St. Louis, MO: The United States Attorney’s Office announced that a federal judge has entered a judgment of $82,642,592 in favor of the United States in a "whisteblower" lawsuit originally filed in the federal district court in St. Louis in 2005, and then transferred to the federal district court in Nashville, Tennessee. The lawsuit claimed that Renal Care Group, Renal Care Group Supply Company and Fresenius Medical Care Holdings, Inc. recklessly disregarded federal law when billing the Medicare program for home dialysis supplies and equipment during 1999-2005.
The Court's orders in this case discuss the concerns of multiple Renal Care Group employees who complained about the operation and Medicare billing activity of the Renal Care Group Supply Company, including one regional manager who wrote, "I do not wish to go to jail," and felt the company "was not in the best interests of patients" after receiving a corporate directive about converting patients into the Renal Care Group Supply Company. The Court further noted that Renal Care Group failed to heed the advice of the company's lawyers when operating the supply company and also discussed an internal audit of the supply company that found that one hundred percent of the company's files were missing information that Medicare required for billing.
Renal Care Group ("RCG") was a publicly traded for-profit corporation and dialysis provider until it merged with dialysis industry competitor Fresenius Medical Care ("FMC"). RCG had its principal place of business in Nashville, Tennessee, and had locations throughout Missouri, including multiple facilities around the St. Louis metropolitan area. RCG Supply Company ("RCGSC") was a Tennessee corporation that was owned and operated by RCG. In August 2009, a District Court Judge in St. Louis transferred the case to the Middle District of Tennessee for trial, finding that a trial in Nashville, Tennessee, would be more convenient for many witnesses. FMC now owns and operates RCG's dialysis facilities after the merger with RCG. RCG and FMC provided renal dialysis and related services to patients with End-Stage Renal Disease (“ESRD”). ESRD is a life threatening condition in which a patient's kidneys are unable to remove toxins from the blood, thus necessitating some form of dialysis treatment. This condition is often suffered by patients who have experienced chronic kidney disease over a period of time. The Government's Medicare program generally provides coverage for ESRD patients.
The Government's complaint alleged that between January 1999 and December 2005, RCGSC submitted claims to the Medicare program for home dialysis supplies provided to ESRD patients for reimbursement of the supplies and equipment. All of these claims, as well as related claims for support services rendered by RCG dialysis clinics were false because the defendants were prohibited from and not qualified to bill Medicare for these home dialysis patients. Under federal law, the Medicare program pays companies that provide dialysis supplies to ESRD patients only if the companies that provide the supplies are truly independent from dialysis facilities and the ESRD patient chooses to receive supplies from the independent supply company. Defendants set up a sham billing company, RCGSC, that was not independent from RCG. Further, RCG interfered with ESRD patients' choice of supply options, requiring patients to "move" to RCGSC. Even after RCG employees raised concerns and industry competitors closed their supply companies, RCG kept RCGSC open because of the illicit revenue it created.
This is the second Medicare fraud case focused on the dialysis industry brought by the United States Attorney’s Office for the Eastern District of Missouri. In December 2005, Gambro Healthcare, a leading owner and operator of renal dialysis clinics in the United States, paid the United States $310.5 million to resolve civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company.
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Tuesday, May 31, 2011
United States Awarded $ 82 Million in a Medicare Fraud Against Renal Care Group & Fresenius Medical Care
Monday, May 30, 2011
Areté Sleep LLC to Pay the United States $650,000 to Resolve False Claims Act Allegations
WASHINGTON – Areté Sleep LLC, Areté Sleep Therapy LLC and Areté Holdings LLC have agreed to pay the United States $650,000 to settle allegations that their sleep medicine and durable medical equipment facilities in Arizona and Texas submitted false claims to Medicare, the Justice Department announced today.
Today’s settlement resolves False Claims Act allegations that, from Nov. 1, 2002, through Dec. 31, 2009, Areté made false claims to Medicare for diagnostic sleep tests performed by technicians lacking the licenses or certifications required by Medicare rules and regulations. The settlement also resolves related allegations that Areté made false claims to Medicare for medical devices resulting from these same technicians’ tests.
On Jan. 26, 2011, Areté filed voluntary petitions for relief under Chapter 11 of the Bankruptcy Code in the U.S. Bankruptcy Court in the District of Arizona. Areté has agreed to pay the False Claims Act settlement from the proceeds of the sale of its assets.
“The Department of Justice is committed to preventing waste, fraud and abuse in the Medicare program and ensuring that these funds are not spent on care that does not meet Medicare’s standards,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division.
“Cheating Medicare harms not only the health care of others but all taxpayers,” said Dennis K. Burke, U.S. Attorney for the District of Arizona. “This settlement demonstrates the ongoing efforts of our office to recover taxpayer dollars for the Medicare program.”
All three Arete entities were named as defendants in a whistleblower lawsuit brought under the False Claims Act, which permits private citizens, known as “relators,” to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant. Relator Amanda Drews will receive $107,250 as her share of the recovery.
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Sunday, May 29, 2011
Andres Cespedes the Vice President of Fraudulent Physical Therapy Company Pleads Guilty to Medicare Fraud
Andres Cespedes, 44, pleaded guilty before U.S. Magistrate Judge Mark A. Pizzo in Tampa to one count of conspiracy to commit health care fraud.
According to court documents, Cespedes was the vice-president of Dynamic Therapy Inc. Cespedes and his co-conspirators purchased Dynamic from its prior owners, and transformed it into a fraudulent enterprise. Dynamic purported to provide physical therapy services to Medicare beneficiaries, but in reality obtained patient information through kickbacks and bribes, and billed Medicare for physical therapy that never occurred.
