HOUSTON—Sunny Robinson, the owner of Memorial Medical Supply—a Houston durable medical equipment business—has been sentenced to 97 months in prison for his role in a Medicare fraud scheme, United States Attorney José Angel Moreno announced today.
U.S. District Judge Ewing Werlein Jr. sentenced Robinson 42, of Houston, and three others convicted for their roles in Robinson’s fraud scheme yesterday, Aug. 30, 2011.
Robinson’s co-defendants—Manuel DeLuna, 50; Lisa Jones, 48; and Shirley Chavis, 44, all of Houston—pleaded guilty in advance of Robinson’s trial, to federal fraud charges. DeLuna, the general manager of Memorial Medical Supply convicted of conspiracy to commit health care fraud, was sentenced to 42 months. Jones and Chavis, both convicted of conspiring to receive kickbacks in exchange for patient information, were sentenced to 22 months in prison and five years’ probation, respectively.
On March 7, 2011, Robinson was convicted at trial of all 19 counts of health care fraud and anti-kickback violations alleged against him for causing the submission of fraudulent medical claims to the Medicare Program in excess of $4.3 million from March 2005 through June 2009. During the five-day trial, the jury heard testimony and received evidence proving Robinson’s health care fraud scheme encompassed buying Medicare referrals, billing Medicare for durable medical equipment and getting paid. The names and Medicare numbers of doctors and Medicare beneficiaries were used to falsify medical records and on false and fraudulent claims to the Medicare and Medicaid programs for reimbursement.
Robinson illegally obtained protected Medicare beneficiary health information including names, dates of birth, medical histories, and Medicare and Social Security numbers from individuals and home health agencies. This health information was then used to submit false and fraudulent claims to Medicare for reimbursement for “Arthritis Kits,” power wheelchairs, diabetic supplies and incontinence supplies. The Medicare beneficiaries in many instances did not need or order the durable medical equipment nor did a physician prescribe the items. Many of the medical claims submitted were for durable medical equipment that wasn’t even provided. Memorial Medical Supply also falsely submitted claims for reimbursement to Medicare for equipment supposedly delivered to 34 deceased Medicare beneficiaries.
In connection with his guilty plea, DeLuna admitted that he and others illegally obtained protected Medicare beneficiary health information from individuals and home health agencies which was then used to submit false and fraudulent claims to Medicare for reimbursement for durable medical equipment. In connection with their guilty pleas, Jones and Chavis both admitted to receiving money in exchange for supplying patient information and billing numbers.
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Monday, September 5, 2011
Houston Medical Equipment Company Owner Sunny Robinson, Lands in Federal Prison for Medicare Fraud
Friday, September 2, 2011
Eighteen Charged for Medicare Fraud Schemes in Detroit Involving $28 Million in False Billings
DETROIT—Eighteen individuals were charged in court documents unsealed today and yesterday in the Eastern District of Michigan for their participation in a series of separate Medicare fraud schemes involving home health and psychotherapy services, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS Office of Inspector General (HHS-OIG).
According to court documents unsealed today and yesterday in U.S. District Court in Detroit, the separate schemes allegedly involved a total of more than $28 million in fraudulent claims submitted to Medicare for services that were medically unnecessary and/or never provided. Fifteen of the defendants were arrested this morning, one defendant was arrested in July 2011, and two defendants remain at large. In addition, law enforcement agents today executed search warrants at 11 locations and seizure warrants of 28 bank accounts related to the alleged fraud schemes.
Including these charges, Medicare Fraud Strike Force operations in Detroit have charged a total of 138 individuals in cases involving approximately $148 million in fraudulent billings to Medicare.
“Today we have charged physicians, nurses, clinic owners and other medical professionals for submitting millions of dollars in false claims to Medicare,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division. “According to court documents, these defendants paid kickbacks to beneficiaries and others, and falsified medical documents in order to deceive the Medicare program. As our strike force efforts have consistently shown, we will not allow criminals to steal from government health care programs.”
“Health care providers should be aware that the days of stealing from Medicare with impunity are over,” said U.S. Attorney Barbara McQuade of the Eastern District of Michigan. “We are relentlessly investigating and prosecuting those who seek to profit from false claims for services that are medically unnecessary or, in some instances, not provided at all.”
“Health care fraud affects every American,” said FBI Special Agent in Charge Andrew G. Arena. “As Americans live longer, health care costs are expected to rise. The FBI, together with its federal, state, and local partners, is working aggressively to pursue health care fraud criminals and bring them to justice.”
“The Medicare Fraud Strike Force in Detroit continues to demonstrate a concentrated and sustained effort in combating health care fraud,” said Lamont Pugh III, HHS-OIG Special Agent in Charge of regional operations. “The Office of Inspector General will continue to work with our strike force partners to focus a spotlight on those who attack the Medicare program and ensure that they are held accountable.”
“These arrests are good news for American taxpayers and a powerful warning to health care ripoff artists,” said Donald M. Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services. “In this instance, the system worked as it should: Medicare detected suspicious behavior and got the information quickly to law enforcement for appropriate follow-up. Together with our law enforcement partners, we helped minimize the theft of taxpayer dollars and maximize criminal consequences to thieves. CMS will continue to relentlessly pursue fraudsters across the country and aggressively feed leads to our law enforcement partners.”
Fourteen individuals are charged in one indictment with conspiracy to commit health care fraud for their roles in a $14 million scheme to defraud Medicare by submitting fraudulent claims for home health care services. The defendants include three physicians, four clinic owners and managers, two clinic employees, one nurse, and four physical therapists and physical therapy assistants. According to court documents, the conspiracy was operated out of multiple home health agencies located in Livonia, Mich., including Physicians Choice Home Health Care LLC, First Care Home Health Care LLC, Quantum Home Care Inc. and Moonlite Home Care Inc.
