PROVIDENCE, R.I. – The United States Attorney’s Office in Rhode Island today announced the filing of an Information in U.S. District Court in Providence charging John M. Almon, 55, of Cranston, R.I., owner and president of Med Care Ambulance LLC, of Warwick, R.I., with two counts of health care fraud, and one count each of obstructing a federal audit and making false statements. It is alleged that Almon defrauded health care programs administered by Medicare and Blue Cross Blue Shield of more than $700,000.
A not guilty plea was entered on behalf of the defendant at his arraignment in U.S. District Court in Providence on Thursday before U.S. District Court Magistrate Judge Lincoln D. Almond. Almon was released on personal recognizance. The Information alleges that John Almon defrauded Medicare of $625,825.31, and defrauded Blue Cross Blue Shield of $78,292.25.
According to the Information, beginning in March 2008 and continuing until December 2010, John Almon obtained payments in excess of $700,000 from Medicare and Blue Cross Blue Shield, by improperly submitting claims for reimbursement to health care benefit programs that falsely and fraudulently represented that Med Care had provided medically necessary Specialty Care ambulance transportation.
Court documents allege that the defendant actively solicited beneficiaries to be transported on a routine basis from their residences, either at home or a nursing facility, to renal care facilities for dialysis treatments. The majority of the transportation was routine in nature and did not require advanced or specialty care.
In addition, Almon actively solicited beneficiaries to agree to be transported for dialysis treatments by waiving the co-payment that the beneficiary would be liable for once Medicare or Blue Cross determined the amount that they would pay for services. By waiving co-payments, Med Care removed the monetary obstacle a patient might have had, and thus would agree to be transported by Med Care. Such transportation can be extremely lucrative because patients are transported two to three times a week on a round trip basis and provide a steady cash stream for an ambulance provider.
In addition to allegations of health care fraud, it is alleged in the Information that John Almon obstructed federal auditors contracted by the U.S. Department of Health and Human Services by instructing members of his executive staff to gather documents responsive to a Medicare Audit, and to “clean them up” and ensure there are no “red flags.
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Monday, May 23, 2011
John M. Almon Faces Federal Charges of Health Care Fraud, Obstructing Federal Agents
Saturday, May 21, 2011
Homero Izquierdo Ruiz Sentenced for Health Care Fraud
Izquierdo Ruiz was sentenced to a 39-month term of imprisonment, concurrently, on two counts of health care fraud, in violation of Title 18, United States Code, Section 1347. On these charges, Izquierdo Ruiz faced a possible maximum term of imprisonment of 10 years. In addition to the terms of imprisonment, Izquierdo Ruiz received a three-year period of supervised release and was ordered to pay restitution to Medicare in the amount of $1,045,977.72, and to forfeit his interest in $104,959.00 to the United States.
According to the stipulated factual basis in support of the guilty plea, the defendant purchased Physical Therapy and Fitness (PT&FI), located in Martin County. PT&FI was a physical therapy outpatient clinic that received reimbursement from Medicare Part A for the treatment of patients referred by physicians for physical therapy. Once the defendant purchased PT&FI, fraudulent billing to Medicare Part A began to occur, especially during the month of July 2010. Medicare records show that PT&FI received a total of approximately $528,094.27 in reimbursement from Medicare beginning on January 3, 2010 through August 13, 2010.
In addition, according to the stipulated factual basis, in May of 2010, the defendant purchased Ebenezer Medical Services, Inc., (Ebenezer) located in Miami Dade, which was a “pharmacy” that received reimbursement from Medicare Part D plan for prescription drugs. At one time, Ebenezer qualified as a pharmacy, but when the Defendant purchased the “business,” Ebenezer was not actually functioning as a pharmacy. Medicare records show that approximately $587,843.06 was paid to Ebenezer from May 14, 2010 through August 13, 2010. Sixteen doctors provided “attestation” letters stating that the items billed by Ebenezer under their names and National Provider Identification (NPI) numbers were billed in a false manner. In addition, four beneficiaries filed complaints that the billing listed prescription drugs that were never issued to them.
Mr. Ferrer commended the investigative efforts of the Department of Health and Human Services, the Federal Bureau of Investigation and the Martin County Sheriff’s Office for their work on this case. The case is being prosecuted by Assistant U.S. Attorney Diana M. Acosta and Assistant U.S. Attorney Antonia Barnes.
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Thursday, May 19, 2011
Sentenced to 84 Months in Prison for Health Care Fraud Scheme Involving More Than $2 Million in False Billings
WASHINGTON – The owner of a Houston-area durable medical equipment (DME) company was sentenced to 84 months in prison for her role in a Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Doris Vinitski, a Houston-area resident, was sentenced yesterday by U.S. District Court Judge Nancy F. Atlas in the Southern District of Texas. Vinitski pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud.
According to court documents, Vinitski, 46, was the owner of Onward Medical Supply, a Houston-area DME company. Onward began billing Medicare for fraudulent DME in 2003. In pleading guilty, Vinitski admitted she paid kickbacks, sometimes $1,000 per patient, to recruiters who brought patients to Onward. Vinitski and her co-conspirator and estranged husband, John Lachman, then billed Medicare for DME that these patients either did not need or never received, including power wheelchairs and orthotic devices. Lachman also pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud and was sentenced to 26 months in prison. According to court documents, the fraud scheme at Onward resulted in more than $2 million in fraudulent billing to Medicare.
