Tuesday, January 29, 2013

Miami-Area Therapist Sentenced to Prison in Florida in $205 Million Community Mental Health Fraud Scheme

WASHINGTON—Miami-area resident Nichole Eckert, former therapist at the mental health care company American Therapeutic Corporation (ATC), was sentenced today to serve 48 months in prison for participating in a $205 million Medicare fraud scheme.
The sentence was announced today by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the Health and Human Services’ Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.
Eckert, 35, was sentenced by U.S. District Judge Patricia A. Seitz in the Southern District of Florida. In addition to the prison term, Judge Seitz sentenced Eckert to serve three years of supervised release and ordered her to pay more than $72 million in restitution, jointly and severally with her co-defendants.
On November 15, 2012, a federal jury in the Southern District of Florida found Eckert guilty of one count of conspiracy to commit health care fraud after a 16-day trial. She has been in federal custody since her conviction.
Evidence at trial demonstrated that the defendant and her co-conspirators caused the submission of false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. The defendant and her co-conspirators also used a related company, American Sleep Institute, to submit fraudulent Medicare claims.
Evidence at trial revealed that ATC secured patients by paying kickbacks to assisted living facility owners and halfway house owners who would then steer patients to ATC. These patients attended ATC, where they were ineligible for the treatment ATC billed to Medicare and where they did not receive the treatment that was billed to Medicare. After Medicare paid the claims, some of the co-conspirators then laundered the Medicare money in order to create cash to pay the patient kickbacks.
Eckert was a therapist at ATC’s Ft. Lauderdale, Florida center from September 2005 to September 2007 and returned to ATC as a therapist from late 2009 to October 2010, when ATC closed its doors as a result of federal charges. Evidence at trial revealed that Eckert fabricated therapist notes and other documents for patient files and submissions, and taught others to fabricate them, to make it appear both that ATC patients were qualified for PHP treatment and that they were receiving the intensive, individualized treatment PHP is supposed to be. ATC used those patient files to substantiate false and fraudulent claims to Medicare. Included in these submissions were claims for patients who were in the late stages of diseases causing permanent cognitive memory loss and patients who had substance abuse issues and were living in halfway houses. These patients were ineligible for PHP treatments, and because they were forced by their assisted living facility owners and halfway house owners to attend ATC, they were not receiving treatment for the diseases they actually had.
ATC and related company Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. On September 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010. Dozens of individuals have been convicted at trial or pleaded guilty for their participation in the scheme.
Evidence at trial showed that the ATC scheme resulted in a total of $205 million in fraudulent Medicare billings.
The cases were prosecuted by Senior Trial Attorney Jennifer L. Saulino and Trial Attorney Laura M.K. Cordova of the Justice Department Criminal Division’s Fraud Section. The 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 Southern District of Florida.
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.

Saturday, January 26, 2013

Another Orthofix Defendant Sentenced for Committing Medicare Fraud

BOSTON—A former Orthofix territory manager was sentenced yesterday for defrauding Medicare by forging patient medical records.
Michael J. McKay, 32, was sentenced by U.S. District Court Judge Denise J. Casper to one year of probation, with the first three months to be served in home confinement, and ordered to forfeit $10,000 and pay a fine of $3,000. In May 2012, McKay pleaded guilty to health care fraud.
Between 2008 and 2009, McKay was a territory manager for Orthofix, a company that manufactured and distributed bone growth stimulator medical devices that were intended to assist patients with bone fractures that did not heal properly. Medicare and many private insurance carriers have specific guidelines describing when it will pay for bone growth stimulators. When McKay received orders for patients that did not satisfy these guidelines, McKay frequently falsified the patients’ medical records to make it appear as though the order met Medicare’s rules so that Medicare would pay for a claim that otherwise would not be covered. Between 2008 and 2010, federal insurance carriers paid more than $70,000 for bone growth stimulators for claims where McKay falsified medical records. McKay altered physicians’ charts notes, changing the dates of patient visits, describing patient visits that did not occur, and inserting false diagnoses. McKay also forged prescriptions and Medicare Certificates of Medical Necessity within the orders. Orthofix fired McKay after it discovered his fraud. Even after he was fired, however, McKay continued to submit orders for stimulators by submitting them to a colleague, Derrick Field, who split the commissions with Field. Even after he was fired, McKay continued to forge chart notes, prescriptions, and CMNs in the orders he submitted to Field. On January 9, 2013, Field was sentenced to five months home confinement, two years of probation, and $44,000 in fines and forfeiture.
In addition to the McKay sentence, the Orthofix investigation has to date resulted in a number of felony charges against employees and contractors of Orthofix, including the following:
In December 2012, Orthofix was convicted of obstruction of a federal audit and ordered to pay $42 million in criminal fines and civil payments and was sentenced to probation for five years.
On January 22, 2013, Tom Guerrieri, the former vice president of sales for Orthofix, was sentenced to eight months in prison and ordered to pay $50,000 in fines and forfeiture for paying kickbacks.
In July 2012, Michael Cobb, a physician’s assistant, was sentenced to six months in prison, six months home confinement, and ordered to forfeit $10,000 and pay a $3,000 fine for accepting kickbacks from Orthofix.
In December 2011, Mitchell Salzman pleaded guilty while he was a regional manager for Orthofix and is scheduled to be sentenced on January 31, 2013.
In September 2012, Brian Racey pleaded guilty to health care while he was a territory manager for Orthofix and is scheduled to be sentenced on February 2, 2013, in the U.S. District Court for the Eastern District of Pennsylvania.
This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations; the Federal Bureau of Investigation Boston Field Office; and the Department of Defense, Defense Criminal Investigative Service-Boston Resident Agency. It was being prosecuted by Assistant U.S. Attorneys David Schumacher and Jeremy Sternberg of Ortiz’s Health Care Fraud Unit.

Houston Man Sentenced for Health Care Fraud

SHREVEPORT, LA—United States Attorney Stephanie A. Finley announced today that Godspower Joseph Essang, 35, of Houston, Texas, was sentenced today, to 37 months in federal prison with three years’ supervised release for Medicare fraud.
Essang was also ordered to pay $613,096 in restitution to Medicare. Judge Maurice S. Hicks immediately remanded Essang into the custody of the U.S. Marshals Service to begin serving his sentence.
Essang was sentenced based on his September 28, 2012 guilty plea to one count of health care fraud. During the guilty plea hearing, Essang admitted owning and operating Shalom Equipment, a durable medical equipment company located on Woodward Avenue in Shreveport. Shalom engaged in the business of providing what were referred to as “ortho kits,” which were braces for various parts of the body. Essang admitted paying individuals to provide him with their Medicare beneficiaries and physicians information. He then used this identifying information to file false claims with Medicare for providing the “ortho kits” to Medicare beneficiaries who did not need, were not prescribed, and/or did not receive the items. Essang admitted that between August 12, 2007 and October 21, 2008, he filed approximately 736 claims, billing Medicare for $1,223,255. Medicare actually paid out $613,096 on the claims.
“Mr. Essang’s scheme was designed to defraud a program whose sole purpose is providing medical services to the elderly and the disabled,” U.S. Attorney Stephanie A. Finley stated. “His actions defrauded the program and, ultimately, U.S. taxpayers. This office will continue to vigorously pursue charges against those who steal from such programs.”
“Durable medical equipment fraud is a major problem that costs taxpayers billions in lost and wasted dollars,” said William W. Root, Assistant Special Agent in Charge, U.S. Department of Health and Human Services. “Today’s sentencing is the culmination of a concerted and joint effort by our Inspector General’s Office, the U.S. Attorney’s Office, and the Federal Bureau of Investigation to quickly bring to justice those who prey on our elderly for financial gain.”
The Federal Bureau of Investigation and the U.S. Department of Health and Human Services-Office of the Inspector General conducted the investigation. Assistant U.S. Attorney C. Mignonne Griffing prosecuted the case.

