Miami-Area Residents Mayelin Santoyo and Jose Martin Olivares Indicted by a Federal Grand Jury for Alleged Roles in $190 Million Medicare Fraud Scheme

October 1, 2013

The Federal Bureau of Investigation on September 27, 2013 released the following:

“WASHINGTON—Two Miami-area residents were indicted in connection with 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 HHS Office of Inspector General (HHS-OIG) Office of Investigations, Miami Office, made the announcement after the indictment was unsealed.

Mayelin Santoyo, 28, and Jose Martin Olivares, 36, were each charged with one count of conspiracy to defraud the United States and to receive illegal health care kickbacks and two counts of receiving health care kickbacks. Each charge carries a maximum penalty of five years in prison upon conviction.

According to the indictment, the scheme that Santoyo and Olivares allegedly participated in lasted from approximately February 2006 to October 2010. The scheme was orchestrated by the owners and operators of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. (Medlink). 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 and Orlando. Both corporations have been defunct since their owners were arrested in October 2010.

The indictment alleges that Santoyo and Olivares served as patient brokers who provided ineligible patients to ATC in exchange for kickbacks in the form of checks and cash. The amount of the kickback was based on the number of days each recruited patient spent at ATC. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services and who attended treatment programs that were not legitimate PHPs so that ATC could bill Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.

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 Trial Attorneys Anne P. McNamara and Robert A. Zink of the Fraud Section.

Since their inception in March 2007, Medicare Fraud 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, 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.”

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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.


“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.”

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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.


Fifty-Nine South Florida Residents Charged as Part of Nationwide Coordinated Takedown by Medicare Fraud Strike Force Operations

May 3, 2012

The Federal Bureau of Investigation (FBI) on May 2, 2012 released the following:

107 Individuals Charged Nationally for Submitting Approximately $452 Million in Fraudulent Billing; South Florida Responsible for more than $137 Million in False Billings

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG); and Henry Gutierrez, Postal Inspector in Charge, U.S. Postal Inspection Service, Miami Division, announced that 59 South Florida residents were charged for their alleged participation in various schemes to defraud Medicare out of more than $137 million. The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that resulted in charges against 107 individuals, including doctors, nurses and other licensed professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing. This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in strike force history.

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. 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 national takedown.

U.S. Attorney Wifredo A. Ferrer stated, “The Medicare program is a valuable and limited trust fund to provide much needed services for the poor, the elderly and the sick. Among the dozens of fraudsters charged in South Florida in this operation are clinic owners, nurses, therapists, patient recruiters, pharmacy owners, accountants, former social workers, and even beneficiaries, all of whom stole precious health care dollars through a variety of schemes. These get rich quick schemes at the expense of the most vulnerable in our society are unacceptable. We will continue to fight health care fraud on all fronts: we will prosecute each link in the fraud chain and each evolving fraud scheme.”

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

“More than half of those charged in a record setting health care fraud takedown today were from the Miami area. The local fraud totaled more than $137 million. Sadly, in Miami, multi-million-dollar health care fraud cases are no longer shocking in their magnitude or frequency,” said John V. Gillies, Special Agent in Charge of the FBI’s Miami Office. “Here’s my message clear and simple: you can run, but as evidenced by today’s nationwide takedown, you can’t hide.”

“Medicare fraud diverts precious resources from those who are eligible and need it most,” said Christopher B. Dennis, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s region covering Florida. “Today’s action should send a strong message that we will continue to track the evidence to ensure that those involved are held accountable.”

U.S. Postal Inspector in Charge Henry Gutierrez stated, “Medicare fraud is an assault on resources for our most needy and vulnerable citizens. This joint effort by the South Florida law enforcement community demonstrates that those who engage in these illegal schemes will be prosecuted to the full extent of the law.”

The South Florida defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, 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 such as home health care, mental health services, and physical and occupational therapy. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes 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 submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.

