Source- http://www.fbi.gov/boston/press-releases/2012/rhode-island-medical-equipment-sales-representative-to-plead-guilty-to-health-care-fraud
PROVIDENCE, RI—A Woonsocket, R.I., woman who allegedly promised custom fit shoes for diabetics and medical equipment for arthritis sufferers “at no cost” to Medicare beneficiaries at Rhode Island senior centers, housing complexes and assisted living centers, has agreed to plead guilty to defrauding Medicare of more than $70,000, announced U.S. Attorney Peter F. Neronha.
Sonja Ascoli, 59, of Woonsocket, R.I, is charged in an information filed with the U.S. District Court in Providence on Monday with allegedly participating in a scheme to entice Medicare beneficiaries to order products and medical equipment from the company she represented, Planned Eldercare, of Illinois, by promising that the products would be provided “at no cost” to them. The Medicare Program does not permit copayments to be waived.
According to the information, it is alleged that once Ascoli obtained some beneficiaries Medicare and physician information, she ordered as many products as possible without regard to whether the beneficiaries actually requested the products or had medical need for the equipment. When beneficiaries complained about receiving items they did not order, it is alleged that Ascoli responded by telling them, “Keep the products in the closet until you need them.”
The information also alleges that as part of the scheme, Ascoli, upon receiving products and equipment returned to her by beneficiaries, did not send the items back to Planned Eldercare, but kept them and gave them to individuals who would not otherwise have qualified for the products. These actions resulted in Medicare paying for products that were not received by beneficiaries and Ascoli allegedly keeping any commissions she had earned on the products sold.
The information alleges that Ascoli was the highest-paid outside sales representative employed by Planned Eldercare for the years 2007 and 2008, who, like other sales representatives working for the company, was paid on a commission basis.
According to the information, is alleged that Ascoli defrauded Medicare of a total of $70,354.
On November 17, 2011, Gary Winner, 49, of Northbrook, Ill., owner of Planned Eldercare, pled guilty in U.S. District Court in Providence to two counts of health care fraud, and one count each of money laundering and the introduction of an adulterated and misbranded medical device into interstate commerce.
Winner admitted to the court that from 2005 through early 2009 he instructed Planned Eldercare employees, upon successfully reaching individuals as a result of unsolicited telemarketing calls, to inform recipients that Planned Eldercare could provide them with products to help with their diabetes or arthritis ailments “at no cost to you” by waiving copayments required by Medicare. Winner admitted that he instructed employees to order as many products as possible whether or not the beneficiaries requested them or had a medical need for the equipment. Winner admitted that Medicare was billed for thousands of products that beneficiaries did not order.
Winner also admitted that he 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 the urinary tract and prostate region. Winner admitted that as part of the scheme, he actually ordered penis enlargers from an x-rated website for $26.00 each, repackaged them, and shipped them to Medicare beneficiaries, for which he received reimbursement from Medicare on average of $284 per item.
Winner is scheduled to be sentenced in U.S. District Court in Providence on February 10, 2012. He has agreed to forfeit approximately $2 million in proceeds derived by defrauding the Medicare program.
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Source- http://www.fbi.gov/neworleans/press-releases/2012/guilty-pleas-in-health-care-fraud-case
BATON ROUGE, LA—United States Attorney Donald J. Cazayoux, Jr. announced that CARLA CLARK, age 47, and LILLIE LAVAN, age 57, both of Pineville, Louisiana, pled guilty today before Senior U.S. District Court Judge Frank J. Polozola to counts of an indictment charging health care fraud.
The indictment arose from a health care fraud scheme involving two companies known as Fusion Services, L.L.C. (“Fusion”), and Grace Social Services, L.L.C. (“Grace”), which operated in Alexandria, Louisiana and the surrounding areas. CLARK and LAVAN were licensed clinical social workers who worked with Sonya Williams, the owner of Fusion and Grace. CLARK and LAVAN participated in creating false and misleading medical records for Fusion indicating that Medicare beneficiaries had received individual, face-to-face psychotherapy when, in fact, no such services had been provided. Williams then prepared false claims for the purported psychotherapy services to elderly patients and submitted them to Medicare for reimbursement. Medicare paid Fusion and Grace approximately $349,715 as a result of the billings, much of the profits were deposited into Williams’ personal accounts.
As a result of her guilty pleas, CLARK faces a maximum sentence of imprisonment of 20 years, a $500,000 fine, or both. As a result of her guilty plea, LAVAN faces a maximum sentence of imprisonment of 10 years, a $250,000 fine, or both. The court may also order CLARK and LAVAN to pay restitution. Sentencing has not yet been set for either defendant.
United States Attorney Donald J. Cazayoux, Jr. stated, “This plea is the result of another successful effort by the Medicare Fraud Strike Force to root out and prosecute health care fraud. Rest assured, we will continue to pursue these fraudsters who undermine our health care system. I commend our partners with the U.S. Department of Health and Human Services, the Federal Bureau of Investigation, the Internal Revenue Service, and AdvanceMed for their continued focus and diligence in finding and stopping fraud within our Medicare system.”
Assistant Special Agent in Charge William W. Root, Health and Human Services said, “We are proud of the outstanding work by the Medicare Fraud Strike Force. The guilty pleas today sends a message to other perpetrators that we will thoroughly investigate all allegations of health care fraud. Protecting the programs intended for our nation’s most vulnerable citizens is paramount to our mission.”
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Source- http://www.fbi.gov/miami/press-releases/2012/miami-area-nurse-pleads-guilty-in-25-million-health-care-fraud-scheme
WASHINGTON—A Miami-area nurse pleaded guilty today for his participation in a $25 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.