Friday, January 25, 2013

La Jolla Oncologist and Medical Practice Plead Guilty to Dispensing Unapproved Drugs

SAN DIEGO—A prominent La Jolla oncologist and his corporate medical practice have pleaded guilty in connection with a scheme to import unapproved foreign cancer drugs at a deep discount, dispense them to unwitting patients, bill Medicare as if the drugs were legitimate, and pocket the profits.
In a hearing before U.S. Magistrate Judge Bernard Skomal on January 15, Dr. Joel I. Bernstein entered a guilty plea to a single count of introducing an unapproved drug into interstate commerce—in this case, a cancer drug called “Mabthera” intended for market in Turkey—and administering it to patients. The approved U.S. drug with the same active ingredient is Rituxan, which is used to treat lymphomas and leukemias such as non-Hodgkin lymphoma and chronic lymphocytic leukemia. Bernstein was released pending sentencing, which is scheduled for April 16 at 1:30 p.m. before Judge Skomal.
In addition, his medical practice, Dr. Joel I. Bernstein, M.D. Inc., also pleaded guilty at a hearing today before U.S. District Judge Cathy Ann Bencivengo to one count of health care fraud. According to the plea agreement with the corporation, employees of Dr. Joel I. Bernstein, M.D. Inc. purchased $3.4 million of foreign cancer drugs, knowing they had not been approved by the U.S. Food and Drug Administration for use in the United States. From 2007 to 2011, Bernstein’s office purchased these drugs for significantly less than market value in the U.S. and then submitted claims to Medicare at the full reimbursement price. To conceal the scheme, the office fraudulently used Medicare reimbursement codes for approved cancer drugs, as Medicare does not pay for unapproved drugs.
The plea agreement for the corporation also calls for $1.7 million in restitution to Medicare, plus forfeiture of $1.2 million in profits. The corporate medical practice is scheduled to be sentenced on May 17, 2013, before Unites States District Judge Cathy Ann Bencivengo.
In addition, the government has also filed a False Claims Act lawsuit in District Court against Dr. Bernstein and his medical corporation for submitting false claims to the Medicare Program for these unapproved drugs. According to this civil complaint, the Medicare Program was defrauded of over $1.7 million, and under the False Claims Act, the United States can recover triple the amount of damages plus monetary penalties.
The cases involving Dr. Bernstein and his practice are the latest example of an alarming nationwide trend that potentially puts patients at risk by exposing them to foreign drugs—particularly injectable chemotherapy drugs—that are not vetted by the FDA. Agency officials have described the trend as an “epidemic of unapproved and counterfeit drugs.”
The FDA’s Office of Criminal Investigations (OCI) currently has over 200 investigations nationwide involving schemes in which medical practices purchase foreign, unapproved drugs and dispense them to unsuspecting patients for personal financial gain.
This practice is particularly disturbing because, unlike traditional prescription drugs which are dispensed to the patient by a pharmacy, oncology drugs are typically infused into a patient without the patient ever seeing the box it came in, or any of the related labeling.
“This isn’t just about the greed of one doctor but about the welfare of many patients,” said U.S. Attorney Laura Duffy. “In a worst-case scenario, chemotherapy drugs that have not been approved by the FDA may be fake, ineffective, unsafe, and dangerous. This is what motivates the Department of Justice and the FDA to be more aggressive in stopping those who would corrupt the integrity of the pharmaceutical supply chain with no regard for the well-being of patients.”
John Roth, director of the FDA’s Office of Criminal Investigations, the lead agency on the case, said, “When medical professionals decide that patient safety is less important than finding a great deal on pharmaceutical products from foreign countries and unknown suppliers our nation’s pharmaceutical supply chain is at risk and patients are vulnerable. FDA’s Office of Criminal Investigations will continue to investigate these cases and work closely with our regulatory counterparts in FDA and our law enforcement partners who share the same commitment to address this problem. We hope this message is heard loud and clear within the medical community—you will face criminal prosecution if you engage in this type of illegal activity.”
Daphne Hearn, Special Agent in Charge of the San Diego FBI, said, “Health care fraud costs the country billions of dollars each year and undermines the security of the Medicare program. The FBI will continue to work with our law enforcement partners and prosecutors to ensure the safety of the public and ensure the Medicare program will be there for those who need it most.”
Derek Benner, Special Agent in Charge of Immigration and Customs Enforcement’s Homeland Security Investigations, said, “As part of this case, HSI agents and our law enforcement partners uncovered an intricate network involved in the illicit distribution and importation of unapproved drugs that were sold to doctors in the U.S. It’s disturbing to see licensed, trusted medical professionals who are willing to put their own financial gain over public health and safety. We owe it to consumers to aggressively pursue pharmaceutical fraud given the significant risk to public health.”
According to the corporation’s plea agreement, Bernstein’s employees knowingly purchased foreign drugs containing the same active ingredient as drugs sold in the United States as Abraxane, Alimta, Aloxi, Boniva, Eloxatin, Gemzar, Neulasta, Rituxan, Taxotere, Venofer, and Zometa, but were intended for use in markets outside the United States and had not been approved for sale in the United States.
The medical practice, in pleading guilty, admitted that it was aware that the drugs were not approved by the FDA in part because the practice had received a notice from the FDA in October 2008 that a shipment of drugs had been detained because the drugs were not approved for use in the United States by the FDA. Despite this warning, Bernstein’s medical practice continued to purchase unapproved cancer drugs and inject them into patients.
The FDA regulates the introduction of pharmaceuticals into commerce. This regulation helps ensure that drugs are safely manufactured, made from appropriate ingredients, and properly labeled. The approval process addresses the chemical composition of the drug, the drug’s safety and effectiveness, and the elements of the drug’s distribution, such as the methods used in the manufacture, processing, and packing of the drug, as well as the labeling to be used for the drug.
Only drugs that comply with vigorous U.S. standards should be given to patients in this country. Drugs manufactured outside the United States that are not intended for use in the United States do not go through this approval process and are considered unapproved and therefore potentially unsafe.
In the Bernstein case, investigators found no evidence the illegal drugs involved were counterfeit. The unapproved foreign medications that were seized during the investigation were tested and found to contain the appropriate level of active ingredients. Although it’s difficult to determine whether a decline in a patient’s health should be attributed to unapproved drugs or to cancer, the investigation uncovered no evidence to indicate that Bernstein’s patients were harmed by the foreign drugs he administered.
There have been numerous similar cases of illegal importation and distribution of foreign unapproved drugs in San Diego and around the United States in recent years.
In cases related to Bernstein, a Florida-based cancer-drug supplier, Martin Paul Bean, III was indicted by a federal grand jury in San Diego in September 2012 for allegedly selling more than $7 million of misbranded and unapproved prescription oncology drugs to U.S. doctors. Please see 12-cr-03734-WQH USA.
The indictment alleged that from 2005 to 2011, Bean, doing business as GlobalRxStore; ordered the misbranded and unapproved drugs from foreign countries, including Turkey, India, and Pakistan; and sold them to the doctors throughout the U.S. at substantially discounted prices via a wholesale pharmacy in San Diego.
That pharmacy—Oberlin Medical Supply and Service Corp.—was owned and operated by Maher Idriss, who pleaded guilty March 8, 2012, to conspiring with Bean to supply the unapproved drugs. Idriss acknowledged that U.S. doctors paid him over $7 million for foreign-sourced unapproved oncology drugs from May 2006 to May 2011. Idriss faces up to five years in prison and restitution and has already forfeited approximately $54,000 of profits. He is scheduled for sentencing May 20, 2013. Please see 12- cr-01775-WQH.
According to the plea agreement for the Bernstein medical practice, employees ordered drugs from Oberlin, among other suppliers.
Idriss admitted that after receiving payments from the doctors, he transferred the funds to the foreign suppliers and to the GlobalRXStore owner’s bank account in Canada, keeping a portion for himself.
In another related case with a San Diego connection, James Newcomb of La Jolla was sentenced in August 2012 to 24 months in prison for conspiring to distribute adulterated prescription drugs to physicians in the United States. Newcomb admitted that he distributed unapproved prescription drugs from foreign countries to physicians located in the United States, with the assistance of persons in Canada and the United Kingdom. Please see 12-cr-00009-RWS-1.
Newcomb and others marketed these illegal drugs to U.S. doctors by offering them at up to 60 percent off the average wholesale price of the legitimate drugs in the United States.
According to the plea agreement of Bernstein’s medical practice, employees of his office purchased unapproved oncology drugs from Newcomb’s businesses, which included Medication Brokers, Pricing Logix, Richard’s Services, Ban Dune Marketing, and Warwick Healthcare Solutions. Newcomb based his operations in offices in La Jolla. La Jolla resident Sandra Behe and Dr. Abid Nisar of St. Louis, Missouri, were also convicted in the same investigation.
Elsewhere in the country, doctors, office staff, and drug suppliers in Maryland, Missouri, Tennessee, and California were indicted in similar schemes in 2011 and 2012. They were accused of importing misbranded cancer drugs at significantly cheaper prices, providing them to patients without disclosing the source of the drugs, and then submitting claims for reimbursement from healthcare programs.
It was the FDA’s discovery of two counterfeit drugs—Avastin, the approved blockbuster cancer drug for treatment of colorectal, lung, kidney, and brain cancer; and Altuzan, the unapproved Turkish version of Avastin—that brought national media attention to the problem. The Altuzan was found to contain no active ingredient at all and thus would provide no benefit whatsoever to patients.
The FDA, recognizing the seriousness of this illegal activity and the discovery of the counterfeit Avastin and Altuzan, took the unprecedented regulatory action of issuing letters to numerous medical practices and physicians around the country, including many that purchased unapproved cancer drugs. To date over 500 letters have been issued.
Dr. Bernstein was among those who received a letter from the FDA prior to being charged with federal crimes.
The letter to Bernstein said, in part, “Purchasing prescription drug products, such as injectable cancer medications, from foreign or unlicensed suppliers puts patients at risk of exposure to drugs that may be fake, contaminated, improperly stored and transported, ineffective, and dangerous. In virtually all cases, purchasing unapproved prescription drugs from foreign sources violates the Federal Food, Drug, and Cosmetic Act and is illegal.”
The letter warned of the risks of purchasing medications from foreign, unfamiliar, or unlicensed suppliers and selling unapproved versions of injectable cancer medications, noting that “patients were unknowingly placed at risk when they received medications of uncertain purity, storage, handling, identity, and sourcing.”
The letter also noted that importing these medications from foreign sources is a violation of the Federal Food, Drug, and Cosmetic Act.
“In an effort to protect the health of patients, health care providers should use only FDA-approved versions of these cancer medications,” the letter said. “Health care providers should be aware that purchasing medications from direct-to-clinic promotions that are from non-verified sources might increase the risk of receiving a potentially unsafe and ineffective product, since the products offered for sale may be unapproved, not manufactured with the quality attributes of FDA-approved products, or counterfeit.”
Defendant Criminal Case No. 13cr0120-BGS
Joel I. Bernstein
Summary of Charges
Title 21, United States Code, Section 331(d), 333(a) (1) and 355(a), a misdemeanor—introducing or causing to be introduced into interstate commerce an unapproved new drug
Maximum Penalties
One year in prison; $100,000 fine, one year supervised release, restitution.
Defendant in Criminal Case No. 13cr0119-CAB 
Dr. Joel I. Bernstein, M.D. Inc.
Summary of Charges
Title 18, United States Code, Section 1347—medicare fraud
Maximum Penalties
Five years’ supervised release, $500,000 fine, mandatory restitution.
Investigating Agencies
The U.S. Food and Drug Administration’s Office of Criminal Investigations was the lead investigative agency in this case. Other agencies involved were the Federal Bureau of Investigation and Immigration and Customs Enforcement’s Homeland Security Investigations. The lead prosecutor is Melanie Pierson.

