Harmony Care Hospice Inc. (Harmony) and Harmony owner and chief executive officer Daniel J. Burton have agreed to pay the United States $1,286,999.32 to settle allegations that the South Carolina-based company submitted false claims to Medicare for patients under care at its hospice facilities, the Justice Department announced today.
Hospices provide palliative care – medical treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis of six months or less. The United States alleged that Harmony and Burton knowingly submitted or caused to be submitted false claims for patients who did not have such a prognosis and thus were not eligible for hospice care. Under today’s agreement, Burton is individually liable for $200,000 of the settlement amount.
“Billing Medicare for unnecessary or inappropriate end-of-life care contributes to the soaring costs of health care for everyone. Today’s settlement demonstrates the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries,” said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Civil Division.
Today’s settlement with Harmony and Burton resolves a lawsuit filed by former Harmony employees Mona Singletary and Lynda Fulton under the qui tam, or whistleblower, provisions of the False Claims Act. Under the False Claims Act, private citizens can bring suit for false claims on behalf of the United States and share in any recovery. Together, Singletary and Fulton will receive $244,529.87 as their share of the government’s recovery.
As part of the settlement, Harmony and Burton will enter into a Corporate Integrity Agreement with the Office of Inspector General (OIG), Department of Health and Human Services (HHS), to address the allegations raised in the qui tam complaint.
“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “The company and its owner have agreed to Federal monitoring and reporting requirements designed to avoid such problems in the future.”
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 $10.1 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 $13.9 billion.
Source- http://www.justice.gov/opa/pr/2012/November/12-crm-1398.html
WASHINGTON – A registered nurse pleaded guilty today and a former program coordinator pleaded guilty yesterday in connection with a health care fraud scheme involving defunct health provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent-in-Charge of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.
John Thoen, 53, of Miami, pleaded guilty today before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. Alexandra Haynes, 36, of Taylor, S.C., pleaded guilty yesterday before Judge Altonaga to one count of conspiracy to commit health care fraud in the same case.
According to court documents, HCSN operated community mental health centers (CMHC) at three locations Miami-Dade County, Fla., and one location in Hendersonville, N.C. HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness. A PHP is a form of intensive treatment for severe mental illness.
According to an indictment unsealed on May 2, 2012, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not even provided. HCSN obtained those beneficiaries in Miami by paying kickbacks to owners and operators of assisted living facilities.
According to court documents, Thoen was a licensed registered nurse in both Florida and North Carolina. In Florida, Thoen participated in the admission to HCSN of patients who were ineligible for PHP services. Thoen participated in the routine fabrication of patient medical records that were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Medicaid.
In North Carolina, Thoen, according to court documents, routinely submitted fraudulent PHP claims for Medicare patients who were not even present at the CMHC on days PHP services were purportedly rendered. Thoen also caused the submission of fraudulent Medicare claims on days the CMHC was closed due to snow.
Thoen also admitted to his role in a money laundering scheme, involving Psychiatric Consulting Network Inc. (PCN), a Florida corporation that was utilized by HCSN as a shell corporation to launder health care fraud proceeds. According to court documents, Thoen was president of PCN.
According to court documents, Haynes was employed in Miami as an intake specialist and routinely fabricated patient medical records. In North Carolina, Haynes was employed as a program coordinator and conducted group therapy sessions and fabricated corresponding group therapy notes even though she was not licensed to provide mental health services in the state.
According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services.
Nine defendants have been charged for their alleged roles in the HCSN health care fraud scheme. Six defendants have pleaded guilty, and three defendants are scheduled for trial on Jan. 14, 2013, before U.S. District Judge Altonaga in Miami. Defendants are presumed innocent until proven guilty at trial.
Source- http://www.justice.gov/opa/pr/2012/November/12-crm-1389.html
WASHINGTON—A Detroit-area registered nurse was sentenced today to serve 30 months in prison for his role in a nearly $13.8 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office.