Specifically, the South Florida cases announced as part of the nationwide Medicare Fraud Strike Force takedown include:

U.S. v. Odalys Fernandez, Kelvin Soto, Yumidia Naranjo, Jose Guerra, Yanuris Lima, and Servando Raya, Case No. 12-20230-CR-Ungaro

In this six-defendant case, two registered nurses employed by Ideal Home Health (Odalys Fernandez and Kelvin Soto) are charged with conspiracy to commit health care fraud for purportedly providing services, such as skilled nursing and physical therapy, to homebound beneficiaries. In fact, however, the services were either medically unnecessary or were never provided. As part of the scheme, the defendants falsified medical paperwork to make it appear as if they had provided the services. Four other defendants (Yumidia Naranjo, Jose Guerra, Yanuris Lima, and Servando Raya) are alleged to be patient recruiters who paid Medicare beneficiaries so they would serve as patients at Ideal Home Health. Ideal, in turn, submitted more than $40 million in false billings to Medicare. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

U.S. v. Eulises Escalona, Case No. 12-20293-CR-Lenard

This indictment charges Eulises Escalona with one count of conspiracy to commit health care fraud, one count of conspiracy to defraud the United States and to receive and pay health care kickbacks, and five counts of payment of health care kickbacks stemming from a $42 million home health care fraud scheme. According to the indictment, Escalona owned and operated Willsand Home Health, Inc. (Willsand), a home health agency that purportedly provided home health and physical therapy services to eligible Medicare beneficiaries. In fact, however, from January 2006 through November 2009, Escalona and others paid kickbacks to Medicare beneficiaries to induce them to become patients at Willsand regardless of medical need and to falsely attest that they had received the purported services. In addition, Escalona and others paid kickbacks to patient recruiters and to doctors who signed fraudulent prescriptions and plans of care (POCs) for unnecessary home health services for patients at Willsand. To execute the scheme, Escalona and others falsified patient files and POCs to make it appear as if the patients had qualified for and actually received home health services. In this way, Willsand allegedly submitted approximately $42 million in false claims to Medicare for services it claimed to have provided to approximately 622 beneficiaries. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

U.S. v. Rodolfo Nieto, Jr., Case No. 12-20290-CR-Altonaga

This indictment charges Rodolfo Nieto, Jr., owner and operator of Ronat Home Health Care, Inc. (Ronat), with one count of conspiracy to defraud the United States and to receive and pay health care kickbacks and three counts of receipt of kickbacks for his participation in a $60 million home health care fraud scheme. According to the indictment, from January 2006 through November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries for placement at Nany Home Health, Inc. (Nany). Nieto allegedly caused Nany to submit claims to Medicare for home health services, including insulin injections and physical therapy, purportedly provided through Ronat. According to the indictment, Nany submitted approximately $60 million in false claims to the Medicare program for services that it purportedly provided to approximately 1474 beneficiaries. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

U.S. v. Maggie Leon, Yuderkis Pena Garcia and Eduardo Vilau, Case No. 12-20274-CR-Seitz

In this case, defendants Maggie Leon, Yuderkis Pena Garcia, and Eduardo Vilau, owners of Leon Medical and Leah Medical, were charged with conspiracy to commit health care fraud and health care fraud for submitting false claims to private insurance companies that were Medicare Advantage contractors under Part C of the Medicare program. As alleged in the indictment, the defendants submitted approximately $1,826,000 in false claims for expensive cancer and HIV injections that were not medically necessary and were not actually provided to the Medicare beneficiaries. In addition, the indictment alleges that the defendants conspired to pay kickbacks to Medicare beneficiaries so that they would serve as patients at Leah and Leon. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Ricardo Martinez, Case No. 12-20316-CR-Martinez

This indictment charges defendant Ricardo Martinez with health care fraud and paying kickbacks to patients. The indictment alleges that the defendant paid kickbacks and bribes to beneficiaries so that they would serve as patients at Rima Medical. The indictment further alleges that Martinez, through Rima Medical, submitted approximately $1,706,701 in false claims for expensive cancer and HIV injections to private insurance companies that were Medicare Advantage contractors under Part C of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Yaquelin Colls, Pedro Colls, and Jesus Fernandez, Case No. 12-20315-CR-Seitz

