Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20May/120531%20Lahiji.html
HOUSTON – A federal grand jury has returned a three-count, superseding indictment against Dr. Hossein Lahiji and his wife, attorney Najmeh Vahid Lahiji, both of McAllen and San Antonio, Texas, United States Attorney Kenneth Magidson announced today. The indictment, alleging conspiracy to commit health care fraud and health care fraud, was returned just a short time ago in Houston.
The three-count indictment accuses the Lahijis of conspiring to defraud multiple health care benefit programs, specifically Medicare, Medicaid, Aetna, Blue Cross Blue Shield, Humana and United Healthcare from January 2003 through Feb. 24, 2012. The indictment alleges they submitted false and fraudulent claims in connection with the use of unlicensed, unqualified medical personal and billed for medical services not rendered.
The Lahijis allegedly submitted claims to these health care benefit programs for urology services performed by Dr. Lahiji when, in fact, he was actually traveling outside the state of Texas and outside the United States. Individuals who actually performed these “urology services, ” according to the indictment, were only licensed as medical assistants and did so without any supervision from any physician or other qualified, licensed personal. This is in violation of protocols established by Medicare, Medicaid, private health insurance as well as the state of Texas.
The scheme also involved specific days where Dr. Lahiji claimed to treat between 65 to 117 patients per day during the office hours of 7:00 a.m. to 6:00 p.m. According to allegations, false and fraudulent representations were made, including that Dr. Lahiji had conducted a “consultation” for another physician when, in fact, he had performed routine medical services for a patient of his own, a practice known as “upcoding.” The indictment further alleges a false representation that the patient’s medical situation had necessitated a comprehensive physical examination and the taking of a comprehensive medical history when the situation had actually not required these actions. Dr. Lahiji did not even perform such an exam nor taken such a history, according to the indictment.
The Indictment also contains two substantive counts of health care fraud occurring on July 1, 2009, and July 28, 2009.
Dr. Lahiji is a physican investor in the physican-owned hospital, Doctor’s Hospital at Renassiance in Edinburg, Texas, according to public records.
The Lahijis each face a sentence of up to 10 years in prison and a maximum fine of $250,000 on each count, if convicted.
The Lahijis were originally charged in an indictment returned Jan. 11, 2011, in the Southern District of Texas. They are also charged in the District of Oregon on unrelated, federal charges. They are currently on bond and are expected to appear in court on these charges in the near future.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/mow/news2012/mccarty.ind.html
KANSAS CITY, Mo. – David M. Ketchmark, Acting United States Attorney for the Western District of Missouri, announced today that a psychologist practicing in the Lebanon, Mo., area has been indicted by a federal grand jury for engaging in a $1.2 million scheme to defraud Medicare and Medicaid.
Rhett E. McCarty, 67, of Lake Ozark, Mo., was charged in a two-count indictment returned under seal by a federal grand jury in Kansas City, Mo., on Wednesday, May 23, 2012. The indictment was unsealed and made public today upon McCarty’s arrest and initial court appearance in the U.S. District Court in Kansas City, Mo.
McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area. The federal indictment alleges that since Aug. 22, 2008, McCarty has submitted Medicare and Medicaid claims for at least 19 beneficiaries for which he was paid $1,276,334.
According to claims that McCarty submitted, the indictment says, he routinely saw beneficiaries seven days per week and worked long hours every day. McCarty allegedly claimed that he worked every single day of the calendar year from mid-September 2008 through early April 2012, except for Christmas. McCarty routinely billed for every weekend day and for all holidays except Christmas, the indictment says. However, according to the indictment, beneficiaries who were interviewed during the course of the investigation told investigators that McCarty did not see them for therapy more than once a week and often much less often. In one case, the indictment alleges that McCarty received $101,712 in payments for a patient he only saw one time.
The federal indictment also charges McCarty with forgery. According to the indictment, McCarty forged (or caused another person to forge) the signatures of beneficiaries on patient sign-in sheets in order to obtain $418,507 in Medicare and Medicaid payments.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/norfolk/press-releases/2012/former-provider-of-home-health-care-services-indicted-for-medicaid-fraud
NORFOLK, VA—Janice W. Holland, 41, of Suffolk, Virginia, has been indicted by a federal grand jury on one count of health care fraud, 31 counts of making false statements relating to health care matters, one count of alteration of records, and two counts of aggravated identity theft.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and Virginia Attorney General Ken Cuccinelli made the announcement after the indictment was unsealed following Holland’s arrest. If convicted, Holland faces a maximum penalty of 10 years in prison for health care fraud, five years on each count for making false statements, 20 years for alteration of records, and two years on each count of aggravated identity theft.
According to the indictment, Holland owned and operated A Caring Hand Home Health Care Services Inc., a business located in Suffolk that was authorized to provide respite care to Medicaid recipients. Respite care is designed to provide temporary, substitute care for a Medicaid recipient that is normally provided by the family or another unpaid primary caregiver of the recipient. These services are provided on a short-term basis because of the emergency absence or need for routine or periodic relief of the primary caregiver. Holland filed approximately 1,100 false and fraudulent claims with the Virginia Medicaid program, representing that respite care had been provided by her company to 30 Medicaid recipients, when in fact no such care had been provided. She filed these claims using, without authority, the recipients’ names, dates of birth, and Medicaid identification numbers As a result, Holland obtained health care benefit payments in the approximate amount of $700,000 to which she was not entitled. She also altered and falsified her office records to conceal and cover up her false billings.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/ma/news/2012/May/IwualaBlessingsSydneyIndictmentPR.html
BOSTON - A Hyde Park man was charged today in federal court with concealing material information from Medicare.