Anthony Parkman, 41, of Southfield, Mich., was sentenced today by U.S. District Judge Gerald E. Rosen in the Eastern District of Michigan. In addition to his prison term, Parkman was sentenced to three years of supervised release and was ordered to pay $450,988 in restitution, jointly and severally with his co-defendants.
Parkman pleaded guilty on June 26, 2012, to one count of conspiracy to commit health care fraud.
According to Parkman’s plea agreement, beginning in approximately December 2008, Parkman, a registered nurse, was paid to sign medical documentation for Physicians Choice Home Health Care LLC, a home health agency that billed and received payments from Medicare for home health care services that were never rendered. Parkman admitted to not seeing or treating the beneficiaries for whom he signed medical documentation and admitted he knew that the documents he signed would be used to support false claims to Medicare. Parkman was paid approximately $150 for each false and fictitious file that he signed.
Parkman was subsequently paid to sign falsified medical documentation and files for First Care Home Health Care LLC, Quantum Home Care Inc. and Moonlite Home Care Inc., which were Detroit-area home health care companies owned by Parkman’s co-conspirators that billed Medicare for services that were never rendered.
The four home health companies for which Parkman worked were paid in total approximately $13.8 million by Medicare. From approximately December 2008 through September 2011, Medicare paid approximately $450,988 to the four home health care companies for fraudulent skilled nursing claims based on falsified files signed by Parkman.
Nine of Parkman’s co-defendants have pleaded guilty and await sentencing. Three co-defendants are fugitives, and six co-defendants await trial.
Source- http://www.justice.gov/usao/md/Public-Affairs/press_releases/Press12/CoventryHealthCareInc.AgreestoPay3MilliontotheU.S.asPartofaNon-prosecutionAgreement.html
Baltimore, Maryland - Coventry Health Care, Inc. (Coventry) has agreed to pay the United States $3 million in return for the agreement by the United States Attorney’s Office for the District of Maryland not to prosecute Coventry criminally for any crimes arising from the unauthorized access by its employees to a Medicare database.
The agreement was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services.
Coventry provides group and individual health insurance to more than five million members in the United States. Coventry administers Medicare Advantage plans for some of its members, and some of its employees have access to the computerized database maintained by the Centers for Medicare and Medicaid Services (CMS) that contains Medicare eligibility information.
According to the agreement, from May 2005 to no later than December 29, 2006, some employees of Coventry and/or First Health Priority Services, a subsidiary, inappropriately accessed the Medicare database to obtain Medicare eligibility information for the sale of Medicare set-aside products. A Medicare set-aside is created from a process that allocates a portion of a worker’s compensation settlement to pay future medical expenses that would otherwise be payable by Medicare. Coventry’s actions were intended in part to give Coventry an unfair advantage over its competitors.
Several senior employees were aware of the unauthorized access to the Medicare database, including Coventry’s senior vice president for worker’s compensation services, senior vice president for government programs, senior vice president of service operations and the manager of Medicare enrollment department. All of these individuals have terminated their employment with Coventry.
Source- http://www.justice.gov/usao/mie/news/2012/2012_11_6_jagbebiyi.html
Jonathan Agbebiyi, 63, of Sterling Heights, Michigan, was sentenced yesterday for his role in a $5.4 million Medicare fraud scheme, announced United States Attorney Barbara L. McQuade. McQuade was joined in the announcement by Assistant Attorney General Lanny A Breuer of the Criminal Division in Washington, DC, Special Agent-In-Charge, Robert Foley, III, Federal Bureau of Investigation and Special Agent in Charge Lamont Pugh III of the Health and Human Services - Office of Inspector General's (OIG) Chicago Regional Office.
Agbebiyi was sentenced by United States District Judge Arthur J. Tarnow to 60 months in prison, followed by 2 years supervised release, and ordered to pay $2,982,029.19 in restitution.
