Source- http://www.justice.gov/opa/pr/2013/November/13-crm-1191.html
The owner of a Detroit-area home health care agency was sentenced today to serve 65 months in prison for her leading role in a $2.2 million Medicare 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 Paul M. Abbate 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) Office of Investigations’ Detroit Office made the announcement.
Mehran Javidan, 51, was sentenced by U.S. District Judge Denise Page Hood in the Eastern District of Michigan. In addition to her prison term, Javidan was sentenced to serve three years of supervised release and was ordered to pay $2.2 million in restitution, jointly and severally with her co-defendants.
Javidan was convicted by a federal jury on April 2, 2013, of one count of conspiracy to commit health care fraud, three counts of health care fraud, three counts of making false statements related to health care matters and one count of conspiracy to solicit or pay health care kickbacks in exchange for referrals of patients to home health care company Acure Home Care Inc. (Acure). The jury found Javidan not guilty of one count of making false statements and one count of health care fraud and did not reach a verdict on one additional count of health care fraud.
Javidan was initially charged along with two other defendants in an indictment unsealed on Feb. 17, 2011, as part of a nationwide Medicare fraud takedown. One co-defendant was also convicted on April 2, 2013, while the other remains a fugitive.
According to evidence presented at trial, Javidan owned and operated Acure, a home health care company in Oak Park, Mich., and later Troy, Mich. Javidan paid doctors to refer non-homebound patients for physical therapy treatment that was medically unnecessary. The evidence showed that she also paid patient recruiters to obtain Medicare information and pre-signed physical therapy documents from Medicare beneficiaries. The recruiters for Acure obtained the Medicare information and pre-signed forms by paying patients in cash and by promising that the referring doctors would prescribe them narcotic prescriptions.
Evidence presented at trial established that Javidan paid physical therapists and physical therapy assistants employed by Acure to create false and fraudulent physical therapy files using the blank, pre-signed forms to make it appear as if physical therapy services were actually rendered, when in fact, the services had not been rendered.
Javidan then directed the submission of Acure’s falsified billing to Medicare. Acure was paid more than $2.2 million from Medicare between December 2008 and November 2010.
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Source- http://www.justice.gov/opa/pr/2013/November/13-crm-1195.html
Detroit-area resident Javed Rehman was sentenced to serve 60 months in prison today for his role in a $13.8 million Medicare 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 Paul M. Abbate 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) Office of Investigations’ Detroit Office made the announcement.
Rehman, 50, of Farmington Hills, Mich., was sentenced by U.S. District Judge Gerald E. Rosen in the Eastern District of Michigan. In addition to his prison term, Rehman was sentenced to serve two years of supervised release and was ordered to pay $1,734,801 in restitution, jointly and severally with his co-defendants. Rehman pleaded guilty on July 12, 2013, before Judge Rosen to one count of conspiracy to commit health care fraud.
According to court records, in or around May 2009, Rehman purchased Quantum Home Care Inc. with co-conspirators Tausif Rahman and Muhammad Ahmad. Rehman paid kickbacks to recruiters to obtain Medicare beneficiary information used to bill Medicare for home health services – including physical therapy and skilled nursing services – that were never rendered. Rehman was the administrator of Quantum and was responsible for the submission of false and fraudulent claims to Medicare based on falsified files created by the co-conspirators.
Medicare paid approximately $1.7 million to Quantum for physical therapy and skilled nursing services that Quantum purported to render between approximately June 2009 and September 2011. According to court documents, between 2008 and 2009, Rehman’s co-conspirators acquired control of three other home health care companies. The four companies, including Quantum, received approximately $13.8 million from Medicare in the course of the conspiracy.
