedly participated in a scheme to cheat the Medicare program out of more than $90 million,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “The indictment alleges that Spectrum billed Medicare for mental health services when patients were actually watching movies, playing bingo or engaging in other activities. Our efforts over the past three years to combat Medicare fraud have been unprecedented, and today’s arrests are another example.”

“This case is another excellent example of the partnership and cooperation between the U.S. Attorney’s Office, the Department of Justice and our investigating agencies,” said U.S. Attorney Kenneth Magidson of the Southern District of Texas . “We will continue to work closely with each other to ensure those who engage in such fraudulent health care practices are brought to justice.”

According to the indictment, Sanjar and Sajadi orchestrated and executed a scheme to defraud Medicare beginning in 2006 and continuing until their arrest today. Sanjar and Sajadi owned Spectrum Care P.A., a Houston mental health company that purportedly provided partial hospitalization programs (PHP). A PHP is a form of intensive outpatient treatment for severe mental illness. Sanjar and Sajadi allegedly submitted false and fraudulent claims to Medicare through Spectrum.

According to the indictment, Nunn owned a Houston assisted living facility. The indictment alleges that Sanjar and Sajadi paid kickbacks to Nunn and other owners and operators of assisted living facilities and to patient brokers in exchange for delivering ineligible Medicare beneficiaries to Spectrum. In some cases, the patients received a portion of those kickbacks.

Sanjar and Sajadi allegedly billed Medicare for treatments purportedly provided to these recruited patients. According to the indictment, the treatments were medically unnecessary or never provided at all. The indictment alleges that Spectrum billed Medicare for more than $90 million in medically unnecessary services.

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Three Patient Recruiters for Miami Home Health Companies Sentenced to Prison in $25 Million Health Care Fraud Scheme

2011-12-15T07:10:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-atj-1641.html

WASHINGTON – Two patient recruiters for a Miami health care agency were sentenced today to 18 and 12 months in prison, respectively, for their participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

U.S. District Judge Joan A. Lenard in Miami sentenced Oscar Martinez, 54, to 18 months in prison, three years of supervised release and ordered Martinez to pay $390,000 in restitution. Judge Lenard sentenced Lesder Casanova, 40, to 12 months in prison, three years of supervised release and ordered Casanova to pay $195,000 in restitution.

In addition, on Dec. 12, 2011, co-conspirator patient recruiter Raul Alvarez, 48, was sentenced by Judge Lenard to 10 months in prison for his role in the fraud scheme. Alvarez was also sentenced to three years of supervised release and ordered to pay $118,000 in restitution.

Alvarez, Martinez and Casanova each pleaded guilty earlier this year to one count of conspiracy to commit health care fraud. They were each ordered to pay their restitution jointly and severally with co-defendants.

According to court documents, Casanova was a patient recruiter for ABC Home Health Care Inc., a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Alvarez and Martinez were patient recruiters for Florida Home Health Care Providers Inc., another related Miami home health care agency. According to court documents, ABC and Florida Home Health only existed to defraud Medicare.

Alvarez, Martinez and Casanova admitted that beginning in approximately January 2006 and continuing until approximately March 2009, they recruited Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. Alvarez, Martinez and Casanova solicited and received kickbacks and bribes from the owners and operators of ABC and Florida Home Health in return for the recruited patients. According to their pleas, Alvarez, Martinez and Casanova knew that the patients they recruited did not qualify for the services billed to Medicare. In addition, the defendants knew that the patient files for their recruited patients were falsified in order to make it appear that the patients qualified for the services.

As a result of the participation of Alvarez, Martinez and Casanova in the illegal scheme, the Medicare program was billed approximately $118,000, $390,000 and $195,000, respectively, for purported home health care services that were not medically necessary and/or were not provided.

Last week, Dr. Jose Nunez was sentenced to 40 months in prison for his role in the fraud scheme and two nurses, Luisa Morciego and Eneida Fry, were each sentenced to 24 months in prison for their roles in the scheme. Another patient recruiter, Vincente Guerra-Nistal, was sentenced to 18 months in prison in October 2011.

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Little Rock Hospice Home Care to Pay $2,700,000 Settlement in Medicare Fraud Case

2011-12-13T07:03:00.000-08:00

Source- http://www.fbi.gov/littlerock/press-releases/2011/hospice-home-care-to-pay-2-700-000-settlement-in-medicare-fraud-case
LITTLE ROCK—Christopher R. Thyer, United States Attorney for the Eastern District of Arkansas; Valerie Parlave, Special Agent in Charge of the Little Rock Field Office of the Federal Bureau of Investigation (FBI); and Mike Fields, Special Agent in Charge of Health and Human Services Office of the Inspector General (HHS-OIG) announced today that the United States has settled a federal qui tam lawsuit filed under the False Claims Act against a Little Rock hospice and its owners and operators for $2,700,000.00. The lawsuit, which was filed by Arkansas Hospice, Inc. as relator, alleges that Hospice Home Care, Inc. billed Medicare for general inpatient (acute) care in situations where only routine care was provided. The Government’s investigation revealed that in a large number of those cases general inpatient care was not required.

The False Claims Act allows private citizens or “whistleblowers” to file lawsuits as “relators” against individuals and entities committing fraud upon the federal government. As incentive for coming forward and exposing wrongdoers, the Act provides for monetary rewards to relators and for the payment of attorney’s fees on successful claims.

According to the Complaint in Intervention filed by the United States on July 17, 2009, the alleged conduct began in January of 2002 and continued through December of 2004. During that time period, Hospice Home Care, Inc. (“HHC”), which lacked an inpatient facility, contracted with Parkview Rehabilitation and Healthcare Center (“Parkview”) to provide inpatient care to HHC patients. HHC then billed the Medicare Program for each HHC patient residing at Parkview at the general inpatient level of care. The United States’ review of the medical records

established that, for a vast majority of the days billed, patients needed only routine care. During the relevant time period, general inpatient care was reimbursed by Medicare at approximately $500 per day, while routine care was reimbursed at only $115 per day.

“As I stated just over a week ago, we are committed to pursue recovery of funds to be returned to the federal treasury when through fraudulent business practices they are stolen from federal agencies and ultimately, the citizens who need the funds for payment of legitimate claims,” stated Thyer. “This is another excellent result of the dedication by our office and investigative partners to protect the people of this district. We make these cases a high priority and commit to recovery of hard-earned tax dollars for future use by citizens who need them for their medical care.”

Fields added, “Any time greed replaces medical necessity as the primary factor in billing for medical services our most vulnerable citizens, the nation’s elderly, are imperiled. Our HHS OIG agents will continue to work closely with our law enforcement partners to investigate providers who loot the Medicare Trust fund. This settlement represents a significant recovery for taxpayers and should deter similar conduct in the future.”

“The Medicare program is relied upon by millions of our citizens and the hospice benefit is intended to provide compassionate care for those who are near the end of life. The FBI will continue to investigate and prosecute those who defraud the Medicare program or take advantage of their beneficiaries for their own pecuniary gain. Today’s settlement demonstrates the government’s commitment to protect the Medicare program from fraud and abuse and ensure Medicare beneficiaries receive the quality medical care they actually need,” said Parlave.

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Sofisha Rajhane Broadway and Emir Ramic Plead Guilty to Medicaid Kickbacks

2011-12-12T23:57:00.000-08:00

Source- http://www.fbi.gov/kansascity/press-releases/2011/kansas-city-woman-st.-louis-man-plead-guilty-to-medicaid-kickbacks

KANSAS CITY, MO—Beth Phillips, United States Attorney for the Western District of Missouri, announced that a Kansas City, Mo., woman and a St. Louis, Mo., man pleaded guilty in federal court today to kickbacks that were paid to refer Medicaid patients to a non-emergency medical transportation business.

Sofisha Rajhane Broadway, 30, of Kansas City, and Emir Ramic, 34, of St. Louis, each pleaded guilty in separate appearances before U.S. District Judge Gary A. Fenner to the charges contained in an Aug. 24, 2011, federal indictment.

Broadway was employed by Logisticare Solutions, Inc., which had a contract with the state of Missouri to provide non-emergency medical transportation for Medicaid patients. Broadway worked as a scheduler at Logisticare’s network operations center in Kansas City, Mo., where she helped arrange transportation services with companies that had contracted with Logisticare to provide transportation services for Missouri Medicaid patients.

Ramic owned and operated Eurotrans Services, a transportation company in St. Louis, Mo., that contracted with Logisticare.

When Ramic complained to Broadway that he wasn’t getting enough referrals, she told him that if he paid her $150 per week she would direct additional Logisticare referrals to Eurotrans. Ramic agreed to make the payments to Broadway. Ramic paid Broadway with 13 wire transfers of $150 each from April to July 2009. In return, Broadway increased the number of referrals to Ramic.

Broadway pleaded guilty today to one count of receiving illegal kickbacks and Ramic pleaded guilty to one count of paying illegal kickbacks.

Houston Federal Jury Returns Guilty Verdicts in Health Care Fraud Trial

2011-12-12T07:34:00.000-08:00

Source- http://www.fbi.gov/houston/press-releases/2011/houston-federal-jury-returns-guilty-verdicts-in-health-care-fraud-trial

HOUSTON—Kelvin Washington, 48, of Houston, has been convicted on all counts of health care fraud, conspiracy and violations of the anti-kickback statute charged against him, United States Attorney Kenneth Magidson announced today. The verdicts were returned less than an hour ago after six days of trial and three-and-a-half hours of deliberation.

The evidence in the week-long trial showed that from 2003 to 2007, Washington received illegal payments for the referral of dialysis patients to a Houston ambulance transport service. In addition, he conspired with others to have unsuspecting doctors sign transport prescriptions for dialysis patients never admitted to a Sugar Land nursing home where he worked.

Testimony at trial showed that Washington was paid for the referral of dialysis patients to an ambulance service that was under contract with the nursing home where he worked. The evidence also showed that he would present prescriptions to doctors who worked at the nursing home. The doctors testified that they would not have signed the prescriptions if they had known the various patients were never admitted to the nursing home.

The jury also heard evidence that the ambulance service paid the Washington in checks totaling $22,200 with many tied to specific patients. Washington did not report all the income he made to the Internal Revenue Service (IRS) from the ambulance service. At trial, an undercover video and audio tape showed one of the managers of the ambulance company bribing a patient to ride with the ambulance company. The ambulance company would later bill Medicare for this patient, a paid informant whose own doctors would not sign a prescription for him. The bill to Medicare was based upon a false script from the nursing home administrator. In a search warrant executed on a co-conspirator’s home, “The List” was discovered which detailed payments made not only to Washington but also to patients who rode with the ambulance service. A computer file from that home also showed detailed records tracking payments for patients, the check numbers for those payments and the fact that payments were made to the defendant.