This indictment charges defendants Yaquelin Colls, Pedro Colls, and Jesus Fernandez with conspiracy to commit health care fraud, substantive health care fraud, conspiracy to pay health care kickbacks, and substantive charges of paying kickbacks. More specifically, the indictment alleges that the defendants owned and operated Ma Medical and Therapy Services, Inc. (Ma Medical), and caused the submission of $972,068 in false medical claims for expensive cancer and HIV injections to a private insurance company that was a Medicare Advantage provider under Part C of the Medicare program. In a similar scheme, the defendants submitted $55,642 in false claims to another private insurance company under Part C of the Medicare program through a second clinic, Healthy Touch Rehab Center Inc. (Healthy Touch), which they also owned and operated at the same address as Ma Medical. The indictment further alleges that the defendants conspired to pay kickbacks and bribes to beneficiaries so that they would serve as patients at Ma Medical and Healthy Touch. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Roberto L. Valdes Gonzalez, Francisca Gema Valdez, Gilberto Faure, and Alberto Sotolongo, Case No. 12-20275-CR-Moore

In this case, defendants Jose L. Valdes Gonzalez, a/k/a “Roberto Gonzalez,” Alberto Sotolongo, a/k/a “Ruben,” Gilberto Faure, and Francisca Gema Valdes were charged with conspiracy to commit health care fraud and substantive counts of health care fraud in connection with the operation of Ilva Pharmacy, Inc. More specifically, the indictment alleges that between 2009 and 2011, the defendants caused Ilva Pharmacy to submit approximately $1.3 million in false claims for prescription drugs that were not provided to Medicare and private insurance companies that were Medicare Advantage contractors under Part D of the Medicare program. The indictment additionally charges Gonzalez and Sotolongo with offering and paying kickbacks to Medicare beneficiaries to induce them to serve as patients at Ilva Pharmacy. This case is being prosecuted by Assistant U.S. Attorney John Couriel.

U.S. v. Alina De Armas, Case No. 12-20282-CR-Zloch

In this case, defendant Alina De Armas is charged with health care fraud and with paying kickbacks to patients. The information alleges that De Armas offered and paid kickbacks to Medicare beneficiaries to induce them to serve as patients at Ultratech Medical Supplies, Inc., d/b/a Guines Pharmacy. In this way, from 2007 through 2011, De Armas caused the submission through Guines Pharmacy of approximately $3.6 million in false claims for prescription drugs to Medicare and private insurance companies that were Medicare Advantage contractors under Part D of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney John Couriel.

U.S. v. Isaura Bou-Melendez and Gricel Font, Case No. 12-20113-CR-MGC

In this case, Isaura Bou-Melendez and Gricel Font are charged with conspiracy to commit health care fraud. Bou and Font, licensed therapists, owned and operated a comprehensive outpatient rehabilitation facility, Font & Bou Rehab Associates, Inc. The information alleges that from January 2006 through February 2010, Font and Bou allegedly submitted approximately $6.9 million in false claims to Medicare for physical and occupational therapy services that were not medically necessary or not provided as claimed. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Maritza Claudia Fernanda Lorza Ramirez, and James Arley Velasco Gonzalez, Case No. 12-60090-CR-KMW

This indictment charges defendants Maritza Lorza Ramirez and James Velasco Gonzalez with conspiracy to commit money laundering and substantive counts of money laundering. More specifically, the indictment alleges that between January 2006 and December 2010, Lorza and Velasco laundered approximately $3 million in health care fraud proceeds for several companies using their own corporations, including Celebration Home Services, Inc., 4 All Your Needs, Inc., VPP Staffing, Inc, and Work Force Innovations, Inc. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Orlando Conrado Piedra Jr., Case No. 12-60091-CR-KMW

This indictment charges Orlando Piedra, an accountant, with conspiracy to commit money laundering and substantive counts of money laundering. More specifically, the indictment alleges that between June 2007 and September 2009, Piedra laundered approximately $500,000 in health care fraud proceeds for several companies through his own company, Media Health Consultants, Inc. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Armando “Manny” Gonzalez, John Thoen, Wondera Eason, Paul Thomas Layman, Alexandra Haynes, Serena Joslin, Ivon Perez, Daniel Martinez, Raymond Rivero, Case No. 12-20291-CR-Altonaga