In May, 2012, Jonathan Agbebiyi, 63, of Sterling Heights, Michigan, was convicted of one count of conspiracy to commit health care fraud, and six counts of health care fraud. Agbebiyi was a staff physician at three clinics which operated in Livonia, Michigan, between 2007 and 2010: Blessed Medical Clinic, Alpha and Omega Medical Clinic, and Manuel Medical Clinic.
According to the evidence presented during the one week trial, Jonathan Agbebiyi, an obstetrician/gynecologist, joined a conspiracy to bill Medicare for medically unnecessary neurological tests. Some of the tests involved sending an electrical current through the arms and legs of the patients. Clinic employees, who lacked any meaningful training, administered the diagnostic tests. The patients never received any follow up treatment by neurologists.
Evidence at trial showed that the patients were not referred to the clinics by their primary care physicians, or for any other legitimate purpose, but rather were recruited with prescriptions for controlled substances, cash payments, and fast food. The three clinics then billed the Medicare program for various diagnostic tests that were medically unnecessary.
United States Attorney Barbara L. McQuade stated, "This doctor exposed patients to electrical currents for neurological testing solely to generate money for himself at the expense of the Medicare program. We hope that cases like this one will deter other doctors from using patients as commodities for personal gain."
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/mow/news2012/hunter.ple.html
SPRINGFIELD, Mo. – David M. Ketchmark, Acting United States Attorney for the Western District of Missouri, announced that the former public administrator of Jasper County, Mo., pleaded guilty in federal court today to document fraud, which was part of a scheme in which she illegally obtained federal benefits for her wards.
Rita Frances Hunter, 60, of Joplin, Mo., pleaded guilty before U.S. Magistrate Judge James C. England to the charge of document fraud contained in a Dec. 14, 2011 federal indictment.
Hunter was the elected Public Administrator for Jasper County from Jan. 1, 2005, to Dec. 31, 2008.
By pleading guilty today, Hunter admitted that her scheme involved a total fraud of $70,000 to $120,000. Hunter directed her employees to submit materially false Medicaid applications for wards under the custody of the Public Administrator=s office. These applications falsely stated that the wards had assets below the $1,000 threshold to be eligible to receive Medicaid benefits, when in fact, the wards had more than $1,000 in assets.
Hunter specifically pleaded guilty to directing her staff to prepare a fraudulent Medicaid eligibility statement for a ward identified only as T.V. Hunter knew the statement, which was submitted to Missouri Health Net on Aug. 6, 2008, was contained false information. The written statement in the document indicated that T.V. had a total bank account balance of $827.27, when in fact, T.V. had funds totaling $6,919. This false statement was made on this document to ensure that T.V. would meet the monetary threshold (no more than $1,000) imposed by Medicaid, and was material to Medicaid’s determination that T.V. was eligible for Medicaid benefits.
Hunter caused this statement to be stamped with her signature verifying that it was true, when in fact it was false. Hunter instructed her employees to fabricate T.V.’s bank statements to ensure T.V. would qualify for Medicaid benefits, when she was, in fact, not eligible.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/opa/pr/2012/November/12-civ-1320.html
Freeman Health System, a healthcare provider and hospital system located in Joplin, Mo., has agreed to pay $9,316,139 to resolve allegations that it violated the Stark Law and the False Claims Act by knowingly providing incentive pay to physicians in a manner that violated federal law, the Justice Department announced today.
The Stark Law forbids a hospital from billing Medicare for certain services referred by physicians that have a financial relationship with the hospital. A prohibited financial relationship includes an agreement between a hospital and a physician to compensate a physician based on the volume of the physician’s referrals or the revenue realized through those referrals.
Freeman disclosed to the U.S. Attorney for the Western District of Missouri that a number of its physicians were eligible for incentive compensation that may have taken into account the value and volume of their referrals. Based on its investigation of Freeman’s disclosures, the United States alleged that Freeman knowingly compensated some of its physicians in a manner that violated the Stark Law. Specifically, the United States alleged that Freeman provided incentive pay to 70 physicians employed at clinics operated by the health system based on the revenue generated by the physicians’ referrals for certain diagnostic testing and other services performed at the clinic, and that this financial arrangement created an incentive to refer patients for such procedures.
