BEAUMONT, TX—A Lufkin physician has been sentenced to federal prison for health care fraud violations in the Eastern District of Texas announced U.S. Attorney John M. Bales today.
Dr. Alexander Orlov, D.O., 47, of Lufkin, pleaded guilty on Nov. 1, 2010, to conspiracy to defraud Medicare and Medicaid and was sentenced to 15 months in federal prison today by U.S. District Judge Ron Clark. Orlov was also ordered to pay $309,000 in restitution and a $30,000 fine.
According to information presented in court, from Nov. 2008 to Apr. 2010, Orlov, a physician and the owner of a Lufkin medical practice and urgent care clinic, and an employee, Haseeb Rehman, submitted claims for physicians’ services to Medicare and Medicaid for services provided by Rehman who was not a licensed medical professional. Orlov controlled and operated Lufkin Urgent Care, P.A. He employed Rehman to run Lufkin Urgent Care. Rehman treated patients, prescribed medication, performed minor surgical procedures, and operated within Lufkin Urgent Care as if he were a licensed medical professional. Claims were submitted to Medicare and Medicaid for Rehman’s services representing that the services were provided by a physician. As a result of these claims, Orlov unlawfully obtained more than $250,000 from Medicare and Medicaid. Orlov was indicted by a federal grand jury on June 3, 2010 and charged with conspiracy to defraud Medicare and Medicaid.
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Wednesday, June 22, 2011
Dr. Alexander Orlov Sentenced for Health Care Fraud Violations
Tuesday, June 21, 2011
Simone Ball the Owner of Houston Health Care Company Pleads Guilty to Defrauding Medicare
WASHINGTON – An owner of a Houston health care company pleaded guilty today in connection with a $654,227 Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Simone Ball, 24, pleaded guilty before U.S. District Judge Lee Rosenthal in Houston to one count of conspiracy to commit health care fraud. In her plea, Ball admitted that she defrauded Medicare of $654,227 .
According to court documents, Ball was an owner and operator of Preferred Plus Medical Supply. Preferred Plus maintained a valid Medicare provider number in order to submit Medicare claims for the costs of durable medical equipment (DME) and purported to provide orthotics and other DME to Medicare beneficiaries. According to court documents, Preferred Plus submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or not provided. Many of the orthotic devices were components of “arthritis kits,” and purported to be for the treatment of arthritis-related conditions, although they were neither medically necessary nor appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads. In total, from August through December 2008, Preferred Plus submitted approximately $654,227 in fraudulent claims to Medicare.
At sentencing, scheduled for Oct. 12, 2011, Ball faces a maximum sentence of 10 years in prison.
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Monday, June 20, 2011
Dr. Gautam Gupta who owns and operates the Nutrition Clinic, was charged with one count each of Mail Fraud, Health Care Fraud and Conspiracy
Criminal charges alleging that the owner of a chain of medically supervised weight-loss clinics defrauded both a private health insurance company and the Illinois Medicaid program were filed earlier this week, announced Robert D. Grant, Special Agent-in-Charge of the Chicago office of the Federal Bureau of Investigation (FBI). Mr. Grant was joined by Hiram Grau, Director of the Illinois State Police and Lamont Pugh III, Special Agent-in-Charge of the Department of Health and Human Services—Office of Inspector General (HHS-OIG) in announcing the charges.
Dr. GAUTAM GUPTA, who owns and operates the Nutrition Clinic, with locations in Arlington Heights, Chicago, Naperville, Rockford and South Beloit, was charged with one count each of Mail Fraud, Health Care Fraud and Conspiracy, all of which are felony offenses, in a criminal complaint filed in U.S. District Court in Springfield.
The complaint alleges that Dr. GUPTA, or members of his staff acting at his direction, submitted claims to both the Blue Cross/Blue Shield Insurance Company and the Illinois Medicaid program for unnecessary procedures or procedures which were never performed. The complaint indicates that, during the period of June 2001 through January of 2010, the Nutrition Clinic was paid nearly $25 million for claims submitted on behalf of clinic patients.
Attempts to locate and apprehend Dr. GUPTA have thus far been unsuccessful. As such, he is now the subject of a nationwide manhunt which is being coordinated by the Chicago FBI. Dr. GUPTA, whose last known address was 1660 North Mulford Road in Rockford, is described as a white/male of Indian descent, 57 years of age, 5’5” tall, 160 pounds, graying black hair which is sometimes worn in a ponytail, and brown eyes.
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Saturday, June 18, 2011
Departments of Justice, Health and Human Services Highlight Joint Efforts to Combat Health Care Fraud in Philadelphia
WASHINGTON – U.S. Attorney General Eric Holder and the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius visited Philadelphia today where they participated in the sixth regional health care fraud prevention summit. The summits bring together a wide array of federal, state and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.
The summits are part of a larger effort on behalf of the Obama Administration to root-out waste, fraud and abuse within the U.S. health care system.
“In communities across the country, and particularly here in Philadelphia, health care fraud schemes are being aggressively and permanently shut down. That’s, in large part, because of the great work being led by Health Care Fraud Prevention and Enforcement Action Team,” said Attorney General Eric Holder. “Not only have we secured record recoveries totaling billions of dollars, we have raised awareness about these crimes and improved the ability of consumers and victims to report suspected fraud schemes. Through this initiative, we have forged partnerships necessary to ensure the strength and integrity of our most essential health care programs.”
