Monday, December 30, 2013

Boyfriend Charged in Pregnant Teen's Killing

The suburban Chicago boyfriend of a pregnant teenager fatally shot on Christmas Day and his brother were denied bail Sunday and will remain in jail after being charged with first-degree murder in the death.
Eva Casara, whose baby survived and remains hospitalized, wasn't an intended target when an apparent robbery spiraled out of control, the Chicago Sun-Times ( http://bit.ly/KeoXnB ) reported.
Charged are her boyfriend, Anthony Lee, 16, and his brother, Diante Lamont Coakley, 21, both from Dolton, a suburb south of Chicago. It wasn't immediately clear if either Lee or Coakley had lawyers.
The 17-year-old Casara was "just in the wrong place at the wrong time with the wrong company," Dolton Police Chief John Franklin told the Sun-Times on Saturday. Franklin said it appeared to be part of a drug deal or robbery gone wrong.
A message left with Franklin by The Associated Press was not immediately returned. It wasn't immediately clear whether Lee would be tried as an adult.
On Sunday, Assistant State's Attorney Christina Kye offered more detail, saying that Lee, Coakley and a third brother headed out to rob someone — and Casara went along. At some point, Casara ended up in the car of the robbery target — and shots were fired at the car as it sped off, Kye said.
Kye said the intended robbery victim only understood Casara was in the car when he heard gurgling sounds behind him, then pulled over and left her. A passerby later came across Casara's body, she said.
Casara, who was 5 1/2 months pregnant, was pronounced dead early on Thursday — several hours after the Wednesday shooting. But doctors were able to save the Calumet City teen's baby.
While Casara was not the intended target in the shooting, the police chief stopped short of calling her death an accident.
"It's hard to call it an accident when you're firing a gun in the direction of people," he said.
Casara's aunt, Melody Vargas, told the Sun-Times, "She was just a victim of their stupidity, and they need to pay for it."

Suspect in 3 Colorado Slayings Captured in Okla.

A month long hunt for a man accused of killing three people in Colorado and then setting a house on fire to cover it up has ended with his capture in Oklahoma.
Harry Carl Mapps, 59, was arrested at a motel in Roland, Okla., on Saturday night, authorities said Sunday.
Mapps faces charges of first-degree murder and arson in the shooting deaths of Kim and Reggie Tuttle and their adult daughter, Dawn Roderick. Their bodies were found in the Tuttles' home in the southern Colorado town of Rye after it was damaged by fire on Nov. 27.
A booking photo showed Mapps with a swollen lip and large red patch on his right cheek, but authorities said there had been no struggle during his capture. No other details of his arrest were released.
Pueblo County, Colo., Sheriff Kirk Taylor said Mapps was found using information developed by the U.S. Marshals Service in Colorado, Oklahoma and Texas. Mapps had lived in Texas.
The Marshals Service had issued a fugitive warrant for Mapps and said authorities were searching for him nationwide.
It wasn't immediately clear if Mapps had an attorney, and authorities did not yet know if he would fight extradition to Colorado.
The fire at the Tuttles' house was ruled arson, and Taylor said it was meant to cover up the shootings.
Three days after the fire, deputies said Mapps was their primary suspect. Authorities said he had been living with the Tuttles and was working for a trucking company owned by Reggie Tuttle, 51.
Taylor said money appeared to be the motive for the shootings. Authorities claimed Mapps stole checks made out to one of the victims and cashed them on the day of the fire. He also faces theft, identity theft and forgery charges.
Pueblo County sheriff's investigators arrived in Oklahoma Sunday and hoped to speak to Mapps, said Lisa Shorter, the sheriff's spokeswoman.
Mapps wasn't armed when he was arrested, but investigators did not yet know whether there were any weapons in the motel room or Mapps' vehicle, said Charles Ahmad of the Marshals Service in Denver.
Ahmad said the firearm used to shoot the Tuttles and Roderick had not been recovered, and investigators believed Mapps still had it. Ahmad declined to identify the weapon.
Shorter and Ahmad said they did not yet know where Mapps had been while he was a fugitive. He once worked as a long-distance trucker, and authorities had said he was familiar with little-used back roads.
Friends called the Tuttles generous and caring.
"Kim and Reggie would help anyone who needed it," Winnie Owens, a friend and neighbor, told the Pueblo Chieftain. "The hearts of everyone in this valley go out to that family."
Kim Tuttle, 55, worked on the culinary staff at Parkview Medical Center in Pueblo.
Roderick, 33, lived in nearby Pueblo and had a husband and three children. Authorities haven't said why she was at her parents' home.
———