Nine additional defendants involved in the Onward fraud scheme are currently serving prison sentences. One remaining defendant is awaiting sentencing in the Eastern District of Texas.
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Wednesday, May 18, 2011
Patrick Crisler Charged with Health Care Fraud and Identity Theft in Connection with Medicaid Billings
TAMPA, FL—United States Attorney Robert E. O'Neill announces the return by a grand jury of an indictment charging Patrick Crisler (45, Inverness) with six counts of health care fraud and six counts of aggravated identity theft. If convicted on all counts, Crisler faces a maximum penalty of 10 years in federal prison on the health care fraud charge, a fine of $250,000, or twice the gross gain/loss caused by the offense, whichever is greater, and a term of supervised release of not more than three years. He faces a consecutive mandatory minimum of two years in federal prison on the aggravated identity theft counts. The indictment also notifies Crisler that the United States intends to seek a money judgment or forfeit any assets which are alleged to be traceable to proceeds of the offense. Crisler was first arrested on these charges on February 17, 2011.
According to the indictment, Crisler, an occupational therapy assistant and owner of Active Life Rehab, Inc., was charged with health care fraud and aggravated identity theft for submitting fraudulent claims of more than $1 million to the Medicaid program for occupational therapy services that were either not provided at all, or not provided as billed to Medicaid. Specifically, Crisler is alleged to have falsified patient records and knowingly engaged in "upcoding" by using the unauthorized Medical Provider Numbers of other licensed occupational therapists to submit claims to Medicaid for payment to Active Life Rehab.
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Tuesday, May 17, 2011
William Goldman Guilty of Health Care Fraud
PLANO, TX—A 52-year-old Paris, Texas podiatrist has pleaded guilty to federal health care fraud charges in the Eastern District of Texas announced U.S. Attorney John M. Bales today.
William Goldman pleaded guilty to health care fraud today before U.S. Magistrate Judge Don Bush.
According to information presented in court, Goldman submitted false claims to Medicare and Medicaid from 2003 to 2008 from surgeries he never performed. Goldman was indicted by a federal grand jury on Apr. 15, 2010.
Goldman faces up to two years in federal prison. He also faces forfeiture of $350,000.00, along with his podiatry license. A sentencing date has not been set.
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Monday, May 16, 2011
A. Rahway Admits Posing as Licensed Physician in Medicaid and Medicare Fraud Scheme
NEWARK, NJ—A Rahway, N.J. man admitted today to posing as a licensed physician and unlawfully treating patients, prescribing medicine, and ordering procedures at an Elizabeth, N.J. medical practice in a Medicaid and Medicare fraud scheme through which more than 20,000 patient visits were conducted by unlicensed individuals, U.S. Attorney Paul J. Fishman announced.
Hamid Bhatti, 33, was the fourth individual to plead guilty in connection with the scheme. Bhatti entered his guilty plea, to an information charging him with one count of conspiracy to commit health care fraud, before U.S. Magistrate Judge Patty Shwartz in Newark federal court. Judge Shwartz recommended to U.S. District Judge Faith S. Hochberg that his plea of guilty be accepted and entered.
According to documents filed in this case and statements made in court:
Bhatti posed as a licensed physician at the direction of Yousuf Masood, 47, of Warren, N.J., the doctor who ran the practice. Yousuf Masood and his wife, Maruk Masood, 43—the practice's office manager—pleaded guilty on April 21, 2011, before Judge Shwartz to conspiracy to commit health care fraud, admitting that they used unlicensed individuals to treat patients and billed Medicaid and Medicare as if Yousuf Masood provided the services. Another individual, Carlos Quijada, 31, of Hawthorne, NJ, pleaded guilty on April 27, 2011, before Judge Shwartz to conspiracy to commit health care fraud, admitting to posing as a licensed physician at the direction of the Masoods.
At today's hearing, Bhatti explained that he had responded to an advertisement the Masoods had placed on craigslist. Although Bhatti told them he had not passed required tests and was not licensed to practice, they directed him to treat, diagnose, and prescribe medication for patients, introducing himself to patients as "Dr. Bhatti." Bhatti admitted that he worked six days per week and regularly saw and treated 30 to 40 patients each day.
Over the course of the scheme, more than 20,000 patient visits were conducted by unlicensed individuals, including Bhatti, but billed to Medicaid and Medicare as if Yousuf Masood had examined the patients. Hakim Muta Muhammad, 31, of Newark, is also charged by complaint for pretending to be a doctor during patient visits, and those charges remain pending.
Yousuf Masood was the top prescriber of drugs to Medicaid patients in New Jersey in 2009, prescribing more than $9 million in Medicaid drugs that year. The next-highest prescribing doctor in New Jersey prescribed less than $6 million. Yousuf Masood provided Bhatti, Muhammad, and Quijada with pre-signed, blank prescription forms to write prescriptions in his name for patients they were improperly examining and treating. Bhatti admitted today that he wrote prescriptions for a wide variety of drugs, including medications used to treat schizophrenia, bipolar disorder, anxiety, insomnia, and other illnesses.
On some days, more than 100 patients visited the medical practice for treatment, and the majority were treated only by unlicensed individuals. Bhatti stated that while he and other unlicensed individuals were diagnosing and treating patients, Yousuf Masood was frequently either not in the office at all, or was in his personal office watching television.