Rahman pleaded guilty on Jan. 5, 2012, to one count of conspiracy to commit health care fraud and one count of money laundering and is scheduled for sentencing on May 21, 2014. Ahmad pleaded guilty on Aug. 28, 2012, to one count of conspiracy to commit health care fraud and is scheduled for sentencing on May 14, 2014.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2013%20November/131107%20-%20Lumbreras.html
McALLEN, Texas – Two former clinic staffers and a physician assistant’s wife have all been ordered to prison for conspiracy to defraud Medicare and the Texas Medicaid program in the operation of the Mission Clinic and La Hacienda Family Clinic, announced United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott.
Eliza Lozano Lumbreras, 46, and San Juanita Gallegos Lozano, 57, a couple who operated the Mission Clinic, were in the midst of trial in late 2012, when they opted to enter guilty pleas for their roles in the conspiracy. Manuel Anthony Puig, 48, and Romelia Puig, 45, both of Edinburg, operated La Hacienda Family Clinic near Alton and both previously pleaded guilty in advance of trial.
Today, Chief U.S. District Judge Ricardo H. Hinojosa sentenced Lumbreras and Lozano to 50 and 33 months in federal prison, respectively. In addition to the prison terms, Judge Hinojosa ordered they pay $371,720.16 in restitution to Medicare and Medicaid for the false and fraudulent claims they submitted or caused to be submitted to the health care programs. Romelia Puig was ordered to pay $185,881.75 in restitution and received a sentence of 18 months. All will also serve three-year-terms of supervised release upon completion of their prison sentences. Manuel Puig will be sentenced Tuesday, Nov. 12, 2013 at 2:30 p.m.
Lumbreras and Lozano conspired together and with the others to submit claims to Medicare and Medicaid using the Medicaid provider number of a medical doctor who for years before his death, was unable to practice medicine. In fact, the doctor suffered from Parkinson’s disease and associated Dementia and had been mentally incompetent to practice medicine since September 2001. Although the doctor was unable to practice, they kept the Mission Clinic open for patient care. Lumbreras and Lozano took the doctor to the Mission Clinic and placed him in an office while Lumbreras saw and treated patients. Neither Lumbreras or Lozano were licensed to provide any medical services. The government’s evidence showed that between September 2001 and January 2006, Lumbreras and Lozano submitted bills to the Medicare and Medicaid programs which fraudulently claimed the doctor had provided patients with more than 13,000 medical benefits, items or services when in fact those services had been provided by Lumbreras or not at all. As a result, Medicare and Medicaid paid more than $344,000 on those claims.
Beginning in April 2005, Lumbreras and Lozano also arranged for Manual Puig to operate La Hacienda Family Clinic in Alton and to send bills to Medicare and Medicaid using the provider number of that same unpracticing doctor. Manuel Puig is physician assistant. By state law, a licensed physician is required to supervise and delegate work to a physician assistant and to be responsible for the physician assistant. At his plea hearing, Manuel Puig admitted he joined the ongoing conspiracy, admitting to fraudulently using the Medicaid provider number of that doctor who was unable to practice medicine nor provide any health care benefits, items or services; who did not delegate authority to Manuel Puig to provide any health care benefits, items or services; and who did not supervise Puig’s attempts to provide health care benefits, items or services.
Romelia Puig admitted that between May 2005 and January 2006, she was the biller at La Hacienda Family Clinic and that she submitted or caused to be submitted more than 6,000 claims to Medicare and Medicaid fraudulently using that Texas Medical provider number for which Medicare and Medicaid paid approximately $173,830.56.
Lumbreras had access to the doctor’s bank accounts and was able to obtain control over the money Medicare and Medicaid paid for the fraudulent bills submitted from the Mission and La Hacienda clinics, which was divided among Lumbreras, Lozano, their families, Puig and his wife.
Previously released on bond, all were allowed to remain on bond and voluntarily surrender to a U.S. Bureau of Prisons facility to be determined in the near future.
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Source- http://www.justice.gov/opa/pr/2013/November/13-crm-1184.html
A patient broker of a South Florida psychiatric hospital was sentenced today to serve 24 months in prison followed by three years of supervised release for her participation in a $67 million Medicare fraud scheme.
