Tuesday, April 30, 2013

San Fernando Valley Doctor Who Pled Guilty in $3 Million Medicare Fraud Case Sentenced to More Than Three Years in Federal Prison

LOS ANGELES—A medical doctor who owns a cosmetic medicine clinic in the Winnetka district of the San Fernando Valley has been sentenced to 42 months in federal prison for bilking Medicare out of more than $3 million by submitting bills for procedures he never performed.
Pezhman Ebrahimzadeh, who uses the name “Pez Abrahams,” 50, of Calabasas, received the three-and-a-half-year sentence yesterday from United States District Judge George H. Wu.
In addition to the prison term, Judge Wu ordered Ebrahimzadeh to pay $3,184,000 in restitution, most of which is to be paid to the Medicare program.
Ebrahimzadeh owns the Winnetka Medical Group, a cosmetic health care clinic that operates under the name Health & Beauty Clinic. At his clinic, Ebrahimzadeh provides cosmetic treatments that involve radiofrequency lasers and liposuction. As some of his patients were Medicare beneficiaries, Ebrahimzadeh obtained their beneficiary information, which was used to bill Medicare for procedures he did not perform.
Ebrahimzadeh also obtained beneficiary information for patients he never met or treated, and he used that information to submit other fraudulent bills to Medicare.
In relation to the bogus bills submitted to Medicare, Ebrahimzadeh typically claimed he had performed three expensive procedures: revascularization, ablation of a bone tumor, or the placement of a radiotherapy catheter in a breast. Ebrahimzadeh made these claims even though he lacked the equipment needed to perform revascularizations or the placement of radiotherapy catheters.
Ebrahimzadeh’s “conduct was so brazen that he billed Medicare for purportedly performing dozens of procedures on patients who were dead,” prosecutors wrote in a sentencing memorandum to the court. “For one such patient, defendant billed Medicare for seven separate high-paying procedures. [Ebrahimzadeh] also altered medical records in an attempt to conceal his fraudulent conduct. In addition to defrauding Medicare, defendant billed private insurance carriers for similar procedures, some of which he claimed he performed on himself.”
Between September 2008 and April 2012, Ebrahimzadeh submitted $7.5 million in bogus claims, and Medicare paid just over $3 million.
Ebrahimzadeh pleaded guilty in January to one count of health care fraud.
In the sentencing memo, prosecutors noted that Ebrahimzadeh was arrested last month on suspicion of sexually assaulting a patient during a physical examination.
The case against Ebrahimzadeh was investigated by the U.S. Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation; and the California Department of Justice, Bureau of Medi-Cal Fraud & Elder Abuse.

Southern California Physician and Two Co-Conspirators Found Guilty for Roles in $1.5 Million Medicare Fraud Scheme

WASHINGTON—A Southern California physician, a durable medical equipment (DME) supply company employee, and a health care professional were found guilty late yesterday by a federal jury in Los Angeles for their roles in a $1.5 million Medicare fraud scheme, announced Acting Assistant Attorney General Mythili Raman of the Criminal Division; U.S. Attorney for the Central District of California AndrĂ© Birotte, Jr.; Bill L. Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office; and Glenn R. Ferry, Special Agent in Charge of the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).
Godwin Onyeabor, 49, of Ontario, California; Sri J. Wijegunaratne, 58, of Anaheim, California; and Heidi Morishita, 48, of Valencia, California, were each found guilty in U.S. District Court in the Central District of California of one count of conspiracy to pay and receive kickbacks. Wijegunaratne was also found guilty of conspiracy to commit health care fraud and six substantive counts of health care fraud. Onyeabor was also found guilty of conspiracy to commit health care fraud and 11 substantive counts of health care fraud.
The trial evidence showed that between January 2007 and February 2012, Onyeabor, an officer at Fendih Medical Supply Inc., a DME supply company located in San Bernadino, California, and others paid cash kickbacks to Wijegunaratne, a physician, and Morishita for fraudulent prescriptions for DME, including power wheelchairs. The evidence showed that Wijegunaratne wrote prescriptions for power wheelchairs and other DME that Medicare beneficiaries did not need and sometimes never used. After receiving prescriptions from Wijegunaratne and Morishita, Onyeabor and others used the prescriptions to fraudulently bill Medicare for the medically unnecessary DME.
At trial, several Medicare beneficiaries testified that they were lured to medical clinics with the promise of free items such as vitamins and juice, only to receive power wheelchairs that they did not need and did not want. The beneficiaries further testified that their attempts to reject delivery of the power wheelchairs from Onyeabor’s supply company were unsuccessful.
As a result of this fraud scheme, Onyeabor, Wijegunaratne, and others submitted and caused the submission of approximately $1.5 million in false and fraudulent claims to Medicare, and received almost $1 million on those claims.
At sentencing, scheduled for September 9, 2013, Onyeabor, Wijegunaratne, and Morishita face a maximum penalty of 10 years in prison and a $250,000 fine for each count.
The case is being prosecuted by Assistant Chief Benton Curtis and Trial Attorneys Fred Medick and Alexander Porter of the Criminal Division’s Fraud Section. The case was investigated by the FBI and the Los Angeles Region of HHS-OIG.
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 Central District of California. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
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, are 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.

