Jacques Roy Arrested for Alleged Role in Nearly $375 Million Health Care Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-260.html 

WASHINGTON - A physician and the office manager of his medical practice, along with five owners of home health agencies, were arrested today on charges related to their alleged participation in a nearly $375 million health care fraud scheme involving fraudulent claims for home health services.

The arrests and charges were announced today by Deputy Attorney General James Cole and Health and Human Services (HHS) Deputy Secretary Bill Corr, along with Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Sarah R. Salda ñ a of the Northern District of Texas; HHS Inspector General Daniel R. Levinson; Special Agent in Charge Robert E. Casey Jr. of the FBI’s Dallas Field Office; Dr. Peter Budetti, Deputy Administrator for Program Integrity for the Centers for Medicare and Medicaid Services (CMS); and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

The indictment, filed in the Northern District of Texas and unsealed today, charges Jacques Roy, M.D., 54, of Rockwall, Texas; Cynthia Stiger, 49, of Dallas; Wilbert James Veasey Jr., 60, of Dallas; Cyprian Akamnonu, 63, of Cedar Hill, Texas; Patricia Akamnonu, RN, 48, of Cedar Hill; Teri Sivils, 44, of Midlothian, Texas; and Charity Eleda, RN, 51, of Rowlett, Texas, each with one count of conspiracy to commit health care fraud. Roy also is charged with nine counts of substantive health care fraud, and Veasey, Patricia Akamnonu and Eleda are each charged with three counts of health care fraud. Eleda also is charged with three counts of making false statements related to a Medicare claim . All the defendants are expected to make their initial appearances at 2:00 p.m. CST today in federal court in Dallas.

In addition to the indictment, CMS announced the suspension of an additional 78 home health agencies (HHA) associated with Roy based on credible allegations of fraud against them.

Today’s enforcement actions are the result of the Medicare Fraud Strike Force operations, which are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). HEAT is a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce anti-fraud laws around the country.

“The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor in the history of HEAT and our Medicare Fraud Strike Force operations,” said Deputy Attorney General Cole. “Thanks to the historic partnerships we’ve built to combat health care fraud, we are sending a clear message: If you victimize American taxpayers, we will track you down and prosecute you.”

“Thanks to our new fraud detection tools, we have greater abilities to identify the kind of sophisticated fraud scheme that previously could have escaped scrutiny,” said HHS Deputy Secretary Corr. “Our aggressive Medicare Fraud Strike Force operations have enabled us to break up a significant alleged fraud operation and the fraud-fighting authorities in the Affordable Care Act have allowed us to stop further payments to providers connected to this scheme. This case and our new detection tools are examples of our growing ability to stop Medicare fraud.”

According to the indictment, Dr. Roy owned and operated Medistat Group Associates P.A. in the Dallas area. Medistat was an association of health care providers that primarily provided home health certifications and performed patient home visits. Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 HHAs for home health services during the past five years. Between January 2006 and November 2011, Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States. These certifications allegedly resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid by Medistat and HHAs.

“Today, the Medicare Fraud Strike Force is taking aim at the largest alleged home health fraud scheme ever committed,” said Assistant Attorney General Breuer . “According to the indictment, Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise in the Dallas area, making millions by recruiting thousands of patients for unnecessary services, and billing Medicare for those services. In Dallas, and the eight other Medicare Fraud Strike Force cities, the Criminal Division and our partners in the U.S. Attorneys’ Offices will continue to crack down on Medicare fraud, and hold accountable those stealing from the public fisc.”

“Fraud schemes, like the one we allege Dr. Roy executed, represent the next wave of Medicare and Medicaid crime that we face,” said U.S. Attorney Salda ñ a. “As enforcement actions have ramped up, not only in the Dallas Metroplex, but in several other areas throughout the country, fraudsters are devising new ways to beat the system. Rest assured, however, that with the tools and resources our district’s Medicare Care Fraud Strike Force provides, we will meet this challenge head-on and bring indictments against those who seek to defraud these critical programs, and you, the taxpayer.”

“Using sophisticated data analysis we can now target suspicious billing spikes,” said HHS Inspector General Levinson. “In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people – Dr. Roy certified more than 5,000.”

“The FBI views health care fraud as a severe crime problem,” said FBI Special Agent in Charge Casey. “It causes increased costs for consumers, tax payers and health insurance plans, and degrades the integrity of our health care system and legitimate patient care. Today’s arrests by the Dallas Medicare Fraud Strike Force send a clear message to those persons who are not only defrauding our federal Medicare and Medicaid and private health insurance programs, but victimizing the elderly, the disadvantaged, and those who are at a vulnerable time in their lives due to legitimate health issues. The FBI will continue to dedicate a substantial amount of expert resources to investigate these crimes.”

The indictment alleges that Dr. Roy used HHAs as recruiters so that Medistat could bill unnecessary home visits and medical services. Dr. Roy and other Medistat physicians certified and recertified plans of care so that HHAs also were able to bill Medicare for home health services that were not medically necessary and not provided. In addition, Dr. Roy allegedly performed unnecessary home visits and ordered unnecessary medical services.

According to the indictment, Medistat maintained a “485 Department,” named for the number of the Medicare form on which the plan of care was documented. Dr. Roy allegedly instructed Medistat employees to complete the 485s by either signing his name by hand or by using his electronic signature on the document.

Three of the HHAs Dr. Roy used as part of the scheme were Apple of Your Eye Healthcare Services Inc., owned and operated by Stiger and Veasey; Ultimate Care Home Health Services Inc., owned and operated by Cyprian and Patricia Akamnonu; and Charry Home Care Services Inc., owned and operated by Eleda. According to the indictment, Veasey, Akamnonu, Eleda and others recruited beneficiaries to be placed at their HHAs so that they could bill Medicare for the unnecessary and not provided services. As part of her role in the scheme, Eleda allegedly visited The Bridge Homeless Shelter in Dallas to recruit homeless beneficiaries staying at the facility, paying recruiters $50 per beneficiary they found at The Bridge and directed to Eleda’s vehicle parked outside the shelter’s gates.