According to court documents, from fall 2009 to summer 2010, Cespedes submitted and caused the submission of $757,654 in fraudulent claims to the Medicare program by Dynamic. Cespedes admitted that he and his co-conspirators paid and caused the payment of kickbacks and bribes to Medicare beneficiaries in order to obtain their Medicare billing information, and used it to submit claims to Medicare for physical therapy services that were never provided. According to court documents, the owners and operators of Dynamic also stole the identities of a physical therapist and Medicare beneficiaries in order to submit additional false claims to Medicare. Cespedes admitted that he knew the Medicare beneficiaries, on whose behalf claims were submitted to Medicare by Dynamic, never received the services billed to Medicare.
At sentencing, Cespedes faces a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not been set.
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Friday, May 27, 2011
Houston Federal Jury Convicts Marion Beverly Metoyer of Medicare Fraud Involving Claims of Hurricane Damage to Power Wheelchairs
WASHINGTON – Marion Beverly Metoyer, a patient recruiter for a Houston durable medical equipment (DME) company, was convicted today by a Houston federal jury of health care fraud related to a power wheelchair fraud scheme, the Departments of Justice, Health and Human Services (HHS) and the FBI announced.
After a four-day trial, Metoyer, 57, of Dayton, Texas, was convicted on one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries, and two counts of receiving illegal kickbacks for referring Medicare beneficiaries.
According to evidence presented at trial, Helen Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies. Metoyer was a recruiter for Luant who was paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare. Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.
Evidence at trial showed that, based on representations from Metoyer and other recruiters, Luant would bill Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008. In fact, the hurricanes did not damage the wheelchairs. Certain beneficiaries testified that they did not even have a power wheelchair before receiving the ones provided to them by Luant. Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.
At trial, beneficiaries in whose names claims were submitted to Medicare testified that recruiters whom they had never met, including Metoyer, came to their homes and offered them free power wheelchairs in exchange for their Medicare information. The power wheelchairs were often billed to Medicare at more than $6,000 per chair.
Etinfoh was previously convicted by a federal jury of health care fraud in April 2010, and was sentenced to 41 months in prison. Paula Whitfield, a patient recruiter for Luant, was also convicted by a federal jury in April 2010, and was sentenced to 21 months in prison. Melvin Barnes, Johnnie Lee Andrews and Monica Rene Perry, each a patient recruiter for Luant, pleaded guilty to conspiracy to commit health care fraud and await sentencing.
At sentencing, Metoyer faces maximum penalties of 10 years in prison for the health care fraud conspiracy; 10 years in prison for committing health care fraud; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary. A sentencing date has not been set.
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Thursday, May 26, 2011
Robert Bourlier Convicted of Drug Offenses Resulting in Patients’ Deaths
PENSACOLA, FL—Destin physician Robert Bourlier, 55, was convicted today of 17 counts of health care fraud and 126 counts of unlawful dispensing of controlled substances, announced Pamela C. Marsh, U.S. Attorney for the Northern District of Florida.
The convictions came at the end of a three-week jury trial in Pensacola. At trial, the government presented evidence that, while operating a medical business known as Dr. Robert Bourlier, Internal Medicine, on U.S. Highway 98 in Destin, Bourlier prescribed controlled substances to patients without a sufficient medical necessity, and did so in quantities and dosages that caused his patients to abuse, misuse, and become addicted to the drugs. Through the testimony of more than 76 witnesses, the government established that Bourlier continued to prescribe controlled substances even after he learned that the patients were addicted to the drugs, had suffered overdoses from them, were doctor-shopping to get more drugs, or were, in some cases, selling the drugs on the street.
The government’s evidence in support of the health care fraud charges included evidence that, as a result of Bourlier’s unlawful prescribing practices, Medicaid, Medicare, Tricare, and Blue Cross/Blue Shield paid for prescriptions that were not medically necessary. The government also presented evidence that Bourlier submitted fraudulent claims for medical services to these health care benefit organizations.
The jury’s verdict included a finding that Bourlier’s dispensing of methadone and alprazolam in September 2006, and his dispensing of hydrocodone and alprazolam in August 2007, resulted in the death of two patients.
Bourlier faces a maximum sentence of 10 years’ imprisonment for each of the health care fraud convictions, a sentence of up to 20 years’ imprisonment on each of the controlled substance dispensing counts, and a mandatory 20 years’ to life term of imprisonment on the one count of dispensing of methadone resulting in death. Sentencing is scheduled for a date after August 12, 2011.
On the day of jury selection, Bourlier’s wife and co-defendant, Victoria Bourlier, pled guilty to charges that she obstructed justice by removing records, documents, and objects, including two safes and a duffel bag from the residence she shared with Robert Bourlier while officials were executing a search warrant at Bourlier’s medical office. Victoria Bourlier is scheduled to be sentenced on a date after July 11, 2011. She faces a maximum of 20 years’ imprisonment.
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Wednesday, May 25, 2011
Obel Martinez and Damaris Gil, Owners and Operators of Medical Equipment Company Plead Guilty to Medicare Fraud
WASHINGTON – Two Miami-area residents who were owners and operators of a durable medical equipment (DME) company, pleaded guilty today for their roles in a scheme to defraud Medicare, the Departments of Justice and Health and Human Services (HHS) announced.
