NEWARK, NJ—A physician with a practice in Madison, New Jersey admitted today to accepting bribes of $2,000 per month in exchange for test referrals as part of a long-running scheme operated by Biodiagnostic Laboratory Services LLC (BLS) of Parsippany, New Jersey; its president; and numerous associates, U.S. Attorney Paul J. Fishman announced.
Wayne Lajewski, 51, pleaded guilty today before U.S. District Judge Stanley R. Chesler in Newark federal court to an information charging him with one count of accepting bribes.
According to documents filed in this and other cases and statements made in court:
Lajewski admitted he accepted bribes of $2,000 cash per month over two years in return for referring patient blood specimens to BLS, for which BLS received more than $850,000.
The bribery count to which Lajewski pleaded guilty carries a maximum potential penalty of five years in prison and a $250,000 fine. Sentencing is scheduled for July 8, 2014. As part of his guilty plea, Lajewski agreed to forfeit $48,000, representing the bribes he received from BLS.
Including Lajewski, 26 people—including 15 physicians—have pleaded guilty in connection with the bribery scheme, which its organizers have admitted involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and various private insurance companies.
The investigation has recovered more than $7 million to date through forfeiture.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford in Newark; U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Thomas O’Donnell; IRS–Criminal Investigation, under the direction of Acting Special Agent in Charge Jonathan D. Larsen; and inspectors of the U.S. Postal Inspection Service, under the direction of Inspector in Charge Maria L. Kelokates, with the ongoing investigation leading to today’s guilty plea.
The government is represented by Assistant U.S. Attorney Joseph Minish, Senior Litigation Counsel Andrew Leven, and Jacob T. Elberg, Chief of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark, as well as Assistant U.S. Attorney Barbara Ward of the office’s Asset Forfeiture and Money Laundering Unit.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act and other statutes.
Thursday, April 10, 2014
Tom’s River Chiropractor Admits Receiving Bribes for Patient Referrals
NEWARK—A chiropractor with a practice in Toms River, New Jersey admitted today to accepting bribes to refer a number of his patients to a New Jersey-licensed pain management physician, U.S. Attorney Paul J. Fishman announced.
Norman Eastburn, 48, of Jackson, New Jersey, pleaded guilty to an information charging him with one count of violating the Anti-Kickback statute. He entered his guilty plea before U.S. District Judge Stanley R. Chesler in Newark federal court.
According to documents filed in this case and statements made in court:
Eastburn was paid a cash fee per patient he referred to the pain management physician. As part of the scheme, the pair negotiated specific kickback amounts that would be paid based on which payor would be billed—Medicare or a private healthcare insurer—and what type of pain treatment would be rendered.
Eastburn indicated to the pain physician that a medical doctor’s involvement in pain procedures would increase Eastburn’s likelihood of being reimbursed by insurers. As an example, Eastburn recounted a prior situation in which he misled a patient by telling her that she required an injection that he did not then believe, in fact, was medically necessary and then paid a doctor $500 in cash to administer it.
The violation of the Anti-Kickback statute carries a maximum potential penalty of five years in prison and a $250,000 fine. In addition, Eastburn has agreed to forfeit to the United States the money he was paid in bribes. Sentencing is scheduled for July 8, 2014.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford, and the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Tom O’Donnell, with the investigation.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Senior Litigation Counsel Andrew Leven of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
Norman Eastburn, 48, of Jackson, New Jersey, pleaded guilty to an information charging him with one count of violating the Anti-Kickback statute. He entered his guilty plea before U.S. District Judge Stanley R. Chesler in Newark federal court.
According to documents filed in this case and statements made in court:
Eastburn was paid a cash fee per patient he referred to the pain management physician. As part of the scheme, the pair negotiated specific kickback amounts that would be paid based on which payor would be billed—Medicare or a private healthcare insurer—and what type of pain treatment would be rendered.
Eastburn indicated to the pain physician that a medical doctor’s involvement in pain procedures would increase Eastburn’s likelihood of being reimbursed by insurers. As an example, Eastburn recounted a prior situation in which he misled a patient by telling her that she required an injection that he did not then believe, in fact, was medically necessary and then paid a doctor $500 in cash to administer it.
The violation of the Anti-Kickback statute carries a maximum potential penalty of five years in prison and a $250,000 fine. In addition, Eastburn has agreed to forfeit to the United States the money he was paid in bribes. Sentencing is scheduled for July 8, 2014.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford, and the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Tom O’Donnell, with the investigation.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Senior Litigation Counsel Andrew Leven of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
Friday, March 28, 2014
Akron Doctor and His Employees Indicted for Prescribing Hundreds of Thousands of Doses of Painkillers
An Akron physician and three of his employees were indicted for illegally prescribing hundreds of thousands of doses of painkillers and other pills to customers for no legitimate medical purpose, even after he learned some customers had died from overdose-related deaths, law enforcement officials announced today.
Adolph Harper, Jr., 63, of Akron; Adria Harper, 34, of Akron; Patricia Laughman, 51, of Barberton, Ohio; and Tequilla Berry, 35, of Akron, are all named in the 134-count indictment.
The charges include conspiring to traffic pharmaceutical drugs, drug trafficking, and health care fraud. Together, they distributed hundreds of thousands of doses of prescription medications—including Oxycontin, Percocet, Roxicet, Opana, and others—from Adolph Harper’s medical officers in Akron between 2009 and 2012, according to the indictment.
Count one of the indictment charges all four defendants with conspiring to distribute addictive controlled substances, including prescription painkillers and anti-anxiety medication, outside the usual course of professional practice and without any legitimate medical purpose.
Adolph Harper’s customers, many of whom were drug addicts exhibiting clear signs of drug addiction during their visits to his office, came to his office and received “prescriptions” for addictive prescription medications without being examined by Harper and often without seeing him at all, according to the indictment.
Harper continued to distribute prescriptions for controlled substances after he learned that some of his customers had died from overdose-related deaths, according to the indictment.
Adria Harper, Patricia Laughman, and Tequilla Berry distributed prescriptions to these customers when Adolph Harper was out of the office and also used Adolph Harper’s prescription pad to distribute prescriptions for addictive painkillers to themselves, according to the indictment.
Counts two through 83 charge Adolph Harper with individual distributions of Schedule II controlled substances including oxycodone, oxymorphone, and methadone.
Counts 84 through 109 charge Adria Harper with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad and for prescriptions that she distributed to customers when Adolph Harper, Jr. was not in the office.
Counts 110 through 123 charge Patricia Laughman with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad.
Counts 124 through 130 charge Tequilla Berry with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself in the name of an unknowing third party using Adolph Harper’s prescription pad.
Counts 131 through 134 charge Adolph Harper with health care fraud. Specifically, these counts charge him with executing four separate schemes to defraud health insurance providers by (1) submitting insurance claims for services using a higher billing code than the service justified; (2) submitting insurance claims for unperformed services; (3) billing an insurance provider for a service after collecting a cash payment for the same service; and (4) causing the submission of insurance claims for prescriptions for controlled substances that were issued outside the usual course of professional practice and not for a legitimate medical purpose.
“The charges describe a defendant who is simply a drug dealer with a stethoscope who happens to work from a medical office instead of a street corner,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “His actions destroyed families and lives.”
Steven D. Anthony, Special Agent in Charge of the Federal Bureau of Investigation’s Cleveland Office, said: “Just because you have a prescription pad does not give you a license to deal drugs. Not only did this doctor violate the physician’s oath, but he also allowed others in his office to abuse his medical privileges.”
“DEA is pleased to acknowledge the indictment of Dr. Adolph Harper,” said Geno Corley, Resident Agent in Charge of the Drug Enforcement Administration’s Cleveland Office. “This case was initiated by the Akron Police Department and investigated by FBI and Health and Human Services, with assistance from the DEA Cleveland Resident Office, Ohio State Board of Pharmacy, and the State of Ohio Medical Board. This arrest of Dr. Harper and his co-conspirators is another important step forward in the fight against the improper prescribing of dangerous and addictive prescription drugs.”
“This is great example of how state and federal collaboration can work to combat prescription drug abuse,” said Kyle Parker, executive director of the Ohio State Pharmacy Board.
This case is being prosecuted by Assistant United States Attorneys Margaret A. Sweeney, Edward F. Feran, and Rebecca C. Lutzko following an investigation by the Federal Bureau of Investigation, the Department of Health and Human Services-Office of the Inspector General, the Drug Enforcement Administration, the Ohio Board of Pharmacy, and the Akron Police Department.
If convicted, the defendants’ sentences will be determined by the court after review of factors unique to this case, including the defendants’ prior criminal record, if any; the defendants’ roles in the offenses; and the characteristics of the violations. In all cases, the sentence will not exceed the statutory maximum, and in most cases it will be less than the maximum.
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
Adolph Harper, Jr., 63, of Akron; Adria Harper, 34, of Akron; Patricia Laughman, 51, of Barberton, Ohio; and Tequilla Berry, 35, of Akron, are all named in the 134-count indictment.
The charges include conspiring to traffic pharmaceutical drugs, drug trafficking, and health care fraud. Together, they distributed hundreds of thousands of doses of prescription medications—including Oxycontin, Percocet, Roxicet, Opana, and others—from Adolph Harper’s medical officers in Akron between 2009 and 2012, according to the indictment.
Count one of the indictment charges all four defendants with conspiring to distribute addictive controlled substances, including prescription painkillers and anti-anxiety medication, outside the usual course of professional practice and without any legitimate medical purpose.
Adolph Harper’s customers, many of whom were drug addicts exhibiting clear signs of drug addiction during their visits to his office, came to his office and received “prescriptions” for addictive prescription medications without being examined by Harper and often without seeing him at all, according to the indictment.
Harper continued to distribute prescriptions for controlled substances after he learned that some of his customers had died from overdose-related deaths, according to the indictment.
Adria Harper, Patricia Laughman, and Tequilla Berry distributed prescriptions to these customers when Adolph Harper was out of the office and also used Adolph Harper’s prescription pad to distribute prescriptions for addictive painkillers to themselves, according to the indictment.
Counts two through 83 charge Adolph Harper with individual distributions of Schedule II controlled substances including oxycodone, oxymorphone, and methadone.
Counts 84 through 109 charge Adria Harper with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad and for prescriptions that she distributed to customers when Adolph Harper, Jr. was not in the office.
Counts 110 through 123 charge Patricia Laughman with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself using Adolph Harper’s prescription pad.
Counts 124 through 130 charge Tequilla Berry with individual distributions of prescriptions for Schedule II controlled substances that she wrote out for herself in the name of an unknowing third party using Adolph Harper’s prescription pad.
Counts 131 through 134 charge Adolph Harper with health care fraud. Specifically, these counts charge him with executing four separate schemes to defraud health insurance providers by (1) submitting insurance claims for services using a higher billing code than the service justified; (2) submitting insurance claims for unperformed services; (3) billing an insurance provider for a service after collecting a cash payment for the same service; and (4) causing the submission of insurance claims for prescriptions for controlled substances that were issued outside the usual course of professional practice and not for a legitimate medical purpose.
“The charges describe a defendant who is simply a drug dealer with a stethoscope who happens to work from a medical office instead of a street corner,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “His actions destroyed families and lives.”
Steven D. Anthony, Special Agent in Charge of the Federal Bureau of Investigation’s Cleveland Office, said: “Just because you have a prescription pad does not give you a license to deal drugs. Not only did this doctor violate the physician’s oath, but he also allowed others in his office to abuse his medical privileges.”
“DEA is pleased to acknowledge the indictment of Dr. Adolph Harper,” said Geno Corley, Resident Agent in Charge of the Drug Enforcement Administration’s Cleveland Office. “This case was initiated by the Akron Police Department and investigated by FBI and Health and Human Services, with assistance from the DEA Cleveland Resident Office, Ohio State Board of Pharmacy, and the State of Ohio Medical Board. This arrest of Dr. Harper and his co-conspirators is another important step forward in the fight against the improper prescribing of dangerous and addictive prescription drugs.”
“This is great example of how state and federal collaboration can work to combat prescription drug abuse,” said Kyle Parker, executive director of the Ohio State Pharmacy Board.
This case is being prosecuted by Assistant United States Attorneys Margaret A. Sweeney, Edward F. Feran, and Rebecca C. Lutzko following an investigation by the Federal Bureau of Investigation, the Department of Health and Human Services-Office of the Inspector General, the Drug Enforcement Administration, the Ohio Board of Pharmacy, and the Akron Police Department.
If convicted, the defendants’ sentences will be determined by the court after review of factors unique to this case, including the defendants’ prior criminal record, if any; the defendants’ roles in the offenses; and the characteristics of the violations. In all cases, the sentence will not exceed the statutory maximum, and in most cases it will be less than the maximum.
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
Wednesday, March 26, 2014
New York Doctor Charged in Alleged Multi-Million-Dollar Medicare Fraud Scheme
BROOKLYN, NY—A criminal complaint was unsealed this morning in Brooklyn federal court charging Dr. Syed Imran Ahmed, 49, with health care fraud in connection with his submission of millions of dollars in false Medicare billings. Seizure warrants seeking millions of dollars of the defendant’s alleged ill-gotten gains, including the contents of seven bank accounts, were also unsealed. In addition, a civil forfeiture complaint was also filed today against the defendant’s residence located in Muttontown, New York, valued at approximately $4 million. Further, earlier today search warrants were executed at six locations in New York, Michigan, and Nevada. The defendant’s initial appearance is scheduled this afternoon before United States Magistrate Judge Marilyn Go at the United States Courthouse, 225 Cadman Plaza East, Brooklyn, New York.
The charges were announced by Loretta E. Lynch, United States Attorney for the Eastern District of New York; David O’Neil, Acting Assistant Attorney General of the Justice Department’s Criminal Division; George Venizelos, Assistant Director in Charge, Federal Bureau of Investigation, New York Field Office; and Thomas O’Donnell, Special Agent in Charge, Department of Health and Human Services-Office of Inspector General (HHS-OIG).
As alleged in the complaint, Ahmed engaged in a scheme to submit claims to Medicare for surgical procedures that were not in fact performed. The complaint cites multiple instances in which either patients told law enforcement officers that they never had the procedures that were billed, or hospital medical records did not contain any evidence that the procedures were actually performed. From January 2011 through mid-December 2013, Medicare was billed at least $85 million for surgical procedures by Ahmed, a sole practitioner.
