Married doctors charged with fraud plead not guilty.

Source- http://www.whec.com/news/stories/S1015747.shtml?cat=565

Two married doctors plead not guilty to stealing close to $250,000. Neither of them would stop talking in court.

Dr. Michael Miran, a psychologist and an adjunct professor at R.I.T. and his wife,

Dr. Esta Miran are accused of medicaid fraud. State

Attorney General Andrew Cuomo's office says they overbilled the state and federal government hundreds of thousands of dollars. Esta Miran is not a psychologist but has a PhD. in education. She is also accused of practicing psychology without a license. Michael Miran is accused of letting her do it.

“This husband and wife team allegedly cheated taxpayers out of hundreds of thousands of dollars,” said Attorney General Cuomo. “My office’s Medicaid Fraud Control Unit continues to root out scams across the state that rip off New Yorkers.”

The indictment against the couple was unsealed in court at their arraignment. One of the charges accuses the Mirans of booking four to five intensive psychotherapy sessions in the same hour and conducting psychotherapy sessions from just one to 12 minutes at a time. The Miran's practice was under investigation by the AG's office for two to three years.

Berkeley Brean: "So people that would have seen them aren't owed money?"
NYS Assistant Attorney General Jerry Solomon: "No this was tax payer funds that were over billed."
In court, the Mirans kept telling Judge John Connell that they couldn't understand why they had to be in jail.

"We would never flee!" Dr. Esta Miran said. "We could have fled at any time. Can't we be released? We would come back."

Dr. Esta Miran continued.

"Can we get out of jail today?" she asked the judge.
"If you can post the $5,000 bail and surrender your passports, yes," Judge Connell answered.

"Can I give you a credit card?" Dr. Esta Miran asked.
"No, you can't do that," Connell said.

Dr. Michael Miran told the judge he fears for his life.
"I'm in a medically distressed position in prison. A position that endangers my life. I'm at immediate risk for a heart attack," Dr. Miran said.

Judge Connell ordered court deputies to make sure Dr. Michael Miran is under medical supervision in jail. However, the Mirans did post bail late Tuesday.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

McKinney man sentenced to 60 months in federal fraud scheme.

Source- http://www.scntx.com/articles/2009/07/03/mckinney_courier-gazette/news/752.txt

Emmanuel Akpan of McKinney gets federal jail time for his role in a motorized wheelchair fraud scheme.

By Danny Gallagher, McKinney Courier-GazetteA McKinney man will serve time in a federal prison for his role in a scheme to bill Medicare for false claims of motorized wheelchairs.

Emmanuel Uko Akpan of McKinney received a 60 month sentence in federal court and an order to pay more than $710,000 on Tuesday in the U.S. District Court of Northern Texas, according to officials with the Internal Revenue Service's Criminal Investigation Division of Dallas.

Akpan owned and operated Atbestcare Medical Equipment and Supply Company of Dallas and conspired with Geneva Sanders, an employee of the emergency room at Methodist South Hospital of Memphis, Tenn. and Walter Sanders, owner of Waltco Medical Equipment and Supplies located in Mesquite, according to the indictment.

The object of the scheme was to "sell and use the means of identification of Medicare beneficiaries and physicians located in Tennessee and elsewhere to [several companies]…for the purpose of executing a scheme to defraud Medicare and to obtained money from Medicare through false representations," according to the indictment.

Sanders obtained the names and personal identification numbers of patents from hospital records and sent them to Sanders "without the authorization of such Medicare beneficiaries, in exchange for remuneration." Sanders and Akpan also visited or directed others to visit beneficiaries to obtain their personal information.

Officials estimate that Sanders and Akpan obtained more than 70 patient records as part of their scheme. They would immediately bill Medicare for false claims for power wheelchairs. After they submitted the claims, some of the beneficiaries would receive less expensive scooters or no equipment at all.

Prosecutors believe the scheme consisted of false claims ranging between $5,800 and $9,800 from February to August of 2003. The claims totaled more $2.7 million netting payments from Medicare totaling $1.3 million, according to the indictment.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Moore doctor sentenced to 9 years in jail.

Source- http://www.normantranscript.com/localnews/local_story_184011511

OKLAHOMA CITY -- A Moore doctor was sentenced to nine years and one month in federal prison for illegal distribution of prescription drugs this week.

Prosecutors said Can D. Phung wrote prescriptions for painkillers without physically examining patients and saw some patients just in the clinic's lobby, according to testimony.

Phung, officials said, had so many patients they sometimes had to wait two to three hours to be seen, and would line up outside before the clinic opened.

Prosecutors called him "a drug dealer."

Phung, 61, of Moore told U.S. District Judge Vicki Miles-LaGrange that drug abusers "took advantage of his compassion."

Miles-LaGrange said she found that very hard, if not impossible, to believe.

Phung was found guilty in February of 51 counts of illegal distribution of prescription drugs, one count of Medicaid fraud and one count of obstruction of justice.

Last week, he was ordered to pay a $10,000 fine, $4,612 in restitution to the Oklahoma Health

Care Authority and a $5,300 special assessment to the United States.

One of his patients, Ian Upchurch, 22, of Mustang, died in March 2007 after overdosing on pain pills and alcohol, an autopsy report shows. Phung faces a civil lawsuit in Oklahoma County District Court over Upchurch's death.

Phung was a surgeon in South Vietnam and fled after communists took over, records show. He came to the United States in 1978.

Phung said he plans to appeal. He has complained he was singled out for prosecution, and that many other doctors have prescribed pills to the same patients who testified against him.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Miami Physician Sentenced to 97 Months in Prison for Medicare Fraud.

Source- http://www.dentalplans.com/articles/43458/miami-physician-sentenced-to-97-months-in-prison-for-role-in-$10-million-medicare-fraud-scheme.html

- WASHINGTON, -- Miami physician Roberto Rodriguez, 54, was sentenced today to 97 months in prison for his role in a Medicare fraud scheme involving HIV infusion services, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division, Acting U.S. Attorney Jeffrey H. Sloman of the Southern District of Florida and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS). Rodriguez was also ordered to pay more than $9 million in restitution to the Medicare program during today's sentencing hearing before U.S. District Judge Paul C. Huck.

Rodriguez pleaded guilty before Judge Huck on March 23, 2009, to conspiracy to commit healthcare fraud. In his guilty plea, Rodriguez admitted that he was a co-owner of and practicing physician at Midway Medical Center Inc. (Midway), a Miami clinic that purported to specialize in the treatment of HIV patients. Rodriguez admitted that, while at Midway, he and his co-conspirators routinely billed the Medicare program for services that were medically unnecessary and in many instances were never provided. Rodriguez further admitted that he purchased only a small fraction of the drugs that were purportedly administered to patients at the clinic.

Most of the services allegedly provided to patients at Midway were billed to the Medicare program as treatments for thrombocytopenia, a disorder involving a low count of platelets in the blood. According to the plea documents, none of Midway's patients actually had low blood platelet counts. Rodriguez admitted that to make it appear that the patients actually had low platelet levels, he and his co-conspirators used chemists to manipulate the blood samples drawn from Midway's patients before the blood was sent to a laboratory for analysis. In his plea, Rodriguez admitted to ordering that patients at Midway receive medications designed to treat thrombocytopenia despite knowing that the laboratory results had been falsified and that the patients did not actually have that condition.

Midway was not the only clinic where Rodriguez purported to treat HIV patients with injection and infusion therapies. In his plea, Rodriguez admitted that he was listed as medical director and practicing physician for five other Miami-area HIV infusion clinics between October 2003 and February 2005, where he engaged in similar criminal activity. Specifically, Rodriguez admitted that he and his co-conspirators at these other clinics billed the Medicare program for HIV injection and infusion services that Rodriguez knew were medically unnecessary and in some instances were never provided. Rodriguez admitted to causing more than $20 million in false claims to be submitted to the Medicare program at all of his clinics, including Midway.

A number of Rodriguez's co-defendants have already been sentenced for their roles at Midway and related clinics. On June 5, 2009, in a sentencing hearing before Judge Huck, chemist Alexis Dagnesses, 44, was sentenced to 90 months in prison; medical assistant Gonzalo Nodarse, 38, was sentenced to 78 months in prison; medical assistant Alexis Carrazana, 41, was sentenced to 72 months in prison; and physician Carlos Garrido, 69, was sentenced to 37 months in prison. Rodriguez's co-defendant Carmen del Cueto, a physician, is scheduled to be sentenced on Sept. 11, 2009.

The case was prosecuted by Trial Attorney John K. Neal of the Criminal Division's Fraud Section and investigated by the HHS Office of the Inspector General and the FBI. The case was brought as part of the Medicare Fraud Strike Force, supervised by Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section and Acting U.S. Attorney Sloman of the Southern District of Florida. Federal prosecutors have indicted 115 cases with 257 defendants in Miami, Los Angeles and Detroit since the inception of strike force operations in March 2007. Collectively, these defendants are alleged to have fraudulently billed the Medicare program for more than $600 million.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. In May 2009, the Department of Justice and HHS announced the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint effort to prevent fraud and enforce current anti-fraud laws around the country. As part of the HEAT initiative, Medicare Fraud Strike Force operations were expanded from South Florida and Los Angeles to Detroit and Houston.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Westfield pastor Kevin Clark charged with Medicaid fraud

Source- http://www.newjerseynewsroom.com/state/westfield-pastor-kevin-clark-charged-with-medicaid-fraud

A Union County minister was indicted Thursday for his alleged role in defrauding the Medicaid program.

Attorney General Anne Milgram said Kevin Clark, 52, the pastor of Bethel Baptist Church in Westfield, was charged with two counts of Medicaid fraud.

Under state law, the crime carries a maximum punishment of three years in state prison and a fine of $10,000. Clark will have to appear in state Superior Court in Elizabeth to answer the charges.According to state Division of Criminal Justice Director Deborah L. Gramiccioni, the indictment returned by a state grand jury alleges that between November 2004, and April 2005, Clark submitted a Medicaid application on behalf of an elderly parishioner, containing false information concerning the disposition of property valued at approximately $183,038 in which the parishioner had an interest.

The Medicaid program, which is funded by the state and federal governments, provides health care services and prescription drugs to persons who may not otherwise be able to afford such services and medicines. The state administers the Medicaid program.

Det. Patricia Yellen and Deputy Attorney General Yvette Gibbons of the Patient Protection Unit investigated and prosecuted the case.

"Abuse of the Medicaid program is a particularly disturbing crime," Gramiccioni said. "Not only do such Medicaid fraud schemes involve theft of tax dollars, they also represent a theft from a program designed to assist persons who can not afford health insurance or health care services. Such cases are a priority for the Office of the Insurance Fraud Prosecutor."

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Former nursing home employee arrested.

Natasha Petit-Homme

Source-http://www.wptv.com/news/local/story/former-nursing-home-employee-arrested-wptvwest/0LL_61dQVUmqQ8yplv0r1A.cspx

TALLAHASSEE, FL – A Palm Beach county woman has been arrested for stealing over $2,300 from an elderly victim under her care according to Attorney General Bill McCollum.

According to a written release from McCollum's office Natasha Petit-Homme was arrested this morning by law enforcement officers with the Attorney General’s Medicaid Fraud Control Unit. The Palm Beach County Sheriff’s Office assisted.

According to the attorney general the victim was an elderly resident of Woodlake Nursing and Rehabilitation Center, in West Palm Beach.

Petit-Homme was employed as an admissions clerk.

The news release says while working at the facility, Petit-Homme gained access to the victim’s checkbook, wrote herself a check totaling $2,341, and deposited the funds into her personal checking account without permission.

Petit-Homme is charged with one count of exploitation of an elderly person, a third-degree felony. She faces up to five years in prison and a $5,000 fine if convicted.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Nearly 53 Doctors, Executives Charged In 50 Million Medicare Fraud.

Source - http://www.huliq.com/1/82671/nearly-53-doctors-executives-charged-50-million-medicare-fraud

Fifty-three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit, Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and FBI Director Robert Mueller announced today.

The Strike Force in Detroit is the third phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.
While the indictments were returned by a grand jury in Detroit, individuals were arrested today in Detroit and Miami as a result of phase three operations of the Strike Force. The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

“As demonstrated by today’s charges and arrests, we will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising health care costs that all Americans must bear,” said Attorney General Holder. “The vast majority of doctors, patients, and medical companies do the right thing and work with the Medicare program to provide access to medical services. To those who work diligently and ethically to provide medical care through the Medicare program, we will work with you to root out the few who corrupt the system and taint the good reputations of health professionals everywhere.”

“The Obama Administration is committed to turning up the heat on Medicare fraud and employing all the weapons in the federal government’s arsenal to target those who are defrauding the American taxpayer,” said HHS Secretary Kathleen Sebelius. “Thanks to cooperation from across the government and some of the best law enforcement professionals in the country, today we were able to save millions of dollars from being lost to criminals and send a powerful message to those who seek to defraud the system, that we are coming after them. But our joint efforts on HEAT don’t just stop at the jailhouse door. Our Medicare program is working closely in partnership with our own and other law enforcement operations to prevent fraud from happening in the first place. Every dollar we can save by stopping fraud can be used to strengthen the long-term fiscal health of Medicare, bring down costs and deliver better service to Medicare beneficiaries.”

The Strike Force operations in Detroit are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a renewed effort announced in May 2009 between the Department of Justice and HHS to focus their joint efforts to prevent fraud and enforce current anti-fraud laws around the country. The HEAT taskforce, co-chaired by Deputy Attorney General David Ogden and Deputy Secretary Bill Corr, is made up of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions. In the May 2009 announcement, Attorney General Holder and Secretary Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars.

Today, federal agents from the FBI and the HHS Office of Inspector General (HHS-OIG) began executing arrest warrants in Detroit and Miami as part of a concentrated effort to address fraud in the metro-Detroit area. Charges were unsealed today against 53 individuals who are accused of various Medicare fraud offenses, including conspiracy to defraud the Medicare program, criminal false claims and violations of the anti-kickback statutes. The Strike Force operations in Detroit have identified two primary areas – infusion therapy and physical/occupational therapy providers – in which schemes were allegedly orchestrated to defraud the Medicare program.
According to the indictments, the defendants charged today participated in schemes to submit claims to Medicare for treatments that were in fact medically unnecessary and oftentimes, never provided. In many cases, indictments allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the unnecessary and not provided treatments. Collectively, the physicians, medical assistants, patients, company owners and executives charged in the indictments are accused of conspiring to submit more than $50 million in false claims to the Medicare program.

“We will continue to work together in the months to come to identify and stop those who would line their own pockets with taxpayer money – those who seek to benefit at the expense of our health care system, our economy and our collective well-being,” said FBI Director Mueller.
“Today’s landmark series of arrests in Detroit and across the country demonstrates that health care fraud can happen anywhere in America,” said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. “We will continue to detect and respond rapidly to emerging fraud schemes to protect our federal health care programs and conserve scarce health care dollars so critically needed for the care of our beneficiaries.”

The work of the Detroit Strike Force is another important step in the multi-phase enforcement and regulatory HEAT initiative designed to reduce the potential for Medicare and Medicaid fraud. Since its inception in March 2007 with phase one in South Florida and expansion to phase two in Los Angeles in May 2008, the Strike Force has obtained indictments of more than 250 individuals and organizations that collectively have billed the Medicare program for more than $600 million. In addition, HHS’ Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the three Detroit Strike Force teams is led by a federal prosecutor supervised by the Justice Department’s Criminal Division’s Fraud Section in Washington, D.C., and the U.S. Attorney’s Office for the Eastern District of Michigan. Each team has four to six agents, with at least one agent from the FBI and HHS-OIG.

The cases are being prosecuted by attorneys from the Fraud Section in the Justice Department’s Criminal Division, including Deputy Chief Kirk Ogrosky and Trial Attorneys John K. Neal and Benjamin D. Singer as well Special Assistant U.S. Attorney Thomas W. Beimers in the U.S. Attorney’s Office for the Eastern District of Michigan, on detail from HHS-OIG.
An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Healthcare owner convicted of Medicare fraud gets jail sentence.

Source- http://www.thenewsstar.com/article/20090617/UPDATES01/90617026

Two whistle-blowers who reported a business owner for Medicare fraud left Wednesday for an island vacation while Janice Davis of West Monroe prepares to spend time in a federal prison.Davis, former owner of the now defunct Aging Care Home Health Care, will spend 15 months in a federal prison beginning Aug. 2 after being sentenced by Judge Robert G. James in Monroe on Monday.

She will also serve three years of supervised release after completion of her sentence.Davis, 62, was charged in July 2008 in a one-count indictment and later pleaded guilty to concealment or falsification of records in a federal investigation. After being served with a subpoena for documents from the Department of Health and Human Services, Office of Inspector General, on July 23, 2003, the defendant personally destroyed, concealed, covered up, and falsified records and documents, including physician service logs, with the intent to impede, obstruct, and influence an investigation into Medicare fraud by Aging Care, according to U.S. Attorney Donald Washington of the Western District of Louisiana.

The civil lawsuit began in October 2002, when former Aging Care employee Becky Roberts and Lori Purcell McDonald, who worked for one of the doctors on Aging Care’s advisory board, filed a whistle-blower lawsuit. The lawsuit was placed under seal but was later unsealed when the federal government joined the suit in 2004.The suit claimed that from 1999 to 2003, Aging Care paid five physicians for advisory services and also billed Medicare for patient services from those doctors.

The company received more than $400,000 in reimbursements from Medicare.The investigation revealed that Davis produced documents that she created after receipt of the Office of Inspector General subpoena and that many of Aging Care’s doctors did not perform the services indicated in the records.Davis had owned and operated Aging Care, a Monroe-based company, from 1991 until its closure in 2005. Aging Care provided nursing and therapy services to patients in their homes. Clinic-based doctors monitored the patients’ home health services by updating treatment plans and prescribing medications. Normally, a physician would bill Care Plan Oversight services directly to Medicare. Payment is made by Medicare directly to the physician for services rendered to home health and hospice patients.

The subpoena issued by Human Services, Office on Inspector General to Aging Care was a result of an October 2002 False Claims Act suit which alleged Aging Care tracked physicians “Care Plan Oversight” services and billed Medicare as a means to induce patient referrals from physicians.In November 2004, the United States intervened in that suit alleging that Janice Davis, her husband Otis Davis, and her company violated federal Stark and Anti-Kickback statutes by creating a sham physician advisory board and paying its members not for legitimate duties actually performed, but instead for Medicare referrals, which is illegal.

The False Claims Act lawsuit ended in 2008 when James granted several motions for summary judgment against Janice Davis, Otis Davis and Aging Care and awarded almost $5 million in damages and penalties to the United States. In that suit, Judge James also found that Janice Davis had destroyed company records, which were responsive to the federal subpoena and attempted to replace them with false records she fabricated in an attempt to mislead federal regulators and law enforcement.

Under whistle-blower laws, Roberts and McDonald stand to receive up to 25 percent of the government’s awards.McDonald said she and Roberts were flying out Wednesday to Cozumel, Mexico. She said the vacation had long been planned and was not a result of Davis being sentenced or any money they expect to receive from the suit.“Healthcare and Medicare fraud should be a concern to every citizen.

The costs associated with this type of fraud compromises the integrity of the Medicare program and negatively impacts the healthcare burden for all of us,” Washington said.Sentencing in federal court is determined by the discretion of federal judges and the governing statute. Parole has been abolished in the federal system.This case was investigated by Special Agent Jeff Richards of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Cytheria D. Jernigan. The related False Claims Act matter was handled by Assistant U.S. Attorneys Alec Alexander and Sara McLean, U.S. Department of Justice, Washington, D.C.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Caldwell couple sentenced for Medicaid fraud.

Source- http://www.2news.tv/news/local/48160717.html

CALDWELL (AP) — A southwest Idaho couple convicted of defrauding the Medicaid system while providing denture services in Caldwell has been sentenced to three years of probation.

A judge in 3rd District Court also ordered Alfred and Vera Lopez, owners of the People's Denture Center, to complete 200 hours of community service and pay $6,863 in restitution during a hearing Monday.

The couple, who authorities say billed Idaho Medicaid for dentures and other services they never provided to recipients of the health insurance program for the poor, pleaded guilty to felony provider fraud in April.

The Lopezes entered an Alford Plea, acknowledging there was enough evidence to convict them without admitting guilt.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Granger eye doctor charged with fraud.

Source- http://www.wsbt.com/news/local/47925197.html

A federal grand jury has indicted a local eye doctor and his wife on health care fraud, wire fraud and criminal conspiracy charges, prosecutors announced Friday.

Philip J. Gabriele, 44, and his wife, Marcella Gabriele, both of Granger, are accused of falsely and fraudulently diagnosing cataracts and other disorders in patients and performing unnecessary surgeries, according to a statement issued by assistant U.S. attorney Donald Schmid.
The indictment alleges that, as part of the fraud scheme, the defendants altered patient charts and records after the fact, in an effort to make it seem as if diagnoses were accurate and correct, said Schmid, who declined to comment beyond his written statement.
As a result, the couple fraudulently billed Medicare, Indiana Medicaid and private health insurers, the indictment alleges.

The charges culminate a two-year investigation led by Schmid and conducted by the state attorney general’s office, Medicaid Fraud Control office, U.S. Health and Human Services, the FBI and South Bend Police Department.
The Gabrieles operate Gabriele Eye Institute, with a main office in Edison Lakes in Mishawaka, a second office in Elkhart and a third location at 2042 E. Ireland Road in South Bend.
The couple planned to turn themselves in Monday morning, their attorneys said. They are expected to make their initial court appearance Monday.
The Gabriele’s declined to be interviewed Friday, according to their attorneys at Baker & Daniels, but said in a written statement that they will continue their practice while the case is pending.

