Source- http://www.justice.gov/opa/pr/2012/July/12-crm-928.html
A superseding indictment was unsealed today charging two owners of a Houston mental health care company, Spectrum Care P.A., some of its employees and the owners of Houston group care homes for their alleged participation in a $97 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.
Mansour Sanjar, 79, Cyrus Sajadi, 64, and Chandra Nunn, 34, were originally charged in December 2011, and are expected to make their initial appearances on the superseding indictment in the coming days. The indictment was originally retuned on July 24, 2012, and was unsealed today.
Adam Main, 31, Shokoufeh Hakimi, 65, Sharonda Holmes, 38, and Shawn Manney, 50, all from the Houston area, were arrested today and are expected to make their initial appearances in U.S. District Court for the Southern District of Texas in Houston either today or tomorrow.
The superseding indictment charges Sanjar, Sajadi, Main, Terry Wade Moore, 51, Hakimi and Nunn each with one count of conspiracy to commit health care fraud; Sanjar, Sajadi, Main and Moore are charged with various counts of health care fraud; Sanjar, Sajadi, Hakimi, Nunn, Holmes and Manney each are charged with one count of conspiracy to defraud the United States and to pay health care kickbacks; and Sanjar, Sajadi, Hakimi, Nunn, Holmes and Manney are charged with various counts of payment and receipt of healthcare kickbacks. The superseding indictment also seeks forfeiture.
According to the indictment, Sanjar and Sajadi orchestrated and executed a scheme to defraud Medicare beginning in 2006 and continuing until their arrest in December 2011. Sanjar and Sajadi owned Spectrum, which purportedly provided partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for severe mental illness. The Medicare beneficiaries for whom Spectrum billed Medicare for PHP services did not qualify for or need PHP services. Sanjar, Sajadi, Main and Moore signed admission documents and progress notes certifying that patients qualified for PHP services, when in fact, the patients did not qualify for or need PHP services. Sanjar and Sajadi also billed Medicare for PHP services when the beneficiaries were actually watching movies, coloring and playing games – activities that are not covered by Medicare.
Sanjar, Sajadi and Hakimi paid kickbacks to Nunn, Holmes, Manney and other group care home operators and patient recruiters in exchange for delivering ineligible Medicare beneficiaries to Spectrum, according to the indictment. In some cases, the patients received a portion of those kickbacks. The indictment alleges that Spectrum billed Medicare for approximately $97 million in services that were not medically necessary and, in some cases, not provided.
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Source- http://www.justice.gov/opa/pr/2012/July/12-crm-932.html
The manager of a Detroit-area health care clinic was sentenced today to serve 40 months in prison for his leading role in a $7.42 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Miami-area resident Alejandro Haber, 27, was sentenced by U.S. District Judge Patrick Duggan in the Eastern District of Michigan in Detroit. In addition to his prison term, Haber was sentenced to serve three years of supervised release and was ordered to pay $5,333,906 in restitution, joint and several with his co-defendants, and was ordered to forfeit approximately $99,000 seized from bank accounts he controlled.
On Oct. 27, 2012, Haber pleaded guilty to one-count of conspiracy to commit health care fraud. According to plea documents, Haber conceived and oversaw fraud schemes at a clinic called Ritecare LLC. Ritecare later merged with a clinic called CompleteHealth LLC. Haber’s role was limited to the operation of Ritecare alone.
On July 24, 2012, Alejandro Haber’s father, Emilio Haber, was sentenced to serve 60 months in prison for his leading role in an $8.5 million Medicare fraud scheme.
According to court documents, w hile operating Ritecare, Alejandro Haber and his co-conspirators billed Medicare for medically unnecessary tests and services. Haber obtained patients for Ritecare through the payment of kickbacks to patient recruiters and directly to Medicare beneficiaries. The majority of patients were obtained through patient recruiters. Typically, co-conspirators at Ritecare paid patient recruiters $100-$150 per patient obtained, with $50-$75 to go to the patient in exchange for coming to Ritecare and subjecting themselves to medically unnecessary tests.
To justify the medically unnecessary tests, co-conspirators at Ritecare instructed the patient recruiters to have the patients feign certain symptoms. Haber admitted that co-conspirators also directly instructed patients to feign symptoms as well. The kickbacks paid to the recruiters and the patients were contingent upon the Medicare beneficiaries identifying the symptoms necessary to justify medically unnecessary tests. Consequently, the patients’ medical records contained false or fabricated symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed. The most expensive tests were nerve conduction studies.
Between approximately August 2007 and approximately October 2009, Haber submitted and/or caused to be submitted approximately $7.42 million in fraudulent claims through Ritecare to the Medicare program for medical and testing services that were procured through the payment of kickbacks, were medically unnecessary, and justified by deception and patient coaching. Medicare actually paid approximately $5.33 million on those claims.
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Source- http://www.fbi.gov/sandiego/press-releases/2012/doctor-and-owner-of-medical-supply-company-charged-in-1.3-million-power-wheelchair-scam
United States Attorney Laura E. Duffy announced that a medical doctor and an owner of a medical supply company were charged with submitting $1.3 million in fraudulent power wheelchair claims to Medicare. Dr. Irving Schwartz was arrested by federal agents on Tuesday in Yuba City, California, and arraigned on one count of conspiracy to receive health care kickbacks and defraud the Medicare trust fund. Jose Melendez, owner and operator of Oceanside Medical Services, was arrested on Wednesday in Long Beach, California, and arraigned on charges of conspiracy, witness tampering, and health care fraud.