Former Miami Clinic Director Sentenced to 70 Months in Prison for Role in HIV Infusion Fraud Scheme

WASHINGTON—A former Miami HIV infusion clinic director was sentenced today to serve 70 months in prison for his role in a $26.2 million HIV infusion fraud scheme, announced Assistant Attorney General Lanny Breuer of the Criminal Division, U.S. Wifredo A. Ferrer of the Southern District of Florida, Acting Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office, and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.
Enrique Gonzalez, 67, formerly of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Judge Altonaga sentenced Gonzalez to serve three years of supervised release and ordered him to pay $17,590,896 in restitution to HHS.
On November 13, 2012, Gonzalez pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims, and to pay health care kickbacks, and one count of conspiracy to commit health care fraud.
Gonzalez admitted that between August 2002 and March 2004, he conspired with co-defendant Ronald Harris, a Miami physician, and alleged co-conspirators to operate Physicians Med-Care and Physicians Health (together the “Physicians Clinics”), two Miami HIV infusion clinics. According to court documents, the Physicians Clinics were owned and controlled by alleged co-conspirators Carlos Benitez and his brother Luis Benitez. The Physicians Clinics purported to specialize in treating patients with HIV but were operated for the sole purpose of committing Medicare fraud, according to court documents. Gonzalez was a director of Physicians Med-Care and, at the direction of his co-conspirators, was responsible for the finances of the Physicians Clinics.
Gonzalez admitted that he agreed with his co-conspirators to handle the finances for the Physicians Clinics, moving the money paid by the Medicare program out of the Physicians Clinics’ accounts and into accounts owned and controlled by his co-conspirators. According to court documents, Harris signed blank checks that Gonzalez used to transfer funds to various Benitez-owned entities and others, as directed by his co-conspirators. In addition, Gonzalez agreed to provide cash to various co-conspirators at the Physicians Clinics to be used to pay bribes and kickbacks to the Medicare beneficiaries in return for those beneficiaries allowing the Physicians Clinics to bill the Medicare program for HIV infusion services that were not medically necessary and often not provided.
Gonzalez admitted that during his association with Physicians Med-Care, the clinic billed the Medicare program approximately $24.5 million in HIV infusion therapy claims, for which the clinic received $16.7 million in payments. Gonzalez also admitted that during his time with Physicians Health, the clinic billed Medicare approximately $1.7 million and received approximately $800,000 in payment from the Medicare program for fraudulent services.
Gonzalez was a fugitive from justice from the time of his indictment in 2008, until he was located and detained in Peru in late 2011. Gonzalez was extradited to the United States in July of 2012. Gonzalez’s daughter, Carmen Gonzalez, was indicted in a related case and is currently a fugitive.
Co-defendant Harris pleaded guilty on August 26, 2008, to one count of conspiracy to defraud the United States, to cause the submission of false claims and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims to the Medicare program. Harris pleaded guilty in connection with his role as the medical director for the Physicians Clinics. On November 4, 2008, Harris was sentenced to serve 84 months in prison for his role in the scheme.
Carlos and Luis Benitez and Thomas McKenzie were charged separately with health care fraud and money laundering crimes in an indictment unsealed on June 11, 2008. According to the separate indictment, the defendants provided the money and staff necessary to open the Physicians Clinics, the Medicare patients that the clinics needed to bill the Medicare program and transportation for the HIV patients who visited the clinics. Carlos and Luis Benitez and McKenzie were charged for their role in committing approximately $109 million in HIV infusion fraud and money laundering through the Physicians Clinics and nine other HIV infusion clinics.
On September 18, 2008, McKenzie pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program and admitted to his role in a $119 million HIV infusion fraud scheme. On December 18, 2008, McKenzie was sentenced to serve 14 years in prison.
Carlos and Luis Benitez are also fugitives. Anyone with information regarding the whereabouts of the fugitives is urged to contact HHS-OIG fugitive reporting phone line at 888-476-4453.
The defendants who have not been convicted are presumed innocent unless and until proven guilty.
The Physicians Med-Care and Physicians Health case is being prosecuted by Trial Attorney N. Nathan Dimock of the Criminal Division’s Fraud Section. The case was investigated by the FBI and the DHS Office of Inspector General.
The case 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 Southern District of Florida. The Department also thanks the Peruvian National Police Interpol Unit for their assistance.
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.

Four Sentenced to Prison in Community Mental Health Center Case

WASHINGTON—The owners of three Miami-area assisted living facilities and an affiliated psychologist were sentenced to prison today in connection with a health care fraud scheme involving now-defunct Miami-area health provider Health Care Solutions Network Inc. (HCSN) in which Medicare was billed for mental health treatments that were unnecessary or not provided.
The sentences were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.
U.S. District Judge Cecilia M. Altonaga sentenced Serena Joslin, 32, of Looneyville, West Virginia, to 63 months in prison, following her previous guilty plea to conspiracy to commit health care fraud. Raymond Rivero, 55, Daniel Martinez, 46, and Ivon Perez, 50, all of Miami, were each sentenced to 28 months in prison. All three had previously pleaded guilty to conspiracy to violate the anti-kickback statute.
According to court documents, HCSN operated community mental health centers both in Miami and North Carolina, including partial hospitalization programs (PHP)—a form of intensive treatment for severe mental illness. HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not provided.
In Miami, HCSN obtained beneficiaries by paying kickbacks to owners and operators of assisted living facilities (ALF) or by otherwise recruiting them from the facilities and from nursing homes. Rivero, Martinez, and Perez admitted during their guilty pleas to referring Medicare beneficiaries to HCSN in exchange for cash bribes. Rivero, former owner of Miami-based God Is First ALF; Martinez, former owner of Homestead, Florida-based Mi Renacer ALF; and Perez, former owner of Homestead-based Kayleen and Denis Care Corp., are no longer permitted to operate such facilities as a condition of their guilty pleas.
According to court documents, ALF residents referred to HCSN by Rivero, Martinez, and Perez were not qualified to be placed in PHP and were only selected because they had Medicare or state of Florida Medicaid benefits. In some cases, ALF patients suffered from dementia, Alzheimer’s disease, mental retardation, or were otherwise unable to benefit from mental health services.
According to court documents, Joslin, a licensed psychologist, was hired by HCSN in North Carolina in April 2010 as a clinical coordinator and later promoted to clinical director. In those roles, she conspired with other HCSN employees to fabricate medical documents to substantiate alleged PHP treatment that was medically unnecessary and, in many instances, not even provided to the beneficiaries. Joslin admitted that many of the HCSN patients were unqualified for the PHP program because they suffered from conditions such as mental retardation and dementia and that she directed therapists to fabricate medical records to support HCSN’s fraudulent billing to the Medicare program. Joslin was also required to surrender her North Carolina license to provide mental health treatment as part of her plea agreement.
According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services.
In addition to the prison terms, Judge Altonaga sentenced Joslin, Rivero, Martinez, and Perez each to serve three years of supervised release and ordered them to pay $4,464,728; $90,896; $76,358; and $89,245 in restitution, respectively.
The cases are being prosecuted by Special Trial Attorney William Parente and Trial Attorney Allan J. Medina of the Criminal Division’s Fraud Section. The cases were investigated by the FBI and HHS-OIG and were 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 Southern District of Florida.
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.

