Tennessee-Based Home Health Care Provider & Related Entities Agree to Pay More Than $9 M to Resolve False Claims Act Lawsuit

Source- http://www.justice.gov/opa/pr/2012/August/12-civ-997.html

James W. Carell, CareAll Management LLC (formerly known as Diversifi ed He alth Mana gementInc.), C are All Inc., the James W. Car ell Family Trust, V IP Home Nursing and Reh abilitation Services L LC, Professional Home He alth Care L LC, University Home H ealth, LLC and Elizabeth Vining (as representative of the Estate of Robert Vining) have agreed to pay $9.375 million to the federal government. This payment is to resolve the lawsuit that the United States filed in 2009 alleging that they violated the False Claims Act, caused Medicare to pay out money through mistake of fact, and were unjustly enriched by falsely concealing the home health agencies’ relationship with their management company, the Justice Department announced today.

VIP, Professional and University now operate under the name CareAll. James W. Carell and the related CareAll entities named above also agreed to be bound by the terms of a Corporate Integrity Agreement with the Department of Health and Human Services – Office of Inspector General (HHS-OIG).

CareAll and its related entities are one of the largest home health providers in Tennessee. This settlement resolves the United States’ lawsuit alleging that the CareAll entities fraudulently submitted eight cost reports for fiscal years 1999, 2000 and 2001 to support their Medicare billings. The United States alleged that these cost reports were false because they knowingly hid the relationship between the management company and the home health agencies. According to the complaint the United States filed in this case, the cost reports should have disclosed that the management company was related to the home health agencies, which would have lowered the Medicare reimbursement for the management company’s services. During the relevant years, the United States alleged that James W. Carell owned the management company, and his friend Robert Vining – an attorney who lived in Missouri – served as the nominee or “sham” owner of the home health agencies.

The United States further alleged in court filings that the management company exerted significant control over the home health agencies in a myriad of ways, including: James. W. Carell’s key role in facilitating Robert Vining’s purchase of the home health agencies; loans worth millions of dollars from companies owned by James W. Carell to the home health agencies; cash transfers for millions of dollars from the management company to the home health agencies; the management company’s day to day control over the home health agencies’ operations; and Robert Vining’s role as a mere figurehead owner. The United States also alleged in court filings that James W. Carell profited greatly from this “sham” owner relationship and that he monetarily rewarded Robert Vining for his participation in this scheme.

“The false reporting scheme alleged in this case robbed the Medicare Trust Fund of millions of taxpayer dollars,” said Stuart Delery, Acting Assistant Attorney General for the Civil Division of the Department of Justice. “Settlements like this one make sure that our federal health care dollars are spent appropriately – on maintaining critical health care programs.”

“This settlement is yet another example of this office’s commitment to enforcing the False Claims Act in health care cases and protecting the taxpayer’s interests,” said Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee. “The U.S. Attorney’s Office will continue to return money to the federal treasury by aggressively pursuing cases where, based on false reporting and concealment, health care companies are unjustly enriched.”

“This settlement represents a significant victory in our fight against fraud in the Medicare system,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “The OIG is committed to protecting the integrity of federal health care programs by aggressively pursuing entities that increase their revenue through deceitful schemes and trickery.”

The United States’ investigation was conducted by the U.S. Attorney’s Office for the Middle District of Tennessee, the Justice Department’s Civil Division and HHS-OIG.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $9.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $12.9 billion.


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Jacob Rafi and his Wife Rena Rafi Plead Guilty to Federal Charge of Health Care Fraud

Source- http://www.fbi.gov/washingtondc/press-releases/2012/owners-of-medical-equipment-company-plead-guilty-to-federal-charge-of-health-care-fraud

WASHINGTON—Jacob Rafi, 54, the owner and president of DC Medical Supply Inc., and his wife, Rena Rafi, 49, the company’s managing director, have pled guilty to health care fraud in connection with the firm’s fraudulent billing practices.

The guilty plea, which took place August 3, 2012, in the U.S. District Court for the District of Columbia, was announced by U.S. Attorney Ronald C. Machen, Jr.; James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office; Nicholas DiGiulio, Special Agent in Charge of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG), for the region including the District of Columbia, and Charles J. Willoughby, Inspector General for the District of Columbia.

Jacob and Rena Rafi, of Silver Spring, Maryland, pled guilty before the Honorable Magistrate Judge Alan Kay. They are to be sentenced on October 30, 2012, before the Honorable Judge Ellen S. Huvelle. Each faces a maximum of 10 years in prison and a $250,000 fine. Under the advisory federal sentencing guidelines, the likely range of imprisonment is six to 12 months.

DC Medical, also known as More Mobility, located in the 5900 block of Georgia Avenue NW, is a provider of medical equipment and supplies including, incontinence supplies and garments, wheelchairs, and other medical devices to Medicaid beneficiaries. During their plea, the Rafis admitted that between January 2007 through December 2010, they submitted false claims to D.C. Medicaid for incontinence products that were never provided to D.C. Medicaid beneficiaries. As a result of the fraud, they derived at least $70,000 in profits.

The U.S. Attorney’s Office, the FBI’s Washington Field Office, the U.S. Department of Health and Human Services, and the District of Columbia Medicaid Fraud Control Unit remains committed to uncovering and prosecuting health care professionals who abuse the public trust and enrich themselves through fraud and abuse.


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7th Defendant Convicted in Multi-Million Dollar Health Care Fraud Scheme

Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20August/120806%20Obi.html

HOUSTON – Tony Nnonso Obi, 56, a naturalized U.S. citizen from the Federal Republic of Nigeria, has entered a plea of guilty for his role in a massive health care fraud conspiracy that billed the Medicare and Medicaid programs for more than $45 million, United States Attorney Kenneth Magidson announced today.

Obi was convicted of one count of conspiracy to commit health care fraud and one count of money laundering.