According to the indictment, the scheme focused on the sale of fraudulent power wheelchair prescriptions, with the end-goal being to obtain reimbursements from Medicare for power wheelchairs that patients did not need and, in some cases, did not want. The indictment alleges that Schwartz and a co-conspirator would travel to El Centro, California in search of elderly Medicare patients. Schwartz would write the patients prescriptions for power wheelchairs, even though the patients did not need the equipment and could walk without assistance. Schwartz collected a $300 cash kickback in exchange for each power wheelchair prescription. One of Schwartz’ co-conspirators would then sell the power wheelchair prescriptions to Melendez, charging him $1,000 per fraudulent prescription.
Melendez, in turn, sold some of the power wheelchair prescriptions to other co-conspirators, charging an additional mark-up on each prescription. As the last step in the scheme, Melendez and other co-conspirator owners of medical supply companies would submit the fraudulent prescriptions to Medicare for reimbursement, billing up to $5,865 for each power wheelchair. The indictment further alleges that Melendez attempted to persuade one of the co-conspirators to lie to federal agents in an effort to hinder the Medicare fraud investigation.
If convicted, Schwartz faces a maximum penalty of five years, and Melendez faces a maximum penalty of 20 years in prison.
In separate but related cases, three co-conspirators, Gloria Hernandez, Aristeo Tavares, and Laura Tavares, have pled guilty and face a maximum of 10 years in prison. All the defendants each also face a maximum $250,000 fine and a mandatory order of restitution to repay the fraudulently obtained proceeds of the scheme.
The public is reminded that an indictment itself is not evidence that the defendants committed the crimes charged. The defendants are presumed innocent until the government meets its burden in court of proving guilt beyond a reasonable doubt.
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Preet Bharara, the United States Attorney for the Southern District of New York, announced today that the United States has filed and simultaneously settled a civil fraud lawsuit alleging that DISTRICT COUNCIL 1707, LOCAL 95 HEAD START EMPLOYEES WELFARE FUND (the “Fund”) violated the False Claims Act and common law when it charged a Head Start grantee higher rates for hospital insurance premiums than it had originally paid for the premiums. As part of the settlement, the Fund admitted, acknowledged, and accepted responsibility for charging more for the insurance premiums than it paid, and agreed to pay the Government approximately $5 million. The settlement was approved today by U.S. District Judge William H. Pauley III.
According to the Complaint filed in Manhattan federal court:
The Fund administers hospitalization insurance for employees who work for agencies that carry out Head Start programs (“Delegate Agencies”). Head Start programs promote school readiness by providing educational, health, nutritional, social and other services to enrolled children and their families. The Delegate Agencies are funded by the New York City Administration for Children’s Services (“ACS”), which is a Head Start grantee. Each year, on behalf of the Delegate Agency employees, the Fund negotiates a contract with an insurance provider for hospitalization insurance, and it sends monthly invoices to ACS for reimbursement. ACS then pays the Fund for the insurance premiums using Head Start grant money. Prior to 2008, the Fund violated the False Claims Act as well as common law when it submitted invoices to ACS for amounts higher than what the Fund actually paid the insurance provider. As a result, over the relevant time period, ACS paid the Fund approximately $3 million more than what the Fund actually paid for the hospitalization insurance premiums.
In addition to acknowledging the overbilling in its settlement with the Government, the Fund will pay the Government approximately $5 million.
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Source- http://www.justice.gov/opa/pr/2012/July/12-crm-918.html
WASHINGTON – The owner of a Detroit-area health care clinic was sentenced today to serve 60 months in prison for his leading role in an $8.5 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Miami-area resident Emilio Haber, 53, was sentenced by U.S. District Judge Patrick Duggan in the Eastern District of Michigan in Detroit. In addition to his prison term, Haber was sentenced to serve three years of supervised release and was ordered to pay $6,341,000 in restitution, joint and several with his co-defendants, and was ordered to forfeit approximately $99,000 seized from bank accounts he controlled.
On Oct. 26, 2012, Haber pleaded guilty to one count of conspiracy to commit health care fraud. According to plea documents, Haber conceived and oversaw fraud schemes at two clinics, Ritecare LLC and CompleteHealth LLC. Haber incorporated and opened Ritecare and CompleteHealth in the state of Michigan in 2007. CompleteHealth merged into Ritecare in July 2008.
According to court documents, while operating CompleteHealth and Ritecare, Haber and his co-conspirators billed Medicare for medically unnecessary tests and services, including, but not limited to, nerve conduction studies. Haber obtained patients for the clinics through the payment of kickbacks to Medicare beneficiaries and patient recruiters. Haber admitted that he and other co-conspirators paid patient recruiters $100-$150 per patient obtained, with $50-$75 to go to the patient in exchange for visiting Ritecare and subjecting themselves to medically unnecessary tests.
To justify the medically unnecessary tests, Haber admitted that he and other co-conspirators told patient recruiters to instruct the patients to feign certain symptoms. Haber and other co-conspirators also directly instructed patients to feign symptoms. The kickbacks paid to the recruiters and the patients were contingent upon the Medicare beneficiaries identifying the symptoms necessary to justify medically unnecessary tests. Consequently, the patients’ medical records contained false or fabricated symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.