Apple allegedly submitted claims to Medicare from Jan. 1, 2006, through July 31, 2011, totaling $9,157,646 for home health services to Medicare beneficiaries that were medically unnecessary and not provided. Dr. Roy or another Medistat physician certified the services. From Jan. 1, 2006, to Aug. 31, 2011, Ultimate submitted claims for medically unnecessary home health services totaling $43,184,628. Charry allegedly submitted fraudulent claims from Aug. 1, 2008, to June 30, 2011, totaling $468,858 in medically unnecessary and not provided home health services.

The indictment alleges that Sivils, as Medistat’s office manager, helped facilitate the fraud scheme by, among other actions, supervising the processing of thousands of plans of care that contained Dr. Roy’s electronic signature and other Medistat physicians’ signatures, permitting HHAs to bill Medicare for unnecessary home health services and accepting cash payments from Cyprian Akamnonu in exchange for ensuring plans of care contained Dr. Roy or another Medistat physician’s signature.

As outlined in the government’s request to the court to detain Dr. Roy, in June 2011, CMS suspended provider numbers for Dr. Roy and Medistat based on credible allegations of fraud, thus ensuring Dr. Roy did not receive payment from Medicare. Immediately after the suspension, nearly all of Medistat’s employees started billing Medicare under the provider number for Medcare HouseCalls. The court document alleges that Dr. Roy was in fact in charge of day-to-day operations at Medcare, and that Dr. Roy continued to certify patients for home health despite the suspension.

Each charged count of conspiracy to commit health care fraud and substantive health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine. Each false statement charge carries a maximum penalty of five years in prison and a $250,000 fine. The indictment also seeks forfeiture of numerous items including funds in bank accounts, a sailboat, vehicles and multiple pieces of property.

An indictment is merely an allegation and defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.



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Connie Ikpoh Sentenced to Serve 36 Months in Prison for $14.2 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-256.html 

WASHINGTON – A former Los Angeles church pastor, who owned and operated several fraudulent durable medical equipment (DME) supply companies with her husband, was sentenced today to serve 36 months in prison for her role in a $14.2 million Medicare fraud scheme, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.

Connie Ikpoh, 49, also was sentenced today by U.S. District Judge Terry J. Hatter for the Central District of California to three years of supervised release and ordered to pay $6.7 million in restitution jointly and severally with her co-conspirators.

In August 2011, a jury found Ikpoh, a nurse who also worked at two Los Angeles-area hospitals, and her husband, Christopher Iruke, 61, 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 presented at trial, Ikpoh and Iruke were pastors at Arms of Grace Christian Center, a Los Angeles church where Ikpoh and Iruke also operated Pascon Medical Supply, a fraudulent DME supply company. Ikpoh and Iruke hired several church members at Arms of Grace to assist them with running Pascon and three other fraudulent DME supply companies, Horizon Medical Equipment and Supply Inc., Contempo Medical Equipment Inc. and Ladera Medical Equipment Inc. The trial evidence showed that Ikpoh owned and operated Horizon. Ikpoh and Iruke used Iruke’s sister Jummal Joy Ibrahim as a straw owner of Contempo and Ladera.

According to the trial evidence, Ikpoh, Iruke, Marroquin and their co-conspirators used fraudulent prescriptions and documents that Ikpoh and 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. Each power wheelchairs cost approximately $900 per wholesale, but were billed to Medicare at a rate of approximately $6,000 per wheelchair. Witness testimony established that Ikpoh and Iruke hid the money they used to pay for these fraudulent prescriptions by writing checks to a company called “Direct Supply,” a fictitious company that Iruke created in the name of an Arms of Grace church member. Iruke cashed the checks that he and Ikpoh wrote to Direct Supply and used the money to purchase the fraudulent prescriptions.

Witnesses who sold the fraudulent prescriptions and documents that Ikpoh, Iruke and their co-conspirators used to defraud Medicare 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.

After Iruke purchased the prescriptions, the trial evidence showed that Ikpoh used the prescriptions at Horizon to bill Medicare primarily for power wheelchairs. In fact, the trial evidence showed that approximately 85 percent of Horizon’s business was power wheelchairs, and that Ikpoh submitted more than $3.2 million in claims to Medicare. Medicare paid Ikpoh more than $1.6 million on these claims. Witnesses who worked at Horizon testified that if Medicare refused to pay Horizon for a power wheelchair, Ikpoh required the witnesses to take back the power wheelchairs from the Medicare beneficiaries.

The trial evidence showed that Ikpoh was also involved with operating Contempo and Ladera. Ikpoh represented herself to state inspectors as Contempo’s manager and appeared on Ladera’s corporate filings with the state. Moreover, witness testimony established that Ikpoh ran the companies when Iruke visited Nigeria and that she and one of her co-defendants, Darawn Vasquez, who was also a church member at Arms of Grace, withdrew money from the Contempo bank account to pay for fraudulent prescriptions.

Witness testimony established that in August 2009, law enforcement agents visited Contempo and Ladera and questioned Marroquin and Vasquez about fraud occurring at the companies. Within a few weeks of the agents’ visit, Iruke closed Contempo and Ladera, which prompted agents to serve Iruke and his and Ikpoh’s attorneys with subpoenas for the companies’ files. Instead of producing the files, Iruke directed that the files be brought to an auditorium used by Arms of Grace, where Ikpoh, Iruke, 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, Ikpoh, Iruke, 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 showed that Ikpoh and Iruke 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.

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. On Jan. 9, 2012, Judge Hatter sentenced Iruke to serve 180 months in prison and three years of supervised release.



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Lodrick "Chidi" Eneh Sentenced For Role In Patient Information Trafficking Scheme

Source-  http://www.justice.gov/usao/txe/News/2012/edtx-hcf-eneh-022112.html 

BEAUMONT, Texas – A 44-year-old Houston man has been sentenced to federal prison for his role in a patient information trafficking scheme in the Eastern District of Texas announced U.S. Attorney John M. Bales today.

Lodrick "Chidi" Eneh pleaded guilty on June 20, 2011, to illegal remunerations charges and was sentenced to 24 months in federal prison today by U.S. District Judge Marcia Crone.

