Healthcare Fraudsters Busted

Discussion in 'Federal Crimes' started by Larry Levine, Dec 21, 2018.

  1. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    hursday, December 20, 2018

    Fort Myers Doctor Agrees To Pay More Than $1.7 Million To Resolve Allegations Of Fraud

    Fort Myers, FL – United States Attorney Maria Chapa Lopez announces that Dr. Jonathan Daitch, M.D. has agreed to a civil settlement that will pay $1.718 million to the United States to resolve allegations that he violated the False Claims Act by receiving illegal kickbacks associated with the provision of anesthesia services and by causing the submission of medically unnecessary urine tests.

    During the relevant period, Dr. Daitch was a practicing interventional pain management specialist and one of two principal owners of Advanced Pain Management Specialists, P.A., which is located in Fort Myers. The other principal owner, Dr. Michael Frey, previously pleaded guilty to two counts of conspiracy to receive healthcare kickbacks and has agreed to a civil settlement with the United States for $2.8 million.

    The civil settlement announced today resolves allegations that, from 2013 through 2016, Dr. Daitch caused the submission of false claims to Medicare and Tricare by causing the submission of definitive Urine Drug Testing (“UDT”) in circumstances where such testing was not reasonable or medically necessary. Definitive UDT testing was financially lucrative for Dr. Daitch because the testing was performed at Advanced Pain’s own in-house laboratory and was billed for by the practice.

    In addition, the civil settlement resolves kickback allegations associated with anesthesia services provided by Anesthesia Partners of SWFL, LLC. Anesthesia Partners was owned by Dr. Daitch and his partner Dr. Frey and provided anesthesia services exclusively for the procedures performed by the Advanced Pain physicians. Anesthesia Partners contracted with Certified Registered Nurse Anesthetists (“CRNAs”) to provide the anesthesia services. These CRNAs were paid a contracted rate. Anesthesia Partners then billed Medicare and Tricare directly for the anesthesia services they provided. This arrangement resulted in improper remuneration to Dr. Daitch as one of the owners Anesthesia Partners. The United States contends that Dr. Daitch’s ownership interest in Anesthesia Partners, and the remuneration he received through this ownership interest, induced him to refer his patients for anesthesia services to Anesthesia Partners.

    On July 9, 2018, the Centers for Medicare & Medicaid Services (“CMS”) suspended all Medicare payments to Anesthesia Partners. As part of this settlement, the United States will retain the funds withheld as a result of the suspension.

    “With this settlement, we have successfully held both of the principal owners of Advanced Pain accountable for their abuse of the federal programs,” said United States Attorney Chapa Lopez. “The investigation of this healthcare company, which has resulted in three guilty pleas and more than $4.5 million returned to the taxpayers, is a great example of our commitment to enforce our nation’s health care laws.”

    In addition to the civil settlement, Dr. Daitch, Advanced Pain, and Park Center for Procedures (“Park Center”—an ambulatory surgical center also owned by Drs. Daitch and Frey, which provides services to patients of Advanced Pain) have entered into a five-year Corporate Integrity Agreement with the Office of Inspector General of the United States Department of Health and Human Services. The Corporate Integrity Agreement, among other obligations, requires Dr. Daitch, Advanced Pain, and Park Center to hire an independent review organization to monitor both claims and financial arrangements. That information, along with other information, will then be reported annually to OIG.
     
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  2. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Thursday, December 20, 2018

    Defendants In Louisville Area Chiropractic Scheme Sentenced To Federal Prison
    Fraudulently Billed Insurance Companies approximately $5 Million for Services Never Performed

    LOUISVILLE, Ky. – U.S. District Judge Rebecca G. Jennings has sentenced defendants of a health care fraud scheme that billed insurance companies for services never performed to years in federal prison, announced United States Attorney Russell M. Coleman.

    “This sentence sends a message that theft in the Western District of Kentucky – health care related or otherwise – results in real time in federal prison,” stated U.S. Attorney Russell Coleman

    On Wednesday, the Court sentenced Ledinson Chavez to 74 months in prison for health care fraud, money laundering, and aggravated identity theft. The sentence is followed by 2 years supervised release, and $1,016,393.23 in restitution. There is no parole in the federal system.

    Sergio Betancourt was sentenced on Wednesday to 37 months imprisonment for health care fraud, money laundering and crimes committed while on pre-trial release. The sentence will be followed by 2 years supervised release, and $1,153,770.34 in restitution.

    According to the evidence before the Court, beginning no later than on or about June 12, 2012, and continuing through on or about November 1, 2014, Claudia Lopez, Ledinson Chavez, Oskel Lezcano, Ariel Borrego-Hernandez, Sergio Betancourt and Yuriesky Diaz Rodriguez recruited unsuspecting chiropractors for employment in Louisville area chiropractic clinics in order to obtain and use the chiropractors’ names and National Provider Identifiers (NPI) to fraudulently bill insurance companies. Each chiropractor provided his/her NPI number to Lopez and Lezcano in order to credential the clinics with various insurance companies.

