Source- http://www.justice.gov/opa/pr/2012/February/12-crm-208.html
WASHINGTON – The co-owner of two Los Angeles-area health care companies was sentenced today to 96 months in prison for his conviction stemming from a nine-year scheme to defraud Medicare, announced the Departments of Justice and Health and Human Services (HHS).
U.S. District Judge Stephen V. Wilson also ordered Evans Oniha, 49, to pay $7 million in restitution and to serve three years of supervised release following his prison term. A federal jury in the Central District of California found Oniha guilty on July 7, 2011, of one count of conspiracy to commit health care fraud, four counts of health care fraud and one count of false statements relating to health care matters.
According to court documents, in 2002, Oniha and co-defendant Camillus Ehigie founded and began operating Prosperity Home Health Services Inc., a home health agency, and Caravan Medical Supplies Inc., a durable medical equipment (DME) company. According to testimony presented at trial, from October 2002 to February 2011, Oniha conspired with Ehigie and others to defraud Medicare by paying “marketers” for Medicare beneficiary information, fraudulent prescriptions and other documents for DME and home health services. Testimony at trial showed that the marketers were individuals who acquired patient Medicare numbers and doctors’ prescriptions and sold them to Oniha. Oniha used these fraudulent documents to submit and cause the submission of false claims to Medicare for DME and home health services that were not medically necessary and that often were not provided to Medicare beneficiaries. According to court documents, Oniha caused Prosperity to submit approximately $8 million in fraudulent claims to Medicare for home health services purportedly provided by Prosperity. Oniha caused Caravan to submit approximately $5.8 million in fraudulent claims to Medicare for DME purportedly provided by Caravan.
On July 5, 2011, Ehigie pleaded guilty to 11 counts of health care fraud, one count of conspiracy to commit health care fraud, one count of making false statements in a federal health care investigation and one count of obstructing a criminal health care investigation. Ehigie is scheduled to be sentenced on July 9, 2012.
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Source- http://www.fbi.gov/charlotte/press-releases/2012/charlotte-woman-sentenced-to-34-months-in-prison-for-health-care-fraud
CHARLOTTE, NC—A Charlotte woman was sentenced yesterday in U.S. District Court to serve 34 months in prison to be followed by three years of supervised release for committing health care fraud, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. U.S. District Judge Frank D. Whitney also ordered Darlene Hughes, 53, of Charlotte, to pay total restitution in the amount of $194,436.61.
U.S. Attorney Tompkins is joined in making today’s announcement by Derrick Jackson, Special Agent in Charge of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region, and Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division.
In August 2010, Hughes entered a plea of guilty to one count of health care fraud. According to a federal criminal bill of information and plea documents, Hughes stole the name and license of a speech therapist and falsely and fraudulently held herself out to be a licensed speech therapist. Hughes then obtained employment as a speech therapist at two local nursing homes and assisted living facilities who relied upon her misrepresentations. According to filed court documents and statements made in court, Hughes’ fraud caused those facilities to submit hundreds of claims to Medicare for services which Hughes was not qualified to provide, defrauding the facilities and Medicare of more than $142,000.
In issuing the sentence in this case, Judge Whitney noted that the scheme to defraud involved a “level of sophistication and skill of deceit that is pretty overwhelming.”
Hughes has been on release since entering her guilty plea in August 2010 and was permitted to self-report to the Federal Bureau of Prisons upon designation of a facility. Federal sentences are served without the possibility of parole.
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Source- http://www.fbi.gov/neworleans/press-releases/2012/louisiana-patient-recruiter-pleads-guilty-in-health-care-fraud-scheme
WASHINGTON—A Baton Rouge area-resident pleaded guilty today for his role in a Medicare fraud scheme involving false claims for unnecessary durable medical equipment (DME), announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS) and the Louisiana State Attorney General’s Office.
Rodney D. Taylor, 45, pleaded guilty before U.S. District Judge James J. Brady of the Middle District of Louisiana to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive health care kickbacks.
According to court documents, Taylor worked as a recruiter for Healthcare 1 LLC, Medical 1 Patient Services LLC and Lifeline Healthcare Services Inc., Louisiana-based companies that fraudulently billed DME to the Medicare program from 2004 to 2009. He and other recruiters were hired to obtain prescriptions for DME such as leg braces, arm braces, power wheel chairs and wheel chair accessories. Taylor obtained information from Medicare beneficiaries as well as prescriptions for medical equipment from the beneficiaries’ physicians. Taylor then sold these prescriptions so they could be used by Healthcare 1, Medical 1 Patient Services and Lifeline Healthcare Services to submit fraudulent claims to the Medicare program.
The indictment alleges that from 2004 to 2009 Medicare was billed more than $21 million as part of this conspiracy.
Taylor faces a maximum penalty of 15 years in prison and a $500,000 fine. A sentencing date has not yet been set.
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Source- http://www.fbi.gov/losangeles/press-releases/2012/los-angeles-man-sentenced-to-77-months-in-prison-for-medicare-fraud-scheme-resulting-in-more-than-18.9-million-in-fraudulent-claims-to-medicare
WASHINGTON—A Los Angeles-area man was sentenced yesterday to 77 months in prison for organizing and leading a medical clinic fraud scheme that used the stolen identities of physicians to submit more than $18.9 million in fraudulent claims to Medicare, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced.
Eduard Aslanyan, 38, of Sherman Oaks, Calif., was sentenced by U.S. District Judge Consuelo B. Marshall in the Central District of California. In addition to his prison term, Aslanyan was sentenced to three years of supervised release and was ordered to pay $10.8 million in restitution.
