NEWARK, NJ—A physician with a practice in Madison, New Jersey admitted today to accepting bribes of $2,000 per month in exchange for test referrals as part of a long-running scheme operated by Biodiagnostic Laboratory Services LLC (BLS) of Parsippany, New Jersey; its president; and numerous associates, U.S. Attorney Paul J. Fishman announced.
Wayne Lajewski, 51, pleaded guilty today before U.S. District Judge Stanley R. Chesler in Newark federal court to an information charging him with one count of accepting bribes.
According to documents filed in this and other cases and statements made in court:
Lajewski admitted he accepted bribes of $2,000 cash per month over two years in return for referring patient blood specimens to BLS, for which BLS received more than $850,000.
The bribery count to which Lajewski pleaded guilty carries a maximum potential penalty of five years in prison and a $250,000 fine. Sentencing is scheduled for July 8, 2014. As part of his guilty plea, Lajewski agreed to forfeit $48,000, representing the bribes he received from BLS.
Including Lajewski, 26 people—including 15 physicians—have pleaded guilty in connection with the bribery scheme, which its organizers have admitted involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and various private insurance companies.
The investigation has recovered more than $7 million to date through forfeiture.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford in Newark; U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Thomas O’Donnell; IRS–Criminal Investigation, under the direction of Acting Special Agent in Charge Jonathan D. Larsen; and inspectors of the U.S. Postal Inspection Service, under the direction of Inspector in Charge Maria L. Kelokates, with the ongoing investigation leading to today’s guilty plea.
The government is represented by Assistant U.S. Attorney Joseph Minish, Senior Litigation Counsel Andrew Leven, and Jacob T. Elberg, Chief of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark, as well as Assistant U.S. Attorney Barbara Ward of the office’s Asset Forfeiture and Money Laundering Unit.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act and other statutes.
Thursday, April 10, 2014
Tom’s River Chiropractor Admits Receiving Bribes for Patient Referrals
NEWARK—A chiropractor with a practice in Toms River, New Jersey admitted today to accepting bribes to refer a number of his patients to a New Jersey-licensed pain management physician, U.S. Attorney Paul J. Fishman announced.
Norman Eastburn, 48, of Jackson, New Jersey, pleaded guilty to an information charging him with one count of violating the Anti-Kickback statute. He entered his guilty plea before U.S. District Judge Stanley R. Chesler in Newark federal court.
According to documents filed in this case and statements made in court:
Eastburn was paid a cash fee per patient he referred to the pain management physician. As part of the scheme, the pair negotiated specific kickback amounts that would be paid based on which payor would be billed—Medicare or a private healthcare insurer—and what type of pain treatment would be rendered.
Eastburn indicated to the pain physician that a medical doctor’s involvement in pain procedures would increase Eastburn’s likelihood of being reimbursed by insurers. As an example, Eastburn recounted a prior situation in which he misled a patient by telling her that she required an injection that he did not then believe, in fact, was medically necessary and then paid a doctor $500 in cash to administer it.
The violation of the Anti-Kickback statute carries a maximum potential penalty of five years in prison and a $250,000 fine. In addition, Eastburn has agreed to forfeit to the United States the money he was paid in bribes. Sentencing is scheduled for July 8, 2014.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford, and the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Tom O’Donnell, with the investigation.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Senior Litigation Counsel Andrew Leven of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
Norman Eastburn, 48, of Jackson, New Jersey, pleaded guilty to an information charging him with one count of violating the Anti-Kickback statute. He entered his guilty plea before U.S. District Judge Stanley R. Chesler in Newark federal court.
According to documents filed in this case and statements made in court:
Eastburn was paid a cash fee per patient he referred to the pain management physician. As part of the scheme, the pair negotiated specific kickback amounts that would be paid based on which payor would be billed—Medicare or a private healthcare insurer—and what type of pain treatment would be rendered.
Eastburn indicated to the pain physician that a medical doctor’s involvement in pain procedures would increase Eastburn’s likelihood of being reimbursed by insurers. As an example, Eastburn recounted a prior situation in which he misled a patient by telling her that she required an injection that he did not then believe, in fact, was medically necessary and then paid a doctor $500 in cash to administer it.