The department said that between approximately August 2007 and approximately October 2009, Haber and his co-conspirators at CompleteHealth and Ritecare submitted and/or caused to be submitted approximately $8.5 million in fraudulent claims to the Medicare program for medical and testing services that were medically unnecessary and procured through the payment of kickbacks. Medicare paid approximately $6.3 million of those claims.
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Source- http://www.justice.gov/usao/mow/news2012/crisp.ind.html
SPRINGFIELD, Mo. - David M. Ketchmark, Acting United States Attorney for the Western District of Missouri, announced a former physician at a Bolivar, Mo., health clinic was indicted by a federal grand jury today for illegally distributing prescription drugs and for health care fraud.
Nolan Denny Crisp, 75, of Half Way, Mo., was charged in a five-count indictment returned by a federal grand jury in Springfield, Mo.
Crisp was employed at Pomme de Terre Wellness Center (also known as the Bolivar Family Wellness Clinic and Northwoods Psychiatric Services, Inc.) in Bolivar from June 2009 through Nov. 10, 2010 to provide pain management and other services to patients.
Today’s indictment charges Crisp with four counts of illegally distributing controlled substances. Crisp allegedly issued prescriptions for OxyContin, Oxycodone Hydrochloride, Oxycodone-Aspirin and Endocet without a legitimate medical purpose and outside the course of usual professional practice. The indictment alleges that Crisp caused a total of 1,225 tablets of these narcotics to be illegally distributed between Dec. 1, 2009, and Oct. 7, 2010.
The indictment also charges Crisp with one count of health care fraud. Crisp allegedly issued illegal prescriptions to Medicaid beneficiaries, who then filled those prescriptions at pharmacies. Those pharmacies then submitted claims to Medicaid for filling the prescriptions, and Medicaid paid those claims. According to the indictment, Medicaid paid a total of $4,619 in claims for illegal prescriptions and an additional $12,111 in claims for office visits at the clinic that were not medically necessary. Crisp allegedly provided services to individuals at the clinic when those individuals, in fact, were only seeking illegal prescriptions for narcotics.
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Source- http://www.fbi.gov/jackson/press-releases/2012/summit-oncologist-madison-biller-plead-guilty-to-health-care-fraud
JACKSON, MS—Dr. Meera Sachdeva, 50, of Summit, Mississippi, and Monica Weeks, 40, of Madison, Mississippi, each pled guilty today to charges of Medicare fraud, U.S. Attorney Gregory K. Davis, FBI Special Agent in Charge Daniel McMullen, and Mississippi Attorney General Jim Hood announced.
Sachdeva, who owned and operated Rose Cancer Center in Summit, pled guilty to submitting claims for chemotherapy services that were supposedly rendered when she was out of the country. Weeks, who owned and operated The Medical Billing Group in Madison, pled guilty to conspiracy to commit health care fraud by covering up false claims made by Sachdeva that were scheduled for an audit.
According to the indictment in this case, Sachdeva is alleged to have billed for more chemotherapy drugs than she actually purchased from drug suppliers from 2007 to 2011. During the plea hearing, the Assistant United States Attorney told the court that if the case had gone to trial, the government would have proven that “[t]he defendant would prepare...chemotherapy treatments by injecting the prescribed chemotherapy drugs into a bag of fluid that would then be connected to the patient via a ‘chest port.’ Each patient believed that they were receiving an amount of chemotherapy medicine that was equal to the amount being billed to their respective health care benefit programs. The defendant was not providing each patient with the fully prescribed dosage of many of the billed chemotherapy drugs.”
Both Sachdeva and Weeks are scheduled to be sentenced on October 1, 2012, by United States District Judge Daniel P. Jordan, III. Weeks faces a maximum of 10 years in prison, a $250,000 fine, and the forfeiture of a $19,549.52 money judgment. Sachdeva faces up to 20 years in prison, $750,000 in fines, and the forfeiture of almost $6,000,000 in illegal proceeds that were previously seized by the government, as well as the forfeiture of several parcels of real property located throughout the state.
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Source- http://www.fbi.gov/detroit/press-releases/2012/michigan-man-pleads-guilty-in-connection-with-detroit-area-medicare-fraud-scheme
WASHINGTON—A Michigan resident pleaded guilty today for his role in a $13.8 million Detroit-area home health care fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Nabeel Shaikh, 30, of Wixom, Michigan, pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan. At sentencing, Shaikh faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in plea documents, Shaikh purported to be a physical therapy assistant with a limited license who provided physical therapy services to homebound Medicare beneficiaries. In fact, Shaikh had a forged physical therapy assistant’s degree and no medical license. Beginning in approximately January 2009, Shaikh was paid to falsify medical documentation for two home health agencies, known as Physicians Choice Home Health Care LLC and Quantum Home Care Inc., each of which billed and received payments from Medicare for home health care services that were never rendered.
According to court documents, Shaikh paid kickbacks and bribes to Medicare beneficiaries in order to obtain the beneficiaries’ Medicare information, which was then used to bill Medicare for home health services that were never provided. Shaikh created evaluations, therapy revisit notes, and other medical documentation memorializing purported physical therapy for patients he did not see or treat. Shaikh and his co-conspirators had Medicare beneficiaries pre-sign forms and visit sheets that were later falsified to make it appear that the beneficiaries had received home health services when, in fact, they had not. Shaikh knew that the documents that he signed would be used to support false claims to Medicare for home health services.
