Source- http://www.fbi.gov/houston/press-releases/2012/second-owner-of-houston-area-home-health-care-agency-sentenced-to-108-months-in-prison-for-role-in-5.2-million-medicare-fraud
WASHINGTON—The former co-owner of a Houston-area home health care company was sentenced in Houston to 108 months in prison for his participation in a $5.2 million Medicare fraud scheme, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).
Princewill Njoku, a former co-owner and administrator at Family Healthcare Group, was sentenced yesterday by U.S. District Judge Nancy Atlas in the Southern District of Texas to 108 months in prison, followed by three years of supervised release. Njoku was ordered to pay $5.1 million in restitution jointly and severally with his co-defendants. In January 2011, Njoku pleaded guilty to one count of conspiracy to commit health care fraud, one count of conspiracy to pay illegal kickbacks to patient recruiters, and 16 counts of paying such illegal kickbacks.
According to court documents and other evidence presented to the court, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries. According to the evidence, Princewill Njoku paid co-conspirators to recruit Medicare beneficiaries for the purpose of Family Healthcare Group filing claims with Medicare for skilled nursing that was medically unnecessary or not provided. Njoku and his co-conspirators then falsified documents to support the fraudulent payments from Medicare.
Njoku is the ninth defendant sentenced in connection with this scheme, including Njoku’s co-owner, Clifford Ubani, who also received a 108 month sentence earlier this month. One remaining defendant awaits sentencing.
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Source- http://www.fbi.gov/houston/press-releases/2012/fourth-defendant-gets-over-12-years-in-massive-health-care-fraud-scheme
HOUSTON—Kenneth Ibezim Anokam, 57, a naturalized U.S. citizen from the Federal Republic of Nigeria, has been handed a 151-month federal prison term for his role in a massive health care fraud conspiracy that billed the Medicare and Medicaid programs for more than $45 million over a 2 ½-year period, United States Attorney Kenneth Magidson announced today.
Anokam was found guilty of one count of conspiracy to commit health care fraud, 27 counts of health care fraud, and four counts of structuring to avoid reporting requirements by a Houston jury on May 27, 2011, following an almost three-week trial. Anokam was an employee and person in charge at City Nursing, where the fraud occurred. The owner of City Nursing, Umawa Oke Imo, and Dr. Christina Joy Clardy, under whose Medicare and Medicaid provider numbers City Nursing billed the fraudulent claims, were also convicted at trial and sentenced to 327 and 135 months, respectively. Joann Michelle White, an employee of City Nursing who pleaded guilty in February 2010, received a 46-month sentence. Godwin Chiedo Nzeocha, who was charged with Anokam with conspiracy to commit health care fraud, health care fraud, mail fraud, and money laundering, was returned to Houston earlier this week from Nigeria to face the charges after federal agents were unable to arrest him in 2009. Nzeocha is presumed innocent until convicted through due process of law.
In arriving at Anokam’s sentence today, United States District Court Judge Melinda Harmon, who presided over the trial, considered Anokam’s role as a manager and supervisor at City Nursing, as well as the amount of fraud committed through the conspiracy. Judge Harmon sentenced Anokam to 120 months for the conspiracy conviction and each of the health care fraud convictions, which will all be served concurrently. He also received an additional 31 months for each of the structuring charges, to be served concurrent to each other but consecutive to the 120-month sentence—for a total sentence of 151 months in federal prison. Judge Harmon further ordered he pay restitution in the amount of $16,817,015.95 to Medicare and $2,230,530.95 to Medicaid, joint and several to the other convicted members of the conspiracy.
According to last year’s trial testimony, Medicare and Medicaid beneficiaries were paid cash for going to City Nursing and signing undated blank treatment forms that were subsequently completed by Anokam and other City Nursing employees to reflect physical therapy treatment that was not provided. City Nursing employees who testified on behalf of the United States described how they handed out cash, usually $100-$150, given to them by Imo and Anokam to beneficiaries and “recruiters” also known as “marketers,” for coming to the clinic. Generally, beneficiaries were paid once a month when they came to City Nursing to see the doctor; however, those beneficiaries who took Medicare Explanation of Benefit statements into the office to complain about the fraudulent billing were given extra payments, sometimes $200-$300 to “settle” matters. Anokam was one of the managers who dealt with the complaining beneficiaries with Medicare statements.
Despite billing more than $45 million for physical therapy services, the evidence at trial established there was never a single licensed or otherwise qualified physical therapist at City Nursing. One Medicare beneficiary testified that when she asked the doctor at City Nursing for physical therapy she was told the clinic did not provide that type of service and to go to her primary care physician for a referral to another clinic. Another Medicare beneficiary described the clinic as looking like an unemployment office with people just hanging out and referred to a day when he saw an employee direct a patient to make a pot of coffee.
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Source- http://www.justice.gov/opa/pr/2012/July/12-crm-847.html
WASHINGTON – An Asheville, N.C., resident pleaded guilty today in U.S. District Court in Miami for her role in a health care fraud scheme that resulted in the submission of more than $63 million in fraudulent claims to Medicare and Medicaid in Miami and Hendersonville, N.C., announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Serena Joslin, 31, a Licensed Psychological Associate, pleaded guilty before U.S. District Judge Cecilia M. Altonaga in Miami to one count of conspiracy to commit health care fraud. Joslin admitted to participating in a fraud scheme that was orchestrated through an entity called Health Care Solutions Network (HCSN). HCSN operated purported partial hospitalization programs (PHPs), a form of intensive mental health treatment for severe mental illness, in both Miami and Hendersonville.