Wednesday, January 23, 2013

Social Worker Indicted for Health Care Fraud

BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced today that a federal grand jury in Buffalo has returned a five-count indictment charging Nina Jafari, a licensed clinical social worker, 62, of Amherst, New York, with health care fraud. The charge carries a maximum penalty of 10 years years in prison, a fine of $250,000, or both.
Assistant U.S. Attorney Michael DiGiacomo, who is handling the case, stated that according to the indictment, the defendant defrauded Blue Cross Blue Shield of Western New York. The scheme involved Jafari submitting reimbursement claim forms to Blue Cross Blue Shield for services that were not rendered. The amount totaled approximately $125,000.
The indictment is the culmination of an investigation on the part of special agents of the Federal Bureau of Investigation, under the direction of Special Agent in Charge Christopher M. Piehota.
The fact that a defendant has been charged with a crime is merely an accusation, and the defendant is presumed innocent until and unless proven guilty.

Owner of Texas Durable Medical Equipment Companies Convicted in Fraud Scheme

WASHINGTON—A Texas federal judge convicted the owner of two Texas-based durable medical equipment companies today on multiple health care fraud charges following a five-day bench trial, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division.
Hugh Marion Willet, 69, of Fort Worth, Texas, was found guilty by U.S. District Judge Jane J. Boyle in the Northern District of Texas on all seven counts of the June 2012 second superseding indictment: one count of conspiracy to commit health care fraud and six counts of health care fraud stemming from a durable medical equipment (DME) fraud scheme. Willett’s wife, Jean Willett, previously pleaded guilty to the same charges and was sentenced in September 2012 to serve 50 months in prison.
The evidence at trial showed that between 2006 and 2010, the Willets co-owned and operated JS&H Orthopedic Supply LLC and Texas Orthotic and Prosthetic Systems Inc., which claimed to provide orthotics and other DME to beneficiaries of Medicare and private insurance benefit programs including Aetna, Blue Cross Blue Shield, and CIGNA.
Evidence presented in court proved that both of these companies intentionally submitted claims to Medicare and other insurers for products that were materially different from and more expensive than what was actually provided and that Hugh Marion Willett was a knowing and willing participant in the fraud.
At sentencing, currently scheduled for April 18, 2013, Hugh Marion Willett faces a maximum potential penalty of 10 years in prison and a $250,000 fine on each count.
The case is being prosecuted by Fraud Section Trial Attorney Ben O’Neil and Deputy Chief Sam Sheldon of the Justice Department’s Criminal Division. The case was investigated by the FBI and the Department of Health and Human Services Office of Inspector General (HHS-OIG) and brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section.
Since their inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Provider of Home Health Care Services Sentenced for Medicaid Fraud

NORFOLK, VA—Janice W. Holland, 42, of Suffolk, Virginia, was sentenced today to 51 months in prison for health care fraud and alteration of records and a mandatory consecutive sentence of 24 months in prison for aggravated identity theft, for a total sentence of 75 months. She was also ordered to pay restitution to the Virginia Medicaid program in the amount of $630,339.30.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and Virginia Attorney General Ken Cuccinelli made the announcement after sentencing by Senior United States District Judge Robert G. Doumar.
Holland pled guilty on September 18, 2012. According to court documents, Holland owned and operated A Caring Hand Home Health Care Services Inc., a business located in Suffolk that was authorized to provide respite care to Medicaid recipients. Respite care is designed to provide temporary, substitute care for a Medicaid recipient that is normally provided by the family or another unpaid primary caregiver of the recipient. These services are provided on a short-term basis because of the emergency absence or need for routine or periodic relief of the primary caregiver. Between January 2008 and October 2011, Holland filed approximately 939 false and fraudulent claims with the Virginia Medicaid program, representing that respite care had been provided by her company to 30 Medicaid recipients, when, in fact, no such care had been provided. She filed these claims using, without authority, the recipients’ names, dates of birth,and Medicaid identification numbers. As a result, Holland obtained health care benefit payments in the approximate amount of $630,339.30, to which she was not entitled. She also altered and falsified her office records to conceal and cover up her false billings.
This case was investigated by the FBI and the Office of the Virginia Attorney General, Medicaid Fraud Control Unit. Assistant United States Attorney Alan M. Salsbury and Special Assistant United States Attorney David W. Tooker prosecuted the case on behalf of the United States.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Eastern District of Virginia at http://www.justice.gov/usao/vae.

Tuesday, January 22, 2013

Former Florida Hospital Employee Sentenced to Federal Prison for Data Theft

ORLANDO—U.S. District Judge Roy B. Dalton, Jr. today sentenced Dale Munroe, II (35, Winter Haven) to 12 months and one day in federal prison for his role in stealing the information of Florida Hospital patients. As part of his sentence, Munroe was also ordered to serve a two-year term of supervised release. Munroe pleaded guilty on October 22, 2012.
According to court documents, Munroe was hired at the Celebration, Florida location of Florida Hospital in July 2006. During his employment, he worked as a registration representative in the Emergency Department, where he would register patients as they came in the main emergency entrance. From January 2009, until his termination in July 2011, Munroe used his position to obtain individually identifiable health information of patients of Florida Hospital who had been involved in motor vehicle accidents. Munroe would then disclose that information to Sergei Kusyakov, who was involved in the operation of two chiropractic clinics (Metro Chiropractic and Wellness Center and City Lights Medical Center). Kuskyakov and other conspirators would then use the stolen information to solicit Florida Hospital patients for chiropractic and legal services. Kusyakov would pay Munroe for his role in providing the stolen information. On July 12, 2011, Munroe was terminated by Florida Hospital for a patient data breach that was unrelated to the conspiracy described above.
Approximately a week after his termination, Katrina Munroe (30, Winter Haven), Munroe’s wife and also an employee of Florida Hospital, was recruited by the conspirators to take over the role of stealing patient data and providing it to Kusyakov. In August 2012, Katrina Munroe was terminated from her position at the hospital, after becoming a suspect in a data breach incident. In December 2012, she pleaded guilty to her role in the conspiracy. She faces a maximum penalty of five years in federal prison. Her sentencing hearing has been set for March 11, 2013.
On January 7, 2013, Sergei Kusyakov (38, Davenport) pleaded guilty to one count of conspiracy and four counts of wrongful disclosure of individually identifiable health information. He faces a maximum penalty of 45 years in federal prison. His sentencing hearing has been set for March 25, 2013.
These cases were investigated by the Federal Bureau of Investigation and the Florida Department of Financial Services, Division of Insurance Fraud. They are being prosecuted by Assistant United States Attorney Roger B. Handberg.

Disability Doctor Peter J. Ajemian Pleads Guilty in Manhattan Federal Court for His Role in Long Island Railroad Fraud Scheme