Armando “Manny” Gonzalez, John Thoen, Wondera Eason, Paul Thomas Layman, Alexandra Haynes, and Serena Joslin are charged with one count of conspiracy to commit health care fraud through a company called Health Care Solutions Network (HCSN). Additionally, defendants Gonzalez, Daniel Martinez, Raymond Rivero, and Ivon Perez are charged with conspiracy to receive and pay health care kickbacks; defendants Martinez, Rivero, and Perez are charged with substantive counts of soliciting and receiving health care kickbacks; defendants Gonzalez and Thoen are charged with one count of conspiracy to commit money laundering; and defendant Gonzalez is charged with substantive counts of money laundering. More specifically, the indictment alleges that between November 2004 and March 2011, Gonzalez, Thoen, Eason, Layman, Haynes, and Joslin conspired to submit approximately $63 million in false claims to Medicare and Medicaid for mental health services that were neither necessary nor provided. The indictment also alleges that Gonzalez conspired with owners of Assisted Living Facilities (ALFs), including Martinez, Rivero, and Perez to pay and receive health care kickbacks in exchange for referring Medicare beneficiaries to HCSN. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Sarah Da Silva Keller, Case No. 12-20289-CR-Cooke

Sarah Da Silva Keller is charged with one count of conspiracy to commit health care fraud. More specifically, the criminal information alleges that between April 2006 and February 2008, Keller conspired with others at HCSN to submit false claims to Medicare for mental health services that were neither medically necessary nor provided. The information further alleges that HCSN submitted approximately $63 million in false claims to Medicare. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Alba Serrano, Case No. 12-20285-CR-Seitz

Alba Serrano is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Serrano, the owner of Elsa’s House of the Elderly, a Miami-Dade ALF, referred residents from her ALF to American Therapeutic Corporation (ATC) in exchange for kickbacks. ATC was a Community Mental Health Center (CMHC) that submitted false claims for intensive mental health services, called Partial Hospitalization Program, based on Serrano’s Medicare beneficiary referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Bobby Ramnarine, Case No. 12-20288-CR-Middlebrooks

Bobby Ramnarine is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Ramnarine, the owner of Elmina’s ALF, in Broward County, recruited residents from Elmina’s to become patients at ATC in exchange for kickbacks. ATC submitted false claims for PHP services based on Ramnarine’s Medicare beneficiary referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Giuseppe Pellerito, Case No. 12-20292-CR-Cooke

In this case, defendant Giuseppe Pellerito is charged with conspiracy to receive health care kickbacks and substantive counts of receiving kickbacks. The indictment alleges that Pellerito, the owner of Florida Sober House (FSH), received kickbacks for recruiting residents from FSH to become patients at ATC. ATC, in turn, submitted false claims for PHP based on Pellerito’s referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Hassan Collins, Case No. 12-20286-CR-Moore

Hassan Collins is charged with one count of conspiracy to pay and receive health care kickbacks. According to the criminal information, Collins was the owner of New Way Recovery Inc. (NWR), which operated several halfway houses in Broward County. Collins allegedly received kickbacks for recruiting Medicare beneficiaries who resided at NWR to become patients at ATC. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Jean Luc Veraguas, Case No. 12-20287-CR-Moreno

Jean-Luc Veraguas is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Veraguas was the owner of Neu Ways Inc., which operated several halfway houses in Broward County. Veraguas allegedly referred residents at his houses to ATC in exchange for kickbacks. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Pablo Orama, Vivian Augustine, a/k/a Vivian Salazar, Ariane Marchioro Amorim, Jose Orelvis Ortega, Marlen Diosdada Garcia, Ivon Perez, Marianela Terrero, Jose Abreu-Gonzalez, Elba M. Caicedo, Carlos A. Herrera, Marisela Sherwood, Nancy Diaz, Daymi Fuentes Gil, Olga Martinez Rodriguez, Yuria Perez Rivero, and Joel Loyola, Case No. 12-20265-CR-Middlebrooks(s)