As part of his plea, Obi admitted to entering into an agreement with the owner of City Nursing, Umawa Imo, to receive 15% of the money City Nursing obtained from Medicare for services billed on individuals referred to City Nursing by Obi, or on Obi’s behalf. Imo, who is currently serving more than 27 years in federal prison for his role in the conspiracy, paid Obi $1,051,425.28. At least three of the beneficiaries taken to City Nursing by Obi were individuals living in Obi’s assisted living facility. Obi also admitted to paying beneficiaries and recruiters and handling office matters when Imo was out of the office.

Obi faces up to 10 years in prison and a $250,000 fine for each count. U.S. District Judge Kennth Hoyt, who accepted the plea today, has set sentencing for Nov. 5, 2012. He has been in custody since his April 3, 2012, arrest where he will remain pending that sentencing hearing.


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Paul Boccone the Owner of Chantilly Pain Clinic Convicted of Drug Trafficking, Fraud Charges

Source- http://www.fbi.gov/washingtondc/press-releases/2012/owner-of-chantilly-pain-clinic-convicted-of-drug-trafficking-fraud-charges

ALEXANDRIA, VA—Paul Boccone, 56, was convicted of conspiring to distribute and distribution of oxycodone, health care fraud, and payroll tax evasion for his role as the owner and president of Chantilly Specialists pain clinic in Chantilly, Virginia. Charles Brown, Jr., 51, a nurse practitioner with Chantilly Specialists, was convicted of conspiring to distribute and distribution of oxycodone.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia; Kenneth T. Cuccinelli, Attorney General of Virginia; James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office; Richard A. Raven, Special Agent in Charge of the Washington Field Office of IRS-Criminal Investigation; and Gary Cantrell, Deputy Inspector General for Investigations at HHS-OIG, made the announcement after the verdict was accepted by United States District Judge Claude M. Hilton.

The defendants will be sentenced on November 9, 2012. Boccone faces a maximum sentence of 350 years in prison, and Brown faces a maximum sentence of 160 years in prison.

According to court records and evidence at trial, Paul Boccone was the owner and president of Chantilly Specialists, a pain management clinic in Chantilly, Virginia. Although not a trained or licensed medical practitioner, the evidence showed that he treated patients and prescribed narcotics by either forging the signatures of medical practitioners or encouraging medical practitioners to endorse prescriptions that he wrote. Charles Brown, Jr. was the lead nurse practitioner at the practice and assisted Boccone by continuing to prescribe large amounts of narcotics to patients without medical need. Over the course of the conspiracy, evidence showed that at least four Chantilly Specialists patients died of overdoses related to the drugs they obtained from the practice.


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Aleksandr N. Zagorodony and Sergey Zagorodny Were Charged in $2.5 Million Health Care Fraud Scheme

Source- http://www.fbi.gov/philadelphia/press-releases/2012/ambulance-company-and-owners-charged-in-2.5-million-health-care-fraud-scheme

PHILADELPHIA—An indictment was unsealed today charging MedEx Ambulance Inc., located in Feasterville, Pennsylvania, and its owners, Aleksandr N. Zagorodony and Sergey Zagorodny, with a total of 41 counts involving health care fraud, false statements in connection with health care matters, wire fraud, and conspiracy, announced United States Attorney Zane David Memeger.

The indictment alleges that defendant MedEx, incorporated in 2004, and its owners operated an ambulance company that transported patients who were able to walk and could travel safely by means other than ambulance and who therefore were not eligible for ambulance transportation under Medicare requirements. It is alleged that the Zagorodony brothers, or others acting on their behalf, falsified reports to make it appear that the patients needed to be transported by ambulance when the defendants and their employees knew that the patients could be transported safely by other means and that many of them were able to walk. The defendants allegedly billed for the ambulance services as if those services were medically necessary and, as a result of the allegedly fraudulent billing, the Medicare program paid more than $2.5 million for this inappropriate method of transportation.

Sergey Zagorodny, 34, of Philadelphia, was arrested this morning. Agents also seized four ambulances owned by MedEx Ambulance, purchased for over $200,000, that are subject to criminal forfeiture proceedings. Three bank accounts also were seized, and the funds contained in those accounts are subject to criminal forfeiture proceedings. Aleksandr Zagorodny is expected to surrender to law enforcement.

Matthew J. Bold, the former Director of Clinical Affairs for MedEx, 36, of Trevose, Pennsylvania, was separately charged by information with one count of health care fraud and aiding and abetting the commission of health care fraud. It is alleged that Bold was involved in transporting and directing other MedEx employees to transport patients by ambulance when those patients could walk or be transported safely by means other than ambulance. It also is alleged that Bold was involved in the falsification of documentation so that certain reports did not reflect the true condition of patients being transported by MedEx ambulances.

If convicted, Aleksandr Zagorodny and Sergey Zagorodny face a substantial term of imprisonment, three years of supervised release, a fine of up to $10.25 million, mandatory restitution, and a $4,100 special assessment. If convicted, MedEx faces significant financial penalties, including substantial criminal fines, restitution, and forfeiture obligations. If convicted, Bold faces a maximum possible sentence of 10 years in prison, three years of supervised release, a fine of up to $250,000, restitution and a $100 special assessment. All defendants could be excluded from participating in federal health care programs if convicted.



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Eulises Escalona Pleads Guilty in $42 Million Medicare Fraud Scheme

Source- http://www.fbi.gov/miami/press-releases/2012/miami-home-health-care-agency-owner-pleads-guilty-in-42-million-medicare-fraud-scheme

WASHINGTON—The owner and operator of a Miami health care agency pleaded guilty today for his participation in a $42 million home health Medicare fraud scheme, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Eulises Escalona, 43, pleaded guilty before U.S. District Judge Joan A. Lenard to one count of conspiracy to commit health care fraud. In addition, as part of his plea agreement, Escalona agreed to forfeit to the government two residential properties and cash proceeds of the fraud contained in several bank accounts.