Preet Bharara, the United States Attorney for the Southern District of New York, announced today that Peter J. Ajemian, a Board-certified orthopedist, pled guilty to charges related to the alleged massive fraud scheme in which Long Island Railroad (LIRR) workers claimed to be disabled upon early retirement so that they could receive disability benefits to which they were not entitled. As described in the complaint, between the late 1990s and 2008, Ajemian recommended that at least 734 retiring LIRR employees receive disability benefits, and he was responsible for treating nearly half of all LIRR employees who retired and received disability benefits in one four-year period. Ajemian pled guilty before U.S. District Judge Victor Marrero. Three additional LIRR retirees, KArl Brittel, Gregory Bianchini, and Brian Delgiorno, also pled guilty to charges related to their participation in the LIRR fraud scheme this week. Brittel pled guilty before Judge Marrero today; Bianchini pled guilty before U.S. Magistrate Judge Kevin Nathaniel Fox on January 16, 2013; and Delgiorno pled guilty before Judge Fox on January 17, 2013. Of the 32 defendants charged, 21 have now pled guilty.
Manhattan U.S. Attorney Preet Bharara stated, “Dr. Ajemian used his medical license to facilitate a massive fraud at the LIRR. By running the functional equivalent of a ‘disability mill’ and fraudulently qualifying hundreds of LIRR patients for undeserved disability benefits, Dr. Ajemian enriched himself and debased his degree. Twenty-one defendants have now pled guilty for their roles in this breathtaking and brazen fraud that cost the Railroad Retirement Board untold millions of dollars.”
According to the complaint, the superseding indictments, the superseding informations, and statements made in other public filings and in court:
The LIRR Disability Fraud Scheme
The Railroad Retirement Board (“RRB”) is an independent U.S. agency that administers benefit programs, including disability benefits, for the nation’s railroad workers and their families. A unique LIRR contract allowed employees to retire at the relatively young age of 50—the age of eligibility has since changed to 55—if they had been employed by the LIRR for at least 20 years. Eligible employees are entitled to receive an LIRR pension, which is a portion of the full retirement payment for which they are eligible at 65. In addition, at full retirement age (between age 60 and age 65 depending on years of service), they are eligible to receive an RRB retirement pension. For LIRR workers who retired at 50 with only an LIRR pension, they would receive less than their prior salary and substantially lower pension payments than those to which they would be entitled at full retirement age. However, LIRR employees who retired and claimed disability could receive a disability payment from the RRB on top of their LIRR pension, regardless of age. A retiree’s LIRR pension, in combination with RRB disability payments, can be roughly equivalent to the base salary earned during his or her career.
Hundreds of LIRR employees have allegedly exploited the overlap between the LIRR pension and the RRB disability program by pre-planning the date on which they would falsely declare themselves disabled so that it would coincide with their projected retirement date. These false statements, made under oath in disability applications, allowed LIRR employees to retire as early as age 50 with an LIRR pension, supplemented by the fraudulently obtained RRB disability annuity. From 1995 through 2011, more than 75 percent of LIRR employees stopped working and began receiving RRB disability benefits, whereas during this same period, only 25 percent of retiring Metro-North employees stopped working and began receiving RRB disability benefits.
Peter J. Ajemian is a Board-certified orthopedist who was instrumental in helping LIRR retirees receive disability benefits to which they were not entitled. As set forth in the complaint, between the late 1990s and 2008, Ajemian declared over 94 percent of the LIRR employees he saw as patients disabled. As part of the massive fraud scheme, Ajemian prepared fraudulent medical narratives for LIRR retirees well before the employees’ planned retirement dates so that the narratives could be submitted to the RRB upon retirement. These medical narratives were completely fabricated or grossly exaggerated so that Ajemian could recommend a set of restrictions that, if legitimate, would render it impossible for the LIRR employees to continue performing their jobs. Many of the purportedly “objective” findings from the tests he conducted showed nothing more than normal degenerative changes one would expect to see in patients within the relevant age bracket.
Ajemian received approximately $800 to $1,200, often in cash, for these fraudulent assessments and narratives, as well as millions of dollars in health insurance payments for unnecessary medical treatments and fees for preparing fraudulent medical support for the claimed disabilities. Of approximately 453 LIRR annuitants studied, Ajemian received approximately $2.5 million in related payments from patients and insurance companies. In turn, those patients received over $90 million in RRB disability benefit payments.
As alleged in the complaint, between 1998 and 2008, Ajemian recommended that at least 734 LIRR employees receive these disability benefits. During one four-year period, August 2004 through August 2008, Ajemian was the treating physician for nearly half of all LIRR retirees younger than 65 years old who filed for RRB disability benefits.
* * *
AJEMIAN, 63, of Oyster Bay Cove, New York, pled guilty to one count of conspiracy to commit mail fraud, wire fraud, and health care fraud, as well as one count of health care fraud, and he faces a maximum of 30 years in prison. He has also agreed to forfeit $116.5 million and pay $116.5 million in restitution. He will be sentenced by Judge Marrero on May 24, 2013, at 2:00 p.m.
Brittel, 62, of Atlantic City, New Jersey, pled guilty to conspiracy to commit mail fraud, wire fraud, and health care fraud; conspiracy to defraud the United States; health care fraud; mail fraud; wire fraud; and perjury; and he faces a maximum of 80 years in prison. Bianchini, 59, of Key Largo, Florida, pled guilty to conspiracy to commit mail fraud, wire fraud, and health care fraud; conspiracy to defraud the United States; health care fraud; mail fraud; and wire fraud; and he faces a maximum of 75 years in prison. Delgiorno, 54, of Howard Beach, New York, pled guilty to conspiracy to commit mail fraud, wire fraud and health care fraud; conspiracy to defraud the United States; false claims; health care fraud; mail fraud; wire fraud; and perjury; and he faces a maximum of 85 years in prison. They will be sentenced by Judge Marrero on July 19, May 16, and May 17, 2013, respectively.
Thirty-two people have been charged in connection with the LIRR disability fraud scheme, 21 of whom have now pled guilty. The charges against the remaining defendants are merely allegations, and they are all presumed innocent unless and until proven guilty.
Mr. Bharara praised the RRB-OIG, the FBI, and the MTA-OIG for their outstanding work in the investigation, which he noted is ongoing. He also acknowledged the previous investigation conducted by the New York State Attorney General’s Office into these pension fraud issues.
The Office’s Complex Frauds Unit is handling the case. Assistant U.S. Attorneys Justin Weddle, Daniel Tehrani, Nicole Friedlander, and Danya Perry are in charge of the prosecution.

Thursday, January 10, 2013

Home Health Care Agency Operator Charged with Health Care Fraud

MINNEAPOLIS—Yesterday in federal court, the operator of Lucky Home Health Care Inc., a home health care agency in Minneapolis, was charged with defrauding Medicaid. On January 8, 2013, Abshir Mohammed Ahmed, age 40, of Minneapolis, was charged via an information with one count of health care fraud.
Allegedly, from January 2008 through June 2011, Ahmed defrauded Medicaid, a federal health care benefit program, out of more than $400,000 by submitting fraudulent billings. Ahmed submitted claims that falsely represented that home health care services were purportedly provided by identified Personal Care Assistants (PCA) that were not, in fact, provided by those PCAs.
For example, a claim for reimbursement submitted on July 16, 2009, billed Medicaid $1,330.56 for PCA services allegedly, but not actually, provided by the identified PCA.
The Medicaid program provides medical care and services to low-income people who meet certain income and eligibility requirements. Home health care, provided by PCAs, is one of the services reimbursed by Medicaid.
If convicted, Ahmed faces a potential maximum penalty of 10 years in federal prison. All sentences will be determined by a federal district court judge.
This case is the result of an investigation by the Federal Bureau of Investigation. It is being prosecuted by Assistant U.S. Attorney David M. Genrich.
The U.S. Attorney’s Office participates in a task force with the Medicaid Fraud Control Unit at the Minnesota Attorney General’s Office that focuses on home health care fraud trends. The task force includes the U.S. Department of Health and Human Services-Office of Inspector General, the FBI, the Internal Revenue Service, and other federal, state, and local law enforcement partners.
As a result of federal convictions for health care fraud, defendants are excluded from participating in federal health benefit programs, including Medicare and Medicaid. Exclusion determinations are made by the U.S. Department of Health and Human Services. Nationwide, more than 3,000 individuals were excluded from program participation in fiscal year 2010 based upon criminal convictions or patient abuse or neglect, license revocations, or other factors.
For more information, visit http://www.stopmedicarefraud.gov.
A defendant, of course, is presumed innocent until he or she pleads guilty or is proven guilty at trial.

Two More Plead Guilty in Patient Data Theft Case

ORLANDO—Sergei Kusyakov (38, Davenport) today pleaded guilty to one count of conspiracy and four counts of wrongful disclosure of individually identifiable health information. Kusyakov faces a maximum penalty of 45 years in federal prison. Sentencing has been set for March 25, 2013.
On December 27, 2012, another conspirator, Katrina Munroe (30, Winter Haven) pleaded guilty to one count of conspiracy. She faces a maximum penalty of five years in federal prison. Sentencing for her has been set for March 11, 2013.
A third conspirator, Dale Munroe, II (35, Winter Haven), pleaded guilty to one count of conspiracy and one count of wrongful disclosure of individually identifiable health information on October 22, 2012. He faces a maximum penalty of 15 years in federal prison. His sentencing has been set for January 14, 2013.
According to their plea agreements, in July 2006, Dale Munroe, II was hired at the Celebration, Florida location of Florida Hospital. During his employment, he worked as a registration representative in the Emergency Department, where he would register patients as they came in the main emergency entrance. From January 2009 until his termination in July 2011, Dale Munroe, II used his position to obtain individually identifiable health information of Florida Hospital patients who had been involved in motor vehicle accidents. Munroe, II would then disclose that information to Kusyakov, who was involved in the operation of two chiropractic clinics (Metro Chiropractic and Wellness Center and City Lights Medical Center). Kusyakov and other conspirators would then use the stolen information to solicit patients of Florida Hospital for chiropractic and legal services. Kusyakov would then pay Munroe for his role in providing the stolen information.
On July 12, 2011, Dale Munroe, II was terminated by Florida Hospital for a patient data breach that was unrelated to the conspiracy described above. Starting about a week after her husband’s termination, Katrina Munroe, who was hired as an insurance representative by Florida Hospital in 2009, was recruited to take over her husband’s role of stealing patient data to be provided to Kusyakov. In August 2012, the data breach was discovered, and Florida Hospital terminated Katrina Munroe shortly after identifying her as a possible suspect. In total, Florida Hospital has identified more than 12,000 patients whose individually identifiable health information was illegally accessed as a part of the conspiracy.
These cases were investigated by the Federal Bureau of Investigation and the Florida Department of Financial Services, Division of Insurance Fraud. They are being prosecuted by Assistant United States Attorney Roger B. Handberg.