In addition to prescribing medication, Bhatti ordered that procedures be performed on patients—including electrocardiograms, bronchodilation responsiveness tests, and transnasal eustachian tube inflation. Yousuf Masood and Maruk Masood billed Medicaid and Medicare for these procedures. At his guilty plea, Yousuf Masood agreed to pay more than $1.8 million in restitution and forfeiture based on the fraudulent Medicaid and Medicare billings.
The conspiracy charge carries a maximum penalty of 10 years in prison and a fine of $250,000, or twice the gross gain or loss from the offense. Sentencing is currently scheduled before Judge Hochberg for July 27, 2011 for Yousuf Masood, Maruk Masood, and Carlos Quijada, and for September 12, 2011 for Bhatti.
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Sunday, May 15, 2011
Houston Federal Jury Convicts Four Defendants in Connection with $5.2 Million Medicare Fraud Scheme
WASHINGTON—A federal jury in Houston convicted four defendants today in connection with a $5.2 million Medicare fraud scheme that operated from April 2006 to August 2009, announced the Departments of Justice and Health and Human Services (HHS), the FBI and the Texas Attorney General.
Ezinne Ubani, 46, of Houston, and Mary Ellis, 55, of Missouri City, Texas, were each convicted of one count of conspiring to commit health care fraud, and two counts of making false statements for use in determining rights for benefit and payment by Medicare. Ellis was also convicted of one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries, and three counts of receiving illegal kickbacks for referring Medicare beneficiaries.
Caroline Njoku, 45, of Houston, was convicted of one count of conspiring to commit health care fraud and one count of conspiring to receive kickbacks for referring a Medicare beneficiary. Njoku was found not guilty of one count of receiving illegal kickbacks for referring a Medicare beneficiary. Terrie Porter, 47, of Houston, was convicted of one count of conspiring to receive illegal kickbacks for referring a Medicare beneficiary and one count of illegally receiving a kickback for referring a Medicare beneficiary. Estella Joseph, 62, of Houston, was found not guilty of one count of conspiring to receive kickbacks for referring a Medicare beneficiary, and not guilty of one count of receiving an illegal kickback for referring a Medicare beneficiary
The four defendants were convicted after a 15-day trial before U.S. District Court Judge Nancy Atlas in Houston. According to the evidence presented at trial, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries. Family Healthcare Group hired Njoku, Ellis, Porter, and other co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. After the Medicare beneficiaries were recruited, Ubani, a registered nurse, and other co-conspirators fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact they knew the beneficiaries were not home-bound and not in need of skilled nursing.
Ubani’s husband, Clifford, and Njoku’s husband, Princewill, were co-owners of Family Healthcare Group and they both previously pleaded guilty to conspiring to commit healthcare fraud and conspiring to paying illegal kickbacks for referring Medicare beneficiaries. Additionally, Adelma Casas-Sevilla, a registered nurse employed by Family Healthcare Group, previously pleaded guilty to conspiring to commit healthcare fraud. Sammie Wilson and Cynthia Garza-Williams, both patient recruiters for Family Healthcare Group, also pleaded guilty to conspiring to commit healthcare fraud. Erica Walker and Florida Holiday Island, both patient recruiters for Family Healthcare Group, pleaded guilty to conspiring to receive illegal kickbacks for referring a Medicare beneficiary and illegally receiving a kickback for referring a Medicare beneficiary. Family Healthcare Group is no longer in business.
At sentencing, scheduled for July 20 and 21, 2011, the defendants face maximum penalties of 10 years in prison for the health care fraud conspiracy count; five years in prison for making false statements for use in determining rights for benefit and payment by Medicare; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary.
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Christopher Fronczak Pleads Guilty to Health Care Fraud
ROCHESTER, NY—U.S. Attorney William J. Hochul, Jr. announced today that Christopher Fronczak, 37, of Victor, New York, pleaded guilty before U.S. District Court Judge Charles J. Siragusa to health care fraud. The charge carries a maximum sentence of 10 years in prison and a $250,000 fine.
Assistant U.S. Attorney Richard A. Resnick, who is handling the case, stated that during the years 2005 and 2010, the defendant, while a Doctor of Chiropractic Medicine, executed a scheme to defraud Excellus BlueCross BlueShield (“Excellus”), a health care benefit program, by submitting reimbursement claims for services he did not perform.
Part of the scheme involved chiropractic services the defendant provided to college football players and other athletes at St. John Fisher College. Fronczak provided adjustments to the athletes after practices which took appropriately five minutes each but he submitted claims to Excellus for more expensive treatments which were not provided, including spinal manipulation, electrical stimulation, mechanical traction, manual therapy techniques, and an office visit. The claims submitted were virtually identical for each football player.
In another case, a 45-year-old patient was treated for shoulder pain once or twice a month. This patient never received mechanical traction and most visits would lasted approximately 10 minutes. Despite this, Fronczak submitted claims for numerous visits which never took place and for services which were never rendered, including application of hot and cold packs, mechanical traction, electrical stimulation, manual therapy techniques, and spinal manipulation.
During the years 2005 through 2009, the defendant was also hired by the Crossman Corporation as an independent contractor to provide Chiropractic services to their employees. The company paid Fronczak approximately $67,000 but he billed the employees’ insurance companies as well.
The total loss to Excellus due to the defendant’s conduct was more than $200,000.