Time Running Short for Teen Declared Brain Dead

Without further court order, a California hospital could unhook a 13-year-old girl declared brain dead from a breathing machine.
Alameda County Superior Court Judge Evelio Grillo's current order allows Children's Hospital of Oakland to remove Jahi McMath from a ventilator at 5 p.m. Monday.
The family was pinning its hopes on a New York facility to care for the child after two California care homes withdrew offers to accept her.
Jahi underwent a tonsillectomy at the hospital on Dec. 9 to treat sleep apnea. After she awoke from the operation, her family said, she started bleeding heavily and went into cardiac arrest.
Doctors at Children's Hospital and an independent pediatric neurologist from Stanford University have concluded the girl is brain dead.
The hospital wants to remove her from life support, but the family said they believe she is still alive.
Chris Dolan, the family's attorney, said he was waiting to hear from the New York hospital after its facility director and medical director speak.
"The family is together, and today everybody is praying and being together," Dolan told the Associated Press Sunday. He said no decisions had been made about legal options for Monday, and would not comment on progress with the New York facility.
On Sunday, the hospital said it had not heard from the New York, or any other, facility about a transfer.
"We need to be able to talk to the other facility to understand what it is they are capable of doing," Cynthia Chiarappa, a hospital spokeswoman, said. "This is not transferring an individual in a vegetative state, but a dead body."
The hospital also said it would need to confirm there is "lawful transportation" included in any plan to transfer Jahi, and written permission from the coroner.
Dolan said previously that the family views the New York site as it's "last, last hope." He has also has said it was possible the family could ask Grillo for more time, or file a federal appeal.

Tuesday, December 24, 2013

Two Miami Women Sentenced to 10 Years in Prison for Conspiring to Pay Health Care Kickbacks

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS‑OIG), Miami Regional Office, announce that U.S. District Judge Federico A. Moreno sentenced Yiral Cardona, 39, of Miami, and Susan Chi, 42, of Miami, to 10 years in prison, stemming from their leadership roles in a conspiracy to pay health care kickbacks.
At trial, Cardona and Chi were convicted on October 22, 2013, of one count of conspiracy to pay health care kickbacks and to defraud the United States, in violation of Title 18, United States Code, Section 371, and three counts of unlawful payment of health care kickbacks, in violation of Title 42, United States Code, Section 1320a-7b(b)(2)(A).
According to the evidence presented at trial and the sentencing hearing, Cardona and Chi owned Vista Home Health Services Inc. (Vista), a Miami-Dade based home health agency that purportedly provided skilled nursing and home health services to Medicare beneficiaries. The defendants illegally obtained Medicare patients by paying bribes and kickbacks of at least $141,000 to patient recruiters to induce the referral of Medicare patients to Vista for home health services. Cardona and Chi billed the Medicare program for home health services that were not medically necessary and/or not provided. Between approximately May 15, 2009 and April 26, 2012, Medicare paid Vista more than $4.1 million in claims. The court ordered the defendants to pay more than $733,000 in restitution.

