Source-
http://www.fbi.gov/pittsburgh/press-releases/2012/mcmurray-doctor-sentenced-for-over-prescribing-painkillers-and-health-care-fraud
PITTSBURGH—A physician from McMurray, Pennsylvania has been sentenced in federal court to 135 months’ imprisonment (11 years and three months), to be followed by three years of supervised release, on his convictions for violating the federal narcotics laws and health care fraud, United States Attorney David J. Hickton announced today.
United States District Judge Arthur J. Schwab imposed the sentence on Oliver W. Herndon, age 40, of McMurray.
“We continue to make addressing the problem of prescription drug abuse one of our highest priorities by targeting the illegal supply chain at every level, from legitimate medical providers to illegal traffickers,” said U.S. Attorney Hickton. “Western Pennsylvania law enforcement is committed to identifying, investigating, and vigorously prosecuting these criminals who prey upon the addicted and threaten the safety of our communities.”
According to information presented to the court, Dr. Herndon prescribed oxycodone and Opana, powerful Schedule II painkillers, to patients outside of the legitimate course of medical practice. Fraud occurred when the cost of the office visits and the narcotics were billed to insurance companies. The parties stipulated to restitution in the amount of $700,000, which will be split between UPMC for You and Gateway Health Insurance (now owned by Highmark).
Dr. Herndon’s medical office in Peters Township was searched by federal agents on February 14, 2012. Dr. Herndon had relocated his office from 500 Lewis Run Road in Pleasant Hills to 1000 Waterdam Plaza only two weeks prior to the search.
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Source-
http://www.fbi.gov/newhaven/press-releases/2012/owner-of-old-saybrook-physical-therapy-practice-pleads-guilty-to-obstructing-federal-audit
The United States Attorney for the District of Connecticut announced that Todd Roberts, 47, of Old Saybrook, waived his right to indictment and pleaded guilty today before United States District Judge Stefan R. Underhill in Bridgeport to one count of obstructing a federal audit.
According to court documents and statements made in court, Roberts is the owner and operator of Roberts Physical and Aquatic Therapy, located at 210 Main Street in Old Saybrook. On January 23, 2009, a Medicare contractor informed Roberts Physical and Aquatic Therapy that the contractor was performing an audit of the practice. Roberts instructed an employee to delay the audit by telling the contractor that medical records were stored at a nonexistent storage facility. Roberts then rented a storage unit at a local facility and used the delay to alter and augment patient records. Specifically, Roberts, and an employee at his direction, created and added patient progress notes when no notes had been created at the time of service. The notes made it appear as though Medicare beneficiaries had obtained direct, one-on-one service from a licensed physical therapist when, in fact, some of the services had been rendered by unlicensed auxiliary personnel.
Judge Underhill has scheduled sentencing for December 18, 2012, at which time Roberts faces a maximum term of imprisonment of five years and a fine of up to $250,000.
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Source-
http://www.fbi.gov/washingtondc/press-releases/2012/maryland-man-sentenced-to-46-months-in-prison-for-stealing-over-1-million-in-scheme-involving-false-health-insurance-claims
WASHINGTON—Luis Rodriguez, 47, of Bethesda, Maryland, a contractor with the Federal Aviation Administration, was sentenced today to 46 months in prison on a charge stemming from the submission of false health care claims, announced U.S. Attorney Ronald C. Machen, Jr. and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office.
Rodriguez pled guilty in June 2012 in the U.S. District Court for the District of Columbia to one count of health care fraud. He was sentenced by the Honorable Richard W. Roberts. Upon completion of his prison term, Rodriguez will be placed on three years of supervised release. He also was ordered to pay $1,014,475 in restitution and to forfeit money and assets totaling $1,014,475. The court also entered a stipulated order of removal, meaning Rodriguez is expected to be deported from the United States upon completion of his 46-month sentence.
According to a statement of offense signed by the defendant as well as the government, Rodriguez is a Spanish national who is in the United States on a G-4 work visa, due to his wife’s employment with the Inter-American Development Bank (IDB). The IDB is an international financial institution established in 1959 by the Organization of American States that maintains its principal offices in Washington, D.C. The IDB is the largest source of development financing for Latin America and the Caribbean and is funded by its 48 member countries, including the United States, which holds 30.01 percent of the IDB’s shares and is the largest shareholder. The United States Secretary of the Treasury serves on the bank’s Board of Governors.
The IDB offers health insurance to all of its staff members and their eligible dependents. IDB’s health insurance plan is administered by CIGNA. Persons covered under the plan may pay their doctor or medical provider out-of-pocket and then submit claims for reimbursement to the IDB, through CIGNA.
From March 2006 through April 2010, Rodriguez submitted approximately 880 reimbursement claim forms to CIGNA, identifying over 25,000 individual services such as physical therapy that Rodriguez claimed had been provided to him or his two minor children. The bills submitted by Rodriguez totaled more than $1.3 million.
In fact, all of those claims were false: none of the claimed services had ever been provided. Based on the submission of false claims, CIGNA sent checks to Rodriguez for more than $1.25 million. Because the fraud was discovered in time to stop payment on some of the checks, the IDB’s actual loss was just over $1,014,475.
When Rodriguez realized federal authorities were investigating his fraud scheme, he devised a plan to obstruct the federal investigation. Rodriguez attempted to impersonate a senior IDB official and ordered CIGNA to tell the FBI to close the investigation without further action.
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Source-
http://www.justice.gov/usao/lam/press/press1207.html#f12
BATON ROUGE, LA – United States Attorney Donald J. Cazayoux, Jr. announced that HELEN FAYE STEWART, age 43, and HENRY RAY STEWART, age 47, both of Plaquemine, Louisiana, were sentenced yesterday by U.S. District Court Judge James J. Brady as a result of a health care fraud scheme perpetrated in the Baton Rouge area. HELEN STEWART was sentenced to thirty-six (36) months in federal prison and HENRY STEWART was sentenced to forty-six (46) months in federal prison.