"We are deeply saddened and dismayed by the government’s decision to proceed with an indictment," their statement said. "We will continue to focus our energies on doing what we love — working tirelessly to provide top-quality medical care for the people of Michiana."
One of their attorneys, J.P. Hanlon, said the allegations are "completely without merit."
"Dr. Gabriele has always made medical decisions based solely on the best interest of his patients," Hanlon said in the statement. "Procedures performed by Dr. Gabriele were medically necessary and resulted in improved eyesight and quality of life for countless patients."
Prosecutors simply "do not understand the practice of good medicine, the workings of a medical office, and particularly complex issues involving eyesight," Hanlon said.
Marcella Gabriele acted as an office manager and ophthalmology technician for Gabriele Eye Institute.

Prosecutors said the couple committed the fraud from 2004 through this year.
In some cases, patients had no cataracts whatsoever, the indictment alleges. In other cases, patients had early cataracts and Philip Gabriele falsely diagnosed them as more developed and "visually significant" cataracts. He also failed to perform basic diagnostic tests and procedures that were needed to determine if a patient in fact had visually significant cataracts and surgery was needed.

Gabriele fraudulently removed healthy eye lenses and inserted artificial lenses into patients, the indictment alleges. Some of these surgeries were poorly performed and resulted in the patient suffering worse eyesight. These patients then underwent further surgeries and procedures in an effort to improve their sight, including further refractive and laser procedures, prosecutors said.
The 19-page, 15-count indictment alleges Gabriele also performed unnecessary "recession and resection" surgeries, as well as surgeries to correct an eye condition called "ptosis."
Some of these surgeries were performed on children, and some resulted in "injuries and harm" to patients, the indictment alleges.

The couple also made false claims in their advertising, such as, "100 percent of patients who have undergone Wavescan Custom Lasik at Gabriele Eye Institute see 20/20 or better after their first procedure," the indictment alleges.
Marcella Gabriele falsely documented patients’ eye sight ability following Lasik procedures to, among other things, support those advertising claims, the indictment alleges.
After investigators launched their probe, Marcella Gabriele allegedly shredded documents in March 2007. Investigators executed search warrants of the three offices and the couple’s Granger home in May 2007.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

UMDNJ to pay additional $2 million to resolve fraud claims.

Source- http://www.newjerseynewsroom.com/healthquest/umdnj-to-pay-additional-2-million-to-resolve-fraud-claims

Federal civil allegations say hospital double billed Medicaid

The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid, the Justice Department announced today.

From 1993 to 2004, UMDNJ's University Hospital submitted claims to Medicaid for outpatient physician services that were also being billed by doctors working in the hospital's outpatient centers. By submitting duplicate claims for payment, University Hospital effectively doubled billed the government's Medicaid program.

"Today's settlement demonstrates that the Department of Justice will not tolerate fraud on our Medicaid programs, which were created to serve our nation's low-income families, children and seniors," said Tony West, Assistant Attorney General for the Justice Department's Civil Division. "We will continue to work with our partners at the Department of Health and Human Services Inspector General's Office to protect the integrity of our public health programs."

The case against UMDNJ and University Hospital originated in a qui tam or whistleblower complaint filed under the Federal False Claims Act by Dr. Steven Simring. In late 2005, the double billing addressed by today's settlement was also the subject of a criminal complaint filed against UMDNJ by the U.S. Attorney's Office for the District of New Jersey. As a result of a Deferred Prosecution Agreement concerning that criminal complaint, the state of New Jersey previously recouped $4.9 million from University Hospital, half of which was to be returned to the federal Medicaid program.

Under the terms of today's agreement, UMDNJ will pay an additional $2 million to the federal government to resolve the outstanding civil federal false claims act allegations. The total federal recovery when combined with the previous payment is $4.45 million. Dr. Simring will receive $801,000 as his share of the total federal recovery.

The Office of the Inspector General of Department of Health and Human Services worked with the Justice Department's Civil Division to obtain today's result

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Ambulance Firms Accused of Medicare Fraud.

Source-http://www.courthousenews.com/2009/06/08/Ambulance_Firms_Accused_of_Medicare_Fraud.htm

DALLAS (CN) - The owner and managers of two ambulance companies face a 15-count federal indictment with conspiracy to commit health care fraud, health care fraud and money laundering. They are charged with fraudulently supplying ambulances to dialysis patients who didn't need them: "many of the companies' records revealed that patients rode to their appointments in a captain's chair in the back of the ambulance rather than lying on a stretcher" prosecutors said.

Muhammed Nasiru Usman, of Arlington, Texas; David McNac of Dallas and Shaun Outen of Aubrey are each charged with one count of conspiracy to commit health care fraud and multiple counts of health care fraud. They are accused of falsely billing Medicare, Texas Medicaid, and the Federal Employees Health Benefit Program for non-emergency ambulance transportation of patients to and from dialysis appointments starting in early 2004.

Usman also was charged with one count of money laundering: buying a Lexus with the fraudulently obtained payments from the health-care programs. Usman, the owner of Royal Ambulance Services, and First Choice EMS, employed McNac as a director of both companies and Outen as a supervisor. Prosecutors say all three were responsible for fraudulent billing exceeding $1.5 million and the payment of more than $550,000 by Medicare, Medicaid, and private insurance.

"The fraudulent claims misrepresented medical conditions of patients in order to qualify for reimbursement from Medicare, Medicaid, and private insurance, and falsely stated that legitimate ambulance services were provided," prosecutors say. "In reality, many of the companies' records revealed that patients rode to their appointments in a captain's chair in the back of the ambulance rather than lying on a stretcher."

The defendants each face up to 5 years in prison and a $250,000 fine if convicted of conspiracy and up to 10 years and a $250,000 fine for each count of health care fraud. Usman also faces up to 10 years, restitution and a $250,000 fine if convicted of money laundering.

The indictment stemmed from "Operation Easy Rider," in which search warrants were executed on ambulance companies across Texas. It was a joint operation between the U.S. Department of Health and Human Services - Office of Inspector General and Texas Attorney General Greg Abbott's Medicaid Fraud Control Unit.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Man pleads guilty to billing Medicaid for bail money.

Source- http://www.therolladailynews.com/news/x1175999033/Man-pleads-guilty-to-billing-Medicaid-for-bail-money

A 29-year-old man pleaded guilty to a federal charge of health-care fraud.

The case involved false statements to Medicaid regarding hourly home health-care services he claimed to have provided during time frames when he was actually in jail, according to Acting United States Attorney Michael W. Reap.

Christopher S. Long, 29, of Jefferson City, signed and submitted numerous “personal-care-assistance service log sheets” to a home health-care agency located in Rolla in 2006, Reap said in a released statement. The log sheets purportedly documented the “total hours worked” by Long during two-week pay periods when he was providing personal-care services for his mother.

Long’s log sheets specifically instructed him to indicate any time his mother spent during the pay period in a hospital or nursing home, or out of the home setting, to enable the accurate calculation of Medicaid reimbursement, Reap said.

Long attempted to defraud the Missouri Medicaid program by falsely representing he had provided hourly-care services to his mother on specific times and dates when he was either in prison or his mother was in the hospital, meaning he actually did not provide any care services in the home setting. The purpose of Long’s scheme was to steal money from the Medicaid program for his personal use, including his bail money, Reap said.

According to court documents, Long signed a contract to be a home-health worker in December 2005, and afterward, was approved by the Missouri Medicaid program to provide personal-care services to his mother, a Medicaid beneficiary, at her residence.

Long pleaded guilty to one count of health-care fraud and will face a maximum penalty of 10 years in prison and, or, fines up to $250,000 when he is sentenced on Aug. 25.

Reap commended investigative work completed on the case by the Medicaid Fraud Control Unit of the Missouri Attorney General’s Office, the Office of Inspector General for the U.S.

Department of Health and Human Services and the Federal Bureau of Investigation.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Doctor accused of Medicare fraud agrees to pretrial diversion program.

Source- http://www.beaumontenterprise.com/news/local/doctor_accused_of_medicare_fraud_agrees_to_pretrial_diversion_program_06-02-2009.html

A Groves doctor accused of helping the owner and officer manager of a Port Arthur pain management clinic commit more than 150 counts of health fraud has agreed to enter a pretrial diversion program rather than stand trial.

Dr. Isam Nazmi Anabtawi is accused of conspiring with Ashley Collin Walkes, the Houston owner of Medic Management at 4500 Gulfway, and office manager Kristi Rose of Bridge City to defraud the Medicare program of more than $10 million.

Walkes and Rose were scheduled to proceed to trial Monday in U.S. Magistrate Marcia Crone's courtroom. While a jury had been selected, the trial was temporarily recessed for the day before any testimony could take place, according to officials.
That trial is set to resume Wednesday.

The U.S. Attorney's Office accuses the trio of overcharging the Medicare program by submitting bills for thousands of 25-minute office visits that actually lasted less than five minutes each.

Anabtawi's attorney, Zack Hawthorn, said the pretrial diversion program requires a defendant to meet certain conditions over a length of time, during which prosecution of a case is deferred. If the person meets the terms of the agreement, charges will be dropped, Hawthorn said.

Anabtawi currently is listed as a licensed physician on the Texas Medical Board's Web site.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Colo gets $2.6M in multistate Zyprexa settlement.

Source- http://www.denverpost.com/news/ci_12477302

DENVER—Colorado has received $2.6 million as part of a multistate settlement with Eli Lilly & Co. over the way the company marketed the anti-psychotic drug Zyprexa.

Indianapolis-based Lilly agreed in January to a $1.42 billion settlement of criminal and civil cases against it.

Lilly promoted Zyprexa to help dementia patients sleep, but regulators had never approved the drug for dementia.

Colorado Attorney General John Suthers announced the state's share of the settlement Thursday. He calls it a significant victory against Medicaid fraud.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Aventis Agrees to Pay $95 Million to Settle FCA Claims.

Source- http://legaltimes.typepad.com/blt/2009/05/aventis-agrees-to-pay-95-million-to-settle-fca-claims.html

The Justice Department has popped another pharmaceutical company for overcharging the Medicaid program. Aventis Pharmaceutical Inc., a subsidiary of Sanofi-Aventis U.S., has agreed to pay the United States $95.5 million to settle allegations that it violated the False Claims Act by misreporting drug prices to skirt its Medicaid rebate obligations, the department announced today.

The company and its corporate predecessors admitted to misreporting best prices for the anti-inflammatory nasal sprays Azmacort, Nasacort, and Nasacort AQ between 1995 and 2000. Aventis entered into “private label” agreements with the HMO Kaiser Permanente, which repackaged Aventis’ drugs under a new label. The arrangement allowed Aventis to underpay drug rebates to the Medicaid program and overcharge certain public health service entities.

The feds will recover about $49 million in the settlement. Aventis will also pay more than $40 million to the Medicaid-participating states and more than $6 million to the public health services entities that paid inflated prices.

The case was handled by the Justice Department's Civil Division, the U.S. Attorney’s Office for the District of Massachusetts, the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General, and the National Association of Medicaid Fraud Control Units.

"We will continue to ensure that programs for the most vulnerable portions of our population do not pay any more for pharmaceutical products than they should under the law," said Tony West, head of the department’s Civil Division, in a statement.

The settlement comes about 10 days after the Justice Department announced it would join whistleblower lawsuits against pharmaceutical giant Wyeth, alleging that the company overcharged state Medicaid programs hundreds of millions of dollars through special pricing arrangements with thousands of hospitals nationwide. Fifteen states and the District of Columbia have also joined the two lawsuits, filed in U.S. District Court for the District of Massachusetts.

For more FCA fare, check out Marcia Coyle’s story this week in The National Law Journal. The law got a serious upgrade in the recently enacted Fraud Enforcement and Recovery Act of 2009. The law strengthens the hand of whistleblowers, but corporate defense and government contract lawyers expect it will be litigated heavily.

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Pharmacist in South Jersey faces prison.

Source- http://www.njbiz.com/weekly_article.asp?aID=19910543.8610467.1016301.6067213.4902421.915&aID2=78168

A South Jersey pharmacist was convicted of peddling narcotics and phony prescriptions as part of a plan to defraud Medicaid and private insurance companies, according to state Attorney General Anne Milgram.

An Atlantic County jury convicted Paola D’Ottavio, 42, of Pleasantville, of health care claims fraud, distribution of a controlled dangerous substance, and Medicaid fraud, according to last week’s notice from Milgram’s office.

D’Ottavio could face a prison term and fines at his July 31 sentencing, said Milgram, who added that the New Jersey Board of Pharmacy will review his pharmacy license.

Between Jan. 1, 2004, and June 30, 2005, D’Ottavio “created false telephone prescriptions for hydrocodone [the main ingredient in the painkiller Vicodin], and provided thousands of the pills to at least two purported customers,” Milgram said. The customers were friends of D’Ottavio, who sold the drugs and split the profits with D’Ottavio, she said.

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Pharmacia May Pay $212M in Medicaid Fraud Case.

Source- http://pharmtech.findpharma.com/pharmtech/Manufacturing/Pharmacia-May-Pay-212M-in-Medicaid-Fraud-Case/ArticleStandard/Article/detail/599057?contextCategoryId=35097

Pfizer’s Pharmacia unit may be ordered to pay nearly $212 million as a result of a February 2009 Wisconsin court ruling that found the company guilty of violating the state’s Medicaid fraud statute 1.44 million times.

Last week, Wisconsin’s Attorney General J.B. Van Hollen requested forfeitures to this amount as well as an injunction that would require the company to report truthful prices.

The $212 million would be in addition to the $9 million the company has already been ordered to pay to compensate the state of Wisconsin for monetary losses resulting from defrauding the Medicaid program and violating consumer protection laws.

According to the government’s allegations, Pharmacia published false average wholesale prices (AWPs), which caused the state to overpay for prescription drugs. According to the Wisconsin Department of Justice, “The jury verdict confirmed the allegation that Pharmacia benefited from the scheme because it was able to attract business and market its pharmaceuticals to healthcare providers by using the inflated prices to reimburse the providers far more than they actually paid for the drugs. As a result, Pharmacia increased its market share and profits. Meanwhile Medicaid was paying a price based on the grossly inflated, fraudulent AWP.”

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Surprise man pleads guilty to Medicare fraud.

Maricopa County Superior Court

Source- http://www.azcentral.com/news/articles/2009/05/19/20090519sr-fraud0520-ON.html?&wired

A man who owns Cave Creek medical supply business recently pleaded guilty to a Medicare fraud scam after he filled unnecessary prescriptions for motorized wheel chairs, profiting about $2,000 from each chair.

Kieran Chikwendu, 56, of Surprise, pleaded guilty Monday to fraudulent schemes and artifices, a class two felony, theft, a class three felony, and two counts of forgery, a class four felony in Maricopa County Superior Court.

Chikwendu is scheduled to be sentenced on July 21. He faces almost nine years in prison, which will be followed by supervised probation.According to the Maricopa County Attorney's Office, Chikwendu set up Savana Medical Supply, a durable medical equipment business, in Cave Creek, but billed Medicare with information from beneficiaries in California.

The scam involved having some patients receive phony medical screenings at various "clinics" for the purpose of issuing the prescription and supplying the wheelchairs. Other Medicare recipients were approached at their homes with brochures and asked to pick out a wheelchair, without ever having any medical screening. None of the Medicare patients actually needed a wheelchair.

Medicare is prohibited from paying for any equipment that is not medically necessary.
Chikwendu billed Medicare for the cost of the wheelchairs and accessories of more than $417,000 and received payments of more than $263,000.

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Albuquerque Dentist Pleads To Medicaid Fraud.

Source- http://www.koat.com/news/19473085/detail.html

ALBUQUERQUE, N.M. -- An Albuquerque dentist has received a deferred sentence after pleading guilty to three misdemeanor counts of Medicaid fraud.

Lilian Jaime, doing business as Sierra Dental, was indicted in November 2007 on eight counts of Medicaid fraud based on fraudulent billings and five counts of falsification of documents for billings to the state program from 2003 through 2005.

Jaime was ordered to reimburse the Human Services Department $17,522 for Medicaid billings and pay the attorney general's Medicaid Fraud and Elder Abuse Division $50,000 to cover its

Her corporation pleaded guilty to a felony count of Medicaid fraud and was fined $1,000.

Jaime is banned from participating in Medicaid and other federal health care for five years. Her corporation is permanently excluded.

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Grand jury indicts woman on Medicaid fraud.

Source - http://www.kpvi.com/Global/story.asp?S=10368258

BOISE, Idaho (AP) - A federal grand jury has indicted a former preschool owner from Eagle on 51 felony counts of defrauding state and federal Medicaid programs out of at least $100,000.

The indictment handed down this week names Tina Lancaster, also known as Tina Kondo-Broski.
She is accused of billing Medicaid for physical therapy services that were not ordered by a doctor or not provided by a licensed therapist. In some cases, the services were not provided at all.

Court records indicate Lancaster was the co-director, president and physical therapist for Idaho Children's Academy and Therapy Center in Eagle. The preschool and service center was dissolved in 2007.

Federal prosecutors also accuse Lancaster of obstructing a federal audit to conceal a scheme between January 2005 and April 2006.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Cuomo issues indictment and sues hospital contractor in Medicaid scam.

Andrew Cuomo (D)

Source- http://www.legalnewsline.com/news/220899-cuomo-issues-indictment-and-sues-hospital-contractor-in-medicaid-scam

BUFFALO, N.Y. (Legal Newsline) - New York Attorney General Andrew Cuomo has indicted and brought criminal charges against a Western New York hospital contractor accused of defrauding Medicaid for more than $730,000.

Named in the suit are Deborah Kantor of Tonawanda, and her company, H.I.S. Holdings, Inc., a debt collection agency that services Niagara Falls Memorial Medical Center and other western New York hospitals.

The suit alleges that Kantor and her company bribed Michael Albrecht, a Niagara county department of social services employee, in exchange for assistance in approving Medicaid coverage for certain hospital patients.

"These allegations outline an elaborate scheme where corrupt individuals intent on lining their pockets through bogus Medicaid payments ripped-off hundreds of thousands of taxpayer dollars," Cuomo said. "This investigation, as others across the state, remains ongoing as my office continues building on the successes of our Medicaid fraud-fighting efforts to return more of the money that rightfully belongs to taxpayers.

"According to the lawsuit, from 2000 to 2007, Kantor allegedly provided names to Albrecht, who researched individuals on the WMS computer to determine whether they were or had been Medicaid recipients, and he provided her with the client identification numbers required for Medicaid billing regarding any active accounts he uncovered.

The Democratic attorney general announced that the suit also seeks an additional nearly $2.2 million in damages from Kantor and H.I.S. for fraud under the State's False Claims Act and Social Services Law.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

McAllen Cardiologist forfeits more than $1 million in Medicare fraud case.

Source- http://www.brownsvilleherald.com/news/aurignac-97862-doctor-mcallen.html

McALLEN - A former McAllen cardiologist pleaded guilty Friday to one federal count of Medicaid fraud and agreed to reimburse the government more than $1.1 million.

As part of a plea agreement with prosecutors, Dr. Fabian Aurignac, 46, admitted to employing unlicensed foreign doctors, billing for evaluations that never took place and conducting dozens of unnecessary medical procedures over a period of five years.

Investigators believe Aurignac - who previously ran McAllen's Cardiology Care Center on the 700 block of North Ware Road - hired several South American doctors who were not authorized to practice in the United States and told the men he would not pay them unless they examined at least 15 patients a day.

He gave them pre-signed prescriptions to hand out while he vacationed in Argentina in 2003 and later billed Medicare and Medicaid claiming he had conducted all of the patient visits, Assistant U.S. Attorney Carolyn Ferko said.

Working with hidden video cameras, the FBI managed to record sessions with Aurignac's assistants who told visiting patients the doctor was not in the country at the time.
Rules governing the federally funded health care programs require the billing doctor to be on hand for all sessions that are charged to the government.

Aurignac's plea comes more than a year after the Texas Medical Board suspended his license to practice based on similar claims. But even after, the embattled doctor continued to peddle medical services out of an RV parked at flea markets and adult day cares, according to court documents.

There, he offered Wal-Mart gift certificates to anyone who agreed to undergo unnecessary procedures. At least one patient treated in the RV later told authorities that Aurignac never even examined her.

Aurignac's makeshift clinic also allegedly bribed daycare managers for access to their residents, according to a superseding indictment unsealed this week. Two co-defendants have been charged in the case, but their names remain under seal.

The doctor said little Friday during his re-arraignment hearing before U.S. District Judge Randy Crane. Dressed in a pressed blue shirt and khaki pants, he agreed to give up the $1,157,000 federal prosecutors seized from two of his bank accounts in February 2008, thousands of dollars taken from his office safe and a 1995 GMC truck.

His attorney, Fela B. Olivarez, did not return calls for comment after the hearing.
Aurignac, a naturalized U.S. citizen originally from Argentina, faces up to 10 years in prison. He will remain in federal custody pending a sentencing hearing scheduled for July 27.

Medicare is a federally funded program offering healthcare assistance for individuals who are 65 and older and for the disabled. Medicaid is a federal-state program that helps pay for health care for the needy, aged, blind and disabled and for low-income families with children.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Plymouth psychologist pleads guilty to health care fraud.

