Source- http://www.justice.gov/usao/fls/PressReleases/130613-01.html
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Michael B. Steinbach, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced the sentencing of defendant Kathryn Abbate, 64, of Hollywood, FL, to 42 months in prison, to be followed by 3 years of supervised release.
According to the factual proffer, the defendant served as Chief Executive Officer (CEO) of the Miami Beach Community Health Center (the Center) from 2002 to mid-2012. The Center was a Federally Qualified Health Center (FQHC) during this time, and was a community-based organization providing medical care to persons regardless of ability to pay or insurance status. As an FQHC, the Center received millions of dollars of federal funding each year from 2008 to 2012
According to the factual proffer, from about 2008 through May 2012, Abbate embezzled money from the Center in a number of ways. First, Abbate caused the Center to pay her non-accrued vacation pay and other forms of compensation, totaling more than $3 million from between 2008 and 2012. Second, Abbate embezzled money from the Center by causing non-payroll checks to be issued payable to her. Specifically, from 2007 to 2012, Abbate caused the Center to disburse approximately 837 checks made payable to her totaling approximately $3 million for purported “community development.”
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Source- http://www.justice.gov/usao/ma/news/2013/June/TerrellIleneindictmentPR.html
BOSTON – A Virginia woman was charged today with making a false declaration to a grand jury.
Ilene Terrell, 65, of Fredericksburg, Va., was indicted with making a false declaration to a grand jury.
The indictment alleges that Terrell, a podiatrist, and representatives of Orthofix, Inc., manipulated patient medical records to induce Medicare to pay for claims for Orthofix bone growth stimulator medical devices that did not meet Medicare’s payment guidelines. When Terrell was asked about these matters before the grand jury, she lied, claiming that she was not aware that any records had been manipulated. Bone growth stimulators are externally-worn medical devices that help regenerate bone cells and are used to assist the healing of broken bones. Medicare only pays for a bone growth stimulator if the medical supplier provides records demonstrating that fracture healing has ceased for three or more months. If the bone may heal on its own, Medicare will not pay for a stimulator, which can cost upwards of $4,000.
On numerous occasions, Terrell prescribed a stimulator for a patient where the claim would not have met Medicare’s guidelines. When this occurred, the Orthofix territory manager, Terrell, and an employee at Terrell’s direction often manipulated the patient’s medical records, making it appear as though the stimulator was not prescribed until three months had elapsed without healing, when in fact that was not true and Medicare should not have paid the claim. On some occasions, Terrell prescribed a stimulator for a patient and the patient’s bone healed within the prohibited three-month window. When that occurred, Terrell, an Orthofix representative, and an employee at Terrell’s direction deleted references in chart notes that the patient was using the stimulator and was healing, and they created a new, fictitious note at the end of the 90-day period stating that the bone was still broken and that a stimulator would be ordered. Terrell also created fictitious prescriptions to support the bogus claims.
On May 22, 2012, Terrell testified before the grand jury. She was asked several times if she was aware that patient records had been manipulated. Terrell lied to the grand jury, emphatically denying that she manipulated patient records or that she was even aware that anyone had done so. Terrell lied about other matters as well, including her communications with an Orthofix representative about the government’s investigation and her role in obstructing an audit performed by Orthofix when the company requested that she provide medical records related to claims for bone growth stimulators.
If convicted, Terrell faces a statutory maximum penalty of five years in prison, to be followed by three years of supervised release and a $250,000 fine on each count.
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Source- http://www.justice.gov/usao/nj/Press/files/Siripurapu,%20Padma%20Plea%20News%20Release.html
NEWARK, N.J. – A Somerset County doctor practicing internal medicine at Newark Community Health Center, where she is the clinical director, today admitted receiving cash kickbacks for diagnostic testing referrals of her patients, U.S. Attorney Paul J. Fishman announced.
Padma Siripurapu, 46, of Belle Mead, N.J., pleaded guilty to an information charging her with one count of soliciting and receiving more than $50,000 in illegal cash kickbacks for patient referrals in violation of the federal health care anti-kickback statute.
According to documents filed in this case and statements made in court:
From 2009 through December 2011, Siripurapu agreed with representatives of the diagnostic center Orange Community MRI LLC (Orange MRI) that Orange MRI would pay her a set amount of cash for every MRI, CAT scan, ultrasound, echocardiogram, and DEXA scan she referred. Siripurapu referred patients for more than a thousand of these tests during that time period and was paid a per-test amount for those referrals.
Siripurapu admitted that on Nov. 2, 2011, she received $3,600 in cash from a government informant at her doctor’s office in Newark in exchange for referrals. On Nov. 17, 2011, again at her office in Newark, Siripurapu received another kickback for patient referrals, this time $3,450 in cash.
The anti-kickback charge carries a maximum potential penalty of five years in prison and a maximum $250,000 fine, or twice the gain or loss caused by the offense. Sentencing is scheduled for Oct. 9, 2013.