Both defendants were also ordered by Judge Brady to pay $1,006,003.83 in restitution and a $100 special assessment. Following their release from imprisonment, both defendants will be required to serve a 2-year term of supervised release.
United States Attorney Donald J. Cazayoux, Jr. stated, “We will continue to prosecute vigorously those who commit Medicare fraud to help protect the integrity of this very important program for disabled Americans and seniors.”
The investigation of this matter was conducted by the U.S. Department of Health and Human Services’ Office of Inspector General, the Federal Bureau of Investigation, and the Louisiana Attorney General’s Office. “These sentencings tell taxpayers the Baton Rouge Medicare Strike Force successfully continues to bring those who defraud health care programs to justice,” said William W. Root, Assistant Special Agent in Charge U.S. Department of Health and Human Services. “The Office of Inspector General appreciates the commitment from the Department of Justice and United States Attorney Donald Cazayoux,” said Root. The case was prosecuted by Assistant United States Attorney Shubhra Shivpuri.
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Source- http://www.justice.gov/usao/pae/News/2012/Sep/benoit_release.htm
PHILADELPHIA – Jo Benoit, a.k.a. Elissa Jo Benoit, 77, of King of Prussia, PA, was sentenced today to 72 months in prison for a health care fraud scheme that included posing as a psychiatrist when she was not one and writing prescriptions for people who suffered from serious mental health issues, including bipolar disorder, post traumatic stress disorder, and other serious conditions. More than 50 patients were victims of Benoit’s scam. In addition to the patients she defrauded and exposed to improper treatment, Benoit stole the identifying information of legitimate psychiatrists and forged prescriptions in their names. She also used one psychiatrist’s identity to bill insurance companies more than $500,000 for patient visits. Benoit was convicted by a federal jury on June 12, 2012 of 76 counts of health care fraud, aggravated identity theft, distribution of controlled substances, and distribution of controlled substances to minors.
The defendant was immediately taken into custody to begin serving her six-year prison sentence. In addition, the defendant was ordered to pay forfeiture and to pay restitution in the full amount that she defrauded patients and insurance companies. In total, she is required to make the victims whole in the amount of $422,583.62. In addition, she was ordered to pay a special assessment of $7,600 and she is subject to three years of supervised release.
Benoit was the CEO and founder of a mental health clinic called Transition Phase III from February 4, 2009 until the clinic was closed after a search warrant was executed in July 2011. She advertised the clinic as a Trauma-Specific mental health clinic, directed at victims of trauma, children, and members of the military and their families. Benoit provided forged prescriptions to the patients at the clinic and medicated the patients that she purported to be treating. Benoit also wrote prescriptions to children, one as young as four years old. During the course of her fraud, the defendant exposed those patients to a serious risk of harm and left them without appropriate treatment.
“This case demonstrates the many serious problems associated with health care fraud,” said Special Agent-in-Charge Nick DiGiulio, of the Inspector General’s Office for the United States Department of Health and Human Services in Philadelphia. “Jo Benoit illegally prescribed dangerous drugs to children and military veterans. She lied to patients about her credentials, provided sham psychiatric services to those with serious mental traumas, stole the identities of legitimate health care professionals, and lied to our insurance programs for money. We will continue to work tirelessly with our law enforcement partners to protect our citizens from these atrocious crimes.”
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Source- http://www.justice.gov/usao/gan/press/2012/09-19-12b.html
ATLANTA, GA - The United States Attorney’s Office for the Northern District of Georgia announced today that it has reached a settlement with Georgia Cancer Specialists I, PC, which agreed to pay $4.1 million to settle claims that it violated the False Claims Act by billing Medicare for evaluation and management services that were not permitted by Medicare rules. Georgia Cancer Specialists is one of the largest private oncology practices in the country with 27 offices located throughout the Atlanta metro area.
Sally Quillian Yates, United States Attorney for the Northern District of Georgia, said, “Health care providers should be on notice that if they inflate their billings, we will aggressively seek to recover not only the overcharges, but also significant penalties under the False Claims Act.”
Ricky Maxwell, Acting Special Agent in Charge, FBI Atlanta Field Office, stated: “The FBI continues to do its part in ensuring that federal funds appropriated to Medicare are spent appropriately and today’s settlement is an example of those efforts. The FBI urges anyone with information related to overbilling or fraudulent billing of our Medicare programs to contact their nearest FBI field office.”
“Today’s settlement sends a clear message to health care providers across the country that they will be held responsible if they misrepresent the services they bill to Medicare,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region. “The Office of Inspector General will continue to work closely with our law enforcement partners to stamp out fraud, waste and abuse within the Medicare system.”
The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. In specific circumstances, providers can avoid this prohibition by submitting their claims marked with modifier -25, which tells Medicare to pay both the procedure and the E&M service. Here, the U.S. Attorney’s Office alleged that Georgia Cancer Specialists applied modifier -25 to claims that did not qualify for its use, leading to overpayments by Medicare.
Because of widespread abuse of the use of modifier -25, the U.S. Department of Health and Human Services, Office of Inspector General has targeted the use of modifier -25 in its yearly work plans. The yearly work plans outline the current focus areas of the OIG and lead to increased scrutiny by the OIG of those areas. The focus on the abuse of the use of modifier -25 was prompted because prior OIG work has shown that improper use of the modifier resulted in inappropriate payments to Medicare providers.
This resolution is part of the government’s emphasis on combating health care fraud under the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services, in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $9.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $12.8 billion.
