Alicia Vasquez Pleads Guilty of Illegal Kickback Conspiracy

Source-  http://www.justice.gov/usao/txs/1News/Releases/2012%20February/120229%20Vasquez.html 

McALLEN, Texas – The owner of a purported health care resource center has pleaded guilty to one count of conspiracy in relation to a scheme to solicit and receive illegal kickbacks from area health care providers, United States Attorney Kenneth Magidson announced today.

Alicia Vasquez, of San Juan, Texas, was charged in a three-count indictment returned under seal Nov. 1, 2011, and unsealed Jan. 27, 2012. The indictment charged Vasquez, 51, with one count of conspiracy and two counts of soliciting and receiving kickbacks in violation of the federal anti-kickback statute. At a hearing this morning before U.S. District Judge Micaela Alvarez, Vasquez pleaded guilty to one count of conspiracy for her involvement in the scheme.

According to information presented in court this morning, from September 2009 through April 2011, Vasquez solicited numerous Medicare and Medicaid patients through a “health care resource center” she operated called David’s Star Loving Vision (DSLV). Vasquez would refer the patients to a variety of health care providers in Hidalgo and Cameron Counties including durable medical equipment (DME) companies, physicians and home healthcare agencies.

Over time, Vasquez referred the patients to these health care providers in exchange for a total of at least $70,000 in payments in violation of the anti-kickback statute. In turn, the providers billed hundreds of thousands of dollars to the Medicare and Medicaid programs as a result of the illegal referrals. Vasquez, and the providers to which she referred the beneficiaries, undertook a variety of measures to conceal Vasquez’s involvement with respect to the referrals. For example, one owner of a DME company paid kickbacks to Vasquez through a third-party – referred to in the indictment as “Person A.” The kickbacks were deposited into person A’s bank account, from where the money was later diverted to Vasquez.

Vasquez is scheduled for sentencing before Judge Alvarez on May 16, 2012, at 9:00 a.m. before Judge Alvarez. At that time, she will face up to five years in federal prison and a $250,000 fine for the conspiracy conviction. Vasquez was permitted to remain on bond pending sentencing.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Hospice Provider Odyssey Healthcare Agrees to Pay $25 Million to Resolve False Claims Act Allegations

Source-  http://www.justice.gov/opa/pr/2012/March/12-civ-272.html 

Odyssey HealthCare, a subsidiary of Gentiva, has agreed to pay $25 million to resolve civil liability under the federal False Claims Act arising from its billing of claims for certain hospice services, the Justice Department announced today. Odyssey Healthcare currently provides hospice services in approximately 27 states, including Wisconsin. Odyssey was purchased by Gentiva Healthcare in 2010.

The Medicare hospice benefit is available for patients who elect palliative treatment for a terminal illness. Patients are eligible for palliative hospice care if they have a terminal diagnosis of six months or less if their disease runs its normal course. The majority of hospice services are billed at the routine care level. Medicare also pays for higher levels of care, including continuous home care. Continuous care is available when the patient is experiencing an acute crisis and his or her symptoms can only be controlled at home through the provision of skilled nursing services. The reimbursement rate for continuous care services is the highest rate available to a hospice and several hundred dollars a day more than the amount paid for routine services. Today’s settlement resolves allegations that Odyssey submitted false claims to the Medicare program for continuous home care services that were unnecessary or that were not performed in accordance with Medicare requirements between January 2006 and January 2009.

“The resolution of the related cases announced today underscores two, critically important components of our focused and effective work in addressing health care fraud,” said James L. Santelle, U.S. Attorney for the Eastern District of Wisconsin. “First, it shows our abiding commitment to the legitimate medical and the financial interests of all of our constituents who are rightly interested in the sound, lawful administration of the Medicare Program. Second, it illustrates our strong support of the qui tam or “whistleblower” process through which private individuals–often employees of offending health care providers–courageously come forward to report on waste, fraud, and abuse in the handling of taxpayer monies and beneficial programs.”

“The federal government pays for the hospice care of Medicare patients to make them more comfortable during the last months of their lives. Yet it is alleged that Odyssey used a diagnosis of terminal illness as an opportunity to bill taxpayers for unnecessary services,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “The size of the settlement shows how seriously the government views Odyssey’s unlawful behavior, and the five-year Corporate Integrity Agreement will help assure that such fraud is not repeated.”

Allegations that Odyssey improperly billed for continuous care services were originally raised in three lawsuits filed against Odyssey under the qui tam, or whistleblower, provisions of the False Claims Act. The Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the United States and share in any recovery. As a part of today’s resolution, the whistleblowers, all former employees of Odyssey, will receive payments totaling more than $4.6 million.

In addition to the $25 million payment, Odyssey entered a five year corporate integrity agreement with the United States Department of Health and Human Services Office of the Inspector General.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Linda M. Jackson, Eunice Sparrow and Uniecesco Smith are Convicted of Health Care Fraud in Baton Rouge

Source-  http://www.fbi.gov/neworleans/press-releases/2012/three-more-convicted-of-health-care-fraud-in-baton-rouge 

BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that LINDA M. JACKSON, age 49, pled guilty yesterday before Chief U.S. District Court Judge Brian A. Jackson to conspiracy to commit health care fraud. The case arose from a multi-year health care fraud scheme involving a company known as A&A Durable Medical Supply, LLC (“A&A”), in Plaquemine, Louisiana, which JACKSON operated and managed. JACKSON’s guilty plea follows those entered by former A&A employees EUNICE SPARROW, age 68, and UNIECESCO SMITH, age 29, both of whom pled guilty last week to multiple counts of health care fraud.

According to the factual basis entered in connection with her guilty plea, from April 2007 through April 2009, JACKSON worked with others to defraud the Medicare program. JACKSON and others accomplished the scheme by knowingly submitting reimbursement claims to Medicare that falsely and fraudulently represented that: (1) certain equipment was medically necessary and had been ordered for the beneficiaries by their physicians; and (2) that the equipment reflected in the claims had in fact been provided to the beneficiaries. For example, JACKSON routinely submitted claims to Medicare seeking reimbursement for power wheelchairs knowing that A&A had not provided power wheelchairs to the beneficiaries and knowing that the beneficiaries’ physicians had not prescribed power wheelchairs for the beneficiaries. According to the stipulated factual basis, the intended loss from this one portion of JACKSON’s scheme exceeded $1 million. JACKSON also submitted approximately 60 false claims totaling more than $170,000 for a device called a “cranial cervical orthosis” knowing that A&A had not provided any of the devices to Medicare beneficiaries and that none of the devices had been prescribed by the beneficiaries’ physicians.