Siripurapu is the twelfth person in the government’s investigation of Orange MRI and its corrupt referring doctors to plead guilty. Nine health care providers to have pleaded guilty to receiving kickbacks have agreed to forfeit $325,300 in illegal kickbacks from Orange MRI. The two other defendants, Ashokkumar Babaria, Orange MRI’s former medical director, and Chirag Patel, Orange MRI’s former executive director, have agreed to forfeit their corrupt gains. Babaria agreed to forfeit his revenues traceable to corrupt referrals, which the government has estimated could reach as much as $2 million. Patel has forfeited $89,180. The remaining defendants charged in the investigation are charged by complaints or indictments at this time.
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Source- http://www.justice.gov/usao/law/news/wdla20130612a.html
SHREVEPORT, La. – United States Attorney Stephanie A. Finley announced that Edozie Chukwudinma Okereke, 57, of Shreveport, was sentenced Monday by U.S. District Judge S. Maurice Hicks Jr. to 21 months in federal prison with three years supervised release for health care fraud. Okereke was also ordered to pay $679,836 in restitution to Medicare.
According to evidence presented at the guilty plea, Okereke, who was the owner/operator of Family Foot and Ankle Clinic, was a doctor of podiatric medicine for patients at the Shreveport clinic, and he was responsible for making sure that the correct treatment was billed by accurately submitting claims for the treatments and services he performed. Starting in 2005, Okereke submitted billing codes for treatment not covered under Medicare. Okereke was providing routine foot care, such as toenail clipping, and then “upcoding” or submitting codes for services that Medicare would cover.
“The defendant’s scheme was designed to defraud a government program that provided medical services to the elderly and the disabled,” U.S. Attorney Finley stated. “His actions were detrimental to the program and ultimately hurt U.S. taxpayers. This office will continue to vigorously pursue charges against those who steal from these types of programs.”
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MINNEAPOLIS—Earlier today in federal court, an Apple Valley woman was sentenced for defrauding both her employer and Medica. United States District Court Judge David S. Doty sentenced Lori Jo Mueller, age 48, to 51 months on one count of wire fraud and one count of health care fraud in connection to the crime. Mueller was charged on January 9, 2013, and pleaded guilty on February 4, 2013. In her plea agreement, Mueller admitted that from June of 2006 through June of 2012, she embezzled approximately $840,000 from Edelweiss Home Health Care, using the funds for her personal use.
Mueller began working for Edelweiss, which is located in Maple Grove, in 2002, and she was ultimately promoted to the position of vice president of operations. In that capacity, she was responsible for the review and payment of corporate invoices, bookkeeping, and other financial matters. Mueller admitted using her access to the corporate checking account to issue payments to herself. She also concealed her actions from the company owners and made misrepresentations concerning the company’s financial state.
In addition, from March of 2010 through June of 2012, Mueller defrauded Medica, a non-profit corporation that provides health insurance products to individuals and families. She administered claims submitted to various insurers seeking reimbursement for services provided by Edelweiss nursing staff. In some instances, Mueller double-billed by allowing claims for the same services to multiple insurance providers. For example, Mueller allowed both Minnesota Medicaid and Medica to be billed for identical services provided to one client. The particular double-billing resulted in a double-payment to Edelweiss with Medicaid being the proper payer and Medica being the overpayer. As a result of this criminal behavior, Mueller defrauded Medica of over $600,000.
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Source- http://www.justice.gov/usao/ohn/news/2013/11juneepp.html
A Cleveland man was sentenced to 12 years in prison for leading a ring that obtained blank prescription pads that were used to fraudulently obtain thousands of prescription painkiller pills, law enforcement officials announced today.
Louis Eppinger, 53, led a conspiracy that forged prescriptions for Oxycontin and Percocet pills, hired people to have them filled at pharmacies throughout the region, then sold the pills on the street, according to court documents. He previously pleaded guilty to conspiracy to possess with intent to distribute Oxycodone, health care fraud and aggravated identity theft.
“We have seen a huge increase in prescription drug abuse in Ohio, and this case demonstrates the lengths people will go to defraud and profit from pills,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “Instead of dealers shipping in drugs from South America, we now have people forging prescriptions.”
“The abuse of illicitly obtained prescription drugs is reaching epidemic proportions, surpassing that of marijuana, cocaine and heroin combined,” said Stephen Anthony, Special Agent in Charge of the Federal Bureau of Investigation’s Cleveland office. “Dismantling illicit drug diversion networks such as the organization charged in this investigation will remain a top FBI priority.”
Besides Eppinger, six other people have pleaded guilty to related crimes. They are: Patricia Arnold, age 61, of Cleveland; Anthony H. Perry, age 42, of East Cleveland; Elizabeth A. Davis, age 40, of East Cleveland; James Byrge, age 62, of Cleveland; Judy Burrows, age 25, of Cleveland, and Brittany N. Glass, age 22, of Cleveland.
Between 2011 and 2012, Eppinger, Arnold, Glass, Perry, Davis, Burrows and Byrge engaged in a conspiracy to possess with intent to distribute oxycodone, according to court documents.
Eppinger obtained blank prescription paper from an unknown source and DEA numbers of various physicians located in Northern Ohio for the purposes of passing fraudulent prescriptions for Oxycontin and/or Percocet, both of which contain oxycodone, according to court documents.