The violation of the Anti-Kickback statute carries a maximum potential penalty of five years in prison and a $250,000 fine. In addition, Eastburn has agreed to forfeit to the United States the money he was paid in bribes. Sentencing is scheduled for July 8, 2014.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford, and the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Tom O’Donnell, with the investigation.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Senior Litigation Counsel Andrew Leven of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
Friday, March 28, 2014
Akron Doctor and His Employees Indicted for Prescribing Hundreds of Thousands of Doses of Painkillers
An Akron physician and three of his employees were indicted for illegally prescribing hundreds of thousands of doses of painkillers and other pills to customers for no legitimate medical purpose, even after he learned some customers had died from overdose-related deaths, law enforcement officials announced today.
Adolph Harper, Jr., 63, of Akron; Adria Harper, 34, of Akron; Patricia Laughman, 51, of Barberton, Ohio; and Tequilla Berry, 35, of Akron, are all named in the 134-count indictment.
The charges include conspiring to traffic pharmaceutical drugs, drug trafficking, and health care fraud. Together, they distributed hundreds of thousands of doses of prescription medications—including Oxycontin, Percocet, Roxicet, Opana, and others—from Adolph Harper’s medical officers in Akron between 2009 and 2012, according to the indictment.
Count one of the indictment charges all four defendants with conspiring to distribute addictive controlled substances, including prescription painkillers and anti-anxiety medication, outside the usual course of professional practice and without any legitimate medical purpose.
Adolph Harper’s customers, many of whom were drug addicts exhibiting clear signs of drug addiction during their visits to his office, came to his office and received “prescriptions” for addictive prescription medications without being examined by Harper and often without seeing him at all, according to the indictment.
Harper continued to distribute prescriptions for controlled substances after he learned that some of his customers had died from overdose-related deaths, according to the indictment.
Adria Harper, Patricia Laughman, and Tequilla Berry distributed prescriptions to these customers when Adolph Harper was out of the office and also used Adolph Harper’s prescription pad to distribute prescriptions for addictive painkillers to themselves, according to the indictment.
Counts two through 83 charge Adolph Harper with individual distributions of Schedule II controlled substances including oxycodone, oxymorphone, and methadone.
Counts 84 through 109 charge Adria Harper with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad and for prescriptions that she distributed to customers when Adolph Harper, Jr. was not in the office.
Counts 110 through 123 charge Patricia Laughman with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad.
Counts 124 through 130 charge Tequilla Berry with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself in the name of an unknowing third party using Adolph Harper’s prescription pad.
Counts 131 through 134 charge Adolph Harper with health care fraud. Specifically, these counts charge him with executing four separate schemes to defraud health insurance providers by (1) submitting insurance claims for services using a higher billing code than the service justified; (2) submitting insurance claims for unperformed services; (3) billing an insurance provider for a service after collecting a cash payment for the same service; and (4) causing the submission of insurance claims for prescriptions for controlled substances that were issued outside the usual course of professional practice and not for a legitimate medical purpose.
“The charges describe a defendant who is simply a drug dealer with a stethoscope who happens to work from a medical office instead of a street corner,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “His actions destroyed families and lives.”
Steven D. Anthony, Special Agent in Charge of the Federal Bureau of Investigation’s Cleveland Office, said: “Just because you have a prescription pad does not give you a license to deal drugs. Not only did this doctor violate the physician’s oath, but he also allowed others in his office to abuse his medical privileges.”
“DEA is pleased to acknowledge the indictment of Dr. Adolph Harper,” said Geno Corley, Resident Agent in Charge of the Drug Enforcement Administration’s Cleveland Office. “This case was initiated by the Akron Police Department and investigated by FBI and Health and Human Services, with assistance from the DEA Cleveland Resident Office, Ohio State Board of Pharmacy, and the State of Ohio Medical Board. This arrest of Dr. Harper and his co-conspirators is another important step forward in the fight against the improper prescribing of dangerous and addictive prescription drugs.”
“This is great example of how state and federal collaboration can work to combat prescription drug abuse,” said Kyle Parker, executive director of the Ohio State Pharmacy Board.
This case is being prosecuted by Assistant United States Attorneys Margaret A. Sweeney, Edward F. Feran, and Rebecca C. Lutzko following an investigation by the Federal Bureau of Investigation, the Department of Health and Human Services-Office of the Inspector General, the Drug Enforcement Administration, the Ohio Board of Pharmacy, and the Akron Police Department.