Blessing Sydney Iwuala, 53, was indicted on charges of knowingly and willfully falsifying, concealing, or covering up by trick, scheme or device a material fact from Medicare.
The Indictment alleges that Iwuala was the owner of Above All Home Care and Supply, Inc. (Above All), a supplier of durable medical equipment (DME) in Braintree. In 2008, he submitted an application to Medicare to supply Medicare beneficiaries with DME. In the application, Medicare required that Iwuala identify any individual who had an ownership interest, was a managing employee, or had a partnership interest in Above All. Iwuala only identified himself and his wife in this section. Iwuala certified that the information in the application was true, correct, and complete, and he certified that he would notify Medicare if he became aware that any information in the application was not true, correct, or complete.
It is alleged that at some point, but by no later than Jan. 19, 2009, Iwuala entered into an arrangement with another individual, identified in the indictment as JN, with respect to Above All. JN had a medical supply company as well, but in or around June 2008, Medicare had suspended JN’s privileges to supply DME to Medicare patients. Iwuala and JN allegedly entered into an agreement whereby JN obtained orders for the overwhelming majority of patients who received medical equipment from Above All. It is alleged that JN handled numerous aspects of these orders, including billing Medicare for the orders using Above All’s names, and that Iwuala sent to JN a substantial portion of the Medicare payments to Above All.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/washingtondc/press-releases/2012/oakton-dentist-indicted-for-alleged-illegal-distribution-of-prescription-medicine-health-care-fraud-and-id-theft
ALEXANDRIA, VA—Hamada Makarita, 50, of Oakton, Virginia, has been charged in a 15-count indictment of using his position as a dentist to illegally distribute prescription pills to patients, employees, and women he dated. He was also charged with allegedly using the identity of another dentist to fraudulently bill an insurance company of more than $160,000 in claims.
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.
Makarita was charged with conspiracy, health care fraud, aggravated identity theft, and 12 counts of dispensing controlled substances. If convicted, he faces a maximum penalty of 10 years in prison on the health care fraud charge, 20 years in prison for conspiracy on each dispensing controlled substances charge, and a consecutive two-year sentence for the aggravated identity theft charge.
According to the indictment, Makarita owns and operates a dental practice in Oakton, Virginia and advertised online at www.fixasmile.com. The indictment alleges that from about 2007 to 2012, Makarita distributed and dispensed thousands of dosages of prescription medicine to patients, employees, and girlfriends, all without a legitimate dental purpose and beyond the bounds of a dental practice. Makarita allegedly asked those who received the prescriptions he issued to return to him some or all the prescribed medicine. On numerous occasions, Makarita would distribute prescription pills to patients and girlfriends in social settings and for prurient purposes, including for consensual and non-consensual sex.
In addition, the indictment alleges that Makarita provided more than $160,000 in services to his family members and billed them to an insurance provider in violation of the provider’s contract. He allegedly billed the services under the name of another dentist who did not practice in Makarita’s office at that time. Makarita received more than $91,000 in reimbursement from the provider for these fraudulent claims.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/newhaven/press-releases/2012/dental-practice-operators-charged-in-20-million-medicaid-fraud-conspiracy
David B. Fein, United States Attorney for the District of Connecticut; Susan J. Waddell, Special Agent in Charge of U.S. Health and Human Services, Office of Inspector General for New England; William P. Offord, Special Agent in Charge of IRS Criminal Investigation in New England; and Kimberly K. Mertz, Special Agent in Charge of the Federal Bureau of Investigation, announced that Gary F. Anusavice, also known as “Gary Andrews,” “Gary Andrus” and “Gary Francis,” 59, of North Kingstown, Rhode Island; and Mehran Zamani, DDS, 47, of Pound Ridge, New York, were arrested today on federal charges related to their alleged involvement in a $20 million Medicaid fraud scheme.
“As alleged, these operators of dental practices throughout Connecticut defrauded the Medicaid program of more than $20 million over a two-year period,” said U.S. Attorney Fein. “We are committed to protecting American taxpayers from health care fraud, which can increase costs and jeopardize the integrity of our health care system. I want to commend HHS-OIG, IRS-Criminal Investigation, and the FBI for their investigative efforts and thank the Connecticut Attorney General’s Office, which provided invaluable assistance during the course of this investigation.”
“Although Gary F. Anusavice was barred from Medicare, Medicaid, and other government health programs back in 1998, he allegedly continued to defraud taxpayers by using an elaborate shield of companies and individuals—including Dr. Zamani—to hide his involvement,” said HHS-OIG Special Agent in Charge Waddle. “Working with federal and state partners, our investigators will penetrate such schemes and help bring suspects to justice.”
“To combat healthcare fraud, IRS Criminal Investigation provides the financial investigative expertise to follow the money trail from the crime to the culprit,” said IRS Criminal Investigation Special Agent in Charge Offord. “We are proud to work with our law enforcement partners to document the financial benefits derived from these fraudulent activities.”