Eppinger provided the blank prescription paper to Arnold, who forged the prescriptions. Eppinger then provided the fraudulent prescriptions to Glass, Perry and Davis, who served as “walkers” and attempted to pass the prescriptions at pharmacies in Northeast Ohio, including several in Cleveland as well as locations in Shaker Heights, Willoughby and Garfield Heights, according to court documents.
Glass, Perry and Davis then gave the pills to Eppinger, who paid them for passing the fraudulent prescriptions. Eppinger then sold the pills or provided them on consignment to Burrows, Burge and others, according to court documents.
Eppinger pleaded guilty to health care fraud for defrauding the Ohio Medicaid program by billing more $21,098 for prescription painkillers to which he was not entitled, according to the indictment. He was ordered to repay that amount in restitution.
Eppinger also used the identities of two people in relation to a felony, resulting the in the aggravated identity theft convictions.
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Source- http://www.justice.gov/opa/pr/2013/June/13-crm-659.html
A federal jury in Tampa found four former executives of WellCare Health Plans Inc., a health maintenance organization (HMO) operator, guilty of various charges, including health care fraud, making false statements relating to health care matters and making false statements to a law enforcement officer, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Robert E. O’Neill of the Middle District of Florida 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
Today, former WellCare Chief Executive Officer Todd S. Farha, 45, of Tampa, was convicted of two counts of health care fraud; former WellCare Chief Financial Officer Paul L. Behrens, 51, Odessa, Fla., was convicted of two counts of making false statements relating to health care matters and two counts of health care fraud; William L. Kale, 63, of Oldsmar, Fla., former vice president of Harmony Behavioral Health Inc. (a wholly-owned subsidiary of WellCare), was found guilty of two counts of health care fraud; and Peter E. Clay, 56, of Wellesley, Mass., former WellCare vice president of medical economics, was found guilty of making false statements to a law enforcement officer.
On March 2, 2011, a federal grand jury sitting in Tampa returned an indictment charging Farha, Behrens, Kale and Clay with various federal criminal violations related to a scheme to defraud the Florida Medicaid program, from the summer of 2003 through the fall of 2007, by making false and fraudulent statements relating to expenditure information for behavioral health care services.
WellCare operates HMOs in several states targeted for government-sponsored health care benefit programs like Medicaid. Two WellCare HMOs operating in Florida, StayWell and Healthease, contracted with the Agency for Health Care Administration (AHCA), the Florida agency which administers the Medicaid program, to provide Florida Medicaid program recipients with an array of services, including behavioral health services.
In 2002, Florida enacted a statute that required Florida Medicaid HMOs to expend 80 percent of the Medicaid premium paid for certain behavioral health services upon the provision of those services. In the event that the HMO expended less than 80 percent of the premium, the difference was required to be returned to AHCA. As part of the scheme, the defendants falsely and fraudulently submitted inflated expenditure information in the company’s annual reports to AHCA, in order to reduce the WellCare HMOs’ contractual payback obligations for behavioral health care services.
On May 5, 2009, the government filed related charges in an information and deferred prosecution agreement (DPA) against WellCare. Under that DPA, WellCare was required to pay $40 million in restitution, forfeit another $40 million to the United States and cooperate with the government’s criminal investigation. The company complied with all of the requirements of the DPA. As a result, the information was later dismissed by the court following a government motion.
In May 2009, an information and plea agreement for Gregory West, 55, of Tampa, a former WellCare analyst, was unsealed. In his plea agreement, West admitted to participating in the scheme to defraud the Medicaid program and agreed to cooperate in the government’s investigation. At trial, West provided extensive and detailed testimony explaining the complex scheme. Other former WellCare executives provided additional testimony about the four individuals' roles in the scheme.
The maximum penalty for each of the health care fraud counts is 10 years in prison. The maximum penalty for all other counts is five years in prison. A sentencing date has not yet been set.
Thaddeus M.S. Bereday, of Tampa, WellCare’s former general counsel, was severed from the trial in February of this year. He will be tried separately, at a later date. Defendants are presumed innocent until proven guilty in a court of law.
The jury returned not guilty verdicts with respect to several counts and was unable to reach a verdict on others. The judge declared a mistrial as to those counts on which the jury was deadlocked. The Justice Department will decide, at a later date, whether to retry the individuals on those charges.
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Source- http://www.justice.gov/usao/nj/Press/files/Nicolls,%20et%20al.%20(BLS)%20Plea%20News%20Release.html
NEWARK, N.J. – The president of Parsippany, N.J.-based Biodiagnostic Laboratory Services LLC (BLS), three BLS employees and three associates admitted today to a conspiracy in which millions of dollars in bribes were paid to physicians over a number of years in exchange for blood sample referrals worth more than $100 million to the company, U.S. Attorney Paul J. Fishman announced.
