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

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

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

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

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

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

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

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



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

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

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

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

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



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

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

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

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

Jimenez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. Jimenez was charged in an indictment unsealed on Feb. 15, 2011, in the Southern District of Florida.

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

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

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

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

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



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

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

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

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

According to testimony presented at trial, from February 2006 through August 2008, Vardges Egiazarian, 63, of Panorama City, owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael. Egiazarian and others recruited doctors to submit applications to Medicare for billing numbers. Popov assumed the role of co-owner and practitioner at the Sacramento clinic, and claims were be submitted to Medicare under his name for medical services purportedly rendered at the clinic.

In fact, Popov never treated a single patient at the clinics. Clinic patients, almost all of whom were elderly and non-English speaking, were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally in the amount of $100 per visit. Patient charts were created falsely stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.

Patient files were then transported to Southern California, where Popov would sign them indicating he provided or approved the treatments therein, and sign related billing forms. These files were then used to support billing submitted to Medicare for treatments and services that were unnecessary, never performed, or both. In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. In return for their roles, Popov and the other involved physicians received 20 percent of the billings paid under their respective provider numbers.

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



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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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



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

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

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

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

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

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



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Barry Nash Pleads Guilty to Fraud and Kickback Scheme

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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



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Ambulance Company Worker Ivan Tkach Pleads Guilty to Fraud Scheme

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

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

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



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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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



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Tausif Rahman Pleads Guilty in Connection with Detroit Medicare Fraud Scheme

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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



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

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

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

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

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



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

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

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

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

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

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

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



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

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

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

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

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

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

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

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



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