“Today, we continue to work with patients to protect their information, with providers to strengthen screening standards, and with private insurers to share strategies about how to prevent fraud,” said HHS Secretary Kathleen Sebelius. “The Affordable Care Act gives us new resources to eliminate waste and kick criminals out of the health care system. As long as we continue to aggressively put these tools to work preventing and prosecuting fraud, we can continue to protect and strengthen Medicare’s future.”
Joining Attorney General Holder and Secretary Sebelius at the University of the Sciences in Philadelphia were Assistant Attorney General Tony West of the Civil Division and U.S. Attorney Zane D. Memeger for the Eastern District of Pennsylvania. The summit featured educational panels aimed at identifying best practices for providers, law enforcement, and beneficiaries in preventing health care fraud. The summit also showcased the success of public-private partnerships in curbing fraudulent schemes.
The U.S. Attorney’s Office for the Eastern District of Pennsylvania continues to show its strength as one of the leading offices in the nation for health care fraud recoveries, bringing in a record $2.7 billion for the Department of Justice in the past two calendar years. The office set a new record in 2009 when it announced the $1.415 billion joint civil and criminal resolution with pharmaceutical manufacturer Eli Lilly over the company’s off-label marketing of the drug Zyprexa. At the time, it was the largest monetary settlement against a single company.
Investments in fraud detection and enforcement have been shown to pay for themselves many times over, and the Administration’s tough stance against fraud is already yielding results. In FY 2010, more than $4 billion was returned to the Medicare Health Insurance Trust Fund, the U.S. Department of the Treasury and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. This was an increase of $1.4 billion, or 56 percent, over FY 2009. The $4 billion recovered in FY 2010 includes recoveries from the $2.5 billion in settlements and judgments obtained in FY 2010 by the Department of Justice in False Claims Act matters alleging health care fraud. This is an unprecedented level of funds obtained in a single year and represents a 53 percent increase over FY 2009, in which $1.63 billion was obtained.
The summits are part of the overall joint health care fraud fighting effort undertaken jointly by the Departments of Justice and Health and Human Services through the Health Care Fraud Prevention and Enforcement Action Team (HEAT). As one part of HEAT’s efforts, Medicare Fraud Strike Force operations have expanded from South Florida and Los Angeles to a total of nine health care fraud hot spots including Houston; Detroit; Brooklyn, N.Y.; Baton Rouge, La.; Tampa, Fla.; Chicago; and Dallas. The Strike Force is a partnership between the Criminal Division’s Fraud Section, U.S. Attorneys’ Offices, HHS’ Office of Inspector General, FBI, and other federal, state and local law enforcement partners.
On June 8, 2010, President Obama announced this nationwide series of regional fraud prevention summits as part of a multi-faceted effort to crack down on health care fraud. The Philadelphia summit was the sixth in a series. Previous summits were held in Miami (July 16, 2010), Los Angeles (Aug. 26, 2010), New York (Nov. 5, 2010), Boston (Dec. 16, 2010) and Detroit (March 15, 2011).
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Friday, June 17, 2011
Joseph Vah Lavien Charged with Defrauding Medicaid
MINNEAPOLIS—Yesterday in federal court, the owner of a home health care company was charged with fraudulently obtaining more than $400,000 from Medicaid between 2008 and June of 2009. Joseph Vah Lavien, age 57, of Brooklyn Park, was charged via an Information with one count of health care fraud.
Lavien allegedly defrauded Medicaid, a health care benefit programs, by submitting reimbursement claims for personal care services that were not actually rendered. Since 2003, Lavien owned and operated Minneapolis-based Palm Healthcare Services, Inc. The business is required to submit Medicaid claims to the Minnesota Department of Human Services ("DHS") for in-home personal care. The Medicaid program, which is a federal program administered in Minnesota by DHS, provides medical care and services to low-income people who meet certain income and eligibility requirements. The fraudulent reimbursements included billing for services not provided to patients, billing for more services than authorized, billing for more services than could be performed in a particular day or month, billing for supervision services rendered by an eligible provider, and submitting false records in support of reimbursement claims. The total estimated loss for Medicaid during the time period specified in the charges is $412,227.17.
In addition, Lavien allegedly defrauded the MinnesotaCare insurance program, through which the State of Minnesota pays for insurance premiums of low-income residents. The total estimated loss for MinnesotaCare as a result of this fraud is $83,939.
If convicted, Lavien faces a potential maximum penalty of ten years in prison. All sentences will be determined by a federal district court judge. This case is the result of an investigation by the Minnesota Attorney General’s Office-Medicaid Fraud Control Unit, the Federal Bureau of Investigation, and the United States Department of Health and Human Services-Office of Inspector General ("HHS-OIG"). It is being prosecuted by Assistant U.S. Attorney Robert M. Lewis.
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Wednesday, June 15, 2011
Scott Burko Sentenced in White Plains Federal Court to Two Years in Prison for Illegally Dispensing Prescription Drugs
PREET BHARARA, the united States Attorney for the Southern District of New York, announced that SCOTT BURKO, 47, a pharmacist, of West Harrison, Westchester County, New York, was sentenced today in White Plains federal court to two years in prison for participating in a conspiracy to dispense prescription drugs without valid prescriptions and dispensing prescription drugs unlawfully and with intent to defraud and mislead. United States District Judge KENNETH M. KARAS imposed the sentence.