Jorge Pineiro, 42, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. Pineiro was originally charged in a February 2011 indictment.
According to plea documents, Pineiro was a registered nurse who worked for ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., two Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Pineiro and his co-conspirators operated ABC and Florida Home Health for the purpose of billing Medicare for expensive services that were not medically necessary and/or were never provided. The medically unnecessary services were prescribed by doctors, including, but not limited to, Pineiro’s co-defendant, Dr. Jose Nunez.
According to court documents, beginning in approximately June 2008, and continuing until approximately March 2009, Pineiro and his co-defendant nurses falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services. Pineiro knew that the beneficiaries did not actually qualify for and did not receive the services. Pineiro and his co-defendant nurses described in nursing notes and patient files symptoms that were non-existent, such as tremors, impaired vision, weak grip and inability to walk without assistance. They included these symptoms to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare.
Pineiro admitted that he knew these files were falsified so that Medicare could be billed for medically unnecessary therapy and home health-related services. As a result of Pineiro’s participation in the illegal scheme, the Medicare program was billed approximately $118,000 for purported home health care services that were not medically necessary and/or were never provided.
Pineiro also recruited Medicare beneficiaries who allowed Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided. Pineiro solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for allowing the agency to bill Medicare on behalf of the patients he recruited. The patients that Pineiro recruited did not qualify for the services that were billed to the Medicare program. Pineiro knew that the patient files for his recruited patients were falsified to make it appear that the patients qualified for services from Florida Home Health.
Eighteen co-defendants, including Nunez, Licet Diaz, and Lisandra Alonso, have pleaded guilty for their roles in the fraud scheme. Nunez, Diaz, and Alonso were sentenced to 40 months, 87 months and 78 months in prison, respectively. Two remaining defendants, Dr. Francisco Gonzalez and Odalys Alvarez-Medina, are scheduled for trial on Feb. 14, 2012. An indictment is merely a charge, and defendants are presumed innocent until proven guilty.
Sentencing for Pineiro has been scheduled for April 9, 2012.
The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendant also faces fines and supervised release, as well as forfeiture of any property or proceeds derived from his criminal activities.
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Source- http://www.fbi.gov/oklahomacity/press-releases/2012/new-york-men-sentenced-in-health-care-fraud-wheelchair-scam
OKLAHOMA CITY—Today, ADEDAYO O. ADEGBOYE and OLALEKAN RUFAI, both age 48 and both of Brooklyn, New York, were each sentenced by United States District Judge Timothy D. DeGiusti to serve 12 months and one day in prison for health care fraud in connection with the sale of power wheelchairs and wheelchair accessories to Medicare beneficiaries, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma. In addition, Judge DeGiusti ordered that the men pay restitution in the amount of $299,624.
Adegboye and Rufai opened First Century Medical Supply, Inc., located in Oklahoma City, to engage in the business of selling power wheelchairs and wheelchair accessories to Medicare beneficiaries. Evidence presented at trial last August showed that from 2007 through 2009 the business obtained identification numbers and personal information from Medicare beneficiaries and used that information to submit claims to Medicare for power wheelchairs and wheelchair accessories. Evidence also showed that the defendants billed Medicare for some beneficiaries who did not receive a power wheelchair at all, some who received a less expensive motorized scooter, and for others who did not have a medical need for a wheelchair or did not even request a wheelchair. In all, the evidence showed that through First Century the defendants submitted over $1.1 million in fraudulent claims to Medicare.
Adegboye and Rufai were indicted by a federal grand jury in January of 2011. Following a six-day trial last August, a jury found both men guilty of committing five counts of health care fraud.
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Source- http://www.justice.gov/opa/pr/2012/January/12-crm-118.html
WASHINGTON – The owner and an employee of a Miami health care agency pleaded guilty for their participation in a $22 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.
Marietha Morales, 38, pleaded guilty on Jan. 24, 2012, before U.S. District Judge Seitz to one count of conspiracy to commit health care fraud and Eduardo Saborit-Dominguez, 48, pleaded guilty today before Judge Seitz to one count of conspiracy to violate the Anti-Kickback Statute. Sentencing for both defendants is scheduled for May 23, 2012. The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years.
According to the court documents, Morales was the president and Saborit-Dominguez was an employee of Prime Home Health Services Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries.
According to plea documents, Morales conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Morales and her co-conspirators paid kickbacks and bribes to patient recruiters in return for these recruiters providing patients to Prime Home Health, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Saborit-Dominguez distributed the kickbacks and bribes to co-conspirator patient recruiters and knew that the payment of kickbacks and bribes was in violation of federal criminal laws. Morales used these prescriptions, plans of care and medical certifications to fraudulently bill the Medicare program for home health care services, which Morales knew was in violation of federal criminal laws.
According to plea documents, at Prime Home Health, nurses and office staff falsified patient files for Medicare beneficiaries to make it appear that such beneficiaries qualified for home health care and therapy services from Prime Home Health. Morales admitted that she knew the beneficiaries did not actually qualify for and did not receive such services. Morales knew that these files were falsified so that the Medicare program could be billed for medically unnecessary therapy and home health related services.
From approximately February 2005 through April 2011, Morales and her co-conspirators submitted approximately $22 million in false and fraudulent claims to Medicare and Medicare paid approximately $14 million on those claims.
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Source- http://www.fbi.gov/neworleans/press-releases/2012/patient-recruiter-pleads-guilty-in-health-care-fraud-scheme
WASHINGTON—A Baton Rouge, Louisiana-area resident pleaded guilty today for her role in a Medicare fraud scheme involving fraudulent claims for medically unnecessary health care equipment, announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS), and the Louisiana State Attorney General’s Office.