    Thereafter, the group of defendants recruited employees from Jeffboat and other local employers to seek chiropractic services from the clinics. However, unbeknownst to the chiropractors, the clinics billed approximately $5,000,000 for methocarbamol injections (a muscle relaxant), using the patients’ names, dates of birth, insurance/policy numbers, addresses, and patient IDs/Social Security Numbers for injections. Most of the patients from Jeffboat were paid to go to the clinics by the defendants and were told the injections were being billed, according to testimony during trial.

    Borrego-Hernandez, Lopez, Betancourt, Chavez and allegedly Lezcano operated and controlled multiple chiropractic clinics in the Louisville area including: Xpress Diagnostics Center, Inc.; Prudential Chiropractic Medical Center, PLLC; Klondike Chiropractic Medical Center, LLC; Be Well Chiropractic Center, Corp.; and Chiropractic and Medical Center, LLC, even though the clinics were placed in various chiropractors’ names.

    According to additional court documents on or about March 14, 2017, and March 17, 2017, while on pre-trial release, Borrego and Lopez conspired to traffic in marijuana – which caused about 109 pounds of marijuana to be transported from Colorado to Kentucky.

    Lopez was sentenced in September to 61 months imprisonment, followed by 3 years of supervised release and ordered to pay $232,617.96 in restitution, as well as forfeit an Audi Q-7 and $53,775 in proceeds.

    Ariel Borrego-Hernandez was sentenced in October to 54 months in prison, followed by 3 years supervised release and ordered Borrego-Hernandez to pay $89,161.81 in restitution, and over $53,000 in forfeited cash.

    Yuriesky Diaz Rodriguez was sentenced in December to 18 months of probation and ordered to pay $104,624.70 in restitution.
     
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  3. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Wednesday, December 19, 2018

    Eight Dallas-Area Pharmacy Owners and Marketers Charged in $9 Million Kickback Scheme

    Eight Dallas-area pharmacy owners and marketers were charged in an indictment unsealed today for their roles in a scheme involving approximately $92 million in compound drug claims to TRICARE and the U.S. Department of Labor (DOL), which were allegedly the product of over $9.1 million in illegal kickbacks.

    Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, Special Agent in Charge Michael Mentavlos of the Defense Criminal Investigative Service (DCIS) Southwest Field Office, Special Agent in Charge Steven Grell of the U.S. Department of Labor - Office of Inspector General’s (DOL-OIG) Dallas Region and Special Agent in Charge CJ Porter of the Office of Inspector General for the U.S. Department of Health and Services (HHS-OIG) made the announcement.

    Richard Hall, 48; Scott Schuster, 47; Dustin Rall, 43; George Lock Paret, 34; and Michael Ranelle, 49, all of Fort Worth, Texas; John Le, 43, of Dallas; Quintan Cockerell, 37, of Manhattan Beach, California; and Turner Luke Zeutzius, 36, of Horseshoe Bay, Texas, were each charged in an indictment filed Dec. 12 in the Northern District of Texas with one count of conspiracy to defraud the United States and pay and receive kickbacks. Hall, Schuster, Rall, and Le were each additionally charged with four counts of paying kickbacks. Zeutzius was additionally charged with two counts of receiving kickbacks and Ranelle and Cockerell were each charged with one count of receiving kickbacks. Hall, Schuster, Rall, Le and Ranelle were arrested yesterday and had their initial court appearances before U.S. Magistrate Court Judge Irma C. Ramirez in Dallas. Paret, Cockerell and Zeutzius self-surrendered this morning and will have their initial court appearances today at 2 p.m. CST before Judge Ramirez.

    According to the indictment, from May 2014 to September 2016, Hall, Schuster, Rall, Paret, Le and their co-conspirators allegedly engaged in a scheme to pay kickbacks and bribes for the referral of TRICARE and DOL beneficiaries to obtain expensive compound drugs. Hall, Shuster and Rall were co-owners of Rxpress Pharmacy and Xpress Compounding, compound pharmacies located at 1000 W. Weatherford St. in Fort Worth.

    As alleged in the indictment, Rxpress and Xpress were separate in name only; Rxpress Pharmacy and Xpress Compounding employed the same staff, operated out of the same building, and utilized a call center to direct prescriptions depending on whether the prescriptions were for private or federal insurance. The indictment alleges that both companies utilized the same marketers but paid them differently depending on whether they were receiving a commission on a federal or private prescription, in order to disguise the illegal kickback payments on federal prescriptions. Specifically, Hall, Schuster, Rall, Paret and Le allegedly devised a scheme to make kickback payments to marketers through Xpress Compounding for the referral of federal prescriptions. These marketers were allegedly set up as sham “W-2” employees to appear as though they were bona fide employees of Xpress Compounding. At the same time, these marketers were paid as 1099 contractors by Rxpress Pharmacy, the indictment alleges.