If convicted, the defendants’ sentences will be determined by the court after review of factors unique to this case, including the defendants’ prior criminal record, if any; the defendants’ roles in the offenses; and the characteristics of the violations. In all cases, the sentence will not exceed the statutory maximum, and in most cases it will be less than the maximum.
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
Adolph Harper, Jr., 63, of Akron; Adria Harper, 34, of Akron; Patricia Laughman, 51, of Barberton, Ohio; and Tequilla Berry, 35, of Akron, are all named in the 134-count indictment.
The charges include conspiring to traffic pharmaceutical drugs, drug trafficking, and health care fraud. Together, they distributed hundreds of thousands of doses of prescription medications—including Oxycontin, Percocet, Roxicet, Opana, and others—from Adolph Harper’s medical officers in Akron between 2009 and 2012, according to the indictment.
Count one of the indictment charges all four defendants with conspiring to distribute addictive controlled substances, including prescription painkillers and anti-anxiety medication, outside the usual course of professional practice and without any legitimate medical purpose.
Adolph Harper’s customers, many of whom were drug addicts exhibiting clear signs of drug addiction during their visits to his office, came to his office and received “prescriptions” for addictive prescription medications without being examined by Harper and often without seeing him at all, according to the indictment.
Harper continued to distribute prescriptions for controlled substances after he learned that some of his customers had died from overdose-related deaths, according to the indictment.
Adria Harper, Patricia Laughman, and Tequilla Berry distributed prescriptions to these customers when Adolph Harper was out of the office and also used Adolph Harper’s prescription pad to distribute prescriptions for addictive painkillers to themselves, according to the indictment.
Counts two through 83 charge Adolph Harper with individual distributions of Schedule II controlled substances including oxycodone, oxymorphone, and methadone.
Counts 84 through 109 charge Adria Harper with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad and for prescriptions that she distributed to customers when Adolph Harper, Jr. was not in the office.
Counts 110 through 123 charge Patricia Laughman with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad.
Counts 124 through 130 charge Tequilla Berry with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself in the name of an unknowing third party using Adolph Harper’s prescription pad.
Counts 131 through 134 charge Adolph Harper with health care fraud. Specifically, these counts charge him with executing four separate schemes to defraud health insurance providers by (1) submitting insurance claims for services using a higher billing code than the service justified; (2) submitting insurance claims for unperformed services; (3) billing an insurance provider for a service after collecting a cash payment for the same service; and (4) causing the submission of insurance claims for prescriptions for controlled substances that were issued outside the usual course of professional practice and not for a legitimate medical purpose.
“The charges describe a defendant who is simply a drug dealer with a stethoscope who happens to work from a medical office instead of a street corner,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “His actions destroyed families and lives.”
Steven D. Anthony, Special Agent in Charge of the Federal Bureau of Investigation’s Cleveland Office, said: “Just because you have a prescription pad does not give you a license to deal drugs. Not only did this doctor violate the physician’s oath, but he also allowed others in his office to abuse his medical privileges.”
“DEA is pleased to acknowledge the indictment of Dr. Adolph Harper,” said Geno Corley, Resident Agent in Charge of the Drug Enforcement Administration’s Cleveland Office. “This case was initiated by the Akron Police Department and investigated by FBI and Health and Human Services, with assistance from the DEA Cleveland Resident Office, Ohio State Board of Pharmacy, and the State of Ohio Medical Board. This arrest of Dr. Harper and his co-conspirators is another important step forward in the fight against the improper prescribing of dangerous and addictive prescription drugs.”
“This is great example of how state and federal collaboration can work to combat prescription drug abuse,” said Kyle Parker, executive director of the Ohio State Pharmacy Board.
This case is being prosecuted by Assistant United States Attorneys Margaret A. Sweeney, Edward F. Feran, and Rebecca C. Lutzko following an investigation by the Federal Bureau of Investigation, the Department of Health and Human Services-Office of the Inspector General, the Drug Enforcement Administration, the Ohio Board of Pharmacy, and the Akron Police Department.
If convicted, the defendants’ sentences will be determined by the court after review of factors unique to this case, including the defendants’ prior criminal record, if any; the defendants’ roles in the offenses; and the characteristics of the violations. In all cases, the sentence will not exceed the statutory maximum, and in most cases it will be less than the maximum.