“As alleged, Ahmed created phantom medical procedures to steal very real taxpayer money. The defendant sought to enrich himself and fund his lifestyle through billing Medicare for services he never performed,” stated United States Attorney Lynch. “We are committed to protecting these taxpayer-funded programs and prosecuting those who steal from them.”
“The Medicare system entrusts doctors to provide patients with the care and services they need,” said Acting Assistant Attorney General O’Neil. “The charges unsealed today allege that Dr. Ahmed billed millions of dollars to Medicare for surgical procedures that he did not actually perform. These charges are yet another example of the Department of Justice’s determination to hold accountable those who abuse the trust placed in them and steal from the system for personal gain.”
FBI Assistant Director in Charge Venizelos stated, “Fraudulently billing the government defrauds every American taxpayer. We will investigate cases of graft and greed to protect important programs for those who need them.”
“For a single physician, the alleged conduct in this case is among the most serious I’ve seen in my law enforcement career,” said SAC for HHS-OIG O’Donnell. “Being a Medicare provider is a privilege, not a right. When Dr. Ahmed allegedly billed Medicare for procedures he never performed, he violated the basic trust that taxpayers extend to health care providers.”
The investigation has been conducted by the FBI and HHS-OIG, brought as part of the Medicare Fraud Strike Force, and supervised by the U.S. Attorney’s Office for the Eastern District of New York and the Criminal Division’s Fraud Section. The case is being prosecuted by Trial Attorney Turner Buford of the Criminal Division’s Fraud Section and Assistant United States Attorneys William Campos and Erin Argo of the U.S. Attorney’s Office for the Eastern District of New York.
The charges in the complaint are merely allegations, and the defendant is presumed innocent unless and until proven guilty. If convicted, the defendant faces a maximum sentence of 10 years.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS- OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
The Defendant:
SYED IMRAN AHMED
Age: 49
Glen Head, New York
The charges were announced by Loretta E. Lynch, United States Attorney for the Eastern District of New York; David O’Neil, Acting Assistant Attorney General of the Justice Department’s Criminal Division; George Venizelos, Assistant Director in Charge, Federal Bureau of Investigation, New York Field Office; and Thomas O’Donnell, Special Agent in Charge, Department of Health and Human Services-Office of Inspector General (HHS-OIG).
As alleged in the complaint, Ahmed engaged in a scheme to submit claims to Medicare for surgical procedures that were not in fact performed. The complaint cites multiple instances in which either patients told law enforcement officers that they never had the procedures that were billed, or hospital medical records did not contain any evidence that the procedures were actually performed. From January 2011 through mid-December 2013, Medicare was billed at least $85 million for surgical procedures by Ahmed, a sole practitioner.
“As alleged, Ahmed created phantom medical procedures to steal very real taxpayer money. The defendant sought to enrich himself and fund his lifestyle through billing Medicare for services he never performed,” stated United States Attorney Lynch. “We are committed to protecting these taxpayer-funded programs and prosecuting those who steal from them.”
“The Medicare system entrusts doctors to provide patients with the care and services they need,” said Acting Assistant Attorney General O’Neil. “The charges unsealed today allege that Dr. Ahmed billed millions of dollars to Medicare for surgical procedures that he did not actually perform. These charges are yet another example of the Department of Justice’s determination to hold accountable those who abuse the trust placed in them and steal from the system for personal gain.”
FBI Assistant Director in Charge Venizelos stated, “Fraudulently billing the government defrauds every American taxpayer. We will investigate cases of graft and greed to protect important programs for those who need them.”
“For a single physician, the alleged conduct in this case is among the most serious I’ve seen in my law enforcement career,” said SAC for HHS-OIG O’Donnell. “Being a Medicare provider is a privilege, not a right. When Dr. Ahmed allegedly billed Medicare for procedures he never performed, he violated the basic trust that taxpayers extend to health care providers.”
The investigation has been conducted by the FBI and HHS-OIG, brought as part of the Medicare Fraud Strike Force, and supervised by the U.S. Attorney’s Office for the Eastern District of New York and the Criminal Division’s Fraud Section. The case is being prosecuted by Trial Attorney Turner Buford of the Criminal Division’s Fraud Section and Assistant United States Attorneys William Campos and Erin Argo of the U.S. Attorney’s Office for the Eastern District of New York.
The charges in the complaint are merely allegations, and the defendant is presumed innocent unless and until proven guilty. If convicted, the defendant faces a maximum sentence of 10 years.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS- OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
The Defendant:
SYED IMRAN AHMED
Age: 49
Glen Head, New York
Wednesday, February 26, 2014
Diagnostic Imaging Group to Pay $15.5 Million for Allegedly Submitting False Claims to Federal and State Health Care Programs
NEWARK—Diagnostic Imaging Group (DIG) has agreed to pay a total of $15.5 million to resolve allegations that its diagnostic testing facilities falsely billed federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians.
U.S. Attorney for the District of New Jersey Paul J. Fishman, Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery, and U.S. Attorney for the Eastern District of New York Loretta E. Lynch announced the settlement today.
DIG has agreed to pay $13.65 million to the federal government and an additional total of $1.85 million to New York and New Jersey. DIG operates a chain of diagnostic testing facilities through its subsidiary, Doshi Diagnostic Imaging Services, which is headquartered in Hicksville, New York. DIG previously operated chains in New Jersey and Florida through subsidiaries Doshi Diagnostic Imaging Services of New Jersey and Signet Diagnostic Imaging Services.
“Health care providers who make decisions based on profit instead of medical need compromise patient safety and confidence,” U.S. Attorney Fishman said. “Unnecessary tests and the payment of kickbacks also siphon precious resources from our health care system. The settlement we’re announcing today is an appropriate response to these unacceptable practices.”
“When health care providers pay kickbacks and submit false claims to Medicare, they not only deplete the Medicare Trust Fund, they undermine the integrity of the health care system,” said Assistant Attorney General Stuart F. Delery. “The Justice Department will relentlessly pursue those who misuse federal health care funds for their own profit.”
The settlement announced today resolves allegations that DIG submitted claims to Medicare, as well as the New Jersey and New York Medicaid Programs, for 3D reconstructions of CT scans that were never performed or interpreted. Additionally, DIG allegedly bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary. Today’s settlement also resolves allegations that DIG paid kickbacks to physicians for the referral of diagnostic tests. According to the government, the kickbacks were in the form of payments that DIG made to physicians ostensibly to supervise patients who underwent nuclear stress testing. These payments allegedly exceeded fair market value and were, in fact, intended to reward physicians for their referrals.
“Patients deserve testing decisions based solely on medical need, not doctors’ pocketbooks,” said U.S. Attorney Lynch. “We will continue to work with our federal and state law enforcement partners to investigate vigorously allegations of fraud on federal programs like Medicare and to pursue those who seek to fraudulently deplete the Medicare Trust Fund.”
“Paying physicians for their referrals and submitting false claims to increase Medicare and Medicaid reimbursements—as was alleged in this case—simply cannot be tolerated,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson. “Besides levying a hefty penalty, the settlement requires an independent organization to review Diagnostic Imaging Group’s claims for five years and to send reports to the government.”
The allegations resolved by today’s settlement were raised in three lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The three whistleblowers will receive the following amounts as part of today’s settlement: Mark Novick, M.D., $1.5 million; Rey Solano, $1.07 million; Richard Steinman, M.D., $209,250.
U.S. Attorney Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Assistant U.S. Attorney Charles Graybow of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark and Trial Attorneys Arthur Di Dio and William Olson of the Justice Department’s Civil Division in all aspects of the case, as well as Assistant U.S. Attorney Paul Kaufman of the U.S. Attorney’s Office for the Eastern District of New York with regard to the Steinman qui tam. New York was represented the New York Attorney General’s Medicaid Control Fraud Unit in New York City, and New Jersey was represented by the New Jersey Attorney General’s Government & Healthcare Fraud Section in Newark.
The settlement is the culmination of an investigation conducted jointly by special agents of the Department of Health and Human Services Office of Inspector General and special agents of the FBI in Newark, under the direction of Special Agent in Charge Aaron T. Ford, with contributions from the Railroad Retirement Board.
The claims settled by this agreement are allegations only, and there has been no determination of liability. The three cases are captioned United States ex rel. Mark Novick, M.D. v. Doshi Diagnostic Imaging Services P.C., Civil Action No. 09-4992 (D.N.J.); United States ex rel. Rey Solano v. Diagnostic Imaging Group et al., Civil Action No. 10-267 (D.N.J.); and United States ex rel. Richard Steinman, M.D. v. Diagnostic Imaging Group, et al., Civil Action No. 10-4161 (E.D.N.Y.).
U.S. Attorney for the District of New Jersey Paul J. Fishman, Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery, and U.S. Attorney for the Eastern District of New York Loretta E. Lynch announced the settlement today.
DIG has agreed to pay $13.65 million to the federal government and an additional total of $1.85 million to New York and New Jersey. DIG operates a chain of diagnostic testing facilities through its subsidiary, Doshi Diagnostic Imaging Services, which is headquartered in Hicksville, New York. DIG previously operated chains in New Jersey and Florida through subsidiaries Doshi Diagnostic Imaging Services of New Jersey and Signet Diagnostic Imaging Services.
“Health care providers who make decisions based on profit instead of medical need compromise patient safety and confidence,” U.S. Attorney Fishman said. “Unnecessary tests and the payment of kickbacks also siphon precious resources from our health care system. The settlement we’re announcing today is an appropriate response to these unacceptable practices.”
“When health care providers pay kickbacks and submit false claims to Medicare, they not only deplete the Medicare Trust Fund, they undermine the integrity of the health care system,” said Assistant Attorney General Stuart F. Delery. “The Justice Department will relentlessly pursue those who misuse federal health care funds for their own profit.”
The settlement announced today resolves allegations that DIG submitted claims to Medicare, as well as the New Jersey and New York Medicaid Programs, for 3D reconstructions of CT scans that were never performed or interpreted. Additionally, DIG allegedly bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary. Today’s settlement also resolves allegations that DIG paid kickbacks to physicians for the referral of diagnostic tests. According to the government, the kickbacks were in the form of payments that DIG made to physicians ostensibly to supervise patients who underwent nuclear stress testing. These payments allegedly exceeded fair market value and were, in fact, intended to reward physicians for their referrals.
“Patients deserve testing decisions based solely on medical need, not doctors’ pocketbooks,” said U.S. Attorney Lynch. “We will continue to work with our federal and state law enforcement partners to investigate vigorously allegations of fraud on federal programs like Medicare and to pursue those who seek to fraudulently deplete the Medicare Trust Fund.”
“Paying physicians for their referrals and submitting false claims to increase Medicare and Medicaid reimbursements—as was alleged in this case—simply cannot be tolerated,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson. “Besides levying a hefty penalty, the settlement requires an independent organization to review Diagnostic Imaging Group’s claims for five years and to send reports to the government.”
The allegations resolved by today’s settlement were raised in three lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The three whistleblowers will receive the following amounts as part of today’s settlement: Mark Novick, M.D., $1.5 million; Rey Solano, $1.07 million; Richard Steinman, M.D., $209,250.
U.S. Attorney Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $535 million in health care fraud and government fraud settlements, judgments, fines, restitution, and forfeiture under the False Claims Act; the Food, Drug, and Cosmetic Act; and other statutes.
The government is represented by Assistant U.S. Attorney Charles Graybow of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark and Trial Attorneys Arthur Di Dio and William Olson of the Justice Department’s Civil Division in all aspects of the case, as well as Assistant U.S. Attorney Paul Kaufman of the U.S. Attorney’s Office for the Eastern District of New York with regard to the Steinman qui tam. New York was represented the New York Attorney General’s Medicaid Control Fraud Unit in New York City, and New Jersey was represented by the New Jersey Attorney General’s Government & Healthcare Fraud Section in Newark.
The settlement is the culmination of an investigation conducted jointly by special agents of the Department of Health and Human Services Office of Inspector General and special agents of the FBI in Newark, under the direction of Special Agent in Charge Aaron T. Ford, with contributions from the Railroad Retirement Board.
The claims settled by this agreement are allegations only, and there has been no determination of liability. The three cases are captioned United States ex rel. Mark Novick, M.D. v. Doshi Diagnostic Imaging Services P.C., Civil Action No. 09-4992 (D.N.J.); United States ex rel. Rey Solano v. Diagnostic Imaging Group et al., Civil Action No. 10-267 (D.N.J.); and United States ex rel. Richard Steinman, M.D. v. Diagnostic Imaging Group, et al., Civil Action No. 10-4161 (E.D.N.Y.).
Tuesday, February 25, 2014
New Jersey Doctor Who Provided Spa Services Pleads Guilty in Medicare Fraud Scheme
Dr. Chang Ho Lee, 68, of Palisades Park, New Jersey, pleaded guilty today to health care fraud and agreed to forfeit more than $3.4 million in fraud proceeds.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
According to court documents, Lee, who is a medical doctor, and two others recruited patients by offering free lunches and recreational classes and provided them with spa services, such as massages and facials, and then falsely billed Medicare for more than $13 million using those patients’ Medicare numbers. Lee and the others billed Medicare for physical therapy, lesion removals, and other services that were neither medically necessary nor provided. The scheme took place at three clinics: URI Medical Center and Sarang Medical PC in Flushing, New York, and 999 Medical Clinic in Brooklyn, New York. Lee received more than $3.4 million through the submission of the fraudulent claims.
Lee is scheduled to be sentenced by United States District Judge Raymond J. Dearie of the Eastern District of New York on June 13, 2014. At sentencing, he faces a maximum sentence of 10 years in prison and approximately $3.4 million in mandatory restitution.
The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Senior Trial Attorney Nicholas Acker and Trial Attorney Bryan D. Fields from the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
According to court documents, Lee, who is a medical doctor, and two others recruited patients by offering free lunches and recreational classes and provided them with spa services, such as massages and facials, and then falsely billed Medicare for more than $13 million using those patients’ Medicare numbers. Lee and the others billed Medicare for physical therapy, lesion removals, and other services that were neither medically necessary nor provided. The scheme took place at three clinics: URI Medical Center and Sarang Medical PC in Flushing, New York, and 999 Medical Clinic in Brooklyn, New York. Lee received more than $3.4 million through the submission of the fraudulent claims.
Lee is scheduled to be sentenced by United States District Judge Raymond J. Dearie of the Eastern District of New York on June 13, 2014. At sentencing, he faces a maximum sentence of 10 years in prison and approximately $3.4 million in mandatory restitution.