Source- http://www.wsbt.com/news/local/44545477.html

SOUTH BEND — At a sentencing hearing Thursday in federal court, a Plymouth psychologist formally pleaded guilty to health care fraud, and his sentencing hearing was set.
Related Content

Marc Allen Zackheim admitted to falsely billing Indiana Medicaid of $137,000. He was a licensed psychologist and owner of Associates in Clinical Psychology P.C., a domestic professional corporation, according to court documents.

But for about three years ending in June 2008, according to those documents, Zackheim and his corporation defrauded Indiana Medicaid by filing billings and claims for reimbursement for therapies that were never provided to patients, were not medically necessary or were not entitled under Medicaid.

Zackheim, 58, will be sentenced July 22.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Miami-Dade doctor pleads guilty -- again -- to Medicare fraud.

Source- http://www.blogger.com/post-create.g?blogID=6275481621303003780

A Miami-Dade physician pleaded guilty Thursday to participating in a Medicare racket with four other doctors accused of prescribing $19.5 million in obsolete infusion drugs for HIV patients who generally didn't need or receive the therapy.

In turn, Dr. Carmen Lourdes del Cueto, the four other doctors and the HIV clinic owner were paid almost $16 million by the federal health insurance program after submitting false claims for costly infusion drugs from 2003 to 2006, according to prosecutors.

In March, del Cueto pleaded guilty to playing a similar role in a separate $10 million HIV infusion scam involving two other doctors during the same period. Medicare paid about half their false claims, totaling $5 million.

Del Cueto, 65, of Southwest Miami-Dade, faces up to 10 years in prison for both convictions at her sentencing set for Sept. 11 -- though she is expected to receive less time because she's cooperating with the U.S. attorney's office. She also must repay Medicare $4.5 million.

Del Cueto, a U.S. citizen, responded with short answers to questions posed by U.S. District Judge Patricia Seitz, who summarized the gravity of the doctor's offenses and her theft from the government healthcare program.

''The objective is to restore Medicare,'' Seitz said. ``Medicare is there because of taxpayers to provide assistance to people in the community.''

In the latest case, del Cueto pleaded guilty to one conspiracy charge of defrauding Medicare. Last month, two other doctors, Marco Tulio Molinares, 74, and Alejandro Enrique Casuso, 73, also pleaded guilty to that charge in plea deals.

Esther Romeu, the owner of Diagnostic Medical Choice in Miami, which hired the physicians, pleaded guilty, too.

Two other doctors in that case, Walter Proano, 46, and Manuel Barbeite, 70, are awaiting trial in August.

In the other Medicare fraud case, del Cueto pleaded guilty along with two physicians, Dr. Roberto Rodriguez, 54, and Dr. Carlos Garrido, 69, to a conspiracy charge. They were indicted along with two medical assistants, Gonzalo Nodarse, 38, and Alexis Carrazana, 41, and a chemist, Alexis Dagnesses, 44, who worked at Midway Medical Center in Miami. They also pleaded guilty.

In both cases, the physicians wrote prescriptions to back up phony claims submitted to Medicare for treating HIV patients who did not need or receive the therapy, federal prosecutors said.
They conspired to manipulate blood samples, pay kickbacks to HIV patients and purchase a small fraction of the infusion drugs billed to Medicare, prosecutors said.

Such schemes in South Florida have plagued the federal healthcare program in recent years.

Medicare officials say they have become more aggressive by denying about $2 billion in South Florida claims for HIV infusion treatments since 2004. But records show Medicare still pays out hundreds of millions of dollars yearly for the HIV infusion services -- despite criticism from medical experts that such therapy has been obsolete for more than a decade.

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Amador gets jail time Medicare fraud.

Source- http://atlanta.bizjournals.com/atlanta/stories/2009/05/04/daily42.html?surround=lfn

A man who set up a series of fake medical clinics in and around Atlanta to support a Medicare fraud ring is headed to federal prison.

Alain Amador, 31, of Miami, was sentenced Tuesday to serve more than four years in prison for conspiracy to commit health care fraud. He also must pay $3.9 million in restitution. Amador pleaded guilty to the charges on March 3.

Amador and his conspirators set up fake medical clinics in metro Atlanta. They leased space in the names of the companies, opened bank accounts, filed corporate documents in the names of the companies, and ultimately applied for and received Medicare billing numbers. However, the companies existed in name only. They maintained no operations, employees, or equipment.

Using improperly obtained identity information of actual doctors and Medicare patients, the conspirators filed more than $12 million in Medicare claims for phony services in less than a year.

Of the amount billed, Medicare paid about $3 million before the scheme was uncovered and the payments were halted. The federal government seized about $2 million of the money, some of which was still present in bank accounts when the scheme was identified, and some of which was in the form of checks that were sitting in the fake offices waiting to be picked up and deposited.

Most of the remainder of the money was transferred to or deposited in foreign bank accounts.

Amador, who has a nursing degree, helped set up and maintain the fake companies. He assisted in incorporating the companies and opening the bank accounts. He periodically traveled from Miami, where most of the conspirators were based, to Atlanta, to keep up appearances at the office space, check the mail and pay rent.

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Doctor and patient arrested, charged with 14 counts of prescription fraud.

Regina Duff

Source- http://dpa.xtn.net/dynamic/News/Story/155328

An Etowah physician and one of his patients have been arrested by the Tennessee Bureau of Investigation on charges of prescription fraud.

Dr. James Durkin, 63, of 915 Pinecrest Dr., Athens, was charged with 14 counts of prescription fraud by TBI agents Wednesday. Durkin's office is located on Grady Road in Etowah. Also arrested on the same indictment was Regina Duff, 38, of 3186 Highway 411 N., Englewood.

According to TBI Public Information Officer Kristin Helm, Duff, a TennCare recipient, had been a patient of Durkin for the past five years. Helm wrote in an e-mail today that Durkin and Duff consider each other friends.

According to Helm, Durkin allegedly prescribed unnecessary medications to Duff. Helm said Durkin is charged with falsely prescribing medication while Duff is charged with obtaining false prescriptions. The case was worked by the TBI's Medicaid Fraud Control Unit, which was able to gain an indictment on Durkin and Duff.

According to Woods Memorial Hosptial's Web site, Durkin is listed as a family practice physician with the hospital. Woods Memorial Hospital Administrator Steve Clapp said he could not comment on the charges against Durkin. However, Clapp said Durkin is a valued member of the hospital staff who provides excellent care for his patients.

He added the hospital and the staff will offer support to Durkin during his time of need. The TBI was assisted in the indictment arrests by the Etowah Police Department. Etowah Police Chief Phil Robinette said the investigation into the alleged prescription fraud has been going on for more than a month. He said when his department was first made aware of the allegations, he contacted the TBI and the state health department's criminal investigation unit. Durkin and Duff were both released on $25,000 bonds. They are scheduled to appear in McMinn County Criminal Court May 5.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.

Allegheny, Beaver Co. Pharmacists Arrested In $1 Million Prescription Drug Medicaid Fraud Case.

Source- http://www.wpxi.com/news/19314212/detail.html

Attorney General Tom Corbett announced Tuesday that agents from the Attorney General's Medicaid Fraud and Insurance Fraud Sections have filed criminal charges against two pharmacists accused of conspiring to fabricate insurance claims for nearly $1 million worth of prescription drugs that were never given to patients.

William M. Sadowski, 43, of McKees Rocks and Eric J. Miladin, 43, of Monaca were arrested in the case.

Corbett said Sadowski is a licensed pharmacist and the former co-owner of Servatus Pharmacy, located in the North Hills section of Pittsburgh. Miladin was a pharmacist employed at Servatus Pharmacy.

According to the criminal complaint, Sadowski conspired to submit false claims to the Pennsylvania Medicaid program and private health insurance companies for high-cost medications that were supposedly given to patients at the Allegheny Valley School, a facility for individuals with intellectual and developmental disabilities. Sadowski allegedly submitted more than $645,000 worth of insurance claims for medications that were not prescribed by any doctors and were not dispensed to any residents at Allegheny Valley School locations in Pittsburgh or Harrisburg.

Corbett said that Sadowski also allegedly submitted more than $180,000 in false claims to Highmark Insurance Company, using the names of employees who worked for businesses in the area where the pharmacy was located. The investigation determined that these medications were never authorized by any doctors and that the drugs were not provided to any patients.

Additionally, Sadowski and Miladin allegedly conspired to use the names of inmates at the Beaver County Jail to submit false claims for drug rebates, using various coupons provided by prescription drug manufacturers. At the time, the Servatus Pharmacy was contracted to provide emergency medication to the Beaver County Jail.

Corbett said that Sadowski and Miladin are accused of creating fictitious prescriptions and submitting claims for more than $155,000 in rebates for drugs such as Levitra, an erectile dysfunction medication; Marinol, a synthetic marijuana; Restoril, a narcotic sleep medication and Pexeva, an expensive antidepressant.

"Medicaid Fraud takes money directly from the pockets of Pennsylvania taxpayers and takes away resources that could be used to provide more care to citizens who are in-need," Corbett said. "Additionally, fraudulent health insurance claims increase the cost of health care for businesses and consumers all across the state.

"Corbett noted that this is an ongoing investigation by the Attorney General's Medicaid Fraud and Insurance Fraud Sections.

Sadowski is charged with two counts of participating in a corrupt organization, both first-degree felonies punishable by up to 20 years in prison and $25,000 fines. He is also charged with one count each of provider prohibited acts (submitting false claims), insurance fraud, theft by deception and criminal conspiracy, all third-degree felonies which are each punishable by up to seven years in prison and $15,000 fines.

Miladin is charged with one count of theft by deception and one count of criminal conspiracy, both third-degree felonies which are each punishable by up to seven years in prison and $15,000 fines.

Sadowski and Miladin both surrendered to agents from the Attorney General's Office on Monday, April 27, and were preliminarily arraigned before Pittsburgh Magisterial District Judge William K. Wagner.

Sadowski was released on $50,000 unsecured bail and Miladin was released on his own recognizance. Preliminary hearings are scheduled for both defendants on June 3.

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Former Abingdon ambulance company owner sentenced for Medicare fraud.

Source- http://www.wsls.com/sls/news/state_regional/article/former_abingdon_ambulance_company_owner_sentenced_for_medicare_fraud/34069/

The former owner of an Abingdon ambulance company will spend more than four years in a federal prison for defrauding Medicare and a private insurer.

U.S. Attorney Julia C. Dudley said 44-year-old Darryl Jack Kiser of Lebanon was sentenced Monday to four years and three months in prison. Kiser had pleaded guilty earlier to health care fraud and conspiracy to commit health care fraud.

Kiser is the former owner of Angel Care Ambulance Service. Dudley says the company fraudulently billed Medicare and the insurer for transporting dialysis patients who didn’t fit their guidelines.

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DeLand businessman was charged with medicaid fraud.

Source- http://www.news-journalonline.com/NewsJournalOnline/News/WestVolusia/wvlWEST04042509.htm

Staff Report

A DeLand businessman was charged Friday with bilking the Florida Medicaid program out of more than $95,000, according to the Attorney General's Office.

Medicaid Fraud Control Unit investigators believe James C. Williams, 46 -- who owned Make a Difference Home Services in DeLand -- billed for services that were not provided. Williams' paperwork between Jan. 1, 2006, and Dec. 31, 2007, was scrutinized, according to a charging affidavit.

The first year Make a Differences Home Services was in business, 2005, total paid claims from the Agency for Health Care Administration were just over $67,000. Claims increased to $511,857 in 2006 and to $566,295 in 2007, the report states.

Three Medicaid recipients under the Developmental Disabilities Waiver -- a program that allows home and community-based services so recipients can live as independently as possible -- were identified by investigators as clients of Williams who didn't receive all the services that were billed to Medicaid, the report states. In one case, Williams initially provided services and billed them properly, but, as time went on, the services were more inconsistent and the service logs did not reflect those actually provided.

Two former employees, a billing clerk and an office manager, made sworn statements to investigators that they regularly billed ahead of time for services that were not rendered. Williams told investigators: "He started losing control when the business expanded and it became too much for him to handle."

Williams was charged with organized scheme to defraud, a first-degree felony, according to the Attorney General's Office.

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Pharmacist Carmine DeTomasis gets jail time for healthcare fraud.

Pharmacist Carmine DeTomasis

Source - http://www.wpri.com/dpp/news/local_news/local_wpri_providence_pharmacist_gets_jail_time_for_fraud_20090423

PROVIDENCE, R.I. (WPRI) - A U.S. District Court judge sentenced Carmine DeTomasis to one year in prison and 18 months home confinement Thursday for illegally buying and selling pharmaceuticals.

The Providence pharmacist must also perform 500 hours of community service while on home confinement, including work with HIV/AIDS patients and pharmacy students. DeTomasis, 74, pleaded guilty in November to illegally buying prescription drugs from Louis Romanelli and selling them to Romanelli.

DeTomasis also pleaded guilty to heath care fraud after admitting to have submitted false reimbursement claims to health care insurers including Medicaid and Medicare. The U.S. Attorney's Office said DeTomasis' store, Prime Drug, billed insurance companies for more drugs than the pharmacy had in its inventory.

The office said the fraudulent claims to health insurance carriers totaled about $400,000. U.S. District Court Judge William E. Smith ordered DeTomasis that he make restitution to the insurers in the amount of $404,000 and pay the government proceeds of his health care fraud totaling $458,000.

Romanelli, 81, pleaded guilty in September to more than a dozen charges in connection to the illegal sales of the drugs, mostly medications used to treat HIV/AIDS. Romanelli also bought controlled substances such as hydrocodone from DeTomasis.

Romanelli is free on bond and currently awaiting sentencing. A task force led by the Food and Drug Administration - and included the Rhode Island Attorney General's Medicaid Fraud Control Unit - conducted the investigation .

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Chiropractor Douglas Dvorak found guilty of Medcaid fraud, mail fraud, identity theft and money laundering.

Chiropractor Douglas Dvorak

Source- http://www.gazetteonline.com/apps/pbcs.dll/article?AID=/20090410/NEWS/704109952/1006

Chiropractor Douglas Dvorak on Thursday blamed his court-appointed attorney for being found guilty in U.S. District Court in Cedar Rapids for Medicaid fraud.

Dvorak, 45, of Cedar Rapids, said outside the courthouse that he was upset with the way attorney David Nadler handled his case and his lack of preparedness. Dvorak wanted to testify in his defense but said he didn't based on his opinion of Nadler. Dvorak was found guilty for 22 counts of mail fraud, 11 counts of aggravated identity theft and six counts of money laundering.

Evidence showed he filed fraudulent Medicaid claims on patients he had never treated using their names and birth dates without their consent. Fifteen mothers testified they didn't know Dvorak and their children were never treated by him, as he had claimed on Medicaid forms.U.S. District Chief Judge Linda Reade read each one of the counts and asked the jurors to raise their hand to acknowledge each guilty verdict.

Dvorak didn't look at the jurors when the verdicts were read. He looked straight ahead or was writing something on a notepad.The jurors were dismissed after the verdict was read and not available for comment. Reade told everybody else in the courtroom to remain until after the jurors left.

According to court records, Dvorak filed a motion for a new attorney March 4, claiming Nadler missed appointments with him, was ill-prepared and missed deadlines in the case.U.S. Magistrate Jon Scoles denied the motion.

Nadler couldn't be reached for comment. He left the courthouse before Dvorak was interviewed. The government presented evidence during the trial to substantiate each of the charges. Dvorak mailed the fraudulent claims to Medicaid and received checks from Medicaid in the mail. He filed claims with names and birth dates of patients, mostly children, who he had never treated.

The jury also was shown bank records proving he cashed or deposited large checks of $17,195 and $19,866 and then withdrew the entire amount of the deposited check within a few days to hide the funds.

Dvorak's defense was poor bookkeeping, claiming he didn't have an office or staff, filed his own paperwork and got behind and overwhelmed.Witnesses testifying on his behalf said he provided services to them free of charge and was regarded as a friend.

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Miami, FL - Two Doctors and Two Medical Assistants Plead Guilty in $10 Million Medicare Fraud Scheme.

Source - http://www.sunherald.com/prnewswire/story/1222384.html

Four Miami-area residents pleaded guilty today in connection with a $10 million Medicare fraud scheme involving HIV infusion clinics, Acting Assistant Attorney General Rita M. Glavin of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

Dr. Roberto Rodriguez, 54; Dr. Carlos Garrido, 69; Gonzalo Nodarse, 38; and Alexis Carrazana, 41; all pleaded guilty before U.S. District Judge Paul C. Huck to one count of conspiracy to commit health care fraud. All four defendants admitted to working at Midway Medical Center Inc. (Midway), a Miami clinic that purported to specialize in the treatment of HIV patients.

According to the plea documents, Rodriguez was a co-owner of and practicing physician at Midway. Rodriguez admitted that he and his co-conspirators routinely billed the Medicare program for services that were medically unnecessary and, in many instances, never provided. Rodriguez admitted to purchasing only a small fraction of the medication that was purportedly being administered to Midway's patients.

Most of the services provided to patients at Midway were billed to the Medicare program as treatments for a diagnosis of thrombocytopenia, a disorder involving a low count of platelets in the blood. According to the plea documents, none of Midway's patients actually had low blood platelet counts. Rodriguez admitted that to make it appear that the patients actually had low platelet levels, he and his co-conspirators used chemists to manipulate the blood samples drawn from Midway's patients before the blood was sent to a laboratory for analysis. In his plea, Rodriguez admitted to ordering that patients at Midway receive medications to treat thrombocytopenia despite knowing that the laboratory results had been falsified and the patients did not actually have that condition.

Midway was not the only clinic where Rodriguez purported to treat HIV patients with injection and infusion therapies. In his plea, Rodriguez admitted that he was listed as a medical director and practicing physician for five other Miami-area HIV infusion clinics between approximately October 2003 and February 2005, where he engaged in similar misconduct. Specifically, Rodriguez admitted he and his co-conspirators billed the Medicare program for HIV injection and infusion services that Rodriguez knew were medically unnecessary and, in some instances, never actually provided. Rodriguez admitted to causing more than $20 million in false claims to be submitted to the Medicare program at all of his clinics, including Midway.

Like Rodriguez, Garrido was a part-owner and practicing physician at Midway. In his plea, Garrido admitted that he and his co-conspirators routinely billed the Medicare program for services that were medically unnecessary and, in many instances, never provided. Garrido admitted to purchasing only a small fraction of the medication that was purportedly being administered to Midway's patients. Garrido ordered that patients be treated with medications he knew they did not need and that, in many instances, he knew the clinic did not have available to provide to the patients. Garrido admitted to working at Midway for approximately eight months before the clinic closed, during which time he admitted to submitting more than $1 million in fraudulent claims to the Medicare program.

Nodarse and Carrazana worked at Midway as medical assistants. In their pleas, the two assistants admitted to making false entries in medical records indicating that they had provided medications on particular dates and in particular dosages to patients, when, in fact, they had not provided medications. The medical assistants also admitted to being fully aware that blood samples drawn from Midway's patients were tainted to make it appear that the patients had conditions they did not have. Both assistants admitted to administering medications to patients that they knew the patients did not need. Nodarse, who worked at Midway throughout its existence, admitted to conspiring to submit more than $10 million in false and fraudulent claims for HIV infusion services allegedly provided at the clinic.

The case is being prosecuted by Trial Attorney John K. Neal of the Criminal Division's Fraud Section. The FBI and the Department of Health and Human Services, Office of Inspector General, conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force (MFSF), supervised by Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section and U.S. Attorney Acosta of the Southern District of Florida. Since the inception of MFSF operations, federal prosecutors have indicted 106 cases with 192 defendants in both Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars. Please report Medicare fraud by calling 1-888-482-6825 or by visiting www.usawhistleblower.com.

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FLORIDA - Dr. Carmen Lourdes del Cueto,65, Dr. Roberto Rodriguez, 54, Dr. Carlos Garrido, 69, Arrested for $10 Million Medicare Fraud Scheme.

Source - http://www.opposingviews.com/articles/news-hiv-aids-doctors-arrested-for-10-million-medicare-fraud#comments

WASHINGTON – Six Miami-Dade County residents have been indicted in connection with an alleged $10 million Medicare fraud scheme operated out of Midway Medical, a Miami clinic that purported to specialize in treating HIV/AIDS patients, Acting Assistant Attorney General Rita M. Glavin of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced.

Carmen Lourdes del Cueto, M.D., 65, Roberto Rodriguez, M.D., 54, Carlos Garrido, M.D., 69, Gonzalo Nodarse, 38, Alexis Carrazana, 41, and Alexis Dagnesses, 44, were all indicted by a grand jury in Miami on Feb. 12, 2009, for conspiracy to commit health care fraud. Del Cueto, Rodriguez, Garrido and Nodarse were also charged with conspiracy to launder health care fraud proceeds, as well as three counts each of substantive money laundering. The indictment seeks the forfeiture of assets from all named defendants.

According to the indictment, the three physicians, del Cueto, Rodriguez and Garrido, were part-owners of Midway Medical. Midway Medical purported to be an infusion clinic that specialized in providing infusions and injections to HIV-positive patients. The indictment alleges that the physicians ordered medically unnecessary infusions and injections, and falsified medical records to make it appear that the HIV services were necessary. The indictment also alleges that many of the infusions or injections were never actually provided.

The indictment also alleges that medical assistants Nodarse and Carrazana assisted the physicians in falsifying the medical records to make it appear that the services were needed. As part of the scheme, Dagnesses is alleged to have manipulated HIV-positive blood samples in order to obtain laboratory reports indicating that the patients had illnesses that they in fact did not have.

Del Cueto, Rodriguez, Garrido and Nodarse are further charged with distributing the proceeds of the fraud through a series of financial transactions involving more that $10,000 in tainted funds.