According to the court documents, Escalona was the owner of Willsand Home Health 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, Escalona conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Escalona and his co-conspirators paid kickbacks and bribes to patient recruiters in return for these recruiters providing patients to Willsand Home Health, as well as prescriptions, Plans of Care (POCs), and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Escalona and his co-conspirators would pay kickbacks and bribes directly to physicians in exchange for those physicians providing home health and therapy prescriptions, POCs, and medical certifications to Escalona and his co-conspirators. Escalona used these prescriptions, POCs, and medical certifications to fraudulently bill the Medicare program for home health care services, which Escalona knew was in violation of federal criminal laws.

According to plea documents, at Willsand Home Health, patient files for Medicare beneficiaries were falsified to make it appear that such beneficiaries qualified for home health care and therapy services when, in fact, many of the beneficiaries did not actually qualify for such services. Escalona knew that in many cases the patient files at Willsand Home Health were falsified.

From approximately January 2006 through November 2009, Escalona and his co-conspirators submitted approximately $42 million in false and fraudulent claims to Medicare and Medicare paid approximately $27 million on those claims.



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Boyd William Leahy Pleads Guilty to Health Care Fraud Conspiracy

Source- http://www.fbi.gov/neworleans/press-releases/2012/covington-man-pleads-guilty-to-health-care-fraud-conspiracy

NEW ORLEANS—Boyd William Leahy, age 45, a resident of Covington, Louisiana, pled guilty yesterday before U.S. District Judge Carl J. Barbier to one count of conspiracy to commit health care fraud, announced U.S. Attorney Jim Letten.

According to the charges in an indictment filed in May 2012, the Leahy, a Covington-area couple, were employed at a sleep clinic in Covington, Louisiana, owned by their friends, two local physicians. The indictment charged that Boyd Leahy, as the office manager for the clinic, and Angelina Leahy, as the part-time billing clerk, conspired to commit health care fraud by creating a rival business entity, Sleep Corp., that the Leahys used to fraudulently bill insurance companies for services that were actually rendered by their employing clinic. When the Leahys received insurance payments on behalf of their rival company Sleep Corp., they kept the proceeds rather than giving it to their friends and employers, whose clinic actually rendered the services. Angelina Leahy then doctored the payment records for their employing clinic to further conceal their fraud.

Additionally, as alleged in the indictment, Boyd Leahy, as office manager of the clinic, used his position to generate extra paychecks for himself and to pay himself more than he was authorized to earn and he did the same for his wife, Angelina Leahy. Boyd Leahy also added his daughter, his father, and a creditor to his employing clinic’s payroll without authorization, causing paychecks to be issued when none of these individuals had performed any work on the clinic’s behalf. Boyd Leahy also used the employing clinic’s corporate credit card and business checking account to fund personal expenses, trips, and household utilities without the clinic owners’ knowledge or authorization. The total loss sustained by the clinic owners for this fraudulent scheme totals $827,946.

If convicted, Boyd Leahy faces a maximum term of imprisonment of 10 years, a fine of $250,000, and three years of supervised release following any term of imprisonment. Additionally, the indictment seeks forfeiture and restitution to the victims. Sentencing for Boyd Leahy is set for November 1, 2012.



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Checarol Robinson Pleads Guilty to $10 Million Psychotherapy Fraud Scheme

Source- http://www.fbi.gov/detroit/press-releases/2012/detroit-area-adult-day-care-center-owner-pleads-guilty-to-10-million-psychotherapy-fraud-scheme

WASHINGTON—A Detroit-area adult day care center owner pleaded guilty today for her role in a $10 million psychotherapy fraud scheme, announced the Departments of Justice and Health and Human Services (HHS) and the FBI.

Checarol Robinson, 41, pleaded guilty today before U.S. District Judge Nancy D. Edmunds in the Eastern District of Michigan in Detroit to an indictment charging her with one count of conspiracy to commit health care fraud and three counts of health care fraud. At her sentencing, scheduled for December 4, 2012, Robinson faces a maximum penalty of 10 years in prison and a $250,000 fine for each count.

According to the indictment, Robinson owned group homes inhabited by Medicare beneficiaries. In return for payments, Robinson allegedly provided these Medicare beneficiaries’ information to a fraudulent psychotherapy company owned by a co-conspirator–Caldwell Thompson Manor Inc. to be used to bill Medicare for psychotherapy services that were not provided and/or not medically necessary.

According to the indictment, Robinson later owned and operated P&C Adult Day Center (P&C), which was incorporated in May 2010. P&C purported to provide psychotherapy services. Robinson allegedly falsely billed Medicare for individual and group therapy services that were not provided by P&C and/or not medically necessary using the Medicare beneficiaries from her group homes. Robinson’s alleged co-conspirator from the scheme at Caldwell Thompson, who was also a licensed social worker, would sign patient charts for psychotherapy services purportedly performed at P&C that were medically unnecessary and never performed.

Caldwell Thompson and P&C allegedly submitted more than $10 million of false claims to Medicare in the course of the conspiracy.



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Eugene Goldman M.D., Also Known as Yevgeniy Goldman Charged in Kickback Scheme Involving a Philadelphia Hospice

Source- http://www.fbi.gov/philadelphia/press-releases/2012/doctor-charged-in-kickback-scheme-involving-a-philadelphia-hospice

WASHINGTON, DC—A Pennsylvania doctor was arrested and charged in a kickback scheme arising from his employment as a medical director at Home Care Hospice Inc. (HCH), a hospice care provider in Philadelphia, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and United States Attorney Zane David Memeger of the Eastern District of Pennsylvania.