In a separate complaint unsealed today, a physician and two other individuals are charged with health care fraud and the submission of false claims in connection with an approximately $11.5 million scheme to defraud the Medicare program. The scheme allegedly involved false billings for individual and group psychotherapy services at two clinics located in Detroit, Quality Recreation and Rehabilitation Inc. and Procare Rehabilitation Inc. According to court documents, the defendants billed Medicare for services that were medically unnecessary and/or never provided.
In another indictment unsealed yesterday, the owner of a medical clinic located in Southfield, Mich., was charged with conspiracy to commit health care fraud, health care fraud and identity theft for a scheme allegedly involving $2.9 million in fraudulent billings to Medicare. According to court documents, the clinic owner is alleged to have used the identities of Medicare providers and beneficiaries to bill for psychotherapy services that were medically unnecessary and never performed.
Defendants charged include: Gerald R. Funderburg Jr., 31, of Southfield, Mich.; Marcus Jenkins, 49, of Farmington Hills, Mich.; Elizabeth Jenkins, 47, of Farmington Hills; Dr. Alphonso Berry, 50, of Orchard, Mich.; Tausif Rahman, 36, of Canton, Mich.; Zahir Yousafzai, 41, of Canton, Mich.; Javed Rehman, 48, of Farmington Hills; Muhammad aka "Sib" Ahmad, 33, of Ypsilanti, Mich.; Jawad Ahmad, 41, of Ypsilanti, Mich.; Dr. Dwight Smith, 58, of Detroit; Dr. Paul Kelly, 74, of Bath, Mich.; Rehan Khan, 38, of Canton, Mich.; Nabeel Shaikh, 29, of Wixom, Mich.; Janaki Chettiar, 36, of Farmington Hills; Jigar Patel, 27, of Madison Heights, Mich.; Anthony Parkman, 40, of Southfield; Hetal Barot, 28, of Canton; and Srinivas Reddy aka "Dr. Reddy", 35, of Bloomfield Hills, Mich.
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Thursday, September 1, 2011
Government Recovers More Than $1.6 Million from 11 Cities to Resolve Allegations They Caused Improper Medicare and Medicaid Ambulance Claims
DALLAS—The Texas cities of Plano, Frisco, Richardson, Mesquite, Celina, DeSoto, Corpus Christi, Cedar Hill, Rowlett, North Richland Hills, and University Park (collectively “Cities”) have agreed to pay the U.S. and Texas the collective amount of $1.69 million to resolve allegations they violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney James T. Jacks of the Northern District of Texas. The U.S. and Texas contend all the Cities caused “upcoded” claims to be submitted to Medicare and Medicaid for city-dispatched 911 ambulance transports between 2006 and 2010. All the Cities fully cooperated with the investigation, and by settling, did not admit any wrongdoing or liability.
Ambulance services generally are coded either as basic life support level or advanced life support (ALS). ALS transports are reimbursed at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend the Cities’ billing contractor coded 911-dispatched transports at the ALS level, which indicates an ALS service was furnished and/or the patient’s condition necessitated an ALS intervention. The U.S. and Texas allege the Cities caused to be submitted for payment claims falsely representing to Medicare and Medicaid that such ALS services were appropriate and furnished by their personnel when in fact no ALS service was rendered and/or the patient did not require an ALS transport.
The U.S. and Texas initiated the investigation in response to a February 2010 whistleblower suit brought by Douglas Moore. Under the False Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the government and collect a share of any proceeds recovered by the suit. Mr. Moore can receive up to 30 percentof the recovery under the settlement.
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Wednesday, August 31, 2011
Farah Maria Perez Pleads Guilty in $25 Million Health Care Fraud Scheme
WASHINGTON – Miami-area resident Farah Maria Perez, a registered nurse, pleaded guilty today for her participation in a $25 million Medicare fraud scheme involving false billings for home health services, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Perez, 40, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. She was originally charged in a February 2011 indictment.
According to plea documents, Perez worked for Florida Home Health Care Providers Inc., a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries. Perez and her co-conspirators operated Florida Home Health for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were medically unnecessary and/or never provided. The medically unnecessary services were prescribed by doctors.
According to court documents, beginning in approximately January 2006 and continuing until approximately March 2009, Perez and her co-defendant nurses falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services from Florida Home Health. Perez admitted that she knew the beneficiaries did not actually qualify for and did not receive the services. Perez and her co-defendant nurses described in nursing notes and patient files symptoms such as tremors, impaired vision, weak grip and inability to walk without assistance. Although the patients did not actually exhibit these symptoms, the symptoms were nevertheless included in patient files to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare. Perez admitted that she knew the files were falsified so that the Medicare program could be billed for medically unnecessary therapy and home health related services. As a result of Perez’s participation in the illegal scheme, the Medicare program was billed approximately $118,000 for purported home health care services that were medically unnecessary and/or never provided.
Perez also admitted that she recruited Medicare beneficiaries who would allow Florida Home Health to bill the Medicare program for home health care and therapy services that were unnecessary or never provided. Perez solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for allowing Florida Home Health to bill Medicare on behalf of the patients she recruited. Perez knew that the patients did not qualify for the services that were billed to Medicare.
Four other co-conspirators who were charged in the February 2011 indictment for their roles in the Florida Home Health fraud scheme have pleaded guilty: Jose Nunez, M.D.; Lisandra Alonso; Luisa Morciego; and Vicente Guerra.
Sentencing for Perez is scheduled for Nov. 14, 2011.
The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendant also face fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from her criminal activities.