The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Senior Trial Attorney Nicholas Acker and Trial Attorney Bryan D. Fields from the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Thursday, February 20, 2014
Government Intervenes in Lawsuit Against Tenet Healthcare Corp. and Georgia Hospital Owned by Health Management Associates Inc. Alleging Payment of Kickbacks
The government has intervened in a False Claims Act lawsuit against Tenet Healthcare Corp. (Tenet) and four of its hospitals in Georgia and South Carolina, as well as a hospital in Monroe, Georgia owned by Health Management Associates Inc. (HMA), alleging that the hospitals paid kickbacks to obstetric clinics serving primarily undocumented Hispanic women in return for referral of those patients for labor and delivery at the hospitals. The hospitals then billed the Medicaid programs in Georgia and South Carolina for the services provided to the referred patients and, in some instances, also obtained additional Medicare reimbursement based on the influx of low-income patients. Tenet and HMA are two of the largest owner/operators of hospitals in the United States. HMA was acquired by Community Health Systems last month. The government also is intervening against the clinics and related entities known as Hispanic Medical Management d/b/a Clinica de la Mama.
“The Department of Justice is committed to ensuring that health care providers who pay kickbacks in return for patient referrals are held accountable,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery. “Schemes such as this one corrupt the health care system and take advantage of vulnerable patients.”
“My office has made the investigation of health care fraud a priority,” said U.S. Attorney for the Middle District of Georgia Michael J. Moore. “In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need. This kind of scheme drives up costs for everyone, not just the vulnerable patients and groups like those targeted in this case.”
The lawsuit alleges that four Tenet hospitals—Atlanta Medical Center, North Fulton Regional Hospital, Spalding Regional Hospital and Hilton Head Hospital in South Carolina—and one HMA facility—Walton Regional Medical Center (since renamed Clearview Regional Medical Center)—paid kickbacks to Hispanic Medical Management d/b/a Clinica de la Mama (Clinica) and related entities in return for Clinica’s agreement to send pregnant women to their facilities for deliveries paid for by Medicaid, in violation of the federal Medicare and Medicaid Anti-Kickback Statute. The kickbacks were disguised as payments for a variety of services allegedly provided by Clinica.
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. The Anti-Kickback Statute is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is instead based on the best interests of the patient.
“Investigations such as these are a high priority for the FBI, and we are determined to hold accountable providers that enrich themselves at the expense of government programs and damage the public trust,” said FBI Assistant Director Ronald T. Hosko. “The FBI is dedicated to preventing and combating all forms of health care fraud; working with federal, state and local partners to effectively resolve allegations and engaging with the public to identify potential schemes.”
The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case. The lawsuit is pending in the Middle District of Georgia .
The government’s intervention in this matter illustrates its emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.
These matters were investigated by the Commercial Litigation Branch of the Justice Department’s Civil Division, the Fraud Section of the department’s Criminal Division, the U.S. Attorney’s Offices for the Middle and Northern Districts of Georgia, the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the Office of the Attorney General for the State of Georgia.
The case is captioned United States ex rel. Williams v. Health Mgmt. Assocs. Inc., Tenet Healthcare, et al., No. 3:09-CV-130 (M.D. Ga.).
The claims asserted against Tenet, the HMA facility and Clinica are allegations only, and there has been no determination of liability.
“The Department of Justice is committed to ensuring that health care providers who pay kickbacks in return for patient referrals are held accountable,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery. “Schemes such as this one corrupt the health care system and take advantage of vulnerable patients.”
“My office has made the investigation of health care fraud a priority,” said U.S. Attorney for the Middle District of Georgia Michael J. Moore. “In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need. This kind of scheme drives up costs for everyone, not just the vulnerable patients and groups like those targeted in this case.”
The lawsuit alleges that four Tenet hospitals—Atlanta Medical Center, North Fulton Regional Hospital, Spalding Regional Hospital and Hilton Head Hospital in South Carolina—and one HMA facility—Walton Regional Medical Center (since renamed Clearview Regional Medical Center)—paid kickbacks to Hispanic Medical Management d/b/a Clinica de la Mama (Clinica) and related entities in return for Clinica’s agreement to send pregnant women to their facilities for deliveries paid for by Medicaid, in violation of the federal Medicare and Medicaid Anti-Kickback Statute. The kickbacks were disguised as payments for a variety of services allegedly provided by Clinica.
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. The Anti-Kickback Statute is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is instead based on the best interests of the patient.
“Investigations such as these are a high priority for the FBI, and we are determined to hold accountable providers that enrich themselves at the expense of government programs and damage the public trust,” said FBI Assistant Director Ronald T. Hosko. “The FBI is dedicated to preventing and combating all forms of health care fraud; working with federal, state and local partners to effectively resolve allegations and engaging with the public to identify potential schemes.”
The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The False Claims Act also permits the government to intervene in such lawsuits, as it has done in this case. The lawsuit is pending in the Middle District of Georgia .
The government’s intervention in this matter illustrates its emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.
These matters were investigated by the Commercial Litigation Branch of the Justice Department’s Civil Division, the Fraud Section of the department’s Criminal Division, the U.S. Attorney’s Offices for the Middle and Northern Districts of Georgia, the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the Office of the Attorney General for the State of Georgia.
The case is captioned United States ex rel. Williams v. Health Mgmt. Assocs. Inc., Tenet Healthcare, et al., No. 3:09-CV-130 (M.D. Ga.).
The claims asserted against Tenet, the HMA facility and Clinica are allegations only, and there has been no determination of liability.
Miami Physician Pleads Guilty in Medicare Fraud Scheme
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG); Michael B. Steinbach, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Mark R. Trouville, Special Agent in Charge, U.S. Drug Enforcement Administration (DEA), Miami Field Division, announce today that Christopher Gregory Wayne, an osteopathic physician residing in Miami, pled guilty before U.S. District Judge Robert N. Scola, Jr., to a criminal information that charges him with health care fraud and conspiracy to violate the narcotics laws of the United States. Sentencing has been scheduled for May 16, 2014.
At sentencing, Wayne faces a maximum sentence of 10 years in prison and a $250,000 fine on the health care fraud charge. The narcotics charge carries a maximum sentence of five years in prison and a $250,000 fine.
In his plea, Wayne admitted to executing a scheme to defraud the Medicare program and attempting to cause a loss in excess of $2,500,000 to Medicare. Wayne agreed to the entry of a forfeiture judgment in the amount of $1,649,042 and the forfeiture of real property and a car, representing proceeds traceable to the health care fraud offense. Wayne also agreed to entry of a money judgment in the amount of $428,300 as proceeds of the narcotics distribution.
Mr. Ferrer commended the investigative efforts of HHS-OIG, FBI, and DEA. The case is being prosecuted by Assistant U.S. Attorneys Eric Morales and Brent Tantillo.
At sentencing, Wayne faces a maximum sentence of 10 years in prison and a $250,000 fine on the health care fraud charge. The narcotics charge carries a maximum sentence of five years in prison and a $250,000 fine.
In his plea, Wayne admitted to executing a scheme to defraud the Medicare program and attempting to cause a loss in excess of $2,500,000 to Medicare. Wayne agreed to the entry of a forfeiture judgment in the amount of $1,649,042 and the forfeiture of real property and a car, representing proceeds traceable to the health care fraud offense. Wayne also agreed to entry of a money judgment in the amount of $428,300 as proceeds of the narcotics distribution.
Mr. Ferrer commended the investigative efforts of HHS-OIG, FBI, and DEA. The case is being prosecuted by Assistant U.S. Attorneys Eric Morales and Brent Tantillo.
Monmouth County Doctor Admits Stealing $1.1 Million from Partners
NEWARK—A pain management doctor with a practice based in Red Bank, New Jersey admitted today that he embezzled more than $1.1 million from a medical practice, U.S. Attorney Paul J. Fishman announced.
Robert Muscio, 40, a resident of Colts Neck, New Jersey, pleaded guilty before U.S. District Judge Stanley R. Chesler in Newark federal court to one count of committing mail fraud to embezzle those monies.
According to documents filed in this case and statements made in court:
Between 2007 and 2008, Muscio misused his position as medical director of a practice—with which he is no longer associated—to write checks on the practice’s bank account to pay his personal expenses. To conceal this misconduct from his partners, Muscio falsely described the payments as business expenses of the practice.
The mail fraud count to which Muscio pleaded guilty is punishable by a maximum potential penalty of 20 years in prison and a $250,000 fine. Sentencing is scheduled for May 21, 2014.
U.S. Attorney Fishman credited special agents of the U.S. Department of Health and Human Services, Office of Inspector General, 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, with the investigation leading to today’s guilty plea.
The government is represented by Senior Litigation Counsel Andrew Leven of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $520 million in health care fraud and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act; the Food, Drug; and Cosmetic Act; and other statutes.
Defense counsel: Joseph J. Benedict Esq., New Brunswick, New Jersey
Robert Muscio, 40, a resident of Colts Neck, New Jersey, pleaded guilty before U.S. District Judge Stanley R. Chesler in Newark federal court to one count of committing mail fraud to embezzle those monies.
According to documents filed in this case and statements made in court:
Between 2007 and 2008, Muscio misused his position as medical director of a practice—with which he is no longer associated—to write checks on the practice’s bank account to pay his personal expenses. To conceal this misconduct from his partners, Muscio falsely described the payments as business expenses of the practice.
The mail fraud count to which Muscio pleaded guilty is punishable by a maximum potential penalty of 20 years in prison and a $250,000 fine. Sentencing is scheduled for May 21, 2014.
U.S. Attorney Fishman credited special agents of the U.S. Department of Health and Human Services, Office of Inspector General, 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, with the investigation leading to today’s guilty plea.
The government is represented by Senior Litigation Counsel Andrew Leven of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $520 million in health care fraud and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act; the Food, Drug; and Cosmetic Act; and other statutes.
Defense counsel: Joseph J. Benedict Esq., New Brunswick, New Jersey
Wednesday, February 19, 2014
Corpus Christi Doctor Convicted in Connection with Fraudulent Health Care Billing Scheme
CORPUS CHRISTI, TX—Dr. Roque Joel Ramirez, 49, of Robstown, has entered a plea of guilty to mail fraud in connection with his scheme to defraud Medicare and Medicaid through fraudulent billings, announced United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott.
Ramirez, a licensed physician in Texas since 1997 and owner of Health Resolutions Inc., was indicted by a federal grand jury on October 9, 2013, in a scheme to defraud Medicare and Medicaid through fraudulent billings. He was set for trial this morning but opted to enter a guilty plea to one count of mail fraud for using the United States Postal Service (USPS) for the purpose executing his scheme. His medical office in Corpus Christi is now closed.
Ramirez admitted he knowingly and willfully engaged in a scheme to defraud Medicare and Texas Medicaid and submitted false and fraudulent billings for medical services he did not provide. He also admitted he committed mail fraud by using USPS to receive payment on the fraudulent bills.
Court documents indicated that Ramirez knowingly and willfully engaged in the scheme from May 2008 through December 2011 by submitting fraudulent billings for physician services he did not provide. Thousands of false and fraudulent bills were submitted, according to the charges. Ramirez billed for medical services he claimed he personally provided to patients who had actually died prior to the dates of his claimed services. He also submitted bills claiming he personally provided services to patients at his clinic when he was actually overseas or in another state. Some of the bills also indicated he would have personally worked more than 24 hours in a single day. Court documents also alleged that when he provided medical services to Medicare and Medicaid patients in nursing homes, he would send fraudulent bills claiming he had seen the patients in private residences in order to collect the higher fees paid for house calls.
Senior U.S. District Judge Hayden Head, who accepted the guilty plea, has set sentencing for May 15, 2014, at which time Ramirez faces up to 20 years in federal prison and a $250,000 maximum fine. He was permitted to remain on bond pending that hearing.
The investigation was conducted by the FBI, U.S. Department of Health and Human Services-Office of Inspector General, and the Texas Attorney General’s Medicaid Fraud Control Unit. Assistant United States Attorney (AUSA) Robert D. Thorpe, Jr. and Special AUSA Rex G. Beasley are prosecuting.
Ramirez, a licensed physician in Texas since 1997 and owner of Health Resolutions Inc., was indicted by a federal grand jury on October 9, 2013, in a scheme to defraud Medicare and Medicaid through fraudulent billings. He was set for trial this morning but opted to enter a guilty plea to one count of mail fraud for using the United States Postal Service (USPS) for the purpose executing his scheme. His medical office in Corpus Christi is now closed.
Ramirez admitted he knowingly and willfully engaged in a scheme to defraud Medicare and Texas Medicaid and submitted false and fraudulent billings for medical services he did not provide. He also admitted he committed mail fraud by using USPS to receive payment on the fraudulent bills.
Court documents indicated that Ramirez knowingly and willfully engaged in the scheme from May 2008 through December 2011 by submitting fraudulent billings for physician services he did not provide. Thousands of false and fraudulent bills were submitted, according to the charges. Ramirez billed for medical services he claimed he personally provided to patients who had actually died prior to the dates of his claimed services. He also submitted bills claiming he personally provided services to patients at his clinic when he was actually overseas or in another state. Some of the bills also indicated he would have personally worked more than 24 hours in a single day. Court documents also alleged that when he provided medical services to Medicare and Medicaid patients in nursing homes, he would send fraudulent bills claiming he had seen the patients in private residences in order to collect the higher fees paid for house calls.
Senior U.S. District Judge Hayden Head, who accepted the guilty plea, has set sentencing for May 15, 2014, at which time Ramirez faces up to 20 years in federal prison and a $250,000 maximum fine. He was permitted to remain on bond pending that hearing.
The investigation was conducted by the FBI, U.S. Department of Health and Human Services-Office of Inspector General, and the Texas Attorney General’s Medicaid Fraud Control Unit. Assistant United States Attorney (AUSA) Robert D. Thorpe, Jr. and Special AUSA Rex G. Beasley are prosecuting.
Friday, February 14, 2014
Local Physician Indicted on Charges of Health Care Fraud
ROCKFORD, IL—A suspended Rockford physician was indicted today by a federal grand jury on charges of healthcare fraud. Charles S. DeHann, 59, of Belvidere, Illinois, was charged with nine counts of engaging in a scheme to defraud Medicare.
