Source- http://www.justice.gov/opa/pr/2013/July/13-crm-841.html
A greater Detroit-area physical therapist assistant – who was also an owner of a home health agency and a patient recruiter – pleaded guilty today for his role in a $22 million home health care fraud scheme.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; 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 Chicago Regional Office of the U.S. Department of Health and Human Services’s Office of Inspector General (HHS-OIG) made the announcement.
Syed Shah, 51, of West Bloomfield, Mich., pleaded guilty before U.S. District Judge Bernard A. Friedman in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, scheduled for Nov. 19, 2013, Shah faces a maximum penalty of 10 years in prison.
According to information contained in plea documents, Shah, a licensed physical therapist assistant, admitted that beginning in or around October 2008 and continuing through approximately September 2012, he conspired with others to commit health care fraud by billing Medicare for home health care services that were not actually rendered and/or not medically necessary. Shah admitted that he began working in approximately October 2008 for Prestige Home Health Services, Inc., a home health agency located in Troy, Mich., owned by alleged co-conspirators. His co-conspirators at Prestige paid him kickbacks in exchange for his obtaining the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare for services that were not provided and/or were not medically necessary. Shah and his co-conspirators then created fictitious therapy files appearing to document physical therapy services provided to Medicare beneficiaries, when in fact no such services had been provided and/or were not medically necessary. Shah admitted that his role in creating the fictitious therapy files was to sign documents and progress notes indicating he had provided physical therapy services to particular Medicare beneficiaries, when in fact he had not. Shah admitted to knowing that the documents he falsified were used to support false claims billed to Medicare by his co-conspirators at Prestige.
In his plea, Shah also acknowledged that in approximately August 2009, he became an owner of Royal Home Health Care, Inc., a home health agency located in Troy, Mich., along with other co-conspirators. He and his co-conspirators at Royal billed Medicare for home health visits that never occurred and were not medically necessary. Shah and his co-conspirators paid kickbacks to Shah and other patient recruiters in exchange for Medicare beneficiary information, which was then used to bill Medicare for services that were not provided and/or were not medically necessary. Shah admitted that he and his co-conspirators created fictitious therapy files, reflecting services that had not been provided and/or were not medically necessary. He knew the documents he falsified would be used to support false claims by Royal to Medicare for home health services.
Shah submitted or caused the submission of claims to Medicare for services that were not medically necessary and/or not provided, which in turn caused Medicare to pay approximately $5,925,843. According to the indictment, two additional home health agencies were involved in the alleged conspiracy. In total, the four home health agencies at the center of the indictment received more than $22 million from the Medicare program.
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Source- http://www.justice.gov/opa/pr/2013/July/13-crm-844.html
A former health care clinic director and licensed clinical psychologist at defunct health provider Health Care Solutions Network Inc. (HCSN) was sentenced today in Miami to serve 135 months in prison for her central role in a fraud scheme that resulted in more than $63 million in fraudulent claims to Medicare and Florida Medicaid.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the Miami office of the U.S. Department of Health and Human Services’s Office of Inspector General (HHS-OIG) made the announcement.
Alina Feas, 53, of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to her prison term, Feas was sentenced to three years of supervised release and ordered to pay $24.1 million in restitution.
On May 7, 2013, Feas pleaded guilty to one count of conspiracy to commit health care fraud and one substantive health care fraud count. During the course of the conspiracy, Feas was employed as a therapist and clinical director of HCSN’s Partial Hospitalization Program (PHP). A PHP is a form of intensive treatment for severe mental illness.
HCSN of Florida (HCSN-FL) operated community mental health centers at two locations. In her capacity as clinical director, Feas oversaw the entire clinical program and supervised therapists and other HCSN-FL personnel. She also conducted group therapy sessions when therapists were absent, and she was aware that HCSN-FL paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Feas also knew that many of the ALF referral patients were ineligible for PHP services because many patients suffered from mental retardation, dementia and Alzheimer's disease.
Feas submitted claims to Medicare for individual therapy she purportedly provided to HCSN-FL patients using her personal Medicare provider number, knowing that HCSN-FL was simultaneously billing the same patients for PHP services. She continued to bill Medicare under her personal provider number while an HCSN community health center in North Carolina (HCSN-NC) simultaneously submitted false and fraudulent PHP claims.
Feas was also aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment and were used to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid. During her employment at HCSN-FL, Feas signed fabricated PHP therapy notes and other medical records used to support false claims to government-sponsored health care programs.
At HCSN-NC, Feas was aware that her co-conspirators were fabricating medical records to support the fraudulent claims she was causing to be submitted to Medicare on behalf of HCSN-NC. She knew that a majority of the fabricated notes were created at the HCSN-FL facility for patients admitted into the PHP at HCSN-NC. In some instances, Feas signed therapy notes and other medical records even though she never provided services in HCSN-NC’s PHP.
From 2004 through 2011, HCSN billed Medicare and the Medicaid program more than $63 million for purported mental health services.