The indictment alleges that the physicians at Midway Medical billed more than $10 million to the Medicare program for services that were medically unnecessary and not actually provided between September 2002 and June 2005. During that time frame, Medicare paid more than $4.8 million on those fraudulent claims submitted by Midway Medical. If convicted on all charges, Del Cueto, Rodriguez, Garrido and Nodarse each face maximum prison sentences of 50 years. Carrazana and Dagnesses face 10 year maximum terms in prison.An indictment is merely a charge and defendants are presumed innocent until proven guilty.

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SouthernCare Inc. Pays U.S. $24.7 Million to Settle Health Care Fraud Claims.

Source - http://news.prnewswire.com/ViewContent.aspx?ACCT=109&STORY=/www/story/01-15-2009/0004955632&EDATE=

WASHINGTON, Jan. 15 /PRNewswire-USNewswire/ -- SouthernCare Inc. and its shareholders have agreed to pay the United States a total of $24.7 million to settle allegations that the Birmingham, Ala.-based company submitted false claims to the government for patients treated at its hospice facilities, the Justice Department announced today. SouthernCare operates approximately 99 locations that provide hospice services in 15 states.

Hospices provide palliative care - any form of medical care or treatment that concentrates on reducing the severity of a disease's symptoms - to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis of six months or less to live. The government alleged that SouthernCare was submitting false claims for hospice care for patients who were not eligible for such care.

"The Medicare hospice benefit is intended to provide compassionate end of life care to terminally ill patients," said Gregory G. Katsas, Assistant Attorney General of the Civil Division. "This settlement sends a clear message that the Department of Justice will not allow health care providers to take advantage of beneficiaries in their attempts to game the reimbursement system."

Today's settlement results from two qui tam suits filed by two former SouthernCare employees, Tanya Rice and Nancy Romeo, on behalf of the United States. The False Claims Act authorizes private parties to file suit against those who defraud the United States and to receive a share of any recovery. The United States will pay $4.9 million to the individuals who filed the actions against SouthernCare.

"Our investigation showed a pattern and practice to falsely admit patients to hospice care who did not qualify and to bill Medicare for that care. This resulted in taxpayers bearing inappropriate costs. Today's settlement evidences the Department of Justice's efforts to both protect the public monies and safeguard Medicare beneficiaries," said Alice H. Martin, U.S. Attorney for the Northern District of Alabama.

"This significant settlement demonstrates our commitment to protect the Medicare trust fund from fraud and abuse and to ensure that Medicare beneficiaries receive quality care," said David E. Nahmias, United States Attorney for the Northern District of Georgia. "Every provider that submits claims to the Medicare program must ensure that its services are billed appropriately. Falsely admitting people to hospice care who did not qualify for the benefit exposed these patients to potential harm and contributes to the soaring costs of health care for everyone." As part of the settlement, SouthernCare will enter into a Corporate Integrity Agreement with the Office of Inspector General (OIG), Department of Health and Human Services (HHS), to address the allegations raised in the qui tam complaints.

"Today's Corporate Integrity Agreement contains rigorous provisions specifically designed to ensure SouthernCare's future compliance with Medicare and Medicaid hospice eligibility requirements," said Daniel R. Levinson, Inspector General for HHS. "This agreement demonstrates OIG's commitment to protect the integrity of federal health care programs."
The investigation was jointly handled by the U.S. Attorney's Office for the Northern District of Alabama, the U.S. Attorney's Office for the Northern District of Georgia, the Justice Department's Civil Division, Office of the Inspector General of the Department of Health and Human Services and the FBI.

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Orlando Pascual Jr., 43, pleads to defrauding the Medicare program in connection with a $5.3 million HIV infusion fraud scheme.

Source - http://www.bizjournals.com/southflorida/stories/2009/01/05/daily39.html

The owner and operator of two Miami medical clinics has pleaded guilty to defrauding the Medicare program in connection with a $5.3 million HIV infusion fraud scheme, according to the U.S. attorney for the Southern District of Florida.

Orlando Pascual Jr., 43, pleaded guilty on Wednesday to conspiracy to commit health care fraud. Pascual admitted that he co-owned two Miami clinics: Medcore Group LLC and M&P Group of South Florida.

The clinics purported to specialize in the treatment of HIV-positive patients. Pascual admitted that between August 2004 and November 2006 he conspired with others to submit about $5.3 million in fraudulent claims to Medicare.

Pascual acknowledged that clinic employees intentionally manipulated patients’ blood samples so they would appear to need treatment, when, in fact, they did not. Pascual said they tampered with test results to make the medical files appear legitimate.

Pascual, who already is serving time for another Medicare fraud involving durable medical equipment, is to be sentenced in April. Seven co-defendants are scheduled for trial next month.

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Dr. Ana Alvarez-Jacinto sentenced to 30 years in prison for for billing Medicare $11 million in bogus HIV therapy claims.

Dr. Ana Alvarez-Jacinto sentenced to 30 years in prison.

Source - http://www.miamiherald.com/news/miami-dade/breaking-news/story/816645.html

A federal judge gave a Miami physician one of the stiffest punishments ever for Medicare fraud Wednesday morning, sentencing Dr. Ana Alvarez-Jacinto to 30 years in prison. U.S. District Judge Federico Moreno ignored the 54-year-old physician's plea for probation, sentencing her for billing Medicare $11 million in bogus HIV therapy claims.

Moreno found the doctor's misconduct so offensive that he went beyond the prosecution's recommendation of 22 years in prison. He cited the fact that she showed no remorse after she was found guilty at trial in October, and that she had lied on the witness stand. ''I find that she lied,'' Moreno said. ``It's as simple as that. She blatantly lied.''

Moreno's sentencing will undoubtedly send a loud and clear message to Medicare fraud perpetrators in Miami-Dade County, recognized as the nation's capital of healthcare corruption.
Sandra Mateos, a nurse who colluded with the doctor, received a seven-year sentence for her minor role in the racket.

Alvarez-Jacinto's 30-year sentence for Medicare fraud stretches far beyond the average length of 2 ½ years, according to the U.S. attorney's office in Miami. The doctor had previously requested probation and had taken out an ad in El Nuevo Herald urging fellow physicians, patients and friends to write letters for leniency to Moreno, who revoked her bond after a jury convicted her of Medicare fraud in October.

''I'm begging you for the sake of my family,'' she told the judge Wednesday. ``My life has been ruined already.'' Alvarez-Jacinto and the 44-year-old nurse, Mateos, worked in a Miami clinic that was a front for a trio of Cuban immigrant brothers who masterminded a $119 million scam against the nation's health insurance program before fleeing to Cuba last June.

The brothers controlled a dozen Miami-Dade clinics that billed Medicare for obsolete HIV infusion treatments that were either unnecessary or not provided to HIV patients, who received kickbacks.

Prosecutors previously recommended that the judge send Alvarez-Jacinto to prison for 22 years, which would have been one of the harshest penalties for a Medicare fraud defendant since the U.S. attorney's office and Justice Department teamed up to crack down on government healthcare corruption last year.

Prosecutors recommended up to 10 years in prison for Mateos, the ex-wife of one of the three Cuban brothers. Mateos is divorced from Luis Benitez, wanted by the FBI on Medicare fraud charges along with his brothers, Carlos and Jose Benitez.

The brothers, whose ill-gotten Medicare millions were invested in real estate and other properties in the Dominican Republic, are now in jail in Havana on immigration violations, according to federal authorities. Meanwhile, FBI agents and Dominican police have been seizing their assets.

Alvarez-Jacinto was indicted along with six other healthcare providers on charges of defrauding Medicare by filing false claims for HIV infusion treatments at St. Jude Rehab Center Inc., 330 SW 27th Ave. Her father, Dr. Orestes Alvarez-Jacinto, brought her to work at the clinic in 2003. He pleaded guilty to Medicare fraud charges last year and was sentenced to 18 months in prison.

This is how the scam worked: The Benitez brothers recruited the HIV patients to come to St. Jude by paying them $150 for each visit. The clinic's physicians prescribed the same treatment for all of the patients, regardless of their medical diagnosis. In turn, St. Jude billed Medicare for an expensive HIV infusion drug called WinRho, made from human plasma. The drug is only medically necessary for HIV patients with low blood platelets.

But none of St. Jude's patients had platelets low enough to require the drug, according to experts who testified at trial. So the costly treatment -- paid for by U.S. taxpayers -- wasn't necessary. And according to prosecutors, it wasn't always administered to the patients.

The father-and-daughter medical team was trained by a physician's assistant, Thomas McKenzie, who worked for the Benitez brothers' chain of clinics. McKenzie, who pleaded guilty and cooperated with authorities, is to be sentenced on Thursday. In her defense, Dr. Ana Alvarez-Jacinto testified she was unaware that St. Jude was a fraudulent front for the Benitez brothers to rip off Medicare.

In her ad that ran in El Nuevo Herald last month, she declared: ``I am innocent of the charges filed against me.'' She urged fellow physicians, patients and others to come to her aid for the sentencing, including writing letters of support to the judge.

Among the 40 letter writers in the court records: her former husband. ''I plead to you, for the sake of Ana, Kathrine [our daughter] and Ana's patients to please consider my request to give Ana a chance,'' said Dr. Lawrence R. Brown, an oral surgeon with a practice in Miami-Dade.
The doctor may be 84 years old when finally released from federal prison.

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Dr. Carlos Contreras, 61, and Dr. Ramon Pichardo, 58, sentenced to 37 months & 48 months in prison for $6.8 million Medicare Fraud Scheme.

SOURCE U.S. Department of Justice

WASHINGTON -- Miami physicians Carlos Contreras, 61, and Ramon Pichardo, 58, were sentenced today to 37 months and 48 months in prison, respectively, for defrauding the Medicare program in connection with a $6.8 million HIV infusion fraud scheme, Acting Assistant Attorney General Matthew Friedrich of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced.

Judge Federico A. Moreno of the U.S. District Court for the Southern District of Florida also ordered that Contreras and Pichardo be placed on three years of supervised release following their prison terms and that they pay $4.2 million in restitution to the Medicare trust fund.

On Sept. 11, 2008, Contreras and Pichardo each pleaded guilty to one count of conspiracy to commit health care fraud. Contreras pleaded guilty in connection with his role as the owner and medical doctor at CNC Medical Corp.

(CNC Medical), a Miami-area HIV clinic that purported to provide HIV infusion services to Medicare beneficiaries. Pichardo pleaded guilty in connection with his role as a medical doctor at CNC Medical. In their pleas, Contreras and Pichardo admitted that between November 2002 and April 2004, they conspired with others to file $6.8 million in false claims to the Medicare program for HIV infusion services that were not provided, nor were they medically necessary.

As a result of their fraud, the Medicare program paid approximately $4.2 million in fraudulent bills. Contreras admitted that after Medicare proceeds were deposited into the CNC Medical bank accounts, he transferred approximately $1.7 million of the proceeds to sham management, marketing and investment companies owned and operated by alleged co-conspirators Carlos, Luis and Jose Benitez.

Carlos Benitez, Luis Benitez and Thomas McKenzie were charged separately with health care fraud and money laundering crimes in an indictment unsealed on June 11, 2008. According to that indictment, these co-conspirators allegedly provided the money and staff necessary to open HIV clinics, the Medicare patients that the clinics would bill to the Medicare program and transportation for the HIV patients who visited the clinics. Also according the indictment, Carlos and Luis Benitez were the true owners of the clinics.

The Benitez brothers and McKenzie were charged for their roles at the clinics and eight other HIV infusion clinics. On Sept. 18, 2008, McKenzie pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program, and admitted to his role in a $119 million HIV infusion fraud scheme. Carlos, Luis and Jose Benitez remain fugitives.

The cases were prosecuted by Assistant Chief Hank Bond Walther and Trial Attorney John K. Neal of the Criminal Division's Fraud Section, and Trial Attorney Constantine Lizas of the Criminal Division's Asset Forfeiture and Money Laundering Section. The FBI and Department of Health and Human Services, Office of the Inspector General, investigated the cases.

The cases were brought as part of the Medicare Fraud Strike Force (MFSF), supervised by Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section and U.S. Attorney Acosta of the Southern District of Florida. Since the inception of MFSF operations in 2007, federal prosecutors have indicted 104 cases with 184 defendants in Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars.

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Report Medicare fraud by calling 1-888-482-6825 or by visiting www.usawhistleblower.com.

Los Angeles Area Health Care Company Owner Melkon Gabriyelyan, 51, Pleads Guilty to Medical Identity Theft and Medicare Fraud.

Source - http://www.ibtimes.com/prnews/20081016/doj-medicare-fraud.htm

WASHINGTON, Oct. 16 /PRNewswire-USNewswire/ -- A La Crescenta man pleaded guilty today to federal criminal charges of defrauding Medicare by using patients' Medicare identification numbers without their knowledge, Acting Assistant Attorney General of the Criminal Division Matthew Friedrich and U.S. Attorney for the Central District of California Thomas P. O'Brien announced. Between August 2003 and April 2008, Melkon Gabriyelyan, 51, billed the Medicare program for more than $1,640,000.

Gabriyelyan pleaded guilty to one count of aggravated identity theft and one count of health care fraud before U.S. District Judge Manuel L. Real in U.S. District Court for the Central District of California. Judge Real scheduled Gabriyelyan's sentencing for Jan. 12, 2009. At sentencing, Gabriyelyan faces a maximum term of 12 years in prison for his crimes.

According to the plea agreement, Gabriyelyan admitted owning and operating TA Medical Supply, a durable medical equipment (DME) company located in the Tujunga area of Los Angeles. In his plea agreement, Gabriyelyan acknowledged that beginning in January 2004 he fraudulently billed Medicare for DME purportedly supplied to Medicare beneficiaries.

Gabriyelyan submitted false claims to Medicare for orthotic braces, power wheelchairs and other DME that were not delivered to Medicare beneficiaries, were not prescribed by the physicians listed on the claims that he made or were not medically necessary.

Gabriyelyan also acknowledged in the plea agreement that to accomplish the fraud he knowingly and willfully stole the identity of a Medicare beneficiary for the purpose of submitting false claims. He admitted billing a back brace and two knee braces that the beneficiary did not need or receive, and that the patient had no knowledge of.

In addition, Gabriyelyan admitted that he created a patient file for this beneficiary that contained a delivery slip with the beneficiary's forged signature. "Medical identity theft is a growing problem that poses significant harm to both the Medicare program and the patients whose personal information is stolen," said Acting Assistant Attorney General Matthew Friedrich. "The Department will continue fighting to protect the rights of Medicare patients as well as prosecuting individuals who defraud the Medicare program." "Medical identity theft is a striking example of the kind of fraud we are combating in the Los Angeles area.

One new weapon in our arsenal is our Strike Force operations, which seek not only to protect American taxpayers from Medicare fraud, but protect the private and personal information of all patients," said U.S. Attorney Thomas P. O'Brien.

Gabriyelyan was arrested in May 2008 following an investigation by the Medicare Fraud Strike Force (MFSF). The MFSF is a multi-agency team of federal, state and local prosecutors and agents designed to combat Medicare fraud. Strike force operations began in the Los Angeles area on March 1, 2008.

The MFSF is led by the Criminal Division's Fraud Section in Washington, D.C., and the office of U.S. Attorney Thomas P. O'Brien of the Central District of California. Since the inception of MFSF operations in 2007, federal prosecutors have indicted 104 cases with 184 defendants in both Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars.

This case is being prosecuted by Assistant U.S. Attorney Margaret L. Carter, and is being investigated by the FBI; the Department of Health and Human Services, Office of the Inspector General; the California Department of Justice; the Bureau of Medical Fraud and Elder Abuse; and the Los Angeles County Health Authority Law Enforcement Task Force.

SOURCE U.S. Department of Justice

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FLORIDA - U.S. Attorney Charges 245 With Health Care Fraud During Fiscal Year 2008

Source - http://www.nbc6.net/news/17592136/detail.html

FLORIDA -The United States Attorney for the Southern District of Florida announced in a joint press conference Tuesday the year-end results of their investigation and prosecution of health care fraud cases in South Florida.

Alex Acosta compared the total number of health care fraud cases prosecuted by his office during fiscal years 2006, 2007, and 2008. The comparison showed a steady increase in the number of health care fraud prosecutions and in the size of the resulting fraud.

In 2006, the U.S. Attorney’s Office charged 111 defendants with health care fraud, resulting in the submission of approximately $138,000,000 in false claims to Medicare.

One year later, that number increased to 197 charged defendants and a corresponding false claims figure of $638,000,000. During fiscal year 2008, the number of defendants charged jumped to 245, with a corresponding fraud amount of $793,448,162.

U.S. Attorney Acosta said, “These defendants are getting rich by stealing your precious Medicare dollars. In a time when money is short, and health care is expensive, this is money that is meant to help the sick and elderly, not to line the pockets of criminals. We will continue to prosecute these cases, but we are not the solution. We need better rules in place to prevent Medicare fraud in the first place.”

FBI Special Agent in Charge Jonathan Solomon said, “The FBI and its partners continue to build on the success of the Medicare Fraud Strike Force. We recognize that health care fraud is a challenging crime problem in South Florida and it will remain a top priority for the FBI.”

Christopher B. Dennis, Special Agent in Charge of the Miami Regional Office of the U.S.

Department of Health and Human Service- Office of Inspector General, added, “These health care fraud prosecutions send a clear message to those who corruptly take advantage of the Medicare and Medicaid systems. Greed, at the expense of our most vulnerable citizens, will not be tolerated."

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Varnador Sutton, 43, sentenced to 10 years in prison for falsely billing counseling services to the Indiana Medicaid program.

Source - http://www.indystar.com/apps/pbcs.dll/article?AID=/20080909/NEWS02/80909049

A U.S. District Court judge has sentenced a former Indianapolis man to 10 years in prison for falsely billing counseling services to the Indiana Medicaid program. Varnador Sutton, 43, submitted bills for more than $9 million for 84,000 counseling sessions that never happened, according to the U.S. attorney's office in Indianapolis. He received more than $3 million in payments.

Judge Larry J. McKinney gave Sutton the maximum prison sentence possible Monday. After he finishes his prison term, Sutton also must serve three years on supervised release and pay nearly $3.3 million in restitution to the Indiana Medicaid program.

A federal jury convicted Sutton of health care fraud in March. He faced charges last year after an investigation by the U.S. Health and Human Services inspector general, the Indiana attorney general’s Medicaid Fraud Control Unit and the FBI.

“There were deliberate efforts to defraud state and federal programs of funds intended to assist our most vulnerable population,” Indiana Attorney General Steve Carter said in a news release.

“Investigators are to be commended for uncovering the billing fraud that allowed justice to be served by this sentence.”

Investigators seized more than $2 million in assets from Sutton, including several luxury cars, real estate and certificates of deposit worth $1.1 million. Sutton had most recently lived in Atlanta, Ga.

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Dr. Michael D. Kim convicted of conspiracy to defraud Medicare of $29 million in a motorized wheelchairs scheme.

Source - http://www.kdbc.com/Global/story.asp?S=8940450&nav=menu608_1

HOUSTON, TEXAS - A federal jury in Houston has convicted a physician of conspiracy to defraud Medicare of $29 million in a motorized wheelchairs scheme. The U.S. Attorney's Office says Dr. Michael D. Kim also was convicted Tuesday on 17 counts of health care fraud. Sentencing is Feb. 12.

Each health care fraud conviction has a maximum penalty of 10 years in prison and a $250,000 fine. The conspiracy conviction has a penalty of 5 years in prison and a $250,000 fine.

Prosecutors say Kim fraudulently certified physically-fit Medicare beneficiaries from Texas and Louisiana for motorized wheelchairs, in exchange for kickbacks from equipment companies.

Medicare paid out more than $10.3 million based on Kim's bogus certificates of need involving 3,240 patients during a 16-month period.

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Dr. Paul Lessler of Newport Beach, CA pleads guilty to Medicare fraud and surrenders his medical license.

Dr. Paul Lessler operated University Pain Specialists

Source -http://www.ocregister.com/articles/medical-board-medicare-2132708-lessler-today

Newport Beach, CA - A Newport Beach doctor who last year pleaded guilty to committing Medicare fraud surrendered his medical license today, the California Medical Board reported.

Dr. Paul Lessler operated University Pain Specialists, a clinic where prosecutors said he participated in a $12 million Medicare scam in which mentally ill and elderly adults received unnecessary respiratory treatments. In May 2007, he pleaded guilty to three counts of conspiracy and health care fraud charges.

According to medical board documents made public today, Lessler hired recruiters who found patients at board and care facilities in Orange County from 2000 to 2006. Recruiters lured them with soda, candy and doughnuts. The lung treatments were provided without supervision at the boarding facilities. Documents say the medical office billed Medicare for the services, even though those services were not provided in the doctor's office, as required by Medicare.

Lessler, 70, agreed to give up his license and signed an agreement with the medical board to do so in July. Santa Ana attorney Raymond McMahon, who represented him in the proceeding, is on vacation and could not be reached for comment.

Federal records indicate Lessler was to be sentenced last month, but the computer system does not indicate the disposition. Neither his defense attorney nor prosecutors could be reached late today.

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Albert C. Albert, 56, owner of Skillcare Rehabilitation Services and Nelbat Rehabilitation Services sentenced to 15 years in prison for Medicare fraud

Albert C. Albert sentenced to 15 years in prison.

Source - http://www.fortbendnow.com/printer_friendly/178857

Missouri City, Texas - A Missouri City therapist, who admitted cheating Medicaid and Medicare out of $225,000, has been sentenced to 15 years in prison. Albert C. Albert, 56, of Orkney Drive, was one of two men arrested last fall for allegedly hatching a scam through which each billed Medicare and Medicaid for services that never were performed.