Karen Rayburn, 47, pleaded guilty before U.S. District Judge James J. Brady of the Middle District of Louisiana to one count of conspiracy to commit health care fraud.
Rayburn admitted that she worked as a recruiter for Healthcare 1 LLC and Medical 1 Patient Services LLC, Louisiana-based companies that fraudulently billed medical equipment to the Medicare program from 2004 to 2009. She and other recruiters were hired to obtain prescriptions for medical equipment such as leg braces, arm braces, power wheel chairs, and wheel chair accessories. Rayburn obtained information from Medicare beneficiaries and approached their physicians to request prescriptions for medical equipment. Rayburn admitted that when patients’ physicians were unwilling to provide medically unnecessary prescriptions, she and other recruiters asked unrelated physicians to write prescriptions based on cursory examinations of the patients. Another technique they used was to generate photocopied forms with reproduced physicians’ signatures. These prescriptions were then used to submit fraudulent claims to the Medicare program.
From 2004 to 2009, Medicare was billed $6.53 million for the beneficiaries that Rayburn provided as part of this fraudulent scheme.
Rayburn faces a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not yet been set.
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Source- http://www.fbi.gov/sanjuan/press-releases/2012/ten-individuals-arrested-for-health-care-fraud
SAN JUAN, PR—On January 12, 2012, a federal grand jury returned two indictments against 10 individuals for conspiracy to commit health care fraud, announced Rosa Emilia RodrÃguez-Vélez, United States Attorney for the District of Puerto Rico. The investigation was led by the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), with the collaboration of the United States Secret Service (USSS) and the Federal Bureau of Investigation (FBI).
Gilberto Gómez, president of Monte Mar Health Corporation (Monte Mar), PROMEDS Medical Inc. (PROMEDS) and Quality Care Medical Supply (Quality); Yolanda GarcÃa-RodrÃguez, aka “Yolanda Gómez,” wife of Gómez and president of PROMEDS, secretary/treasurer of Monte Mar and an authorized official of Quality; Lissette Acevedo, independent sales coordinator; Doctor Francisco Garrastegui; Luisa Nieves, independent sales coordinator; Glendaly Báez, billing director for Monte Mar, PROMEDS and Quality; Mario Rivera, independent sales coordinator; and Marcos Sarraga, independent sales coordinator, are charged in a 39-count indictment for conspiracy to commit health care fraud and a forfeiture allegation of $1,956,750.54. The government seeks to forfeit two bank accounts, one investment account, and a Gallery Plaza Condominium located in the Condado area in San Juan, Puerto Rico.
The indictment alleges that from on or about November, 2008, until on or about May, 2010, Monte Mar submitted at least 1,518 false and fraudulent claims to Medicare totaling approximately $2,993,127.35 for Durable Medical Equipment (DME) that was not medically necessary, causing Medicare to disburse approximately $1,440,597.65. In March 2010, the indictment further alleges that after Monte Mar had been placed in a pre-payment status by Medicare, defendants Gilberto Gómez and Yolanda GarcÃa-RodrÃguez purchased PROMEDS and submitted false claims to Medicare seeking reimbursement for DME, including power wheelchairs, power pressure reducing air mattresses and knee orthosis. PROMEDS submitted at least 359 fraudulent claims to Medicare totaling approximately $786,368.34, causing Medicare to disburse approximately $335,493.12. In October 2010, the indictment alleges that a third company, Quality, was purchased by Gómez and GarcÃa-RodrÃguez after PROMEDS had been placed in a pre-payment status by Medicare. From on or about October 2010, until May, 2011, Quality submitted at least 115 false claims to Medicare totaling approximately $298,321.26, causing Medicare to disburse approximately $180,659.77. The indictment alleges a total amount of $4,077,816.95 fraudulently billed by using Monte Mar, PROMEDS and Quality, where Medicare disbursed a total of approximately $1,956,750.54.
Doctor Francisco Garrastegui was a physician licensed to practice medicine in Puerto Rico but not a Medicare provider. Garrastegui signed and completed false progress notes, prescriptions, Certificate of Medical Necessity (CMNs) and Statements of Ordering Physician for Medicare beneficiaries that were billed by Monte Mar, PROMEDS and Quality. The doctor was paid kickbacks by the three health corporations for the preparation of these false documents. The other defendants’ participation during the conspiracy involved the creation and submission of the fraudulent claims to Medicare.
The health care fraud scheme charged in the second indictment involves Luz M. Vega, president of Preferred Medical Equipment (PME), Doctor Francisco Garrastegui, Lissette Acevedo, Luisa Nieves and MarÃa Elisa Pérez. According to the 60-count indictment, from on or about April 2010, until on or about March 2011, PME submitted false claims to Medicare, seeking reimbursement for Durable Medical Equipment including: power wheelchairs, power pressure reducing air mattresses, wheelchair accessories, lumbar-sacral orthosis, knee orthosis and hospital beds. The co-conspirators submitted at least 95 fraudulent claims totaling approximately $210,223.47, causing Medicare to disburse approximately $107,876.73. Defendants Garrastegui, Acevedo and Nieves also participated in the first conspiracy charged in the previously mentioned indictment. The government seeks to forfeit $107,876.73 and one bank account.
