Houston doctor Christina Joy Clardy Gets 11+ Years in Health Care Fraud Scheme

Source- http://www.fbi.gov/houston/press-releases/2011/local-doctor-gets-11-years-in-health-care-fraud-scheme

HOUSTON—Houston doctor Christina Joy Clardy, 61, has been sentenced to 135 months in federal prison for her role in a massive health care fraud conspiracy that billed the federal Medicare and Texas Medicaid programs for $45,039,230 over a two-and-a-half-year period, United States Attorney Kenneth Magidson announced today. Clardy was sentenced just a short while ago in federal court in Houston.

Clardy is the third defendant to be sentenced in this matter. Last week, Umawa Oke Imo, the owner of City Nursing Services of Texas, Inc., was sentenced to 327 months for his role in the conspiracy and health care fraud. Clardy, who was found guilty of one count of conspiracy to commit health care fraud, 14 counts of health care fraud and three counts of mail fraud on May 27, 2011, after an 18-day trial in front of U.S. District Judge Melinda Harmon, was also ordered to pay $15,626,084.01 in restitution to Medicare and Medicaid. In arriving at Clardy’s sentence today, Judge Harmon considered the pivotal role Clardy played in abusing the trust of the Medicare and Medicaid programs by allowing the fraudulent billing under her provider numbers.

City Nursing billed more than $25 million worth of physical therapy services under Clardy’s physician provider numbers between January 2007 and August 2008. The United States introduced a letter at trial, sent by Clardy to Imo in July of 2007—a year before she left the clinic—showing her knowledge of the fraudulent activities at the clinic, ordering Imo to immediately cease billing Medicare under her provider number, to notify Medicare of the prior fraudulent billing and threatening to notify Medicare of the fraud if he did not. Clardy testified at trial that after Imo received her letter they had a private meeting at her house and after that she never contacted Medicare about the fraud and never asked Imo if he contacted Medicare or stopped the fraudulent billing. Other evidence introduced by the United States showed that beginning in August 2007, a few weeks after Clardy’s letter, Imo began making large cash payments to Clardy and continued to bill approximately $21 million worth of false and fraudulent physical therapy services.

City Nursing employee Joann Michelle White, who played a minor role in the health care fraud conspiracy, pleaded guilty to conspiracy in February 2010 and testified for the United States during the trial. She was sentenced to 46 months on Oct. 14, 2011. The last convicted defendant, Kenneth Anokam, will be sentenced later next month.



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Justina Okehie, aka Dr. Tina Collins Pleads Guilty to Health Care Fraud Conspiracy

Source- http://www.fbi.gov/houston/press-releases/2011/houston-chiropractor-pleads-guilty-to-health-care-fraud-conspiracy

HOUSTON—Justina Okehie, aka Dr. Tina Collins, 55, of Richmond, Texas, has pleaded guilty to one count of conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today.

The conspiracy resulted in fraudulent physical therapy and chiropractic claims being paid by the Medicare and the Texas Medicaid programs. From January 2007 through August 2010, Medicare and Medicaid paid approximately $2.1 million to Okehie.

Okehie owned and operated Adom Rehabilitation Services and Healthcare and Wellness Medical Center, which were both located in southwest side Houston. As part of the conspiracy, Okehie would pay patient recruiters to refer Medicare beneficiaries to her clinics. Okehie also paid the Medicare beneficiaries themselves for just showing up at the clinics. In many instances, the physical therapy and chiropractic services billed to the government health care programs were not performed and were not medically necessary. Some of the Medicare beneficiaries were actually receiving medical services at inpatient hospital facilities at the time Okehie was purportedly providing them physical therapy and chiropractic services in her clinics.

Co-defendant Cassandra Tasby Barnes, 48, of Houston, who was employed by Barnes as an office manager, had previously pleaded guilty in this case to one count of conspiracy to violate the anti-kickback statute. Barnes pleaded guilty for her role in paying Medicare beneficiaries and patient recruiters for referring Medicare beneficiaries for physical therapy and chiropractic services. Both Okehie and Barnes are currently on bond and are scheduled to be sentenced on May 21, 2012, before U.S. District Judge Nancy Atlas.



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Gregory Bane and Tracy Bane, The Vice President and The Billing Supervisor Was Sentenced for Medicare and Medicaid Fraud

Source- http://www.fbi.gov/tampa/press-releases/2011/major-principals-of-dme-company-sentenced-for-medicare-and-medicaid-fraud?utm_campaign=email-Immediate&utm_medium=email&utm_source=tampa-press-releases&utm_content=40353

TAMPA, FL—U.S. Attorney Robert E. O’Neill announces that U.S. District Judge Virginia Hernandez Covington sentenced Gregory Bane (41, Valrico), the vice president for operations and IT manager of Bane Medical Services and Oxygen and Respiratory Therapy to three years in federal prison for conspiracy to commit health care fraud, health care fraud, and submitting false claims. Tracy Bane (41, Valrico), the billing supervisor, was sentenced to six months in federal prison, and 18 months of house arrest for conspiracy to commit health care fraud, health care fraud, and submitting false claims.

Previously, on September 12, 2011, Judge Covington sentenced Ben Bane (65, Plant City) President of Bane Medical Services and Oxygen and Respiratory Therapy, Inc. to 12 years and six months in federal prison for conspiracy to commit health care fraud, health care fraud, and submitting false claims.

They were each also ordered to pay $7 million in restitution, a $3 million fine, a $1,000 special assessment, and the court also entered a money judgment in the amount of $5,800,000, representing the proceeds of the health care fraud.