Aslanyan pleaded guilty in April 2011. He admitted that between March 2007 and September 2008, he established a series of fraudulent medical clinics in and around Los Angeles to defraud Medicare. Carolyn Vasquez, who previously pleaded guilty to conspiring with Aslanyan to defraud Medicare, recruited physicians to serve as the medical directors of Aslanyan’s fraudulent medical clinics. The physicians did not perform services at the clinics and were rarely present at the clinics. Physician assistants were hired by Aslanyan and Vasquez and were complicit in the fraud scheme at the clinics.
According to court documents, Aslanyan hired patient recruiters to find Medicare beneficiaries who were willing to provide the recruiters with their Medicare billing information in exchange for expensive, high-end power wheelchairs and other medical equipment which the patient recruiters told the beneficiaries they could receive for free. Often, the Medicare beneficiaries did not have a legitimate medical need for the power wheelchairs and equipment. The patient recruiters then provided the beneficiaries’ Medicare billing information to Aslanyan or brought the beneficiaries to Aslanyan’s clinics. Aslanyan paid the patient recruiters cash kickbacks in exchange for recruiting the Medicare beneficiaries.
In court documents, Aslanyan admitted that he and Vasquez instructed and paid physician assistants who worked at his clinics to prescribe medically unnecessary power wheelchairs, medical equipment and diagnostic tests for the Medicare beneficiaries. The physician assistants used stolen identities of physicians who did not supervise them or work at the clinics.
According to court documents, Aslanyan profited from the scheme at his fraudulent medical clinics in several ways. Aslanyan admitted that he allowed fraudulent diagnostic testing facilities to use the Medicare billing information he purchased from patient recruiters to submit false claims to Medicare for tests ordered at the clinics. In exchange, the fraudulent diagnostic testing facilities paid Aslanyan cash kickbacks that were disguised as rent payments to Aslanyan.
Aslanyan also profited from the scheme by selling fraudulent prescriptions and documents generated at his clinics to the owners and operators of fraudulent durable medical equipment (DME) supply companies, which used the prescriptions and documents to submit false claims to Medicare. Aslanyan also used the fraudulent prescriptions and documents to submit false claims to Medicare through his own fraudulent DME supply companies, Vila Medical Supply Inc. and Blanc Medical Supplies.
According to court documents, as a result of Aslanyan’s conduct, he and his co-conspirators submitted approximately $18.9 million in fraudulent claims to Medicare.
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Source- http://www.justice.gov/opa/pr/2012/February/12-civ-182.html
Dava Pharmaceuticals Inc. has agreed to pay the United States $11 million to settle allegations that it violated the False Claims Act by misreporting drug prices in order to reduce its Medicaid Drug Rebate obligations, the Justice Department announced today.
The settlement resolves allegations that between Oct. 1, 2005 and Sept. 30, 2009, Dava and its corporate predecessors knowingly underpaid their rebate obligations under the Medicaid Prescription Drug Rebate Program. Under that program, participating drug companies are required to pay quarterly rebates to state Medicaid programs based, in part, on whether a drug is a “generic” or “branded” product and the difference between what the health care program paid for the drug and prices paid by other purchasers.
In order to reduce its Medicaid rebate obligation, Dava incorrectly treated its version of the drugs cefdinir, clarithromycin and methotrexate as “generic” drugs rather than “branded” products, thereby lowering the overall percentage rebate payable to Medicaid. In addition, Dava further reduced its Medicaid rebate obligations by incorrectly calculating average manufacturer prices for its versions of the drugs cefdinir, clarithromycin, methotrexate and rheumatrex. As a result, Dava underpaid drug rebates to the Medicaid program and overcharged certain public health service entities for these products.
“Pharmaceutical companies that participate in Medicaid must accurately report drug prices and pay their fair share of rebates to the federal and statement governments,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “Settlements like this one help maintain important programs on which so many depend for needed health care.”
The federal government’s portion of the settlement is approximately $5.7 million. Dava will also pay over $5 million to the Medicaid participating states and approximately $200,000 to certain public health services entities who paid inflated prices for the drugs at issue.
The settlement resolves a lawsuit filed in federal court in the District of Maryland under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. As part of today’s resolution, the whistleblower – Jim Conrad – will receive 15 percent of the settlement proceeds.
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Source- http://www.justice.gov/opa/pr/2012/February/12-crm-181.html
WASHINGTON – An assistant administrator of a Houston hospital was arrested today on charges related to his alleged participation in a $116 million Medicare fraud scheme involving false claims for mental health treatment, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
An indictment filed in the Southern District of Texas and unsealed today charges Mohammed Khan, 62, of Houston, with one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive illegal health care kickbacks and five counts of paying or offering to pay health care kickbacks. Khan is expected to make his initial appearance in federal court today in Houston.
“The indictment against Mr. Kahn alleges that he used his position as a hospital assistant administrator to submit millions in false claims to the Medicare program,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “According to the charges, he paid kickbacks to patient recruiters, owners of group homes and assisted living facilities, and beneficiaries so that he could fill his hospital with patients for whom he could bill the government for medically unnecessary services or services that were never provided. We will continue aggressively to pursue individuals who attempt to enrich themselves at the expense of the Medicare program.”
“The defendant charged in this indictment is accused of stealing precious Medicare resources by billing for services that were medically unnecessary or never provided," said Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office. “Our health care fraud efforts have never been more collaborative and aggressive. We will continue to work with our law enforcement partners to protect patients and fight against health care fraud.”
According to the indictment, Khan, as the assistant administrator of a Houston hospital, allegedly operated a scheme to defraud Medicare beginning in 2008 and continuing until his arrest today. Khan allegedly caused the submission of false and fraudulent claims for partial hospitalization program (PHP) services to Medicare through the hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.