From approximately January 2009 through September 2011, Medicare paid approximately $900,430 to Physicians Choice and Quantum for fraudulent physical therapy claims based on falsified files and notes signed by Shaikh.
Overall, between approximately July 2008 and September 2011, Physicians Choice, Quantum, and two other fraudulent home health care agencies involved in the conspiracy, known as First Care Home Health Care LLC and Moonlite Home Care Inc., were paid approximately $13.8 million in fraudulent home health claims by the Medicare program for services that were medically unnecessary and/or never rendered.
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Source- http://www.fbi.gov/detroit/press-releases/2012/rehabilitation-agency-owner-in-detroit-sentenced-to-84-months-in-prison-for-role-in-3-million-therapy-fraud-scheme
WASHINGTON—The owner of a Detroit-area rehabilitation agency was sentenced today to 84 months in prison for his leading role in a $3 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Detroit-area resident Tariq Mahmud, 54, was sentenced by U.S. District Judge Avern Cohn in the Eastern District of Michigan. In addition to his prison term, Mahmud was sentenced to three years of supervised release and was ordered to pay $1.8 million in restitution, joint and several with his co-defendants.
Mahmud was convicted by a federal jury on February 2, 2012, after a four-day trial, of one count of conspiracy to commit health care fraud and six counts of health care fraud. Mahmud was charged along with four other defendants in an indictment unsealed on February 17, 2011, as part of a nationwide Medicare fraud takedown, and subsequently in a superseding indictment on December 28, 2011. The four other defendants have pleaded guilty and have been sentenced.
According to evidence presented during the trial, Mahmud was the owner of Comprehensive Rehabilitation Services Inc. (CRS), a fraudulent rehabilitation agency located in Dearborn, Michigan. Between January 2003 and February 2007, CRS purchased falsified physical and occupational therapy files from more than 30 therapy and rehabilitation companies and used them to fraudulently bill Medicare for more than $3 million.
As part of the scheme, Medicare beneficiaries were paid cash kickbacks and given prescription drugs to sign forms and visit sheets that were later falsified to indicate that they received therapy services that were never provided. Physical and occupational therapists created false evaluations, progress notes, and discharge papers indicating that the therapy services were given, when, in fact, they never were. Evidence at trial showed that the therapists never met the beneficiaries and Mahmud never provided or supervised the therapy billed to Medicare.
In addition to submitting more than $3 million in false therapy claims, Mahmud made additional false statements to Medicare regarding services that were never rendered. For instance, when Medicare inquired regarding a beneficiary who complained that he had not received the services for which CRS billed Medicare, Mahmud returned the payment and told Medicare that he consulted with his professional staff and the beneficiary had not been satisfied with services. In fact, CRS had no professional staff; the therapists who signed the beneficiary’s file never rendered any services; and the beneficiary never received services. Evidence at trial established that the beneficiary’s identity was stolen and used by CRS and a fraudulent file-making company to bill Medicare.
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Source- http://www.fbi.gov/chicago/press-releases/2012/chicago-physician-sentenced-to-30-months-in-prison-for-health-care-fraud-involving-unnecessary-patient-tests
CHICAGO—A physician who operated a south side medical clinic, Dr. Jaswinder Rai Chhibber, was sentenced to 2½ years in federal prison for engaging in a health care fraud scheme between 2007 and July 2010, federal law enforcement officials announced today. Chhibber, who operated the former Cottage Grove Community Medical Clinic, located at 642 East 79th St., Chicago, was convicted following a trial in March of defrauding BlueCross BlueShield of Illinois by submitting false insurance claims for medically unnecessary tests he ordered for patients and using false diagnosis codes to justify those tests.
Chhibber, 50, of Schaumburg, was ordered to begin serving his 30-month prison term on September 5 by U.S. District Judge Suzanne Conlon, who imposed the sentence, along with a $15,000 fine, late yesterday in federal court.
Chhibber was found guilty of five counts of health care fraud and four counts of making false statements involving a health care benefits program after a week-long trial. The jury found him not guilty of seven additional counts.
The evidence at trial showed that Chhibber ordered medically unnecessary tests, falsified patients’ medical records, and used false diagnosis codes on insurance claim forms in various fashions for at least five patients who testified at trial, including two undercover federal agents who posed as patients. Evidence also showed that Chhibber administered echocardiograms, electrocardiograms, nerve conduction studies, carotid doppler exams, and abdominal ultrasounds for an unusually high percentage of his patients.
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Source- http://www.fbi.gov/detroit/press-releases/2012/michigan-man-pleads-guilty-in-connection-with-detroit-area-medicare-fraud-scheme
WASHINGTON—A Michigan resident pleaded guilty today for his role in a $13.8 million Detroit-area home health care fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Nabeel Shaikh, 30, of Wixom, Michigan, pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan. At sentencing, Shaikh faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in plea documents, Shaikh purported to be a physical therapy assistant with a limited license who provided physical therapy services to homebound Medicare beneficiaries. In fact, Shaikh had a forged physical therapy assistant’s degree and no medical license. Beginning in approximately January 2009, Shaikh was paid to falsify medical documentation for two home health agencies, known as Physicians Choice Home Health Care LLC and Quantum Home Care Inc., each of which billed and received payments from Medicare for home health care services that were never rendered.