Obel Martinez and Damaris Gil, a married couple, each pleaded guilty before U.S. District Judge Donald M. Middlebrooks in the Southern District of Florida to one count of conspiracy to commit health care fraud.
According to plea documents, Martinez and Gil incorporated and operated OM Best Help Corp. in 2006 for the purpose of defrauding Medicare. OM Best purportedly specialized in the provision of DME and prescription drugs to Medicare beneficiaries.
According to court documents, starting in 2008, Martinez and Gil submitted and caused the submission of approximately $1,089,234 in fraudulent claims to the Medicare program. The defendants and their co-conspirators used without authorization the Medicare billing identifiers of licensed medical doctors and falsely represented to Medicare that the doctors had prescribed DME, when, in fact, the doctors had not done so. The defendants also knew that the Medicare beneficiaries, on whose behalf claims were submitted to Medicare by OM Best, never received the items OM Best billed to Medicare.
Sentencing for Martinez and Gil is scheduled for Aug. 23, 2011. Each defendant faces a maximum of 10 years in prison.
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Tuesday, May 24, 2011
Kimberly Boccacio Who Obstructed Federal Investigation Is Sentenced
David B. Fein, United States Attorney for the District of Connecticut, announced that KIMBERLY BOCCACIO, 40, of Pomfret Center, was sentenced today by Chief United States District Judge Alvin W. Thompson in Hartford to three years of probation.
According to court documents and statements made in court, BOCCACIO was employed as the nursing home administrator at Haven Health Center of Jewett City. On July 14, 2008, BOCCACIO was interviewed by federal agents concerning the forging of the signature of a former resident of Haven Health Center of Jewett City on a resident admissions agreement. BOCCACIO provided materially false information to the agents and stated that she had witnessed the patient sign the agreement when, in fact, BOCCACIO knew that the signature was a forgery.
On August 24, 2009, BOCCACIO pleaded guilty to one count of obstruction of a federal criminal health care investigation.
This matter stems from a larger investigation into fraud at Haven Healthcare, a chain of nursing homes formerly headquartered in Middletown. The investigation also has resulted in convictions of Raymond Termini, the former CEO of Haven Healthcare; Fred Dalicandro, the former director of cash management of Haven Healthcare; and Serena Sylvia, a former regional accounts receivable manager for Haven Healthcare.
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Monday, May 23, 2011
John M. Almon Faces Federal Charges of Health Care Fraud, Obstructing Federal Agents
PROVIDENCE, R.I. – The United States Attorney’s Office in Rhode Island today announced the filing of an Information in U.S. District Court in Providence charging John M. Almon, 55, of Cranston, R.I., owner and president of Med Care Ambulance LLC, of Warwick, R.I., with two counts of health care fraud, and one count each of obstructing a federal audit and making false statements. It is alleged that Almon defrauded health care programs administered by Medicare and Blue Cross Blue Shield of more than $700,000.
A not guilty plea was entered on behalf of the defendant at his arraignment in U.S. District Court in Providence on Thursday before U.S. District Court Magistrate Judge Lincoln D. Almond. Almon was released on personal recognizance. The Information alleges that John Almon defrauded Medicare of $625,825.31, and defrauded Blue Cross Blue Shield of $78,292.25.
According to the Information, beginning in March 2008 and continuing until December 2010, John Almon obtained payments in excess of $700,000 from Medicare and Blue Cross Blue Shield, by improperly submitting claims for reimbursement to health care benefit programs that falsely and fraudulently represented that Med Care had provided medically necessary Specialty Care ambulance transportation.
Court documents allege that the defendant actively solicited beneficiaries to be transported on a routine basis from their residences, either at home or a nursing facility, to renal care facilities for dialysis treatments. The majority of the transportation was routine in nature and did not require advanced or specialty care.
In addition, Almon actively solicited beneficiaries to agree to be transported for dialysis treatments by waiving the co-payment that the beneficiary would be liable for once Medicare or Blue Cross determined the amount that they would pay for services. By waiving co-payments, Med Care removed the monetary obstacle a patient might have had, and thus would agree to be transported by Med Care. Such transportation can be extremely lucrative because patients are transported two to three times a week on a round trip basis and provide a steady cash stream for an ambulance provider.
In addition to allegations of health care fraud, it is alleged in the Information that John Almon obstructed federal auditors contracted by the U.S. Department of Health and Human Services by instructing members of his executive staff to gather documents responsive to a Medicare Audit, and to “clean them up” and ensure there are no “red flags.
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Saturday, May 21, 2011
Homero Izquierdo Ruiz Sentenced for Health Care Fraud
Izquierdo Ruiz was sentenced to a 39-month term of imprisonment, concurrently, on two counts of health care fraud, in violation of Title 18, United States Code, Section 1347. On these charges, Izquierdo Ruiz faced a possible maximum term of imprisonment of 10 years. In addition to the terms of imprisonment, Izquierdo Ruiz received a three-year period of supervised release and was ordered to pay restitution to Medicare in the amount of $1,045,977.72, and to forfeit his interest in $104,959.00 to the United States.
According to the stipulated factual basis in support of the guilty plea, the defendant purchased Physical Therapy and Fitness (PT&FI), located in Martin County. PT&FI was a physical therapy outpatient clinic that received reimbursement from Medicare Part A for the treatment of patients referred by physicians for physical therapy. Once the defendant purchased PT&FI, fraudulent billing to Medicare Part A began to occur, especially during the month of July 2010. Medicare records show that PT&FI received a total of approximately $528,094.27 in reimbursement from Medicare beginning on January 3, 2010 through August 13, 2010.