Wednesday, January 9, 2013

Detroit Doctor Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme

WASHINGTON—A Detroit doctor at the center of a $13.2 million psychotherapy fraud scheme, which used the Medicare information of mentally-disabled Detroit residents to defraud Medicare, pleaded guilty today for his role in the scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s 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 (HHS-OIG), Chicago Regional Office.
Dr. Alphonso Berry, 51, of Orchard Lake, Michigan, pleaded guilty before U.S. District Judge Stephen J. Murphy, III in the Eastern District of Michigan to one count of conspiracy to commit health care fraud and five counts of health care fraud. Marcus Jenkins and Beth Jenkins, Dr. Berry’s co-conspirators in the scheme, pleaded guilty on January 7 and January 3, 2012, respectively, to the same charges for their roles in the scheme.
Dr. Berry admitted that he and others conspired to defraud Medicare through Quality Recreation & Rehabilitation LLC (QRR) and Procare Rehabilitation Inc., two Detroit adult day care centers. Dr. Berry admitted that he created a Medicare provider number for these businesses to allow them to bill Medicare for psychotherapy in his name. According to court documents, the Medicare recipients at QRR and Procare were severely mentally-disabled residents of Detroit adult foster care homes. Dr. Berry admitted that, although he did not provide any psychotherapy to these patients at QRR and Procare, he signed psychotherapy progress notes that were used at these companies to submit psychotherapy claims to Medicare, including claims that he provided psychotherapy to a dead person.
Court documents allege that Dr. Berry and his co-conspirators used Dr. Berry’s Medicare number to submit more than 116,000 psychotherapy claims in his name, amounting to more than $8.2 million. From 2004 through 2011, QRR and Procare submitted more than 185,000 claims to Medicare totaling more than $13.2 million for group and individual psychotherapy that was not provided. According to court documents, Medicare paid $4,777,792 on these claims.
At sentencing, scheduled for April 26, 2013, Dr. Berry faces a maximum penalty of 60 years in prison and a $1.5 million fine.
This case is being prosecuted by William G. Kanellis and Tarek Helou of the Criminal Division’s Fraud Section. It 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.
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.

Doctor and Wife Guilty of Tax Evasion; Millions of Amphetamine-Based Pills Illegally Dispensed at Area Weight Loss Clinics

HAMMOND, IN—A physician who owned weight loss clinics in northwest Indiana and south suburban Chicago pleaded guilty to illegally dispensing millions of pills containing amphetamine-based controlled substances to patients, and he and his wife also pleaded guilty to federal tax evasion relating to their operation of the clinics, federal law enforcement officials announced today. The defendants, DR. Rakesh Anand and Meena Anand, who owned and managed Doctors Weight Loss Clinics in Merrillville in Indiana and Tinley Park and Orland Park in Illinois, also agreed to forfeiture and restitution totaling nearly $5.2 million.
Rakesh Anand, 57, a licensed physician in Indiana and Illinois, and Meena Anand, 53, both of Tinley Park, entered their guilty pleas yesterday before U.S. District Judge Joseph S. Van Bokkelen in federal court in Hammond. The U.S. Attorney’s Office in Chicago is handling the prosecution in the Northern District of Indiana. Judge Van Bokkelen accepted the couple’s guilty pleas to tax evasion and deferred accepting Rakesh Anand’s guilty plea to conspiracy to distribute controlled substances until sentencing, which was scheduled for March 20. The defendants remain free on bond while awaiting sentencing, but the judge yesterday added electronic monitoring to the conditions of Rakesh Anand’s release.
Rakesh Anand’s plea agreement contemplates an advisory federal sentencing guidelines range of 46 to 57 months in prison, while Meena Anand’s plea agreement contemplates a range of 30 to 37 months. Tax evasion carries a maximum penalty of five years in prison and a $250,000 fine, as well as mandatory costs of prosecution. Defendants convicted of tax offenses also remain civilly liable to the government for any and all back taxes and a civil fraud penalty of up to 75 percent of the underpayment plus interest. Rakesh Anand also faces a maximum of 10 years in prison and a $500,000 fine for conspiracy to distribute controlled substances. On both counts, the court may impose an alternative fine totaling twice the gross gain or loss resulting from the crimes, whichever is greater.
As part of their plea agreements, the Anands agreed to pay restitution of $745,872 to the Internal Revenue Service for taxes they owed on nearly $2 million of unreported income between 2005 and 2008. The restitution is to be paid from funds frozen in a brokerage account when the Anands were indicted in August 2011. In addition, they agreed to forfeit more than $4.45 million in additional funds that were frozen or seized during the investigation, bringing to nearly $5.2 million the total amount of funds being applied to forfeiture and restitution.
Rakesh Anand admitted that between January 2002 and February 2010, he and another physician, Dr. Dinesh Saraiya, purchased and dispensed more than one million pills containing Phendimetrazine, a Schedule III controlled substance, and more than three million pills containing Phentermine, a Schedule IV controlled substance, and the Anands grossed more than $5 million from their operation of the three weight loss clinics.
(Saraiya, 75, of Tinley Park, cooperated in the case and is awaiting sentencing after pleading guilty in federal court in Chicago to conspiracy to distribute controlled substances.)
According to Rakesh Anand’s plea agreement, between 2002 and February 2010, he hired Saraiya, who agreed with him to illegally dispense the amphetamine-based controlled substances as weight loss medications to patients without performing physical examinations or any medical tests, and without reviewing patients’ records, obtaining a complete medical history, or providing any subsequent monitoring. In return, Rakesh Anand paid Saraiya based on how many patients he saw and how many pills he dispensed to patients on a daily basis. In dispensing the medications, Rakesh Anand and Saraiya failed to determine whether patients had first made a reasonable effort to lose weight through diet and exercise, a prerequisite to prescribing controlled substances for weight loss. In some instances, Rakesh Anand employed clerks to dispense the controlled substances even though he was not present and had not consulted with them.
During the course of the investigation, several undercover law enforcement agents, including two with slight builds and body mass indexes well below the obesity level, purchased controlled substances at the clinics without any of the appropriate medical protocols.
The guilty pleas were announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois. The investigation was conducted by the Federal Bureau of Investigation, the Drug Enforcement Administration, the Internal Revenue Service-Criminal Investigation Division, the Food and Drug Administration, and the Indiana State Police.
The government is being represented by Assistant U.S. Attorneys Matthew Schneider, Diane Berkowitz, and Orest Szewciw.

Golden Living Nursing Homes Settle Allegations of Substandard Wound Care

ATLANTA—The United States Attorney’s Office today announced that the United States and the state of Georgia have reached a settlement with GGNSC Holdings LLC of Plano, Texas, the operator of skilled nursing facilities located in Atlanta, Georgia, to resolve allegations under the False Claims Act and the Georgia State False Medicaid Claims Act that GGNSC provided inadequate and worthless wound care services to residents at two of its Atlanta-area nursing homes. GGNSC operates nursing homes under the “Golden Living” name. GGNSC has agreed to pay $613,300 to resolve these allegations. The United States’ share of the settlement is $423,544.
Sally Quillian Yates, United States Attorney for the Northern District of Georgia, said, “Our office is committed to protecting our most vulnerable citizens and improving the lives of nursing home residents. By failing to provide adequate wound care services to its nursing home residents, Golden Living placed at risk the life and health of individuals who were entrusted to its care. This type of threat to the health and well-being of the elderly in our communities will not be tolerated.”
“Golden Living fraudulently billed Medicaid for nursing services which were substandard and, tragically, resulted in harm to patients,” said Attorney General Sam Olens. “The nursing home patients depended on Golden Living to provide them with quality wound care services to help them heal, but, instead, were mistreated. We will not stand for such egregious misconduct by a Medicaid provider.”
“Quality of care in nursing homes is a top priority for the Office of Inspector General,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region. “Health care providers need to know that if they provide worthless services to those most in need, they will pay the price.”
Mark F. Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated, “The FBI will continue to dedicate its investigative personnel and resources toward such cases of Medicaid and Medicare fraud as was seen here. These federally funded programs provide much needed services but are limited and health care providers that abuse these programs will be held accountable.”
“The Defense Criminal Investigative Service is committed to ensuring that TRICARE beneficiaries receive the high quality medical care that they deserve,” said John F. Khin, Special Agent in Charge, Southeast Field Office, Defense Criminal Investigative Service. “This settlement sends the message that providers of substandard care will be brought to justice through the collaborative efforts of law enforcement agencies and the Department of Justice.”
The government alleges that GGNSC submitted false claims to Medicare, Medicaid, and the Veterans Administration because it provided residents at Golden LivingCenter–Glenwood (GLCG) and Golden LivingCenter–Dunwoody (GLCD), f/k/a Golden LivingCenter–Northside, with inadequate and worthless monitoring, documentation, and prevention and treatment of wounds during the period from January 1, 2006 through May 31, 2011. The claims settled in the civil settlement are allegations only, and there has been no determination of liability.
GGNSC executed a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services, Office of Inspector General, which will require six GGNSC facilities in the Atlanta area (in addition to GLCG and GLCD, Golden LivingCenter–Briarwood, Golden LivingCenter–Decatur, Golden LivingCenter–Kennestone, and Golden LivingCenter–Medical Arts) to continue to implement certain policies and procedures to ensure compliance with applicable statutes and regulations governing patient care. In addition, an independent monitor was appointed to oversee operations at the six Atlanta-area GGNSC facilities for up to five years to verify that the policies and procedures are working effectively and that patients receive appropriate care.
The civil settlement resolves some of the claims in a lawsuit filed by Dr. Joseph L. Micca under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The case, pending in the Northern District of Georgia, is filed under United States & State of Georgia ex rel. Micca v. GGNSC Holdings, LLC, et al., No. 1:10-cv-1055-ODE (Northern District of Georgia, April 9, 2010). Dr. Micca will receive a share of the settlement payment that resolves certain claims in the qui tam suit that he filed.
This case was investigated by special agents of the Federal Bureau of Investigation; the U.S. Department of Health & Human Services, Office of Inspector General; the Defense Criminal Investigative Service; and the Georgia Medicaid Fraud Control Unit.
The civil settlement was reached by Assistant United States Attorneys Amy Berne and Lena Amanti.
For further information please contact the U.S. Attorney’s Public Information Office at USAGAN.Pressemails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.