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 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.
Gloria Himmons, 54, of Union Springs, Ala., was sentenced by U.S. District Judge Jose E. Martinez in the Southern District of Florida. In March 2013, Himmons pleaded guilty to one count of conspiracy to receive health care kickbacks and one count of receiving a health care kickback. In addition to her prison term, Himmons was ordered to pay $14 million in restitution, joint and severally with her co-defendants.
According to court documents, Himmons was a patient broker at Hollywood Pavilion LLC (HP), a state-licensed psychiatric hospital in South Florida that purported to offer both inpatient and outpatient mental health services. Himmons would provide Medicare beneficiaries to HP in exchange for bribes and kickbacks, and she knew that the patients she provided to HP were not appropriate for inpatient psychiatric hospitalization or for outpatient mental health treatment. The patients she provided to HP included those who were not severely mentally ill, as well as substance abusers looking for rehabilitation programs. The patients did not have legitimate referrals from hospitals or doctors who had been treating acute-phase, severe mental illness.
From at least 2005 through September 2012, in exchange for bribes and kickbacks, Himmons knowingly and willfully provided to HP Medicare beneficiaries who did not need inpatient or outpatient psychiatric treatment. As a result of Himmons’s participation in this scheme, HP was improperly paid more than $7 million by Medicare. From at least 2003 through at least August 2012, HP billed Medicare approximately $67 million for services that were not properly rendered, for patients that did not qualify for the services being billed, and for claims for patients who were procured through bribes and kickbacks. Medicare reimbursed HP on approximately $40 million of those claims.
On Sept. 10, 2013, co-defendants Karen Kallen-Zury, Daisy Miller and Christian Coloma were sentenced on their June 2013 jury convictions. Kallen-Zury, the chief executive officer of HP, and Miller and Coloma were convicted on all counts at trial and sentenced to 300 months, 180 months and 144 months, respectively. Kallen-Zury and Miller were ordered to pay, jointly and severally with their co-defendants, nearly $40 million in restitution. Coloma was ordered to pay, jointly and severally, more than $20 million in restitution.
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Source- http://www.justice.gov/opa/pr/2013/November/13-civ-1179.html
Hospice of the Comforter Inc. (HOTCI) has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program for hospice services provided to patients who were not eligible for the Medicare hospice benefit, the Justice Department announced today. HOTCI is headquartered in Altamonte Springs, Fla., and provides hospice services to patients residing in Seminole, Osceola and Orange counties in Florida.
“This settlement is a result of the Justice Department’s continuing efforts to prevent the abuse of the taxpayer-funded Medicare hospice program, which is intended to provide comfort and care to terminally ill persons during the last six months of their lives,” said Assistant Attorney General for the Civil Division Stuart F. Delery. “We will pursue those who seek to misuse this important benefit for their own enrichment.”
The government alleged that between December 2005 and December 2010, HOTCI engaged in practices that resulted in billing Medicare for patients who were not terminally ill. Specifically, HOTCI allegedly directed its staff to admit all referred patients without regard to whether they were eligible for the Medicare hospice benefit, falsified medical records to make it appear that certain patients were eligible for the benefit when they were not, employed field nurses without hospice training, established procedures to limit physicians’ roles in assessing patients’ terminal status and delayed discharging patients when they became ineligible for the benefit.
As part of this settlement, HOTCI has agreed to enter into a Corporate Integrity Agreement with the Inspector General of the Department of Health and Human Services that provides for procedures and reviews to be put in place to promptly detect and prevent future conduct similar to that which gave rise to the settlement. In addition, HOTCI’s former Chief Executive Officer Robert Wilson has agreed to a three-year, voluntary exclusion from Medicare, Medicaid and other federal health care programs.
