SoCal Woman Sentenced to 13 Years in Federal Prison in Medicare Fraud Scheme Involving Durable Medical Equipment

LOS ANGELES—A Carson woman has been sentenced to 156 months in federal prison in an $8 million Medicare fraud case in which she illegally paid kickbacks for referrals to patients whose beneficiary information was used to make bogus claims to the government health care program.
Uben Ogbu Rush, 54, received the 13-year sentence yesterday afternoon from United States District Judge George H. King.
During yesterday’s hearing, Judge King said Rush was motivated by greed and the lengthy sentence was necessary, in part, to send a message of deterrence to others who might commit crimes against Medicare.
Rush owned or controlled six companies that ostensibly sold durable medical equipment, such as motorized wheelchairs and powered pressure-reducing mattresses. The companies were located in Carson, Gardena, Torrance, and Paramount.
At a trial in November 2011, federal prosecutors showed a jury how Rush paid marketers to recruit Medicare beneficiaries who would allow their identities and Medicare numbers to be used for the submission of false claims. The evidence also showed how Rush paid kickbacks to marketers, who in turn paid kickbacks to doctors who fraudulently wrote prescriptions, even though the physicians had not examined the patients or an examination revealed that the medical equipment was not medically necessary.
During the course of a scheme that ran from 1999 until 2008, Rush submitted more than $15 million in fraudulent claims to Medicare seeking payment for motorized wheelchairs, hospital beds, air pressure mattresses, and other items for patients who did not need the equipment. Medicare paid more than $8.1 on the bogus claims.
A co-defendant in the case, Carlos Alberto Rezabala, 60, of Downey, was sentenced by Judge King in June 2012 to 41 months in federal prison. Rezabala was a recruiter who brought Medicare beneficiaries into the scheme so their information could be used to submit fraudulent bills.
Another co-defendant, Phitsamay Syvoravong, 58, of Orange County, another recruiter who brought Medicare beneficiaries into the scheme, is scheduled to be sentenced by Judge King on May 20.
A related defendant, Dr. Alfred Glover, 57, of Playa Vista, testified at trial that he was paid for writing fraudulent prescriptions for Medicare beneficiaries, many of whom he never saw. Glover is schedule to be sentenced on May 28.
The investigation into Rush and her Medicare fraud scheme was conducted by the Federal Bureau of Investigation.

Durable Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment

HOUSTON—Andrea Michelle Tellison, 46, has been arrested following the return of a 21-count indictment charging her with health care fraud and aggravated identity theft, United States Attorney Kenneth Magidson announced today.
The indictment was returned under seal Wednesday, March 20, 2013, and unsealed today upon her arrest. She made her initial appearance this morning before U.S. Magistrate Judge Mary Milloy, at which time she was released on bond.
Tellison, of Houston, is one of the owners of Texas Durable Medical Company, located in Houston, according to the indictment. She is alleged to have submitted false and fraudulent claims to Medicare and Medicaid for durable medical equipment (DME), including enteral nutrition feeding kits that were not provided to Medicare beneficiaries, not ordered by physicians, and not medically necessary. Enteral nutrition is provided by feeding tubes and accessories rather than consumed orally.
According to the indictment, Tellison also falsely signed certain Medicare forms stating there was documentation in patient medical records detailing the need for enteral nutrition when there was not. The indictment also alleges Tellison delivered formula to Medicare beneficiaries that expressly stated “not for tube feeding.” Additionally, Tellison allegedly failed to purchase sufficient inventory to deliver all the enteral nutrition and supplies she billed to Medicare and Medicaid. The indictment indicates that between March 29, 2008, and November 30, 2009, Tellison submitted approximately $1,480,511.31 worth of claims for enteral nutrition and supplies and received approximately $786,222.11 as payment for those claims.
If convicted, she faces up to 10 years in prison and a possible $250,000 fine for each conviction of health care fraud. Aggravated identity theft further carries a mandatory two-year prison term that must be served consecutively to any sentence for the underlying offense and up to a $250,000 fine, upon conviction.
The investigation into Tellison was the result of a joint investigation conducted by agents from the FBI, Railroad Retirement Board-Office of the Inspector General, Department of Health and Human Service-Office of Inspector General, and the Texas Attorney General Office-Medicare Fraud Control Unit. Assistant United States Attorney Julie Redlinger is prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.