According to the indictment, from September 2006 until November 2008, Houston businessman, Eneh conspired to pay and receive kickbacks for the referral of Medicare patients. Eneh entered into arrangements with Anthony Nnadi, Chima Imoh, and John Nasky Okonkwo, owners of medical supply businesses, in which he agreed to provide them with patient information that would be used to submit claims to Medicare. After the business owners submitted claims to Medicare and were reimbursed, they would split a percentage of the proceeds with Eneh. Eneh was indicted by a federal grand jury on Jan. 5, 2011.

Nnadi, Imoh, and Nasky have all pleaded guilty to health care fraud offenses. Nnadi was sentenced to five years probation and ordered to pay $576,000.00 in restitution to the Medicare program and to forfeiture of $100,000. Nasky was sentenced to 45 months in federal prison and ordered to pay restitution of $4.9 million to the Medicare and Medicaid programs and forfeiture of $4.8 million. Imoh was sentenced to a five year term of probation and ordered to pay $56,000 in restitution to Medicare for his role in the scheme.



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Michelle Turner Convicted in $1.1 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-253.html 

WASHINGTON – A patient recruiter for a Houston durable medical equipment (DME) company was convicted today by a federal jury in Houston of health care fraud related to an “arthritis kit” fraud scheme, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.

After a four-day trial, Michelle Turner, 44, of Spring, Texas, was convicted of one count of conspiracy to commit health care fraud, one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries and two counts of receiving illegal kickbacks for referring Medicare beneficiaries.

According to evidence presented at trial, Clifford Ubani and Princewill Njoku were the owners of Family Healthcare Services. Family Healthcare maintained a valid Medicare provider number in order to submit Medicare claims for the costs of DME and purported to provide orthotics and other DME to Medicare beneficiaries. Ubani and Njoku hired co-conspirators Turner, Ana Quinteros and others to recruit beneficiaries for the purposes of filing claims with Medicare for DME. Once Ubani and Njoku obtained Medicare beneficiary numbers, Family Healthcare submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or not provided. Co-conspirator Rolondae Mitchell-Straughter was the office manager and was responsible for processing the fraudulent claims. Many of the orthotic devices were components of what was referred to as an “arthritis kit” and were purported to be for the treatment of arthritis-related conditions, but the devices were not medically necessary or appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices, including braces for both sides of the body and related accessories, such as heat pads. Ubani and Njoku paid kickbacks to the recruiters for their referrals. In total, Family Healthcare submitted approximately $1.1 million in fraudulent claims to Medicare.

Evidence at trial showed that Turner operated a “boiler room” and hired teenagers to make unsolicited telephone calls to elderly Medicare beneficiaries asking them if they wanted a free arthritis kit. The arthritis kit was billed to Medicare at more than $3,000. Under Medicare rules, unsolicited telephone calls are prohibited. Additionally, a Medicare beneficiary is responsible for paying a 20 percent co-pay for all DME. Beneficiaries’ doctors further testified at trial that the beneficiaries did not need the arthritis kit.

Ubani and Njoku previously pleaded guilty to conspiracy to commit health care fraud and await sentencing. Mitchell-Straughter pleaded guilty to conspiracy to commit health care fraud and was sentenced to 18 months in prison. Quinteros previously pleaded guilty to conspiracy to commit health care fraud and was sentenced to probation. A sixth defendant, Mary Ellis, was acquitted in this case by a jury in December 2010, but was later convicted of conspiracy to commit health care fraud in May 2011 in a separate case and was sentenced to 63 months in prison.

At sentencing, Turner faces maximum penalties of 10 years in prison for the health care fraud conspiracy count; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for each count of receiving an illegal kickback for referring a Medicare beneficiary.



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Mohammad Khan Pleads Guilty to Participating in $116 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-243.html 

WASHINGTON – An assistant administrator of a Houston hospital pleaded guilty today for his role in a $116 million Medicare fraud scheme involving false claims for mental health treatment, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Mohammad Khan, 62, of Houston, pleaded guilty before U.S. District Judge Sim Lake in the Southern District of Texas to one count of conspiracy to commit health care fraud, one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks, and five counts of paying or offering to pay health care kickbacks. Khan was arrested on Feb. 8, 2012. In his plea, Khan admitted that, from January 2008 until the time of his arrest, he caused the submission of $116 million worth of fraudulent claims to Medicare for partial hospitalization program (PHP) services purportedly provided by the hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.

“As an assistant administrator at a Houston hospital, Mr. Kahn participated in a $116 million fraud against the government,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “For years, he operated a scheme to bill Medicare for partial hospitalization services that were medically unnecessary or never provided. With our Medicare Fraud Strike Force teams in nine cities, we are holding accountable people across the country who have calculated – incorrectly – that they can get away with trying to bilk the Medicare program.”

According to court documents, Khan was the assistant administrator of Riverside General Hospital and controlled the day-to-day operations of Riverside’s PHPs. Riverside maintained a valid Medicare provider number that was used to submit claims to Medicare for PHP services that were not medically necessary, and in some cases, never provided. Many of the beneficiaries for whom Riverside submitted claims to Medicare for PHP services did not have severe mental illness and did not need the treatment provided in a PHP. In his plea, Khan admitted that he paid and caused the payment of kickbacks to patient recruiters and owners of assisted living facilities and group care homes in exchange for the recruiters and owners sending Medicare beneficiaries to Riverside’s PHPs. Khan also paid Medicare beneficiaries in the form of cigarettes, food and coupons redeemable for items available at Riverside’s “country stores,” in exchange for those beneficiaries attending Riverside’s PHPs.

In his plea, Khan admitted that he and his co-conspirators submitted approximately $116 million in claims to Medicare for PHP services purportedly provided by the hospital to the recruited beneficiaries, when in fact, the PHP services were medically unnecessary or never provided.

Khan is scheduled to be sentenced on May 25, 2012. Khan faces a maximum sentence of 10 years in prison for the conspiracy to commit health care fraud count, five years in prison for the conspiracy to defraud the United States count and five years in prison for each health care kickbacks count.