The indictment alleges that Khan paid kickbacks to owners and operators of group care homes and assisted living facilities and to patient recruiters in exchange for delivering ineligible Medicare beneficiaries to the hospital’s PHPs. The indictment alleges that Khan also paid kickbacks to Medicare beneficiaries who attended the hospital’s PHPs. These kickbacks included cigarettes, food and coupons redeemable for items available at the hospital’s “country stores.” Khan and his co-conspirators submitted or caused to be submitted approximately $116 million in claims to Medicare for PHP services purportedly provided by the hospital to the recruited beneficiaries, when in fact, the PHP services were medically unnecessary or never provided.
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Source- http://www.fbi.gov/birmingham/press-releases/2012/former-hospice-owner-sentenced-for-health-care-fraud
BIRMINGHAM—A federal judge today sentenced a Muscle Shoals man to 28 months in prison for taking part in a health care fraud totaling more than $3 million in connection to a hospice care program he operated, announced U.S. Attorney Joyce White Vance, FBI Special Agent in Charge Patrick Maley and Health and Human Services, Office of Inspector General, Special Agent in Charge Derrick Jackson.
U.S. District Judge Inge P. Johnson sentenced JACKIE RANDOPLH GIST, 55, for engaging in a criminal conspiracy to defraud Medicare from about March 2006 to July 2009. During that time, Gist operated Good Samaritan Hospice USA Inc., an Alabama corporation that provided hospice care in Muscle Shoals. Gist pleaded guilty in September to one count of conspiracy to commit health care fraud and three counts of health care fraud and agreed to forfeit $3,192,285 to the government as proceeds of illegal activity. Gist must report to prison April 2.
“In three years this defendant stole more than $3 million from the Medicare program, costing all U.S. taxpayers,” Vance said. “This office will not tolerate such fraud and remains committed to aggressively prosecuting individuals and companies that seek to steal from government programs.”
Medicare’s hospice benefit program allows a beneficiary with a terminal illness to forgo curative treatment for the illness and instead receive palliative care, which is the relief of pain and other uncomfortable symptoms.
Gist’s scheme involved submitting claims to Medicare for amounts greater than warranted for the services provided, according to the charges and his plea agreement. The billing code which Gist caused GSH to submit to Medicare is generally used for services provided in an inpatient facility for pain control or acute or chronic symptom management that cannot be managed in other settings and is typically provided in the short-term. However, the services GSH provided were routine services, not inpatient services.
As a result of the scheme, GSH received reimbursements from Medicare totaling $4,108,924 when, if the correct code had been used, GSH would have been reimbursed $916,639. Accordingly, the fraud resulted in a loss to the Medicare program of about $3,192,285.
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Source- http://www.fbi.gov/sanantonio/press-releases/2012/dme-business-owner-lands-in-federal-prison-for-10-years-for-health-care-fraud-and-identity-theft-scheme
MCALLEN, TX—Juan De Leon, 41, of Edinburg, Texas and owner of United DME Inc., was sentenced today to 120 months in federal prison without parole for his role in a health care fraud and identity theft scheme, United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott announced today.
Following a four-day trial and approximately an hour of deliberations in late September 2011, a federal jury in McAllen convicted De Leon on charges of conspiracy, health care fraud, and aggravated identity theft related to his scheme to submit fraudulent claims to Medicare and Medicaid for a variety of medical items including power wheelchairs and diabetic supplies. At a hearing this morning, U.S. District Judge Randy Crane, who presided over the trial, sentenced De Leon to 120 months in federal prison, the statutory maximum prison sentence for health care fraud, and ordered him to pay $750,000 in restitution to Medicare and Medicaid. De Leon will also have to serve a three-year term of supervised release upon completion of his prison term.
De Leon owned and operated United DME Inc.—a durable medical equipment (DME) company located in Weslaco, Texas. During the trial, the United States presented evidence that from 2007 through 2010, De Leon directed his employees to submit false and fraudulent claims to Medicare and Medicaid for power wheelchairs that were not delivered and for diabetic supplies and other medical items that were not delivered. The jury heard evidence that instead of providing the medically necessary power wheelchairs prescribed by the patients’ doctors, De Leon would instead provide the patients with less expensive, and more difficult to operate, scooters that they could not use. In other cases, De Leon or his staff submitted claims to Medicare and Medicaid for medical items allegedly delivered after the beneficiary had passed away. According to evidence at trial, De Leon attempted to conceal the scheme by altering records contained within patient files including backdating delivery tickets and forging patient signatures on delivery tickets.
At today’s sentencing hearing, the United States presented additional evidence that during the investigation and prosecution of the case, De Leon obstructed justice by altering and forging patient files prior to producing them to investigators. In addition, De Leon attempted to influence and intimidate government witnesses by instructing them to lie to investigating agents about various matters.
Previously on bond, De Leon was ordered into federal custody following the jury’s verdicts in September where he has remained and will remain pending transfer to a Bureau of Prisons facility to be determined in the near future.
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Source- http://www.fbi.gov/miami/press-releases/2012/fort-lauderdale-florida-area-halfway-house-owner-sentenced-to-28-months-in-prison-for-participating-in-medicare-fraud-kickback-scheme
WASHINGTON—The owner and president of a Fort Lauderdale-area halfway house company was sentenced today to 28 months in prison for her role in a kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Natalie Evans, 50, was sentenced by U.S. District Judge Jose E. Martinez in the Southern District of Florida. In addition to her prison term, Evans was sentenced to three years of supervised release and was ordered to pay $253,867 in restitution.
Evans pleaded guilty in October 2011 to one count of conspiracy to commit health care fraud. Evans was the president of Vision of Hope Recovery Inc., which operated five halfway houses in Fort Lauderdale.
According to court documents, most of the residents at Evans’s halfway houses were recovering from drug and/or alcohol addictions, and some had recently been released from prison. ATC purported to operate partial hospitalization programs (PHPs) in seven different locations throughout south Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness.