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Tuesday, August 30, 2011
Occupational Theraptist Carol Gant Pleads Guilty to Medicare Fraud Scheme
WASHINGTON—A Detroit-area occupational therapist pleaded guilty today for her participation in a Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Carol Gant, 66, pleaded guilty before U.S. District Judge Avern Cohn in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, Gant faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to the plea documents, Gant was an occupational therapist who worked for Jos Campau Physical Therapy, which purported to provide physical and occupational therapy services. In 2005, Gant was hired by Jos Campau Physical Therapy to create and sign falsified occupational therapy files. Gant created patient evaluation forms for Medicare beneficiaries whom she had never met, seen or evaluated.
Gant admitted that she hired an uncertified occupational therapy assistant, who fabricated and signed notes for occupational therapy patient visits that the assistant purported to perform. Gant paid the uncertified assistant for creating these fictitious patient visit notes and countersigned them. Gant also filled out patient discharge paperwork. Gant provided no services to the patients whose files she created and countersigned. Gant was paid for each patient file that she created. Gant knew that neither she nor the uncertified occupational therapy assistant were providing occupational therapy services to the beneficiaries as stated in the falsified files.
Gant admitted that between approximately June 2005 and May 2007, she and her co-conspirators at Jos Campau submitted or caused the submission of fraudulent claims to the Medicare program. Gant submitted or caused to be submitted approximately $897,512 in claims for occupational therapy services that were never rendered.
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Monday, August 29, 2011
Jose Rosario Sentenced to 48 Months in Prison for Medicare Fraud Schemes Totaling More Than $15 Million
WASHINGTON—An owner of three Detroit-area clinics was sentenced to 48 months in prison today for his role in schemes that attempted to defraud the Medicare program of more than $15 million, the Departments of Justice and Health and Human Services (HHS) announced.
Jose Rosario, 54, was sentenced by U.S. District Judge Gerald E. Rosen in the Eastern District of Michigan. In addition to the prison term, Rosario was sentenced to three years of supervised release and was ordered to pay, jointly and severally with other defendants in the case, $10.7 million in restitution. Judge Rosen ordered the sentence to run consecutive to a 46 month sentence that Rosario received in the Southern District of Florida in July 2011, in connection with an unrelated mortgage fraud case.
Rosario pleaded guilty on Aug. 18, 2009, to one count of conspiracy to commit health care fraud. According to court documents, Rosario acknowledged that in approximately September 2006, he and a co-defendant incorporated Sacred Hope Medical Center Inc. in Michigan. Sacred Hope purported to specialize in providing injection and infusion therapy services to Medicare patients. Rosario admitted that he and the co-defendant were the owners of the clinic, and agreed to split the profits generated there evenly between them.
According to court documents, during the time that Sacred Hope was open, the clinic routinely billed the Medicare program for services that were medically unnecessary and/or never provided. Rosario admitted that he knew the clinic purchased only a small fraction of the medications that the clinic billed to Medicare. Rosario admitted he participated in hiring co-conspirators to falsify the medical files to make the treatments purportedly provided at Sacred Hope appear legitimate, when in fact he knew they were not.
Rosario also admitted that Medicare beneficiaries were not referred to Sacred Hope by their primary care physicians or for any legitimate medical purpose. Rather, they were recruited to come to the clinic through the payment of kickbacks. In exchange for the kickbacks, the beneficiaries visited the clinic and signed documents falsely indicating that they had received the services billed to Medicare. According to information contained in the plea documents, kickbacks came in the form of cash and prescriptions for narcotic drugs.
In addition to the conduct at Sacred Hope, Rosario admitted to being a part owner of Dearborn Medical Rehab Center (DMRC), another infusion clinic, and to playing similar roles at a third Detroit-area infusion clinic, Xpress Center. Rosario admitted that he was fully aware that the DMRC and Xpress Center routinely billed the Medicare program for services that were medically unnecessary and, in many instances, never provided. Rosario admitted that the purpose of the DMRC and Xpress Center was not to provide legitimate health care to patients, but rather to defraud the Medicare program.
Between approximately March 2006 and March 2007, Rosario admitted to causing the submission of approximately $15.3 million in false and fraudulent claims to Medicare for services purportedly provided at Sacred Hope, DMRC and Xpress Center. Based on the fraudulent claims, approximately $10.7 million was paid.
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Saturday, August 27, 2011
Ben Bane Sentenced to 12 ½ Years for Medicare and Medicaid Fraud
TAMPA, FL—U.S. Attorney Robert E. O’Neill announces that U.S. District Judge Virginia Hernandez Covington today sentenced Ben Bane (64, Plant City) to 12 ½ years in federal prison for conspiracy to commit health care fraud, health care fraud, and submitting false claims. His prison sentence is to be followed by three years of supervised release. Bane was also ordered to pay $7 million in restitution, a $3 million fine, and a $1,000 special assessment. The court also entered a money judgment in the amount of $5,800,000, representing the proceeds of the health care fraud.
Bane was found guilty by a federal jury on December 15, 2010. According to the testimony and evidence presented over the course of the six-week trial, he was the President of Bane Medical Services, which was a Durable Medical Equipment (DME) company that provided oxygen and oxygen-related services to Medicare beneficiaries. Bane knowingly broke a core rule of Medicare prohibiting DME companies from performing the qualification testing for oxygen, that is, the company that sells the service cannot be the one to determine if a patient is in need of that service. In violation of this rule and over the course of four years, Bane Medical performed the wrong kinds of tests and lied to doctors about them; falsified test results to make it appear that patients qualified for Medicarereimbursed oxygen when they did not; and forged doctors’ signatures on Certificates of Medical Necessity.
In the end, Ben Bane sold Bane Medical Services to another DME company. Shortly before the sale, and to cover up the crime, hundreds of test results were fabricated in order to make it appear that an independent lab had done the necessary tests. At Ben Bane’s house, bags full of records were burned. In total, Bane Medical fraudulently obtained more than $6.8 million from Medicare. Ben Bane sold the company for $21 million.
