“Medicare Fraud Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing”

May 14, 2013

The Federal Bureau of Investigation (FBI) on May 14, 2013 released the following:

“WASHINGTON— Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 89 individuals, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billing.

Attorney General Holder and Secretary Sebelius were joined in the announcement by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, FBI Assistant Director Ron Hosko, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG), and Deputy Administrator and Director of Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity Peter Budetti.

This coordinated takedown was the sixth national Medicare fraud takedown in strike force history. In total, almost 600 individuals have been charged in connection with schemes involving almost $2 billion in fraudulent billings in these national takedown operations alone. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, strike force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 billion. In addition, CMS, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Approximately 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown.

“Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems,” said Attorney General Holder. “These significant actions build on the remarkable progress that the HEAT has enabled us to make—alongside key federal, state, and local partners—in identifying and shutting down fraud schemes. They are helping to deter would-be criminals from engaging in fraudulent activities in the first place. And they underscore our ongoing commitment to protecting the American people from all forms of health care fraud, safeguarding taxpayer resources, and ensuring the integrity of essential health-care programs.”

“The Affordable Care Act has given us additional tools to preserve Medicare and protect the tens of millions of Americans who rely on it each day,” said Secretary Sebelius. “By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars. Today we’re sending a strong, clear message to anyone seeking to defraud Medicare: you will get caught and you will pay the price. We will protect a sacred trust and an earned guarantee.”

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, primarily home health care, but also mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and ambulance services.

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers so that the providers could then submit fraudulent billing to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of conspiring to submit a total of approximately $223 million in fraudulent billing.

“We have made it part of our core mission at the Department of Justice to hold accountable those who steal from the Medicare program to line their own pockets,” said Acting Assistant Attorney General Raman. “There are Medicare fraudsters in prisons across the country—some who will be there for decades—who can attest to our determination, and our effectiveness.”

“We all feel the effects of health care fraud,” said FBI Assistant Director Hosko. “It leads to higher health care costs and makes it harder for seniors and those who are ill to get the care they need. The FBI and our law enforcement partners are committed to preventing and prosecuting health care fraud at all levels. But we need the public’s help. Take the time to be aware of fraud and call law enforcement if you see anything suspicious included in the billings to your insurance, Medicare, or Medicaid or have any unusual encounters with health care providers. We can work together to ensure your hard-earned dollars are used to care for the sick and not to line the pockets of criminals.”

“Taxpayers expect us to work harder and smarter, and that is exactly what happened across the nation today,” said HHS Inspector General Levinson. “In addition to the work of my agents and other federal, state, and local law enforcement officials, investigators from nine other IG offices joined us today. Working together we can break down silos, pool expertise, reduce costs, and the successful result speaks for itself.”

“Today’s takedown is the result of dedicated commitment to working with our law enforcement partners to root out fraud in the Medicare program,” said CMS Program Integrity Deputy Administrator Budetti. “This collaboration has been strengthened by the Affordable Care Act, which provided CMS with the tools it needs to stop the flow of money while working to rid our programs of fraud, waste, and abuse.”

In Miami, a total of 25 defendants, including two nurses, a paramedic, and a radiographer, were charged today and yesterday for their participation in various fraud schemes involving a total of $44 million in false billings for home health care, mental health services, occupational and physical therapy, DME, and HIV infusion. In one case, three defendants were charged for participating in a $20 million home health fraud scheme involving a home health agency, Trust Care Health Services. Court documents allege that the defendants bribed Medicare beneficiaries for their Medicare information, which was used to bill for home health services that were not rendered or that were not medically necessary. According to court documents, the lead defendant spent much of the money from the scheme and purchased multiple luxury vehicles, including two Lamborghinis, a Ferrari, and a Bentley.