According to court documents, Evans agreed to provide Medicare beneficiaries from Vision of Hope halfway houses to ATC for PHP services. Evans admitted that she knew the beneficiaries at her halfway houses needed day treatment for addiction and not PHP services. Evans also knew that ATC fraudulently billed the Medicare program for the PHP services provided to the beneficiaries she referred to ATC. According to court documents, Evans gave patient information, such as Medicare numbers, to a co-conspirator, and the patients were then transported to and from ATC by ATC employees.
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. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare for more than $200 million in medically unnecessary services.
According to the plea agreement, Evans’s participation in the fraud resulted in more than $645,975 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 10 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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Source- http://www.fbi.gov/sanantonio/press-releases/2012/pharmacy-owner-pleads-guilty-to-conspiring-to-commit-health-care-fraud
MCALLEN, TX—Sara Elicia Garza, 55, of Mission, Texas, has been convicted of conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott. Garza is a pharmacist and the owner and operator of Sara’s Pharmacy and Gift Corner located in Mission.
Garza pleaded guilty to conspiracy to commit health care fraud at a hearing held earlier today before U.S. District Judge Randy Crane. At that hearing, Garza admitted she participated in the conspiracy to defraud the Texas Medicaid/Vendor Drug program by submitting false and fraudulent claims for prescription medication that was not dispensed or provided. Specifically, Garza admitted the claims were false and fraudulent for one or more of a variety of reasons—medications were never provided or dispensed, the beneficiary had never seen the physician purporting to prescribe the medication, prescription medications were written for the treatment of medical conditions that the beneficiary did not have, claims were for refills of prescription medications authorized by a physician but which the beneficiary did not request and did not receive, and/or that the prescription medications were never dispensed to beneficiaries but were billed (referred to as “running extras” by Garza and her co-conspirators) in lieu of collecting co-pay for prescriptions that were actually dispensed or in lieu of collecting money for purchases from the Sara’s Pharmacy Gift Store.
Garza also admitted that to cover up the fraud and conspiracy, she and her co-defendant, Valerie Flores, 38, also of Mission, along with other unindicted co-conspirators, forged prescriptions, doctors’ signatures on prescriptions, patients’ signatures on logs that purportedly indicated that a customer beneficiary had received medications, and altered pharmacy records. Flores previously pleaded guilty to conspiracy to commit health care fraud on Dec. 16, 2011, and is scheduled for sentencing April 5, 2012.
Garza faces a maximum punishment of 10 years in prison and up to a $250,000 fine plus up to three years of post-prison supervised release. Her sentencing hearing is set for April 16, 2012. Garza was permitted to remain on bond pending sentencing, at which time the court will also decide the amount of restitution to be ordered in the matter.
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Source- http://www.justice.gov/opa/pr/2012/February/12-crm-165.html
WASHINGTON – An owner of multiple Baton Rouge medical equipment companies pleaded guilty today for her role in a Medicare fraud scheme involving false claims and illegal kickback payments for unnecessary durable medical equipment (DME), announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS) and the Louisiana State Attorney General’s Office.
Chikenna D. Jones, 36, pleaded guilty before U.S. District Judge James J. Brady of the Middle District of Louisiana to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive health care kickbacks.
According to court documents, Jones owned and operated Healthcare 1 LLC, Medical 1 Patient Services LLC, Lifeline Healthcare Services Inc., and Rose Medical Inc., Louisiana-based companies that fraudulently billed DME to the Medicare program from 2004 to 2009. She and Henry Jones, who was her husband at the time, hired patient recruiters to obtain prescriptions for DME such as leg braces, arm braces, power wheel chairs and wheel chair accessories. Specifically, the patient recruiters obtained information from Medicare beneficiaries and used the information to acquire prescriptions for DME from the beneficiaries’ primary care physicians. Chikenna Jones paid the recruiters illegal kickbacks for the DME prescriptions, which she knew were not medically necessary.
Court documents allege that the companies owned and operated by Chikenna Jones billed Medicare for more than $21 million.
Jones faces a maximum penalty of 10 years in prison on the conspiracy to commit health care fraud count and five years in prison on the conspiracy to defraud the United States count. A sentencing date has not yet been set.
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Source- http://www.justice.gov/opa/pr/2012/February/12-crm-158.html
WASHINGTON - The owner of a rehabilitation agency in Dearborn, Mich., was convicted today by a federal jury in Detroit for his leading role in a fraudulent Medicare therapy scheme, announced the Department of Justice, FBI and the Department of Health and Human Services (HHS).
Detroit-area resident Tariq Mahmud, 55, was convicted of one count of conspiracy to commit health care fraud and six counts of health care fraud. At sentencing, Mahmud faces a maximum penalty of 10 years in prison on the conspiracy count and each count of health care fraud, as well as a $250,000 fine per count. A sentencing date has not yet been set by the court.
According to evidence presented during the four-day trial, Mahmud was the owner of Comprehensive Rehabilitation Services Inc (CRS), a fraudulent rehabilitation agency located in Dearborn. Between January 2003 and February 2007, CRS purchased pre-packaged, falsified physical and occupational therapy files from more than 30 therapy and rehab companies and used them to fraudulently bill Medicare for more than $2 million.
As part of the scheme, Medicare beneficiaries were paid cash kickbacks and given prescription drugs to sign forms and visit sheets that were later falsified to indicate that they received therapy service that they had never received. Physical and occupational therapists created false evaluations, progress notes and discharge papers indicating that the therapy services were given, when in fact they never were. Evidence at trial showed that the therapists never met the beneficiaries and Mahmud never provided or supervised the therapy billed to Medicare.