Former Owner of Los Angeles Medical Equipment Supply Company Pleads Guilty to Conspiring to Defraud Medicare

WASHINGTON—A former owner of a Los Angeles-area medical equipment supply company pleaded guilty today to conspiring with others to defraud Medicare, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney AndrĂ© Birotte, Jr. of the Central District of California; Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); and Bill L. Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office.
Tigran Aklyan, 37, of Van Nuys, California, pleaded guilty before U.S. District Judge Michael W. Fitzgerald in the Central District of California to one count of conspiracy to commit health care fraud.
According to court documents, Aklyan was the owner and president of Las Tunas Medical Equipment Inc., a durable medical equipment (DME) supply company located in San Gabriel, California. Aklyan admitted that from approximately October 2007 through May 2009, he conspired with others to commit health care fraud through the operation of Las Tunas by providing medically unnecessary power wheelchairs and other DME to Medicare beneficiaries and submitting false and fraudulent claims to Medicare. Aklyan admitted that he paid the owners and operators of fraudulent medical clinics to provide him with prescriptions and supporting medical documentation for the power wheelchairs and DME that he billed to Medicare. Aklyan admitted knowing that the prescriptions and medical documents that the clinics produced were fraudulent, yet he certified to Medicare with the submission of each claim that the DME was medically necessary. Aklyan also admitted that he knew it was illegal for him to pay for prescriptions, but he did so anyway.
From approximately December 17, 2007 through February 20, 2009, Aklyan, through Las Tunas, submitted approximately $910,377 in fraudulent claims to Medicare for power wheelchairs and related services, and Medicare paid Las Tunas approximately $653,461 on those claims.
At sentencing, scheduled for August 5, 2013, Aklyan faces a maximum penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Trial Attorneys David M. Maria and Blanca Quintero of the 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 Central District of California.
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, are 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.

Friday, April 26, 2013

Harrison County Man Sentenced for Dealing Meth in East Texas

MARSHALL, TX—A 56-year-old Marshall, Texas man has been sentenced to federal prison for drug trafficking violations in the Eastern District of Texas, announced U.S. Attorney John M. Bales today.
Adrian Denova Sanchez pleaded guilty on January 30, 2013, to conspiracy to possess with intent to distribute and distribution of methamphetamine and was sentenced to 127 months in federal prison on April 19, 2013, by U.S. District Judge Rodney Gilstrap. Sanchez was also ordered to forfeiture of $10,000 to the U.S. Marshals Service.
According to information presented in court, between November 2009 and October 2012, Sanchez was involved in a conspiracy to manufacture and distribute methamphetamine and cocaine in East Texas. Sanchez admitted to distributing over 50 grams of methamphetamine and selling a semi-automatic pistol during the conspiracy. Sanchez and four others were indicted on November 7, 2012, and charged with federal drug and gun crimes.
This case was investigated by the Federal Bureau of Investigation, the Marshall Police Department, the Harrison County District Attorney’s Office, the Harrison County Sheriff’s Office, and the Texas Department of Public Safety-Special Crimes and was prosecuted by Assistant U.S. Attorney Allen Hurst.