Owners of Woodbridge Home Health Business Sentenced to 121 Months for Health Care Fraud and Aggravated Identity Theft

ALEXANDRIA, VA—The owners of a Woodbridge, Virginia-based home health care business were sentenced today to 121 months in prison, followed by three years of supervised release, for submitting more than $2.1 million in false claims to Virginia Medicaid and Antehm Blue Cross and Blue Shield (BCBS) for reimbursement of services they did not provide.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia; Ken Cuccinelli, Attorney General of Virginia; and Valerie Parlave, Assistant Director in Charge of the FBI’s Washington Field Office, made the announcement after sentencing by United States District Judge Claude M. Hilton.
Irvine Johnston King, 46, and Aisha Rashidatu King, 40, of Woodbridge, were convicted at trial on January 10, 2013, of conspiracy and multiple counts of health care fraud, in addition to two counts of aggravated identity theft. At sentencing today, they were also ordered by the court to pay $931,894 in restitution and to forfeit the same amount.
According to court records and evidence at trial, the Kings owned and operated Bright Beginnings Healthcare Services, a business that provided in-home personal and respite care and private duty nursing services to Medicaid-eligible individuals. From at least January 2008 through June 2011, the Kings carried out a scheme to defraud the Virginia Medicaid program and Anthem Blue Cross and Blue Shield (BCBS) by submitting inflated claims for services. They submitted $2.1 million in fraudulent claims, of which Virginia Medicaid paid out $766,620 and BCBS paid out $165,273.
In May 2009, after learning that Virginia Medicaid had retained an outside firm to audit Bright Beginnings, the Kings began an extensive effort to cover up the fraud by creating false nursing documentation to support the claims, including timesheets and notes in the names of several nurses who had never worked at Bright Beginnings. They supervised an unlicensed employee who completed timesheets under the name of a licensed nurse and billed the employee’s time to Virginia Medicaid as licensed practical nursing services. They also directed the father of a patient to sign blank timesheets, which were then falsified to support fraudulent billing for services that had never been provided to that patient.
The investigation was conducted by FBI’s Washington Field Office and the Virginia Attorney General’s Medicaid Fraud Control Unit, with the assistance of the Virginia Department of Medical Assistance Services. Assistant U.S. Attorney Timothy D. Belevetz and Special Assistant U.S. Attorney Steven W. Grist of the Virginia Attorney General’s Office are prosecuting 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.

McAllen Urologist and Wife Charged in Heath Care Fraud Scheme and Conspiracy to Violate Iranian Sanctions