Eleven individuals were charged by the Baton Rouge Strike Force. Five individuals were charged today, including two doctors, in New Orleans by the Baton Rouge Strike force for participating in a different $51 million home health fraud scheme. According to court documents, the defendants recruited beneficiaries, offering cash and other incentives in exchange for their Medicare information, which was used to bill medically unnecessary home health services. The Baton Rouge Strike Force also announced a superseding indictment and an information charging six individuals, including another doctor, with over $30 million in fraud in connection with a community mental health center called Shifa Texas. These charges come on top of charges brought against the owners and operators of Shifa Baton Rouge, a related community mental health center which is at the center of an alleged $225 million scheme charged in an earlier indictment.

In Houston, two individuals, a nurse and a social worker, were charged today with fraud schemes involving at total of $8.1 million in false billings for home health care. The defendants, who are brother and sister, allegedly used patient recruiters to obtain Medicare beneficiary information that they then used to bill for services that were not medically necessary and not provided.

Thirteen defendants were charged in Los Angeles for their roles in schemes to defraud Medicare of approximately $23 million. In one case, three individuals allegedly billed Medicare for more than $8.7 million in fraudulent billing for DME. According to the indictment, the defendants allegedly paid illicit kickbacks to patient recruiters to bribe beneficiaries to participate in the scheme. Once the individuals provided their Medicare information to recruiters, doctors and medical clinics conspiring with the defendants allegedly wrote prescriptions for medically unnecessary power wheelchairs, which they sold to the defendants for illegal kickbacks.

In Detroit, 18 defendants, including two doctors, a physician’s assistant, and two therapists, were charged for their roles in fraud schemes involving approximately $49 million in false claims for medically unnecessary services, including home health, psychotherapy, and infusion therapy. In one case, three individuals were charged in a $12 million scheme where they allegedly held themselves out to be licensed physicians—which they were not—and signed prescriptions for drugs and documents about purported psychotherapy they provided.

In Tampa, nine individuals were charged in a variety of schemes, ranging from pharmacy fraud health care-related money laundering. In one case, four individuals were charged for their alleged roles in establishing and operating four supposed healthcare clinics in Tampa, Florida—Palmetto General Health Care Inc., United Healthcare Center Inc., New Imaging Center Inc., and Lord Physical Rehabilitation Center Inc.—which they allegedly used to steal more than $2.5 million from Medicare for surgical procedures that were never performed. The defendants allegedly billed Medicare for surgical procedures used to treat patients with high blood pressure by collapsing veins in the legs, but they did not actually perform the procedures.

In Chicago, seven individuals were charged, including two doctors, with a variety of health care fraud schemes.

In Brooklyn, New York, four individuals, including two doctors, were charged in fraud schemes involving $9.1 million in false claims. In one case, three additional individuals were allegedly involved in what is now alleged to be a $15 million scheme where massages by unlicensed therapists were billed to Medicare as physical therapy. Six defendants were previously charged in the scheme.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Eastern District of New York, the Southern District of Texas, the Central District of California, the Middle District of Louisiana, the Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

To learn more about HEAT, go to http://www.stopmedicarefraud.gov.”

————————————————————–

Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

————————————————————–

To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Federal Grand Jury Returns a Federal Criminal Indictment Alleging Physician Michael Schuster Unlawfully Distributed Prescription Drugs

May 2, 2013

The Federal Bureau of Investigation (FBI) on May 1, 2013 released the following:

Grand Jury Returns Indictment Charging Manhattan Physician with Unlawfully Distributing Prescription Drugs

TOPEKA, KS— A grand jury has returned an indictment charging a physician in Manhattan, Kansas with unlawfully distributing prescription drugs, U.S. Attorney Barry Grissom said today.

Physician Michael Schuster, 53, who operates Manhattan Pain and Spine in Manhattan, Kansas, is charged with four counts: one count of conspiracy to illegally distribute controlled substances, one count of unlawful distribution of controlled substances, one count of unlawfully distributing controlled substances to a person under 21 years old and one count of maintaining a premises in furtherance of unlawful drug distribution.

The indictment alleges that Schuster employed unlicensed staff members who distributed controlled substances to patients using Schuster’s signature on prescriptions while he was traveling out of the state or out of the country. Schuster was out of the office when a total of 540 patients received prescriptions for medications including oxycodone, morphine, hydromorphone, methadone, oxymorphone, tapentadol, fentanyl, amphetamine, methylphenidate, hydrocodone, alprazolam, clonazepam, diazepam, and zolpidem.