Texas Doctor Indicted for Health Care Fraud Violations

TYLER, TX—A Dallas County, Texas physician has been arrested and charged with health care fraud violations in the Eastern District of Texas, announced U.S. Attorney John M. Bales today.
Tariq Mahmood, 61, of Cedar Hill, Texas, was indicted by a federal grand jury on April 11, 2013, and charged with conspiracy to commit health care fraud and seven counts of health care fraud. Mahmood went before U.S. Magistrate Judge John D. Love today for an initial appearance.
According to the indictment, Mahmood, a general practitioner, owned and operated several hospitals in the state of Texas, including Cozby Germany Hospital in Grand Saline, Renaissance Terrell Hospital in Terrell, Central Texas Hospital in Cameron, Community General Hospital in Dilley, and Shelby Regional Medical Center in Center. From April 2010 to April 2013, Mahmood and others are alleged to have carried out a scheme to defraud Medicare and Medicaid through the submission of false and fraudulent claims. Mahmood and others added, changed, deleted, and incorrectly sequenced diagnostic codes in a way that did not reflect the actual diagnoses and conditions of the patients. They submitted false and fraudulent claims to Medicare and Medicaid based on the added, changed, deleted, and incorrectly sequenced diagnostic codes. By means of fraudulent billing practices, the defendant and his co-conspirators are alleged to have unlawfully submitted false claims of more than $1.1 million and obtained more than $375,000.
If convicted, Mahmood faces up to 10 years in federal prison for each charge.
The investigation leading to the charges was conducted by agents from the Texas Office of the Attorney General-Medicaid Fraud Control Unit (OAG-MFCU), the Federal Bureau of Investigation (FBI), the U.S. Department of Health and Human Services-Office of the Inspector General (HHS-OIG), and the U.S. Postal Inspection Service (USPIS). Assistant U.S. Attorney Nathaniel C. Kummerfeld is prosecuting this case.
Any individuals with knowledge of these or other health care fraud violations are encouraged to contact the Department of Health and Human Services’ fraud hotline at 1-800-HHS-TIPS (447-8477)
A grand jury indictment is not evidence of guilt. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Wednesday, April 24, 2013

Lake Charles Doctor Pleads Guilty to Health Care Fraud

LAFAYETTE, LA—United States Attorney Stephanie A. Finley announced today that Dr. Lynn E. Foret, 63, of Lake Charles, Louisiana, pleaded guilty before U.S. District Court Judge Richard T. Haik to defrauding Medicare, Medicaid, and private insurance companies of close to $1 million.
According to the bill of information, from 2003 to 2009, Foret injected his patients’ knees with a steroid solution while falsely billing and receiving payments from Medicare, Medicaid, and private insurance companies for a more costly drug called Hyalgan. During the time period outlined in the bill of information, he received reimbursements totaling $948,249.11. Foret is a Lake Charles medical doctor who specialized in orthopedic surgery since 1976. He closed his practice in December 2012.
Various types of steroids are often used to treat osteoarthritis of the knee. Hyalgan is another more costly type of medication that is used to treat osteoarthritis. It contains a natural substance called Hyaluronate, which is normally found in the fluid that lubricates and cushions knee joints and is injected directly into a patient’s knee to relieve inflammation.
Foret faces a maximum penalty of 10 years in prison, a $250,000 fine, restitution, and three years of supervised release for the count of heath care fraud. A sentencing date has not been set.
The Medicaid Fraud Control Unit (MFCU) of the Louisiana State Attorney General’s Office, FBI, U.S. Food and Drug Administration, and the Department of Health and Human Services-Office of Inspector General (OIG) conducted the investigation. Assistant U.S. Attorney Kelly P. Uebinger is prosecuting the case.