Medicare is a federal health benefits program that generally covers individuals who are 65 years old or older. The costs are borne by the American taxpayers and by individuals who elect to participate in certain parts of Medicare, e.g., Part B (Medical Insurance). Medicaid provides medical coverage to certain qualifying low income individuals and families. The state and federal government share the costs of the Medicaid program.
“These crimes represent a deliberate attempt to defraud the government and citizens in need of legitimate services,” said U.S. Attorney O’Neill. ” We will continue to work with our respective partners to pursue and prosecute these types of crimes.”
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Friday, August 26, 2011
Jose Nunez Pleads Guilty in $25 Million Health Care Fraud Scheme
WASHINGTON—A Miami-area medical doctor who owned two medical offices pleaded guilty today for his participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, FBI and the Department of Health and Human Services (HHS).
Jose Nunez, 63, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. According to plea documents, Nunez provided home health care and therapy prescription referrals to ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.
Nunez admitted that he knew co-conspirators at ABC and Florida Home Health operated the agencies in order to bill the Medicare program for expensive physical therapy and home health care services that were medically unnecessary and/or were never provided. The medically unnecessary services were prescribed by Nunez and other doctors.
According to court documents, beginning in approximately January 2006, and continuing until approximately March 2009, Nunez prescribed medically unnecessary services, including home health and therapy prescriptions, plans of care and medical certifications in exchange for kickbacks and bribes. The kickbacks and bribes were paid to Nunez by nurses, patient recruiters and the owners and operators of ABC and Florida Home Health. According to plea documents, Nunez furthered the scheme by falsifying patient files with descriptions of non-existent medical conditions for the Medicare beneficiaries, including hand tremors, unsteady gait and poor vision. These symptoms were included to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under the Medicare program. Nunez knew that the files were falsified so that Medicare could be billed for medically unnecessary therapy and home health-related services. As a result of Nunez’s participation in the illegal scheme, the Medicare program was billed approximately $1.5 million for purported home health care services that were medically unnecessary and/or were never provided.
Three other co-conspirators—Lisandra Alonso, Luisa Morciego and Vicente Guerra—have pleaded guilty for their roles in the fraud scheme.
Sentencing has been scheduled for Dec. 5, 2011.
The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendant also faces fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from his criminal activities.
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Thursday, August 25, 2011
Owner of Miami-Area Mental Health Care Corporation Judith Negron, Convicted on All Counts for Orchestrating $205 Million Medicare Fraud Scheme
WASHINGTON—A federal jury today convicted a Miami-area owner of a mental health care company, American Therapeutic Corporation (ATC), for orchestrating a fraud scheme that resulted in the submission of more than $205 million in fraudulent claims to Medicare, announced the Department of Justice, FBI and Department of Health and Human Services (HHS).
After a six-day trial, a jury in the Southern District of Florida found Judith Negron, 40, guilty of 24 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering, and structuring to avoid reporting requirements. Negron was charged in a superseding indictment unsealed on Feb. 15, 2011.
“Judith Negron and her co-conspirators masterminded one of the largest fraud schemes ever prosecuted by the Medicare Fraud Strike Force,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division. “They brazenly submitted more than $200 million in fraudulent claims to the Medicare program. Ms. Negron may have thought she could scam the American taxpayer with impunity. Today a Miami jury showed her otherwise, and now she has found out that the price of Medicare fraud is extremely high.”
“Through bribery, kickbacks, and the creation of false patient files and other documents, Negron and her co-conspirators submitted hundreds of millions of dollars in fraudulent claims to Medicare for community mental health treatments for ineligible patients,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida. “After a week-long trial, a jury convicted Negron of orchestrating this massive fraud scheme. She and her co-defendants now face the prospect of lengthy prison sentences. The U.S. Attorney’s Office will continue to lead the battle against Medicare fraud and abuse.”
Evidence at trial demonstrated that Negron, along with ATC co-owners Lawrence Duran and Marianella Valera, masterminded and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010. Duran and Valera pleaded guilty to all charges against them in April 2011. Evidence at trial established that the three owners submitted false and fraudulent claims to Medicare through 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 severe mental illness. Negron and her co-conspirators also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.
According to the evidence at trial, Negron, Duran, Valera, and others paid bribes and kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs, so that ATC and ASI could bill Medicare for more than $200 million in unnecessary or illegitimate services.
According to the evidence, Negron and her co-conspirators used another company they owned and operated, Medlink Professional Management Group Inc., to conceal the fraud and kickbacks scheme from Medicare and law enforcement. Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera and others transferred the money to Medlink. Evidence at trial showed that Negron and her co-conspirators used Medlink to pay millions of dollars in kickback payments by using an extensive money laundering scheme.
Evidence at trial demonstrated that Negron signed kickback checks to patient recruiters whose only jobs at ATC were to provide patients from halfway houses or assisted living facilities. Evidence at trial also established that Negron and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments and that the treatments provided were legitimate PHP treatments. For instance, evidence established that Negron would “robo-sign” patient files, meaning she would sign patient documents as a supervising therapist without having treated the patients. The evidence also showed that Negron signed files as though she had been in two places at once, in Boca and Homestead, Fla., at the same time. Evidence further revealed that Negron knew doctors were similarly signing patient files without reading them or seeing the patients. In some cases, Negron provided the doctors with the files for their signature. According to evidence presented at trial, Negron and her co-conspirators billed Medicare for PHP treatment, including group psychotherapy, provided to a patient who was in a neuro-vegetative state, who would not lift her head or respond. The evidence also showed that Negron and her co-conspirators caused doctors to refer ATC patients to ASI even though the patients did not qualify for sleep studies.
According to evidence at trial, the defendant and her co-conspirators concealed the fraud scheme by, among other things, creating false medical records in patient charts, concealing kickback payments as “transportation” payments, and creating sham companies with fake employee files to launder money.
