Archive for the ‘Medicaid Fraud’ Category

Former Owner of Emmanuel Medical Supply Pleads Guilty to $2.6 Million Medicare Fraud Scheme

Akinola Afolabi, former owner and president of Emmanuel Medical Supply located in Long Beach, California, plead guilty to engaging in a Medicare fraud scheme from June 2006 through September 2009 wherein he submitted over $2 million in fraudulent claims to Medicare for providing medically unnecessary power wheelchairs and other durable medical equipment to Medicare beneficiaries.  He obtained the Medicare beneficiaries’ information through various schemes including paying marketers for referrals of beneficiary information.  Afolabi used the information to submit or cause the submission of false and fraudulent claims for wheelchairs and other durable medical equipment.  Afolabi knew that the prescriptions and medical documents for the wheelchairs and durable medical equipment were fraudulent. He also admitted that some of the beneficiaries did not receive the equipment even though he certified to Medicare with each submitted claim that the equipment was received and medically necessary.

Afolabi submitted over $2 million in fraudulent claims to Medicare and was reimbursed approximately $1,490,532 on the claims.  Afolabi faces a maximum penalty of ten years in prison and a $250, 000 fine at his sentencing scheduled for November 25, 2013.

Posted in Healthcare Fraud, Medicaid Fraud, Medicare FraudNo Comments

A 30 Month Prison Sentence for Brooklyn, New York Surgeon’s Role in Medicare and Private Insurance Fraudulent Billing Scheme

On Monday, December 10, 2012, the Department of Justice announced that Dr. Boris Sachakov, a board certified colorectal surgeon of Brooklyn, New York, was sentenced to thirty months in prison for his role in a fraud scheme to bill Medicare and more than ten private insurance companies for surgeries and other complex medical procedures that were never performed.

During a two week trial in June, 2012, evidence showed that from January 2008 to January 2012, Dr. Sachakov, owner and operator of the Colon and Rectal Care of New York PC, clinic fraudulently billed Medicare and the private insurance companies for surgeries and medical services he never provided to his patients.  After receiving complaints from patients that Sachakov never performed the surgeries, including hemorrhoidectomies for which he submitted billing, several of the private insurance companies began an investigation into Sachakov activities.  Trial evidence showed that the records in patients’ files created and maintained by Sachakov did not support the extensive billing claims he submitted to the private insurance companies and Medicare.  Further evidence showed that upon being confronted by several of the insurance companies about his billing practices, Sachakov wrote letters to patients asking them to falsely certify in writing that they had undergone the fraudulent surgeries.  During this time period Sachakov submitted or caused to be submitted false claims for such procedures to Medicare and the private insurance companies totaling more than $22.6 million and he received more than $9 million in reimbursements on those claims.

Posted in Medicaid Fraud, Medicare FraudNo Comments

Brooklyn Clinic Owner and Physician Pleads Guilty to $11.7 Million Medicare Fraud Scheme

The Department of Justice announced on Monday, December 10, 2012, that Dr. Ho Yon Kim of Flushing, New York, pleaded guilty for his role in a scheme that resulted in more than $11.7 million fraudulent claims submitted to Medicare.

Dr. Kim was the president of URI Medical Service PC and Sarang Medical PC, two medical clinics located in Flushing, New York.  The clinics were supposed to provide physical therapy services and electric stimulation treatment.  Dr. Kim admitted that, between March 2007 to October 2011, he conspired with others to provide kickbacks to Medicare beneficiaries to allow the medical clinics to use their Medicare numbers to submit claims for medical services that were never provided or were medically unnecessary.  In exchange for the use of their Medicare numbers, Dr. Kim and his co-conspirators provided the Medicare beneficiaries with a variety of spa services, including massages, facials, lunches and dancing classes.

Dr. Kim faces a maximum of ten years in prison.  Two co-conspirators, Dr. Hoi Yat Kim and Dr. Peter Lu still await their trials for this particular scheme.

Posted in Healthcare Fraud, Medicaid FraudNo Comments

Continued Convictions in $14.5 Million Medicare Home Health Care Fraud Scheme

On Friday October 26, 2012, a physician, a home health agency owner and a patient recruiter were convicted for their participation in a $14.5 million Medicare fraud scheme.  Sixteen other co-conspirators have previously pled guilty for their involvement in the scheme. The three current defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare for skilled nursing and physical therapy services for Medicare beneficiaries that in fact where never provided and/or medically unnecessary.

The scheme involved two home health care companies, Patient Choice and All American located in Oak Park, Michigan.  The co-conspirators used patient recruiters to get Medicare beneficiaries to sign blank documents for physical therapy.  These “”patients”” were paid in cash for their signatures on the blank documents.  Next, the owners of Patient Choice and All American paid physicians to sign referrals and other documents necessary to bill Medicare.  Contracted physical therapists and physical therapist assistants would create fake medical records using the pre-signed blank documents previously provided by the patient recruiters to make it appear that the physical therapy services had actually been provided, when in fact those services were never rendered.