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Butler Moultrie Sentenced to 33 Months in Prison for Participating in Fraud and Kickback Scheme

Source-  http://www.fbi.gov/miami/press-releases/2012/fort-lauderdale-florida-area-halfway-house-operator-sentenced-to-33-months-in-prison-for-participating-in-fraud-and-kickback-scheme 

WASHINGTON—The manager and operator of a Fort Lauderdale, Fla.-area halfway house was sentenced today to 33 months in prison for his role in a Medicare fraud kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Butler Moultrie, 46, was sentenced by U.S. District Judge Donald M. Middlebrooks in the Southern District of Florida. In addition to his prison term, Moultrie was sentenced to three years of supervised release and was ordered to pay $801,000 in restitution.

Moultrie pleaded guilty in December 2011 to one count of conspiracy to commit health care fraud.

According to court documents, most of the residents at Moultrie’s halfway house were recovering from drug and/or alcohol addictions. Moultrie agreed to refer Medicare beneficiaries who resided at his halfway house to ATC to purportedly receive intensive mental health services called partial hospitalization program (PHP) treatment in exchange for illegal health care kickbacks. Moultrie admitted that he knew the kickbacks were illegal and that ATC fraudulently billed the Medicare program for the PHP services. Moultrie also knew that no doctor had prescribed PHP treatment for his patient referrals and that his residents required drug and/or alcohol addiction treatment rather than mental health services.

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 its related company, the American Sleep Institute (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. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare more than $200 million in medically unnecessary services.

According to the plea agreement, Moultrie’s participation in the fraud resulted in approximately $1.9 million in fraudulent billing to the Medicare program.

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 ten 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. In addition to Moultrie, 11 other assisted living facility and halfway house owners and operators and patient recruiters have been convicted for their roles in the fraud scheme. Eight of these defendants, including Moultrie, have been sentenced to prison.



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Former Vice-President of Pharmacutical Company Johnny Perry, Pleads Guilty to FDA Violations and Health Care Fraud

Source-  http://www.fbi.gov/louisville/press-releases/2012/former-vice-president-of-pharmacutical-company-pleads-guilty-to-fda-violations-and-health-care-fraud 

LOUISVILLE, KY—The former vice-president of National Respiratory Services, LLC (NRS) has pled guilty in United States District Court before Chief Judge Joseph H. McKinley, Jr., to charges of misbranding and altering drugs and to committing health care fraud announced David J. Hale, United States Attorney for the Western District of Kentucky.

Johnny Perry, age 62, of Mt. Washington, Kentucky, was indicted by a federal grand jury in Louisville on August 3, 2011. The five count indictment alleged that between June of 2006 and June of 2008, Perry, as vice-president of NRS, provided compounded medications to patients, but led both Medicare and the patients’ doctors to believe that the pharmaceutical company was providing non-compounded medications (FDA approved-commercially manufactured). Compounded medications are not FDA approved, but FDA regulations permit pharmacists to make compounded drugs, including prescription drugs, in limited amounts and under narrow circumstances, for particular patients, and at the direction of a physician when other available drugs cannot be prescribed.

The defendant, through the NRS Corporation submitted false and fraudulent claims to Medicare for the cost of FDA-approved, commercially manufactured, prescription inhalation drugs, when they were not. As a result of this conduct, NRS received approximately $2,030,343 in payments from Medicare to which they were not legally entitled.

It is further alleged that Ms. Perry, aided and abetted by others, from November 2006 through June 2008, misbranded inhalation drugs in that they contained false and misleading labeling that misrepresented the strength and potency of their active ingredients or the type of drug actually provided. During the same period it is alleged that Perry, aided and abetted by others, adulterated inhalation drugs in that the strength differed from what it was purported or represented to possess and that the drugs were contaminated and non-sterile.

“This case should send a clear message that offenses endangering public health will be vigorously prosecuted,” stated U.S. Attorney David J. Hale. “Misrepresenting the strength and potency of a prescribed medication and delivering contaminated products to patients are unconscionable crimes.”

“The Office of Inspector General is committed to protecting the health of patients covered by Medicare and Medicaid,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services in Atlanta, Georgia, “This company billed for medications that never should have been dispensed in the first place which created serious quality of care concerns.”

The maximum potential penalties are 46 years in prison, a $770,000 fine, and supervised release for a period of three years.



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Sonja Ascoli Pleads Guilty to Federal Charge of Health Care Fraud

Source-  http://www.fbi.gov/boston/press-releases/2012/medical-equipment-sales-rep-pleads-guilty-to-federal-charge-of-health-care-fraud 

PROVIDENCE, RI—Sonja Ascoli, 59, of Woonsocket, R.I., pled guilty in U.S. District Court in Providence today to defrauding the federal Medicare program of more than $70,000, announced United States Attorney Peter F. Neronha.

Ascoli admitted to the court that she participated in a scheme to entice Medicare beneficiaries to order products and medical equipment from the company she represented, Planned Eldercare, in Buffalo Grove, Ill., by promising that products would be provided “at no cost” to them. The Medicare Program does not permit copayments to be waived. Ascoli, who was the highest paid outside sales representative employed by Planned Eldercare between 2007 and 2008, admitted that she defrauded the Medicare program of a total of $70,354. Her salary was paid on a commission basis.

Ascoli, who pled guilty to one count of health care fraud, faces up to 10 years in federal prison when she is sentenced by U.S. District Court Judge William E. Smith on May 4, 2012.

On February 10, 2012, Gary Winner, 50, of Northbrook, Ill., owner of Planned Eldercare, was sentenced in federal court in Providence to 37 months in federal prison for defrauding the Medicare program of more than $2.2 million. In November 2011, Winner pled guilty 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 was also ordered to pay restitution in the amount of $2,210,152 to the Medicare program and to pay a fine of $12,500.

At today’s hearing before U.S. District Court Judge William E. Smith, Ascoli admitted that she 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.