According to an indictment unsealed on May 2, 2012, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not provided. HCSN obtained those beneficiaries by paying kickbacks to owners and operators of assisted living facilities (ALFs) or by otherwise recruiting them from ALFs and nursing homes. According to court documents, Joslin admitted that she was aware that HCSN recruited patients who were inappropriate for PHP treatment. Nevertheless, Joslin agreed with other HCSN employees to, among other things, fabricate therapy notes and other medical records, and to direct therapists to fabricate therapy notes and other medical records, all to make it appear as if HCSN patients received appropriate PHP services. Joslin was aware that fraudulent claims to Medicare would be submitted on behalf of these patients.
At sentencing, scheduled for Jan. 11, 2013, Joslin faces a maximum of 10 years in prison and a $250,000 fine.
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Source- http://www.justice.gov/opa/pr/2012/July/12-civ-843.html
NextCare Inc., an Arizona-based company, has agreed to pay $10 million to settle federal and state allegations that it submitted false claims, the Justice Department announced today. NextCare is an owner of a chain of urgent care facilities with locations in Arizona, Colorado, Texas, North Carolina, Ohio and Virginia.
The settlement resolves allegations that NextCare submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Program, as well as the Medicaid programs of Colorado, Virginia, Texas, North Carolina and Arizona, by billing for unnecessary allergy, H1N1 virus and respiratory panel testing. The United States also alleged that NextCare inflated billings for urgent care medical services in the years under review, a practice known as upcoding.
“This settlement demonstrates the Justice Department’s commitment to ensuring that federal health care dollars are spent appropriately,” said Stuart Delery, Acting Assistant Attorney General for the Civil Division. “Health care providers who administer unnecessary services or who overcharge for care will be held accountable.”
Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina, noted that, “Today’s $10 million settlement with NextCare demonstrates our commitment to putting a stop to improper billing practices that exploit Medicare and drain vital resources from our health care system. NextCare’s upcoding and unnecessary medical testing wasted taxpayers’ dollars. This is a strong message to companies and individuals who engage in such conduct. We are here, we are watching, and we will use all of our resources to safeguard the integrity of important public programs and protect consumers across the nation.”
Daniel R. Levinson, Inspector General of the Department of Health and Human Services (HHS-OIG), added, “P roviders who subject beneficiaries to unnecessary medical testing, as alleged against NextCare, compromise the well-being of their patients and squander Federal health care funds .”
As a condition of the settlement, NextCare Inc. is also required to enter into a Corporate Integrity Agreement with HHS-OIG under which the company will be monitored for a period of five years to ensure that in the future it complies with all federal healthcare program rules.
The allegations resolved by today’s settlement were initially raised in a lawsuit filed against NextCare by former NextCare employee Lorin Cohen. Under the False Claims Act, private citizens acting as relators can bring suit on behalf of the United States and share in the recovery. Ms. Cohen will receive $1.614 million as her share of the recovery.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20June/120625%20Washington_print.html
HOUSTON – Kelvin Washington, 49, of Houston, has been handed a 24-month federal sentence following his convictions of health care fraud, conspiracy and violations of the anti-kickback statute, United States Attorney Kenneth Magidson announced today. Washington was convicted after six days of trial and three and a half hours of deliberation on Dec. 8, 2011.
Today, U.S. District Court Judge Nancy Atlas, who presided over the trial, sentenced Washington to 24 months for each of the six convictions of health care fraud, conspiracy conviction and three counts of violating the anit-kickback statute, all to be served concurrently. The court additionally ordered three years supervised release, of which the first 12 months of to be served as home confinement. He was ordered to pay approximately $480,000 in restitution to Medicare and Medicaid.
The evidence in the weeklong trial showed that from 2003 to 2007, Washington received illegal payments for the referral of dialysis patients to a Houston ambulance transport service. In addition, he conspired with others to have unsuspecting doctors sign transport prescriptions for dialysis patients never admitted to a Sugar Land nursing home where he worked.
Testimony at trial showed Washington was paid for the referral of dialysis patients to an ambulance service that was under contract with the nursing home where he worked. The evidence also showed he would present prescriptions to doctors who worked at the nursing home. The doctors testified at trial that they would not have signed the prescriptions if they had known the various patients were never admitted to the nursing home.
The jury also heard evidence that the ambulance service paid the Washington in checks totaling $22,200 with many tied to specific patients. Washington did not report all the income he made to the Internal Revenue Service (IRS) from the ambulance service. At trial, an undercover video and audio tape showed one of the managers of the ambulance company bribing a patient to ride with the ambulance company. The ambulance company would later bill Medicare for this patient, a paid informant whose own doctors would not sign a prescription for him. The bill to Medicare was based upon a false script from Washington. In a search warrant executed on a co-conspirator’s home, “The List” was discovered which detailed payments made not only to Washington but also to patients who rode with the ambulance service. A computer file from that home also showed detailed records tracking payments for patients, the check numbers for those payments and the fact that payments were made to the defendant.
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Source- http://www.justice.gov/opa/pr/2012/July/12-civ-842.html
Global health care giant GlaxoSmithKline LLC (GSK) agreed to plead guilty and to pay $3 billion to resolve its criminal and civil liability arising from the company’s unlawful promotion of certain prescription drugs, its failure to report certain safety data, and its civil liability for alleged false price reporting practices, the Justice Department announced today. The resolution is the largest health care fraud settlement in U.S. history and the largest payment ever by a drug company.