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Saturday, May 14, 2011
Jacqueline Wheeler Indicted for Health Care Fraud, Other Charges After Investigation into Billing Practices
WASHINGTON—Jacqueline Wheeler, 54, a health care provider who did business in the District of Columbia, was indicted today by a federal grand jury and charged with one count of health care fraud and 39 counts of false statements in a health care matter.
The indictment was announced by U.S. Attorney Ronald C. Machen Jr.; James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office; Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services; and Charles J. Willoughby, Inspector General for the District of Columbia.
The grand jury returned the indictment in the U.S. District Court for the District of Columbia. Wheeler, of Chevy Chase, Md., faces a maximum sentence of 10 years in prison and a $250,000 fine. Under the advisory federal sentencing guidelines, the likely range of imprisonment, if convicted, is 51 to 63 months.
According to the indictment, Wheeler was the chief executive officer of the Health Advocacy Center, Inc., in the 900 block of Sheridan Street NW, Washington, D.C. She was also the owner of Sheridan Rehabilitative and Wellness Centers, Inc. a private company, which was located at the same Sheridan Street address.
The Health Advocacy Center was purportedly engaged in serving as an advocate for improved health care delivery to the community. It also provided management support, as well as financial advice and assistance to other health care providers. It was a registered District of Columbia Medicaid provider.
Sheridan was purportedly engaged in providing rehabilitative services to the mentally and physically disabled community. It also purportedly provided housing to mentally and physically challenged individuals. Sheridan was not an authorized D.C. Medicaid provider.
Wheeler was a registered naturopath with the District of Columbia Department of Health, Health Professional Licensing Administration. However, she was not a medical doctor and was not licensed to practice medicine. Wheeler did work with a licensed medical doctor, who was part owner of the Health Advocacy Center. This doctor’s specialty was physical medicine and rehabilitation.
Because Sheridan was not authorized as a D.C. Medicaid provider, it was unable to submit bills to D.C. Medicaid. From on or about January 2006 through on or about April 2008, Wheeler prepared and submitted all of the billing for the Health Advocacy Center, and handled all financial matters for both the Health Advocacy Center and Sheridan.
During that time period, she submitted or caused the submission of approximately 603 claims to D.C. Medicaid for manual therapy services that the Health Advocacy Center purportedly provided to approximately 22 District of Columbia Medicaid beneficiaries. In these claims, she maintained that the Health Advocacy Center provided in excess of 20 continuous hours of manual therapy for each patient in a single 24-hour period, and sought approximately $6.2 million from D.C. Medicaid for manual therapy services.
In performing therapeutic procedures such as manual therapy, the health care provider is required to bill in 15 minute intervals or units. There are only 1,440 minutes in a day. However, Wheeler routinely billed and/ or caused D.C. Medicaid to be billed from 1,440 of continuous minutes of manual therapy for a single patient in a 24-hour day, to as many as 2,910 continuous minutes (or 48.5 hours) of manual therapy for a single patient in a 24-hour period.
D.C. Medicaid paid the Health Advocacy Center in excess of $2.5 million for manual therapy services that were purportedly provided to the patients. The payments were deposited in bank accounts controlled by Wheeler.
After D.C. Medicaid paid the Health Advocacy Center for the fraudulent claims, Wheeler diverted the proceeds of the fraud for her personal use and benefit, including the purchase of real estate in Florida, North Carolina, and the District of Columbia.
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Friday, May 13, 2011
Aleksandr Kharkover Pleads Guilty to Fraud Scheme Involving False Billings to Medicare
WASHINGTON – A Brooklyn physical therapist pleaded guilty today for his role in submitting false and fraudulent claims to Medicare for physical therapy services that were medically unnecessary and never provided, announced the Departments of Justice and Health and Human Services (HHS).
Aleksandr Kharkover, 49, pleaded guilty before U.S . Magistrate Judge Marilyn Go in the Eastern District of New York to an indictment charging him with five counts of health care fraud. Kharkover faces a maximum of 10 years in prison for each count of health care fraud. His sentencing has not yet been scheduled.
According to the indictment, between January 2005 and July 2010, Kharkover caused the submission of approximately $11.9 million in false and fraudulent claims to Medicare for physical therapy services that were not performed and were not medically necessary. According to the indictment, Kharkover hired individuals who were not certified as physical therapy assistants to purportedly provide physical therapy to Medicare beneficiaries.
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Thursday, May 12, 2011
Tuan Duc Tran Arraigned on Federal Mail Fraud Charges Alleging Medicare Scam
SANTA ANA, CA—The owner and chief executive officer of an Orange County rehabilitation facility has been arraigned in federal court on charges related to a scheme in which he allegedly submitted nearly $1 million in fraudulent claims to Medicare for services that were not prescribed by treating doctors and were not medically necessary.
Tuan Duc Tran, 50, of Westminster, appeared yesterday in United States District Court and pleaded not guilty to charges contained in a nine-count indictment. Tran was arraigned after surrendering to federal authorities.
Tran operated the Fountain Valley Healthcare Center (FVHC). From May 2003 through January 2008, Tran allegedly sought payments from Medicare based on false claims that Medicare beneficiaries had been referred to FVHC for physical and respiratory therapy by their treating doctors. The indictment also alleges that many of the beneficiaries did not have a medical need for therapy and that Tran employed unlicensed personnel at FVHC.
Tran is charged with nine counts of mail fraud based on a total of $910,588 in checks that were sent to FVHC between March 2006 and January 2008. A federal grand jury returned the indictment in late March.