HOUSTON—A federal grand jury has returned a four-count, superseding indictment against urologist Hossein Lahiji M.D. and his wife, attorney Najmeh Vahid Lahiji, both of McAllen and San Antonio, United States Attorney Kenneth Magidson announced today. The second superseding indictment, returned late yesterday, charges the couple with conspiracy to commit health care fraud, health care fraud, and for conspiring to violate Iranian sanctions.
The Lahijis are set to appear in Houston tomorrow morning at 9:45 before U.S. District Judge Mary Milloy.
This indictment alleges the Lahijis conspired to violate Iranian Sanctions by transferring approximately $1.1 million to Iran. The Lahijis allegedly utilized an unlicensed money remitting business called the Espadana Exchange to avoid the United States banking regulations and to allegedly make it appear they were not violating the United States embargo with Iran. The indictment alleges the defendants sent some of the money representing profits of their alleged illegal health care fraud scheme to Iran for the purpose of making an investment on behalf of Hossein Lahiji and Najmeh Vahid Lahiji in real estate rental property in Iran, all in violation of the Iranian sanctions.
“The Internal Revenue Service (IRS) will tenaciously pursue individuals who violate international emergency economic powers statutes,” said IRS-Criminal Investigation (CI) Special Agent in Charge Lucy Cruz. “IRS-CI’s unique skill set is to unravel the often concealed complex networks used to disguise international financial crimes.”
The health care fraud scheme alleged in this indictment accuses Hossein and Najmeh Lahiji of conspiring to defraud multiple health care benefit programs by submitting false and fraudulent claims in connection with the use of unlicensed and unqualified medical personal and for billing for medical services not rendered. The scheme allegedly ran from January 2003 through February 24, 2012, and involved Medicare, Medicaid, Aetna, Blue Cross Blue Shield, Humana, and United Healthcare. The indictment further alleges the Lahijis submitted claims to these health care benefit programs for urology services allegedly performed by Hossein Lahiji M.D. when, in fact, he was traveling outside Texas and outside the United States. The individuals, who were only licensed as medical assistants, were the ones actually performing these “urology services” without any supervision from any physician or other qualified, licensed personal in violation of protocols established by Medicare, Medicaid, private health insurance, and the state of Texas.
The scheme also allegedly involved specific days in which Hossein Lahiji claimed to treat between 65 to 117 patients per day during the office hours of 7:00 a.m. to 6:00 p.m. The indictment further alleges false and fraudulent representations including that Hossein Lahiji had conducted a “consultation” for another physician. In reality, he allegedly performed routine medical services for a patient of his own, a practice known as “upcoding. Lahiji allegedly indicated that the patient’s medical situation had necessitated a comprehensive physical examination and the taking of a comprehensive medical history. However, the patient’s situation had not required such an examination or history-taking, and Hossein Lahiji had not performed such services, according to the indictment.
The indictment also contains two substantive counts of health care fraud occurring on July 1, 2009 and July 28, 2009.
Hossein Lahiji M.D. is a physician investor in the physician-owned hospital Doctor’s Hospital at Renassiance in Edinburg.
The Lahijis each face a sentence of up to 10 years in prison and a maximum $250,000 fine if convicted of the health care offenses as well as a maximum of 20 years in prison and a possible $1 million fine upon conviction of conspiracy to violate Iranian sanctions.
The Lahijis are currently scheduled for a jury trial in Southern District of Texas on March 25, 2013. They are also scheduled for trial in the District of Oregon on June 4, 2013, on unrelated federal charges.
The investigation leading to the charges in this case was conducted by the FBI, the Texas Attorney General’s Medicaid Fraud Control Unit, and IRS-CI. Assistant United States Attorneys Carolyn Ferko and Jim McAlister are prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless and until convicted through due process of law.

Medical Director for Miami-Based Health Care Clinic Sentenced to 144 Months in Prison for Role in $50 Million Medicare Fraud Scheme

WASHINGTON—A former medical director for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced today to serve 144 months in prison for his role in a 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.
Dr. Gary Kushner, 72, of Plantation, Florida, was sentenced by U.S. District Judge Robert N. Scola, Jr. in the Southern District of Florida. In addition to the prison term, Kushner was ordered to serve three years of supervised release.
Kushner was convicted on August 24, 2012, of one count of conspiracy to commit health care fraud and one substantive count of health care fraud, following a two-month jury trial.
According to the evidence at trial, Kushner and his co-conspirators caused the submission of over $50 million dollars 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 of providing legitimate PHP services, 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 were not properly reimbursable by Medicare. Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.
The evidence at trial further showed that, as Biscayne Milieu’s medical director, Kushner authorized the treatment of patients that he knew were ineligible for PHP treatment. Biscayne Milieu then billed Medicare for millions of dollars in PHP treatments for these patients under Kushner’s name. Evidence further revealed that Kushner would often conduct cursory examinations lasting only minutes before authorizing such fraudulent billings.
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. Antonio and Jorge Macli and Sandra Huarte—the owners and operators of Biscayne Milieu—were each convicted at trial of various offenses and are scheduled for sentencing in April 2013.
This case is being prosecuted by Assistant U.S. Attorneys Michael Davis, Marlene Rodriguez and James V. Hayes of the U.S. Attorney’s Office for the Southern District of Florida; James V. 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.
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.