The false scripts alone resulted in $1.2 million billed to Medicare and Medicaid and approximately $450,000 paid.

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Local Physician Gets 11 Years in Prison…Again

2011-12-11T07:38:00.000-08:00

Source- http://www.fbi.gov/houston/press-releases/2011/local-physician-gets-11-years-in-prison...again

HOUSTON—Dr. Ira Klein, the local physician who was sentenced in 2007 to federal prison for defrauding insurance companies of more than $10 million, has once again appeared in federal court for a resentencing hearing, United States Attorney Kenneth Magidson announced today.

A federal jury convicted Klein, 65, of Houston, in November 2006 of 18 counts of mail fraud and 26 counts of health care fraud in connection with a scheme to defraud various insurance companies of more $10 million. In August 2007, U.S. District Judge David Hittner sentenced Klein to 135 months in prison to be followed by a three-year term of supervised release and ordered Klein to pay $11,590,784 in restitution. Klein appealed his conviction and sentence to the Fifth Circuit, which upheld all of Klein’s convictions but remanded the case for re-sentencing on the narrow issues of the amount of loss and Klein’s restitution calculation.

In March 2010, Klein represented himself at his re-sentencing hearing. On his second appeal, the Fifth Circuit ruled that Klein had not knowingly and intelligently waived his right to counsel and remanded the case for a third sentencing.

At today’s sentencing hearing, Judge Hittner again sentenced Klein to the same 135-month-term of imprisonment. Specifically, Judge Hittner found that Klein’s actual loss remained in excess of $11 million even after Klein was properly credited for the value of the medication he provided to his patients. Judge Hittner reserved his ruling on the amount of restitution owed by Klein for 90 days to give the victim insurance companies time to calculate their net losses. Judge Hittner also entered a $10 million criminal forfeiure against Klein.

At his original sentencing in 2007, the court also found Klein had obstructed justice when he conspired with jailhouse inmates to murder the Assistant United States Attorney prosecuting the case as well as one of the FBI special agents investigating the case and his wife. The court found that while in federal custody Klein met three inmates to discuss his plan. Later, Klein met with an individual and discussed the payment of $250,000 to kill his wife and the payment of an undetermined amount at a later date to kill the agent. Klein wired $250,000 from a bank account to the individual. What Klein did not know at the time was that the individual he discussed and sent payment to was a federal undercover agent. Klein ultimately pleaded guilty to charges stemming from the murder-for-hire plot and was sentenced to an additional term of imprisonment for that conduct.

Originally indicted in February 2006, Klein specialized in treating patients diagnosed with Hepatitis C and billed insurance companies for services he did not provide to patients and misrepresented services that were actually provided. The fraudulent scheme involved ordering large quantities of medications used to treat Hepatitis C and providing medications to patients to self administer at home and then billing the insurance companies as if the injections had been administered by him or his staff in his office. Evidence at trial proved Klein ordered Hepatitis C treatment kits containing both interferon and ribavirin at a cost of $695 each, but would unbundle the kit and submit claims to the insurance company for more than $3,840 for the components of the kits. The majority of the claims filed for services provided were for dates when patients were not in his office.

Klein also billed insurance companies for injecting his patients with the prescription drugs epoetin and neupogen during office visit, but again the evidence proved no office visit had occurred, and his patients were, in fact, self-administering those medications at home. Klein purchased epoetin at a cost of approximately $1,246 for 10 units of medication but in turn billed insurance companies $39,500 for the same 10 units. The Nuepogen was purchased at a cost of $1,885 for 10 units of medication, yet Klein billed insurance companies $32,700 for the same 10 units.

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Dr. Jose Nunez and Two Nurses Luisa Morciego and Eneida Fry Sentenced to Prison for Roles in $25 Million Miami Health Care Fraud Scheme

2011-12-10T07:21:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1582.html

WASHINGTON – Two nurses and a doctor were sentenced yesterday in Miami federal court for their participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

The following defendants were sentenced by U.S. District Judge Joan A. Lenard in Miami:

Jose Nunez, 63, a medical doctor, was sentenced to 40 months in prison and was ordered to pay $1.1 million in restitution.

Luisa Morciego, 40, a registered nurse, was sentenced to 24 months in prison and was ordered to pay $296,000 in restitution.

Eneida Fry, 46, a licensed practical nurse, was sentenced to 24 months in prison and was ordered to pay $395,000 in restitution.

Nunez, Morciego and Fry were also each sentenced to three years of supervised release. The defendants were ordered to pay restitution jointly and severally with the co-defendants in this case and in a separate but related Medicare fraud case.

Morciego, Nunez and Fry each pleaded guilty to one count of conspiracy to commit health care fraud.

According to plea documents, Nunez was a medical doctor at two Miami-area medical offices that he owned and operated. Nunez referred patients to ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. According to court documents, ABC and Florida Home Health billed the Medicare program for expensive physical therapy and home health services that were not medically necessary and/or never provided. Prescriptions, plans of care (POCs) and medical certifications for medically unnecessary therapy and services were issued through Nunez’s offices and other doctors’ offices in return for kickbacks and bribes. Nunez falsified patient files with descriptions of non-existent medical conditions, such as hand tremors, unsteady gait and poor vision, to make it appear that beneficiaries qualified for home health and therapy services.

From approximately January 2006 through March 2009, Nunez referred approximately 43 Medicare beneficiaries for medically unnecessary services to ABC and Florida Home Health. The medically unnecessary referrals, POCs and medical certifications resulted in approximately $1.5 million in fraudulent billings to Medicare, of which approximately $1.1 million was paid.

According to court documents, Morciego and Fry worked at ABC and Florida Home Health. Morciego and Fry, along with their co-defendant nurses, falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services, when, in fact, they did not. Morciego, Fry and their co-defendant nurses did so by, among other things, describing in the nursing notes and patient files symptoms that were nonexistent. Morciego and Fry knew that these files were falsified to bill Medicare for unnecessary services, which they knew was in violation of federal criminal laws.

Fry’s additional role in the scheme was to recruit Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided. Fry solicited and received kickbacks and bribes from the owners and operators of ABC and Florida Home Health in return for allowing the agencies to bill Medicare on behalf of the recruited patients. Fry knew that the patients she recruited did not qualify for the services billed to Medicare and that their files were falsified to make it appear that they did qualify for the services.

As a result of Morciego’s and Fry’s participation in the illegal scheme, the Medicare program was billed approximately $296,000 and $395,000, respectively, for purported home health care services that were unnecessary and/or never provided.

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Owners of Houston Health Care Company Kemmie Houston and Sharon Beal Sentenced to Prison for Medicare Fraud

2011-12-09T07:14:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1585.html

WASHINGTON – Two owners of a Houston durable medical equipment (DME) company were each sentenced to prison today for their roles in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

U.S. District Judge David Hittner in the Southern District of Texas sentenced Kemmie Houston to 63 months in prison and Sharon Beal to 51 months in prison. In addition to their prison terms, Houston and Beal were sentenced to two years of supervised release and were ordered to pay $403,704 in restitution, jointly and severally.

Beal, 48, and Houston, 43, pleaded guilty in June 2011 to one count of conspiracy to commit health care fraud.

According to court documents, Beal and Houston owned and operated STK Consultants. STK maintained a Medicare provider number to submit Medicare claims for the costs of DME and purported to provide orthotics, power wheelchairs, power wheelchair accessories and other DME to Medicare beneficiaries. According to court documents, Beal and Houston caused STK to submit claims to Medicare for DME that was medically unnecessary and/or not provided, including orthotic devices that were components of “arthritis kits.” The arthritis kit generally contained a number of devices including braces for both sides of the body and related accessories such as heat pads. In total, from August 2005 through August 2010, STK submitted approximately $851,212 in fraudulent claims to Medicare.

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Judith Negron Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme

2011-12-08T07:07:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1604.html

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

Judith Negron, 40, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida. Judge King ordered Negron to pay more than $87 million in restitution, jointly and severally with her co-defendants. Negron was also sentenced to three years of supervised release following her prison term. Two other owners of ATC, Lawrence Duran and Marianella Valera, were sentenced in September 2011 to 50 and 35 years in prison, respectively, for their roles in the scheme. These sentences are the three longest prison sentences ever imposed in a Medicare Fraud Strike Force case.

On Aug. 24, 2011, after a six-day trial, a federal jury in the Southern District of Florida found Negron guilty of 24 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements.

Evidence at trial demonstrated that Negron, along with Duran and Valera, masterminded and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010. Evidence at trial established that the three owners submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that purportedly operated 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. Negron and her co-conspirators also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to the evidence at trial, Negron, Duran, Valera and others paid bribes and kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs, so that ATC and ASI could bill Medicare for more than $205 million in unnecessary or illegitimate services.

According to the evidence, Negron and her co-conspirators used another company they owned and operated, Medlink Professional Management Group Inc., to conceal the fraud and kickback scheme from Medicare and law enforcement. Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera and others transferred the money to Medlink. Evidence at trial showed that Negron and her co-conspirators used Medlink to pay millions of dollars in kickback payments by using an extensive money laundering scheme.

Evidence at trial demonstrated that Negron signed kickback checks to patient recruiters whose only jobs at ATC were to provide patients from halfway houses or assisted living facilities. Evidence at trial also established that Negron and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments and that the treatments provided were legitimate PHP treatments. For instance, evidence established that Negron would “robo-sign” patient files, meaning she would sign patient documents as a supervising therapist without having treated the patients. The evidence also showed that Negron signed files as though she had been in two places at the same time, in Boca Raton and Homestead, Fla. Evidence further revealed that Negron knew doctors were similarly signing patient files without reading them or seeing the patients. In some cases, Negron provided the doctors with the files for their signature. According to evidence presented at trial, Negron and her co-conspirators billed Medicare for PHP treatment, including group psychotherapy, provided to a patient who was in a neuro-vegetative state, who would not lift her head or respond. The evidence also showed that Negron and her co-conspirators caused doctors to refer ATC patients to ASI even though the patients did not qualify for sleep studies.

Negron has been in federal custody since her conviction.

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. The 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. A top manager, Margarita Acevedo, was sentenced in September 2011 to 91 months in prison.

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Dora Binimelis Pleads Guilty in Connection with Medicare Fraud Scheme

2011-12-07T07:01:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/December/11-crm-1587.html

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

Dora Binimelis, 53, of Miami, pleaded guilty before U.S. District Judge Arthur J. Tarnow in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, Binimelis faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to the plea documents, Binimelis was an owner of Blessed Medical Clinic, which purported to be a medical clinic that specialized in diagnostic testing. Binimelis admitted that the clinic defrauded Medicare by billing for expensive and medically unnecessary tests. The owners and operators of Blessed paid patient recruiters, who paid cash bribes to Medicare beneficiaries. In exchange for the cash bribes, the beneficiaries agreed to attend the clinic where they provided their Medicare provider numbers and other information, which was used to bill Medicare for unnecessary tests and services. According to her plea, Binimelis knew that the purpose of the clinic was not to treat sick patients, but to make money by defrauding Medicare. Binimelis provided diagnostic testing equipment and the capital infusion to open Blessed. In exchange for her contributions, she received a share of the Medicare fraud proceeds. According to court documents, Blessed billed Medicare $2.4 million for medically unnecessary diagnostic tests.