Each of the seven defendants – David Nicoll, 39, of Mountain Lakes, N.J.; Scott Nicoll, 32, of Wayne, N.J.; Cliff Antell, 38, of Rumson, N.J.; Luke Chicco, 40, of Garden City, N.Y.; Doug Hurley, 33, of Hillsborough, N.J.; Kevin Kerekes, 47, of Florham Park, N.J.; and Craig Nordman, 34, of Whippany, N.J. – pleaded guilty to an information charging him with one count of conspiracy to violate the Anti-Kickback Statute and the Federal Travel Act and one count of money laundering. The defendants entered their guilty pleas before U.S. District Judge Stanley R. Chesler in Newark federal court.
“Today seven men, including the president of a diagnostic lab, admitted to a conspiracy making more than $100 million in illegal income from business brought through bribes,” said U.S. Attorney Fishman. “Individual greed has no place in a treatment plan, and people seeking medical help deserve to know a doctor’s recommendations are based on professional expertise, not illicit profits. Today is an important step, but we aren’t finished holding criminals responsible for this conspiracy, or who break the law to put profits over patients.”
“Health care fraud is a serious crime which impacts all Americans either directly or indirectly, by inflating costs in the health care system,” said Newark FBI Special Agent in Charge Aaron T. Ford. “In this day and age when health care is a daily topic of discussion, the Newark office of the FBI remains dedicated and committed to combating fraud throughout the health care system. This investigation and these pleas entered today represent a tremendous effort by law enforcement to stem the tide of pay to play in health care in New Jersey.”
“Financial inducements, little more than bribes, must never interfere with proper medical care,” said Tom O’Donnell, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services region including New Jersey. “We will tirelessly pursue criminals greedily manipulating public health care programs serving vulnerable Americans.”
According to documents filed in this case and statements made in court:
On April 9, 2013, federal agents arrested BLS president and part owner, David Nicoll; Scott Nicoll, a senior BLS employee and David Nicoll’s brother; and Nordman, a BLS employee and the CEO of Advantech Sales LLC – an entity used by BLS to make illegal payments. They were then 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 remain pending.
Hurley, also a BLS employee, and associates Antell, Chicco and Kerekes, surrendered today to the FBI.
The conspiracy made millions in illegal profits between 2006 and April of 2013. During their guilty pleas, David and Scott Nicoll admitted that BLS made substantially more than $100 million from Medicare and private insurance companies – just from bills related to blood specimens sent to BLS by bribed doctors.
Statements during today’s pleas also detailed the means through which BLS paid doctors millions of dollars – in cash or under the guise of sham lease, service, and consulting agreements through an elaborate network of shell entities used for that purpose. The defendants also admitted that one component of the bribery scheme was to pay some doctors a fee per test to induce them to increase their ordering of certain tests.
In one text message conversation between Santangelo and David Nicoll detailed in filed documents, Santangelo stated that he and another doctor had “put our heads together and added a significant amount of testing. . .The testing is 90% legit.” The documents allege Santangelo planned to send $1 million per month in blood testing referrals to BLS by increasing the number of blood tests being ordered, including medically unnecessary tests.
Those who pleaded guilty today each face a maximum potential penalty of five years in prison and a $250,000 fine on the bribery conspiracy charge and 20 years in prison and a $500,000 fine on the money laundering charge, or twice the gross gain or loss from the offense. In addition, David and Scott Nicoll have agreed to forfeit $50 million and $25 million to the United States, respectively. The other five defendants will forfeit amounts ranging between $800,000 and $1.3 million. Sentencing for all seven defendants is scheduled for Sept. 11, 2013.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Ford; U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge O’Donnell; IRS–Criminal Investigation, under the direction of Special Agent in Charge Shantelle P. Kitchen, and the U.S. Postal Inspection Service, under the direction of Acting Inspector in Charge Maria Kelokates, with the ongoing investigation leading to today’s guilty pleas.
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Source- http://www.justice.gov/usao/ian/news/2013/jun_13/6_6_13_Schuller.html
Dennis Schuller, D.D.S., a Cedar Rapids dentist, has agreed to pay $100,000 to resolve allegations that he violated the False Claims Act by improperly billing the Medicaid system for certain x-rays and exams, medically unnecessary procedures, and other medically unnecessary items.
Specifically, the government alleged that, between August 1, 2008, and June 30, 2010, Dr. Schuller improperly billed for visits performed exclusively by a hygienist as well as medically unnecessary debridements and scalings. In addition, the government claimed Dr. Schuller improperly charged the Medicaid system for certain single tooth
x-rays, medically unnecessary occlusal guards, and medically unnecessary doses of desensitizing medication. The claims settled by the agreement are allegations only; there has been no admission or judicial determination of liability.
“This settlement is an important step in furthering our district’s healthcare fraud enforcement program,” said Sean Berry, United States Attorney for the Northern District of Iowa. “Citizens are encouraged to report potential fraudulent conduct by healthcare providers to help our office ensure fair and efficient health systems throughout the district.”
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Source- http://www.justice.gov/opa/pr/2013/June/13-crm-648.html
Lansing-area resident Dr. Paul Kelly was sentenced to 18 months in prison today for his role in a $13.8 million Medicare fraud scheme.