Wednesday, December 18, 2013

New Jersey Opthalmologist Admits Lying to Federal Agents During Fraud Investigation About Reuse of Lucentis Vials

NEWARK—An ophthalmologist with a medical practice in Englewood, New Jersey admitted today to lying to federal agents during a health care fraud investigation into the reuse of single-use vials of prescription Lucentis medication for multiple patients, U.S. Attorney Paul J. Fishman announced.
Bernard J. Fowler, 68, of Mahwah, New Jersey, pleaded guilty to an information charging him with making false statements to federal agents with the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG). He entered his plea before U.S. District Judge Susan D. Wigenton in Newark federal court.
According to documents filed in this case and statements made in court:
Fowler was a licensed and board-certified ophthalmologist operating his own medical practice called Retina Vitreous Consultants, when he was interviewed by HHS-OIG special agents on July 27, 2011. Fowler no longer operates the practice.
During his guilty plea, Fowler admitted that in 2008 and 2009, he had administered injections from one vial of Lucentis to more than one patient on multiple occasions but told the investigating agents that he had not. Fowler admitted he knew the statement was false and he intended to deceive the agents.
In addition to the potential health risks of reusing single-use vials on multiple individuals, such reuse can generate fraudulent billings to patients and insurers based on the approximately $2,000 cost of a full vial.
The false statements charge carries a maximum potential penalty of five years in prison and a $250,000 fine, or twice the gain or loss caused by the offense. Sentencing is scheduled for March 24, 2014.
U.S. Attorney Fishman credited special agents of HHS-OIG, under the direction of Special Agent in Charge Thomas O’Donnell, and the FBI, under the direction of Special Agent in Charge Aaron T. Ford, for the investigation leading to the guilty plea.
The government is represented by Assistant U.S. Attorneys Scott B. McBride and R. David Walk of the U.S. Attorney’s Office’s Health Care and Government Fraud Unit.

Monday, December 16, 2013

Manhattan U.S. Attorney, FBI, and IRS Announce Charges Against Pharmacy Owner in Multi-Million-Dollar Medicare, Medicaid Fraud Scheme