The indictment, unsealed today in the U.S. District Court for the Eastern District of Pennsylvania in Philadelphia, charges Huntingdon Valley, Pennsylvania resident Eugene Goldman M.D., also known as Yevgeniy Goldman, with violations of the federal anti-kickback statute and a conspiracy to violate the anti-kickback statute. According to the indictment, Goldman, 54, was a physician licensed by the state of Pennsylvania with a practice in Philadelphia.

According to the indictment, from approximately December 2000 until approximately July 2011, Goldman served as the medical director for HCH and regularly referred Medicare or Medicaid patient beneficiaries to HCH. FBI and Health and Human Services agents arrested Goldman this morning.

HCH was a for-profit business that provided hospice services for patients at nursing homes, hospitals, and private residences. According to the indictment unsealed today, HCH paid kickbacks to Goldman in checks drawn on an HCH bank account or in cash. To conceal the fact that kickbacks were paid, the indictment alleges that HCH and Goldman entered a written contract to create the false appearance that all payments to Goldman from HCH were for services rendered in Goldman’s capacity as medical director for HCH.

The indictment further alleges that from January 2004 to October 2008, HCH made payments to Goldman totaling approximately $228,773 for Medicare and Medicaid patient referrals. Finally, the indictment charges that on five separate occasions between January and March 2009, Goldman solicited and received payments by cash and/or checks for patient referrals.

For count one, the maximum penalty for a conspiracy violation is five years’ imprisonment, a $250,000 fine, a three year term of supervised release and a $100 special assessment. A conviction also results in mandatory exclusion from participation in any federal health care program.



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Santo Saglimbeni and Emilio “Tony” Figueroa Plead Guilty to Participating in Kickback Scheme at New York City Hospital

Source- http://www.justice.gov/opa/pr/2012/July/12-at-958.html

WASHINGTON – Two former high-ranking employees of facilities operations at New York Presbyterian Hospital (NYPH) pleaded guilty today to an indictment charging them with conspiring to defraud NYPH, the Department of Justice announced.

Former vice president of facilities operations, Santo Saglimbeni, and former director of facilities operations, Emilio “Tony” Figueroa, were charged in a four-count superseding indictment filed on June 16, 2011. Saglimbeni, who was charged on all four counts, was convicted of counts one and two on Feb. 2, 2012. Figueroa, who was charged on counts one, three and four, was convicted on count one on Feb. 2, 2012. Counts three and four were severed from that indictment, and Saglimbeni and Figueroa pleaded guilty in the U.S. District Court in Manhattan to those counts today.

Saglimbeni and Figueroa pleaded guilty today for their participation in a mail fraud conspiracy, which lasted from as early as June 2001 and continued through June 2006. The scheme to defraud NYPH centered on Saglimbeni, who with the assistance of Figueroa, awarded contracts for the installation and repair of heating, ventilation and air conditioning systems (HVAC), to a co-conspirator’s company in return for kickbacks given to Saglimbeni and Figueroa in the form of cash, goods and services from that co-conspirator. Saglimbeni and Figueroa also pleaded guilty to a substantive mail fraud offense based upon a payment made to the co-conspirator by NYPH on an HVAC contract awarded in furtherance of the HVAC conspiracy.

“By awarding contracts in return for kickbacks, Saglimbeni and Figueroa used their positions to subvert the competitive bidding process for essential services at NYPH,” said Joseph Wayland, Acting Assistant Attorney General in charge of the Justice Department’s Antitrust Division. “Today’s guilty pleas demonstrate the Antitrust Division’s commitment to holding purchasing officials accountable for this type of illegal conduct.”

On Feb. 2, 2012, after a four week trial, Saglimbeni and Figueroa were convicted of the first two counts of the indictment. At the trial, Michael Yaron and two companies owned by him, Cambridge Environmental & Construction Corp., which does business as National Environmental Associates (Cambridge/NEA), an asbestos abatement company, and Oxford Construction & Development Corp., a construction company; Moshe Buchnik, the president of two asbestos abatement companies; and Artech Corporation, a company owned by a relative of Saglimbeni, were also convicted of conspiracy to defraud NYPH. Yaron, his companies, Buchnik, Saglimbeni and Artech were also convicted of a substantive wire fraud violation.

These convictions centered on a scheme to defraud NYPH, whereby Saglimbeni, who with the assistance of Figueroa, awarded asbestos abatement, air monitoring and general construction contracts to Yaron, Buchnik and their companies in return for more than $2.3 million in kickbacks paid to Saglimbeni. Those kickbacks were funneled by Yaron to Saglimbeni through Artech, a sham company Saglimbeni created in the name of his mother.

Each count of conspiracy to commit mail fraud carries a maximum penalty of 20 years in prison and a fine of $250,000 for individuals. The fine may be increased to twice the gross gain the conspirators derived from the crime or twice the gross loss caused to the victims of the crime by the conspirators.

Including today’s pleas, 15 individuals and six companies have been convicted or pleaded guilty to charges arising out of this federal antitrust investigation. On July 10, 2012, Yaron was sentenced to serve 60 months in jail and Buchnik was sentenced to serve 48 months. Each was sentenced to pay a $500,000 criminal fine. Cambridge/NEA, Oxford and Artech, were each sentenced to pay a $1 million criminal fine.



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Dr. Meera Sachdeva and Monica Weeks Each Pled Guilty Today to Charges of Medicare Fraud

Source- http://www.fbi.gov/jackson/press-releases/2012/summit-oncologist-madison-biller-plead-guilty-to-health-care-fraud

JACKSON, MS—Dr. Meera Sachdeva, 50, of Summit, Mississippi, and Monica Weeks, 40, of Madison, Mississippi, each pled guilty today to charges of Medicare fraud, U.S. Attorney Gregory K. Davis, FBI Special Agent in Charge Daniel McMullen, and Mississippi Attorney General Jim Hood announced.