In addition to submitting more than $2 million in false therapy claims, Mahmud made additional false statements to Medicare regarding services that were never rendered. For instance, when Medicare inquired regarding a beneficiary who complained that he had not received the services for which CRS billed Medicare, Mahmud returned the payment and told Medicare that he consulted with his professional staff and the beneficiary had not been satisfied with services. In fact, CRS had no professional staff; the therapists who signed the beneficiary’s file never rendered any services; and the beneficiary never received services. Evidence at trial established that the beneficiary’s identity was stolen and used by CRS and a fraudulent file-making company to bill Medicare.
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Source- http://www.fbi.gov/detroit/press-releases/2012/nine-health-care-professionals-including-five-doctors-charged-in-kickback-scheme
GRAND RAPIDS, MI—U.S. Attorney Donald A. Davis and Michigan Attorney General Bill Schuette announced today the federal indictment of eight individuals, including four licensed physicians and one licensed physician’s assistant, for conspiracy to violate the federal Anti-Kickback Statute. Additionally, a state charge was filed against a Jackson, Michigan physician for allegedly accepting kickbacks to refer his patients to certain rehabilitation facilities. All eight federally charged defendants appeared today before U.S. Magistrate Judge Hugh W. Brenneman for an initial appearance on the charge, which carries a penalty of up to five years’ imprisonment, a $250,000 fine, three years of supervised release, and restitution.
The federal indictment alleges that Babubhai Rathod owned and operated medical clinics, outpatient rehabilitation facilities, and home health care companies that paid employees and outside health care providers for the referral of patients. The Indictment identifies many of Rathod’s companies, which include Lakeshore Spine & Pain, P.C., with clinics in cities including Ludington and Edmore, Michigan, and U.S. Rehab Services, P.C., with facilities around the state, including in Mt. Pleasant, Michigan. The indictment identifies Rajesh Makwana as an administrator of Lakeshore Spine & Pain and Raju Nakum as a manager of U.S. Rehab Services.
The indictment alleges that Rathod, Makwana, and Nakum paid health care providers agreed rates for the referral of patients for electrodiagnostic testing, physical therapy, and home health care services. The indictment identifies Lino S. Dial, Jr., D.O., Natalie Schutte, P.A., Niti Thakur, M.D., Andre Blair Smith, M.D., and Muhammad Salman Rais, M.D. as health care providers who referred Medicare and Medicaid patients to companies operated by Rathod in return for illegal kickback payments. The indictment further alleges that the kickback payments were falsely disguised as reimbursement for other purported expenses, including mileage, medical director fees, continuing medical education, and contractual labor.
Kevin S. Witt, D.O., 51, is charged in 54B District Court in East Lansing, Michigan with two felony violations of MCL 400.604, which makes it a crime to receive kickbacks in exchange for referring patients for treatment elsewhere. The charge is a four-year felony. Witt was arrested this morning by Attorney General investigators and was arraigned this afternoon.
U.S. Attorney Davis stated that the state and federal charges result from a joint investigation with the Health Care Fraud Division of Michigan Attorney General Bill Schuette’s office. Special agents from the Bay City, Michigan Office of the Federal Bureau of Investigation and the Grand Rapids, Michigan Office of the U.S. Department of Health and Human Services, Office of Inspector General are coordinating the federal investigation.
U.S. Attorney Davis noted, “The federal Anti-Kickback Statute prohibits the payment of any remuneration that is designed to induce or reward medical referral decisions involving Medicare, Medicaid, and other federally-funded health care programs. In passing the anti-kickback legislation, Congress intended that medical decisions be made with the patient’s best interest in mind and not because the referral of a patient will result in a financial benefit to the referring physician. Because our health care system relies heavily on the trust and integrity of medical professionals to provide services under the appropriate conditions and in the interests of patients, we will continue to aggressively investigate allegations of fraud and kickbacks and prosecute cases where professionals have abused this trust.”
“Patients deserve to know that when a doctor refers them for additional treatment, the decision to do so is based upon quality health advice—not what is best for the doctor’s bank account,” said Attorney General Schuette. “Kickbacks with the Medicaid program don’t just hurt patients, they affect the taxpayers who support the bottom line. Medically unnecessary treatments drive up the costs of Medicaid, and taxpayers ultimately pay the price.”
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Source- http://www.fbi.gov/boston/press-releases/2012/rhode-island-medical-equipment-sales-representative-to-plead-guilty-to-health-care-fraud
PROVIDENCE, RI—A Woonsocket, R.I., woman who allegedly promised custom fit shoes for diabetics and medical equipment for arthritis sufferers “at no cost” to Medicare beneficiaries at Rhode Island senior centers, housing complexes and assisted living centers, has agreed to plead guilty to defrauding Medicare of more than $70,000, announced U.S. Attorney Peter F. Neronha.
Sonja Ascoli, 59, of Woonsocket, R.I, is charged in an information filed with the U.S. District Court in Providence on Monday with allegedly participating in a scheme to entice Medicare beneficiaries to order products and medical equipment from the company she represented, Planned Eldercare, of Illinois, by promising that the products would be provided “at no cost” to them. The Medicare Program does not permit copayments to be waived.
According to the information, it is alleged that once Ascoli obtained some beneficiaries Medicare and physician information, she ordered as many products as possible without regard to whether the beneficiaries actually requested the products or had medical need for the equipment. When beneficiaries complained about receiving items they did not order, it is alleged that Ascoli responded by telling them, “Keep the products in the closet until you need them.”
The information also alleges that as part of the scheme, Ascoli, upon receiving products and equipment returned to her by beneficiaries, did not send the items back to Planned Eldercare, but kept them and gave them to individuals who would not otherwise have qualified for the products. These actions resulted in Medicare paying for products that were not received by beneficiaries and Ascoli allegedly keeping any commissions she had earned on the products sold.