Detroit-Area Home Health Agency Office Manager Convicted in $5.8 Million Medicare Fraud Scheme

WASHINGTON—A federal jury in Detroit today convicted the office manager of a home health agency for her participation in a $5.8 million Medicare fraud scheme, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Robert D. Foley, III, Special Agent in Charge of the FBI Detroit Field Office; and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations, Detroit Office.
Nabila Mahbub, 27, the office manager of All American Home Care Inc., was found guilty in U.S. District Court for the Eastern District of Michigan of one count of conspiracy to commit health care fraud.
Mahbub was charged in a superseding indictment returned March 27, 2012. Nineteen other individuals who worked at or were associated with All American were previously convicted for their roles in the fraudulent scheme; one was acquitted at trial but was convicted at trial for a separate, but related, scheme.
According to evidence presented at trial, the defendant and her co-conspirators caused the submission of false and fraudulent claims to Medicare through All American, a home health care company located in Oak Park, Michigan, that purported to provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area.
The evidence at trial showed that the defendant and her co-conspirators used patient recruiters, who paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. The owners of All American paid physicians to sign referrals and other therapy documents necessary to bill Medicare. Physical therapists and physical therapist assistants then created fake medical records using blank, pre-signed forms obtained by the patient recruiters to make it appear as if physical therapy services were actually rendered, when, in fact, they were not.
According to evidence presented at trial, Mahbub doctored and directed the doctoring of fake patient files to facilitate the commencement and billing of home health services purportedly provided by physical therapists and physical therapist assistants working for All American. Mahbub also directed the physical therapists and physical therapist assistants who created fake therapy visit notes using blank, pre-signed forms, to make it appear that physical therapy services billed to Medicare were actually provided.
All American was paid more than $5.8 million from Medicare between September 2008 and November 2009.
At sentencing, scheduled for July 25, 2013, Mahbub faces a maximum penalty of 10 years in prison.
This case is being prosecuted by Deputy Chief Gejaa T. Gobena and Trial Attorney Matthew C. Thuesen of the Criminal Division’s Fraud Section. The investigation was led by the FBI and HHS-OIG and was brought by the Medicare Fraud Strike Force, a joint effort of the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 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.

Tuesday, April 23, 2013

Charlotte Woman Pleads Guilty to $4.8 Million Medicaid Scheme, Aggravated Identity Theft, and Other Charges