In this case, 16 defendants are charged with conspiracy to pay and receive health care kickbacks and substantive counts of paying and receiving kickbacks in connection with a federal health care program. According to the indictment, defendant Pablo Orama was the owner of Superstar Home Health, a Miami-Dade County home health agency that purportedly provided skilled nursing services and physical therapy to homebound Medicare beneficiaries. Vivian Augustine and Ariane Amorim were employees of the company. Jose Orelvis Ortega, Marlen Garcia, Ivon Perez, Marianela Terrero, Jose Abreu-Gonzalez, Elba Caicedo, Carlos Herrera, Marisela Sherwood, and Nancy Diaz were recruiters who offered money to Medicare beneficiaries in return for their agreement to serve as patients at Superstar. Defendants Daymi Fuentes Gil, Olga Rodriguez, Yuria Rivero, and Joel Loyola were Medicare beneficiaries who accepted kickbacks in return for agreeing to serve as patients at Superstar. This case is being prosecuted by Assistant U.S. Attorney Eric E. Morales.

U.S. v. Jorge Luis Reyes and Waldo Gonzalez, Case No. 12-14030-CR-Moore

This indictment charges Jorge Luis Reyes and Waldo Gonzalez, owners of a medical clinic that purported to treat HIV-positive Medicare beneficiaries at locations in Miami-Dade and St. Lucie Counties. According to the indictment, between November 2005 and January 2009, the defendants submitted approximately $15,201,162 in fraudulent claims to Medicare for treatment that was not provided, and in many cases would not have been medically necessary. The majority of the fraudulent claims (more than $13.6 million) were submitted to private insurance companies that were a Medicare Advantage contractor under Part C of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney Marc Osborne.

U.S. v. Manotte Bazile, Case No. 12-20284-CR-Lenard

Defendant Manotte Bazile, a former social worker and licensed intern at Biscayne Milieu, was charged with health care fraud conspiracy for purportedly treating patients who did not qualify for PHP treatment. This case is part of larger indictment involving of Biscayne Milieu, a CMHC that was involved in the submission of $57 million in false claims to Medicare for purportedly providing PHP services to Medicare beneficiaries who did not qualify for or receive the treatments that were billed to Medicare. In this case, Bazile assisted non-U.S. citizen patients by completing immigration forms on their behalf that falsely indicated that the patients suffered from mental illnesses, thereby fraudulently enabling the patients to avoid taking the citizenship test. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

U.S. v. Roselyn Nicole Charles, Case No. 12-20283-CR-Ungaro

Defendant Roselyn Nicole Charles, a former patient recruiter at Biscayne Milieu, was charged with conspiracy to pay health care fraud kickbacks. More specifically, the criminal information alleges that Charles recruited patients to participate in Biscayne Milieu’s PHP in exchange for kickbacks. These patients, who did not qualify for PHP treatment, were promised assistance with their U.S. citizenship applications in exchange for their participation in Biscayne Milieu’s PHP. This case is part of larger indictment of Biscayne Milieu, a CMHC that was involved in the submission of more than $57 million in false claims to Medicare for purportedly providing PHP services to Medicare beneficiaries who did not qualify for PHP treatment or receive the treatments that were billed to Medicare. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

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 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.

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 nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. Miami was the first Strike force city in the nation, and the model for others that followed.

An indictment or information is only an accusation and defendants are presumed innocent until proven guilty.

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.”

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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.


Eight Los Angeles-Area Residents Charged in an Alleged Medicare Fraud

May 2, 2012

The Federal Bureau of Investigation (FBI) on May 2, 2012 released the following:

“Eight Los Angeles-Area Residents Charged in Nationwide Medicare Fraud Strike Force Takedown

Total of 107 Defendants Charged in Seven Cities for Approximately $452 Million in False Billing

LOS ANGELES—Eight Los Angeles-area residents, including two doctors, were charged today for their roles in schemes to submit more than $14 million in false billing to Medicare, announced the Departments of Justice and Health and Human Services (HHS).