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Source- http://www.justice.gov/opa/pr/2012/September/12-crm-1138.html
WASHINGTON – Five individuals were charged in court documents unsealed today in the Eastern District of Michigan for their participation in a Medicare fraud scheme involving purported home health and psychotherapy services, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
According to court documents, the scheme allegedly involved a total of more than $24.7 million in fraudulent claims submitted to Medicare for purported home health care and psychotherapy services that were medically unnecessary and/or never provided.
Court documents allege that the defendants are operators, employees and marketers associated with home health care and psychotherapy clinics operating in and around Detroit. Defendants charged in court documents unsealed today include: Mohammed Sadiq, 65, Troy, Mich.; Jamella Al-Jumail, 23, of Brownstown, Mich.; Firas Alky, 40, of Shelby Township, Mich.; Clarence Cooper, 53, of Detroit; and Beverly Cooper, 58, of Detroit.
Four defendants charged in the superseding indictment were previously charged and arrested in May 2012 for their roles in the scheme. Defendants previously charged include: Sachin Sharma, 36, of Shelby Township; Dana Sharma, 29, of Shelby Township; Abdul Malik Al-Jumail, aka Tony, 52, of Brownstown; Felicar Williams, 49, of Dearborn, Mich.
The superseding indictment charges all defendants with one count of conspiracy to commit health care fraud; Sachin Sharma with five counts of health care fraud; Sachin Sharma, Abdul Malik Al-Jumail, Williams, Sadiq, Alky and Clarence Cooper with one count of conspiracy to pay and receive health care kickbacks; and Jamella Al-Jumail with one count of destruction of records in a federal investigation. The superseding indictment also seeks forfeiture from all defendants.
According to the superseding indictment, from January 2007 through April 2012, the defendants operated a large network of purported home health care and psychotherapy companies in the Detroit area through which they conspired to defraud Medicare.
According to court documents, Sachin Sharma, Dana Sharma, Abdul Malik Al-Jumail, Williams, Jamella Al-Jumail, Sadiq, Alky and other alleged co-conspirators incorporated home health care, psychotherapy and other medical service companies to carry out the scheme, including Reliance Home Care, LLC; First Choice Home Health Care Services Inc.; Associates in Home Care Inc.; Haven Adult Day Care Center LLC; Swift Home Care LLC; ABC Home Care Inc.; Accessible Home Care Inc.; and Be Well Home Care LLC. The defendants, along with co-conspirators, allegedly submitted Medicare enrollment applications to permit these companies to bill Medicare. Sachin Sharma, Abdul Malik-Al-Jumail, Sadiq, Alky and others allegedly paid kickbacks and bribes to recruiters, including Williams and Clarence Cooper, to obtain Medicare beneficiaries’ information, which could be used to fraudulently bill Medicare for purported services provided by the companies they operated and controlled. The defendants then allegedly caused these companies to bill Medicare for home health and psychotherapy services, even though these services were not medically necessary and were often not provided.
According to the superseding indictment, the defendants caused Reliance, First Choice, Associates, Haven, Swift, ABC, Accessible and other home health, psychotherapy and medical services companies to submit approximately $24.7 million in claims to Medicare for services that were medically unnecessary and/or not provided. In addition, Jamella Al-Jumail is charged with destroying records relating to Accessible’s Medicare billings upon learning of the May 2012 arrest of Abdul Malik Al-Jumail, her co-conspirator and father.
Clarence and Beverly Cooper, Sadiq and Jamella Al-Jumail were arrested yesterday.
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Source- http://www.justice.gov/opa/pr/2012/September/12-crm-1142.html
WASHINGTON – A Detroit-area doctor was charged and arrested today in the Eastern District of Michigan for his alleged leading role in a $40 million Medicare fraud scheme involving physician home visits and home health services, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS-Office of Inspector General (OIG). In addition to the arrest, law enforcement agents executed search warrants at three locations and seizure warrants for three bank accounts related to the scheme.
According to a criminal complaint unsealed today in U.S. District Court in Detroit, Dr. Hicham Elhorr, 45, masterminded a $40 million scheme involving the submission of fraudulent claims submitted to Medicare for services that were medically unnecessary and/or never provided through House Calls Physicians (HCP), a physician home visiting service he owned and operated. Elhorr allegedly submitted claims through HCP for physician home visits for patients who were never seen and for visits conducted by doctors who were not licensed. The complaint alleges Elhorr submitted claims to Medicare for physician home visits purportedly rendered when he was out of the country, when beneficiaries were hospitalized or when the beneficiary was dead.
Elhorr is also alleged to have referred Medicare beneficiaries for medically unnecessary home health services, as well as accepted kickbacks from home health agencies in exchange for writing these referrals. According to court documents, since January 2008, HCP has billed Medicare for approximately $9.2 million. In the same time period, HCP has allegedly referred Medicare beneficiaries for home health services that have resulted in approximately $30.8 million of reimbursements from Medicare.
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Source- http://www.justice.gov/usao/nj/Press/files/Patel,%20Dinesh%20Plea%20News%20Release.html
NEWARK, N.J. – Dinesh Patel, a New Jersey doctor practicing in Newark, pleaded guilty today to participating in a cash-for-patients scheme with a diagnostic facility in Orange, N.J., and agreed to pay back thousands of dollars in bribe money he received in the past two years, U.S. Attorney Paul J. Fishman announced.
Patel, 58, of Livingston, N.J., pleaded guilty today before U.S. District Judge Claire C. Cecchi to an Information charging him with one count of violating the federal healthcare program anti-kickback statute. Patel will forfeit $7,600 he received in kickbacks during the years 2010 and 2011.