Preet Bharara, the United States Attorney for the Southern District of New York; George Venizelos, the Assistant Director in Charge of the New York Field Office of the Federal Bureau of Investigation (FBI); and Toni Weirauch, the Special Agent in Charge of the New York Field Office of the Internal Revenue Service-Criminal Investigation (IRS-CI), announced that Purna Chandra Aramalla was arrested yesterday for engaging in a scheme to defraud Medicaid and Medicare through the sale of illegally diverted prescription drugs. Aramalla was also charged with a related money laundering offense. Aramalla was arrested yesterday morning and was presented in Manhattan federal court before U.S. Magistrate Judge Debra Freeman yesterday afternoon. A preliminary hearing is scheduled for January 13, 2014.
Manhattan U.S. Attorney Preet Bharara said, “The illegal diversion of prescription medications threatens the health of those induced to sell their medication rather than take it. It threatens the health of those who unwittingly purchase the repackaged drugs believing them to be factory-fresh. And, as alleged here, Purna Aramalla’s diversion scheme defrauded millions of dollars from Medicare and Medicaid, taxpayer-funded programs established to provide health care assistance for the elderly and indigent. This office is committed not only to punishing and preventing fraud, and safeguarding Medicare and Medicaid, but also to protecting the public.”
FBI Assistant Director in Charge Venizelos said, “As alleged in the complaint, Aramalla conspired to defraud our government health care programs and profit from the illness and misfortune of others. Aramalla treated our American health care system as a vehicle to fuel his greed and line his own pockets. The FBI, in conjunction with our law enforcement partners, will continue to investigate and bring to justice criminals who bilk the system and defraud the American taxpayer.”
IRS-CI Special Agent in Charge Weirauch said, “The illegal sale of prescription drugs by pharmaceutical professionals is an escalating problem. Not only does it put potentially dangerous medications in the wrong hands, but fraudulent Medicare and Medicaid reimbursements divert resources from the government. The money laundering statutes have always been effective tools in the fight against illegal drugs. We are now applying these same laws to the illegal prescription drug business, tracing the lucrative proceeds that the sales of these drugs generate.”
According to the allegations contained in the criminal complaint unsealed today:
Aramalla operates A Fair Deal Pharmacy Inc. in Queens, New York, and Quality Health Drug Inc. in Bronx, New York. Using these pharmacies, Aramalla allegedly carried out a multi-million-dollar scheme to defraud New York State Medicaid and Medicare programs through the sale of diverted pharmaceutical drugs, that is, drugs not obtained from legitimate sources.
As part of the scheme, Aramalla purchased pharmaceuticals, including high-cost medications used to treat HIV, that were obtained from patients who sold the pharmaceuticals rather than use them to treat their illnesses. Aramalla then repackaged and resold those pharmaceuticals to his customers, as if the pharmaceuticals were new drugs obtained from legitimate sources. Aramalla requested and received reimbursement from Medicaid and Medicare in connection with these sales, even though Medicaid and Medicare would not have been willing to reimburse the cost of second-hand drugs. In addition, in some cases, Medicaid or Medicare had already paid for the pharmaceuticals when they were initially dispensed. In order to make the diverted pharmaceuticals appear to be new pharmaceuticals from legitimate sources, Aramalla and his co-conspirators used lighter fluid and other means to dissolve the adhesive on the patient labels on prescription bottles so that they could be removed and replaced with new labels.
Aramalla also sought and obtained reimbursement for pharmaceuticals that were never actually dispensed to patients. Instead, customers with prescriptions for pharmaceuticals essentially “sold” their prescriptions to Aramalla, agreeing not to take delivery of the pharmaceuticals in exchange for a share of the reimbursed proceeds.
From October 2010 to August 2012, Aramalla purchased approximately $1.7 million of certain branded HIV medications from two legitimate, licensed wholesalers that were his primary sources of legitimate drugs. During that same period, he received approximately $4.3 million in reimbursements from Medicare and Medicaid for those same drugs, an amount far in excess of what he would have been entitled to had he only sought reimbursement for the legitimately obtained drugs.
* * *
Aramalla, 65, of Port Washington, New York, is charged with one count of conspiracy to commit health care fraud and wire fraud, which carries a maximum term of 20 years in prison, and one count of money laundering, which also carries a maximum term of 20 years in prison. He was ordered detained pending satisfaction of bail conditions, including a $2 million personal recognizance bond.
Mr. Bharara praised the outstanding investigative work of the FBI and the IRS. He also thanked the U.S. Department of Health and Human Services, Office of Inspector General; the New York State Office of Medicaid Inspector General; and the New York City Human Resources Administration.
The New York FBI Health Care Fraud Task Force was formed in 2007 in an effort to combat health care fraud in the greater New York City area. The task force comprises agents, officers, and investigators from the FBI, NYPD, the New York State Insurance Fraud Bureau, U.S. Department of Labor, U.S. Office of Personnel Management-Inspector General, U.S. Food and Drug Administration, New York State Attorney General’s Office, New York State Office of Medicaid Inspector General, New York State Health and Hospitals Inspector General, and the National Insurance Crime Bureau.
If you think you may have purchased second-hand prescription drugs or were otherwise victimized by this scheme, you can call the FBI Hotline at 212-384-3555.
The case is being prosecuted by the Office’s Complex Frauds Unit. Assistant U.S. Attorney Niketh Velamoor is in charge of the prosecution.
The charges contained in the complaint are merely accusations, and the defendant is presumed innocent unless and until proven guilty.

