United States Files Suit Against Guidant and Boston Scientific Corp. for Selling Defective Heart Devices That Were Implanted in Medicare Patients

Source- http://www.justice.gov/opa/pr/2011/January/11-civ-117.html

WASHINGTON – The United States has filed a complaint against Boston Scientific Corp. and related Guidant entities under the False Claims Act for conduct relating to certain of its cardiac devices, the Justice Department announced today. The United States alleges that Guidant sold cardiac devices, the Ventak Prizm 2 and the Renewal 1 and 2, even though Guidant knew the devices were defective. Despite Guidant’s fixing the defect in these lines of devices, the company continued to sell their remaining stock of defective devices anyway.

The devices at issue are implantable cardioverter defibrillators, which are designed to deliver therapy to prevent sudden cardiac death. The devices are surgically implanted into patients’ chests. When they detect an irregular heartbeat, the devices send an electrical pulse to the heart to "shock" it back to normal rhythm.

The government’s complaint alleges that Guidant hid the problems with their defibrillators from patients, doctors and the Food and Drug Administration (FDA). In February 2010, Guidant pleaded guilty to misleading the FDA about the problems in the devices. A district court in Minnesota accepted the company’s plea on Jan. 12, 2011. Guidant was acquired by Boston Scientific in 2006.

"Patients with serious heart conditions who depend on these devices should not have to second-guess whether they are safe and effective," said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. "When a medical device manufacturer conceals problems with its products, as is alleged here, not only is taxpayer money wasted, but lives are put at risk."

"When companies like Guidant request and receive federal dollars for products they know to be defective, the United States is committed to aggressively seeking the recovery of those payments. That is especially true when the defective products endanger human lives. In today’s environment, it is essential that Medicare and other public health care programs be made whole to ensure their continued vitality for future generations," said John R. Marti, First Assistant U.S. Attorney for the District of Minnesota.

The United States alleges that Guidant knew as early as April 2002 that an implantable cardiac device it manufactured and sold, known as the Prizm 2, contained a potentially life-threatening defect. The government’s complaint also alleges that Guidant knew as early as November 2003 that another implantable device it manufactured and sold, the Renewal 1 and 2, contained a similar, potentially life-threatening defect. Yet, the United States alleges that, even after Guidant took corrective action to fix the defects, the company continued to sell its stock of the old, defective versions of the devices. Moreover, as information about the cause and nature of the defect grew within the top ranks of the company, the United States contends that Guidant took steps to hide the problem from patients, doctors and the FDA. According to the government’s complaint, instead of disclosing the problem, Guidant issued a misleading communication to doctors that misinformed them about the nature of the defect.

The United States alleges that Guidant did not fully disclose the problem in the devices to doctors and the FDA until May 2005, after first being contacted by a reporter. The company subsequently recalled the devices shortly after a front-page article about the defects appeared in The New York Times.

The United States joined a lawsuit filed under the qui tam or whisteblower provisions of the False Claims Act by James Allen, who allegedly received one of the defective devices. Under the act’s qui tam provisions, a private citizen, known as a "relator," can sue on behalf of the United States and share in any recovery.


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

Patient Recruiter Melvin Young Sentenced to 40 Months in Prison for His Role in a Fraudulent Diagnostic Testing Scheme

Source- http://detroit.fbi.gov/dojpressrel/pressrel11/de012611.htm

WASHINGTON—A Detroit-area patient recruiter was sentenced today to 40 months in prison for his role in a conspiracy to defraud the Medicare program, the Departments of Justice and Health and Human Services (HHS) announced today.

Melvin Young, 57, was also sentenced by U.S. District Judge Patrick J. Duggan in the Eastern District of Michigan to three years of supervised release following his prison term and was ordered to pay restitution, joint and several with co-defendants, in the amount of $533,643. Young pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud.

According to the plea documents, beginning in approximately September 2007, Young and a co-conspirator began recruiting and transporting patients to a clinic called Ritecare LLC. Ritecare was owned and operated by co-conspirators and had locations in Detroit and Livonia, Mich. Young admitted that he and this co-conspirator, Emma King, paid kickbacks to Medicare beneficiaries whom they recruited and transported to Ritecare. According to the plea documents, the owners and operators of Ritecare were the source of the funds used by Young to pay the Medicare beneficiaries he recruited. Young admitted that he would keep part of these funds as a kickback. Typically, the owners of Ritecare would provide $100-$150 per patient Young recruited, with Young retaining $50-$75 of that amount.

According to the plea documents, the patients Young recruited had to subject themselves to medically unnecessary tests to receive the money. Per instructions from the owners and operators of Ritecare, Young admitted that he instructed the patients to claim they had certain symptoms to trigger medically unnecessary tests. Consequently, the patients' medical records contained false symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.

Young admitted that King and he were responsible for recruiting at least 269 patients to Ritecare. Through his recruitment efforts, Young caused the submission of approximately $940,760 in false or fraudulent billings by Ritecare. Medicare paid approximately $533,643 on those claims.

 King pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud and was sentenced on Dec. 14, 2010, to 8 months in prison.


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

Thompson W. Chinwoh and Stephanie Dangerfield both Pled Guilty for Conspiracy to Commit Health Care Fraud

Source- http://neworleans.fbi.gov/dojpressrel/pressrel11/no012511.htm

BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that THOMPSON W. CHINWOH, age 57 and STEPHANIE DANGERFIELD, age 49 of Baton Rouge, Louisiana, both pled guilty yesterday before U.S. District Court Judge James J. Brady to one count of an indictment charging conspiracy to commit health care fraud. SAMUEL B. JOHNSON, age 48 of Baton Rouge, also pled guilty to one count of conspiracy to commit health care fraud and one count of money laundering.

The superseding indictment in this matter, filed December 8, 2010, arose from a health care fraud scheme involving a company known as Medical Supplies of Baton Rouge, Inc. ("MSBR"). CHINWOH and JOHNSON were owners of MSBR and DANGERFIELD worked for the company. MSBR was a company engaged in the business of providing power wheelchairs, orthotics and other durable medical equipment to Medicare beneficiaries. CHINWOH, JOHNSON and DANGERFIELD conspired with each other to defraud the Medicare program and commit health care fraud by submitting false claims to Medicare seeking reimbursement for sets of expensive braces (including a back brace, knee braces, and other items) knowing that the braces were not medically necessary and had not been prescribed for the beneficiaries by their physicians.

As a result of their guilty pleas, CHINWOH and DANGERFIELD each face a maximum sentence of a term of imprisonment of ten years. As a result of his guilty plea, JOHNSON faces a maximum sentence of a term of imprisonment of thirty years. Sentencing has not yet been set for these defendants.