The charges in Los Angeles are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that led to charges against 107 individuals for their alleged participation in schemes to collectively submit more than $452 million in fraudulent claims to Medicare. This takedown involved the highest amount of false Medicare billing in a single takedown in strike force history.

“The results we are announcing today are at the heart of an Administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said United States Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

“Medicare fraud drains vital resources and harms consumers across the nation,” said United States Attorney André Birotte Jr. “The problem is national in scope and it calls out for the type of coordinated national response that today’s crackdown represents. This office is dedicated to working with all our partners, both locally and nationally, to protect this important public program that serves our elderly and disabled.”

“As today’s strike force operation demonstrates, health care fraud is not limited to just one or two types of health care providers,” said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of HHS’s Office of Inspector General (OIG). “Whether it is a physician, a business owner, or any other provider, OIG and our law enforcement partners are committed to pursuing those that attempt to steal precious dollars from the Medicare program.”

According to court documents filed in the Central District of California, two Orange County doctors and two of their co-schemers were charged for allegedly submitting nearly $5.7 million in false claims to Medicare for durable medical equipment (DME). Specifically, the defendants billed Medicare for enteral nutrition, a liquid nutritional supplement. Medicare will only pay for enteral nutrition if a patient has a feeding tube. According to the indictment, Dr. Augustus Ohemeng, 62, of Buena Park, and Dr. George Tarryk, 72, of Seal Beach, wrote fraudulent prescriptions for enteral nutrition for patients who did not have feeding tubes. Co-defendant George Samuel Laing, 41, of Sylmar, who managed the clinic where Tarryk and Ohemeng practiced, allegedly received kickbacks in exchange for referring the prescriptions to Ivy Medical Supply, owned by co-defendant Emmanuel Chidueme, 59, of Mira Loma. Ivy then fraudulently billed Medicare for the enteral nutrition, even though it was not medically necessary and was not delivered to patients in the quantities billed to Medicare. Ohemeng, Tarryk, Laing, and Chidueme were arrested this morning and are scheduled to make their initial appearances before a U.S. Magistrate Judge this afternoon.

“The charges announced today emphasize disturbing health care fraud trends, including the arrest of physicians, that exploit federal health care meant for those in need,” said Steven Martinez, Assistant Director in Charge of the FBI’s Los Angeles Field Office. “The cases charged in Southern California and around the U.S. indicate the staggering amount of fraud adversely affecting the U.S. economy and illustrate the need for the continued focus on protecting federally funded health care programs.”

In a separate case, two defendants were arrested on charges related to their DME company, Latay Medical Services, which allegedly submitted more than $8 million in fraudulent billings to Medicare for power wheelchairs, orthotics, and hospital beds that were either not provided or were medically unnecessary. The indictment charges Latay’s owner, Bolademi Adetola, 46, of Harbor City, and Latay employee Yuri Martin Lopez, 46, of Lawndale, with obtaining fraudulent prescriptions for the DME, creating fake documentation to make it seem as though the DME had been delivered when it had not, and delivering DME less expensive than that listed on Latay’s Medicare claims.

Two additional defendants are scheduled to self-surrender today on charges related to Greatcare Home Health Inc., a home health agency that received more than $5.4 million from Medicare for skilled nursing and physical therapy services that were often either never performed or performed by unlicensed individuals. Greatcare’s owner, Hee Jung Mun, also paid illegal kickbacks to doctors, individuals known as marketers, and patients themselves in order to recruit Medicare beneficiaries. Mun, along with three other Greatcare employees, have already pleaded guilty to the fraud and are awaiting sentencing before U.S. District Judge Dean D. Pregerson. Yeong Ja Lee, 50, of Mid-City, is scheduled to make her initial court appearance this afternoon on charges that she visited and provided services to patients without a license and created false documentation for Greatcare and one of its referring doctors. Sang Whan Ahn, 60, of Koreatown, is also scheduled to appear on charges that she acted as a marketer, accepting kickbacks in exchange for referring patients to Greatcare.

As a part of the operation, members of the strike force in Los Angeles also executed three search warrants today.