Ascoli admitted to the court that once she 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 a medical need for the equipment. When beneficiaries complained about receiving items they did not order, Ascoli admitted that she responded by telling them, “Keep the products in the closet until you need them.” When others complained on the beneficiaries’ behalf, she responded, “You know how it is, they forget what they ordered.”

Ascoli also admitted that as part of the scheme, upon receiving products and equipment returned to her by beneficiaries, she 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 keeping any commissions she had earned on the products sold.



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Tylese Marie Rodriquez Charged With Obtaining Controlled Substances By Fraud And Health Care Fraud

Source-  http://www.justice.gov/usao/sd/pressreleases/SF-2012-02-10-Rodriquez.html 

US Attorney Brendan V. Johnson announced that a Hudson, South Dakota, woman has been indicted by a federal grand jury for Obtaining Controlled Substances by Fraud and Health Care Fraud.

Tylese Marie Rodriquez, a/k/a Tylese Marie Pearson, age 32, was indicted by a federal grand jury on February 7, 2012, for Obtaining Controlled Substances by Fraud and Health Care Fraud. She appeared before US Magistrate Judge John E. Simko on February 9, 2012, and pled not guilty to the indictment.

The maximum penalty upon conviction for Obtaining Controlled Substances by Fraud is four years of imprisonment, a $250,000 fine, or both. The maximum penalty upon conviction for Health Care Fraud is 10 years in prison, a $250,000 fine, or both. The charges are merely accusations, and Rodriquez is presumed innocent until and unless proven guilty.



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Lori Brill, Butch Brill, Jeff Vernon, and Chris Vernon In Multi-Million Dollar Hemophilia Medication Kickback Scheme

Source-  http://www.justice.gov/usao/als/news/2012/021412-1.html 

United States Attorney Kenyen R. Brown announces today that a federal jury has convicted Lori Brill, Butch Brill, Jeff Vernon, and Chris Vernon of various charges arising out of their participation in a scheme to bill Alabama Medicaid for unnecessary hemophilia medication and to supply inducements, in the form of illicit commission payments, for Medicaid referrals.

In announcing the convictions, Mr. Brown stated, “Healthcare fraud in the United States costs consumers billions of dollars, whether the victim is a private medical insurer or a public program such as Medicaid. Individuals exhibiting sheer greed through extensive fraudulent billing and awarding improper inducements for Medicaid business are driving up healthcare costs and are depriving those who really need medical assistance as provided by these government funded programs. Our office, in conjunction with our law enforcement partners, will aggressively continue to safeguard precious taxpayer dollars, protect our nation’s most essential health care programs, and dismantle criminal networks that bilk the system.”

Mobile Division Special Agent in Charge, Lewis M. Chapman, stated: “This conviction sends a strong message to those who abuse our tax dollars to enrich themselves that they will be identified, caught and punished.” Chapman further stated: “This conviction was also the direct result of a strong interagency effort which allowed the leveraging of resources and strengths to achieve this outcome.” Anyone with information regarding such fraudulent activity is encouraged to contact the FBI.

The evidence at trial demonstrated that Lori Brill (“Brill”), mother of a hemophiliac son, ran a hemophilia care company known as Hemophilia Management Specialties, Inc. (“H.M.S.”), which provided cost free services to clients who suffered from hemophilia, including, among other things, ordering their extremely expensive medication called “Factor” through MedfusionRx, L.L.C., a speciality pharmacy owned and operated by brothers Jeff and Chris Vernon. The Factor costs of hemophilia sufferers can, on average, be in the hundreds of thousands of dollars each year. In fact, in 2009 alone, Alabama Medicaid reimbursed specialty pharmacies over $21 million dollars for the Factor claims of just 87 hemophilia sufferers, most of whom were children. In an effort to increase commissions received from Medfusion, Brill worked with her estranged husband Butch Brill and H.M.S. employees Ashley Sprinkle and Sherry Demouey, both of whom previously pleaded guilty to health care fraud charges stemming from their roles in this scheme, to falsify the Factor tracking logs of H.M.S. clients. Together, and at the direction of Lori Brill, they manipulated logs to indicate that H.M.S. clients took the maximum amount of Factor at the greatest frequency allowed under their prescriptions without verifying the clients’ actual usage. These logs were then forwarded to Medfusion to order more Factor medication. In turn, the unnecessary medication was billed to Medicaid. One hemophilia client whose logs were manipulated was Travis Goodwin, who pleaded guilty just before trial to aiding and abetting healthcare fraud. Based on this scheme, the jury convicted Lori and Butch Brill of conspiracy to commit healthcare fraud, pursuant to 18 U.S.C. § 1349.

The trial evidence further demonstrated that Jeff Vernon and Chris Vernon paid illicit kickbacks to Brill and another patient manager, Leroy Waters, himself a hemophilia sufferer, in order to induce them to fill their Medicaid clients’ Factor prescriptions at Medfusion. Brill had an unlawful commission agreement with the Vernons whereby she received commissions equal to 45% of the profits the pharmacy generated by filling the Factor prescriptions of H.M.S. clients who were Medicaid recipients. Likewise, the Vernons and Waters had an illegal commission agreement which mirrored Brill’s, with Waters receiving commissions totaling 50% of the profits Medfusion brought in from filling his Medicaid clients’ Factor prescriptions. Waters pleaded guilty just before trial to a substantive anti-kickback charge due to his receipt of these illicit commissions. Based on this scheme, the jury convicted Lori Brill and Chris Vernon of three substantive charges of violating the anti-kickback statute, pursuant to 42 U.S.C. § 1320a-7b(b). The jury convicted Jeff Vernon of one count of conspiracy to violate the anti-kickback statute, pursuant to 18 U.S.C. § 371, and six substantive counts of violating the statute.



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Felicitas Velez Alanis and her daughter-in-law Erika Ortega Alanis Both Pleas Guilty in Health Care Fraud Scheme

Source-  http://www.fbi.gov/sanantonio/press-releases/2012/brownsville-mother-and-daughter-in-law-guilty-in-health-care-fraud-scheme 

McALLEN, TX—Felicitas Velez Alanis, 51, and her daughter-in-law, Erika Ortega Alanis, 27, both of Brownsville, Texas, have entered pleas of guilty to conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott.