Sachdeva, who owned and operated Rose Cancer Center in Summit, pled guilty to submitting claims for chemotherapy services that were supposedly rendered when she was out of the country. Weeks, who owned and operated The Medical Billing Group in Madison, pled guilty to conspiracy to commit health care fraud by covering up false claims made by Sachdeva that were scheduled for an audit.

According to the indictment in this case, Sachdeva is alleged to have billed for more chemotherapy drugs than she actually purchased from drug suppliers from 2007 to 2011. During the plea hearing, the Assistant United States Attorney told the court that if the case had gone to trial, the government would have proven that “[t]he defendant would prepare...chemotherapy treatments by injecting the prescribed chemotherapy drugs into a bag of fluid that would then be connected to the patient via a ‘chest port.’ Each patient believed that they were receiving an amount of chemotherapy medicine that was equal to the amount being billed to their respective health care benefit programs. The defendant was not providing each patient with the fully prescribed dosage of many of the billed chemotherapy drugs.”

Both Sachdeva and Weeks are scheduled to be sentenced on October 1, 2012, by United States District Judge Daniel P. Jordan, III. Weeks faces a maximum of 10 years in prison, a $250,000 fine, and the forfeiture of a $19,549.52 money judgment. Sachdeva faces up to 20 years in prison, $750,000 in fines, and the forfeiture of almost $6,000,000 in illegal proceeds that were previously seized by the government, as well as the forfeiture of several parcels of real property located throughout the state.


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Mansour Sanjar, Cyrus Sajadi and Chandra Nunn Were Charged for Alleged Roles in $97 Million Medicare Fraud Scheme

Source- http://www.justice.gov/opa/pr/2012/July/12-crm-928.html

A superseding indictment was unsealed today charging two owners of a Houston mental health care company, Spectrum Care P.A., some of its employees and the owners of Houston group care homes for their alleged participation in a $97 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Mansour Sanjar, 79, Cyrus Sajadi, 64, and Chandra Nunn, 34, were originally charged in December 2011, and are expected to make their initial appearances on the superseding indictment in the coming days. The indictment was originally retuned on July 24, 2012, and was unsealed today.

Adam Main, 31, Shokoufeh Hakimi, 65, Sharonda Holmes, 38, and Shawn Manney, 50, all from the Houston area, were arrested today and are expected to make their initial appearances in U.S. District Court for the Southern District of Texas in Houston either today or tomorrow.

The superseding indictment charges Sanjar, Sajadi, Main, Terry Wade Moore, 51, Hakimi and Nunn each with one count of conspiracy to commit health care fraud; Sanjar, Sajadi, Main and Moore are charged with various counts of health care fraud; Sanjar, Sajadi, Hakimi, Nunn, Holmes and Manney each are charged with one count of conspiracy to defraud the United States and to pay health care kickbacks; and Sanjar, Sajadi, Hakimi, Nunn, Holmes and Manney are charged with various counts of payment and receipt of healthcare kickbacks. The superseding indictment also seeks forfeiture.

According to the indictment, Sanjar and Sajadi orchestrated and executed a scheme to defraud Medicare beginning in 2006 and continuing until their arrest in December 2011. Sanjar and Sajadi owned Spectrum, which purportedly provided partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for severe mental illness. The Medicare beneficiaries for whom Spectrum billed Medicare for PHP services did not qualify for or need PHP services. Sanjar, Sajadi, Main and Moore signed admission documents and progress notes certifying that patients qualified for PHP services, when in fact, the patients did not qualify for or need PHP services. Sanjar and Sajadi also billed Medicare for PHP services when the beneficiaries were actually watching movies, coloring and playing games – activities that are not covered by Medicare.

Sanjar, Sajadi and Hakimi paid kickbacks to Nunn, Holmes, Manney and other group care home operators and patient recruiters in exchange for delivering ineligible Medicare beneficiaries to Spectrum, according to the indictment. In some cases, the patients received a portion of those kickbacks. The indictment alleges that Spectrum billed Medicare for approximately $97 million in services that were not medically necessary and, in some cases, not provided.



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Alejandro Haber was Sentenced to Serve 40 Months in Prison for Role in $8.5 Million Diagnostic Testing Fraud Scheme

Source- http://www.justice.gov/opa/pr/2012/July/12-crm-932.html

The manager of a Detroit-area health care clinic was sentenced today to serve 40 months in prison for his leading role in a $7.42 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

Miami-area resident Alejandro Haber, 27, was sentenced by U.S. District Judge Patrick Duggan in the Eastern District of Michigan in Detroit. In addition to his prison term, Haber was sentenced to serve three years of supervised release and was ordered to pay $5,333,906 in restitution, joint and several with his co-defendants, and was ordered to forfeit approximately $99,000 seized from bank accounts he controlled.

On Oct. 27, 2012, Haber pleaded guilty to one-count of conspiracy to commit health care fraud. According to plea documents, Haber conceived and oversaw fraud schemes at a clinic called Ritecare LLC. Ritecare later merged with a clinic called CompleteHealth LLC. Haber’s role was limited to the operation of Ritecare alone.

On July 24, 2012, Alejandro Haber’s father, Emilio Haber, was sentenced to serve 60 months in prison for his leading role in an $8.5 million Medicare fraud scheme.

According to court documents, w hile operating Ritecare, Alejandro Haber and his co-conspirators billed Medicare for medically unnecessary tests and services. Haber obtained patients for Ritecare through the payment of kickbacks to patient recruiters and directly to Medicare beneficiaries. The majority of patients were obtained through patient recruiters. Typically, co-conspirators at Ritecare paid patient recruiters $100-$150 per patient obtained, with $50-$75 to go to the patient in exchange for coming to Ritecare and subjecting themselves to medically unnecessary tests.

