HOUSTON—The owners of a Houston area durable medical equipment company have been convicted by a jury of multiple counts of health care fraud arising from their roles in a scheme to defraud Medicaid through fraudulent billing for adult urinary incontinence supplies, United States Attorney José Angel Moreno and Texas Attorney General Greg Abbott announced today.
Bassey Essien, 60, and his daughter, Rose Essien, 31, of Houston, were found guilty on April 7, 2011, after an eight-day trial of multiple felony counts. Bassey Essien was convicted of all 19 counts alleged in the indictment against him—including conspiracy, health care fraud, and aggravated identity theft. Rose Essien was convicted of 15 of the 19 counts including 11 counts of health care fraud and five counts of aggravated identity theft. A third defendant, the Essien’s delivery driver, was acquitted on all counts.
Through the operation of Logic World Medical and Roben Medical, both durable medical equipment (DME) companies located in Houston, the Essiens unlawfully received Medicaid beneficiaries’ information, including names, addresses, and Medicaid numbers, which they then use to file false claims with the Medicaid program.
The evidence showed that the Essiens routinely billed Medicaid for adult urinary incontinence supplies they did not deliver to the Medicaid beneficiaries or for delivering supplies in amounts significantly less than the amounts billed to Medicaid. Additionally, the Essiens routinely billed Medicaid for adult urinary incontinence supplies provided to Medicaid beneficiaries who either did not need the supplies or whose physicians had not prescribed them. Adult incontinence supplies include adult diapers, underpads, wipes and pull-up briefs.
Through their DME company, the defendants continued to bill Medicaid for incontinence supplies even after their delivery staff and/or delivery contractors were told by the beneficiaries they did not need or want the supplies. They regularly billed Medicaid for the delivery of 300 diapers, the maximum allowed amount of incontinence supplies each month per beneficiary, and for extra-large size diaper briefs, which have the highest Medicaid reimbursement rate, without consideration to the actual size needed by the beneficiary. They even billed Medicaid for delivering a quantity of extra large adult size diapers far in excess of the amount they purchased from wholesale suppliers. The evidence showed the defendants only purchased six percent of the amount of extra large diapers they claimed to have delivered.
The scheme to defraud began in April 2004, under the company Logic World, with the last false claim having been filed in February 2010 under the name Roben Medical. The Essiens billed Medicaid for claims totaling approximately $2,341,293.64 and received payments for those claims totaling approximately $1,455,837.91.
Over government objection, the court has permitted Bassey and Rose Essien to remain on bond pending sentencing on July 8, 2011
Benjamin Essien, 34, Bassey Essien’s son, pleaded guilty to conspiracy to commit health care fraud, health care fraud, and aggravated theft in advance of trial.
All three defendants face a maximum of 10 years’ imprisonment and a $250,000 fine for the conspiracy conviction as well as each health care fraud conviction. Each count of aggravated identity theft carries a mandatory two-year consecutive term of imprisonment.
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Saturday, April 9, 2011
Jury Convicts Bassey Essien and his Daughter Rose Essien of Health Care Fraud
Friday, April 8, 2011
Margarita Acevedo Pleads Guilty for Her Role in Community Mental Health Care Fraud Scheme Involving More Than $100 Million in Fraudulent Medicare Claims
WASHINGTON – A Miami-area resident pleaded guilty today in U.S. District Court in Miami for her role in managing a community mental health care fraud scheme that resulted in the submission of more than $100 million in fraudulent claims to Medicare, the Departments of Justice and Health and Human Services (HHS) announced.
Margarita Acevedo pleaded guilty before U.S. Magistrate Judge Barry L. Garber to one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive illegal health care kickbacks. In pleading guilty, Acevedo admitted that since 2005, she served as the marketing director for American Therapeutic Corporation (ATC), a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for mental illness.
Acevedo admitted that as marketing director, her job was to orchestrate the payment of kickbacks and bribes used to recruit Medicare beneficiaries to attend ATC and a related company, American Sleep Institute (ASI). Acevedo admitted that the Medicare beneficiaries recruited by ATC and ASI, were not eligible to receive the PHP and sleep study services that ATC and ASI billed to Medicare, and that the services were not medically necessary. During the period of her involvement in the fraud scheme, the defendant admitted that she and her co-conspirators caused between $100 million and $200 million in fraudulent claims to be submitted to Medicare for services purportedly provided at ATC and ASI.
According to court documents, Acevedo and others paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for providing ineligible patients to ATC and ASI. Acevedo and her co-conspirators knew that Medicare beneficiaries were recruited regardless of their medical needs and in some cases the beneficiaries received a portion of the kickbacks. Acevedo and her co-conspirators actively recruited ALF and halfway house owners and operators and patient brokers to participate in this kickback scheme. Acevedo admitted that she and other co-conspirators paid and caused the payment of millions of dollars in kickbacks in exchange for Medicare beneficiaries to attend ATC and ASI programs for which they did not qualify so that ATC and ASI could bill Medicare for medically unnecessary services.
Acevedo also admitted that she and her co-conspirators engaged in elaborate and sophisticated measures to conceal their fraudulent activities from Medicare and from law enforcement.
Acevedo and her co-conspirators were charged in a superseding indictment unsealed on Feb. 15, 2011. The superseding indictment alleges that ATC and ASI submitted a total of more than $200 million in claims to Medicare.