In imposing the sentence on BURKO, Judge KARAS, citing the defendant's "brazen and longstanding criminal conduct" and the fact that his conduct required "planning, guile, and attention to detail," underscored the need to impose a sentence that would deter others from engaging in similar conduct.
On November 30, 2010, BURKO pled guilty to three counts of an Indictment. The first count to which BURKO pled guilty charged that BURKO participated in a conspiracy from at least 2003 through March 31, 2006, to cause the dispensing without valid prescriptions of prescription drugs held for sale after shipment in interstate commerce. According to the Indictment, BURKO worked as a pharmacist for a company that operated pharmacies in Rockland County, Orange County, Dutchess County, and Westchester County. The second and third counts to which BURKO pled guilty charged that BURKO dispensed Prednisone on April 8, 2005, and March 31, 2006, pursuant to fraudulent prescriptions. As charged in the Indictment, on both occasions, BURKO dispensed Prednisone, a steroid, in 10 milligram tablets, pursuant to fraudulent prescriptions BURKO issued in the names of fictitious patients.
According to statements made by the Government during prior proceedings in this matter and in the Government's submission filed in advance of the sentencing proceeding:
On 163 occasions, BURKO falsified pharmacy records and filled and dispensed Prednisone prescriptions for fictitious individuals. The dispensing of Prednisone pursuant to the fraudulent prescriptions was part of a larger scheme by which BURKO and at least one co-conspirator stole drugs from the pharmacies at which BURKO worked. Burko falsified pharmacy records to make it appear that he had received oral prescriptions (via telephone calls from doctors) for Prednisone for fictitious patients.· BURKO then "filled" the false prescriptions and dispensed the medication to a co-conspirator, who came to the pharmacy to pick up the medication. When the co-conspirator left the pharmacy, he left with a bag containing the Prednisone, as well as numerous other medications.
In addition to his sentence of two years in prison, BURKO was also ordered to pay $400,000 in restitution. Judge KARAS also imposed a term of three years’ supervised release.
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Tuesday, June 14, 2011
Angel Gonzalez and Adrian Chalarca Plead Guilty in Tampa, Fla., to Medicare Fraud
WASHINGTON—Two Miami-area residents who were officers of a fraudulent physical therapy company in Lakeland, Fla., pleaded guilty today for their roles in a scheme to defraud Medicare, the Departments of Justice and Health and Human Services (HHS) announced.
Angel Gonzalez, 43, and Adrian Chalarca, 24, each pleaded guilty before U.S. Magistrate Judge Mark A. Pizzo in Tampa, Fla., to one count of conspiracy to commit health care fraud.
According to court documents, Gonzalez was the owner and vice president of Dynamic Therapy Inc. and Chalarca was the president and administrator of the company. Gonzalez, Chalarca and their co-conspirators purchased Dynamic from its prior owners and transformed it into a fraudulent enterprise. Under Gonzalez and Chalarca, Dynamic purported to provide physical therapy services to Medicare beneficiaries.
According to court documents, from fall 2009 to summer 2010, Gonzalez and Chalarca submitted and caused the submission of $757,654 in fraudulent claims by Dynamic to the Medicare program. Gonzalez and Chalarca admitted that they paid and caused the payment of kickbacks and bribes to Medicare beneficiaries in order to obtain their Medicare billing information and used it to submit claims to Medicare for physical therapy services that were never provided. According to court documents, Gonzalez and others also stole the identities of a physical therapist and Medicare beneficiaries in order to submit additional false claims to Medicare. Gonzalez and Chalarca admitted that they knew the Medicare beneficiaries, on whose behalf claims were submitted to Medicare, never received the services billed to Medicare.
Another vice president of Dynamic, Andres Cespedes, pleaded guilty in May 2011 for his participation in the fraud scheme.
At sentencing, Gonzalez and Chalarca each face a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not yet been scheduled.
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Monday, June 13, 2011
Dr. Rajiv Yakhmi Sentenced to One Year in Prison for Health Care Fraud and Income Tax Fraud
COLUMBUS—Dr. Rajiv Yakhmi, 46, of Powell, Ohio, was sentenced in U.S. District Court here to 12 months and one day in prison and ordered to pay $310,000 plus interest and penalties to the IRS and an additional $590,278.60 to the government and private health care insurers he defrauded.
Carter M. Stewart, United States Attorney for the Southern District of Ohio; Ohio Attorney General Mike DeWine; Lamont Pugh, Special Agent in Charge, U.S. Department of Health and Human Services Office of Inspector General (HHS); Jose A. Gonzalez, Special Agent in Charge, Internal Revenue Service Criminal Investigation, Cincinnati Field Office (IRS); and J. Mark Batts, Acting Special Agent in Charge, Federal Bureau of Investigation (FBI) announced the guilty plea entered before U.S. District Judge Gregory L. Frost.
Yakhmi pleaded guilty on January 11, 2011 to one count of health care fraud and to one count of willfully filing a false income tax return with the IRS.
According to court documents, Yakhmi is a licensed medical doctor who had an office located at 2415 Deewood Drive, Columbus, Ohio. Between October 2005 and November 2007, Yakhmi contracted with DosHealth billing service to submit medical claims on his behalf to the Medicare and Medicaid programs as well as to private insurers. DosHealth relied on patient information provided by Yakhmi to submit medical claims to Medicare, Medicaid and private insurers.