In order to satisfy the $5.8 million money judgment, the court also ordered Ben Bane to forfeit a number of assets, including $1.425 million in cash, two mortgages, 17 real properties (homes and buildings) and four vehicles and vessels. In addition, the court has entered three writs of execution to enforce the restitution order against properties owned by Bane, or which were held for his benefit. The total money received by the Financial Litigation Unit of the United States Attorney’s Office from those writs of execution is approximately $1,868,000.00. Those funds will be disbursed as restitution to the victims.

Each of the Banes were found guilty by a federal jury on December 15, 2010. According to the testimony and evidence presented over the course of the six week trial, the Banes knowingly broke a core rule of Medicare prohibiting DME companies from performing the qualification testing for oxygen, that is, the company that sells the product cannot be the one that also determines whether or not a patient needs it. In violation of this rule and over the course of four years, Bane Medical Services and Oxygen and Respiratory Therapy, Inc., performed the wrong tests and lied to doctors about it, falsified test results to make it appear that the patients qualified for Medicare-reimbursed oxygen when they did not, and forged doctors signatures on Certificates of Medical Necessity.

Later, Ben Bane sold Bane Medical Services to another DME company. Shortly before the sale, and to cover up the crime, hundreds of test results were fabricated in order to make it appear that an independent lab had done the necessary tests. At Ben Bane’s house, bags full of records were burned. In total, Bane Medical fraudulently obtained more than $6.8 million from Medicare. Ben Bane then sold the company for $21 million.



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Veronica Sharon Cunningham Arrested for Health Care Fraud and Use of Fraudulently Obtained Social Security Number

Source- http://www.fbi.gov/richmond/press-releases/2011/richmond-woman-arrested-for-health-care-fraud-filing-false-tax-return-and-use-of-fraudulently-obtained-social-security-number

RICHMOND, VA—Veronica Sharon Cunningham, 48, of Richmond, Va., was arrested today on an indictment charging her with health care fraud in connection with her operation of Community Neurological Services (CNS), a Richmond business that administered Intravenous Immune Globulin (IVIG) to patients suffering from immune deficiency disorders.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia, made the announcement, along with Michael F.A. Morehart, Special Agent in Charge of the Federal Bureau of Investigation’s Richmond Division; Jeannine A. Hammett, Acting Special Agent in Charge of the Washington Field Office of the Internal Revenue Service-Criminal Investigation; Nick DiGiulio, Special Agent in Charge, United States Department of Health and Human Services Office of the Inspector General, Office of Investigations; and Michael McGill, Special Agent in Charge, Social Security Administration-Office of Inspector General.

A federal grand jury in Richmond indicted Cunningham on October 4, 2011 for 30 counts of health care fraud, eight counts of making false statements in health care matters, a single count of failing to file a tax return for the year 2006, a single count of filing a false tax return for the year 2005, and a single count using a fraudulently obtained Social Security number in interviews with federal agents regarding this matter. Cunningham faces a maximum penalty of 10 years on each of the health care fraud counts, a maximum penalty of five years on each of the health care false statement counts, a maximum penalty of 12 months on the failure to file tax return count, a maximum penalty of three years on the false tax return count, and a maximum of five years on the Social Security number count.

The indictment alleges that Cunningham regularly and systematically billed insurance companies and the Medicare and Medicaid programs for IVIG not actually administered. She also allegedly failed to a file tax return for the year 2006, falsely reported the gross income of CNS in her 2005 tax return, and used a fraudulently obtained Social Security number in an interview with agents during the investigation.



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Natalie Evans Pleads Guilty to Fraud and Kickback Scheme Conspiracy to Commit Health care Fraud

Source- http://www.fbi.gov/miami/press-releases/2011/miami-area-halfway-house-owner-pleads-guilty-to-fraud-and-kickback-scheme

WASHINGTON—The owner and president of a Miami-area halfway house company pleaded guilty today for her role in a kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), and its related company, the American Sleep Institute (ASI), announced the Department of Justice, FBI, and Department of Health and Human Services (HHS).

Natalie Evans, 50, pleaded guilty before U.S. District Judge Jose E. Martinez in Miami to one count of conspiracy to commit health care fraud. Evans was the president of Vision of Hope Recovery Inc., which operated five halfway houses in Fort Lauderdale, Fla.

According to court documents, most of the residents at Evans’ halfway houses were recovering from drug and/or alcohol addictions, and some had recently been released from prison. ATC purported to operate partial hospitalization programs (PHPs) in seven different locations throughout south Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness.

According to court documents, Evans agreed to provide Medicare beneficiaries from Vision of Hope halfway houses to ATC for PHP services. Evans admitted that she knew the beneficiaries at her halfway houses needed day treatment for addiction and not PHP services. Evans also knew that ATC fraudulently billed the Medicare program for the PHP services provided to the beneficiaries she referred to ATC. According to court documents, Evans gave patient information, such as Medicare numbers, to a co-conspirator and the patients were then transported to and from ATC by ATC employees.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare for more than $200 million in medically unnecessary services.

According to the plea agreement, Evans’s participation in the fraud resulted in more than $645,975 in fraudulent billing to the Medicare program. At sentencing, scheduled for Jan. 19, 2012, Evans faces a maximum of 10 years in prison and a $250,000 fine.