Dr. Pramod Raval was found guilty of accepting kickbacks in exchange for referring patients to Patient Choice and All American home health care companies.  Dr. Raval referred patients from his own practice as well as patients recruited by the patient recruiters.

Chiradeep Gupta a physical therapist and part owner of All American was found guilty of providing the physical therapists and physical therapy assistants to Patient Choice and All American, who then created the false patient files from which the Medicare claims were submitted for services that were never provided and/or were medically unnecessary.  Gupta also directed the creation of these fake patient files.  Additionally, it was shown at trial that Gupta laundered the fraudulent Medicare reimbursements through multiple shell companies.

Richard Shannon, a patient recruiter was found guilty of recruiting patients and paying them cash for their signatures on the blank physical therapy forms, which were then used to create the fake patient files.

Posted in Health Care Reform, Healthcare Fraud, Medicaid Fraud, Medical Billing Fraud, Medicare Fraud, Medicare WhistleblowerNo Comments

CardioMax EMS Administrator Pleads Guilty to Medicare Fraud

“The Department of Justice announced on October 15, 2012, that Okechukwu Ofoegbu, administrator of CardioMax EMS, a Houston, Texas based ambulance company, pleaded guilty to the charges that he submitted approximately $1,734,550 in fraudulent claims for ambulance transport services to the Medicare program.

Medicare has very specific and narrow regulations under which ambulance transport services are covered. According to the plea agreement, from January 2011 through December 2011, Ofoegbu and others at CardioMax EMS transported patients that did not meet the Medicare regulations, falsified ambulance run sheets that describe a patient’s health condition and thus qualify the patient for transportation, and used such falsified run sheets to file claims with Medicare.  Ofoegbu admitted that he knew the claims were miscoded, the services were not medically necessary and, in some cases, not provided.

Ofoegbu was originally indicted in a nationwide sting on May 2, 2102, that resulted in 107 individuals being charged with Medicare fraud amounting to a total of $452 million. As part of Ofoegbu’s plea, he agreed to pay $553,002 in restitution to the United States.  On January 24, 2013, he faces a maximum of a ten year prison sentence.”

Posted in Medicaid Fraud, Medical Billing Fraud, Medicare FraudNo Comments

Physician Assistant Found Guilty in $18.9 Million Medicare Fraud Scheme

On June 1, 2012, following a two week trial in a Los Angeles federal court, a jury found David James Garrison guilty of one count of conspiracy to commit health care fraud, six counts of health care fraud and one count of aggravated identity theft, the Department of Justice announced on Monday, June 4, 2012.

Trial evidence showed that Mr. Garrison and his co-conspirators owned and operated several medical clinics in Los Angeles that they established for the sole purpose of defrauding Medicare.  Through these fraudulent medical clinics, Mr. Garrison and his co-conspirators operated prescription mills, trafficked in fraudulent prescriptions and orders for medically unnecessary power wheelchairs, durable medical equipment (DME) and diagnostic tests.  Mr. Garrison and his co-conspirators also worked with fraudulent DME supply companies and medical testing facilities, some of which were owned by Mr. Garrison and his co-conspirators, to submit false and fraudulent claims to Medicare for reimbursement.

Mr. Garrison and his co-conspirators engaged in this fraudulent activity between March 2007 and September 2008.  Among the fraudulent activities for which the jury found Mr. Garrison guilty, was the paying of kickbacks to patient recruiters to find Medicare beneficiaries willing to provide their Medicare information in exchange for high end wheel chairs and other DME.

Trial evidence showed that the fraudulent billing of Medicare in the Los Angeles area is so rampant, that the patient recruiters often had to use Medicare beneficiaries information from persons who resided 300 miles away from the city.  This was necessary because the billing information of Medicare beneficiaries living in and around Los Angeles had already been used in other fraud schemes and could no longer be billed to Medicare.

Another part of the scheme involved using fraudulent DME supply companies for the provision of wheelchairs.  Mr. Garrison submitted fraudulent prescriptions for wheelchairs from approximately six different doctors to the supply companies.  The DME supply companies paid approximately $900.00 per wheelchair; but billed Medicare approximately $5, 000.00 per wheelchair.  Mr. Garrison also ordered the same medically unnecessary diagnostic tests for each Medicare beneficiary, including tests for sleep studies, ultrasounds and nerve conduction.

As a result of these schemes, Mr. Garrison and his co-conspirators submitted or caused to be submitted over $18 million in false and fraudulent claims to Medicare.  They received $10.7 million in reimbursement.