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 nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 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.

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 Central District of California, the Southern District of Florida, the Eastern District of Michigan, the Southern District of Texas, the Middle District of Louisiana, the Northern District of Illinois, and the Middle District of Florida; and agents from the Federal Bureau of Investigation, HHS-OIG, and state and local Medicaid Fraud Control Units, including the California Department of Justice and Los Angeles Sheriff’s Department’s Health Authority Law Enforcement Task Force.

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.

CONTACT:
Assistant United States Attorney Kristen A. Williams
Major Frauds Section
(213) 894-0526

Special Assistant United States Attorney Grant Gelberg
Major Frauds Section
(213) 894-2872

Assistant United States Attorney Consuelo S. Woodhead
Major Frauds Section
(213) 894-3987″

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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.


Bryan Day Charged by a Federal Grand Jury in an Indictment Alleging a $1 Million Medicare Fraud Scheme

May 2, 2012

The Federal Bureau of Investigation (FBI) on May 2, 2012 released the following:

“Chicago-Area Man Charged in $1 Million Medicare Fraud Scheme

CHICAGO— A south suburban resident who purported to provide psychotherapy services to Medicare patients was charged with participating in a $1 million health care fraud scheme, the Departments of Justice and Health and Human Services announced today.

The defendant, Bryan Day, 42, of Richton Park, who is not a licensed medical professional, operated and was part owner of Charm Development LLC, located in Chicago Heights, which purported to provide psychotherapy services to patients, primarily in nursing homes and long-term care facilities. Day was charged with six counts of health care fraud in an indictment returned by a federal grand jury last week and announced today by Patrick J. Fitzgerald, 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 D. Grant, Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation.

Day is scheduled to be arraigned at 1:30 p.m. May 14 before U.S. District Judge Virginia Kendall in federal court in Chicago.

The indictment alleges that between January 2008 and June 2009 Day submitted fraudulent claims to Medicare totaling $1,078,733, and caused Medicare to pay approximately $438,852. Day allegedly submitted claims for individual psychotherapy services purportedly performed by Doctor A, knowing that Doctor A did not provide the services claimed. In addition, the claims included services that were purportedly provided at times when Doctor A was not present at Charm and not licensed by the state of Illinois. The claims also included services that were purportedly provided by Doctor A after Doctor A was no longer employed by Charm, and Day allegedly submitted Medicare claims for services purportedly rendered by Doctor A in excess of 24 hours a day.

According to the indictment, Doctor A was licensed to practice medicine in Illinois until July 31, 2008, and Doctor A was employed by Charm from May 2005 until February 2009.

The indictment seeks forfeiture of approximately $438,852. The government is represented by Assistant U.S. Attorney Michael J. Chmelar. Each count of health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine, or an alternate fine totaling twice the loss or twice the gain, whichever is greater. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.

An indictment contains merely charges 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 guilt beyond a reasonable doubt.

The case is part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that led to charges against 107 individuals for their alleged participation in schemes to collectively submit approximately $452 million in fraudulent claims to Medicare. This takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.

“The results we are announcing today are at the heart of an Administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

The Medicare Fraud Strike Force operations, which expanded to Chicago in February 2011, 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. Approximately three dozen defendants have been charged in health care fraud cases since the strike force began operating in Chicago last year.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 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.”

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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.


Medicare Fraud Strike Force Charges 107 Individuals for Approximately $452 Million in Alleged False Billing

May 2, 2012

The Federal Bureau of Investigation (FBI) on May 2, 2012 released the following:

“WASHINGTON— Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in seven cities has resulted in charges against 107 individuals, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing.

Attorney General Holder and Secretary Sebelius were joined in the announcement by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, FBI Deputy Director Sean Joyce, Deputy Inspector General for Investigations Gary Cantrell of the HHS Office of Inspector General (HHS-OIG), and Dr. Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS).

This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in strike force history.

HHS also suspended or took other administrative action against 52 providers following a data-driven analysis and credible allegations of fraud. The new health care law, the Affordable Care Act, significantly increased HHS’s ability to suspend payments until an investigation is complete.