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Twenty-Four Defendants Charged in Health Care Billing Scams that Defrauded Insurance Companies, Medicare, and Medicaid Out of Millions of Dollars

Source- http://www.fbi.gov/newyork/press-releases/2011/twenty-four-defendants-charged-in-health-care-billing-scams-that-defrauded-insurance-companies-medicare-and-medicaid-out-of-millions-of-dollars

PREET BHARARA, the United States Attorney for the Southern District of New York, JANICE K. FEDARCYK, the Assistant Director in Charge of the New York Office of the Federal Bureau of Investigation (“FBI”), RAYMOND W. KELLY, the Police Commissioner of the City of New York (“NYPD”), THOMAS O’DONNELL, the Special Agent in Charge of the New York Office of the Inspector General, Department of Health and Human Services (“HHS”), and BENJAMIN M. LAWSKY, the Superintendent of the New York Department of Financial Services (“NY DFS”), announced today the unsealing of three separate Indictments, charging 24 defendants with health care fraud. Two of the indictments charge a total of 22 defendants with participating in fraudulent billing scams that caused no-fault insurance carriers to pay out millions of dollars in reimbursements for medical treatments that were never provided to patients or that were medically unnecessary. Among the individuals charged today are (i) doctors who faked ownership of medical clinics located in Brooklyn and Queens to conceal that the clinics’ true owners and operators were non-medical professionals; (ii) these same “front” doctors and other medical practitioners and clinic employees who caused the submission of fraudulent bills to insurance companies for treatments that were not medically necessary, that were not provided at all, and/or that were not provided as billed; (iii) “runners” who were paid to recruit patients to the clinics; and (iv) patients who faked and exaggerated their injuries from automobile accidents, and who received coaching from the clinics’ employees about their supposed injuries. The third indictment unsealed today charges two operators of a medical supply company with orchestrating a billing scam targeting Medicare and Medicaid in which the defendants allegedly forged doctors’ signatures and prescriptions to support fraudulent billings to Medicare and Medicaid for millions of dollars in durable medical equipment—such as motorized wheelchairs—that was never supplied to patients.

Twenty-two of the 24 charged defendants were taken into custody this morning and were arraigned in Manhattan federal court this afternoon. One defendant, RUBIN KAYKOV, has previously been arrested on a complaint. The last defendant, ILYA SLEPAK, remains at large. Six search warrants were executed and 10 accounts were frozen in connection with today’s arrests.



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Ahmed Mohamed Abugroon Charged with Medicaid Fraud

Source- http://www.fbi.gov/indianapolis/press-releases/2011/hogsett-announces-indianapolis-man-charged-with-medicaid-fraud

INDIANAPOLIS—Joseph H. Hogsett, United States Attorney, announced today that Ahmed Mohamed Abugroon, 56, of Indianapolis, Indiana, was charged with health care fraud following an investigation by the Federal Bureau of Investigation and the Indiana Attorney General’s Medicaid Fraud Control Unit.

Abugroon operated Pacific Transportation, which provided transportation services to Indiana Medicaid patients, and the information alleges that Abugroon made false and fraudulent representations to the Indiana Medicaid Program in order to secure reimbursements at a higher rate than he was entitled. Specifically, it is alleged that, between January 2005 and February 2008, Abugroon received $24,869.81 from the Indiana Medicaid Program to which he knew he was not entitled.


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Bassey Monday Idiong the Owner of Health Care Company Sentenced to 33 Months in Prison for Medicare Fraud

Source- http://www.justice.gov/opa/pr/2011/October/11-crm-1352.html

WASHINGTON – The owner and operator of a Houston durable medical equipment (DME) company was sentenced yesterday in Houston federal court to 33 months in prison for his role in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Bassey Monday Idiong, 32, of Humble, Texas, was sentenced by U.S. District Judge Vanessa D. Gilmore. In addition to his prison term, Idiong was sentenced to two years of supervised release and was ordered to pay $527,023 in restitution.

Idiong pleaded guilty on March 1, 2010, to one count of conspiracy to commit health care fraud and five counts of health care fraud. Idiong owned and operated B.I. Medical Supply LLC.

According to court documents, Idiong paid patient recruiters kickbacks in exchange for the names of beneficiaries for whom bills could be submitted to Medicare. B.I. Medical billed Medicare for expensive, rigid orthotics and braces that were packaged together and referred to as an “arthritis kit,” at a cost of approximately $4,000 per kit. B.I. Medical then supplied the beneficiaries with different, less expensive products that were not medically necessary. Court documents indicate that in one instance, B.I. Medical billed Medicare for an arthritis kit that included two knee braces for a beneficiary who had only one leg. In total, B.I. Medical submitted approximately $846,000 in fraudulent claims to Medicare.


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Angel Gonzalez and Jorge Zamora Owners of Fraudulent Lakeland, Florida Physical Therapy Company Sentenced to 42 and 46 Months in Prison

Source- http://www.fbi.gov/tampa/press-releases/2011/owners-of-fraudulent-lakeland-florida-physical-therapy-company-sentenced-to-42-and-46-months-in-prison?utm_campaign=email-Immediate&utm_medium=email&utm_source=tampa-press-releases&utm_content=37748

WASHINGTON—Miami-area residents Angel Gonzalez and Jorge Zamora, who were the owners and operators of a fraudulent physical therapy company in Lakeland, Fla., were sentenced yesterday and today to 42 months in prison and 46 months in prison, respectively, for their leading roles in a scheme to defraud Medicare, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

U.S. District Judge James D. Whittemore of the Middle District of Florida also sentenced Gonzalez and Zamora to three years of supervised release following their prison terms and ordered them to pay $82,765.84 in restitution, jointly and severally with their co-defendants.

On June 10, 2011, Gonzalez, 43, pleaded guilty before U.S. Magistrate Judge Mark A. Pizzo in Tampa, Fla., to one count of conspiracy to commit health care fraud. Zamora, 48, pleaded guilty before Judge Pizzo on July 14, 2011, to the same charge.

In pleading guilty, Gonzalez and Zamora admitted they were the owners and operators of Dynamic Therapy Inc. According to court documents, Gonzalez, Zamora and their co-conspirators purchased Dynamic from its prior owners and transformed it into a fraudulent enterprise that purported to provide physical therapy services to Medicare beneficiaries.