GSK agreed to plead guilty to a three-count criminal information, including two counts of introducing misbranded drugs, Paxil and Wellbutrin, into interstate commerce and one count of failing to report safety data about the drug Avandia to the Food and Drug Administration (FDA). Under the terms of the plea agreement, GSK will pay a total of $1 billion, including a criminal fine of $956,814,400 and forfeiture in the amount of $43,185,600. The criminal plea agreement also includes certain non-monetary compliance commitments and certifications by GSK’s U.S. president and board of directors. GSK’s guilty plea and sentence is not final until accepted by the U.S. District Court.
GSK will also pay $2 billion to resolve its civil liabilities with the federal government under the False Claims Act, as well as the states. The civil settlement resolves claims relating to Paxil, Wellbutrin and Avandia, as well as additional drugs, and also resolves pricing fraud allegations.
“Today’s multi-billion dollar settlement is unprecedented in both size and scope. It underscores the Administration’s firm commitment to protecting the American people and holding accountable those who commit health care fraud,” said James M. Cole, Deputy Attorney General. “At every level, we are determined to stop practices that jeopardize patients’ health, harm taxpayers, and violate the public trust – and this historic action is a clear warning to any company that chooses to break the law.”
“Today’s historic settlement is a major milestone in our efforts to stamp out health care fraud,” said Bill Corr, Deputy Secretary of the Department of Health and Human Services (HHS). “For a long time, our health care system had been a target for cheaters who thought they could make an easy profit at the expense of public safety, taxpayers, and the millions of Americans who depend on programs like Medicare and Medicaid. But thanks to strong enforcement actions like those we have announced today, that equation is rapidly changing.”
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Source- http://www.fbi.gov/miami/press-releases/2012/miami-area-patient-recruiters-sentenced-to-prison-for-roles-in-200-million-medicare-fraud-scheme
WASHINGTON—Two Miami-area patient recruiters were sentenced to 84 months and 63 months in prison, respectively, for recruiting Medicare beneficiaries as part of a $200 million Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services announced today.
James Edwards was sentenced today to 84 months in prison and three years of supervised release and Nelson Fernandez was sentenced yesterday to 63 months in prison and three years of supervised release. In addition, Fernandez was sentenced to pay $13.1 million in restitution, joint and several with co-conspirators, and Edwards was sentenced to pay $4.1 million in restitution, joint and several with co-conspirators. Edwards and Fernandez were both sentenced by U.S. District Judge Patricia A. Seitz.
Fernandez, 43, pleaded guilty to the scheme on Aug. 2, 2011, and Edwards, 65, pleaded guilty on July 13, 2011. Both admitted to serving as patient brokers for American Therapeutic Corporation (ATC). ATC, its management company, Medlink Professional Management Group Inc., and a related company, the American Sleep Institute (ASI), were Florida corporations headquartered in Miami. ATC 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. ASI purported to provide diagnostic sleep disorder testing.
According to court documents, Fernandez and Edwards recruited patients to attend ATC’s PHP program in exchange for per patient, per day kickbacks. Based on their recruiting, Fernandez admitted to causing $8 million in fraudulent submissions to Medicare and Edwards admitted to causing $8.16 in fraudulent bills to Medicare. Both Fernandez and Edwards admitted that they knew the patients they recruited for ATC were not qualified to receive PHP treatment. Both men also admitted to recruiting ineligible patients for ASI’s sleep studies. Fernandez additionally admitted to causing $14.7 million in fraudulent bills to Medicare in a separate home health services scheme in which he used some of the same patients that he brokered to ATC. Edwards additionally admitted to causing $4.1 million in fraudulent bills to Medicare in a separate PHP scheme.
According to court filings, ATC’s owners and operators paid millions of dollars in kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare. According to court filings and evidence admitted at trials of co-defendants, ATC and ASI also did not provide the treatment billed to Medicare and co-conspirators fabricated documents in patient files to hide the ineligible patients and inappropriate treatment.
ATC, Medlink, and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011. ATC, Medlink and 19 of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial on Oct. 22, 2012, before Judge Seitz. A defendant is presumed innocent unless proven guilty beyond a reasonable doubt in a court of law.
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Source- http://www.fbi.gov/sandiego/press-releases/2012/medical-supply-company-owner-pleads-guilty-to-bilking-medicare
United States Attorney Laura E. Duffy announced that the owner of a San Diego medical supply store pleaded guilty today for her participation in a scheme that defrauded the Medicare trust fund of more than $320,000.
As detailed during her guilty plea, Oddeth Afara was the owner and operator of Trinity Heart Medical Supply, a company that sold durable medical equipment like power wheelchairs and hospital beds. Afara pleaded guilty before U.S. Magistrate Judge Bernard Skomal to conspiring to commit health care fraud, admitting that she was paid more than $320,000 by Medicare based upon false and fraudulent claims related to power wheelchairs. The plea is subject to final acceptance by United States District Judge Thomas J. Whelan.
According to her plea agreement, Afara purchased power wheelchair prescriptions for individuals who were covered by Medicare B despite knowing that the patients who received the power wheelchairs did not need the equipment and could walk without any assistance. As stated during today’s court hearing, the prescriptions themselves were completely fraudulent. Twelve different physicians confirmed that the prescriptions contained forged signatures and faulty diagnoses for unnecessary power wheelchairs. Afara used these fraudulent prescriptions to submit false claims to Medicare seeking reimbursement. In total, Afara submitted claims for 82 Medicare beneficiaries who did not need the power wheelchairs. The scheme lasted for more than a year, beginning in April 2008 and continuing until June 2009.