“This settlement represents a fair and appropriate resolution of this troubling matter,” said Acting U.S. Attorney for the Middle District of Florida A. Lee Bentley III. “Hospice providers in our district should be on notice that our office will do what it takes to protect our citizens from this kind of misconduct.”
“Hospice care is a sacred trust from which no provider should fraudulently profit,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson. “Claiming tax dollars for people who are not terminally ill ?? and therefore ineligible for hospice care ?? cannot be tolerated.”
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 $16.7 billion through False Claims Act cases, with more than $11.9 billion of that amount recovered in cases involving fraud against federal health care programs.
The allegations settled today arose from a lawsuit filed by a former HOTCI employee, Douglas Stone, under the qui tam, or whistleblower, provisions of the False Claims Act. Under the act, private citizens can bring suit on behalf of the government for false claims and share in any recovery. Stone’s share of the recovery has not been determined.
This matter was handled by the Justice Department’s Civil Division, Commercial Litigation Branch; the U.S. Attorney’s Office for the Middle District of Florida and the Department of Health and Human Services Office of the Inspector General.
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Source- http://www.justice.gov/usao/txn/PressRelease/2013/NOV2013/nov4Comfort_Gates_trial.html
DALLAS — Comfort Gates, 48, was sentenced this afternoon, by U.S District Judge David C. Godbey, to 72 months in federal prison and ordered to pay $830,000 in restitution following her conviction at trial in April 2013 on charges stemming from her involvement in the operation of Euless Healthcare Corporation (EHC) and Medic Healthcare Incorporated (Medic). Gates is one six defendants convicted in the conspiracy. Judge Godbey ordered that Gates, a current resident of Houston, surrender to the Bureau of Prisons on January 13, 2014. Today’s announcement was made by U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Gates, an employee of Medic, and coconspirator Godwin Umotong, 58, an employee of EHC and Medic, were each convicted at trial on one count of conspiracy to commit health care fraud. Gates was also convicted on two counts of health care fraud and Umotong was also convicted on five counts of health care fraud. Umotong is scheduled to be sentenced on December 2, 2013; he faces a maximum statutory penalty of 10 years in federal prison and a $250,000 fine on each of the counts of conviction. He could also be ordered to pay restitution.
Other defendants in the case who have been convicted and sentenced are listed below. Each was also ordered to pay restitution of amounts ranging from approximately $195,000 to $1.4 million.
Ovsanna Agopian, 58, Houston, 120 months in federal prison
Boghos Babadjanian, 55, of Sherman Oaks, Calif., probation
Leslie Omagbemi, 56, of Dallas, 30 months in federal prison
Munda Massaquoi, 69, of Houston, 37 months in federal prison
ECH was located on West Bedford Euless Road in Hurst Texas, and Medic, which operated from October 2009 to May 2011, was located on Bonhomme Road in Houston. Agopian, 58, was the operator of both EHC and Medic.
According to documents filed in the case and evidence presented at trial, Agopian, Umotong, Omagbemi, Massaquoi and Gates conspired together to submit, or cause to be submitted, fraudulent claims to Medicare for diagnostic tests and office visits. Agopian recruited unlicensed doctors to work for EHC and Medic by telling them that they would treat beneficiaries in the beneficiaries’ homes. Medicare does not pay for services performed by unlicensed persons. Nevertheless, these recruits went to beneficiaries’ homes and purported to conduct medical examinations, including ordering diagnostic tests. In total, more than $2.7 million was fraudulently billed, and of that amount, Medicare paid more than $1.3 million.
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Source- http://www.justice.gov/opa/pr/2013/November/13-crm-1167.html
The owner of a Louisiana medical equipment supply company and a marketer who worked for the company have been indicted for allegedly engaging in a $3 million Medicare fraud scheme.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, Special Agent in Charge Mike Fields of the Dallas Region of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), and Special Agent in Charge Michael Anderson of the FBI’s New Orleans Division made the announcement.