According to court documents, Shaikh paid kickbacks and bribes to Medicare beneficiaries in order to obtain the beneficiaries’ Medicare information, which was then used to bill Medicare for home health services that were never provided. Shaikh created evaluations, therapy revisit notes, and other medical documentation memorializing purported physical therapy for patients he did not see or treat. Shaikh and his co-conspirators had Medicare beneficiaries pre-sign forms and visit sheets that were later falsified to make it appear that the beneficiaries had received home health services when, in fact, they had not. Shaikh knew that the documents that he signed would be used to support false claims to Medicare for home health services.
From approximately January 2009 through September 2011, Medicare paid approximately $900,430 to Physicians Choice and Quantum for fraudulent physical therapy claims based on falsified files and notes signed by Shaikh.
Overall, between approximately July 2008 and September 2011, Physicians Choice, Quantum, and two other fraudulent home health care agencies involved in the conspiracy, known as First Care Home Health Care LLC and Moonlite Home Care Inc., were paid approximately $13.8 million in fraudulent home health claims by the Medicare program for services that were medically unnecessary and/or never rendered.
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Source- http://www.justice.gov/opa/pr/2012/July/12-crm-876.html
WASHINGTON – The owner of a Detroit-area rehabilitation agency was sentenced today to 84 months in prison for his leading role in a $3 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Detroit-area resident Tariq Mahmud, 54, was sentenced by U.S. District Judge Avern Cohn in the Eastern District of Michigan. In addition to his prison term, Mahmud was sentenced to three years of supervised release and was ordered to pay $1.8 million in restitution, joint and several with his co-defendants.
Mahmud was convicted by a federal jury on Feb. 2, 2012, after a four-day trial, of one count of conspiracy to commit health care fraud and six counts of health care fraud. Mahmud was charged along with four other defendants in an indictment unsealed on Feb. 17, 2011, as part of a nationwide Medicare fraud takedown, and subsequently in a superseding indictment on Dec. 28, 2011. The four other defendants have pleaded guilty and have been sentenced.
According to evidence presented during the trial, Mahmud was the owner of Comprehensive Rehabilitation Services Inc. (CRS), a fraudulent rehabilitation agency located in Dearborn, Mich. Between January 2003 and February 2007, CRS purchased falsified physical and occupational therapy files from more than 30 therapy and rehabilitation companies and used them to fraudulently bill Medicare for more than $3 million.
As part of the scheme, Medicare beneficiaries were paid cash kickbacks and given prescription drugs to sign forms and visit sheets that were later falsified to indicate that they received therapy services that were never provided. Physical and occupational therapists created false evaluations, progress notes and discharge papers indicating that the therapy services were given, when in fact they never were. Evidence at trial showed that the therapists never met the beneficiaries and Mahmud never provided or supervised the therapy billed to Medicare.
In addition to submitting more than $3 million in false therapy claims, Mahmud made additional false statements to Medicare regarding services that were never rendered. For instance, when Medicare inquired regarding a beneficiary who complained that he had not received the services for which CRS billed Medicare, Mahmud returned the payment and told Medicare that he consulted with his professional staff and the beneficiary had not been satisfied with services. In fact, CRS had no professional staff; the therapists who signed the beneficiary’s file never rendered any services; and the beneficiary never received services. Evidence at trial established that the beneficiary’s identity was stolen and used by CRS and a fraudulent file-making company to bill Medicare.
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Source- http://www.fbi.gov/washingtondc/press-releases/2012/maryland-woman-convicted-of-health-care-fraud-other-charges-for-defrauding-d.c.-medicaid-program-by-submitting-over-7-million-in-phony-claims
WASHINGTON—Jacqueline Wheeler, 54, the chief executive officer and owner of two health care companies, was convicted today by a federal jury in the District of Columbia of one count of health care fraud and 34 counts of false statements for submitting more than $7 million in fraudulent claims to the D.C. Medicaid program.
The guilty verdicts were announced by U.S. Attorney Ronald C. Machen, Jr.; James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office; Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services; and Charles J. Willoughby, Inspector General for the District of Columbia.
Wheeler, of Chevy Chase, Maryland, was convicted following a trial in the U.S. District Court for the District of Columbia. She faces a maximum sentence of 10 years in prison and a $250,000 fine for the health care fraud conviction and five years in prison and a $250,000 fine for each of the false statements convictions. Wheeler is scheduled to be sentenced on October 5, 2012, before the Honorable Ellen S. Huvelle. The judge ordered that Wheeler be jailed pending sentencing.
According to the government’s evidence at trial, Wheeler was the chief executive officer of the Health Advocacy Center Inc., which was located in the 900 block of Sheridan Street NW. She was also the owner of Sheridan Rehabilitative and Wellness Centers Inc., a private company located at the same Sheridan Street NW address. Beginning in January 2006 and continuing through April 2008, Wheeler, through the Health Advocacy Center, submitted false claims for services that were not provided. She collected at least $2.6 million before the activities were detected. Evidence showed that she used the proceeds of her fraud to support the purchase of four luxury vehicles, two beachfront properties in Florida, and her home.
“This CEO stole millions trying to get rich off a program designed to provide health care for our most vulnerable citizens,” said U.S. Attorney Machen. “The dozens of guilty verdicts reached today demonstrate the success of our efforts to protect American taxpayers from health care fraud, which drives up costs and threatens the integrity of our health care system. I want to congratulate the prosecutors and investigators who worked so hard to hold this business owner accountable for ripping off the taxpayer.”