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Source- http://www.justice.gov/opa/pr/2013/July/13-crm-840.html
The daughter of a church pastor and owner of a California-based durable medical equipment (DME) supply company was found guilty by a jury of Medicare fraud charges for her role in a Medicare fraud scheme that resulted in over $11 million in fraudulent billings to Medicare.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney André Birotte Jr. of the Central District of California; Special Agent in Charge Glenn R. Ferry of the Los Angeles Region of the U.S. Department of Health and Human Services’s Office of Inspector General (HHS-OIG); Assistant Director in Charge Bill Lewis of the FBI’s Los Angeles Field Office; and Special Agent in Charge Joseph Fendrick of the California Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse made the announcement.
Obiageli Agbu, 26, of Carson, Calif., was found guilty on July 19, 2013, of one count of conspiracy to commit health care fraud and eight counts of health care fraud following a two-week trial.
The evidence introduced at trial showed that Agbu owned Ibon Inc., a fraudulent DME supply company that she operated from a nondescript office building in Carson. Agbu’s father and co-defendant, Charles Agbu, a church pastor who pleaded guilty to Medicare fraud and money laundering charges in December 2012, ran a fraudulent DME supply company called Bonfee Inc. from the same office building that housed Ibon. The trial evidence showed that from Ibon and Bonfee, Agbu, her father and others working with them submitted more than $11 million in fraudulent claims from Ibon and Bonfee to Medicare for expensive, high-end power wheelchairs, hospital beds, braces and other DME that customers either did not need or receive.
According to evidence at trial, Agbu and her father purchased the power wheelchairs wholesale for approximately $900 per wheelchair, but they billed the wheelchairs to Medicare at $4,000 to $5,000 per power wheelchair. These power wheelchairs were a type of medical equipment of last resort reserved for people with severe mobility limitations and could cause harm if the wheelchairs were supplied to people who did not have a legitimate medical need for them.
Agbu and her father paid kickbacks to street-level patient recruiters or “marketers” who would find senior citizens with Medicare and Medi-Cal benefits and cajole the seniors into agreeing to accept power wheelchairs and other DME that the seniors did not need. The seniors were directed to doctors who received cash kickbacks of $200 to $1,000 to write fraudulent prescriptions and other Medicare-specific documents conspirators used at Bonfee and Ibon to submit fraudulent claims to Medicare.
As a result of this scheme, between July 2005 and February 2011, Agbu, her father and those working with them submitted approximately $11,094,918 million in fraudulent claims to Medicare and received approximately $5,788,725 on those claims.
At sentencing, scheduled for Oct. 17, 2013, Agbu faces a maximum penalty of 10 years in prison for each count of conviction. Agbu’s father is scheduled for sentencing on Aug. 15, 2013. Agbu’s other co-defendants – Dr. Juan Van Putten, Dr. Emmanuel Ayodele, Alejandro Maciel and Candalaira Estrada – have each pleaded guilty to Medicare fraud charges and are scheduled for sentencing in September and October 2013.
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Source- http://www.justice.gov/usao/nv/news/2013/20130723_little.html
RENO, Nev. – Two women were sentenced today for their guilty pleas to federal health care fraud charges after they defrauded the Nevada Medicaid program of approximately $1 million, announced Daniel G. Bogden, United States Attorney for the District of Nevada.
Cassandra Little, 49, of Reno, was sentenced to 33 months in prison, three years of supervised release, and ordered to pay $81,400 in restitution. Little pleaded guilty in March to 28 counts of health care fraud and 10 counts of money laundering.
Susan Hill, 66, of Las Vegas, was sentenced to 18 months in prison, three years of supervised release, and ordered to pay $81,400 in restitution. Hill pleaded guilty in March to one count of health care fraud and one count of money laundering.
Senior U.S. District Judge Howard D. McKibben in Reno sentenced both women, and allowed them to self-report to federal prison by Oct. 15, 2013.
“As this case demonstrates, health care fraud is a serious criminal offense with serious consequences that can land you in federal prison,” said U.S. Attorney Bogden. “The U.S. Department of Justice is committed to investigating and prosecuting persons who commit this type of crime.”
“Our attorneys and investigators work closely with our partners to find Medicaid violators and prosecute them to the fullest extent of the law for cheating the system,” said Nevada Attorney General Catherine Cortez Masto. “We hope today's prison sentence and combined restitution of approximately $81,000 sends a strong message to others who may consider stealing from taxpayers. We will not tolerate those that take advantage of the system."