In addition, according to the stipulated factual basis, in May of 2010, the defendant purchased Ebenezer Medical Services, Inc., (Ebenezer) located in Miami Dade, which was a “pharmacy” that received reimbursement from Medicare Part D plan for prescription drugs. At one time, Ebenezer qualified as a pharmacy, but when the Defendant purchased the “business,” Ebenezer was not actually functioning as a pharmacy. Medicare records show that approximately $587,843.06 was paid to Ebenezer from May 14, 2010 through August 13, 2010. Sixteen doctors provided “attestation” letters stating that the items billed by Ebenezer under their names and National Provider Identification (NPI) numbers were billed in a false manner. In addition, four beneficiaries filed complaints that the billing listed prescription drugs that were never issued to them.
Mr. Ferrer commended the investigative efforts of the Department of Health and Human Services, the Federal Bureau of Investigation and the Martin County Sheriff’s Office for their work on this case. The case is being prosecuted by Assistant U.S. Attorney Diana M. Acosta and Assistant U.S. Attorney Antonia Barnes.
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Thursday, May 19, 2011
Sentenced to 84 Months in Prison for Health Care Fraud Scheme Involving More Than $2 Million in False Billings
WASHINGTON – The owner of a Houston-area durable medical equipment (DME) company was sentenced to 84 months in prison for her role in a Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Doris Vinitski, a Houston-area resident, was sentenced yesterday by U.S. District Court Judge Nancy F. Atlas in the Southern District of Texas. Vinitski pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud.
According to court documents, Vinitski, 46, was the owner of Onward Medical Supply, a Houston-area DME company. Onward began billing Medicare for fraudulent DME in 2003. In pleading guilty, Vinitski admitted she paid kickbacks, sometimes $1,000 per patient, to recruiters who brought patients to Onward. Vinitski and her co-conspirator and estranged husband, John Lachman, then billed Medicare for DME that these patients either did not need or never received, including power wheelchairs and orthotic devices. Lachman also pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud and was sentenced to 26 months in prison. According to court documents, the fraud scheme at Onward resulted in more than $2 million in fraudulent billing to Medicare.
Nine additional defendants involved in the Onward fraud scheme are currently serving prison sentences. One remaining defendant is awaiting sentencing in the Eastern District of Texas.
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Wednesday, May 18, 2011
Patrick Crisler Charged with Health Care Fraud and Identity Theft in Connection with Medicaid Billings
TAMPA, FL—United States Attorney Robert E. O'Neill announces the return by a grand jury of an indictment charging Patrick Crisler (45, Inverness) with six counts of health care fraud and six counts of aggravated identity theft. If convicted on all counts, Crisler faces a maximum penalty of 10 years in federal prison on the health care fraud charge, a fine of $250,000, or twice the gross gain/loss caused by the offense, whichever is greater, and a term of supervised release of not more than three years. He faces a consecutive mandatory minimum of two years in federal prison on the aggravated identity theft counts. The indictment also notifies Crisler that the United States intends to seek a money judgment or forfeit any assets which are alleged to be traceable to proceeds of the offense. Crisler was first arrested on these charges on February 17, 2011.
According to the indictment, Crisler, an occupational therapy assistant and owner of Active Life Rehab, Inc., was charged with health care fraud and aggravated identity theft for submitting fraudulent claims of more than $1 million to the Medicaid program for occupational therapy services that were either not provided at all, or not provided as billed to Medicaid. Specifically, Crisler is alleged to have falsified patient records and knowingly engaged in "upcoding" by using the unauthorized Medical Provider Numbers of other licensed occupational therapists to submit claims to Medicaid for payment to Active Life Rehab.
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Tuesday, May 17, 2011
William Goldman Guilty of Health Care Fraud
PLANO, TX—A 52-year-old Paris, Texas podiatrist has pleaded guilty to federal health care fraud charges in the Eastern District of Texas announced U.S. Attorney John M. Bales today.
William Goldman pleaded guilty to health care fraud today before U.S. Magistrate Judge Don Bush.
According to information presented in court, Goldman submitted false claims to Medicare and Medicaid from 2003 to 2008 from surgeries he never performed. Goldman was indicted by a federal grand jury on Apr. 15, 2010.
Goldman faces up to two years in federal prison. He also faces forfeiture of $350,000.00, along with his podiatry license. A sentencing date has not been set.
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Monday, May 16, 2011
A. Rahway Admits Posing as Licensed Physician in Medicaid and Medicare Fraud Scheme
NEWARK, NJ—A Rahway, N.J. man admitted today to posing as a licensed physician and unlawfully treating patients, prescribing medicine, and ordering procedures at an Elizabeth, N.J. medical practice in a Medicaid and Medicare fraud scheme through which more than 20,000 patient visits were conducted by unlicensed individuals, U.S. Attorney Paul J. Fishman announced.
Hamid Bhatti, 33, was the fourth individual to plead guilty in connection with the scheme. Bhatti entered his guilty plea, to an information charging him with one count of conspiracy to commit health care fraud, before U.S. Magistrate Judge Patty Shwartz in Newark federal court. Judge Shwartz recommended to U.S. District Judge Faith S. Hochberg that his plea of guilty be accepted and entered.