“Today’s sentencing demonstrates that those who steal from Medicaid and exploit the system for their own benefit will be vigorously pursued,” said Assistant Director in Charge McJunkin. “The FBI will continue to work with our partners at HHS-OIG, the D.C. OIG, and the U.S. Attorney’s Office to bring to justice those who commit health care fraud.”
“The verdict today demonstrates again how the Office of the Inspector General, in this instance the Medicaid Fraud Control Unit, works constructively with its federal partners in protecting the interests of the District government, its residents, and the District treasury, a task that is all the more important in these financially and otherwise difficult times,” said Inspector General Willoughby. “The District government and its residents can take pride in the legal and investigative role played by the Office of the Inspector General in the achievement of this verdict.”
The Health Advocacy Center was purportedly engaged in serving as an advocate for improved health care delivery to the community. It also provided management support, as well as financial advice and assistance to other health care providers. It was a registered District of Columbia Medicaid provider.
Sheridan Rehabilitative and Wellness Centers was purportedly engaged in providing rehabilitative services to the mentally and physically disabled community. It also purportedly provided housing to mentally and physically challenged individuals. The company was not an authorized D.C. Medicaid provider.
Wheeler was a registered naturopath with the District of Columbia Department of Health, Health Professional Licensing Administration. However, she was not a licensed medical doctor. Wheeler did work with a licensed medical doctor, who was a part-owner of the Health Advocacy Center. This doctor’s specialty was physical medicine and rehabilitation.
Because Sheridan Rehabilitative and Wellness Centers was not authorized as a D.C. Medicaid provider, it was unable to submit bills to D.C. Medicaid. From January 2006 through April 2008, Wheeler prepared and submitted all of the billing for the Health Advocacy Center and handled all financial matters for both the Health Advocacy Center and Sheridan.
During that time period, Wheeler submitted over 600 claims to D.C. Medicaid for manual therapy services that the Health Advocacy Center purportedly provided to approximately 22 District of Columbia Medicaid beneficiaries. In these claims, she maintained that the Health Advocacy Center provided in excess of 20 continuous hours of manual therapy for each patient in a single 24-hour period and sought over $6.5 million from D.C. Medicaid for manual therapy services.
In performing therapeutic procedures such as manual therapy, the health care provider is required to bill in 15-minute intervals or units. There are only 1,440 minutes in a day. However, Wheeler routinely billed D.C. Medicaid from 1,440 continuous minutes of manual therapy for a single patient in a 24-hour period to as many as 2,910 continuous minutes (or 48.5 hours) of manual therapy for a single patient in a 24-hour period.
D.C. Medicaid paid the Health Advocacy Center in excess of $2.5 million for manual therapy services that were not provided to the patients. The payments were deposited in bank accounts controlled by Wheeler.
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Source- http://www.fbi.gov/oklahomacity/press-releases/2012/city-dentist-pleads-guilty-to-committing-health-care-fraud
OKLAHOMA CITY—Robin R. Lockwood, 44, a dentist from Oklahoma City, pled guilty to committing health care fraud, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma.
Lockwood is a dentist licensed to practice in the state of Oklahoma and was employed under contract by Ocean Dental at offices located at 1610 Southwest 74th Avenue, Oklahoma City. Ocean Dental’s dentists provided dental care to Medicaid-eligible children. The Medicaid Program is a cooperative program that provides federal and state funds to pay for health care benefits for individuals with insufficient incomes to meet the costs of necessary medical expenses. In Oklahoma, Medicaid is administered as “SoonerCare” by the Oklahoma Health Care Authority (OHCA), a state governmental agency. Ocean Dental submitted claims to the OHCA for reimbursement of dentists’ services based on patient treatment notes created by the dentists. Ocean Dental paid Lockwood a percentage of the funds that OHCA reimbursed to Ocean Dental for services she personally rendered.
The information alleged that from July 1, 2007 through December 31, 2010, Lockwood engaged in a scheme to defraud Medicaid by submitting claims for dental services that she did not provide. Specifically, Lockwood recorded in the patient’s treatment notes that she had placed dental restorations on certain teeth when, in fact, she had not treated the teeth at all. On other teeth, Lockwood recorded that she had placed dental restorations on more surfaces of the tooth than she had, in fact, restored or recorded that she had placed a dental restoration on the tooth when, in fact, she had placed on the tooth a type of treatment that is non-reimbursable by Medicaid. Ocean Dental submitted claims for reimbursement to Medicaid and paid Lockwood a percentage of those reimbursements. Lockwood used the proceeds of the fraud for her own personal benefit.
Today, Lockwood pled guilty to the charges in the information. At sentencing, she faces up to 10 years in prison and a $250,000 fine. A sentencing hearing will be set by the court in approximately 90 days.
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Source- http://www.fbi.gov/detroit/press-releases/2012/two-charged-for-medicare-fraud-schemes-in-detroit-involving-8.8-million-in-false-billings
A federal indictment was unsealed today in Detroit charging two individuals for their participation in a series of separate Medicare fraud schemes involving home health services, United States Attorney Barbara L. McQuade announced.
McQuade was joined in the announcement by Acting Special Agent in Charge Edward Hanko of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh, III of the HHS-OIG Office of Investigation.
Charged in the indictment were Usha Shah, 63, and Deepak Shah, 63, both of West Bloomfield, Michigan. According to the indictment, the Shahs were allegedly involved in fraudulent claims submitted to Medicare totaling more than $8.8 million through their company, Miracle Home Health of Southfield, for home health care services that were medically unnecessary and/or never provided.