As a result of her guilty plea, JACKSON faces a maximum sentence of a term of imprisonment of 10 years and a fine. In addition, JACKSON has agreed to forfeit all property derived from the proceeds of her crime and to make full restitution.

SPARROW and SMITH—JACKSON’s mother and daughter, respectively—entered guilty pleas on February 22, 2012 to several counts of health care fraud. In their plea agreements, SPARROW and SMITH admitted that they knowingly aided and abetted the submission of JACKSON’s fraudulent Medicare claims by completing and signing false delivery tickets and other fraudulent documents at JACKSON’s direction. A&A kept the fraudulent documents in its patient files in an attempt to substantiate the claims it submitted to Medicare, and JACKSON later provided the false documents to an auditor who requested the patient files in the course of an investigation into A&A’s claims.

United States Attorney Donald J. Cazayoux, Jr. remarked, “Perpetrators of health care fraud increase the costs of care for us all. The public deserves a health care system free of those who seek personal gain through crime. This successful prosecution demonstrates our firm commitment to the aggressive and effective prosecution of Medicare fraud.”



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Dr. Robert M. Ritchea Submitted False Claims to Medicare for Unnecessary Pain Injections Administered by an Unlicensed Medical Assistant

Source-  http://www.fbi.gov/atlanta/press-releases/2012/doctor-banned-from-federal-health-care-programs-for-seven-years 

ATLANTA—The United States Attorney’s Office announced today that it has reached a settlement with ROBERT M. RITCHEA, M.D., 49, of Phenix City, Alabama, to resolve allegations under the False Claims Act that RITCHEA submitted more than $2.2 million in false or fraudulent claims to Medicare. Pursuant to the settlement, RITCHEA will be excluded from payment from all federal health care programs for a period of seven years. The payment prohibition applies to RITCHEA, anyone who employs or contracts with him, and any hospital or other provider for which he provides services. RITCHEA will also pay the United States the proceeds from the sale of a second home and $5,000 immediately. In the settlement process, a defendant’s ability to pay is taken into consideration when determining the settlement amount.

Sally Quillian Yates, United States Attorney for the Northern District of Georgia, said, “Our office is committed to pursuing doctors who put money before the health and safety of their patients. Dr. Ritchea admitted to allowing an unlicensed medical assistant to inject patients with pain medications and billing Medicare for these injections. As a result he will be excluded from all federal health care programs for seven years.”

The civil settlement resolves a complaint filed by the United States against RITCHEA, United States v. Robert M. Ritchea, M.D., 1:10-cv-02410-JOF. The complaint alleges that RITCHEA violated the False Claims Act by improperly billing Medicare for unnecessary pain injections administered by an unlicensed medical assistant. As a condition of the settlement, RITCHEA admitted that he allowed the unlicensed medical assistant to administer at least 80% of the pain injections. He also admitted to both the Alabama State Board of Medical Examiners and the Georgia Composite State Board of Medical Examiners that the injections were unnecessary.

The United States’ settlement is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department used to recover approximately $2.4 billion nationwide in fiscal year 2011 in cases involving fraud against federal health care programs. The Justice Department’s total health care fraud recoveries under the False Claims Act since January 2009 have been over $6.6 billion.

This settlement also highlights another powerful tool to protect federal health care programs and beneficiaries and to hold accountable those that commit health care fraud—the exclusion authority of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG). Section 1128 of the Social Security Act gives HHS-OIG the authority to exclude individuals and entities from participation in federal health care programs for fraud or other misconduct.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Manhattan U.S. Attorney Announces Charges Against 36 Individuals for Participating in $279 Million Health Care Fraud Scheme

Source-  http://www.fbi.gov/newyork/press-releases/2012/manhattan-u.s.-attorney-announces-charges-against-36-individuals-for-participating-in-279-million-health-care-fraud-scheme 

Preet Bharara, the United States Attorney for the Southern District of New York; Janice K. Fedarcyk, the Assistant Director in Charge of the New York Office of the Federal Bureau of Investigation (“FBI”); and Raymond W. Kelly, the Police Commissioner of the City of New York (“NYPD”), announced today the unsealing of charges against 36 defendants involved in a systematic scheme to defraud private insurance companies of more than $279 million under New York’s no-fault automobile insurance law. The indictment includes racketeering charges against eight members and associates of a criminal organization consisting primarily of individuals of Russian descent who were the owners and controllers of fraudulent medical clinics (the “No Fault Organization”), as well as 10 licensed doctors and three attorneys. The alleged scheme identified today is the largest single no-fault automobile insurance fraud ever charged, and the first case of its kind to allege violations of the Racketeer Influenced and Corrupt Organizations (“RICO”) Act.

All of the defendants were arrested this morning in connection with today’s charges. Thirty-five were taken into custody in New York and New Jersey and will be presented and arraigned in Manhattan federal court before U.S. Magistrate Judge Theodore H. Katz later this afternoon. One defendant was arrested in Duluth, Minnesota and will be presented tomorrow in federal court in the District of Minnesota.

Manhattan U.S. Attorney Preet Bharara said: “Today’s charges expose a colossal criminal trifecta, as the fraud’s tentacles simultaneously reached into the medical system, the legal system, and the insurance system, pulling out cash to fund the defendants’ lavish lifestyles. As alleged, the scheme relied on a cadre of corrupt doctors who essentially peddled their medical licenses like a corner fraudster might sell fake IDs, except those medical licenses allowed unlawful entry, not to a club or a bar, but to a multi-billion-dollar pool of insurance proceeds.”

FBI Assistant Director in Charge Janice K. Fedarcyk said: “Our investigation uncovered a pattern of lucrative fraud exploiting New York’s no-fault auto insurance system to the tune of more than a quarter-of-a-billion dollars. The criminal enterprise, while it lasted, was obscenely profitable. The scheme not only unjustly enriched the defendants and defrauded insurance companies. Auto insurance fraud is also a crime that indirectly victimizes every driver in New York.”

NYPD Commissioner Raymond W. Kelly said: “Our undercover officers were treated like thousands of other ‘patients’ receiving therapy, tests, and medical equipment they didn’t need. I want to congratulate the U.S. Attorney’s Office and the agents and detectives assigned to the joint FBI-NYPD Organized Crime Task Force for bringing this investigation to a successful conclusion.”