Thursday, April 7, 2011
Dr. Ghulam Mustafa Pleads Guilty to Making False Health Care Statements
BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced today that Ghulam Mustafa, 48, of Albion, New York, pleaded guilty before Judge Richard J. Arcara, to a felony charge of making false statements in connection with a health care matter. The charge carries a maximum penalty of five years in prison and a $250,000 fine.
Assistant U.S. Attorney Mary Ellen Kresse, who is handling the case, stated that on multiple occasions between January 2005 and December 2007, Mustafa, a physician working with Hassan Medical Group in Albion, New York, submitted claims to health insurance companies seeking reimbursement for vaccines he administered to patients. The patients were insured by those companies but Mustafa received the vaccines for free through the Vaccines for Children Program—a federally funded program administered by New York State. The program is designed to provide free vaccines to underprivileged children. Mustafa falsely indicated that more patients were eligible for the free vaccines than actually were. As a result, the defendant received over $80,000 in reimbursements from private insurance companies to which he was not entitled.
“Our office will not tolerate any attempts to defraud our country’s health care sector,” said U.S. Attorney Hochul. “In this case, the defendant targeted not only private health insurance companies but also a federal program designed to provide health care assistance to those who need it most.”
The guilty plea is the result of an investigation by the Federal Bureau of Investigation, under the direction of Acting Special Agent in Charge Richard Kollmar, and Health and Human Services, Office of Inspector General, New York Region, under the direction of Special Agent in Charge Thomas O’Donnell.
Tuesday, April 5, 2011
Rex Healthcare Hospital to Pay U.S. $1.9 Million to Resolve Allegations Related to Kyphoplasty and Other Procedures
WASHINGTON – Rex Healthcare, a 655-bed hospital in Raleigh, N.C., has agreed to pay the United States $1.9 million, plus interest, to settle allegations that it submitted false claims to Medicare, the Justice Department announced today. The government alleges that the hospital routinely submitted claims to Medicare for a variety of minimally-invasive procedures during the period 2004 through 2007, which the hospital classified as inpatient admissions in order to increase its reimbursement from Medicare, despite the absence of medical necessity justifying the more expensive inpatient admissions.
The allegations arise from a lawsuit that was brought under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery. The lawsuit was filed in 2008 in federal district court in Buffalo, N.Y., by former Kyphon employees Craig Patrick and Charles Bates. They will receive a total of approximately $80,000 as their share of the settlement proceeds for those claims related to kyphoplasty claims. The settlement also involves claims related to a variety of other minimally-invasive procedures that the hospital classified as inpatient admissions in order to increase its reimbursement when less costly outpatient visits would have been appropriate.
“We pursue cases like this because when hospitals submit false claims in order to increase their Medicare reimbursement, as we allege here, it artificially drives up the cost of health care, leaving taxpayers to foot the inflated bill," said Tony West, Assistant Attorney General for the Justice Department’s Civil Division.
“This settlement shows the continuing commitment by the U.S. Attorney’s Office for the Western District of New York to investigate and recover any improper billings for kyphoplasty procedures and to partner with our colleagues in other U.S. Attorney Offices when necessary to remedy similar billing abuses related to non-kyphoplasty procedures,” said William J. Hochul Jr., U.S. Attorney for the Western District of New York.
“This resolution demonstrates the department’s ability to coordinate efficiently among districts and with our partners at the U.S. Department of Health and Human Services to achieve a comprehensive and fair result,” said George E.B. Holding, U.S. Attorney for the Eastern District of North Carolina. “We are committed to ensuring that Medicare funds are expended appropriately in all cases.”
“Submitting inflated claims - as Rex Healthcare is alleged to have done - drains critically-needed dollars from government health care programs,” said Daniel R. Levinson, Inspector General for the U.S. Department of Health and Human Services. “OIG is committed to working closely with our law enforcement partners to pursue and hold accountable entities that defraud Medicare and ultimately U.S. taxpayers.”
Assistant Attorney General West noted that the settlements with these hospitals were the result of a coordinated effort among the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Western District of New York, the U.S. Attorney’s Office for the Eastern District of North Carolina and the Department of Health and Human Services’ Office of Inspector General.
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Monday, April 4, 2011
U.S. Files Complaint Against Texas-Based Healthpoint Ltd. Under the False Claims Act
WASHINGTON – The United States has filed a complaint against Healthpoint Ltd., alleging civil False Claims Act violations arising from the company’s sale of an unapproved prescription drug that was ineligible for payment under Medicaid and Medicare, the Justice Department announced today. In the complaint, filed in the District of Massachusetts, the government alleges that the Ft. Worth, Texas-based subsidiary of DFB Pharmaceuticals Inc., submitted false statements concerning the regulatory status of Xenaderm to the United States, thereby causing false or fraudulent prescription claims for the unapproved drug to be submitted to Medicaid and Medicare.
Xenaderm, a skin ointment primarily used to treat bed and pressure sores, otherwise known as “decubitus ulcers,” was launched by Healthpoint in 2002 without any approval by the Food and Drug Administration (FDA). Xenaderm contains trypsin as an active ingredient, which is intended to function in the unapproved drug as a debriding agent, i.e., for the removal of dead tissue around a wound. In the 1970s, however, the FDA determined on at least two separate occasions that trypsin was ineffective as a debriding agent and rescinded the market approval for products containing trypsin as a debriding agent. As a result of these determinations, Xenaderm, which came onto the market much later, was ineligible for reimbursement under Medicaid and Medicare.