Yakhmi knowingly submitted or caused to be submitted claims for patient office visits and medical services, including, but not limited to psychological tests, pulmonary stress tests and audio tests, knowing that such services were wrongfully coded, medically unnecessary or not provided to his patients.
In addition, on Wednesdays during part of 2006 and 2007, Yakhmi refused to accept insurance and accepted cash only from his patients for medical services and office visits which he knowingly failed to report as income on his 2006 and 2007 federal income tax returns.
The investigation discovered that in late 2006, Dr Yakhmi devised a scheme to evade federal income taxes by opening a checking account with Key Bank in the name of “Spyder Medical”. Dr. Yakhmi wrote checks from his business checking account with Huntington National Bank to “Spyder Medical” to make it appear as though he had purchased the equipment from “Spyder Medical” for his medical practice; thereby claiming a fraudulent expense of $108,000 on his 2006 Federal Income Tax return.
In November, 2007, Yakhmi terminated his contracts with Medicaid and Medicare as well as private insurance and began only accepting cash payments from his patients for all office visits and medical services. The investigation revealed that Yakhmi knowingly failed to report a significant amount of these cash payments as income to the IRS on his 2007 and 2008 federal tax income tax returns.
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Saturday, June 11, 2011
Novo Nordisk Inc., Pays $1.725 Million to Resolve Claims That its Sales Representatives Paid Pharmacists for Access to Confidential Patient Information
Novo Nordisk, Inc. has entered into a civil settlement agreement with the United States in which it has agreed to pay the United States and several states $1.725 million to resolve allegations that the company caused false or fraudulent claims to be submitted to the Medicaid program in connection with its marketing of the diabetes drugs Novolin, Novolin 70/30, Novolog, and Novolog 70/30.
The settlement was announced by Loretta E. Lynch, United States Attorney for the Eastern District of New York.
As alleged in the civil settlement agreement, Novo Nordisk sales representatives in four states and the District of Columbia made payments to Rite Aid pharmacists in exchange for those pharmacists recommending the Novolin and Novolog products. The pharmacists, together with Novo Nordisk sales representatives in those states, identified patients who were candidates to use Novolin or Novolog and communicated with physicians, patients, or other pharmacists to encourage them to use or recommend the use of those drugs. As part of these activities, the pharmacists accessed, or allowed Novo Nordisk representatives to access, confidential patient information, which was used for the purpose of conducting marketing events that were designed to switch patients from competitor diabetes drugs to Novolin or Novolog.
In addition to entering into the federal settlement and agreeing to enter into settlement agreements with the states, Novo Nordisk, which has not admitted to engaging in the conduct at issue, has also entered into a Corporate Integrity Agreement with the Department of Health and Human Services, Office of Inspector General.
The investigation that lead to the settlement began after a former Novo Nordisk sales representative filed a complaint against the company on behalf of the United States in the Eastern District of New York. Under the federal False Claims Act, a private individual who has uncovered fraud against the federal government may file a suit in federal court on behalf of the United States. If the United States is successful in resolving those claims, the individual who filed the complaint may receive a share of the recovery.
“We are committed to battling health care fraud, especially when money is exchanged in an attempt to impact treatment decisions,” stated United States Attorney Lynch. “The allegations in this case were particularly egregious because they involved the disclosure of confidential patient information.”
“When pharmaceutical companies pay kickbacks – as Novo Nordisk is alleged to have done – it is especially insidious because patients may not be receiving untainted medical advice,” said Tom O’Donnell, Special Agent-in-Charge of New York’s Office of the Inspector General for the Department of Health and Human Services. “When those in the health care industry insist on misusing private patient health information at taxpayer expense, they should not be surprised when they are held accountable for their actions.”
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Friday, June 10, 2011
U.S. Subsidiary of Belgian Pharmaceutical Manufacturer UCB S.A. Pleads Guilty to Off-Label Promotion; Company to Pay More Than $34 Million
WASHINGTON—The U.S. subsidiary of Belgian pharmaceutical manufacturer UCB S.A. pleaded guilty today to the off-label promotion of its epilepsy drug Keppra and will pay more than $34 million to resolve criminal and civil liability arising out of its illegal conduct, the Justice Department announced today.
Under the terms of the plea agreement before the U.S. Court for the District of Columbia, UCB Inc., which has its headquarters in Smyrna, Ga., pleaded guilty to a misdemeanor in connection with the company’s misbranding of Keppra, in violation of the Food, Drug and Cosmetic Act. Keppra was approved by the Food and Drug Administration (FDA) as an anti-epileptic drug, for the treatment of seizures in adults and children suffering from epilepsy. Keppra is not approved for the treatment of migraine, headache, psychiatric conditions or pain conditions. Once approved by the FDA, a manufacturer may not market or promote a drug for any use not specified in the FDA-approved product label. These uses are also known as unapproved or “off-label” uses.
The government alleged that UCB promoted the sale of Keppra for off-label use in the treatment of migraine by generating and disseminating posters representing that Keppra was safe and effective for treating migraine based on purportedly independent investigator-initiated studies. The posters did not disclose UCB’s sponsorship of these studies or that UCB’s own clinical trial had failed to demonstrate that Keppra was effective in treating migraine.