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Source- http://www.fbi.gov/miami/press-releases/2012/miami-area-resident-pleads-guilty-to-participating-in-63-million-medicare-fraud-scheme
WASHINGTON—A Miami-area resident pleaded guilty today in U.S. District Court in Miami for her role in a health care fraud scheme that resulted in the submission of more than $63 million in fraudulent claims to Medicare and Medicaid, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Sarah Da Silva Keller, 27, pleaded guilty before U.S. District Judge Marcia G. Cooke in Miami to one count of conspiracy to commit health care fraud. Keller admitted to participating in a fraud scheme that was orchestrated by the owner and operators of Health Care Solutions Network (HCSN), which operated purported partial hospitalization programs (PHPs), a form of intensive mental health treatment for severe mental illness.
According to an indictment unsealed on May 2, 2012, HCSN paid kickbacks to owners and operators of assisted living facilities in exchange for referring Medicare beneficiaries to HCSN for PHP treatment that was unnecessary and, in many instances, not provided. According to court documents, Keller admitted that she falsified records at the direction of others so that HCSN could bill Medicare for patients who did not receive the services from HCSN. Keller knew that the falsification of these records was part of a plan for HCSN to commit health care fraud.
At sentencing, scheduled for Oct. 17, 2012, Keller faces a maximum of 10 years in prison and a $250,000 fine for each count.
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Source- http://www.justice.gov/usao/lam/press/press1204.html#f10
BATON ROUGE, LA – United States Attorney Donald J. Cazayoux, Jr. announced that EUNICE SPARROW, age 68, and UNIECESCO SMITH, age 30, both of Plaquemine, Louisiana, have been sentenced to prison by Chief U.S. District Court Judge Brian A. Jackson as a result of their roles in a two-year health care fraud scheme.
SMITH was sentenced on June 20, 2012, and ordered to serve a term of imprisonment of 14 months. SPARROW was sentenced this morning to serve a term of imprisonment of 12 months and 1 day. Each was ordered to serve a term of supervised release following her release from imprisonment, and to make restitution to the United States Department of Health & Human Services. SMITH was also ordered to pay a $7,500 fine.
SMITH and SPARROW previously entered guilty pleas, on February 22, 2012, to several counts of health care fraud. In their plea agreements, the defendants admitted that they knowingly aided and abetted a health care fraud scheme perpetrated by their co-defendant, LINDA M. JACKSON. From April of 2007 through April of 2009, JACKSON operated a company in Plaquemine, Louisiana called A&A Durable Medical Supply, and used the company to defraud Medicare by submitting false reimbursement claims to Medicare for items that the company had never provided. In their plea agreements, SPARROW and SMITH admitted that they assisted JACKSON in her scheme by completing and signing false delivery tickets and other fraudulent documents at JACKSON’s direction. A&A kept the fraudulent documents in its patient files in an attempt to substantiate the fraudulent claims JACKSON submitted to Medicare, and JACKSON later provided the false documents to an auditor who requested the patient files in the course of an investigation into A&A’s claims. JACKSON is awaiting sentencing.
U.S. Attorney Donald J. Cazayoux, Jr., stated, “This is another in a long line of prosecutions for health care fraud in our district. We remain committed to protect the integrity of our health care system and we will continue to strictly enforce our federal health care laws. This sentencing should serve as a deterrent for others who attempt to defraud our health care system for their own personal greed.”
“No American citizen should tolerate theft from our federal health care programs,” said Assistant Special Agent-in-Charge William W. Root of the United States Department of Health and Human Services. “Today’s sentencings are a clear signal that greed has no place in the health care service arena. If you steal from Medicare, we will catch you and you will go to jail,” said Root.
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Source- http://www.justice.gov/opa/pr/2012/June/12-crm-807.html
WASHINGTON – The owner of a Miami-area assisted living facility was sentenced today to 37 months in prison for her role in a kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), the Department of Justice, the FBI and the Department of Health and Human Services announced today.
Billy Denica, 50, was sentenced by U.S. District Judge Joan A. Lenard in Miami. In addition to her prison term, Denica was sentenced to two years of supervised release and was ordered to pay $538,875 in restitution. Denica pleaded guilty on April 2, 2012, to one count of conspiracy to commit health care fraud.
Denica was the owner of an assisted living facility called Robyll Care Assisted Living Facility. According to court documents, Denica agreed to send Robyll residents to ATC in exchange for illegal health care kickbacks. ATC purported to operate partial hospitalization programs, a form of intensive treatment for severe mental illness, in seven different locations throughout south Florida and Orlando. According to court documents, Denica admitted that she knew ATC falsely billed Medicare for PHP treatment based on her fraudulent referrals. Denica was aware that some of the Robyll residents would be offered gifts such as money, cigarettes and candy, so that they would agree to be admitted to a hospital for purposes of later attending ATC. She also admitted that she referred her residents to ATC because they had Medicare, because she would receive a cash kickback and because they were willing to go. According to the plea agreement, Denica’s participation in the fraud resulted in more than $1.1 million in fraudulent billing to the Medicare program.
ATC, its management company Medlink Professional Management Group Inc., and more than 20 individual defendants charged for their participation in the scheme have pleaded guilty or have been convicted at trial.