CHARLOTTE, NC—A Charlotte woman pleaded guilty today in U.S. District Court for her involvement in a health care fraud scheme that attempted to defraud Medicaid of $4.8 million for sham mental and behavioral health services, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. Rodnisha Sade Cannon, 26, of Charlotte, also pleaded guilty to stealing a therapist’s identity to commit the fraud, money laundering conspiracy, and attempting to sell her Mercedes-Benz in order to prevent law enforcement agents from seizing the vehicle.
U.S. Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID); Roger A. Coe, Acting Special Agent in Charge of the Federal Bureau of Investigation (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.
Cannon appeared this morning before U.S. Magistrate Judge David Cayer and pleaded guilty to one count of health care fraud conspiracy, one count of aggravated identity theft, and one count of money laundering conspiracy. Cannon also pleaded guilty to a single count of attempting to remove property subject to seizure, namely, a 2010 Mercedes-Benz CLS550, in a related case. At today’s plea hearing, Cannon admitted that from 2010 to 2012, she and others submitted in excess of $4.8 million in false claims to Medicaid. According to filed court documents and statements made in court, Cannon and her co-conspirators operated after-school and summer childcare programs in Gastonia and Shelby, North Carolina. Although therapists initially performed some services at these programs, Cannon and others devised a scheme to defraud Medicaid by using the Medicaid provider numbers assigned to other companies and individual therapists for all therapy services supposedly provided at their programs regardless of whether those companies and individuals actually provided the claimed services. In many instances, the claimed mental and behavioral health services were never provided at all. Cannon and others accomplished this scheme by re-directing Medicaid payments away from the Medicaid providers’ bank accounts and to bank accounts controlled by Cannon and her co-conspirators.
According to the criminal bill of information and court documents, Cannon was not licensed or qualified to provide mental and behavioral health services and she was not approved by Medicaid. Instead, Cannon and others stole the identity of Medicaid-approved providers who had some relationship with the programs in order to accomplish the fraud. For example, court documents indicate that Cannon hired M.B. to work for her company in or about May 2012, and M.B. worked there for a single day. Cannon stole M.B.’s Medicaid provider information and redirected all Medicaid payments to M.B. to be deposited into a bank account controlled by Cannon and others. Cannon and others then billed claims to Medicaid in excess of $800,000 for services that M.B. never provided, including claims for dates of service before M.B. worked for Cannon and her co-conspirators. In total, from 2010 to 2012, pursuant to the scheme to defraud, Cannon and her co-conspirators submitted approximately $4.8 million in false and fraudulent claims to Medicaid, resulting in payments of over $2.5 million to Cannon and her co-conspirators.
According to documents filed in court, Cannon also worked with Victoria Brewton, who pleaded guilty in January 2013 to carrying out a similar $8 million Medicaid fraud scheme in Shelby. Cannon assisted Brewton by providing and selling Medicaid beneficiary identification numbers and information to be used in Brewton’s fraud scheme. Brewton’s sentencing date has not been set yet.
As part of her plea, Cannon also admitted that she used the proceeds of her scheme to defraud Medicaid to purchase a 2010 Mercedes-Benz CLS550 for the purchase price of $59,500. In September 2012, law enforcement agents sought and obtained a warrant to seize this vehicle as the proceeds of Cannon’s health care fraud scheme. According to court documents, when Cannon learned that agents had a seizure warrant for the vehicle, she attempted to sell the Mercedes-Benz in order to avoid seizure of the vehicle. Cannon has agreed to forfeit the Mercedes-Benz as part of her plea today.
“Stealing money from Medicaid degrades the integrity of our health care system and victimizes those who rely on this important health care program for legitimate patient care,” said U.S. Attorney Tompkins. “The money that Cannon stole through her health care fraud scheme was intended to cover patient needs, not to purchase luxury items. Cannon will be held accountable for her actions,” Tompkins added.
Attorney General Roy Cooper stated, “Cheating Medicaid hurts needy patients, wastes taxpayer money, and drives up health care costs. Our Medicaid Investigations Division attorneys and investigators will continue to work closely with federal officials to root out fraud in North Carolina and make wrongdoers pay.”
“Money gained through illegal sources, such as health care fraud, is part of the untaxed, underground economy. This untaxed underground economy poses a threat to our voluntary tax compliance system and undermines the overall public confidence in our American system of taxation,” stated Charlotte Field Office Special Agent in Charge Jeannine A. Hammett, IRS-Criminal Investigation.
At sentencing, Cannon 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 charge; a maximum term of 10 years in prison and a $250,000 for the money laundering conspiracy charge and maximum term of imprisonment of five years and a $250,000 fine for the attempted removal of property to prevent seizure. In her plea agreement, Cannon 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 Cannon’s sentencing hearing, which has not been scheduled yet.
Cannon has been in local federal custody since her arrest on the attempted removal of property to prevent seizure charge on September 28, 2012.
The investigation into Cannon was handled by the FBI, MID, IRS, and HHS-OIG. The prosecution was handled by Assistant U.S. Attorney Kelli Ferry 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.
If you suspect Medicare or Medicaid fraud, please report it by phone at 1-800-447- 8477 (1-800-HHS-TIPS) or e-mail at HHSTips@oig.hhs.gov. To report Medicaid fraud in North Carolina, call the North Carolina Medicaid Investigations Division at 919-881-2320.

Friday, April 19, 2013

San Fernando Valley Doctor Who Pled Guilty in $3 Million Medicare Fraud Case Sentenced to More Than Three Years in Federal Prison