At yesterday’s arraignment, Tran’s case was assigned to United States District Judge Josephine Staton Tucker, who scheduled a trial for July 5. During yesterday’s hearing, Tran was freed on a $10,000 bond.
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Tuesday, May 10, 2011
Dentist James Crow in Health Care Fraud Scheme
SAN ANGELO, TX—Following a nearly two-week trial before U.S. District Judge Sam R. Cummings, a jury has found James Crow, a dentist from Brownwood, Texas, guilty on 17 of the 20 counts of a superseding indictment charging offenses related to a health care fraud scheme he ran, announced U.S. Attorney James T. Jacks of the Northern District of Texas.
The jury convicted Crow, 67, on two counts of making false statements involving a health care matter and 15 counts of health care fraud. Each false statement count carries a maximum statutory sentence of five years in prison and a $250,000 fine. Each of the health care fraud counts carries a maximum statutory sentence of 10 years in prison and a $250,000 fine. Judge Cummings ordered a pre-sentence investigation report; a sentencing date will be set after the conclusion of that report.
After the verdict, Judge Cummings entered a preliminary order of forfeiture which will require Crow to forfeit property derived from the proceeds of his scheme, including funds in various bank/investment accounts, a truck, several Harley Davidson motorcycles, a residence located on Lakeview Court in Brownwood, additional real estate in Brown County, Texas, a camper and trailer, and a boat and trailer.
The government presented evidence at trial that from January 2004 through December 2007, Crow, a dentist who was enrolled with Medicaid, filed, and caused to be filed, Medicaid claims for payment of services that he did not render and for payment of services that were billed with improper billing codes. Crow billed Medicaid for numerous resin-based composites restorations (cavity fillings), when in fact, either no such fillings were performed, or he instead performed other dental services not reimbursed by Medicaid.
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Monday, May 9, 2011
DME Company Owner Lia St. Junius and Marketers Devon Spicer and Martha Ramos Convicted of Defrauding Medicare of Millions
HOUSTON—A federal jury has convicted a durable medical equipment (DME) company owner and two marketers of defrauding both federal health care programs—Medicare and Medicaid—United States Attorney José Angel Moreno announced today.
Lia St. Junius, 25, the owner of The Mobility Store—a Houston area DME company—and Devon Spicer, 48, and Martha Ramos, 57, all of Houston, were found guilty late Friday afternoon by a jury following a two-week trial. Medicare and Medicaid are health care benefit programs funded by the federal government which pay for health care services provided to the elderly, the blind and disabled.
The indictment, returned in October 2010, charged St. Junuis, Spicer, and Ramos, along with James Claude Reese Jr., Brenda Lopez, and Lily Johnson, with the commission of various federal crimes including conspiracy to commit health care fraud, health care fraud, paying or receiving kickbacks, money laundering, and tax evasion. Today's verdicts found St. Junius guilty of conspiracy to commit health care fraud and paying kickbacks for the referral of Medicare beneficiaries and Medicaid recipients, health care fraud, and conspiracy to commit money laundering. Ramos and Spicer were convicted of receiving kickbacks for referring Medicare beneficiaries and Medicaid recipients to The Mobility Store.
St. Junius was convicted of conspiracy to commit health care fraud, counts 10 through 16 of substantive health care fraud, and conspiracy to commit money laundering, but acquitted on substantive health care fraud counts two through nine. Through their verdicts, the jury found that St. Junius conspired to defraud Medicare and Medicaid by billing Medicare and Medicaid for orthotic braces and devices, referred to as "The Artho Kit" that were different than equipment that was provided to Medicare beneficiaries or not ordered by a physician. During the trial, several witnesses testified that in May 2004, St. Junius had submitted an application with Medicare to become enrolled as a DME company called The Mobility Store. Although the application requested the name of all persons who had an ownership interest in the company, St. Junius failed to reveal that co-defendant James Reese was involved in the company. Reese, who pleaded guilty to health care fraud and tax evasion before trial, had previously operated a DME that had been suspended for submitting fraudulent claims. Between 2005 and 2008, St. Junius submitted fraudulent documents to Medicare indicating that Reese was not involved in the operation of The Mobility Store and that marketers were not soliciting Medicare beneficiaries. The jury also heard testimony that St. Junius paid marketers 10 percent of the amount received from Medicare for each orthotic brace or device billed.
Spicer was convicted on all substantive counts of receiving kickbacks based upon evidence presented that showed her referral of Medicare beneficiaries in 2005 to The Mobility Store resulted in $750,000 being paid by Medicare. Spicer received approximately $75,000 during 2005. The jury acquitted Spicer of conspiracy to commit health care fraud. Ramos was also acquitted of the conspiracy charge but found guilty on all substantive counts of receiving kickbacks based upon evidence that as a result of referrals by her, The Mobility Store was paid $40,000 and Ramos received approximately $4,000.
In 2008, Medicare revoked The Mobility Store's provider number because of its failure to provide accurate information about its operation procedures. As a result of the fraudulent scheme, The Mobility Store billed Medicare and Medicaid more than $10 million and was paid more than $5 million. Through testimony, the jury heard that St. Junius purchased several expensive cars and a home valued at more than $650,000 with proceeds from the fraudulent scheme.
Immediately following the return of the verdicts, United States District Judge David Hittner, who presided over the trial, revoked each defendant's bond and ordered that each be remanded into the custody of the U.S. Marshals Service.