Following today’s verdict, U.S. District Judge James Lawrence King remanded Negron into custody. A sentencing date for Negron has not yet been scheduled.
Duran and Valera have been in federal custody since their arrests in October 2010 and are scheduled to be sentenced on Sept. 14, 2011, at 9:30 a.m. Negron, Duran and Valera each face a maximum of 10 years in prison for each count of conspiracy to commit health care fraud and each count of health care fraud; five years in prison for each count of conspiracy to pay and receive health care kickbacks; 20 years in prison for each count of conspiracy to commit money laundering; 10 to 20 years in prison for each count of money laundering; and 10 years in prison for each count of structuring to avoid reporting requirements. The defendants’ assets were frozen at the time of their arrests through civil forfeiture proceedings.
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Wednesday, August 24, 2011
Caridad Guilarte and Clara Guilarte, Plead Guilty to $9.1 Million Detroit Medicare Fraud Scheme
WASHINGTON—Two sisters who owned a fraudulent Detroit-area medical clinic and who are former “most wanted” health care fraud fugitives pleaded guilty today in Miami for their leading roles in a $9.1 million Medicare fraud scheme, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).
Caridad Guilarte, 54, and Clara Guilarte, 57, each pleaded guilty before U.S. District Judge Cecilia M. Altonaga to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. The sisters were charged in an indictment unsealed in June 2009 and were placed on the HHS Office of Inspector General (HHS-OIG) Most Wanted Fugitives list. They were arrested on March 13, 2011, by law enforcement authorities in Colombia and were returned to the United States on March 14, 2011.
In pleading guilty, the Guilarte sisters admitted that in approximately March 2005, they opened Dearborn Medical Rehabilitation Center (DMRC), in Dearborn, Mich., with the express intent to defraud the Medicare program. DMRC routinely billed Medicare for exotic and expensive medications that were medically unnecessary and were never provided. Although they billed Medicare for millions of dollars of these medications, the Guilartes admitted that they and their co-conspirators at the clinic had purchased only a small fraction of the medications.
The Guilartes admitted that Medicare beneficiaries were not referred to DMRC by their primary care physicians, or for any other legitimate medical purpose, but were recruited to come to the clinic through the payment of cash kickbacks. In exchange for those kickbacks, the Medicare beneficiaries would visit the clinic and sign documents indicating that they had received the services billed to Medicare. Patients were prescribed medications not based on need, but based on what medications were likely to generate the greatest reimbursements from Medicare.
According to court documents, Caridad and Clara Guilarte laundered the proceeds of the health care fraud through shell corporations in order to conceal the source and ownership of the funds stolen from Medicare.
The Guilartes admitted that between approximately March 2005 and March 2007, they caused the submission of approximately $9.1 million in false and fraudulent claims to the Medicare program for services purportedly provided at DMRC. Medicare paid approximately $6 million on those claims.
The defendants consented to have their case transferred to the Southern District of Florida for plea and sentencing. Caridad Guilarte also consented to the forfeiture of $464,096 seized from bank accounts she controlled.
At their sentencing, scheduled for Nov. 3, 2011, the Guilartes face a maximum of 10 years in prison for each count of conspiracy to commit health care fraud and 20 years in prison for each count of conspiracy to commit money laundering.
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Tuesday, August 23, 2011
Department of Health and Human Services Employee Jihan S. Cover, Pleads Guilty to Theft of Government Funds
WASHINGTON — An employee of the Department of Health and Human Services (HHS) pleaded guilty today in U.S. District Court in Asheville, N.C., to theft of approximately $114,494 in government funds, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division.
Jihan S. Cover, 33, of Arden, N.C., pleaded guilty before Magistrate Judge Dennis L. Howell in the Western District of North Carolina to a one-count criminal information charging her with theft of government property. According to the criminal information, filed Aug. 11, 2011, Cover has worked as a purchasing agent with the National Institutes of Health (NIH), National Cancer Institute (NCI), a subdivision of HHS, from 2006 through the present. Cover’s sole job function involved procuring authorized items and services for NIH/NCI using assigned government credit cards or purchase cards.
According to court documents, between June 2009 and December 2010, Cover, who received regular training in the proper use of purchase cards, admitted using and causing to be used NIH/NCI purchase cards assigned to her in more than 250 unauthorized personal transactions totaling approximately $114,494.
According to the plea agreement, Cover used and caused the purchase cards to be used to make more than 170 personal purchases totaling approximately $16,000 from Amazon.com for toys, exercise equipment, books, clothes and other personal items. Almost all of these items were shipped to Cover’s residence in Arden. In addition, Cover admitted to using the purchase cards to pay off more than $29,000 in balances she accrued with various cash advance and payday loan vendors. Cover also made more than $47,000 in payments to personal accounts she created on PayPal, an online payment website.
In addition, Cover admitted that she tried to conceal her actions by submitting various dispute forms to the bank servicing her purchase cards, claiming that she did not recognize certain charges or did not authorize them, when in fact, she knowingly made or caused to be made the personal charges. During the guilty plea hearing, Cover admitted that in January and June 2011, she lied to investigators, claiming that she had reimbursed the personal transactions she made with her NIH/NCI purchase cards using her personal bank account, which in fact she knew she had not done. Previously, when confronted by her supervisor at NIH/NCI regarding suspicious transactions, Cover claimed falsely that she had been the victim of identity theft, when in fact she knew that she had caused the transactions.
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Saturday, August 20, 2011
Adedayo O. Adegboye and Olalekan Rufai, Convicted of Health Care Fraud in Wheelchair Scam
OKLAHOMA CITY—Late yesterday, a jury found two New York men guilty of committing five counts of health care fraud in connection with the sale of power wheelchairs and wheelchair accessories to Medicare beneficiaries, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma.