“The FBI views health care fraud as a serious crime problem,” said FBI Special Agent in Charge Mertz. “It degrades the integrity of our health care system and legitimate patient care. Today’s arrests send a clear message to those persons who are defrauding our federal Medicare and Medicaid and private health insurance programs. The FBI remains committed to investigating health care fraud and bringing these individuals to justice. The FBI will continue to work aggressively with our law enforcement partners to investigate those who violate the public trust by stealing taxpayer money. We urge anyone with information regarding health care fraud activity to contact its nearest FBI field office.”
According to court documents, the Medicaid program is a joint federal-state program that provides funds for medical services to lower-income individuals who qualify for benefits. The program is jointly administered by the U.S. Department of Health and Human Services and supervised by the Centers for Medicare and Medicaid Services. In Connecticut, the Medicaid program is administered by the State of Connecticut Department of Social Services (DSS).
As alleged in court documents, Anusavice was previously a registered dentist in several states. In July 1997, Anusavice sustained a felony conviction in Massachusetts for submitting false health care claims. Based on that conviction, the U.S. Department of Health and Human Services notified Anusavice in April 1998 that he was being excluded from participation in Medicare and state health care programs, including Medicaid. As part of that notice, Anusavice was informed that, as an excluded individual, he may not “submit claims or cause claims to be submitted” for payment from the federal Medicaid program. Further, Anusavice was advised that Medicaid reimbursement payments are prohibited to any entity in which he serves as an “employee, administrator, operator, or in any other capacity....”
In November 2005, Anusavice surrendered his right to practice dentistry in Rhode Island, and the Massachusetts Board of Registration in Dentistry permanently revoked Anusavice’s license to practice dentistry in Massachusetts in 2006.
The criminal complaint alleges that Anusavice established several dental practices in Connecticut, which were operated by other dentists, including Zamani. These dental practices received millions of dollars in Medicaid reimbursements from the Connecticut Medicaid program, which payments were prohibited given Anusavice’s exclusion from the Medicaid program. The dental practices operated by Anusavice and Zamani included Landmark Dental in West Haven, Dental Group of Connecticut in Trumbull, and Dental Group of Stamford. Despite his permanent exclusion, Anusavice was involved in reviewing patient charts, suggesting dental procedures to be performed, reviewing billing records, reviewing income reports, interviewing and hiring dentists, and providing overall management direction to the offices.
It is alleged that Anusavice hired Zamani at Landmark Dental in October 2008 and that Zamani soon became aware of Anusavice’s disciplinary history. In January 2009, Zamani submitted a Medicaid Provider Enrollment Application with the DSS in order to obtain a Medicaid provider number for Mehran Zamani LLC, listing his group practice name as Landmark Dental. In May 2009, Zamani submitted an application with the DSS for a Medicaid provider number for Landmark Dental. In the applications Zamani submitted, he failed to disclose that Anusavice had an ownership or control interest in Landmark Dental, even though Zamani knew that Anusavice was running the practice and profited from it. From approximately February 2009 to March 2011, Mehran Zamani LLC and Landmark Dental received more than $12.9 million in Medicaid reimbursement payments.
It is further alleged that in April 2009, Zamani and “Haven Consulting,” an entity Anusavice created, entered into a Business Consultant Contract for the Dental Group of Stamford, a practice that Zamani had operated previously. Although the contract provided that Haven Consulting was a “business consultant” to the Dental Group of Stamford, Anusavice had an ownership interest in the practice and acted in an ownership and managerial capacity. Zamani’s DSS application in May 2009 failed to disclose Anusavice’s involvement in the practice and his disciplinary history. From approximately June 2009 to March 2011, the Dental Group of Stamford received more than $4.4 million in Medicaid reimbursement payments.
It is further alleged that Zamani’s April 2010 DSS application for a Medicaid provider number for the Dental Group of Connecticut also failed to disclose Anusavice’s involvement in the practice. From approximately August 2010 to March 2011, the Dental Group of Connecticut received more than $3.5 million in Medicaid reimbursement payments.
It is further alleged that on April 13, 2011, the DSS suspended Medicaid payments to Mehran Zamani, DDS, Landmark Dental, Dental Group of Stamford, and Dental Group of Connecticut based upon a pending investigation of a credible allegation of fraud. As a result, the last Medicaid payment to any of these entities occurred on or about March 22, 2011. By that time, it is alleged that the Anusavice-Zamani entities had collectively received nearly $21 million in Medicaid reimbursement funds. Further, according to Zamani’s accountant’s records, between February 2009 and March 2011, Anusavice-controlled entities received more than $3 million in payments from Zamani-related entities.
It is further alleged that Anusavice and another dentist are now operating a new set of dental clinics, doing business as Alpha Dental Group in Cromwell, Dental Group of New Britain, and Hartford Dental Care. Between November 2011 and March 2012, Arbor Dental has received more than $2.6 million in Medicaid funds. Anusavice also has recently reopened a dental practice at the former location of Dental Care of Connecticut in Trumbull.
Anusavice was arrested this morning at his home in North Kingstown, Rhode Island on a federal criminal complaint charging him with conspiring to commit health care fraud, committing health care fraud, and making false statements involving federal health care programs. Zamani was arrested today at his home in New York on a criminal complaint charging him with the same offenses. Both appeared this afternoon before United States Magistrate Judge Holly B. Fitzsimmons in Bridgeport.