UCB will pay a $7.55 million criminal fine for the misbranding of Keppra and an asset forfeiture of $1.078 million.
In addition, UCB will pay $25.7 million to resolve civil allegations under the False Claims Act that the company illegally promoted Keppra and caused false claims to be submitted to government healthcare programs for a variety of off-label uses that were not medically accepted indications and therefore not covered by those programs, including headache, migraine, pain, bipolar, mood disorders and anxiety. The federal share of the civil settlement is $15,871,208, and the state Medicaid share of the civil settlement is $9,893,322.
“UCB put its pursuit of profits ahead of its obligations to patients,” said Ronald C. Machen Jr., U.S. Attorney for the District of Columbia. “Today’s guilty plea and UCB’s $34 million payout should remind drug companies that try to cleverly design off-label marketing schemes that we will not allow them to compromise patient safety.”
“Patients have a right to know that the drugs they are prescribed have been approved by the FDA as safe and effective for a particular use,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “Off-label promotion of pharmaceuticals undermines the FDA’s important role in protecting the public and is a drain on taxpayer dollars.”
“This settlement demonstrates the ongoing efforts to pursue violations of the False Claims Act and recover taxpayer dollars for Medicaid and other federal health care programs,” noted Dwight C. Holton, U.S. Attorney for the District of Oregon. “Our office will continue to work with whistleblowers and law enforcement to stop health care fraud.”
The civil settlement resolves two whistleblower lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act that are pending in Washington, D.C., and Oregon: United States ex rel. Root v. UCB, Civil Action No. 1:07-cv-1056, and United States ex rel. Maly v. UCB, Inc., Civil Action No. 1:08–cv-1161. As part of today’s resolution, the whistleblowers will receive payments totaling more than $2.8 million from the federal share of the civil recovery.
Also as part of the resolution accepted by the court, UCB has entered into an expansive corporate integrity agreement (CIA) with the Office of Inspector General of the Department of Health and Human Services. That agreement provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to this matter.
“Patients have a right to be prescribed drugs based on sound medical judgment - not on drug company payoffs or off-label promotions,” said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. “Taxpayers shouldn't have to pay for unlawful conduct.”
“Today’s guilty plea and settlement is evidence of the government’s continued commitment to hold pharmaceutical companies accountable when they undermine the drug approval process by promoting drugs for uses not approved by the FDA as safe and effective,” said Acting Director Kathleen Martin-Weis of FDA’s Office of Criminal Investigations. “We will continue to join forces with the Department of Justice and our law enforcement counterparts to seek this kind of criminal resolution when pharmaceutical companies put profits ahead of the public health and safety.”
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Thursday, June 9, 2011
City of Dallas to Pay $2.47 Million to Resolve Allegations That It Caused Improper Medicare and Medicaid Ambulance Clai
DALLAS—The City of Dallas has agreed to pay the U.S. and Texas $2.47 million and enter into certain compliance obligations to resolve allegations that it violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney James T. Jacks of the Northern District of Texas. The U.S. and Texas contend Dallas caused “upcoded” claims to be submitted to Medicare and Medicaid for city-dispatched 911 ambulance transports between 2006 and 2010. Dallas fully cooperated with the investigation, and by settling did not admit any wrong-doing or liability.
Ambulance services generally are coded either as basic life support level or advanced life support (ALS). ALS transports are reimbursed at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend Dallas directed its billing contractor to code every 911-dispatched transport at the ALS level, which indicates an ALS service was furnished and/or the patient’s condition necessitated an ALS intervention. The U.S. and Texas believe Dallas caused to be submitted for payment claims falsely representing to Medicare and Medicaid that such ALS services were appropriate and furnished by Dallas personnel when in fact no ALS-service was rendered and/or the patient did not require an ALS transport.
The U.S. and Texas initiated the investigation in response to an August 2009 whistleblower suit brought by Douglas Moore, a former employee of Dallas’ auditing department. Under the False Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the U.S. and Texas and collect a share of any proceeds recovered by the suit. Mr. Moore can receive up to 30 percent of the recovery under the settlement.
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Wednesday, June 8, 2011
Florida Radiology Clinic Midtown Imaging LLC, and Former Owners Midtown Imaging P.A. and PBC Medical Imaging to Pay $3 Million to Resolve Medicare False Claims Act Allegations
WASHINGTON – Midtown Imaging LLC, a radiology clinic, and its former owners Midtown Imaging P.A. and PBC Medical Imaging have agreed to pay $3 million to resolve allegations that the clinic violated the False Claims Act, the Justice Department announced today. The West Palm Beach clinic is alleged to have submitted false claims to Medicare during the period 2000 through 2008 by entering into certain leasing and professional services agreements with referring physicians and physician groups that violated the Anti-Kickback Statute and Stark Law.
The Anti-Kickback Statute, among other things, prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or other federally-funded programs. The Stark Law prohibits a hospital from profiting from patient referrals made by a physician with whom the hospital has an improper financial arrangement. Both the Anti-Kickback Statute and the Stark Law are intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and are based solely on the best interests of the patient.
“The Justice Department is committed to investigating cases that threaten the integrity of the Medicare program,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. “The department will continue to protect patients by pursuing federal health care providers that have improper financial relationships with referring physicians.”