According to the court records, from about January 2007 to January 2011, Hill and Little defrauded the Nevada Medicaid program of approximately $1 million by fraudulently billing for expensive therapy-related services such as psychosocial rehabilitation and basic skills training which were never provided. To execute their scheme, Hill and Little formed a company, the Hill/Little LLC, and entered into a contract with Nevada Medicaid to provide health care services to children who were eligible for Medicaid. Hill was the president of the LLC. Little, a PhD and licensed social worker, was to provide the clinical services to the children. Hill and Little then created a program to obtain aid for the parents of the children who were eligible to receive the Medicaid funding; however, the program was not authorized or allowed under their Medicaid contract with the state. Hill recruited parents and guardians to provide services to their own children following minimal training provided by Hill/Little LLC. The services were nothing more than what parents normally do without reimbursement. Hill/Little LLC then billed Medicaid approximately $8,000 per month for each child, using a billing code which was only authorized for services that could have been provided by Little, the licensed social worker. Hill/Little kept $5,000 per month for each child and paid each parent/guardian approximately $3,000. The parents/guardians reported that their children received little or no services from Hill or Little, and none of the services billed by Hill/Little from January 2007 to January 2011 were ever properly provided or authorized under Medicaid rules. Using this scheme, Hill and Little unlawfully received approximately $1 million from Medicaid for services they did not provide.
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Source- http://www.justice.gov/usao/nys/pressreleases/July13/DharayanetalArrestPR.php
Preet Bharara, the United States Attorney for the Southern District of New York, Thomas O’Donnell, the Special Agent-in-Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), and Steven G. Hughes, the Special Agent-in-Charge of the New York Office of the U.S. Secret Service today announced charges against eight individuals for their alleged involvement in a lucrative scheme in which information technology vendors paid over $2.3 million in bribes and kickbacks to secure business from executives of a Manhattan-based medical cost management company (the “New York Company”). The defendants charged with paying the bribes and kickbacks are SARVESH DHARAYAN, SANJAY GUPTA, VENKATA ATLURI, RANGARAJAN KUMAR, VADAN KUMAR KOPALLE, and DARREN SIRIANI. The defendants charged with receiving the bribes and kickbacks are ANIL SINGH and KEITH BUSH. DHARAYAN, GUPTA, KOPPALLE, and SIRIANI were arrested this morning at their homes in New Jersey, and were presented in Manhattan federal court this afternoon before U.S. Magistrate Judge James L. Cott. SINGH, who was previously arrested in April 2013, pled guilty to honest services fraud and other charges before U.S. District Judge Denise L. Cote on July 11, 2013. BUSH, who was also arrested previously on July 12, 2013, is next scheduled to appear in court for a pretrial conference on August 15, 2013. ATLURI and KUMAR are not yet in custody.
Manhattan U.S. Attorney Preet Bharara said: “For the eight defendants charged in this multi-million dollar scheme, bribes and kickbacks were allegedly the cost they imposed for doing business with this medical-cost management company. As today’s charges detail, the defendants achieved their years-long fraud through fake companies, sham invoices and made-up consulting services. Today’s actions underscore our commitment to work with our law enforcement partners to bring to justice individuals who break the law out of greed.”
HHS-OIG Special Agent-in-Charge Thomas O’Donnell said: “This scheme was motivated by greed and it deprived its victim, a company in the health care field, of the honest labor of its employees. We will continue to aggressively investigate those who pay kickbacks and bribes to gain an advantage in the public and private health care sectors.”
USSS Special Agent-in-Charge Steven G. Hughes said: “The Secret Service continues to enjoy its partnership with the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General. We find partnerships such as this to be an effective way to share resources and stop criminals from continuing to engage in fraudulent schemes.”
According to the allegations contained in the Complaint, the Informations filed against BUSH and SINGH, and other statements made in Manhattan federal court:
SINGH was employed as a Senior Vice President and the Chief Information Officer at the New York Company, which provided nation-wide medical cost management solutions including, among other things, medical reimbursement services, and BUSH was employed as the company’s Director of Database Administration. SINGH and BUSH had considerable influence over the selection of vendors, specifically vendors of database administrators (“DBAs”), hired by the New York Company.
From 2008 to September 2012, various individuals collectively paid over $2.3 million in money and other benefits to SINGH and BUSH in exchange for SINGH’s and BUSH’s agreement to steer millions of dollars of the New York Company’s DBA business to them. Specifically, as alleged:
DHARAYAN, the owner of a New Jersey information technology company (“Vendor 1”) and GUPTA, an employee of Vendor 1, paid approximately $1,722,620 in kickbacks and bribes to BUSH and SINGH in exchange for receiving DBA business from the New York Company. From 2010 to 2012, the New York Company paid Vendor 1 approximately $6,625,479.20 for placing DBAs with the New York Company.
ATLURI, the owner of another New Jersey information technology company (“Vendor 2”), paid approximately $190,436.75 in kickbacks and bribes to BUSH and SINGH in exchange for receiving DBA business from the New York Company. From 2008 to 2012, the New York Company paid Vendor 2 approximately $11,495,804.88 for placing DBAs with the New York Company.
KUMAR paid approximately $247,634 in kickbacks and bribes to BUSH and SINGH in exchange for their agreement to steer DBA business to another New Jersey information technology company (“Vendor 3”). From 2009 to 2012, the New York Company paid Vendor 3 approximately $2,593,210.38 for placing DBAs with the New York Company.