“Today’s resolution underscores our commitment to ensure that health care decisions are based on the best interests of patients rather than the personal financial interests of referring physicians,” said Stuart F. Delery, Acting Assistant Attorney General for the Department’s Civil Division. “The Department of Justice encourages companies to disclose potential violations of law, as was the case here .”
“Our priority is protecting the patients,” said David M. Ketchmark, Acting U.S. Attorney for the Western District of Missouri. “These laws are intended to ensure that physicians make referrals for health care services based solely on the medical needs of their patients rather than any financial incentives. These laws also protect the integrity of the government-funded health care benefit programs.”
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 $10.1 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 $13.8 billion.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/opa/pr/2012/November/12-crm-1322.html
WASHINGTON – The owner of a Miami-Dade County assisted living facility (ALF) was sentenced today to 15 months in prison for her role in a kickback scheme that funneled ALF patients to fraudulent mental health providers American Therapeutic Corporation (ATC) and Health Care Solutions Network (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department's Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI's Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.
Alba Serrano, 66, of Miami, was sentenced today by U.S. District Judge Patricia A. Seitz in the Southern District of Florida. In addition to her prison term, Serrano was sentenced to serve three years of supervised release and ordered to pay $258,329 in restitution.
On June 6, 2012, Serrano pleaded guilty in Miami to one count of conspiracy to commit health care fraud.
According to court documents, Serrano was the owner of Elsa's House, an ALF that she operated for more than two decades in South Miami. Serrano pleaded guilty to sending Medicare beneficiaries who resided at Elsa’s House to both ATC and HCSN for partial hospitalization program (PHP) services, a form of intensive treatment for severe mental illness, in exchange for illegal health care kickbacks. In her plea agreement, Serrano admitted that she referred beneficiaries to both ATC and HCSN in exchange for cash kickbacks, even though she knew that some of the beneficiaries did not suffer from severe mental illness and accepting health care kickbacks was illegal.
According to the plea agreement, Serrano's participation in the fraud resulted in at least $591,385 in fraudulent billing to the Medicare program.
In related cases, ATC, its management company, Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed in February 2011. ATC, Medlink and more than 20 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/ncw/pressreleases/Charlotte-2012-11-5-wills-gibson.html
CHARLOTTE, N.C. – A Rowan County woman and her Mecklenburg County co-conspirator were sentenced to prison on Friday, November 2, 2012, in U.S. District Court for their role in a scheme to defraud Medicare and Medicaid and related offenses, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.
Chief U.S. District Court Judge Robert J. Conrad, Jr. sentenced Karen Wills (a/k/a Karen Boykin and Karen Jackson), 43, of Salisbury, to serve 97 months in prison, followed by three years of supervised release. She was also ordered to pay $786,316 as restitution to Medicaid, Medicare and Medco Health Solutions. Wills’ co-defendant, Wendy Gibson (a/k/a Wendy Fitzgerald), 40, of Charlotte, was sentenced to 48 months in prison, followed by three years of supervised release. Judge Conrad ordered Gibson to pay $358,330 as restitution to Medicare, Medicaid and Medco Health Solutions.
In January 2012, Wills and Gibson pleaded guilty to one count of health care fraud conspiracy, one count of paying and receiving illegal kickbacks and one count of conspiracy to distribute controlled substances. Wills pleaded guilty to one additional count of health care fraud conspiracy.
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); Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region; Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division; Russell F. Nelson, Special Agent in Charge of the United States Secret Service (USSS), Charlotte Field Division; Greg McLeod, Director of the North Carolina State Bureau of Investigation (NC SBI); Sheriff Kevin L. Auten of the Rowan County Sheriff’s Office; and Chief Rodney D. Monroe of the Charlotte-Mecklenburg Police Department (CMPD).