Acting Assistant Attorney General Mythili Raman of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services, Office of Inspector General’s (HHS-OIG), Chicago Regional Office, made the announcement.
Kelly, 76, was sentenced by U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan. In addition to his prison term, Dr. Kelly was sentenced to three years of supervised release and ordered to pay $582,912 in restitution.
Kelly pleaded guilty on Jan. 10, 2013, to one count of health care fraud. According to information contained in plea documents, beginning in or around January 2011 and continuing through approximately March 2011, Kelly signed home health care referrals for a home health agency called Moonlite Home Care Inc., located in Livonia, Mich. Kelly certified Medicare beneficiaries as homebound, a requirement for receiving home health care, when in fact, Kelly had never examined or met the beneficiaries, and they were not homebound. Medicare paid approximately $582,912 for fraudulent home health care claims submitted by Moonlite based on Kelly's referrals.
This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. This case was prosecuted by Trial Attorney Catherine K. Dick of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2013%20June/130606%20-%20Shittu.html
HOUSTON – Abdul Waheed Alex Shittu, 55, a naturalized United States citizen from the Federal Republic of Nigeria, has been sentenced to 81 months in federal prison following his convictions of conspiracy to commit health care fraud and aggravated identity theft, United States Attorney Kenneth Magidson announced today.
Today, U.S. District Judge Keith P. Ellison, who accepted the guilty plea, handed Shittu a sentence of 57 months for conspiring to commit health care fraud and 24 months for aggravated identity theft which must be served consecutively for a total sentence of 81 months in federal prison. He was further ordered to pay $597,865.19 in restitution to Medicare and Medicaid.
Shittu, the owner of S & S Medical Supply Etc. located in Stafford, admitted during his re-arraignment on Nov. 14, 2012, that he billed Medicare and Medicaid for DME listed on purchased physician orders, even though he did not deliver all the DME and he delivered durable medical equipment (DME) to Medicare and Medicaid beneficiaries he knew did not want or need the supplies. Shittu also admitted he gave his billing agent the incorrect coding information so he would receive more money from Medicare and Medicaid for each DME claim. Between Dec. 1, 2008, and Sept. 30, 2009, Shittu submitted approximately $1,154,025 in fraudulent claims to Medicare and Medicaid and received $597,865.19 for those claims. The defendant also admitted that he began purchasing physician orders for durable medical equipment (DME), including wrist, back, foot, ankle, knee, elbow and shoulder braces as well as wheelchairs around Dec. 1, 2008, and that he purchased the orders from at least five recruiters for $200 - $300 per order. The physicians whose names were on the orders had not seen or treated by the patients.
After long oral argument from both sides today, Judge Ellison cited the seriousness of the crime as one of the reasons for arriving at the sentence. The United States introduced numerous photographs of DME delivered by Shittu to Medicare and Medicaid beneficiaries that was not medically necessary and which had sat unused for years after Shittu was paid for delivering it. The United States also referenced a chart of Medicare claims data demonstrating how his billing to Medicare dramatically increased when he began purchasing physician orders for $200 - $300 per prescription from recruiters in December 2008. The defense argued that Shittu should receive a lesser sentence because of the actual cost of purchasing the medically un-necessary DME and because he committed the crime due to a tough economic climate. Judge Ellison considered the defendant’s character references and lack of prior criminal history prior to issuing the sentence and concluded that the sentence reflected the seriousness of the crime.
Shittu was permitted 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.fbi.gov/louisville/press-releases/2013/london-physician-pleads-guilty-to-health-care-fraud-charges-in-first-case-of-its-kind-in-kentucky
FRANKFORT—A London, Kentucky cardiologist pleaded guilty to charges that he falsely recorded the severity of patients’ illnesses in order to receive payment for numerous heart procedures.
Sandesh Rajaram Patil, 51, a former cardiologist at St. Joseph’s Hospital in London, admitted Tuesday in Frankfort to making false statements regarding the placement of heart stents. Stents are metal tubes surgically inserted into a patient’s arteries in order to improve blood flow.
Patil reached an agreement with the U.S. Attorney’s Office to serve a prison term between 30 and 37 months, pending a judge’s approval. Patil is scheduled for sentencing on August 27, 2013. St Joseph’s hospital has repaid the government $256,800 for cardiac stent procedures that Patil falsely submitted for reimbursement in 2009 and 2010.
Patil is the third cardiologist in the nation and the first in Kentucky to be federally prosecuted for health care fraud related to the placement of heart stents.
“Dr. Patil violated the public’s trust in physicians,” said Kerry B. Harvey, U.S. Attorney for the Eastern District of Kentucky. “Both patients and the entities that pay for medical services trust that our physicians will accurately and honestly assess a patient’s medical condition. We will aggressively pursue any physician or provider that breaches this trust and places their own financial well-being ahead of the well-being of the patients.”
Under federal law, Medicare and Medicaid reimburse physicians for procedures that are deemed medically necessary. For a cardiac stent procedure to qualify as a medical necessity, it is generally accepted that a patient must have at least 70 percent blockage of an artery and symptoms of blockage. Patil admitted that he placed stents in arteries that had substantially less than 70 percent blockage. Patil nonetheless recorded blockage of 70 percent or more in patient documents to guarantee payment from Medicare and Medicaid.