KOPALLE, who was in charge of delivery and operations at a Texas information technology company (“Vendor 4”), paid approximately $142,967.50 in kickbacks and bribes to BUSH and SINGH in exchange for receiving DBA business from the New York Company. From 2009 to 2010, the New York Company paid Vendor 4 approximately $1,035,660 for placing DBAs with the New York Company.
SIRIANI, the owner and operator of another New Jersey information technology company (“Vendor 5”) paid approximately $23,000 to $29,000 in cash kickbacks and bribes to BUSH and SINGH in exchange for receiving business from the New York Company. SIRIANI also paid for hotel rooms in Las Vegas and Costa Rica, deep sea fishing, massages, sports tickets, and other things, all in exchange for receiving business from the New York Company. From 2008 to 2012, the New York Company paid Vendor 5 approximately $1,177,600.91 for various services and products.
According to the Complaint, DHARAYAN, GUPTA, ATLURI, KUMAR, and KOPALLE paid the kickbacks and bribes through conduit companies established by BUSH and SINGH for the very purpose of disguising the true nature and origin of the illegal payments. To further conceal the bribery and kickback scheme, BUSH and SINGH sent false invoices to the conduit companies for consulting services that never occurred. Many of the kickbacks and bribes were paid pursuant to these false invoices.
* * *
DHARAYAN, 42, of Edison, New Jersey, GUPTA, 38 of East Windsor, New Jersey, ATLURI, 41, of Monmouth Junction, New Jersey, KUMAR, 47, of Monroe, New Jersey, KOPALLE, 43, of Edison, New Jersey, and SIRIANI, 45, of Matawan, New Jersey, were each charged with one count of conspiracy to commit honest services fraud, which carries a maximum term of 20 years in prison, one count of conspiracy to violate the Travel Act, which carries a maximum term of five years in prison, one count of honest services fraud, which carries a maximum term of 20 years in prison, and one count of violating the Travel Act, which carries a maximum term of five years in prison. DHARAYAN, GUPTA, ATLURI, KUMAR, and KOPALLE were also charged with one count of conspiracy to commit money laundering, which carries a maximum term of 20 years in prison.
SINGH, 40, a resident of East Brunswick, New Jersey pled guilty to one count each of conspiracy to commit honest services fraud, conspiracy to violate the Travel Act, honest services fraud, violating the Travel Act, and conspiracy to commit money laundering. He faces a maximum penalty of 70 years in prison on all counts. BUSH, 41, a resident of Rahway, New Jersey, is charged with one count each of conspiracy to commit honest services fraud, conspiracy to violate the Travel Act, honest services fraud, violating the Travel Act, and conspiracy to commit money laundering. He also faces a maximum penalty of 70 years in prison if convicted on all counts.
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Source- http://www.justice.gov/usao/nj/Press/files/Aponte,%20Dennis%20et%20al.%20Plea%20News%20Release%20.html
NEWARK, N.J. – Three New Jersey doctors admitted today they accepted tens of thousands of dollars in bribes from Parsippany, N.J.-based Biodiagnostic Laboratory Services LLC (BLS) as part of a long-running scheme operated by the lab, its president, and numerous associates, U.S. Attorney Paul J. Fishman announced.
Dennis Aponte, 46, of Cedar Grove, N.J.; Claudio Dicovsky, 51, of Fort Lee, N.J.; and Franklin Dana Fortunato, 63, of Montville, N.J., each pleaded guilty to violating the Federal Travel Act. Fortunato also pleaded guilty to filing a false tax return, admitting that from 2004 to 2008, he failed to disclose and report as income more than $640,000 in bribe money and patient co-pays and failed to pay more than $160,000 in taxes he owed as a result of that unreported income. The defendants entered their guilty pleas today before U.S. District Judge Stanley R. Chesler in Newark federal court.
“Decisions about medical care should not be influenced by doctors and providers who are more interested in lining their pockets than in providing quality healthcare,” U.S. Attorney Fishman said. “The doctors who pleaded guilty today admitted making decisions about the care they provided based on being paid in return for their referrals. We will continue to seek out and punish those doctors and other medical professionals who put profit before patient care.”
Newark FBI Special Agent in Charge Aaron T. Ford said: “Patients have every right to insist that their physician is making medical referrals based on what is best for the patient. However, these three physicians decided to accept bribes in exchange for referrals. These types of kickback arrangements cripple the healthcare industry and severely impact patient care. The FBI remains committed to investing its resources to combat these types of schemes.”
“Today’s pleas should send a loud and clear message that kickbacks and unnecessary billing have no place in our Federal healthcare system,” Thomas O’Donnell, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Region covering New Jersey, said. “We will aggressively investigate those suspected of defrauding taxpayers and the Medicare program.”
According to documents filed in this and other cases and statements made in court:
On April 9, 2013, federal agents arrested BLS president and part owner, David Nicoll, 39, of Mountain Lakes, N.J.; Scott Nicoll, 32, of Wayne, N.J., a senior BLS employee and David Nicoll’s brother; and Craig Nordman, 34, of Whippany, N.J., a BLS employee and the CEO of Advantech Sales LLC – an entity used by BLS to make illegal payments. They were charged by federal complaint with the bribery conspiracy, along with the BLS company and New Jersey physician Frank Santangelo, 43, of Boonton, N.J. The charges against BLS and Santangelo are pending.