The information alleges that Ascoli was the highest-paid outside sales representative employed by Planned Eldercare for the years 2007 and 2008, who, like other sales representatives working for the company, was paid on a commission basis.
According to the information, is alleged that Ascoli defrauded Medicare of a total of $70,354.
On November 17, 2011, Gary Winner, 49, of Northbrook, Ill., owner of Planned Eldercare, pled guilty in U.S. District Court in Providence to two counts of health care fraud, and one count each of money laundering and the introduction of an adulterated and misbranded medical device into interstate commerce.
Winner admitted to the court that from 2005 through early 2009 he instructed Planned Eldercare employees, upon successfully reaching individuals as a result of unsolicited telemarketing calls, to inform recipients that Planned Eldercare could provide them with products to help with their diabetes or arthritis ailments “at no cost to you” by waiving copayments required by Medicare. Winner admitted that he instructed employees to order as many products as possible whether or not the beneficiaries requested them or had a medical need for the equipment. Winner admitted that Medicare was billed for thousands of products that beneficiaries did not order.
Winner also admitted that he instructed his employees to falsely inform male diabetic beneficiaries that an “erectile pump” was good for prostate problems, and was designed to help blood circulation exclusively in the urinary tract and prostate region. Winner admitted that as part of the scheme, he actually ordered penis enlargers from an x-rated website for $26.00 each, repackaged them, and shipped them to Medicare beneficiaries, for which he received reimbursement from Medicare on average of $284 per item.
Winner is scheduled to be sentenced in U.S. District Court in Providence on February 10, 2012. He has agreed to forfeit approximately $2 million in proceeds derived by defrauding the Medicare program.
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Source- http://www.fbi.gov/neworleans/press-releases/2012/guilty-pleas-in-health-care-fraud-case
BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that CARLA CLARK, age 47, and LILLIE LAVAN, age 57, both of Pineville, Louisiana, pled guilty today before Senior U.S. District Court Judge Frank J. Polozola to counts of an indictment charging health care fraud.
The indictment arose from a health care fraud scheme involving two companies known as Fusion Services, L.L.C. (“Fusion”), and Grace Social Services, L.L.C. (“Grace”), which operated in Alexandria, Louisiana and the surrounding areas. CLARK and LAVAN were licensed clinical social workers who worked with Sonya Williams, the owner of Fusion and Grace. CLARK and LAVAN participated in creating false and misleading medical records for Fusion indicating that Medicare beneficiaries had received individual, face-to-face psychotherapy when, in fact, no such services had been provided. Williams then prepared false claims for the purported psychotherapy services to elderly patients and submitted them to Medicare for reimbursement. Medicare paid Fusion and Grace approximately $349,715 as a result of the billings, much of the profits were deposited into Williams’ personal accounts.
As a result of her guilty pleas, CLARK faces a maximum sentence of imprisonment of 20 years, a $500,000 fine, or both. As a result of her guilty plea, LAVAN faces a maximum sentence of imprisonment of 10 years, a $250,000 fine, or both. The court may also order CLARK and LAVAN to pay restitution. Sentencing has not yet been set for either defendant.
United States Attorney Donald J. Cazayoux, Jr. stated, “This plea is the result of another successful effort by the Medicare Fraud Strike Force to root out and prosecute health care fraud. Rest assured, we will continue to pursue these fraudsters who undermine our health care system. I commend our partners with the U.S. Department of Health and Human Services, the Federal Bureau of Investigation, the Internal Revenue Service, and AdvanceMed for their continued focus and diligence in finding and stopping fraud within our Medicare system.”
Assistant Special Agent in Charge William W. Root, Health and Human Services said, “We are proud of the outstanding work by the Medicare Fraud Strike Force. The guilty pleas today sends a message to other perpetrators that we will thoroughly investigate all allegations of health care fraud. Protecting the programs intended for our nation’s most vulnerable citizens is paramount to our mission.”
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Source- http://www.fbi.gov/miami/press-releases/2012/miami-area-nurse-pleads-guilty-in-25-million-health-care-fraud-scheme
WASHINGTON—A Miami-area nurse pleaded guilty today for his participation in a $25 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.
Jorge Pineiro, 42, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. Pineiro was originally charged in a February 2011 indictment.
According to plea documents, Pineiro was a registered nurse who worked for ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., two Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Pineiro and his co-conspirators operated ABC and Florida Home Health for the purpose of billing Medicare for expensive services that were not medically necessary and/or were never provided. The medically unnecessary services were prescribed by doctors, including, but not limited to, Pineiro’s co-defendant, Dr. Jose Nunez.
According to court documents, beginning in approximately June 2008, and continuing until approximately March 2009, Pineiro and his co-defendant nurses falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services. Pineiro knew that the beneficiaries did not actually qualify for and did not receive the services. Pineiro and his co-defendant nurses described in nursing notes and patient files symptoms that were non-existent, such as tremors, impaired vision, weak grip and inability to walk without assistance. They included these symptoms to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare.
Pineiro admitted that he knew these files were falsified so that Medicare could be billed for medically unnecessary therapy and home health-related services. As a result of Pineiro’s participation in the illegal scheme, the Medicare program was billed approximately $118,000 for purported home health care services that were not medically necessary and/or were never provided.
Pineiro also recruited Medicare beneficiaries who allowed Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided. Pineiro solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for allowing the agency to bill Medicare on behalf of the patients he recruited. The patients that Pineiro recruited did not qualify for the services that were billed to the Medicare program. Pineiro knew that the patient files for his recruited patients were falsified to make it appear that the patients qualified for services from Florida Home Health.
Eighteen co-defendants, including Nunez, Licet Diaz, and Lisandra Alonso, have pleaded guilty for their roles in the fraud scheme. Nunez, Diaz, and Alonso were sentenced to 40 months, 87 months and 78 months in prison, respectively. Two remaining defendants, Dr. Francisco Gonzalez and Odalys Alvarez-Medina, are scheduled for trial on Feb. 14, 2012. An indictment is merely a charge, and defendants are presumed innocent until proven guilty.