Two Medicare Beneficiaries Found Guilty of Soliciting Kickbacks in Home Health Care Case

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge, Federal Bureau of Investigation (FBI); Miami Field Office, Antonio J. Gomez, Postal Inspector in Charge of the U.S. Postal Inspection Service; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), inform that a federal jury found defendants Rene Suarez-Basanta, 67 years of age, and Marta Gonzalez, also 67 years of age, guilty of charges related to Medicare fraud.
The conviction of the defendants stemmed from the investigation of Safe Home Health Care Inc., a home health agency in Miami that was offering and paying kickbacks to obtain beneficiaries to serve as patients for home health services, mostly physical therapy. Conspirators at the agency used the beneficiary information to bill Medicare. Defendants Suarez-Basanta and Gonzalez were convicted of conspiring to pay and receive kickbacks. Defendant Gonzalez was also convicted of two additional counts for soliciting and accepting kickbacks in exchange for serving as a patient of Safe Home Health Care Inc. and having her parents serve as patients of Safe Home. In addition to be patients recruiters, Suarez-Basanta and Gonzalez are Medicare beneficiaries.
In total, nine defendants have been convicted of paying and receiving health care kickbacks in this investigation. Defendants Suarez-Basanta and Gonzalez are scheduled to be sentenced on May 25, 2013, at 10:00 a.m., before United States District Judge Ursula Ungaro, in Miami.
Mr. Ferrer commended the investigative efforts of the Federal Bureau of Investigation, U.S. Postal Inspection Service and the Office of the Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Eric Morales.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls.

Substance Abuse Counselor Pleads Guilty to Federal Health Care Fraud Charge

David B. Fein, United States Attorney for the District of Connecticut, announced that Alan Emmett Bradley, 57, of Norwalk, Connecticut, and Ocoee, Florida, pleaded guilty today before United States District Judge Vanessa L. Bryant in Hartford to one count of health care fraud.
According to court documents and statements made in court, Bradley, a certified alcohol and drug abuse counselor, obtained the Medicaid identification numbers of various Medicaid clients and used the identification numbers to submit hundreds of claims to Connecticut’s Department of Social Services. The claims alleged that Bradley performed 75- to 80-minute individual psychotherapy sessions to these Medicaid clients at his office in Norwalk. Hundreds of these counseling sessions did not occur and, for many of them, Bradley was actually living and attending school in Florida.
The Connecticut Medicaid program is a joint federal-state program designed primarily to finance the provision of medical services to the indigent. It is administered in Connecticut by the Department of Social Services and is also supervised by the federal Centers for Medicare and Medicaid Service.
Through this scheme, Bradley defrauded the Connecticut Medicaid program of $151,898.75.
Bradley was arrested in Florida on May 17, 2012. He has been detained since November 29, 2012, after he was found to have violated certain conditions of his pretrial release.
Judge Bryant has scheduled sentencing for June 5, 2013, at which time Bradley faces a maximum term of imprisonment of 10 years and a fine of up to $250,000.
This matter is being investigated by the U.S. Department of Health and Human Services-Office of Inspector General and the Federal Bureau of Investigation. The case is being prosecuted by Special Assistant United States Attorney Michael Ahearn, Assistant United States Attorney David Sheldon, and Auditor Kevin Saunders.
U.S. Attorney Fein encouraged individuals who suspect health care fraud to report it by calling the Health Care Fraud Task Force at 203-777-6311 or 1-800-HHS-TIPS.