In addition, the court documents allege that the Shahs engaged in a conspiracy to pay cash kickbacks in return for obtaining Medicare beneficiaries’ whose Medicare identifications were used to bill the Medicare program.
U.S. Attorney Barbara L. McQuade said, “Medicare fraud cheats taxpayers out of money intended to pay for health care. We want providers to know that we are scrutinizing billing records to root out fraud.”
FBI Acting Special Agent in Charge Edward Hanko said, “Those who seek to steal from the medicare system and collect millions of dollars illegally must be brought to justice. These types of crimes motivated by greed will continue to be investigated vigorously by the FBI and our law enforcement partners.”
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Source- http://www.fbi.gov/sacramento/press-releases/2012/second-physician-sentenced-to-more-than-six-years-in-federal-prison-for-role-in-massive-medicare-fraud-scheme
SACRAMENTO, CA—Lana Le Chabrier, 64, of Santa Barbara, was sentenced today by United States District Judge Morrison C. England, Jr. to six and a half years in prison for conspiring to commit health care fraud. She was found guilty by a jury on July 8, 2011.
In sentencing Le Chabrier, Judge England found that she abused her position of trust as a physician and was responsible for close to a million dollars in fraudulent billings submitted to Medicare and more than $400,000 in payments made on false claims. Following her arrest and prior to trial, Le Chabrier attempted to flee the United States and was apprehended at the Canadian border with $55,000 in cash, an expired United States passport (she was required to surrender her valid passport upon her arrest), and a bottle of hair dye. Judge England found the attempted escape to be an obstruction of justice.
According to testimony presented at trial, from February 2006 through August 2008, Vardges Egiazarian, 63, of Panorama City, owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael. Egiazarian and others recruited doctors to submit applications to Medicare for billing numbers. Le Chabrier assumed the role of co-owner and practitioner at the Richmond clinic, and claims were submitted to Medicare under her name for medical services purportedly rendered at the clinic.
In fact, Le Chabrier never treated a single patient at the clinic. Clinic patients, almost all of whom were elderly and non-English speaking, were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally $100 per visit. False charts were created stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.
Patient files were then transported to Southern California, where Le Chabrier signed them indicating she provided or approved the treatments. In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. In return for their roles, Le Chabrier and the other physicians received 20 percent of the billings paid under their respective provider numbers. When the Richmond clinic closed, Le Chabrier began the same activity at another fraudulent clinic in Burbank.
Speaking on her own behalf, Le Chabrier claimed she was a victim of credential fraud. At the judge’s request, she listed her educational accomplishments, including an M.D. from Australia, an MBA from Switzerland, a medical fellowship at Harvard, and coursework toward two PhDs.
In pronouncing sentence, Judge England recognized Dr. Le Chabrier as “one of the most highly educated defendants that has been in this courtroom or any courtroom I’ve ever been in,” stating it was “inconceivable that someone with this much education, experience, common sense, and worldly knowledge—that you’d be involved in a health care fraud” conspiracy without knowing it. “Your involvement was not an accident.” Judge England said, “You have taken a medical system that is meant to care for...those that can’t afford it,” he said, “and you subverted it in such a way” to enrich the members of the conspiracy.
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Source- http://www.fbi.gov/chicago/press-releases/2012/chicago-physician-sentenced-to-30-months-in-prison-for-health-care-fraud-involving-unnecessary-patient-tests
CHICAGO—A physician who operated a south side medical clinic, Dr. Jaswinder Rai Chhibber, was sentenced to 2½ years in federal prison for engaging in a health care fraud scheme between 2007 and July 2010, federal law enforcement officials announced today. Chhibber, who operated the former Cottage Grove Community Medical Clinic, located at 642 East 79th St., Chicago, was convicted following a trial in March of defrauding BlueCross BlueShield of Illinois by submitting false insurance claims for medically unnecessary tests he ordered for patients and using false diagnosis codes to justify those tests.
Chhibber, 50, of Schaumburg, was ordered to begin serving his 30-month prison term on September 5 by U.S. District Judge Suzanne Conlon, who imposed the sentence, along with a $15,000 fine, late yesterday in federal court.
Chhibber was found guilty of five counts of health care fraud and four counts of making false statements involving a health care benefits program after a week-long trial. The jury found him not guilty of seven additional counts.
The evidence at trial showed that Chhibber ordered medically unnecessary tests, falsified patients’ medical records, and used false diagnosis codes on insurance claim forms in various fashions for at least five patients who testified at trial, including two undercover federal agents who posed as patients. Evidence also showed that Chhibber administered echocardiograms, electrocardiograms, nerve conduction studies, carotid doppler exams, and abdominal ultrasounds for an unusually high percentage of his patients.
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Source- http://www.fbi.gov/atlanta/press-releases/2012/kenneth-b.-beverly-sentenced-for-health-care-fraud
Michael J. Moore, United States Attorney for the Middle District of Georgia, announced the sentencing of Kenneth B. Beverly, age 66, of Thomasville, Georgia, on June 28, 2012, in Albany by the Honorable W. Louis Sands, United States District Judge for the Middle District of Georgia.
Mr. Beverly was found guilty of six felony counts related to a conspiracy to falsify Medicaid records, witness tampering, and misleading statements after a seven-day jury trial December 10, 2010. Mr. Beverly was sentenced to a prison term of 24 months, a $50,000 fine, three years of supervised release, and a $600 assessment fee. The court allowed Beverly to self-report to the Bureau of Prisons at a date to be determined by the Bureau of Prisons.