Dicovsky
Dicovsky admitted he agreed with David Nicoll to accept bribes from BLS in exchange for his referral of blood specimens. To disguise those bribes, Dicovsky and BLS entered into a sham lease agreement and a sham service agreement in which the monthly bribe payments of more than $5,000 were characterized as “lease” and “service” payments. While the lease agreement purported to be for 1,000 square feet of space, little or no space was allocated to BLS in Dicovsky’s medical office in Paterson, N.J. Between November 2006 and August 2009, Dicovsky received more than $224,000 in bribe payments from BLS, and BLS made more than $800,000 through testing on blood specimens referred by Dicovsky.
Fortunato
On May 2, 2013, two former sales representatives of BLS, Peter Breihof, 42, of Nutley, N.J., and William Dailey, 41, of Wall, N.J., pleaded guilty to an information charging them with conspiracy to violate the Anti-Kickback Statute and the Federal Travel Act. They admitted using phony lease and service agreements to bribe physicians to send their patients’ blood samples to BLS. Breihof and Dailey also admitted that they paid various physicians a fee per test on behalf of BLS in order to induce those physicians to order more of the blood tests than they otherwise would have.
Fortunato admitted entering into bribe arrangements with BLS through Breihof, with David Nicoll’s knowledge and approval, for the referral of blood specimens of patients of Fortunato’s Montclair, N.J., practice. Fortunato received more than $100,000 in bribe payments – often more than $5,000 per month – from BLS disguised through sham lease and sham service agreements between 2006 and 2009, and BLS made more than $430,000 through testing on blood specimens referred by Fortunato.
Aponte
Aponte admitted that he and David Nicoll agreed that BLS would pay Aponte bribes to refer to BLS blood specimens from the patients of his West New York, N.J., medical practice. From October 2012 to March 2013, Nordman, acting at David Nicoll’s direction, paid Aponte approximately $3,000 per month in cash in return for blood specimens referred to BLS. The lab made more than $175,000 through testing on blood specimens referred by Aponte.
The count to which Aponte, Dicovsky and Fortunato each pleaded guilty is punishable by a maximum potential penalty of five years in prison and a $250,000 fine. Fortunato also faces a maximum potential penalty of five years in prison and a $250,000 fine on the filing a false tax return charge. Sentencing for all three defendants is scheduled for Oct. 22, 2013.
Aponte has agreed to forfeit $235,000, Dicovsky has agreed to forfeit more than $220,000, and Fortunato has agreed to forfeit more than $635,000. The investigation has so far recovered more than $2 million through forfeiture.
On June 10, 2013, David Nicoll, Scott Nicoll, Nordman, and four other associates of BLS pleaded guilty to informations charging them with one count of conspiracy to violate the Anti-Kickback Statute and the Federal Travel Act and one count of money laundering. The charges and allegations against Santangelo and BLS are merely accusations, and the defendants are considered innocent unless and until proven guilty.
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Source- http://www.justice.gov/opa/pr/2013/July/13-crm-795.html
The former medical director at defunct health provider Health Care Solutions Network (HCSN) and six therapists were arrested today, accused of conspiring to fraudulently bill Medicare and Florida Medicaid more than $63 million.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Southern District of Florida Wifredo A. Ferrer; Special Agent in Charge Michael B. Steinbach 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, made the announcement after the indictment was unsealed following the arrests.
The former HCSN medical director, Roger Rousseau, 71, of Miami, was indicted on July 11, 2013, and charged with conspiracy to commit health care fraud and two counts of health care fraud. In addition, six therapists from Miami – Doris Crabtree, 61; Angela Salafia, 65; Liliana Marks, 46; Ruben Busquets, 49; Alina Fonts, 47; and Blanca Ruiz, 59 – were also charged in the same indictment with conspiracy to commit health care fraud. Fonts was also charged with two counts of health care fraud, and Crabtree, Salafia, Marks and Busquets were each charged with two counts of making false statements related to health care matters. The indictment also seeks forfeiture of proceeds from the alleged healthcare fraud offenses.
According to the indictment, HCSN purported to provide intensive mental health treatment to Medicare and Medicaid beneficiaries in Miami and Hendersonville, N.C., from approximately 2004 through 2011 for purported mental health services that were not medically necessary and often never provided. The indictment also alleges that in Miami, HCSN paid kickbacks to assisted living facility owners and operators who, in exchange, referred beneficiaries to HCSN. In total, HCSN is alleged to have fraudulently billed Medicare and Medicaid approximately $63.7 million, from which HCSN allegedly received payments totaling approximately $28 million.