The following allegations are based on the unsealed indictment and other documents filed today in Manhattan federal court:

Under New York state law, every vehicle registered in the state is required to have no-fault automobile insurance, which enables the driver and passengers of a registered and insured vehicle to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, regardless of fault (the “No-Fault Law”). The No-Fault Law requires prompt payment for medical treatment, thereby obviating the need for claimants to file personal injury lawsuits in order to be reimbursed. Under the No-Fault Law, patients can assign their right to reimbursement from an insurance company to others, including medical clinics that provide treatment for their injuries. New York state law also requires that all medical clinics in the state be incorporated, owned, operated, and/or controlled by a licensed medical practitioner in order to be eligible for reimbursement under the No-Fault Law. Insurance companies will not honor claims for medical treatments from a medical clinic that is not actually owned, operated, and/or controlled by a licensed medical practitioner.

From at least 2007 through 2012, the No-Fault Organization has engaged in a massive and sophisticated scheme to defraud automobile insurance companies of hundreds of millions of dollars by, among other things, creating and operating medical clinics that provided unnecessary and excessive medical treatments in order to take advantage of the No-Fault Law. In order to mislead New York authorities and private insurers, the true owners of these medical clinics (“Clinic Controllers”), almost all of whom were also members and associates of a criminal organization consisting primarily of individuals of Russian descent, paid licensed medical practitioners, including doctors, to use their licenses to incorporate the professional corporations, through which the medical clinics billed the private insurers for the bogus medical treatments. These doctors effectively operated as “straw owners” of the clinics.

The Clinic Controllers paid thousands of dollars in kickbacks to runners who recruited automobile accident passengers to receive medically unnecessary treatments from the no-fault clinics. They also instructed the clinic doctors/straw owners to prescribe excessive and unwarranted referrals for various “modality treatments” for every patient they saw. The treatments included physical therapy, acupuncture, and chiropractic treatments—as many as five times per week for each—and treatments for psychology, neurology, orthopedics, and audiology. Clinic doctors also prescribed unnecessary MRI’s, x-rays, orthopedics, and medical supplies. The Clinic Controllers received thousands of dollars in kickbacks for patient referrals from the owners of the modality clinics (“Modality Controllers”), who were members and associates of the same criminal organization to which the members of the No-Fault Organization and Clinic Controllers belonged.

The Clinic Controllers also referred patients to personal injury lawyers who filed bogus lawsuits on behalf of the patients and coached them on what injuries to claim in order to get as many treatments as possible. The personal injury lawyers also paid the Clinic Controllers thousands of dollars in kickbacks for these referrals.

In order to conceal and disguise the millions of dollars in claims paid by the automobile insurance companies, the members of the No-Fault Organization laundered the money through shell companies and corrupt check-cashing services. Often, checks would be written from the No-Fault or Modality Clinics with the payee line left blank, and in amounts less than $10,000 in order to avoid potential financial institution reporting requirements and other scrutiny. The checks were then cashed through check-cashers who made the checks payable to shell companies they controlled in order to conceal the true nature and purpose of the checks. The cash was then returned to members of the No-Fault Organization to fund kickbacks and for their personal use. At other times, the members and associates of the No-Fault Organization paid themselves through their own shell companies and then used the criminal proceeds to fund expensive vacations and to purchase luxury goods.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Jacques Roy Arrested for Alleged Role in Nearly $375 Million Health Care Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-260.html 

WASHINGTON - A physician and the office manager of his medical practice, along with five owners of home health agencies, were arrested today on charges related to their alleged participation in a nearly $375 million health care fraud scheme involving fraudulent claims for home health services.

The arrests and charges were announced today by Deputy Attorney General James Cole and Health and Human Services (HHS) Deputy Secretary Bill Corr, along with Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Sarah R. Salda ñ a of the Northern District of Texas; HHS Inspector General Daniel R. Levinson; Special Agent in Charge Robert E. Casey Jr. of the FBI’s Dallas Field Office; Dr. Peter Budetti, Deputy Administrator for Program Integrity for the Centers for Medicare and Medicaid Services (CMS); and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

The indictment, filed in the Northern District of Texas and unsealed today, charges Jacques Roy, M.D., 54, of Rockwall, Texas; Cynthia Stiger, 49, of Dallas; Wilbert James Veasey Jr., 60, of Dallas; Cyprian Akamnonu, 63, of Cedar Hill, Texas; Patricia Akamnonu, RN, 48, of Cedar Hill; Teri Sivils, 44, of Midlothian, Texas; and Charity Eleda, RN, 51, of Rowlett, Texas, each with one count of conspiracy to commit health care fraud. Roy also is charged with nine counts of substantive health care fraud, and Veasey, Patricia Akamnonu and Eleda are each charged with three counts of health care fraud. Eleda also is charged with three counts of making false statements related to a Medicare claim . All the defendants are expected to make their initial appearances at 2:00 p.m. CST today in federal court in Dallas.

In addition to the indictment, CMS announced the suspension of an additional 78 home health agencies (HHA) associated with Roy based on credible allegations of fraud against them.

Today’s enforcement actions are the result of the Medicare Fraud Strike Force operations, which are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). HEAT is a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce anti-fraud laws around the country.

“The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor in the history of HEAT and our Medicare Fraud Strike Force operations,” said Deputy Attorney General Cole. “Thanks to the historic partnerships we’ve built to combat health care fraud, we are sending a clear message: If you victimize American taxpayers, we will track you down and prosecute you.”

“Thanks to our new fraud detection tools, we have greater abilities to identify the kind of sophisticated fraud scheme that previously could have escaped scrutiny,” said HHS Deputy Secretary Corr. “Our aggressive Medicare Fraud Strike Force operations have enabled us to break up a significant alleged fraud operation and the fraud-fighting authorities in the Affordable Care Act have allowed us to stop further payments to providers connected to this scheme. This case and our new detection tools are examples of our growing ability to stop Medicare fraud.”

According to the indictment, Dr. Roy owned and operated Medistat Group Associates P.A. in the Dallas area. Medistat was an association of health care providers that primarily provided home health certifications and performed patient home visits. Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 HHAs for home health services during the past five years. Between January 2006 and November 2011, Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States. These certifications allegedly resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid by Medistat and HHAs.

“Today, the Medicare Fraud Strike Force is taking aim at the largest alleged home health fraud scheme ever committed,” said Assistant Attorney General Breuer . “According to the indictment, Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise in the Dallas area, making millions by recruiting thousands of patients for unnecessary services, and billing Medicare for those services. In Dallas, and the eight other Medicare Fraud Strike Force cities, the Criminal Division and our partners in the U.S. Attorneys’ Offices will continue to crack down on Medicare fraud, and hold accountable those stealing from the public fisc.”

