FBI Arrests Dozens in alleged Medicaid Drug Scheme

July 17, 2012

The Wall Street Journal on July 17, 2012 released the following:

“By Chad Bray

Four dozen people have been charged in a scheme to illegally resell expensive prescription drugs obtained by Medicaid recipients in New York City to pharmacies nationwide.

Federal prosecutors in Manhattan said that people involved in the alleged scheme obtained hundreds of millions of dollars worth of prescription drugs from low-income and other Medicaid recipients — who would get them at a steep discount or for free — and then resold the drugs through a network of corrupt wholesale distribution companies.

The drugs, which are costly when purchased legitimately, included treatments for HIV, schizophrenia and asthma. For example, the defendants allegedly targeted HIV drugs Atripla and Truvada and schizophrenia treatment Zyprexa, all of which retail for more than $1,000 a bottle.

Prosecutors have charged 48 people in total in the case, ranging from persons who allegedly bought the drugs on the street to persons who allegedly resold them to wholesale distribution channels. The charges include: conspiracy to commit mail fraud, wire fraud and healthcare fraud; conspiracy to misbrand and unlawfully distribute prescription drugs; conspiracy to traffic in counterfeit goods; and engaging in a narcotics conspiracy.

The Federal Bureau of Investigation had taken 35 people into custody across the country on Tuesday morning, including more than a dozen in New York and New Jersey, said spokesman Peter Donald.

FBI officials are expected to join Preet Bharara, the U.S. attorney in Manhattan, and New York City Police Commissioner Raymond Kelly at a 1 p.m. press conference Tuesday to discuss the case.

The investigation is the latest in an ongoing effort to crack down on fraud within government health-care programs, which costs the U.S. billions of dollars each year.

In February, the U.S. Department of Justice and the Department of Health and Human Services said efforts to prevent and combat fraud had resulted in the recovery of nearly $4.1 billion in taxpayer dollars in fiscal year 2011. In May, doctors and nurses were among 107 people arrested nationwide in a coordinated sweep related to some $452 million in bogus claims to Medicare, which provides health insurance to the elderly and the disabled.

In the latest case, the Medicaid recipients allegedly sold their drugs for cash on street corners and in bodegas in New York City, including in the Washington Heights neighborhood of Manhattan and the Bronx, prosecutors said. Those drugs then pass up a chain of persons, known as “collectors” and “aggregators,” who then sell the second-hand drugs into corrupt distribution channels that resell the drugs to pharmacies.

Prosecutors said that members of the scheme used lighter fluid and other potentially hazardous chemicals to remove the original patient labels from the drug bottles, which include information about the patient, the original pharmacy where it was purchased and dosage instructions, prosecutors said. Other times, they replaced the original manufacturers’ labels with counterfeit ones when the drugs have expired or are close to their expiration dates.”

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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

Federal Mail Fraud Crimes

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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.


Dental Practice Operators Charged in an Alleged $20 Million Medicaid Fraud Conspiracy

May 25, 2012

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

“David B. Fein, United States Attorney for the District of Connecticut; Susan J. Waddell, Special Agent in Charge of U.S. Health and Human Services, Office of Inspector General for New England; William P. Offord, Special Agent in Charge of IRS Criminal Investigation in New England; and Kimberly K. Mertz, Special Agent in Charge of the Federal Bureau of Investigation, announced that Gary F. Anusavice, also known as “Gary Andrews,” “Gary Andrus” and “Gary Francis,” 59, of North Kingstown, Rhode Island; and Mehran Zamani, DDS, 47, of Pound Ridge, New York, were arrested today on federal charges related to their alleged involvement in a $20 million Medicaid fraud scheme.