Posted in Anti-Kickback Statute, Health Care Reform, Healthcare Fraud, Medicaid Fraud, Medical Billing FraudNo Comments

Joel Androphy on ABC News

A nurse in a small Texas town blew the whistle on a doctor who she believed was improperly performing surgeries and mis-prescribing drugs. See what whistleblower attorney Joel Androphy has to say in this short video clip from ABC:

 

Posted in Fraud, Health Care Reform, Healthcare Fraud, Medicaid Fraud, Medical Billing Fraud, Medicare Fraud, Medicare Whistleblower, Whistle BlowersNo Comments

Universal Health Sevices, Inc. and the Commonwealth of Virginia Settle False Claims Act Allegations

The Department of Justice announced on March 28, 2012, the settlement of False Claims Act allegations pending against Universal Health Services, Inc. and two subsidiaries – Keystone Education and Youth Services, LLC and Keystone Marion, LLC d/b/a Keystone Marion Youth Center. The $6.85 million settlement with the United States and the Commonwealth of Virginia resolves the allegations that Universal Health Services, Inc. and its subsidiaries provided substandard psychiatric counseling and treatment at the Keystone Marion Youth Center, a residential facility in Marion, Virginia.

The three whistleblowers, Megan Johnson, Leslie Webb and Kimberly Stafford-Payne, former therapists at the now closed facility, alleged that not only was substandard care provided to emotionally troubled youth at the residential center; but false records were created and false claims were submitted to Medicaid for reimbursement.  Universal Health Services, Inc. closed the residential facility in early 2012.

Posted in Health Care Reform, Healthcare Fraud, Medicaid Fraud, Medical Billing Fraud, Medicare FraudNo Comments

New Sentencing in Florida Health Care Fraud Case

In the Department of Justice’s ongoing case against American Therapeutic Corporation (ATC) and American Sleep Institute (ASI), a company related to ATC, the Department announced on Friday, March 9, 2012, the sentencing of a co-conspirator in ATC and ASI’s Medicare billing fraud scheme.

Barry Nash, the owner and operator of Starter House, a halfway house located in Broward County, Florida, was sentenced to 24 months in prison, and three years of supervised release for one count of conspiracy to commit health care fraud.

Mr. Nash admitted that in exchange for kickbacks in the form of monetary payments, he agreed to refer Medicare beneficiaries staying at Starter Home to ATC and ASI.  Mr. Nash admitted that he knew ATC and ASI were fraudulently billing Medicare for partial hospitalization program services and sleep treatment when he made the referrals.  He would deliver the patients to ATC and ASI in exchange for payments. Sometimes the patients received a portion of the kickbacks.

Overall, the Department of Justice estimates that ATC and ASI fraudulently billed Medicare for $200 million in medically unnecessary services.  Mr. Nash’s participation resulted in almost $1 million in fraudulent billing.

The next set of defendants related to this scheme are set for trial April, 9, 2012.

Posted in Medicaid Fraud, Medical Billing Fraud, Medicare Fraud, Whistle BlowersNo Comments

New Healthcare Fraud Detection Tools Result in Indictment for $375 Million Health Care Fraud

On February 28, 2012, the Department of Justice announced the indictment of Dr. Jacques Roy, owner and operator of Medistat Group Associates P.A. and his associates of a nearly $375 million health care fraud scheme involving fraudulent claims for home health services that were medically unnecessary.  Dr.  Roy fraudulently certified or directed certification for home health services for persons who did not qualify for such services.  Additionally, Dr. Roy performed unnecessary home visits and ordered unnecessary medical services.  Dr. Roy worked with home health agencies to recruit Medicare beneficiaries for these unnecessary services.

The detection of the fraud that led to the indictment is a result of the new fraud detection tools that the Medicare Fraud Strike Force, a part of the Health Care Fraud Prevention & Enforcement Action Team, now has access.  Utilizing sophisticated data analysis, the Medicare Fraud Strike Force in Dallas, Texas targeted Dr. Roy’s suspicious billing spikes.  The Strike Force’s analysts detected that in 2010, 99 percent of the physicians certified 104 or few patients for home health services, while Dr. Roy certified more than 5,000 patients. Even though the Centers for Medicare and Medicaid Services suspended Dr. Roy’s and Medistat’s Medicare provider billing numbers, all of Medistat’s employees started billing Medicare under MedCare HouseCalls provider number.   Dr. Roy was in charge of the day-to-day operations at MedCare HouseCalls, and as such continued to perpetrate the fraud.

As of now Dr. Roy and his associates are indicted of these allegations, and these defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Posted in Anti-Kickback Statute, Healthcare Fraud, Medicaid Fraud, Medical Billing Fraud, Medicare Fraud, Whistle BlowersNo Comments

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