“Fraud schemes, like the one we allege Dr. Roy executed, represent the next wave of Medicare and Medicaid crime that we face,” said U.S. Attorney Salda ñ a. “As enforcement actions have ramped up, not only in the Dallas Metroplex, but in several other areas throughout the country, fraudsters are devising new ways to beat the system. Rest assured, however, that with the tools and resources our district’s Medicare Care Fraud Strike Force provides, we will meet this challenge head-on and bring indictments against those who seek to defraud these critical programs, and you, the taxpayer.”

“Using sophisticated data analysis we can now target suspicious billing spikes,” said HHS Inspector General Levinson. “In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people – Dr. Roy certified more than 5,000.”

“The FBI views health care fraud as a severe crime problem,” said FBI Special Agent in Charge Casey. “It causes increased costs for consumers, tax payers and health insurance plans, and degrades the integrity of our health care system and legitimate patient care. Today’s arrests by the Dallas Medicare Fraud Strike Force send a clear message to those persons who are not only defrauding our federal Medicare and Medicaid and private health insurance programs, but victimizing the elderly, the disadvantaged, and those who are at a vulnerable time in their lives due to legitimate health issues. The FBI will continue to dedicate a substantial amount of expert resources to investigate these crimes.”

The indictment alleges that Dr. Roy used HHAs as recruiters so that Medistat could bill unnecessary home visits and medical services. Dr. Roy and other Medistat physicians certified and recertified plans of care so that HHAs also were able to bill Medicare for home health services that were not medically necessary and not provided. In addition, Dr. Roy allegedly performed unnecessary home visits and ordered unnecessary medical services.

According to the indictment, Medistat maintained a “485 Department,” named for the number of the Medicare form on which the plan of care was documented. Dr. Roy allegedly instructed Medistat employees to complete the 485s by either signing his name by hand or by using his electronic signature on the document.

Three of the HHAs Dr. Roy used as part of the scheme were Apple of Your Eye Healthcare Services Inc., owned and operated by Stiger and Veasey; Ultimate Care Home Health Services Inc., owned and operated by Cyprian and Patricia Akamnonu; and Charry Home Care Services Inc., owned and operated by Eleda. According to the indictment, Veasey, Akamnonu, Eleda and others recruited beneficiaries to be placed at their HHAs so that they could bill Medicare for the unnecessary and not provided services. As part of her role in the scheme, Eleda allegedly visited The Bridge Homeless Shelter in Dallas to recruit homeless beneficiaries staying at the facility, paying recruiters $50 per beneficiary they found at The Bridge and directed to Eleda’s vehicle parked outside the shelter’s gates.

Apple allegedly submitted claims to Medicare from Jan. 1, 2006, through July 31, 2011, totaling $9,157,646 for home health services to Medicare beneficiaries that were medically unnecessary and not provided. Dr. Roy or another Medistat physician certified the services. From Jan. 1, 2006, to Aug. 31, 2011, Ultimate submitted claims for medically unnecessary home health services totaling $43,184,628. Charry allegedly submitted fraudulent claims from Aug. 1, 2008, to June 30, 2011, totaling $468,858 in medically unnecessary and not provided home health services.

The indictment alleges that Sivils, as Medistat’s office manager, helped facilitate the fraud scheme by, among other actions, supervising the processing of thousands of plans of care that contained Dr. Roy’s electronic signature and other Medistat physicians’ signatures, permitting HHAs to bill Medicare for unnecessary home health services and accepting cash payments from Cyprian Akamnonu in exchange for ensuring plans of care contained Dr. Roy or another Medistat physician’s signature.

As outlined in the government’s request to the court to detain Dr. Roy, in June 2011, CMS suspended provider numbers for Dr. Roy and Medistat based on credible allegations of fraud, thus ensuring Dr. Roy did not receive payment from Medicare. Immediately after the suspension, nearly all of Medistat’s employees started billing Medicare under the provider number for Medcare HouseCalls. The court document alleges that Dr. Roy was in fact in charge of day-to-day operations at Medcare, and that Dr. Roy continued to certify patients for home health despite the suspension.

Each charged count of conspiracy to commit health care fraud and substantive health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine. Each false statement charge carries a maximum penalty of five years in prison and a $250,000 fine. The indictment also seeks forfeiture of numerous items including funds in bank accounts, a sailboat, vehicles and multiple pieces of property.

An indictment is merely an allegation and defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Connie Ikpoh Sentenced to Serve 36 Months in Prison for $14.2 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-256.html 

WASHINGTON – A former Los Angeles church pastor, who owned and operated several fraudulent durable medical equipment (DME) supply companies with her husband, was sentenced today to serve 36 months in prison for her role in a $14.2 million Medicare fraud scheme, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.

Connie Ikpoh, 49, also was sentenced today by U.S. District Judge Terry J. Hatter for the Central District of California to three years of supervised release and ordered to pay $6.7 million in restitution jointly and severally with her co-conspirators.

In August 2011, a jury found Ikpoh, a nurse who also worked at two Los Angeles-area hospitals, and her husband, Christopher Iruke, 61, 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 presented at trial, Ikpoh and Iruke were pastors at Arms of Grace Christian Center, a Los Angeles church where Ikpoh and Iruke also operated Pascon Medical Supply, a fraudulent DME supply company. Ikpoh and Iruke hired several church members at Arms of Grace to assist them with running Pascon and three other fraudulent DME supply companies, Horizon Medical Equipment and Supply Inc., Contempo Medical Equipment Inc. and Ladera Medical Equipment Inc. The trial evidence showed that Ikpoh owned and operated Horizon. Ikpoh and Iruke used Iruke’s sister Jummal Joy Ibrahim as a straw owner of Contempo and Ladera.

According to the trial evidence, Ikpoh, Iruke, Marroquin and their co-conspirators used fraudulent prescriptions and documents that Ikpoh and 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. Each power wheelchairs cost approximately $900 per wholesale, but were billed to Medicare at a rate of approximately $6,000 per wheelchair. Witness testimony established that Ikpoh and Iruke hid the money they used to pay for these fraudulent prescriptions by writing checks to a company called “Direct Supply,” a fictitious company that Iruke created in the name of an Arms of Grace church member. Iruke cashed the checks that he and Ikpoh wrote to Direct Supply and used the money to purchase the fraudulent prescriptions.