Albert, an occupational therapist and owner of Skillcare Rehabilitation Services and Nelbat Rehabilitation Services, billed the government health care programs for nearly $1.3 million. Of that, about $225,000 was obtained fraudulently, Texas Attorney General Greg Abbott has said.

Albert pleaded guilty in June to charges of felony theft by a government contractor. On Tuesday, he was sentenced in Harris County District Court to 15 years in prison.

According to a statement from Abbott's office on Wednesday, investigators were able to uncover the payment scam after interviews with 33 of Albert's patients showed most of them never received treatments shown in Albert's billings to the government.

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Lonnie Robinson, 59, an insurance agent arrested on allegations that he forged Medicare applications of two elderly women.

Lonnie Robinson, 59, arrested at his home for Medicare fraud.

Source - http://www.gainesvilletimes.com/news/article/7347/

Gainsville, Georgia - An insurance agent from Flowery Branch was arrested this morning on allegations that he forged Medicare applications of two elderly women in order to receive a commission check.

Lonnie Robinson, 59, was arrested at his home in the Legend Falls subdivision and charged with two counts of insurance fraud shortly after 6 a.m. today.

Georgia Department of Insurance officials say they began investigating Robinson, a Gwinnett County insurance agent, after two women notified them that their Medicare prescription plans had been changed to the Medicare Advantage program without their consent.

John Oxendine, the state's insurance commissioner, who stood by while Hall County Sheriff's deputies and department of insurance officials apprehended Robinson, said Robinson's arrest was the fifth of its kind this year.

Oxendine said insurance commissioners across the country are noticing that the Medicare Advantage program particularly has made it easy for insurance agents to take advantage of elderly people.

"Crimes against senior citizens (are) a major problem," Oxendine said. "Medicare Advantage, specifically, has become very rampant across this entire country."

Oxendine said the compensation system that awards insurance agents anywhere between $500 to $600 for signing people up for Medicare Advantage, and the fact that applicants do not have to pay for their insurance makes those who are eligible for Medicare susceptible to fraud.
"I sign you up, you don't have to give me any money, I turn in the paperwork and the federal government pays me the commission," Oxendine said. "And that's what happened in these two cases."

Robinson is being held in the Hall County Jail on a $5,000 bond.

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Sixty-five-year-old Martin McLaren, who owns Pain Management Center has been sentenced to three years in federal prison.

Source - http://www.wtop.com/?nid=25&sid=1439307

WASHINGTON (AP) - A Bethesda doctor convicted in a health care fraud scheme has been sentenced to three years in federal prison.

Sixty-five-year-old Martin McLaren, who owns Pain Management Center in Hyattsville, pleaded guilty in February to issuing $1.75 million of false claims to Medicaid, Medicare and private insurance companies. He was sentenced Friday in U.S. District Court.

A prosecutor called the case one of the biggest individual health care fraud scams in the area. McLaren also agreed to pay $5 million in restitution and damages to the government. He told the judge he hoped to "emerge as a much stronger, better person."

Defense attorney Kirby D. Behre says McLaren stands to lose his medical license, and has already been punished enough.

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Aisa Perera, 42, sentenced to 30 months in prison for her role in an $11 million scheme to defraud the Medicare program.

MIAMI, FLORIDA - Miami resident Aisa Perera, 42, was sentenced today to 30 months in prison for her role in an $11 million scheme to defraud the Medicare program, Acting AssistantAttorney General Matthew Friedrich of the Criminal Division and U.S.Attorney R. Alexander Acosta of the Southern District of Florida announced.

Perera was sentenced in the U.S. District Court for the SouthernDistrict of Florida by Judge Federico A. Moreno. In addition to the prisonsentence, Judge Moreno ordered that the defendant be placed on three yearsof supervised release following her release from prison and pay $8,289,286 in restitution to the U.S. Department of Health and Human Services (HHS).

On April 23, 2008, Perera pleaded guilty to one count of conspiracy tocommit health care fraud, in connection with her role as administrator ofSaint Jude Rehab Center Inc., an HIV clinic that purported to provide HIVinfusion services to Medicare beneficiaries. In connection with her plea,Perera admitted that in June 2003, she opened Saint Jude with threeco-conspirators who owned and operated several HIV clinics in the Miami area.

The co-conspirators, Carlos, Luis and Jose Benitez were chargedseparately with health care fraud and money laundering crimes in anindictment unsealed on June 11, 2008. According to the separate indictment,these co-conspirators are alleged to have provided the money and staffnecessary to open Saint Jude, the Medicare patients that Saint Jude wouldbill to the Medicare program and transportation for the HIV patients whovisited Saint Jude. In return, the co-conspirators are alleged to havereceived 60 percent of all payments Saint Jude received from the Medicareprogram.

Perera also admitted that between June 2003 and November 2003, SaintJude submitted approximately $11.3 million in fraudulent claims to theMedicare program for HIV infusion services that were either never providedor not medically necessary. Medicare paid more than $8.2 million of the$11.3 million in fraudulent claims. As part of the conspiracy, Perera andher co-defendants allegedly paid patients who attended Saint Judeapproximately $100 to $150 in cash kickbacks per visit and then hired amedical biller for the purpose of altering the bills being submitted to the Medicare program to make them appear legitimate. The co-defendants, MarielaRodriguez, Beatriz Delgado, Carmen Gonzalez and Sandra Mateos, wereindicted along with Perera on April 2, 2008.

In a related case, on Aug. 28, 2007, medical biller Rita Campos-Ramirezpleaded guilty to one count of conspiracy to commit health care fraud andone count of submitting false claims to the Medicare program, in connectionwith her participation in the Saint Jude fraud scheme and approximately 74 other HIV infusion fraud schemes. In connection with her plea, Campos-Ramirez admitted that over the course of three and a half years, shesubmitted approximately $170 million in fraudulent bills to the Medicareprogram on behalf of approximately 75 health clinics that purported toprovide HIV infusion services to Medicare beneficiaries.

Of the $170 million that was billed, approximately $105 million was paid by Medicare.On April 2, 2008, the Honorable Alan S. Gold sentenced Campos-Ramirez to 12years in prison. In another related case, on June 12, 2007, Dr. Orestes Alvarez-Jacintopleaded guilty to one count of conspiracy to commit health care fraud inconnection with his participation in the Saint Jude fraud scheme.

Inconnection with his plea, Alvarez-Jacinto admitted to authorizing andapproving the use of the drug WinRho, along with a mix of various vitaminsupplements, for each HIV patient he was seeing, knowing that the HIVpatients did not need WinRho and that the drug could actually harm them.During this period, Alvarez-Jacinto signed bills for WinRho treatments thatmisrepresented the amount of drugs actually administered to the patients.

He also signed inflated bills for treatments that were medicallyunnecessary for the purpose of forwarding those bills to Medicare forpayment. On Oct. 2, 2007, the Honorable Patricia A. Seitz sentencedAlvarez-Jacinto to 18 months in prison. The Saint Jude case was prosecuted by Trial Attorneys Hank Bond Waltherand John K. Neal of the Criminal Division's Fraud Section in Washington, D.C., with the investigative assistance of the FBI and the HHS Office ofInspector General.

The case was brought as part of the Medicare FraudStrike Force, supervised by Deputy Chief Kirk Ogrosky of the CriminalDivision's Fraud Section and U.S. Attorney Acosta of the Southern Districtof Florida. From investigations opened during the period of strike forceoperations between March and October of 2007, federal prosecutors haveindicted 82 cases with 142 defendants in South Florida. Collectively, thesedefendants fraudulently billed the Medicare program for more than $492 million.

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Maria T. Hernandez and her two thieving daughters get prison terms for Medicare fraud.

Source - http://miami.fbi.gov/dojpressrel/pressrel08/mm20080627.htm

Miami, Florida - The owners of four Miami-based healthcare corporations were sentenced and remanded to prison yesterday for their roles in schemes to defraud the Medicare program, Acting Assistant Attorney General Matthew Friedrich of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

Collectively, the three defendants through their companies collected more than $14 million from the Medicare program for unnecessary medicine, durable medical equipment (DME) and home health care services.

U.S. District Judge Cecilia M. Altonaga sentenced Maria T. Hernandez (Mayte), 50, to 51 months in prison; Marta F. Jimenez, 67, to 31 months in prison; and Maivi Rodriguez, 34, to 51 months in prison. All three were remanded into federal custody at the conclusion of the sentencing. Hernandez and Rodriguez are the daughters of Jimenez.

On March 7, 2008, after a five week trial, a jury convicted Hernandez, Jimenez and Rodriguez on all charged counts, including conspiracy to defraud the U.S. government, to cause the submission of false claims to Medicare, and to solicit and receive kickbacks; and conspiracy to commit health care fraud.

Additionally, the defendants were found guilty of multiple counts of receiving kickbacks in exchange for referring Medicare patients.At trial, the jury heard testimony that Hernandez, Jimenez and Rodriguez controlled more than 60 Medicare beneficiaries for the sole purpose of defrauding Medicare through the businesses they owned.

Hernandez owned Action Best Medical Supplies Inc., a DME company. Jimenez and Rodriguez owned Esmar Medical Equipment Inc., a DME company; A & A Medical Services Inc., a home health care company; and M & M Comprehensive Inc., an assisted living facility. Patients testified at trial that they were paid cash kickbacks in exchange for use of their Medicare cards. Several of the patients lived in the assisted living facility owned by Jimenez and Rodriguez.

Patients testified that they knowingly took cash kickbacks, were falsely diagnosed with chronic obstructive pulmonary disease and prescribed unnecessary aerosol medications, including commercially unavailable compounds. Compounding refers to the process of a pharmacist mixing the medication in the pharmacy, instead of purchasing it from a pharmaceutical manufacturer.

Trial testimony revealed that one of the men making the medicine was trained as an auto mechanic without any education, training or experience manufacturing medicine. In total, the co-conspirator pharmacies associated with Hernandez, Jimenez and Rodriguez were paid more than $14 million between 2000 and 2003 based on the submission of claims for medically unnecessary aerosols.

The case was prosecuted by Deputy Chief Kirk Ogrosky and Senior Trial Attorney John S. Darden of the Criminal Division’s Fraud Section in Washington, D.C., with the investigative assistance of the Department of Health and Human Services, Office of Inspector General and the FBI.

The case was brought as part of the Medicare Fraud Strike Force, supervised by the Fraud Section of the Criminal Division and U.S. Attorney Acosta of the Southern District of Florida. From investigations opened during the period of strike force operations between March and October of 2007, federal prosecutors have indicted 82 cases with 142 defendants in South Florida. Collectively, these defendants billed the Medicare program for more than $492 million.

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Three Miami Area Brothers and Physician’s Assistant Charged in $110 Million Health Care Fraud Scheme.

Source - www.usdoj.gov/usao/fls.

Miami, Florida - Three Miami area brothers who allegedly financed 11 corrupt HIV infusion clinics and a physician’s assistant who worked at those clinics have been charged in a $110 million HIV infusion fraud scheme, the Department of Justice’s Criminal Division and the U.S. Attorney’s Office for the Southern District of Florida announced today.

The indictment alleges that between January 2001 and November 2004, Carlos and Luis Benitez conspired to submit approximately $110 million in false and fraudulent claims to the Medicare program for HIV infusion services allegedly provided at 11 corrupt HIV infusion clinics that they owned and controlled.

As part of the scheme, Carlos and Luis Benitez referred Medicare beneficiaries to the clinics and directed the beneficiaries be paid kickbacks to induce them to claim they received legitimate services at the clinics when in fact the HIV infusion services were either not provided or were not medically necessary.

The HIV infusion clinics that they owned and controlled were: AH Medical Office Inc.; Advanced Medical Rehabilitation Center Inc.; Best Medi Corp.; Physician’s Health Med-Care; Physician’s Med-Care Inc.; Saint Jude Rehab Center Inc.; Global Med-Care Corp.; CNC Medical Corp.; G&S Medical Centers Inc.; Karla Medical Services Inc.; and Best Medicare Inc.

The indictment alleges that Jose Benitez owned and operated one of the eleven clinics, Advanced Medical, and assisted in submitting approximately $10 million of the false and fraudulent claims to the Medicare program for HIV infusion services that were not provided and for services that were not medically necessary. Thomas McKenzie was a physician’s assistant at the HIV infusion clinics owned and operated by Carlos, Luis and Jose Benitez.

The indictment alleges that, at the direction of Carlos, Luis and Jose Benitez, McKenzie was responsible for training physicians and providers in how to make it appear that legitimate and appropriate medical services were being provided as well as overseeing the preparation of documents to make it appear that the services were actually rendered and medically necessary.

After obtaining the proceeds from their crimes, the indictment alleges that Carlos, Luis, and Jose Benitez engaged in a scheme to launder those proceeds by, among other things, transferring millions of dollars in proceeds to sham “marketing” and “management” companies that they owned and controlled and by transferring proceeds among the corrupt HIV infusion clinics.

Carlos Benitez, Luis Benitez, Jose Benitez, and Thomas McKenzie were charged with conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; conspiracy to commit health care fraud; and submitting false claims to the Medicare program.

Carlos, Luis and Jose Benitez were charged with conspiracy to launder the proceeds of their crimes, and Carlos and Luis Benitez were each charged with money laundering. The indictment also seeks forfeiture of assets held by all defendants. Carlos and Luis Benitez each face a maximum sentence of 155 years in prison, Jose Benitez faces a maximum of 40 years, and Thomas McKenzie faces a maximum of 50 years.

This case is being prosecuted by Trial Attorneys Hank Bond Walther and John K. Neal of the Criminal Division’s Fraud Section, as well as Laurel Loomis Rimon and Constantine Lizas of the Criminal Division’s Asset Forfeiture and Money Laundering Section, with the investigative assistance of the FBI and the Department of Health and Human Services Office of the Inspector General.

The case was brought as part of the Medicare Fraud Strike Force that has been operating in Miami since March 2007. The Strike Force is led by Deputy Chief Kirk Ogrosky of the Criminal Division’s Fraud Section in Washington, D.C., and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida.

A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov/

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Virginia - New River Valley pain doctor Linda Cheek loses her license to practice medicine for defrauding the Medicaid and Medicare.

Dr. Linda Cheek

Source - http://www.wdbj7.com/Global/story.asp?S=8384349&nav=S6aK

A New River Valley pain doctor who pled guilty in February to health care fraud was sentenced Tuesday.

Dr. Linda Cheek was sentenced to four years probation, will have to pay $24,000 to Medicare & Medicaid, and pay a $1,000 fine. She will also lose her license to practice medicine. Cheek is a primary care physician who took up alternative medicines, including pain management.

The 59-year-old doctor pleaded guilty in court in February to defrauding the Medicaid and Medicare health care programs for her own financial gain. She admitted to filing a series of false claims at her office for services she had not performed.

Dr. Cheek even admitted to billing for services performed by nurse practitioners at her office while she was out of the country.

Though Dr. Cheek admitted defrauding the government, the judge had difficulty believing she accepted responsibility. In a unusual move Tuesday, Judge Glen Conrad quizzed Cheek under oath until she acknowledged she'd committed a crime.

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Dr. Antoine Francis Cawog, 62, is accused of 24 counts of violating the state drug act and 10 counts of attempting to commit Medicaid fraud.

Source - http://www.tradingmarkets.com/.site/news/Stock%20News/1477124/

A doctor on staff at Excela Health Westmoreland Hospital in Greensburg was charged Wednesday with selling prescriptions for painkillers and other drugs to a confidential informant, including two alleged transactions inside the hospital.

Dr. Antoine Francis Cawog, 62, of 102 Foxwood Drive, Unity, is accused of 24 counts of violating the state drug act and 10 counts of attempting to commit Medicaid fraud, according to the state Attorney General's office. Greensburg District Judge James Albert issued a warrant for the doctor's arrest.

Cawog, a general practitioner, was taken into custody yesterday by Internal Revenue Service agents, who have charged him with income tax evasion, authorities said. The charges were filed simultaneously because of concerns that Cawog might flee the country, authorities said. A detention hearing remained to be scheduled.

Excela spokeswoman Robin Jennings said an arrest of a physician results in the immediate end of medical privileges in the hospital. She said a letter ending those ties would be sent soon to Cawog, who can apply for reinstatement if he is found innocent of the charges.

Jennings declined to comment on the alleged sales of prescriptions inside the medical facility. According to a probable cause affidavit, Cawog sold prescriptions for painkillers and mood-changing drugs to a confidential informant from late 2007 to March 23, 2008. During some of these rendezvous, state and Greensburg police said in court papers that Cawog pulled up to make the sales in his black Cadillac Escalade.

On Dec. 19, authorities allege that Cawog wrote prescriptions for 60 Hydrocodone tablets and 60 Alprazolam tablets for $150 in the hospital lobby.

"Dr. Cawog initially wanted to meet at the Shop 'n Save parking lot, but later called and asked the (confidential informant) to meet him in the lobby of the Westmoreland Hospital," the affidavit said. "The (confidential informant) was provided $150 and ... met Cawog in the hospital lobby for approximately four minutes and paid him $150."

The prescriptions were written for Lortab and Xanax tablets, police said.

After this meeting, Greensburg police Detective Jerry Vernail saw a black Cadillac Escalade in the physicians' parking lot at the hospital, court papers said.

On Jan. 4, Cawog sold prescriptions for Lortab and Xanax for $165 in a hospital stairwell, documents indicated. Originally, Cawog arranged the meeting to be out in front of the hospital, then took the informant inside the medical facility, court papers showed.

Another sale of prescriptions occurred on Dec. 6 in the parking lot of the Shop 'n Save store on East Pittsburgh Street, documents said. Prescriptions for 30 Lorcet and 45 Xanax tablets were obtained at this time, police said.

"Dr. Cawog was observed operating a black Cadillac Escalade and met with the (confidential informant) in a parking space," the affidavit said.

On Feb. 1, an undercover meeting was arranged at Cawog's home, police said.

"This transaction was arranged on a prior date and it entailed the installation of gutter guards on Dr. Cawog's house by the (confidential informant) in exchange for a prescription written to the (confidential informant) for services rendered," the affidavit said.

Scripts for 45 Xanax and 45 Vicodin tablets were written, court papers showed. Other transactions occurred at a Sunoco gasoline station in the Greensburg area and at the Boston Market store in Hempfield, according to court papers.

Police estimated that 15 prescriptions for more than 800 pills were sold to the confidential informant for nearly $1,000.

According to court papers, Cawog also wrote prescriptions for an undercover investigator from the state Attorney General's office. The investigator had obtained a University of Pittsburgh Medical Center health card, then visited Cawog's office on Main Street in Irwin 10 times.

The agent, known to Cawog as Julia M. Hall, received unnecessary prescriptions from Cawog without him getting a complete patient history, giving a physical or reviewing past medical records or diagnostic tests, according to the affidavit. The agent, whose card involved Medical Assistance funds, noted that no scales or blood-pressure cuffs were in the examination room. At the end of each of the first six visits, Cawog requested $60 in the exam room. For the last four visits, Cawog requested $120 in cash, and the agent received a prescription for approximately twice the amount of drugs given during the first six visits, court papers showed.

In 2006, IRS agents seized three properties owned by Cawog after he allegedly failed to pay more than $2.4 million in taxes.

Cawog had filed for bankruptcy at least five times since 1998, according to court papers.
A medical office he operated in Youngwood until 2004 was destroyed by a fire.

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Dr. Tarek Wehbe accused of giving patients inadequate doses of chemotherapy, and of billing Medicare and Medicaid for procedures that were never done.

Dr. Tarek Wehbe

Feds seeking to forfeit $3 million from Dr. Tarek Wehbe

Source - http://www.turnto10.com/northeast/jar/news.apx.-content-articles-JAR-2008-04-10-0009.html

Federal prosecutors are seeking to forfeit $3 million from a doctor accused of giving patients inadequate doses of chemotherapy, and of billing Medicare and Medicaid for procedures that were never done.

The state Department of Health suspended Tarek Wehbe's medical license on Monday after officials realized his records of chemotherapy purchases did not match his bills to medical insurers.

Federal and state authorities had been investigating him since 2006. A complaint filed in U.S. District Court in Providence on Wednesday seeks forfeiture of the nearly $3 million that prosecutors say Wehbe fraudulently billed Medicare, Medicaid and private insurers for services that were either medically unnecessary or were not performed.

Prosecutors say Wehbe billed for procedures and visits, if actually done, that would have taken more than a full day, and once billed for 87 patient visits in a single day.

He is also accused of fraudulently billing for chemotherapy drugs and infusion treatments of drugs used to treat inflammatory disorders. Prosecutors say he billed for more treatments than he could have possibly performed.

John Tarantino, a lawyer for Wehbe, declined to comment Thursday. The complaint also seeks the forfeiture of a Citizens Bank account and real estate in North Providence, Lincoln, Jamestown and Smithfield.

Prosecutors say the properties are proceeds of the alleged health care fraud.

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Seven Miami-Area Residents Charged in $11 Million Medicare Fraud Scheme.