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Sentenced to 51 Months for Defrauding Medicaid of Nearly $1 Million

2011-12-06T23:17:00.000-08:00

Source- http://www.fbi.gov/washingtondc/press-releases/2011/woodbridge-woman-sentenced-to-51-months-for-defrauding-medicaid-of-nearly-1-million

ALEXANDRIA, VA—Yanick Pierre, 51, of Woodbridge, Va., was sentenced today to 51 months in prison, followed by a three-year term of supervised release, for fraudulently billing Medicaid nearly $1 million from August 2008 to May 2010.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia; Ken Cuccinelli, Attorney General of Virginia; and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office, made the announcement after sentencing by United States District Judge Leonie M. Brinkema.

Pierre was convicted by a federal jury on Sept. 8, 2011. According to court documents, Pierre was the office manager and office administrator for First Call Home Health, a home health care business that provided home health aides and private duty nursing care to individuals so they may remain at home rather than in a hospital or nursing facility. First Call received payment for its home health services provided to Medicaid-eligible individuals through the Virginia Department of Medical Assistance Services (DMAS), which is responsible for paying medical service producers for care and services received by Medicaid recipients in Virginia.

Beginning in 2008, Pierre began submitting false claims to a DMAS intermediary for home health services to Medicaid recipients when she knew the services had not been provided. To cover up the fraud, Pierre enlisted First Call Home Health employees and family members of Medicaid recipients to fabricate nursing time sheets to corroborate the fraudulent billing. In total, the attempted loss attributed to the fraudulent billing by Pierre was approximately $979,000. Of that amount, First Call received $698,434.47. The court also entered a restitution order and a forfeiture order against Pierre in that amount.

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Matthew Paul Brown Sentenced for Health Care Fraud and Criminal HIPAA Violations

2011-12-05T07:25:00.000-08:00

Source- http://www.fbi.gov/atlanta/press-releases/2011/fake-doctor-sentenced-for-health-care-fraud-and-criminal-hipaa-violations

ATLANTA—MATTHEW PAUL BROWN, 30, formerly of Atlanta, Georgia, was sentenced this week by United States District Judge Amy Totenberg to over five years in prison on charges of health care fraud and wrongful disclosure of individually identifiable health information.

United States Attorney Sally Quillian Yates said, “Unlike most fraud cases, which endanger the bank accounts and financial soundness of victims, this defendant’s fraud scheme also placed his victims’ health at risk. While posing as a doctor, he treated over 1,100 patients. His crime defrauded those individual victims of the care they deserved, and defrauded Medicare, Medicaid and private health insurance companies of funds intended and needed for legitimate health care.”

FBI Atlanta Special Agent in Charge Brian D. Lamkin said, “The FBI remains committed to investigating these types of health care fraud matters, to include fraud against private health care companies and medicare fraud. Individuals such as Mr. Brown, who attempt to profit through such fraudulent schemes at the expense of others who truly rely on these programs for their health care will remain as the priority focus of the FBI’s health care fraud efforts.”

BROWN was sentenced to five years and 10 months in prison, to be followed by three years of supervised release, and ordered to pay restitution totaling $1,063,004. On September 14, 2011, BROWN pleaded guilty to 16 counts of health care fraud, as well as one count of wrongful disclosure of individually identifiable health information, in violation of the Health Insurance Portability and Accountability Act (“HIPAA”).

According to United States Attorney Yates, the charges, and other information presented in court: From November 2009 through April 5, 2011, BROWN carried out a health care fraud scheme in the metro Atlanta, Georgia, and Nashville, Tennessee, areas. While operating in the Atlanta area, from November 2009 through August 2010, BROWN approached numerous practicing physicians and persuaded them to bill Medicare, Medicaid, and private health insurers under their own provider numbers for allergy-related care provided by BROWN. The care was provided both at the physicians’ own offices and at health fairs, with the physicians agreeing to pay BROWN between 50 and 85 percent of a total of approximately $1.2 million they received from the health care benefit programs. BROWN has never been licensed in Georgia as a physician, physician assistant, nurse practitioner, or clinical nurse specialist.

The investigation did not indicate that any patient who received care from BROWN was seriously injured by the care. The evidence gathered reflected that BROWN had purchased the needles and allergy shots from a legitimate commercial pharmacy and that BROWN ever used unsterile needles for the shots.

The individually identifiable health information wrongfully disclosed by BROWN, according to the evidence, was a spreadsheet he created with information concerning each person he treated. BROWN sent the spreadsheet to an undercover FBI agent, who BROWN believed to be an investor considering a large investment in BROWN’s business.

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Vanessa Dowell Pleads Guilty to Participating in Medicare Fraud Scheme

2011-12-03T07:43:00.000-08:00

Source- http://www.fbi.gov/detroit/press-releases/2011/detroit-area-occupational-therapy-assistant-pleads-guilty-to-participating-in-medicare-fraud-scheme

WASHINGTON—A Detroit-area occupational therapy assistant has pleaded guilty for her participation in a Medicare fraud scheme, announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Vanessa Dowell, 50, pleaded guilty yesterday before U.S. District Court Judge Avern Cohn in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, Dowell faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to the plea documents, Dowell was an uncertified occupational therapy assistant who worked for Jos Campau Physical Therapy, which purported to provide physical and occupational therapy services. In 2005, Dowell was hired by a co-defendant to create and sign falsified occupational therapy files for Jos Campau Physical Therapy, which was owned and operated by two co-defendants. Dowell purported to be a certified occupational therapy assistant and fabricated and signed patient notes for occupational therapy services that she claimed she had provided. In fact, the services were never provided. Furthermore, as an unsupervised and uncertified assistant, Dowell was not permitted to perform the occupational therapy services.

Between approximately June 2005 and May 2007, Dowell and her co-conspirators at Jos Campau submitted or caused the submission of fraudulent physical therapy and occupational therapy claims to the Medicare program. Dowell personally submitted or caused to be submitted approximately $807,760 in claims for occupational therapy services that were never provided.

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Benjamin Amadi Sentenced to Prison Term for Health Care Fraud

2011-12-02T07:40:00.000-08:00

Source- http://www.fbi.gov/neworleans/press-releases/2011/baton-rouge-man-sentenced-to-prison-term-for-health-care-fraud

BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that BENJAMIN AMADI, age 55, of Baton Rouge, Louisiana, was sentenced this morning by U.S. District Court Judge James J. Brady to serve 30 months in federal prison as a result of a lengthy health care fraud scheme that he perpetrated in the Baton Rouge area.

AMADI was charged in an indictment that was filed on April 28, 2010, and AMADI pled guilty to health care fraud, in violation of 18 U.S.C. § 1347, on March 3, 2011. The case arose from a fraud scheme involving a company known as Liberty Medical Services, LLC (“Liberty”), which provided power wheelchairs and other durable medical equipment to Medicare beneficiaries in the Baton Rouge area. AMADI owned, operated, and managed Liberty. Through Liberty, AMADI engaged in a scheme to defraud the Medicare program by submitting false and fraudulent claims to Medicare for equipment that had not been provided and was medically unnecessary. For instance, in January of 2008, AMADI submitted a claim to Medicare seeking $9,350, representing to Medicare that Liberty had provided a beneficiary with an extra heavy-duty power wheelchair, designed for beneficiaries weighing more than 600 pounds. In fact, Liberty had purchased and provided a much less expensive wheelchair. In connection with his guilty plea, AMADI admitted that his scheme continued for at least a year.

This morning, Judge Brady sentenced AMADI to serve a term of imprisonment of 30 months. AMADI was also ordered to pay $632,500.31 in restitution, a $7,500 fine, and a $100 special assessment. The court also ordered AMADI to forfeit an additional $632,500.31 in proceeds from his fraud scheme. Following his release from imprisonment, AMADI will be required to serve a two-year term of supervised release.

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Santiago Villa-Restrepo Pleads Guilty in Connection with $5.4 Million Medicare Fraud Scheme in Detroit

2011-12-01T07:37:00.000-08:00

Source- http://www.fbi.gov/detroit/press-releases/2011/patient-recruiter-pleads-guilty-in-connection-with-5.4-million-medicare-fraud-scheme-in-detroit

WASHINGTON—A patient recruiter pleaded guilty today for his participation in a Medicare fraud scheme operated out of three Detroit-area health care clinics, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Santiago Villa-Restrepo, 33, of Miami, pleaded guilty before U.S. District Judge Arthur J. Tarnow in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, Villa-Restrepo faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to the plea documents, Villa-Restrepo recruited Medicare beneficiaries for three Detroit-area health care clinics owned by co-conspirators. In exchange for cash bribes paid by Villa-Restrepo and others, the beneficiaries agreed to attend the clinics where they provided their Medicare provider numbers and other information, which allowed the clinics to bill for diagnostic tests that were medically unnecessary, and in some cases, not provided at all. According to court documents, Medicare was billed $5.4 million for medically unnecessary diagnostic tests by the clinics associated with the scheme.

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Akinsunbo Akinbile The Owner of Houston Health Care Company Pleads Guilty to Defrauding Medicare

2011-11-30T07:33:00.000-08:00

Source- http://www.fbi.gov/houston/press-releases/2011/owner-of-houston-health-care-company-pleads-guilty-to-defrauding-medicare-1

WASHINGTON—The owner of a Houston health care company pleaded guilty today in connection with a Medicare fraud scheme involving durable medical equipment (DME), announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Akinsunbo Akinbile, 44, pleaded guilty before U.S. District Judge Keith P. Ellison in Houston to eight counts of health care fraud.

Akinbile admitted that he was the owner and operator of Hallco Medical Supply, a company that purported to provide DME to Medicare beneficiaries. According to court documents, Hallco submitted claims to Medicare for DME, including orthotic devices, that were medically unnecessary and/or never provided. Many of the orthotic devices were components of “arthritis kits,” and purported to be for the treatment of arthritis-related conditions. The arthritis kits generally contained a number of devices including braces for both sides of the body and related accessories such as heat pads. In total, from June 2007 through May 2009, Hallco submitted approximately $737,770 in fraudulent claims to Medicare.

At sentencing, scheduled for Feb. 15, 2012, Akinbile faces a maximum sentence of 10 years in prison.