Witnesses who sold the fraudulent prescriptions and documents that Ikpoh, Iruke and their co-conspirators used to defraud Medicare 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.

After Iruke purchased the prescriptions, the trial evidence showed that Ikpoh used the prescriptions at Horizon to bill Medicare primarily for power wheelchairs. In fact, the trial evidence showed that approximately 85 percent of Horizon’s business was power wheelchairs, and that Ikpoh submitted more than $3.2 million in claims to Medicare. Medicare paid Ikpoh more than $1.6 million on these claims. Witnesses who worked at Horizon testified that if Medicare refused to pay Horizon for a power wheelchair, Ikpoh required the witnesses to take back the power wheelchairs from the Medicare beneficiaries.

The trial evidence showed that Ikpoh was also involved with operating Contempo and Ladera. Ikpoh represented herself to state inspectors as Contempo’s manager and appeared on Ladera’s corporate filings with the state. Moreover, witness testimony established that Ikpoh ran the companies when Iruke visited Nigeria and that she and one of her co-defendants, Darawn Vasquez, who was also a church member at Arms of Grace, withdrew money from the Contempo bank account to pay for fraudulent prescriptions.

Witness testimony established that in August 2009, law enforcement agents visited Contempo and Ladera and questioned Marroquin and Vasquez about fraud occurring at the companies. Within a few weeks of the agents’ visit, Iruke closed Contempo and Ladera, which prompted agents to serve Iruke and his and Ikpoh’s attorneys with subpoenas for the companies’ files. Instead of producing the files, Iruke directed that the files be brought to an auditorium used by Arms of Grace, where Ikpoh, Iruke, 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, Ikpoh, Iruke, 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 showed that Ikpoh and Iruke 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.

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. On Jan. 9, 2012, Judge Hatter sentenced Iruke to serve 180 months in prison and three years of supervised release.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Lodrick "Chidi" Eneh Sentenced For Role In Patient Information Trafficking Scheme

Source-  http://www.justice.gov/usao/txe/News/2012/edtx-hcf-eneh-022112.html 

BEAUMONT, Texas – A 44-year-old Houston man has been sentenced to federal prison for his role in a patient information trafficking scheme in the Eastern District of Texas announced U.S. Attorney John M. Bales today.

Lodrick "Chidi" Eneh pleaded guilty on June 20, 2011, to illegal remunerations charges and was sentenced to 24 months in federal prison today by U.S. District Judge Marcia Crone.

According to the indictment, from September 2006 until November 2008, Houston businessman, Eneh conspired to pay and receive kickbacks for the referral of Medicare patients. Eneh entered into arrangements with Anthony Nnadi, Chima Imoh, and John Nasky Okonkwo, owners of medical supply businesses, in which he agreed to provide them with patient information that would be used to submit claims to Medicare. After the business owners submitted claims to Medicare and were reimbursed, they would split a percentage of the proceeds with Eneh. Eneh was indicted by a federal grand jury on Jan. 5, 2011.

Nnadi, Imoh, and Nasky have all pleaded guilty to health care fraud offenses. Nnadi was sentenced to five years probation and ordered to pay $576,000.00 in restitution to the Medicare program and to forfeiture of $100,000. Nasky was sentenced to 45 months in federal prison and ordered to pay restitution of $4.9 million to the Medicare and Medicaid programs and forfeiture of $4.8 million. Imoh was sentenced to a five year term of probation and ordered to pay $56,000 in restitution to Medicare for his role in the scheme.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Michelle Turner Convicted in $1.1 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-253.html 

WASHINGTON – A patient recruiter for a Houston durable medical equipment (DME) company was convicted today by a federal jury in Houston of health care fraud related to an “arthritis kit” fraud scheme, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.

After a four-day trial, Michelle Turner, 44, of Spring, Texas, was convicted of one count of conspiracy to commit health care fraud, one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries and two counts of receiving illegal kickbacks for referring Medicare beneficiaries.

According to evidence presented at trial, Clifford Ubani and Princewill Njoku were the owners of Family Healthcare Services. Family Healthcare maintained a valid Medicare provider number in order to submit Medicare claims for the costs of DME and purported to provide orthotics and other DME to Medicare beneficiaries. Ubani and Njoku hired co-conspirators Turner, Ana Quinteros and others to recruit beneficiaries for the purposes of filing claims with Medicare for DME. Once Ubani and Njoku obtained Medicare beneficiary numbers, Family Healthcare submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or not provided. Co-conspirator Rolondae Mitchell-Straughter was the office manager and was responsible for processing the fraudulent claims. Many of the orthotic devices were components of what was referred to as an “arthritis kit” and were purported to be for the treatment of arthritis-related conditions, but the devices were not medically necessary or appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices, including braces for both sides of the body and related accessories, such as heat pads. Ubani and Njoku paid kickbacks to the recruiters for their referrals. In total, Family Healthcare submitted approximately $1.1 million in fraudulent claims to Medicare.

Evidence at trial showed that Turner operated a “boiler room” and hired teenagers to make unsolicited telephone calls to elderly Medicare beneficiaries asking them if they wanted a free arthritis kit. The arthritis kit was billed to Medicare at more than $3,000. Under Medicare rules, unsolicited telephone calls are prohibited. Additionally, a Medicare beneficiary is responsible for paying a 20 percent co-pay for all DME. Beneficiaries’ doctors further testified at trial that the beneficiaries did not need the arthritis kit.

Ubani and Njoku previously pleaded guilty to conspiracy to commit health care fraud and await sentencing. Mitchell-Straughter pleaded guilty to conspiracy to commit health care fraud and was sentenced to 18 months in prison. Quinteros previously pleaded guilty to conspiracy to commit health care fraud and was sentenced to probation. A sixth defendant, Mary Ellis, was acquitted in this case by a jury in December 2010, but was later convicted of conspiracy to commit health care fraud in May 2011 in a separate case and was sentenced to 63 months in prison.

At sentencing, Turner faces maximum penalties of 10 years in prison for the health care fraud conspiracy count; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for each count of receiving an illegal kickback for referring a Medicare beneficiary.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Mohammad Khan Pleads Guilty to Participating in $116 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-243.html 

WASHINGTON – An assistant administrator of a Houston hospital pleaded guilty today for his role 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).