    The indictment alleges that as a result of the scheme, Zeutzius was paid approximately $4.4 million, Cockerell (through an unnamed person) was paid approximately $2.1 million, and Ranelle was paid approximately $2.6 million in illegal kickbacks, for a total of approximately $9.1 million in illegal kickbacks.

    The charges in the indictment are merely allegations and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
     
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  4. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Wednesday, December 19, 2018

    Greensburg Doctor Indicted for Illegally Distributing Controlled Substances and Health Care Fraud Now Facing Additional Charges of Witness Tampering and Lying to the FBI

    PITTSBURGH, PA - A family practice physician has been indicted by a federal grand jury in Pittsburgh on charges of unlawfully dispensing controlled substances, health care fraud, tampering with a witness and false statements to the government, United States Attorney Scott W. Brady announced today.

    The 56-count superseding indictment, returned on Dec. 18, named Milad Shaker, 49, of Greensburg, Pa., as the sole defendant.

    According to the superseding indictment, from 2014 to 2017, Shaker, a licensed physician, unlawfully distributed controlled substances, including Vicodin, Percocet, Tramadol and others, in return for sexual favors provided to him either physically or by electronic communication, such as text messaging. Shaker is also charged with health care fraud for causing fraudulent claims to be submitted to Highmark Health Plan and Aetna. The superseding indictment further alleges that Shaker tampered with a witness and was untruthful to agents of the Federal Bureau of Investigation.

    The law provides for a per count sentence of 20 years in prison, a fine of $1,000,000.00, or both, for counts 1-36; five years in prison, a fine of $250,000, or both on counts 37-52; 20 years in prison and fines of $500,000.00 for counts 53-54; 20 years in prison and $250,000 in fines on count 55; and five years in prison and $250,000 fine on count 56. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offenses and the prior criminal history, if any, of the defendant.

    Assistant United States Attorney Robert S. Cessar is prosecuting this case on behalf of the government.

    The Federal Bureau of Investigation conducted the investigation leading to the superseding indictment in this case.
     
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  5. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Tuesday, December 11, 2018

    Former Owner of Chicago Medical Clinic Guilty of Selling Opioid Prescriptions to Patients Who Lacked Medical Need for the Drugs

    CHICAGO — The former owner of a Chicago medical clinic admitted in federal court today that he sold opioid prescriptions to patients whom he knew lacked a legitimate medical need for the drugs.

    MOHAMMED SHARIFF, who owned Midtown Medical Center in Chicago’s Uptown neighborhood, conspired with a physician to sell oxycodone, hydrocodone, and other medications to patients whom they knew lacked a medical reason for taking the drugs, according to a plea agreement filed today in U.S. District Court in Chicago. At Shariff’s direction, the physician, DR. THEODORE GALVANI, wrote prescriptions for the powerful opioids without conducting an appropriate physical examination or performing any medical tests, the plea agreement states. Dr. Galvani often met with more than 70 patients per day, sometimes seeing them in groups of two or more at the same time, the plea agreement states. At Shariff’s direction, a “crew leader” often organized groups of people to see Dr. Galvani and obtain opioid prescriptions from him, the plea agreement states.

    Shariff, 68, of Lincolnwood, pleaded guilty to one count of conspiracy to knowingly dispense controlled substances outside the usual course of professional practice and without a legitimate medical purpose. The charge carries a maximum prison sentence of 20 years and a maximum fine of $1 million. U.S. District Judge Harry D. Leinenweber set sentencing for March 19, 2019.

    Dr. Galvani, of Spring Grove, previously pleaded guilty to drug conspiracy charges. He is awaiting sentencing.

    Shariff’s guilty plea was announced by John R. Lausch, Jr., United States Attorney for the Northern District of Illinois; Brian McKnight, Special Agent-in-Charge of the Chicago Field Division of the U.S. Drug Enforcement Administration; Jeffrey Sallet, Special Agent-in-Charge of the Chicago office of the Federal Bureau of Investigation; Gabriel L. Grchan, Special Agent-in-Charge of the Internal Revenue Service Criminal Investigation Division in Chicago; and Lamont Pugh III, Special Agent-in-Charge of the Chicago Regional Office of the U.S. Department of Health and Human Services Office of Inspector General. The government is represented by Assistant U.S. Attorneys Peter M. Flanagan and Andrew C. Erskine.