Source - U.S. Department of Justice

WASHINGTON, April 2, 2008 /PRNewswire-USNewswire/ -- Seven Miami-area residents have been indicted in connection with an $11 million Medicare fraud scheme involving HIV infusion clinics, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

Dr. Ana Alvarez, 54, Mariela Rodriguez, 39, Aisa Perera, 42, Beatriz Delgado, 48, Angel Rodriguez, 40, Sandra Mateos, 43, and Carmen Gonzalez, 33, were all charged today in federal district court in Miami with: conspiracy to defraud the United States, to cause the submission of false claims, to pay health care kickbacks, and conspiracy to commit health care fraud. The indictment also seeks forfeiture of assets held by all named defendants. Mariela Rodriguez, Perera, and Delgado also were charged with four counts of submitting false claims to the Medicare program. Alvarez also was charged with three counts of submitting false claims and Mariela Rodriguez was charged with one count of perjury.

According to the indictment, Mariela Rodriguez and Perera incorporated Saint Jude Rehab Center, Inc. (Saint Jude) in April 2003 as a medical clinic that purported to specialize in treating HIV patients. Delgado, a receptionist at Saint Jude, agreed to be incorrectly listed on filed corporate records as president and registered agent of Saint Jude. Mariela Rodriguez and Perera hired Dr. Alvarez to work at Saint Jude despite having no prior expertise in the clinic's proclaimed specialty of treating HIV patients. Dr. Alvarez ordered unnecessary tests, signed medical analysis and diagnosis forms, and authorized treatments without regard to medical necessity, to make it appear that legitimate medical services were being provided to HIV patients receiving Medicare benefits.

The indictment further charges that during the conspiracy, Mariela Rodriguez, Perera, and Delgado withdrew cash from Saint Jude's bank account for Angel Rodriguez, Mateos and Gonzalez, assistants at Saint Jude, to pay cash kickbacks of approximately $100 to $150 per visit to HIV patients. In return for the kickbacks, patients signed logs stating that they had received the treatments that were billed to Medicare, when in fact the patients had not received the claimed treatments.From June 2003 through November 2003, Saint Jude billed approximately $11 million to the Medicare program under the Medicare provider numbers of Dr. Alvarez and Dr. Orestes Alvarez-Jacinto, receiving more than $8 million in payments for HIV infusion services that were not actually provided and services that were not medically necessary.

Dr. Orestes-Alvarez Jacinto, a former doctor at Saint Jude, pleaded guilty in June 2007 to conspiracy to commit health care fraud and was sentenced in October 2007 to 18 months in prison. In a related case, Rita Campos Ramirez, the medical biller employed by Saint Jude, pleaded guilty in August 2007 to a $170 million conspiracy to commit health care fraud.

Sentencing is scheduled for later today.If convicted on all charges, Mariela Rodriguez, Perera and Delgado each face maximum prison sentences of 35 years. Alvarez faces a maximum prison sentence of 30 years while Angel Rodriguez, Mateos and Gonzalez each face maximum prison terms of 15 years.An indictment is merely a charge and defendants are presumed innocent until proven guilty.This case is being prosecuted by Trial Attorneys Hank Bond Walther and John K. Neal of the Criminal Division's Fraud Section, with the investigative assistance of the FBI. The Medicare Strike Force is led by Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida.

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Daniel Arnold, 51, owner of D&D Medical of Aurora, CO, faces up to 16 years in prison for stealing $1 million from the Colorado Medicaid system.

Source - http://origin.denverpost.com/news/ci_8749648

The owner of an Aurora medical supply company that provided and repaired wheelchairs has pleaded guilty to stealing more than $1 million from the Colorado Medicaid system during a five year period.

Daniel Arnold, 51, the owner and manager of D&D Medical of Aurora, faces up to 16 years in prison when he is sentenced May 7, according to Colorado Attorney General John Suthers. Under the plea bargain, Arnold must repay the more than $1 million he swindled, said the attorney general.

A large percentage of D&D's business was for disabled individuals whose wheelchair services were covered by Medicaid.

Investigators said that Arnold billed Medicaid for hundreds of thousands of dollars in wheelchair repair services that took only a small fraction of the time claimed.

The Adams County grand jury that indicted Arnold said Arnold oversaw billing and operations of D&D even when others occupied management positions.

Arnold told certain employees that they were expected to bill heavily for repairs to wheelchairs and other equipment of Medicaid clients, said the indictment. He told the employees to bill a high number of repair hours for repairs that either took a fraction of the time billed or did not occur at all.

To accomplish the fraud, employees allegedly printed false work orders and documented false repair times to permit the unjustified billing. Arnold was also accused of falsifying manufacturer invoices to inflate the company's reimbursements for new wheelchairs and parts and accessories. Arnold allegedly told the employees that the fraudulent billing was required for the business to continue in operation and for the employees to keep their jobs.

Investigators said a majority of the repairs billed to Medicaid did not occur, or only took a fraction of the time claimed for in the billings.

Many labor claims were in the amount of six, seven and even eight hours. Several employees said the time claimed were "grossly exaggerated."

Arnold pleaded guilty to four counts, including racketeering; theft of more than $15,000; theft between $500 and $15,000, and forgery.

A number of Arnold's employees also pleaded guilty in the scheme. One of the employees received a five-year prison term. Another received a deferred sentence and a third a probationary sentence.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Kieran Chikwendu, 55, of Surprise, Arizona, has been indicted on 68 counts in a Medicare fraud case.

Kieran Chikwendu has been indicted on 68 counts in a Medicare fraud case.

Source - http://www.azcentral.com/community/westvalley/articles/0316medicarefraud0316-ON.html

A 55-year-old Surprise man has been indicted on 68 counts in a Medicare fraud case, the Maricopa County Attorney's Office said Sunday. According to the office, Kieran Chikwendu set up a Cave Creek medical supply company, got California patients to sign up for wheelchairs they didn't need, and received $263,000 of $417,000 billed to Medicare.

Under the alleged scheme, some patients received fake medical screenings to issue bogus prescriptions for the chairs, while others were approached at their homes and asked to pick one out. Doctors' signatures on prescriptions for the chairs were forged, the County Attorney's Office said.

Chikwendu issued 65 phony prescriptions for wheelchairs, making roughly $2,000 per chair, the County Attorney's Office said. Mike Scerbo, a County Attorney's Office spokesman, said it was unclear how long the ruse had been going on.

Chikwendu was arraigned March 10 on 65 counts of forgery, one count of fraud, and one count of theft. A pretrial conference is scheduled April 30.

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Dr. Dipak K. Desai agrees to surrender his license - FBI joins the investigation of the Endoscopy Center for possible Medicare fraud.

Dr. Dipak Desai owns 65 percent of Endoscopy Center of Southern Nevada

Source - http://www.thehindu.com/holnus/001200803081762.htm

New York (PTI): A prominent Indian doctor and majority owner of a Las Vegas clinic chain has surrendered his medical license following a probe into allegations of unsafe medical practices, including reusing of syringes and vials, at a centre which may have put over 40,000 patients at risk.

The Nevada State Board of Medical Examiners had requested Dipak K. Desai, owner of the Endoscopy Center of Southern Nevada where six cases of Hepatitis have been confirmed, to voluntarily stop practicing medicine, until the Board's investigation into allegations has been completed.

The Board said Desai had agreed to surrender his license, pending a probe into the centre's operations but did not give a timeframe as to how long the investigation may take. A second Indian doctor linked to the scandal Vishvinder Sharma also resigned from the State Medical Board but did not turn over his medical license, local media reports said.

The FBI has also joined the investigation of the Endoscopy Center for possible Medicare fraud. Investigators want to know whether the center billed Medicare for 30-minute appointments that did not last that long.

The clinic may have also committed fraud for billing Medicare for two vials in instances when only one was used, officials said.

As many as 40,000 people may have been infected with the deadly Hepatitis C virus or HIV from the clinic over the last four years, officials said, adding six of Desai's facilities have been closed.

Desai, who has been practising medicine in Nevada for 28 years, is reportedly an alumnus of Gujarat University.

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Albert Sarian Ulit, a nurse, is facing up to 10 years in prison for his role in a $9.6 million home health-care agency Medicare fraud scheme.

Source - http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2008/03/05/state/n084357S60.DTL&type=health

A Lomita nurse is facing up to 10 years in federal prison for his role in a $9.6 million home health-care agency Medicare fraud scheme based in Rancho Palos Verdes.

Albert Sarian Ulit pleaded guilty Tuesday to one count of health-care fraud. Besides prison time, he will likely be fined $250,000 when he's sentenced July 21.

Ulit worked for United Life Home Health which allegedly sent unlicensed nurses to patient homes, charged for services never provided and billed the government for visits never made.

Federal prosecutors say United Life falsified claim forms to make it appear patients were confined to their homes and needed skilled nursing care.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Tami Menzel of Albuquerque, New Mexico sentenced to 18 months in prison for Medicaid Fraud.

Source - http://www.kdbc.com/Global/story.asp?S=7923903&nav=menu608_2_3

ALBUQUERQUE (AP) - An Albuquerque woman has been sentenced to a year in jail and must pay nearly $59,000 after pleading guilty to Medicaid fraud and conspiracy charges.

Tami Menzel was sentenced Monday by state District Judge Mark Macaron. She had pleaded guilty in October to charges that she submitted fraudulent billings for personal care services between April 2002 and December 2005.

Macaron sentenced Menzel to 18 months in prison on each of the three counts and ordered the terms be served consecutively. All but 364 days of the sentence were suspended. Following her prison term, Menzel will be on probation for 3 1/2 years and she must pay restitution for services not provided.

Menzel has been given until March 14 to surrender herself and begin her sentence.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Russian immigrants, Dr. Ilya Zavelsky, 46, and his wife, Rina Zavelsky, 40, a nurse, indicted in a $14 million Medicaid fraud scheme.

Source - http://www.inrich.com/cva/ric/news.apx.-content-articles-RTD-2008-02-21-0170.html

A Glen Allen couple who provided respite care and other services to Russian-speaking communities in Virginia were indicted yesterday in an alleged $14 million Medicaid fraud.
Ilya Zavelsky, 46, a physician, and his wife, Rina Zavelsky, 40, a nurse, were charged by a federal grand jury with conspiracy to commit health-care fraud and money laundering since 2002. The two Russian immigrants did business as Renaissance Inc. Neither returned calls made to their home yesterday evening.

After incorporating the business, the indictment alleges, Renaissance signed up with Virginia Medicaid as a provider of personal and respite-care services primarily to Eastern European clients in Richmond, Tidewater, Northern Virginia and Harrisonburg.

The Zavelskys are accused of using a number of fraudulent means, among them billing for services at a higher-than-allowed rate, billing for services not provided, using uncertified aides and recipients and falsifying employment records.

Those and other alleged deficiencies were uncovered in 2003 and 2006 by audits performed by the Virginia Department of Medical Assistance Services. The indictment alleges that the company persisted in the same fraudulent practices, which it says gained more than $4 million in reimbursements since 2006.

The indictment alleges that the company was paid $14,356,204 in Medicaid funds since 2002. The indictment says Rina Zavelsky came to the U.S. with other members of her family and initially settled in Michigan before moving to Virginia with her husband. She was once a nurse with what is now VCU Health Systems.

Her husband is a licensed physician. At one time, he had privileges to practice at a number of hospitals in the Richmond area. The indictment alleges that as Renaissance and its profits grew, he became the president and sole shareholder of Renaissance and worked there full time.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Galletta brothers sentenced in $5.5 million Medicaid fraud scheme.

Source - http://www.pressofatlanticcity.com/news/local/cumberland/story/7534543p-7437230c.html

Two Vineland-area brothers were sentenced to federal prison Friday for defrauding the federal Medicaid program of $5.5 million.

Ernest Galletta, 58, of Buena Vista Township, received a 55-month sentence for submitting false claims for medical services that were never rendered at two adult day-care centers, U.S. Attorney Chris Christie announced Friday.

George Galletta, 55, of Vineland, received a six-month sentence to be followed by six months of home confinement. The brothers pleaded guilty to the charges against them, related to Medicaid claims filed for their facilities in West Trenton and Prospect Park.

Ernest Galletta, the vice president of Horizon National Healthcare of Vineland, allegedly filed claims for federal payments larger than Horizon should have received. He ran the scam for two years and hid it from his brother, who owned the company, for nearly two years, authorities said. His brother then continued the scam for four months before authorities caught up to them. For example, the Galletta brothers admitted that on Dec. 3, 2003, they submitted a request for payment for adult day-care services provided on Nov. 26, 2003, to approximately 156 Medicaid beneficiaries at the West Trenton center. They later admitted they had only served 101 Medicaid beneficiaries that day.

The Galletta brothers have begun paying back the money under an agreement with authorities. Their criminal activity, however, has resulted in the shutdown of a mental health treatment center in Vineland. Last week, a Vineland mental health treatment center owned by George Galletta's ex-wife was forced to close because the Medicaid program revoked the program number used by it.

Federal agents reportedly cleared Simone Galletta, who ran the center under the same name, Horizon National Healthcare, of any wrongdoing. However, she had continued to use the same Medicaid program number as her ex-husband's facilities after she took sole ownership of the Vineland facility.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Nine Miami Defendants Sentenced for $56.5 Million in Medicare Fraud

Source - Nine Miami Defendants in Strike Force Cases Sentenced for $56.5 Million in Medicare Fraud

WASHINGTON, Jan. 23 /PRNewswire-USNewswire/ -- Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today that owners of nine separate Miami-based health care corporations have been sentenced to prison terms within the past two weeks. Collectively, the nine defendants filed fraudulent claims with Medicare for $56,599,832 worth of unnecessary durable medical equipment (DME) and infusion therapy.

The nine defendants sentenced in Miami are: (1) Luis Soto, 41, sentenced to 87 months in prison; (2) Noel Rodriguez, 50, sentenced to 51 months in prison; (3) Rosabel Gonzalez, 32, sentenced to 30 months in prison; (4) Christian Vasquez, 22, sentenced to 41 months in prison; (5) Maria De La Serna, 55, sentenced to 19 months in prison; (6) Ariel Betancourt, 35, sentenced to 24 months in prison; (7) Jose Prieto, 58, sentenced to 41 months in prison; (8) Armando Jorge Herrera, 27, sentenced to 36 months in prison; and (9) Reinaldo Lopez, 40, sentenced to 46 months in prison.

Soto was sentenced by U.S. District Judge Marcia G. Cooke on January 23, 2008. Soto owned and operated Ocean Medical Equipment, Adriana Medical Supply, Advance Medical Equipment, Family Health Medical Equipment, First AA Medical, KB Medical Services, Rossmary Medical Supplies, R&R Medical Equipment, Sagua Medical Supplies, Telimay Medical Service, West Side Medical, Future Medical Center, Siboney Medical Center, and Tampa Trauma that billed for items such as oxygen concentrators, nebulizers and wheelchairs that were never provided. Soto submitted claims to Medicare for unnecessary medical equipment and he caused the submission of false claims for pharmaceuticals. In total, Soto, through his companies, was responsible for over $47 million in false claims to Medicare. Soto pleaded guilty on October 16, 2007.

Rodriguez was sentenced by U.S. District Judge James Lawrence King on January 16, 2008. Rodriguez owned and operated OxyCare of Miami, a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Between September of 2001 and June of 2003, OxyCare submitted claims to Medicare for medical equipment largely consisting of unnecessary oxygen concentrators, hospital beds and pressure reducing mattresses. Further, Rodriguez caused the submission of false claims for pharmaceuticals. In total, Rodriguez, through his companies, was responsible for over $1.2 million in false claims to Medicare. Rodriguez pleaded guilty on October 10, 2007.

Gonzalez, the owner and operator of Genesis Associates Group, Inc., was sentenced by U.S. District Judge Donald L. Graham on January 10, 2008. Genesis was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Gonzalez submitted over $1.5 million in false claims to Medicare largely consisting of unnecessary power pressure reducing mattresses and orthotics. Gonzalez pleaded guilty on November 2, 2007.

Vasquez, the named owner of Tamiami Medical Supply, Inc., was sentenced by U.S. District Judge Joan A. Lenard on January 16, 2008. Tamiami was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Tamiami submitted over $1.2 million in false claims to Medicare. The previous named owner of Tamiami, Justo Padron, 36, died in November of 2007 after an alligator attack at the Miccosukee Tribe Indian Reservation. Vasquez pleaded guilty on October 22, 2007.

De La Serna was sentenced by U.S. District Marcia G. Cooke on January 23, 2008. De La Serna owned and operated Respiratory One Equipment, Inc., a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Between September of 2001 and June of 2003, Respiratory One submitted claims to Medicare for medical equipment largely consisting of unnecessary oxygen concentrators and nebulizers. Further, De La Serna caused the submission of false claims for pharmaceuticals. In total, De La Serna was responsible for over $345,000 in false claim to Medicare. De La Serna pleaded guilty on November 15, 2007.

Betancourt, the named owner of Lincoln Medical Supply, was sentenced by U.S. District Judge James Lawrence King on January 16, 2008. Lincoln Medical was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Lincoln Medical submitted over $480,000 in false claims to Medicare for largely unnecessary equipment such as wound therapy pumps and expensive wound care items. Betancourt pleaded guilty on November 15, 2007.

Prieto and Herrera were sentenced by U.S. District Judge Jose A. Gonzalez for their involvement on January 18, 2008. Prieto and Herrera were owners and operators of Coral Way Medical, a fraudulent HIV infusion clinic that also billed for unnecessary procedures such as paravertebral joint injections. Prieto and Herrera used these two companies to submit over $900,000 in fraudulent Medicare claims. Prieto pleaded guilty on November 15, 2007. Herrera pleaded guilty on November 1, 2007.

Lopez, the owner and operator of Reny Medical Equipment, was sentenced by U.S. District Judge Marcia G. Cooke on January 23, 2008. Reny Medical was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Lopez submitted over $450,000 in false claims to Medicare for unnecessary items such as prosthetics and ostomy supplies. Lopez pleaded guilty on November 7, 2007.

The Department of Justice places a high priority on investigating and prosecuting those who steal tax payer money intended to provide health care for the elderly and disabled, said Assistant Attorney General Fisher. We have dedicated a team of experienced prosecutors to focus on Medicare and other healthcare fraud around the country.

The fight against Health Care fraud in Miami is a top priority, said U.S. Attorney Acosta. With the help of the newly formed HHS-OIG Florida Region which will add federal agents to our efforts we expect to see a significant impact on reducing fraud.

According to data from the Centers for Medicare and Medicaid Services (CMS), Miami-Dade County alone accounted for more paid DME claims than 44 other states. Only some of the most populous states in the country including California, Texas, New York, Michigan, and Ohio billed Medicare for more than Miami-Dade County. According to that same data, an average Medicare patient in Miami-Dade County allegedly receives $6,200 worth of DME every year based on paid amounts; whereas patients throughout the rest of the United States average approximately $1,200 per year.

The Soto and De La Serna cases were prosecuted by Deputy Chief Kirk Ogrosky from the Criminal Divisions Fraud Section in Washington, D.C., and Assistant U.S. Attorney Ryan Stumphauser of the Southern District of Florida. The Vasquez and Betancourt cases were prosecuted by Assistant U.S. Attorney Stumphauser. The Rodriguez case was prosecuted by Deputy Chief Ogrosky, and Assistant U.S. Attorney Randy Katz. The Gonzalez case was prosecuted by Trial Attorney John S. Darden of the Fraud Section, the Prieto and Herrera cases were prosecuted by Trial Attorney Jerrob Duffy and Deputy Chief Ogrosky of the Fraud Section; and the Lopez case was prosecuted by Trial Attorney John Cunningham of the Fraud Section.

All cases were done with the investigative assistance of the U.S. Department of Health and Human Services Office of Inspector General and the FBI. The cases were each brought as part of the Medicare Fraud Strike Force, supervised by the Fraud Section of the Criminal Division and U.S. Attorney Acosta of the Southern District of Florida.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Federal authorities are investigating Medicare Fraud allegations involving Fresenius Medical Care of North America.

Source - http://www.elpasotimes.com/ci_7906586?source=most_viewed

Federal authorities are investigating Medicare fraud allegations involving millions of dollars set out in two recently unsealed civil lawsuits against Fresenius Medical Care of North America, which operates four clinics in El Paso, according to federal court documents.

Last month, U.S. District Judge Phillip Martinez unsealed the whistleblower complaint filed under the False Claims Act by Rebecca Gonzalez against her former employer, Fresenius, and Dr. Alfonso Chavez.

Based in Germany, Fresenius is the world's largest provider of products and services for people with chronic kidney failure, the company's Web site states.

No one representing Fresenius could be reached for comment about the case, but Chavez said Gonzalez's allegations are untrue.

"Unfortunately, these allegations are misconstrued and lack foundation," Chavez said. "They are just getting deeper and deeper in trouble."

Martinez sealed Gonzalez's case when it was filed in 2006, as required by federal law, to allow time for the government to investigate, Gonzalez's El Paso lawyer, Tom Stanton, said when asked about the case.

"The FBI has picked it up and is looking at it, but I don't know the status of the investigation," Stanton said.

The suit states that the FBI executed a search warrant at the Cliffview clinic in January 2007.
The U.S. attorney's office disclosed its involvement in November and stated it was not formally intervening but reserved the right to do so.

"At the present time, the government's investigation is far from being complete and, as such, the United States is not able to decide whether to proceed with the action. ... However, the government's investigation will continue," the U.S. attorney's office stated in a document requesting that the case not be unsealed until Dec. 27.

A complaint filed under the federal False Claims Act is brought with the cooperation and consent of the federal government, which is a party to the case along with the plaintiff, Stanton said. If the allegations of fraud prove true, Stanton said, the plaintiff is eligible for a percentage of the money the government recovers.

In the False Claims Act case, Gonzalez alleged that Chavez was the supervising physician at the Fresenius clinics on Cliff-view and at 10767 Gateway Blvd. West where Ramiro Debora was allowed to treat patients as if he were a doctor.