“Health care fraud affects all of us,” said U.S. Attorney Coats. “Fraud takes critical resources out of our health care system at the expense of the American taxpayer, patients, and private insurers, and drives up the cost of health care for everyone. I commend the efforts of the law enforcement agents and prosecutors who worked so diligently in prosecuting this case.”
ADEDAYO O. ADEGBOYE and OLALEKAN RUFAI, both age 48, and both of Brooklyn, New York, opened First Century Medical Supply, Inc., located in Oklahoma City, to engage in the business of selling power wheelchairs and wheelchair accessories to Medicare beneficiaries. Evidence at trial showed that from 2007 through 2009 the business obtained identification numbers and personal information from Medicare beneficiaries and used that information to submit claims to Medicare for power wheelchairs and wheelchair accessories. Evidence also showed that the defendants billed Medicare for some beneficiaries who did not receive a power wheelchair at all, some who received a less expensive motorized scooter, and for others who did not have a medical need for a wheelchair or did not even request a wheelchair. In all, the evidence showed that through First Century the defendants submitted over $1.1 million in fraudulent claims to Medicare.
Adegboye and Rufai were indicted by a federal grand jury in January of this year. The trial lasted approximately six days before the jury found the men guilty of committing five counts of health care fraud. The jury found the men not guilty of conspiracy. At sentencing, each of the men faces up to 10 years in prison and a $250,000 fine for each count, plus mandatory restitution. A sentencing hearing will be set by the court in approximately 90 days.
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Friday, August 19, 2011
Stephen Jon Rondestvedt and Mustafa Hassan Mussa Charged in Medicaid Fraud Schemes
MINNEAPOLIS—Earlier today in federal court, a former employee and the operator of Universal Home Health, a home health care agency located in Golden Valley, were charged with offenses related to defrauding Medicaid. In separate Informations, Stephen Jon Rondestvedt, age 58, of Minneapolis, was charged with one count of health care fraud, and Mustafa Hassan Mussa, age 56, of Minnetonka, was charged with one count of aggravated identity theft.
Allegedly, from February 18, 2008, through December of 2010, Rondestvedt, an employee of Universal, defrauded Medicaid by submitting false reimbursement claims for personal care services. Rondestvedt allegedly agreed to provide and facilitate kickback payments to the family of a Medicaid recipient, who did not actually receive the personal care assistant services for which Universal billed Medicaid. The total estimated loss to Medicaid due to these actions is approximately $55,000.
Universal submitted its Medicaid claims for reimbursement to the Minnesota Department of Human Services (“DHS”), which administers the Medicaid program in Minnesota. The Medicaid program provides medical care and services to low-income people who meet certain income and eligibility requirements. Personal care attendants (“PCA”) visit Medicaid patients in their homes and assist with daily tasks.
Furthermore, on May 26, 2009, Mussa, who operated Universal, allegedly used the identification of a Medicaid recipient during and in relation to the submission of fraudulent billings to Medicaid. The fraudulent claim represented to DHS that a PCA was providing service to a Medicaid recipient who, in fact, was not receiving services from the PCA. The claim submitted in May 2009 was allegedly one of a substantial number of similarly fraudulent claims submitted to Medicaid through Universal between 2008 and 2010.
If convicted, Rondestvedt faces a potential maximum penalty of ten years in prison, and Mussa faces a mandatory penalty of two years in prison. All sentences will be determined by a federal district court judge.
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Wednesday, August 17, 2011
Nnanta Felix Ngari, Dr. Sofjan Lamid, Henry Lamont Jones and Ernest Payne Convicted in $4.7 Million Louisiana Medicare Fraud Scheme
WASHINGTON – The owner of a Baton Rouge, La., durable medical equipment (DME) company, a medical doctor and two patient recruiters were each convicted late yesterday for their roles in a $4.7 million Medicare fraud scheme, announced the Department of Justice, the FBI, the Department of Health and Human Services and the Medicaid Fraud Control Unit (MFCU) of the Louisiana State Attorney General’s Office.
After a two-week trial, Nnanta Felix Ngari, Dr. Sofjan Lamid, Henry Lamont Jones and Ernest Payne were each convicted by a federal jury in the Middle District of Louisiana of one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.
Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge-area DME supplier that specialized in the provision of power wheelchairs to Medicare beneficiaries. Evidence at trial established that beginning in late 2003, Ngari paid recruiters, including Jones and Payne, to locate and solicit Medicare beneficiaries to attend “health fairs” hosted by Jones and Payne at churches and other locations. At the health fairs, doctors, including Dr. Lamid, prescribed the beneficiaries power wheelchairs that were medically unnecessary. The prescriptions were used by Ngari to submit false and fraudulent claims, on behalf of Unique, to Medicare. According to information presented at trial, the doctors, including Dr. Lamid, were paid illegal kickbacks by Payne and Jones based on the number of power wheelchair prescriptions generated at the health fairs. Jones and Payne were also paid kickbacks by Ngari on a per prescription basis.
Between 2003 and 2009, Unique submitted approximately $4.7 million in claims to Medicare for purported services. Medicare paid Unique approximately $2.5 million for these claims.
A sentencing date has not yet been scheduled. Both conspiracy counts carry a maximum penalty of 10 years in prison and a $250,000 fine.
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Tuesday, August 16, 2011
Joseph M. Tages Indicted for Engaging in Alleged Health Care Fraud Scheme and Federal Income Tax Fraud
CHICAGO—An Aurora physician was indicted for allegedly engaging in federal tax and health care fraud in connection with operating a medical clinic he owned, federal law enforcement officials announced today. The defendant, Joseph M. Tages, was charged in a 12-count indictment returned yesterday by a federal grand jury. Tages allegedly diverted more than $750,000 in cash receipts from his medical practice and failed to report the income on both corporate and individual federal income tax returns for the years 2004-06, thus avoiding payment of more than $260,000 in taxes he owed on that income. He also allegedly defrauded various health insurance providers, including labor union health and welfare funds, by submitting reimbursement claims falsely stating that he regularly saw patients for follow-up office visits on Mondays, two days after performing such outpatient procedures as removing genital warts.
