Source- http://www.justice.gov/usao/hi/news/1308wgh.html
HONOLULU - Wahiawa General Hospital ("WGH") of Honolulu, Hawaii, shall pay $451,428.00 to settle two lawsuits alleging that WGH improperly billed the Medicare program, the State of Hawaii Medicaid program, and TRICARE, the federal health benefits program for military dependents. The settlement grew out of civil "whistleblower" lawsuits brought under the federal and State of Hawaii False Claims Acts in federal and state court by a doctor who had worked at the Physicians Center at Mililani (“PCM”), an out-patient clinic operated by WGH. The doctor alleged that WGH had submitted bills to Medicare and Medicaid programs for services provided by resident doctors without the level of supervision required by federal law. The federal and state governments initiated an investigation based upon the doctor’s allegations.
According to the settlement agreement signed on August 29, 2013, the federal and state governments alleged that WGH wrongfully submitted claims to the Medicare, Medicaid, and TRICARE programs for services provided to federal beneficiaries at WGH and PMC, during the time period from April 1, 2008, through March 31, 2011, by resident doctors participating in the Family Practice Residency Program (“FPRP”) sponsored by the John A. Burns School of Medicine, without satisfactory documentation of the required supervision by the FPRP’s teaching faculty or where the coding of services performed could not be confirmed by the doctors’ entries in the patients’ medical records. While WGH agreed to the settlement, it did not admit liability. Under the terms of the settlement agreement, WGH shall pay the federal government a settlement payment of $451,428.00. WGH also agreed to pay $75,000.00 in attorney’s fees and costs to the attorneys who represented the doctor.
Florence T. Nakakuni, United States Attorney for the District of Hawaii, noted that under the federal False Claims Act, the United States can seek up to triple damages, plus penalties, for false and fraudulent claims for payment that are submitted to government programs. To encourage assistance from the public, the False Claims Act allows private persons bring civil lawsuits on behalf of the government and to receive a share of any damages recovered through the lawsuit if the person substantially contributes to the successful prosecution of the action. In this case, the doctor who initiated the lawsuits will receive $84,642.75 of the $451,428.00 settlement payment. Nakakuni praised the doctor for his courage in coming forward and reporting the alleged wrongdoing, and expressed appreciation for the efforts of his attorneys, Margery Bronster, Esq., and Sunny Lee, Esq., both of Honolulu.
Wade McFaul, Assistant Special Agent in Charge for the U.S. Department of Health and Human Services, Office of Inspector General region including Hawaii, stated: "We will work tirelessly to protect the taxpayers and these vitally important federal health care programs. Working with law enforcement partners, our investigators, auditors and attorneys uncovered evidence that WGH allegedly submitted bills to Medicare for services performed by resident doctors without properly documenting the required supervision."
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New York-based Imagimed LLC, the company’s former owners, William B. Wolf III and Dr. Timothy J. Greenan, and the company’s former chief radiologist, Dr. Steven Winter, will pay $3.57 million to resolve allegations that they submitted to federal healthcare programs false claims for magnetic resonance imaging (MRI) services, the Justice Department announced today. Imagimed owns and operates fifteen MRI facilities, located primarily in New York state, under the name “Open MRI.”
Allegedly, from July 1, 2001, through April 23, 2008, Imagimed, Greenan, Wolf and Winter submitted claims to Medicare, Medicaid and TRICARE for MRI scans performed with a contrast dye without the direct supervision of a qualified physician. Since a potential adverse side effect of contrast dye is anaphylactic shock, federal regulations require that a physician supervise the administration of contrast dye when it is used for an MRI. Also, allegedly, from July 1, 2005, to April 23, 2008, Imagimed, Greenan, Wolf and Winter submitted claims for services referred to Imagimed by physicians with whom Imagimed had improper financial relationships. In exchange for these referrals, Imagimed entered into sham on-call arrangements, provided pre-authorization services without charge and provided various gifts to certain referring physicians, in violation of the Stark Law and the Anti-Kickback Statute.
“The Department of Justice is committed to guarding against abuse of federal healthcare programs,” said Stuart F. Delery, Assistant Attorney General for the Civil Division. “We will help protect patients’ health by ensuring doctors who submit claims to federal healthcare programs follow proper safety precautions at all times.”
U.S. Attorney for the Northern District of New York, Richard S. Hartunian said: “This case is an example of our commitment to using all of the remedies available, including civil actions under the False Claims Act, to ensure patient safety and combat health care fraud. Stripping away the profit motive for circumventing physician supervision requirements has both a remedial and a deterrent effect. The settlement announced today advances our critical interest in both the integrity of our health care system and the safe delivery of medical services.”