Wednesday, December 11, 2013

Former Doctor Sentenced to Home Detention on Health Care Fraud Convictions

BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced that former medical doctor Daniel C. Gillick, 63, of Youngstown, New York, who previously pleaded guilty to obtaining controlled substances by fraud and health care fraud, was sentenced today to six months of home detention and two years’ probation. As a part of the plea, the defendant surrendered his medical license.
Assistant U.S. Attorney Timothy C. Lynch and Maura K. O’Donnell, who handled the case, stated that between August 2011 and September 7, 2011, the defendant was employed as an emergency room physician at Schuyler Hospital. During that time, Gillick devised a scheme whereby on September 7, 2011, his then-girlfriend, Christine Guilfoyle, reported to the emergency room at Schuyler Hospital and pretended to suffer from a medical condition known as trygeminal neuralgia. The defendant then performed an apparent examination of her, fraudulently diagnosed her as suffering from trygeminal neuralgia and issued a prescription to her for Dilauded, a controlled substance.
In reality, Gillick's girlfriend was not suffering from this condition and had no medical need for the drug Dilaudid. In participating in this illegal scheme, the defendant defrauded Schuyler Hospital and also aided and abetted his former girlfriend in obtaining a controlled substance by fraud.
“This office has previously spoken about the need for all segments of the community to understand and help combat the dangers associated with the illegal trafficking in painkillers,” said United States Attorney Hochul. “Doctors and other medical professionals need to also understand that this office will not hesitate to bring criminal charges against them when warranted by the facts and the law.”
On November 22, 2013, U.S. Magistrate Judge Hugh B. Scott sentenced Christine Guilfoyle to time-served for her misdemeanor conviction for possessing cocaine base.
These cases are the result of an investigation on the part of special agents of the United States Drug Enforcement Administration, under the direction of Brian R. Crowell, Special Agent in Charge, New York Field Division; special agents of the Federal Bureau of Investigation, under the direction of Special Agent in Charge Brian P. Boetig; the New York State Police, under the direction of Major Michael Cerretto; Customs and Border Protection, under the direction of James Engleman, Director of Field Operations; the New York State Attorney General Medicaid Fraud Control Unit; the Amherst Police Department, under the direction of Chief John Askey; the Buffalo Police Department, under the direction of Commissioner Daniel Derenda; the Lancaster Police Department, under the direction of Chief Gerald Gill; the Erie County Sheriff's Department, under the direction of Sheriff Timothy Howard; the Depew Police Department, under the direction of Chief Stan Carwile; and the Niagara County Sherif's Drug Task Force, under the direction of Sheriff James Votour.

Friday, December 6, 2013

Manhattan U.S. Attorney and FBI Assistant Director in Charge Announce Health Care Fraud Charges Against Current and Former Russian Diplomats and Their Spouses