From fall 2009 to summer 2010, Gonzalez and Zamora submitted and caused the submission of $757,654 in fraudulent claims by Dynamic to the Medicare program. Gonzalez 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, Gonzalez, Zamora and others also stole the identities of a physical therapist and Medicare beneficiaries to submit additional false claims to Medicare. In pleading guilty, Gonzalez and Zamora admitted that they knew the Medicare beneficiaries, on whose behalf claims were submitted to Medicare, never received the services billed to Medicare.

All five defendants charged in the Dynamic Therapy fraud scheme have pleaded guilty and have been sentenced to prison terms for their roles in the fraud scheme. On Aug. 29, 2011, Andres Cespedes was sentenced to 21 months in prison; on Sept. 19, 2011, Adrian Chalarca was sentenced to 24 months in prison; on Oct. 11, 2011, Ariel Chong was sentenced to six months in prison.


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Mustafa Hassan Mussa Pleads Guilty to Aggravated Identity Theft Related to Health Care Fraud

Source- http://www.fbi.gov/minneapolis/press-releases/2011/home-health-care-agency-owner-pleads-guilty-to-aggravated-identity-theft-related-to-health-care-fraud?utm_campaign=email-Immediate&utm_medium=email&utm_source=minneapolis-press-releases&utm_content=37436

MINNEAPOLIS—Recently in federal court, the operator of Universal Home Health, a home health care agency located in Golden Valley, pleaded guilty to an offense related to defrauding Medicaid. On October 7, 2011, Mustafa Hassan Mussa, age 56, of Minnetonka, pleaded guilty to one count of aggravated identity theft. Mussa, who was charged on August 18, 2011, entered his plea before United States District Court Judge Susan Richard Nelson.

In his plea agreement, Mussa admitted that on May 26, 2009, he knowingly caused fraudulent billings to be submitted to Medicaid. The fraudulent claims were made to the Minnesota Department of Human Services (“DHS”), which administers the federal Medicaid program here in Minnesota. The claims indicated that a personal care attendant (“PCA”) was providing service to a Medicaid recipients when, in fact, the Personal Care Assistant was not providing services to the recipient. For example, a claim for reimbursement, submitted in May 2009, was one of a numerous fraudulent claims submitted to Medicaid through Universal between 2008 and 2010.

The U.S. recovered more than $700,000 to be returned to the Medicaid program in connection with this matter.

The Medicaid program provides medical care and services to low-income people who meet certain income and eligibility requirements. Home health care, provided by PCAs, is one of the services reimbursed by Medicaid.

On September 14, 2011, Stephen Jon Rondestvedt, age 58, of Minneapolis, pleaded guilty to one count of health care fraud in a related case. Rondestvedt, who was an employee of Universal, was also charged on August 18, 2011.

In his plea agreement, Rondestvedt admitted that from February 18, 2008, through December of 2010, he defrauded Medicaid by submitting false reimbursement claims for personal care services. Rondestvedt agreed to provide and facilitate kickback payments to the family of a Medicaid recipient who did not actually receive the personal care services for which Universal billed Medicaid.

For his crime, Mussa faces a mandatory penalty of two years in prison, while Rondestvedt faces a potential maximum penalty of ten years. Judge Nelson will determine their sentences at future hearings, yet to be scheduled.


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Doctor Robert Williams Sentenced to Prison for Submitting Fraudulent Bills to Medicare and Medicaid

Source- http://www.fbi.gov/atlanta/press-releases/2011/doctor-sentenced-to-prison-for-submitting-fraudulent-bills-to-medicare-and-medicaid?utm_campaign=email-Immediate&utm_medium=email&utm_source=atlanta-press-releases&utm_content=37210

ATLANTA—Dr. ROBERT WILLIAMS, 77, of Atlanta, Georgia, was sentenced to prison today by United States District Judge Richard W. Story on federal health care fraud charges.

United States Attorney Sally Quillian Yates said, “This doctor attempted to bilk Medicare and Medicaid for over $2 million for psychological services he never provided to elderly nursing home patients. Some of the patients were dead at the time he claimed he provided services; others never received treatment. Now he’s headed to prison.”

“Many of Georgia’s neediest citizens rely on Medicaid for access to health care. The Attorney General’s office is committed to weeding out fraud so that every dollar is spent on those who need this vital assistance,” said Georgia Attorney General Sam Olens.

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “The much needed assistance available through programs such as Medicare and Medicaid is finite and the FBI has dedicated significant investigative resources in ensuring that those programs are used properly. The FBI will continue to work with its many and varied law enforcement partners in bringing those individuals to justice who would exploit these programs and asks that anyone with information concerning Medicaid/Medicare fraud to contact their nearest FBI field office.”

WILLIAMS was sentenced to one year and three months in prison to be followed by three years of supervised release. He was also ordered to pay $771,596 in restitution to Medicare and $227,846 in restitution to Georgia Medicaid. There is no parole in the federal system. WILLIAMS pleaded guilty to the charges on June 6, 2011.

According to United States Attorney Yates, the charges, and other information presented in court: WILLIAMS is a licensed physician, practicing in the Atlanta area. From approximately July 2007 through October 2009, he contracted with a medical services company to provide group psychological therapy to nursing home patients in a variety of nursing homes in the Atlanta area. During that time period, over 55,000 claims were submitted to Medicare using WILLIAMS’ provider number for group psychological therapy seeking reimbursement for over $2,000,000, and ultimately causing Medicare to reimburse WILLIAMS over $750,000. During the same time period, over 40,000 Medicaid claims were submitted using WILLIAMS’ provider number for group psychological therapy, causing Georgia Medicaid to pay out over $225,000.