In association with today’s arrests, investigating agencies conducted court-authorized searches of Anusavice’s Rhode Island residence and dental clinics he is allegedly operating in New Britain and Trumbull.
The government also has filed a civil forfeiture complaint against the real property located at 229 Potter Road, North Kingstown, Rhode Island, an 8,145 square foot home on 9.66 acres of land, where Anusavice resides. The forfeiture complaint alleges that this property was purchased in February 2011 for $695,000 by AMZ Consulting Inc., a nominee entity controlled by Anusavice and that proceeds used to purchase the property stem from Anusavice’s alleged Medicaid fraud scheme.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/atlanta/press-releases/2012/armenian-national-sentenced-to-five-years-in-prison-for-role-in-1-million-health-care-fraud-and-money-laundering-scheme
BRUNSWICK, GA—Sahak Tumanyan, 42, was sentenced Wednesday by Chief United States District Court Judge Lisa Godbey Wood to five years in prison for his role in a health care fraud and money laundering conspiracy in which more than $1.5 million was stolen from Medicare through a phony medical business in Brunswick, Georgia.
United States Attorney Edward J. Tarver said, “The defendant’s cohorts stole over $1 million of taxpayer dollars from Medicare. Then, the defendant helped launder the ill-gotten gains through an intricate series of phony businesses. Our team of federal prosecutors, agents, and auditors will follow the trails of stolen money so that organized criminals such as these will be held accountable for their fraudulent schemes.”
Derrick L. Jackson, Special Agent in Charge of the Atlanta Region for the Office of Inspector General of the Department of Health and Human Services, said, “This sentence sends a clear-cut message to organized crime groups that infiltrate our nation’s health care system to steal from the taxpayers. The Office of Inspector General will continue to work closely with our law enforcement partners to bring these criminal enterprises to justice.”
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, stated, “The FBI remains committed to identifying, investigating, and presenting for prosecution those individuals such as Mr. Tumanyan who would launder stolen federal funds from programs such as Medicare. While the FBI dedicates extensive investigative resources to these matters, we also ask for the public’s assistance in bringing forward any instances of health care fraud, to include Medicare and Medicaid fraud, to the appropriate authorities.”
Tumanyan, who was in the United States on an expired Visa from Armenia and who resided in Los Angeles until the time of his arrest in this case, previously pleaded guilty to a money laundering conspiracy charge. According to the evidence presented at the guilty plea and sentencing hearings:
Brunswick Medical Supply was a fraudulent medical equipment provider that was opened in Brunswick in 2007. Associates of Tumanyan fraudulently obtained a Medicare provider number for this phony businesses, stole the identities of hundreds of Medicare beneficiaries, stole the identities of dozens of doctors, and used this stolen information to submit millions of dollars in phony claims for health care services that were never provided. Medicare paid approximately $1.5 million for these fraudulent claims before Brunswick Medical Supply was shut down. Tumanyan then took numerous steps to launder the money stolen from Medicare. Tumanyan opened at least four sham businesses in Los Angeles; opened multiple bank accounts in the names of these businesses; and used these bank accounts to launder the proceeds of the fraud at Brunswick Medical Supply. The evidence also showed that Tumanyan helped launder hundreds of thousands of dollars of other money stolen through various schemes to defraud, such as identity theft, check kiting, and other health care fraud schemes.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/ks/PressReleases/2012/May%202012/May21a.html
WICHITA, KAN. – Roger W. Evans, M.D. and his company, EECP Heart Center of Kansas, Inc. (EECP), have agreed to pay $1.5 million to the United States to settle allegations that Evans and EECP submitted false claims to the Medicare program, U.S. Attorney Barry Grissom announced today. Evans is owner and president of EECP.
Evans operated several clinics across Kansas and provided enhanced counterpulsation therapy, an in-patient service for the treatment of coronary artery disease. The United States contends that from July 2005, through June 2009, Evans submitted claims to Medicare for services when Evans was not actually present at the clinics and did not provide direct supervision of the procedures as required by Medicare.
During ECP treatment, a patient is placed on a treatment table and the patient’s lower trunk and lower extremities are wrapped in a series of compressive air cuffs which inflate and deflate in synchronization with the patient’s cardiac cycle. The cuffs compress blood vessels in the calves and thighs to increase blood flow and improve cardiac function. A full course of ECP therapy usually consists of 35 one-hour treatments which may be offered once or twice daily, usually five days per week.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/neworleans/press-releases/2012/covington-man-arrested-on-health-care-fraud-and-conspiracy-charges
NEW ORLEANS—Boyd William Leahy, age 45, was arrested this morning on charges of health care fraud and conspiracy. Boyd Leahy and his wife, Angelina Gaitan Leahy, also age 45, both residents of Covington, Louisiana, were charged in a 17-count indictment for health care fraud and conspiracy to commit health care fraud, announced U.S. Attorney Jim Letten.
According to the charges in the indictment, the Leahys were employed at a sleep clinic in Covington, Louisiana, owned by their friends, two local physicians. The bill of indictment charges that Boyd Leahy, as the office manager for the clinic, and Angelina Leahy, as the part-time billing clerk, conspired to commit health care fraud by creating a rival business entity, Sleep Corp., that the Leahys used to fraudulently bill insurance companies for services which were actually rendered by their employing clinic. When the Leahys received insurance payments on behalf of their rival company Sleep Corp., they kept the proceeds rather than giving them to their friends and employers, whose clinic actually rendered the services. Angelina Leahy then doctored the payment records for their employing clinic to further conceal their fraud.