The government’s complaint alleges that Healthpoint knew Xenaderm was unapproved, and knew of or recklessly disregarded the FDA notices concerning trypsin’s lack of effectiveness as a debriding agent. According to the complaint, Healthpoint nonetheless falsely represented to the United States that the drug was eligible for Medicaid and Medicare reimbursement. As a result of Healthpoint’s false statements, the United States alleges that Healthpoint caused Medicaid and Medicare to pay tens of millions of dollars for an unapproved drug that was ineligible for reimbursement.
“The complaint filed today underscores our commitment to pursuing manufacturers that provide false information to obtain taxpayer dollars for unapproved and ineffective drugs,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice.
“This action reflects our continued efforts to ensure that drug manufacturers do not evade the drug approval process or cause the government to pay for less than effective drugs,” said Carmen Ortiz, U.S. Attorney for the District of Massachusetts.
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Saturday, April 2, 2011
Dannette M. Hawthorne The Owner of the Two Columbus Clinics Pleaded Guilty to Illegally Distributing Thousands of Pain Pills
COLUMBUS—The owner and two employees of two pain management clinics in Columbus have pleaded guilty in U.S. District Court to distributing prescriptions for the equivalent of more than 11,000 dosages of pain medicine without a legitimate medical need for the prescriptions and fraudulently billing a government insurance program for the drugs.
Dannette M. Hawthorne, 48, of Columbus, the owner of the two Columbus clinics, Trinity Medical Center, LLC, and Perspective Medical Solutions, Inc. pleaded guilty today to one count each of conspiracy to distribute Schedule II controlled substances, conspiracy to commit health care fraud, submission of fraudulent claims, and aggravated identity theft.
Charlene Breedlove-Jones, 53, of Columbus and the office manager for both clinics, pleaded guilty Monday, March 28 to one count each of conspiracy to distribute Schedule II controlled substances, health care false statements, obtaining controlled substances by fraud, attempted distribution of a controlled substance and aggravated identity theft.
In 2010, Hawthorne and Breedlove-Jones illegally distributed 170 grams of oxycodone, or the equivalent of more than 11,000 dosages of 15-milligram pills.
The U.S. Attorney’s Office asked the court to order that Hawthorne and Breedlove-Jones remain in custody until sentencing.
Deneshia M. Wakefield, 37, of Columbus, who was employed at both clinics, pleaded guilty on March 25 to one count each of health care false statements and obtaining a controlled substance by fraud.
According to statements read during their plea hearings, Hawthorne owned the clinics operating on Karl Court in Columbus. The clinics accepted cash payments only and charged approximately $365 for each new patient and $265 for returning patients. In June 2010 Hawthorne and Jones had a physician employed by the clinic sign numerous prescriptions for oxycodone in the hotel room where he was staying, knowing that he had not seen any of the patients for whom the prescriptions were intended.
Between August, 2010 and December, 2010, Trinity and Perspective employed no licensed physicians. Hawthorne and Breedlove-Jones conspired to forge hundreds of physician signatures on prescriptions for pain medications and other controlled substances. Hawthorne and Breedlove-Jones used the names of physicians who had previously worked at Trinity and Perspective without the physicians’ knowledge. Breedlove-Jones and Hawthorne distributed the prescriptions to patients of the clinics, many of whom had addictions to pain medications. Patients subsequently had the prescriptions filled at various pharmacies throughout Ohio and neighboring states.
Hawthorne also had prescriptions for pain medications filled in the names of co-workers who were receiving Medicaid benefits and illegally billed the Medicaid program more than $29,000 for filling the prescriptions.
“Illegal diversion of prescription drugs and Medicaid fraud are two crimes we vigorously prosecute,” Stewart said. “We are committed to working with the Ohio Attorney General’s office and other state, local and federal agencies to attack the prescription diversion problem.”
“I commend our team of federal, state, and local law enforcement officers and prosecutors who helped convict these three drug dealers,” Ohio Attorney General DeWine said. “The Ohio Attorney General’s Office will continue to partner with the U.S. Attorney’s Office and local law enforcement to protect Ohio families from the predators who try to poison them through prescription drug abuse.”
substances is punishable and attempted distribution of a controlled substance are each punishable by up to 20 years' imprisonment and a fine of up to $1 million. Conspiracy to commit health care fraud is punishable by up to 10 years' imprisonment and a fine of $250,000. Submitting fraudulent claims is punishable by up to five years in prison. Obtaining a controlled substance by fraud is punishable by up to four years in prison. Aggravated identity theft carries a mandatory two-year sentence which must be served consecutive to the sentences imposed for any of the other crimes.
Judge Frost will determine the sentences and schedule a sentencing hearing following the completion of a pre-sentence investigation by the court.
Stewart commended the cooperative investigation by the federal, state and local law enforcement agencies who are investigating the case, and Assistant U.S. Attorney Kenneth Affeldt, and Special Assistant U.S. Attorney Shawn Napier with Ohio Attorney General Mike DeWine’s Office, who are prosecuting the case.