St. Junius faces a maximum of 20 years in prison and a fine of up to $500,000 for his convictions. Spicer and Ramos each face up to a five-year maximum prison term and a $250,000 fine for their convictions. A sentencing date has not been set. The three others charged for their involvement in this health care fraud scheme—Reece, Lopez, and Johnson—pleaded guilty to conspiring to commit health care fraud in advance of trial. A sentencing date for these three defendants has yet been set.
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Saturday, May 7, 2011
Martin and Joaquin Tasis and Leoncio Alayon Convicted in $9.1 Million Medicare Fraud Scheme in Detroit
WASHINGTON—Two owners of a fraudulent Detroit-area medical clinic, Martin and Joaquin Tasis, and a man who helped them launder the proceeds of the fraud, Leoncio Alayon, were convicted today by a federal jury in Detroit for their roles in a $9.1 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Martin Tasis and Joaquin Tasis were each convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay health care kickbacks and three counts of health care fraud. Martin Tasis was also convicted of one count of conspiracy to commit money laundering and one count of money laundering, and found not guilty on one money laundering count. Alayon was convicted of one count of conspiracy to commit money laundering and two counts of money laundering.
According to evidence presented during the one-week trial, Martin and Joaquin Tasis were owners of Dearborn Rehabilitation and Medical Center (DMRC), a fraudulent HIV-infusion therapy clinic located in Dearborn, Mich. The Tasis brothers oversaw the payment of kickbacks to patients whose Medicare information was then used by DMRC to fraudulently bill Medicare for treatments they never received. Evidence showed that DMRC, an outpatient clinic that purported to specialize in infusion and injection therapy, was established for the sole purpose of defrauding Medicare.
Between November 2005 and March 2007, DMRC billed approximately $9.1 million in claims to Medicare for injection therapy services that were never provided and were not medically necessary. Medicare paid approximately $6 million of those claims. The Tasis brothers used Alayon and a bogus “research” company to launder hundreds of thousands of dollars in proceeds of the fraud.
Evidence presented at trial showed that the Tasis brothers and their co-conspirators helped relocate the highly lucrative infusion therapy fraud scheme from South Florida to Michigan after increased law enforcement scrutiny in South Florida. Evidence at trial showed that Medicare beneficiaries were not referred to DMRC by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of cash kickbacks. DMRC then billed Medicare for expensive medications, purportedly given to treat HIV and Hepatitis-C, which were never administered. For example, evidence at trial showed that DMRC billed $9.1 million to Medicare, but purchased only $36,000 in medication and medical supplies.
Once Medicare started paying the co-conspirators, Martin Tasis enlisted a family friend, Leoncio Alayon, to help him launder the proceeds of the fraud through a shell corporation in Florida called Infinity Research Corp. Evidence at trial showed that Infinity Research Corp. had no employees, did no research and was based at Alayon’s residence. Alayon, after taking a commission, distributed the laundered proceeds to Martin Tasis, Joaquin Tasis and their co-conspirators.
Including today’s guilty verdicts, 12 individuals involved with DMRC have been convicted for their roles in the DMRC scheme. Defendants Clara Guilarte and Caridad Guilarte are currently awaiting trial on charges related to their alleged roles at DMRC. An indictment is merely a charge and defendants are presumed innocent until proven guilty.
A sentencing date for the Tasis brothers and Alayon has not yet been scheduled by the court. Each count of conspiracy to commit health care fraud, health care fraud and money laundering carries a maximum penalty of 10 years in prison and a $250,000 fine. The conspiracy to commit money laundering count carries a maximum penalty of 20 years in prison and a $500,000 fine, and the conspiracy to pay health care kickbacks carries a maximum penalty of five years in prison and a $250,000 fine.
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Friday, May 6, 2011
Houston Federal Jury Convicts Four Defendants in Connection with $5.2 Million Medicare Fraud Scheme
WASHINGTON—A federal jury in Houston convicted four defendants today in connection with a $5.2 million Medicare fraud scheme that operated from April 2006 to August 2009, announced the Departments of Justice and Health and Human Services (HHS), the FBI and the Texas Attorney General.
Ezinne Ubani, 46, of Houston, and Mary Ellis, 55, of Missouri City, Texas, were each convicted of one count of conspiring to commit health care fraud, and two counts of making false statements for use in determining rights for benefit and payment by Medicare. Ellis was also convicted of one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries, and three counts of receiving illegal kickbacks for referring Medicare beneficiaries.
Caroline Njoku, 45, of Houston, was convicted of one count of conspiring to commit health care fraud and one count of conspiring to receive kickbacks for referring a Medicare beneficiary. Njoku was found not guilty of one count of receiving illegal kickbacks for referring a Medicare beneficiary. Terrie Porter, 47, of Houston, was convicted of one count of conspiring to receive illegal kickbacks for referring a Medicare beneficiary and one count of illegally receiving a kickback for referring a Medicare beneficiary. Estella Joseph, 62, of Houston, was found not guilty of one count of conspiring to receive kickbacks for referring a Medicare beneficiary, and not guilty of one count of receiving an illegal kickback for referring a Medicare beneficiary
The four defendants were convicted after a 15-day trial before U.S. District Court Judge Nancy Atlas in Houston. According to the evidence presented at trial, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries. Family Healthcare Group hired Njoku, Ellis, Porter, and other co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. After the Medicare beneficiaries were recruited, Ubani, a registered nurse, and other co-conspirators fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact they knew the beneficiaries were not home-bound and not in need of skilled nursing.