Additionally, as alleged in the indictment, Boyd Leahy, as office manager of the clinic, used his position to generate extra paychecks for himself and to pay himself more than he was authorized to earn, and he did the same for his wife. Boyd Leahy also added his daughter, his father, and a creditor to his employing clinic’s payroll without authorization, causing paychecks to be issued when none of these individuals had performed any work on the clinic’s behalf. Boyd Leahy also used the employing clinic’s corporate credit card and business checking account to fund personal expenses, trips, and household utilities without the clinic owners’ knowledge or authorization. The total loss sustained by the clinic owners for this fraudulent scheme totals $827,946.
If convicted, Boyd Leahy and Angelina Leahy each face a maximum term of imprisonment of 10 years, a fine of $250,000, and three years of supervised release following any term of imprisonment. The indictment also seeks forfeiture and restitution to the victims.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/flm/press/2012/may/20120518_Wagner.html
Orlando, FL - United States Attorney Robert E. O'Neill announces that the United States has filed a criminal complaint charging Joseph Wagner (62, Daytona Beach) with illegally dispensing and distributing prescription drugs and health care fraud. If convicted, Wagner faces a maximum penalty of 10 years in federal prison for each charge.
According to court documents, in 2009, the Personal Injury Protection Fraud Squad of the Florida Department of Financial Services opened an investigation into Wagner Chiropractic and Acupuncture Clinic (WCAC) after receiving complaints about WCAC from the Special Investigative Units of several private automobile insurance carriers. These complaints involved charges submitted to the insurance carriers by WCAC for medical and chiropractic services and treatments that had never taken place. In addition, investigators learned that Wagner, at the time a chiropractor who was not authorized to prescribe any drugs, submitted prescriptions for customers on pre-stamped or pre-signed prescription pads using the names of medical doctors, making each such prescription unlawful.
The Federal Bureau of Investigation (FBI) and other federal agencies adopted the investigation, and on August 4, 2011, agents executed a federal search warrant at WCAC. Following the execution of the search warrant, in August 2011, the Florida Department of Health served Wagner with an Emergency Suspension Order, and his Florida chiropractic licensed was revoked.
According to interviews conducted by the FBI and other federal agencies, none of the WCAC customers had ever been treated or examined by anyone other than Wagner or, in some instances, by Wagner’s son. Yet those customers had received prescriptions for controlled substances, primarily Lortab (Hydrocodone) and Xanax, from medical doctors who had never examined or treated the customers. All of the prescriptions were relayed to various local pharmacies in the Daytona Beach area by telephone or facsimile after the customers had been to WCAC and had seen Wagner. Customers who did not have any type of health insurance paid Wagner $100 cash, every month, and received a monthly prescription for controlled substances, as well as a "back crack" from Wagner.
Other customers, who were on social security disability and were covered by Medicare, received weekly prescriptions for controlled substances in the same manner. However, their Medicare coverage was billed for treatments provided by a medical doctor who had never treated or examined them. Still other customers, who were covered by a private health insurance plan, were provided weekly prescriptions for controlled substances, again relayed either by telephone or facsimile to local pharmacies. The prescriptions were issued by a medical doctor who had never treated or examined the customers, and the customers' private health insurance plans were billed in the name of doctors who had never treated or examined the customers.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/pae/News/2012/May/temple,kubacki_release.htm
PHILADELPHIA - Dr. Joseph Kubacki and Temple University - Of the Commonwealth System of Higher Education ("Temple") have agreed to pay the United States a combined $1,088,574.93, resolving Temple's voluntary disclosure that it improperly billed the United States for medical services provided by residents but that Temple billed as though they had been performed by attending physicians.
The False Claims Act makes it illegal for any person or entity to present a false or fraudulent claim to the United States for payment and/or to retain overpayments that were improperly received. Federal programs only reimburse hospitals for services which attending physicians performed or which attending physicians were present for the critical portions. Those physicians certify that they were present when the critical portion of the services were performed as part of the charting and billing process.
Dr. Kubacki, formerly the Chairman of Temple's Ophthalmology Department, was convicted by a jury on August 22, 2011 of 73 counts of health care fraud, 73 counts of false statements in health care matters, and four counts of wire fraud. The evidence at his trial showed that he had billed the United States for performing services that were performed by residents when he was not even physically present in the hospital. The settlement with Temple pertains both to this fraud and to other fraud discovered in Temple's plastic surgery department, where attending physicians were present in the hospital at the time services were performed but were not actually present for the critical portions of the services for which they submitted claims.
Although Temple trained its physicians in charting and billing requirements, this training did not prevent the fraud from occurring.
“Combating Medicare fraud and overbilling is an increasingly critical issue,” said Memeger. “Every year we lose tens of billions of dollars to Medicare and Medicaid fraud. Those billions represent health care dollars that could be spent on medicine, elder care or emergency room visits. This is unacceptable, and we are committed to working with health care providers like Temple and with the Department of Health and Human Services to eradicate it.”