Schuster initially was charged in a criminal complaint filed April 23, 2013, in U.S. District Court in Topeka. According to an investigator’s affidavit, the investigation began early in 2012 when the Riley County Police Department received reports that Schuster was issuing prescriptions for high dosages of scheduled drugs based on minimal or cursory physical examinations.

The indictment returned today states that controlled substances may be dispensed and distributed lawfully by means of a prescription that is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. The practitioner must be registered with the Drug Enforcement Administration. Signing a blank prescription and having unauthorized, unlicensed individuals who are not registered with the DEA distribute controlled substances is not a lawful prescription.

The indictment alleges Schuster routinely pre-signed blank prescription forms with the intent that his unlicensed staff members would use them to issue controlled substances to patients while he was not at the clinic.

Count two of the indictment alleges Schuster caused unlicensed staff using blank prescriptions to distribute controlled substances while he was out of the clinic at various locations including Russia, South Africa, Uruguay, Canada, New York, Chile, Argentina, Brazil, and Israel.

Count three alleges that on June 16, 2010, Schuster caused oxycodone to be distributed to a person under the age of 21, who is identified in the indictment as Rex V.

Count four alleges that from April 2007 to August 2012 Schuster knowingly maintained a premises, his office at 1135 Westport Drive in Manhattan, Kansas, for the purpose of unlawfully distributing controlled substances.

The indictment also seeks the forfeiture of all the proceeds from the crimes.

Upon conviction, the crimes carry the following penalties:

Conspiracy: A maximum penalty of 20 years in federal prison and a fine up to $1 million. If death or bodily injury results from the crime, the penalty is not less than 20 years.

Unlawful distribution of controlled substances: A maximum penalty of 20 years in federal prison and a fine up to $1 million. If death or bodily injury results from the crime, the penalty is not less than 20 years.

Unlawful distribution of controlled substances to a person under 21 years old: A maximum penalty of 20 years in federal prison and a fine up to $1 million. If death or bodily injury results from the crime, the penalty is not less than 20 years.

Maintaining drug involved premises: A maximum penalty of 20 years and a fine up to $500,000.

Investigating agencies include the Riley County Police Department; the Federal Bureau of Investigation; the Department of Defense, Criminal Investigative Service (DCIS); the Department of Health and Human Services, Office of Inspector General (HHS-OIG); the Drug Enforcement Administration (DEA); the Department of Homeland Security-Homeland Security Investigations (DHS-HSI); and the Diplomatic Security Service (DSS).

In all cases, defendants are presumed innocent until and unless proven guilty. The indictments merely contain allegations of criminal conduct.”

————————————————————–

Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

————————————————————–

To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


“FBI, HHS agents raid Fla. health care insurer”

March 29, 2013

The Miami Herald on March 28, 2013 released the following:

“THE ASSOCIATED PRESS

ST. PETERSBURG, Fla. — Agents with the FBI and Department of Health and Human Services have executed search warrants at the St. Petersburg offices of a health care insurance company under investigation for possible fraud and mismanagement.

Officials with the two agencies confirmed the raid Thursday at Universal Health Care. The company is already in the process of liquidation under a Leon County judge’s order because of insolvency.

The state Department of Insurance Regulation has accused Universal of financial irregularities including possible fraud. Company officials did not immediately return a telephone call seeking comment.

Universal operated two related companies that provide Medicare Advantage insurance and Medicaid to about 100,000 members. They will be sent letters explaining their options for health care coverage after April 1.”

————————————————————–

Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

————————————————————–

To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Houston-Area Physician and Local Businessman Charged in an Alleged Diagnostic Testing Fraud Scheme

May 24, 2012

The Federal Bureau of Investigation (FBI) on May 24, 2012 released the following:

“HOUSTON— Dr. Donald Gibson, II, 56, of Sugarland, Texas, and Sunday Joseph Edem, 53, of Richmond, Texas, have been arrested for health care fraud and conspiracy to commit health care fraud relating medically unnecessary diagnostic testing and physical therapy, United States Attorney Kenneth Magidson announced today.