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Doctor Gwendolyn Washington Sentenced to 120 Months for Public Corruption, Illegal Prescription Drug Trafficking, and Health Care Fraud

2011-11-29T07:29:00.000-08:00

Source- http://www.fbi.gov/detroit/press-releases/2011/southfield-family-practice-doctor-gwendolyn-washington-sentenced-to-120-months-for-public-corruption-illegal-prescription-drug-trafficking-and-health-care-fraud

Gwendolyn Washington, M.D., age 67, was sentenced today to 120 months’ imprisonment for public corruption, health care fraud, and conspiring to illegally distribute prescription drugs, United States Attorney Barbara L. McQuade announced. McQuade was joined in the announcement by Andrew G. Arena, Special Agent in Charge, Federal Bureau of Investigation, Detroit Field Division, and Lamont Pugh, III, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General. Dr. Washington was sentenced by the Honorable Paul D. Borman.

On March, 7, 2011, Dr. Washington pleaded guilty to conspiring to defraud and defrauding the Detroit Public School (“DPS”) system of over $3.3 million. Dr. Washington, along with her sister Sherry Washington, and others doing business as “Associates for Learning” paid kickbacks to Stephen Hill, former DPS Executive Director of Risk Management, who authorized their submission to DPS and payment by DPS of grossly inflated invoices for services allegedly rendered to DPS in the form of a wellness program.

On July 28, 2011, Dr. Washington pleaded guilty to four felony counts involving drug trafficking and health care fraud. At her plea, Washington admitted that between 2004 and 2010, she performed unnecessary ultrasounds, nuclear cardiac stress tests, balance tests, sleep tests, and nerve conduction tests on patients, who were urged to return to Washington’s office every few months for repeat tests, even though initial results were normal. Washington billed Medicare and Blue Cross and Blue Shield more than $5 million for these tests, some of which were potentially harmful to patients. Most significantly, Dr. Washington ordered unnecessary and actively harmful nuclear stress tests for her patients at a frequency beyond that of any other medical practice in the country. Because each of these tests is the radiation equivalent of at least 80 to120 chest x-rays and because excess radiation creates a greater risk of cancer, Dr. Washington exposed her patients to a substantial risk of cancer.

Dr. Washington also admitted that she solicited and received kickbacks from home health care agencies and diagnostic testing facilities in return for referring patients to them for medical services. Washington referred patients to home health agencies, falsely certifying them as being confined to the home, in return for payments from home health care agencies of $200 to $500 per patient. In return for ordering nuclear stress tests, Dr. Washington received $200 per test. In total, Washington received $350,000 in total kickback payments. Medicare paid approximately $2.8 million to agencies receiving the fraudulent referrals. Washington received another $250,000 directly from Medicare for false certifications of patients for home health services.

Dr. Washington also admitted to committing two counts of controlled substances offenses. In February 2010, when Medicare suspended payments to Washington, resulting in a drastic reduction in her income, she began writing prescriptions for tens of thousands of doses of OxyContin, Opana ER, and Roxicodone, highly addictive pain medications that have a significant “street value” on the illicit market. Washington sometimes wrote prescriptions for individuals who were not her patients, without an examination or determination of medical necessity, and without an appropriate diagnosis or entry in a patient chart. Washington then provided these illegal prescriptions to Virginia Dillard, her niece and codefendant. Dillard filled the prescriptions at various pharmacies in Highland Park, Warren, and Detroit. After filling the illegal prescriptions, Virginia Dillard delivered the controlled substances to prescription drug dealers in exchange for money. Dillard sold each filled prescription in amounts ranging from $1,000 to $2,200, and shared the proceeds with Washington. Dillard was sentenced, on October 20, 2011, to 112 months’ imprisonment.

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Former Maxim Healthcare Services Senior Manager Bryan Lee Shipman Sentenced to Prison for Health Care Fraud

2011-11-28T07:09:00.000-08:00

Source- http://www.fbi.gov/newark/press-releases/2011/former-maxim-healthcare-services-senior-manager-sentenced-to-prison-for-health-care-fraud

TRENTON, NJ—A former senior manager and 13-year employee of Maxim Healthcare Services, Inc. (“Maxim”), was sentenced today to five months in prison and five months of home confinement with electronic monitoring for his involvement in the unlicensed operation of Maxim office that billed nearly a million dollars to government health care programs, J. Gilmore Childers, First Assistant U.S. Attorney announced.

Bryan Lee Shipman, 38, of Athens, Ga., pleaded guilty in Trenton federal court on June 17, 2010, to an Information charging him with one count of health care fraud. Shipman was charged in connection with his role as a regional account manager supervising Maxim’s decision to open and operate Maxim’s Gainesville, Ga., office without a license from 2008 through 2009, when he and others directed billings from that office to be submitted for reimbursement by the Medicaid program as if they were from another, licensed office. Shipman entered his guilty plea before U.S. District Judge Anne E. Thompson, who also imposed the sentence today in Trenton federal court.

On Sept. 12, 2011, Maxim—one of the nation’s leading providers of home healthcare services—entered into a settlement agreement to resolve criminal and civil charges relating to a nationwide scheme to defraud Medicaid programs and the Veterans Affairs program of more than $61 million. Maxim was charged in a criminal Complaint with conspiracy to commit health care fraud, and entered into a Deferred Prosecution Agreement (“DPA”) with the Department of Justice. The agreement allows Maxim to avoid a health care fraud conviction on the charges if it complies with the DPA’s requirements. As required by the DPA, Maxim agreed to pay approximately $150 million—a criminal penalty of $20 million and approximately $130 million in civil settlements in the matter, including to settle federal False Claims Act claims.

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

According to documents filed in this and related cases and statements made in court:

Shipman had been employed by Maxim for 13 years, the last eight as a regional account manager. As a regional account manager, Shipman reported directly to one of two nationwide vice presidents, who in turn reported to Maxim’s president. He also managed 13 offices in 2008 with hundreds of employees and total annual sales of more than $42 million, much of which derived from government programs. In his last full year of employment, Shipman earned more than $325,000, and was among the top 25 individuals at Maxim in terms of compensation out of the more than 80,000 individuals employed by Maxim in that year.

Shipman’s annual compensation—which ranked him within the top .03 percent of the Company—was based to a significant degree on meeting sales goals. Shipman said his superiors demanded levels of growth based “not on any market analysis, but simply on a belief that dramatic growth was necessary regardless of market conditions.” It was in response to that pressure, Shipman said, that he authorized and supervised the unlicensed operation of the Gainesville office.

At one point, when Maxim employees believed a state regulator would be visiting the office, lower-level employees were directed by Shipman and others to provide false information to the state regulator in an effort to prevent the Medicaid program from learning about the unlicensed operation of the office.

In addition to the prison term, Judge Thompson sentenced Shipman to two years of supervised release and ordered him to pay a $10,000 fine.

The other eight individuals who pleaded guilty were sentenced by Judge Thompson as follows:

Gregory Munzel, 35, of Charleston, S.C., was employed as a regional account manager, reporting directly to a vice president, responsible for Maxim offices throughout the southeastern United States. He pleaded guilty on Dec. 4, 2009, to one count of making false statements relating to health care fraud matters. During his plea hearing, Munzel admitted that he was aware individuals he supervised were submitting time cards for work that had not actually been done—a practice Munzel said was in response to pressure from Maxim superiors to increase revenue. Munzel also acknowledged forging caregiver credentials such as CPR cards throughout his time at Maxim, in order to make it appear that the caregivers were properly credentialed, when they were not. Munzel indicated he learned the practice from his supervisors when he first joined Maxim, and that those under him engaged in the practice when he took on a leadership role with the company. Munzel was sentenced on Sept. 29, 2011, to three months of home confinement as part of a two-year term of probation. Munzel was also ordered to pay a $1,000 fine.

Matthew Skaggs, 39, was employed as a regional account manager, reporting directly to a vice president, responsible for Maxim’s offices in Texas. He pleaded guilty on Sept. 23, 2010, to making false statements relating to health care fraud matters. During his plea hearing, Skaggs acknowledged having knowingly made false statements to a surveyor from Texas’ Medicaid Program, who was investigating the operation of an unlicensed Maxim office in Houston. Skaggs was sentenced on June 10, 2011, to a three-year term of probation and ordered to pay a $4,000 fine.

Andrew Sabbaghzadeh, 30, of Clay, N.Y., was employed as an account manager; and Jason Bouche, 27, of Paradise Valley, Ariz., was employed as a recruiter at Maxim’s Tempe, Ariz. office. They pleaded guilty to health care fraud on Nov. 4, 2009, and April 23, 2010, respectively. During their plea hearings, Sabbaghzadeh and Bouche acknowledged creating fraudulent time cards in order to bill government programs. They acknowledged that in some instances, Maxim employees cut signatures from legitimate time cards and pasted them onto forged time cards in order to submit them for reimbursement. Sabbaghzadeh was sentenced on Sept. 26, 2011, to six months of home confinement as part of a three-year term of probation. Sabbaghzadeh was also ordered to pay a $2,000 fine. Bouche was sentenced on Nov. 17, 2011, to a two-year term of probation and ordered to pay a $500 fine.

Donna Ocansey, 49, of Medford, N.J., was employed as a director of clinical services (supervising nurse) in Maxim’s Cherry Hill, N.J., office. She pleaded guilty on May 28, 2010, to making false statements relating to health care fraud matters. Ocansey, a registered nurse (RN), had responsibility for, among other things, ensuring that Medicaid-required supervisory visits of patients were conducted periodically—meaning that an RN periodically visited each patient to check each patient’s condition and the care the patient was receiving from Maxim Home Health Aides, who lack the skills and training of RNs. During her plea hearing, Ocansey acknowledged that she fabricated documentation in order to make it appear that other nurses had conducted Medicaid-mandated supervisory visits, when in fact they had not. Ocansey stated that she fabricated documentation in response to pressure from her superiors at Maxim, who expected her to make sure that all supervisory visits were completed without providing adequate resources for her to do so. Ocansey was sentenced on Oct. 18, 2011, to four months of home confinement as part of a a three-year term of probation. Ocansey was also ordered to pay a $2,000 fine.

Mary Shelly Janvier-Pierre, 43, of Lake Worth, Fla., and Sandy Cave, 39, of West Palm Beach, Fla., pleaded guilty to health care fraud on Feb. 1, 2010, and June 21, 2010, respectively. During their plea hearings, Janvier-Pierre, who had been employed by Maxim’s West Palm Beach office as a licensed practical nurse; and Cave, the mother of a former pediatric patient of Maxim, admitted to their roles in a scheme to fraudulently bill Medicaid, through Maxim, for services that were not rendered. Janvier-Pierre and Cave acknowledged that they agreed to submit billings as if Janvier-Pierre was taking care of Cave’s child, when she was not. Janvier-Pierre and Cave then split the money Janvier-Pierre received for purportedly providing the care. As a result of the scheme, Maxim was paid more than $70,000 by Florida’s Medicaid program. Janvier-Pierre was sentenced on Sept. 21, 2011, to six months of home confinement as part of a three-year term of probation. Cave was sentenced on Nov. 17, 2011, to five months of home confinement as part of a three-year term of probation. Cave was also ordered to pay a $1,000 fine.