The allegations resolved by the settlement were brought in a lawsuit filed under the False Claims Act’s whistleblower provisions, which permit private parties to sue for false claims on behalf of the government and to share in any recovery. The whistleblower in this case, Dr. Patrick Lynch, was a local radiologist and will receive $565,500.
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. 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 this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $14.8 billion through False Claims Act cases, with more than $10.8 billion of that amount recovered in cases involving fraud against federal health care programs.
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Source- http://www.justice.gov/usao/txn/PressRelease/2013/AUG2013/aug27Tuan_Truong_plea.html
Defendant Worked as a Pediatric Dental Provider at Kool Smiles and Personally Benefitted From Scheme
ABILENE, Texas — A dentist who practiced pediatric dentistry at Kool Smiles in Abilene, Texas, has admitted that he made false and fraudulent statements and entries on patient records, which caused Medicaid to be billed for, and pay, at least $120,000 for services falsely claimed to have been performed, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Dr. Tuan Truong, aka “Terry Truong,” of Abilene, pleaded guilty this afternoon, before U.S. District Judge Jorge A. Solis, to an information charging one count of making a false statement in connection with a health care matter. Truong, who will remain on bond, faces a maximum statutory penalty of five years in federal prison, a $250,000 fine and restitution. A sentencing date was not set.
According to documents filed in the case, in summer 2008, Truong began working for Kool Smiles, which paid him a base salary and offered opportunities for bonuses based on additional procedures he performed in excess of daily targets set by Kool Smiles management. Dentists were required to use professional judgment in the treatment and management of patient care.
Beginning on June 30, 2008, and continuing to July 10, 2009, Truong made false entries on Kool Smiles patient records, purporting to have performed dental services for Medicaid beneficiaries that he well knew he had not performed. As a result of the false and fraudulent statements and entries Truong made, Kool Smiles billed Medicaid for procedures that were not performed. In fact, during this time period, Truong made false entries in the Kool Smiles electronic database that caused Kool Smiles to bill and receive payment from Medicaid (and Medicaid affiliates) of more than $120,000, but less than $200,000 for services he claimed to have performed, but did not.
In addition, according to the factual resume filed, Truong personally benefitted from this scheme by receiving bonuses of $32,749 to which he would not have been otherwise entitled.
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Source- http://www.justice.gov/usao/co/news/2013/aug/8-26-13.html
DENVER – Joel E. Miller, age 55, of Craig, Colorado, was arrested without incident today on charges of health care fraud, money laundering and distributing/dispensing controlled substances, federal and state authorities announced. Miller was indicted by federal grand jury in Denver on August 21, 2013, which remained under seal until his arrest and first court appearance. Miller was arrested without incident in Steamboat Springs, Colorado. He made his initial appearance this afternoon before a U.S. Magistrate Judge in Grand Junction, where he was advised of his rights and the charges pending against him.
According to the indictment, Miller was a licensed physician in the state of Colorado and obtained Doctor of Osteopathic Medicine (D.O.) degree in 1990. He was licensed to practice medicine in Colorado in 1994. In 2003 he practiced medicine in Moffat County, Colorado and in 2008, Miller opened a solo private medical practice located in Craig, Colorado. The legal name of his business was DODXRX, doing business as High Country Medical.
In September 2009, the State of Colorado Board of Medical Examiners (“Board”) entered a Stipulation and Final Agency Order in which the Board issued a Letter of Admonition against Miller based upon findings he mis-prescribed neuropsychiatric medications to certain patients. The Board ordered Miller, among other things, to attend a continuing medical education course “in the area of prescribing” and provide proof of completion of such a course. In March of 2011, Miller sent a letter to the Board acknowledging completion of the ordered course.
Approximately between May 2008 and September 2012, Miller executed and attempted to execute a scheme to defraud health care benefit programs, namely Medicaid, Medicare, and commercial health care plans. Particularly, Miller prescribed controlled substances to patients without determining a sufficient medical necessity for the prescription of controlled substances; prescribed controlled substances to patients in a manner which was inconsistent with the usual course of professional practice and for other than legitimate medical purpose; and prescribed pharmaceuticals to patients for whom the prescription was not intended, and directed the persons to whom he prescribed the pharmaceuticals to give the prescription to third parties.