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

Doctors Tammy Lee Cashion and her spouse Paul J. Curcio Pleaded Guilty to Conspiracy to Commit Health Care Fraud and Theft from a Health Care Plan

Source- http://washingtondc.fbi.gov/dojpressrel/pressrel11/wfo012511a.htm

ALEXANDRIA, VA—Doctors Tammy Lee Cashion, age 48, and her spouse Paul J. Curcio, age 47, of Clifton, Virginia, pleaded guilty today to the charge of conspiracy in connection with the operation of their Chiropractic Family Health Center in Centreville, Virginia.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia and James W. McJunkin, Assistant Director in Charge of the FBI Washington Field Office made the announcement after the pleas were accepted by United States District Judge Claude M. Hilton and United States Magistrate Judge John F. Anderson.

Sentencing for Doctor Cashion is set for April 22, 2011. Cashion faces a maximum penalty of five years of incarceration and full restitution. Sentencing for Doctor Curcio is set for April 26, 2011. Curcio, who pleaded guilty to a conspiracy to commit misdemeanor theft, faces up to one year of incarceration and full restitution.

According to statements of fact filed with both plea agreements, besides performing chiropractic adjustments which were properly billed to insurance companies, both Cashion and Curcio conspired with their associate chiropractor Benjamin Hopsicker to bill for physical therapy ostensibly performed on their patients when the therapy was either not performed at all or was not performed for a sufficient length of time to be billable under the American Medical Association's CPT codes. Beginning in April 2008 Anthem Blue Cross required that physicians and licensed therapists spend a minimum of eight minutes with a patient, one-on-one, performing certain therapeutic procedures in order to bill for those procedures. In the case of the Chiropractic Family Health Center, before Anthem would pay any claims, it required that Cashion and Curcio and their associate physicians document in their notes the amount of time spent with each physical therapy procedure. Shortly thereafter, Curcio initiated an agreement with his employee Hopsicker to bill for physical therapy and, when necessary, to falsify their physician notes making it appear that they had spent a minimum of eight minutes or more performing the procedure when in fact they had not done so. According to both plea agreements, Cashion and Cucio agreed to repay three insurance companies, Anthem Blue Cross, Aetna, and United Health Care, a total of $110,000.


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

Christine Horning Receives 24-Month Prison Sentence for Identity Theft and Health Care Fraud Conviction

Source- http://albuquerque.fbi.gov/dojpressrel/pressrel11/aq012511.htm

This morning, Senior United States District Judge C. LeRoy Hansen sentenced Albuquerque resident Christine Horning, 35, to a 24-month term of imprisonment to be followed by four-years’ supervised release based on her guilty pleas to aggravated identity theft and health care fraud. Judge Hansen also ordered Horning to pay $24,679.48 in restitution to Medicaid and Presbyterian Health Care Services (PHS). Horning is required to surrender to the United States Bureau of Prisons to start serving her prison sentence once her prison facility has been designated.

Horning was charged in a 26-count indictment that was filed on April 14, 2010. The indictment charged Horning with 15 counts of mail fraud, three counts of health care fraud and eight counts of aggravated identity theft. The indictment alleged that, between May 2008 and June 2008, Horning, then employed at a PHS pharmacy, devised a scheme to defraud PHS by causing fraudulent prescription reimbursements checks to be issued to her friends and relatives who turned the proceeds over to Horning. According to the indictment, Horning used the names of legitimate PHS customers and their identification information to create the fraudulent checks. It further alleges that Horning used this scheme to generate 17 fraudulent checks in the aggregate amount of $27,129.63 and obtained $24,679.48 in proceeds from 15 checks that were cashed.

United States Attorney Kenneth J. Gonzales said that, on July 26, 2010, Horning entered a guilty plea to a two-count information charging her with (1) aggravated identity theft, and (2) health care fraud resulting in a loss of $24,679.48 under a plea agreement with the United States Attorney's Office. In her plea agreement, Horning admitted that she used the PHS computer database to create 17 fraudulent prescription reimbursement checks, and that she used the names and identification information of PHS members to generate the checks. Horning further admitted that, for each fraudulent check she generated, she changed the payee name and address to a name and address of her choosing and caused the checks to be mailed to the individual she identified. Horning admitted that she convinced the recipients of the checks to provide the proceeds to her and that she received a total of $24,679.48 from her fraudulent scheme.


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

Dr. Joseph J. Kubacki Charged in Health Care Fraud Scheme Involving More Than $3 Million in Fraudulent Claims

Source- http://philadelphia.fbi.gov/dojpressrel/pressrel11/ph012511.htm

PHILADELPHIA—Dr. Joseph J. Kubacki was charged today in a 144-count indictment with health care fraud and making false statements in health care matters, announced United States Attorney Zane David Memeger. The indictment alleges that Kubacki was the Chairperson of the Ophthalmology Department of the Temple University School of Medicine and also served as the Assistant Dean for Medical Affairs. According to the indictment, between 2002 and 2007, Kubacki caused thousands of false claims to be submitted to health care benefit programs with false charges totaling more than $3 million for services rendered to patients whom Kubacki did not personally see or evaluate.

Defendant Kubacki allegedly directed staff employees in the Ophthalmology Department to bring to his office the charts of patients seen by other physicians in the Ophthalmology Department. As a result, it is alleged that large stacks of patient charts frequently were stacked outside Kubacki's office door at the main campus of Temple University Hospital. The indictment alleges that, after defendant Kubacki collected the patient charts, he would make notations in the charts falsely indicating that he had personally seen and evaluated the patients. It is alleged that Kubacki would then sign the patient charts and would fill out fee slips for the services that he falsely claimed to have provided to the patients. According to the indictment, Kubacki was outside of Pennsylvania in other locations on some of the days that he claimed to have treated patients, including Las Vegas, Nevada, Sarasota, Florida and Indian Wells, California. As a result, health care benefit programs, including Medicare and private health insurers, allegedly made payments on fraudulent claims in excess of $1.5 million. The indictment further charges that Kubacki made false statements in the medical records of patients attesting that he had personally seen the patients, when, as Kubacki knew, he had created these false records solely for the purpose of submitting fraudulent billings to health care benefit programs.


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

Minnesota-Based St. Jude Medical Pays U.S. $16 Million to Settle Claims that Company Paid Kickbacks to Physicians

Source- http://www.justice.gov/opa/pr/2011/January/11-civ-078.html

WASHINGTON – St. Jude Medical Inc. of St. Paul, Minn., has agreed to pay the United States $16 million to resolve allegations that the company used post-market studies and a registry to pay kickbacks to induce physicians to implant the company’s pacemakers and defibrillators, the Justice Department announced today.