The indictment alleges that DeHaan, a physician licensed in Illinois, and president of Housecall Physicians Group of Rockford, South Carolina, treated numerous patients at Rockford-area assisted living facilities and, as a physician, had access to patients and patient records. The indictment alleges that, from January 2013 through January 24, 2014, in order to enrich himself, DeHaan submitted false claims to Medicare for reimbursement for medical services that DeHaan provided to patients in their homes. As part of the scheme, DeHaan allegedly obtained patient information of Medicare beneficiaries through his affiliation with and privileges granted to him at various Rockford-area assisted living facilities, without the knowledge or consent of the patients. It is also alleged that DeHaan billed for medical services purportedly provided to patients whom DeHaan never actually treated and billed routine visits with Medicare patients at the highest levels of in-home care when he knew that his visits with these patients typically did not qualify for such billing.
In addition, DeHaan allegedly billed for medical services provided to patients when he knew he did not provide any reimbursable medical service. For instance, on multiple occasions, DeHaan billed Medicare for medical services purportedly provided to patients, when DeHaan’s visit with the patient involved no medical care and instead involved DeHaan’s having sexual contact and attempting to have sexual contact with a patient and making sexual advances toward a patient, according to the indictment.
DeHaan was initially charged with federal health care fraud last month when he was arrested on a criminal complaint. He was released on bond and will appear for arraignment on February 12, 2014, at 10:00 a.m. in federal court in Rockford, before U.S. Magistrate Iain D. Johnston.
Each count of health care fraud carries a maximum potential penalty of up to 10 years in prison, a fine of up to $250,000, and full restitution. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The charges were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Robert J. Holley, Special Agent in Charge of the Chicago Office of Federal Bureau of Investigation; and Lamont Pugh, III, Special Agent in Charge of the Chicago Regional Office of the U.S. Department of Health and Human Services Office of Inspector General.
The federal case was investigated by the FBI and HHS-OIG, with the assistance of the Illinois Department of Financial and Professional Regulation. The government is being represented by Assistant U.S. Attorney Scott R. Paccagnini.
The public is reminded that an indictment is only a charge and is not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving his guilt beyond a reasonable doubt.
The indictment alleges that DeHaan, a physician licensed in Illinois, and president of Housecall Physicians Group of Rockford, South Carolina, treated numerous patients at Rockford-area assisted living facilities and, as a physician, had access to patients and patient records. The indictment alleges that, from January 2013 through January 24, 2014, in order to enrich himself, DeHaan submitted false claims to Medicare for reimbursement for medical services that DeHaan provided to patients in their homes. As part of the scheme, DeHaan allegedly obtained patient information of Medicare beneficiaries through his affiliation with and privileges granted to him at various Rockford-area assisted living facilities, without the knowledge or consent of the patients. It is also alleged that DeHaan billed for medical services purportedly provided to patients whom DeHaan never actually treated and billed routine visits with Medicare patients at the highest levels of in-home care when he knew that his visits with these patients typically did not qualify for such billing.
In addition, DeHaan allegedly billed for medical services provided to patients when he knew he did not provide any reimbursable medical service. For instance, on multiple occasions, DeHaan billed Medicare for medical services purportedly provided to patients, when DeHaan’s visit with the patient involved no medical care and instead involved DeHaan’s having sexual contact and attempting to have sexual contact with a patient and making sexual advances toward a patient, according to the indictment.
DeHaan was initially charged with federal health care fraud last month when he was arrested on a criminal complaint. He was released on bond and will appear for arraignment on February 12, 2014, at 10:00 a.m. in federal court in Rockford, before U.S. Magistrate Iain D. Johnston.
Each count of health care fraud carries a maximum potential penalty of up to 10 years in prison, a fine of up to $250,000, and full restitution. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The charges were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Robert J. Holley, Special Agent in Charge of the Chicago Office of Federal Bureau of Investigation; and Lamont Pugh, III, Special Agent in Charge of the Chicago Regional Office of the U.S. Department of Health and Human Services Office of Inspector General.
The federal case was investigated by the FBI and HHS-OIG, with the assistance of the Illinois Department of Financial and Professional Regulation. The government is being represented by Assistant U.S. Attorney Scott R. Paccagnini.
The public is reminded that an indictment is only a charge and is not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving his guilt beyond a reasonable doubt.
Tuesday, February 4, 2014
Queens Doctor Sentenced for His Role in $15 Million Medicare Fraud Scheme
A Queens, New York medical doctor was sentenced today to serve 12 months and a day in prison for his role in a scheme that fraudulently billed Medicare more than $15 million for, among other things, physical therapy and lesion removal services that were medically unnecessary and never provided.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta E. Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
Hoi Yat Kam, 59, was sentenced by U.S. District Judge Edward R. Korman in the Eastern District of New York. In addition to his prison term, Kam was sentenced to serve three years of supervised release and to pay $2,217,656 in restitution.
Kam pleaded guilty on January 9, 2013, to conspiracy to commit health care fraud. According to court documents, Kam conspired with others to execute a fraudulent scheme in which he and others provided a variety of spa services, such as massages and facials, as well as free meals and social activities to Medicare beneficiaries at URI Medical Service PC and Sarang Medical PC to induce those beneficiaries to allow their Medicare numbers to be billed for medical services that were never provided and were not medically necessary. URI and Sarang were two clinics in Queens that purportedly provided physical therapy and lesion removals. In total, Kam and his co-conspirators submitted approximately $15.1 million in false and fraudulent claims to Medicare.
The case was investigated by HHS-OIG and the FBI and brought as part of the Medicare Fraud Strike Force, under the supervision by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case was prosecuted by Senior Trial Attorney Nicholas Acker and Trial Attorney Bryan D. Fields of the Fraud Section. Trial Attorney Katherine Houston formerly prosecuted the case.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta E. Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
Hoi Yat Kam, 59, was sentenced by U.S. District Judge Edward R. Korman in the Eastern District of New York. In addition to his prison term, Kam was sentenced to serve three years of supervised release and to pay $2,217,656 in restitution.
Kam pleaded guilty on January 9, 2013, to conspiracy to commit health care fraud. According to court documents, Kam conspired with others to execute a fraudulent scheme in which he and others provided a variety of spa services, such as massages and facials, as well as free meals and social activities to Medicare beneficiaries at URI Medical Service PC and Sarang Medical PC to induce those beneficiaries to allow their Medicare numbers to be billed for medical services that were never provided and were not medically necessary. URI and Sarang were two clinics in Queens that purportedly provided physical therapy and lesion removals. In total, Kam and his co-conspirators submitted approximately $15.1 million in false and fraudulent claims to Medicare.
The case was investigated by HHS-OIG and the FBI and brought as part of the Medicare Fraud Strike Force, under the supervision by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case was prosecuted by Senior Trial Attorney Nicholas Acker and Trial Attorney Bryan D. Fields of the Fraud Section. Trial Attorney Katherine Houston formerly prosecuted the case.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Friday, January 31, 2014
Three Miami Residents Indicted for Alleged Roles in $190 Million Medicare Fraud Scheme
Three Miami residents have been indicted for their alleged participation in a $190 million Medicare fraud scheme.
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. Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami Office made the announcement after the indictment was unsealed.
On January 28, 2014, a federal grand jury in Miami returned a 10-count indictment charging Nelson Rojas, 43; Roger Bergman, 64; and Rodolfo Santaya, 54, for allegedly participating in a scheme to defraud Medicare by submitting false and fraudulent claims from approximately December 2002 to October 2010.
Rojas was charged with conspiracy to pay and receive bribes and kickbacks in connection with a federal health care program, conspiracy to commit money laundering, two counts of money laundering, and one count of aggravated identity theft. Bergman and Santaya were each charged with conspiracy to commit health care fraud and wire fraud. In addition, Bergman was charged with conspiracy to make false statements relating to health care matters. Santaya was also charged with conspiracy to pay and receive bribes and kickbacks in connection with a federal health care program, as well as two counts of receiving bribes and kickbacks in connection with a federal health care benefit program.
According to the indictment, Rojas, Bergman, and Santaya allegedly participated in a scheme orchestrated by the owners and operators of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. ATC and Medlink were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs), a form of intensive treatment for severe mental illness, in seven different locations throughout South Florida. Both corporations have been defunct since October 2010.
The indictment alleges that Bergman was a licensed physician’s assistant who participated in the scheme by, among other things, admitting Medicare beneficiaries to ATC facilities for PHP treatment even though they did not quality for such treatment and falsifying patient records to make it appear as though patients needed, qualified for and actually received legitimate PHP treatment when they did not. The indictment alleges that Santaya served as a patient recruiter who provided ineligible patients to ATC in exchange for kickbacks. The indictment alleges that Rojas was the co-owner of a check cashing business and that he facilitated the payments of bribes and kickbacks from ATC to various patient recruiters.
ATC, Medlink, and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC and Medlink have pleaded guilty or have been convicted at trial. In September 2011, ATC owner Lawrence Duran was sentenced to 50 years in prison for his role in orchestrating and executing the scheme to defraud Medicare.
The charges and allegations contained in the indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.
The case is being 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. The case is being prosecuted by Assistant Chief Robert A. Zink and Trial Attorney Nicholas E. Surmacz.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,700 defendants who collectively have falsely billed the Medicare program for more than $5.5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney 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. Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami Office made the announcement after the indictment was unsealed.
On January 28, 2014, a federal grand jury in Miami returned a 10-count indictment charging Nelson Rojas, 43; Roger Bergman, 64; and Rodolfo Santaya, 54, for allegedly participating in a scheme to defraud Medicare by submitting false and fraudulent claims from approximately December 2002 to October 2010.
Rojas was charged with conspiracy to pay and receive bribes and kickbacks in connection with a federal health care program, conspiracy to commit money laundering, two counts of money laundering, and one count of aggravated identity theft. Bergman and Santaya were each charged with conspiracy to commit health care fraud and wire fraud. In addition, Bergman was charged with conspiracy to make false statements relating to health care matters. Santaya was also charged with conspiracy to pay and receive bribes and kickbacks in connection with a federal health care program, as well as two counts of receiving bribes and kickbacks in connection with a federal health care benefit program.
According to the indictment, Rojas, Bergman, and Santaya allegedly participated in a scheme orchestrated by the owners and operators of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. ATC and Medlink were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs), a form of intensive treatment for severe mental illness, in seven different locations throughout South Florida. Both corporations have been defunct since October 2010.
The indictment alleges that Bergman was a licensed physician’s assistant who participated in the scheme by, among other things, admitting Medicare beneficiaries to ATC facilities for PHP treatment even though they did not quality for such treatment and falsifying patient records to make it appear as though patients needed, qualified for and actually received legitimate PHP treatment when they did not. The indictment alleges that Santaya served as a patient recruiter who provided ineligible patients to ATC in exchange for kickbacks. The indictment alleges that Rojas was the co-owner of a check cashing business and that he facilitated the payments of bribes and kickbacks from ATC to various patient recruiters.
ATC, Medlink, and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC and Medlink have pleaded guilty or have been convicted at trial. In September 2011, ATC owner Lawrence Duran was sentenced to 50 years in prison for his role in orchestrating and executing the scheme to defraud Medicare.
The charges and allegations contained in the indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.
The case is being 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. The case is being prosecuted by Assistant Chief Robert A. Zink and Trial Attorney Nicholas E. Surmacz.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,700 defendants who collectively have falsely billed the Medicare program for more than $5.5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Thursday, January 30, 2014
U.S. Attorney Joseph Hogsett Announces Charges Against Indianapolis Man for Health Care Fraud
INDIANAPOLIS—Joseph H. Hogsett, the United States Attorney, announced today that Ronald Reed, age 46, has been charged with conspiring to commit health care fraud in a scheme that involved the sale of electric wheelchairs and scooters and the potential loss of hundreds of thousands in taxpayer dollars. This comes as Hogsett’s office has continued an effort to crack down on white-collar fraud in Indiana’s business community.
“This alleged scheme not only defrauded taxpayers but also victimized some of the most vulnerable in this community,” Hogsett said. “This case embodies a culture of corruption that is unacceptable, and together with our law enforcement partners, we’re going to put a stop to it.”
According to a federal indictment announced today, Reed was the controlling owner of the Indianapolis-based business Benchmark Mobility Corporation, which sold medical equipment including powered wheelchairs, scooters, lift chairs, and hospital beds. As part of these sales, Benchmark would often bill various state and federal health care programs for reimbursement, including Medicare and Indiana Medicaid.
The indictment alleges that beginning in March 2007, Benchmark began having difficulty obtaining operating capital. In response, Reed allegedly began submitting claims to Medicare and Medicaid for used equipment that he had purchased online and refurbished and was selling as “new.” These used pieces of equipment were often purchased on websites such as eBay and Craigslist, and employees were allegedly directed to change serial numbers and take other actions to hide the fraud.
All told, it is alleged that between March 2007 and March 2011, Reed submitted and was reimbursed for $388,872 in claims to Indiana’s Medicaid program and $53,816 in claims to Medicare. Reed is also charged with 13 counts of aggravated identity theft for allegedly using a Medicaid recipient’s identification without permission as part of the scheme.
According to Assistant U.S. Attorney Bradley P. Shepard, who is prosecuting the case for the government, this case was the result of a joint investigation by the Department of Health and Human Services and the Federal Bureau of Investigation. Reed faces up to 10 years in federal prison if convicted, as well as significant fines.
An indictment is only a charge and is not evidence of guilt. A defendant is presumed innocent and is entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt.
“This alleged scheme not only defrauded taxpayers but also victimized some of the most vulnerable in this community,” Hogsett said. “This case embodies a culture of corruption that is unacceptable, and together with our law enforcement partners, we’re going to put a stop to it.”
According to a federal indictment announced today, Reed was the controlling owner of the Indianapolis-based business Benchmark Mobility Corporation, which sold medical equipment including powered wheelchairs, scooters, lift chairs, and hospital beds. As part of these sales, Benchmark would often bill various state and federal health care programs for reimbursement, including Medicare and Indiana Medicaid.
The indictment alleges that beginning in March 2007, Benchmark began having difficulty obtaining operating capital. In response, Reed allegedly began submitting claims to Medicare and Medicaid for used equipment that he had purchased online and refurbished and was selling as “new.” These used pieces of equipment were often purchased on websites such as eBay and Craigslist, and employees were allegedly directed to change serial numbers and take other actions to hide the fraud.
All told, it is alleged that between March 2007 and March 2011, Reed submitted and was reimbursed for $388,872 in claims to Indiana’s Medicaid program and $53,816 in claims to Medicare. Reed is also charged with 13 counts of aggravated identity theft for allegedly using a Medicaid recipient’s identification without permission as part of the scheme.