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Source- http://www.justice.gov/usao/okw/news/2012/2012_06_20_2.html
Oklahoma City, Oklahoma – Sanford C. Coats, United States Attorney for the Western District of Oklahoma, and Scott E. Pruitt, Oklahoma Attorney General, jointly announce that the Harmon County Healthcare Authority (Harmon Memorial Hospital) and Dr. Akram R. Abraham, of Hollis, Oklahoma, have agreed to pay $1,550,000 to settle claims of health care fraud of the Medicare and Medicaid programs.
The settlement concludes a lawsuit styled United States of America and State of Oklahoma ex rel. Randy L. Curry v. Harmon County Healthcare Authority, Akram R. Abraham, M.D., P.C., and Akram R. Abraham, M.D., Case No CIV-09-1321-D, filed in Oklahoma City federal court. This suit was brought under the qui tam or whistleblower, provisions of the federal False Claims Act (FCA) and the Oklahoma Medicaid False Claims Act (OMFCA). These Acts allow private citizens with knowledge of fraud to bring civil actions for health care fraud of the federal and state health care programs on behalf of the United States and State of Oklahoma and share in any recovery.
Randy L. Curry is from Harmon County and served as the hospital Administrator of Harmon County Healthcare Authority (HCHA) from 2008 to 2009. HCHA operates the Harmon Memorial Hospital in Hollis, Oklahoma. Dr. Akram R. Abraham, M.D., is a medical doctor licensed to practice in the State of Oklahoma who has a medical practice and resides in Hollis, Oklahoma.
The United States and State of Oklahoma alleged that from July 1, 2001, through May 30, 2008, both HCHA and Dr. Abraham violated the FCA and the OMFCA by submitting claims, or causing claims to be submitted, to the Medicare and Medicaid programs that violated the federal “Stark” regulations and Anti-Kickback Statute. Specifically, the government alleged that there was a prohibited contractual relationship between HCHA and Dr. Abraham resulting in excessive remuneration which was not commercially reasonable in the absence of health care referrals and that HCHA and Dr. Abraham made false certifications that the Medicare and Medicaid claims they submitted were in compliance with federal and state regulations. The alleged improper remuneration included, but was not limited to, free rent of office space, free billing and staff personnel, reimbursement of uncollected accounts receivable, duplicative per encounter payments for emergency room services, and improper payment of locum tenens physician services. HCHA and Dr. Abraham have each denied liability.
In the settlement, HCHA agreed to pay $550,000 and Dr. Abraham agreed to pay $1,000,000 to resolve the claims. In addition, both HCHA and Dr. Abraham have entered into five year corporate integrity agreements with the United States Department of Health and Human Services Office of the Inspector General which requires additional regulatory compliance reporting and monitoring. Under the qui tam provisions of the FCA and OMFCA, Randy Curry will receive a share of the settlement proceeds.
Since January 2009, the Department of Justice has recovered over $11.1 billion under the False Claims Act. Of this amount, more than $7.4 billion was recovered in health care fraud matters. Last year, more than 630 qui tam matters were filed with the Department of Justice – more than in any other year in the history of the FCA and an increase of more than 47% since 2009. More than two-thirds of these qui tam cases alleged false claims to government health care programs.
The OMFCA went into effect on November 1, 2007, and its focus is solely on fraud perpetrated against the Oklahoma Medicaid Program. Since its passage, over 351 qui tam cases have been filed on behalf of the State of Oklahoma. The State has received over $63.8 million in civil recoveries resulting from cases alleging fraud on the Oklahoma Medicaid system. The Oklahoma Attorney General’s MFCU is the only Oklahoma law enforcement agency dedicated to the investigation and prosecution of Medicaid fraud.
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Source- http://www.fbi.gov/kansascity/press-releases/2012/hospice-care-of-kansas-and-texas-based-parent-company-to-pay-6.1-million-to-resolve-allegations-of-false-claims
WASHINGTON—Hospice Care of Kansas LLC and its parent company, Ft. Worth, Texas-based Voyager HospiceCare Inc., have agreed to pay $6.1 million to resolve allegations that they violated the False Claims Act by submitting claims to the Medicare program for ineligible hospice services, the Justice Department announced today. Hospice Care of Kansas currently provides hospice services throughout the state of Kansas. Hospice Care of Kansas, which is based in Wichita, Kansas, was purchased by Voyager in 2004.
The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from the symptoms, pain, and stress of a serious illness) for a terminal illness and who have a life expectancy of six months or less if the disease runs its normal course. Today’s settlement resolves allegations that Hospice Care of Kansas and Voyager submitted or caused the submission of false Medicare claims between January 2004 and December 2008 for beneficiaries that did not have a terminal prognosis of six months or less.
The government alleged that Hospice Care of Kansas and Voyager engaged in certain practices that resulted in the submission of false claims, including the provision of compensation to clinical employees based on patient census and admissions, delaying discharges of patients determined not to have a six month or less prognosis, instructions to staff to document patient conditions in a misleading manner, and implementation of an inadequate compliance program.
“The Medicare hospice benefit is intended to provide comfort and care to terminally ill persons in the final stages of their disease,” said Stuart F. Delery, Acting Assistant Attorney General for the Department of Justice’s Civil Division. “This settlement shows that the Department of Justice will not tolerate hospice providers that attempt to maximize their profits at the expense of their legal and ethical obligations to the Medicare program, taxpayers, and beneficiaries.”