The investigation of WILLIAMS’ claims showed, however, that in many cases, he sought payment for services provided to beneficiaries who were dead at the time he purportedly rendered the care. In two cases, the patient died over a year before he was allegedly seen by WILLIAMS in the nursing home. Numerous claims were submitted to Medicare and Medicaid for group psychological therapy when the beneficiary was hospitalized at the time of service and, consequently, could not have received care at the nursing home as WILLIAMS had claimed in the documents submitted.


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Matthew Kolodesh, a/k/a “Matvei Kolodech Charged in Health Care Fraud and Embezzlement Scheme

Source- http://www.fbi.gov/philadelphia/press-releases/2011/hospice-owner-charged-in-health-care-fraud-and-embezzlement-scheme?utm_campaign=email-Immediate&utm_medium=email&utm_source=philadelphia-press-releases&utm_content=37208

PHILADELPHIA—An indictment was unsealed today charging Matthew Kolodesh, a/k/a “Matvei Kolodech,” with conspiracy to defraud Medicare of more than $14 million through his home hospice business, announced United States Attorney Zane David Memeger. Kolodesh was arrested this morning. According to the indictment, Kolodesh’s business, Home Care Hospice, Inc. (“HCH”), located at 2801 Grant Avenue in Philadelphia, submitted claims totaling approximately $14.3 million for patients that were not eligible for or did not receive the hospice services billed to Medicare. Kolodesh also allegedly diverted $9.36 million dollars from HCH’s operating account for his own personal use, such as extensive renovations to his house, travel expenses, college tuition for his son, and a luxury automobile. This also included substantial sums of cash siphoned from the HCH operating account through kickbacks from HCH vendors using a system of phony and inflated invoicing, and a cash kickback scam through sham charitable donations made in the name of the hospice.

Kolodesh is charged with conspiracy to commit health care fraud, 21 counts of health care fraud, 11 counts of money laundering, and two counts of mail fraud.

The indictment alleges that Kolodesh and his co-conspirator, identified only as “A.P.,” would pay health care professionals, including doctors, for referring patients to HCH even when those patients were not eligible or appropriate for hospice services. In an effort to mask the alleged kickback scheme, HCH fraudulently represented that some of those health care professionals were paid for services as medical directors, advisors, or hospice physicians.

Among the ineligible patients, the indictment alleges, were patients who were not terminally ill and patients who were on the service list for more than six months. At the direction of Kolodesh and A.P., it is further alleged that HCH staff would routinely “doctor” or alter patient charts to make it appear on paper as though the patient’s medical condition was worse than it actually was. The staff was also allegedly directed to bill certain claims at a higher, more costly rate of service than was actually provided to the patient.

In February 2007, HCH was notified that it was subject to a claims review audit. According to the indictment Kolodesh, through A.P., directed members of HCH staff to falsify documentation to be submitted for the audit. In September 2007, HCH was notified that it had exceeded its cap for Medicare reimbursement and would have to repay $2,625,047 to the government program. At that point, it is alleged, Kolodesh ordered a mass discharge of patients and A.P. had 79 hospice patients discharged in October 2007 and a total of 128 discharged by January 2008, some of whom had been ineligible for hospice or inappropriately maintained on hospice service in excess of six months. Of those discharged patients, 16 were admitted to Kolodesh’s other hospice business, Community Home Health in Bucks County. Once the Medicare cap was resolved, it is alleged that 11 of those patients were returned to HCH.


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Martin Tasis Sentenced to 10 Years in Prison for Role in $9.1 Million Medicare Fraud Scheme

Source- http://www.justice.gov/opa/pr/2011/October/11-crm-1338.html

WASHINGTON – Martin Tasis was sentenced today to 10 years in prison for his leading role in a $9.1 million Detroit-area Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Tasis was sentenced by U.S. District Judge Arthur Tarnow in the Eastern District of Michigan.  In addition to his prison term, Tasis was sentenced to three years of supervised release and was ordered to pay $6 million in restitution, jointly and severally with his co-conspirators.

Martin Tasis and co-defendants Joaquin Tasis and Leoncio Alayon were convicted by a jury in May 2011 after a five-day trial. Evidence presented at trial showed that the Tasis brothers and their co-conspirators helped relocate a highly lucrative infusion therapy fraud scheme to Michigan from South Florida after increased law enforcement scrutiny there.

According to evidence presented at trial, Martin and Joaquin Tasis were the owners of a Detroit-area clinic called Dearborn Medical Rehabilitation Center (DMRC). 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 and exotic medications, purportedly administered to treat HIV and Hepatitis-C. However, the medications were never administered.

Once Medicare started paying the co-conspirators, Martin Tasis enlisted Alayon, a family friend, 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 for himself, distributed the laundered proceeds to Martin and Joaquin Tasis and their co-conspirators.

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/or were not medically necessary. Medicare paid approximately $6 million of those claims. Evidence at trial showed that DMRC purchased only $36,000 in medication and medical supplies.

Martin Tasis was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay health care kickbacks, three counts of health care fraud, one count of conspiracy to commit money laundering and one count of money laundering.

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Eight Indicted in Health Care Fraud and Drug Distribution Scheme

Source- http://www.fbi.gov/detroit/press-releases/2011/eight-indicted-in-health-care-fraud-and-drug-distribution-scheme

DETROIT—An indictment returned by a federal grand jury in Detroit was unsealed today charging eight individuals for their roles in a health care fraud and drug distribution scheme, United States Attorney Barbara L. McQuade announced today. McQuade was joined in her announcement by Special Agent in Charge Andrew G. Arena of the Federal Bureau of Investigation (FBI) and Lamont Pugh, Special Agent in Charge of the Inspector General of the Department of Health and Human Services (HHS).