“We are deeply satisfied with today’s settlement and encourage potential whistleblowers to come forward with evidence of wrongdoing affecting the Medicare program,” said Wifredo Ferrer, U.S. Attorney for the Southern District of Florida. “We are committed to fighting fraud and abuse to help preserve scarce Medicare funds for those who need it the most, the sick and the elderly.”
Midtown Imaging was named as a defendant in a suit brought in 2009 by two former Midtown Imaging radiologists under the whistleblower provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and to share in any recovery. The lawsuit alleged that Midtown Imaging entered into prohibited financial relationships with certain physicians and physician groups. Under the civil settlement announced today, the whistleblowers, Dr. Teresa M. Cortinas and Dr. Walter E. Wojcicki, will receive $600,000.
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Tuesday, June 7, 2011
Dr. Robert Williams Pleads Guilty to Billing Medicare and Medicaid for Counseling Sessions with Dead Patients
ATLANTA—ROBERT WILLIAMS, 72, of Atlanta, Georgia, pleaded guilty today in federal district court on two counts of health care fraud as part of a scheme to bill for group psychological therapy that WILLIAMS never provided.
United States Attorney Sally Quillian Yates said, “With so many elderly citizens and others who need specialized psychological care, this defendant ignored his duty as a doctor and became a billing machine who claimed to treat patients who were in fact dead. This blatant attempt to rip off the system took funds and care away from real live patients with real problems. Medicare and Medicaid need all the money they can get for legitimate patient care and this physician will get none of that money.”
“This case sends a strong message that Medicare and Medicaid fraud will not be tolerated in Georgia,” said Georgia Attorney General Sam Olens. “At a time when our state budget is heavily strained, every dollar intended for the needy must reach the recipient. We will continue to work with our partners, the U.S. Attorney’s Office, and the FBI, to weed out fraud in Georgia.”
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “Dr. Williams had for years, enjoyed a position of trust within the medical and health provider industry. He chose to abandon that trust and instead displayed a level of greed that will not be tolerated. Medicare fraud should be promptly reported to the nearest FBI field office so that the much needed federal health care benefits will be there for those individuals who truly need them.”
According to United States Attorney Yates, the charges, and other information presented in court: WILLIAMS was a licensed physician, practicing in the Atlanta area. From approximately July 2007 through October 2009, he contracted with a medical services company to provide group psychological therapy to nursing home patients in a variety of nursing homes. Under his signature, thousands of claims were submitted to Medicare and Georgia Medicaid seeking reimbursement for group psychological therapy that WILLIAMS purportedly provided to beneficiaries at several nursing homes in the Atlanta area. In many instances, however, WILLIAMS did not actually provide the therapy.
Specifically, from July 2007 through October 2009, Medicare claims data indicated that over 55,000 claims were submitted using WILLIAMS’ provider number for group psychological therapy. Those claims sought reimbursement for over $2,000,000, and ultimately caused Medicare to reimburse WILLIAMS over $750,000. For the same time period, over 40,000 Medicaid claims were submitted by WILLIAMS for group psychological therapy, causing Georgia Medicaid to pay out over $225,000.
An investigation of WILLIAMS’ claims showed that, in many cases, he sought payment for services provided to beneficiaries who were deceased at the time he purportedly rendered the care. In two cases, the patient died over a year before he was allegedly seen by WILLIAMS in the nursing home. Numerous claims were submitted to Medicare and Medicaid for group psychological therapy when the beneficiary was hospitalized at the time of service and, consequently, could not have received care at the nursing home as represented.
WILLIAMS was indicted on February 22, 2011 on 10 counts of health care fraud. Today WILLIAMS pleaded guilty to two of those counts. He could receive a maximum sentence of 10 years in prison and a fine of up to $250,000 for each count. In determining the actual sentence, the court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.
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Monday, June 6, 2011
Nicodemus Udofia Pleaded Guilty of Health Care Fraud
TYLER, TX—A 51-year-old Tyler man has pleaded guilty to federal health care fraud charges in the Eastern District of Texas, announced U.S. Attorney John M. Bales today.
Nicodemus Udofia pleaded guilty on May 31, 2011, to health care fraud and illegal remunerations charges before U.S. Magistrate Judge Judith K. Guthrie. According to information presented in court, from 2006 to 2008, Udofia, the owner of a medical equipment business in Tyler, submitted claims to Medicare and Medicaid for medical equipment and supplies which were not provided to beneficiaries. As a result of these claims, Udofia unlawfully obtained more than $50,000 from Medicare and Medicaid. Udofia also offered to pay illegal remunerations, or cash kickbacks, in exchange for patient information that he could use to submit claims to Medicare and Medicaid. Udofia was indicted by a federal grand jury on June 3, 2010.
Udofia faces up to 10 years in federal prison at sentencing. A sentencing date has not been set.
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Saturday, June 4, 2011
Jo Ann Girod Sentenced to Federal Prison for Health Care Fraud
NEW ORLEANS, LA—JO ANN GIROD, age 36, a resident of Marrero, Louisiana, was sentenced today in federal court by U.S. District Judge Mary Ann Lemmon to 12 months and one day imprisonment for health care fraud, announced U.S. Attorney Jim Letten. GIROD was also ordered to pay restitution in the amount of $65,131 to the Louisiana Medicaid program. In addition to the term of imprisonment, Judge Lemmon ordered that GIROD be placed on three years of supervised release following the term of imprisonment, during which time the defendant will be under federal supervision and risks an additional term of imprisonment should she violate any terms of her supervised release.