Post-market studies are intended to assess the clinical performance of a medical device or drug after that device or drug has been approved by the Food and Drug Administration. Registries are collections of data maintained by a device manufacturer concerning its products that have been sold and implanted in patients.

The United States contends that St. Jude used three post-market studies and a device registry as vehicles to pay participating physicians kickbacks to induce them to implant St. Jude pacemakers and defibrillators. Although St. Jude collected data and information from participating physicians, it is alleged that the company knowingly and intentionally used the studies and registry as a means of increasing its device sales by paying certain physicians to select St. Jude pacemakers and I mplantable cardioverter defibrillator for their patients. In each case, St. Jude paid each participating physician a fee that ranged up to $2,000 per patient. The United States alleges that St. Jude solicited physicians for the studies in order to retain their business and/or convert their business from a competitor’s product.

“When companies pay kickbacks to health care providers in order to pad their bottom line, it taints the information patients rely on to make informed choices about their health,” said Tony West, Assistant Attorney General for the Civil Division. “It is critical that physicians base their decisions on which medical device to implant on the best interest of the patient, not on whether a device manufacturer will pay an extra fee or honoraria for the implant.”

“Medical device and pharmaceutical companies can use post-market studies legitimately to obtain information about how their products work in the field, but they cannot use those studies, and the honoraria associated with them, to induce physicians to select their products. Cardiologists and electrophysiologists should make their decisions on which pacemaker or defibrillator to implant in a patient based on their independent medical judgment, not based on how much the manufacturer is paying them to implant the device,” said Carmen Ortiz, U.S. Attorney for the District of Massachusetts.

This action was initiated by the filing of a qui tam action under the False Claims Act (FCA) by a relator, Charles Donigian. The FCA permits a whistle blower to recover a share of the government recovery, and in this case Mr. Donigian will recover $2.64 million.

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 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 $6.8 billion since January 2009 in cases involving fraud against federal health care programs.

The settlement was the result of an investigation by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the District of Massachusetts, the Office of Inspector General at the U.S. Department of Health and Human Services and the FBI.


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

Clifford Ubani and Princewill Njoku Plead Guilty to Alleged $5.2 Million Medicare Fraud Scheme

Source- http://houston.fbi.gov/dojpressrel/pressrel11/ho012011a.htm

WASHINGTON—Two owners of a Houston health care company pled guilty today in connection with an alleged $5.2 million Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).

Clifford Ubani, 52, and Princewill Njoku, 51, each pled guilty before U.S. District Court Judge Nancy Atlas in Houston to one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks and 16 counts of payment of kickbacks to Medicare beneficiary recruiters.

According to court documents, Ubani and Njoku were owners and operators of Family Healthcare Group (Family Group), a home health care company. Family Group purported to provide skilled nursing to Medicare beneficiaries. According to court documents, Ubani and Njoku hired co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. Ubani and Njoku admitted that they paid kickbacks to the recruiters for their referrals.

Ubani and Njoku previously pled guilty to conspiracy to commit health care fraud related to their ownership of another Houston health care company, Family Healthcare Services (Family Services). Family Services submitted approximately $1.1 million in fraudulent claims to Medicare for the costs of durable medical equipment.

At sentencing, scheduled for July 19, 2011, Ubani and Njoku each face a maximum sentence of 10 years in prison for each health care fraud conspiracy count, five years in prison for each kickback conspiracy count and five years in prison for each kickback count.


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

Dr. Harold Wagner pleaded Guilty in Health Care Fraud Scheme

Source- http://dallas.fbi.gov/dojpressrel/pressrel11/dl011911.htm

PLANO, TX—A 53-year-old DeSoto, Texas physician has pleaded guilty to federal health care fraud-related charges in the Eastern District of Texas, announced U.S. Attorney John M. Bales today.

Dr. Harold Wagner pleaded guilty to accepting illegal kickbacks involving health care programs today before U.S. Magistrate Judge Don Bush.

According to information presented in court, Wagner had accepted kickbacks from a wheelchair supplier for referring wheelchair patients, who were Medicare and Medicaid recipients to the supplier. The supplier was later reimbursed by these programs for the wheelchairs. It is against federal law for a Medicare or Medicaid provider to make referrels to medical equipment suppliers in exchange for kickbacks. Wagner was indicted by a federal grand jury on Jan 14, 2010.

Wagner faces up to five years in federal prison. A sentencing date has not been set.


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

Six more states to join legal challenge to federal health care law

Source- http://www.in.gov/attorneygeneral/2369.htm

INDIANAPOLIS - Today six additional states sought to join the group of 20 plaintiff states -- including Indiana - that have brought a legal challenge to the new federal health care law. Attorney General Greg Zoeller, who joined the lawsuit on behalf of Indiana in May, issued this statement:

"Now that the number of plaintiff states has expanded from 20 to 26, it underscores that this lawsuit is widely understood to have merit. After the health care law was ruled unconstitutional in a separate lawsuit in Virginia that raised many of the same arguments, no one now can claim that this legal challenge is a frivolous lawsuit," Zoeller said.

"Regardless of the eventual ruling by the federal court in our case, it is important that the states have an opportunity as sovereign entities to challenge the constitutionality of the federal government's claims of authority. Under our federalist system, this respectful legal challenge is a proper check on the role of the federal government," Zoeller added.

"We and the other plaintiff states contend the federal mandate that individuals purchase a private health insurance product or face a penalty is unconstitutional, and that ultimately this question should be decided by the United States Supreme Court. Having met with Hoosiers across our state, I agree that some type of health insurance reform is needed in this country, but implementing it ought to be done in a constitutional manner," Zoeller said.

In addition to Indiana, the group of 20 plaintiff states bringing the legal challenge included Florida, South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Colorado, Michigan, Pennsylvania, Washington, Idaho, South Dakota, Mississippi, Nevada, Arizona, Georgia, Alaska and North Dakota. Also joining as plaintiffs were two private individuals and the National Federation of Independent Business (NFIB).

Today, the plaintiffs filed a motion with the court to amend the complaint so that six more states can join the case: Ohio, Kansas, Wyoming, Wisconsin, Maine and Iowa, bringing the total plaintiff states to 26. The U.S. Department of Justice represents the federal government defendants.

 On December 16, the U.S. District Court in the Northern District of Florida heard arguments on the merits of the case, and Judge Roger Vinson is likely to rule sometime early in 2011. From there, the case is likely to be appealed to a federal circuit court of appeals, and from there potentially to the United States Supreme Court.