Armenian National Sentenced to 41 Months in Prison for Role in Health Care Fraud Conspiracy

BRUNSWICK, GA—Khoren Gasparian, 30, an Armenian national, was sentenced last Friday by Chief United States District Court Judge Lisa Godbey Wood to 41 months in prison for his role in a conspiracy to defraud Medicare through phony medical businesses in Savannah, Georgia.
Gasparian, who at the time of these offenses was in the United States on an expired visa from Armenia, previously pleaded guilty to a conspiracy to defraud Medicare. According to the evidence presented at Gasparian’s guilty plea and sentencing hearings:
From 2008 through 2010, Gasparian and others opened medical equipment companies in Savannah, Georgia, known as Healthy Family, SOJ Group, and Savana Medical. Once opened, Gasparian and his cohorts stole the identities of hundreds of Medicare beneficiaries; stole the identities of dozens of doctors; and used this stolen information to submit hundreds of thousands of dollars in phony claims to Medicare for health care services that were never provided. Gasparian and others used the stolen identities of doctors and patients from multiple different states, including Alaska, California, New York, and Ohio and even submitted claims for people that were dead at the time they were alleged to have been provided medical equipment. Gasparian was also connected with at least two other phony health care businesses located in California and New Mexico. He was responsible for approximately $1 million worth of fraudulent claims submitted to Medicare.
United States Attorney Edward J. Tarver said, “Medicare fraud affects every American taxpayer. The United States Attorney’s Office has aggressively pursued healthcare fraudsters from around the world who’ve attempted to set up shop here in the Southern District of Georgia. The risk of detection is high for those who submit fraudulent claims to Medicare and the penalty will be substantial.”
“Criminals who steal from federal health care programs and taxpayers will be prosecuted to the fullest extent of the law,” 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. “The Office of Inspector General and our law enforcement partners will continue to aggressively pursue these thieves to ensure they are held accountable.”
Mark F. Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated, “The FBI will continue to work with its various law enforcement partners to identify, investigate, and bring forward for prosecution those individuals such as Mr. Gasparian who would steal funds from much needed federal programs such as Medicare.”
In addition to being sentenced to 41 months in prison, Gasparian was ordered to pay restitution in the amount of $182,735 and to serve three years of supervised release upon completion of his prison sentence. There is no parole in the federal system. At the time of his guilty plea in Georgia, Gasparian was serving a prison sentence based on his guilty plea to a health care fraud offense in the United States District Court for the District of New Mexico. After Gasparian finishes serving his prison sentences, he will face immigration proceedings that will likely result in his deportation to Armenia.
The prosecution of Gasparian in the Southern District of Georgia is part of a multi-jurisdictional investigation involving more than $200 million worth of phony claims submitted to Medicare. More than 35 defendants were arrested as part of this investigation. In addition to the Southern District of Georgia, numerous charges were filed in New York, Los Angeles, Cleveland, and Albuquerque.
The investigation in the Southern District of Georgia was the result of a multi-agency team of federal, state, and local agents, led by the Federal Bureau of Investigation (FBI), the Department of Health and Human Services-Office of the Inspector General (HHS/OIG), and Immigration and Customs Enforcement (ICE), working together to combat health care fraud. Assistant United States Attorney Brian T. Rafferty prosecuted the case on behalf of the United States. For additional information, please contact First Assistant United States Attorney James D. Durham at (912) 201-2547.

Owner and Operator of Houston-Area Ambulance Service Convicted in Medicare Fraud Scheme