“Our goals are to protect taxpayer dollars, ensure the viability of government health care programs, and strengthen our national health care system,” said Barry Grissom, U.S. Attorney for the District of Kansas. “This case is a step in that direction.”
“We expect providers of Medicare services to operate with the utmost integrity and with the best interests of our beneficiaries in mind. Working with our partners at the Department of Justice, we will hold those accountable who do not operate in this manner,” said Gerald Roy, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General.
The allegations that are the subject of today’s settlement were originally raised in a lawsuit filed by a former Hospice Care of Kansas nurse, Beverly Landis, under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring an action on behalf of the United States and share in any recovery. As a part of today’s resolution, Ms. Landis will receive payments totaling $1.342 million.
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Source- http://www.fbi.gov/detroit/press-releases/2012/detroit-area-clinic-owner-pleads-guilty-to-16-million-psychotherapy-fraud-scheme
WASHINGTON—Detroit-area resident Louisa Thompson pleaded guilty today for her role in a $16 million fraud scheme, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).
Thompson, 63, pleaded guilty today before U.S. District Judge Nancy D. Edmunds in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, scheduled for Oct. 18, 2012, Thompson faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to the plea documents, in approximately January 2006, Thompson began billing Medicare for psychotherapy services through two companies, TGW Medical Inc. and Caldwell Thompson Manor Inc. The services billed by Thompson at TGW and Caldwell Thompson were never performed or were performed by unlicensed staff who were not authorized to perform services reimbursed by Medicare. The unlicensed staff members also fabricated therapy notes for patients that were never seen and billed Medicare using document templates created by Thompson.
According to court documents, Thompson also received payments from the owner of P&C Adult Day Care Inc., a psychotherapy clinic. Those payments to Thompson were, in part, for the use of Thompson’s provider number by P&C. Thompson also admitted signing therapy documents for P&C patients she never saw or treated. P&C, like TGW and Caldwell Thompson, billed for psychotherapy services that were either not performed or performed by unlicensed staff. Caldwell Thompson and P&C shared Medicare beneficiaries and/or beneficiary information.
Thompson admitted to submitting or causing to be submitted approximately $15.9 million in fraudulent psychotherapy claims on behalf of TGW, Caldwell Thompson and P&C. Medicare paid approximately $4.9 million of those claims.
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Source- http://www.fbi.gov/oklahomacity/press-releases/2012/city-dentist-charged-with-health-care-fraud
OKLAHOMA CITY—Robin R. Lockwood, 44, a dentist from Oklahoma City, has been charged with committing health care fraud, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma.
Lockwood is a dentist licensed to practice in the state of Oklahoma and was employed under contract by Ocean Dental at offices located at 1610 Southwest 74th Avenue, Oklahoma City. Ocean Dental’s dentists provided dental care to Medicaid-eligible children. The Medicaid Program is a cooperative program that provides federal and state funds to pay for health care benefits for individuals with insufficient incomes to meet the costs of necessary medical expenses. In Oklahoma, Medicaid is administered as “SoonerCare” by the Oklahoma Health Care Authority (OHCA), a state governmental agency. Ocean Dental submitted claims to the OHCA for reimbursement of dentists’ services based on patient treatment notes created by the dentists. Ocean Dental paid Lockwood a percentage of the funds that OHCA reimbursed to Ocean Dental for services she personally rendered.
The information alleges that from July 12, 2007 through December 31, 2010, Lockwood engaged in a scheme to defraud Medicaid by submitting claims for dental services that she did not provide. Specifically, it is alleged that Lockwood recorded in the patient’s treatment notes that she had placed dental restorations on certain teeth when, in fact, she had not treated the teeth at all. It is also alleged that on other teeth, Lockwood recorded that she had placed dental restorations on more surfaces of the tooth than she had, in fact, restored or recorded that she had placed a dental restoration on the tooth when, in fact, she had placed on the tooth a type of treatment that is non-reimbursable by Medicaid. Relying upon Lockwood’s treatment notes, Ocean Dental submitted claims for reimbursement to Medicaid and paid Lockwood a percentage of those reimbursements. It is alleged that Lockwood used the proceeds of the fraud for her own personal benefit.
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Source- http://www.fbi.gov/louisville/press-releases/2012/ambulance-company-agrees-to-pay-5-426-000-to-settle-fraudulent-billing-of-medicare
LOUISVILLE—United States Attorney for the Western District of Kentucky, David J. Hale; along with U.S. Attorney Joyce White Vance for the Northern District of Alabama; and the Health and Human Services Inspector General today announced the settlement agreement and scheduled voluntary payment of $5,426,000 by Rural/Metro Corporation, Rural/Metro of Central Alabama Inc., and Mercury Ambulance Service Inc., doing business as Rural/Metro Ambulance, with the United States to resolve claims that the ambulance company improperly billed Medicare.
“Our office led an extensive investigation of conduct occurring in Kentucky, and we are pleased with the outcome announced today,” stated David J. Hale, U.S. Attorney for the Western District of Kentucky. “Coordinating our efforts with federal and state law enforcement partners in Kentucky and Alabama, we avoided duplication of efforts and contributed significantly to today’s recovery of taxpayer dollars.”
The United States Attorney’s Office for the Western District of Kentucky, in conjunction with several federal and state law enforcement agencies, investigated conduct occurring in Kentucky and worked with the United States Attorney’s Office in the Northern District of Alabama to include the Kentucky-based claims in the Alabama lawsuit.