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
Wednesday, March 26, 2014
New York Doctor Charged in Alleged Multi-Million-Dollar Medicare Fraud Scheme
BROOKLYN, NY—A criminal complaint was unsealed this morning in Brooklyn federal court charging Dr. Syed Imran Ahmed, 49, with health care fraud in connection with his submission of millions of dollars in false Medicare billings. Seizure warrants seeking millions of dollars of the defendant’s alleged ill-gotten gains, including the contents of seven bank accounts, were also unsealed. In addition, a civil forfeiture complaint was also filed today against the defendant’s residence located in Muttontown, New York, valued at approximately $4 million. Further, earlier today search warrants were executed at six locations in New York, Michigan, and Nevada. The defendant’s initial appearance is scheduled this afternoon before United States Magistrate Judge Marilyn Go at the United States Courthouse, 225 Cadman Plaza East, Brooklyn, New York.
The charges were announced by Loretta E. Lynch, United States Attorney for the Eastern District of New York; David O’Neil, Acting Assistant Attorney General of the Justice Department’s Criminal Division; George Venizelos, Assistant Director in Charge, Federal Bureau of Investigation, New York Field Office; and Thomas O’Donnell, Special Agent in Charge, Department of Health and Human Services-Office of Inspector General (HHS-OIG).
As alleged in the complaint, Ahmed engaged in a scheme to submit claims to Medicare for surgical procedures that were not in fact performed. The complaint cites multiple instances in which either patients told law enforcement officers that they never had the procedures that were billed, or hospital medical records did not contain any evidence that the procedures were actually performed. From January 2011 through mid-December 2013, Medicare was billed at least $85 million for surgical procedures by Ahmed, a sole practitioner.
“As alleged, Ahmed created phantom medical procedures to steal very real taxpayer money. The defendant sought to enrich himself and fund his lifestyle through billing Medicare for services he never performed,” stated United States Attorney Lynch. “We are committed to protecting these taxpayer-funded programs and prosecuting those who steal from them.”
“The Medicare system entrusts doctors to provide patients with the care and services they need,” said Acting Assistant Attorney General O’Neil. “The charges unsealed today allege that Dr. Ahmed billed millions of dollars to Medicare for surgical procedures that he did not actually perform. These charges are yet another example of the Department of Justice’s determination to hold accountable those who abuse the trust placed in them and steal from the system for personal gain.”
FBI Assistant Director in Charge Venizelos stated, “Fraudulently billing the government defrauds every American taxpayer. We will investigate cases of graft and greed to protect important programs for those who need them.”
“For a single physician, the alleged conduct in this case is among the most serious I’ve seen in my law enforcement career,” said SAC for HHS-OIG O’Donnell. “Being a Medicare provider is a privilege, not a right. When Dr. Ahmed allegedly billed Medicare for procedures he never performed, he violated the basic trust that taxpayers extend to health care providers.”
The investigation has been conducted by the FBI and HHS-OIG, brought as part of the Medicare Fraud Strike Force, and supervised by the U.S. Attorney’s Office for the Eastern District of New York and the Criminal Division’s Fraud Section. The case is being prosecuted by Trial Attorney Turner Buford of the Criminal Division’s Fraud Section and Assistant United States Attorneys William Campos and Erin Argo of the U.S. Attorney’s Office for the Eastern District of New York.
The charges in the complaint are merely allegations, and the defendant is presumed innocent unless and until proven guilty. If convicted, the defendant faces a maximum sentence of 10 years.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS- OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
The Defendant:
SYED IMRAN AHMED
Age: 49
Glen Head, New York
The charges were announced by Loretta E. Lynch, United States Attorney for the Eastern District of New York; David O’Neil, Acting Assistant Attorney General of the Justice Department’s Criminal Division; George Venizelos, Assistant Director in Charge, Federal Bureau of Investigation, New York Field Office; and Thomas O’Donnell, Special Agent in Charge, Department of Health and Human Services-Office of Inspector General (HHS-OIG).
As alleged in the complaint, Ahmed engaged in a scheme to submit claims to Medicare for surgical procedures that were not in fact performed. The complaint cites multiple instances in which either patients told law enforcement officers that they never had the procedures that were billed, or hospital medical records did not contain any evidence that the procedures were actually performed. From January 2011 through mid-December 2013, Medicare was billed at least $85 million for surgical procedures by Ahmed, a sole practitioner.
“As alleged, Ahmed created phantom medical procedures to steal very real taxpayer money. The defendant sought to enrich himself and fund his lifestyle through billing Medicare for services he never performed,” stated United States Attorney Lynch. “We are committed to protecting these taxpayer-funded programs and prosecuting those who steal from them.”