Felicitas Alanis owned and operated Vel-Ala Inc.—a Texas corporation which did business as Nisi Medical Equipment and Supplies in and around Brownsville, Harlingen and elsewhere in South Texas. Her daughter-in-law, Erika Alanis, assisted in the day-to-day operation of the company. Nisi Medical Equipment and Supplies was enrolled with the Texas Medicaid program to provide durable medical equipment (DME) to Texas Medicaid beneficiaries. The term DME means medical equipment and supplies used in the home and includes blood-testing strips, blood glucose monitors, alcohol wipes, diabetic supplies, and other medically necessary items.

The government alleged that the two women submitted more than $646,000 in false and fraudulent bills to the Texas Medicaid program for diabetic supplies which Nisi Medical Equipment and Supplies never purchased or supplied to Medicaid beneficiaries. The delivery records and billing records of Nisi show that the Texas Medicaid program was routinely billed for more items than were actually delivered and the purchase records revealed that the Texas Medicaid program was billed for medical supplies and items that Nisi had never purchased. Medicaid paid more than $554,000 on the false and fraudulent claims submitted.

Felicitas and Ericka Alanis admitted in court today that they conspired to send false and fraudulent bills to the Texas Medicaid program in the name of Nisi Medical Equipment and Supplies between on or about Jan. 1, 2005, through on or about Oct. 12, 2006, and that they routinely billed the Medicaid program for allegedly providing 200 boxes of alcohol prepartion pads to Medicaid beneficiaries when in fact only one box of alcohol preparation pads was ever delivered.



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Edmund Nwaudobi Convicted of Medicare Fraud in Kansas

Source-  http://www.fbi.gov/kansascity/press-releases/2012/texas-man-convicted-of-medicare-fraud-in-kansas 
KANSAS CITY, KS—A Texas man has been convicted of fraudulently billing Medicare for power wheelchairs and other medical devices, U.S. Attorney Barry Grissom said today.

A jury convicted Edmund Nwaudobi, 48, Sugar Land, Texas, on one count of conspiracy to defraud Medicare, two counts of health care fraud, and one count of aggravated identity theft.

“Health care fraud is a widespread problem,” said U.S. Attorney Barry Grissom. “We are working hard to protect the American people and safeguard precious taxpayer dollars.”

During trial, federal prosecutors presented evidence that from 2004 to 2009 Nwaudobi conspired with co-defendants Tom Alabraba, Iyaye Ishmael, and George Tasie to fraudulently bill Medicare for power wheelchairs and other medical devices, such as leg and body braces. In some instances, Medicaid was billed for devices that were not medically necessary, including leg braces for an individual who had previously had his legs amputated, and who never received the braces. In other instances, Medicare was billed for medical devices that Medicare recipients never received.

Nwaudobi conducted business on behalf of Good Care, Inc., an Overland Park, Kan., company that supplied durable medical equipment such as orthotics. Nwaudobi shared patient information with Tom Alabraba, who owned or operated Tal-Med, Inc., a Kansas City, Kan., company that supplied durable medical devices; George Tasie, who owned or operated Central Medical, Inc., a Kansas City, Kan., company that supplied durable medical devices; and Iyaye Ishmael, who was a manager of Central Medical, Inc.

The companies billed more than $2.9 million in Medicare claims for 397 beneficiaries living in Missouri and Kansas, and received more than $1.5 million from those claims.



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Mary Ellis, Caroline Njoku, Terrie Porter and Florida Holiday Island Sentenced to More Than Five Years in Prison for Roles in $5.2 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-216.html 

WASHINGTON – Two Houston-area nurses and two of their co-conspirators have been sentenced in Houston for their participation in a $5.2 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Service (HHS).

Mary Ellis, 56, a registered nurse, was sentenced today to 63 months in prison followed by three years of supervised release and was ordered to pay $401,000 in restitution. Ellis was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks, three counts of receiving illegal kickbacks and two counts of making false statements following a May 2011 trial.

Caroline Njoku, 46, also a registered nurse, was sentenced yesterday to 63 months in prison followed by one year of supervised release and was ordered to pay $631,295 in restitution. Njoku was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay kickbacks following a May 2011 trial. 

Terrie Porter, 48, was sentenced yesterday to two years in prison and two years of supervised release and was ordered to pay $482,380 in restitution. Porter was convicted of one count of conspiracy to receive kickbacks and one count of receiving illegal kickbacks following a May 2011 trial.

Florida Holiday Island, 62, was sentenced yesterday to 20 days in prison, five months of home detention and two and a half years of supervised release and was ordered to pay $59,739 in restitution. Island pleaded guilty in March 2011 to one count of conspiracy to receive kickbacks and one count of receiving illegal kickbacks.

The defendants were sentenced by U.S. District Judge Nancy Atlas in the Southern District of Texas. The four defendants were ordered to pay restitution jointly and severally with co-conspirators and defendants in a related case. As part of the sentencing, the court found that Ellis and Porter had obstructed justice by testifying untruthfully at trial.

According to the evidence presented at trial and in court documents, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries. Family Healthcare Group paid Ellis, Porter, Island and other co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. According to evidence presented at trial, Njoku and Ellis falsified documents to support the fraudulent payments. After the Medicare beneficiaries were recruited, other co-conspirators fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact they knew the beneficiaries were not home-bound and not in need of skilled nursing.

Co-defendant Adelma Casas Sevilla, a registered nurse, was previously sentenced to 18 months in prison. A second co-defendant, Sammie Wilson, received three years of probation after pleading guilty to one count of conspiracy to commit health care fraud. Four other defendants involved in the scheme are pending sentencing.



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Evans Oniha Sentenced to 96 Months in Prison for Health Care Fraud

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-208.html 

WASHINGTON – The co-owner of two Los Angeles-area health care companies was sentenced today to 96 months in prison for his conviction stemming from a nine-year scheme to defraud Medicare, announced the Departments of Justice and Health and Human Services (HHS).