Sentencing for Pineiro has been scheduled for April 9, 2012.
The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendant also faces fines and supervised release, as well as forfeiture of any property or proceeds derived from his criminal activities.
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Source- http://www.fbi.gov/oklahomacity/press-releases/2012/new-york-men-sentenced-in-health-care-fraud-wheelchair-scam
OKLAHOMA CITY—Today, ADEDAYO O. ADEGBOYE and OLALEKAN RUFAI, both age 48 and both of Brooklyn, New York, were each sentenced by United States District Judge Timothy D. DeGiusti to serve 12 months and one day in prison for health care fraud in connection with the sale of power wheelchairs and wheelchair accessories to Medicare beneficiaries, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma. In addition, Judge DeGiusti ordered that the men pay restitution in the amount of $299,624.
Adegboye and Rufai opened First Century Medical Supply, Inc., located in Oklahoma City, to engage in the business of selling power wheelchairs and wheelchair accessories to Medicare beneficiaries. Evidence presented at trial last August showed that from 2007 through 2009 the business obtained identification numbers and personal information from Medicare beneficiaries and used that information to submit claims to Medicare for power wheelchairs and wheelchair accessories. Evidence also showed that the defendants billed Medicare for some beneficiaries who did not receive a power wheelchair at all, some who received a less expensive motorized scooter, and for others who did not have a medical need for a wheelchair or did not even request a wheelchair. In all, the evidence showed that through First Century the defendants submitted over $1.1 million in fraudulent claims to Medicare.
Adegboye and Rufai were indicted by a federal grand jury in January of 2011. Following a six-day trial last August, a jury found both men guilty of committing five counts of health care fraud.
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Source- http://www.justice.gov/opa/pr/2012/January/12-crm-118.html
WASHINGTON – The owner and an employee of a Miami health care agency pleaded guilty for their participation in a $22 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.
Marietha Morales, 38, pleaded guilty on Jan. 24, 2012, before U.S. District Judge Seitz to one count of conspiracy to commit health care fraud and Eduardo Saborit-Dominguez, 48, pleaded guilty today before Judge Seitz to one count of conspiracy to violate the Anti-Kickback Statute. Sentencing for both defendants is scheduled for May 23, 2012. The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years.
According to the court documents, Morales was the president and Saborit-Dominguez was an employee of Prime Home Health Services Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries.
According to plea documents, Morales conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Morales and her co-conspirators paid kickbacks and bribes to patient recruiters in return for these recruiters providing patients to Prime Home Health, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Saborit-Dominguez distributed the kickbacks and bribes to co-conspirator patient recruiters and knew that the payment of kickbacks and bribes was in violation of federal criminal laws. Morales used these prescriptions, plans of care and medical certifications to fraudulently bill the Medicare program for home health care services, which Morales knew was in violation of federal criminal laws.
According to plea documents, at Prime Home Health, nurses and office staff falsified patient files for Medicare beneficiaries to make it appear that such beneficiaries qualified for home health care and therapy services from Prime Home Health. Morales admitted that she knew the beneficiaries did not actually qualify for and did not receive such services. Morales knew that these files were falsified so that the Medicare program could be billed for medically unnecessary therapy and home health related services.
From approximately February 2005 through April 2011, Morales and her co-conspirators submitted approximately $22 million in false and fraudulent claims to Medicare and Medicare paid approximately $14 million on those claims.
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Source- http://www.fbi.gov/neworleans/press-releases/2012/patient-recruiter-pleads-guilty-in-health-care-fraud-scheme
WASHINGTON—A Baton Rouge, Louisiana-area resident pleaded guilty today for her role in a Medicare fraud scheme involving fraudulent claims for medically unnecessary health care equipment, announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS), and the Louisiana State Attorney General’s Office.
Karen Rayburn, 47, pleaded guilty before U.S. District Judge James J. Brady of the Middle District of Louisiana to one count of conspiracy to commit health care fraud.
Rayburn admitted that she worked as a recruiter for Healthcare 1 LLC and Medical 1 Patient Services LLC, Louisiana-based companies that fraudulently billed medical equipment to the Medicare program from 2004 to 2009. She and other recruiters were hired to obtain prescriptions for medical equipment such as leg braces, arm braces, power wheel chairs, and wheel chair accessories. Rayburn obtained information from Medicare beneficiaries and approached their physicians to request prescriptions for medical equipment. Rayburn admitted that when patients’ physicians were unwilling to provide medically unnecessary prescriptions, she and other recruiters asked unrelated physicians to write prescriptions based on cursory examinations of the patients. Another technique they used was to generate photocopied forms with reproduced physicians’ signatures. These prescriptions were then used to submit fraudulent claims to the Medicare program.
From 2004 to 2009, Medicare was billed $6.53 million for the beneficiaries that Rayburn provided as part of this fraudulent scheme.
Rayburn faces a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not yet been set.
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Source- http://www.fbi.gov/sanjuan/press-releases/2012/ten-individuals-arrested-for-health-care-fraud
SAN JUAN, PR—On January 12, 2012, a federal grand jury returned two indictments against 10 individuals for conspiracy to commit health care fraud, announced Rosa Emilia Rodríguez-Vélez, United States Attorney for the District of Puerto Rico. The investigation was led by the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), with the collaboration of the United States Secret Service (USSS) and the Federal Bureau of Investigation (FBI).