Ubani’s husband, Clifford, and Njoku’s husband, Princewill, were co-owners of Family Healthcare Group and they both previously pleaded guilty to conspiring to commit healthcare fraud and conspiring to paying illegal kickbacks for referring Medicare beneficiaries. Additionally, Adelma Casas-Sevilla, a registered nurse employed by Family Healthcare Group, previously pleaded guilty to conspiring to commit healthcare fraud. Sammie Wilson and Cynthia Garza-Williams, both patient recruiters for Family Healthcare Group, also pleaded guilty to conspiring to commit healthcare fraud. Erica Walker and Florida Holiday Island, both patient recruiters for Family Healthcare Group, pleaded guilty to conspiring to receive illegal kickbacks for referring a Medicare beneficiary and illegally receiving a kickback for referring a Medicare beneficiary. Family Healthcare Group is no longer in business.
At sentencing, scheduled for July 20 and 21, 2011, the defendants face maximum penalties of 10 years in prison for the health care fraud conspiracy count; five years in prison for making false statements for use in determining rights for benefit and payment by Medicare; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary.
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Thursday, May 5, 2011
Pharmaceutical Manufacturers Serono Laboratories Inc., Agrees to Pay $44.3 Million to Settle False Claims Act Case
WASHINGTON - P harmaceutical manufacturers Serono Laboratories Inc., EMD Serono Inc., Merck Serono S.A, and Ares Trading S.A. have agreed to pay $44.3 million to resolve False Claims Act allegations in connection with the marketing of the drug Rebif, the Justice Department announced.
“It’s imperative that medical determinations are guided by a patient's needs, not tainted by illegal incentives or fraud,” said Tony West, Assistant Attorney General of the Civil Division. “We are committed to ensuring that the chronically ill and other vulnerable members in our communities who rely on Medicare and Medicaid programs receive the best possible care.”
“Health care decisions must be based solely upon what is best for the individual patient and not on which pharmaceutical company is paying the doctor the biggest kickback,” said Rod J. Rosenstein, U.S. Attorney for the District of Maryland. “All consumers have the right to know that their health care provider’s judgment about medications they should take has not been undermined by kickbacks from pharmaceutical manufacturers.”
“In settling this second case with Serono, the Office of the Inspector General extended Serono’s existing corporate integrity agreement by three years, and required enhanced provisions such as specifically requiring that company directors and senior executives take responsibility for ensuring and monitoring compliance with federal law,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services (HHS-OIG). “If we can alter the cost-benefit calculus of some directors and executives, OIG can influence corporate behavior without putting access to government health care benefits at risk.”
Under the agreement announced today, the proceeds from the settlement will be split between the federal government and various states, with the United States receiving $34.6 million to resolve the federal claims and the states receiving $9.7 million to settle their respective claims under Medicaid.
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Wednesday, May 4, 2011
American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc., Pleaded Guilty to More Than $200 Million Medicare Fraud
WASHINGTON—Two Miami-area corporations, American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc., pleaded guilty today in U.S. District Court in Miami for a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, the Departments of Justice and Health and Human Services (HHS) announced.
According to court documents, ATC is a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando, Fla. A PHP is a form of intensive treatment for severe mental illness. Medlink is a Florida corporation headquartered in Miami that purported to act as a “management company” for health care businesses. In reality, ATC and a related company, the American Sleep Institute (ASI), were Medlink’s only clients. ATC and Medlink are each charged with conspiracy to commit health care fraud in a superseding indictment unsealed on Feb. 15, 2011. ATC is also charged in the superseding indictment with health care fraud and conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.
“ATC and Medlink, and their owners, have now pleaded guilty to perpetrating a massive $200 million Medicare fraud scheme in South Florida,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “The fraud scheme was staggering in scope, and those who concocted the scheme exhibited a complete disregard for the elderly, infirm, and disabled victims who were used to commit it. Today’s guilty pleas mark an important step forward in our effort to hold accountable everyone—and every entity—involved in the scheme, and to recover the maximum amount possible on behalf of American taxpayers.”
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Tuesday, May 3, 2011
Nine Individuals and Three Corporations Face 31 Count Health Care Fraud Indictment
NEW ORLEANS, LA—A Federal Grand Jury sitting in New Orleans returned a 31-count indictment against nine (9) individuals and three (3) corporations charging approximately $12,500,000 in Medicare and Medicaid fraud, announced U. S. Attorney Jim Letten.
Specifically, ARAM KHLGATIAN, age 55, of Metairie, LA; DR. JACK VOIGHT, age 79, of Metairie, LA; ERNESTINE “TWEET” GIROD, age 46, of Marrero, LA; JO ANN GIROD, age 38, of Marrero, LA; and HEALTH PLUS CONSULTING, INC., a Louisiana corporation, were each indicted on 8 counts of health care fraud. ARTEM GASPARYAN, age 45, of Metairie, LA; DARIA LITVINOVA, age 24, of Kenner, LA; and SATURN MEDICAL GROUP, a Louisiana corporation, were each indicted on 9 counts of health care fraud. DR. JERRY HASKIN, age 78, of New Orleans, LA; VADIM MYSAK, age 24, of Kenner, LA, were each indicted on 23 counts of health care fraud. ANAHIT PETROSYAN, age 32, of Metairie, LA; and NEW MILLENIUM MEDICAL GROUP, INC., a Louisiana corporation, were each indicted on 14 counts of health care fraud.