“As part of the nation’s health care system, Medicare serves vulnerable populations,” said United States Attorney, Rosa Emilia RodrÃguez-Vélez. “Today’s arrests by HHS-OIG agents and our law enforcement partners show that we will not tolerate criminals who engage in fraudulent schemes which deplete the Medicare program of funds which are destined for our elderly population, in order to enrich themselves.”
“HHS/OIG works diligently to investigate allegations of Medicare fraud. Today’s arrests involving durable medical equipment (DME) fraud demonstrate our resolve to bring these subjects to justice. Furthermore, as seen on the attached chart (DME data), our efforts, along with the U.S. Attorney’s Office and our law enforcement partners, have made a dramatic reduction on the total dollars billed and paid for DME in Puerto Rico.”
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Source- http://www.fbi.gov/atlanta/press-releases/2012/owner-of-doraville-medical-clinic-indicted-for-health-care-fraud
ATLANTA—DAVID SONG SEN CUI, 43, of Duluth, Georgia, has been indicted by a federal grand jury on charges of health care fraud.
United States Attorney Sally Quillian Yates said of the case, “Medicare dollars provide critical medical services for elderly and disabled persons. This defendant is charged with defrauding Medicare by repeatedly billing for ‘physical therapy’ that in truth was only massages given by unlicensed massage therapists. Medicare and our taxpayers cannot afford such criminal abuse of health care dollars.”
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “The FBI, in conjunction with its various law enforcement partners, is committed to the protection of such federally funded programs. Individuals engaged in such fraudulent acts, as is alleged in this indictment, demonstrate a lack of compassion and greed that simply cannot and will not be tolerated. The FBI urges anyone with information regarding healthcare fraud activity to contact its nearest FBI field office.”
According to United States Attorney Yates, the charges, and other information presented in court: From November 2008 through August 2011, CUI operated the Atlanta Hope Medical Group, Inc., a clinic located in Doraville, Georgia. The clinic purported to provide physical therapy services for elderly patients. However, the clinic actually offered massage services, which were performed by unlicensed massage therapists. CUI allegedly billed the massages fraudulently to Medicare as “physical therapy” under a doctor’s name who did not render the services and was not even present at the clinic. As part of the scheme, Atlanta Hope employed a doctor who was present at the clinic only two days a week. The indictment alleges that, during the operation of the clinic, CUI fraudulently billed over $5.5 million in false claims to Medicare.
The indictment charges 11 counts of health care fraud. Each count carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.
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Source- http://www.fbi.gov/miami/press-releases/2012/miami-area-resident-sentenced-to-35-months-in-prison-for-laundering-money-in-200-million-medicare-fraud-scheme
WASHINGTON—A Miami-area resident was sentenced today to 35 months in prison for her role in laundering money for a $200 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Adriana Mejia, 40, was sentenced by U.S. District Judge Patricia A. Seitz in Miami. In addition to the prison term, Mejia was also sentenced to one year of supervised release.
Mejia pleaded guilty on July 13, 2011, to one count of conspiracy to commit money laundering. Mejia admitted that she served as a money launderer for American Therapeutic Corporation (ATC), its management company, Medlink Professional Management Group Inc., and the owners and operators of ATC and Medlink. Mejia created fictitious entities and bank accounts to convert millions of dollars of Medicare payments into cash for ATC, Medlink and their owners and operators.
ATC, Medlink and a related company, the American Sleep Institute (ASI), were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs)—a form of intensive treatment for severe mental illness—in seven different locations throughout South Florida and Orlando. ASI purported to provide diagnostic sleep disorder testing.
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 to attend treatment programs that were not legitimate PHPs. ATC and ASI then billed Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.
ATC, Medlink and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011. ATC, Medlink and 10 of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial April 9, 2012, before Judge Seitz. A defendant is presumed innocent unless proven guilty beyond a reasonable doubt in a court of law.
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Source- http://www.fbi.gov/albany/press-releases/2012/windham-county-woman-sentenced-to-37-months-in-prison-for-1.4-million-health-care-fraud
The Office of the United States Attorney for the District of Vermont stated that on January 12, 2012, Senior United States District Judge J. Garvan Murtha sentenced Sharon Johnson, 63, of West Dover, Vermont, to 37 months in prison for conspiracy to commit health care fraud. Judge Murtha also ordered Johnson to pay restitution to Mutual of Omaha Insurance Company in the amount of $1,395,755.42.
Johnson previously pled guilty to one count of conspiracy to commit health care fraud and mail fraud. As part of the plea agreement, Johnson admitted that she had obtained over $1,000,000 in fraudulent proceeds from Mutual of Omaha.
Mutual of Omaha discovered the fraud during a 2006 audit of its claims processing system, and referred the matter to the FBI. Subsequent investigation revealed that Rachel Lenagh, a then-employee of Mutual of Omaha, had paid almost $1.4 million in fraudulent claims to Johnson. Investigators also discovered that Lenagh processed payment to Johnson on claims for which there were no supporting medical bills or other relevant documentation, and that these fraudulent payments occurred at Johnson’s direction.
On October 17, 2007, a federal grand jury sitting in Omaha, Nebraska returned a seven-count indictment against Johnson and Lenagh. Lenagh pled guilty in Nebraska to conspiracy to commit health care fraud and was sentenced on February 6, 2009 to 24 months in prison and restitution in the amount of $1,395,755.42.
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Source- http://www.justice.gov/opa/pr/2012/January/12-crm-063.html
WASHINGTON – A Miami-area resident pleaded guilty today in U.S. District Court in Miami for her role in a Medicare fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Sandra Jimenez, 38, admitted to participating in a fraud scheme that was orchestrated by the owners and operators of American Therapeutic Corporation (ATC); its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute (ASI). ATC, Medlink and ASI were all Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs) – a form of intensive treatment for severe mental illness – in seven different locations throughout South Florida and Orlando. ASI purported to provide diagnostic sleep disorder testing.