According to documents filed in this case and statements made in court:
On Dec.13, 2011, Patel was arrested and charged with accepting cash kickback payments from Orange Community MRI (“Orange MRI”), a diagnostic facility, in exchange for his referral of Medicare and Medicaid patients. Also on Dec. 13, 2011, 12 other New Jersey doctors and one nurse practitioner were arrested and charged in separate complaints with accepting similar cash kickback payments from Orange MRI. As revealed in the Complaints, each of the defendants were recorded taking envelopes of cash in exchange for patient referrals. On Dec. 8, 2011, an Orange MRI executive was arrested and charged in a separate Complaint in connection with his participation in the scheme.
Patel is the fifth person arrested in the December 13 takedown to plead guilty. In all, the five defendants who have pleaded guilty thus far accepted nearly $150,000 in illegal kickbacks from Orange MRI.
Starting in 2010, Orange MRI began making monthly cash kickback payments to Patel in exchange for his referral of patients to Orange MRI for diagnostic tests. At the end of each calendar month, individuals at Orange MRI printed patient reports that detailed how many magnetic resonance imagings (“MRIs”) and computed axial tomographies (“CAT Scans”) were referred by Patel. These patient reports were used to calculate the monthly kickback payment owed to Patel. Pursuant to Patel’s agreement with Orange MRI, he was paid kickbacks for each Medicare or Medicaid beneficiary MRI or CAT Scan referred to Orange MRI.
Patel received two separate payments from a cooperating government witness during the course of the investigation. On Nov. 4, 2011, Patel accepted $500 in cash for his September 2011 referrals to Orange MRI; he accepted another $600 in cash on Nov. 17, 2011, for his October 2011 referrals to Orange MRI.
Judge Cecchi continued Patel on bail pending sentencing. Patel faces a maximum penalty of five years imprisonment and a maximum fine of $250,000. Judge Cecchi set sentencing in the matter for Jan. 9, 2013.
The status of the other defendants charged in the investigation is as follows:
(1) Jose Castaneda, a nurse practitioner formerly practicing in Newark, pleaded guilty before Judge Cecchi on April 3, 2012, and is scheduled to be sentenced on Nov. 14, 2012.
(2) On May 4, 2012, Yash Khanna, a doctor practicing in East Orange, N.J., was indicted by a federal grand jury on one count of accepting kickbacks; Judge Cecchi has set the trial date for October 9, 2012.
(3) Dov Rand, a doctor practicing in West Orange, N.J., pleaded guilty before Judge Cecchi on May 18, 2012, and is scheduled to be sentenced on Oct. 24, 2012.
(4) Daisy Deguzman, a doctor practicing in Newark, pleaded guilty before Judge Cecchi on June 4, 2012, and is scheduled to be sentenced on Oct. 25, 2012.
(5) On July 13, 2012, Maryam Jafari, another Newark doctor, was indicted by a federal grand jury on one count of accepting kickbacks. On Sept.14, 2012, the same grand jury returned a superseding indictment against Jafari, charging her with one count of conspiracy and two counts of accepting kickbacks. Judge Cecchi has set the trial date for Oct. 22, 2012.
(6) William Lagrada, another Newark doctor, pleaded guilty before Judge Cecchi on July 11, 2012, and is scheduled to be sentenced on Oct. 17, 2012.
(7) On Sept. 7, 2012, Chikezie Onyenso, an Irvington, N.J., doctor, was indicted by a federal grand jury on one count of accepting kickbacks; Judge Cecchi has not yet set a trial date.
All other defendants remain charged in Criminal Complaints at this time.
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Source- http://www.justice.gov/opa/pr/2012/September/12-civ-1133.html
HCA Inc., one of the nation’s largest for-profit hospital chains, has agreed to pay the United States and the state of Tennessee $16.5 million to settle claims that it violated the False Claims Act and the Stark Statute, the Department of Justice announced today.
As alleged in the settlement agreement, during 2007, HCA, through its subsidiaries Parkridge Medical Center, located in Chattanooga, Tenn., and HCA Physician Services (HCAPS), headquartered in Nashville, Tenn., entered into a series of financial transactions with a physician group, Diagnostic Associates of Chattanooga, through which it provided financial benefits intended to induce the physician members of Diagnostic to refer patients to HCA facilities. These financial transactions included rental payments for office space leased from Diagnostic at a rate well in excess of fair market value in order to assist Diagnostic members to meet their mortgage obligations and a release of Diagnostic members from a separate lease obligation.
The Stark Statute restricts financial relationships that hospitals may enter into with physicians who potentially may refer patients to them. Federal law prohibits the payment of medical claims that result from such prohibited relationships.
“The Department of Justice continues to pursue cases involving improper financial relationships between health care providers and their referral sources, because such relationships can corrupt a physician’s judgment about the patient’s true healthcare needs,” said Stuart F. Delery, the Acting Assistant Attorney General for the Department of Justice’s Civil Division.
“Physicians should make decisions regarding referrals to health care facilities based on what is in the best interest of patients without being induced by payments from hospitals competing for their business,” said Bill Killian, U.S. Attorney for the Eastern District of Tennessee.
“ Improper business deals between hospitals and physicians jeopardize both patient care and federal program dollars,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “Our investigators continue to work shoulder to shoulder with other law enforcement authorities to stop schemes that imperil scarce health care resources.”
The civil settlement resolves a lawsuit, United States ex rel. Bingham v. HCA, No. 1:08-CV-71 (E.D. Tenn.), pending in federal court in the Eastern District of Tennessee under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. As part of the civil settlement, HCA has agreed to pay $16.5 million to the United States and the state of Tennessee, with the federal portion representing $15,693,000 of the settlement amount. The whistleblower will receive an 18.5 percent share.