U.S. District Judge Stephen V. Wilson also ordered Evans Oniha, 49, to pay $7 million in restitution and to serve three years of supervised release following his prison term. A federal jury in the Central District of California found Oniha guilty on July 7, 2011, of one count of conspiracy to commit health care fraud, four counts of health care fraud and one count of false statements relating to health care matters.

According to court documents, in 2002, Oniha and co-defendant Camillus Ehigie founded and began operating Prosperity Home Health Services Inc., a home health agency, and Caravan Medical Supplies Inc., a durable medical equipment (DME) company. According to testimony presented at trial, from October 2002 to February 2011, Oniha conspired with Ehigie and others to defraud Medicare by paying “marketers” for Medicare beneficiary information, fraudulent prescriptions and other documents for DME and home health services. Testimony at trial showed that the marketers were individuals who acquired patient Medicare numbers and doctors’ prescriptions and sold them to Oniha. Oniha used these fraudulent documents to submit and cause the submission of false claims to Medicare for DME and home health services that were not medically necessary and that often were not provided to Medicare beneficiaries. According to court documents, Oniha caused Prosperity to submit approximately $8 million in fraudulent claims to Medicare for home health services purportedly provided by Prosperity. Oniha caused Caravan to submit approximately $5.8 million in fraudulent claims to Medicare for DME purportedly provided by Caravan.

On July 5, 2011, Ehigie pleaded guilty to 11 counts of health care fraud, one count of conspiracy to commit health care fraud, one count of making false statements in a federal health care investigation and one count of obstructing a criminal health care investigation. Ehigie is scheduled to be sentenced on July 9, 2012.



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Darlene Hughes Sentenced to 34 Months in Prison for Health Care Fraud

Source-  http://www.fbi.gov/charlotte/press-releases/2012/charlotte-woman-sentenced-to-34-months-in-prison-for-health-care-fraud 

CHARLOTTE, NC—A Charlotte woman was sentenced yesterday in U.S. District Court to serve 34 months in prison to be followed by three years of supervised release for committing health care fraud, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. U.S. District Judge Frank D. Whitney also ordered Darlene Hughes, 53, of Charlotte, to pay total restitution in the amount of $194,436.61.

U.S. Attorney Tompkins is joined in making today’s announcement by Derrick Jackson, Special Agent in Charge of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region, and Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division.

In August 2010, Hughes entered a plea of guilty to one count of health care fraud. According to a federal criminal bill of information and plea documents, Hughes stole the name and license of a speech therapist and falsely and fraudulently held herself out to be a licensed speech therapist. Hughes then obtained employment as a speech therapist at two local nursing homes and assisted living facilities who relied upon her misrepresentations. According to filed court documents and statements made in court, Hughes’ fraud caused those facilities to submit hundreds of claims to Medicare for services which Hughes was not qualified to provide, defrauding the facilities and Medicare of more than $142,000.

In issuing the sentence in this case, Judge Whitney noted that the scheme to defraud involved a “level of sophistication and skill of deceit that is pretty overwhelming.”

Hughes has been on release since entering her guilty plea in August 2010 and was permitted to self-report to the Federal Bureau of Prisons upon designation of a facility. Federal sentences are served without the possibility of parole.



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Rodney D. Taylor Pleads Guilty in Health Care Fraud Scheme

Source-  http://www.fbi.gov/neworleans/press-releases/2012/louisiana-patient-recruiter-pleads-guilty-in-health-care-fraud-scheme 

WASHINGTON—A Baton Rouge area-resident pleaded guilty today for his role in a Medicare fraud scheme involving false claims for unnecessary durable medical equipment (DME), announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS) and the Louisiana State Attorney General’s Office.

Rodney D. Taylor, 45, 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 and one count of conspiracy to defraud the United States and to pay and receive health care kickbacks.

According to court documents, Taylor worked as a recruiter for Healthcare 1 LLC, Medical 1 Patient Services LLC and Lifeline Healthcare Services Inc., Louisiana-based companies that fraudulently billed DME to the Medicare program from 2004 to 2009. He and other recruiters were hired to obtain prescriptions for DME such as leg braces, arm braces, power wheel chairs and wheel chair accessories. Taylor obtained information from Medicare beneficiaries as well as prescriptions for medical equipment from the beneficiaries’ physicians. Taylor then sold these prescriptions so they could be used by Healthcare 1, Medical 1 Patient Services and Lifeline Healthcare Services to submit fraudulent claims to the Medicare program.

The indictment alleges that from 2004 to 2009 Medicare was billed more than $21 million as part of this conspiracy.

Taylor faces a maximum penalty of 15 years in prison and a $500,000 fine. A sentencing date has not yet been set.



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Eduard Aslanyan Sentenced to 77 Months in Prison for Medicare Fraud Scheme Resulting in More Than $18.9 Million in Fraudulent Claims to Medicare

Source-  http://www.fbi.gov/losangeles/press-releases/2012/los-angeles-man-sentenced-to-77-months-in-prison-for-medicare-fraud-scheme-resulting-in-more-than-18.9-million-in-fraudulent-claims-to-medicare 

WASHINGTON—A Los Angeles-area man was sentenced yesterday to 77 months in prison for organizing and leading a medical clinic fraud scheme that used the stolen identities of physicians to submit more than $18.9 million in fraudulent claims to Medicare, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced.

Eduard Aslanyan, 38, of Sherman Oaks, Calif., was sentenced by U.S. District Judge Consuelo B. Marshall in the Central District of California. In addition to his prison term, Aslanyan was sentenced to three years of supervised release and was ordered to pay $10.8 million in restitution.

Aslanyan pleaded guilty in April 2011. He admitted that between March 2007 and September 2008, he established a series of fraudulent medical clinics in and around Los Angeles to defraud Medicare. Carolyn Vasquez, who previously pleaded guilty to conspiring with Aslanyan to defraud Medicare, recruited physicians to serve as the medical directors of Aslanyan’s fraudulent medical clinics. The physicians did not perform services at the clinics and were rarely present at the clinics. Physician assistants were hired by Aslanyan and Vasquez and were complicit in the fraud scheme at the clinics.