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. More than 500 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 20 search warrants in connection with ongoing strike force investigations.

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

“Today’s arrests send a strong message to criminals that the consequences of committing Medicare fraud are serious,” said HHS Secretary Sebelius. “In addition to these arrests, we used new authority from the health care law to stop all future payments to 52 health care providers suspected of fraud before they are ever made. Today’s actions are another example of how the Affordable Care Act is helping the Obama Administration fight fraud and strengthen the Medicare program.”

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, 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 such as home health care, 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 oftentimes 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 submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of conspiring to submit a total of approximately $452 million in fraudulent billing.

“As charged in the indictments, these fraud schemes were committed by people up and down the chain of healthcare providers,” said Assistant Attorney General Breuer. “Today’s operations mark the fourth in a series of historic Medicare fraud takedowns over the past two years. These indictments remind us that Medicare is an attractive target for criminals. But it should also remind those criminals that they risk prosecution and prison time every time they submit a false claim.”

“Health care fraud is not a victimless crime,” said FBI Deputy Director Joyce. “Every person who pays for health care benefits, every business that pays higher insurance costs to cover their employees, every taxpayer who funds Medicare—all are victims. The FBI will continue to work closely with our federal, state, and local law enforcement partners to address health care vulnerabilities, fraud and abuse. We will use every tool we have to ensure our health care dollars are used to care for the sick—not to line the pockets of criminals.”

“Today over 200 OIG special agents, forensic examiners, and analysts have deployed throughout the country to ensure that those responsible for committing Medicare fraud are held accountable,” said HHS-OIG Deputy Inspector General Cantrell. “OIG is committed to the strike force model and will continue to use advanced data analytics along with traditional investigative methods to root out those who steal from our Medicare program.”

In Miami, a total of 59 defendants, including three nurses and two therapists, were charged today and yesterday for their participation in various fraud schemes involving a total of $137 million in false billings for home health care, mental health services, occupational and physical therapy, DME and HIV infusion. Two of these 59 defendants were originally charged in April 2012 but were indicted on additional charges today. In one case, 10 defendants were charged for participating in a fraud scheme at Health Care Solutions Network, which led to approximately $63 million in fraudulent billing for community mental health center (CMHC) services. Court documents allege that therapists at Health Care Solutions Network were instructed to alter notes and other medical documents to justify CMHC services for beneficiaries who did not need the services.

Seven individuals were charged today in Baton Rouge, Louisiana for participating in a fraud scheme involving $225 million in false claims for CMHC services. The case represents the largest CMHC-related scheme ever prosecuted by the Medicare Fraud Strike Force. According to court documents, the defendants recruited beneficiaries from nursing homes and homeless shelters, some of whom were drug addicted or mentally ill, and provided them with no services or medically inappropriate services.

In Houston, nine individuals, including one doctor and one nurse, were charged today with fraud schemes involving a total of $16.4 million in false billings for home health care and ambulance services. According to court documents, the owners and operators of four different ambulance companies billed Medicare for ambulance rides that were medically unnecessary.

Eight defendants, including two doctors, were charged in Los Angeles for their roles in schemes to defraud Medicare of approximately $14 million. In one case, two individuals allegedly billed Medicare for more than $8 million in fraudulent billing for DME.

In Detroit, 22 defendants, including four licensed social workers, were charged for their roles in fraud schemes involving approximately $58 million in false claims for medically unnecessary services, including home health, psychotherapy, and infusion therapy.

In Tampa, Florida, a pharmacist was charged with illegal diversion of controlled substances. One defendant was charged last week in Chicago for his alleged role in a scheme to submit approximately $1 million in false billing to Medicare for psychotherapy services.

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 nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 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.

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. Attorneys’ Offices for the Southern District of Florida, the Eastern District of Michigan, 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.”

Federal Mail Fraud Crimes – 18 U.S.C. § 1341

Federal Wire Fraud Crimes – 18 U.S.C. § 1343

Federal Bank Fraud Crimes – 18 U.S.C. § 1344

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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

————————————————————–

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.


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.

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