Tracy Brown, 43, of New Orleans, and Sandra Parkman Thompson, 62, who is currently incarcerated in Texas, were charged in the Eastern District of Louisiana in an 18-count indictment including charges of health care fraud, conspiracy to commit health care fraud, conspiracy to pay and receive health care fraud kickbacks, and illegal remuneration. If convicted, the defendants face 10 years in prison for each health care fraud conspiracy and health care fraud count, and five years in prison for each remaining count.
According to the indictment, Brown owned Psalms 23-DME and is alleged to have billed Medicare more than $3 million for power wheelchairs, wheelchair accessories and orthotic equipment for Medicare beneficiaries who neither wanted nor needed the equipment. Brown also allegedly paid illegal kickbacks to Thompson and other “marketers” to locate doctors who were willing to prescribe the equipment to Medicare beneficiaries who did not want or need these items. Thompson and other marketers were paid for each prescription they obtained for Psalms 23-DME, regardless of whether the items prescribed were wanted or needed.
Thompson and other marketers allegedly obtained falsified prescriptions for medically unnecessary equipment from Drs. Anthony Jase and Michael Hunter. A third physician allegedly provided falsified prescriptions directly to Brown. In exchange, Brown paid this physician approximately $250 per prescription.
The indictment alleges that in some cases, the equipment Psalms 23-DME billed to Medicare was never provided to a Medicare beneficiary. In other cases, Brown would bill for the most expensive types of durable medical equipment allowed by Medicare but would provide Medicare beneficiaries with much less expensive versions of the equipment, which would not have been reimbursed by Medicare.
According to the indictment, Brown allegedly paid Thompson and other marketers approximately $500 for each wheelchair referral submitted and between approximately $200 and $250 for a so-called “arthritis kit” referral, a term used by Psalms 23-DME for a number of braces and other orthotic items that were billed for Medicare beneficiaries regardless of medical need or physician request.
Jase and Hunter pleaded guilty to health care fraud charges on Oct. 31, 2013, and Sept. 26, 2012, respectively, and are awaiting sentencing.
An indictment is merely an accusation and defendants are presumed innocent until and unless they are proven guilty.
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Source- http://www.justice.gov/usao/nys/pressreleases/November13/panosspyrosplea.php
Preet Bharara, the United States Attorney for the Southern District of New York, announced that DR. SPYROS PANOS, an orthopedic surgeon, pled guilty today in White Plains federal court before U.S. District Judge Nelson S. Roman to operating a long-running health care fraud scheme in which PANOS defrauded Medicare, the New York State Insurance Fund, and numerous private health insurance providers (the “Health Insurance Providers”) out of over $2.5 million by systematically lying about the nature and scope of the surgical procedures that he performed.
Manhattan U.S. Attorney Preet Bharara said: “Dr. Panos was brazen in his fraud on federal, state, and private health insurance providers. He filed claims for thousands of surgical procedures, often more than 20 a day, billing a total of over $35 million, when he actually performed lesser procedures, or none at all. We and our law enforcement partners finally put a halt to his abuses.”
According to the Information and other documents filed in this case:
PANOS was a board certified orthopedic surgeon licensed to practice medicine in the State of New York who was part a medical group with offices in Dutchess County, New York, (the “Medical Group”) and performed orthopedic surgical procedures (“Surgical Procedures”) at hospitals in Poughkeepsie, New York. From at least 2006 through July 2011, PANOS maintained a high-volume orthopedic practice, which enabled him to carry out his fraud scheme on a large scale. Panos performed thousands of Surgical Procedures, and often as many as 20 or more in a single day, for which he and the Medical Group submitted claims in excess of $35 million to Health Care Providers. Health Care Providers paid the Medical Group in excess of $13 million on these claims.