Marion Morton, 45, of North Charleston, S.C., was employed as a home health aide and personal care assistant by Maxim’s Charleston, S.C., office. He pleaded guilty on May 3, 2010, to one count of making false statements relating to health care fraud matters. During his plea hearing, Morton acknowledged that, at the instruction of Maxim employees, he fabricated timecards reflecting work he had not done. On multiple occasions, Maxim submitted bills to Medicaid based on timecards which showed he worked more than 24 hours on certain days. Morton was sentenced on May 24, 2011, to a three-year term of probation and ordered to pay a $5,000 fine.

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Dr. Richard Alan Behnan Pleads Guilty to Health Care Fraud

2011-11-27T07:11:00.000-08:00

Source- http://www.fbi.gov/detroit/press-releases/2011/clarkston-podiatrist-pleads-guilty-to-health-care-fraud

Dr. Richard Alan Behnan, D.P.M., 55, of Clarkston, Michigan, pleaded guilty to a federal indictment charging him with Conspiracy to Commit Health Care Fraud, United States Attorney Barbara L. McQuade announced today.

McQuade was joined in the announcement by Andrew G. Arena, Special Agent in Charge, Federal Bureau of Investigation, Detroit Field Division and Lamont Pugh, III, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General.

Behnan was a traveling podiatrist who provided services at various senior centers and assisted living facilities in Bay City, Flint, Detroit, and Lansing, Michigan. Behnan and his co-defendant, Kelly Morel, provided routine foot care to patients consisting primarily of toenail trimming. The two routinely billed these services to health insurance companies, including Medicare and Blue Cross Blue Shield of Michigan (BCBSM ), as a surgical procedure. Specifically, Behnan and Morel trimmed toenails and billed the service as a nail avulsion. A nail avulsion is a surgical procedure used to treat ingrown toenails wherein the nail, or portion of the nail, is removed or torn from the nail bed below.

The investigation revealed that patients never received nail avulsion procedures from Behnan or Morel as they claimed. Further, investigators determined that Behnan and Morel billed Medicare for surgical procedures performed while Behnan traveled outside the United States. As a result of all nail avulsion claims submitted from September 2000 to December 2010, Behnan and Morel received $1,624,089.66 from Medicare and BCBSM.

Previously, on May 26, 2011, following four days of trial, Kelly Morel, 49, of Davison, Michigan, pleaded guilty to conspiring to commit health care fraud along with Behnan and eleven substantive counts of health care fraud.

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Gary Winner Pleads Guilty to Health Care Fraud, Money Laundering and Selling Adulterated and Misbranded Medical Devices

2011-11-26T07:16:00.000-08:00

Source- http://www.fbi.gov/boston/press-releases/2011/nationwide-supplier-of-medical-equipment-pleads-guilty-to-health-care-fraud-money-laundering-and-selling-adulterated-and-misbranded-medical-devices?utm_campaign=email-Immediate&utm_medium=email&utm_source=boston-press-releases&utm_content=49960

PROVIDENCE, RI—The owner of Planned Eldercare, a nationwide supplier of durable medical equipment located in Buffalo Grove, Ill., pled guilty today in U.S. District Court in Providence, R.I., to defrauding the Medicare program by targeting arthritic and/or diabetic Medicare beneficiaries, and ensuring that his company ordered and shipped medical equipment and supplies to Medicare beneficiaries that they did not order and/or were not medically necessary.

U.S. Attorney Peter F. Neronha announced the guilty plea of Gary Winner, 49, of Northbrook, Ill., to two counts of health care fraud, and one count each of money laundering and the introduction of an adulterated and misbranded medical device into interstate commerce. Winner faces a maximum sentence of 33 years’ imprisonment, a fine of $760,000, and a term of supervised release of four years when he is sentenced on February 10, 2012. Winner has agreed to forfeit approximately $2 million in proceeds derived by defrauding the Medicare program.

Winner admitted to the court that from 2005 through early 2009 he instructed Planned Eldercare employees, upon successfully reaching individuals as a result of unsolicited telemarketing calls, to inquire if they suffered from diabetes or arthritis. Once call recipients identified themselves as suffering from either ailment, as an inducement for recipients to provide their Medicare and physician information, employees were instructed to inform recipients that Planned Eldercare could provide them with products to help with their ailments “at no cost to you.” Once employees obtained Medicare beneficiaries’ agreement to receive certain products, Winner instructed employees to order as many products as possible whether or not the beneficiaries requested them or had a medical need for the equipment. Winner admitted that Medicare was billed for thousands of products that beneficiaries did not order.

Winner also admitted that he instructed his employees to falsely inform male diabetic beneficiaries that an “erectile pump” was good for prostate problems, and was designed to help blood circulation exclusively in the urinary tract and prostate region. Winner admitted that as part of the scheme, he ordered penis enlargers from an x-rated website for $26.00 each, repackaged them with an information sheet stating that regular use of the enclosed “erectile pump” helps with bladder control, urinary flow and prostate comfort, and then shipped them to recipients. Winner received in reimbursement from Medicare an average of $284 per item.

Winner also admitted that he waived copayments for all Medicare patients, a practice which is prohibited by Medicare. By waiving copayments they otherwise would be responsible for, Winner induced beneficiaries to accept products they had not ordered and not report the alleged fraudulent billing to Medicare.

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Ramchand Ramrup, aka Ramy Ramrup Pleads Guilty to Medicare Fraud and Kickback Scheme

2011-11-25T07:19:00.000-08:00

Source- http://www.fbi.gov/miami/press-releases/2011/fort-lauderdale-area-assisted-living-facility-manager-pleads-guilty-to-fraud-and-kickback-scheme

WASHINGTON—The manager of a Fort Lauderdale, Fla.-area assisted living facility and owner of a purported community mental health center pleaded guilty yesterday for his role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Ramchand Ramrup, aka Ramy Ramrup, 35, pleaded guilty before U.S. District Judge Marcia G. Cooke in Miami to one count of conspiracy to commit health care fraud. Ramrup was the manager and operator of Boynton Beach Assisted Living Facility (BBALF) and the owner of a purported community mental health center called Florida Behavioral Specialists Inc.

Ramrup admitted that in exchange for illegal health care kickbacks, he agreed to provide Medicare beneficiaries who resided at BBALF to ATC for intensive mental health treatment called partial hospitalization program (PHP) services. ATC purported to operate PHPs in seven different locations throughout south Florida and Orlando. According to court documents, Ramrup was paid approximately $40 per Medicare beneficiary per day the beneficiary attended ATC for purported PHP treatment. ATC paid the kickbacks by check made out to Florida Behavioral Specialists Inc.

According to court documents, Ramrup knew that ATC would fraudulently bill Medicare for the PHP treatment that his referrals would purportedly receive at ATC. Ramrup admitted that he did not refer beneficiaries to ATC because a physician had ordered PHP treatment. He referred beneficiaries to ATC because, among other things, he would receive kickbacks, his referrals were covered by Medicare and they were willing to attend ATC.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI). In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare more than $200 million in medically unnecessary services.

According to the plea agreement, Ramrup’s participation in the fraud resulted in more than $873,200 in fraudulent billing to the Medicare program. At sentencing, scheduled for Feb. 8, 2012, Ramrup faces a maximum of 10 years in prison and a $250,000 fine.

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

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Robert Spano Charged with False Statements Regarding Health Care Matters

2011-11-24T07:25:00.000-08:00

Source- http://www.fbi.gov/philadelphia/press-releases/2011/former-middle-smithfield-township-supervisor-charged-with-false-statements-regarding-health-care-matters

The United States Attorney’s Office for the Middle District of Pennsylvania announced that a former supervisor in Middle Smithfield Township, Monroe County, was indicted yesterday by a federal grand jury in Scranton for making false statements in connection with health care benefits.

According to United States Attorney Peter J. Smith, Robert Spano, age 62, was charged with two counts of violating a federal statute prohibiting the making of false statements in connection with a health care matter.

The indictment alleges that Spano, while he was a Superviser as well as an employee of Middle Smithfield Township, participated in the township’s group health benefits plan administered by Blue Cross of Northeastern PA and in the township’s dental care benefits plan administered plan by United Concordia.

Spano allegedly completed health insurance and dental insurance enrollment forms in November of 2007, in which he listed his girlfriend, referred to in the indictment as “C.B., “ as his spouse, and as having the last name “Spano,” when, in fact, her last name was not “ Spano” and she was not his spouse. The indictment alleges that Robert Spano was still legally married to another person, and filed for divorce from his wife in January of 2011.

Allegedly, as a result of Spano’s misrepresentations, Middle Smithfield Township, Blue Cross of Northeastern Pennsylvania, and United Concordia incurred expenses totaling approximately $24,488 for medical and dental services provided to C.B. and for higher health insurance premiums between 2007 and 2010.

If convicted, the defendant faces a maximum penalty of five years in prison, followed by a three year term of supervised release and a $250,000 fine.

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Foot Doctor Errol Sherman Pleads Guilty to Medicare Fraud Scheme

2011-11-23T07:34:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/November/11-crm-1530.html

WASHINGTON – A Detroit-area foot doctor pleaded guilty today for his participation in a Medicare fraud scheme, announced the Department of Justice, FBI and the Department of Health and Human Services (HHS).

Errol Sherman pleaded guilty before U.S. District Judge Gerald E. Rosen in the Eastern District of Michigan to one count of health care fraud. At sentencing, Sherman faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to the plea documents, Sherman is a Doctor of Podiatric Medicine licensed in the State of Michigan. Between January 2003 and December 2006, Sherman billed Medicare and Blue Cross Blue Shield of Michigan for a procedure known as an “avulsion of the nail plate” or “nail avulsion” procedure. Sherman billed for this procedure thousands of times with respect to hundreds of beneficiaries during that time period. According to court documents, Medicare was billed by Sherman for nail avulsion procedures that were never rendered.

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

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United States Files Complaint Against BestCare Laboratories, Inc, Alleging False Claims for Medicare Funds

2011-11-22T07:36:00.000-08:00

Source- http://www.justice.gov/opa/pr/2011/November/11-civ-1523.html

WASHINGTON – The United States filed a complaint against BestCare Laboratories, Inc. and its founder and principal, Karim A. Maghareh, in the U.S. District Court for the Southern District of Texas, the Justice Department announced today. The suit alleges that the defendants knowingly misrepresented the distances traveled by its lab technicians to artificially increase reimbursement from Medicare for mileage-based technician travel allowance fees.