"Debora is neither a licensed physician, nor a physician's assistant," the case states. "Defendants, through their management and operations at the facilities, are well aware of Debora's lack of licensure and credentialing."

Fresenius bills Medicare for prescriptions and treatment of dialysis patients, whose bills amount to as much as $30,000 a year, the case states.

The Cliffview clinic has about 144 patients and bills Medicare for as much as $5 million a year.
"Patients come to the Cliffview and Gateway clinic and ask to speak to 'Dr. Ramiro,' " Gonzalez alleges in the case. "Defendants and Debora encourage this illusion by bearing a white lab coat.
"Chavez has admonished and threatened employees who informed patients that Debora is not a physician."

Gonzalez, in a second lawsuit filed last year, alleges the company retaliated against her when they learned she had filed a false claims complaint and after she refused in writing last July "to aid the defendants in concealing their fraud from Medicare auditors."
She resigned in July.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Dr. Robert Stokes, a East Grand Rapids, Michigan dermatologist to serve 10.5 years in prison for healthcare fraud.

Dr. Robert Stokes arrives at the federal court and is sentenced to 10.5 years in prison for Medicaid fraud.

Photo by Lori Niedenfuer Cool

Source - http://blog.mlive.com/chronicle/2007/12/chronicle_news_servicelori_nie.html

GRAND RAPIDS -- Dr. Robert Stokes must serve 10.5 years in prison as well as three years supervised release for health care fraud, a federal judge ruled about 7 p.m. tonight.

U.S. District Judge Gordon Quist also ordered Stokes, an East Grand Rapids dermatologist, to pay a $175,000 fine. However, Quist held off on a decision about restitution, which was a major point of contention between the government and Stokes' attorneys. Quist said he would recommend that Stokes go to a minimum security federal prison in Morgantown, W. Va, as the doctor's attorneys suggested.

Stokes, who was released on bond and will report later to prison, left hurriedly and gave no response to questions asked by reporters outside the federal courthouse in downtown Grand Rapids.

During the sentencing hearing, Stokes told the judge, "I became a physician to help people. I never intended to harm my patients, and I don't think I've done so."

He said while he respects the jury's decision, "there is much more to my life than the actions that led to my conviction."

More warningsThe Kent County Health Department is warning more patients of Dr. Stokes that they may have been exposed to unsanitary practices and should get tested.

He noted that he is a father, was a soccer coach and served as an assistant professor for Michigan State University.

"My reputation is now in ruins," Stokes said. "I only hope that the sentence imposed gives me an opportunity to rebuild my life."

Assistant U.S. Attorney Ray Beckering told the judge that Stokes' statement in court did not include an apology, nor acknowledgment of the fraud, which Beckering called "pervasive."

Stokes was convicted in April for fraudulently billing insurance companies of nearly $2 million. The government says he put patients through unnecessary and costly procedures, and had questionable sanitary practices.

A day of testimony leading up to the sentence included an employee of Stokes, a patient and a doctor, all of whom said he performed unsanitary or unnecessary procedures in his dermatology practice. Quist is holding off on a decision on restitution.

Federal sentencing guidelines called for a prison term of 12 1/2 to 15 1/2 years, but prosecutors had urged the judge to consider a longer sentence, citing "an epidemic of fraud that infected Dr. Stokes' practice."

Dr. Edward Yob, a dermatologist who reviewed medical records from Dr. Robert Stokes' office, was among those to testify today that Stokes seemed to routinely remove lesions that did not need surgery. Yob talked about three different patients who had numerous lesions removed.

In one instance, a patient had 30 to 40 lesions removed by Stokes, but Yob said only three showed any abnormalities and the rest were benign "My opinion is the majority of those lesions absolutely did not need to be removed," he said.

Yob also testified that he doesn't know of any other dermatologist who used chemical sterilization of surgical tools. The danger is that the chemical can cause an allergic reaction in patients, he said.

While Quist did hear testimony from patients, he made it clear that Stokes' sentence would be limited to his fraud conviction.

"Dr. Stokes is convicted of three different types of fraud convictions," U.S. District Judge Gordon Quist said. "He's not convicted of malpractice."

A former worker for Dr. Robert Stokes testified this afternoon that Stokes carried the same syringe as he went from patient to patient.

Jaime Droog suspected that Stokes used the same syringe on different patients. Stokes also re-used blades on his scalpels rather than discarding them like other doctors do.

Droog is also among thousands of Stokes' former patients allegedly put at risk by his unsanitary practices. Many were in the courtroom gallery. His former patients sent so many letters to the judge that he did not have time to read them all.

Chronicle News Service illustration/Ed RiojasDr. Robert Stokes, right, and his attorney, N.C. Deday LaRene, sit in court this morning awaiting his sentencing.

A patient, Anne Gulch, testified that Stokes told her in 2006 that she needed 30 to 40 moles removed because of their irregular shape and color. Stokes' staff told her the moles were pre-cancerous.

After she had five removed, she went to another doctor who told that that "nothing needed to be removed." She believed that Stokes only removed freckles.

Her testimony was to show that Stokes billed insurance companies for unnecessary procedures.
Hastings Mayor Robert May, who went to Stokes more than four years ago to have a lesion removed from his ear, plans to say his piece to the judge.

May said he ended up going back to Stokes every few weeks after Stokes told him he needed to have a different spot removed from his body, or that a lesion had become infected.

"It just got to the point we could not afford it any longer," May said outside the courtroom today, describing how his insurance carrier would not pay the full expense. He stopped going to Stokes in 2003.

A statistician testified in the hearing that Stokes, whose scheme included telling patients they had cancer so he could up fees for minor procedures, had bilked Blue Cross/Blue Shield and Medicare for $626,823 from 2001 to 2003. The figures did not include billings to other insurance companies.

Dennis Gilliland, a Michigan State University professor and expert in statistics, provided the loss estimate as a government witness.

Another estimate said that he fraudulently billed Medicare and Blue Cross Blue Shield of Michigan for more than $1.9 million between 2001 and 2006.

Stokes, 56, who worked from an office in East Grand Rapids and lives in a 14,000-square-foot estate on Reeds Lake, was convicted in April on 31 counts of health-care fraud.

Stokes' lawyers, who described him as a caring, compassionate doctor, sought a light sentence. They argued the feds over-estimated insurance losses and that his sentence shouldn't be influenced by allegations about inadequate sterilization of surgical instruments.

Letters from former patients, employees, colleagues, relatives and friends described a different Stokes: an honest, caring and dedicated doctor with high standards.

The conviction was Stokes' second. In November 1999, the then-47-year-old doctor shoplifted $33.94 worth of items -- sunglass cases, key chains, expandable tote bags and rolls of athletic tape -- from a Meijer store in Grand Rapids.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Arthur Pilavyan, of Altadena, CA, gets 10 year prison sentence & was ordered to pay $7 million in restitution to the federal health care program.

Source - http://www.dailynews.com/ci_7759897?source=rss

The owner of a Pasadena-based outfit that recruited patients to receive home health care in a scheme that defrauded Medicare out of more than $7 million has been sentenced to 120 months in federal prison.

Arthur Pilavyan, 33, of Altadena, was sentenced Monday afternoon by United States District Judge Stephen V. Wilson, who also ordered Pilavyan to pay $7 million in restitution to Medicare, the federal health care program.

Pilavyan pleaded guilty in July to health care fraud, conspiracy and money laundering. When he pleaded guilty, Pilavyan admitted that over the course of about 18 months, he caused the submission of fraudulent claims to Medicare in excess of $8 million. Medicare paid $7 million of the claims, and almost $4 million went to Pilavyan.

Pilavyan operated as a "capper" who recruited Medicare beneficiaries to receive home health services. Pilavyan admitted in his plea agreement that he conspired with Lourdes Perez, the owner of Provident Home Health Care Services in Eagle Rock, who is currently serving a 46-month prison term.

According to Pilavyan's plea agreement, he recruited Medicare beneficiaries who were willing to sign up for home health services, inducing some to accept services by paying them approximately from $100 to $400 in cash.

After signing up the Medicare beneficiaries, Pilavyan would refer them to Provident Home Health Care Services, which paid Pilavyan approximately $1,200 to $1,700 per Medicare beneficiary for those that received intermittent care and approximately $4,800 per Medicare beneficiary for twice-a-day care. The Medicare beneficiaries were not confined to the home and did not need skilled nursing or therapy services.

Pilavyan also admitted that, in an effort to conceal payments he was receiving from Provident, he directed Perez to make some payments in cash and others in checks that were made out to other entities.

In sentencing Pilavyan, Judge Wilson said the defendant's conduct "corrupts a program designed to help the poor." The judge added:

"He's damaging millions of people who need Medicare and government services."

IRS-Criminal Investigation Special Agent in Charge Debra D. King stated: "The sentence of 10 years in prison in this case should speak volumes to those individuals who choose to undermine the integrity of our federal healthcare systems. IRS Criminal investigators are highly skilled in tracing financial transactions that lead to exposing money laundering. IRS-Criminal Investigation will continue to work with our law enforcement partners in combating healthcare fraud."

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Dr. Jose Joaquin Rodriguez has been arrested by law enforcement investigators with the attorney general's Medicaid fraud control unit in Miami.

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Source - http://www.bizjournals.com/southflorida/stories/2007/12/10/daily47.html

FLORIDA - A Miami-Dade County pediatrician has been arrested for defrauding the state Medicaid program out of more than $65,000.

Dr. Jose Joaquin Rodriguez was arrested by law enforcement investigators with the attorney general's Medicaid fraud control unit in Miami, and will be charged with organized theft and grand fraud.

Rodriguez allegedly regularly billed Medicaid for more than 24 hours a day, and on some days billed for as many as 44 hours.

The attorney general's office said Rodriguez billed for Sunday office visits, even though his office was closed on Sundays, and interviews with Medicaid recipients and further investigations found Rodriguez often failed to provide the services billed to Medicaid.

If convicted on both charges, Rodriguez faces up to 45 years in prison and fines of up to $20,000. The Miami-Dade County State Attorney's Office will prosecute the case.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

New Jersey Hospital to Pay US $7.5 Million to Resolve Medicare Fraud Allegations.

Source - http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/12-10-2007/0004720124&EDATE

WASHINGTON and NEWARK, N.J., Dec. 10 /PRNewswire-USNewswire/ -- WarrenHospital in Phillipsburg, N.J., has agreed to pay the United States $7.5million to settle allegations that it defrauded Medicare, the Department ofJustice announced today. The settlement resolves allegations that thehospital improperly increased charges to Medicare patients in order toobtain enhanced reimbursement from Medicare.

In addition to its standard payment system, Medicare providessupplemental reimbursement, called outlier payments, to hospitals and otherhealth care providers in cases where the cost of care is unusually high.Congress enacted the supplemental outlier payment system to ensure thathospitals possess the incentive to treat inpatients whose care requiresunusually high costs.

The Justice Department alleged that, between January 1999 and August2003, Warren purposefully inflated charges for inpatient and outpatientcare to make these cases appear more costly than they actually were, andthereby obtained outlier payments from Medicare that it was not entitled toreceive. The settlement also resolves claims that the hospital violatedMedicare's anti-self-referral statute, known as the Stark law, whichprohibits claims for Medicare patients referred by physicians with whom ahospital has an unlawful financial relationship.

"Today's settlement demonstrates that the Department of Justice iscommitted to protecting the Medicare program from overcharging and toassuring that patients receive medical care only on the basis of theiractual medical need," said Jeffrey S. Bucholtz, acting Assistant AttorneyGeneral for the Department's Civil Division.

The civil settlement agreement resolves allegations against Warren thatwere filed in two separate federal lawsuits brought by "whistleblowers"under the federal False Claims Act. The False Claims Act permits privatecitizens to bring lawsuits on behalf of the United States. Under the settlement, Peter Salvatori and Sara Iveson, the relators in the first of the two lawsuits filed against Warren, will share 16 percent of the total recovery, or $1.2 million.

United States Attorney Christopher J. Christie said, "The Medicaresystem is of great importance within New Jersey, and this settlement showsa concerted and coordinated government effort to ensure its integrity."

Warren has also entered into a Corporate Integrity Agreement with theUnited States Department of Health and Human Services, Office of InspectorGeneral. The Corporate Integrity Agreement contains measures to ensurecompliance with Medicare regulations and policies in the future.

The settlement with Warren was the result of a coordinated effort bythe Justice Department's Civil Division, Commercial Litigation Branch; theU.S. Attorney's Office for the District of New Jersey, Affirmative CivilEnforcement Unit; the U.S. Attorney's Office for the Eastern District ofPennsylvania; the Department of Health and Human Services, Office ofInspector General and Office of Counsel to the Inspector General; theCenters for Medicare and Medicaid Services; and the Federal Bureau ofInvestigation, in investigating and resolving the allegations.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Christian Onwuegbusi, 56, was sentenced to 15 years in prison on Wednesday for stealing more than $900,000 from the Medicare program.

Source - http://www.chron.com/disp/story.mpl/metropolitan/5359289.html

A Houston man was sentenced to 15 years in prison on Wednesday for stealing more than $900,000 from the Medicare program.

Christian Onwuegbusi, 56, owner of Houston-based Texas Memorial Medical Institute Rehabilitation Services, was convicted of theft by a government contractor for fraudulently billing Medicare for motorized wheelchairs that were never delivered.

Testimony in state District Judge Devon Anderson's court also showed that Onwuegbusi overbilled Medicaid for physical therapy services, some that were never provided.

Harris County prosecutors argued that the defendant billed the government more than $900,000 for motorized wheelchairs and then delivered less-expensive scooters.

The case was investigated by the Medicaid Fraud Control Unit of the Texas Attorney General's Office; the FBI; and the Office of Inspector General of the Health and Human Services Commission.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

A $1.5 million civil fraud consent judgment was entered Thursday against a former Alva doctor Gregory Pinegar.

Source - http://www.enidnews.com/localnews/local_story_334002152.html

A $1.5 million civil fraud consent judgment was entered Thursday against a former Alva doctor now serving a 33-month federal prison sentence for Medicare fraud.

Gregory Pinegar was convicted in April of defrauding Medicare in a parallel criminal proceeding. He is in the federal penitentiary in Beaumont, Texas. The civil case, according to John C. Richter, U.S. attorney for the Western District of Oklahoma, originated with a complaint filed under the False Claims Act that alleged Pinegar overbilled Medicare for the administration of certain drugs.

It was alleged from 2000 to 2005, Pinegar defrauded Medicare for two prescription medications: Procrit and Remicade. Procrit is administered by injection and stimulates production of red blood cells. It is prescribed for anemia conditions, including those suffered by cancer patients in chemotherapy, HIV-positive patients in drug-therapy regimes and by kidney disease patients undergoing dialysis.

Between January 2000 and May 2005, Pinegar’s practice billed Medicare for 19.75 million units of Procrit but ordered no more than 7.4 million units from suppliers. Remicade is administered by intravenous infusions and is used to treat rheumatoid arthritis, Crohn’s disease, ulcerative colitis and other diseases of the gastrointestinal tract.

From January 2003 to May 2005, Pinegar’s practice billed Medicare for 112,110 milligrams of Remicade but ordered no more than 49,600 milligrams from suppliers. The civil case alleged before sending billing information to Medicare, Pinegar altered billing forms to show either his office had administered drugs that were not actually administered or his office had administered the drugs in quantities greater than what actually were administered, according to a release from Richter’s office.

In the criminal case, Pinegar also was ordered to pay $473,881.55 in restitution to Medicare and $69,685.26 in restitution to BlueCross BlueShield of Oklahoma. The civil case that concluded Thursday is in addition to, and separate from, the restitution and prison term ordered in the criminal case. As a condition of his guilty plea in the criminal case, Pinegar has surrendered his medical license. If his medical license is later restored, the Department of Health and Human Services has instituted administrative proceedings to exclude him from the being able to bill Medicare in the future.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Canton, Ohio Grandmother, Antoinette Menapace helped the federal government uncover millions of dollars in healthcare fraud!

Whistleblower Antoinette Menapace

Source - http://www.cantonrep.com/index.php?ID=388386&r=0&Category=11&subCategoryID=0

Antoinette Menapace helped the federal government uncover millions of dollars in health care fraud. She isn’t a doctor, a lawyer or a cop. She’s a grandmother and former medical coder who didn’t think the numbers added up.

Almost two years ago, she filed a lawsuit against her former employer, Dr. Mohammed Aiti, claiming he and other doctors at Premier Medical Group were billing government and private insurance companies for unnecessary heart-related tests. The FBI and federal prosecutors took up the case, which led to Aiti’s conviction, the end of his medical career and the forfeiture of close to $1.9 million.

Aiti is to be sentenced Jan. 10. He faces up to five years in prison and a $250,000 fine. Being a whistle-blower has come with personal costs. Menapace spent a year and a half out of work. She and her husband lost their home of 25 years in foreclosure.

Now, with the help of her lawyers, the 49-year-old Canton woman is in court with hopes of getting a portion of the forfeiture, but it’s not a sure thing. “The government is trying to encourage people like Antoinette to come forward, but at the end there might not be anything,” said attorney Elizabeth Raies.

NOT ADDING UP Menapace started working for Premier in 2004. The practice had offices in Canton, Massillon, Dover and Cleveland. Aiti, a cardiologist, ran the show, and after three months on the job, Menapace started to question his billing methods. Before patients came to the office they were flagged for expensive heart-related tests as often as their insurance would pay for them. “Even if they were coming in for a sore throat,” Menapace said. Most of the patients were older and didn’t question the tests, one of which was a stress test involving the injection of radioactive dye.

When a patient had qualms, Premier staffers would say the test was a safeguard and that they wouldn’t have to pay out of pocket. Few refused. To justify further tests, Aiti altered results. “I kept picturing my parents, who were elderly, and a doctor doing this to them,” Menapace said. “And it just wasn’t right.” When employees, including other Premier doctors, questioned his orders, Aiti became irate, Menapace said. He also coerced doctors who depended on Premier to sponsor their work visas, according to court papers. She recalled an angry exchange between Aiti and a female doctor who wouldn’t order a stress test. “The lady is pregnant. I am not going to have her have a stress test,” Menapace recalled the female doctor telling Aiti. That doctor eventually left the practice.

While Menapace didn’t like what she saw, she also doubted herself. Maybe she misunderstood the billing process. But when she consulted her medical billing instructor in Canton City Schools’ adult education program, the instructor shared her concerns. Menapace got a job as a medical coder in another office, although she was laid off six months later and spent the next year and a half unemployed.

During that time, she lost her home. She also contacted lawyers who took up her case. “When she came to us, we said, ‘All right, are you sure?’ ” attorney Lee Plakas said. Menapace had documents to back her claims, including altered test results she picked from Premier’s trash and a sheet that showed employees how to match diagnosis and test codes to secure insurance payments.

QUI TAM ‘Qui tam.’ It’s an abbreviation of a Latin phrase meaning, ‘Who sues on behalf of a king as well as for himself.’ America doesn’t have kings, but in federal law, it’s the government’s way of encouraging citizens to sue when they suspect graft. In return for their work, whistleblowers under the federal False Claims Act get a share of any money recovered.

In fiscal year 2007, whistleblowers helped the federal government recover $1.45 billion and received $177 million for their work, according to the Justice Department. Plakas, Raies and attorney Megan Frantz went to work on Menapace’s claim. With her help they located former Premier employees. Some would help, others wouldn’t. It took nearly a year to build the lawsuit, which remained under seal as federal agents conducted a criminal investigation.

Aiti, his wife and another doctor were indicted. On the eve of trial, Aiti pleaded guilty. Charges were dropped against his co-defendants. Menapace was relieved. She’s working again and has stopped having nightmares about her old job, she said. But the case isn’t over for her. The government could try to get more money out of Aiti through a civil action, but isn’t. That’s a sign there isn’t much left for Menapace to recover on her own, Frantz said. So Menapace is seeking between 15 and 25 percent of the government’s share of the forfeiture. Her attorneys would get part of that. Private insurance companies may also have claims for restitution.

Menapace didn’t expose Aiti for money, “but it’s our job to make sure she gets treated fairly by the system,” Plakas said. In court papers, Menapace’s attorneys note the financial and emotional costs she incurred by leaving her job with Premier and reporting Aiti’s conduct.

Whether a judge accepts her claim remains to be seen. Case law on the subject is limited, Raies said. This week, a judge granted the federal government’s request to put Menapace’s claim on hold, a decision her attorneys are fighting. She doesn’t regret blowing the whistle on Aiti, she said, because he can’t practice medicine anymore. “What they were doing — I couldn’t get it through my head — was so wrong,” Menapace said.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Marianela Smith, owner of Smith Medical Equipment in Miama found guilty of Medicare fraud and has been sentenced to 66 months incarceration.

Source - http://lawfuel.com/show-release.asp?ID=16149

Miami, Florida - The owner and operator of a Florida health care company has been sentenced to 66 months incarceration for Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

Marianela Smith was sentenced on Friday, Nov. 9, 2007, by U.S. District Court Judge Joan A. Lenard at the federal court in Miami. Judge Lenard also ordered Smith to pay approximately $363,000 in restitution for submitting approximately $800,000 worth of fraudulent claims to the Medicare program.

Smith owned and operated Smith Medical Equipment, a Miami medical equipment company, from approximately 2000-2003. She was convicted on five charges following a seven-day trial in August 2007. At trial, the government established that Smith had been paying kickbacks to Medicare beneficiaries throughout Miami-Dade County to gain access to their Medicare information. After gaining access to their Medicare cards, Smith billed Medicare for unnecessary services on behalf of these patients, including oxygen concentrators and nebulizers.