According to Assistant U.S. Attorney Bradley P. Shepard, who is prosecuting the case for the government, this case was the result of a joint investigation by the Department of Health and Human Services and the Federal Bureau of Investigation. Reed faces up to 10 years in federal prison if convicted, as well as significant fines.
An indictment is only a charge and is not evidence of guilt. A defendant is presumed innocent and is entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt.
Wednesday, January 29, 2014
Saint Joseph London Hospital to Pay $16.5 Million to Settle False Claims Act Allegations of Unnecessary Heart Procedures
LONDON—Saint Joseph Health System Inc., d/b/a Saint Joseph London Hospital (Saint Joseph) has agreed to pay the U.S. government $16.5 million to resolve civil allegations that it submitted false or fraudulent claims to the Medicare and Kentucky Medicaid programs for a variety of medically unnecessary heart procedures.
“We all rely on health care providers to make treatment decisions based on clinical, not financial, considerations,” said U.S. Attorney Kerry B. Harvey. “The conduct alleged in this case violates that fundamental trust and squanders scarce public resources set aside for legitimate health care needs. We will use every available tool to protect our federal health care programs and the patients who they serve.”
According to the settlement agreement, the U.S. government contends that from January 1, 2008 until August 31, 2011, several doctors working at the hospital performed numerous invasive cardiac procedures on Medicare and Medicaid patients who did not need them. The hospital then billed the federal programs for these unnecessary procedures, which include coronary stents, pacemakers, coronary artery bypass graft surgeries (CABGS), and diagnostic catheterizations. The claims seeking reimbursement allegedly violated the False Claims Act because under federal law, Medicare and Medicaid programs only reimburse health care providers for operations that are deemed medically necessary. Hospitals generally receive between $10,000 and $15,000 for medical procedures such as heart stents.
These doctors were affiliated with Cumberland Clinic, a physician group that entered an exclusive arrangement with Saint Joseph in 2008 to provide cardiology services to the hospital’s patients.
The settlement also resolves allegations that Saint Joseph violated the federal Stark Law and Anti-Kickback Statute by entering into sham management agreements with doctors at the Cumberland Clinic. These agreements served as an inducement for the doctors to refer patients to Saint Joseph. Therefore, the government contends that Medicare and Medicaid are not responsible to pay claims that resulted from this improper financial relationship between the doctors and the hospital.
In connection with this settlement, Saint Joseph has agreed to enter into a Corporate Integrity Agreement with the Department of Health and Human Services, Office of Inspector General (HHS-OIG), which obligates the hospital to undertake substantial internal compliance reforms and commit to a third-party review of its claims to federal health care programs for the next five years.
“Cases such as this threaten both the health of patients and the financial integrity of the Medicare and Medicaid programs,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “This settlement is another example of the OIG’s commitment to protecting our beneficiaries and to recovering any money that has been improperly paid as a result of medically unnecessary procedures.”
Today’s agreement represents the second largest health care fraud settlement in the Eastern District of Kentucky (district includes 67 counties).
The settlement stems in large part from a whistleblower complaint that was filed by three Lexington cardiologists pursuant to the qui tam provisions of the False Claims Act. That law allows the whistleblowers, also known as relators, to share in settlement proceeds that result from their bringing claims of fraud to the government’s attention. In this case, Doctors Michael Jones, Paula Hollingsworth, and Michael Rukavina will receive $2,458,810 of the $16.5 million settlement. Prior to the relators filing their complaint, Saint Joseph voluntarily disclosed to the government that one of its cardiologists, Dr. Sandesh Patil, had performed medically unnecessary coronary stents. Dr. Patil previously pleaded guilty to a federal health care fraud offense and was sentenced to 30 months’ imprisonment.
“Hospitals that place their financial interests above the well-being of their patients will be held accountable,” said Stuart Delery, Assistant Attorney General for the Civil Division of the United States Department of Justice. “The Department of Justice will not tolerate those who abuse the public health care programs to which we all contribute and on which we all depend.”
“The criminal investigation and civil settlements are excellent examples of the importance of whistleblower complaints,” said Perry K. Turner, Special Agent in Charge of the FBI in Kentucky. “This result would not be possible without the commitment of private citizens exposing this type of egregious fraud.”
The Commonwealth of Kentucky is also a party to the agreement and will receive approximately $365,851, which represents the state’s share of the government’s recovery of Medicaid funds. The Medicaid program is funded jointly by the federal and state governments.
“I applaud the hard work of my Medicaid Fraud Unit and all of the agencies involved in this case,” said Kentucky Attorney General Jack Conway. “I am pleased that we have reached this settlement and are recovering thousands of dollars for a vital state program and for taxpayers.”
While the settlement resolves claims against Saint Joseph London, the U.S. government will intervene in the case initiated by the whistleblowers and continue litigating allegations of False Claims Act violations arising out of unnecessary cardiac procedures against most of the other defendants named in the qui tam. It will also continue a related criminal investigation.
The investigation was conducted by the FBI, HHS-OIG, Kentucky Office of Attorney General, Medicaid Fraud and Abuse Control Unit (MFCU), the Civil Frauds Section of the Department of Justice in Washington, D.C., and the U.S. Attorney’s Office.
“We all rely on health care providers to make treatment decisions based on clinical, not financial, considerations,” said U.S. Attorney Kerry B. Harvey. “The conduct alleged in this case violates that fundamental trust and squanders scarce public resources set aside for legitimate health care needs. We will use every available tool to protect our federal health care programs and the patients who they serve.”
According to the settlement agreement, the U.S. government contends that from January 1, 2008 until August 31, 2011, several doctors working at the hospital performed numerous invasive cardiac procedures on Medicare and Medicaid patients who did not need them. The hospital then billed the federal programs for these unnecessary procedures, which include coronary stents, pacemakers, coronary artery bypass graft surgeries (CABGS), and diagnostic catheterizations. The claims seeking reimbursement allegedly violated the False Claims Act because under federal law, Medicare and Medicaid programs only reimburse health care providers for operations that are deemed medically necessary. Hospitals generally receive between $10,000 and $15,000 for medical procedures such as heart stents.
These doctors were affiliated with Cumberland Clinic, a physician group that entered an exclusive arrangement with Saint Joseph in 2008 to provide cardiology services to the hospital’s patients.
The settlement also resolves allegations that Saint Joseph violated the federal Stark Law and Anti-Kickback Statute by entering into sham management agreements with doctors at the Cumberland Clinic. These agreements served as an inducement for the doctors to refer patients to Saint Joseph. Therefore, the government contends that Medicare and Medicaid are not responsible to pay claims that resulted from this improper financial relationship between the doctors and the hospital.
In connection with this settlement, Saint Joseph has agreed to enter into a Corporate Integrity Agreement with the Department of Health and Human Services, Office of Inspector General (HHS-OIG), which obligates the hospital to undertake substantial internal compliance reforms and commit to a third-party review of its claims to federal health care programs for the next five years.
“Cases such as this threaten both the health of patients and the financial integrity of the Medicare and Medicaid programs,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “This settlement is another example of the OIG’s commitment to protecting our beneficiaries and to recovering any money that has been improperly paid as a result of medically unnecessary procedures.”
Today’s agreement represents the second largest health care fraud settlement in the Eastern District of Kentucky (district includes 67 counties).
The settlement stems in large part from a whistleblower complaint that was filed by three Lexington cardiologists pursuant to the qui tam provisions of the False Claims Act. That law allows the whistleblowers, also known as relators, to share in settlement proceeds that result from their bringing claims of fraud to the government’s attention. In this case, Doctors Michael Jones, Paula Hollingsworth, and Michael Rukavina will receive $2,458,810 of the $16.5 million settlement. Prior to the relators filing their complaint, Saint Joseph voluntarily disclosed to the government that one of its cardiologists, Dr. Sandesh Patil, had performed medically unnecessary coronary stents. Dr. Patil previously pleaded guilty to a federal health care fraud offense and was sentenced to 30 months’ imprisonment.
“Hospitals that place their financial interests above the well-being of their patients will be held accountable,” said Stuart Delery, Assistant Attorney General for the Civil Division of the United States Department of Justice. “The Department of Justice will not tolerate those who abuse the public health care programs to which we all contribute and on which we all depend.”
“The criminal investigation and civil settlements are excellent examples of the importance of whistleblower complaints,” said Perry K. Turner, Special Agent in Charge of the FBI in Kentucky. “This result would not be possible without the commitment of private citizens exposing this type of egregious fraud.”
The Commonwealth of Kentucky is also a party to the agreement and will receive approximately $365,851, which represents the state’s share of the government’s recovery of Medicaid funds. The Medicaid program is funded jointly by the federal and state governments.
“I applaud the hard work of my Medicaid Fraud Unit and all of the agencies involved in this case,” said Kentucky Attorney General Jack Conway. “I am pleased that we have reached this settlement and are recovering thousands of dollars for a vital state program and for taxpayers.”
While the settlement resolves claims against Saint Joseph London, the U.S. government will intervene in the case initiated by the whistleblowers and continue litigating allegations of False Claims Act violations arising out of unnecessary cardiac procedures against most of the other defendants named in the qui tam. It will also continue a related criminal investigation.
The investigation was conducted by the FBI, HHS-OIG, Kentucky Office of Attorney General, Medicaid Fraud and Abuse Control Unit (MFCU), the Civil Frauds Section of the Department of Justice in Washington, D.C., and the U.S. Attorney’s Office.
Owner of Houston Medical Equipment Companies Indicted in $3.4 Million Medicare Fraud Scheme
Huey P. Williams, Jr., the owner and operator of two durable medical equipment (DME) companies, was arrested yesterday for his alleged role in a $3.4 million Medicare fraud scheme.
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, Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.
The indictment charges Williams, 44, of Katy, Texas, with one count of health care fraud, which carries a maximum penalty of 10 years in prison upon conviction. Williams is expected to make his initial appearance in U.S. District Court for the Southern District of Texas in Houston.
According to the indictment, Williams orchestrated and executed a scheme to defraud Medicare beginning in 2006 and continuing until July 2010. Williams allegedly submitted false and fraudulent claims to Medicare through his Houston-area DME companies—Hermann Medical Supplies Inc. and Hermann Medical Supplies II (Hermann Medical)—which purported to provide orthotics and other DME to Medicare beneficiaries.
Hermann Medical allegedly submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or never provided. Many of the orthotic devices were components of an arthritis kit and were purported to be for the treatment of arthritis-related conditions. From December 2006 through July 2010, Williams submitted claims of approximately $3.4 million to Medicare.
An indictment is merely a formal accusation. Defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
The case was investigated by the FBI, HHS-OIG, and MFCU 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 Texas. The case is being prosecuted by Trial Attorney Ashlee Caligone McFarlane of the 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 & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office, Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.
The indictment charges Williams, 44, of Katy, Texas, with one count of health care fraud, which carries a maximum penalty of 10 years in prison upon conviction. Williams is expected to make his initial appearance in U.S. District Court for the Southern District of Texas in Houston.
According to the indictment, Williams orchestrated and executed a scheme to defraud Medicare beginning in 2006 and continuing until July 2010. Williams allegedly submitted false and fraudulent claims to Medicare through his Houston-area DME companies—Hermann Medical Supplies Inc. and Hermann Medical Supplies II (Hermann Medical)—which purported to provide orthotics and other DME to Medicare beneficiaries.
Hermann Medical allegedly submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or never provided. Many of the orthotic devices were components of an arthritis kit and were purported to be for the treatment of arthritis-related conditions. From December 2006 through July 2010, Williams submitted claims of approximately $3.4 million to Medicare.
An indictment is merely a formal accusation. Defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
The case was investigated by the FBI, HHS-OIG, and MFCU 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 Texas. The case is being prosecuted by Trial Attorney Ashlee Caligone McFarlane of the 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 & 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.
Patient Recruiter Pleads Guilty in Connection with $13 Million Health Care Fraud Scheme
Pavel Zborovskiy, 57, of Brooklyn, New York, pleaded guilty today to conspiracy to pay and receive illegal health care kickbacks in connection with a $13 million health care fraud and money laundering scheme.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta E. Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) made the announcement.
Zborovskiy pleaded guilty before U.S. District Judge Nina Gershon of the Eastern District of New York and is the sixth defendant to plead guilty in connection with the scheme. At sentencing on May 28, 2014, Zborovskiy faces a maximum penalty of five years in prison and a fine of more than $2.5 million.
According to court documents, from 2010 to 2012, Zborovskiy, working through an ambulette company, recruited patients to attend a Brooklyn clinic called Cropsey Medical Care PLLC. An ambulette is a vehicle that is licensed by New York State’s Medicaid program to transport beneficiaries to and from medical facilities when such transportation is medically necessary. Zborovskiy’s ambulette company transported the patients he had recruited to and from Cropsey Medical and billed Medicaid for such transportation. Once Zborovskiy’s beneficiaries were transported to Cropsey Medical, Zborovskiy and others paid such beneficiaries cash kickbacks to induce them to continue to attend the clinic and to receive medically unnecessary physical therapy, diagnostic testing, and other services. Such purported medical services were then billed by Cropsey Medical to Medicare and Medicaid.
According to court documents, from approximately November 2009 to October 2012, Cropsey Medical submitted more than $13 million in claims to Medicare and Medicaid, seeking reimbursement for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy, and diagnostic tests.
The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Trial Attorney Sarah M. Hall of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Shannon Jones of the Eastern District of New York.
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 www.stopmedicarefraud.gov.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta E. Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) made the announcement.
Zborovskiy pleaded guilty before U.S. District Judge Nina Gershon of the Eastern District of New York and is the sixth defendant to plead guilty in connection with the scheme. At sentencing on May 28, 2014, Zborovskiy faces a maximum penalty of five years in prison and a fine of more than $2.5 million.
According to court documents, from 2010 to 2012, Zborovskiy, working through an ambulette company, recruited patients to attend a Brooklyn clinic called Cropsey Medical Care PLLC. An ambulette is a vehicle that is licensed by New York State’s Medicaid program to transport beneficiaries to and from medical facilities when such transportation is medically necessary. Zborovskiy’s ambulette company transported the patients he had recruited to and from Cropsey Medical and billed Medicaid for such transportation. Once Zborovskiy’s beneficiaries were transported to Cropsey Medical, Zborovskiy and others paid such beneficiaries cash kickbacks to induce them to continue to attend the clinic and to receive medically unnecessary physical therapy, diagnostic testing, and other services. Such purported medical services were then billed by Cropsey Medical to Medicare and Medicaid.
According to court documents, from approximately November 2009 to October 2012, Cropsey Medical submitted more than $13 million in claims to Medicare and Medicaid, seeking reimbursement for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy, and diagnostic tests.