According to the complaint, BestCare transported laboratory test specimens as air cargo from nursing home customers located in the Austin, Dallas/Ft. Worth, El Paso, San Antonio and Waco areas to BestCare’s laboratory close to Houston, but claimed mileage for ground travel as though its technicians personally drove the specimens one-way or round-trip between those cities and its lab in Houston. The complaint also alleges that Mr. Maghareh supervised BestCare’s day-to-day operations and directed or authorized the false billing. BestCare is a clinical laboratory founded in 2002.”

“There’s no question that health care providers are entitled to recover their reasonable costs for services they actually deliver, but we have zero patience for those who invent or inflate Medicare reimbursement claims,” said Assistant Attorney General for the Civil Division Tony West. “As today demonstrates, the Justice Department will vigorously enforce the False Claims Act to protect our seniors and safeguard the Medicare trust fund.”

“Our office is dedicated to recovering tax payer dollars misappropriated from Medicare,” said Kenneth Magidson, U.S. Attorney for the Southern District of Texas. “We are committed to aggressively litigating civil suits against dishonest providers to protect the seniors who depend on Medicare.”

The original lawsuit was filed by Richard Drummond under the qui tam, or whistleblower,provisions of the False Claims Act. The qui tam provisions allow private parties, called “relators,” to sue on behalf of the United States persons or companies they believe have knowingly submitted false claims for government funds. Relators are entitled to receive 15 to 25 percent of any recovery if the United States intervenes in the suit, as it has here, or 25 to 30 percent if the United States declines intervention. Defendants who violate the False Claims Act are liable for three times the government’s damages plus civil penalties.

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Sara Elicia Garza and Valerie Jean Flores Indicted on Federal Health Care Fraud and Conspiracy Charges

2011-11-21T07:30:00.000-08:00

Source- http://www.fbi.gov/houston/press-releases/2011/pharmacy-owner-and-technician-indicted-on-federal-health-care-fraud-and-conspiracy-charges

MCALLEN, TX—Sara Elicia Garza, 55, and Valerie Jean Flores 38, both of Mission, Texas, have been arrested on charges of health care fraud and conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott.

A federal grand jury in McAllen returned the 15-count sealed indictment on Nov. 15, 2011. In it, Garza is charged with one count of conspiracy to defraud the Texas Medicaid/Vendor Drug program, one count of conspiracy a defraud Humana Insurance, seven counts of submitting false and fraudulent claims to the Texas Medicaid/Vendor Drug program and five counts of submitting false and fraudulent claims to Humana Insurance. The indictment also charges Flores with one count of conspiracy a defraud the Texas Medicaid/Vendor Drug program and seven counts of submitting false and fraudulent claims to the Texas Medicaid/Vendor Drug program. The indictment was unsealed today after the pair was taken into custody by federal and state authorities this morning. Both appeared before United States Magistrate Judge Dorina Ramos today for an initial appearance on the charges and a detention hearing. Judge Ramos ordered that Garza be released on a $100,000 bond with a 10 percent cash deposit and that Flores be released on a $50,000 unsecured bond. Garza and Flores are scheduled to be arraigned on Nov. 23, 2011, at 11:00 a.m.

Garza is a pharmacist and the owner and operator of Sara’s Pharmacy and Gift Corner located in Mission, Texas, while Flores was formerly employed by Garza as the senior pharmacist technician at Sara’s Pharmacy. In July 2011, agents from the FBI and the Medicaid Fraud Control Unit of the Texas Attorney General’s Office executed a federal search warrant and seized documents and computers at Sarah’s Pharmacy and Gift Store. The pharmacy closed on or about Oct. 28, 2011, while the gift store remains operational.

The indictment alleges that Garza and Flores conspired to send false and fraudulent bills to the Texas Medicaid/Vendor Drug program and to Humana Insurance and that they submitted false and fraudulent claims to Medicaid/Vendor Drug and to Humana for prescription medications that were never dispensed or provided to the Medicaid beneficiaries or the persons insured by Humana. The indictment alleges that false and fraudulent claims for prescription medication were also submitted to other health care benefit programs such as Blue Cross/Blue Shield and Caremark. Not only were the false and fraudulent claims submitted for prescription medications that were never dispensed but some of the claims were for prescription medications used to treat medical conditions that the “patients” never had, according to the indictment. In some cases, the doctors whose names were used on the prescriptions had never seen the “patients.” To cover up their fraudulent scheme and billings, the pair forged prescriptions, forged doctors’ signatures on prescriptions, forged patients’ signatures on logs that purportedly indicated that the patient had received medications and altered pharmacy records.

According to the indictment, Garza and Flores caused the Medicaid/Vendor Drug program to pay more than $461,951 for fraudulent claims for medications that never dispensed to patients. Humana is alleged to have paid Garza an excess of $78,711 for similar fraudulent claims. As a result of this fraudulent scheme, an excess of $540,663 was to paid to Sara’s Pharmacy from on or about Nov. 15, 2006, through on or about June 17, 2011.

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Marion Beverly Metoyer Sentenced to 21 Months in Prison for Medicare Fraud Scheme Involving Claims of Hurricane Damage to Power Wheelchairs

2011-11-19T07:28:00.000-08:00

Source- http://www.fbi.gov/houston/press-releases/2011/houston-patient-recruiter-sentenced-to-21-months-in-prison-for-medicare-fraud-scheme-involving-claims-of-hurricane-damage-to-power-wheelchairs

WASHINGTON—A patient recruiter for a Houston durable medical equipment (DME) company was sentenced today to 21 months in prison for her role in a health care fraud scheme involving power wheelchairs, announced the Department of Justice, FBI and the Department of Health and Human Services (HHS).

Marion Beverly Metoyer, 57, of Dayton, Texas, was sentenced by U.S. District Judge Gray Miller in the Southern District of Texas. Metoyer was convicted by a jury on May 26, 2011, of one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiracy to defraud the United States and to receive health care kickbacks and two counts of receiving kickbacks.

Three co-conspirators were also sentenced today: Johnny Lee Andrews, 59, of Houston; Monica Renee Perry, 44, of Abbeville, La.; and Melvin Barnes, 61, of Humble, Texas. Andrews and Perry were each sentenced to 15 months in prison and Barnes was sentenced to one year of probation. Andrews, Perry and Barnes pleaded guilty on Sept. 23, 2010, to one count of conspiracy to commit health care fraud.

According to court documents, Helen Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies. Metoyer, Andrews, Perry and Barnes were patient recruiters for Luant and were paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare. In addition to recruiting patients, Barnes and Andrews were also delivery drivers for Luant. Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.

According to court documents, Luant billed Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008, based on representations from Metoyer, Andrews, Perry and Barnes. In fact, the hurricanes did not damage the wheelchairs. Certain beneficiaries did not even have a power wheelchair before receiving the ones provided to them by Luant. Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.

Metoyer, Andrews, Perry and Barnes visited the homes of beneficiaries in whose names claims were submitted to Medicare, and offered the beneficiaries free power wheelchairs in exchange for their Medicare information. The power wheelchairs were often billed to Medicare at more than $6,000 per chair. In total, Luant fraudulently billed Medicare approximately $3 million.

Etinfoh was convicted by a federal jury of health care fraud in April 2010, and was sentenced to 41 months in prison. Paula Whitfield, a patient recruiter for Luant, was also convicted by a federal jury in April 2010, and was sentenced to 21 months in prison.

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Isabel Roque The President of Isa & Yami Inc., Pleads Guilty to Medicare Fraud and Kickback Scheme

2011-11-17T07:37:00.000-08:00

Source- http://www.fbi.gov/miami/press-releases/2011/miami-area-patient-recruiter-pleads-guilty-to-fraud-and-kickback-scheme

WASHINGTON—The owner and president of a Miami-area transportation company pleaded guilty today for her role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Isabel Roque, 55, pleaded guilty before U.S. District Judge K. Michael Moore in Miami to one count of conspiracy to commit health care fraud. Roque was the president of Isa & Yami Inc., which purported to provide patient transportation services in Miami.

According to court documents, Roque agreed to provide Medicare beneficiaries to ATC for partial hospitalization program (PHP) services in exchange for kickbacks. A PHP is a form of intensive treatment for severe mental illness. ATC purported to operate PHPs in seven different locations throughout South Florida and Orlando. According to court documents, Roque provided Medicare beneficiaries to four of ATC’s locations, including facilities in Boca Raton, Broward, Homestead and Miami.

Roque admitted that she knew the beneficiaries whom she referred to ATC did not need PHP treatment. Roque also knew that ATC fraudulently billed the Medicare program for the PHP services provided to the beneficiaries she referred. Roque often coached her referrals on what to say to doctors and therapists at ATC so that they could receive purported PHP services. According to court documents, Roque also paid kickbacks to the beneficiaries whom she referred to ATC in exchange for those beneficiaries agreeing to attend ATC.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI). In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare more than $200 million in medically unnecessary services.

According to the plea agreement, Roque’s participation in the fraud resulted in more than $3.8 million in fraudulent billing to the Medicare program. At sentencing, Roque faces a maximum of 10 years in prison and a $250,000 fine.

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

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Former Houston Doctor Armando Chavez Sentenced to Federal Prison for Conspiracy to Commit Medicare Fraud and Mail Fraud

2011-11-15T07:41:00.000-08:00

Source- http://www.fbi.gov/houston/press-releases/2011/former-houston-doctor-sentenced-to-federal-prison

HOUSTON—A former Houston physician has been sentenced to 70 months in prison following his convictions for conspiracy to commit mail fraud and mail fraud, United States Attorney Kenneth Magidson announced today.

Armando Chavez, 42, a former physician and owner of the Chavez Medical Group in East Houston, was sentenced this morning by U.S. District Judge David Hittner to 60 months for the conspiracy charge and to 70 months for each of the three mail fraud charges, all to run concurrently. Chavez was also ordered to pay $3,821,082 in restitution.

Chavez was charged by criminal information in April 2011 and later waived indictment and entered a plea of guilty to one count of conspiracy and three counts of mail fraud.

The charges stem from improper billing at the Chavez Medical Group between 2005 and 2007. Chavez billed for services he did not perform through a process of “unbundling” medical codes used on claims he filed to increase the amount he was paid by insurance companies. Following the initiation of the investigation, Chavez voluntarily surrendered his medical license to the Texas Board of Medicine.

According to the documents filed of record in the case, Chavez was board certified in internal medicine, licensed by the Texas Board of Medicine in 1997. He started his medical practice in family medicine and in 2005, began to perform endovenous laser ablation, a procedure used to repair varicose veins in the legs.