To justify the medically unnecessary tests, co-conspirators at Ritecare instructed the patient recruiters to have the patients feign certain symptoms. Haber admitted that co-conspirators also directly instructed patients to feign symptoms as well. The kickbacks paid to the recruiters and the patients were contingent upon the Medicare beneficiaries identifying the symptoms necessary to justify medically unnecessary tests. Consequently, the patients’ medical records contained false or fabricated symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed. The most expensive tests were nerve conduction studies.

Between approximately August 2007 and approximately October 2009, Haber submitted and/or caused to be submitted approximately $7.42 million in fraudulent claims through Ritecare to the Medicare program for medical and testing services that were procured through the payment of kickbacks, were medically unnecessary, and justified by deception and patient coaching. Medicare actually paid approximately $5.33 million on those claims.



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Dr. Irving Schwartz Was Charged in $1.3 Million Power Wheelchair Scam

Source- http://www.fbi.gov/sandiego/press-releases/2012/doctor-and-owner-of-medical-supply-company-charged-in-1.3-million-power-wheelchair-scam

United States Attorney Laura E. Duffy announced that a medical doctor and an owner of a medical supply company were charged with submitting $1.3 million in fraudulent power wheelchair claims to Medicare. Dr. Irving Schwartz was arrested by federal agents on Tuesday in Yuba City, California, and arraigned on one count of conspiracy to receive health care kickbacks and defraud the Medicare trust fund. Jose Melendez, owner and operator of Oceanside Medical Services, was arrested on Wednesday in Long Beach, California, and arraigned on charges of conspiracy, witness tampering, and health care fraud.

According to the indictment, the scheme focused on the sale of fraudulent power wheelchair prescriptions, with the end-goal being to obtain reimbursements from Medicare for power wheelchairs that patients did not need and, in some cases, did not want. The indictment alleges that Schwartz and a co-conspirator would travel to El Centro, California in search of elderly Medicare patients. Schwartz would write the patients prescriptions for power wheelchairs, even though the patients did not need the equipment and could walk without assistance. Schwartz collected a $300 cash kickback in exchange for each power wheelchair prescription. One of Schwartz’ co-conspirators would then sell the power wheelchair prescriptions to Melendez, charging him $1,000 per fraudulent prescription.

Melendez, in turn, sold some of the power wheelchair prescriptions to other co-conspirators, charging an additional mark-up on each prescription. As the last step in the scheme, Melendez and other co-conspirator owners of medical supply companies would submit the fraudulent prescriptions to Medicare for reimbursement, billing up to $5,865 for each power wheelchair. The indictment further alleges that Melendez attempted to persuade one of the co-conspirators to lie to federal agents in an effort to hinder the Medicare fraud investigation.

If convicted, Schwartz faces a maximum penalty of five years, and Melendez faces a maximum penalty of 20 years in prison.

In separate but related cases, three co-conspirators, Gloria Hernandez, Aristeo Tavares, and Laura Tavares, have pled guilty and face a maximum of 10 years in prison. All the defendants each also face a maximum $250,000 fine and a mandatory order of restitution to repay the fraudulently obtained proceeds of the scheme.

The public is reminded that an indictment itself is not evidence that the defendants committed the crimes charged. The defendants are presumed innocent until the government meets its burden in court of proving guilt beyond a reasonable doubt.



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Welfare Fund Admits Overbilling by More Than $3 Million and Agrees to Pay Approximately $5 Million in Damages

Source- http://www.justice.gov/usao/nys/pressreleases/july12/headstartsettlement.html

Preet Bharara, the United States Attorney for the Southern District of New York, announced today that the United States has filed and simultaneously settled a civil fraud lawsuit alleging that DISTRICT COUNCIL 1707, LOCAL 95 HEAD START EMPLOYEES WELFARE FUND (the “Fund”) violated the False Claims Act and common law when it charged a Head Start grantee higher rates for hospital insurance premiums than it had originally paid for the premiums. As part of the settlement, the Fund admitted, acknowledged, and accepted responsibility for charging more for the insurance premiums than it paid, and agreed to pay the Government approximately $5 million. The settlement was approved today by U.S. District Judge William H. Pauley III.

According to the Complaint filed in Manhattan federal court:

The Fund administers hospitalization insurance for employees who work for agencies that carry out Head Start programs (“Delegate Agencies”). Head Start programs promote school readiness by providing educational, health, nutritional, social and other services to enrolled children and their families. The Delegate Agencies are funded by the New York City Administration for Children’s Services (“ACS”), which is a Head Start grantee. Each year, on behalf of the Delegate Agency employees, the Fund negotiates a contract with an insurance provider for hospitalization insurance, and it sends monthly invoices to ACS for reimbursement. ACS then pays the Fund for the insurance premiums using Head Start grant money. Prior to 2008, the Fund violated the False Claims Act as well as common law when it submitted invoices to ACS for amounts higher than what the Fund actually paid the insurance provider. As a result, over the relevant time period, ACS paid the Fund approximately $3 million more than what the Fund actually paid for the hospitalization insurance premiums.

In addition to acknowledging the overbilling in its settlement with the Government, the Fund will pay the Government approximately $5 million.



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Emilio Haber Sentenced to Serve 60 Months in Prison for Role in $8.5 Million Diagnostic Testing Fraud Scheme

Source- http://www.justice.gov/opa/pr/2012/July/12-crm-918.html

WASHINGTON – The owner of a Detroit-area health care clinic was sentenced today to serve 60 months in prison for his leading role in an $8.5 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

Miami-area resident Emilio Haber, 53, was sentenced by U.S. District Judge Patrick Duggan in the Eastern District of Michigan in Detroit. In addition to his prison term, Haber was sentenced to serve three years of supervised release and was ordered to pay $6,341,000 in restitution, joint and several with his co-defendants, and was ordered to forfeit approximately $99,000 seized from bank accounts he controlled.