Rousseau served as the medical director for HCSN in Florida, and the indictment alleges that he routinely signed what he knew to be fabricated and altered medical records without ever reviewing the materials, and, in most instances, without ever meeting with the patient. The indictment also alleges that Crabtree, Salafia, Marks, Busquets, Fonts and Ruiz fabricated HCSN medical records to support false and fraudulent claims for partial hospitalization program services that were not medically necessary and were not provided.
The charges and allegations contained in the indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.
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Source- http://www.justice.gov/usao/nye/pr/2013/2013jul16.html
BROOKLYN, NY – Earlier today, Anatoly Kraiter, 35, of Brooklyn, New York, was sentenced today to 37 months in prison for his role as a money launderer for a $77 million Medicare fraud scheme. In addition to the prison term, U.S. District Judge Nina Gershon of the Eastern District of New York sentenced Kraiter to three years of supervised release and ordered him to forfeit $100,000. Kraiter’s surrender date is September 16, 2013.
The sentence was announced by U.S. Attorney for the Eastern District of New York Loretta E. Lynch; Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; George Venizelos, Assistant Director-in-Charge, Federal Bureau of Investigation, New York Field Office (FBI); and Special Agent-in-Charge Thomas O’Donnell of the HHS Office of Inspector General (HHS-OIG).
Kraiter pleaded guilty on July 24, 2012 to one count of conspiracy to commit money laundering. Including Kraiter, 13 individuals were convicted in this case, either through guilty plea or trial conviction.
According to court documents, from 2008 to 2010, Kraiter opened and operated numerous shell companies and bank accounts through which he laundered the proceeds of health care fraud from Brooklyn clinic SZS Medical Care PLLC (“SZS Medical”). The owners and operators of SZS Medical, along with closely related medical clinics Bay Medical Care PC and SVS Wellcare Medical PLLC (collectively, “the Bay Medical clinics”) committed a $77 million Medicare fraud from 2005 to 2010. According to court documents, the Bay Medical clinics submitted more than $77 million in claims to Medicare, seeking reimbursement for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests.
The government’s investigation included the use of a court-ordered audio/video recording device hidden in a room at the clinic, in which the conspirators paid cash kickbacks to corrupt Medicare beneficiaries. The conspirators were recorded paying approximately $500,000 in cash kickbacks during a period of approximately six weeks from April to June 2010. This room was marked “PRIVATE” and featured a Soviet-era poster of a woman with a finger to her lips and the words “Don’t Gossip” in Russian. The purpose of the kickbacks was to induce the beneficiaries to receive unnecessary medical services or to stay silent when services not provided to the patients were billed to Medicare.
To generate the large amounts of cash needed to pay the patients, the conspirators used a network of external money launderers, including Kraiter. According to court documents, Kraiter conspired with others to accept checks from the Bay Medical clinics, which were made payable to various shell companies Kraiter and his co-conspirators controlled. These checks did not represent payment for any legitimate service, but rather were written to launder the Bay Medical clinics’ fraudulently obtained health care proceeds. Kraiter admitted at his change of plea hearing that he deposited such checks into bank accounts he controlled, intending these transactions to hide and disguise the fact that these funds were proceeds of a crime. He admitted that he knew these funds were proceeds of health care fraud.
According to court documents, Kraiter and his co-conspirators negotiated and cashed these checks and provided the cash back to the owners and operators of the Bay Medical clinics. Such cash was then diverted to the personal use of the owners and operators of the Bay Medical clinics, and used to pay illegal cash kickbacks to the Bay Medical clinics’ purported patients.
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Source-http://www.justice.gov/usao/nj/Press/files/Reaves,%20Lori%20Sentencing%20News%20Release.html
TRENTON, N.J. – A doctor who was the owner and founder of Visiting Physicians of South Jersey (VPA) – a Hammonton, N.J., provider of home-based physician services for seniors – was sentenced today to 24 months in prison for charging lengthy visits to elderly patients that they did not receive, U.S. Attorney Paul J. Fishman announced.
Lori Reaves, 52, of Waterford Works, N.J., previously pleaded guilty before U.S. District Judge Freda L. Wolfson to an information charging her with one count of health care fraud. Judge Wolfson imposed the sentence today in Trenton federal court.
According to documents filed in this case and statements made in court:
Reaves admitted lying in Medicare billings about the amount of face-to-face time she spent with patients, which led to her receiving at least $511,068 in criminal profits. Reaves was the highest billing home care provider among the more than 24,000 doctors in New Jersey from Jan. 1, 2008, through Oct. 14, 2011.
VPA provided home-based physician health care for elderly and homebound patients in New Jersey, offering services throughout South Jersey. As part of her responsibilities at VPA, Reaves was responsible for Medicare billings as a Medicare-approved provider. The claim submitted by the health care provider requires a physician to state a diagnosis and provide a procedure code – called a Current Procedural Technology (CPT) code – identifying services rendered. Medicare regulations require that each provider certify that the services rendered were medically necessary and were furnished by that provider. A warning at the bottom of the form specifically states that any false claims or statements in relation to the submission of a claim for reimbursement are prosecutable under federal or state law.