Also as part of the settlement, Parkridge Medical Center has entered into a comprehensive five-year Corporate Integrity Agreement with the Office of Inspector General of the U.S. Department of Health and Human Services to ensure its continued compliance with federal health care benefit program requirements.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $9.4 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.1 billion.
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Source- http://www.fbi.gov/losangeles/press-releases/2012/los-angeles-physician-assistant-sentenced-to-72-months-in-prison-for-role-in-18.9-million-medicare-fraud-scheme
WASHINGTON—A Los Angeles physician assistant who stole the identities of doctors to write medically unnecessary prescriptions for expensive durable medical equipment (DME) and diagnostic tests was sentenced today to serve 72 months in prison in connection with a $18.9 million Medicare fraud scheme, announced the Department of Justice, FBI and U.S. Department Health and Human Services (HHS).
David James Garrison, 50, was sentenced by U.S. District Judge Consuelo B. Marshall in the Central District of California. In addition to his prison term, Garrison was sentenced to three years of supervised release and ordered to pay $24,935 in restitution, jointly and severally with convicted co-defendants.
In June 2012, after a two-week trial, a federal jury found Garrison guilty of one count of conspiracy to commit health care fraud, six counts of health care fraud, and one count of aggravated identity theft. The trial evidence showed that Garrison worked at fraudulent medical clinics that operated as prescriptions mills and trafficked in fraudulent prescriptions and orders for medically unnecessary DME and diagnostic tests that were used by fraudulent DME supply companies and medical testing facilities to defraud Medicare. Garrison wrote the prescriptions and ordered the tests on behalf of doctors whom he never met and who did not authorize him to write prescriptions and order tests on their behalf.
The trial evidence showed that between March 2007 and September 2008, Garrison’s co-conspirator Edward Aslanyan and others owned and operated several Los Angeles medical clinics established for the sole purpose of defrauding Medicare. Aslanyan and others hired street-level patient recruiters to find Medicare beneficiaries willing to provide the recruiters with their Medicare billing information in exchange for expensive, high-end power wheelchairs and other DME, which the patient recruiters told the beneficiaries they would receive for free. Often, the solicited Medicare beneficiaries did not have a legitimate medical need for the power wheelchairs and equipment. The patient recruiters then provided the beneficiaries’ Medicare billing information to Aslanyan and others or brought the beneficiaries to the fraudulent medical clinics. In exchange for recruiting the Medicare beneficiaries, Aslanyan and others paid the recruiters a cash kickback for every beneficiary they recruited.
The evidence presented at trial showed that Garrison wrote prescriptions for power wheelchairs, which the beneficiaries did not need and did not use. In some cases, Garrison wrote power wheelchair prescriptions for beneficiaries he never examined and who never visited the clinics. Once Garrison wrote the power wheelchair prescriptions, Aslanyan and others sold them from $1,000 to $1,500 to the owners and operators of approximately 50 different fraudulent DME supply companies, which used the prescriptions to submit fraudulent power wheelchair claims to Medicare. The DME supply companies purchased the power wheelchairs wholesale for approximately $900 per wheelchair but billed the wheelchairs to Medicare at a rate of approximately $5,000 per wheelchair. Aslanyan also used the prescriptions Garrison wrote at two fraudulent DME supply companies that Aslanyan owned and operated.
In addition, the trial evidence showed that Garrison ordered the same medically unnecessary diagnostic tests for every Medicare beneficiary, including tests for sleep studies, ultrasounds and nerve conduction. These tests were then billed to Medicare by fraudulent diagnostic testing companies that paid Aslanyan kickbacks to operate from the medical clinics.
The trial evidence showed that Garrison admitted to writing prescriptions for power wheelchairs and ordered diagnostic tests on behalf of approximately six different doctors, many of whom never met Garrison and never had a delegation of services agreement with him, as required by law. The trial evidence also showed that Garrison was paid up to $10,000 a week in cash for his work at the clinics.
As a result of this fraud scheme, Garrison and his co-conspirators submitted over $18.9 million in false claims to Medicare and received $10.7 million on those claims.
Currently, Garrison is facing federal drug charges as a result of his alleged involvement with another medical clinic where medically unnecessary prescriptions for Oxycontin were distributed. Garrison is scheduled for trial on the federal drug charges on November 6, 2012. He is presumed innocent of the charges against him.
Aslanyan pleaded guilty for his role in the scheme in April 2011 and was sentenced on February 6, 2012, to 77 months in prison. Carolyn Vasquez, another co-conspirator, pleaded guilty for her role in the scheme in March 2011 and was sentenced on January 9, 2012, to 60 months in prison.
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Source- http://www.fbi.gov/detroit/press-releases/2012/plymouth-doctor-indicted-on-charges-of-illegal-drug-distribution-and-medicare-fraud
An indictment was unsealed today charging Dr. Mikhayl Soliman, 59, of Plymouth, Michigan, with Medicare fraud and distribution of prescription drugs, United States Attorney Barbara L. McQuade announced today.
McQuade was joined in the announcement by the Special Agent in Charge Robert Corso, Drug Enforcement Administration, Detroit Division; Special Agent in Charge, Robert D. Foley, III, Federal Bureau of Investigation; Special Agent in Charge Lamont Pugh, Health and Human Services, Office of Inspector General; and Police Chief Jason Wright, City of Wayne, Michigan.
The 10-count indictment charges that between 2007 and 2012, Dr. Soliman billed Medicare for services not rendered and distributed controlled substances outside the course of usual medical practice and for no legitimate purpose. During that time frame, Dr. Soliman billed Medicare for approximately $4,155,565 in claims. The majority of the claims were for physician home visits that were purportedly provided when Dr. Soliman was not present in the home, as required by Medicare. Dr. Soliman is also charged with providing prescriptions for OxyContin, Vicodin, and other pharmaceutical narcotics in exchange for cash payments outside the course of usual medical practice and for no legitimate purpose.