Count one charged Mr. Beverly with a conspiracy to falsify records, a violation of Title 18, United States Code, Sections 371 and 1519; counts two and three, falsification of records, in violation of Title 18, United States Code, Section 1519; counts four and five charged Mr. Beverly with witness tampering, in violation of Title 18, United States Code, Section 1512(b)(1); and count six charged Mr. Beverly with misleading statements, in violation of Title 18, United States Code, Section 1512(b)(3).
The court noted that the essence of the case was the creation of false documents and the forging of signatures in order to induce state and federal authorities to send a total of approximately $13.9 million Medicare and Medicaid monies to Archbold Medical Center in Thomasville, Georgia.
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Source- http://www.fbi.gov/philadelphia/press-releases/2012/pennsylvania-man-charged-with-fraud-in-ambulance-scheme
WASHINGTON—A Churchville, Pennsylvania man was arrested today on charges contained in a 23-count indictment for his alleged role in a scheme to defraud Medicare by billing for fraudulent ambulance services, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and U.S. Attorney Zane D. Memeger.
An indictment unsealed today charges William V. Hlushmanuk, aka “Bill Le,” 35, of Churchville, Pennsylvania, with 21 counts of health care fraud, one count of conspiring to commit health care fraud, and one count of aiding and abetting in a false statement relating to a health care matter.
The indictment alleges that between 2006 and April 2011, Hlushmanuk and others devised a scheme to defraud Medicare of more than $5.4 million dollars. According to the indictment, Hlushmanuk used a straw owner to fraudulently open Starcare Ambulance because he was otherwise ineligible to own the company. Starcare primarily transported dialysis patients and fraudulently billed Medicare for patient transport for patients who could walk and whose transportation by Medicare was not medically required. The scheme involved transports in vans and fraudulent representations to Medicare’s administrative contractor, Highmark Medicare Services, to induce them to pay for these services. The indictment seeks forfeiture of $5,443,315, as well as a 2006 Hummer.
If convicted of all charges, Hlushmanuk faces a statutory maximum sentence of 10 years in prison on each of the health care fraud and conspiracy counts, five years for aiding and abetting in false statements relating to health care fraud, a three-year term of supervised release, and a fine of up to $250,000.
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Source- http://www.fbi.gov/sanantonio/press-releases/2012/rgv-dme-owner-and-others-indicted-on-multiple-health-care-crimes
MCALLEN, TX—The owner of a now-defunct McAllen-area durable medical equipment (DME) business, his wife, and two former employees have been charged in a 22-count indictment for their alleged roles in a scheme to defraud Medicare and Medicaid through fraudulent billings, United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott announced today.
Those charged and arrested include Marcello Herrera, 39, the owner of RGV DME, and his wife Carla Cantu Herrera, 31, both of Mission, Texas; Ramon De La Garza, 51, also of Mission; and Beatriz Ramos, 27, of Edinburg, Texas. The sealed indictment, returned Tuesday, June 26, 2012, was unsealed upon their respective arrests this morning. The charges include one count of conspiracy to commit health care fraud, six counts of health care fraud, five counts of wire fraud, and 10 counts of aggravated identity theft. They could make their initial appearances as early as 10:30 a.m. today before U.S. Magistrate Judge Peter Ormsby. Otherwise, they will appear in federal court tomorrow.
From early 2004 through early 2010, Marcello Herrera, who did business as RGV DME in the McAllen area, allegedly engaged in and directed a scheme to submit fraudulent claims to Medicare and Texas Medicaid for power wheelchairs, incontinence supplies, hospital beds, and mattresses, as well as other DME supplies. The indictment alleges that Carla Cantu Herrera, De La Garza, and Ramos participated in the conspiracy and aided Marcello Herrera and each other in the submission of fraudulent billings, wire fraud, and theft of the identities of beneficiaries and doctors.
According to allegations contained in the indictment, RGV DME submitted approximately 25,000 claims totaling approximately $11 million to Medicare and Texas Medicaid for DME allegedly provided to Medicare and Medicaid beneficiaries and was paid more than $7.1 million. The indictment alleges that 80 to 90 percent of the billings were fraudulent and that the fraudulent claims to Medicare were sent by wire transmissions in interstate commerce.
The indictment also alleges the defendants illegally paid “marketers” to obtain Medicare and Medicaid identification numbers and other information from beneficiaries and then used those numbers and information to fraudulently bill Medicare and Medicaid for expensive power wheelchairs, hospital beds and mattresses, incontinence supplies, and other DME. The defendants allegedly billed for DME that was never prescribed, was never delivered, was not needed, and in some cases was claimed to have been delivered to persons who were deceased at the time of the alleged delivery. To conceal the fraud, the indictment alleges the defendants forged documents and illegally used the identities of beneficiaries and doctors on their unlawful billings.
Conspiracy to commit health care fraud and each of the six counts of health care fraud carry a maximum punishment of 10 years in federal prison without parole and a $250,000 fine upon conviction. Each of the five counts of wire fraud carries a maximum punishment of 20 years in federal prison without parole and a $250,000 fine upon conviction. Each of the 10 counts of aggravated identity theft carries a mandatory two-year additional prison term, which must be served consecutive to any other prison sentence imposed for conviction on any of the other crimes charged.
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