Preet Bharara, the United States Attorney for the Southern District of New York, and George Venizelos, the Assistant Director in Charge of the New York Field Office of the Federal Bureau of Investigation (FBI), today announced charges against 49 defendants for participating in a widespread fraud scheme from 2004 to August 2013 to illegally obtain nearly half-a-million dollars in Medicaid benefits. Each of the defendants charged in the complaint unsealed today is a current or former Russian diplomat or the spouse of a diplomat employed at either the Russian Mission to the United Nations (the Mission), the Russian Federation Consulate General in New York (the Consulate), or the Trade Representation of the Russian Federation in the USA, New York Office (the Trade Representatio”). The complaint alleges that each of the defendants and their unnamed co-conspirators participated in a widespread scheme to illegally obtain Medicaid benefits for prenatal care and related costs by, among other things, falsely underreporting their income or falsely claiming that their child was a citizen of the United States.
Manhattan U.S. Attorney Preet Bharara said, “Diplomacy should be about extending hands, not picking pockets in the host country. Here, as alleged, a multitude of Russian diplomats and their spouses ran a scam on a health care system designed to help Americans in need. As the complaint alleges, the scam exploited a weakness in the Medicaid system, and the charges expose shameful and systemic corruption among Russian diplomats in New York.”
FBI Assistant Director in Charge George Venizelos said, “The United States government values its long-standing relationship with foreign diplomats and diplomatic establishments for cooperation on many issues. Unfortunately, as detailed in the complaint, some Russian officials in New York allowed these defendants to take advantage of that relationship.
"Motivated by greed and the purchase of high-end luxury items, these defendants allegedly perpetrated a fraud to illegally obtain Medicaid benefits to which they were not entitled. The unsealing of the complaint today highlights the criminal activities of these defendants and reminds the public that health care fraud remains an ongoing problem in our country. The FBI and our law enforcement partners, including the New York City Human Resources Administration and the New York State Department of Health, are committed to preventing and prosecuting health care fraud at all levels.”
According to the allegations in the complaint unsealed today in Manhattan federal court:
Medicaid is a largely federally funded program in the United States designed to assist low-income families afford health care. In New York State, the Department of Health administers the Medicaid program, and the New York City Human Resources Administration oversees the program and processes applications in New York City. In New York State, pregnant women can receive immediate prenatal care following a preliminary assessment of the pregnant woman’s and, if applicable, her spouse’s, income. If the pregnant woman provides an income level that is higher than the Medicaid eligibility threshold, the provider will generally not process the Medicaid application. Proof of United States citizenship is not required for a pregnant woman to receive Medicaid benefits because the unborn child is presumed to acquire United States citizenship by virtue of being born in the United States. Once completed, the pregnant woman is entitled to Medicaid benefits pursuant to the original application until the 60th post-partum day, and the newborn child is entitled to benefits on the mother’s initial application until the child’s first birthday. Diplomats, their spouses, and their children are generally not entitled to Medicaid benefits except in cases of emergency.
While in the United States, the individuals employed by the Mission, Consulate, and Trade Representation are paid a salary by the Russian government, which is not subject to United States federal, state, or local taxes. Employees of the Mission and Consulate generally live in housing, the vast majority of which is paid for by the Russian government. The Mission and Consulate historically have also paid for the medical expenses of their employees, including hospital and doctor bills, as well as dental expenses. Each of the defendants named in the Complaint is a Russian diplomat who works or worked at the Mission, Consulate, or Trade Representation, or was married to such an individual. As a result of an international convention among multiple nations and a bilateral agreement between the United States and Russia, children born in the United States to Russian diplomats generally do not acquire United States citizenship.
The investigation revealed the widespread submission of falsified applications for Medicaid benefits associated with medical costs for prenatal care, birth, and young children by the defendants, which enabled the defendants to obtain Medicaid benefits that they were not otherwise entitled to receive. Approximately $1,500,000 in fraudulently received benefits were obtained by the defendants and dozens of other co-conspirators not named in the complaint. In general, the defendants underreported their income to an amount below or at the applicable Medicaid eligibility level in order to qualify for Medicaid benefits. In support of the underreported income, the defendants generally submitted letters signed by employees of the Mission, Consulate, or Trade Representation, purporting to corroborate that the falsely underreported income was the true income amount. The defendants’ true income was often hundreds, if not thousands, of dollars more per month than what was falsely reported to Medicaid. Moreover, before, during, and after the time that the defendants received Medicaid benefits, several of the defendants opened credit card accounts in which they reflected salaries thousands of dollars higher than they reported to Medicaid.
In addition, one set of defendants failed to disclose their marriage on their initial Medicaid application—falsely claiming that they were brother and sister instead of husband and wife. As a result, those defendants failed to disclose any income the husband earned from the Mission. Because of their lies, they received almost $21,000 in Medicaid income to which they were not entitled. Three other defendants falsely claimed that their children—Russian nationals residing in the United States pursuant to visas issued by the Department of State reflecting their Russian citizenship—were citizens of the United States in order to obtain Medicaid benefits for their children. To support these lies, a United States Social Security card was provided for one application, and both a United States Social Security Card and a birth certificate issued by the New York City Department of Mental Health and Hygiene was provided in support of another application.
Moreover, before, during, and after the time that the defendants applied for and received hundreds of thousands of dollars in Medicaid benefits, they spent tens of thousands of dollars on luxury items, including cruise vacations and purchases such as watches, shoes, and jewelry, at stores such as Tiffany & Co., Jimmy Choo, Prada, Bloomingdale’s, and Burberry.
For example, Timor Salomatin, a former diplomat at the Mission, and his wife, Nailya Babaeva, applied for Medicaid pregnancy benefits in November 2010 and represented Salomatin’s salary to be $3,000 a month and submitted a renewal application in June 2011 in which they claimed that Salomatin made $4,400 a month. In support of both applications, they submitted a letter signed by Mikhail Korneev, formerly a counselor at the Mission, in which Korneev falsely confirmed the underreported income amount. However, beginning in June 2011, Salomatin began to receive direct payroll deposits from the Russian government into his bank account. Between June 2011 and December 2011, Salomatin received an average of $5,160 a month—over $2,000 more than he reported to Medicaid on the initial application. In February 2011, shortly after Salomatin and Babeva applied for Medicaid benefits, and shortly before they applied for renewal benefits, Salomatin applied for a credit card and represented his salary to be $8,333 a month. In December 2011, while Babeva’s and Salomatin’s children continued to receive Medicaid benefits, Salomatin represented his salary to be $60,000 a year, or $5,000 a month. During the period between February 2012 and December 2012, while their children continued to receive Medicaid benefits, Salomatin and Babeva made and paid for over $50,000 in purchases, including over $8,400 from Apple and over $10,000 from retailers, including, among others, Prada and Bloomingdale’s. Babaeva and her children obtained almost $31,000 in Medicaid benefits to which they were not entitled.
Andrey Artasov and Nataliya Artasova falsely represented to Medicaid that Artasov made only $2,900 a month (or approximately $34,800 a year) in salary in November 2008. In March 2007—over a year-and-a-half prior to Artasova applying for Medicaid, Artasov reported to a credit card company that he made $60,000 a year in salary. In 2008, the year that Artasova received Medicaid benefits, Artasov and Artasova made and paid for over $48,000 in purchases on this credit card, spending thousands of dollars at Swarovski and Apple, among other things.
* * *
Each of the defendants was charged with one count of conspiracy to commit health care fraud and one count of conspiracy to steal government funds and make false statements relating to health care matters, which carry maximum sentences of ten years and five years in prison, respectively.
Of the 49 defendants, 11 are currently in the United States. Five of those individuals are diplomats working at the Mission. Five of those individuals are the spouses of the diplomats. One is currently employed at the Russian Federation’s embassy in Washington, D.C., but at the time of the charged offenses was employed at the Consulate. The remaining 38 no longer reside in the United States.
Manhattan U.S. Attorney Bharara praised the investigative work of the FBI and thanked the New York City Human Resources Administration and the New York State Department of Health for their assistance in this investigation.
The Office’s Public Corruption and Terrorism and International Narcotics Units are handling the case. Assistant U.S. Attorneys Rebecca Ricigliano, Shane Stansbury, and Ian McGinley are in charge of the prosecution.
The charges contained in the complaint are merely an accusation, and the defendants are presumed innocent unless and until proven guilty.
- Press conference remarks prepared for FBI New York ADIC George Venizelos