According to documents filed in this case and statements made in court:
Bhatti posed as a licensed physician at the direction of Yousuf Masood, 47, of Warren, N.J., the doctor who ran the practice. Yousuf Masood and his wife, Maruk Masood, 43—the practice's office manager—pleaded guilty on April 21, 2011, before Judge Shwartz to conspiracy to commit health care fraud, admitting that they used unlicensed individuals to treat patients and billed Medicaid and Medicare as if Yousuf Masood provided the services. Another individual, Carlos Quijada, 31, of Hawthorne, NJ, pleaded guilty on April 27, 2011, before Judge Shwartz to conspiracy to commit health care fraud, admitting to posing as a licensed physician at the direction of the Masoods.
At today's hearing, Bhatti explained that he had responded to an advertisement the Masoods had placed on craigslist. Although Bhatti told them he had not passed required tests and was not licensed to practice, they directed him to treat, diagnose, and prescribe medication for patients, introducing himself to patients as "Dr. Bhatti." Bhatti admitted that he worked six days per week and regularly saw and treated 30 to 40 patients each day.
Over the course of the scheme, more than 20,000 patient visits were conducted by unlicensed individuals, including Bhatti, but billed to Medicaid and Medicare as if Yousuf Masood had examined the patients. Hakim Muta Muhammad, 31, of Newark, is also charged by complaint for pretending to be a doctor during patient visits, and those charges remain pending.
Yousuf Masood was the top prescriber of drugs to Medicaid patients in New Jersey in 2009, prescribing more than $9 million in Medicaid drugs that year. The next-highest prescribing doctor in New Jersey prescribed less than $6 million. Yousuf Masood provided Bhatti, Muhammad, and Quijada with pre-signed, blank prescription forms to write prescriptions in his name for patients they were improperly examining and treating. Bhatti admitted today that he wrote prescriptions for a wide variety of drugs, including medications used to treat schizophrenia, bipolar disorder, anxiety, insomnia, and other illnesses.
On some days, more than 100 patients visited the medical practice for treatment, and the majority were treated only by unlicensed individuals. Bhatti stated that while he and other unlicensed individuals were diagnosing and treating patients, Yousuf Masood was frequently either not in the office at all, or was in his personal office watching television.
In addition to prescribing medication, Bhatti ordered that procedures be performed on patients—including electrocardiograms, bronchodilation responsiveness tests, and transnasal eustachian tube inflation. Yousuf Masood and Maruk Masood billed Medicaid and Medicare for these procedures. At his guilty plea, Yousuf Masood agreed to pay more than $1.8 million in restitution and forfeiture based on the fraudulent Medicaid and Medicare billings.
The conspiracy charge carries a maximum penalty of 10 years in prison and a fine of $250,000, or twice the gross gain or loss from the offense. Sentencing is currently scheduled before Judge Hochberg for July 27, 2011 for Yousuf Masood, Maruk Masood, and Carlos Quijada, and for September 12, 2011 for Bhatti.
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Sunday, May 15, 2011
Houston Federal Jury Convicts Four Defendants in Connection with $5.2 Million Medicare Fraud Scheme
WASHINGTON—A federal jury in Houston convicted four defendants today in connection with a $5.2 million Medicare fraud scheme that operated from April 2006 to August 2009, announced the Departments of Justice and Health and Human Services (HHS), the FBI and the Texas Attorney General.
Ezinne Ubani, 46, of Houston, and Mary Ellis, 55, of Missouri City, Texas, were each convicted of one count of conspiring to commit health care fraud, and two counts of making false statements for use in determining rights for benefit and payment by Medicare. Ellis was also convicted of one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries, and three counts of receiving illegal kickbacks for referring Medicare beneficiaries.
Caroline Njoku, 45, of Houston, was convicted of one count of conspiring to commit health care fraud and one count of conspiring to receive kickbacks for referring a Medicare beneficiary. Njoku was found not guilty of one count of receiving illegal kickbacks for referring a Medicare beneficiary. Terrie Porter, 47, of Houston, was convicted of one count of conspiring to receive illegal kickbacks for referring a Medicare beneficiary and one count of illegally receiving a kickback for referring a Medicare beneficiary. Estella Joseph, 62, of Houston, was found not guilty of one count of conspiring to receive kickbacks for referring a Medicare beneficiary, and not guilty of one count of receiving an illegal kickback for referring a Medicare beneficiary
The four defendants were convicted after a 15-day trial before U.S. District Court Judge Nancy Atlas in Houston. According to the evidence presented at trial, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries. Family Healthcare Group hired Njoku, Ellis, Porter, and other 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. After the Medicare beneficiaries were recruited, Ubani, a registered nurse, and other co-conspirators fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact they knew the beneficiaries were not home-bound and not in need of skilled nursing.
Ubani’s husband, Clifford, and Njoku’s husband, Princewill, were co-owners of Family Healthcare Group and they both previously pleaded guilty to conspiring to commit healthcare fraud and conspiring to paying illegal kickbacks for referring Medicare beneficiaries. Additionally, Adelma Casas-Sevilla, a registered nurse employed by Family Healthcare Group, previously pleaded guilty to conspiring to commit healthcare fraud. Sammie Wilson and Cynthia Garza-Williams, both patient recruiters for Family Healthcare Group, also pleaded guilty to conspiring to commit healthcare fraud. Erica Walker and Florida Holiday Island, both patient recruiters for Family Healthcare Group, pleaded guilty to conspiring to receive illegal kickbacks for referring a Medicare beneficiary and illegally receiving a kickback for referring a Medicare beneficiary. Family Healthcare Group is no longer in business.