    According to Shariff’s plea agreement, individuals paid $100 to $200 in cash to Shariff and Galvani in exchange for the improper prescriptions. For individuals insured by Medicare, Shariff and Dr. Galvani prescribed the opioids and then submitted or caused others to submit false claims to Medicare, seeking reimbursement for purported office visits with those individuals, the plea agreement states. From February 2012 to March 2013, Shariff and Dr. Galvani received a total of at least $584,188 through the improper prescription scheme, the plea agreement states. Shariff admitted that he personally kept at least $292,094 as his share of the proceeds. Shariff further admitted that, during the same period of time, he and Dr. Galvani together were responsible for prescribing more than two kilograms of oxycodone, more than 595,000 hydrocodone pills, and more than 190,000 alprazolam pills (commonly known as Xanax), to individuals whom they knew had no legitimate medical need for those drugs.

    In addition to the improper prescriptions, Shariff admitted in his plea agreement that he attempted to carry out a separate fraud scheme involving a home health care company that he owned, Elgin-based Home Health Resource LLC. In a May 2016 meeting in Chicago, Shariff offered to pay an unidentified physician $500 each time the doctor certified a Medicare beneficiary as eligible for home health care and referred the patient to Shariff’s company, the plea agreement states. Unbeknownst to Shariff, the doctor was cooperating with law enforcement, and their conversation was surreptitiously recorded. During the meeting, Shariff claimed that he arranged for his home health company’s employees to conceal the fact that their clients were not truly eligible for home health services. Shariff told the cooperating physician that he instructed nurses at the company to “tell the patient you are homebound,” and that “when the doctor come, don’t say that you go out and drive and this and that. Don’t tell anybody you drive, don’t tell anybody you’re taking the bus, even going to the groceries. If anybody asks, ‘I stay home. I’m homebound.’”
     
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  6. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Tuesday, December 11, 2018

    Warren County Doctor Sentenced to 40 Months Imprisonment for Illegallly Distributing Opioids and Medicare Fraud

    St. Louis, MO – Dr. Philip Dean, 62, a resident of Warren County, Missouri, was sentenced today to 40 months of imprisonment and ordered to pay restitution to the Medicare and Medicaid programs in the amount of $312,377. Dr. Dean previously pled guilty to two felony charges, illegally distributing opiate medications and making a false statement to the Medicare program, on August 22, 2018. Dr. Dean was sentenced by Senior United States District Judge E. Richard Webber.

    According to his plea agreement, Dr. Dean operated a medical office in Warren County, Missouri. Dr. Dean had personal relationships with three women, living with these women for some time periods. While engaging in personal relationships with these women, Dr. Dean also prescribed them with prescription opioid pain relief medications, including Oxycodone, Hydrocodone, and several formats of Fentanyl. The two felony charges from Dr. Dean’s plea agreement involve two of these women, referred to by their initials in the plea agreement as R.W. and C.H.

    Regarding patient R.W., before his prescribing decisions at issue in this case, Dr. Dean was aware that R.W. had lost her health care provider license after experiencing serious prescription drug abuse problems. Dr. Dean was also aware that R.W. had been involved in motor vehicle accidents and traffic stops by police after driving while intoxicated because of prescription drugs. Nevertheless, during 2015-16, Dr. Dean prescribed R.W. with assorted opioid medications, including a fentanyl medication that was only approved for medical use by cancer patients with break-through pain. R.W. does not have cancer. R.W. repeatedly consumed her thirty day supplies of these prescription drugs before thirty days had elapsed. Recognizing that prescribing R.W. with duplicative and overlapping prescriptions for thirty day supplies of opiates would raise suspicion, Dr. Dean repeatedly prescribed R.W. with additional opiate prescriptions using the name of R.W.’s family member. Medicare funded these prescriptions, not knowing that R.W. was ending up with these medications. Dr. Dean personally picked up and paid a co-payment for one of these hydrocodone prescriptions that he wrote for R.W. using another patient’s name.

    Regarding C.H., defendant issued her a prescription for Codeine, an opiate pain medication and controlled substance, on March 31, 2017 after exchanging text messages of a personal nature with her. Dr. Dean did not examine C.H. before issuing the prescription on March 31, 2017. According to medical records seized during the execution of a search warrant at the medical office, C.H. had not visited Dr. Dean’s office since January 24, 2017.

    Dr. Dean admitted in his plea agreement that his opioid prescribing decisions exposed these patients to a risk of serious bodily injury, given the potency and side effects of the drugs he was prescribing and the patients’ histories of drug problems.

    Steve Hanson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Kansas City Region, stated, “Regarding our agency’s ongoing efforts in combating our nation’s opioid crisis, our office will continue to aggressively pursue those who misuse their positions and recklessly prescribe medication to our beneficiaries.”

    “Prescription opioids serve an important purpose when used legitimately for patients suffering from chronic pain and illness. In this particular case, we had a doctor with the power to write prescriptions misrepresenting the truth, supplying narcotics to people with serious addiction issues that he was aware of and bilking all of us who pay taxes while doing it. The Drug Enforcement Administration will continue to pursue these bad actors to bring them to justice. Addiction to opioids is a serious illness and we will not allow doctors to abuse their authority for personal gain,” said Special Agent in Charge William J. Callahan of the Drug Enforcement Administration.
     