According to court documents, Aslanyan hired patient recruiters to find Medicare beneficiaries who were willing to provide the recruiters with their Medicare billing information in exchange for expensive, high-end power wheelchairs and other medical equipment which the patient recruiters told the beneficiaries they could receive for free. Often, the Medicare beneficiaries did not have a legitimate medical need for the power wheelchairs and equipment. The patient recruiters then provided the beneficiaries’ Medicare billing information to Aslanyan or brought the beneficiaries to Aslanyan’s clinics. Aslanyan paid the patient recruiters cash kickbacks in exchange for recruiting the Medicare beneficiaries.

In court documents, Aslanyan admitted that he and Vasquez instructed and paid physician assistants who worked at his clinics to prescribe medically unnecessary power wheelchairs, medical equipment and diagnostic tests for the Medicare beneficiaries. The physician assistants used stolen identities of physicians who did not supervise them or work at the clinics.

According to court documents, Aslanyan profited from the scheme at his fraudulent medical clinics in several ways. Aslanyan admitted that he allowed fraudulent diagnostic testing facilities to use the Medicare billing information he purchased from patient recruiters to submit false claims to Medicare for tests ordered at the clinics. In exchange, the fraudulent diagnostic testing facilities paid Aslanyan cash kickbacks that were disguised as rent payments to Aslanyan.

Aslanyan also profited from the scheme by selling fraudulent prescriptions and documents generated at his clinics to the owners and operators of fraudulent durable medical equipment (DME) supply companies, which used the prescriptions and documents to submit false claims to Medicare. Aslanyan also used the fraudulent prescriptions and documents to submit false claims to Medicare through his own fraudulent DME supply companies, Vila Medical Supply Inc. and Blanc Medical Supplies.

According to court documents, as a result of Aslanyan’s conduct, he and his co-conspirators submitted approximately $18.9 million in fraudulent claims to Medicare.



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Dava Pharmaceuticals Inc to Pay U.S. $11 Million to Settle False Claims Act Allegations

Source-  http://www.justice.gov/opa/pr/2012/February/12-civ-182.html 

Dava Pharmaceuticals Inc. has agreed to pay the United States $11 million to settle allegations that it violated the False Claims Act by misreporting drug prices in order to reduce its Medicaid Drug Rebate obligations, the Justice Department announced today.

The settlement resolves allegations that between Oct. 1, 2005 and Sept. 30, 2009, Dava and its corporate predecessors knowingly underpaid their rebate obligations under the Medicaid Prescription Drug Rebate Program. Under that program, participating drug companies are required to pay quarterly rebates to state Medicaid programs based, in part, on whether a drug is a “generic” or “branded” product and the difference between what the health care program paid for the drug and prices paid by other purchasers.

In order to reduce its Medicaid rebate obligation, Dava incorrectly treated its version of the drugs cefdinir, clarithromycin and methotrexate as “generic” drugs rather than “branded” products, thereby lowering the overall percentage rebate payable to Medicaid. In addition, Dava further reduced its Medicaid rebate obligations by incorrectly calculating average manufacturer prices for its versions of the drugs cefdinir, clarithromycin, methotrexate and rheumatrex. As a result, Dava underpaid drug rebates to the Medicaid program and overcharged certain public health service entities for these products.

“Pharmaceutical companies that participate in Medicaid must accurately report drug prices and pay their fair share of rebates to the federal and statement governments,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “Settlements like this one help maintain important programs on which so many depend for needed health care.”

The federal government’s portion of the settlement is approximately $5.7 million. Dava will also pay over $5 million to the Medicaid participating states and approximately $200,000 to certain public health services entities who paid inflated prices for the drugs at issue.

The settlement resolves a lawsuit filed in federal court in the District of Maryland under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. As part of today’s resolution, the whistleblower – Jim Conrad – will receive 15 percent of the settlement proceeds.



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Mohammed Khan Indicted for Alleged Role in $116 Million Medicare Fraud Scheme

Source-  http://www.justice.gov/opa/pr/2012/February/12-crm-181.html 

WASHINGTON – An assistant administrator of a Houston hospital was arrested today on charges related to his alleged participation in a $116 million Medicare fraud scheme involving false claims for mental health treatment, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

An indictment filed in the Southern District of Texas and unsealed today charges Mohammed Khan, 62, of Houston, with one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive illegal health care kickbacks and five counts of paying or offering to pay health care kickbacks. Khan is expected to make his initial appearance in federal court today in Houston.

“The indictment against Mr. Kahn alleges that he used his position as a hospital assistant administrator to submit millions in false claims to the Medicare program,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “According to the charges, he paid kickbacks to patient recruiters, owners of group homes and assisted living facilities, and beneficiaries so that he could fill his hospital with patients for whom he could bill the government for medically unnecessary services or services that were never provided. We will continue aggressively to pursue individuals who attempt to enrich themselves at the expense of the Medicare program.”

“The defendant charged in this indictment is accused of stealing precious Medicare resources by billing for services that were medically unnecessary or never provided," said Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office. “Our health care fraud efforts have never been more collaborative and aggressive. We will continue to work with our law enforcement partners to protect patients and fight against health care fraud.”

According to the indictment, Khan, as the assistant administrator of a Houston hospital, allegedly operated a scheme to defraud Medicare beginning in 2008 and continuing until his arrest today. Khan allegedly caused the submission of false and fraudulent claims for partial hospitalization program (PHP) services to Medicare through the hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.

The indictment alleges that Khan paid kickbacks to owners and operators of group care homes and assisted living facilities and to patient recruiters in exchange for delivering ineligible Medicare beneficiaries to the hospital’s PHPs. The indictment alleges that Khan also paid kickbacks to Medicare beneficiaries who attended the hospital’s PHPs. These kickbacks included cigarettes, food and coupons redeemable for items available at the hospital’s “country stores.” Khan and his co-conspirators submitted or caused to be submitted approximately $116 million in claims to Medicare for PHP services purportedly provided by the hospital to the recruited beneficiaries, when in fact, the PHP services were medically unnecessary or never provided.



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