Tages, 65, of Plainfield, will be arraigned at a later date in U.S. District Court in Chicago. Tages owns West Suburban Medical and Surgical Associates S.C., and operates the Aurora Health center (AHC) on Weston Avenue in Aurora. He was charged with six counts of filing false corporate and individual income tax returns, two counts of mail fraud, and four counts of making false statements involving a health care benefit program. The indictment also seeks forfeiture of at least $10,000.
The charges were announced by Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois, together with Robert D. Grant, Special Agent in Charge of the Chicago Office of Federal Bureau of Investigation; Alvin Patton, Special Agent in Charge of the Internal Revenue Service Criminal Investigation Division in Chicago; and James Vanderberg, Special Agent in Charge of the U.S. Department of Labor Office of Inspector General in Chicago.
The tax charges allege that Tages diverted a total of $765,593 in cash receipts from AHC and under-reported the business’s income on its corporate tax returns for 2004-06. As a result, AHC failed to pay approximately $267,956 in corporate taxes owed to the IRS. At the same time, he allegedly failed to report the diverted cash on his personal income tax returns by a total of $766,772 during those three years. As he result, he failed to pay approximately $282,787 in personal taxes owed to the IRS.
Between 2006 and 2009, Tages allegedly defrauded various health insurance providers by falsely claiming reimbursement totaling at least $10,000 for services that he did not provide. According to the indictment, between 2001 and 2009, Tages diagnosed genital condyloma on numerous male patients at his affiliated Latino Institute of Surgery, and generally performed wart removal procedures on Saturdays. That same day, he allegedly falsely noted in some patients’ files that he had already seen the patient in his office on the upcoming Monday. Subsequently, Tages submitted insurance claims falsely stating that patients were seen in his office when they were not, the indictment alleges.
Between 2006 and 2009, the indictment alleges that Tages diagnosed gastro esophogeal reflux disease, also known as GERD or acid reflux, in numerous patients and caused others to perform an esophagogastroduodenoscopy, or EGD, procedure on Saturdays in which a bendable tube with a camera is inserted through a patient’s mouth to examine the esophagus, stomach and small intestine. Again, that same Saturday he allegedly falsely noted in some patients’ files that he had already seen the patient in his office on the upcoming Monday. Tages then submitted insurance claims falsely stating that patients were seen in his office when they were not, the charges allege. The government is being represented by Assistant U.S. Attorney Kaarina Salovaara.
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Monday, August 15, 2011
Elizabet Lombera is 10th Person Arrested for Her Role in Leading $27 Million Health Care Fraud Conspiracy
U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigations, announced today’s arrest of Elizabet Lombera, 39, of Miami Lakes, Florida. On August 4, 2011, a federal grand jury in Miami indicted Lombera with one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349, six counts of health care fraud, in violation of Title 18, United States Code, Section 1347, and six counts of aggravated identity theft, in violation of Title 18, United States Code, Section 1028A, Case No. 11-20528-Cr-Seitz.
If convicted, the defendant faces a possible maximum statutory sentence of 10 years’ imprisonment on the conspiracy and the health care fraud counts. In addition, each count of aggravated identity theft carries a two-year mandatory minimum term of imprisonment to run consecutive to any other sentence.
According to the indictment, Lombera and her co-conspirators installed nominee presidents to hide her control of five durable medical equipment companies in Miami that submitted fraudulent claims to Medicare, including Mercy Medical Supply, Inc., JHH Group, Inc., La Numero 1 Farmacia Discount Corp., Yani’s Pharmacy, Inc., and El Perimetro Farmacia Discount Corp. Collectively, these five companies submitted approximately $27,383,328 in fraudulent claims to Medicare and received $12,438,952 in reimbursements. The indictment alleges that Lombera used the proceeds for personal gain, including paying for a trip to Japan.
Six of Lombera’s co-conspirators have already been sentenced for their roles in this conspiracy. Maykel Diaz Escalona, the nominee owner of Mercy Medical Supply, Inc., was sentenced to 37 months’ imprisonment in United States v. Maykel Diaz Escalona, Case No. 09-Cr-20084-Graham. Marcelino Avila, the nominee owner of JHH Group, was sentenced to 46 months’ imprisonment, inUnited States v. Marcelino Avila, Case No. 08-20730-Cr-Seitz. Douglas Reina, the nominee owner of Yani’s Pharmacy, was sentenced to 37 months’ imprisonment in United States v. Douglas Reina, Case No. 08-Cr-20330-Huck. Obel Martinez was sentenced to 36 months’ imprisonment for laundering approximately $620,000 of health care fraud proceeds in United States v. Obel Martinez, Case No. 10-Cr-20546-King. Emilio Bezanilla was sentenced to 30 months’ imprisonment for laundering approximately $195,000 in United States v. Emilio Bezanilla, Case No. 11-Cr-20096-Lenard. Finally, Edisnel Diaz Soler was sentenced to 27 months’ imprisonment for laundering approximately $580,000 of health care fraud proceeds in United States v. Edisnel Diaz Soler, Case No. 10-Cr-20876-Huck.
Four other individuals have been charged. Luis Fuentes, the nominee owner of El Perimetro, was charged in United States v. Luis Fuentes, Case No. 08-Cr-20199-Martinez, but remains a fugitive. Eliezer Lazo, Joel Martinez Hernandez, and Casimiro Martinez have been arrested and charged separately for their roles in laundering the proceeds of the health care fraud and are awaiting trial in United States v. Eliezer Lazo, Case No. 11-20447-Cr-Altonaga; United States v. Joel Martinez Hernandez, Case No. 11-20446-Cr-Moreno; and United States v. Casimiro Martinez, Case No. 11-Cr-20448-Jordan.