Both defendants were arrested without incident this morning and are expected to make an initial appearance tomorrow before U.S. Magistrate Judge Mary Milloy.

According to the indictment, returned Thursday, May 17, 2012, and unsealed today upon their arrests, Gibson ordered, prescribed, and authorized medically unnecessary diagnostic tests and other procedures, which included allergy tests, pulmonary function tests, vestibular tests, urodynamic tests, and physical therapy, among others. These services were then billed to Medicare and Medicaid for payment under Gibson’s billing number.

From January 2007 through January 2012, Gibson allegedly caused more than $19.4 million in medical claims to the Medicare and Texas Medicaid Programs. As a result, Medicare deposited approximately $8.5 million into a bank account owned and controlled by Gibson.

The indictment also alleges Edem operated medical clinics under the names of other individuals to conceal his financial interest in the businesses. Edem and Gibson allegedly conspired with one another to cause the submission of false claims to the Medicare and Medicaid programs and share in the proceeds. Gibson and Edem paid patient recruiters for referring Medicare/Medicaid beneficiaries, according to the indictment, and also paid Medicare beneficiaries for showing up at the medical clinics.

This case is the result of a joint investigation involving multiple federal and state agencies, including agents and investigators of the Railroad Retirement Board, Secret Service, Drug Enforcement Administration, FBI, the Texas Attorney General’s Medicaid Fraud Control Unit, and U.S. Department of Health and Human Services-Office of Inspector General. Special Assistant U.S. Attorney Justin Blan and Assistant U.S. Attorney Andrew Leuchtmann are prosecuting this case.

An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.”

————————————————————–

Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

Federal Crimes – Appeal

————————————————————–

To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Ten Individuals Charged by a Federal Grand Jury for Alleged Conspiracy to Commit Health Care Fraud

January 19, 2012

The Feral Bureau of Investigation (FBI) on January 19, 2012 released the following:

“Ten Individuals Arrested for Health Care Fraud

SAN JUAN, PR—On January 12, 2012, a federal grand jury returned two indictments against 10 individuals for conspiracy to commit health care fraud, announced Rosa Emilia Rodríguez-Vélez, United States Attorney for the District of Puerto Rico. The investigation was led by the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), with the collaboration of the United States Secret Service (USSS) and the Federal Bureau of Investigation (FBI).

Gilberto Gómez, president of Monte Mar Health Corporation (Monte Mar), PROMEDS Medical Inc. (PROMEDS) and Quality Care Medical Supply (Quality); Yolanda García-Rodríguez, aka “Yolanda Gómez,” wife of Gómez and president of PROMEDS, secretary/treasurer of Monte Mar and an authorized official of Quality; Lissette Acevedo, independent sales coordinator; Doctor Francisco Garrastegui; Luisa Nieves, independent sales coordinator; Glendaly Báez, billing director for Monte Mar, PROMEDS and Quality; Mario Rivera, independent sales coordinator; and Marcos Sarraga, independent sales coordinator, are charged in a 39-count indictment for conspiracy to commit health care fraud and a forfeiture allegation of $1,956,750.54. The government seeks to forfeit two bank accounts, one investment account, and a Gallery Plaza Condominium located in the Condado area in San Juan, Puerto Rico.