According to filed documents, statements made in court, and Friday’s sentencing hearings:
From around January 2008 to around 2009, Wills, Gibson and others engaged in an illegal kickbacks scheme involving power wheelchairs. Wills used her position with her employer’s company to submit fictitious referrals for patients to receive medically unnecessary power wheelchairs from Gibson’s employer’s company. In some instances, Wills forged a physician’s signature on required qualification documents, while Gibson tracked and directed payment to those referrals. The defendants admitted to concealing the illegal kickback payments by falsely representing on invoices and checks that the payments were for nursing and billing services. This scheme resulted in payments for the medically unnecessary equipment from Medicare and Medicaid in excess of $300,000.
The defendants also conspired to distribute controlled substances and to commit health care fraud. Wills admitted that she forged a physician’s signature on prescription pads she misappropriated from her employer, and issued fraudulent prescriptions in Gibson’s name. The prescriptions were written for controlled substances including oxycodone and hydrocodone/acetaminophen pills. Gibson admitted that she used her health insurance prescription benefit program to pay for the fraudulent prescriptions resulting in payments in over $30,000 for these fraudulent prescriptions. Wills and Gibson obtained and illegally distributed approximately 3,000 oxycodone pills, and approximately 5,000 hydrocodone/acetaminophen pills.
From around 2008 to January 2011, Wills also participated in a separate scheme to defraud Medicare and Medicaid by submitting false and fraudulent claims for medical services, including electromyography (“EMG”) and anorectal manometry (“AM”), among others. These diagnostic and treatment procedures were medically unnecessary, not provided, or both. As a result of this scheme, Medicare and Medicaid paid over $400,000 in reimbursement payments to the fraudulent claims.
From around August 2008, Wills and others became aware of the investigation into the fraudulent billing practices. In an effort to cover the fraudulent scheme, Wills created several false EMG and AM reports and placed them in patient files. As part of her guilty plea, Willis admitted that the amount of loss intended to be caused by the scheme was in excess of $400,000 but less than $1,000,000.
Wills has been in federal custody on these charges since August 2011. She will be transferred to the custody of the Federal Bureau of Prisons upon designation of a federal facility. Gibson is released on bond and will be ordered to report to a federal facility to serve her prison sentence. Federal sentences are served without the possibility of parole.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/txs/1News/Releases/2012%20November/121105%20-%20Obi.html
HOUSTON – Tony Nnonso Obi, 56, a naturalized U.S. citizen from the Federal Republic of Nigeria, has been sentenced to 41 months in federal prison for his role in a massive health care fraud conspiracy that billed the Medicare and Medicaid programs for more than $45 million, United States Attorney Kenneth Magidson announced today.
Obi entered a plea of guilty to one count of conspiracy to commit health care fraud and one count of money laundering in August of this year. As part of his plea, Obi admitted to entering into an agreement with the owner of City Nursing, Umawa Imo, to receive 15% of the money City Nursing obtained from Medicare for services billed on individuals referred to City Nursing by Obi, or on Obi’s behalf. Imo, who is currently serving more than 27 years in federal prison for his role in the conspiracy, paid Obi $1,051,425.28. At least three of the beneficiaries taken to City Nursing by Obi were individuals living in his assisted living facility. Obi also admitted to paying beneficiaries and recruiters and handling office matters when Imo was out of the office.
The City Nursing case has to date seen the conviction of a total of eight individuals, seven of whom have now been sentenced to federal prison.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/opa/pr/2012/November/12-civ-1309.html
Orthofix International NV, has agreed to pay the United States $30 million to settle allegations that an Orthofix subsidiary, Blackstone Medical Inc., paid illegal kickbacks to physicians in order to induce use of the company’s products, the Justice Department announced today. Orthofix, which manufactures spinal implants and other spinal surgery products, is a publicly traded company headquartered in Curacao.