At sentencing, scheduled for July 20 and 21, 2011, the defendants face maximum penalties of 10 years in prison for the health care fraud conspiracy count; five years in prison for making false statements for use in determining rights for benefit and payment by Medicare; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary.
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Christopher Fronczak Pleads Guilty to Health Care Fraud
ROCHESTER, NY—U.S. Attorney William J. Hochul, Jr. announced today that Christopher Fronczak, 37, of Victor, New York, pleaded guilty before U.S. District Court Judge Charles J. Siragusa to health care fraud. The charge carries a maximum sentence of 10 years in prison and a $250,000 fine.
Assistant U.S. Attorney Richard A. Resnick, who is handling the case, stated that during the years 2005 and 2010, the defendant, while a Doctor of Chiropractic Medicine, executed a scheme to defraud Excellus BlueCross BlueShield (“Excellus”), a health care benefit program, by submitting reimbursement claims for services he did not perform.
Part of the scheme involved chiropractic services the defendant provided to college football players and other athletes at St. John Fisher College. Fronczak provided adjustments to the athletes after practices which took appropriately five minutes each but he submitted claims to Excellus for more expensive treatments which were not provided, including spinal manipulation, electrical stimulation, mechanical traction, manual therapy techniques, and an office visit. The claims submitted were virtually identical for each football player.
In another case, a 45-year-old patient was treated for shoulder pain once or twice a month. This patient never received mechanical traction and most visits would lasted approximately 10 minutes. Despite this, Fronczak submitted claims for numerous visits which never took place and for services which were never rendered, including application of hot and cold packs, mechanical traction, electrical stimulation, manual therapy techniques, and spinal manipulation.
During the years 2005 through 2009, the defendant was also hired by the Crossman Corporation as an independent contractor to provide Chiropractic services to their employees. The company paid Fronczak approximately $67,000 but he billed the employees’ insurance companies as well.
The total loss to Excellus due to the defendant’s conduct was more than $200,000.
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Saturday, May 14, 2011
Jacqueline Wheeler Indicted for Health Care Fraud, Other Charges After Investigation into Billing Practices
WASHINGTON—Jacqueline Wheeler, 54, a health care provider who did business in the District of Columbia, was indicted today by a federal grand jury and charged with one count of health care fraud and 39 counts of false statements in a health care matter.
The indictment was announced by U.S. Attorney Ronald C. Machen Jr.; James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office; Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services; and Charles J. Willoughby, Inspector General for the District of Columbia.
The grand jury returned the indictment in the U.S. District Court for the District of Columbia. Wheeler, of Chevy Chase, Md., faces a maximum sentence of 10 years in prison and a $250,000 fine. Under the advisory federal sentencing guidelines, the likely range of imprisonment, if convicted, is 51 to 63 months.
According to the indictment, Wheeler was the chief executive officer of the Health Advocacy Center, Inc., in the 900 block of Sheridan Street NW, Washington, D.C. She was also the owner of Sheridan Rehabilitative and Wellness Centers, Inc. a private company, which was located at the same Sheridan Street address.
The Health Advocacy Center was purportedly engaged in serving as an advocate for improved health care delivery to the community. It also provided management support, as well as financial advice and assistance to other health care providers. It was a registered District of Columbia Medicaid provider.
Sheridan was purportedly engaged in providing rehabilitative services to the mentally and physically disabled community. It also purportedly provided housing to mentally and physically challenged individuals. Sheridan was not an authorized D.C. Medicaid provider.
Wheeler was a registered naturopath with the District of Columbia Department of Health, Health Professional Licensing Administration. However, she was not a medical doctor and was not licensed to practice medicine. Wheeler did work with a licensed medical doctor, who was part owner of the Health Advocacy Center. This doctor’s specialty was physical medicine and rehabilitation.
Because Sheridan was not authorized as a D.C. Medicaid provider, it was unable to submit bills to D.C. Medicaid. From on or about January 2006 through on or about April 2008, Wheeler prepared and submitted all of the billing for the Health Advocacy Center, and handled all financial matters for both the Health Advocacy Center and Sheridan.
During that time period, she submitted or caused the submission of approximately 603 claims to D.C. Medicaid for manual therapy services that the Health Advocacy Center purportedly provided to approximately 22 District of Columbia Medicaid beneficiaries. In these claims, she maintained that the Health Advocacy Center provided in excess of 20 continuous hours of manual therapy for each patient in a single 24-hour period, and sought approximately $6.2 million from D.C. Medicaid for manual therapy services.
In performing therapeutic procedures such as manual therapy, the health care provider is required to bill in 15 minute intervals or units. There are only 1,440 minutes in a day. However, Wheeler routinely billed and/ or caused D.C. Medicaid to be billed from 1,440 of continuous minutes of manual therapy for a single patient in a 24-hour day, to as many as 2,910 continuous minutes (or 48.5 hours) of manual therapy for a single patient in a 24-hour period.
D.C. Medicaid paid the Health Advocacy Center in excess of $2.5 million for manual therapy services that were purportedly provided to the patients. The payments were deposited in bank accounts controlled by Wheeler.
After D.C. Medicaid paid the Health Advocacy Center for the fraudulent claims, Wheeler diverted the proceeds of the fraud for her personal use and benefit, including the purchase of real estate in Florida, North Carolina, and the District of Columbia.
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Friday, May 13, 2011
Aleksandr Kharkover Pleads Guilty to Fraud Scheme Involving False Billings to Medicare
WASHINGTON – A Brooklyn physical therapist pleaded guilty today for his role in submitting false and fraudulent claims to Medicare for physical therapy services that were medically unnecessary and never provided, announced the Departments of Justice and Health and Human Services (HHS).