Kerry B. Harvey, U.S. Attorney for the Eastern District of Kentucky; Perrye Turner, Special Agent in Charge, Federal Bureau of Investigation; and Jack Conway, Kentucky Attorney General, jointly announced the plea.
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Source-http://www.justice.gov/usao/can/news/2013/2013_06_05_mand.sentenced.press.html
SAN JOSE - Gurinder Mand was sentenced today to 13 months in prison and ordered to pay $254,906.20 in restitution for her involvement in a health care fraud scheme operated out of a San Jose pharmacy, United States Attorney Melinda Haag announced.
Mand pleaded guilty on December 12, 2012, to conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349. According to the plea agreement, Mand admitted to knowingly and willfully conspiring with the former owner of EZ Step Pharmacy in San Jose to submit false and fraudulent claims to health care benefit programs, including Medicare, Medi-Cal and private insurance companies. The false and fraudulent claims included: (1) seeking reimbursement for claims without prescriptions; and (2) seeking reimbursement for the cost of licensed durable medical equipment (known as “DME”) and related prescription medications, benefits, items, and services. In furtherance of the scheme, Mand fabricated DME authorizations, certificates of medical necessity, and related documents, and forged the signatures of physicians and other authorized health care providers of beneficiaries on these documents.
Mand, 30, of San Jose, was indicted by a federal grand jury on June 30, 2011. She was charged with one count of conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349; six counts of health care fraud, in violation of 18 U.S.C. § 1347; and two counts of obstructing a criminal investigation into health care fraud violations, in violation of 18 U.S.C. § 1518.
The sentence was handed down by The Honorable Lucy H. Koh, U.S. District Judge, following Mand’s guilty plea. Judge Koh also sentenced Mand to a three-year period of supervised release, and ordered restitution in the amount of $254,906.20. Mand will begin serving the sentence on August 5, 2013.
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Deirdre M. Daly, Acting United States Attorney for the District of Connecticut; Susan J. Waddell, Special Agent in Charge of U.S. Health and Human Services, Office of Inspector General for New England, William P. Offord, Special Agent in Charge of IRS Criminal Investigation in New England, and Kimberly K. Mertz, Special Agent in Charge of the Federal Bureau of Investigation, announced that GARY F. ANUSAVICE, also known as “Gary Andrews,” “Gary Andrus” and “Gary Francis,” 60, of North Kingstown, R.I., pleaded guilty today before United States Magistrate Judge William I. Garfinkel in Bridgeport to health care fraud and tax evasion offenses stemming from his involvement in a $20 million Medicaid fraud scheme.
“This defendant’s illegal operation of three Connecticut dental clinics, and his failure to pay income on the substantial amount of money he received from his involvement in this scheme, has siphoned millions of dollars from the Medicaid program and the U.S. Treasury,” said Acting U.S. Attorney Daly. “Health care fraud increases costs and threatens the integrity of our health care system, and we are committed to protecting American taxpayers by prosecuting these crimes. I want to thank HHS-OIG, IRS-Criminal Investigation and the FBI for their investigative efforts, and thank the Connecticut Attorney General’s Office, which has provided important assistance during the course of this investigation.”
“Although this defendant was barred from Medicaid and other Government health programs after his health care fraud conviction in 1998, he continued to bill these programs using an elaborate scheme to conceal his involvement,” said HHS-OIG Special Agent in Charge Waddell. “Working with Federal and State partners, our investigators effectively penetrate such schemes and help bring suspects to justice.”
“When a health care provider steals from the government via Medicaid Fraud, the money is part of the untaxed underground economy,” said IRS Criminal Investigation Special Agent in Charge Offord. “Gary Anusavice admitted his guilt today, and also agreed to forfeit significant assets that he purchased with the proceeds of the Medicaid fraud scheme.”
“Despite being excluded from participating in both Medicare and Medicaid, Mr. Anusavice devised and orchestrated elaborate schemes to defraud these government-sponsored health care programs with undaunted avarice and greed,” said FBI Special Agent in Charge Mertz. “His frauds not only greatly undermined the financial security of these vital programs but also impacted the ability of legitimate medical professionals to provide important health services to those truly in need.”
According to court documents and statements made in court, in July 1997, ANUSAVICE was convicted in Massachusetts state court for submitting false health care claims in relation to his involvement in dental clinics. He subsequently surrendered his dentistry licenses in Massachusetts and Rhode Island for five years. After additional investigations, ANUSAVICE surrendered his right to practice dentistry in Rhode Island for 18 months in 2005, and the Massachusetts Board of Registration in Dentistry permanently revoked ANUSAVICE’s license to practice dentistry in Massachusetts in 2006. As of May 1998, ANUSAVICE has been excluded from participation in Medicare and state health care programs, including Medicaid.