The civil settlement resolves allegations that Blackstone paid kickbacks to spinal surgeons. These alleged kickbacks took a number of forms, including sham consulting agreements, sham royalty arrangements, sham research grants, travel and entertainment.
“Kickbacks to physicians are incompatible with a properly functioning health care system,” said Stuart F. Delery, the Acting Assistant Attorney General for the Department’s Civil Division. “They can corrupt physicians’ medical judgment and cause misallocation of vital health care resources. Today’s settlement reflects the progress we are making in the ongoing fight against abusive and illegal practices in the healthcare industry.”
“This settlement demonstrates the government’s continued resolve to ensure that patients receive, and the government pays for, health care that is based solely on sound medical judgment, not compromised by kickbacks,” said Carmen M. Ortiz, U.S. Attorney for the District of Massachusetts. “We believe that this is a just and meaningful resolution that is in the best interests of the citizens of the Commonwealth and taxpayers across the nation.”
“To those contemplating taking advantage of Medicare for their own gain, today’s settlement sends a loud, clear message,” said Susan Waddell, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General New England region. “Law enforcement will work aggressively to eliminate efforts to abuse vital taxpayer-funded health care programs.”
“Our men and women in uniform and their beneficiaries rely on their healthcare providers to perform their jobs without bias and make decisions in the best interest of their patients,” said Kathryn Feeney, Resident Agent in Charge for the Defense Criminal Investigative Service, New Haven Resident Agency. “Kickbacks, like those alleged here, undermine the TRICARE Military Health System . A settlement like this helps maintain the integrity of an important program our armed services depend on.”
“Blackstone Medical, Inc. now knows the FBI and our law enforcement partners are committed to investigating and uncovering healthcare fraud in all its forms, particularly schemes like the kickbacks Blackstone perpetrated to obtain profits at the expense of taxpayers,” said Richard DesLauriers, Special Agent in Charge of the Federal Bureau of Investigation Boston Field Division.
As part of the settlement, Orthofix also agreed to enter into a corporate integrity agreement with the Office of Inspector General of the Department of Health and Human Services, which provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that alleged in this matter.
The allegations resolved by today’s settlement were initially alleged in a whistleblower suit filed under the False Claims Act, which authorizes private citizens to bring suit on behalf of the government for false claims for government funds, and share in any recovery. The whistleblower in this case, Susan Hutcheson, will receive $8 million as her share of the settlement amount.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.fbi.gov/washingtondc/press-releases/2012/maryland-woman-sentenced-to-75-months-in-prison-for-defrauding-d.c.-medicaid-program-by-submitting-over-7-million-in-phony-claims
WASHINGTON—Jacqueline Wheeler, 55, the chief executive officer and owner of two health care companies, was sentenced today to six years and three months in prison for health care fraud and other federal offenses stemming from the submission of more than $7 million in fraudulent claims to the District of Columbia Medicaid program.
The sentencing was announced by U.S. Attorney Ronald C. Machen, Jr.; James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office; Nicholas DiGiulio, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General region including the District of Columbia; and Charles J. Willoughby, Inspector General for the District of Columbia.
Wheeler, of Chevy Chase, Maryland, was found guilty by a jury in July 2012, following a trial in the U.S. District Court for the District of Columbia. She has been incarcerated ever since. Today, she was sentenced by the Honorable Ellen S. Huvelle.
In addition to the prison term, the judge ordered Wheeler to pay about $3.17 million in restitution and ordered the forfeiture of a money judgment of the same amount. Upon completion of her prison term, Wheeler will be placed on three years of supervised release. During that time, she must perform 115 hours a year of community service. In addition, Judge Huvelle ordered Wheeler not to work in the medical field, including billing, and not to open new credit lines or make major purchases without the authorization of probation authorities.