“As alleged, these operators of dental practices throughout Connecticut defrauded the Medicaid program of more than $20 million over a two-year period,” said U.S. Attorney Fein. “We are committed to protecting American taxpayers from health care fraud, which can increase costs and jeopardize the integrity of our health care system. I want to commend HHS-OIG, IRS-Criminal Investigation, and the FBI for their investigative efforts and thank the Connecticut Attorney General’s Office, which provided invaluable assistance during the course of this investigation.”

“Although Gary F. Anusavice was barred from Medicare, Medicaid, and other government health programs back in 1998, he allegedly continued to defraud taxpayers by using an elaborate shield of companies and individuals—including Dr. Zamani—to hide his involvement,” said HHS-OIG Special Agent in Charge Waddle. “Working with federal and state partners, our investigators will penetrate such schemes and help bring suspects to justice.”

“To combat healthcare fraud, IRS Criminal Investigation provides the financial investigative expertise to follow the money trail from the crime to the culprit,” said IRS Criminal Investigation Special Agent in Charge Offord. “We are proud to work with our law enforcement partners to document the financial benefits derived from these fraudulent activities.”

“The FBI views health care fraud as a serious crime problem,” said FBI Special Agent in Charge Mertz. “It degrades the integrity of our health care system and legitimate patient care. Today’s arrests send a clear message to those persons who are defrauding our federal Medicare and Medicaid and private health insurance programs. The FBI remains committed to investigating health care fraud and bringing these individuals to justice. The FBI will continue to work aggressively with our law enforcement partners to investigate those who violate the public trust by stealing taxpayer money. We urge anyone with information regarding health care fraud activity to contact its nearest FBI field office.”

According to court documents, the Medicaid program is a joint federal-state program that provides funds for medical services to lower-income individuals who qualify for benefits. The program is jointly administered by the U.S. Department of Health and Human Services and supervised by the Centers for Medicare and Medicaid Services. In Connecticut, the Medicaid program is administered by the State of Connecticut Department of Social Services (DSS).

As alleged in court documents, Anusavice was previously a registered dentist in several states. In July 1997, Anusavice sustained a felony conviction in Massachusetts for submitting false health care claims. Based on that conviction, the U.S. Department of Health and Human Services notified Anusavice in April 1998 that he was being excluded from participation in Medicare and state health care programs, including Medicaid. As part of that notice, Anusavice was informed that, as an excluded individual, he may not “submit claims or cause claims to be submitted” for payment from the federal Medicaid program. Further, Anusavice was advised that Medicaid reimbursement payments are prohibited to any entity in which he serves as an “employee, administrator, operator, or in any other capacity….”

In November 2005, Anusavice surrendered his right to practice dentistry in Rhode Island, and the Massachusetts Board of Registration in Dentistry permanently revoked Anusavice’s license to practice dentistry in Massachusetts in 2006.

The criminal complaint alleges that Anusavice established several dental practices in Connecticut, which were operated by other dentists, including Zamani. These dental practices received millions of dollars in Medicaid reimbursements from the Connecticut Medicaid program, which payments were prohibited given Anusavice’s exclusion from the Medicaid program. The dental practices operated by Anusavice and Zamani included Landmark Dental in West Haven, Dental Group of Connecticut in Trumbull, and Dental Group of Stamford. Despite his permanent exclusion, Anusavice was involved in reviewing patient charts, suggesting dental procedures to be performed, reviewing billing records, reviewing income reports, interviewing and hiring dentists, and providing overall management direction to the offices.

It is alleged that Anusavice hired Zamani at Landmark Dental in October 2008 and that Zamani soon became aware of Anusavice’s disciplinary history. In January 2009, Zamani submitted a Medicaid Provider Enrollment Application with the DSS in order to obtain a Medicaid provider number for Mehran Zamani LLC, listing his group practice name as Landmark Dental. In May 2009, Zamani submitted an application with the DSS for a Medicaid provider number for Landmark Dental. In the applications Zamani submitted, he failed to disclose that Anusavice had an ownership or control interest in Landmark Dental, even though Zamani knew that Anusavice was running the practice and profited from it. From approximately February 2009 to March 2011, Mehran Zamani LLC and Landmark Dental received more than $12.9 million in Medicaid reimbursement payments.