LOS ANGELES—A medical doctor who owns a cosmetic medicine clinic in the Winnetka district of the San Fernando Valley has been sentenced to 42 months in federal prison for bilking Medicare out of more than $3 million by submitting bills for procedures he never performed.
Pezhman Ebrahimzadeh, who uses the name “Pez Abrahams,” 50, of Calabasas, received the three-and-a-half-year sentence yesterday from United States District Judge George H. Wu.
In addition to the prison term, Judge Wu ordered Ebrahimzadeh to pay $3,184,000 in restitution, most of which is to be paid to the Medicare program.
Ebrahimzadeh owns the Winnetka Medical Group, a cosmetic health care clinic that operates under the name Health & Beauty Clinic. At his clinic, Ebrahimzadeh provides cosmetic treatments that involve radiofrequency lasers and liposuction. As some of his patients were Medicare beneficiaries, Ebrahimzadeh obtained their beneficiary information, which was used to bill Medicare for procedures he did not perform.
Ebrahimzadeh also obtained beneficiary information for patients he never met or treated, and he used that information to submit other fraudulent bills to Medicare.
In relation to the bogus bills submitted to Medicare, Ebrahimzadeh typically claimed he had performed three expensive procedures: revascularization, ablation of a bone tumor, or the placement of a radiotherapy catheter in a breast. Ebrahimzadeh made these claims even though he lacked the equipment needed to perform revascularizations or the placement of radiotherapy catheters.
Ebrahimzadeh’s “conduct was so brazen that he billed Medicare for purportedly performing dozens of procedures on patients who were dead,” prosecutors wrote in a sentencing memorandum to the court. “For one such patient, defendant billed Medicare for seven separate high-paying procedures. [Ebrahimzadeh] also altered medical records in an attempt to conceal his fraudulent conduct. In addition to defrauding Medicare, defendant billed private insurance carriers for similar procedures, some of which he claimed he performed on himself.”
Between September 2008 and April 2012, Ebrahimzadeh submitted $7.5 million in bogus claims, and Medicare paid just over $3 million.
Ebrahimzadeh pleaded guilty in January to one count of health care fraud.
In the sentencing memo, prosecutors noted that Ebrahimzadeh was arrested last month on suspicion of sexually assaulting a patient during a physical examination.
The case against Ebrahimzadeh was investigated by the U.S. Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation; and the California Department of Justice, Bureau of Medi-Cal Fraud & Elder Abuse.

Tuesday, April 9, 2013

Miami-Based Health Care Clinic and Its Owners and Operators Sentenced in $50 Million Fraud Scheme

WASHINGTON—The owners and operators of Biscayne Milieu, a Miami-based mental-health clinic, and the clinic itself were sentenced today for their participation in a Medicare fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, 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.
Antonio Macli, 73, Jorge Macli, 41, and Sandra Huarte, 49, all of Miami, and Biscayne Milieu were sentenced by U.S. District Judge Robert N. Scola, Jr. in the Southern District of Florida. Antonio Macli was sentenced to serve 360 months in prison; Jorge Macli was sentenced to serve 300 months in prison; and Huarte was sentenced to serve 262 months in prison. In addition, Biscayne Milieu, the corporate entity these defendants controlled, was sentenced to one year of probation. In addition to their prison terms, Antonio Macli, Jorge Macli, and Huarte were each sentenced to serve three years of supervised release. Restitution payments for each of the defendants will be determined on April 25, 2013.
The defendants were each convicted on August 24, 2012, of conspiracy to commit health care fraud, at least one substantive count of health care fraud, and conspiracy to offer and pay kickbacks following a two-month jury trial. Antonio and Jorge Macli and Huarte were also each convicted of conspiracy to commit money laundering and substantive money laundering counts at trial.
According to the evidence at trial, Biscayne Milieu was a closely held, family-run fraudulent clinic that was owned by Antonio Macli and his son Jorge Macli. Antonio Macli’s daughter Sandra Huarte was an executive at the clinic. Together, the defendants created and oversaw a scheme in which they, along with their co-defendants, submitted over $50 million in false and fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP)—a form of intensive treatment for severe mental illness. Instead, the defendants devised a scheme in which they paid patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided or that were not reimbursable under applicable Medicare rules. Many of the patients admitted to Biscayne Milieu that they were not eligible for PHP treatment because they were chronic substance abusers, suffered from dementia and would not benefit from group therapy, or were not mentally ill and were procuring false diagnoses of mental illness in order to obtain exemptions from the civics portion of the U.S. citizenship application.
The evidence at trial further showed that Antonio and Jorge Macli and Huarte collectively paid patient recruiters more than $1 million in illegal kickbacks to recruit Medicare patients who were ineligible for PHP treatment. Biscayne Milieu then billed Medicare for tens of millions of dollars in PHP treatments for these patients. Antonio and Jorge Macli and Huarte also hired doctors, therapists, and other health care professionals to further their massive illegal scheme. Along with co-conspirators working at their direction, they created falsified medical records intended to conceal their Medicare fraud and phony “case manger” contracts in an attempt to hide their extensive illegal kickbacks.
Antonio Macli was the initiator of the fraud scheme, enlisted his son and daughter to participate in it, and had primary control over the clinic’s bank accounts that received money stolen from Medicare that was then used to pay illegal kickbacks.
Jorge Macli was most responsible for the clinic’s day-to-day operations and took steps, on a daily basis, to conceal and further the fraud, including deflecting complaints from patients and staff and paying bribes to patients in exchange for their silence.
Huarte oversaw both the kickback payments and the Medicare billings for the clinic. Huarte ensured that Biscayne Milieu’s fraudulent claims could pass scrutiny by Medicare by creating fraudulent paperwork and medical files, and soliciting other employees to do the same, so that these false claims were paid.
Evidence further revealed that Antonio and Jorge Macli and Sandra Huarte engaged in a sophisticated scheme to use a series of ostensibly legitimate corporations to conceal and launder Biscayne Milieu’s fraudulent profits.
Various owners, doctors, managers, therapists, patient brokers, and other employees of Biscayne Milieu have also been charged with various health care fraud, kickback, money laundering, and other offenses in two indictments unsealed in September 2011 and May 2012. Biscayne Milieu, its owners, and more than 25 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial.
The case is being prosecuted by Assistant U.S. Attorneys for the Southern District of Florida Michael Davis, Marlene Rodriguez, and James V. Hayes. Hayes was formerly a Trial Attorney in the Criminal Division’s Fraud Section. The case was investigated by the FBI with the assistance of HHS-OIG and was brought by the U.S. Attorney’s Office for the Southern District of Florida in coordination with 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.