Jimenez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. Jimenez was charged in an indictment unsealed on Feb. 15, 2011, in the Southern District of Florida.
According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities (ALFs) 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, to attend treatment programs that were not legitimate PHPs. ATC and ASI then billed Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.
In pleading guilty, Jimenez admitted that she served as a marketer for ATC and ASI. In this role, Jimenez solicited beneficiaries and paid kickbacks to assisted living facility owners in exchange for the beneficiaries. The amount of the kickback was based on the number of days each patient spent at ATC.
Jimenez also admitted that she participated in a separate Medicare fraud scheme through Priority Home Health, a Miami home health agency that submitted fraudulent claims to Medicare for home health services . Jimenez and her co-conspirators recruited Medicare beneficiaries to Priority Home Health who did not qualify for home health services.
According to the plea agreement, Jimenez’s participation in the ATC fraud and the Priority Home Health fraud resulted in $46 million in fraudulent billings to the Medicare program.
Sentencing for Jimenez is scheduled for June 27, 2012, at 8:30 a.m. Jimenez faces a maximum penalty of 15 years in prison and a $250,000 fine.
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Source- http://www.fbi.gov/sacramento/press-releases/2012/physician-sentenced-to-eight-years-in-federal-prison-for-role-in-massive-medicare-fraud-scam
SACRAMENTO, CA—United States Attorney Benjamin B. Wagner announced that Alexander Popov, 47, of Los Angeles, was sentenced today by United States District Judge Morrison C. England Jr. to eight years and one month in prison for committing health care fraud and conspiring to commit health care fraud. He was found guilty by a jury on July 8, 2011.
In sentencing, Judge England found that Popov, a medical doctor, was responsible for more than a million dollars in fraudulent billings submitted to Medicare and more than $600,000 in payments made on false claims. Popov abused his position of trust as a physician and endangered the health of patients. Evidence at trial showed that Popov gave false testimony and manufactured evidence at trial, amounting to an obstruction of justice. In particular, a letter produced by Popov on the eve of trial, and supposedly written years earlier while the conspiracy was in progress.
According to testimony presented at trial, from February 2006 through August 2008, Vardges Egiazarian, 63, of Panorama City, owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael. Egiazarian and others recruited doctors to submit applications to Medicare for billing numbers. Popov assumed the role of co-owner and practitioner at the Sacramento clinic, and claims were be submitted to Medicare under his name for medical services purportedly rendered at the clinic.
In fact, Popov never treated a single patient at the clinics. Clinic patients, almost all of whom were elderly and non-English speaking, were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally in the amount of $100 per visit. Patient charts were created falsely stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.
Patient files were then transported to Southern California, where Popov would sign them indicating he provided or approved the treatments therein, and sign related billing forms. These files were then used to support billing submitted to Medicare for treatments and services that were unnecessary, never performed, or both. In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. In return for their roles, Popov and the other involved physicians received 20 percent of the billings paid under their respective provider numbers.
In pronouncing sentence, Judge England stated that the conspiracy was “a very sophisticated operation.” Dr. Popov requested leniency on the basis of the benefits he had provided and could continue to provide to society in his role as a physician. The Judge rejected this, stating, “a physician should be held to a higher standard rather than a lower standard. … People trust their doctors, people want to trust their doctors … this was about making money. … He used his profession, he used his education, he used his intelligence in the worst possible way. It’s extremely troubling.”
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Source- http://www.fbi.gov/losangeles/press-releases/2012/former-huntington-hospital-executive-sentenced-to-three-years-in-prison-in-kickback-scheme-that-cost-hospital-nearly-5-million
LOS ANGELES—The former director of construction for Huntington Memorial Hospital in Pasadena was sentenced this morning to three years in federal prison and ordered to pay $4.8 million in restitution for orchestrating a kickback scheme in which companies were paid for work that was never done at the Pasadena hospital.
David Hamedany, 55, of Glendale, was sentenced by United States District Judge Percy Anderson. Hamedany pleaded guilty in May 2011 to two counts of mail fraud.
At this morning’s sentencing hearing, Judge Anderson said Hamedany was an immigrant who realized the American Dream, but had “lost his moral compass” and became motivated by greed.
Hamedany served as the director of construction for Huntington Memorial Hospital during the years from 2006 through 2010. Beginning in 2008, Hamedany orchestrated a billing and kickback scheme that resulted in the hospital paying more than $3 million to companies that performed no work at all for the hospital. The companies funneled 90 percent of the fees paid by the hospital to entities controlled by Hamedany. During the same time period, Hamedany entered into inflated contracts with entities that were performing services for the hospital, but agreed to inflate the price and pay the excess money in kickbacks to entities controlled by Hamedany. In total, the scheme, resulted in losses to the hospital of approximately $4.8 million.
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- http://www.fbi.gov/philadelphia/press-releases/2012/harrisburg-ambulance-company-owner-and-employee-indicted-on-federal-medicare-fraud-charges
The United States Attorney’s Office for the Middle District of Pennsylvania announced today that a Harrisburg-based ambulance company, its owner, and a managerial employee have been indicted by a grand jury in Harrisburg on federal health care fraud charges.
Advantage Medical Transport, Inc, headquartered at 733 Fire House Lane, Harrisburg, and its owner, Serge Sivchuk, age 26, also of Harrisburg, were charged in the indictment with 14 counts of health care fraud, one count of conspiracy, and 14 counts of false statements in health care matters. Advantage’s EMT and dispatcher supervisor, David Paul, age 42, of York, Pennsylvania, was also charged with conspiracy and 14 counts of false statements in health care matters.