Charged in the indictment were Orlando Mena, of Miami, FL; .Xiomara Rodriguez, of Miami, FL; Dr. Russell Crispell, of Troy, MI; Reinald Orellana, of Westland, MI; Lisette Orellana, of Miami, FL; Akim Mena of Miami, FL; Dr. Virinder Grewal, of Williamston, MI; and Carla Degraffenreid of Detroit.

The indictment alleges that the defendants conspired to defraud Medicare with a fraudulent diagnostic testing scheme operating at World Health Care, LLC and Wyoming Medical Centers, PLC. As part of the scheme, Medicare was billed in excess of $2 million for medically unnecessary tests and services. The indictment also charges Orlando Mena, Xiomara Rodriguez, Dr. Russell Crispell, Reinald Orellana, Lisette Orellana, and Akim Mena with conspiracy to distribute Oxycontin (oxycodone) and 13 counts of distribution of a controlled substance.

The indictment alleges Xiomara Rodriguez incorporated World Health Care in Redford, Michigan, on July 11, 2008. Orlando Mena, and others recruited Medicare beneficiaries in Southeast Michigan to see Dr. Russell Crispell, who was employed by World Health Care. Most of the patients were scheduled for doctor visits by employee Lisette Orellana. The Medicare beneficiaries would be transported to World Health Care by employee “drivers,” who were under the direction and control of Akim Mena. The Medicare beneficiaries would be required to undergo medically unnecessary tests in order to receive a prescription for Oxycontin. In addition, Medicare beneficiaries were paid in cash for their time and the use of their Medicare card for billing purposes.

The indictment also alleges that Akim Mena would arrange to have drivers transport the Medicare beneficiaries to various pharmacies to fill their prescriptions. Once the prescription was filled, the driver would pay the Medicare beneficiaries from $150 to $800, in cash, for their Oxycontin prescription, for further distribution.

The indictment alleges that Reinaldo Orellana and Akim Mena incorporated Wyoming Medical Centers in East Lansing, Michigan, on March 25, 2009, and acquired a valid Medicare provider number to submit Medicare claims for office visits and tests. Medicare beneficiaries were required to visit Wyoming Medical Centers, and see Dr. Virinder Grewal, who did not perform a medical examination, but caused a claim to be submitted to Medicare for various diagnostic tests, then the Medicare beneficiaries would return to World Health Care to receive a prescription for Oxycontin.

“Today’s indictments and arrests illustrate the Office of Inspector General’s continued and sustained commitment to the fight against fraud in Federal health care programs,” said Lamont Pugh III, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Chicago Region. “The OIG in concert with our law enforcement partners, will continue to protect Medicare beneficiaries and the taxpayers through these types of enforcement actions.”


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Gary Winner Plead Guilty in Rhode Island to Health Care Fraud, Money Laundering, and Selling Adulterated and Misbranded Medical Devices

Source- http://www.fbi.gov/boston/press-releases/2011/nationwide-supplier-of-medical-equipment-to-plead-guilty-in-rhode-island-to-health-care-fraud-money-laundering-selling-and-adulterated-and-misbranded-medical-devices

PROVIDENCE, RI—An Illinois businessman has agreed to plead guilty in U.S. District Court in Providence, R.I., to a five-count information charging him with health care fraud; the introduction of an adulterated and misbranded medical device into interstate commerce; and money laundering, it was announced by U.S. Attorney Peter F. Neronha.

In addition, Gary Winner, 49, of Northbrook, Illinois, has agreed to forfeit approximately $2 million in proceeds allegedly derived by defrauding the Medicare program.

According to an information and plea agreement filed with the court, from 2005 through early 2011, Planned Eldercare, a nationwide supplier of durable medical equipment located in Buffalo Grove, Illinois, and owned by Winner, allegedly targeted, through unsolicited telemarketing, arthritic and/or diabetic Medicare beneficiaries. Winner ensured that his company ordered medical equipment and supplies for Medicare beneficiaries that they did not order and/or were not medically necessary.

According to court documents, Gary Winner instructed Planned Eldercare employees, upon successfully reaching an individual on the phone as a result of an unsolicited telemarketing call, to inquire if they suffered from diabetes or arthritis. Once call recipients identified themselves as suffering from either diabetes or arthritis, as an inducement for recipients to provide their Medicare and physician information, employees were instructed to inform recipients that Planned Eldercare could provide them with products to help with their ailments “at no cost to you.” Once Planned Eldercare employees obtained Medicare beneficiaries’ agreement to receive certain products, Winner allegedly instructed employees to order as many products as possible for those beneficiaries whether or not beneficiaries actually requested the products or had a medical need for the equipment. Medicare was then billed for thousands of products that beneficiaries did not order.

Court documents allege that Winner also directed his sales force to send beneficiaries “packages” of arthritic supplies regardless of medical necessity. When confronted by employees who questioned the practice, Winner typically responded by saying that “it doesn’t cost the client anything as the government is paying for it, and that the government would just print more money, so order more.” Winner responded to beneficiaries who received items that they did not order by stating, “If you don’t need them, put them under the sink.”

According to court documents, it is alleged that Winner also instructed his employees to falsely inform male diabetic beneficiaries that an “erectile pump” was good for prostate problems, and was designed to help blood circulation exclusively in males. Employees were instructed to tell beneficiaries that regular use of the pump increases blood flow in the urinary tract and prostate region.