To receive payments for Surgical Procedures from the Health Insurance Providers, PANOS was required to submit, and caused the Medical Group to submit, information to the Health Insurance Providers regarding the nature and details of the Surgical Procedures. With respect to many of the Surgical Procedures he performed, PANOS furnished, and caused the Medical Group to furnish, false information to Health Insurance Providers that resulted in the Health Insurance Providers paying the Medical Group at least $2.5 million more than PANOS and the Medical Group were entitled to receive based on the true nature and details of the Surgical Procedures PANOS performed. Among PANOS’s false representations were the following:
a. PANOS claimed he performed open surgeries, when in fact PANOS performed the surgeries arthroscopically;
b. PANOS claimed he used certain techniques and procedures during the course of the Surgical Procedures, when in fact PANOS did not, either because they were not medically necessary or because PANOS used other techniques and procedures that would have resulted in lower payments, if any, from the Health Insurance Providers; and
c. PANOS removed body tissue, known in the medical field as loose bodies, in excess of certain size criteria, when in fact PANOS either removed no loose bodies or removed loose bodies that were smaller than the thresholds set by the Health Insurance Providers for payment.
PANOS, was compensated handsomely -- during the years 2007 through 2011, he was paid over $7.5 million by the Medical Group, a number that was inflated as a result of his fraud scheme.
Beginning in or about December 2010, PANOS attempted to conceal his scheme by, among other things, falsely representing to the Medical Group that the Fraudulent Claims were the result of clerical errors.
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PANOS, 45, of Hopewell Junction, New York, faces a maximum sentence of 10 years in prison. PANOS agreed to the entry of a $5 million order of forfeiture against him, representing the approximate proceeds of his charged crime. As a result of his conviction, PANOS is subject to mandatory exclusion from participation in any Federal health care program, including Medicare and Medicaid, and he has agreed not to oppose a request by the Government that, as part of his sentence, the Court prohibit him from practicing medicine as a condition of probation or supervised release. Following the uncovering of the scheme, Panos surrendered his New York State medical license. As part of his plea agreement, PANOS must take any reasonable steps necessary to ensure that his Connecticut, Pennsylvania, and Virginia medical licenses are revoked, surrendered, or suspended by the time of sentencing. PANOS is scheduled to be sentenced by U.S. District Court Judge Roman on March 7, 2014.
Mr. Bharara praised the work of the United States Postal Inspection Service, the United States Department of Health and Human Services – Office of Inspector General, and the Federal Bureau of Investigation, and thanked the United States Department of Health and Human Services, Office of Counsel to the Inspector General, the New York State Insurance Fund, and the New York Workers’ Compensation Board Office of the Fraud Inspector General for their extraordinary assistance in the investigation.
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Source- http://www.justice.gov/opa/pr/2013/October/13-crm-1162.html
A federal jury in Houston has convicted Gwendolyn Climmons-Johnson, 53, of multiple counts of health care fraud for submitting false and fraudulent claims to Medicare for ambulance services.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division and U.S. Attorney Kenneth Magidson of the Southern District of Texas made the announcement.
After a three-day trial, the jury convicted Climmons-Johnson on Oct. 30, 2013, of one count of conspiracy to commit health care fraud and four counts of health care fraud. She faces a maximum penalty of 10 years in prison for each count when she is sentenced on Feb. 7, 2014.
According to evidence presented at trial, Climmons-Johnson was the owner and operator of Urgent Response EMS (Urgent Response), a Texas-based entity that purportedly provided non-emergency ambulance services to Medicare beneficiaries in the Houston area. The evidence showed that from January 2010 through December 2011, Climmons-Johnson and others conspired to unlawfully enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and/or not provided. Climmons-Johnson, who controlled the day-to-day operations of Urgent Response, submitted, and caused to be submitted, approximately $2.4 million in fraudulent ambulance service claims to Medicare.
At trial, the evidence showed that patient records had been falsified and the Medicare beneficiaries for whom Climmons-Johnson had billed ambulance services did not need ambulance services and were not in the condition stated in the records.
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