The indictment alleges that from on or about November, 2008, until on or about May, 2010, Monte Mar submitted at least 1,518 false and fraudulent claims to Medicare totaling approximately $2,993,127.35 for Durable Medical Equipment (DME) that was not medically necessary, causing Medicare to disburse approximately $1,440,597.65. In March 2010, the indictment further alleges that after Monte Mar had been placed in a pre-payment status by Medicare, defendants Gilberto Gómez and Yolanda García-Rodríguez purchased PROMEDS and submitted false claims to Medicare seeking reimbursement for DME, including power wheelchairs, power pressure reducing air mattresses and knee orthosis. PROMEDS submitted at least 359 fraudulent claims to Medicare totaling approximately $786,368.34, causing Medicare to disburse approximately $335,493.12. In October 2010, the indictment alleges that a third company, Quality, was purchased by Gómez and García-Rodríguez after PROMEDS had been placed in a pre-payment status by Medicare. From on or about October 2010, until May, 2011, Quality submitted at least 115 false claims to Medicare totaling approximately $298,321.26, causing Medicare to disburse approximately $180,659.77. The indictment alleges a total amount of $4,077,816.95 fraudulently billed by using Monte Mar, PROMEDS and Quality, where Medicare disbursed a total of approximately $1,956,750.54.

Doctor Francisco Garrastegui was a physician licensed to practice medicine in Puerto Rico but not a Medicare provider. Garrastegui signed and completed false progress notes, prescriptions, Certificate of Medical Necessity (CMNs) and Statements of Ordering Physician for Medicare beneficiaries that were billed by Monte Mar, PROMEDS and Quality. The doctor was paid kickbacks by the three health corporations for the preparation of these false documents. The other defendants’ participation during the conspiracy involved the creation and submission of the fraudulent claims to Medicare.

The health care fraud scheme charged in the second indictment involves Luz M. Vega, president of Preferred Medical Equipment (PME), Doctor Francisco Garrastegui, Lissette Acevedo, Luisa Nieves and María Elisa Pérez. According to the 60-count indictment, from on or about April 2010, until on or about March 2011, PME submitted false claims to Medicare, seeking reimbursement for Durable Medical Equipment including: power wheelchairs, power pressure reducing air mattresses, wheelchair accessories, lumbar-sacral orthosis, knee orthosis and hospital beds. The co-conspirators submitted at least 95 fraudulent claims totaling approximately $210,223.47, causing Medicare to disburse approximately $107,876.73. Defendants Garrastegui, Acevedo and Nieves also participated in the first conspiracy charged in the previously mentioned indictment. The government seeks to forfeit $107,876.73 and one bank account.

“As part of the nation’s health care system, Medicare serves vulnerable populations,” said United States Attorney, Rosa Emilia Rodríguez-Vélez. “Today’s arrests by HHS-OIG agents and our law enforcement partners show that we will not tolerate criminals who engage in fraudulent schemes which deplete the Medicare program of funds which are destined for our elderly population, in order to enrich themselves.”

“HHS/OIG works diligently to investigate allegations of Medicare fraud. Today’s arrests involving durable medical equipment (DME) fraud demonstrate our resolve to bring these subjects to justice. Furthermore, as seen on the attached chart (DME data), our efforts, along with the U.S. Attorney’s Office and our law enforcement partners, have made a dramatic reduction on the total dollars billed and paid for DME in Puerto Rico.”

“The U.S. Secret Service is committed to investigate any financial fraud crimes to include identity theft along with our partner agencies to safeguard our financial system,” said Pedro Gómez, Special Agent in Charge. We will continue to investigate these types of crimes to the fullest extent of the law and bring to justice these criminals that engage in identity theft to facilitate other criminal activities.”

HHS-OIG, USSS, and the FBI conducted the investigations. The agencies that conducted the arrests were HHS-OIG, USSS, FBI, and the U.S. Marshal Service.

The cases are being prosecuted by Assistant U.S. Attorneys Julia Díaz-Rex, health care fraud coordinator, and Héctor Ramírez-Carbó, and Special Assistant U.S. Attorney Wallace A. Bustelo.

If found guilty, the defendants could face a possible sentence of 10 years in prison for the health care fraud offense with a consecutive term of imprisonment of two years for the aggravated identity theft offense and a fine of up to $250,000. Indictments contain only charges and are not evidence of guilt. Defendants are presumed to be innocent unless and until proven guilty.”

————————————————————–

Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

————————————————————–

To find additional federal criminal news, please read Federal Crimes Watch Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition and OFAC SDN Sanctions Removal.