From 2008 to April 2011, ANUSAVICE owned and operated several dental clinics in Connecticut, but used a licensed dentist to act as the nominal head of the clinics. The clinics included Landmark Dental in West Haven, Dental Group of Connecticut in Trumbull, and Dental Group of Stamford. ANUSAVICE and the licensed dentist provided false Medicaid Provider Enrollment Applications to DSS that did not disclose ANUSAVICE’s controlling interest in the clinics or his disciplinary history. As a result of this fraud, the Connecticut Medicaid program reimbursed ANUSAVICE’s dental practices nearly $21 million.
ANUSAVICE actively managed the dental clinics, recruited dentists and oversaw their hiring. At various times, he trained personnel on Medicaid billing codes and procedures, and also determined salary and compensation for the clinics’ doctors and support staff.
ANUSAVICE attempted to conceal his involvement in these dental practices by establishing multiple nominee entities, including AMZ Consulting, Inc., Haven Consulting, Inc. and New England Preservation Services, Inc., and he directed his business partners and employees to make checks payable to these entities. ANUSAVICE deposited the checks into bank accounts he opened for the entities, and then used the funds to purchase assets for his personal use, including a residence in North Kingstown, R.I, a 33-foot yacht and a Mercedes Benz.
ANUSAVICE received $3,325,272 in income from the dental clinics, but did not file federal tax returns for the 2008 through 2011 tax years, resulting in a tax loss to the government of more than $1.2 million.
ANUSAVICE pleaded guilty to one count of health care fraud, which carries a maximum term of imprisonment of 10 years, and one count of tax evasion, which carries a maximum term of imprisonment of five years. He is scheduled to be sentenced by United States District Judge Vanessa L. Bryant in Hartford on August 23, 2013.
ANUSAVICE has agreed to forfeit his Rhode Island property, yacht and Mercedes Benz, as well as $91,700 in cash that was seized from his residence on May 24, 2012. He also has agreed to pay back taxes in the amount of $1,894,258.71, plus applicable interest and penalties. The tax loss figure includes more than $600,000 in federal taxes that ANUSAVICE failed to pay from 1990 to 2003.
In a related matter, the Connecticut Attorney General’s Office today announced that it has reached a settlement with ANUSAVICE and six of his management and consulting companies. Under the terms of the settlement, ANUSAVICE has agreed to pay the state $9.9 million, which represents treble damages under the Connecticut False Claims Act and restitution under the Connecticut Unfair Trade Practices Act.
ANUSAVICE was arrested on May 24, 2012, and has been released on a $500,000 bond since October 2012.
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Source- http://www.justice.gov/usao/pae/News/2013/June/goldmanconvicted_release.htm
PHILADELPHIA – A federal jury has returned guilty verdicts against Eugene Goldman, M.D., 55, of Philadelphia, on one count of conspiring to violate the anti-kickback statute and four counts of violating the anti-kickback statute in relation to his role in a kickback scheme arising from his employment as the Medical Director at Home Care Hospice Inc. (HCH). U.S. District Court Judge Eduardo Robreno scheduled a sentencing hearing for September 9, 2013.
The evidence at trial proved that from approximately December 2000 until approximately July 2011, Dr. Goldman served as the medical director for HCH and regularly referred Medicare or Medicaid patient beneficiaries to HCH. HCH was a for-profit business in Philadelphia that provided hospice services for patients at nursing homes, hospitals and private residences.
In December 2000 the defendant and one of the co-owners of HCH entered into a written contract to create the false appearance that all payments to Goldman from HCH were for services rendered in Goldman’s capacity as medical director for HCH, when in fact the large majority of payments from HCH to Goldman were illegal payments for the referral of Medicare and/or Medicaid patients to HCH. From January 2003 to October 2008, Goldman received approximately $263,000 in illegal payments for patient referrals. In January, February and March 2009, Goldman was captured on tape receiving kickbacks for patient referrals.
The maximum penalty for each count is five years in prison, a $250,000 fine, a three year term of supervised release and a $100 special assessment. The conviction will result in the mandatory exclusion of Dr. Goldman from participation in any federal health care program.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2013%20June/130603%20-%20Sharma.html
HOUSTON - Drs. Arun and Kiran Sharma, two local physicians previously sentenced for defrauding Medicare, Medicaid and more than a dozen private insurers, have appeared in federal court for a resentencing hearing on restitution and forfeiture issues, United States Attorney Kenneth Magidson announced today.
The Sharmas, both 58, are a married couple who operated medical clinics in Baytown and Webster under the name Allergy, Asthma, Arthritis and Pain Center. In April 2010, they pleaded guilty to conspiracy to commit health care and mail fraud as well as one count of health care fraud for their decade-long scam of billing health care providers for injection procedures that they did not perform. U.S. District Judge David Hittner later sentenced Arun and Kiran Sharma to 15 and eight years in federal prison, respectively. A restitution order of more than $40 million was imposed, and the defendants were ordered to forfeit all property funded with the proceeds of their fraudulent scheme, including their $700,000 home in Kemah, numerous parcels of real property and a large number of investment accounts.