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Friday, April 1, 2011
Carolyn Ann Vasquez Pleads Guilty to Participating in a Medicare Fraud Scheme Using Fraudulent Medical Clinics and Stolen Doctor Identities to Defraud Medicare of More Than $6.2 Million
WASHINGTON—A Los Angeles woman has pleaded guilty to using fraudulent medical clinics and the stolen identities of physicians to defraud Medicare of more than $6.2 million, the Departments of Justice and Health and Human Services (HHS) announced.
Carolyn Ann Vasquez, 46, pleaded guilty yesterday before U.S. District Judge Terry J. Hatter Jr. in the Central District of California. Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. According to court documents, physician assistants recruited to work at the clinics by Vasquez and working at her direction performed these services and prescribed and ordered the wheelchairs, medical equipment, and diagnostic tests.
According to court documents, Vasquez told the physicians she recruited that they would be the medical directors of the clinics, but that if they did not want to work full time, the clinics would hire physician assistants. Vasquez assisted the physicians in obtaining Medicare provider numbers and entering into management agreements that gave Vasquez's co-conspirators authority to operate and manage the clinics in exchange for 75 percent of the reimbursement payments the physicians received from Medicare.
According to court documents, Vasquez's involvement in the recruitment of the physicians gave her access to their personal and Medicare information, which Vasquez stole to further the fraud scheme at the medical clinics. Vasquez admitted that in approximately 2007, a physician contacted her about a job at one of the fraudulent medical clinics, but the physician decided not to accept the job. Nevertheless, Vasquez's co-conspirators printed prescription pads with the physician's name and Medicare provider number on them. Vasquez admitted that she instructed a physician assistant working at one of the fraudulent medical clinics to use the prescription pads to write fraudulent prescriptions and medical documentation for diagnostic tests, power wheelchairs and other medical equipment in the physician's name even through Vasquez knew that the physician did not work at the clinic. Vasquez admitted that as a result of her conduct, Medicare was defrauded of approximately $6,268,899.
At sentencing, scheduled for July 11, 2011, Vasquez faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in court documents in this case, Vasquez pleaded guilty in 1993 to participating in a health care fraud scheme. According to court documents, Vasquez and others used telemarketing or "boiler room" schemes to defraud government-funded health care benefit programs of approximately $41 million.
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Thursday, March 31, 2011
Marlon Oslvaldo Palma Sentenced to Nearly Five Years in Prison in $1.8 Million Medicare Fraud Scheme
LOS ANGELES—The owner of a South Los Angeles medical supply company that fraudulently collected nearly $2 million from Medicare for unneeded electric wheelchairs and other durable medical equipment has been sentenced to 57 months in federal prison.
Marlon Oslvaldo Palma, 40, of South Los Angeles, was sentenced late yesterday by United States District Judge Christina A. Synder.
Palma, the co-owner of Santos Medical Supply, pleaded guilty in March 2010 to conspiracy to commit health care fraud. Palma admitted to bilking the Medicare program by submitting claims for $5,000 power wheelchairs and other medical equipment that were unnecessary and, in many instances, never provided to patients. As part of the scheme, Palma bought Medicare patient information and bogus prescriptions from a medical clinic and patient recruiters and then used that information to bill Medicare. Santos Medical Supply submitted nearly $3 million worth of fraudulent claims to Medicare, which paid out $1,822,016.
Palma was arrested in September 2008 after an investigation by the Medicare Fraud Strike Force, a multi-agency team comprised of the Federal Bureau of Investigation; the Department of Health and Human Services, Office of Inspector General (HHS-OIG); the Fraud Section in the Criminal Division at the United States Department of Justice in Washington; and the United State’s Attorney’s Office in Los Angeles.
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Wednesday, March 30, 2011
Carolyn Ann Vasquez Pleads Guilty to Participating in a Medicare Fraud Scheme Using Fraudulent Medical Clinics and Stolen Doctor Identities to Defraud Medicare of More Than $6.2 Million
WASHINGTON—A Los Angeles woman has pleaded guilty to using fraudulent medical clinics and the stolen identities of physicians to defraud Medicare of more than $6.2 million, the Departments of Justice and Health and Human Services (HHS) announced.
Carolyn Ann Vasquez, 46, pleaded guilty yesterday before U.S. District Judge Terry J. Hatter Jr. in the Central District of California. Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. According to court documents, physician assistants recruited to work at the clinics by Vasquez and working at her direction performed these services and prescribed and ordered the wheelchairs, medical equipment, and diagnostic tests.
According to court documents, Vasquez told the physicians she recruited that they would be the medical directors of the clinics, but that if they did not want to work full time, the clinics would hire physician assistants. Vasquez assisted the physicians in obtaining Medicare provider numbers and entering into management agreements that gave Vasquez's co-conspirators authority to operate and manage the clinics in exchange for 75 percent of the reimbursement payments the physicians received from Medicare.