For purposes of billing, the medical insurance industry provides certain billing codes for the laser ablation procedure, which include a group of procedures billed under one code for the entire procedure. Chavez instructed his staff to “unbundle” or separate the codes for this procedure and to bill for individual steps in the procedure, resulting in greater reimbursement and payment for each patient. Additionally, Chavez submitted claims alleging he repaired all six veins for each patient, when in fact—in most cases—he repaired fewer than six veins. By alleging he repaired all six veins, Chavez alleged he performed six procedures over a period of six days, another aspect of the fraudulent billing which he used to justify the unbundling of codes and allowed him to be reimbursed at the highest possible rate.

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Xpress Flex Inc. Owner Michael Wayne Davis, Indicted for Wire Fraud and Theft from a Health Care Benefit Plan

2011-11-13T07:47:00.000-08:00

Source- http://www.fbi.gov/saltlakecity/press-releases/2011/xpress-flex-owner-indicted-for-wire-fraud-and-theft-from-a-health-care-benefit-plan

BOISE—Michael Wayne Davis, II, 45, of Raleigh, North Carolina, formerly of Eagle, Idaho, was indicted yesterday by a federal grand jury in Boise on eight counts of wire fraud and three counts of theft from a health care benefit plan, U.S. Attorney Wendy J. Olson announced.

According to the indictment, from 2002 until 2010, Davis owned and operated Xpress Flex, Inc. Xpress Flex was located in Boise, Idaho, and administered flexible benefits plans that allowed employees of Xpress Flex’s clients to pay for health care, dependent care, group insurance premiums, parking, and public transportation expenses with pre-tax withholdings from their paychecks. Through their employers, employees contributed funds to Xpress Flex and submitted claims to Xpress Flex for reimbursement after they incurred expenses. Xpress Flex was responsible for processing, adjudicating, and paying employees’ claims for reimbursement from these funds. In return for this service, the employers paid Xpress Flex an administrative fee.

According to the indictment, from 2009 to 2010, Davis devised a scheme to misappropriate the funds contributed by employers to Xpress Flex on behalf of their employees. Despite representations in Xpress Flex plan documents and agreements with employers that these funds belonged to the employers, and that Xpress Flex had no authority to dispose or invest them, Davis used these funds without authorization to pay for personal expenditures and the business expenses of another company he owned, Payroll America, Inc. The indictment alleges that these personal expenditures included concert tickets, meals at restaurants, gasoline, and merchandise from Amazon.com. The indictment also alleges that when Xpress Flex was late in paying reimbursement claims to Xpress Flex’s clients, or bounced reimbursement checks, employees of Xpress Flex made false statements to the clients, at Davis’ direction, about the causes of the delayed payments or bounced checks. The indictment alleges that after Xpress Flex’s operations ceased in March 2010, Davis continued to misappropriate client funds for his personal use and Payroll America’s purposes.

The indictment alleges thefts from the Independent School District of Boise City and Skagit County, Washington, flexible benefits plans and contains a forfeiture allegation seeking approximately $1,036,706, or substitute assets, including property, valued at this amount.

Each count of wire fraud is punishable by up to 20 years in prison, a maximum fine of $250,000 or twice the gain or loss from the offense, and up to three years of supervised release. Each count of theft from a health care benefit plan is punishable by up to 10 years in prison, a maximum fine of $250,000 or twice the gain or loss from the offense, and up to three years of supervised release.

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Miami-Area Patient Recruiter Beatriz Torres-Cruz Pleads Guilty in $25 Million Health Care Fraud Scheme

2011-11-09T07:10:00.000-08:00

Source- http://www.fbi.gov/miami/press-releases/2011/miami-area-patient-recruiter-pleads-guilty-in-25-million-health-care-fraud-scheme?utm_campaign=email-Immediate&utm_medium=email&utm_source=miami-press-releases&utm_content=45323

WASHINGTON—A patient recruiter of a Miami health care agency pleaded guilty yesterday for her participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Beatriz Torres-Cruz, 50, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud and one count of solicitation of health care kickbacks. Torres-Cruz was charged in a February 2011 indictment. According to plea documents, Torres-Cruz was a patient recruiter for Florida Home Health Providers Inc., a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. According to court documents, Florida Home Health billed the Medicare program for expensive physical therapy and home health care services that were medically unnecessary and/or never provided. Court documents allege that the medically unnecessary services were prescribed by doctors, including Jose Nunez, M.D. Nunez was also charged in the February 2011 indictment along with Torres-Cruz and 19 other co-conspirators.

Torres-Cruz admitted that, beginning in approximately January 2006 and continuing until approximately March 2009, she, along with co-defendants, offered and paid kickbacks and bribes to Medicare beneficiaries in return for those beneficiaries allowing Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided. Torres-Cruz solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for her patient recruiting. Torres-Cruz knew that the patients she recruited for Florida Home Health did not qualify for the services billed to Medicare.

As a result of Torres-Cruz’s participation in the illegal scheme, Medicare was billed approximately $195,000 for purported home health care services that were not medically necessary and/or were not rendered.

Seventeen other co-conspirators have pleaded guilty for their roles in the fraud scheme, including Dr. Nunez.

Sentencing has been scheduled for Jan. 30, 2012.

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

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Rochester Chiropractor Christopher Fronczak Sentenced for Health Care Fraud

2011-11-07T07:10:00.000-08:00

Source- http://www.fbi.gov/buffalo/press-releases/2011/rochester-chiropractor-sentenced-for-health-care-fraud

ROCHESTER, NY—U.S. Attorney William J. Hochul, Jr. announced today that Christopher Fronczak, 37, of Victor, N.Y., who was convicted of health care fraud, was sentenced to five years’ probation by U.S. District Court Judge Charles J. Siragusa. Judge Siragusa also ordered Fronczak to pay $199,999 in restitution to Excellus BlueCross BlueShield (“Excellus”).

Assistant U.S. Attorney Richard A. Resnick, who is handling the case, stated that during the years 2005 and 2010, the defendant, while a Doctor of Chiropractic Medicine, executed a scheme to defraud Excellus BlueCross BlueShield (“Excellus”), a health care benefit program, by submitting reimbursement claims for services he did not perform.

Part of the scheme to defraud involved chiropractic services the defendant provided to college football players and other athletes at St. John Fisher College. While the defendant provided treatments known as adjustments to the athletes at the college after practices, which took appropriately five minutes for each, Fronczak submitted insurance claims to Excellus for more expensive treatments which were not provided, including spinal manipulation, electrical stimulation, mechanical traction, manual therapy techniques, and an office visit. The fraudulent insurance claims submitted to Excellus for the football players were virtually identical for each player.

In another case, a 45-year-old patient was treated for shoulder pain once or twice a month. This patient never received mechanical traction and most visits would lasted approximately 10 minutes. Despite this, Fronczak submitted claims for numerous visits which never took place and for services which were never rendered, including application of hot and cold packs, mechanical traction, electrical stimulation, manual therapy techniques, and spinal manipulation.

During the years 2005 through 2009, the defendant was also hired by the Crossman Corporation as an independent contractor to provide Chiropractic services to their employees. The Crossman Corporation paid the defendant approximately $67,000 for the chiropractic services provided by the defendant to the employees. The defendant billed the employees’ insurance companies as well.

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Zafar Mehmood Arrested in Connection with $30 Million Medicare Home Health Scheme

2011-11-05T07:50:00.000-07:00

Source- http://www.fbi.gov/detroit/press-releases/2011/detroit-area-man-arrested-in-connection-with-30-million-medicare-home-health-scheme?utm_campaign=email-Immediate&utm_medium=email&utm_source=detroit-press-releases&utm_content=43737

WASHINGTON—A Detroit-area resident was charged and arrested today in the Eastern District of Michigan for his alleged leading role in a $30 million Medicare fraud scheme involving home health services, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS-Office of Inspector General (OIG). In addition to the arrest, law enforcement agents executed search warrants at five locations, seizure warrants for 31 bank accounts related to the scheme and suspended Medicare payments to 16 health care companies associated with the scheme.

According to a criminal complaint unsealed today in U.S. District Court in Detroit, Zafar Mehmood, 45, allegedly masterminded a $30 million scheme involving the submission of fraudulent claims submitted to Medicare for services that were medically unnecessary and/or never provided through at least four home health agencies. The four home health agencies named in the complaint are Access Care Home Care Inc. and Patient Care Home Care Inc., in Ypsilanti, Mich., and Hands On Healing Home Care Inc. and All State Home Care Inc., in Detroit.

Mehmood is alleged to have paid kickbacks to patient recruiters and billed Medicare for services that were not medically necessary and/or not performed through Access, Patient Care, Hands On Healing and All State. Mehmood is also accused of laundering the proceeds of the scheme through sham companies and intermediaries.

Mehmood is scheduled to make his initial appearance today before U.S. Magistrate Judge Mona K. Majzoub.

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Former “Most Wanted” Health Care Fraud Fugitives Sentenced to 14 Years in Prison for $9.1 Million Detroit Medicare Fraud Scheme

2011-11-04T07:47:00.000-07:00

Source- http://www.justice.gov/opa/pr/2011/November/11-crm-1450.html

WASHINGTON – Two sisters who owned a fraudulent Detroit-area medical clinic and who are former “Most Wanted” health care fraud fugitives were each sentenced in Miami today to 14 years in prison for their leading roles in a $9.1 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Caridad Guilarte, 54, and Clara Guilarte, 57, were sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. The Guilartes were also sentenced to three years of supervised release and were ordered to pay approximately $6 million in restitution, jointly with co-defendants.

The Guilartes pleaded guilty on Aug. 24, 2011, to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. The sisters were charged in an indictment unsealed in June 2009 in the Eastern District of Michigan. After fleeing the United States to Panama and then Venezuela to avoid arrest, they were placed on the HHS-Office of Inspector General (HHS-OIG) Most Wanted Fugitives list. They were arrested on March 13, 2011, by law enforcement authorities in Colombia and were returned to the United States on March 14, 2011. The Guilartes consented to have their cases transferred to the Southern District of Florida for plea and sentencing. As part of her plea, Caridad Guilarte agreed to forfeit approximately $465,000, which was seized by the FBI as part of its investigation.

According to court documents, the Guilartes opened Dearborn Medical Rehabilitation Center (DMRC) in November 2005 solely for the purpose of defrauding Medicare. DMRC purported to be an infusion clinic that administered infusions of exotic and expensive medications to patients suffering serious illnesses, such as HIV and Hepatitis-C. Between November 2005 and March 2007, DMRC submitted more than $9 million in claims to Medicare for infusion treatments and related services.

The Guilartes admitted that they purchased only a small fraction of the medications billed to Medicare. The Medicare beneficiaries who visited DMRC did not need infusion treatments, but instead came to DMRC because they were bribed to do so with the payment of cash kickbacks. The Guilartes recruited a number of individuals to assist them in defrauding Medicare, including beneficiary recruiters, who paid cash kickbacks, and a doctor, to give the clinic an appearance of legitimacy.