Mohammad Khan, 62, of Houston, pleaded guilty before U.S. District Judge Sim Lake in the Southern District of Texas to one count of conspiracy to commit health care fraud, one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks, and five counts of paying or offering to pay health care kickbacks. Khan was arrested on Feb. 8, 2012. In his plea, Khan admitted that, from January 2008 until the time of his arrest, he caused the submission of $116 million worth of fraudulent claims to Medicare for partial hospitalization program (PHP) services purportedly provided by the hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.

“As an assistant administrator at a Houston hospital, Mr. Kahn participated in a $116 million fraud against the government,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “For years, he operated a scheme to bill Medicare for partial hospitalization services that were medically unnecessary or never provided. With our Medicare Fraud Strike Force teams in nine cities, we are holding accountable people across the country who have calculated – incorrectly – that they can get away with trying to bilk the Medicare program.”

According to court documents, Khan was the assistant administrator of Riverside General Hospital and controlled the day-to-day operations of Riverside’s PHPs. Riverside maintained a valid Medicare provider number that was used to submit claims to Medicare for PHP services that were not medically necessary, and in some cases, never provided. Many of the beneficiaries for whom Riverside submitted claims to Medicare for PHP services did not have severe mental illness and did not need the treatment provided in a PHP. In his plea, Khan admitted that he paid and caused the payment of kickbacks to patient recruiters and owners of assisted living facilities and group care homes in exchange for the recruiters and owners sending Medicare beneficiaries to Riverside’s PHPs. Khan also paid Medicare beneficiaries in the form of cigarettes, food and coupons redeemable for items available at Riverside’s “country stores,” in exchange for those beneficiaries attending Riverside’s PHPs.

In his plea, Khan admitted that he and his co-conspirators 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.

Khan is scheduled to be sentenced on May 25, 2012. Khan faces a maximum sentence of 10 years in prison for the conspiracy to commit health care fraud count, five years in prison for the conspiracy to defraud the United States count and five years in prison for each health care kickbacks count.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Butler Moultrie Sentenced to 33 Months in Prison for Participating in Fraud and Kickback Scheme

Source-  http://www.fbi.gov/miami/press-releases/2012/fort-lauderdale-florida-area-halfway-house-operator-sentenced-to-33-months-in-prison-for-participating-in-fraud-and-kickback-scheme 

WASHINGTON—The manager and operator of a Fort Lauderdale, Fla.-area halfway house was sentenced today to 33 months in prison for his role in a Medicare fraud kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Butler Moultrie, 46, was sentenced by U.S. District Judge Donald M. Middlebrooks in the Southern District of Florida. In addition to his prison term, Moultrie was sentenced to three years of supervised release and was ordered to pay $801,000 in restitution.

Moultrie pleaded guilty in December 2011 to one count of conspiracy to commit health care fraud.

According to court documents, most of the residents at Moultrie’s halfway house were recovering from drug and/or alcohol addictions. Moultrie agreed to refer Medicare beneficiaries who resided at his halfway house to ATC to purportedly receive intensive mental health services called partial hospitalization program (PHP) treatment in exchange for illegal health care kickbacks. Moultrie admitted that he knew the kickbacks were illegal and that ATC fraudulently billed the Medicare program for the PHP services. Moultrie also knew that no doctor had prescribed PHP treatment for his patient referrals and that his residents required drug and/or alcohol addiction treatment rather than mental health services.

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, Moultrie’s participation in the fraud resulted in approximately $1.9 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 ten 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. In addition to Moultrie, 11 other assisted living facility and halfway house owners and operators and patient recruiters have been convicted for their roles in the fraud scheme. Eight of these defendants, including Moultrie, have been sentenced to prison.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Former Vice-President of Pharmacutical Company Johnny Perry, Pleads Guilty to FDA Violations and Health Care Fraud

Source-  http://www.fbi.gov/louisville/press-releases/2012/former-vice-president-of-pharmacutical-company-pleads-guilty-to-fda-violations-and-health-care-fraud 

LOUISVILLE, KY—The former vice-president of National Respiratory Services, LLC (NRS) has pled guilty in United States District Court before Chief Judge Joseph H. McKinley, Jr., to charges of misbranding and altering drugs and to committing health care fraud announced David J. Hale, United States Attorney for the Western District of Kentucky.

Johnny Perry, age 62, of Mt. Washington, Kentucky, was indicted by a federal grand jury in Louisville on August 3, 2011. The five count indictment alleged that between June of 2006 and June of 2008, Perry, as vice-president of NRS, provided compounded medications to patients, but led both Medicare and the patients’ doctors to believe that the pharmaceutical company was providing non-compounded medications (FDA approved-commercially manufactured). Compounded medications are not FDA approved, but FDA regulations permit pharmacists to make compounded drugs, including prescription drugs, in limited amounts and under narrow circumstances, for particular patients, and at the direction of a physician when other available drugs cannot be prescribed.

The defendant, through the NRS Corporation submitted false and fraudulent claims to Medicare for the cost of FDA-approved, commercially manufactured, prescription inhalation drugs, when they were not. As a result of this conduct, NRS received approximately $2,030,343 in payments from Medicare to which they were not legally entitled.

It is further alleged that Ms. Perry, aided and abetted by others, from November 2006 through June 2008, misbranded inhalation drugs in that they contained false and misleading labeling that misrepresented the strength and potency of their active ingredients or the type of drug actually provided. During the same period it is alleged that Perry, aided and abetted by others, adulterated inhalation drugs in that the strength differed from what it was purported or represented to possess and that the drugs were contaminated and non-sterile.

“This case should send a clear message that offenses endangering public health will be vigorously prosecuted,” stated U.S. Attorney David J. Hale. “Misrepresenting the strength and potency of a prescribed medication and delivering contaminated products to patients are unconscionable crimes.”

“The Office of Inspector General is committed to protecting the health of patients covered by Medicare and Medicaid,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services in Atlanta, Georgia, “This company billed for medications that never should have been dispensed in the first place which created serious quality of care concerns.”

The maximum potential penalties are 46 years in prison, a $770,000 fine, and supervised release for a period of three years.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Sonja Ascoli Pleads Guilty to Federal Charge of Health Care Fraud

Source-  http://www.fbi.gov/boston/press-releases/2012/medical-equipment-sales-rep-pleads-guilty-to-federal-charge-of-health-care-fraud 

PROVIDENCE, RI—Sonja Ascoli, 59, of Woonsocket, R.I., pled guilty in U.S. District Court in Providence today to defrauding the federal Medicare program of more than $70,000, announced United States Attorney Peter F. Neronha.