The Sharmas appealed the restitution and forfeiture aspects of their sentences to the Fifth Circuit. The convictions were upheld, but the case was remanded for re-sentencing on the narrow issue of the amount of restitution owed to their victims. At today's hearing, Judge Hittner ordered the Sharmas to pay $37,670,826.32 in restitution and ordered them jointly liable for a personal money judgment in the same amount. To date, the United States has seized assets valued at $27.6 million (cash, bank accounts, investment accounts, annuities and jewelry) as well as real estate potentially worth an additional $3.5 million after payment of liens.
All of the proceeds of these forfeitures will be returned to the victims of the Sharmas’ fraud.
Originally charged in June 2009, the Sharmas operated the clinics at multiple locations in Baytown and Webster. Arun Sharma was known as an easy touch for prescribing the “pain cocktail” of hydrocodone, Xanax and Soma. In addition to the prescription of narcotics, a large part of the practice was to provide patients with injections of lidocaine combined with steroids which, at times, provided temporary relief of various joint and muscle pain. Although the injections given to the patients were superficial, they were billed falsely to the insurance companies as facet joint injections, paravertebral injections, sacroiliac nerve injections, sciatic nerve injections and various nerve block injections.
The pain management practice at the clinics grew quickly during the time period of the conspiracy. The doctors went from seeing an average of 50-60 patients per day in 1998 to more than 100 per day beginning in 2003 with a high of 279 on Jan. 6, 2005. From 1998 through 2002, Kiran Sharma saw pain patients at the clinics in addition to her own allergy patients. She maintained a modest allergy practice and would sign patient procedure forms and superbills, falsely indicating that she had administered facet joint injections or other paravertebral injections when in reality she did not. She also prescribed the pain cocktail when she saw pain management patients.
Nearly every patient was prescribed one or more controlled substances and put on a regimen of shots every two weeks. The patients were required to sign the medical progress and procedure notes in their patient chart to prove they were at the clinic and received the shots. Arun Sharma tried to convince all patients to have shots at every visit, but many of the patients did not want the shots every two weeks. For those patients who ultimately refused the shots, he regularly required the patients to sign the progress and procedure notes even though they received only a prescription for controlled substances and did not receive any injections. By the beginning of 2000, Arun Sharma had certain patients sign blank procedure/progress notes and then used those forms to generate a superbill in order to bill the insurance companies for injection procedures on days when the patient was not in the clinic.
Dr. Kiran Sharma hired several foreign medical graduates (FMGs) over the course of the conspiracy to assist in the movement of patients through the clinics. Several of the FMGs helped add fictitious patient examination information to the blank progress/procedure notes after Arun Sharma had added non-existent medical procedures to the blank forms so that insurance companies could be billed as if the person had been in the clinic when in reality they had not. Kiran Sharma witnessed the FMGs creating the fictitious patient progress/procedure notes and knew their ultimate purpose was to bill the insurance companies for procedures that never occurred.
Demonstrative of the implausibility of the volume of patients who allegedly received injections is the fact that the defendants’ own records purport to show that more than 100 patients purportedly received injections on 708 different days during the conspiracy. Further, their fraudulent billings showed that as many as 279 patients allegedly received injections on Jan. 6, 2005.
Both of the defendants have been in custody since their guilty pleas in April 2010 and were remanded back to their respective federal correctional institutions following the resentencing hearing.
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Source- http://www.justice.gov/usao/nv/news/2013/20130529_phankonsy.html
LAS VEGAS, Nev. – A woman who defrauded the Medicare program of $11.1 million in a fraudulent medical equipment billing scheme, was sentenced today to 51 months in prison, three years of supervised release, and criminal forfeiture of $11.1 million in assets, announced Daniel G. Bogden, United States Attorney for the District of Nevada.
Alegria Phankonsy, 43, formerly of Orange County, Calif., but currently in custody, was sentenced by U.S. District Judge Kent J. Dawson. Phankonsy pleaded guilty in November 2012 to one count of health care fraud and one count of tax evasion.
According to the indictment and the facts supporting the guilty plea, between about March 2005 and February 2010, Phankonsy operated several medical equipment supply companies in Las Vegas, Proforma Medical Source, Divine Health and Freemotion Plus Medical Supply. Phankonsy operated the first two companies using the alias’ Marie Villanueva and Marie Phan, respectively, and operated Freemotion using the name Phankonsy. Between about March 2005 and March 2010, Phankonsy fraudulently billed Medicare for medical equipment, such as leg prostheses and power wheelchairs that had not been ordered by a physician, were not needed by clients or were not provided to clients at all. To identify clients, Phankonsy paid “marketers” in southern California to obtain patients for her various companies. The marketers provided these clients with money in exchange for their Medicare information, which was used to bill Medicare for the unnecessary items or items not provided. The scheme resulted in Phankonsy receiving $11.1 million to which she was not entitled.
For the tax years 2006, 2007, and 2008, Phankonsy prepared and submitted false individual income tax returns by underreporting the income she earned from the Medicare fraud scheme. During those three years, Phankonsy underreported approximately $7.8 million in gross receipts, resulting in a total tax loss of approximately $2.4 million. Phankonsy also appended fraudulent W-2 forms to her returns and falsely represented that she had made significant estimated tax payments, when she had not.
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