It is further alleged that in April 2009, Zamani and “Haven Consulting,” an entity Anusavice created, entered into a Business Consultant Contract for the Dental Group of Stamford, a practice that Zamani had operated previously. Although the contract provided that Haven Consulting was a “business consultant” to the Dental Group of Stamford, Anusavice had an ownership interest in the practice and acted in an ownership and managerial capacity. Zamani’s DSS application in May 2009 failed to disclose Anusavice’s involvement in the practice and his disciplinary history. From approximately June 2009 to March 2011, the Dental Group of Stamford received more than $4.4 million in Medicaid reimbursement payments.

It is further alleged that Zamani’s April 2010 DSS application for a Medicaid provider number for the Dental Group of Connecticut also failed to disclose Anusavice’s involvement in the practice. From approximately August 2010 to March 2011, the Dental Group of Connecticut received more than $3.5 million in Medicaid reimbursement payments.

It is further alleged that on April 13, 2011, the DSS suspended Medicaid payments to Mehran Zamani, DDS, Landmark Dental, Dental Group of Stamford, and Dental Group of Connecticut based upon a pending investigation of a credible allegation of fraud. As a result, the last Medicaid payment to any of these entities occurred on or about March 22, 2011. By that time, it is alleged that the Anusavice-Zamani entities had collectively received nearly $21 million in Medicaid reimbursement funds. Further, according to Zamani’s accountant’s records, between February 2009 and March 2011, Anusavice-controlled entities received more than $3 million in payments from Zamani-related entities.

It is further alleged that Anusavice and another dentist are now operating a new set of dental clinics, doing business as Alpha Dental Group in Cromwell, Dental Group of New Britain, and Hartford Dental Care. Between November 2011 and March 2012, Arbor Dental has received more than $2.6 million in Medicaid funds. Anusavice also has recently reopened a dental practice at the former location of Dental Care of Connecticut in Trumbull.

Anusavice was arrested this morning at his home in North Kingstown, Rhode Island on a federal criminal complaint charging him with conspiring to commit health care fraud, committing health care fraud, and making false statements involving federal health care programs. Zamani was arrested today at his home in New York on a criminal complaint charging him with the same offenses. Both appeared this afternoon before United States Magistrate Judge Holly B. Fitzsimmons in Bridgeport.

In association with today’s arrests, investigating agencies conducted court-authorized searches of Anusavice’s Rhode Island residence and dental clinics he is allegedly operating in New Britain and Trumbull.

The government also has filed a civil forfeiture complaint against the real property located at 229 Potter Road, North Kingstown, Rhode Island, an 8,145 square foot home on 9.66 acres of land, where Anusavice resides. The forfeiture complaint alleges that this property was purchased in February 2011 for $695,000 by AMZ Consulting Inc., a nominee entity controlled by Anusavice and that proceeds used to purchase the property stem from Anusavice’s alleged Medicaid fraud scheme.

U.S. Attorney Fein stressed that a complaint is only a charge and is not evidence of guilt. Charges are only allegations, and each defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt.

This matter is being investigated by the U.S. Department of Health and Human Services, Office of Inspector General; the Internal Revenue Service-Criminal Investigation; and the Federal Bureau of Investigation. The Connecticut Attorney General’s Office provided assistance and cooperation throughout the investigation.

This case is being prosecuted by Assistant United States Attorneys Susan Wines and Richard Molot, and Special Assistant United States Attorney Sean Beaty. The United States Attorney’s Office for the District of Rhode Island and Assistant United States Attorney Paul Daly have provided valuable assistance.”

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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.