According to court documents, Vasquez's involvement in the recruitment of the physicians gave her access to their personal and Medicare information, which Vasquez stole to further the fraud scheme at the medical clinics. Vasquez admitted that in approximately 2007, a physician contacted her about a job at one of the fraudulent medical clinics, but the physician decided not to accept the job. Nevertheless, Vasquez's co-conspirators printed prescription pads with the physician's name and Medicare provider number on them. Vasquez admitted that she instructed a physician assistant working at one of the fraudulent medical clinics to use the prescription pads to write fraudulent prescriptions and medical documentation for diagnostic tests, power wheelchairs and other medical equipment in the physician's name even through Vasquez knew that the physician did not work at the clinic. Vasquez admitted that as a result of her conduct, Medicare was defrauded of approximately $6,268,899.
At sentencing, scheduled for July 11, 2011, Vasquez faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in court documents in this case, Vasquez pleaded guilty in 1993 to participating in a health care fraud scheme. According to court documents, Vasquez and others used telemarketing or "boiler room" schemes to defraud government-funded health care benefit programs of approximately $41 million.
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Monday, March 28, 2011
Fred Dweck Sentenced to 24 Months in Prison for Role in $37 Million Medicare Fraud Scheme Involving Miami-Area Home Health Agencies
WASHINGTON – A Miami-area doctor, Fred Dweck, was sentenced to 24 months in prison today for his role in a wide-ranging Medicare fraud scheme involving several Miami-area home health agencies, the Departments of Justice and Health and Human Services (HHS) announced today.
U.S. District Judge Adalberto Jordan also sentenced Dweck to three years of supervised release following his prison term and ordered him to pay $22 million in restitution jointly and severally with his co-defendants and co-conspirators in a related case. The restitution is to be paid to the victim in this case, the Centers for Medicare and Medicaid Services (CMS).
According to court documents, Dr. Dweck was the physician at Courtesy Medical Group, a Miami medical clinic that purported to provide health care services to Miami-area residents. The clinic was at various times owned by two of Dweck’s co-defendants, Auturo Fonseca and Yudel Cayro. At his plea hearing, Dweck admitted that while employed at the clinic, he wrote hundreds of prescriptions and signed hundreds of plans of care and medical certifications for Medicare beneficiaries to receive purported home health services. These services included twice or three-times daily skilled nursing visits to provide diabetic insulin injections. Dweck admitted that, in fact, these Medicare beneficiaries were able to care for themselves and did not actually need or qualify for the expensive home health services. Dweck also admitted to having prescribed unnecessary physical therapy services for many of the same Medicare beneficiaries.
According to court documents, the owners of Courtesy Medical Group would solicit and accept bribes and kickbacks from patient recruiters and the owners of Miami-area home health agencies in return for providing the bogus prescriptions signed by Dweck. Those prescriptions would then be used by dozens of Miami-area home health agencies to fraudulently bill the Medicare program for millions of dollars in unnecessary services.
Dweck admitted that in total, from about August 2006 through December 2009, he referred approximately 858 patients through Courtesy Medical Group and other Miami-area clinics for these unnecessary home health and therapy services, resulting in more than $37 million being fraudulently billed to the Medicare program. Of that amount, more than $22 million was actually paid out by the Medicare program to various Miami-area home health agencies. According to court documents, more than $16 million of those fraudulent billings stemmed from prescriptions issued by Dweck through Courtesy Medical Group, of which close to $10 million was actually paid out by Medicare.
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Sunday, March 27, 2011
Melanie Newman and her Husband Michael Anthony Goodloe Jr, Sentenced for Conspiracy to Commit Health Care Fraud
MELANIE NEWMAN, age 25, and her husband, MICHAEL ANTHONY GOODLOE, JR., age 28, both of Carrollton, Texas, were sentenced today in federal court by U. S. District Judge Mary Ann Vial Lemmon for their roles in a health care fraud conspiracy, announced U. S. Attorney Jim Letten. Specifically, NEWMAN was sentenced to twenty-four (24) months in prison and GOODLOE was sentenced to eighteen (18) months in prison to be followed by six (6) months of home confinement. Both defendants were ordered to serve three (3) years’ supervised release following imprisonment during which time they will be under federal supervision and risk additional imprisonment should they violate the terms of the supervision. In addition, NEWMAN was ordered to pay restitution in the amount of $152,915.04 and GOODLOE in the amount of $103,325 to the Medical Center of Louisiana Foundation. 10/21
According to court documents, both defendants pled guilty on October 21, 2010. NEWMAN admitted that, as a bookkeeper employed at the Medical Center of Louisiana Foundation, she created and forged Foundation checks to pay for personal items and expenses, such as her wedding to GOODLOE, payment of student loans and to purchase automobiles. NEWMAN further admitted that she also gave forged checks to GOODLOE who had no legitimate business with the Foundation. During the conspiracy, NEWMAN and GOODLOE took approximately $220,603.65, some of which was retrieved by the Foundation.
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Saturday, March 26, 2011
Dr. Selwyn Carrington Charged with Conspiring to Distribute Controlled Substances
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Pam Bondi, Florida Attorney General, Medicaid Fraud Control Unit (MFCU), West Palm Beach Bureau; William J. Maddalena, Acting Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigations; John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service (DCIS); and the Greater Palm Beach Health Care Fraud Task Force, announced the arrest of Dr. Selwyn Carrington, a 57-year-old physician living in Miami, Florida.