The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Trial Attorney Sarah M. Hall of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Shannon Jones of the Eastern District of New York.
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 www.stopmedicarefraud.gov.
Tuesday, January 28, 2014
Illinois Hospice Executive Charged with Federal Health Care Fraud for Allegedly Falsely Elevating Level of Patients’ Care
CHICAGO—An owner of an Illinois hospice company was charged with federal health care fraud for allegedly engaging in an extensive scheme to obtain higher Medicare and Medicaid payments by fraudulently elevating the level of hospice care for patients, many of whom resided at nursing homes he also controlled across the state. In many instances, the level of hospice care allegedly exceeded what was medically necessary or actually provided, including for some patients who did not have terminal illnesses or who were enrolled far longer―sometimes for several years―than the required life expectancy of six months or less.
The defendant, Seth Gillman, 46, of Lincolnwood, was charged with one count each of health care fraud and obstructing a federal audit in a criminal complaint that was filed late Friday in U.S. District Court. He is scheduled to appear at 3 p.m. today before Magistrate Judge Geraldine Soat Brown in federal court.
Gillman, an attorney, is the corporate agent, administrator, and one-fourth owner of Passages Hospice LLC, based in west suburban Lisle, and is also the agent and secretary of Asta Healthcare Company Inc., which operates Asta Care Center nursing homes in Bloomington, Colfax, Elgin, Ford County, Pontiac, Rockford, and Toluca, Illinois. Passages did not have its own inpatient facility but instead deployed nurses to visit hospice patients in nursing homes and private residences. As Passages grew, it divided its operations into geographic regions covering Chicago and the western suburbs, Rockford, Bloomington, and Belleville, with different nurses, nursing directors, and medical directors for each region.
The charges allege that between August 2008 and January 2012, Gillman trained and caused to be trained Passages nurses to look for signs that allegedly would qualify a hospice patient for general inpatient care (GIP), resulting in higher payments per day, compared to routine care. Gillman allegedly knew that many of Passages’ patients were improperly being placed on GIP, in part as a result of a 2009 review of patient files, a 2009 report by an outside consultant, and a 2010 internal audit. Gillman also knew that some patients were placed on GIP without a medical director’s approval.
In fiscal year 2012, Medicare’s daily reimbursement for GIP was $671.84, while the daily payment for routine care was $151.23. According to claims data, from January 2006 to late 2011, Passages submitted claims for approximately 4,769 patients to Medicare and/or Medicaid and was paid approximately $95 million from Medicare and approximately $30 million from Medicaid. Between July 2008 and late 2011, Passages was paid approximately $23 million by Medicare for claimed GIP services, in addition to Medicaid payments for claimed GIP services submitted on behalf of more than 200 patients.
According to a 69-page affidavit in support of the charges, federal agents have interviewed patients, family members, and more than 30 former and current employees of Passages, including several who reported allegedly fraudulent billing and marketing practices to Medicare and/or law enforcement before they were contacted by agents. Investigators have also reviewed e-mails, documents, and patient files that were obtained in response to a 2011 civil investigative demand, a January 2012 search warrant, and subpoenas issued in 2013, as well as claims data from Medicare and Medicaid.
Medicare claims data revealed that approximately 22 percent of Passages’ patients between 2006 and late 2011 had more than six months of hospice care, with 28 patients receiving more than 1,000 days of hospice care in that period. By contrast, according to the National Hospice and Palliative Care Organization, only 11.8 percent of all hospice patients in 2009 were on hospice care for longer than six months.
For example, the complaint affidavit cites Patient JW, who was admitted to an Asta nursing home in 2003 following a major stroke, and Passages billed for more than 2,000 days of hospice services. In another example, Passages submitted bills for 1,443 days of hospice care for Patient LJ, who was admitted to an Asta nursing home in 2001. Patient LJ’s son told investigators that his mother appeared in no danger of dying until the last month of her life.
The charges also cite Medicare claims data showing that Passages’ billing for GIP services grew significantly. In 2010, Passages billed approximately 1,161 GIP patient days to Medicare monthly, and the figure rose to 1,430 GIP patient days a month through the first nine months of 2011. The average GIP payments that Passages received per month was $4,437 in the period from mid-2006 to mid-2008, and the monthly payments increased to $946,743 in 2011.
A hospice physician retained by the government reviewed files for 13 Passages patients, 10 of whose admissions exceed six months and extended to as many as 1,598 days over two admission periods. The government’s expert found that nine of the 13 patients were not eligible for Medicare hospice benefits for part or all of their admission and that all the 503 days of GIP submitted for those patients were improper and excessive.
A woman, identified as Individual E in the affidavit, who helped Gillman and his father start Passages and served as its clinical director for several years until she was fired told agents that Gillman said if a patient was under Passages’ care, they were sick enough to warrant GIP care. When Individual E confronted Gillman over the GIP eligibility of Patient DB, Gillman allegedly told her to mind her own business because he needed the money, the affidavit states.
The charges further allege that in the fall of 2008, Gillman began paying bonuses, sometimes well in excess of their salary, to Passages’ directors overseeing nurses and certified nursing assistants based on the amount of GIP under their supervision. Gillman also authorized large bonuses to himself and a co-administrator, Individual A, based on the number of patients per day at certain nursing homes in the Belleville region, including $833,375 to himself between March 2009 and April 2011. The bonuses increased as the number of patients on GIP increased and as the number of facilities counted for the bonuses increased, according to the affidavit.
Passages also allegedly had arrangements with approximately eight nursing homes in 2010 in which it paid the nursing homes $250 for every patient who was on GIP per day.
The obstructing a federal audit count alleges that in August and September 2009, Gillman, Individual A, and others oversaw and conducted an effort to alter patient files that had been requested by TrustSolutions, which contracted with the Centers for Medicare and Medicaid Services to audit providers for fraud and abuse. Several former Passages employees have admitted to agents their involvement in the altering of patient files in the summer of 2009 as well as in another session in 2010, the affidavit states.
The charges were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Lamont Pugh, III, Special Agent in Charge of the Chicago Regional Office of the HHS-OIG; and Robert J. Holley, Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation. The Illinois Attorney General’s Office is also participating in the investigation.
The government is being represented by Assistant U.S. Attorney Stephen C. Lee.
Health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine, and obstructing a federal audit carries a maximum of five years in prison and a $250,000 fine, and restitution is mandatory. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The public is reminded that a complaint is not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
The Medicare Fraud Strike Force began operating in Chicago in February 2011 and consists of agents from the FBI and HHS-OIG working together with prosecutors from the U.S. Attorney’s Office and the Justice Department’s Fraud Section. The strike force is 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. Scores of defendants have been charged locally in health care fraud cases since the strike force began operating in Chicago.
To report health care fraud to learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
The defendant, Seth Gillman, 46, of Lincolnwood, was charged with one count each of health care fraud and obstructing a federal audit in a criminal complaint that was filed late Friday in U.S. District Court. He is scheduled to appear at 3 p.m. today before Magistrate Judge Geraldine Soat Brown in federal court.
Gillman, an attorney, is the corporate agent, administrator, and one-fourth owner of Passages Hospice LLC, based in west suburban Lisle, and is also the agent and secretary of Asta Healthcare Company Inc., which operates Asta Care Center nursing homes in Bloomington, Colfax, Elgin, Ford County, Pontiac, Rockford, and Toluca, Illinois. Passages did not have its own inpatient facility but instead deployed nurses to visit hospice patients in nursing homes and private residences. As Passages grew, it divided its operations into geographic regions covering Chicago and the western suburbs, Rockford, Bloomington, and Belleville, with different nurses, nursing directors, and medical directors for each region.
The charges allege that between August 2008 and January 2012, Gillman trained and caused to be trained Passages nurses to look for signs that allegedly would qualify a hospice patient for general inpatient care (GIP), resulting in higher payments per day, compared to routine care. Gillman allegedly knew that many of Passages’ patients were improperly being placed on GIP, in part as a result of a 2009 review of patient files, a 2009 report by an outside consultant, and a 2010 internal audit. Gillman also knew that some patients were placed on GIP without a medical director’s approval.
In fiscal year 2012, Medicare’s daily reimbursement for GIP was $671.84, while the daily payment for routine care was $151.23. According to claims data, from January 2006 to late 2011, Passages submitted claims for approximately 4,769 patients to Medicare and/or Medicaid and was paid approximately $95 million from Medicare and approximately $30 million from Medicaid. Between July 2008 and late 2011, Passages was paid approximately $23 million by Medicare for claimed GIP services, in addition to Medicaid payments for claimed GIP services submitted on behalf of more than 200 patients.
According to a 69-page affidavit in support of the charges, federal agents have interviewed patients, family members, and more than 30 former and current employees of Passages, including several who reported allegedly fraudulent billing and marketing practices to Medicare and/or law enforcement before they were contacted by agents. Investigators have also reviewed e-mails, documents, and patient files that were obtained in response to a 2011 civil investigative demand, a January 2012 search warrant, and subpoenas issued in 2013, as well as claims data from Medicare and Medicaid.
Medicare claims data revealed that approximately 22 percent of Passages’ patients between 2006 and late 2011 had more than six months of hospice care, with 28 patients receiving more than 1,000 days of hospice care in that period. By contrast, according to the National Hospice and Palliative Care Organization, only 11.8 percent of all hospice patients in 2009 were on hospice care for longer than six months.
For example, the complaint affidavit cites Patient JW, who was admitted to an Asta nursing home in 2003 following a major stroke, and Passages billed for more than 2,000 days of hospice services. In another example, Passages submitted bills for 1,443 days of hospice care for Patient LJ, who was admitted to an Asta nursing home in 2001. Patient LJ’s son told investigators that his mother appeared in no danger of dying until the last month of her life.
The charges also cite Medicare claims data showing that Passages’ billing for GIP services grew significantly. In 2010, Passages billed approximately 1,161 GIP patient days to Medicare monthly, and the figure rose to 1,430 GIP patient days a month through the first nine months of 2011. The average GIP payments that Passages received per month was $4,437 in the period from mid-2006 to mid-2008, and the monthly payments increased to $946,743 in 2011.
A hospice physician retained by the government reviewed files for 13 Passages patients, 10 of whose admissions exceed six months and extended to as many as 1,598 days over two admission periods. The government’s expert found that nine of the 13 patients were not eligible for Medicare hospice benefits for part or all of their admission and that all the 503 days of GIP submitted for those patients were improper and excessive.
A woman, identified as Individual E in the affidavit, who helped Gillman and his father start Passages and served as its clinical director for several years until she was fired told agents that Gillman said if a patient was under Passages’ care, they were sick enough to warrant GIP care. When Individual E confronted Gillman over the GIP eligibility of Patient DB, Gillman allegedly told her to mind her own business because he needed the money, the affidavit states.
The charges further allege that in the fall of 2008, Gillman began paying bonuses, sometimes well in excess of their salary, to Passages’ directors overseeing nurses and certified nursing assistants based on the amount of GIP under their supervision. Gillman also authorized large bonuses to himself and a co-administrator, Individual A, based on the number of patients per day at certain nursing homes in the Belleville region, including $833,375 to himself between March 2009 and April 2011. The bonuses increased as the number of patients on GIP increased and as the number of facilities counted for the bonuses increased, according to the affidavit.
Passages also allegedly had arrangements with approximately eight nursing homes in 2010 in which it paid the nursing homes $250 for every patient who was on GIP per day.
The obstructing a federal audit count alleges that in August and September 2009, Gillman, Individual A, and others oversaw and conducted an effort to alter patient files that had been requested by TrustSolutions, which contracted with the Centers for Medicare and Medicaid Services to audit providers for fraud and abuse. Several former Passages employees have admitted to agents their involvement in the altering of patient files in the summer of 2009 as well as in another session in 2010, the affidavit states.
The charges were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Lamont Pugh, III, Special Agent in Charge of the Chicago Regional Office of the HHS-OIG; and Robert J. Holley, Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation. The Illinois Attorney General’s Office is also participating in the investigation.
The government is being represented by Assistant U.S. Attorney Stephen C. Lee.
Health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine, and obstructing a federal audit carries a maximum of five years in prison and a $250,000 fine, and restitution is mandatory. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The public is reminded that a complaint is not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
The Medicare Fraud Strike Force began operating in Chicago in February 2011 and consists of agents from the FBI and HHS-OIG working together with prosecutors from the U.S. Attorney’s Office and the Justice Department’s Fraud Section. The strike force is 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. Scores of defendants have been charged locally in health care fraud cases since the strike force began operating in Chicago.
To report health care fraud to learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Thursday, January 23, 2014
Government Intervenes in Lawsuits Against Health Management Associates Inc. Hospital Chain Alleging Unnecessary Inpatient Admissions and Payment of Kickbacks
The government has intervened in eight False Claims Act lawsuits against Health Management Associates Inc. (HMA) alleging that HMA billed federal health care programs for medically unnecessary inpatient admissions from the emergency departments at HMA hospitals and paid remuneration to physicians in exchange for patient referrals, the Justice Department announced today. The government also has joined in the allegations in one of these lawsuits that Gary Newsome, HMA’s former CEO, directed HMA’s corporate practice of pressuring emergency department physicians and hospital administrators to raise inpatient admission rates, regardless of medical necessity. HMA operates 71 hospitals in 15 states: Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Washington, and West Virginia.
“Unlawful financial relationships between hospitals and physicians solely to increase referrals are, unfortunately, a common practice that corrupts the health care system,” said U.S. Attorney for the Southern District of Florida Wifredo A. Ferrer. “The system also suffers a direct financial hit when hospitals fraudulently increase admissions where they are not indicated, solely to benefit hospitals’ bottom line. We will not relent in our efforts to combat these kinds of fraudulent schemes and recover funds for the Medicare program.”
“The Department of Justice is committed to ensuring that health care providers who attempt to misuse federal health care programs for their own profit are held accountable,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery. “Schemes such as this one can contribute significantly to the rising cost of delivering health care and create needless patient risk.”
The lawsuits allege that HMA’s corporate officers, at the direction of Newsome, exerted significant pressure on doctors in the emergency department to admit patients who could have been placed in observation, treated as outpatients or discharged, and that this resulted in the submission of inflated or false claims to federal health care programs. One lawsuit also alleges that patients were improperly admitted for scheduled surgical procedures that should have been done on an outpatient basis. The complaints further allege that HMA paid kickbacks, either in the form of bonuses or awarded contracts, to physician groups staffing HMA emergency rooms to induce the physicians to admit patients unnecessarily.