Friday, April 5, 2013

Former CEO/Owner of Home Health Care Provider Pleads Guilty to Falsifying Records in Connection with a Federal Audit

WASHINGTON—Jeannette N. Awasum, the former owner of a health care provider, pled guilty today to a federal charge stemming from falsifying records in connection with a U.S. Department of Health and Human Services audit.
The guilty plea was announced by U.S. Attorney Ronald C. Machen, Jr.; Valerie Parlave, Assistant Director in Charge of the FBI’s Washington Field Office; and Nicholas DiGiulio, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) for the region including the District of Columbia.
Awasum, 49, of Germantown, Maryland, pled guilty in the U.S. District Court for the District of Columbia to a charge of falsification of records in connection with a federal investigation. She is to be sentenced July 9, 2013, by the Honorable Richard J. Leon. The charge carries a maximum statutory sentence of 20 years in prison and a fine of up to $250,000.
According to a statement of offense, signed by the defendant as well as the government, in early June 2010, Awasum, the chief executive officer and owner of Tri State Home Health and Equipment Service, was informed that the U.S. Department of Health and Human Services requested the physician-signed plans of care for 130 of its patients. These plans of care are what authorize providers like Tri State to provide home healthcare services to Medicare and D.C. Medicaid beneficiaries.
Awasum knew that Tri State lacked plans of care for 62 of these 130 patients. Tri State received approximately $1,879,853 from Medicare and D.C. Medicaid for treating these 62 patients during the period for which plans of care were missing. Awasum directed her employees to fraudulently create plans of care for the services that these 62 patients received, making it appear as if the documents had been created prior to the services being provided. In total, the employees created 81 plans of care for these 62 patients.
Awasum instructed one of her employees to take the 81 fabricated forms to a doctor whom Awasum knew never examined these patients. Despite the fact that this doctor never examined these patients, he signed the plans of care in June 2010, making it appear as if he authorized these 62 patients receiving home health care services prior to the time that Tri State provided these services. The employee, at Awasum’s directions, placed the fraudulent 81 plans of care in Tri State’s file so that the forms would be present when the U.S. Department of Health and Human Services audited the services provided to these 62 patients.
In announcing the plea, U.S. Attorney Machen, Assistant Director in Charge Parlave, and Special Agent in Charge DiGiulio commended the efforts of those who investigated the case from the FBI’s Washington Field Office and the Office of the Inspector General of the U.S. Department of Health and Human Services. They also praised those who worked on the case from the U.S. Attorney’s Office, including Legal Assistant Donna Galindo, former Assistant U.S. Attorney Courtney G. Saleski, and Assistant U.S. Attorney Matt Graves, who is prosecuting the matter.