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 also was 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 exploited a health care program for our most vulnerable citizens in order to steal tax dollars,” said U.S. Attorney Machen. “Her greed drove her to submit hundreds of phony claims for millions of dollars. As a result of today’s sentence, she will be spending the next 75 months in a federal prison instead of the Florida beach houses she financed through fraud. Her fate should make clear to other health care providers our seriousness about protecting the integrity of federal health care programs.”
“Ms. Wheeler stole from Medicaid by submitting more than 600 false claims for services that she knew had never been provided to patients,” said Assistant Director in Charge McJunkin. “As today’s sentence demonstrates, such fraudulent exploitation of our health care system will be vigorously pursued by the FBI and our partners at HHS-OIG, the D.C. OIG, and the U.S. Attorney’s Office.”
“Individuals such as Jacqueline Wheeler, insistent on stealing from government health programs like Medicaid, can expect zealous pursuit by law enforcement and to ultimately pay a heavy price for their actions,” said Special Agent in Charge DiGiulio. “We will not allow these criminals to defraud patients or fund their personal piggy banks with taxpayer dollars.”
“This matter reflects how state and federal entities, represented by the District of Columbia Office of the Inspector General, the United States Attorneys’ Office, the Federal Bureau of Investigation, and the Office of the Inspector General of the United States Department of Health and Human Services, respectively, can collaborate to safeguard individuals and the public fisc, a collaboration involving the investigatory and prosecutorial resources of the District of Columbia Office of the Inspector General for which the District and its residents should take great pride,” said Inspector General Willoughby.
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 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 $7.7 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 $3.17 million for manual therapy services that were not provided to the patients. The payments were deposited in bank accounts controlled by Wheeler.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
Source- http://www.justice.gov/usao/ncw/pressreleases/Charlotte-2012-11-1-patronis.html
CHARLOTTE, N.C. – A Gaston County woman was sentenced on Wednesday, October 31, 2012, to serve 15 months in prison, to be followed by three years of supervised release for her role in a scheme to defraud North Carolina Medicaid, announced the U.S. Attorney’s Office for the Western District of North Carolina.
Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID), Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region and Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division, join the U.S. Attorney’s Office in making today’s announcement.
Joanna Patronis, 41, of Gastonia, N.C. pleaded guilty in April 2011, to one count of conspiring to commit health care fraud. According to court documents and court proceedings, Patronis and others engaged in a scheme to defraud Medicaid by submitting fraudulent claims for mental and behavioral health services which falsely listed Medicaid-approved providers as the attending clinicians when those providers, in fact, did not provide the claimed services. Filed court documents show that in or about December 2009, Patronis created the company A Time for Everything (“ATE”) for the sole purpose of allowing non-approved Medicaid providers to submit claims to Medicaid. Patronis falsely stated to Medicaid that Dr. L.D., a licensed psychologist, was associated with ATE and then submitted fraudulent claims to Medicaid indicating that Dr. L.D. had provided services to ATE clients. Dr. L.D. did not provide any of the claimed services.
According to court documents and court proceedings, Patronis also engaged in a similar scheme to submit false claims to Medicaid through a second company, Hope and Family Behavioral Resources (“HFBR”). Co-conspirator Giraud Hope, the owner of HFBR, agreed to submit claims through HFBR’s Medicaid provider number which falsely listed Dr. L.D. as the attending clinician. Patronis acted as the medical biller for these false claims and introduced co-conspirators to Hope for the purpose of submitting false claims through HFBR’s provider number.
U.S. District Court Judge Max O. Cogburn, Jr. also ordered Patronis to pay $2,742,337 in restitution and to forfeit $46,857.57 in funds seized during the course of the investigation, a 2010 Toyota Rav-4, and her residence located in Cramerton.
Judge Cogburn sentenced Giraud Hope in October 2011 to 15 months in prison for conspiring to commit health care fraud.
***********************************************************************
Report Medicare & Medicaid Fraud by Calling 1-888-482-6825 or by visiting
www.usawhistleblower.com