The United States alleges that the defendants created and submitted false and fraudulent records and claims for payment by governmental healthcare providers. According to the settlement agreement, from the period of January 1, 2008 to December 31, 2010, Rural/Metro of Central Alabama (RMCA) and Rural Metro/Central Tennessee (RMCT) submitted reimbursement claims to Medicare for non-emergency ambulance transportation services for Medicare beneficiaries to receive dialysis services, which did not meet Medicare criteria.
The United States further contends, from the period of January 1, 2008 to August 31, 2011, Mercury submitted reimbursement claims to Medicare for non-emergency ambulance transportation services, provided by Mercury in Louisville, Kentucky, for Medicare beneficiaries to receive dialysis services, which did not meet Medicare criteria. Medicare’s regulations allow the reimbursement of certain ambulance services only if other means of transport are not advisable for medical reasons. This generally means that ambulance transportation is reimbursable only if the beneficiary is bed-confined or if the beneficiary’s transportation by ambulance is medically required.
The United States partially intervened in this lawsuit that began as a federal whistleblower action against the defendants, brought by Carl Crawly, a former employee of Rural/Metro of Central Alabama Inc. According to the terms of the settlement agreement, Crawley will receive $1,030,940 of the settlement. Crawly originally filed the qui tam lawsuit on September 10, 2009, in U.S. District Court for the Northern District of Alabama. The lawsuit was filed under the qui tam provisions of the False Claims Act, which permit private parties to sue on behalf of the United States when they believe that defendants submitted false claims for government funds. The private plaintiffs are called “relators” and, under the statute, are entitled to receive a share of any funds recovered through the lawsuit. The False Claims Act permits the government to recover three times its damages, plus civil penalties.
In the complaint, Crawley alleged that Rural/Metro Corporation and Rural/Metro of Central Alabama Inc. violated the False Claims Act by submitting false claims for ambulance services that were never provided and were medically unnecessary. The United States filed a motion to partially intervene in this action on March 11, 2011. The United States’ motion was granted on March 14, 2011. The United States then filed a Complaint-in-Intervention alleging that from September 11, 2003 to the present, the defendants submitted false claims for transportation services provided to dialysis patients in several states, including Alabama and Kentucky. The allegations in the complaint did not relate to the quality of the care provided by the defendants during transportation.
The settlement agreement is neither an admission of liability by the defendants nor intended to be interpreted as such in any subsequent proceedings, nor is it a concession by the United States that its claims are not well-founded. This agreement relates to Medicare claims only and does not limit the Commonwealth of Kentucky from pursuing its own investigation into claims made by the defendant to the Medicaid program.
Rural/Metro Corporation, through its subsidiaries and affiliates, provides ambulance transportation services to Medicare beneficiaries in approximately 20 states, including Kentucky.
According to the terms of the settlement agreement, payment of the $5,426,000 must be made by electronic transfer no later than five business days after the settlement agreement is fully signed.
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Source- http://www.fbi.gov/miami/press-releases/2012/owner-and-employee-of-miami-home-health-company-sentenced-to-prison-in-22-million-medicare-fraud-scheme
WASHINGTON—The owner and an employee of a Miami home health care agency were sentenced today to 108 months and 46 months in prison, respectively, for their participation in a $22 million Medicare fraud scheme, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).
U.S. District Judge Patricia A. Seitz in Miami sentenced Marietha Morales, 38, to 108 months in prison and Eduardo Saborit-Dominguez, 48, to 46 months in prison. Both defendants were each sentenced to three years of supervised release. In addition, Morales was ordered to pay $14 million in restitution and Dominugez was ordered to pay $2 million in restitution, jointly and severally with each other.
Last year, Morales pleaded guilty to one count of conspiracy to commit health care fraud, and Dominguez pleaded guilty to one count of conspiracy to defraud the United States and to receive and pay health care kickbacks.
Morales was the president and Dominguez was an employee of Prime Home Health Services Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries.
According to plea documents, Morales conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Morales and her co-conspirators paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Prime Home Health, as well as prescriptions, plans of care (POCs), and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Dominguez distributed the kickbacks and bribes to co-conspirator patient recruiters and knew that the payment of kickbacks and bribes was in violation of federal criminal laws. Morales used these prescriptions, POCs, and medical certifications to fraudulently bill Medicare for home health care services, which Morales knew was in violation of federal criminal laws.
According to plea documents, nurses and office staff at Prime Home Health falsified patient files for Medicare beneficiaries to make it appear that such beneficiaries qualified for home health care and therapy services. Morales admitted that she knew the beneficiaries did not actually qualify for and did not receive such services. Morales knew that these files were falsified so that Medicare could be billed for medically unnecessary therapy and home health related services.
From approximately February 2005 through April 2011, Morales and her co-conspirators submitted approximately $22 million in false and fraudulent claims to Medicare. Medicare actually paid approximately $14 million on those claims.
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Source- http://www.fbi.gov/losangeles/press-releases/2012/rancho-palos-verdes-doctor-agrees-to-pay-530-000-to-settle-civil-lawsuit-alleging-home-health-kickback-scheme
LOS ANGELES—A Rancho Palos Verdes doctor has agreed to pay $530,000 to resolve allegations that he and his late wife, who managed his medical office, received cash payments and patient referrals in exchange for referring Medicare beneficiaries to GreatCare Home Health Inc., a now defunct home health agency that was based in the Westlake District of Los Angeles.
Bo W. Paik has already paid the United States $30,000, and he has agreed to pay an installment of $400,000 by June 20. The balance is due within six months.