Tuesday, April 2, 2013

Former Texas Health and Human Services Investigator Guilty of Theft of Federal Funds

BEAUMONT, TX—A 62-year-old Diboll, Texas woman has pleaded guilty to theft of federal funds in the Eastern District of Texas, announced U.S. Attorney John M. Bales.
Melva Darlene Blakemore pleaded guilty to an information charging her with theft of federal funds on March 26, 2013 before U.S. District Judge Marcia Crone.
According to information presented in court, in May of 2008, while Blakemore was employed as a senior investigator with the Texas Health and Human Services Commission, she advised an individual receiving Supplemental Nutrition Assistance that they had been overpaid $2,520 on their Lone Star Card. Blakemore told the individual that if they did not repay the money, she would be indicted and prosecuted. Blakemore also advised the individual that if the money was paid in cash, with no receipt expected, Blakemore would send the money to someone she knew in Austin and that no charges would be filed. The individual contacted local authorities, who were able to observe the individual meeting Blakemore in a Nacogdoches, Texas parking lot. Blakemore left the parking lot and drove away with the money before stopping to deposit a portion of it into her bank account. The remainder of the money was found in her vehicle.
Blakemore faces up to 10 years in federal prison and restitution of up to $31,008. A sentencing date has not been set.
This case is being investigated by the Texas Health and Human Services Commission, Texas Rangers, Federal Bureau of Investigation, Texas Department of Public Safety, and the Nacogdoches County Sheriff’s Office. This case is being prosecuted by Assistant U.S. Attorney Randall L. Fluke.

Former Doctor Pleads Guilty in More Than $19 Million Health Care Fraud Scheme

HOUSTON—Donald Gibson II, 56, of Richmond, has been convicted of conspiracy to commit health care fraud relating to medically unnecessary diagnostic testing and physical therapy, United States Attorney Kenneth Magidson announced today.
Gibson entered a plea of guilty just minutes ago, admitting he conspired to commit health care fraud along with co-defendant, Sunday Joseph Edem, 53, also of Richmond.
Gibson ordered, prescribed, and authorized medically unnecessary diagnostic tests and other procedures which included allergy tests, pulmonary function tests, vestibular tests, urodynamic tests, and physical therapy, among others. These services were then billed to Medicare and Medicaid for payment under Gibson’s billing number.
From January 2007 through January 2012, Gibson caused more than $19.4 million in medical claims to the Medicare and Texas Medicaid Programs. As a result, Medicare deposited approximately $8.5 million into a bank account owned and controlled by Gibson.
Edem operated medical clinics under the names of other individuals to conceal his financial interest in the businesses. Edem and Gibson conspired with one another to cause the submission of false claims to the Medicare and Medicaid programs and share in the proceeds. Gibson and Edem paid patient recruiters for referring Medicare/Medicaid beneficiaries and also paid Medicare beneficiaries for showing up at the medical clinics.
Gibson is set for sentencing on July 1, 2013, at which time he faces up to 10 years in federal prison and a possible $250,000 fine.
Edem also pleaded guilty to the same charge on February 25, 2013. He is scheduled to be sentenced on May 28, 2013.
This case is the result of a joint investigation involving multiple federal and state agencies including agents and investigators of the U.S. Department of Health and Human Services-Office of Inspector General, Railroad Retirement Board, Secret Service, Drug Enforcement Administration, FBI, and the Texas Attorney General’s Medicaid Fraud Control Unit. Special Assistant U.S. Attorney Justin Blan and Assistant U.S. Attorney Andrew Leuchtmann are prosecuting this case.