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Tuesday, December 3, 2013

Health Care Clinic Owners Sentenced for Roles in $8 Million Health Care Fraud Scheme

WASHINGTON—Two health care clinic owners were sentenced today in connection with an $8 million health care fraud scheme involving the now-defunct home health care company Flores Home Health Care Inc.
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, 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 made the announcement.
Miguel Jimenez, 43, and Marina Sanchez Pajon, 29, both of Miami, were sentenced by U.S. District Judge Ursula Ungaro in the Southern District of Florida. Jimenez was sentenced to serve 87 months in prison, and Pajon was sentenced to serve 57 months in prison. Jimenez and Pajon pleaded guilty in August to conspiracy to commit health care fraud.
Jimenez and Pajon, who are married, were owners and operators of Flores Home Health, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.
According to court documents, Jimenez and Pajon operated Flores Home Health for the purpose of billing Medicare for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or not provided. Jimenez’s primary role at Flores Home Health involved controlling the company and running and overseeing the schemes conducted through Flores Home Health. Both Jimenez and Pajon were responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims to the Medicare program.
Jimenez, Pajon, and their co-conspirators paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Flores Home Health for home health and therapy services that were medically unnecessary and/or not provided. They also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications, and other documentation. Jimenez, Pajon, and their co-conspirators used the prescriptions, medical certifications, and other documentation to fraudulently bill Medicare for home health care services, which Jimenez and Pajon knew was in violation of federal criminal laws.
From approximately October 2009 through approximately June 2012, Flores Home Health was paid approximately $8 million by Medicare for fraudulent claims for home health services that were not medically necessary and/or not provided.
The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, 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 http://www.stopmedicarefraud.gov.