According to court documents, A New Beginning of New Orleans, Inc.(ANBNO), was a Medicaid Provider located in Harvey, Louisiana that made claims for personal care services it claimed to have provided to Medicaid recipients. Personal care Sservices (PCS) are Medicaid services provided by attendants to eligible recipients meeting the medical necessity criteria who are unable to care for themselves. ANBNO solicited mothers with children who had Medicaid benefits to apply for PCS.
GIROD, the mother to three children who were Medicaid recipients, signed forms and represented that ANBNO provided PCS services to each of her children for two hours a day every day between April, 2001 and February, 2005. Instead of providing PCS, ANBNO workers assigned to care for GIROD’S children paid GIROD cash kickbacks for the use of her children’s Medicaid information. Based upon this fraudulent information, Medicaid paid approximately $65,131 to ANBNO for services that were not performed related specifically to GIROD’S children.
From the time of the inception of ANBNO, through May 4, 2005, Medicaid paid approximately $3,977,288 as a result of the fraudulent claims made by ANBNO and its employees. On September 9, 2009, three other workers and parents associated with ANBNO were convicted after a jury trial. Additionally, several other employees were convicted after guilty pleas, as was AKASIA LEE, the owner of ANBNO.
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Friday, June 3, 2011
Federal Jury Convicts Umawa Imo, Kenneth Anokam and Dr. Christina Clardy in Medicare Fraud Scheme
HOUSTON—After approximately 12 hours of deliberation, a Houston jury has convicted Umawa Imo, 57, a citizen of the Federal Republic of Nigeria; Kenneth Anokam, 56, a naturalized citizen; and Houston physician Dr. Christina Clardy, 61, United States Attorney Angel José Moreno announced today. Clardy, previously released on bond, was taken into custody after the verdict was returned. Imo and Anokam, already in federal custody since 2009, were ordered to remain in custody. Dr. Thaddeus Hume, 63, another Houston-area physician, was acquitted of all charges.
Today’s verdict found Imo guilty of conspiracy to commit health care fraud, 39 counts of health care fraud, three counts of mail fraud, and five counts of money laundering; Anokam was found guilty of conspiracy, 27 counts of health care fraud, and four counts of structuring; while Clardy was found guilty of conspiracy, 14 counts of health care fraud, and three counts of mail fraud.
The second superseding indictment, returned on March 25, 2010, charged Imo, Anokam, Clardy, Hume, and two others—who are believed to have fled the United States—with various federal crimes, including one count of conspiracy to commit health care fraud and 39 substantive health care fraud counts. Three counts of mail fraud were also charged which related to paper checks valued at approximately $180,448 that were mailed by the Medicaid contract administrator, Texas Medicaid and Healthcare Partnership, to City Nursing Services of Texas Inc., a business owned by Imo, in lieu of electronic fund deposits. The charged also included five counts of money laundering related to five transactions totaling $2,805,195 from a City Nursing bank account for referrals, the purchase and shipping of tankers to Lagos, Nigeria, as well as a check for more than $1 million payable to Imo himself and four counts of structuring financial transactions to avoid reporting requirements related to a series of bank withdrawals over a two-week period by Anokam. Another co-defendant, Joann White, pleaded guilty to conspiracy to commit health care fraud on Feb. 12, 2010 and was called to testify at the trial by the United States.
During the 13-day trial beginning May 9, 2011, the jury learned that City Nursing Services of Texas Inc., a clinic located on the 9800 block of Bissonnet Street in Houston, billed Medicare and Medicaid for approximately $45 million worth of physical therapy services they did not provide over a two-and-a-half-year period. By March 2009, Medicare and Medicaid had paid approximately $30 million on the physical therapy claims. Between March 2009 and June 2009, approximately $4 million in payments were withheld by Medicare due to lack of documentation of services rendered.
Jurors heard testimony from numerous Medicare and Medicaid beneficiaries about how they were paid for coming to the clinic and signing undated blank treatment forms. One beneficiary testified that when she asked for physical therapy she was told the clinic did not provide that type of services and was instructed to go to her primary care physician for a referral. Another beneficiary described the clinic as looking like an unemployment office with people just hanging out and referred to a day when he saw an employee direct a patient to make a pot of coffee. There was no licensed physical therapist working at the clinic and “treatments” were predominantly limited to short massages and hot packs. Beneficiaries could use the treadmills and other exercise equipment at their own will. Three former employees of the clinic testified about how they handed out cash given to them by Imo and Anokam to beneficiaries and to “recruiters” or “marketers” who brought beneficiaries to the clinic. Beneficiaries were paid once a month when they came to see the doctor; however, those beneficiaries who took Medicare Explanation of Benefit statements into the office to complain about the fraudulent billing were given extra payments, sometimes $200 - $300, to “settle” matters. The employees also testified about how the clinic billed Medicare for treatment that was not provided, including treatment for numerous individuals who were deceased. According to the employees, Imo and Anokam enlisted their help to create false and fraudulent patient file documents to reflect physical services that had not been provided.
Medicare and Medicaid experts explained to the jury that when physical therapy services are billed under a physician’s Medicare provider number, as was the case here, the physician must be qualified to provide physical therapy and either personally provide the services, or be present in the office directly supervising the provision of the services.