WASHINGTON—The owner and operator of a Houston-area ambulance company was convicted by a federal jury in Houston of multiple counts of health care fraud for submitting false and fraudulent claims to Medicare, Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office, and Special Agent in Charge Mike Fields of the U.S. Health and Human Services Office of Inspector General-Office of Investigations Houston Office announced today.
Olusola Elliott, 44, of Fort Bend County, Texas, was convicted late yesterday by a federal jury in U.S. District Court in the Southern District of Texas of one count of conspiracy to commit health care fraud and six counts of health care fraud.
Elliott was the owner and operator of Double Daniels LLC, a Texas entity that purportedly provided non-emergency ambulance services to Medicare beneficiaries in the Houston area. According to evidence presented at trial, Elliott and others conspired from April 2010 through December 2011 to unlawfully enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and not provided. Evidence showed that Elliott falsified patient records in order to fraudulently bill Medicare on behalf of beneficiaries who were not in need of ambulance services.
During the course of the scheme, Elliott submitted and caused the submission of approximately $1,713,716 in fraudulent ambulance service claims to Medicare. According to court documents, Elliot transferred the proceeds of the fraud to himself and others after Medicare payments were sent to Double Daniels.
Elliot is scheduled for sentencing on May 31, 2013, in Houston. The six health care fraud counts and the conspiracy count each carry a maximum potential penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Trial Attorneys Christopher Cestaro and Laura M.K. Cordova of the Criminal Division’s Fraud Section, with assistance from former Special Assistant U.S. Attorney James S. Seaman. The case was investigated by the FBI, HHS-OIG, and the Texas Attorney General Medicaid Fraud Control Unit. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas 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.

Owner and Operator of Houston-Area Ambulance Service Convicted in Medicare Fraud Scheme

WASHINGTON—The owner and operator of a Houston-area ambulance company was convicted by a federal jury in Houston of multiple counts of health care fraud for submitting false and fraudulent claims to Medicare, Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office, and Special Agent in Charge Mike Fields of the U.S. Health and Human Services Office of Inspector General-Office of Investigations Houston Office announced today.
Olusola Elliott, 44, of Fort Bend County, Texas, was convicted late yesterday by a federal jury in U.S. District Court in the Southern District of Texas of one count of conspiracy to commit health care fraud and six counts of health care fraud.
Elliott was the owner and operator of Double Daniels LLC, a Texas entity that purportedly provided non-emergency ambulance services to Medicare beneficiaries in the Houston area. According to evidence presented at trial, Elliott and others conspired from April 2010 through December 2011 to unlawfully enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and not provided. Evidence showed that Elliott falsified patient records in order to fraudulently bill Medicare on behalf of beneficiaries who were not in need of ambulance services.
During the course of the scheme, Elliott submitted and caused the submission of approximately $1,713,716 in fraudulent ambulance service claims to Medicare. According to court documents, Elliot transferred the proceeds of the fraud to himself and others after Medicare payments were sent to Double Daniels.
Elliot is scheduled for sentencing on May 31, 2013, in Houston. The six health care fraud counts and the conspiracy count each carry a maximum potential penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Trial Attorneys Christopher Cestaro and Laura M.K. Cordova of the Criminal Division’s Fraud Section, with assistance from former Special Assistant U.S. Attorney James S. Seaman. The case was investigated by the FBI, HHS-OIG, and the Texas Attorney General Medicaid Fraud Control Unit. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas 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.

Nelson County Drug Store Owner Charged with Health Care Fraud and Wire Fraud

LOUISVILLE, KY—The owner of Crume Drug Store, located in Nelson County, Kentucky, was charged in United States District Court this week in a two-count federal information with wire fraud and billing private insurance companies and Medicare Part D for fraudulent prescriptions, announced David J. Hale, United States Attorney for the Western District of Kentucky.
According to the federal charges, Timothy Sizemore, age 36, of Bardstown, Kentucky, knowingly devised and executed a scheme between April 2010 and February 2012 whereby he used patients’ and doctors’ names to create fraudulent prescriptions and billed Anthem and other private insurance companies for those fraudulent prescriptions, even though those prescriptions were never actually filled. Further, it is alleged that during the same time period, Sizemore used patients’ and doctors’ names to create fraudulent prescriptions and billed Medicare Part D for those fraudulent prescriptions which were never filled.
If convicted at trial, Sizemore could be face no more than 30 years in prison, a fine of $500,000, and three years of supervised release. An initial appearance on the charges has not been scheduled.
This case is being prosecuted by Assistant United States Attorney David Weiser and is being investigated by the Federal Bureau of Investigation (FBI) and U.S. Department of Health and Human Services Office of Inspector General.

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The indictment of a person by a grand jury is an accusation only and that person is presumed innocent until and unless proven guilty.