In most instances during the relevant time period, Reaves submitted forms that falsely claimed she had provided prolonged service visits to her patients in order to induce Medicare to make payments to her that were significantly higher than the payments she should have received. She routinely billed Medicare using codes that would have required her – under Medicare regulations and depending on the corresponding service – to spend between 60 and 150 minutes with a patient. Many of the claims Reaves submitted would have required her to spend a minimum of 2.5 hours of face-to-face time with her elderly clients, when she actually spent far less. As a result, Medicare reimbursed Reaves more than $511,068 for the fraudulent prolonged service visits Reaves claimed to have made.
In addition to the prison term, Judge Wolfson sentenced Reaves to three years of supervised release. In addition to Reaves forfeiture of $511,068, Judge Wolfson ordered Reaves to pay restitution of $511,068 and pay a fine of $5,000.
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Source- http://www.justice.gov/opa/pr/2013/July/13-crm-814.html
The owner of a Los Angeles-area durable medical equipment (DME) supply company has pleaded guilty to conspiring to defraud Medicare and Medi-Cal of more than $650,000.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney André Birotte Jr. of the Central District of California; Special Agent in Charge Glenn R. Ferry for the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); Assistant Director in Charge Steven Martinez of the FBI’s Los Angeles Field Office; and Special Agent in Charge Joseph Fendrick of the California Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse, made the announcement.
Kim Ricks, of Moreno Valley, Calif., pleaded guilty on July 17, 2013, before U.S. District Judge Fernando M. Olguin in the Central District of California to one count of conspiracy to commit health care fraud.
In court, Ricks admitted that she owned and operated Kim’s Medical Supplies (“KMS”), a DME company that was located in Moreno Valley. Ricks enrolled KMS in both Medicare and Medi-Cal, which allowed her to submit claims to both programs. Ricks admitted that between approximately December 2005 and September 2012, she submitted claims to Medicare and Medi-Cal for power wheelchairs (PWCs) and other DME on behalf of people who did not have a legitimate medical need for the equipment, a practice that, Ricks admitted in court, she knew violated Medicare and Medi-Cal rules and regulations.
Ricks also admitted that she submitted claims to Medicare and Medi-Cal for PWCs and other DME that neither she nor her co-conspirators delivered to KMS’s customers, which Ricks knew violated the rules and regulations of both Medicare and Medi-Cal. In some cases, Ricks obtained the Medicare billing and personal information of individuals and, without their knowledge, used that information to submit claims to Medicare and Medi-Cal for PWCs and other DME that neither she nor her co-conspirators provided to the individuals. Ricks admitted that she submitted these types of claims to Medicare and Medi-Cal because she needed the money to keep KMS viable. Ricks also admitted that she submitted claims to Medicare and Medi-Cal for power wheelchairs and DME that she knew were supported by fraudulent prescriptions forged by her co-conspirators.
Ricks admitted that she was responsible for the claims that KMS submitted to Medicare and Medi-Cal, although, at times, her co-conspirators used her Medicare and Medi-Cal provider numbers to submit false and fraudulent claims to both programs. As a result of this conspiracy, Ricks admitted that she and her co-conspirators submitted and caused the submission of approximately $643,468 in fraudulent Medicare claims and received approximately $236,882 in ill-gotten reimbursement payments. Ricks admitted further that she and her co-conspirators submitted and caused the submission of approximately $11,849 in fraudulent Medi-Cal claims and received approximately $8,660 in ill-gotten reimbursement payments.
At sentencing, scheduled for Oct. 24, 2013, Ricks faces a maximum penalty of 10 years in prison.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2013%20July/130711%20-%20Herrera.html
McALLEN, Texas - The owner of a now defunct McAllen area durable medical equipment (DME) business has been ordered to prison for his role in a conspiracy and scheme to defraud Medicare and Medicaid through fraudulent billings, United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott announced today. The scheme involved approximately $11.1 million in false claims to Medicare and Medicaid.
Former RGV DME Owner Marcello Herrera, 40, along with his wife Carla Cantu Herrera, 32, and their former employee Ramon De La Garza, 52, all of Mission, pleaded guilty on Feb. 21, 2013, to conspiring to defraud Medicare and Texas Medicaid. Beatriz Ramos, 28, of Edinburg, a former biller for RGV DME, pleaded guilty to the conspiracy on Oct. 16, 2012. Marcelo Herrera and De La Garza also pleaded guilty to one count of aggravated identity theft for unlawfully using the identity of a beneficiary to bill Medicare and Medicaid $5,000 for a power wheelchair that was not requested, prescribed, needed or delivered.
Today, Marcello Herrera was handed a sentence of 120 months for the conspiracy conviction in addition to a mandatory 24-month-term for aggravated identity theft which must be served consecutively to the other sentence imposed, resulting in a total 144 months in federal prison. He will also serve three years of supervision following his release. In addition to the prison sentence, he was ordered to pay restitution to Medicare and Medicaid in the amount of $6,103,953.74.