FBI director Robert Mueller tells Miami Chamber: Mortgage fraud and other white-collar crimes rate high priority

April 5, 2012

The Miami Herald on April 5, 2012 released the following:

“FBI Director Robert Mueller told a Chamber of Commerce audience that the agency remains committed to solving major financial crimes prevalent in South Florida

BY MARTHA BRANNIGAN

The FBI has remade itself in the post-9/11 era to focus on counterterrorism, but the agency continues to battle major financial fraud in key areas familiar to South Florida, like mortgages and healthcare as well as corporate and securities violations, FBI director Roberts Mueller told a lunch audience at the Greater Miami Chamber of Commerce Wednesday.

The events of Sept. 11, 2001 triggered a new emphasis on cooperation among agencies and the use of intelligence to drive traditional white-collar crime investigations, Mueller told the gathering of 350 business and government officials at the Jungle Island luncheon.

“We have not neglected our criminal responsibilities,’’ he said. “What has changed is that we make greater use of intelligence and partnerships to focus our limited resources.’’

With tighter lending standards in the wake of the housing meltdown, mortgage fraud has morphed into “schemes aimed at distressed homeowners, such as loan modification scams and phony foreclosure rescues,’’ said Mueller, who became the FBI’s top cop on Sept. 4, 2001, the eve of the terror attacks.

Mueller said so-called “rescue services’’ hold out hope of helping homeowners avoid foreclosure, but instead extract big fees and personal information from victims, who sometimes are swayed “to sign away the deeds to their homes.’’

Among other priorities for the new FBI, Mueller said, is targeting rampant healthcare fraud. “Providers bill the government and insurers for excessive or unnecessary services and even for services they never provide,’’ he said, citing the recent case against officials at South Florida-based American Therapeutic Corp., who manipulated patients to receive unneeded treatment and padded bills to Medicare.

Another FBI focus — corporate and securities fraud — is also a familiar phenomenon to South Florida, Mueller said, citing the case of Scott Rothstein, the Fort Lauderdale attorney who led a $1.6 billion Ponzi scheme that hinged on selling interests in the proceeds of judgments from non-existent lawsuits.

In summing up, the FBI director urged chamber guests to take action when they see financial shenanigans. “You can learn to recognize financial fraud and unscrupulous business practices to better protect yourself and your companies. And you can alert us wehn you see these activities take place,’’ he said.

Chamber president Barry Johnson said the FBI and the chamber worked for two years to schedule Mueller’s visit. “He was interested in talking to South Florida, given the level of financial fraud operating in our part of the world. And they were looking for a business venue,’’ Johnson said.”

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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 Mail Fraud Crimes

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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 C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


“Rockwall Doctor Charged In Biggest U.S. Healthcare Fraud Ever”

February 28, 2012

CBS DFW on February 28, 2012 released the following:

“ROCKWALL (CBSDFW.COM) – A North Texas doctor has been arrested and charged in what’s being described as the largest healthcare fraud case in U.S. history.

Between January, 2006 and November of last year, Dr. Jacques Roy is accused of cheating Medicare and Medicaid, and ultimately taxpayers, nearly $380 million dollars.

Top U.S. Justice department officials have flown to Dallas Tuesday to make the announcement along with the U.S. Attorney for the Northern District of Texas, and the Special Agent in charge of the Dallas FBI, Robert Casey.

Roy will make an appearance in federal court Tuesday afternoon.

Six other people have also been indicted in the massive fraud case. They include Dr. Roy’s office manager Teri Sivils, and the owners of North Texas home health care agencies.

CBS 11 cameras were rolling last June 2nd, when agents from the FBI and the Office of Health and Humans Services Inspector General executed search warrants at Roy’s Rockwall house and at one of the healthcare agencies, Charry Home Care Services in Dallas.

These other six defendants will appear today before a judge in federal court as well.

As of this writing at 1:08 p.m. on February 28, Roy’s Texas medical license is still active. However, the Texas Medical Board typically suspends the licenses of doctors who are charged with felonies.”

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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 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.