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Saturday, August 13, 2011
Dr. Norman Werther and Pharmacist Ihsanullah “Sean” Maaf Among Those Arrested in Drug Conspiracy and Health Care Fraud Case
PHILADELPHIA—A 498-count indictment was unsealed today charging 53 defendants, including a Montgomery County physician and a Northeast Philadelphia pharmacist, in a multi-million-dollar drug conspiracy involving phony prescriptions, phony patients, and an alleged drug trafficking organization. The indictment was announced by United States Attorney Zane David Memeger, Drug Enforcement Administration Special Agent in Charge John J. Bryfonski, Department of Health and Human Services Special Agent in Charge Nick DiGiulio, and Federal Bureau of Investigation Special Agent in Charge George C. Venizelos. In addition to charges of drug possession and drug distribution, the indictment contains 240 counts of health care fraud. Agents from multiple federal and local agencies arrested defendants this morning.
Included in the indictment are Dr. Norman Werther, of Horsham; pharmacist Ihsanullah “Sean” Maaf, of Northeast Pharmacy in Philadelphia; and alleged drug trafficker William Stukes, of Philadelphia. According to the indictment, Stukes and his alleged drug trafficking organization recruited large numbers of pseudo patients and then transported them to Dr. Werther’s medical office for fake examinations. These ‘patients’ paid an office visit fee, usually $150, to the office staff and Werther would write prescriptions for those ‘patients’ to obtain oxycodone-based drugs without there being a medical need for the prescription. The ‘patients’ were then driven to various pharmacies to have their prescriptions filled, including Northeast Pharmacy where Maaf would fill the prescription. The drugs were then turned over to Stukes or his drivers. Stukes and his organization would allegedly sell the narcotics to numerous drug dealers, who are also named in the indictment, who would also then resell the drugs on the street. It is estimated that between September 2009 and July 2011, the Stukes drug trafficking organization earned more than $5 million through these illegal prescriptions and that the defendants unlawfully acquired and distributed over 200,000 pills containing oxycodone.
“Doctors and pharmacists are trained to help real patients suffering from actual medical conditions, not drug trafficking organizations,” said Memeger. “Ignoring the clear health risks that Oxycodone presents when introduced into the human body, Dr. Werther and pharmacist Maaf elected to use their medical training to engage in fraud by feeding the habits of drug abusers seeking a quick fix. Werther and Maaf are just like the street corner drug dealers they supplied, despite their professional status.”
According to the indictment, pharmacist Ihsanullah Maaf filled Dr. Werther’s illegally obtained prescriptions for the drug trafficking organization and laundered the money he received for his services by structuring his cash bank deposits to avoid federal reporting requirements. Maaf is charged with 119 counts of money laundering, 119 counts of structuring of financial transactions, and one count of aggravated structuring of financial transactions. A forfeiture notice seeks at least $920,574 in United States currency, representing the amount of property involved in the money laundering conspiracy.
Defendants Rita Myles, Rashida Lyles, and Tina Weisz worked in Dr. Werther’s office and allegedly helped facilitate and verify the prescriptions; defendants Gerald Brinkley and Darrah Robinson allegedly aided Stukes in the running of the drug organization; drivers for the Stukes organization include defendants Herbert Hughes, Carlos Richards, Warren Johnson, Gregory Johnson, Claude Nolan, and Darrell Hendricks; charged as bulk pill buyers are Timothy Peden, Troy Fletcher, Christopher Pizzo, Ato Strong, Sylvester Adams, Jason Romm, James Lyles, and Michael Sanders.
Charged in the indictment as ‘pseudo patients’ are: Zaniah Beard, Donald Brown, Kim Carter, Andre Dawkins, Evette Gringrow, Leon Harris, Denise Hawkins, Ronnie Jackson, Carla Jenkins, Beatrice Lewis, Michael Littlejohn, Vernell McDaniels, Eric Perry, Mark Reid, Michael Rominiecki, Wayne Rucker, Patricia Simmons, Lawrence Stith, Debra Stukes, Viola Stukes, Steven Thompson, Eric Treadwell, Julia Turner, Geraldine Watkins, Yolanda Williams, Lamont Butcher, Khaliff Headen, Sophia Holder, Latoisha Jones, Dawn Little, and Derek Stukes. These 31 pseudo patients are charged with conspiracy to distribute controlled substances and numerous counts of health care fraud.
“This case underscores the magnitude of the prescription drug abuse problem facing the United States today,” said Bryfonski (DEA). “The drugs in this case, when abused, can bring about the same tragic consequences as cocaine and heroin. Even more disturbing, the alleged deception involved suggests that those sworn to treat and administer to the sick can be drawn into a criminal web of drug trafficking for personal gain.”
“The abuse of prescription medications has become a major public health crisis fueled by fraud,” said DiGiulio (HHS-OIG). “All too often prescriptions have no real medical purpose, are fraudulently billed to our health insurance programs, and then sold on the street to drug abusers. Today’s arrests, carried out with our law enforcement partners, are intended to serve justice.”
“Doctors and pharmacists who illegally dispense narcotics and other controlled substances are no different than street corner drug dealers,” said Venizelos (FBI). “These types of heath care fraud schemes not only divert limited resources from patients that really need and deserve care, they also endanger people’s lives.”
The crimes of conspiracy, distribution of controlled substance, possession with intent to distribute, and money laundering each carry a maximum possible sentence of 20 years in prison; health care fraud and aggravated structuring each carry a maximum sentence of 10 years in prison; structuring financial transactions carries a maximum possible sentence of five years in prison. Each defendant also faces possible fines, periods of supervised release, and special assessments.
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