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

Ebb Greenwood Indicted for Health Care Fraud

Source- http://indianapolis.fbi.gov/dojpressrel/pressrel11/ip011311.htm

HAMMOND, IN—The United States Attorney's Office announced the following indictment was returned in South Bend:

Ebb Greenwood, 59, of Gary, Indiana, was charged in an indictment returned today with two counts of health care billing fraud and two additional counts of conspiracy to commit billing fraud. In particular, the indictment alleges that Greenwood, as part of one fraud scheme, caused Human Services Transport Provider Incorporated, located in Gary, Indiana, to submit fraudulent billings to Indiana Medicaid from 2006 through 2010 for medical transportation services that were never in fact provided. A second fraud count alleges that Greenwood executed and participated in a similar fraud scheme on behalf of At Your Service Transport Provider from 2009 through 2010. The indictment alleges a loss to Medicaid of $1.9 million.

“In Indiana, there is a significant problem with individuals submitting fraudulent or inflated claims to the Medicaid program for reimbursement, which means taxpayer dollars are diverted away from their proper and lawful purpose. The Indiana Medicaid Fraud Control Unit of my office works closely with our colleagues from the U.S. Attorney’s Office and FBI to investigate and deter such fraud against Medicaid, and I am also working with the Indiana General Assembly to seek to require such providers to post surety bonds as insurance against fraud,” Indiana Attorney General Greg Zoeller said.

These charges were filed as the result of an investigation by the Federal Bureau of Investigation and the Indiana Medicare Fraud Control Unit. This case has been assigned to and will be prosecuted by Assistant United States Attorney Donald Schmid.

The United States Attorney's Office emphasized that an Indictment is merely an allegation and that all persons charged are presumed innocent until and unless proven guilty in court.

The specific sentence in each case to be imposed upon conviction will be determined by the judge after a consideration of federal sentencing statutes and the Federal Sentencing Guidelines.


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

Renier Vicente Rodriguez Fleitas Sentenced to 37 Months’ Imprisonment for Conspiring to commit Part D Health Care Fraud

Source- http://www.blogger.com/post-create.g?blogID=6275481621303003780

U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigation, announce today’s sentencing of defendant Renier Vicente Rodriguez Fleitas, 60, of Miami-Dade County. U.S. District Court Judge Cecilia M. Altonaga sentenced Rodriguez to 37 months’ imprisonment, to be followed by 3 years of supervised release. In addition, the Court ordered the defendant to pay $135,930 in restitution for Rodriguez’ role in a health care fraud conspiracy.

On October 28, 2010, Rodriguez pled guilty to conspiring to commit health care fraud, in violation of Title 18, United States Code, Section 1349. According to the plea agreement executed by the parties, the defendant agreed that in November 2009, he purchased Pirifer Medical Supplies, Inc., d/b/a/ Pirifer Pharmacy and Discount, located in Hialeah, Florida. Rodriguez admitted that he opened three bank accounts and completed numerous Part D Medicare applications with plan administrators on behalf of the company. Finally, he admitted that, between December 2009 and March 2010, Pirifer submitted approximately $1.8 million in fraudulent claims to various Part D plan administrators, and received approximately $135,930 from Medicare.


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

Medical Device Manufacturer Guidant LLC, Sentenced for Failure to Report Defibrillator Safety Problems to FDA

Source- http://www.justice.gov/opa/pr/2011/January/11-civ-035.html

WASHINGTON – Guidant LLC, a wholly-owned subsidiary of Boston Scientific Corporation, was formally convicted and sentenced today in St. Paul, Minn., before U.S. District Court Judge Donovan W. Frank for criminal violations relating to its interactions with the Food and Drug Administration (FDA). Judge Frank sentenced Guidant to pay more than $296 million in criminal fines and forfeiture and also to submit to the supervision of the U.S. Probation Office for three years. The Justice Department brought criminal charges against Guidant for its mishandling of short-circuiting failures of three models of its implantable cardioverter defibrillators: the Ventak Prizm 2 DR (Model 1861) and the Contak Renewal (Models H135 and H155). Guidant’s Cardiac Rhythm Management division, which produced the defibrillators, is headquartered in Arden Hills, Minn. The company pleaded guilty to the charges last April.

Implantable cardioverter defibrillators are lifesaving devices used to detect and treat abnormal heart rhythms that can result in sudden cardiac death. The devices, once surgically implanted, continually monitor the electrical activity in a patient’s heart for deadly arrhythmias and deliver an electrical shock to the heart in an effort to return the heartbeat to normal rhythm. If they fail to operate properly when needed, a person can die within minutes.

Judge Frank sentenced Guidant for withholding information from the FDA regarding catastrophic failures in some of its lifesaving devices. Guidant made decisions at various junctures to conceal information from the FDA and medical professionals regarding the device failures. In June 2005, the company finally went public about the problem with information it had known for 10 months, and then only after three deaths had occurred.

The Justice Department’s sentencing memorandum filed with the court explains how Guidant decided to continue to implant hundreds of defective Renewal devices, even after the company had decided to stop shipping them from the factory due to the seriousness of the health risk they represented. Guidant developed a strategy to mitigate the health risk while not raising FDA concerns about the problem. This strategy included the company advising its sales representatives to tell physicians that “nothing was broken” with the Renewal, and falsely telling the FDA that c hanges it proposed to the device in response to the electrical short-circuiting “were not being done to correct device flaws that threaten patient safety” but were rather “to improve process throughout.”

Under today’s sentence, Guidant is required to forfeit $42,079,675 to the United States and pay a criminal fine of $253,962,251. In addition, Guidant was sentenced to three years of probation. During that period, Guidant is required to make quarterly reports to the Probation Office and to submit to regular, unannounced inspections of its records by the Probation Office. The court also required Guidant to notify its employees and shareholders of its criminal conviction.

“The sentence the court imposed reflects the seriousness of Guidant’s conduct,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “Patients are put at risk when health care companies fail to meet their responsibility to provide complete and accurate information to the FDA.”

Guidant was charged in federal district court on Feb. 25, 2010. Last April, Judge Frank declined to accept a proposed plea agreement between the government and Guidant.

“The safety and integrity of critical medical devices is assured only by close FDA oversight,” said First Assistant U.S. Attorney John Marti of the District of Minnesota. “This agency can only perform its mandated duty when medical device manufacturers provide the agency with timely and accurate information. When Guidant withheld important information, patient safety was jeopardized. The court’s sentence recognizes the harm of Guidant’s conduct.”

“FDA always works closely with companies to support compliance with standards that prevent serious safety problems from occurring. However, as today's sentence demonstrates, when companies fail to comply, we will use our enforcement tools to ensure the safety and efficacy of the medical products that Americans rely on every day,” said Margaret Hamburg, M.D., Commissioner of Food and Drugs.


