Thirteen Individuals Indicted in an Alleged Health Care Fraud and Drug Distribution Scheme

March 20, 2013

The Federal Bureau of Investigation (FBI) on March 19, 2013 released the following:

“Five Doctors, Four Pharmacists, and Home Health Agency Owner Among Those Indicted in Follow-Up to the Babubhai Patel Case

Thirteen individuals have been charged in a large-scale health care fraud and drug distribution scheme, United States Attorney Barbara L. McQuade announced today.

McQuade was joined in the announcement by Special Agent in Charge Robert L. Corso of the Drug Enforcement Administration, Special Agent in Charge Robert D. Foley, III of the Federal Bureau of Investigation, and Lamont Pugh, Special Agent in Charge of the Inspector General of the Department of Health and Human Services.

The superseding indictment, unsealed yesterday, adds 13 new defendants and new charges to a 2011 indictment, which charged Canton Pharmacist Babubhai ‘Bob” Patel with overseeing a massive health care fraud and drug distribution ring at more than 20 pharmacies that he owned and controlled in metro-Detroit.

The 13 new defendants named in the superseding indictment include five doctors, four pharmacists, and a home health agency owner:

  • pharmacist Mehul Patel, 34, of Canton
  • pharmacist Pradeep Pandya, 49, of Grand Blanc
  • pharmacist Vikas Sharma, 34, of Windsor
  • pharmacist Mukesh Khunt, 33, of Toronto
  • physicians Richard Utarnachitt, 71; of Clinton Township
  • physician Ruben Benito, 72, of Madison Heights
  • physician Javaid Bashir, 59, of Jackson
  • physician Carl Fowler, 60, of West Bloomfield
  • physician Rajat Daniel, 47, of West Bloomfield
  • home health agency owner Vinod Patel, 40, of Canton
  • business associate Atul Patel, 31, of Canton
  • marketer Anthony Macklin, a.k.a. “Jimbo,” of Detroit
  • marketer Michael Thoran, a.k.a. “Ace,” also of Detroit

The 21-count superseding indictment charges that Babubhai Patel was the owner and controller of approximately 26 Michigan pharmacies. The indictment alleges that Babubhai Patel would offer and provide kickbacks, bribes, and other illegal benefits to physicians to induce those physicians to write prescriptions for patients with Medicare, Medicaid, and private insurance. Patel would also direct that those prescriptions be presented to one of the Patel Pharmacies for billing. In exchange for their kickbacks and inducements, the physicians would write prescriptions for the patients and bill the relevant insurers for services supposedly provided to the patients without regard to the medical necessity of those prescriptions and services. The physicians would direct the patients to fill their prescriptions at one of the Patel Pharmacies, where Babubhai Patel and his pharmacists would bill insurers, including Medicare, Medicaid, and private insurers, for dispensing the medications, despite the fact that the medications were medically unnecessary and, in many cases, never provided. Patients were recruited into the scheme by patient recruiters or “marketers,” who would pay kickbacks and bribes to patients in exchange for the patients’ permitting the Patel Pharmacies and the physicians associated with Patel to bill their insurance for medications and services that were medically unnecessary and/or never provided.

The indictment further alleges a conspiracy to distribute controlled substances at the Patel pharmacies to facilitate the submission of false and fraudulent claims to Medicare, Medicaid, and private insurers. According to the indictment, Babubhai Patel and his associates paid physicians kickbacks for prescriptions for controlled substances for their patients and directed those patients to fill the prescriptions at a Patel Pharmacy. The controlled substances included the Schedule II drug oxycodone (Oxycontin), the Schedule III drug hydrocodone (Vicodin, Lortab), the Schedule IV drug alprazolam (Xanax), and the Schedule V drug cough syrup with codeine. According to the indictment, prescriptions for these drugs were written outside the course of legitimate medical practice. Babubhai Patel and his pharmacists would then dispense the controlled drugs to patients without medical necessity. The distribution of controlled substances in this manner was intended, in part, as a kickback to the patients for agreeing to enable their insurance cards to be billed for medications purportedly dispensed at the Patel Pharmacies. The indictment also alleges that Babubhai Patel and his pharmacists dispensed controlled substances outside the scope of legitimate medical practice to patient recruiters or “marketers,” as a kickback for their efforts in to recruit patients into the scheme.