EMH Regional Medical Center and North Ohio Heart Center to Pay U.S. $4.4 Million to Resolve False Claims Act Allegations

WASHINGTON—EMH Regional Medical Center (EMH) has agreed to pay the United States $3,863,857, and North Ohio Heart Center Inc. (NOHC) has agreed to pay the United States $541,870 to settle allegations that they submitted false claims to Medicare, the Justice Department announced today.
EMH is a non-profit community hospital system located in Lorain County, Ohio. During the relevant time period, NOHC was an independent physician group located in Lorain County that practiced at EMH. The settlement resolves allegations that between 2001 and 2006, EMH and NOHC performed unnecessary cardiac procedures on Medicare patients. Specifically, the United States alleged that EMH and NOHC performed angioplasty and stent placement procedures on patients who had heart disease but whose blood vessels were not sufficiently occluded to require the particular procedures at issue.
“Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and puts patients at risk. The settlement demonstrates the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries,” said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Justice Department’s Civil Division.
“Most doctors act responsibly,” said Steven M. Dettelbach, U.S. Attorney for the Northern District of Ohio. “These few didn’t. Patient health and taxpayer dollars have to come before greed.”
This matter was initiated by the filing of a whistleblower complaint under the False Claims Act (FCA). Under the FCA, private citizens can bring suit for false claims on behalf of the United States and receive a share of the recovery obtained by the government. The whistleblower in this matter, Kenny Loughner, was the former manager of EMH’s catheterization and electrophysiology laboratory. As a result of the settlement, Mr. Loughner will receive $660,859 of the United States’ recovery.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. 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 that effort is the False Claims Act, which the Justice Department has used to recover more than $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.8 billion.
The investigation was jointly handled by the U.S. Attorney’s Office for the Northern District of Ohio, the Justice Department’s Civil Division, the Office of the Inspector General of the Department of Health and Human Services Cleveland Field Office, and the FBI. The claims resolved by this settlement are allegations only, and there has been no determination of liability.
The case is captioned United States ex rel. Loughner v. EMH Regional Medical Center et al., Case

Tuesday, January 8, 2013

EMH Regional Medical Center and North Ohio Heart Center to Pay U.S. $4.4 Million to Resolve False Claims Act Allegations

WASHINGTON—EMH Regional Medical Center (EMH) has agreed to pay the United States $3,863,857, and North Ohio Heart Center Inc. (NOHC) has agreed to pay the United States $541,870 to settle allegations that they submitted false claims to Medicare, the Justice Department announced today.
EMH is a non-profit community hospital system located in Lorain County, Ohio. During the relevant time period, NOHC was an independent physician group located in Lorain County that practiced at EMH. The settlement resolves allegations that between 2001 and 2006, EMH and NOHC performed unnecessary cardiac procedures on Medicare patients. Specifically, the United States alleged that EMH and NOHC performed angioplasty and stent placement procedures on patients who had heart disease but whose blood vessels were not sufficiently occluded to require the particular procedures at issue.
“Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and puts patients at risk. The settlement demonstrates the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries,” said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Justice Department’s Civil Division.
“Most doctors act responsibly,” said Steven M. Dettelbach, U.S. Attorney for the Northern District of Ohio. “These few didn’t. Patient health and taxpayer dollars have to come before greed.”
This matter was initiated by the filing of a whistleblower complaint under the False Claims Act (FCA). Under the FCA, private citizens can bring suit for false claims on behalf of the United States and receive a share of the recovery obtained by the government. The whistleblower in this matter, Kenny Loughner, was the former manager of EMH’s catheterization and electrophysiology laboratory. As a result of the settlement, Mr. Loughner will receive $660,859 of the United States’ recovery.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. 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 that effort is the False Claims Act, which the Justice Department has used to recover more than $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.8 billion.
The investigation was jointly handled by the U.S. Attorney’s Office for the Northern District of Ohio, the Justice Department’s Civil Division, the Office of the Inspector General of the Department of Health and Human Services Cleveland Field Office, and the FBI. The claims resolved by this settlement are allegations only, and there has been no determination of liability.
The case is captioned United States ex rel. Loughner v. EMH Regional Medical Center et al., Case No. 1:06-cv-2441 (N.D. Oh.).

Cabell County Doctor Sentenced to Two Years in Prison for Federal Drug Crime

HUNTINGTON, WV—United States Attorney Booth Goodwin today announced that a Cabell County doctor was sentenced to two years in prison for violating federal drug control laws. Dr. Anita Dawson, 55, of Milton, West Virginia, previously pleaded guilty in July to aiding and abetting the illegal acquisition of prescription drugs by misrepresentation, fraud, forgery, deception, and subterfuge. The sentence is four times the maximum sentence recommended under federal sentencing guidelines, which called for a sentence of zero to six months.
Dawson admitted that from July 2006 until May 21, 2009, she wrote prescriptions for addictive pain medications to an individual identified by the initials E.B. Dawson admitted she prescribed a total of nearly 6,000 pills containing oxycodone and more than 220 pills for the painkiller Endocet. Dawson further admitted that at the time she wrote the prescriptions for E.B., she knew that the patient was seeking pain medication for an addiction and other inappropriate reasons.
Dawson and E.B. entered into a pain management agreement that required the patient to submit to drug tests and pill counts. Despite E.B.’s repeated violations of the pain management agreement, Dawson admitted she continued to prescribe pain medication.
At today’s sentencing hearing, United States District Judge Robert C. Chambers heard from family members of three people killed in 2009 when their vehicle was hit by another vehicle driven by a patient of Dawson’s. The patient was addicted to prescription drugs and was under the influence of prescription medication at the time of the crash. In imposing Dawson’s sentence, Judge Chambers also noted that nine other patients of Dawson’s had died of prescription drug overdoses.
“It’s hard to put into words the devastating impact of this defendant’s crimes,” said U.S. Attorney Goodwin. “My heart goes out to the families who spoke at today’s hearing and to everyone who lost a loved one because of Dr. Dawson. Judge Chambers was right: This woman’s behavior is shocking, and this case should send a message to other doctors who abuse their prescription power.”
“The vast majority of physicians prescribe responsibly,” Goodwin continued, “but even a handful of bad doctors can flood our communities with illegal pills. Every time we put a law-breaking doctor out of business, it’s a big step toward getting this problem under control.”
In sentencing Dawson, Judge Chambers said that doctors who violate prescription laws need to be held accountable for their role in the “horrible problem” of prescription drug abuse. Judge Chambers said he intended the sentence to send a warning to doctors that they will be held accountable for their prescribing practices.
Dawson’s medical license was suspended by the West Virginia Board of Osteopathy in April 2010, on the same day federal and state investigators executed a search warrant at her Milton office. Following the search and the suspension of her medical license, Dawson voluntarily gave up her license permanently.
This case was prosecuted as part of an ongoing effort led by the United States Attorney’s Office for the Southern District of West Virginia to combat the illicit sale and misuse of prescription drugs. The U.S. Attorney’s Office, joined by federal, state, and local law enforcement agencies, is committed to aggressively pursuing and shutting down illegal pill trafficking, eliminating open air drug markets, and curtailing the spread of opiate painkillers in communities across the Southern District.
The investigation was conducted by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Inspector General, and the Drug Enforcement Administration, with assistance from the West Virginia State Police and the Cabell County Sheriff’s Office. Assistant United States Attorney Steven Loew handled the prosecution.