According to U.S. Attorney Peter J. Smith, the indictment alleges that between January 2009 and June 2011 Advantage and Sivchuk devised and perpetrated a scheme to defraud Medicare out of at least $1,000,000 by submitting hundreds of claims for the non-emergency transport of Medicare beneficiaries to and from dialysis treatment centers. The indictment alleges the claims were fraudulent because the patients were ambulatory and the ambulance transports were not medically necessary.
During 2010 Medicare paid Advantage $166.64 plus $5.49 per mile for each leg of a transport to and from a dialysis treatment center. Many dialysis patients underwent three treatments per week. Thus, one week’s transport of a dialysis patient could yield Advantage more than $1,000.
The indictment focuses on an August 2010 pre-payment audit conducted by Medicare. Allegedly, of 40 claims audited, it was discovered Advantage and Sivchuk had submitted 14 re-written and forged ambulance “Trip Sheets” in support of the claims. The Trip Sheets, which are prepared by Emergency Medical Technicians (EMTs) at the time of each transport, had been allegedly rewritten to omit references to the patients’ ability to walk, stand or otherwise ambulate. The patients’ vital signs (blood pressure, pulse, and respirations) on two Trip sheets were changed and the signatures of some of the EMTs were allegedly forged. The Indictment alleges Sivchuk and Paul directed Advantage’s EMTs to re-write the 14 Trip Sheets and to prepare many others in a manner that concealed the ambulatory nature of the patients.
The indictment alleges the EMTs were threatened with a reduction in hours or termination if they did not prepare the Trip Sheets as they were directed.
Each health care fraud count is punishable by up to 20 years’ imprisonment and $1,000,000 fine. The conspiracy count and each false statement count is punishable by up to five years’ imprisonment and $1,000,000 fine.
The indictment also seeks the criminal forfeiture of Sivchuk’s Farmcrest Lane, Harrisburg, Pennsylvania residence, Advantage’s business premises at 733 Fire House Lane, Harrisburg, $860,972 in six Harrisburg area bank accounts controlled by Sivchuk, plus Sivchuk’s 2006 Bentley and 2010 Land Rover.
The indictment was the result of a federal investigation that began earlier this year with the execution of search warrant at Advantage’s business premises. During the search, voluminous records and documents were seized. At the same time the search warrant was executed, the U.S. Attorney’s Office filed a civil action in U.S. District Court in Harrisburg freezing more than $936,000 in Advantage and Sivchuk controlled bank accounts.
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Source- http://www.fbi.gov/minneapolis/press-releases/2012/owner-of-home-health-care-agency-is-sentenced-for-defrauding-medicaid-out-of-more-than-650-000
MINNEAPOLIS—Yesterday in federal court in St. Paul, the owner of a home health care agency was sentenced for defrauding Medicaid and obtaining more than $650,000 through false billing. United States District Court Judge Paul A. Magnuson sentenced John Alemoh Momoh, age 52, of Brooklyn Park, to 24 months in prison on one count of health care fraud. Momoh was charged on April 12, 2011, and pleaded guilty on September 29, 2011.
In his plea agreement, Momoh admitted that from May of 2007 through March of 2008, he submitted false claims billing Medicaid for personal care assistance (“PCA”) services. The claims were false in multiple ways, including regarding the hours of services provided, the PCA providing those services, and the type of services provided. In addition, claims lacked required documentation and were sometimes submitted for services not medically necessary. Momoh also submitted claims for PCA services provided by an individual who was disqualified from the program for safety reasons.
The fraudulent claims were made to the Minnesota Department of Human Services (“DHS”), which administers the federal Medicaid program here in Minnesota. Momoh owned Hopecare Services, Inc., located in Brooklyn Park. In March of 2007, DHS opened an investigation into Hopecare’s billing practices after a Medicaid recipient complained about Momoh’s billing. After reviewing this complaint, DHS twice notified Momoh that he had billed improperly, both by an agency notice explaining Momoh’s false billing and by meeting with Momoh in person. Despite these warnings, Momoh continued to fraudulently bill Medicaid, submitting more than 800 fraudulent claims for PCA services in less than one year.
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Source- http://www.fbi.gov/baltimore/press-releases/2012/gambrills-podiatrist-sentenced-to-over-four-years-in-prison-for-fraudulently-billing-medicare-over-1.1-million
BALTIMORE—U.S. District Judge James K. Bredar sentenced Larry Bernhard, age 56, a podiatrist who operated his business from his home in Gambrills, Maryland, today to 54 months in prison followed by three years of supervised release for health care fraud and aggravated identity theft related to a scheme to fraudulently bill Medicare for more than $1.1 million. Judge Bredar also entered an order requiring Bernhard to pay restitution of $1,122,992.08.
The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.
“Health insurance programs trust providers to bill honestly for medical services, so it is essential to punish doctors who betray that trust,” said U.S. Attorney Rod J. Rosenstein. “Dr. Larry Bernhard flagrantly ripped off Medicare Advantage by fabricating claims for services that he never provided, collecting more than $1 million in new false claims even after he was caught and prohibited from billing federal health care programs.”