Aleksandr Kharkover, 49, pleaded guilty before U.S . Magistrate Judge Marilyn Go in the Eastern District of New York to an indictment charging him with five counts of health care fraud. Kharkover faces a maximum of 10 years in prison for each count of health care fraud. His sentencing has not yet been scheduled.
According to the indictment, between January 2005 and July 2010, Kharkover caused the submission of approximately $11.9 million in false and fraudulent claims to Medicare for physical therapy services that were not performed and were not medically necessary. According to the indictment, Kharkover hired individuals who were not certified as physical therapy assistants to purportedly provide physical therapy to Medicare beneficiaries.
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Thursday, May 12, 2011
Tuan Duc Tran Arraigned on Federal Mail Fraud Charges Alleging Medicare Scam
SANTA ANA, CA—The owner and chief executive officer of an Orange County rehabilitation facility has been arraigned in federal court on charges related to a scheme in which he allegedly submitted nearly $1 million in fraudulent claims to Medicare for services that were not prescribed by treating doctors and were not medically necessary.
Tuan Duc Tran, 50, of Westminster, appeared yesterday in United States District Court and pleaded not guilty to charges contained in a nine-count indictment. Tran was arraigned after surrendering to federal authorities.
Tran operated the Fountain Valley Healthcare Center (FVHC). From May 2003 through January 2008, Tran allegedly sought payments from Medicare based on false claims that Medicare beneficiaries had been referred to FVHC for physical and respiratory therapy by their treating doctors. The indictment also alleges that many of the beneficiaries did not have a medical need for therapy and that Tran employed unlicensed personnel at FVHC.
Tran is charged with nine counts of mail fraud based on a total of $910,588 in checks that were sent to FVHC between March 2006 and January 2008. A federal grand jury returned the indictment in late March.
At yesterday’s arraignment, Tran’s case was assigned to United States District Judge Josephine Staton Tucker, who scheduled a trial for July 5. During yesterday’s hearing, Tran was freed on a $10,000 bond.
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Tuesday, May 10, 2011
Dentist James Crow in Health Care Fraud Scheme
SAN ANGELO, TX—Following a nearly two-week trial before U.S. District Judge Sam R. Cummings, a jury has found James Crow, a dentist from Brownwood, Texas, guilty on 17 of the 20 counts of a superseding indictment charging offenses related to a health care fraud scheme he ran, announced U.S. Attorney James T. Jacks of the Northern District of Texas.
The jury convicted Crow, 67, on two counts of making false statements involving a health care matter and 15 counts of health care fraud. Each false statement count carries a maximum statutory sentence of five years in prison and a $250,000 fine. Each of the health care fraud counts carries a maximum statutory sentence of 10 years in prison and a $250,000 fine. Judge Cummings ordered a pre-sentence investigation report; a sentencing date will be set after the conclusion of that report.
After the verdict, Judge Cummings entered a preliminary order of forfeiture which will require Crow to forfeit property derived from the proceeds of his scheme, including funds in various bank/investment accounts, a truck, several Harley Davidson motorcycles, a residence located on Lakeview Court in Brownwood, additional real estate in Brown County, Texas, a camper and trailer, and a boat and trailer.
The government presented evidence at trial that from January 2004 through December 2007, Crow, a dentist who was enrolled with Medicaid, filed, and caused to be filed, Medicaid claims for payment of services that he did not render and for payment of services that were billed with improper billing codes. Crow billed Medicaid for numerous resin-based composites restorations (cavity fillings), when in fact, either no such fillings were performed, or he instead performed other dental services not reimbursed by Medicaid.
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Monday, May 9, 2011
DME Company Owner Lia St. Junius and Marketers Devon Spicer and Martha Ramos Convicted of Defrauding Medicare of Millions
HOUSTON—A federal jury has convicted a durable medical equipment (DME) company owner and two marketers of defrauding both federal health care programs—Medicare and Medicaid—United States Attorney José Angel Moreno announced today.
Lia St. Junius, 25, the owner of The Mobility Store—a Houston area DME company—and Devon Spicer, 48, and Martha Ramos, 57, all of Houston, were found guilty late Friday afternoon by a jury following a two-week trial. Medicare and Medicaid are health care benefit programs funded by the federal government which pay for health care services provided to the elderly, the blind and disabled.
The indictment, returned in October 2010, charged St. Junuis, Spicer, and Ramos, along with James Claude Reese Jr., Brenda Lopez, and Lily Johnson, with the commission of various federal crimes including conspiracy to commit health care fraud, health care fraud, paying or receiving kickbacks, money laundering, and tax evasion. Today's verdicts found St. Junius guilty of conspiracy to commit health care fraud and paying kickbacks for the referral of Medicare beneficiaries and Medicaid recipients, health care fraud, and conspiracy to commit money laundering. Ramos and Spicer were convicted of receiving kickbacks for referring Medicare beneficiaries and Medicaid recipients to The Mobility Store.