The author of this blog is Douglas McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Six Defendants Charged in Los Angeles as Part of Nationwide Medicare Fraud Strike Force Takedown

September 8, 2011

The Federal Bureau of Investigation on September 7, 2011 released the following:

“LOS ANGELES—As part of a nationwide effort to target fraud against the Medicare program, two doctors and four others have been charged here for allegedly participating in schemes to defraud the Medicare program of nearly $11 million.

The charges brought by prosecutors in Los Angeles—four indictments naming six defendants—are part of coordinated action that resulted today in 70 defendants being charged by Medicare Fraud Strike Force prosecutors across the nation. In cases filed in six cities that were announced today by top officials with the Justice Department and the Department of Health and Human Services, prosecutors have alleged a variety of Medicare fraud schemes involving approximately $263.6 million in false billings. Justice Department prosecutors also have recently charged an additional 21 defendants who are accused of participating in fraud schemes that sought more than $31 million. This coordinated action targeting a total of 91 defendants involves the highest amount of false Medicare billings in a single takedown in Strike Force history.

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare—jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Eric Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud, and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive—or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

“The criminal prosecutions announced today are the result of a collaborative effort that demonstrate our resolve to target those intent on taking resources away from the sick and infirm among us,” said United States Attorney André Birotte Jr. “There is too much money being stripped from public health care programs. The impact to the Medicare system—as well as the impact to those with legitimate needs—demands action by law enforcement.”

In the first case unsealed today in Los Angeles, George Hakopian and Yervand Khachatryan are accused in a Medicare fraud scheme involving durable medical equipment (DME). Hakopian and Khachatryan were the owners of Midvalley Medical Supply, a DME supply company in Van Nuys. The indictment alleges that Midvalley, over a one-year period, submitted more than $4.8 million in claims for power wheelchairs and orthotics that either were not medically necessary or were never provided to Medicare beneficiaries. The fraud allegedly included claims for beneficiaries who were deceased at the time of purported services and parents of Midvalley employees. Hakopian and Khachatryan are also charged with laundering approximately $1 million that was the proceeds of their fraud. Hakopian, 54, of Tujunga, was arrested this morning by federal authorities and is scheduled to make his initial court appearance this afternoon in United States District Court in Los Angeles. Khachatryan, a 54, who at the time of the alleged scheme resided in Glendale, is a fugitive currently being sought by federal authorities.

Dr. Byung Ho Pak and Mary Lim are charged in an indictment for their roles in a Medicare fraud scheme involving fraudulent billing for physical therapy. But instead of providing physical therapy, the indictment alleges that patients received non-covered services such as acupuncture, acupressure and moxibustion (the burning of mugwort on the skin in an effort to improve circulation). The indictment alleges that Pak and Lim, who managed Pak’s Seoul East West Medical Center in Garden Grove, submitted approximately $2 million in claims to Medicare for services that were not provided. Medicare paid more than $1.4 million, according to the indictment. Pak, 71, of Orange, and Lim, 48, of Desert Hot Springs, were both arrested this morning. Pak is expected to make his initial court appearance tomorrow in United States District Court in Santa Ana. Lim is expected to make her initial appearance later this afternoon in federal court in Riverside.

In another case filed in Los Angeles, Dr. Owusu Firempong is charged with submitting approximately $1.3 million in claims to Medicare for diagnostic tests that either were not performed or were medically unnecessary, such as nerve conduction tests and sleep studies. Firempong allegedly submitted the fraudulent claims and was paid more than $780,000 by Medicare after he was evicted from his Los Angeles and Fountain Valley Medical Clinics. Firempong, 60, who resides in the Crenshaw district of Los Angeles, was arrested this morning and is expected to make his first court appearance this afternoon in United States District Court.

In the fourth case filed in Los Angeles, Zina Tamamian, 49, of North Hollywood, is charged with submitting approximately $2.9 million in fraudulent claims to Medicare for DME—most of which was never provided to patients. A seven-count indictment alleges that Medicare suffered approximately $2.1 million in losses when it paid fraudulent claims for orthotic devices that were submitted through Tamamian’s company, Gana Medical Supply in Sherman Oaks. Tamamian is currently a fugitive.