Furthermore, Miller prescribed controlled substances in quantities and dosages that would cause patients to abuse, misuse, and become addicted to the controlled substances. He also pre-signed prescriptions and allowed office employees to distribute controlled substance prescriptions to patients in his absence and without a doctor’s examination of the patient. According to the indictment, in August of 2010, Miller dispensed and distributed to a patient hydrocodone (Schedule III controlled substance), alprazolam and clonazepam, (both Schedule IV controlled substances) which resulted in the death of the patient. The indictment also alleges that in May 2012, Miller dispensed and distributed to a patient hydrocodone (Schedule III controlled substance), and diazepam (a Schedule IV controlled substance) which also resulted in death.
“Defrauding our health care system, causing the cost of care to increase is one thing,” said U.S. Attorney John Walsh. “It is quite another when a doctor over prescribes prescription medication that, as alleged in this case, causes patients to be addicted, and in two cases here, die.”
"Dr. Joel E. Miller's over prescribing and distribution of licit drugs is no different than the drug traffickers that DEA targets," said Drug Enforcement Administration Denver Special Agent in Charge Barbra Roach. "Dr. Miller destroyed the life of at least two patients, has hurt many other patients and disguised his drug dealing by conducting those activities in his professional office and while wearing a doctor's coat. DEA will continue to target "drug dealers" no matter their social or professional status."
"Crimes like this are motivated purely by greed and the patients are the real victims in this case," said Stephen Boyd, Special Agent in Charge, IRS Criminal Investigation, Denver Field Office. "Prescription drug abuse is a serious problem and we are committed to investigate along with our law enforcement partners those individuals who are responsible for the illegal distribution of prescription medicine."
“Many people in Moffat County were directly negatively affected by the actions of Dr. Miller,” said Moffat County Sheriff Tim Jantz. “Some in our community were caused great harm and pain, which will never go away for those families. Hopefully this arrest and indictment will bring some closure to those affected by his actions.”
Miller was charged with thirty four counts as follows; one count of health care fraud with death resulting, which carries a penalty of life in prison, and up to a $250,000 fine; eight counts of health care fraud, which carries a penalty of not more than 10 years in federal prison, and a fine of up to $250,000 per count; ten counts of money laundering, which carries a penalty of not more than 20 years in federal prison, and a fine of up to $500,000 or twice the value of the property involved, per count; two counts of dispensing of controlled substances resulting in death, which carries a penalty of not less than 20 years, and up to life in federal prison, and up to a $1,000,000 fine; seven counts of dispensing of controlled substances, which carries a penalty of not more than 20 years in federal prison, and up to a $1,000,000 fine; dispensing of controlled substances, which carries a penalty of not more than 10 years in federal prison, and up to a $250,000 fine; one count of dispensing a controlled substance, which carries a penalty of not more than 10 years in federal prison, and up to a $500,000 fine; and one count of furnishing false and fraudulent material information, which carries a penalty of not more than 4 years in federal prison, and up to a $250,000 fine. The indictment also includes an asset forfeiture allegation.
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Source- http://www.justice.gov/opa/pr/2013/August/13-crm-957.html
A former owner of a Los Angeles-area medical equipment supply company pleaded guilty today to a $2.6 million Medicare fraud scheme.
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 Office of Inspector General (HHS-OIG); and Assistant Director in Charge Bill L. Lewis of the FBI’s Los Angeles Field Office made the announcement.
Akinola Afolabi, 54, of Long Beach, Calif., pleaded guilty before U.S. District Judge Philip S. Gutierrez in the Central District of California to one count of health care fraud.
According to court documents, Afolabi was the owner and president of Emmanuel Medical Supply, a durable medical equipment (DME) supply company located in Long Beach. Afolabi admitted that from approximately June 2006 through September 2009, he engaged in a scheme to commit health care fraud through the operation of Emmanuel by providing medically unnecessary power wheelchairs and other DME to Medicare beneficiaries and by submitting false and fraudulent claims to Medicare. Afolabi admitted that he obtained Medicare beneficiary information through various means, including “marketers,” whom he paid to refer Medicare beneficiaries to Emmanuel for the purpose of using that information to submit, and cause the submission of, false and fraudulent claims to Medicare on behalf of Emmanuel. Afolabi admitted knowing that the prescriptions and medical documents were fraudulent and that some of the beneficiaries did not receive the DME, yet he certified to Medicare with the submission of each claim that the DME was received and was medically necessary.
From approximately June 7, 2006, through Sept. 28, 2009, Afolabi, through Emmanuel, submitted approximately $2,668,384 in fraudulent claims to Medicare for power wheelchairs and related services, and Medicare paid Emmanuel approximately $1,490,532 on those claims.
At sentencing, scheduled for Nov. 25, 2013, Afolabi faces a maximum penalty of 10 years in prison and a $250,000 fine.
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