The criminal complaint charges the defendant, Dr. Carrington with conspiring to dispense and distribute and to cause the dispensing and distribution of controlled substances through medical clinics in Hallandale and West Palm Beach, Florida, in violation of Title 21, United States Code, Sections 846 and 841(a)(1). If convicted, Dr. Carrington faces a maximum statutory sentence of 20 years. Selwyn Carrington is a licensed physician in the State of Florida. Carrington’s primary practice is at 1613 North Hiatus Road, Pembroke Pines, Florida.
According to the complaint and corresponding affidavit, Dr. Carrington served as the medical director of Primary Care Primary Care Practitioners, a family medical practice owned by two advanced registered nurse practitioners (ARNPs). Primary care practitioners operates clinics in Hallandale and West Palm Beach, Florida.
According to court documents, the investigation revealed that Dr. Carrington did not treat or evaluate any clients at the clinics and he was not at the clinics during their normal business hours. The investigation revealed that, in exchange for $5,000 per month, Dr. Carrington went to the clinics approximately once per week to sign progress notes for patients that had been previously seen by the ARNPs and to pre-sign blank prescriptions so that the ARNPs and other employees, who have no medical licenses, could illegally prescribe controlled substances to their clients. According to the charging documents, Percocet, Oxycodone, and Xanax were all illegally prescribed in this manner.
An analysis of the payments made by Florida Medicaid for the time period from March 2005 through January 2011 indicated that over 300,000 pills containing controlled substances were dispensed to Primary Care Practitioner’s clients due to the prescriptions pre-signed by Dr. Carrington. The Florida Medicaid Program paid for these pills. The 300,000 pill total includes 150,000 pills containing Schedule II control substances. Schedule II controlled substances, such as Oxycodone, have a high level of abuse or misuse and so their use is severely restricted in the United States.
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Friday, March 25, 2011
Andrea R. Williams Sentenced for Medicaid Fraud
INDIANAPOLIS—Joseph H. Hogsett, United States Attorney, announced today that Andrea R. Williams, 23, Connersville, Ind., was sentenced to two years’ probation today by U.S. District Judge William T. Lawrence, for health care fraud following a six month investigation by the Department of Health and Human Services, Office of Inspector General, Federal Bureau of Investigation and Indiana Attorney General Greg Zoeller’s Medicaid Fraud Control Unit.
From January 2008, and continuing through May 20, 2010, Andrea Williams, the billing manager of Handy Van Medical Transportation (HVM), used her position at the company to carry out a scheme to defraud the Indiana Medicaid Program.
HVM is a company operating in the Connersville, Ind., area which transports Indiana Medicaid beneficiaries to medical appointments. Williams, as the billing manager, submitted claims for payment to Indiana Medicaid falsely indicating that HVM was providing all of its services to wheelchair bound patients, thereby causing Indiana Medicaid to pay at higher rate. Williams further represented that most patients required an additional attendant to help transport these patients which was also false.
Law enforcement executed a search warrant at the premises of HVM on May 20, 2010. During this search, Williams confessed to the above scheme. As a result of her actions, Indiana Medicaid lost $102.012.02.
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Thursday, March 24, 2011
John Milisitz Sentenced to Prison in Scheme to Defraud the Baltimore Washington Medical Center
BALTIMORE—U.S. District Judge J. Frederick Motz sentenced John Milisitz, age 37, formerly of Encinitas, California, today to 21 months in prison, followed by three years of supervised release, for mail fraud in connection with a scheme to defraud the Baltimore Washington Medical Center (BWMC), where his mother, Margie Milisitz, was employed. Judge Motz also ordered Milisitz to pay restitution of $380,000.
The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.
According to the plea agreement, Margie Milisitz was employed by BWMC as the manager of telecommunications. In addition to being responsible for overseeing the purchase and maintenance of telecommunication services and equipment for BWMC, it was part of Margie Milisitz’s duties to select vendors for the various telecommunications services and equipment, issue purchase orders, and to approve invoices from those vendors for payment.
Beginning in May 2005, and continuing until January 15, 2008, John Milisitz and his mother submitted false invoices to BWMC for telecommunications services and equipment that were never provided to the hospital. Margie Milisitz submitted invoices to the BWMC Accounts Payable Department, in the name of Global 1 Telecommunications and U.S. Cellular, companies associated with John Milisitz, falsely indicating that the goods and services listed on the Global 1 and US Cellular invoices had been received by BWMC. This caused the accounts payable department to issue payments on the invoices, which were deposited into bank accounts controlled by John Milisitz. As a result of this scheme, the Milisitz’ obtained more than $380,000 from BWMC, which they used for their own benefit, including paying credit card and household expenses, entertainment and travel.
Margie L. Milisitz, age 58, of Severna Park, Maryland, pleaded guilty to the same charge and was sentenced to 21 months in prison on February 2, 2011. Judge Motz also ordered Margie Milisitz to pay restitution of $380,000.
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Wednesday, March 23, 2011
United States District Court Sentences Psychologist Lorne Allan Semrau for False Billings to Medicare/Medicaid
MEMPHIS, TN—Edward L. Stanton, United States Attorney for the Western District of Tennessee, announced today that Lorne Allan Semrau, 64, of Jackson, Tennessee, was sentenced by United States District Court Chief Judge Jon P. McCalla to 18 months’ imprisonment to be followed by three years of supervised release. The defendant was also ordered to pay restitution to Medicare and Medicaid in the amount of $245,435.86. Semrau was convicted by a federal jury on June 17, 2010, for three counts of submitting false and fraudulent claims to defraud health care benefits programs such as Medicare and Medicaid in Tennessee and Mississippi. The three-week trial was held before Chief United States District Court Judge Jon P. McCalla in Jackson.