“Medicare is intended to provide health care funds for our most vulnerable citizens,” U.S. Attorney McQuade said. “Doctors and other providers who steal taxpayer money by cheating the Medicare program will be prosecuted.”
Robert Corso, DEA Special Agent in Charge said, “Today’s arrest is another example of DEA’s determination to combat the troubling prescription drug abuse problem in this country. Dr. Soliman abused his position of trust and jeopardized the lives of many individuals by illegally distributing highly addictive opiate painkillers. Today’s arrest of Dr. Soliman makes it clear that the DEA and our partners in law enforcement will continue to investigate and bring to justice those individuals that are responsible for the illegal distribution of prescription medicines.”
Robert D. Foley, III, FBI Special Agent in Charge said, “These charges represent a serious abuse of the health care system. Those motivated by greed who unlawfully take from a system designed to care for patients, will be tirelessly pursued by the FBI and prosecuted for their crimes.”
“Today’s arrest sends a clear message that the unlawful distribution of controlled substances and the fraudulent billing of Medicare will not be tolerated” said Lamont Pugh III, Special Agent in Charge of the Chicago Region for the U.S. Department of Health and Human Services, Office of Inspector General. “The OIG, working with our federal, state, and local partners, will continue to fight to protect the safety of patients and taxpayer dollars.”
Soliman was arrested today and appeared in federal court this afternoon for his arraignment.
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Source- http://www.fbi.gov/dallas/press-releases/2012/federal-grand-jury-indicts-owners-operators-of-hyperbaric-oxygen-therapy-companies-in-health-care-fraud-conspiracy
DALLAS—Stanley Thaw, 70, and his wife, Kernell Thaw, 49, both of Frisco, Texas, and Michael Kincaid, 55, of Plano, Texas, have been charged in an indictment, unsealed late yesterday, on charges including conspiracy, health care fraud, making false statements to a financial institution, and engaging in illegal monetary transactions with fraud proceeds, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas. They are expected to make their initial appearances this afternoon in federal court in Dallas, before U.S. Magistrate Judge Paul D. Stickney.
Stanley and Kernell Shaw and Michael Kincaid owned various hyperbaric oxygen therapy (HBOT) companies in North Texas, Houston, and San Antonio, Texas. The HBOT entities employed physicians to supervise the provision of HBOT to federal health care program and private-pay patients. The indictment alleges that from January 2008 to June 2011, Stanley Thaw and Michael Kincaid engaged in a scheme to defraud Medicare by double-billing for the physician supervision and attendance of HBOT-related services.
The false statements charges involve properties in Frisco and Dallas, Texas that Stanley and Kernell Thaw purchased from a local home builder. The indictment alleges that the Thaws made material false statements to a financial institution to obtain a $1.3 million residential loan. The indictment contends had the financial institution known the Thaws’ representations were false, it would have rejected their loan.
The indictment specifically charges Stanley Thaw and Michael Kincaid each with one count of conspiracy to commit health care fraud and five substantive counts of health care fraud. Stanley and Kernell Thaw each are charged with three counts of making false statements to a financial institution. Each of the three defendants is charged with one count of money laundering.
An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty. If convicted, however, the conspiracy count and each of the health care fraud counts carries a maximum statutory sentence of 10 years in prison and a $250,000 fine. Upon conviction, each of the false statements counts carries a maximum statutory sentence of 30 years in prison and a $1 million fine. Upon conviction, each of the money laundering counts can result in up to 10 years in prison and a $250,000 fine. The indictment also includes a forfeiture allegation, which would require Stanley Thaw and Michael Kincaid to forfeit all proceeds traceable to their offenses and the more than $32,000 that was seized from an account at a local bank.
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Source- http://www.justice.gov/opa/pr/2012/September/12-crm-1117.html
WASHINGTON – Four individuals were charged in court documents unsealed today in the Eastern District of Michigan for their participation in a Medicare fraud scheme involving home health services, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI, and the HHS Office of Inspector General (HHS-OIG).
According to court documents unsealed today in U.S. District Court in Detroit, the scheme allegedly involved a total of more than $1.6 million in fraudulent claims submitted to Medicare for home health care services that were medically unnecessary and/or never provided. All four defendants were arrested this morning. In addition, law enforcement agents today executed search warrants at two locations and seizure warrants for 16 bank accounts related to the alleged fraud schemes.
Four individuals are charged in one indictment including one physician, two clinic owners and one nurse. According to court documents, the conspiracy was allegedly operated out of Angle’s Touch Home Health Care LLC, a home health agency in Taylor, Mich.
Defendants charged include: Dr. Sonjai Poonpanij, 77, of Rochester, Mich.; clinic owners Attaullah Arain, 45, of Brownstown, Mich., and Nadia Arain, 39, of Brownstown; and registered nurse Judith Ragasa, 49, of Windsor, Ontario, Canada.
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Source- http://www.fbi.gov/charlotte/press-releases/2012/shelby-woman-pleads-guilty-to-defrauding-medicaid-of-6.1-million
CHARLOTTE, NC—A Shelby woman pleaded guilty in U.S. District Court today for her involvement in a health care fraud scheme that defrauded Medicaid of at least $6.1 million for sham mental and behavioral health services, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.
U.S. Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID); Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division; Jeannine A. Hammett, Special Agent in Charge of the Internal Revenue Service, Criminal Investigation (IRS-CI); and Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region.