In addition to his pharmacies, the indictment alleges that Babubhai Patel had an ownership interest in a home health agency managed by his brother, Vinod Patel. The indictment alleges that Vinod Patel, Babubhai Patel, and others bribed physicians and other referral sources for referrals to that home health agency and then billed the Medicare program for home health services that were medically unnecessary and never provided.

Of the 26 defendants originally charged in the indictment, six, including Babubhai Patel and four pharmacists, were convicted at a trial last summer. Fifteen additional defendants, including six pharmacists and two doctors, have pleaded guilty in the case. The five remaining defendants whose charges were renewed in the superseding indictment are set for trial on June 10, 2013. On February 1, 2013, Babubhai Patel was sentenced to 17 years’ imprisonment by U.S. District Judge Arthur J. Tarnow.

“Taxpayers fund Medicare and Medicaid to provide health care for needy citizens,” McQuade said. “We hope that doctors and pharmacists will take note that if they exploit these programs for personal profit, they will face serious consequences.”

Robert L. Corso, Special Agent in Charge of DEA’s Detroit Field Division stated, “Confronting the illegal diversion and abuse of controlled pharmaceuticals is a top priority of DEA and our law enforcement partners. Today’s indictments, particularly of the medical professionals are significant. It is alleged that these individuals abused their positions of trust and endangered the lives of countless people by illegally distributing opiate painkillers and depressants throughout southeast Michigan. This investigation makes it clear that the DEA and our partners in law enforcement will continue to investigate and bring to justice those individuals that are responsible for the illegal distribution of prescription medicines.”

FBI Special Agent Robert Foley stated, “Dishonest health care providers and pharmacists who exploit Medicare and Medicaid through fraudulent billing and other schemes will be held accountable for their crimes. The FBI remains committed to investigating this type of fraud and bringing those who abuse the system to justice.”

“Schemes involving the illegal diversion and/or distribution of controlled substances go hand and hand with the fraudulent billing of Medicare and other health care programs,” said Lamont Pugh, III, Special Agent in Charge of the U.S. Department of Health & Human Services, Office of Inspector General—Chicago Regional Office. “The OIG and our law enforcement partners are acutely aware of the potential for those who commit health care fraud to utilize this blended approach when seeking to line their pockets with tax payer dollars. The indictments and arrests announced today illustrate our combined commitment and effort to protect the safety and well-being of the public and as well as the health care programs they rely upon.”

The investigation in this case was handled by the Drug Enforcement Administration, the Federal Bureau of Investigation, and the Department of Health and Human Services Office of Inspector General. The case is being prosecuted by Assistant U.S. Attorneys John K. Neal and Wayne F. Pratt.

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.”

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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

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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.


Alleged Sinola Cartel Members Arrested in Drug Conspiracy

September 4, 2012

The Federal Bureau of Investigation (FBI) on September 4, 2012 released the following:

“CONCORD—Three members of the Sinaloa Cartel were arrested on drug conspiracy charges after a three-year long investigation, announced United States Attorney John P. Kacavas.

Manuel Jesus Guttierez Guzman, Rafael Humberto Celaya Valenzuela, and Samuel Zazueta Valenzuela were arrested in the port city of Algeciras, Spain, on August 7, 2012, by the Federal Bureau of Investigation and the Spanish National Police. The arrests resulted from a three-year long investigation into the drug smuggling activities of the Sinaloa Cartel as it attempted to establish a market for cocaine in Europe and in the United States. Law enforcement authorities also seized 346 kilograms of cocaine that were shipped by the cartel as part of the undercover operation. Authorities seized a quantity of heroin and methamphetamine in May 2012 in Detroit, Michigan, that was tendered by the cartel as partial payment for costs incurred in previously scheduled by aborted shipments of cocaine.

Also arrested in Spain was Jesus Soto, an individual who was sent to Spain by the cartel to monitor the safety of the shipment of cocaine.

Manuel Guzman is the first cousin of Joaquin Guzman-Loera, also known as “Chapo,” the reputed leader of the Sinaloa Cartel.

A New Hampshire grand jury returned an indictment charging Guttierez Guzman and the Valenzuelas and others with conspiracy to distribute 1000 or more kilograms of cocaine. The investigation involved meetings with members of the conspiracy in New Hampshire, Florida ,and the Virgin Islands at which the details of the drug distribution scheme were discussed.