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  7. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Monday, December 10, 2018

    Unlicensed Dentist Convicted Of Healthcare Fraud, Conspiracy To Commit Healthcare Fraud, And Conspiracy To Violate The Anti-Kickback Statute

    Geoffrey S. Berman, the United States Attorney for the Southern District of New York, announced that LUIS OMAR VARGAS, an unlicensed dentist, was convicted last Friday, after a two-week jury trial, for defrauding health insurance companies by billing for false claims, billing for claims performed by him as an unlicensed provider, and for conspiring to pay kickbacks to his patients. The trial was presided over by United States District Judge Ronnie Abrams.

    U.S. Attorney Geoffrey S. Berman said: “Luis Omar Vargas defrauded taxpayer-funded health insurance plans and his patients by posing as a dentist licensed to practice, when he was not. Vargas billed for services he never performed and induced his patients to visit his dental clinic by providing them kickback payments. Now, for his fraud and abuse of the system, Vargas stands convicted of three crimes and faces a substantial term in prison.”

    According to allegations in the Indictment and evidence introduced at trial:

    From in or around 2012 through at least November 2017, in the Southern District of New York and elsewhere, VARGAS and others conspired and participated in a scheme to defraud insurance providers of more than $2 million. Vargas and others induced patients to be seen at a dental clinic on the Upper West Side of Manhattan by offering patients a $25 cash kickback. Once the patients were in the door, VARGAS and his coconspirators charged insurance companies for services that were never performed and for services performed by VARGAS that he was not licensed to perform.

    * * *

    VARGAS, 46, of Roselle, New Jersey, was convicted of one count of health care fraud and one count of conspiracy to commit health care fraud, each of which carries a maximum sentence of 10 years in prison, and one count of conspiracy to violate the Anti-Kickback Statute, which carries a maximum sentence of five years in prison. VARGAS will be sentenced on April 5, 2019, by Judge Abrams.

    Other members of the conspiracy, including Dr. Mehmet Dikengil, 70, and Anna Jones, 60, previously pled guilty to related offenses.
     
  8. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Tuesday, December 4, 2018

    Las Vegas Pharmacist Sentenced To Prison For Health Care Fraud Conspiracy
    Owner and operator of Atlas Specialty Pharmacy ordered to pay over $3.7 million in restitution

    LAS VEGAS, Nev. – A Las Vegas pharmacist was sentenced Monday by U.S. District Judge Richard F. Boulware II, to 14 months in prison and three years of supervised release for conspiring with others to commit health care fraud, announced U.S. Attorney Dayle Elieson for the District of Nevada. As part of his sentence, he was ordered to pay $3,749,121 in restitution.

    Nelson M. Mukuna, 41, previously pleaded guilty to conspiracy to commit health care fraud and structuring transactions to evade reporting requirements. He was the owner and operator of Atlas Specialty Pharmacy which concentrated in specialty drugs.

    The conspiracy was in place between July 2016 to December 2017. It started when Mukuna became friends with Robert Harvey, who in turn introduced him to co-conspirator Alejandro Incera, an Advanced Practice Registered Nurse. In November 2016, Mukuna and Incera conspired and agreed that Mukuna would provide Incera with Xeomin, a form of Botox injection, in exchange for Incera’s patient referrals to Atlas Pharmacy for their prescriptions. As their business relationship developed, Incera referred more patients to Atlas. By January 2017, Mukuna started paying Incera $100 cash for each patient referral. Soon after, Mukuna approached other providers and offered cash for their patient referrals. In November 2016, Incera introduced Mukuna to co-conspirator Leslie Kalyn who started engaging in the same kickback referral scheme. In January 2017, Mukuna agreed to pay his co-conspirators $200 per patient referral. The approximate kickback payments totaled $175,000.

    In an effort to conceal the kickback scheme, Mukuna structured cash withdrawals from his business bank account in order to avoid a Currency Transaction Report from being generated. Domestic financial institutions, like banks, are required to file transaction reports for cash transactions exceeding $10,000 in a single day.

    As a result of this prosecution, Atlas Pharmacy has closed and Mukuna has surrendered his pharmacy and DEA licenses.
     
  9. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Monday, December 3, 2018

    Federal Jury Convicts Chicago Doctor on Fraud Charges for Billing Insurance Companies for Nonexistent Treatment

    CHICAGO — A federal jury has convicted a Chicago doctor on fraud charges for billing insurance companies for purported chiropractic manipulations that were never performed.

    DR. PAUL MADISON, an anesthesiologist and pain management specialist, owned Watertower SurgiCenter LLC, an outpatient surgical center on North Michigan Avenue in Chicago. From 2005 to 2009, Dr. Madison directed Watertower’s billing staff to submit false bills to insurers for manipulation-under-anesthesia of body parts that chiropractors at Watertower had not actually performed. As part of the scheme, Dr. Madison and others falsified patient records to support the fraudulent health insurance claim forms. Dr. Madison then caused these fraudulent claims to be submitted to patients’ insurance companies for payment.