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

Healthcare Worker Angelia Chupa Sentenced for Medicaid Fraud

Source- http://ag.state.nv.us/newsroom/press/2011/Angelia%20Chupa%20Medicaid%20Fraud.pdf

Las Vegas –Las Vegan Angelia Chupa, age 50, was sentenced today for two misdemeanor
offenses of Submission of False Claims. Justice of the Peace William Jansen sentenced her to 90 days in jail, suspended, payment of $7,100 in restitution, penalties, and costs, and one year
probation in this Medicaid fraud case. The case was investigated and prosecuted by the Attorney General’s Medicaid Fraud Control Unit.

“Fraud against Medicaid by providers in the health care community will be investigated and
punished,” said Attorney General Catherine Cortez Masto. “Prosecution of these crimes and the
restitution penalties returning funds to Medicaid helps ensure continued support of those in need
of services.”

The investigation began in 2008 after information was obtained that Chupa was not providing
personal care assistant services to a Medicaid recipient and was receiving payment for those
purported services. Medicaid has a personal care assistant program to keep people living
independently in their own homes by providing basic services, including bathing, dressing, house cleaning and meal preparation. Medicaid contracts with home care companies that in turn employ individuals to provide the actual day-to-day care. The investigation developed information that Chupa indeed failed to provide care services for the patient for whom she was employed, yet claimed that she performed the services and received payment as if she had actually performed the services.


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

DME Owner Patrick Ita, Indicted in Alleged Scheme to Defraud Medicare of Millions

Source- http://houston.fbi.gov/dojpressrel/pressrel11/ho011011a.htm

HOUSTON—A 31-count sealed indictment charging a durable medical equipment company (DME) owner with conspiracy, health care fraud, wire fraud, and money laundering in a scheme to defraud Medicare of nearly $5 million has been unsealed, United States Attorney José Angel Moreno and Texas Attorney General Greg Abbott announced today.

Patrick Ita, 55, the owner of Masspoint Medical Equipment & Supplies, a DME located in southwest Houston, was arrested by FBI agents at Bush Intercontinental Airport on New Year’s Day after arriving on a flight from Amsterdam. Today, Ita was ordered detained without bond pending trial on the charges before United States District Judge Sim Lake. Trial is scheduled for Feb. 22, 2011. The indictment has been unsealed.

The scheme alleged in the 31-count indictment involved the filing of millions of dollars in claims with Medicare/Medicaid by Ita’s DME company for power wheelchairs allegedly supplied to victims of Hurricanes Katrina and Rita.

According to allegations in the indictment, between October 2005 and November 2006, Ita purchased Medicare beneficiary information from a defunct DME company in order to solicit those beneficiaries for power wheelchairs. Ita used marketers to recruit unwitting Medicare beneficiaries in Texas and Louisiana by promising them a free motorized wheelchair after Hurricanes Katrina and Rita. Ita allegedly fraudulently billed Medicare using a special modifier code issued by Medicare for claims resulting from a catastrophe or disaster like Hurricanes Katrina and Rita. The CR Modifier was supposed to be used by a DME supplier when that supplier had provided a replacement piece of equipment, like a power wheelchair, that had been severely damaged or destroyed by either Hurricane Katrina or Rita. Instead, the indictment alleges, Ita used the CR Modifier for hundreds of fraudulent power wheelchair claims where the CR Modifier did not apply because the beneficiary either: a) did not possess a power wheelchair prior to either Hurricane Katrina or Rita; or b) did not suffer significant damage to, or destruction of, his/her power wheelchair from either Hurricane Katrina or Rita; or c) never received a power wheelchair from the defendant after either Hurricane Katrina or Rita.

Upon conviction, the conspiracy count carries a maximum penalty of 20 years imprisonment and a $250,000 fine. Each of the 21 health care fraud counts carries a maximum penalty of 10 years in a federal prison and a $250,000 fine, while each of the six wire fraud counts carries a maximum penalty of 20 years’ imprisonment and a $250,000 fine. The money laundering counts carry a 20-year maximum penalty and a $500,000 fine. Parole has been abolished in the federal prison system.


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

Pennsylvania will receive more than $2.6 million as part of a national settlement with the Swiss drug maker Novartis resolving allegations of improper marketing.

Source- http://www.attorneygeneral.gov/press.aspx?id=5917

HARRISBURG - Pennsylvania will receive more than $2.6 million as part of a national settlement with the Swiss drug maker Novartis resolving allegations of improper marketing.

The joint federal and state investigation alleged that the company engaged in a pattern of unlawful marketing activity, including "off-label" marketing to promote and sell pharmaceutical drugs.

Off-label marketing involves promoting a drug for uses that have not been approved by the U.S. Food and Drug Administration (FDA). While it is not illegal for a physician to prescribe a drug for an unapproved use, federal law prohibits a manufacturer from promoting a drug for uses not approved by the FDA.

Investigators allege that Novartis Pharmaceuticals Corporation improperly promoted the drug Trileptal, a drug approved to treat partial seizures in patients with epilepsy. The company also allegedly engaged in unlawful kickback schemes to entice physicians to prescribe not only Trileptal, but Diovan, Zelnorm, Sandostatin, Exforge and Tekturna.

Novartis will pay the states and federal government $237.5 million in damages and penalties for losses to the Medicaid and other federal health care programs. Pennsylvania will receive more than $2.6 million.

Novartis will also plead guilty to a misdemeanor charge of misbranding under the Food, Drug and Cosmetic Act and pay a $185 million fine.

As one of the conditions of the settlement, Novartis has entered into a Corporate Integrity Agreement with the United State Department of Health and Human Services, Office of the Inspector General, which will closely monitor the company's future marketing and sales practices.


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

New Braunfels Wholesaler Brian Bailey, Charged With Selling Unapproved Medical Devices

Source- https://www.oag.state.tx.us/oagNews/release.php?id=3595

SAN ANTONIO – Texas Attorney General Greg Abbott charged a New Braunfels-based medical devices wholesaler with acquiring, stocking and selling products that were not approved for sale in the United States. A court-ordered temporary restraining order granted last Thursday halts the business activities of defendants Elite Med, LLC, S&B Marketing and Brian Bailey.

The State’s legal action cites defendants Elite Med, S&B Marketing Inc. and Brian Bailey with providing unapproved medical devices to Texas clinics and physicians. Last November, two of those clinics, Dr. Bliss W. Clark and Clark Orthopedics & Rehabilitation, agreed to pay civil penalties to the State and refrain from using unapproved medical devices in the future.