“The Medicare system entrusts doctors to provide patients with the care and services they need,” said Acting Assistant Attorney General O’Neil. “The charges unsealed today allege that Dr. Ahmed billed millions of dollars to Medicare for surgical procedures that he did not actually perform. These charges are yet another example of the Department of Justice’s determination to hold accountable those who abuse the trust placed in them and steal from the system for personal gain.”
FBI Assistant Director in Charge Venizelos stated, “Fraudulently billing the government defrauds every American taxpayer. We will investigate cases of graft and greed to protect important programs for those who need them.”
“For a single physician, the alleged conduct in this case is among the most serious I’ve seen in my law enforcement career,” said SAC for HHS-OIG O’Donnell. “Being a Medicare provider is a privilege, not a right. When Dr. Ahmed allegedly billed Medicare for procedures he never performed, he violated the basic trust that taxpayers extend to health care providers.”
The investigation has been conducted by the FBI and HHS-OIG, brought as part of the Medicare Fraud Strike Force, and supervised by the U.S. Attorney’s Office for the Eastern District of New York and the Criminal Division’s Fraud Section. The case is being prosecuted by Trial Attorney Turner Buford of the Criminal Division’s Fraud Section and Assistant United States Attorneys William Campos and Erin Argo of the U.S. Attorney’s Office for the Eastern District of New York.
The charges in the complaint are merely allegations, and the defendant is presumed innocent unless and until proven guilty. If convicted, the defendant faces a maximum sentence of 10 years.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS- OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
The Defendant:
SYED IMRAN AHMED
Age: 49
Glen Head, New York
Wednesday, February 26, 2014
Diagnostic Imaging Group to Pay $15.5 Million for Allegedly Submitting False Claims to Federal and State Health Care Programs
NEWARK—Diagnostic Imaging Group (DIG) has agreed to pay a total of $15.5 million to resolve allegations that its diagnostic testing facilities falsely billed federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians.
U.S. Attorney for the District of New Jersey Paul J. Fishman, Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery, and U.S. Attorney for the Eastern District of New York Loretta E. Lynch announced the settlement today.
DIG has agreed to pay $13.65 million to the federal government and an additional total of $1.85 million to New York and New Jersey. DIG operates a chain of diagnostic testing facilities through its subsidiary, Doshi Diagnostic Imaging Services, which is headquartered in Hicksville, New York. DIG previously operated chains in New Jersey and Florida through subsidiaries Doshi Diagnostic Imaging Services of New Jersey and Signet Diagnostic Imaging Services.
“Health care providers who make decisions based on profit instead of medical need compromise patient safety and confidence,” U.S. Attorney Fishman said. “Unnecessary tests and the payment of kickbacks also siphon precious resources from our health care system. The settlement we’re announcing today is an appropriate response to these unacceptable practices.”
“When health care providers pay kickbacks and submit false claims to Medicare, they not only deplete the Medicare Trust Fund, they undermine the integrity of the health care system,” said Assistant Attorney General Stuart F. Delery. “The Justice Department will relentlessly pursue those who misuse federal health care funds for their own profit.”
The settlement announced today resolves allegations that DIG submitted claims to Medicare, as well as the New Jersey and New York Medicaid Programs, for 3D reconstructions of CT scans that were never performed or interpreted. Additionally, DIG allegedly bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary. Today’s settlement also resolves allegations that DIG paid kickbacks to physicians for the referral of diagnostic tests. According to the government, the kickbacks were in the form of payments that DIG made to physicians ostensibly to supervise patients who underwent nuclear stress testing. These payments allegedly exceeded fair market value and were, in fact, intended to reward physicians for their referrals.
“Patients deserve testing decisions based solely on medical need, not doctors’ pocketbooks,” said U.S. Attorney Lynch. “We will continue to work with our federal and state law enforcement partners to investigate vigorously allegations of fraud on federal programs like Medicare and to pursue those who seek to fraudulently deplete the Medicare Trust Fund.”
“Paying physicians for their referrals and submitting false claims to increase Medicare and Medicaid reimbursements—as was alleged in this case—simply cannot be tolerated,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson. “Besides levying a hefty penalty, the settlement requires an independent organization to review Diagnostic Imaging Group’s claims for five years and to send reports to the government.”