Clardy took the stand and testified that she did not sign certain Medicare and Medicaid documents; however, she was unable to recall whether or not she had authorized anyone else to sign the documents. The United States introduced a letter sent by Clardy to the owner of the clinic, Imo, in July of 2007—a year before she left the clinic. The letter showed her knowledge of the fraudulent activities at the clinic and requesting that Imo immediately cease billing Medicare under her physician provider number. In it, Clardy also threatened to notify Medicare of the fraud. The United States also introduced evidence showing that not long after the July 2007 letter, Clardy began receiving substantial monthly payments from Imo along with evidence that Clardy allowed Imo to fraudulently bill an additional $21 million under her number between August 2007 and August 2008. A total of $29 million was billed under Clardy’s Medicare number by City Nursing.
United States District Court Judge Melinda Harmon, who presided over the case has scheduled sentencing for Sept. 9, 2011, for the defendants. The possible punishment for health care fraud, conspiracy to commit health care fraud, and money laundering is a maximum 10 years in prison and a $250,000 fine, while mail fraud carries a possible punishment of up to 20 years in prison. Structuring carries a possible punishment of up to 10 years in prison and a $500,000 fine.
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Thursday, June 2, 2011
Mark W. Izard Pays $2.2 Million to Settle Allegations Under the False Claims Act
David B. Fein, United States Attorney for the District of Connecticut, today announced that MARK W. IZARD, M.D., a physician with a medical practice located at 85 Seymour Street, Hartford, Connecticut, and MARK W. IZARD, P.C., his professional corporation, have entered into a civil settlement with the government in which they will pay $2.2 million to resolve allegations that IZARD violated the False Claims Act.
U.S. Attorney Fein explained that the allegations against IZARD involve fraudulent billing to Medicare and Medicaid for medical services allegedly provided at various Hartford-area nursing homes, as well as at Hartford Hospital. The government alleges that IZARD billed Medicare and Medicaid for services he supposedly provided to patients in nursing homes when the patients were, in fact, not present in the nursing homes. Instead, the patients had been transferred to local hospitals for treatment. Yet IZARD billed government health care programs as if he had provided medical services to the patients in the nursing homes.
In addition, the government alleges that IZARD improperly billed Medicare and Medicaid for medical services at Hartford Hospital that were actually provided by Hartford Hospital nurses and medical residents. IZARD would regularly bill for services when the medical note in the patients’ charts clearly indicated that the services in question were performed by Advanced Practice Registered Nurses or Hartford Hospital medical residents. It was IZARD’s regular practice to countersign the note in question and to not include his own note reflecting any services he allegedly performed as the attending physician.
Pursuant to these improper billing practices, IZARD was able to bill the government on numerous occasions for more than 24 hours of medical services in a single day.
To resolve their liability under the False Claims Act, IZARD and his professional corporation will pay $2.2 million, in order to reimburse the Medicare and Medicaid programs for conduct occurring between July 1, 2004 and April 30, 2009.
In addition, under the terms of the settlement agreement, IZARD and his professional corporation are excluded from Medicare, Medicaid, and all other federal health care programs, for a period of seven years. This exclusion has national effect and prohibits IZARD and his professional corporation from receiving payment from any federal health care program during the exclusion period. It also prohibits payment to any individual or entity, such as a hospital, which employs or contracts with IZARD, for any services furnished, ordered, or prescribed by IZARD.
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Wednesday, June 1, 2011
Isachi Gil Convicted of Health Care Fraud and False Statements Regarding Health Care Matters
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigations, Miami Regional Office, announced that a federal jury in Miami found Isachi Gil, 36, of Doral, Florida, guilty of health care fraud and making false statements related to health care matters. More specifically, after a three week trial, the jury convicted Gil of five counts of health care fraud, in violation of Title 18, United States Code, Section 1347, and six counts of false statements related to health care matters, in violation of Title 18, United States Code, Section 1035.
Sentencing is scheduled for July 27, 2011 before U.S. District Judge Marcia Cooke. Gil faces a statutory maximum of 10 years’ imprisonment as to each of the fraud charges, and five year imprisonment as to each of the false statement charges.
According to the evidence presented at trial, Gil was a registered nurse employed by 13 separate Miami-Dade based home health care agencies. As part of her job as a home health nurse, Gil provided skilled nursing services to Medicare beneficiaries that were homebound, diabetic, insulin-dependent, and so ill that they were unable to inject themselves with insulin. Under Medicare regulations, Gil was required to keep records of each time she provided a skilled nursing service to a Medicare beneficiary. Between March 2007 and July 2009, Gil completed hundreds of documents in which she claimed that she had injected Medicare beneficiaries with insulin two times a day, seven days per week.
At trial, however, the evidence showed that at least two of the Medicare beneficiaries that the defendant claimed to be injecting with insulin were not diabetic. In addition, the evidence showed more than 160 instances in which the defendant was out of the country, including being in Panama, Mexico, or the Dominican Republic, during the dates that she claimed to be providing skilled nursing services to Medicare beneficiaries. As well, the defendant signed dozens of documents claiming that she was providing skilled nursing services when, in fact, she was attending classes at Florida International University. Also, the defendant claimed to be providing skilled nursing visits to two and three patients simultaneously, double and triple billing Medicare. The defendant’s false statements resulted in the submission of hundreds of thousands of dollars in false claims to Medicare for services that were either not medically necessary or provided to Medicare beneficiaries.
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