Shelby Woman Pleads Guilty to Defrauding Medicaid of $8 Million, Aggravated Identity Theft, and Tax Fraud

CHARLOTTE—A Shelby, North Carolina woman pleaded guilty today for her involvement in a health care fraud scheme that defrauded Medicaid of $8 million for sham mental and behavioral health services, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. In addition to defrauding Medicaid, Victoria Finney Brewton, 37, also pleaded guilty to stealing a therapist’s identity to commit the fraud and to filing a false tax return.
U.S. Attorney Tompkins is joined in making today’s announcement by North Carolina Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID); Roger A. Coe, Acting Special Agent in Charge of the FBI, Charlotte Division; Jeannine A. Hammett, Special Agent in Charge of the Internal Revenue Service, Criminal Investigation Division (IRS-CI); and Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region.
Brewton pleaded guilty today before U.S. Magistrate Judge David Keesler to seven counts of health care fraud and health care fraud conspiracy, one count of aggravated identity theft, and one count of filing a false tax return. At today’s plea hearing, the defendant admitted that from 2008 to 2012, Brewton, her co-defendant Linda Radeker, also of Shelby, and others submitted in excess of $8 million in false claims to Medicaid. According to filed court documents and statements made in court, Brewton operated a series of after-school and summer childcare programs in Shelby. Brewton recruited juvenile Medicaid recipients to her childcare programs by promising that the program would be free for Medicaid recipients. After Brewton obtained the children’s and families’ Medicaid recipient numbers, she used this information to fraudulently bill Medicaid for mental and behavioral health services that were never provided.
According to the criminal information, Brewton was not licensed or qualified to provide mental and behavioral health services, and she was not approved by Medicaid. Instead, Brewton enlisted the assistance of other complicit Medicaid-approved providers, such as Linda Radeker and, in other instances, stole the identity of Medicaid-approved providers in order to accomplish the fraud. Court documents indicate that Brewton conspired with Radeker, a licensed professional counselor enrolled with North Carolina Medicaid, to submit claims to Medicaid making it appear that Radeker had provided the claimed mental and behavioral health services when, in fact, Radeker did not provide any of the services. Radeker and Brewton then split the Medicaid payments 50/50 for these false claims.
Filed documents also indicate that Brewton hired licensed therapist K.S.M. in October 2010 to provide services at Brewton’s company, Healing Hearts. Although K.S.M. provided some mental and behavioral health services while she worked at Healing Hearts, Brewton submitted false and fraudulent claims to Medicaid through K.S.M.’s Medicaid provider number far in excess of the services actually provided by K.S.M. In or about October 2011, K.S.M. left Healing Hearts after learning that Brewton had submitted false claims through K.S.M.’s Medicaid provider number. Thereafter, Brewton misappropriated K.S.M.’s identity, specifically her Medicaid provider number, in order to continue to submit fraudulent claims to Medicaid after K.S.M. was no longer employed at Healing Hearts. Specifically, the defendant admitted that on or about October 27, 2011, Brewton submitted an Electronic Funds Transfer Authorization Agreement to Medicaid directing that reimbursements for claims submitted through K.S.M.’s provider numbers be deposited into a bank account held and controlled by Brewton. From in or about April 2011 to May 2012, Brewton submitted in excess of $1.8 million in false claims through K.S.M.’s provider number which K.S.M. did not provide. According to court documents, Brewton also misused the Medicaid provider numbers of other therapists employed by her companies in order to submit false claims to Medicaid through their numbers.
As part of her plea, Brewton also admitted that she defrauded the United States by filing a false tax return for the year 2009 that intentionally failed to report the income Brewton received from her scheme to defraud Medicaid. She also failed to file tax returns for 2010 and 2011, which further masked the income from her fraud scheme. Brewton agreed to forfeit a 2005 Dodge Magnum which was seized as the proceeds of fraud during the investigation.
Brewton, who was released on bond, faces a mandatory two years in prison consecutive to any other term of imprisonment and a $250,000 fine for the aggravated identity theft charge, a maximum term of 10 years in prison, and a $250,000 fine for the health care fraud charges; and a maximum term of three years in prison and a $250,000 fine for the filing of a false tax return charge. In her plea agreement, Brewton has agreed to pay full restitution to Medicaid for any losses resulting from her criminal scheme. The final restitution amount will be determined by the court at Brewton’s sentencing hearing, which has not been scheduled yet.
Radeker pleaded guilty to charges of health care conspiracy and money laundering on September 13, 2012, and is awaiting sentencing.
The investigation into Brewton was handled by the FBI, MID, IRS, and HHS-OIG. Special assistance to the task force was provided by the North Carolina Division of Medical Assistance, Program Integrity Section. The prosecution was handled by Assistant U.S. Attorneys Kelli Ferry and Jenny Grus Sugar of the U.S. Attorney’s Office in Charlotte.
The investigation and charges are the work of the Western District’s joint Health Care Fraud Task Force. The task force is multi-agency team of experienced federal and state investigators, working in conjunction with criminal and civil Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system, and reducing the potential for health care fraud in the future. The task force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistleblower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The task force builds upon existing partnerships between the agencies, and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.

Medical Assistant Pleads Guilty to Conspiracy to Bill Medicare for Unlicensed Physician’s Services

NEWARK—A medical assistant at a pair of large medical services companies with offices in New Jersey and New York admitted today to conspiring with the companies’ chief executive officer to defraud Medicare over a four-year period by performing illegal, unlicensed physicians’ services for patients, U.S. Attorney Paul J. Fishman announced.
Mario Roncal, 61, of Woodland Park, New Jersey, pleaded guilty before U.S. District Judge Jose L. Linares in Newark federal court to an indictment charging him with one count of conspiracy to commit health care fraud.
According to documents filed in this case and statements made in court:
In 1988, Roncal received a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico. Since that time, however, he was never licensed to practice medicine in New Jersey, New York, or any other state in the United States. In 2000 and 2002, Roncal was advised by the New Jersey Board of Medical Examiners that he were ineligible to obtain a medical license in New Jersey because his medical school was not accredited and he lacked certain requirements for international medical students to obtain a license in the United States.
From 2004 to the present, Roncal was employed ostensibly as a medical assistant for Cardio-Med Services LLC in New Jersey and for Comprehensive Healthcare & Medical Services LLC in Manhattan and Queens, New York. These companies were owned and operated by the CEO and head physician at Cardio-Med and Comprehensive Healthcare, who is a board-certified cardiologist licensed to practice medicine in New Jersey and New York, and who is identified in the indictment as the “CEO-physician.”
According to Roncal, from 2004 through at least 2008, he conspired with the CEO-physician to cause Cardio-Med and Comprehensive Healthcare to submit false billing claims to Medicare representing that physicians’ services had been provided by the CEO-physician when those services had, in fact, been provided by Roncal. Roncal admitted that he held himself out to fellow employees and to patients as “Dr. Roncal” and that he examined new patients as well as the CEO-physician’s follow-up patients. He also admitted that he ordered diagnostic tests for patients; diagnosed patients with medical conditions, diseases, and the like; and recommended and prescribed courses of treatment, including surgery and enhanced external counter pulsation (or EECP) for patients. Roncal stated that he intentionally ordered unnecessary diagnostic tests for the patients he unlawfully treated and that he willfully misdiagnosed patients with diseases and conditions such as coronary artery disease and angina, for the purpose of fraudulently prescribing and administering treatments of EECP, at the direction of the CEO-physician. To disguise that he, rather than the CEO-physician, was providing these physicians’ services to patients, Roncal forged the CEO-physician’s signature on paperwork associated with these unlawful services, including on prescription pads and patient charts.
The count to which Roncal pleaded guilty is punishable by a maximum potential penalty of 10 years in prison. Sentencing is scheduled for April 17, 2013.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Acting Special Agent in Charge David Velazquez; the U.S. Department of Health and Human Services, Office of the Inspector General, under the direction of Special Agent in Charge Thomas F. O’Donnell; the U.S. Postal Inspection Service, under the direction of Acting Inspector in Charge Marie Kelokates; the Social Security Administration, Office of the Inspector General, under the direction of Special Agent in Charge Edward J. Ryan; IRS-Criminal Investigation, under the direction of Acting Special Agent in Charge Shantelle P. Kitchen; and criminal investigators at the U.S. Attorney’s Office, for the investigation leading to the guilty plea.
The case is being prosecuted by Assistant U.S. Attorney Scott B. McBride the U.S. Attorney’s Office’s Health Care and Government Fraud Unit.

Monday, January 7, 2013

Owner of Detroit Adult Day Care Centers Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme

WASHINGTON—The owner of several Detroit-area adult day care centers pleaded guilty today for her role in a $13.2 million psychotherapy fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s 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 (HHS-OIG), Chicago Regional Office.
Beth Jenkins, 48, of Farmington Hills, Michigan, pleaded guilty to one count of conspiracy to commit health care fraud and five counts of health care fraud before U.S. District Judge Stephen J. Murphy, III in the Eastern District of Michigan.
Jenkins admitted that she and others conspired to defraud Medicare through Quality Recreation & Rehabilitation LLC (QRR) and Procare Rehabilitation Inc., two adult day care centers she owned and operated with alleged co-conspirators. According to court documents, Jenkins and her alleged co-conspirators owned and operated several Detroit-area adult foster care homes (AFCs) that housed severely mentally disabled Medicare recipients. Court documents allege that Medicare beneficiaries living at AFCs, some of which were owned and operated by Jenkins and her alleged co-conspirators, were transported to QRR and Procare by Jenkins and others. According to court documents, Jenkins and her alleged co-conspirators used the AFC residents’ Medicare information to bill Medicare for group and individual psychotherapy that was never provided.
From 2004 through 2011, Jenkins and her alleged co-conspirators submitted more than 185,000 claims to Medicare totaling more than $13.2 million for group and individual psychotherapy that was not provided. According to court documents, Medicare paid $4,777,792 on these claims.
At sentencing, scheduled for April 19, 2013, Jenkins faces a maximum penalty of 60 years in prison and a $1,500,000 fine.
Jenkins’s co-defendants, Dr. Alphonso Berry and Marcus Jenkins, Beth Jenkins’s husband, are scheduled for trial on January 8, 2013. They are presumed innocent until proven guilty at trial.
This case is being prosecuted by William G. Kanellis and Tarek Helou of the Criminal Division’s Fraud Section. It 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.
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.