    The jury in federal court in Chicago on Thursday convicted Dr. Madison, 65, of Chicago, on all eleven counts against him. The conviction includes six counts of health care fraud, three counts of making false statements in connection with the delivery of health care services, and two counts of aggravated identity theft. U.S. District Judge Robert M. Dow, Jr., set sentencing for March 25, 2019.

    The verdict was announced by John R. Lausch, Jr., United States Attorney for the Northern District of Illinois; Jeffrey S. Sallet, Special Agent-in-Charge of the Chicago office of the Federal Bureau of Investigation; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor’s Office of Inspector General in Chicago. The government is represented by Assistant U.S. Attorneys Edward G. Kohler and Jennie Levin.

    Watertower SurgiCenter was an outpatient surgical center where a variety of medical and chiropractic procedures were performed, including manipulations-under-anesthesia. An MUA involves chiropractic adjustments on patients who had been anesthetized. Evidence at trial revealed that Dr. Madison disguised Watertower’s fraudulent billing by creating false medical and billing records. In at least two instances, Dr. Madison included in the fraudulent billings the names, addresses and dates of birth of patients without their knowledge.

    Each count of health care fraud is punishable by a maximum sentence of ten years in prison, while the false statement counts each carry a maximum penalty of five years. Each aggravated identity theft count carries a mandatory consecutive sentence of two years. The Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
     
  10. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Monday, November 26, 2018

    Behavioral Health Counselor Sentenced to Prison for Defrauding Medicaid

    OKLAHOMA CITY – SAMUEL OKERE, 61, of Oklahoma City, has been sentenced to a year in prison for Medicaid fraud, announced Robert J. Troester of the United States Attorney’s Office and Mike Hunter, Oklahoma Attorney General.

    Okere was a licensed professional counselor and owner of New Life Counseling Services. On November 15, 2017, a federal grand jury charged him with 224 counts of defrauding the Oklahoma Health Care Authority through false claims for behavioral health counseling. In particular, the indictment alleged that Okere billed for counseling sessions for multiple individuals, primarily children, at times when he could not have been counseling them. For example, some of the times and dates billed were when clients were at school. Others were when Okere was engaged in activities inconsistent with counseling, such as speaking on the phone with representatives of the Oklahoma Health Care Authority.

    Okere pleaded guilty to health care fraud on April 3, 2018.

    Today U.S. District Judge Stephen P. Friot sentenced Okere to a year and a day in federal prison, to be followed by three years of supervised release. Pursuant to his plea agreement, he has paid $141,545.16 in restitution to Medicaid. A portion of the restitution will go to SoonerCare and a portion to the Centers for Medicare and Medicaid Services. Judge Friot also ordered Okere to pay a fine of $10,000.
     
  11. Larry Levine

    Larry Levine Verified Criminal Litigator & Prison Consultant

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    Friday, November 16, 2018

    Burlington, New Jersey, Doctor Arrested for Role in $20 Million Telemedicine Compounded Medication Scheme

    NEWARK, N.J. – A Burlington, New Jersey, man was arrested Friday for his role in a telemedicine scheme to prescribe expensive compounded medications to patients who did not need them, U.S. Attorney Craig Carpenito announced.

    Dr. Bernard Ogon, 45, is charged by complaint with one count of conspiracy to commit health care fraud. He made his initial court appearance this afternoon before U.S. Magistrate Judge Joseph A. Dickson in Newark federal court and was released on $500,000 secured bond.

    According to documents filed in this case and statements made in court:

    Telemedicine allows health care providers to evaluate, diagnose, and treat patients remotely – without the need for an in-person visit –by interacting with a patient using telecommunications technology, such as the internet or telephone. Ogon was paid by various telemedicine companies to prescribe exorbitantly expensive compounded medications, such as pain creams, scar creams, migraine creams, and metabolic supplements/“wellness capsules,” regardless of whether they were medically necessary for the patient.

    The telemedicine companies sent Ogon prescriptions to sign for compounded medications, and Ogon signed the prescriptions without having established any prior doctor-patient relationship, speaking with the patient, or conducting any kind of medical evaluation.

    The telemedicine companies often filled out the prescriptions completely – including selecting the compound medications to be prescribed – before Ogon ever saw them. Once Ogon received the filled-out prescriptions, he needed only to sign them to complete the prescription.

    Ogon often received little or no information about the patients before he signed the prescriptions. As a result, Ogon on multiple occasions signed prescriptions for either expensive compounded scar cream or pain cream even though he had not received any information indicating that the patient needed them. Ogon also signed prescriptions for patients residing in states where he was not licensed to practice medicine.