Temple brought this case to the government’s attention by voluntarily disclosing the improper blling. Memeger complimented Temple on its approach to these issues, stating “When health care providers come forward, forthrightly acknowledge improper conduct, and take steps to prevent that conduct from recurring in the future, everyone benefits. Temple’s decision to disclose the misconduct, to reveal the results of their internal investigation, and to cooperate with our investigation demonstrated that they were serious about providing patients with appropriate medical care and about compliance with the law. Temple also improved its compliance program, promptly terminated its relationship with the physicians implicated in this fraud, and agreed to voluntarily repay both the federal and private payors who had been defrauded. These are critical factors in our decision whether to pursue health care providers in litigation or whether to reach an amicable resolution.”
In light of Temple’s voluntary disclosure and self-audit, and upon the evaluation of Temple’s compliance structure by the Office of the Inspector General of the Department of Health and Human Services, Temple will continue to implement its corporate compliance program without the need for a Corporate Integrity Agreement overseen by the Office of the Inspector General.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20May/120514%20Giveneter%20and%20Shavabskaya.html
HOUSTON - Michael Giventer, 53, formerly of Brownsville, Texas, has just pleaded guilty to conspiracy to commit bankruptcy fraud, United States Attorney Kenneth Magidson announced today. Giventer’s wife, Julia Shavabskaya, 40, currently residing in Florida, also pleaded guilty to the same charge on April 30, 2012.
From on or about Aug. 27, 2002, and continuing to July 2010, Giventer caused the incorporation of two business entities, Ambucare Inc. and Open Diagnostic Imaging Inc., located in the Brownsville area, as holding companies to receive income from clinics providing various forms of health care services to individuals who were covered by Workers’ Compensation insurance. Ownership of both Ambucare and Open Diagnostic Imaging was placed solely in the name of Shvabskaya. Through these two companies, Giventer received income from a number of these clinics, such as Valley Center for Pain and Stress Management, Functional Pain Center, Palladium for Surgery and Valley Comprehensive Pain Management.
On Nov. 4, 2005, Giventer filed for bankruptcy under chapter 7 in the Southern District of Texas. During the bankruptcy, Giventer was required to file under penalty of perjury various Schedules consisting of assets, debts, liabilities and a Statement of Financial Affairs in which he was required to disclose among other things, his income, debts, property and transfers of property. In some of the documents, Giventer indicated he did not own an interest in Ambucare, Open Diagnostic Imaging and other properties and assets when in truth and in fact, he controlled, managed and received income from these entities and made all decisions about how their income would be distributed. Shavabskaya falsely testified that she owned the companies and that Giventer did not own or operate them. Additionally, both Giventer and Shavabskaya knew and falsely denied under oath any ownership interest in these entities in order to deceive, frustrate and prevent creditors and the bankruptcy Trustee from identifying and collecting assets as part of the bankruptcy estate to be distributed for the benefit of creditors.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/philadelphia/press-releases/2012/ambulance-company-worker-sentenced-to-prison-term-for-fraud-scheme
PHILADELPHIA—Ivan Tkach, 30, of Newtown, Pennsylvania, was sentenced today to 46 months in prison for his role in a scheme to defraud Medicare and the U.S. government. Tkach pleaded guilty January 10, 2012, admitting that he gave false statements in his application for reinstatement to the Medicare program in 2009 and paid illegal kickbacks to a secretary at Philadelphia College of Osteopathic Medicine, all in relation to a private ambulance company’s involvement in a health care fraud scheme. In addition to the prison term, U.S. District William H. Yohn, Jr. ordered Tkach to pay restitution in the amount of $1.26 million to Medicare and ordered three years’ supervised release.
Tkach was indicted along with his boss Ilya Sivchuk, who was convicted by a jury in November 2011. 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. Advantage Ambulance has a new owner. Ilya Sivchuk is awaiting sentencing.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/opa/pr/2012/May/12-crm-634.html
WASHINGTON – A Houston-area nurse was sentenced today in Houston for her 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).
Ezinne Ubani, the former director of nursing at Family Healthcare Group, a Houston home health care company, was sentenced by U.S. District Judge Nancy Atlas in the Southern District of Texas to 97 months in prison, followed by three years supervised release. Ubani was ordered to pay $2.5 million in restitution jointly and severally with her codefendants. Ubani was convicted of one count of conspiracy to commit health care fraud and two counts of making false statements following a May 2011 trial.
According to the evidence presented at trial and in court documents, Family Healthcare Group purported to provide skilled nursing to Medicare beneficiaries. Family Healthcare Group paid 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. The evidence showed that Ezinne Ubani 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.
Ubani is the seventh defendant sentenced in connection with this scheme. Three other defendants, Clifford Ubani, Princewill Njoku and Cynthia Garza Williams, await sentencing in the Southern District of Texas.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/detroit/press-releases/2012/detroit-area-physician-convicted-in-6.7-million-medicare-fraud-scheme
A federal jury sitting in Detroit, Michigan convicted a Detroit-area physician for his role in a $6.7 million Medicare Fraud scheme, the Department of Justice, the FBI, and the Department of Health and Human Services (HHS) announced today.
Jonathan Agbebiyi, 62, of Sterling Heights, Michigan, was convicted of one count of conspiracy to commit health care fraud and six counts of health care fraud. Agbebiyi was a staff physician at three clinics that operated in Livonia, Michigan between 2007 and 2010: Blessed Medical Clinic, Alpha and Omega Medical Clinic, and Manuel Medical Clinic.