One of these patients testified that Smith paid him in cash and that he did not need the treatments or medication that Smith was billing to Medicare. Further, he testified that he threw away the medication that was paid for by Medicare. According to trial testimony, Smith paid $150 per month if the patients agreed to accept unneeded aerosol medications, such as Albuterol, and related respiratory equipment such as oxygen concentrators.

Smith obtained the compounded aerosol medications from previously convicted pharmacy owners in Miami. From 2000 to 2003, these pharmacies billed the Medicare program for over $17 million.

The case was prosecuted by Assistant Chief John Kelly and Trial Attorney Hank Bond Walther from the Fraud Section of the U.S. Department of Justice in Washington, D.C., with the investigative assistance of the U.S. Department of Health and Human Services, Office of the Inspector General; the FBI; and the Medicaid Fraud Control Unit from the State of Florida.

This case was brought as part of the Medicare Fraud Strike Force initiative created in March 2007, led by the Fraud Section in Washington, D.C., and the U.S. Attorney’s Office in the Southern District of Florida. The Strike Force operates out of the federal Health Care Fraud Facility in Miramar, Florida, and has brought over 74 cases involving 120 defendants since March 1, 2007.

A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at www.usdoj.gov/usao/fls . Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on .

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Indictment charges Alan M. Gardner, 54, of in Battle Creek, MI, with 15 counts of aggravated trafficking in drugs & 7 counts of trafficking in drugs.

DEFIANCE - A former Defiance physician has been indicted on 21 counts in connection with trafficking in drugs, about three years after he was first indicted on five felony charges related to the narcotic pain reliever OxyContin and Medicaid fraud.

The current indictment charges Alan M. Gardner, 54, who now lives in Battle Creek, Mich., with 15 counts of aggravated trafficking in drugs and seven counts of trafficking in drugs, all felonies. He is to be arraigned Tuesday.

Authorities allege Mr. Gardner prescribed controlled substances to patients outside the usual course of medical practice and for other than legitimate medical purposes, Prosecutor Jeffrey Strausbaugh said in a statement.

Mr. Gardner pleaded not guilty to the earlier charges. In March, 2006, the charges were dropped when he agreed to surrender his medical license. A Defiance County assistant prosecutor said at the time that the agreement would not affect future charges.

Mr. Gardner was a ProMedica Health System physician and worked at Defiance Regional Medical Center about four years, beginning in July, 2000. He was fired, but the cause was unrelated to the criminal charges, a ProMedica spokesman said in 2004. He later had a private practice in pain management in Defiance.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Texas Attorney General's Medicaid Fraud Investigation Leads To 27 Years In Prison For Hidalgo County Counselor Sigifredo Flores.

Source: Texas Attorney General

November 8, 2007 -- MCALLEN – A Hidalgo County jury today sentenced licensed professional counselor Sigifredo Flores, 52, of Progreso Lakes, to 27 years in prison for sexually assaulting patients in his care. An investigation by Texas Attorney General Greg Abbott’s Medicaid Fraud Control Unit (MFCU) revealed that Flores sexually abused two children and two adults during counseling sessions.

Flores was convicted Tuesday on 11 counts of sexual assault and two counts of sexual contact, all second-degree felonies. He also was fined $125,000. The Hidalgo County District Attorney’s Office prosecuted Flores based on evidence uncovered by the MFCU.

“This sex predator violated the trust of patients who needed care and counseling,” Attorney General Abbott said. “The Office of the Attorney General is committed to aggressively prosecuting criminals who sexually abuse innocent victims. In this case, the defendant was a Medicaid provider who billed the government for his counseling services. Our Medicaid Fraud Control Unit will continue to investigate waste, fraud, and abuse by unscrupulous providers.” Attorney General Abbott added: “We are grateful to Hidalgo County District Attorney Rene Guerra’s office for prosecuting this very troubling case. Thanks to our joint investigation with the Texas Department of Family and Protective Services, Texas Health and Human Services Commission, and HHSC’s Office of Inspector General, a sex predator is no longer providing counseling services in Hidalgo County.”

The Texas Department of Family and Protective Services referred the case to the MFCU in June 2005 after allegations surfaced indicating that Flores was sexually abusing patients. During witness interviews, MFCU investigators, along with the Texas Health and Human Services Commission (HHSC) and the HHSC Office of Inspector General, learned that Flores had sexually assaulted two adults and two children who depended on him for mental health care. MFCU investigators arrested Flores in August 2006.

In December 2006, a Hidalgo County grand jury returned multiple indictments against Flores, including one count of theft over $20,000, a second-degree felony for which Flores will stand trial at a later date. According to MFCU investigators, Flores fraudulently billed Medicaid from June 2004 to June 2005 for one-hour individual counseling sessions. Investigators allege that Flores’ sessions lasted only 15 minutes and often included three or four patients at a time.

In 2005 alone, the costs of the Medicaid program in Texas totaled more than $17 billion. As the state’s chief law enforcement official, Attorney General Abbott has dramatically expanded the Medicaid Fraud Control Unit (MFCU) to save more taxpayer dollars and increase protection for Texas seniors. The Unit has established field offices in Corpus Christi, Dallas, El Paso, Houston, Lubbock, McAllen, San Antonio and Tyler through authorization and funding from the 77th Texas Legislature. Attorney General Abbott’s MFCU works with federal, state and local agencies to identify and prosecute those who defraud Medicaid.

The MFCU was honored in 2004 by the U.S. Department of Health and Human Services with the Inspector General’s State Fraud Award for effectiveness and efficiency during federal fiscal year 2003 in combating fraud, patient abuse and neglect in the Medicaid program.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Four members of the Berenguer family sentenced to 57 months in prison for Medicare fraud.

Source - http://www.miamiherald.com/business/story/302698.html

After pleading guilty to one of the fast-growing Medicare frauds in South Florida, four family members who owned healthcare businesses have each been sentenced to 57 months in prison, the U.S. Attorney's Office announced Friday.

U.S. District Judge Jose E. Martinez sentenced Carlos Berenguer, 61; Ivan Aguera, 34; Aristides Berenguer, 64; and Robert Berenguer, 58. Each was also ordered to pay $1.4 million in restitution. The four pleaded guilty in March.

The four participated in submitting false claims for compounded aerosol medications, which are powders put together by local pharmacists rather than packaged ingredients that come directly from drug manufacturers.

The Justice Department reports that in 2006 the Medicare program paid for more than $155 million worth of aerosol medications in Miami-Dade County, making it the single most common item billed not related to hospital stays.

From 2005 to 2006, claims for these aerosol medications increased more than 100 percent, prosecutors said. Miami-Dade County alone accounted for more paid durable medical equipment claims than every U.S. state except California, Texas, New York, Michigan and Ohio, according to Medicare data.

Carlos and Aristides Berenguer, who are brothers, owned Select Medical Equipment. Another brother, Robert Berenguer, operated Professional Medical Equipment. Carlos Berenguer's stepson, Ivan Aguera, operated Palm Medical Equipment.

Through these companies, the four defendants recruited and paid cash to Medicare patients to participate in schemes that involved the submission of false claims to Medicare for unnecessary oxygen concentrators and compounded medications.

Prosecutors alleged that the defendants conspired with owners of Miami pharmacies to refer patients. For doing so, they received half of what Medicare paid for aerosol drugs. From 2001 to 2003, the Berenguers and Aguera were responsible for Medicare paying over $1.4 million based on false claims, prosecutors charged.

Another family member, Ricardo ''Pichi'' Aguera, who owned three Miami healthcare companies, was sentenced to 10 years in prison after being convicted during a week-long trial in March. The case was prosecuted by Kirk Ogrosky and Jeffrey Neiman.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Abdul Razzaque Ahmed, 59, of Brookline, pleads guilty to one count of obstruction of a criminal investigation and turns over $2.9 million in assets.

Source - http://news.yahoo.com/s/ap/20071105/ap_on_re_us/doctor_fraud_1

A prominent dermatologist accused of submitting fake diagnoses for patients to get Medicare payments pleaded guilty to a lesser charge Monday, and federal prosecutors agreed not to pursue health care fraud charges against him.

Abdul Razzaque Ahmed, 59, of Brookline, pleaded guilty to one count of obstruction of a criminal investigation and also agreed to turn over $2.9 million in assets. He originally faced 15 counts. Ahmed, a specialist rare skin diseases, was scheduled to be sentenced Feb. 4. Prosecutors and his attorney had no immediate comment after the brief plea hearing in U.S. District Court in Boston.

Ahmed is widely credited in the medical community with almost single-handedly persuading Medicare to cover the costs of expensive, intravenous immunoglobulin treatments for patients with pemphigus vulgaris, a rare, potentially fatal skin disease.

But prosecutors say he began to defraud Medicare in 1997, when he submitted fake diagnoses for patients who had a less severe skin disease called pemphigoid, which at the time was not reimbursed by Medicare, the federally subsidized health insurance program for the elderly and people with disabilities.

Prosecutors had said Ahmed not only falsified records, but even went so far as to mix blood samples from patients with the more severe, Medicare-covered disease with blood samples from patients who had the less-serious disease so he could charge the government program for the costly treatments.

People who have worked with Ahmed say he wasn't driven by profit, but instead by a desire to help patients who would not have been able to afford the intravenous immunoglobulin treatments, which cost approximately $10,000 to $12,000 for a monthly dose.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

George Galletta of Vineland and his brother, Ernest Galletta of Buena Vista Township plead guilty to conspiracy to commit health care fraud.

Source - http://www.thedailyjournal.com/apps/pbcs.dll/article?AID=/20071103/NEWS01/711030304/1002

TRENTON -- George Galletta of Vineland and his brother, Ernest Galletta of Buena Vista Township pleaded guilty Friday to conspiracy to commit health care fraud in federal court and could face a maximum five years in federal prison and a $250,000 when they are sentenced Feb. 8.

George Galletta, 55, was the owner and operator of Horizon National Healthcare LLC, a Vineland company that operated adult medical day-care centers in Prospect Park and West Trenton. Ernest Galletta, 58, worked at the Horizon facilities, according to U.S. Attorney Christopher J. Christie.

According to information contained in the plea agreement, the brothers conspired to submit inflated claims for payment to Medicaid for services that were never rendered to patients at their adult medical day care centers. In one instance, the Gallettas told the court that on Dec. 3, 2003, they submitted a request for payment for adult day-care services provided a week earlier to about 156 people with Medicaid coverage. However, only 101 patients were admitted to their West Trenton center.

As the result of the false claims filed by the Gallettas, Medicaid overpaid Horizon approximately $5.5 million, Christie said.

A civil settlement agreement was reached with Horizon and its associated entities Feb. 1, when Horizon agreed to repay the government $5.5 million.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Dianon Systems Agrees to Pay U.S. $1.5 Million to Resolve Claims of Mischarging Medicare.

Source - http://pressmediawire.com/article.cfm?articleID=3174

(PressMediaWire) WASHINGTON Oct 30, 2007-- Dianon Systems Inc. has agreed to pay the United States $1.5 million to resolve claims under the False Claims Act that the company mischarged Medicare and TRICARE for certain tests it performed, the Justice Department announced today.Dianon, a reference lab located in Stratford, Conn., specializes in conducting tests to detect and stage various types of cancer.

Doctors obtain tissue or liquid specimens from patients and refer the specimens to Dianon to determine whether they contain cancer cells, and if so, the stage of the disease.The original suit against Dianon was filed by Dr. James Tiesinga, a pathologist formerly employed by the company. He filed the complaint against the company on behalf of the United States under the qui tam or whistleblower provisions of the False Claims Act. Dr. Tiesinga will receive $300,000 as his share of the proceeds of the settlement.

The complaint alleged that Dianon billed for medically unnecessary tests in that it performed 26 flow cytometry tests on every sample sent to the company for diagnosis regardless of whether all 26 were medically necessary for a particular patient. Flow cytometry tests can be used to measure the amount of DNA in cells.

The investigation and settlement were jointly handled by the Office of the United States Attorney for the District of Connecticut and the Justice Department’s Civil Division, with the assistance of the Office of Inspector General for the Department of Health and Human Services, the U.S. Defense Criminal Investigative Service, and the Federal Bureau of Investigation.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

200 FBI agents raid Wellcare Health Plans in a surprise search.

Source - http://www.myfoxtampabay.com/myfox/pages/News/Detail?contentId=4727517&version=1&locale=EN-US&layoutCode=TSTY&pageId=3.2.1

TAMPA - Federal agents raided a Tampa healthcare business on Wednesday, apparently looking for evidence of fraud.

Agents with the FBI joined colleagues from the state Department of Health and Human Services and the state Attorney General's Office Medicaid Fraud Control Unit in a surprise search of the Wellcare Health Plans offices on Henderson Road.

Employees tell FOX 13 that dozens of armed agents swarmed the offices this morning, telling employees of the billing department to go home.

Steve Cole, a spokesman for the U.S. Attorney's Office in Tampa, confirmed that more than 200 agents were involved in the raid, which he said covered several different buildings as part of an ongoing investigation.

Wellcare is a Medicare premium company that occupies the former Capital One building.
Cole insisted that the investigation should not impact anyone's health care service.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Irit Gutman, 63, off to prison for 5 years and ordered to pay $2 million to State of Illinois.

Source - http://cbs2chicago.com/topstories/medicaid.fraud.fine.2.409507.html

CHICAGO (AP) ― A 63-year-old suburban woman was ordered to pay $2 million in restitution to the state after defrauding the Illinois Department of Healthcare and Family Services.

Irit Gutman will also spent five years in prison after being convicted of fraud, theft and money laundering.

Prosecutors say Gutman's company -- Universal Public Transportation -- billed the state for services it never provided and padded its invoices with extra fees.

The company provided transportation for state Medicaid recipients. Authorities say Gutman also deliberately hid her involvement in the company, since she'd been banned from participating in the state's transportation program for Medicaid patients in 1999.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

TEXAS - Barbara King, a family counselor, was arrested Wednesday on Medicaid fraud and theft charges.

Source - http://caller.com/news/2007/oct/06/counselor-arrested-fraud-charges/

CORPUS CHRISTI, TEXAS — A 61-year-old Corpus Christi woman is at the center of an investigation by the Texas Attorney General's Medicaid fraud control unit.

Barbara King, a family counselor, was arrested Wednesday on Medicaid fraud and theft charges, said Lauri Saaphosf, a spokeswoman with the state agency.

Last month, a grand jury indicted King on 46 counts of third-degree felony theft and two counts of Medicaid fraud, according to court records.

King, who is accused of billing the Medicaid program for services she did not provide, since has been released from the Nueces County Jail on bond, according to jail officials.

Saaphosf did not release further details of the case citing the ongoing investigation. A trial date has not been scheduled, she added.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Rodolfo Aenlle, 47, of Direct Nursing Assistance, Inc. was found guilty on all counts of fraud, conspiracy, taking kickbacks, and related charges.

Source - http://www.earthtimes.org/articles/show/news_press_release,192731.shtml

Miami, Florida - A federal jury in Miami has convicted the owner and operator of Direct Nursing Assistance Inc. of Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

After a four day trial, Rodolfo Aenlle, 47, was found guilty on all counts of conspiracy, fraud, taking kickbacks, and related charges. U.S. District Judge Donald Middlebrooks of the Southern District of Florida remanded Aenlle into immediate custody following the verdict.

Aenlle faces a maximum of 40 years in prison. His sentencing is scheduled for Dec. 13, 2007. Aenlle owned and operated Direct Nursing Assistance Inc. from October of 2001 through June of 2006. The jury heard testimony that Aenlle paid cash kickbacks to patients and physicians as part of his scheme to defraud Medicare. While Aenlle was president of Direct Nursing Assistance, the company submitted claims to Medicare for $1 million. Evidence at trial established that Aenlle had prescription pads printed, and forged the names and signatures of physicians.

Trial exhibits confirmed that Aenlle had 130 paid patients at Direct Nursing who received services and drugs that they did not need. Many of the phony prescriptions were for non-commercially available aerosol medications so that they could be illegally "compounded." Compounding is the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer. The jury found that Aenlle conspired with the owners of Unimed Pharmacy to refer paid patients to the pharmacy in exchange for half of what Medicare paid for compounded aerosols.

One of the patients testified during trial that Aenlle paid her $150 per month to use her Medicare card and to obtain phony prescriptions in her name. Unimed Pharmacy fraudulently billed Medicare more than $200,000 using the phony prescriptions that Aenlle obtained. In exchange, Aenlle received kickbacks of over $100,000. Aenlle's partner at Direct Nursing Assistance, Carlos Carrion, was convicted of Medicare Fraud in September 2007.

In 2006, the Medicare program paid for over $155 million worth of aerosol medications in Miami-Dade County alone. These drugs were the single most common item billed to Medicare Part B and accounted for over 32 percent of all claims filed with the Durable Medical Equipment (DME) Regional Carrier in Miami-Dade County. From 2005 to 2006, claims for aerosol medications rose over 100 percent in Miami-Dade County. According to Medicare data, Miami-Dade County alone accounted for more paid DME claims than every state in the country except California, Texas, New York, Michigan, and Ohio.

The case was prosecuted by Deputy Chief Kirk Ogrosky from the Fraud Section of the Criminal Division and Assistant U.S. Attorney Ryan K. Stumphauzer of the Southern District of Florida. The U.S. Department of Health and Human Services Office of the Inspector General, the FBI, and the Florida Medicaid Fraud Control Unit provided investigative assistance.

The Medicare Strike Force is led by the Fraud Section of the Criminal Division in Washington, D.C., and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida. The Strike Force operates out of the federal Health Care Fraud Facility in Miramar, Fla. Since March 1, 2007, the strike force has brought approximately 80 cases against 120 defendants, including 42 convictions.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Miami-Dade County bail bondsman arrested on charges that he forged court documents while representing a Medicaid fraud defendant.

Bondsman allegedly falsified documents for ‘Operation Dirty Dozen’ defendant after a series of arrests shut down multi-county health care fraud scheme.

Source: Florida Attorney General

TALLAHASSEE, FL – Florida Attorney General Bill McCollum today announced the arrest of a Miami-Dade County bail bondsman on charges that he forged court documents while representing a Medicaid fraud defendant.

Marc J. Cooper allegedly forged the signature of a notary public and fraudulently used her seal on two affidavits being used in an attempt to bail out his client who was facing racketeering charges in Palm Beach County.

The defendant, Dinorah Mateu, is one of 12 arrested in May 2007 by law enforcement agents with the Attorney General’s Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services. Mateu and her co-defendants were involved in an elaborate scheme to defraud the Medicaid and Medicare programs out of millions of dollars through a bogus HIV infusion clinic located in Belle Glade.

Cooper is Mateu’s bondsman. The fraudulent affidavits were intended to be used to secure Mateu’s release and in the process, Cooper was to earn a $7,500 fee for his services. Mateu remains in custody because she has not been able to show that the source of funds used to post her $150,000 bail came from legitimate sources and not from sources involved with the alleged racketeering.

Authorities with the Miami-Dade Police Department arrested Cooper this morning and are preparing to transfer him to the Palm Beach County jail. He faces two counts of forgery and two counts of providing false or misleading information in an application for bail. If convicted, he faces up to 20 years in prison. The case was investigated by the Attorney General’s Medicaid Fraud Control Unit and will be prosecuted by the Attorney General’s Office of Statewide Prosecution.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

New York - Charles Zizi, 46, and Ricardo Francois, 37, accused of siphoning off $300G from New York Medicaid Program.

Source - http://www.nydailynews.com/news/crime_file/2007/10/02/2007-10-02_two_accused_of_siphoning_off_300g_from_m.html

A Manhattan man and his business associate were arraigned yesterday on charges that they bilked the state out of $300,000 by submitting inflated Medicaid claims.

Charles Zizi, 46, allegedly falsified tax returns, forged documents and falsely padded the hours of nursing care service his outfit, Always There Home Care, provided to Medicaid patients.
Ricardo Francois, 37, of Westbury is accused of participating in the fraud by acting as the billing agent for the Carle Place business, which also had offices in Hempstead.

Zizi was also charged with identity theft for allegedly obtaining corporate credit cards under the name of the firm's previous owner to fund his lavish lifestyle, prosecutors said yesterday.

The illegal purchases totaled more than $100,000 and included shopping sprees at Neiman Marcus and Saks Fifth Avenue, jewelry bought over the Internet and trips to Paris, Santo Domingo, Jamaica and Fort Lauderdale, authorities said.

Francois was also in possession of one of the bogus credit cards, which he used to buy jewelry and book trips to Florida, officials said.

Zizi, of Battery Park City, was further charged with laundering money through another home health agency he controlled and keeping employees' payroll withholding funds that were meant for state and federal taxes, according to state Attorney General Andrew Cuomo.

"He used the corporation as his own personal piggy bank," said Nassau District Attorney Kathleen Rice, whose prosecutors teamed up with investigators from the attorney general's office to root out what she said was the biggest case of Medicaid fraud in the state. "It's the first fruit of a partnership I am very excited about and will be a model statewide," Cuomo said of the pairing of county and state prosecutors.

The accused were arraigned yesterday in Nassau County Supreme Court, where the judge ordered Zizi held on a $150,000 bond and Francois on $100,000 bond. If convicted on the grand larceny charges, the defendants could face up to 15 years in prison.

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To report Medicare or Medicaid fraud call 1 (888) 482-6825 or visit http://www.usawhistleblower.com./

Nelson Valdes, owner of a Miami pharmacy who has been convicted of Medicare fraud 3 times, has been sentenced to 12 years in prison.