Clark Orthopedics and other physicians and clinics improperly acquired arthritis injections from Elite Med, which is not licensed to distribute those devices in Texas. Elite Med distributed Orthovisc, Synvisc, Hyalgan and Eufflexa, which it purchased in bulk from a Canadian company, M.T.E. Diagnostics. The injections are used to relieve arthritis-related pain in patients’ knees.

Although the injections, when properly labeled, are generally approved for use in the U.S., Elite Med failed to seek a license from the Texas Department of State Health Services (DSHS) to distribute the devices, which is a violation of state law.

According to inspectors with DSHS – which referred the case to the Attorney General’s Office – defendant Bailey operated Elite Med out of a small home on Hunter Road near New Braunfels. After inspecting Bailey’s records for the past six months, DSHS officers used lot numbers on invoices and conversations with the manufacturer to determine that the devices were actually intended for shipment to Turkey and other countries. However, the unapproved devices were shipped back into the U.S. by M.T.E. Diagnostics of Canada.

DSHS also found that labels on the devices were written in languages other than English, another violation of state law. Because the items were originally intended for export to another country, DSHS determined they were misbranded devices and not legally authorized for use in the U.S.

Bailey could provide no documentation to DSHS that Elite Med’s products were approved for importation or had been cleared for entry by the U.S. Customs Service.

According to the State’s enforcement action, the defendants violated the Texas Deceptive Trade Practices Act and the Health and Safety Code. The State is seeking civil penalties and attorneys’ fees.


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

Doctor Dahlia V. Kirkpatrick and Emmanuel M. Komandu, the owner and operator of the medical equipment company, each pleaded guilty to one count of conspiracy to commit health care fraud

Source- http://www.justice.gov/opa/pr/2011/January/11-crm-017.html

WASHINGTON – A New Orleans-area medical doctor and the owner and operator of a medical equipment company were sentenced today to 48 and 30 months in prison, respectively, for their roles in a Baton Rouge-area durable medical equipment (DME) health care fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

Medical doctor Dahlia V. Kirkpatrick and Emmanuel M. Komandu, the owner and operator of the medical equipment company, each pleaded guilty on Oct. 4, 2010, before U.S. District Judge Brian A. Jackson in the Middle District of Louisiana, to one count of conspiracy to commit health care fraud.

In addition to their prison terms, Judge Jackson sentenced Kirkpatrick and Komandu each to three years of supervised release. Kirkpatrick and Komandu also were ordered to pay $302,811 in restitution jointly and severally with each other. The restitution is to be paid to the victim in this case, HHS’s Centers for Medicare and Medicaid Services (CMS).

According to plea documents, Kirkpatrick began working with Komandu in approximately January 2005. Komandu was the owner and operator of Alpha Medical Solutions Inc., a purported DME supplier based in Baker, La. Alpha purportedly specialized in the provision of power wheelchairs, wheelchair accessories and feeding nutrients to Medicare beneficiaries.

According to court documents, from approximately January 2005 through February 2010, Komandu and Kirkpatrick submitted and caused the submission, on behalf of Alpha, of approximately $775,019 in fraudulent claims to the Medicare program. The majority of Alpha’s fraudulent claims were based on prescriptions for medically unnecessary DME that were written and provided by Kirkpatrick. Kirkpatrick wrote prescriptions for medically unnecessary DME, such as power wheelchairs, wheelchair accessories and feeding nutrients. Medicare paid $302,811 to Alpha based on these fraudulent claims.

Today’s sentences were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division, U.S. Attorney Donald J. Cazayoux for the Middle District of Louisiana, FBI Special Agent in Charge David W. Welker and HHS Office of Inspector General (HHS-OIG) Special Agent in Charge Mike Fields.

This case was prosecuted by Trial Attorneys O. Benton Curtis III and Sarah M. Hall of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG and the Louisiana Attorney General’s Office. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana.

Since their inception in March 2007, Strike Force operations in seven districts nationwide have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.


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

Patricia Young that Claimed to Provide Psychotherapy Services to Medicare Patients Pleads Guilty to $1.25 Million Fraud

Source- http://chicago.fbi.gov/dojpressrel/pressrel11/cg010511.htm

CHICAGO—A former Chicago woman, who claimed her business provided psychotherapy services to Medicare beneficiaries residing in skilled nursing facilities in the Chicago area, pleaded guilty to a federal health care fraud charge, admitting that she defrauded Medicare of more than $1.25 million, federal law enforcement officials announced. The defendant, Patricia Young, 51, of Newton, Miss., and formerly of Chicago, owned and operated a defunct business, Healthy People 2000, Inc., through which she fraudulently purported to provide psychotherapy services using social workers and a physician.

Young pleaded guilty yesterday to one count of health care fraud at her arraignment after being charged in a criminal information that was filed on Dec. 15, 2010, in U.S. District Court. She faces a maximum penalty of 10 years in prison and a $250,000 fine and restitution is mandatory. The court may also impose a fine totaling twice the loss to any victim or twice the gain to the defendant, whichever is greater. A written plea agreement contemplates an advisory federal sentencing guideline range of 37 to 46 months in prison. U.S. District Judge Robert M. Dow, Jr., set sentencing for July 12.

According to the plea agreement, sometime before 2006, Young and an unnamed physician agreed that the physician would obtain a Medicare provider number associated with Healthy People, which he designated to receive third-party payments for claims billed under his provider number. Under this arrangement, the physician allowed Young to submit insurance claims for psychotherapy services performed by social workers and other providers. Medicare then directly reimbursed Healthy People for these services and Young paid a portion of the funds to the physician, knowing that he had taken no part in the therapy sessions. Further, she directed her social workers to perform group therapy sessions with patients and, if that was not possible, to perform individual therapy lasting no more than 20 minutes.

Between 2006 and 2008, Young submitted false claims to Medicare totaling more than $5 million, as well as false claims of approximately $76,450 to Blue Cross Blue Shield of Illinois. These claims resulted in payments to Healthy People of approximately $1,258,623 by Medicare and $11,534 by Blue Cross. Young knew that the claims were false in three materials respects: first, that they stated the physician provided the claimed services when she knew that the physician did not provide or supervise the services and was not present at the skilled nursing facility when the services were being performed; second, that she billed all or almost all of the services using the most expensive reimbursement code for 45-50 minutes of individual therapy when she knew that she had instructed social workers to perform only group therapy or, at most, 20 minutes of individual therapy; and third, that she submitted claims for services on days when no service was rendered.