On Oct. 26, 2012, Haber pleaded guilty to one count of conspiracy to commit health care fraud. According to plea documents, Haber conceived and oversaw fraud schemes at two clinics, Ritecare LLC and CompleteHealth LLC. Haber incorporated and opened Ritecare and CompleteHealth in the state of Michigan in 2007. CompleteHealth merged into Ritecare in July 2008.

According to court documents, while operating CompleteHealth and Ritecare, Haber and his co-conspirators billed Medicare for medically unnecessary tests and services, including, but not limited to, nerve conduction studies. Haber obtained patients for the clinics through the payment of kickbacks to Medicare beneficiaries and patient recruiters. Haber admitted that he and other co-conspirators paid patient recruiters $100-$150 per patient obtained, with $50-$75 to go to the patient in exchange for visiting Ritecare and subjecting themselves to medically unnecessary tests.

To justify the medically unnecessary tests, Haber admitted that he and other co-conspirators told patient recruiters to instruct the patients to feign certain symptoms. Haber and other co-conspirators also directly instructed patients to feign symptoms. The kickbacks paid to the recruiters and the patients were contingent upon the Medicare beneficiaries identifying the symptoms necessary to justify medically unnecessary tests. Consequently, the patients’ medical records contained false or fabricated symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.

The department said that between approximately August 2007 and approximately October 2009, Haber and his co-conspirators at CompleteHealth and Ritecare submitted and/or caused to be submitted approximately $8.5 million in fraudulent claims to the Medicare program for medical and testing services that were medically unnecessary and procured through the payment of kickbacks. Medicare paid approximately $6.3 million of those claims.



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Nolan Denny Crisp was Indicted For Illegally Dispensing Narcotics, Health Care Fraud

Source- http://www.justice.gov/usao/mow/news2012/crisp.ind.html

SPRINGFIELD, Mo. - David M. Ketchmark, Acting United States Attorney for the Western District of Missouri, announced a former physician at a Bolivar, Mo., health clinic was indicted by a federal grand jury today for illegally distributing prescription drugs and for health care fraud.

Nolan Denny Crisp, 75, of Half Way, Mo., was charged in a five-count indictment returned by a federal grand jury in Springfield, Mo.

Crisp was employed at Pomme de Terre Wellness Center (also known as the Bolivar Family Wellness Clinic and Northwoods Psychiatric Services, Inc.) in Bolivar from June 2009 through Nov. 10, 2010 to provide pain management and other services to patients.

Today’s indictment charges Crisp with four counts of illegally distributing controlled substances. Crisp allegedly issued prescriptions for OxyContin, Oxycodone Hydrochloride, Oxycodone-Aspirin and Endocet without a legitimate medical purpose and outside the course of usual professional practice. The indictment alleges that Crisp caused a total of 1,225 tablets of these narcotics to be illegally distributed between Dec. 1, 2009, and Oct. 7, 2010.

The indictment also charges Crisp with one count of health care fraud. Crisp allegedly issued illegal prescriptions to Medicaid beneficiaries, who then filled those prescriptions at pharmacies. Those pharmacies then submitted claims to Medicaid for filling the prescriptions, and Medicaid paid those claims. According to the indictment, Medicaid paid a total of $4,619 in claims for illegal prescriptions and an additional $12,111 in claims for office visits at the clinic that were not medically necessary. Crisp allegedly provided services to individuals at the clinic when those individuals, in fact, were only seeking illegal prescriptions for narcotics.



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Dr. Meera Sachdeva and Monica Weeks Each Plead Guilty to Health Care Fraud

Source- http://www.fbi.gov/jackson/press-releases/2012/summit-oncologist-madison-biller-plead-guilty-to-health-care-fraud

JACKSON, MS—Dr. Meera Sachdeva, 50, of Summit, Mississippi, and Monica Weeks, 40, of Madison, Mississippi, each pled guilty today to charges of Medicare fraud, U.S. Attorney Gregory K. Davis, FBI Special Agent in Charge Daniel McMullen, and Mississippi Attorney General Jim Hood announced.

Sachdeva, who owned and operated Rose Cancer Center in Summit, pled guilty to submitting claims for chemotherapy services that were supposedly rendered when she was out of the country. Weeks, who owned and operated The Medical Billing Group in Madison, pled guilty to conspiracy to commit health care fraud by covering up false claims made by Sachdeva that were scheduled for an audit.

According to the indictment in this case, Sachdeva is alleged to have billed for more chemotherapy drugs than she actually purchased from drug suppliers from 2007 to 2011. During the plea hearing, the Assistant United States Attorney told the court that if the case had gone to trial, the government would have proven that “[t]he defendant would prepare...chemotherapy treatments by injecting the prescribed chemotherapy drugs into a bag of fluid that would then be connected to the patient via a ‘chest port.’ Each patient believed that they were receiving an amount of chemotherapy medicine that was equal to the amount being billed to their respective health care benefit programs. The defendant was not providing each patient with the fully prescribed dosage of many of the billed chemotherapy drugs.”

Both Sachdeva and Weeks are scheduled to be sentenced on October 1, 2012, by United States District Judge Daniel P. Jordan, III. Weeks faces a maximum of 10 years in prison, a $250,000 fine, and the forfeiture of a $19,549.52 money judgment. Sachdeva faces up to 20 years in prison, $750,000 in fines, and the forfeiture of almost $6,000,000 in illegal proceeds that were previously seized by the government, as well as the forfeiture of several parcels of real property located throughout the state.



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Nabeel Shaikh Pleads Guilty in Connection with Detroit-Area Medicare Fraud Scheme

Source- http://www.fbi.gov/detroit/press-releases/2012/michigan-man-pleads-guilty-in-connection-with-detroit-area-medicare-fraud-scheme

WASHINGTON—A Michigan resident pleaded guilty today for his role in a $13.8 million Detroit-area home health care fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).