According to the indictment, all of the defendants participated in a criminal organization for the purpose of fraudulently billing Medicare and Medicaid. It is alleged that recruiters were used to find patients to bring to the various medical clinics for medical tests that were not performed or not medically necessary. It is further alleged that the patients were moved between the various clinics in order to repeatedly perform the same unnecessary tests. According to the indictment, the patients were provided with prescription drugs for their cooperation, and the recruiters were provided cash and prescription drugs for their services.
Further, the Government provided notice of forfeiture as to certain property that represents proceeds of the illicit activities contained in the indictment. The properties included in this provision are:
Each count carries a possible maximum sentence of ten (10) years’ imprisonment, a $250,000 fine and three (3) years’ supervised release. If convicted, ARAM KHLGATIAN, DR. JACK VOIGHT, ERNESTINE “TWEET” GIROD, and JO ANN GIROD face a possible maximum sentence of eighty (80) years’ imprisonment and millions in fines; ARTEM GASPARYAN and DARIA LITVINOVA face a possible maximum sentence of ninety (90) years’ imprisonment and millions in fines; JERRY HASKIN and VADIM MYSAK face a possible maximum sentence two hundred thirty (230) years’ imprisonment and millions in fines; and ANAHIT PETROSYAN faces a possible maximum sentence of one hundred forty (140) years’ imprisonment and millions in fines. Also, if convicted, the three corporations also face millions in fines.
KHLGATIAN, VOIGHT, JO ANN GIROD, GASPARYAN, LITVINOVA, HASKIN, MYSAK and PETROSYAN were arrested last week pursuant to a criminal complaint. DR. JERRY HASKIN has been released on a $500,000 secured bond. All remaining defendants are in custody.
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Monday, May 2, 2011
David Villanueva Convicted of Health Care Fraud
MCALLEN, TX—-A former employee of a McAllen-area durable medical equipment (DME) company has been convicted of conspiracy to commit health care fraud, United States Attorney José Angel Moreno announced today.
David Villanueva, 33, of Edinburg, Texas, pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Randy Crane at a hearing this afternoon. Judge Crane scheduled sentencing for July 19, 2011, at 2 p.m. Villanueva, who was indicted in March 2011, faces up to 10 years in federal prison without parole and a $250,000 fine for the conviction.
At today's hearing, Villanueva admitted that, from July 2008 through April 2010, he conspired with other individuals associated with United DME Inc., of Weslaco, Texas, to submit hundreds of thousands of dollars in fraudulent claims to Medicare and Medicaid related to the purported sale of power wheelchairs and diabetic supplies. Villanueva admitted that, on at least one occasion, he delivered a used power wheelchair to a Medicare/Medicaid beneficiary knowing that United would submit a claim for a brand new power wheelchair. In an attempt to conceal the fraud, Villanueva spray painted the wheelchair black to make it appear new. Villanueva also admitted to conspiring with others to submit fraudulent claims related to diabetic supplies that were billed to Medicare and Medicaid but never delivered to the beneficiaries. In particular, Villanueva frequently delivered a one-month supply of diabetic supplies to a beneficiary and, at the time of delivery, would persuade the beneficiary to sign both the delivery ticket for the instant delivery as well as additional delivery tickets for purported future deliveries of diabetic supplies which would be billed to Medicare and Medicaid but never delivered.
Villanueva has been permitted to remain on bond pending his sentencing hearing.
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Sunday, May 1, 2011
Darwin Minnis Sentenced to 70 Months in Federal Prison for Defrauding Workers Comp and Other Insurers of $1.4 Million
CHICAGO—A chiropractor who owned and operated a clinic in Maywood for more than a decade was sentenced today to 70 months in federal prison after pleading guilty last year to healthcare fraud. The defendant, Darwin Minnis, admitted that he and others submitted false claims to obtain payments from workers’ compensation and other insurers for services that were not provided and inflated claims for services that were provided, which resulted in an intended loss of at least $3 million and an actual loss of more than $1.4 million.
Minnis, 56, who is in federal custody and formerly of West Chicago, was also ordered to pay restitution totaling $1,450,202 by U.S. District Judge John Grady, who imposed the sentence in Federal Court.
From at least 2000 through June 2009, Minnis owned the Spine and Joint Rehabilitation Center, where most of the patients were U.S. Postal Service employees who were eligible for benefits from the U.S. Labor Department’s Office of Workers’ Compensation Program. Three medical doctors also worked at the clinic at various times.
Minnis, at least one doctor, a billing employee and others illegally submitted false and inflated claims to obtain workers compensation payments for the clinic and patients from the Labor Department, as well as private health insurers, for various services related to patients’ work-related injuries, including medical, diagnostic, and physical therapy services. Minnis forged doctors’ signatures on documents supporting the false claims, misrepresenting that services, treatment, physical therapy and/or testing had been provided, ordered or supervised by medical doctors. Minnis knew that Workers’ Comp would not accept a chiropractor’s opinions or reports as medical evidence to support patients’ claims. Under the Federal Employees’ Compensation Act, chiropractors were not qualified physicians and their opinions did not constitute medical evidence except in very limited cases involving specific spine problems.
Minnis, the physician and the billing employee were indicted together in March 2010. Minnis pleaded guilty last November. The other two defendants have also pleaded guilty and are awaiting sentencing.
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