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

Dr. Howard Grant Sentenced to 41 Months in Prison for Role in Medicare Fraud Scheme

Source- http://www.justice.gov/opa/pr/2011/January/11-crm-009.html

WASHINGTON – Houston-area residents Dr. Howard Grant, Obisike Nwankwo and John Lachman were sentenced today to 41 months in prison, 21 months in prison, and 26 months in prison, respectively, for their roles in a multi-million dollar durable medical equipment (DME) Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced today.

In addition to the prison terms, U.S. District Court Judge Nancy Atlas in the Southern District of Texas sentenced Grant, Nwankwo and Lachman each to three years of supervised release. Grant was ordered to pay $121,742 in restitution jointly and severally with co-defendants. Nwankwo was ordered to pay $29,052 in restitution jointly and severally with co-defendants. Lachman was ordered to pay $1.14 million in restitution jointly and severally with co-defendants.

Grant and Nwankwo were both convicted by a federal jury after a two-week trial in the Southern District of Texas in May and June 2010. Grant was convicted of two counts of health care fraud and one count of conspiracy to commit health care fraud and Nwankwo was convicted of one count of conspiracy to commit health care fraud . Lachman pleaded guilty prior to the trial to one count of conspiracy to commit health care fraud.

Evidence at trial established that Onward Medical Supply, a Houston-area DME company, billed Medicare for fraudulent DME, including power wheelchairs and orthotic devices, beginning in 2003 and continuing until late 2009. In addition to the three co-conspirators sentenced today, one additional individual was convicted at trial, and seven individuals have pleaded guilty for their participation in various parts of Onward’s Medicare fraud scheme, including Onward’s owner, Doris Vinitski.

According to evidence presented at trial, Vinitski worked with Medicare biller and co-defendant John Nasky Okonkwo and others in late 2008 and early 2009 to submit fraudulent claims to Medicare identifying Dr. Howard Grant as the prescribing physician for the DME. The claims were submitted in several groups in November 2008. Evidence presented at trial showed that Grant learned about the fraudulent prescriptions prior to Onward’s submission of the claims to Medicare. Evidence at trial also showed that, upon learning of the prescriptions, Grant asked Vinitski for $10,000 in exchange for allowing the fraud scheme to continue. Okonkwo agreed to plead guilty for his participation in the scheme. Following the verdict, U.S. District Court Judge Nancy Atlas ordered Grant to surrender his medical license and his Drug Enforcement Administration (DEA) number and to stop all billing to Medicare and Medicaid.

Evidence at trial established that Nwankwo acted as a delivery driver for Onward and several other DME companies and that he delivered DME such as power wheelchairs and orthotics for Onward to beneficiaries who did not want or need the equipment. One beneficiary testified at trial that when Nwankwo tried to deliver a power wheelchair to her, she told him to get off her front step or she would call the police.

Lachman managed the Onward fraud scheme in the early years, until the end of 2006. During that time, he created fraudulent patient files, managed payments of kickbacks to recruiters and delivery drivers, and operated the day-to-day business of Onward.

The sentences were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Richard C. Powers, Special Agent-in-Charge of the FBI’s Houston office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of the HHS Office of Inspector General (OIG), Office of Investigations; and Texas Attorney General Greg Abbott on behalf of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

The cases were prosecuted by Trial Attorneys Jennifer L. Saulino, O. Benton Curtis III and Nicola J. Mrazek of the Criminal Division’s Fraud Section. The cases were investigated by the FBI, HHS-OIG and MFCU.

The cases were brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section. Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.


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

Leonid and Yelena Stolya Indicted for Fraudulent Healthcare Billing Scheme

Source- http://denver.fbi.gov/dojpressrel/pressrel11/dn010411.htm

DENVER—Leonid and Yelena Stolyar, both age 49, and both of Denver, Colorado, were indicted by a federal grand jury in Denver late yesterday on charges of conspiracy and health care fraud, federal and state authorities announced. The defendants are expected to surrender on Thursday, January 6, 2011, based on arrest warrants issued with the indictments. The defendants are expected to then make their initial appearances in U.S. District Court in Denver, where they will be advised of the charges pending against them.

According to the indictment, from August 2001 and continuing until October 2009, in the District of Colorado and elsewhere, Leonid Stolyar (aka Leon Stolyar), and Yelena Stolyar, executed a scheme to defraud health care benefit programs; namely, the Colorado Medicaid program as well as the Medicare program. The defendants owned and operated Y&L Corporation (dba Medcenter Supply). Y&L Corporation was an excluded entity, meaning they were not allowed to do business with Medicare or Medicaid. As part of the scheme, the defendants created Orthomed Supply Inc. in order to conceal their ownership status and to continue to do business as Y&L Corporation. They also failed to disclose Yelena Stolyar’s status as an excluded individual to the Colorado Medicaid program and Medicare. While excluded, Yelena Stolyar participated in the daily operations of Orthomed Supply, Inc., acted as an agent of Orthomed Supply, Inc., and maintained approximately a 50% ownership interest in Orthomed Supply, Inc.

Leonid and Yelena Stolyar, as a further part of the scheme, submitted false and fraudulent claims for durable medical equipment, items including incontinence products, ankle supports, knee supports, shoulder supports, amongst other items, with the Medicare and Colorado Medicaid Programs in order to obtain money to which they were not entitled during a period of time that Yelena was excluded from participation in the Colorado Medicaid program, the Medicare program, and all federally funded health benefit programs. Furthermore, they created and caused to be created false and fraudulent claims relating to the delivery of ankle supports, shoulder supports, and adult diapers and liners. Leonid Stolyar used bank accounts to conceal monies and transactions, and from which Yelena Stolyar was compensated for her interest in Orthomed Supply, Inc.

On or about December 20, 2001, Yelena Stolyar was excluded for a period of 10 years by the Secretary of Health and Human Services from participating in the Medicare program, the Medicaid program, and all federal health care programs as a result of a felony conviction associated with the delivery of a health care item or service under the Medicare program. She later received a lifetime exclusion in December 2005.

Medicare is a federal insurance program that provides health insurance coverage for people age 65 and older, and for certain disabled people as well. The Medicare program is divided into several different parts: "Part A" of the Medicare program covers health services provided by hospitals, skilled nursing facilities, hospices, and home health agencies; "Part B" of the Medicare program covers most outpatient services, including durable medical equipment (DME), that is, equipment which may be used in the home or on a repeated basis for a medical purpose. DME include, among other things, wound care supplies, diabetic supplies, and wheelchairs. The Medicaid Program is a jointly funded between the Federal and State governments to assist States in the provision of adequate medical care to eligible needy persons. In Colorado, Medicaid is funded with approximately 50% federal monies, and the remaining 50% is paid by the state.