In addition, the lawsuits allege that HMA paid kickbacks to other physician groups to induce referrals. For example, HMA allegedly provided improper remuneration, both through the provision of free office space and staffing and through direct payments, to Primary Care Associates, a physician practice group in Port Charlotte, Florida, in exchange for referrals to two HMA hospitals in Florida. HMA also allegedly paid kickbacks to physicians in Lancaster, Pennsylvania, by paying inflated prices for physician-owned assets, providing sham medical directorship contracts and selling assets to physicians for below fair market value.
The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded programs. The Stark Statute prohibits a hospital from submitting claims for patient referrals made by a physician with whom the hospital has an improper financial arrangement. Both the Anti-Kickback Statute and Stark Statute are intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is instead based on the best interests of the patient.
“This intervention decision marks the culmination of a lengthy and comprehensive investigation into a variety of serious fraud allegations against one of our district’s largest health care providers,” said Acting U.S. Attorney for the Middle District of Florida A. Lee Bentley III. “We hope that this case will serve as a reminder to our provider community that this office is fully engaged in the struggle against misconduct of this kind.”
“Improper hospital admissions cost the government millions of dollars in unnecessary fees and subject patients to excessive treatment and needless risk, driving up the cost of health care,” said U.S. Attorney for the Western District of North Carolina Anne M. Tompkins. “The government will pursue aggressively providers that boost their profits at the expense of Medicare and other government programs.”
“HMA’s submission of claims to Medicare, Medicaid, and TRICARE for unnecessary inpatient stays is a serious matter that threatens the integrity of our entire health care system, and the end result is that those who need health care cannot afford it,” said U.S. Attorney for the Middle District of Georgia Michael J. Moore. “The Middle District of Georgia is committed to fighting health care fraud.”
“Investigations such as these are a very high priority for the FBI because of the potential impact to the nation’s health care system and to the public,” said FBI Assistant Director Ron Hosko. “Because of the priority nature of these cases as well as their complexity, we have created a centralized team to provide nationwide support to our field offices called the Major Provider Response Team. The FBI is committed to working with our partners in these types of investigations and appreciates the public’s involvement in the process.”
The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The False Claims Act also permits the government to intervene in such lawsuits, as it has done in these cases. The eight lawsuits are pending in the Southern and Middle Districts of Florida, Middle District of Georgia, Northern District of Illinois, Western District of North Carolina, Eastern District of Pennsylvania, and District of South Carolina.
The government’s intervention in these matters illustrates its emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $17 billion through False Claims Act cases, with more than $12.2 billion of that amount recovered in cases involving fraud against federal health care programs.
These matters were investigated by the Commercial Litigation Branch of the Justice Department’s Civil Division; the U.S. Attorney’s Offices for the Southern and Middle Districts of Florida, Middle District of Georgia, Northern District of Illinois, Western District of North Carolina, Middle and Eastern Districts of Pennsylvania, and District of South Carolina; the Department of Health and Human Services Office of Inspector General; and the Federal Bureau of Investigation.
The cases are captioned United States ex rel. Paul Meyer v. Health Mgmt. Assocs. Inc., et al.,11-62445 cv-Williams (S.D. Fla.); United States ex rel. Brummer v. Health Mgmt. Assocs. Inc., et al.,3-09-cv-135 (CDL)(M.D. Ga.); United States ex rel. Williams v. Health Mgmt. Assocs. Inc. et al., 3:12-cv-151 (M.D. Ga.); United States ex rel. Plantz v. Health Mgmt. Assocs. Inc., et al., 13C-1212 (N.D. Ill.); United States ex rel. Miller v. Health Mgmt. Assocs. Inc., et al., 10-3007 (E.D. Pa.); United States ex rel. Mason v. Health Mgmt. Assocs. Inc., et al., 3:10-CV-472-GCM (W.D.N.C.); United States ex rel. Nurkin v. Health Mgmt. Assocs. Inc., et al., 2:11-cv-14-FtM-29DNF (M.D. Fla.); United States ex rel. Jacqueline Meyer & Cowling v. Health Mgmt. Assocs. Inc., et al.; 0:11-cv-01713-JFA (D.S.C.).
The claims asserted against HMA and Newsome are allegations only, and there has been no determination of liability.
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 http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.
“Unlawful financial relationships between hospitals and physicians solely to increase referrals are, unfortunately, a common practice that corrupts the health care system,” said U.S. Attorney for the Southern District of Florida Wifredo A. Ferrer. “The system also suffers a direct financial hit when hospitals fraudulently increase admissions where they are not indicated, solely to benefit hospitals’ bottom line. We will not relent in our efforts to combat these kinds of fraudulent schemes and recover funds for the Medicare program.”
“The Department of Justice is committed to ensuring that health care providers who attempt to misuse federal health care programs for their own profit are held accountable,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery. “Schemes such as this one can contribute significantly to the rising cost of delivering health care and create needless patient risk.”
The lawsuits allege that HMA’s corporate officers, at the direction of Newsome, exerted significant pressure on doctors in the emergency department to admit patients who could have been placed in observation, treated as outpatients or discharged, and that this resulted in the submission of inflated or false claims to federal health care programs. One lawsuit also alleges that patients were improperly admitted for scheduled surgical procedures that should have been done on an outpatient basis. The complaints further allege that HMA paid kickbacks, either in the form of bonuses or awarded contracts, to physician groups staffing HMA emergency rooms to induce the physicians to admit patients unnecessarily.
In addition, the lawsuits allege that HMA paid kickbacks to other physician groups to induce referrals. For example, HMA allegedly provided improper remuneration, both through the provision of free office space and staffing and through direct payments, to Primary Care Associates, a physician practice group in Port Charlotte, Florida, in exchange for referrals to two HMA hospitals in Florida. HMA also allegedly paid kickbacks to physicians in Lancaster, Pennsylvania, by paying inflated prices for physician-owned assets, providing sham medical directorship contracts and selling assets to physicians for below fair market value.
The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded programs. The Stark Statute prohibits a hospital from submitting claims for patient referrals made by a physician with whom the hospital has an improper financial arrangement. Both the Anti-Kickback Statute and Stark Statute are intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is instead based on the best interests of the patient.
“This intervention decision marks the culmination of a lengthy and comprehensive investigation into a variety of serious fraud allegations against one of our district’s largest health care providers,” said Acting U.S. Attorney for the Middle District of Florida A. Lee Bentley III. “We hope that this case will serve as a reminder to our provider community that this office is fully engaged in the struggle against misconduct of this kind.”
“Improper hospital admissions cost the government millions of dollars in unnecessary fees and subject patients to excessive treatment and needless risk, driving up the cost of health care,” said U.S. Attorney for the Western District of North Carolina Anne M. Tompkins. “The government will pursue aggressively providers that boost their profits at the expense of Medicare and other government programs.”
“HMA’s submission of claims to Medicare, Medicaid, and TRICARE for unnecessary inpatient stays is a serious matter that threatens the integrity of our entire health care system, and the end result is that those who need health care cannot afford it,” said U.S. Attorney for the Middle District of Georgia Michael J. Moore. “The Middle District of Georgia is committed to fighting health care fraud.”
“Investigations such as these are a very high priority for the FBI because of the potential impact to the nation’s health care system and to the public,” said FBI Assistant Director Ron Hosko. “Because of the priority nature of these cases as well as their complexity, we have created a centralized team to provide nationwide support to our field offices called the Major Provider Response Team. The FBI is committed to working with our partners in these types of investigations and appreciates the public’s involvement in the process.”
The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The False Claims Act also permits the government to intervene in such lawsuits, as it has done in these cases. The eight lawsuits are pending in the Southern and Middle Districts of Florida, Middle District of Georgia, Northern District of Illinois, Western District of North Carolina, Eastern District of Pennsylvania, and District of South Carolina.
The government’s intervention in these matters illustrates its emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $17 billion through False Claims Act cases, with more than $12.2 billion of that amount recovered in cases involving fraud against federal health care programs.
These matters were investigated by the Commercial Litigation Branch of the Justice Department’s Civil Division; the U.S. Attorney’s Offices for the Southern and Middle Districts of Florida, Middle District of Georgia, Northern District of Illinois, Western District of North Carolina, Middle and Eastern Districts of Pennsylvania, and District of South Carolina; the Department of Health and Human Services Office of Inspector General; and the Federal Bureau of Investigation.
The cases are captioned United States ex rel. Paul Meyer v. Health Mgmt. Assocs. Inc., et al.,11-62445 cv-Williams (S.D. Fla.); United States ex rel. Brummer v. Health Mgmt. Assocs. Inc., et al.,3-09-cv-135 (CDL)(M.D. Ga.); United States ex rel. Williams v. Health Mgmt. Assocs. Inc. et al., 3:12-cv-151 (M.D. Ga.); United States ex rel. Plantz v. Health Mgmt. Assocs. Inc., et al., 13C-1212 (N.D. Ill.); United States ex rel. Miller v. Health Mgmt. Assocs. Inc., et al., 10-3007 (E.D. Pa.); United States ex rel. Mason v. Health Mgmt. Assocs. Inc., et al., 3:10-CV-472-GCM (W.D.N.C.); United States ex rel. Nurkin v. Health Mgmt. Assocs. Inc., et al., 2:11-cv-14-FtM-29DNF (M.D. Fla.); United States ex rel. Jacqueline Meyer & Cowling v. Health Mgmt. Assocs. Inc., et al.; 0:11-cv-01713-JFA (D.S.C.).
The claims asserted against HMA and Newsome are allegations only, and there has been no determination of liability.
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 http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.
Freeport Physician Sentenced to 30 Years for Illegally Prescribing Controlled Substances
PENSACOLA, FL—Freeport physician Robert L. Ignasiak, Jr., 58, was sentenced to 30 years in prison yesterday for health care fraud, illegally distributing controlled substances, and failing to appear for trial. The sentence imposed by the court was announced by Pamela C. Marsh, United States Attorney for the Northern District of Florida.
Between 2001 and 2005, while operating the Freeport Medical Clinic, Ignasiak developed a reputation as a physician who freely prescribed highly addictive controlled substances. During that time, Ignasiak prescribed drugs such as hydrocodone, oxycodone, morphine, diazepam, and alprazolam in dosages and combinations that caused his patients to abuse and become addicted to the drugs. Ignasiak continued to prescribe these substances even after becoming aware that his patients were abusing them. He did this in spite of indications that his patients were not taking the medicines as prescribed, were stealing drugs, were “doctor shopping,” were taking the medicines with alcohol, were suffering overdoses, or were exhibiting other out-of-control behaviors. Ignasiak’s illegal prescribing practices resulted in the deaths of several of his patients.
Ignasiak was initially indicted on these charges in 2008. Following a jury trial in the fall of that year, Ignasiak was convicted of 12 counts of health care fraud and 31 counts of illegally distributing controlled substances. In 2012, Ignasiak’s convictions were reversed on appeal, and he was released from custody pending a retrial. On October 31, 2012, Ignasiak faked his own suicide and fled. A warrant was issued for his arrest. He was arrested in Coral Springs, Florida, in September 2013, and his retrial had been scheduled for December 2, 2013.
In October 2013, Ignasiak pled guilty to 12 counts of health care fraud, 29 counts of illegally distributing controlled substances, and one count of failing to appear for trial.
The charges were the result of a four-year joint investigation by the North Florida Health Care Fraud Task Force, composed of the Federal Bureau of Investigation-Jacksonville Division, the Florida Department of Financial Services, the Florida Department of Law Enforcement, the Florida Attorney General’s Office, the Drug Enforcement Administration-Miami Division, the National Drug Intelligence Center Document Exploitation Division, the Defense Criminal Investigative Service, the Walton County Sheriff’s Office, and the State Surgeon General-Florida Department of Health.
Assistant U.S. Attorneys Karen Rhew-Miller and Alicia Kim prosecuted this case.
Between 2001 and 2005, while operating the Freeport Medical Clinic, Ignasiak developed a reputation as a physician who freely prescribed highly addictive controlled substances. During that time, Ignasiak prescribed drugs such as hydrocodone, oxycodone, morphine, diazepam, and alprazolam in dosages and combinations that caused his patients to abuse and become addicted to the drugs. Ignasiak continued to prescribe these substances even after becoming aware that his patients were abusing them. He did this in spite of indications that his patients were not taking the medicines as prescribed, were stealing drugs, were “doctor shopping,” were taking the medicines with alcohol, were suffering overdoses, or were exhibiting other out-of-control behaviors. Ignasiak’s illegal prescribing practices resulted in the deaths of several of his patients.
Ignasiak was initially indicted on these charges in 2008. Following a jury trial in the fall of that year, Ignasiak was convicted of 12 counts of health care fraud and 31 counts of illegally distributing controlled substances. In 2012, Ignasiak’s convictions were reversed on appeal, and he was released from custody pending a retrial. On October 31, 2012, Ignasiak faked his own suicide and fled. A warrant was issued for his arrest. He was arrested in Coral Springs, Florida, in September 2013, and his retrial had been scheduled for December 2, 2013.
In October 2013, Ignasiak pled guilty to 12 counts of health care fraud, 29 counts of illegally distributing controlled substances, and one count of failing to appear for trial.
The charges were the result of a four-year joint investigation by the North Florida Health Care Fraud Task Force, composed of the Federal Bureau of Investigation-Jacksonville Division, the Florida Department of Financial Services, the Florida Department of Law Enforcement, the Florida Attorney General’s Office, the Drug Enforcement Administration-Miami Division, the National Drug Intelligence Center Document Exploitation Division, the Defense Criminal Investigative Service, the Walton County Sheriff’s Office, and the State Surgeon General-Florida Department of Health.
Assistant U.S. Attorneys Karen Rhew-Miller and Alicia Kim prosecuted this case.
Monday, January 13, 2014
Brotherly Love Ambulance EMT Charged in Health Care Fraud Scheme
PHILADELPHIA—Neel Jackson, 35, of Philadelphia, Pennsylvania, was charged today by information with health care fraud and aiding and abetting health care fraud, announced United States Attorney Zane David Memeger.