Semrau was indicted in June 2007 and at that time was the owner, president and CEO of Superior Life Care Services and Foundation Life Care Services. According to the indictment, Semrau contracted with nursing homes in Tennessee and Mississippi to provide medication and mental health services to residents. Semrau then allegedly contracted with psychiatrists to perform the medication and mental health services pursuant to the nursing home contracts. As stated in the indictment, Semrau then implemented a billing scheme to defraud Medicare, Medicaid, and others by submitting, through his companies Superior and Foundation, claims for services that were not provided by the physicians and claims which Semrau knew to be false.
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Tuesday, March 22, 2011
John Milisitz Sentenced to Prison in Scheme to Defraud the Baltimore Washington Medical Center
BALTIMORE, MD—U.S. District Judge J. Frederick Motz sentenced John Milisitz, age 37, formerly of Encinitas, California, today to 21 months in prison, followed by three years of supervised release, for mail fraud in connection with a scheme to defraud the Baltimore Washington Medical Center (BWMC), where his mother, Margie Milisitz, was employed. Judge Motz also ordered Milisitz to pay restitution of $380,000.
The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.
According to the plea agreement, Margie Milisitz was employed by BWMC as the manager of telecommunications. In addition to being responsible for overseeing the purchase and maintenance of telecommunication services and equipment for BWMC, it was part of Margie Milisitz’s duties to select vendors for the various telecommunications services and equipment, issue purchase orders, and to approve invoices from those vendors for payment.
Beginning in May 2005, and continuing until January 15, 2008, John Milisitz and his mother submitted false invoices to BWMC for telecommunications services and equipment that were never provided to the hospital. Margie Milisitz submitted invoices to the BWMC Accounts Payable Department, in the name of Global 1 Telecommunications and U.S. Cellular, companies associated with John Milisitz, falsely indicating that the goods and services listed on the Global 1 and US Cellular invoices had been received by BWMC. This caused the accounts payable department to issue payments on the invoices, which were deposited into bank accounts controlled by John Milisitz. As a result of this scheme, the Milisitz’ obtained more than $380,000 from BWMC, which they used for their own benefit, including paying credit card and household expenses, entertainment and travel.
Margie L. Milisitz, age 58, of Severna Park, Maryland, pleaded guilty to the same charge and was sentenced to 21 months in prison on February 2, 2011. Judge Motz also ordered Margie Milisitz to pay restitution of $380,000.
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Monday, March 21, 2011
Nine Sentenced in Southwest Florida Prescription Drug Fraud Ring
FORT MYERS, FL—U.S. Attorney Robert E. O'Neill announced today the culmination of a nine-defendant prescription fraud ring case in Southwest Florida. The following defendants, all residents of Lee County, were sentenced to federal imprisonment for conspiring to distribute Oxycodone, Methadone, and Alprazolam.
Robert Powner 57 11 Years 3/7/2011
Susan Hamilton 51 10 years 5/24/2010
Julie Becker 35 5 years 3/29/2010
Matthew Gross 32 5 years 8/3/2010
Jarrett Sprafka 31 6 ½ years 4/29/2010
Carey Bergin 37 6 ½ years 3/9/2011
Shandy Albert 34 6 ½ years 6/22/2010
Theresa Martinez 47 6 years 4/26/2010
This case involved fraudulent prescriptions that were passed in local pharmacies, which enabled the defendants in the conspiracy to obtain thousands of highly addictive pain medication pills, mostly Oxycodone. According to court documents, the defendants provided local pharmacies with a false telephone number, whereby one of the conspirators pretended to be a physician's office in order to verify the fraudulent prescriptions. The heads of the drug organization, Jason and Carey Bergin, then sold a large number of the pills for profit.
This case was investigated by agents of the Drug Enforcement Administration Task Force and prosecuted by Chief Assistant U.S. Attorney Nicole Waid and Assistant U.S. Attorney Douglas Molloy.
"We are combining our resources, at every level possible," said U.S. Attorney Robert O'Neill. "By sharing broader intelligence, information, and investigative strategies among our law enforcement partners, we will aggressively investigate and prosecute these types of crimes."
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Friday, March 18, 2011
Alton Bates, Robert Ivory Levy and Juanita Anderson Hilton Sentenced in Scheme to Defraud Medicare
BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that U.S. District Judge Brian Jackson sentenced Alton Bates, 62, an attorney in Baton Rouge, Louisiana, to 34 months in prison, to pay restitution of $1,063,873 to Medicare, to forfeit the gross proceeds of his scheme to defraud Medicare, and to three years' supervised release after imprisonment. Judge Jackson also sentenced co-defendants Robert Ivory Levy, 59, and Juanita Anderson Hilton, age 42, both of whom are residents of Baton Rouge and were licensed clinical social workers. Levy was sentenced to 15 months' imprisonment, was ordered to pay restitution of $120,946.89 to Medicare, and to serve three years' supervised release after imprisonment. Anderson Hilton was sentenced to three years' probation with a condition that she serve six months in a local halfway house and repay $89,450 to Medicare.