The allegations resolved by today’s settlement were raised in three lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The three whistleblowers will receive the following amounts as part of today’s settlement: Mark Novick, M.D., $1.5 million; Rey Solano, $1.07 million; Richard Steinman, M.D., $209,250.
U.S. Attorney Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Assistant U.S. Attorney Charles Graybow of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark and Trial Attorneys Arthur Di Dio and William Olson of the Justice Department’s Civil Division in all aspects of the case, as well as Assistant U.S. Attorney Paul Kaufman of the U.S. Attorney’s Office for the Eastern District of New York with regard to the Steinman qui tam. New York was represented the New York Attorney General’s Medicaid Control Fraud Unit in New York City, and New Jersey was represented by the New Jersey Attorney General’s Government & Healthcare Fraud Section in Newark.
The settlement is the culmination of an investigation conducted jointly by special agents of the Department of Health and Human Services Office of Inspector General and special agents of the FBI in Newark, under the direction of Special Agent in Charge Aaron T. Ford, with contributions from the Railroad Retirement Board.
The claims settled by this agreement are allegations only, and there has been no determination of liability. The three cases are captioned United States ex rel. Mark Novick, M.D. v. Doshi Diagnostic Imaging Services P.C., Civil Action No. 09-4992 (D.N.J.); United States ex rel. Rey Solano v. Diagnostic Imaging Group et al., Civil Action No. 10-267 (D.N.J.); and United States ex rel. Richard Steinman, M.D. v. Diagnostic Imaging Group, et al., Civil Action No. 10-4161 (E.D.N.Y.).
U.S. Attorney for the District of New Jersey Paul J. Fishman, Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery, and U.S. Attorney for the Eastern District of New York Loretta E. Lynch announced the settlement today.
DIG has agreed to pay $13.65 million to the federal government and an additional total of $1.85 million to New York and New Jersey. DIG operates a chain of diagnostic testing facilities through its subsidiary, Doshi Diagnostic Imaging Services, which is headquartered in Hicksville, New York. DIG previously operated chains in New Jersey and Florida through subsidiaries Doshi Diagnostic Imaging Services of New Jersey and Signet Diagnostic Imaging Services.
“Health care providers who make decisions based on profit instead of medical need compromise patient safety and confidence,” U.S. Attorney Fishman said. “Unnecessary tests and the payment of kickbacks also siphon precious resources from our health care system. The settlement we’re announcing today is an appropriate response to these unacceptable practices.”
“When health care providers pay kickbacks and submit false claims to Medicare, they not only deplete the Medicare Trust Fund, they undermine the integrity of the health care system,” said Assistant Attorney General Stuart F. Delery. “The Justice Department will relentlessly pursue those who misuse federal health care funds for their own profit.”
The settlement announced today resolves allegations that DIG submitted claims to Medicare, as well as the New Jersey and New York Medicaid Programs, for 3D reconstructions of CT scans that were never performed or interpreted. Additionally, DIG allegedly bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary. Today’s settlement also resolves allegations that DIG paid kickbacks to physicians for the referral of diagnostic tests. According to the government, the kickbacks were in the form of payments that DIG made to physicians ostensibly to supervise patients who underwent nuclear stress testing. These payments allegedly exceeded fair market value and were, in fact, intended to reward physicians for their referrals.
“Patients deserve testing decisions based solely on medical need, not doctors’ pocketbooks,” said U.S. Attorney Lynch. “We will continue to work with our federal and state law enforcement partners to investigate vigorously allegations of fraud on federal programs like Medicare and to pursue those who seek to fraudulently deplete the Medicare Trust Fund.”
“Paying physicians for their referrals and submitting false claims to increase Medicare and Medicaid reimbursements—as was alleged in this case—simply cannot be tolerated,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson. “Besides levying a hefty penalty, the settlement requires an independent organization to review Diagnostic Imaging Group’s claims for five years and to send reports to the government.”
The allegations resolved by today’s settlement were raised in three lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The three whistleblowers will receive the following amounts as part of today’s settlement: Mark Novick, M.D., $1.5 million; Rey Solano, $1.07 million; Richard Steinman, M.D., $209,250.