Ascoli admitted to the court that she participated in a scheme to entice Medicare beneficiaries to order products and medical equipment from the company she represented, Planned Eldercare, in Buffalo Grove, Ill., by promising that products would be provided “at no cost” to them. The Medicare Program does not permit copayments to be waived. Ascoli, who was the highest paid outside sales representative employed by Planned Eldercare between 2007 and 2008, admitted that she defrauded the Medicare program of a total of $70,354. Her salary was paid on a commission basis.

Ascoli, who pled guilty to one count of health care fraud, faces up to 10 years in federal prison when she is sentenced by U.S. District Court Judge William E. Smith on May 4, 2012.

On February 10, 2012, Gary Winner, 50, of Northbrook, Ill., owner of Planned Eldercare, was sentenced in federal court in Providence to 37 months in federal prison for defrauding the Medicare program of more than $2.2 million. In November 2011, Winner pled guilty 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 was also ordered to pay restitution in the amount of $2,210,152 to the Medicare program and to pay a fine of $12,500.

At today’s hearing before U.S. District Court Judge William E. Smith, Ascoli admitted that she 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.

Ascoli admitted to the court that once she 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 a medical need for the equipment. When beneficiaries complained about receiving items they did not order, Ascoli admitted that she responded by telling them, “Keep the products in the closet until you need them.” When others complained on the beneficiaries’ behalf, she responded, “You know how it is, they forget what they ordered.”

Ascoli also admitted that as part of the scheme, upon receiving products and equipment returned to her by beneficiaries, she 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 keeping any commissions she had earned on the products sold.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Tylese Marie Rodriquez Charged With Obtaining Controlled Substances By Fraud And Health Care Fraud

Source-  http://www.justice.gov/usao/sd/pressreleases/SF-2012-02-10-Rodriquez.html 

US Attorney Brendan V. Johnson announced that a Hudson, South Dakota, woman has been indicted by a federal grand jury for Obtaining Controlled Substances by Fraud and Health Care Fraud.

Tylese Marie Rodriquez, a/k/a Tylese Marie Pearson, age 32, was indicted by a federal grand jury on February 7, 2012, for Obtaining Controlled Substances by Fraud and Health Care Fraud. She appeared before US Magistrate Judge John E. Simko on February 9, 2012, and pled not guilty to the indictment.

The maximum penalty upon conviction for Obtaining Controlled Substances by Fraud is four years of imprisonment, a $250,000 fine, or both. The maximum penalty upon conviction for Health Care Fraud is 10 years in prison, a $250,000 fine, or both. The charges are merely accusations, and Rodriquez is presumed innocent until and unless proven guilty.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Lori Brill, Butch Brill, Jeff Vernon, and Chris Vernon In Multi-Million Dollar Hemophilia Medication Kickback Scheme

Source-  http://www.justice.gov/usao/als/news/2012/021412-1.html 

United States Attorney Kenyen R. Brown announces today that a federal jury has convicted Lori Brill, Butch Brill, Jeff Vernon, and Chris Vernon of various charges arising out of their participation in a scheme to bill Alabama Medicaid for unnecessary hemophilia medication and to supply inducements, in the form of illicit commission payments, for Medicaid referrals.

In announcing the convictions, Mr. Brown stated, “Healthcare fraud in the United States costs consumers billions of dollars, whether the victim is a private medical insurer or a public program such as Medicaid. Individuals exhibiting sheer greed through extensive fraudulent billing and awarding improper inducements for Medicaid business are driving up healthcare costs and are depriving those who really need medical assistance as provided by these government funded programs. Our office, in conjunction with our law enforcement partners, will aggressively continue to safeguard precious taxpayer dollars, protect our nation’s most essential health care programs, and dismantle criminal networks that bilk the system.”

Mobile Division Special Agent in Charge, Lewis M. Chapman, stated: “This conviction sends a strong message to those who abuse our tax dollars to enrich themselves that they will be identified, caught and punished.” Chapman further stated: “This conviction was also the direct result of a strong interagency effort which allowed the leveraging of resources and strengths to achieve this outcome.” Anyone with information regarding such fraudulent activity is encouraged to contact the FBI.

The evidence at trial demonstrated that Lori Brill (“Brill”), mother of a hemophiliac son, ran a hemophilia care company known as Hemophilia Management Specialties, Inc. (“H.M.S.”), which provided cost free services to clients who suffered from hemophilia, including, among other things, ordering their extremely expensive medication called “Factor” through MedfusionRx, L.L.C., a speciality pharmacy owned and operated by brothers Jeff and Chris Vernon. The Factor costs of hemophilia sufferers can, on average, be in the hundreds of thousands of dollars each year. In fact, in 2009 alone, Alabama Medicaid reimbursed specialty pharmacies over $21 million dollars for the Factor claims of just 87 hemophilia sufferers, most of whom were children. In an effort to increase commissions received from Medfusion, Brill worked with her estranged husband Butch Brill and H.M.S. employees Ashley Sprinkle and Sherry Demouey, both of whom previously pleaded guilty to health care fraud charges stemming from their roles in this scheme, to falsify the Factor tracking logs of H.M.S. clients. Together, and at the direction of Lori Brill, they manipulated logs to indicate that H.M.S. clients took the maximum amount of Factor at the greatest frequency allowed under their prescriptions without verifying the clients’ actual usage. These logs were then forwarded to Medfusion to order more Factor medication. In turn, the unnecessary medication was billed to Medicaid. One hemophilia client whose logs were manipulated was Travis Goodwin, who pleaded guilty just before trial to aiding and abetting healthcare fraud. Based on this scheme, the jury convicted Lori and Butch Brill of conspiracy to commit healthcare fraud, pursuant to 18 U.S.C. § 1349.