St. Junius was convicted of conspiracy to commit health care fraud, counts 10 through 16 of substantive health care fraud, and conspiracy to commit money laundering, but acquitted on substantive health care fraud counts two through nine. Through their verdicts, the jury found that St. Junius conspired to defraud Medicare and Medicaid by billing Medicare and Medicaid for orthotic braces and devices, referred to as "The Artho Kit" that were different than equipment that was provided to Medicare beneficiaries or not ordered by a physician. During the trial, several witnesses testified that in May 2004, St. Junius had submitted an application with Medicare to become enrolled as a DME company called The Mobility Store. Although the application requested the name of all persons who had an ownership interest in the company, St. Junius failed to reveal that co-defendant James Reese was involved in the company. Reese, who pleaded guilty to health care fraud and tax evasion before trial, had previously operated a DME that had been suspended for submitting fraudulent claims. Between 2005 and 2008, St. Junius submitted fraudulent documents to Medicare indicating that Reese was not involved in the operation of The Mobility Store and that marketers were not soliciting Medicare beneficiaries. The jury also heard testimony that St. Junius paid marketers 10 percent of the amount received from Medicare for each orthotic brace or device billed.
Spicer was convicted on all substantive counts of receiving kickbacks based upon evidence presented that showed her referral of Medicare beneficiaries in 2005 to The Mobility Store resulted in $750,000 being paid by Medicare. Spicer received approximately $75,000 during 2005. The jury acquitted Spicer of conspiracy to commit health care fraud. Ramos was also acquitted of the conspiracy charge but found guilty on all substantive counts of receiving kickbacks based upon evidence that as a result of referrals by her, The Mobility Store was paid $40,000 and Ramos received approximately $4,000.
In 2008, Medicare revoked The Mobility Store's provider number because of its failure to provide accurate information about its operation procedures. As a result of the fraudulent scheme, The Mobility Store billed Medicare and Medicaid more than $10 million and was paid more than $5 million. Through testimony, the jury heard that St. Junius purchased several expensive cars and a home valued at more than $650,000 with proceeds from the fraudulent scheme.
Immediately following the return of the verdicts, United States District Judge David Hittner, who presided over the trial, revoked each defendant's bond and ordered that each be remanded into the custody of the U.S. Marshals Service.
St. Junius faces a maximum of 20 years in prison and a fine of up to $500,000 for his convictions. Spicer and Ramos each face up to a five-year maximum prison term and a $250,000 fine for their convictions. A sentencing date has not been set. The three others charged for their involvement in this health care fraud scheme—Reece, Lopez, and Johnson—pleaded guilty to conspiring to commit health care fraud in advance of trial. A sentencing date for these three defendants has yet been set.
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Saturday, May 7, 2011
Martin and Joaquin Tasis and Leoncio Alayon Convicted in $9.1 Million Medicare Fraud Scheme in Detroit
WASHINGTON—Two owners of a fraudulent Detroit-area medical clinic, Martin and Joaquin Tasis, and a man who helped them launder the proceeds of the fraud, Leoncio Alayon, were convicted today by a federal jury in Detroit for their roles in a $9.1 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Martin Tasis and Joaquin Tasis were each convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay health care kickbacks and three counts of health care fraud. Martin Tasis was also convicted of one count of conspiracy to commit money laundering and one count of money laundering, and found not guilty on one money laundering count. Alayon was convicted of one count of conspiracy to commit money laundering and two counts of money laundering.
According to evidence presented during the one-week trial, Martin and Joaquin Tasis were owners of Dearborn Rehabilitation and Medical Center (DMRC), a fraudulent HIV-infusion therapy clinic located in Dearborn, Mich. The Tasis brothers oversaw the payment of kickbacks to patients whose Medicare information was then used by DMRC to fraudulently bill Medicare for treatments they never received. Evidence showed that DMRC, an outpatient clinic that purported to specialize in infusion and injection therapy, was established for the sole purpose of defrauding Medicare.
Between November 2005 and March 2007, DMRC billed approximately $9.1 million in claims to Medicare for injection therapy services that were never provided and were not medically necessary. Medicare paid approximately $6 million of those claims. The Tasis brothers used Alayon and a bogus “research” company to launder hundreds of thousands of dollars in proceeds of the fraud.
Evidence presented at trial showed that the Tasis brothers and their co-conspirators helped relocate the highly lucrative infusion therapy fraud scheme from South Florida to Michigan after increased law enforcement scrutiny in South Florida. Evidence at trial showed that Medicare beneficiaries were not referred to DMRC by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of cash kickbacks. DMRC then billed Medicare for expensive medications, purportedly given to treat HIV and Hepatitis-C, which were never administered. For example, evidence at trial showed that DMRC billed $9.1 million to Medicare, but purchased only $36,000 in medication and medical supplies.
Once Medicare started paying the co-conspirators, Martin Tasis enlisted a family friend, Leoncio Alayon, to help him launder the proceeds of the fraud through a shell corporation in Florida called Infinity Research Corp. Evidence at trial showed that Infinity Research Corp. had no employees, did no research and was based at Alayon’s residence. Alayon, after taking a commission, distributed the laundered proceeds to Martin Tasis, Joaquin Tasis and their co-conspirators.
Including today’s guilty verdicts, 12 individuals involved with DMRC have been convicted for their roles in the DMRC scheme. Defendants Clara Guilarte and Caridad Guilarte are currently awaiting trial on charges related to their alleged roles at DMRC. An indictment is merely a charge and defendants are presumed innocent until proven guilty.
A sentencing date for the Tasis brothers and Alayon has not yet been scheduled by the court. Each count of conspiracy to commit health care fraud, health care fraud and money laundering carries a maximum penalty of 10 years in prison and a $250,000 fine. The conspiracy to commit money laundering count carries a maximum penalty of 20 years in prison and a $500,000 fine, and the conspiracy to pay health care kickbacks carries a maximum penalty of five years in prison and a $250,000 fine.
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