U.S. Attorney Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Assistant U.S. Attorney Charles Graybow of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark and Trial Attorneys Arthur Di Dio and William Olson of the Justice Department’s Civil Division in all aspects of the case, as well as Assistant U.S. Attorney Paul Kaufman of the U.S. Attorney’s Office for the Eastern District of New York with regard to the Steinman qui tam. New York was represented the New York Attorney General’s Medicaid Control Fraud Unit in New York City, and New Jersey was represented by the New Jersey Attorney General’s Government & Healthcare Fraud Section in Newark.
The settlement is the culmination of an investigation conducted jointly by special agents of the Department of Health and Human Services Office of Inspector General and special agents of the FBI in Newark, under the direction of Special Agent in Charge Aaron T. Ford, with contributions from the Railroad Retirement Board.
The claims settled by this agreement are allegations only, and there has been no determination of liability. The three cases are captioned United States ex rel. Mark Novick, M.D. v. Doshi Diagnostic Imaging Services P.C., Civil Action No. 09-4992 (D.N.J.); United States ex rel. Rey Solano v. Diagnostic Imaging Group et al., Civil Action No. 10-267 (D.N.J.); and United States ex rel. Richard Steinman, M.D. v. Diagnostic Imaging Group, et al., Civil Action No. 10-4161 (E.D.N.Y.).
Tuesday, February 25, 2014
New Jersey Doctor Who Provided Spa Services Pleads Guilty in Medicare Fraud Scheme
Dr. Chang Ho Lee, 68, of Palisades Park, New Jersey, pleaded guilty today to health care fraud and agreed to forfeit more than $3.4 million in fraud proceeds.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
According to court documents, Lee, who is a medical doctor, and two others recruited patients by offering free lunches and recreational classes and provided them with spa services, such as massages and facials, and then falsely billed Medicare for more than $13 million using those patients’ Medicare numbers. Lee and the others billed Medicare for physical therapy, lesion removals, and other services that were neither medically necessary nor provided. The scheme took place at three clinics: URI Medical Center and Sarang Medical PC in Flushing, New York, and 999 Medical Clinic in Brooklyn, New York. Lee received more than $3.4 million through the submission of the fraudulent claims.
Lee is scheduled to be sentenced by United States District Judge Raymond J. Dearie of the Eastern District of New York on June 13, 2014. At sentencing, he faces a maximum sentence of 10 years in prison and approximately $3.4 million in mandatory restitution.
The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Senior Trial Attorney Nicholas Acker and Trial Attorney Bryan D. Fields from 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 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
According to court documents, Lee, who is a medical doctor, and two others recruited patients by offering free lunches and recreational classes and provided them with spa services, such as massages and facials, and then falsely billed Medicare for more than $13 million using those patients’ Medicare numbers. Lee and the others billed Medicare for physical therapy, lesion removals, and other services that were neither medically necessary nor provided. The scheme took place at three clinics: URI Medical Center and Sarang Medical PC in Flushing, New York, and 999 Medical Clinic in Brooklyn, New York. Lee received more than $3.4 million through the submission of the fraudulent claims.
Lee is scheduled to be sentenced by United States District Judge Raymond J. Dearie of the Eastern District of New York on June 13, 2014. At sentencing, he faces a maximum sentence of 10 years in prison and approximately $3.4 million in mandatory restitution.
The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Senior Trial Attorney Nicholas Acker and Trial Attorney Bryan D. Fields from 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 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Thursday, February 20, 2014
Government Intervenes in Lawsuit Against Tenet Healthcare Corp. and Georgia Hospital Owned by Health Management Associates Inc. Alleging Payment of Kickbacks
The government has intervened in a False Claims Act lawsuit against Tenet Healthcare Corp. (Tenet) and four of its hospitals in Georgia and South Carolina, as well as a hospital in Monroe, Georgia owned by Health Management Associates Inc. (HMA), alleging that the hospitals paid kickbacks to obstetric clinics serving primarily undocumented Hispanic women in return for referral of those patients for labor and delivery at the hospitals. The hospitals then billed the Medicaid programs in Georgia and South Carolina for the services provided to the referred patients and, in some instances, also obtained additional Medicare reimbursement based on the influx of low-income patients. Tenet and HMA are two of the largest owner/operators of hospitals in the United States. HMA was acquired by Community Health Systems last month. The government also is intervening against the clinics and related entities known as Hispanic Medical Management d/b/a Clinica de la Mama.
“The Department of Justice is committed to ensuring that health care providers who pay kickbacks in return for patient referrals are held accountable,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery. “Schemes such as this one corrupt the health care system and take advantage of vulnerable patients.”