It is alleged that Winner ordered penis enlargers from an x-rated website for $26.00 each, repackaged them, enclosing an information sheet stating that regular use of the enclosed “erectile pump” helps with bladder control, urinary flow and prostate comfort, and shipped them to recipients. Winner allegedly billed Medicare on average $284 per item, representing to Medicare that the devices sold were designed to treat erectile dysfunction. Under certain circumstances, the Medicare program covers reimbursement for products for the treatment of organic impotence and/or erectile dysfunction. Medicare regulations require that the devices be medically necessary and prescribed by a physician. It is alleged that the devices shipped to Medicare beneficiaries and billed to Medicare served no medical purpose.

In addition, it is alleged in court documents that Winner waived copayments for all Medicare patients, a practice which is prohibited by Medicare. By waiving copayments they otherwise would be responsible for, Winner induced beneficiaries to accept products they had not ordered and not report the alleged fraudulent billing to Medicare. Employees were instructed by Winner to tell beneficiaries that they should ignore their Medicare explanation of benefits form because Planned Eldercare forgave any “remainder of cost.”

Health care fraud and money laundering are punishable by maximum sentences of 10 years’ imprisonment, a fine of $250,000, and a term of supervised release of three years; the introduction of an adulterated and misbranded medical device into interstate commerce is punishable by a maximum sentence of three years’ imprisonment, a fine of $10,000, a term of supervised release of one year. At sentencing Winner faces a maximum sentence of 33 years’ imprisonment, a fine of $760,000, and a term of supervised release of four years.


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Pharmacist John D. Love, Sentenced for Health Care Fraud and Money Laundering

Source- http://www.fbi.gov/indianapolis/press-releases/2011/terre-haute-pharmacist-sentenced-for-health-care-fraud-and-money-laundering

TERRE HAUTE—United States Attorney Joseph H. Hogsett announced that John D. Love, 54, of Brazil, Ind., was sentenced today to 51 months of imprisonment for health care fraud and money laundering. This follows an investigation by the U.S. Department of Health and Human Services, Office of Inspector General (HHS), the Internal Revenue Service (IRS), the Federal Bureau of Investigation (FBI), and Indiana Attorney General Greg Zoeller’s Medicaid Fraud Enforcement Unit (MFCU).

“This was a case of someone who used Hoosier taxpayer dollars to live well beyond his means,” said Hogsett. “As today’s sentence makes clear, this office has zero tolerance for those who abuse public programs through fraud.”

From January 2006 through September 2010, John Love, a pharmacist and controlling member of the Terre Haute Prescription Shop (THPS), used his position to carry out a scheme to defraud the Indiana Medicaid Program. Love submitted claims to the Indiana Medicaid Program for prescriptions that were never given to patients.

Love used his access and knowledge of the THPS computer system to input false prescriptions into the billing system, which would then bill the Indiana Medicaid Program for the fraudulent claim. As soon as the computer system submitted the claim for the prescription to the Indiana Medicaid Program, Love would access the computer system again and void the prescription before any other employee of THPS could notice a record for a prescription that was never filled or dispensed.


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Alfredo Rasco Sentenced to More Than 11 Years in Prison for Multi-Million-Dollar Medicare Fraud Scheme

Source- http://www.fbi.gov/atlanta/press-releases/2011/miami-man-sentenced-to-more-than-11-years-in-prison-for-multi-million-dollar-medicare-fraud-scheme

SAVANNAH, GA—Alfredo Rasco, 52, from Miami, Florida, was sentenced on Wednesday by United States District Court Judge William T. Moore, Jr. to 133 months in prison for his role in defrauding Medicare of approximately $4 million. Rasco’s wife, Niurka Rasco, 50, was also sentenced on Wednesday to three years’ probation for her role in the scheme.

United States Attorney Edward J. Tarver said, “Alfredo Rasco and his cohorts stole millions of taxpayer dollars by defrauding Medicare and preying upon vulnerable citizens suffering from life-threatening illnesses. In hatching his scheme, Alfredo Rasco made the mistake of thinking he could evade law enforcement by fleeing Miami and committing his fraud in the Southern District of Georgia. He will now get to spend more than a decade in prison reflecting on that mistake. The stern sentence imposed upon him should serve as a powerful warning to others intent on stealing from taxpayers in this District—this office, and our law enforcement partners, will investigate and prosecute you to the fullest extent of the law.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, stated, “The unbridled greed displayed by the defendant and his associates in this case is a stark reminder of the important role of the FBI’s Health Care Fraud Unit and its agents in ensuring that those funds benefit those in need. Individuals who choose to exploit such well intended government funded programs for their own personal gain will always be an investigative priority for the FBI.”

“This case demonstrates how hardened criminals are migrating from traditional crimes likes drugs into health care fraud,” said Derrick L. Jackson, Special Agent in Charge of the HHS Office of Inspector General’s Atlanta Office. “This sentence sends a clear message that health care fraud is a serious crime with serious consequences.”

The evidence at the guilty plea hearings for the Rascos showed that from December 2005 through March 2008, Alfredo Rasco, aided by Niurka Rasco and others, devised a scheme to defraud Medicare that involved bribing Medicare beneficiaries afflicted with HIV or AIDS with promises of free food, transportation, and gift cards, to get the patients to come to United Therapy, a healthcare clinic in downtown Savannah. Once at United Therapy, Alfredo Rasco and others used the patients’ Medicare information to submit $6.5 million worth of phony bills to Medicare for infusion services that were not provided to those patients. Before law enforcement put a stop to this fraud, Alfredo Rasco and others stole approximately $4 million from Medicare through these phony claims.

At the sentencing hearing, the court heard evidence that Alfredo Rasco was associated with other schemes to defraud Medicare in and around Miami, and that he opened up the fraudulent clinic in Savannah to escape increased law enforcement scrutiny of health care fraud in Miami. The court also heard evidence that this was not Alfredo Rasco’s first brush with the law, as he had prior federal felony convictions for assaulting a federal law enforcement officer and narcotics trafficking.