Nabeel Shaikh, 30, of Wixom, Michigan, pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan. At sentencing, Shaikh faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to information contained in plea documents, Shaikh purported to be a physical therapy assistant with a limited license who provided physical therapy services to homebound Medicare beneficiaries. In fact, Shaikh had a forged physical therapy assistant’s degree and no medical license. Beginning in approximately January 2009, Shaikh was paid to falsify medical documentation for two home health agencies, known as Physicians Choice Home Health Care LLC and Quantum Home Care Inc., each of which billed and received payments from Medicare for home health care services that were never rendered.

According to court documents, Shaikh paid kickbacks and bribes to Medicare beneficiaries in order to obtain the beneficiaries’ Medicare information, which was then used to bill Medicare for home health services that were never provided. Shaikh created evaluations, therapy revisit notes, and other medical documentation memorializing purported physical therapy for patients he did not see or treat. Shaikh and his co-conspirators had Medicare beneficiaries pre-sign forms and visit sheets that were later falsified to make it appear that the beneficiaries had received home health services when, in fact, they had not. Shaikh knew that the documents that he signed would be used to support false claims to Medicare for home health services.

From approximately January 2009 through September 2011, Medicare paid approximately $900,430 to Physicians Choice and Quantum for fraudulent physical therapy claims based on falsified files and notes signed by Shaikh.

Overall, between approximately July 2008 and September 2011, Physicians Choice, Quantum, and two other fraudulent home health care agencies involved in the conspiracy, known as First Care Home Health Care LLC and Moonlite Home Care Inc., were paid approximately $13.8 million in fraudulent home health claims by the Medicare program for services that were medically unnecessary and/or never rendered.



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Tariq Mahmud was Sentenced to 84 Months in Prison for Role in $3 Million Therapy Fraud Scheme

Source- http://www.fbi.gov/detroit/press-releases/2012/rehabilitation-agency-owner-in-detroit-sentenced-to-84-months-in-prison-for-role-in-3-million-therapy-fraud-scheme

WASHINGTON—The owner of a Detroit-area rehabilitation agency was sentenced today to 84 months in prison for his leading role in a $3 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

Detroit-area resident Tariq Mahmud, 54, was sentenced by U.S. District Judge Avern Cohn in the Eastern District of Michigan. In addition to his prison term, Mahmud was sentenced to three years of supervised release and was ordered to pay $1.8 million in restitution, joint and several with his co-defendants.

Mahmud was convicted by a federal jury on February 2, 2012, after a four-day trial, of one count of conspiracy to commit health care fraud and six counts of health care fraud. Mahmud was charged along with four other defendants in an indictment unsealed on February 17, 2011, as part of a nationwide Medicare fraud takedown, and subsequently in a superseding indictment on December 28, 2011. The four other defendants have pleaded guilty and have been sentenced.

According to evidence presented during the trial, Mahmud was the owner of Comprehensive Rehabilitation Services Inc. (CRS), a fraudulent rehabilitation agency located in Dearborn, Michigan. Between January 2003 and February 2007, CRS purchased falsified physical and occupational therapy files from more than 30 therapy and rehabilitation companies and used them to fraudulently bill Medicare for more than $3 million.

As part of the scheme, Medicare beneficiaries were paid cash kickbacks and given prescription drugs to sign forms and visit sheets that were later falsified to indicate that they received therapy services that were never provided. Physical and occupational therapists created false evaluations, progress notes, and discharge papers indicating that the therapy services were given, when, in fact, they never were. Evidence at trial showed that the therapists never met the beneficiaries and Mahmud never provided or supervised the therapy billed to Medicare.

In addition to submitting more than $3 million in false therapy claims, Mahmud made additional false statements to Medicare regarding services that were never rendered. For instance, when Medicare inquired regarding a beneficiary who complained that he had not received the services for which CRS billed Medicare, Mahmud returned the payment and told Medicare that he consulted with his professional staff and the beneficiary had not been satisfied with services. In fact, CRS had no professional staff; the therapists who signed the beneficiary’s file never rendered any services; and the beneficiary never received services. Evidence at trial established that the beneficiary’s identity was stolen and used by CRS and a fraudulent file-making company to bill Medicare.



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Dr. Jaswinder Rai Chhibber was Sentenced to 30 Months in Prison for Health Care Fraud Involving Unnecessary Patient Tests

Source- http://www.fbi.gov/chicago/press-releases/2012/chicago-physician-sentenced-to-30-months-in-prison-for-health-care-fraud-involving-unnecessary-patient-tests

CHICAGO—A physician who operated a south side medical clinic, Dr. Jaswinder Rai Chhibber, was sentenced to 2½ years in federal prison for engaging in a health care fraud scheme between 2007 and July 2010, federal law enforcement officials announced today. Chhibber, who operated the former Cottage Grove Community Medical Clinic, located at 642 East 79th St., Chicago, was convicted following a trial in March of defrauding BlueCross BlueShield of Illinois by submitting false insurance claims for medically unnecessary tests he ordered for patients and using false diagnosis codes to justify those tests.

Chhibber, 50, of Schaumburg, was ordered to begin serving his 30-month prison term on September 5 by U.S. District Judge Suzanne Conlon, who imposed the sentence, along with a $15,000 fine, late yesterday in federal court.

Chhibber was found guilty of five counts of health care fraud and four counts of making false statements involving a health care benefits program after a week-long trial. The jury found him not guilty of seven additional counts.

The evidence at trial showed that Chhibber ordered medically unnecessary tests, falsified patients’ medical records, and used false diagnosis codes on insurance claim forms in various fashions for at least five patients who testified at trial, including two undercover federal agents who posed as patients. Evidence also showed that Chhibber administered echocardiograms, electrocardiograms, nerve conduction studies, carotid doppler exams, and abdominal ultrasounds for an unusually high percentage of his patients.



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