Medicare paid in excess of $6 million to DMRC. The Guilartes laundered the proceeds of the fraud through various co-conspirators and a series of shell corporations, which had no legitimate business function. More than 10 individuals have pleaded guilty to health care fraud and/or money laundering in connection with the DMRC scheme.

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Brooklyn, N.Y., Medicare Fraud Strike Force Charges 12 Individuals for Participating in Health Care Fraud Schemes Totaling More Than $95 Million

2011-11-03T07:44:00.000-07:00

Source- http://www.justice.gov/opa/pr/2011/November/11-crm-1440.html

WASHINGTON – Twelve individuals, including three medical doctors, a doctor of osteopathy and a chiropractor, were charged today in the Eastern District of New York for their roles in separate health care fraud schemes that resulted in the submission of more than $95 million in false claims to the Medicare program, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

The defendants are charged with a variety of health care fraud-related and money laundering offenses in two indictments and a superseding indictment filed in federal court in Brooklyn, N.Y. Eleven defendants were arrested or surrendered to authorities today. The last defendant is expected to surrender at a later time.

“Today 12 individuals – including three medical doctors and other licensed health professionals – were charged with participating in sophisticated Medicare fraud and money laundering schemes throughout Brooklyn and Queens ,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “According to court documents, these defendants sought to profit by stealing millions of taxpayer dollars from the Medicare program and laundering the proceeds of this illegal activity. The Medicare Fraud Strike Force, which operates in nine cities across the country, will continue to aggressively pursue those intent on cheating American taxpayers and stealing from the Medicare program.”

“These defendants allegedly invested significant time and energy in subterfuge to conceal their ill gotten government funds. Money laundering is a critical part of large scale health care fraud schemes and often the most difficult piece to unravel. Law enforcement will not be deterred by the schemes and evasions used to hide these proceeds of fraud. We will ‘follow the money’ and bring to justice all who would engage in financial transactions designed to disguise the proceeds of Medicare fraud,” stated Loretta E. Lynch, U.S. Attorney for the Eastern District of New York. Ms. Lynch expressed her grateful appreciation to the FBI and HHS-OIG, the agencies responsible for leading the government’s investigation, and thanked the New York State Attorney General’s Office for its assistance.

“What all these criminal schemes have in common is the exploitation of Medicare,” said FBI Assistant Director in Charge Janice K. Fedarcyk. “A program to help seniors manage the costs of health care was here abused to line the pockets of unscrupulous doctors and others. Medicare and Medicaid are taxpayer funded, so the outrageous conduct of these defendants victimized everyone. The FBI is committed to policing health care fraud, to catch the crooks and to rein in costs.”

“Physical therapy fraud and illegal financial kickbacks remain a problem in the Brooklyn area,” said Thomas O’Donnell, Special Agent in Charge of the HHS-Office of Inspector General’s (OIG) New York Region. “So, along with federal and state law enforcement partners, we will target these and similar schemes that divert valuable, scarce Medicare funds.”

According to a superseding indictment, five defendants are charged for their roles in a scheme to launder the proceeds of Medicare fraud at three Brooklyn-area medical clinics: Bay Medical Care PC, SVS Wellcare Medical PLLC and SZS Medical Care PLLC. These clinics allegedly paid kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for approximately $71 million in services that were medically unnecessary and never provided. Larisa Shelabadova, 34, Alexander Zaretser, 31, Anatoly Kraiter, 33, Vladimir Kornev, 52, and Yelena Galper, 38, all of Brooklyn, are charged for participating in the money laundering scheme. The superseding indictment also charges five other individuals who were previously charged for their roles in the scheme in the original indictment filed in October 2010.

A second indictment alleges that six defendants, including three medical doctors and a chiropractor, participated in a fraud scheme at URI Medical Center and Sarang Medical PC, two medical clinics in Flushing, N.Y. The defendants allegedly submitted approximately $11.7 million in false claims to the Medicare program for physical therapy, electric stimulation treatments and other services. Ho Yon Kim, 85, of Flushing; Hoi Yat Kam, 57, of Flushing; Peter Lu, 36, of New York City; John Knox, 54, of Bronx, N.Y.; Elaine Kim, 50, of Bayside, N.Y.; and Gilbert Kim, 59, of Bayside, allegedly provided a variety of spa services such as massages and facials, and billed Medicare for physical therapy and other services that were medically unnecessary and never provided. The indictment alleges that the defendants also recruited Medicare beneficiaries to their clinic by offering lunches and dancing classes, in exchange for the beneficiaries providing their Medicare numbers to be billed for medical services that they did not need and never received.

Emma Poroger, 56, of Staten Island, N.Y., is charged in a third indictment for participating in a scheme to defraud Medicare of approximately $13 million. Poroger, a doctor of osteopathy, allegedly billed Medicare for a variety of services she purported to provide, including vitamin infusion therapy, sleep studies, nerve conduction tests and duplex scans, that were medically unnecessary and never provided.

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Ekpedeme Obot Sentenced to 41 Months in Prison in Connection with $1.3 Million Medicare Fraud Scheme

2011-11-02T07:43:00.000-07:00

Source- http://www.justice.gov/opa/pr/2011/October/11-crm-1428.html

WASHINGTON – An owner and operator of a Houston durable medical equipment (DME) company was sentenced today in Houston federal court to 41 months in prison for his role in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Ekpedeme Obot, 35, of Houston, was sentenced by U.S. District Judge Lee Rosenthal in Houston. In addition to his prison term, Obot was sentenced to three years of supervised release and was ordered to pay $945,637 in restitution.

Obot pleaded guilty on June 22, 2011, to one count of making false statements relating to health care matters and one count of health care fraud.

According to court documents, Obot was an owner and operator of Praise DME, a company that purported to provide orthotics and other DME to Medicare beneficiaries. According to court documents, Praise submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or not provided. Many of the orthotic devices were components of an “arthritis kit,” and were purported to be for the treatment of arthritis-related conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads. From March 2007 through August 2008, Obot submitted claims of more than $1.3 million to Medicare and was paid approximately $945,637.

In addition, according to court documents, Obot admitted that he made false statements to Medicare in his supplemental Medicare Enrollment Application when he failed to provide information about a prior felony conviction. Specifically, the Medicare Enrollment Application included a section entitled “Adverse Legal Actions/Convictions,” which required DME providers to list prior felony convictions. Obot was convicted on March 5, 2007, in Harris County, Texas, on a felony theft charge. In his application, he represented only that he had been subject to a recoupment action by Texas Medicaid in November 2006 that was resolved by entering into a payment plan.

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Houston doctor Christina Joy Clardy Gets 11+ Years in Health Care Fraud Scheme

2011-10-31T07:55:00.000-07:00

Source- http://www.fbi.gov/houston/press-releases/2011/local-doctor-gets-11-years-in-health-care-fraud-scheme

HOUSTON—Houston doctor Christina Joy Clardy, 61, has been sentenced to 135 months in federal prison for her role in a massive health care fraud conspiracy that billed the federal Medicare and Texas Medicaid programs for $45,039,230 over a two-and-a-half-year period, United States Attorney Kenneth Magidson announced today. Clardy was sentenced just a short while ago in federal court in Houston.

Clardy is the third defendant to be sentenced in this matter. Last week, Umawa Oke Imo, the owner of City Nursing Services of Texas, Inc., was sentenced to 327 months for his role in the conspiracy and health care fraud. Clardy, who was found guilty of one count of conspiracy to commit health care fraud, 14 counts of health care fraud and three counts of mail fraud on May 27, 2011, after an 18-day trial in front of U.S. District Judge Melinda Harmon, was also ordered to pay $15,626,084.01 in restitution to Medicare and Medicaid. In arriving at Clardy’s sentence today, Judge Harmon considered the pivotal role Clardy played in abusing the trust of the Medicare and Medicaid programs by allowing the fraudulent billing under her provider numbers.

City Nursing billed more than $25 million worth of physical therapy services under Clardy’s physician provider numbers between January 2007 and August 2008. The United States introduced a letter at trial, sent by Clardy to Imo in July of 2007—a year before she left the clinic—showing her knowledge of the fraudulent activities at the clinic, ordering Imo to immediately cease billing Medicare under her provider number, to notify Medicare of the prior fraudulent billing and threatening to notify Medicare of the fraud if he did not. Clardy testified at trial that after Imo received her letter they had a private meeting at her house and after that she never contacted Medicare about the fraud and never asked Imo if he contacted Medicare or stopped the fraudulent billing. Other evidence introduced by the United States showed that beginning in August 2007, a few weeks after Clardy’s letter, Imo began making large cash payments to Clardy and continued to bill approximately $21 million worth of false and fraudulent physical therapy services.

City Nursing employee Joann Michelle White, who played a minor role in the health care fraud conspiracy, pleaded guilty to conspiracy in February 2010 and testified for the United States during the trial. She was sentenced to 46 months on Oct. 14, 2011. The last convicted defendant, Kenneth Anokam, will be sentenced later next month.

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Justina Okehie, aka Dr. Tina Collins Pleads Guilty to Health Care Fraud Conspiracy

2011-10-30T07:47:00.000-07:00

Source- http://www.fbi.gov/houston/press-releases/2011/houston-chiropractor-pleads-guilty-to-health-care-fraud-conspiracy

HOUSTON—Justina Okehie, aka Dr. Tina Collins, 55, of Richmond, Texas, has pleaded guilty to one count of conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today.

The conspiracy resulted in fraudulent physical therapy and chiropractic claims being paid by the Medicare and the Texas Medicaid programs. From January 2007 through August 2010, Medicare and Medicaid paid approximately $2.1 million to Okehie.

Okehie owned and operated Adom Rehabilitation Services and Healthcare and Wellness Medical Center, which were both located in southwest side Houston. As part of the conspiracy, Okehie would pay patient recruiters to refer Medicare beneficiaries to her clinics. Okehie also paid the Medicare beneficiaries themselves for just showing up at the clinics. In many instances, the physical therapy and chiropractic services billed to the government health care programs were not performed and were not medically necessary. Some of the Medicare beneficiaries were actually receiving medical services at inpatient hospital facilities at the time Okehie was purportedly providing them physical therapy and chiropractic services in her clinics.

Co-defendant Cassandra Tasby Barnes, 48, of Houston, who was employed by Barnes as an office manager, had previously pleaded guilty in this case to one count of conspiracy to violate the anti-kickback statute. Barnes pleaded guilty for her role in paying Medicare beneficiaries and patient recruiters for referring Medicare beneficiaries for physical therapy and chiropractic services. Both Okehie and Barnes are currently on bond and are scheduled to be sentenced on May 21, 2012, before U.S. District Judge Nancy Atlas.

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