According to his plea agreement, Bernhard has been a licensed podiatrist in Maryland since 1981 and operated a podiatry practice from his home known as Chesapeake Wound Care Center. On October 30, 2007, Bernhard entered into a Settlement Agreement with the government to resolve allegations that from April 1, 2002 through October 11, 2004, he had submitted 80 claims to Medicare for podiatry services purportedly provided at skilled nursing facilities, when in fact the patients were in hospitals. As part of the settlement, Bernhard agreed to be excluded from “Medicare, Medicaid, and all other Federal health care programs” for a period of three years.
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Source- http://www.fbi.gov/losangeles/press-releases/2012/glendale-man-pleads-guilty-in-5-million-loan-fraud-case
WASHINGTON—The owner and operator of a Broward County, Florida-area halfway house pleaded guilty today for his role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).
Barry Nash, 69, pleaded guilty before U.S. Magistrate Judge Barry L. Garber in Miami to one count of conspiracy to commit health care fraud. Nash was the owner and operator of Starter House, a halfway house operating in Broward County.
Nash admitted that, in exchange for illegal health care kickbacks, he agreed to refer Medicare beneficiaries who resided at Starter House to American Therapeutic Corporation (ATC) for purported intensive mental health treatment called partial hospitalization program (PHP) services, and to the American Sleep Institute (ASI), a company related to ATC, for purported sleep treatment. Nash knew that ATC and ASI would fraudulently bill Medicare for the PHP treatment and sleep studies that his referrals would purportedly receive.
According to court documents, ATC’s principals 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 conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. Ultimately, ATC and ASI billed Medicare for more than $200 million in medically unnecessary services.
According to the plea agreement, Nash’s participation in the fraud resulted in more than $959,901 in fraudulent billing to the Medicare program. At sentencing, scheduled for March 8, 2012, Nash faces a maximum of 10 years in prison and a $250,000 fine.
ATC, its management company Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011. ATC, Medlink and nine of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial April 9, 2012, before U.S. District Judge Patricia A. Seitz.
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Source- http://www.fbi.gov/losangeles/press-releases/2012/owner-of-westlake-home-health-agency-pleads-guilty-to-bilking-medicare-out-of-over-5-million-in-health-care-fraud-scheme
LOS ANGELES—A registered nurse who operated a home health agency based in Westlake has pleaded guilty to federal health care fraud charges in a $5 million Medicare fraud scheme involving kickbacks to doctors and patients who did not qualify for in-home health services.
Hee Jung Mun, who often used the name Angela Mun, 50, of Rancho Palos Verdes, pleaded guilty yesterday afternoon before United States District Judge Dean D. Pregerson.
Mun owned Greatcare Home Health, Inc., which was shut down in March 2011 when special agents with the Federal Bureau of Investigation and the Department of Health and Human Services, Office of Inspector General, executed a search warrant at the company’s office. The criminal investigation into Greatcare was prompted by a still-pending “whistleblower” lawsuit filed by a former employee.
In a plea agreement filed in United States District Court, Mun admitted that she orchestrated the scheme that defrauded Medicare in a number of ways: paying illegal kickbacks to doctors for patient referrals, to “cappers” or “marketers” for patient referrals, and to patients to induce them to sign up for home health services; billing Medicare for patients who were not homebound or who otherwise did not quality for home health services, and for services provided by unlicensed individuals or not provided at all; creating bogus medical records to support fraudulent claims to Medicare; and “upcoding” or exaggerating patient conditions to generate larger reimbursements from Medicare. The scheme targeted elderly, primarily Korean, Medicare beneficiaries.
A nurse who worked at Greatcare also pleaded guilty yesterday afternoon. Ji Hae Kim, 43, of Fullerton, pleaded guilty to conspiracy to commit health care fraud, admitting that she prepared false forms to fraudulently justify that Medicare beneficiaries needed home health services. Kim also falsely claimed to have made patient visits that she knew were either conducted by unlicensed individuals or not conducted at all, leading to $1.1 million in payments from Medicare.
As a result of their guilty pleas this afternoon, Mun and Kim both face statutory maximum sentences of 10 years in federal prison.
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Source- http://www.fbi.gov/philadelphia/press-releases/2012/ambulance-company-worker-pleads-guilty-to-fraud-scheme
HILADELPHIA—Ivan Tkach, 30, of Philadelphia, pleaded guilty today to charges relating to a private ambulance company’s involvement in a health care fraud scheme. Tkach admitted to giving false statements relating to health care and illegal remunerations relating to health care services. A sentencing hearing is scheduled for April 12, 2012 before U.S. District William H. Yohn, Jr. Tkach faces an advisory sentencing guideline range of 37 to 57 months in prison and has agreed to pay restitution in the amount of $1.26 million to Medicare.
Tkach was indicted along with his bosses Alla and Ilya Sivchuk; Ilya Sivchuk was convicted by a jury in November 2011 and Alla Sivchuk was acquitted. Tkach was excluded by the U.S. Department of Health and Human Services in 2004 from providing services under the Medicare Program due to his prior criminal convictions, yet continued to operate Advantage Ambulance Company and drive patients in ambulances. Tkach ran Advantage with the knowledge of Ilya Sivchuk, who also made false statements regarding the nature of Tkach’s employment to federal agents. In addition, Tkach gave kickback payments in 2008 to a worker at a Philadelphia kidney dialysis center in exchange for patient referrals to Advantage.
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Source- http://www.fbi.gov/washingtondc/press-releases/2012/alexandria-dentist-pleads-guilty-to-health-care-fraud
ALEXANDRIA, VA—Tuan Vu, 43, of Annandale, Va., pleaded guilty today to fraudulently billing insurance providers hundreds of thousands of dollars for dental services that he did not provide to his patients.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office, made the announcement after the plea was accepted by United States District Judge Liam O’Grady.