Alfredo Rasco faced a maximum statutory penalty of 10 years’ imprisonment for the conspiracy to commit health care fraud conviction; two years’ imprisonment for his conviction of aggravated identity theft, consecutive to his sentence on conspiracy to commit health care fraud; fines up to $500,000; and three years of supervised release. Niurka Rasco faced a maximum statutory penalty of up to six (6) months’ imprisonment; a fine up to $2,000; and one (1) year of supervised release.

The court further ordered Defendants Alfredo Rasco and Niurka Rasco to forfeit $1.3 million in U.S. currency and a 42’ yacht known as the “Thank You, God,” that were seized by investigators during the investigation of this case. In total, government agents were able to recover approximately $2 million of the $4 million stolen from Medicare.


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Isachi Gil Sentenced to 43 Months for Medicare Fraud Also Ordered to Perform 300 Hours of Community Service and to Pay Restitution in The Amount of $335,968

Source- http://www.fbi.gov/miami/press-releases/2011/doral-woman-sentenced-to-43-months-for-medicare-fraud?utm_campaign=email-Immediate&utm_medium=email&utm_source=miami-press-releases&utm_content=34550

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced today’s sentencing of defendant Isachi Gil, of Doral, Florida. At today’s hearing, U.S. District Judge Marcia Cooke sentenced Gil to 43 months in prison, to be followed by three years of supervised release. In addition, Gil was also ordered to perform 300 hours of community service and to pay restitution in the amount of $335,968.

On May 24, 2011, following a three week trial, Gil was convicted of charges of health care fraud and making false statements related to health care matters. According to evidence presented at trial, Gil was a registered nurse employed by 13 separate Miami-Dade home health care agencies. As a registered nurse, Gil purportedly provided skilled nursing services to homebound insulin dependent diabetics who were so ill that they were unable to inject themselves with insulin. Under Medicare regulations, Gil was required to keep records of each time she provided a skilled nursing service to a Medicare beneficiary. Between March 2007 and July 2009, the defendant completed hundreds of documents in which she claimed that she had injected Medicare beneficiaries with insulin two times a day, seven days per week. The trial evidence showed that at least two of the Medicare beneficiaries that the defendant claimed to be injecting with insulin were not even diabetic. In addition, the evidence showed that there were over 150 instances in which the defendant was in Panama, Mexico or the Dominican Republic while she claimed to be providing skilled nursing services to Medicare beneficiaries in Miami-Dade County. In addition, the defendant also signed dozens of documents claiming that she was providing skilled nursing services when, in fact, she was attending classes at Florida International University. As a result of the defendant’s false statements, Medicare was billed for hundreds of thousands of dollars in claims for services that were not medically necessary or actually provided to Medicare beneficiaries.


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Patrick Ita Sentenced to Prison for Defrauding Medicare of Millions in Wake of Hurricanes Katrina and Rita

Source- http://www.fbi.gov/houston/press-releases/2011/dme-owner-sentenced-to-prison-for-defrauding-medicare-of-millions-in-wake-of-hurricanes-katrina-and-rita?utm_campaign=email-Immediate&utm_medium=email&utm_source=houston-press-releases&utm_content=34597

HOUSTON—A former owner of a durable medical equipment company (DME) was sentenced today to more than six years in federal prison for engaging in a conspiracy to defraud Medicare of more than $5 million and wire fraud, United States Attorney José Angel Moreno announced today.

Patrick Ita, 55, the owner of Masspoint Medical Equipment & Supplies and of PUITA Research & Procurement Inc., a medical billing company, was sentenced to a total of 78 months in prison without parole to be followed by a three-year term of supervised release today by U.S. District Judge Sim Lake for the conspiracy and wire fraud convictions. The court also ordered Ita to pay restitution to Medicare and Medicaid in the total amount of $1,582,946.44. Masspoint is no longer in operation.

Ita pleaded guilty to conspiring to defraud Medicare on April 15, 2011. During that proceeding he admitted to having participated in a 13-month conspiracy to defraud Medicare by billing Medicare using a specific code created by Medicare to expedite the approval and payment of claims for DME lost or destroyed by Hurricanes Katrina and Rita. Ita’s fraudulent claims involved the alleged replacement of power wheelchairs by Masspoint. Ita used the CR modifier for power wheelchair claims: 1) where the beneficiary did not have a power wheelchair before the hurricanes; 2) where the power wheelchair owned by the beneficiary did not sustain any hurricane-related damage; 3) where Ita never delivered a power wheelchair to the beneficiary; and 4) where Ita delivered a scooter instead of a power wheelchair to the beneficiary.

Ita also admitted purchasing beneficiaries’ Medicare information from the owner of a former DME company and using that list to bill Medicare for a new power wheelchair for every beneficiary without determining whether the beneficiary had lost a wheelchair in the hurricane. Ita also paid marketers to solicit additional Medicare beneficiaries for power wheelchairs and used the CR modifier for every power wheelchair sold to a beneficiary by the marketers.

Ita also pleaded guilty to wire fraud admitting he filed fraudulent Medicare claims with Palmetto GBA, a Medicare contractor located in Columbia, S.C. All Medicare payments made based on the fraudulent claims were sent by electronic funds transfer from Columbia to Ita’s bank account in Houston. Ita billed Medicare in excess of $5.4 million and was paid at least $1.6 million as a result of his scheme.

Ita, who has been in custody without bond since his January 2011 arrest, will remain in the custody of the U.S. Marshals Service pending transfer to a Bureau of Prisons facility to be designated in the near future.


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