The settlement with Paik was announced today after all of the parties involved in the civil lawsuit signed a settlement agreement on Wednesday.
The settlement resolves allegations in a “whistleblower” lawsuit that Paik violated the federal False Claims Act, as well as the federal Anti-Kickback Statute, when he referred patients to GreatCare in exchange for cash payments. The Anti-Kickback Statute prohibits anyone from offering, paying, soliciting, or receiving anything of value to generate referrals for items or services payable by any federal health care program. Paik also allegedly violated federal law when he submitted claims to Medicare for services he provided to patients referred to him by GreatCare.
The lawsuit alleged that over a three-year period GreatCare billed Medicare for thousands of home health visits that were not rendered, were medically unnecessary, or both. The lawsuit further alleged that GreatCare executed the scheme by recruiting Medicare beneficiaries and paying kickbacks to the beneficiaries and to doctors to induce referrals for home health services.
The scheme that was run out of GreatCare came to light in March 2010 when GreatCare’s then-receptionist, Misha Kim, filed a qui tam lawsuit under the federal False Claims Act. The lawsuit named as defendants GreatCare; the company’s owner and director, Hee Jung Mun; three physicians, including Paik, who allegedly referred patients to GreatCare; as well as a physical therapist and several licensed nurses and other unlicensed persons employed by Greatcare. United States District Judge Stephen V. Wilson unsealed the whistleblower lawsuit in October 2011, and Dr. Paik is the first defendant to settle the allegations made in the civil case.
Paik agreed to pay the settlement sum without admitting any wrongdoing.
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Source- http://www.fbi.gov/miami/press-releases/2012/owner-and-operator-of-halfway-house-company-pleads-guilty-to-role-in-medicare-fraud-scheme
WASHINGTON—The owner and operator of New Way Recovery Inc., a Florida corporation that operated several halfway houses, pleaded guilty today in Miami to a criminal charge related to a $205 million Medicare fraud scheme involving fraudulent claims for purported partial hospitalization program (PHP) services, the Justice Department, the FBI, and the Department of Health and Human Services announced today.
Hassan Collins, 41, pleaded guilty to one count of conspiracy to receive and pay health care fraud kickbacks before U.S. Magistrate Judge Edwin G. Torres.
According to court documents, from in or about April 2004 through September 2010, Collins received kickback payments in exchange for referring Medicare beneficiaries to American Therapeutic Corporation (ATC), a Florida corporation that operated several purported Partial Hospitalization Programs (PHP) throughout Florida. He and his co-conspirators caused false and fraudulent claims to be submitted to Medicare for PHP services purportedly provided at ATC’s locations, when, in fact, the services were never provided.
According to the plea agreement, Collins’s participation in the fraud resulted in more than $2.4 million in fraudulent billing to the Medicare program. At sentencing, scheduled for September 6, 2012, Collins faces a maximum sentence of five years in prison.
In related cases, more than 20 individuals have been convicted for their roles in the ATC fraud scheme. In 2011, ATC executives Lawrence Duran, Marianella Valera, and Judith Negron were sentenced to 50 years, 35 years, and 35 years, respectively, for their roles in the scheme. These sentences are the three longest prison sentences ever imposed in a Medicare Fraud Strike Force case. ATC and Medlink pleaded guilty to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. The corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010. Acevedo, a marketer for ATC, was sentenced to 91 months in prison.
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Source- http://www.fbi.gov/richmond/press-releases/2012/richmond-marketing-company-owner-sentenced-to-37-months-for-conspiring-to-receive-health-care-kickbacks
RICHMOND, VA—Lorie Monroe, 51, of Richmond, Virginia, was sentenced today to 37 months in prison, followed by three years of supervised release, for conspiracy to receive health care kickbacks, in violation of Title 18, United States Code, Section 371. In addition, Monroe was ordered to pay $545,410 in restitution to the Virginia Department of Medical Assistance Services.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia; and Kenneth T. Cuccinelli, Attorney General of Virginia, made the announcement after sentencing by United States District Judge Henry E. Hudson. On January 24, 2012, Monroe waived indictment and pled guilty to a one-count Information alleging conspiracy to receive health care kickbacks.
According to court documents, Monroe was the owner and operator of Creed Xtreme Marketing Concepts, a.k.a Creed Extreme Marketing (“Creed”), a company located in Glen Allen, Virginia. Sometime prior to December 2008, Monroe and “Individual A” agreed that Creed would serve as a marketing company for “Company 1.” Company 1 was an IIH provider located in the Eastern District of Virginia that was licensed through the Commonwealth of Virginia and under contract with Medicaid to provide Intensive In-Home (IIH) Therapy services. IIH services are designed to assist those youth and adolescents who are at risk of being removed from their homes or are being returned to their homes after removal because of a significant mental health, behavioral, or emotional issues. Monroe and Individual A verbally agreed that Monroe would receive approximately half of the Medicaid payments for each child Monroe referred to Company 1 for IIH services.
On or about December 2008, Monroe hired two employees to canvass low income areas, specifically, Section 8 housing and subsidized housing projects in the greater Richmond and Petersburg, Virginia areas, to find children who were Medicaid beneficiaries to refer to Company 1. Company 1 contacted the individuals recruited by Creed. Company 1 then enrolled many of these Medicaid-eligible children in its IIH program and billed Medicaid for IIH services rendered. Between December 2008 and January 2010, Company 1 paid Monroe a total of $545,410 in kickbacks for recruiting beneficiaries for IIH services.
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