Additionally, the defendants were charged with 49 counts of money laundering associated with financial transactions derived from their fraudulent activities.

“Healthcare fraud results in higher costs for everyone,” said U.S. Attorney John Walsh. “Prosecutions such as this are vitally important to protect those who need Medicare and Medicaid from these unnecessary cost increases.”

“Colorado’s Medicaid program and the federal Medicare program provide essential health services to the neediest among us,” Colorado Attorney General John Suthers said. “Individuals and companies that defraud these programs not only steal from the state and federal government, but also detract from the resources available to the poor and elderly. This case underlines the partnership we have with federal law enforcement to investigate and prosecute Medicaid and Medicare fraud.”

“Combating Health Care Fraud is a top criminal priority for the FBI,” said FBI Special Agent in Charge James Davis. “The FBI will continue our unwavering support to our state and federal partners in disrupting and dismantling criminal enterprises that defraud all federally funded healthcare benefit programs.”

“The Office of the Inspector General of Health and Human Services is appreciative of the collaborative efforts of our law enforcement partners and the United States Attorney’s Office in this investigation. The OIG will continue to devote maximum investigative resources to protect the Medicare Trust Fund, beneficiaries and taxpayers against fraud, waste and abuse,” said Les Hollie, Special Agent in Charge of the Kansas City Regional Office of HHS-OIG.

“Health care fraud harms everyone and increases the costs of legitimate health care; to combat healthcare fraud, IRS CI provides financial investigative expertise to multi-agency task forces where we follow the money trail from the crime to the culprit,” said Lilia Ruiz, Acting Special Agent in Charge, IRS Criminal Investigation, Denver Field Office.

Leonid and Yelena Stolyar were each charged with 1 count of conspiracy to commit health care fraud, 2 counts of health care fraud, 10 counts of making false statements relating to health care matters, 1 count of causing false representations in relation to health care programs, 26 counts of money laundering, and 1 count of conspiracy to commit money laundering. Leonid was charged with an additional 22 counts of money laundering for a total of 48 counts of money laundering.

Conspiracy to commit health care fraud, making false statements relating to health care matters, and causing false representations in relation to health care programs carry a penalty of not more than 5 years’ incarceration and a fine of up to $250,000 per count. Health care fraud, money laundering, and conspiracy to commit money laundering carry a penalty of 10 years’ incarceration and a fine of up to $250,000 per count.

If convicted, the defendants shall forfeit to the United States of America, all of their interest in any property, real or personal, that constitutes or is derived, directly or indirectly, from gross proceeds traceable to the commission of the scheme. In this case, the Stolyars face asset forfeiture of $3.8 million to compensate Medicaid and over $500,000 to compensate Medicare for their fraudulent criminal conduct.

This case was investigated by the Federal Bureau of Investigation (FBI), IRS – Criminal Investigation, Health and Human Services Office of the Inspector General, and the Medicaid Fraud Control Unit.

The case is being prosecuted by Assistant U.S. Attorney’s Jaime Pena and Tonya Andrews.

The charges in the indictment are allegations, and the defendants are presumed innocent unless and until proven guilty.


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

Seven Hospitals in Six States to Pay U.S. More Than $6.3 Million to Resolve False Claims Act Allegations Related to Kyphoplasty

Source- http://www.justice.gov/opa/pr/2011/January/11-civ-006.html

WASHINGTON – Seven hospitals located in Florida, Mississippi, Texas, South Carolina, North Carolina and Alabama have agreed to pay the United States a total of more than $6.3 million to settle allegations that the health care facilities submitted false claims to Medicare, the Justice Department announced today.

The settlements resolve allegations that these hospitals overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. In many cases, the procedure can be performed safely as a less costly out-patient procedure, but the government contends that the hospitals performed the procedure on an in-patient basis in order to increase their Medicare billings.

"Hospitals that participate in the Medicare program must bill for their services accurately and honestly," said Tony West, Assistant Attorney General for the Department’s Civil Division. "The Department of Justice is committed to ensuring that Medicare funds are expended appropriately."

"These settlements show the continuing commitment by the U.S. Attorney’s Office to investigate and recover any improper billings for kyphoplasty procedures which the hospitals inappropriately classified as inpatient, rather than outpatient," said William J. Hochul Jr., U.S. Attorney for the Western District of New York. "These actions not only protect taxpayers and the integrity of the Medicare program in the short term, they will in the long run help ensure optimal care for Medicare beneficiaries, by insisting that medicine, and not money, be used to determine the best course medical decision for a given case."

The settling facilities include the following: Lakeland Regional Medical Center, Lakeland, Fla. ($1,660,134.49); The Health Care Authority of Morgan County – City of Decatur dba Decatur General Hospital, Decatur, Ala. ($537,892.88); St. Dominic-Jackson Memorial Hospital, Jackson, Miss. ($555,949.35); Seton Medical Center, Austin, Texas ($1,232,955.91); Greenville Memorial Hospital, Greenville, S.C. ($1,026,764.01); Presbyterian Orthopaedic Hospital, Charlotte, N.C.($637,872.57); and The Health Care Authority of Lauderdale County and the City of Florence, Ala., dba the Coffee Health Group, fka Eliza Coffee Memorial Hospital ($676,038.00).

The settlements with these facilities follow the settlements that the government reached in May 2009, September 2009, and May 2010 with 18 other hospitals for kyphoplasty-related Medicare claims, as well as the government’s May 2008 settlement with Medtronic Spine LLC, corporate successor to Kyphon Inc. Medtronic Spine paid $75 million to resolve allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as an in-patient procedure, even though the minimally-invasive procedure should have been done in many cases as an out-patient procedure.

All of the settling facilities were named as defendants in a lawsuit filed under the False Claims Act in 2008 in federal district court in Buffalo, New York by Craig Patrick and Charles Bates. The qui tam, or whistleblower, provisions of the Act permit private citizens, called "relators," to file lawsuits on behalf of the United States and share in any recovery. Mr. Patrick of Hudson, Wis., is a former reimbursement manager for Kyphon, and Mr. Bates was formerly a regional sales manager for Kyphon in Birmingham, Ala. The relators will receive a total of approximately $1.1 million as their share of the settlement proceeds.

"Hospitals overcharging Medicare take critically needed resources necessary to provide quality care and drive up health care costs," said Daniel R. Levinson, Inspector General for the U.S. Department of Health and Human Services. "When Medicare and taxpayers' dollars are threatened, OIG and its federal partners will hold perpetrators accountable."

Assistant Attorney General West noted that the settlements with these hospitals were the result of a coordinated effort among the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Western District of New York, and the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General.

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 approximately $4.2 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 have topped $6.8 billion.


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