Gilberto Gómez, president of Monte Mar Health Corporation (Monte Mar), PROMEDS Medical Inc. (PROMEDS) and Quality Care Medical Supply (Quality); Yolanda García-Rodríguez, aka “Yolanda Gómez,” wife of Gómez and president of PROMEDS, secretary/treasurer of Monte Mar and an authorized official of Quality; Lissette Acevedo, independent sales coordinator; Doctor Francisco Garrastegui; Luisa Nieves, independent sales coordinator; Glendaly Báez, billing director for Monte Mar, PROMEDS and Quality; Mario Rivera, independent sales coordinator; and Marcos Sarraga, independent sales coordinator, are charged in a 39-count indictment for conspiracy to commit health care fraud and a forfeiture allegation of $1,956,750.54. The government seeks to forfeit two bank accounts, one investment account, and a Gallery Plaza Condominium located in the Condado area in San Juan, Puerto Rico.
The indictment alleges that from on or about November, 2008, until on or about May, 2010, Monte Mar submitted at least 1,518 false and fraudulent claims to Medicare totaling approximately $2,993,127.35 for Durable Medical Equipment (DME) that was not medically necessary, causing Medicare to disburse approximately $1,440,597.65. In March 2010, the indictment further alleges that after Monte Mar had been placed in a pre-payment status by Medicare, defendants Gilberto Gómez and Yolanda García-Rodríguez purchased PROMEDS and submitted false claims to Medicare seeking reimbursement for DME, including power wheelchairs, power pressure reducing air mattresses and knee orthosis. PROMEDS submitted at least 359 fraudulent claims to Medicare totaling approximately $786,368.34, causing Medicare to disburse approximately $335,493.12. In October 2010, the indictment alleges that a third company, Quality, was purchased by Gómez and García-Rodríguez after PROMEDS had been placed in a pre-payment status by Medicare. From on or about October 2010, until May, 2011, Quality submitted at least 115 false claims to Medicare totaling approximately $298,321.26, causing Medicare to disburse approximately $180,659.77. The indictment alleges a total amount of $4,077,816.95 fraudulently billed by using Monte Mar, PROMEDS and Quality, where Medicare disbursed a total of approximately $1,956,750.54.
Doctor Francisco Garrastegui was a physician licensed to practice medicine in Puerto Rico but not a Medicare provider. Garrastegui signed and completed false progress notes, prescriptions, Certificate of Medical Necessity (CMNs) and Statements of Ordering Physician for Medicare beneficiaries that were billed by Monte Mar, PROMEDS and Quality. The doctor was paid kickbacks by the three health corporations for the preparation of these false documents. The other defendants’ participation during the conspiracy involved the creation and submission of the fraudulent claims to Medicare.
The health care fraud scheme charged in the second indictment involves Luz M. Vega, president of Preferred Medical Equipment (PME), Doctor Francisco Garrastegui, Lissette Acevedo, Luisa Nieves and María Elisa Pérez. According to the 60-count indictment, from on or about April 2010, until on or about March 2011, PME submitted false claims to Medicare, seeking reimbursement for Durable Medical Equipment including: power wheelchairs, power pressure reducing air mattresses, wheelchair accessories, lumbar-sacral orthosis, knee orthosis and hospital beds. The co-conspirators submitted at least 95 fraudulent claims totaling approximately $210,223.47, causing Medicare to disburse approximately $107,876.73. Defendants Garrastegui, Acevedo and Nieves also participated in the first conspiracy charged in the previously mentioned indictment. The government seeks to forfeit $107,876.73 and one bank account.
“As part of the nation’s health care system, Medicare serves vulnerable populations,” said United States Attorney, Rosa Emilia Rodríguez-Vélez. “Today’s arrests by HHS-OIG agents and our law enforcement partners show that we will not tolerate criminals who engage in fraudulent schemes which deplete the Medicare program of funds which are destined for our elderly population, in order to enrich themselves.”
“HHS/OIG works diligently to investigate allegations of Medicare fraud. Today’s arrests involving durable medical equipment (DME) fraud demonstrate our resolve to bring these subjects to justice. Furthermore, as seen on the attached chart (DME data), our efforts, along with the U.S. Attorney’s Office and our law enforcement partners, have made a dramatic reduction on the total dollars billed and paid for DME in Puerto Rico.”
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Source- http://www.fbi.gov/atlanta/press-releases/2012/owner-of-doraville-medical-clinic-indicted-for-health-care-fraud
ATLANTA—DAVID SONG SEN CUI, 43, of Duluth, Georgia, has been indicted by a federal grand jury on charges of health care fraud.
United States Attorney Sally Quillian Yates said of the case, “Medicare dollars provide critical medical services for elderly and disabled persons. This defendant is charged with defrauding Medicare by repeatedly billing for ‘physical therapy’ that in truth was only massages given by unlicensed massage therapists. Medicare and our taxpayers cannot afford such criminal abuse of health care dollars.”
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “The FBI, in conjunction with its various law enforcement partners, is committed to the protection of such federally funded programs. Individuals engaged in such fraudulent acts, as is alleged in this indictment, demonstrate a lack of compassion and greed that simply cannot and will not be tolerated. The FBI urges anyone with information regarding healthcare fraud activity to contact its nearest FBI field office.”
According to United States Attorney Yates, the charges, and other information presented in court: From November 2008 through August 2011, CUI operated the Atlanta Hope Medical Group, Inc., a clinic located in Doraville, Georgia. The clinic purported to provide physical therapy services for elderly patients. However, the clinic actually offered massage services, which were performed by unlicensed massage therapists. CUI allegedly billed the massages fraudulently to Medicare as “physical therapy” under a doctor’s name who did not render the services and was not even present at the clinic. As part of the scheme, Atlanta Hope employed a doctor who was present at the clinic only two days a week. The indictment alleges that, during the operation of the clinic, CUI fraudulently billed over $5.5 million in false claims to Medicare.
The indictment charges 11 counts of health care fraud. Each count carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.
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