Linda Smoot Radeker, 61, of Shelby, North Carolina, pleaded guilty today before U.S. Magistrate Judge David S. Cayer to one count of health care fraud conspiracy and two counts of money laundering. At today’s plea hearing, Radeker admitted that from 2008 to 2011 she obtained at least $6.1 million in fraudulent reimbursement payments from false claims submitted to Medicaid. According to filed court documents and statements made in court, Radeker, a licensed professional counselor enrolled with North Carolina Medicaid, claimed in the fraudulent Medicaid billings that she was the attending clinician for these provided services, when, in fact, she provided no services to the claimed beneficiaries. Court records indicate that Radeker oversaw a network of co-conspirators, operating in Gaston and Cleveland Counties and elsewhere, who billed for false and fraudulent claims through Radeker’s provider number. In exchange for her willingness to “rent out” her Medicaid provider number, Radeker kept a percentage of the Medicaid reimbursements, sometimes as much as 50 percent.
Filed documents also indicate that the claimed Medicaid beneficiaries primarily were children recruited from the community, whose parents thought they were enrolling in after school programs owned and operated by Radeker’s co-conspirators and located in Shelby, Kings Mountain, and Bessemer City, North Carolina. Through those programs, Radeker and her co-conspirators obtained the children’s Medicaid information which they used to file the fraudulent claims.
According to court documents, Radeker made several large purchases using criminal proceeds including $21,500 to purchase a 2010 Ford Ranger and $44,440 to purchase a 2010 Lincoln MKS SUV. Radeker also used Medicaid money to purchase a recreational vehicle (RV) and at least $500,000 in jewelry.
In announcing today’s guilty plea, U.S. Attorney Tompkins said, “Radeker’s criminal conduct is an assault on health care resources meant to cover the needs of the poor, the sick and the elderly. In 2010, we formed the Western District of North Carolina Health Care Fraud Task Force to target criminals and illegal schemes like Radeker’s. I am proud of the work of the task force and the continued commitment of our federal, state, and local partners in identifying and prosecuting those who compromise the integrity of a health care system that provides much needed services to vulnerable North Carolinians.”
North Carolina Attorney General Roy Cooper stated, “Medicaid cheaters waste taxpayer money and drive up medical costs for everyone. We’ll continue our strong partnership with federal law enforcement to root out fraud and abuse in our health care system.”
“Radeker’s scheme targeted some of the most vulnerable families in North Carolina. She betrayed parents dependent on Medicaid for their children’s care. Health care fraud not only poses a potential risk to patients, it increases costs for everyone,” said FBI Special Agent in Charge Chris Briese.
IRS-CI Special Agent in Charge Hammett stated, “The abuse and misuse of Medicaid Programs impacts each of us as taxpayers and citizens. IRS-CI will continue to work jointly with the United States Attorney’s Office and other law enforcement agencies to ferret out those who might consider Medicaid fraud as a way to make easy money.”
At sentencing, Radeker faces a maximum term of 10 years in prison and a $250,000 fine for the health care fraud conspiracy charge, and a maximum term of 10 years in prison and a $250,000 fine or twice the value of the transaction for each count of money laundering. In her plea agreement, Radeker has agreed to pay full restitution to Medicaid for any losses resulting from her criminal scheme. The final restitution amount will be determined by the court at Radeker’s sentencing hearing, which has not been scheduled yet.
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Source- http://www.justice.gov/usao/cac/Pressroom/2012/122a.html
LOS ANGELES – A doctor already serving a lengthy prison sentence in a narcotics case has been convicted of health care fraud for submitting approximately $1 million in fraudulent bills to Medicare in just seven months.
After less than a day of deliberations, a federal jury on Monday afternoon convicted Dr. Owusu Ananeh Firempong of five counts of health care fraud.
Firempong, 61, who resided in the Crenshaw district of Los Angeles and had been practicing in the Los Angeles region for more than three decades, submitted fraudulent bills for nerve conduction tests and sleep studies that were never performed. As a result of the fraudulent bills, Medicare paid him nearly $700,000.
During a four-day trial in United States District Court, prosecutors presented evidence that Firempong obtained information about Medicare beneficiaries who were not his patients and then used that information to bill Medicare.
The evidence presented at trial showed that Firempong repeatedly lied to Medicare about services he claimed to have provided at clinic locations from which he had been evicted. The jury also heard expert testimony from a neurologist about Firempong’s patient files, which contained so many internal inconsistencies and improbably identical results that they appeared to have been a “copy-and-paste job.”
As a result of this week’s guilty verdicts, Firempong faces up to 50 years in federal prison. Firempong is scheduled to be sentenced by United States District Judge Gary A. Feess on December 10.
“Taxpayers expect that Medicare services they pay for are both necessary and provided by the proper health provider,” said Glenn R. Ferry, the Los Angeles Region’s Special Agent in Charge for the Office of Inspector General of the Department of Health and Human Services. “Such billing based on improper Medicare provider numbers will continue to be aggressively investigated and prosecuted.”
Firempong is currently in custody after being sentenced in Michigan last year to 324 months in federal prison in an unrelated cocaine trafficking and money laundering case. That case is currently on appeal.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20September/120912%20Lopez.html
McALLEN, Texas - An Edinburg, Texas, resident has been sentenced to 33 months in federal custody in connection with a mail fraud scheme she developed in the McAllen area, United States Attorney Kenneth Magidson announced today. San Juana Aidee Lopez, 60, pleaded guilty June 29, 2102, to two counts of mail fraud in connection with her employment as an insurance agent.
At the time of her guilty plea, she admitted that she created a scheme to defraud victims when she approached them about purchasing insurance with for health care policies and for funeral and burial insurance policies. She was paid commissions immediately based on the number of new policies she sold.