    After Ogon signed the medically unnecessary prescriptions, they were sent to compounding pharmacies with whom he or other entities involved in the scheme had relationships. The compounding pharmacies then filled the prescriptions and billed the patient’s health care benefit program regardless of medical necessity.

    The telemedicine companies paid Ogon on a per-prescription basis for many prescriptions he signed. One telemedicine company paid Ogon between $20 and $30 per prescription. Ogon’s participation in the conspiracy caused a loss to health care benefit programs of more than $20 million, at least $3 million of which was sustained by TRICARE – a health care benefit program for members of the military and their families.

    The charge of conspiracy to commit health care fraud is punishable by a maximum of 10 years in prison and a fine of $250,000 fine, or twice the gross gain or loss from the offense.

    U.S. Attorney Carpenito credited special agents of the FBI, under the direction of Special Agent in Charge Gregory W. Ehrie in Newark; the U.S. Department of Defense, Office of the Inspector General, Defense Criminal Investigative Service, under the direction of Special Agent in Charge Leigh-Alistair Barzey, and special agents of the Department of Health and Human Services, under the direction of Special Agent in Charge Scott J. Lampert, with the ongoing investigation leading to today’s arrest.
     
  12. Auntie Cipation

    Auntie Cipation Well-Known Member

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    Thank you! There are some smarmy folks I am trying to keep eyes on, who are involved with some presumably-fraudulent pass-through lab schemes around the country. They are being sued by the insurance companies and I am eager to see how that plays out. I will be watching this thread to see if they appear on your radar. Thanks!
     
  13. SeesSeas

    SeesSeas FLORIDIAN

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    I attended the sentencing hearing of Anda Norbergs last year in Tampa federal court. She was loved by her patients, disliked by many of her colleagues, and her bookkeeper stole more than $2 million from the business between 2001 and 2007. Bookkeeper was released 10/01/2018 after 12 years in state prison. Now the former doctor sits in federal prison.
    Bookkeeper's Theft Draws 12-Year Prison Term

    Inmate Locator
    D ANDA NORBERGS
    Register Number: 62499-018
    Age: 63
    Race: White
    Sex: Female
    Located at: Coleman Medium FCI
    Release Date: 01/31/2023


    Palm Harbor Oncologist Sentenced To Nearly Six Years For Treating Patients With Unapproved Cancer Drugs

    Department of Justice
    U.S. Attorney’s Office
    Middle District of Florida
    FOR IMMEDIATE RELEASE
    Monday, August 7, 2017
    Palm Harbor Oncologist Sentenced To Nearly Six Years For Treating Patients With Unapproved Cancer Drugs
    Tampa, Florida – U.S. District Judge James S. Moody, Jr. has sentenced D. Anda Norbergs to 5 years and 10 months in federal prison for receipt and delivery of misbranded drugs, smuggling goods into the United States, health care fraud, and mail fraud. As part of her sentence, the Court also entered a money judgment in the amount of $848,671.19, the proceeds of the criminal conduct. A federal jury found Norbergs guilty on November 18, 2016.

    According to testimony and evidence presented during the nine-day trial, Norbergs, a licensed physician in Florida, was the head doctor, owner, and operator of East Lake Oncology (“ELO”), a cancer treatment clinic located in Palm Harbor. Beginning in at least May 2009, she ordered, and directed others at ELO to order, drugs from foreign, unlicensed distributors, including Quality Specialty Products (“QSP”). The drugs sold to ELO by QSP and other foreign, unlicensed distributors were not FDA-approved. In fact, QSP had reportedly sold counterfeit versions of a chemotherapy medication that did not have the key ingredient in the drug. Norbergs learned of this news from other sources yet continued to have QSP drugs administered to patients. When QSP shut down, Norbergs switched to buying drugs from another foreign, unlicensed distributor. Many of the drugs were shipped directly to ELO from a location outside the United States, usually from the United Kingdom. The packaging and documents shipped with the drugs showed that they were manufactured and packaged for distribution in foreign countries, such as Turkey, India, and Germany.

    Unbeknownst to patients, these misbranded drugs were then administered at ELO. After administering these drugs to patients, ELO submitted claims for reimbursement to Medicare. In submitting those claims, Norbergs falsely represented that the FDA-approved versions of the drugs had been administered, when she knew that unapproved and misbranded versions had been given to patients. In so doing, Norbergs intended to generate profits from the difference between the Medicare reimbursement rates for the FDA-approved drugs and the discounted prices of the misbranded versions of those drugs purchased from foreign distributors.

    This case was investigated by U.S. Department of Health and Human Services – Office of Inspector General and the U.S. Food and Drug Administration. It was prosecuted by Assistant United States Attorneys Adam M. Saltzman and Jay Trezevant.
     