As part of his plea of guilty, Marcelo Herrera agreed to the entry of a money judgment against him in the sum of $6,103,953.74 and to forfeit wheelchairs, scooters and other DME items discovered in his leased storage facility in Alamo, which had been rented by him and ultimately seized by the FBI.
From early 2004 through late 2011, Marcello Herrera, who did business as RGV DME in the McAllen area, engaged in and directed a scheme to submit fraudulent claims to Medicare and Texas Medicaid for power wheelchairs, incontinent supplies, hospital beds and mattresses as well as other DME supplies. At various times, his wife, Carla Cantu Herrera - who admitted to being marketing director, chief financial officer, chief operating officer, office manager, human resources manager and co-owner of RGV DME - and billers De La Garza and Ramos all participated in the conspiracy and aided Marcello Herrera and each other in the submission of fraudulent billings, wire fraud and theft of the identities of beneficiaries and doctors.
In court on Feb. 21, 2013, Marcelo Herrera admitted that during the time of his fraudulent scheme, he submitted or caused the submission of more than $11.1 million in false and fraudulent claims to Medicare and Texas Medicaid for which he illegally received in excess of $6.1 million. Carla Herrera admitted that during her participation in the conspiracy, the fraudulent billings exceeded $9.9 million for which they received illegal payments exceeding $5.5 million, while De La Garza admitted that during his participation in the conspiracy the fraudulent billing exceed $9.6 million for which payments exceeded $5 million. Marcelo Herrera, Carla Herrera and De La Garza admitted that approximately 85% of their Medicare and Texas Medicaid billings were false and fraudulent.
The three defendants in court on Feb. 21, 2013, also admitted that marketers were used to obtain Medicare and Medicaid identification numbers and other information from beneficiaries which they in turn used to fraudulently bill Medicare and Medicaid for DME that was either never prescribed or prescribed but never delivered. The Herreras further acknowledged they or their marketers attempted to obtain referrals of patients or orders for DME from doctors in exchange for gifts.
Ramon De La Garza will be sentenced July 24, while Beatriz Ramos and Carla Herrera are set for Aug. 27 and Sept. 18, 2013, respectively.
Marcelo Herrera has been in custody since his arrest on June 12, 2012. He will remain in custody pending transfer to a U.S. Bureau of Prisons facility to be determined in the near future.
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Source- http://www.justice.gov/usao/nj/Press/files/Agarwal,%20Shashi%20Sentencing%20News%20Release.html
NEWARK, N.J. – An Edison, N.J., cardiologist was sentenced today to 30 months in prison for referring patients for diagnostic testing in exchange for cash kickbacks as part of a cash-for-patients scheme with a diagnostic facility in Orange, N.J., U.S. Attorney Paul J. Fishman announced.
Shashi Agarwal, 61, who had his own cardiology practice in East Orange, N.J., previously pleaded guilty before U.S. District Judge Claire C. Cecchi to an information charging him with one count of soliciting and receiving more than $100,000 in cash kickbacks in violation of the federal health care anti-kickback statute. Judge Cecchi imposed the sentence today in Newark federal court.
According to documents filed in this case and statements made in court:
From early 2009 through December, 2011, Orange MRI paid Agarwal for each MRI and CAT scan he referred. According to Agarwal, Orange MRI gave him $100 cash for each Medicare or Medicaid patient he referred for an MRI. Agarwal also received $50 for each CAT scan referral. Agarwal admitted that he agreed to refer as many as 20 MRIs to Orange MRI each month.
During his plea proceeding, Agarwal identified two occasions on which he was paid kickbacks. On Oct. 11, 2011, Agarwal received $2,600 in cash from a government informant at Salvadoreño restaurant in Elizabeth, N. J., in exchange for MRI and CAT scan referrals. On Nov. 10, 2011, at his office in East Orange, N.J., Agarwal received another kickback for patient referrals of $2,500 in cash.
Agarwal was one of 12 doctors and one nurse practitioner arrested Dec. 13, 2011, and charged with accepting cash kickback payments.
In addition to the prison term, Judge Cecchi sentenced Agarwal to two years of supervised release and ordered him to perform 100 hours of community service. At his plea hearing, Agarwal also agreed to forfeit $101,750 in bribe money.
The investigation ultimately led to the arrest of and charges against 15 individuals, including those arrested in December 2011. Of those charged, 12 have pleaded guilty to date.
Daisy Deguzman, a doctor practicing in Newark, was sentenced to six months in prison and six months of home confinement on Jan. 31, 2013. Dov Rand, a doctor practicing in West Orange, N.J., was sentenced to five months in prison and five months of home confinement on Feb.13, 2013. Rameshcha Kania, an East Orange, N.J., doctor, was sentenced to three months in prison and three months of home confinement on June 24, 2013. Lucio Cardoso, a North Arlington, N.J., doctor, was sentenced to four months in prison and four months of home confinement on June 25, 2013. The defendants were also ordered to forfeit their illegal gains.
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