Vu was charged today by criminal information with health care fraud, and he faces a maximum penalty of 10 years in prison when he is sentenced on May 4, 2012.
In a statement of facts filed with his plea agreement, Vu admitted to committing health care fraud from at least January 2007 to September 2011. Vu is the owner of Cosmetic & Family Dentistry, PLLC, a dental practice located in Alexandria, Va. During the time of his health care fraud scheme, Vu consistently billed dental insurance providers for services that he did not provide his patients. As a result of Vu’s offense, at least 10 private insurance providers suffered more than $400,000 in losses. Dr. Vu’s conduct also resulted in a substantial loss to the federal government and the Commonwealth of Virginia, including $87,389 to the Federal Employee Health Benefits Program and $180,048 to the Virginia Medicaid program.
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Source- http://www.fbi.gov/losangeles/press-releases/2012/los-angeles-church-pastor-sentenced-to-180-months-in-prison-for-14.2-million-medicare-fraud-scheme
WASHINGTON—The pastor of a now defunct Los Angeles church who owned and operated several fraudulent durable medical equipment (DME) supply companies was sentenced today to 180 months in prison for his role in a $14.2 million Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced.
Christopher Iruke, 61, was also ordered to pay $6.7 million in restitution, jointly and severally with his co-conspirators, by U.S. District Judge Terry J. Hatter of the Central District of California. In addition, Judge Hatter ordered Iruke to serve three years of supervised release following his prison term.
In August 2011, a jury found Iruke and his wife, Connie Ikpoh, 49, and one of their employees, Aura Marroquin, guilty of conspiracy and health care fraud offenses following a two-week trial in Los Angeles.
According to evidence introduced at trial, Iruke and Ikpoh were pastors at Arms of Grace Christian Center, a church that operated from 5700 Crenshaw Boulevard in Los Angeles, where Iruke and Ikpoh also operated Pascon Medical Supply, a fraudulent DME supply company. Iruke and Ikpoh hired several of their parishioners at Arms of Grace to assist them in running Pascon and another fraudulent DME supply company, Horizon Medical Equipment and Supply Inc. Horizon was owned by Ikpoh, who also worked as a nurse at two Los Angeles-area hospitals.
According to evidence presented at trial, Iruke, Ikpoh, Marroquin, and their co-conspirators used fraudulent prescriptions and documents that Iruke purchased from a number of illicit sources to bill Medicare for expensive, high-end power wheelchairs and orthotics that were medically unnecessary or never provided. These power wheelchairs cost approximately $900 per wheelchair wholesale, but were billed to Medicare at a rate of approximately $6,000 per wheelchair.
Evidence introduced at trial established that when it appeared to Iruke that he would have to close Pascon due to an audit by Medicare, Iruke convinced his sister, Jummal Joy Ibrahim, and a member of Arms of Grace to allow him to use their names and identities to open two new fraudulent DME supply companies. These companies, Contempo Medical Equipment Inc. and Ladera Medical Equipment Inc., also operated from Los Angeles. After Pascon and Horizon closed, Iruke and his co-conspirators continued to operate the fraud scheme from Contempo and Ladera.
Witnesses who sold fraudulent prescriptions and documents to Iruke testified that they and others paid cash kickbacks to street-level marketers to offer Medicare beneficiaries free power wheelchairs and other DME in exchange for the beneficiaries’ Medicare card numbers and personal information. These witnesses testified that they and their associates used this information to create fraudulent prescriptions and medical documents which they sold to Iruke and the operators of other fraudulent DME supply companies for $1,100 to $1,500 per prescription.
Trial testimony established that Iruke took extensive efforts to conceal the fraud scheme and his involvement with the companies. One witness who worked at the companies testified that Iruke directed her and Marroquin to lie to state and Medicare inspectors about his involvement with Contempo and Ladera when the inspectors visited the companies.
Witness testimony established that shortly after agents visited Ladera, Iruke directed Marroquin and Darawn Vasquez, a member of Arms of Grace who worked at the supply companies, not to talk to law enforcement. Iruke provided Marroquin and Vasquez with cellular telephones, and directed them to use the phones in order to prevent law enforcement from intercepting their conversations. Iruke and Vasquez then met at Arms of Grace, and shredded evidence of the fraud scheme.
Witness testimony and evidence introduced at trial also established that within a few weeks of the agents visiting Ladera, Iruke closed Contempo and Ladera, which prompted agents to serve Iruke and his attorneys with subpoenas for the files of the companies. Instead of producing the files, Iruke directed that the files be brought to an auditorium used by Arms of Grace, where Iruke, Ikpoh, Marroquin and others altered and destroyed documents within the files to remove evidence of the fraud scheme. Law enforcement agents found Marroquin with these files when they arrested her.
Evidence introduced at trial showed that as a result of this fraud scheme, Iruke, Ikpoh, Marroquin and their co-conspirators submitted more than $14.2 million in fraudulent claims to Medicare, and received approximately $6.7 million in reimbursement payments from Medicare. The evidence at trial showed that Iruke and Ikpoh diverted most of this money from the bank accounts of the supply companies to pay for the fraudulent prescriptions and documents which Iruke purchased to further the scheme, and to cover the leases on their Mercedes vehicles, home remodeling expenses and other personal expenses.
Ikpoh is scheduled to be sentenced on Feb. 27, 2012. Vasquez and Ibrahim pleaded guilty to conspiracy and false statement charges in February 2011 and March 2011, respectively, and are awaiting sentencing. On Dec. 9, 2011, Judge Hatter sentenced Marroquin to time served and three years of supervised release.
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