The scheme was elaborate with many facets, but the most common thread was that she took personal identification information from existing policyholders and signed them up for certain policies they did not authorize. Since she was paid immediately for all new policies she sold, it was to her benefit to create as many new policy sales as she could. She created bogus and fraudulent policies without the knowledge of the person whose name she used. She also placed payment for the policies on automatic electronic bank draft by using the accounts of other policyholders who already had an existing policy. When the unsuspecting victim whose bank account was drafted called to complain, she told them it was an administrative error. This helped Lopez to accomplish and further the scheme because as long as two successive payments were made on the new policy, any adjustments for refunds were not taken from her commissions but were paid from a reserve account. This scheme resulted in harm to more than 20 victims who suffered an aggregate loss of more than $49,000.
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Source- http://www.justice.gov/opa/pr/2012/September/12-crm-1097.html
WASHINGTON – A patient recruiter for several Louisiana durable medical equipment (DME) companies was sentenced today to serve 18 months in prison for her role in a Medicare fraud scheme involving fraudulent claims and illegal kickback payments for unnecessary DME, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the Louisiana State Attorney General's Office.
Karen T. Rayburn, 47, was sentenced today by U.S. District Judge James J. Brady of the Middle District of Louisiana. In addition to her prison term, Rayburn was sentenced to two years of supervised release and ordered to pay $3.18 million in restitution.
Rayburn pleaded guilty on Jan. 19, 2012, to one count of conspiracy to commit health care fraud.
According to court documents, Rayburn worked as a recruiter for Healthcare 1 LLC, Medical 1 Patient Services LLC and Lifeline Healthcare Services Inc., Louisiana-based companies that fraudulently billed medical equipment to the Medicare program from 2004 to 2009. She and other recruiters were hired to obtain prescriptions for medical equipment such as leg braces, arm braces, power wheel chairs and wheel chair accessories. Rayburn obtained information from Medicare beneficiaries as well as falsified prescriptions for medical equipment. These prescriptions were then used to submit fraudulent claims to the Medicare program.
According to court documents, from 2004 to 2009, the companies involved in these schemes submitted more than $21 million in fraudulent claims to Medicare, and as a result of the prescriptions that Rayburn collected the companies submitted more than $6 million in fraudulent claims.
Eight other defendants have been sentenced for their roles in this scheme, and three additional defendants await sentencing.
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Source- http://www.justice.gov/usao/ct/Press2012/20120906.html
David B. Fein, United States Attorney for the District of Connecticut, announced that DANIEL FIORE, 60, of Brooklyn, Conn., was sentenced today by Senior United States District Judge Ellen Bree Burns in New Haven to two years of probation and a fine of $20,000 for unlawfully dispensing controlled substances. FIORE must serve the first six months of his probation in home confinement under electronic monitoring by the United States Probation Office.
According to court documents and statements made in court, FIORE owned and operated Daniel’s Pharmacy, a retail pharmacy located at 42 Reynolds Street in Danielson. In 2009 and 2010, FIORE unlawfully dispensed a Schedule III controlled substance containing a mixture of hydrocodone and acetaminophen (generic Vicodin) and Schedule IV controlled substances, including diazepam (Valium), alprazolam (Xanax), or triazolam (Halcion), to friends and family members without any valid prescriptions for such medications. In order to conceal his conduct, FIORE created fraudulent prescriptions in his own handwriting as if the prescriptions had been called in by a physician’s office, and then documented filling the prescriptions in the same manner that he documented legitimate prescriptions. In total, FIORE unlawfully dispensed 1,542 tablets of Schedule III and 210 tablets of Schedule IV controlled substances.
After his arrest in January 2011, FIORE agreed to surrender his federal and state licenses to dispense controlled substances.
On April 18, 2012, FIORE waived his right to indictment and pleaded guilty to one count of unlawfully dispensing controlled substances.
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Source- http://www.justice.gov/usao/ma/news/2012/July/CobbMichaelSentencingPR.html
Michael Cobb, 42, was sentenced by U.S. District Judge George A. O’Toole to one year incarceration (six months in prison, six months home confinement), to be followed by two years of supervised release and a $3,000 fine. Cobb was also ordered to forfeit $10,000 of proceeds from the offense to the federal government. Cobb pleaded guilty to violating the Anti-Kickback law on April 19, 2012.
Between 2004 and 2011, Cobb, a physician’s assistant, took kickbacks from Orthofix Inc., a medical device company, in return for ordering Orthofix’s device. Orthofix manufactures bone growth stimulators, which are externally-worn medical devices that emit electromagnetic waves that help regenerate bone cells. Cobb was a physician’s assistant for a neurosurgeon in Rhode Island who prescribed bone growth stimulators for patients who underwent spinal fusion surgery. The surgeon had no preference as to which company’s bone growth stimulator was used, believing that there were no clinical differences amongst the stimulators on the market. The surgeon left this decision to Cobb, who was in a position to direct the stimulator business to whichever medical device company he chose. Between 2004 and 2011, Orthofix paid Cobb for each bone growth stimulator that was ordered by the surgeon in payments ranging from $50 to $300. Cobb never disclosed to the surgeon that he was taking these payments, and the surgeon would not have authorized the arrangement. Cobb was paid approximately $120,000 between 2004 and 2011 for bone growth stimulator orders. In return, Cobb steered more than a $1 million of reimbursement from insurance carriers to Orthofix, including approximately $350,000 in payments from federal insurance carriers.
In addition, Cobb committed perjury during his testimony before a grand jury when he falsely denied that he was ever paid by a territory manager who worked for Orthofix, and he lied by testifying that the surgeon he worked for was aware of the financial arrangement. Cobb admitted that, through his perjury, he obstructed the government’s investigation, as part of his guilty plea.
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