“The FBI and its Strike Force partners are focused on identifying those who profit from Medicare fraud,” said Steven Martinez, the Assistant Director in Charge of the FBI in Los Angeles. “Criminals are responsible for billing and fraudulently receiving millions of taxpayer dollars every year for services never performed and products never delivered. We are committed to eradicating these schemes that cost so much and compromise the care that legitimate Medicare beneficiaries are entitled to receive.”

An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proven guilty.

The Los Angeles cases were investigated by the Federal Bureau of Investigation; the Department of Health and Human Services, Office of Inspector General; IRS – Criminal Investigation; and the California Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse.

The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, Strike Force operations in Los Angeles and eight other locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS 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 find additional federal criminal news, please read Federal Crimes Watch Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition and OFAC SDN Sanctions Removal.

The author of this blog is Douglas McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.

Bookmark and Share


Larry Bernhard Pleads Guilty in Maryland Federal Court to Health Care Fraud and Aggravated Identity Theft

July 7, 2011

The U.S. Attorney’s Office District of Maryland on July 6, 2011 released the following:

“GAMBRILLS PODIATRIST PLEADS GUILTY TO FRAUDULENTLY BILLING MEDICARE OVER $1.1 MILLION

Was Prohibited From Billing Medicare as Part of a Settlement Agreement Related to Previous Allegations of Fraudulent Billing

Baltimore, Maryland – Larry Bernhard, age 55, a podiatrist who operated his business from his home in Gambrills, Maryland, pleaded guilty to health care fraud and aggravated identity theft related to a scheme to fraudulently bill Medicare for more than $1.1 million.

The guilty plea was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.

“Health insurance programs trust providers to bill honestly for medical services, so it is essential to punish doctors who betray that trust,” said U.S. Attorney Rod J. Rosenstein. “Dr. Larry Bernhard flagrantly ripped off Medicare Advantage by fabricating claims for services that he never provided, collecting more than $1 million in new false claims even after he was caught and prohibited from billing federal health care programs.”

According to Bernhard’s plea agreement, since 1981 he has been a licensed podiatrist in Maryland and operated a podiatry practice under the business name, Chesapeake Wound Care Center. Bernhard ran the Chesapeake Wound Care Center business from his home. On October 30, 2007, Bernhard entered into a Settlement Agreement with the government to resolve allegations that from April 1, 2002 through October 11, 2004, Bernhard submitted eighty claims to Medicare for podiatry services purportedly provided at skilled nursing facilities when, in fact, the patients were actually in hospitals at the time the services were allegedly provided. As part of the settlement Bernhard agreed to be excluded from “Medicare, Medicaid, and all other Federal health care programs” for a period of three years.

Bernhard admits that from October 31, 2007 to July 20, 2010, he fraudulently billed Medicare Advantage plans and was paid at least $1.1 million from these plans. All of the fraudulent billing occurred while Bernhard was excluded from billing all federal health care programs, including Medicare Advantage plans. Of the $1.1 million received by Bernhard , at least $1 million was for services that were not rendered. Bernhard admits that he used the names and personal identifying information of approximately 200 patients at various nursing homes to submit false bills for podiatry care that he never performed.

Bernhard faces a maximum penalty of 10 years in prison for health care fraud and a mandatory two years in prison, consecutive to any other sentence imposed, for aggravated identity theft. U.S. District Judge James K. Bredar has scheduled sentencing for November 21, 2011 at 10:00 a.m. As part of his plea agreement, Bernhard has agreed to pay restitution of $1,122,992.08.

United States Attorney Rod J. Rosenstein commended the HHS-Office of Inspector General and FBI for their work in the investigation. Mr. Rosenstein thanked Assistant United States Attorney Paul E. Budlow, who is prosecuting the case.”

To find additional federal criminal news, please read The Federal Crimes Watch Daily.

Douglas McNabb and other members of the U.S. law firm practice and write extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition and OFAC SDN List Removal.

The author of this blog is Douglas McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.

Bookmark and Share