The trial evidence further demonstrated that Jeff Vernon and Chris Vernon paid illicit kickbacks to Brill and another patient manager, Leroy Waters, himself a hemophilia sufferer, in order to induce them to fill their Medicaid clients’ Factor prescriptions at Medfusion. Brill had an unlawful commission agreement with the Vernons whereby she received commissions equal to 45% of the profits the pharmacy generated by filling the Factor prescriptions of H.M.S. clients who were Medicaid recipients. Likewise, the Vernons and Waters had an illegal commission agreement which mirrored Brill’s, with Waters receiving commissions totaling 50% of the profits Medfusion brought in from filling his Medicaid clients’ Factor prescriptions. Waters pleaded guilty just before trial to a substantive anti-kickback charge due to his receipt of these illicit commissions. Based on this scheme, the jury convicted Lori Brill and Chris Vernon of three substantive charges of violating the anti-kickback statute, pursuant to 42 U.S.C. § 1320a-7b(b). The jury convicted Jeff Vernon of one count of conspiracy to violate the anti-kickback statute, pursuant to 18 U.S.C. § 371, and six substantive counts of violating the statute.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Felicitas Velez Alanis and her daughter-in-law Erika Ortega Alanis Both Pleas Guilty in Health Care Fraud Scheme

Source-  http://www.fbi.gov/sanantonio/press-releases/2012/brownsville-mother-and-daughter-in-law-guilty-in-health-care-fraud-scheme 

McALLEN, TX—Felicitas Velez Alanis, 51, and her daughter-in-law, Erika Ortega Alanis, 27, both of Brownsville, Texas, have entered pleas of guilty to conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott.

Felicitas Alanis owned and operated Vel-Ala Inc.—a Texas corporation which did business as Nisi Medical Equipment and Supplies in and around Brownsville, Harlingen and elsewhere in South Texas. Her daughter-in-law, Erika Alanis, assisted in the day-to-day operation of the company. Nisi Medical Equipment and Supplies was enrolled with the Texas Medicaid program to provide durable medical equipment (DME) to Texas Medicaid beneficiaries. The term DME means medical equipment and supplies used in the home and includes blood-testing strips, blood glucose monitors, alcohol wipes, diabetic supplies, and other medically necessary items.

The government alleged that the two women submitted more than $646,000 in false and fraudulent bills to the Texas Medicaid program for diabetic supplies which Nisi Medical Equipment and Supplies never purchased or supplied to Medicaid beneficiaries. The delivery records and billing records of Nisi show that the Texas Medicaid program was routinely billed for more items than were actually delivered and the purchase records revealed that the Texas Medicaid program was billed for medical supplies and items that Nisi had never purchased. Medicaid paid more than $554,000 on the false and fraudulent claims submitted.

Felicitas and Ericka Alanis admitted in court today that they conspired to send false and fraudulent bills to the Texas Medicaid program in the name of Nisi Medical Equipment and Supplies between on or about Jan. 1, 2005, through on or about Oct. 12, 2006, and that they routinely billed the Medicaid program for allegedly providing 200 boxes of alcohol prepartion pads to Medicaid beneficiaries when in fact only one box of alcohol preparation pads was ever delivered.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Edmund Nwaudobi Convicted of Medicare Fraud in Kansas

Source-  http://www.fbi.gov/kansascity/press-releases/2012/texas-man-convicted-of-medicare-fraud-in-kansas 
KANSAS CITY, KS—A Texas man has been convicted of fraudulently billing Medicare for power wheelchairs and other medical devices, U.S. Attorney Barry Grissom said today.

A jury convicted Edmund Nwaudobi, 48, Sugar Land, Texas, on one count of conspiracy to defraud Medicare, two counts of health care fraud, and one count of aggravated identity theft.

“Health care fraud is a widespread problem,” said U.S. Attorney Barry Grissom. “We are working hard to protect the American people and safeguard precious taxpayer dollars.”

During trial, federal prosecutors presented evidence that from 2004 to 2009 Nwaudobi conspired with co-defendants Tom Alabraba, Iyaye Ishmael, and George Tasie to fraudulently bill Medicare for power wheelchairs and other medical devices, such as leg and body braces. In some instances, Medicaid was billed for devices that were not medically necessary, including leg braces for an individual who had previously had his legs amputated, and who never received the braces. In other instances, Medicare was billed for medical devices that Medicare recipients never received.

Nwaudobi conducted business on behalf of Good Care, Inc., an Overland Park, Kan., company that supplied durable medical equipment such as orthotics. Nwaudobi shared patient information with Tom Alabraba, who owned or operated Tal-Med, Inc., a Kansas City, Kan., company that supplied durable medical devices; George Tasie, who owned or operated Central Medical, Inc., a Kansas City, Kan., company that supplied durable medical devices; and Iyaye Ishmael, who was a manager of Central Medical, Inc.

The companies billed more than $2.9 million in Medicare claims for 397 beneficiaries living in Missouri and Kansas, and received more than $1.5 million from those claims.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com

Mary Ellis, Caroline Njoku, Terrie Porter and Florida Holiday Island Sentenced to More Than Five Years in Prison for Roles in $5.2 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-216.html 

WASHINGTON – Two Houston-area nurses and two of their co-conspirators have been sentenced in Houston for their participation in a $5.2 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Service (HHS).

Mary Ellis, 56, a registered nurse, was sentenced today to 63 months in prison followed by three years of supervised release and was ordered to pay $401,000 in restitution. Ellis was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks, three counts of receiving illegal kickbacks and two counts of making false statements following a May 2011 trial.

Caroline Njoku, 46, also a registered nurse, was sentenced yesterday to 63 months in prison followed by one year of supervised release and was ordered to pay $631,295 in restitution. Njoku was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay kickbacks following a May 2011 trial. 

Terrie Porter, 48, was sentenced yesterday to two years in prison and two years of supervised release and was ordered to pay $482,380 in restitution. Porter was convicted of one count of conspiracy to receive kickbacks and one count of receiving illegal kickbacks following a May 2011 trial.

Florida Holiday Island, 62, was sentenced yesterday to 20 days in prison, five months of home detention and two and a half years of supervised release and was ordered to pay $59,739 in restitution. Island pleaded guilty in March 2011 to one count of conspiracy to receive kickbacks and one count of receiving illegal kickbacks.

The defendants were sentenced by U.S. District Judge Nancy Atlas in the Southern District of Texas. The four defendants were ordered to pay restitution jointly and severally with co-conspirators and defendants in a related case. As part of the sentencing, the court found that Ellis and Porter had obstructed justice by testifying untruthfully at trial.

According to the evidence presented at trial and in court documents, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries. Family Healthcare Group paid Ellis, Porter, Island and other co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. According to evidence presented at trial, Njoku and Ellis falsified documents to support the fraudulent payments. After the Medicare beneficiaries were recruited, other co-conspirators fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact they knew the beneficiaries were not home-bound and not in need of skilled nursing.

Co-defendant Adelma Casas Sevilla, a registered nurse, was previously sentenced to 18 months in prison. A second co-defendant, Sammie Wilson, received three years of probation after pleading guilty to one count of conspiracy to commit health care fraud. Four other defendants involved in the scheme are pending sentencing.



***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com