The United States Attorney’s Office for the District of New Hampshire is working with the Office of International Affairs and the kingdom of Spain to obtain the extradition of those arrested. Each of the arrested individuals is a citizen of Mexico.

The case was investigated by the Federal Bureau of Investigation and the Boston Police Department with the assistance of the Spanish National Police.

The public is reminded that an indictment is a charge brought by the grand jury, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt.”

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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 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.


Eight Indicted in Alleged Health Care Fraud and Drug Distribution Scheme

October 7, 2011

The Federal Bureau of Investigation (FBI) on October 6, 2011 released the following:

“DETROIT—An indictment returned by a federal grand jury in Detroit was unsealed today charging eight individuals for their roles in a health care fraud and drug distribution scheme, United States Attorney Barbara L. McQuade announced today. McQuade was joined in her announcement by Special Agent in Charge Andrew G. Arena of the Federal Bureau of Investigation (FBI) and Lamont Pugh, Special Agent in Charge of the Inspector General of the Department of Health and Human Services (HHS).

Charged in the indictment were Orlando Mena, of Miami, FL; .Xiomara Rodriguez, of Miami, FL; Dr. Russell Crispell, of Troy, MI; Reinald Orellana, of Westland, MI; Lisette Orellana, of Miami, FL; Akim Mena of Miami, FL; Dr. Virinder Grewal, of Williamston, MI; and Carla Degraffenreid of Detroit.

The indictment alleges that the defendants conspired to defraud Medicare with a fraudulent diagnostic testing scheme operating at World Health Care, LLC and Wyoming Medical Centers, PLC. As part of the scheme, Medicare was billed in excess of $2 million for medically unnecessary tests and services. The indictment also charges Orlando Mena, Xiomara Rodriguez, Dr. Russell Crispell, Reinald Orellana, Lisette Orellana, and Akim Mena with conspiracy to distribute Oxycontin (oxycodone) and 13 counts of distribution of a controlled substance.

The indictment alleges Xiomara Rodriguez incorporated World Health Care in Redford, Michigan, on July 11, 2008. Orlando Mena, and others recruited Medicare beneficiaries in Southeast Michigan to see Dr. Russell Crispell, who was employed by World Health Care. Most of the patients were scheduled for doctor visits by employee Lisette Orellana. The Medicare beneficiaries would be transported to World Health Care by employee “drivers,” who were under the direction and control of Akim Mena. The Medicare beneficiaries would be required to undergo medically unnecessary tests in order to receive a prescription for Oxycontin. In addition, Medicare beneficiaries were paid in cash for their time and the use of their Medicare card for billing purposes.

The indictment also alleges that Akim Mena would arrange to have drivers transport the Medicare beneficiaries to various pharmacies to fill their prescriptions. Once the prescription was filled, the driver would pay the Medicare beneficiaries from $150 to $800, in cash, for their Oxycontin prescription, for further distribution.

The indictment alleges that Reinaldo Orellana and Akim Mena incorporated Wyoming Medical Centers in East Lansing, Michigan, on March 25, 2009, and acquired a valid Medicare provider number to submit Medicare claims for office visits and tests. Medicare beneficiaries were required to visit Wyoming Medical Centers, and see Dr. Virinder Grewal, who did not perform a medical examination, but caused a claim to be submitted to Medicare for various diagnostic tests, then the Medicare beneficiaries would return to World Health Care to receive a prescription for Oxycontin.

“Today’s indictments and arrests illustrate the Office of Inspector General’s continued and sustained commitment to the fight against fraud in Federal health care programs,” said Lamont Pugh III, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Chicago Region. “The OIG in concert with our law enforcement partners, will continue to protect Medicare beneficiaries and the taxpayers through these types of enforcement actions.”

FBI Special Agent in Charge Arena stated, “Health care fraud and the abuse/diversion of prescription medications are increasing criminal threats to the United States. Dishonest health care providers involved in fraudulent activities frequently exploit Medicare and Medicaid through fraudulent billing schemes which abuse tax payer’s dollars. The FBI remains committed to investigating this fraud and bringing these individuals to justice.”

“Medicare fraud steals funds from all of us as taxpayers,” McQuade said. “Our hope is that robust enforcement of these cases will deter other providers from committing Medicare fraud in the future.”

An indictment is a charging document and not evidence of guilt. Each and every defendant is presumed to be innocent.”

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.

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