Alton Bates pled guilty on July 21, 2009 to two counts of health care fraud and two counts of paying illegal kickbacks. Levy and Anderson Hilton both pled guilty to one count of health care fraud. Anderson Hilton pled guilty on July 21, 2009 and Levy pled guilty on September 21, 2009.
Alton Bates, Robert Levy, and Juanita Anderson Hilton schemed to defraud the Medicare program by submitting false and fraudulent claims for psychotherapy services that were not provided. In total, the three defendants’ participation in this scheme involved more than 7,700 false claims seeking Medicare payments totaling $3,052,838. Due to the scheme, Medicare program paid more than $1,000,000 to Above and Beyond, LLC, the Baton Rouge company which the defendants operated between 2003 and 2005.
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Thursday, March 17, 2011
Raymond Lamont Shoemaker and Earnest Levi Garner, Jr., Indicted in Healthcare Fraud Scheme
OXFORD, MS—John Marshall Alexander, United States Attorney for the Northern District of Mississippi, Daniel McMullen, Special Agent in Charge, Federal Bureau of Investigation (FBI), and Abelino Farias, Special Agent in Charge, United States Department of Agriculture—Office of Inspector General, announced that:
Raymond Lamont Shoemaker, 38, of Tupelo, former Chief Executive Officer and former Chief Operating Officer of Tri-Lakes Medical Center in Batesville, Mississippi, and Earnest Levi Garner, Jr., 66, of Batesville, were indicted earlier this month by the federal grand jury for the Northern District of Mississippi in connection with a nursing services kickback and bribery scheme at the Tri-Lakes Medical Center. The ten-count federal indictment charged Shoemaker with a nursing services kickback and bribery conspiracy, receiving kickbacks for nursing services, conspiracy to commit and committing healthcare fraud, making false statements to the FBI in connection with a federal investigation, making false statements to USDA in connection with a loan, and embezzlement from Tri-Lakes Medical Center. Shoemaker was also charged with embezzling from Humphreys County Hospital in Belzoni, Mississippi, while he was the Administrator of the Humphreys County Hospital. Garner, a Panola County businessman, was charged with a nursing services kickback and bribery conspiracy, engaging in a healthcare fraud conspiracy and healthcare fraud, and bribery, all in connection with Tri-Lakes Medical Center.
Shoemaker faces up to 80 years in prison and $2.5 million in fines if he is convicted on all counts. Garner faces up to 25 years in prison and $1 million in fines if he is convicted on all counts. Both could be ordered to pay restitution to their victims. Shoemaker and Garner appeared before United States Magistrate Judge S. Allan Alexander in Oxford today and were each released on a $50,000 secured bond. Trial dates have not yet been set.
John Marshall Alexander, United States Attorney for the Northern District of Mississippi said: “Our healthcare system depends upon fair dealing by medical service providers. Decisions affecting the health and well-being of our citizens cannot be tainted by kickbacks, corruption, and fraud. When individuals and companies attempt to pervert the healthcare system, it is our healthcare consumers and taxpayers who suffer the consequences. We will work vigorously to ensure that instances of fraud and corruption in our healthcare system are discovered and that those committing it are brought to justice. The United States Attorney’s Office is grateful for the hard work of all of the federal, state and local agencies involved in this investigation, and we will continue to work with them until this case is brought to a conclusion.”
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Tuesday, March 15, 2011
Dr. Jerry A. Spiegel Sentenced on Health Care Fraud Charges
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Field Office, announce today’s sentencing of defendant Jerry A. Spiegel, 78, of Boynton Beach, Florida. U.S. District Court Judge Joan A. Lenard sentenced Spiegel to 41 months’ imprisonment, to be followed by three years of supervised release. As a condition of his supervised release, Spiegel was required to relinquish his medical license. In addition, the court ordered Spiegel to pay $880,958 in restitution for his role in the health care fraud conspiracy.
Last year, Spiegel was found guilty of conspiring to commit health care fraud, in violation of Title 18, United States Code, Section 1349. According to court documents, Spiegel was the medical director of three Miami-Dade County HIV/AIDS-infusion clinics: R&M Services Center Corp., Buena Vista Family Medical Center, Inc., and Solution Diagnostic Center, Inc. While medical director of these three clinics, Spiegel signed patient prescriptions without first examining patients or reviewing patient files. The HIV/AIDS-infusion medications that Spiegel prescribed were not medically necessary and were not administered to patients.
According to court documents, during Spiegel’s tenure as medical director, and based on the prescriptions he signed, the three clinics billed the Medicare program for more than $2.3 million in fraudulent claims. For example, from September 3, 2008 to December 31, 2008, R&M Services submitted $952,589 in fraudulent claims to Medicare, and received $425,385. From August 29, 2008 to January 23, 2009, Buena Vista submitted $769,094 in fraudulent claims to Medicare, and received $270,703. And from October 10, 2008 to February 23, 2009, Solution Diagnostic submitted $617,415 in fraudulent claims to Medicare, and received $184,870.
Mr. Ferrer commended the investigative efforts of the Federal Bureau of Investigation and the United States Department of Health and Human Services, Office of Inspector General. This case was prosecuted by Department of Justice Trial Attorney Benton Curtis and Assistant United States Attorney Robert J. Luck.
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