“My office has made the investigation of health care fraud a priority,” said U.S. Attorney for the Middle District of Georgia Michael J. Moore. “In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need. This kind of scheme drives up costs for everyone, not just the vulnerable patients and groups like those targeted in this case.”
The lawsuit alleges that four Tenet hospitals—Atlanta Medical Center, North Fulton Regional Hospital, Spalding Regional Hospital and Hilton Head Hospital in South Carolina—and one HMA facility—Walton Regional Medical Center (since renamed Clearview Regional Medical Center)—paid kickbacks to Hispanic Medical Management d/b/a Clinica de la Mama (Clinica) and related entities in return for Clinica’s agreement to send pregnant women to their facilities for deliveries paid for by Medicaid, in violation of the federal Medicare and Medicaid Anti-Kickback Statute. The kickbacks were disguised as payments for a variety of services allegedly provided by Clinica.
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. The Anti-Kickback Statute is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is instead based on the best interests of the patient.
“Investigations such as these are a high priority for the FBI, and we are determined to hold accountable providers that enrich themselves at the expense of government programs and damage the public trust,” said FBI Assistant Director Ronald T. Hosko. “The FBI is dedicated to preventing and combating all forms of health care fraud; working with federal, state and local partners to effectively resolve allegations and engaging with the public to identify potential schemes.”
The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case. The lawsuit is pending in the Middle District of Georgia .
The government’s intervention in this matter illustrates its 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 Secretary of Health and Human Services 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 $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.
These matters were investigated by the Commercial Litigation Branch of the Justice Department’s Civil Division, the Fraud Section of the department’s Criminal Division, the U.S. Attorney’s Offices for the Middle and Northern Districts of Georgia, the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the Office of the Attorney General for the State of Georgia.
The case is captioned United States ex rel. Williams v. Health Mgmt. Assocs. Inc., Tenet Healthcare, et al., No. 3:09-CV-130 (M.D. Ga.).
The claims asserted against Tenet, the HMA facility and Clinica are allegations only, and there has been no determination of liability.
“The Department of Justice is committed to ensuring that health care providers who pay kickbacks in return for patient referrals are held accountable,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery. “Schemes such as this one corrupt the health care system and take advantage of vulnerable patients.”
“My office has made the investigation of health care fraud a priority,” said U.S. Attorney for the Middle District of Georgia Michael J. Moore. “In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need. This kind of scheme drives up costs for everyone, not just the vulnerable patients and groups like those targeted in this case.”
The lawsuit alleges that four Tenet hospitals—Atlanta Medical Center, North Fulton Regional Hospital, Spalding Regional Hospital and Hilton Head Hospital in South Carolina—and one HMA facility—Walton Regional Medical Center (since renamed Clearview Regional Medical Center)—paid kickbacks to Hispanic Medical Management d/b/a Clinica de la Mama (Clinica) and related entities in return for Clinica’s agreement to send pregnant women to their facilities for deliveries paid for by Medicaid, in violation of the federal Medicare and Medicaid Anti-Kickback Statute. The kickbacks were disguised as payments for a variety of services allegedly provided by Clinica.
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. The Anti-Kickback Statute is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is instead based on the best interests of the patient.
“Investigations such as these are a high priority for the FBI, and we are determined to hold accountable providers that enrich themselves at the expense of government programs and damage the public trust,” said FBI Assistant Director Ronald T. Hosko. “The FBI is dedicated to preventing and combating all forms of health care fraud; working with federal, state and local partners to effectively resolve allegations and engaging with the public to identify potential schemes.”
The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case. The lawsuit is pending in the Middle District of Georgia .
The government’s intervention in this matter illustrates its 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 Secretary of Health and Human Services 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 $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.
These matters were investigated by the Commercial Litigation Branch of the Justice Department’s Civil Division, the Fraud Section of the department’s Criminal Division, the U.S. Attorney’s Offices for the Middle and Northern Districts of Georgia, the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the Office of the Attorney General for the State of Georgia.
The case is captioned United States ex rel. Williams v. Health Mgmt. Assocs. Inc., Tenet Healthcare, et al., No. 3:09-CV-130 (M.D. Ga.).
The claims asserted against Tenet, the HMA facility and Clinica are allegations only, and there has been no determination of liability.
Subscribe to:
Posts (Atom)