According to the evidence presented during the one-week trial before United States District Judge Arthur Tarnow, Jonathan Agbebiyi, an obstetrician/gynecologist, joined a conspiracy to bill Medicare for medically unnecessary neurological tests. Some of the tests involved sending an electrical current through the arms and legs of the patients. Clinic employees, who lacked any meaningful training, administered the diagnostic tests. The patients never received any follow up treatment by neurologists.
Evidence at trial showed that the patients were not referred to the clinics by their primary care physicians, or for any other legitimate purpose but, rather, were recruited with prescriptions for controlled substances, cash payments, and fast food. The three clinics then billed the Medicare program for various diagnostic tests that were medically unnecessary.
United States Attorney Barbara L. McQuade stated, “This doctor exposed patients to neurological testing solely to generate money for himself at the expense of the Medicare program. We are grateful for the hard work that uncovered this betrayal of medical ethics and theft of taxpayer funds.”
Including today’s guilty verdicts, nine individuals involved with the three clinics have been convicted for their roles in the scheme.
A sentencing date for Agbebiyi has been set for August 13, 2012. Each count of conspiracy to commit health care fraud and health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/sanantonio/press-releases/2012/local-dentist-orthodontist-couple-convicted-of-making-false-statements-on-bills-to-texas-medicaid
LAREDO, TX—Local dentist Dr. Carlos Armin Morales-Ryan, 45, and his wife, local orthodontist Dr. Nelia Patricia Garcia-Morales, 42, have pleaded guilty to a criminal information admitting they made false statements on bills to Texas Medicaid, United States Attorney Kenneth Magidson announced today.
Morales-Ryan and Garcia-Morales owned and operated Orthogenesis International Centre, a Laredo dentistry and orthodontics business, and a substantial portion of their business was targeted to rendering services to Medicaid-eligible children. Applicable Texas law and Medicaid regulations required them to be in their offices when services were rendered on Medicaid patients as a prerequisite to receiving payment for the services from Medicaid. Similar consumer protection laws and regulations are applicable to most types of physicians for many of the services they render in Texas, regardless of whether the patient is or is not a Medicaid beneficiary.
Morales-Ryan’s signed plea agreement states that though he and Garcia-Morales were in Hawaii on or about October 12, 2007, he falsely represented to Medicaid that he performed an evaluation and management of a new patient on that date claiming entitlement to payment. However, at the time he made this false representation to Medicaid, he and Garcia-Morales knew the statement was false and that neither of them performed that service on or about that date. Similarly, Garcia-Morales admitted that though she and Morales-Ryan were en route to the U.S. Virgin Islands on March 23, 2007, she falsely represented to Medicaid that she performed an orthodontic retention on that date, claiming entitlement to payment. However, at the time she made this false representation to Medicaid, she and Morales-Ryan knew the statement was false and that neither of them performed an orthodontic retention on or about that date.
Texas Medicaid is a health care program funded in part by the federal government through payroll taxes and in part by the state of Texas.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/mie/news/2012/2012_5_11_jagbebiyi.html
A federal jury sitting in Detroit, Michigan, convicted a Detroit area physician for his role in a $6.7 million Medicare Fraud scheme, the Department of Justice, the FBI, and the Department of Health and Human Services (HHS) announced today..
Jonathan Agbebiyi, 62, of Sterling Heights, Michigan, was convicted of one count of conspiracy to commit health care fraud, and six counts of health care fraud. Agbebiyi was a staff physician at three clinics which operated in Livonia, Michigan, between 2007 and 2010: Blessed Medical Clinic, Alpha and Omega Medical Clinic, and Manuel Medical Clinic.
According to the evidence presented during the one week trial before United States District Judge Arthur Tarnow, Jonathan Agbebiyi, an obstetrician/gynecologist, joined a conspiracy to bill Medicare for medically unnecessary neurological tests. Some of the tests involved sending an electrical current through the arms and legs of the patients. Clinic employees, who lacked any meaningful training, administered the diagnostic tests. The patients never received any follow up treatment by neurologists.
Evidence at trial showed that the patients were not referred to the clinics by their primary care physicians, or for any other legitimate purpose, but rather were recruited with prescriptions for controlled substances, cash payments, and fast food. The three clinics then billed the Medicare program for various diagnostic tests that were medically unnecessary.
United States Attorney Barbara L. McQuade stated, "This doctor exposed patients to neurological testing solely to generate money for himself at the expense of the Medicare program. We are grateful for the hard work that uncovered this betrayal of medical ethics and theft of taxpayer funds."
Including today's guilty verdicts, 9 individuals involved with the three clinics have been convicted for their roles in the scheme.
A sentencing date for Agbebiyi has been set for August 13, 2012. Each count of conspiracy to commit health care fraud and health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/birmingham/press-releases/2012/lauderdale-county-doctor-indicted-for-health-care-fraud-and-wire-fraud
BIRMINGHAM—A federal grand jury today indicted a Lauderdale County physician for fraud totaling about $1.3 million in connection to billing a health insurer and Medicare for non-reimbursable cosmetic skin treatments, announced U.S. Attorney Joyce White Vance and FBI Special Agent in Charge Patrick J. Maley.