In July 2010, Feda Kuran, who is charged elsewhere and has pleaded guilty, began operating Brotherly Love Ambulance Inc. with a co-schemer. According to the information, Jackson, an Emergency Medical Technician (EMT) employed by Brotherly Love, transported patients by ambulance when those patients could have been transported safely by other means and were, therefore, not eligible for ambulance service under Medicare and Medicaid requirements. It is further alleged that Jackson and others completed paperwork, including “run sheets,” representing that patients needed ambulance services, when he knew that they were able to walk or to be transported by public transportation or para-transit van. In addition, it is alleged that Jackson gave envelopes he understood to contain cash or other payments to induce patients to allow Brotherly Love to transport them and/or to induce them to remain with Brotherly Love. Finally, it is alleged that Jackson received payments for referring patients to Feda Kuran and/or Brotherly Love. According to the information, as a result of Jackson’s actions, the Medicare program paid more than $200,000 in inappropriate bills. As a result of the overall scheme at Brotherly Love, it is alleged that the Medicare program paid more than $2 million in inappropriate bills.
If convicted, the defendant faces a maximum possible sentence of 10 years of in prison, three years of supervised release, a $250,000 fine, a $100 special assessment, and an order of restitution and forfeiture.
The case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation, and the U.S. Department of Labor Office of the Inspector General. It is being prosecuted by Assistant United States Attorneys Matthew J.D. Hogan and Paul W. Kaufman.
An Information is an accusation. A defendant is presumed innocent unless and until proven guilty.
In July 2010, Feda Kuran, who is charged elsewhere and has pleaded guilty, began operating Brotherly Love Ambulance Inc. with a co-schemer. According to the information, Jackson, an Emergency Medical Technician (EMT) employed by Brotherly Love, transported patients by ambulance when those patients could have been transported safely by other means and were, therefore, not eligible for ambulance service under Medicare and Medicaid requirements. It is further alleged that Jackson and others completed paperwork, including “run sheets,” representing that patients needed ambulance services, when he knew that they were able to walk or to be transported by public transportation or para-transit van. In addition, it is alleged that Jackson gave envelopes he understood to contain cash or other payments to induce patients to allow Brotherly Love to transport them and/or to induce them to remain with Brotherly Love. Finally, it is alleged that Jackson received payments for referring patients to Feda Kuran and/or Brotherly Love. According to the information, as a result of Jackson’s actions, the Medicare program paid more than $200,000 in inappropriate bills. As a result of the overall scheme at Brotherly Love, it is alleged that the Medicare program paid more than $2 million in inappropriate bills.
If convicted, the defendant faces a maximum possible sentence of 10 years of in prison, three years of supervised release, a $250,000 fine, a $100 special assessment, and an order of restitution and forfeiture.
The case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation, and the U.S. Department of Labor Office of the Inspector General. It is being prosecuted by Assistant United States Attorneys Matthew J.D. Hogan and Paul W. Kaufman.
An Information is an accusation. A defendant is presumed innocent unless and until proven guilty.
Southern California Doctor Sentenced to More Than Three Years in Prison for Role in Medicare Fraud Scheme
SACRAMENTO, CA—Dr. Emilio Louis Cruz, III, 61, of Carson, California, was sentenced today by United States District Judge Morrison C. England, Jr. to three years and two months in prison and ordered to pay $601,581 in restitution for his role in a conspiracy to commit Medicare fraud, United States Attorney Benjamin B. Wagner announced.
According to court documents, Cruz earned an undergraduate degree from Johns Hopkins University and his medical degree from Yale University. He held medical licenses in three states and was board certified in neurology. According to his plea agreement and the testimony heard at the trial of Cruz’s co-defendants, doctors Ramanathan Prakash, Alexander Popov, and Lana LeChabrier, and a man named Vardges Egiazarian owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael from February 2006 through August 2008. Over this time period, Cruz ran the practice at the Carmichael clinic on 3609 Mission Avenue. He established a Medicare provider number for the clinic and established a bank account into which Medicare funds were deposited. Hundreds of claims were submitted to Medicare seeking reimbursement for services allegedly performed at the Carmichael clinic under Cruz’s care. Cruz, however, never treated a single patient. Indeed, during the majority of the time that the Carmichael clinic operated, he was living and practicing in North Dakota. A similar pattern was followed at the other two clinics operated by Egiazarian, and not one of the physicians submitting bills to Medicare ever treated a single patient.
According to evidence at trial, the clinic’s patients were primarily elderly and non-English speaking. They were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally $100 per visit. False charts were created stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.
In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. With respect to claims submitted for services purportedly provided by Cruz at the Carmichael clinic, Medicare paid $601,581.
The only defendants to go to trial, doctors Prakash, Popov, and LeChabrier, were found guilty by a jury on July 8, 2011, of conspiracy to commit healthcare fraud and various counts of health care fraud.
This case is the product of an investigation by the Office of the Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation. Assistant United States Attorneys Philip Ferrari and Jean M. Hobler are prosecuting the case.
Others who were charged in this matter include:
According to court documents, Cruz earned an undergraduate degree from Johns Hopkins University and his medical degree from Yale University. He held medical licenses in three states and was board certified in neurology. According to his plea agreement and the testimony heard at the trial of Cruz’s co-defendants, doctors Ramanathan Prakash, Alexander Popov, and Lana LeChabrier, and a man named Vardges Egiazarian owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael from February 2006 through August 2008. Over this time period, Cruz ran the practice at the Carmichael clinic on 3609 Mission Avenue. He established a Medicare provider number for the clinic and established a bank account into which Medicare funds were deposited. Hundreds of claims were submitted to Medicare seeking reimbursement for services allegedly performed at the Carmichael clinic under Cruz’s care. Cruz, however, never treated a single patient. Indeed, during the majority of the time that the Carmichael clinic operated, he was living and practicing in North Dakota. A similar pattern was followed at the other two clinics operated by Egiazarian, and not one of the physicians submitting bills to Medicare ever treated a single patient.
According to evidence at trial, the clinic’s patients were primarily elderly and non-English speaking. They were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally $100 per visit. False charts were created stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.
In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. With respect to claims submitted for services purportedly provided by Cruz at the Carmichael clinic, Medicare paid $601,581.
The only defendants to go to trial, doctors Prakash, Popov, and LeChabrier, were found guilty by a jury on July 8, 2011, of conspiracy to commit healthcare fraud and various counts of health care fraud.
This case is the product of an investigation by the Office of the Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation. Assistant United States Attorneys Philip Ferrari and Jean M. Hobler are prosecuting the case.
Others who were charged in this matter include:
- Ramanathan Prakash, a doctor involved with the Sacramento clinic, is currently serving 10 years in prison.
- Lana LeChabrier, a doctor involved with the Richmond clinic, is currently serving six and a half years in prison.
- Vardges Egiazarian pleaded guilty early in the case and has served his six-and-a-half years' sentence.
- Alexander Popov, a doctor involved with the Sacramento clinic, is currently serving eight years and one month in prison.
- Nazaret Salmanyan, an unlicensed ultrasound technician who worked at all three clinics, pleaded guilty and on November 14, 2013, was sentenced to 20 months in prison.
- Derrick Johnson, a doctor involved with the Richmond clinic, pleaded guilty and is awaiting sentencing.
- Zoya Belov, a nurse licensed in Russia but not the United States who worked at all three clinics, pleaded guilty and is awaiting sentencing.
- Liw Jiaw Saechao, aka Jenny Saechao, recruited patients, pleaded guilty and is awaiting sentencing.
- Migran Petrosyan, a co-owner of the Richmond clinic, pleaded guilty, and on December 5, 2013, was sentenced to 27 months in prison.
- Shushanik Martirosyan, a medical biller who submitted claims to Medicare for all three clinics, pleaded guilty and on October 24, 2013, was sentenced to 18 months in prison.
Tuesday, January 7, 2014
Suspect Allegedly Caught Coaching How to Fake Depression
Court documents released today include a transcript of a suspect in an alleged multi-million dollar fraud coaching a New York City employee on how to fake depression and anxiety.
The call allegedly recorded Joseph Esposito, 70, advising the person to "pretend" to have "panic attacks."
He also "coaches" the employee on how to behave when faced with a medical panel considering the application for disability benefits:
"Okay. When you get there, usually the first question they ask you is "How did you get here?" You're gonna say "My sister drove me." The next question they generally ask is "Who does the cooking, cleaning, shopping in your house?" You're gonna say "My mother" and your sister. They, they drove [U/I] for you. When you get to see the doctor, he's gonna ask you questions. He's not trying to trick you. He, uh, they ask these questions, different variations for everybody. They just want to see if you can concentrate. They'll say to you, "But what do you do with yourself all day? How do you spend your day?" You're gonna tell 'em "I don't sleep well at night. I'm up three, four times. Usually, I, I nap on and off during the day. I put the television on, you know, I keep changing channels 'cause I, I can't concentrate on the television. Just, just to hear a voice in the house." And they're liable to say, "From the word—spell the word "world," so you go "W-R-L-D." Then they're gonna say "Spell it backwards." You think about it, and you can't spell it backwards. Then they're liable to say "From a hundred, subtract seven." You know, a hundred, ninety-three, and then you're trying to concentrate, and make it to eighty-six or eighty-five, you know. You're not too sure. Then they might tell you, uh—"I'm going to tell you three things to remember. A spoon, a fork, and a dish," and they're going to ask you later on in the conversation to remember them. You remember one of them. No jewelry, no cellphone – uh, when you're talking to the guy, don't look directly at him. You know, put your head down now and then, don't answer right away. You know, pause for a second. You're just trying to show that, you know, you're depressed. You, you can't, you, you don't have any desire for anything, and if can, you pretend you have panic attacks?
The call allegedly recorded Joseph Esposito, 70, advising the person to "pretend" to have "panic attacks."
He also "coaches" the employee on how to behave when faced with a medical panel considering the application for disability benefits:
"Okay. When you get there, usually the first question they ask you is "How did you get here?" You're gonna say "My sister drove me." The next question they generally ask is "Who does the cooking, cleaning, shopping in your house?" You're gonna say "My mother" and your sister. They, they drove [U/I] for you. When you get to see the doctor, he's gonna ask you questions. He's not trying to trick you. He, uh, they ask these questions, different variations for everybody. They just want to see if you can concentrate. They'll say to you, "But what do you do with yourself all day? How do you spend your day?" You're gonna tell 'em "I don't sleep well at night. I'm up three, four times. Usually, I, I nap on and off during the day. I put the television on, you know, I keep changing channels 'cause I, I can't concentrate on the television. Just, just to hear a voice in the house." And they're liable to say, "From the word—spell the word "world," so you go "W-R-L-D." Then they're gonna say "Spell it backwards." You think about it, and you can't spell it backwards. Then they're liable to say "From a hundred, subtract seven." You know, a hundred, ninety-three, and then you're trying to concentrate, and make it to eighty-six or eighty-five, you know. You're not too sure. Then they might tell you, uh—"I'm going to tell you three things to remember. A spoon, a fork, and a dish," and they're going to ask you later on in the conversation to remember them. You remember one of them. No jewelry, no cellphone – uh, when you're talking to the guy, don't look directly at him. You know, put your head down now and then, don't answer right away. You know, pause for a second. You're just trying to show that, you know, you're depressed. You, you can't, you, you don't have any desire for anything, and if can, you pretend you have panic attacks?
More than 100 current, former NYC employees to be charged with disability scam
A law enforcement official says more than 100 current and former city workers, including dozens of police officers and firefighters, are being charged with faking psychiatric problems in order to get federal disability benefits.
Arrests in the sweeping case began early Tuesday morning. An afternoon news conference is planned at Manhattan District Attorney Cyrus R. Vance Jr.'s office. Arraignments are expected to begin Tuesday.
The official says the scam stretched back more than two decades, with the ex-officers and other workers claiming mental health problems so severe that they couldn't work at all.
The official wasn't authorized to discuss the case and spoke on condition of anonymity.
Huge 9/11 Fraud Case Accuses Retired New York Cops, Firefighters
Scores of retired New York City police, fire and corrections officers were arrested today in a crackdown on disability fraud stemming from the Sept. 11 terror attacks. The fraud cost taxpayers millions of dollars, prosecutors claim.
The Manhattan district attorney's office accuses the retired workers, along with their lawyers and doctors, of faking work-related stress, including feigned psychiatric disorders related to 9/11.
Among those busted today was John Minerva, the disability consultant for the Detectives Endowment Association, officials said.
Today's arrests cap a two year investigation, aided by federal investigators, the city's Department of Investigation and the NYPD's Internal Affairs Bureau.
The alleged fraud cost taxpayers hundreds of millions of dollars in improper Social Security benefits.
None of the accused actually suffered from debilitating stress, officials claim. Many were caught working after retirement, a violation of disability benefits.
And some of the retired officers retained their gun permits. Retired officers cannot possess guns if they are being treated for stress.
The 9/11 attacks took a heavy toll on the city's cops, called "New York's Finest," and firefighters, dubbed "New York's Bravest." The casualty count from the terror attacks included 23 police officers and 343 firefighters.
Most of the arrests in the fraud sweep took place in the city, with others being busted in Florida and elsewhere in New York State.
It was the second 9/11 scam to be revealed this week. On Monday, two New Jersey men pleaded guilty to raising and keeping $50,000 for a Sept. 11 charity that was supposed to help families who lost loved one in the catastrophe.
Thomas Scalgione and Mark Niemczyk never gave any of the more than $50,000 in proceeds to the victims' families or to charities as promised, they told the court.
The Manhattan district attorney's office accuses the retired workers, along with their lawyers and doctors, of faking work-related stress, including feigned psychiatric disorders related to 9/11.
Among those busted today was John Minerva, the disability consultant for the Detectives Endowment Association, officials said.
Today's arrests cap a two year investigation, aided by federal investigators, the city's Department of Investigation and the NYPD's Internal Affairs Bureau.
The alleged fraud cost taxpayers hundreds of millions of dollars in improper Social Security benefits.
None of the accused actually suffered from debilitating stress, officials claim. Many were caught working after retirement, a violation of disability benefits.
And some of the retired officers retained their gun permits. Retired officers cannot possess guns if they are being treated for stress.
The 9/11 attacks took a heavy toll on the city's cops, called "New York's Finest," and firefighters, dubbed "New York's Bravest." The casualty count from the terror attacks included 23 police officers and 343 firefighters.
Most of the arrests in the fraud sweep took place in the city, with others being busted in Florida and elsewhere in New York State.
It was the second 9/11 scam to be revealed this week. On Monday, two New Jersey men pleaded guilty to raising and keeping $50,000 for a Sept. 11 charity that was supposed to help families who lost loved one in the catastrophe.
Thomas Scalgione and Mark Niemczyk never gave any of the more than $50,000 in proceeds to the victims' families or to charities as promised, they told the court.
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