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  14. stringofpurls

    stringofpurls New Member

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    I work in fraud detection for a health insurance company and I'm familiar with some of these cases. The things people do are disgusting. The telehealth is a real thorn in my side. That scheme is also tied to all the back brace commercials you see on day time TV.
     
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  15. Trackergd

    Trackergd SAR Search Manager

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    Spend 8 years of your life to learn medicine, take a rather difficult board exam and take an oath to "do no harm", then proceed to do just that by preying on those poor souls who are in need of medical assistance.
     
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  16. SeesSeas

    SeesSeas FLORIDIAN

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    Vet sentenced for implanting heroin in puppies as drug mules

    Andres Lopez Elorez has been held responsible for the reprehensible use of his veterinary skills to conceal heroin inside puppies as part of a scheme to import dangerous narcotics into the United States . . .
    Colombian Veterinarian Sentenced in Brooklyn Federal Court to 72 Months’ Imprisonment for Heroin Importation Conspiracy
    Department of Justice
    U.S. Attorney’s Office
    Eastern District of New York
    FOR IMMEDIATE RELEASE
    Thursday, February 7, 2019

    Colombian Veterinarian Sentenced in Brooklyn Federal Court to 72 Months’ Imprisonment for Heroin Importation Conspiracy
    Defendant Surgically Implanted Liquid Heroin in Puppies to Smuggle Narcotics
    Earlier today, at the federal courthouse in Brooklyn, Andres Lopez Elorez, a veterinarian who surgically implanted liquid heroin in puppies on behalf of Colombian drug traffickers, was sentenced by United States District Judge Sterling Johnson, Jr. to 72 months’ imprisonment. In September 2018, Elorez pleaded guilty to conspiring to import heroin into the United States. Upon completion of his sentence, the defendant will be deported.

    Richard P. Donoghue, United States Attorney for the Eastern District of New York, and Ray Donovan, Special Agent-in-Charge, Drug Enforcement Administration, New York Division (DEA), announced the sentence.

    “Every dog has its day, and with today’s sentence, Elorez has been held responsible for the reprehensible use of his veterinary skills to conceal heroin inside puppies as part of a scheme to import dangerous narcotics into the United States,” stated United States Attorney Donoghue. “This Office and our law enforcement partners will continue to investigate and prosecute drug trafficking organizations, operating here and abroad, to reduce the availability of opioids and save American lives.” Mr. Donoghue extended his grateful appreciation to the U.S. Drug Enforcement Administration, New York and Miami Divisions and Bogota and Madrid Country Offices; the United States Marshals Service; the Colombian National Police; the Government of Spain and the Spanish Guardia Civil for their assistance in the investigation, extradition and prosecution.

    “This sentencing closes the case on a trafficking organization that used live puppies to smuggle drugs from Colombia to New York,” stated DEA Special Agent-in-Charge Donovan. “Today, the veterinarian responsible for surgically implanting packets of liquid heroin in puppies has been sentenced to 72 months in federal prison. I commend our law enforcement partners and U.S. Attorney’s Office, Eastern District of New York, for their diligent efforts throughout this 14-year investigation.”

    According to court filings and facts presented during court proceedings, Elorez and his co-conspirators, based in Colombia, smuggled heroin into the United States using various methods to conceal the narcotics from law enforcement. Specifically, between September 8, 2004 and January 1, 2005, Elorez leased a farm in Medellin, Colombia, where he secretly raised dogs and surgically implanted bags of liquid heroin in nine puppies for importation into the United States. On January 1, 2005, law enforcement searched the farm and seized 17 bags of liquid heroin weighing nearly three kilograms, including 10 bags that were removed from the puppies. Three of the puppies died after they contracted a virus following the surgeries.

    Elorez was a fugitive until he was arrested in Spain in 2015. Elorez was extradited to the United States in May 2018.

    The government’s case is being handled by the Office’s International Narcotics and Money Laundering Section. Assistant United States Attorneys Nathan D. Reilly and Alicia N. Washington are in charge of the prosecution.

    The Defendant:
    ANDRES LOPEZ ELOREZ
    Age: 39
    Country of Birth: Colombia
    E.D.N.Y. Docket No. 05-CR-835 (SJ)
     
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  17. Trackergd

    Trackergd SAR Search Manager

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    There was a lot of fraud in the mobility vehicle industry, knee brace, back brace, etc. Medical equipment fraud has been around for quite a while. There is a fine collection of bogus and even dangerous equipment at the Mutter Museum in Philadelphia. Today's crooks seem to target those on medicare.
     
  18. stringofpurls

    stringofpurls New Member

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    DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) are the easiest fraud because you don't have to have any sort of degree or license to open up shop. It never dies, just changes. They target Medicare (original and PPO/PFFS MAPD plans) using codes that don't require authorizations. They are improperly "setting up shop" in virtual offices or using UPS store mailboxes. They hire doctors to sign off on medical records for "patients" they have never seen or spoken with.
     
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