The 96-count indictment filed in U.S. District Court charges DIANA K. McCUTCHEON, 54, of Killen, with committing health care fraud and wire fraud through her medical clinics in Elgin and Lexington in North Alabama. The indictment charges McCutcheon with operating a scheme to defraud Blue Cross Blue Shield of Alabama and Medicare between 2007 and 2012 by fraudulently billing for the removal of multiple skin lesions on patients who had received cosmetic laser and other treatments for various skin conditions, including sun spots, age spots, and wrinkles, that were not covered by insurance.
The indictment charges 48 counts each of health care fraud and wire fraud. It seeks forfeiture of $1.3 million from McCutcheon as proceeds of the frauds.
“Health care and the cost of insurance are vitally important issues to us all,” Vance said. “Anyone who fraudulently bills private and public insurance plans for money he or she is not entitled to drives up costs for everyone. We will thoroughly investigate and aggressively prosecute this crime,” she said.
Each of the health care fraud counts carries a maximum punishment of 10 years in prison and a $250,000 fine. Each of the wire fraud counts carries a maximum penalty of 20 years in prison and a $250,000 fine.
.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/flm/press/2012/may/20120509_Crisler.html
Tampa, FL - United States Attorney Robert E. O'Neill announces today that United States District Judge Elizabeth A. Kovachevich sentenced Patrick Timothy Crisler (46, Inverness) to 30 months in federal prison for defrauding Medicare and Medicaid. The court also ordered Crisler to forfeit $455,537.30, which are proceeds traceable to his offense.
Crisler pled guilty on March 5, 2012.
According to court documents, Crisler, an occupational therapy assistant and owner of Active Life Rehab, Inc., was charged with health care fraud and aggravated identity theft for submitting fraudulent claims of more than $1 million to the Medicaid program. The claims submitted were for occupational therapy services that were either not provided at all, or not provided as billed to Medicaid.
Specifically, Crisler falsified patient records and knowingly engaged in "upcoding" by using the unauthorized Medical Provider Numbers of other licensed occupational therapists to submit claims to Medicaid for payment to Active Life Rehab. Crisler also submitted false claims to Medicare. In total, he billed or caused Medicaid and Medicare to be billed approximately $1.5 million. Crisler received $455,537.30 in unwarranted payments, as a result of his fraudulent scheme.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/opa/pr/2012/May/12-crm-590.html
WASHINGTON – Detroit-area residents Zahir Yousafzai and Dr. Dwight Smith pleaded guilty yesterday for their roles in a $13.8 million home health care fraud and money laundering scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Yousafzai, 42, pleaded guilty before U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan to one count of conspiracy to commit health care fraud and one count of money laundering. Smith, 59, pleaded guilty before Judge Rosen to one count of conspiracy to commit health care fraud.
According to information contained in plea documents, in 2009, Yousafzai and his co-conspirators acquired beneficial ownership and control over two home health companies, First Care Home Health Care LLC and Moonlite Home Care Inc. Yousafzai also assisted in the operation of two home health care companies owned by co-conspirators, Physicians Choice Home Health Care LLC and Quantum Home Care Inc. Yousafzai admitted that these home health agencies billed Medicare for home health visits that never occurred. Between July 2008 and September 2011, Yousafzai and his co-conspirators submitted or caused the submission of approximately $13.8 million in fraudulent home health claims to the Medicare program by the four home health agencies. Medicare paid more than $4 million to First Care and Moonlite, the companies that Yousafzai beneficially owned in whole or in part.
Yousafzai admitted to paying and directing the payment of various medical professionals, including doctors, nurses, physical therapists and physical therapy assistants, to create fictitious patient files to document purported home health services that were never provided. Yousafzai, a physical therapy assistant, also signed fictitious patient files in which physical therapy services were documented, but never actually provided.
Yousafzai also admitted that he paid and directed the payment of kickbacks to recruiters who obtained beneficiaries’ information and used the information to submit claims for home health services that were never provided. The beneficiaries sometimes pre-signed forms and visit sheets that were later falsified to indicate that they received home health services that were never provided. Other times, the beneficiaries’ signatures were forged on forms and visit sheets.
Additionally, Yousafzai admitted that he incorporated a shell company known as A-1 Nursing and Rehab Inc. for the purpose of laundering the proceeds of health care fraud, which were obtained through the submission of false and fraudulent claims to Medicare.
According to plea documents, beginning in or around September 2009, Smith began referring Medicare beneficiaries for home health care services to Physicians Choice Home Health Care LLC and Quantum Home Care Inc. During that time, Smith owned and controlled Supreme Medical Associates PLLC, a Michigan corporation doing business in Detroit under the assumed name of Smith Medical Center. In May 2010, Smith incorporated Phoenix Visiting Physicians PLLC.
Smith Medical Center and Phoenix employed individuals who claimed to be doctors, but, in fact, were not licensed in the state of Michigan to perform any medical services. The unlicensed doctors met with and purported to examine Medicare beneficiaries for home health care services. Smith did not meet or examine these beneficiaries and they were not homebound. Many of the beneficiaries were paid to pre-sign patient visit forms and did not receive home health services from Physicians Choice, First Care and Quantum. From in or around September 2009 through in or around September 2011, Medicare paid approximately $6.5 million for fraudulent home health care claims submitted by Physicians Choice, First Care and Quantum based on Smith’s referrals.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
