Archive for the ‘Medicare 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

Michigan Oncologist Charged in $35 Million Medicare Fraud Scheme

Dr. Farid Fata, owner and operator of Michigan Hematology Oncology Centers has been charged in a criminal complaint for submitting fraudulent claims to Medicare for medically unnecessary services that include chemotherapy treatments, Positron Emission Tomograph scans and other cancer and hematology treatments for patients who did not need them.

The criminal complaint alleges that the defendant endangered patient safety through misdiagnosis, over or misprescription of chemotherapy and other treatments, as well as, delaying hospital care for patients with serious injuries. The complaint further alleges  Dr Fata directed the administration of unnecessary chemotherapy to patients in remission; deliberate misdiagnoses of patients as having cancer to justify unnecessary cancer treatment and expensive testing; administration of chemotherapy to end-of-of life patients who did not benefit from such therapy; fabrication of diagnoses such as anemia and fatigue to justify unnecessary hematology treatments, and distribution of controlled substances to patients without medical necessity or administering drugs at dangerous levels. Dr. Fata also falsified and directed others to falsify documents to justify the cancer treatments for billing purposes.

Through is his Michigan Hematology Oncology Centers located in Clarkston, Bloomfield Hills, Lapeer, Sterling Heights, Troy and Oak Park Michigan, Fata billed Medicare approximately $35 million dollars over a two year period, and approximately $25 million was directly attributatble to Dr. Fata.

Dr. Fata is now awaiting trial on these allegations and remains innocent until proven guilty.

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Florida Home Health Care Owners Plead Guilty for Roles in $8 Million Medicare Health Care Fraud Scheme

Miguel Jimenez and Marina Sanchez Pajon, owners and operators of Flores Home Health, a Miami, Florida home health care agency, plead guilty to one count each of conspiracy to commit health care fraud.  This husband and wife team ran the now defunct Flores Home Health agency for the purpose of billing Medicare for expensive physical therapy and home health services that were neither medically necessary nor provided.  Both were responsible for negotiating and paying kickbacks and bribes, interacting with the patient recruiters and coordinating and overseeing the submission of fraudulent claims submitted to Medicare.

The kickback and bribes paid by Jimenez, Pajon and their co-conspirators were in exchange for patients recruiters’ referrals of patients to the Flores Home Health for home health and therapy services that were not medially necessary and/or provided.  Kickbacks and bribes were also provided to doctors’ officers and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation.  Jimenez, Pajon and their co-conspirators used these medical documents to fraudently bill Medicare for home health services that Jimenez and Pajon knew were in violation of federal criminal laws. From approximately October 2009 through June 2102, Medicare reimbursed $8 million to Flores Home Health for services that were not medically necessary and/or provided.

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Owner of Nonexistant Clinic Charged with Medicare Fraud

The Office of the US Attorney in Los Angeles announced this week that Manuk Karapetyan, a 46 year old healthcare clinic owner, has been convicted of Medicare fraud. Karapetyan allegedly fraudulently billed more than $3.4 million to Medicare in the names of four doctors whose identities he had stolen. The fraudulent claims came on behalf of nearly 800 patients who were supposedly treated at a non-existent medical clinic, USA Independence Medical Corp.

Karapetyan had been paid $566,000 form Medicare funds by the time he was discovered. The investigation began when the patients whose names Karapetyan had used began to submit fraud complaints to their doctors and Medicare after reviewing their bills and noticing unexpected charges filed in their names.

Sentencing for Karapetyan, who has been in custody since April of 2009, is scheduled for June 21. He could receive up to 320 years in prison for fraud and identity theft.

Posted in Healthcare 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

Patient Recruiters Sentenced for Riles in $50 Million Medicare Fraud Scheme

Two former patient recruiters for the Miami base mental health clinic Biscayne Milieu Health Care Inc., were sentenced November 16, 2012, for their roles in a Medicare fraud billing scheme that involved the submission of more than $50 million in fraudulent billings to Medicare.

The patient recruiters, Anthony Roberts and Derek Alexander, both of Miami, participated in the Medicare billing scheme with the owners of Biscayne Milieu Health Care Inc. and twenty-five other individuals including doctors, clinic managers, therapists, patient brokers and other employees.  Biscayne Milieu Health Care Inc. (Biscayne Milieu) is a Florida corporation headquartered in Miami that purported to provide a partial hospitalization program (PHP). A PHP provides intensive treatment services for patients suffering from severe mental illness.

The co-conspirators submitted the fraudulent Medicare billing in connection with the operation of Biscayne Milieu.  The co-conspirators paid the patient recruiters, among them Roberts and Alexander, to refer ineligible Medicare beneficiaries to Biscayne Milieu for PHP services that were never provided.  Many of the patients admitted to Biscayne Milieu were not eligible because they did not meet the medical qualifications such as chronic substance abuse, suffering from severe Alzheimer’s disease or dementia or had no mental health diagnosis but instead were seeking the fraudulent treatment in order to gain exemption from certain requirements for application of United States citizenship.

Anthony Roberts was sentenced to serve eighty-seven months in prison and ordered to pay $887,085 in restitution. Derek Alexander was sentenced to serve forty-two months in prison and ordered t pay $300,876 in restitution.

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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

New Partnership to Prevent Health Care Fraud

“On July 26, 2012, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced the launch of a new partnership between the federal government, state officials, several leading private health insurance organizations and anti-fraud health care groups to combat health care fraud and safeguard health care dollars.

This voluntary partnership is designed to share information and best practises in order for the group to develop improved detection of fraud and to prevent payment of fraudulent health care claims by public and private insurance payors.

Examples of the partnership’s goals are to share information on specific schemes, utilized billing codes, and geographical fraud hot spots so action can be taken to prevent losses to the government and private health plans before they occur.  A long range goal is to utilize sophisticated technology and analytics on industry-wide health care data to predict and detect health care fraud schemes.

This partnership builds on the changes provided under the Affordable Care Act that already strengthens the government’s ability to fight health care fraud such as tougher sentences for those convicted of health care fraud, enhanced screening of Medicare and Medicaid providers and suppliers to prevent fraudsters from these programs, and suspension of payments to providers and suppliers allegedly engaged in fraudulent activity.

Several private-public work groups are currently meeting to finalize the operational structure of this voluntary partnership and develop a work plan.  A meeting of the Executive Board, Data Analysis and Review Committee and the Information Sharing Committee will hold their first meeting in September.”

Posted in Healthcare Fraud, Medicare Fraud, Medicare WhistleblowerNo Comments

Texas Durable Medical Equipment Suppliers Arrested for Health Care Fraud

“Federal agents in McAllen, Texas arrested four people on Thursday, June 29, 2012, for allegedly falsely billing Medicare and Medicaid for durable medical equipment (DME), such as wheelchairs and hospital beds that were never actually prescribed by  doctors nor delivered to the customers.

Marcello Herrera, owner of RGV DME, a now defunct DME supply store, his wife and RGV DME’s marketing director, Carla Cantu Herrera, and two former employees, Ramon de la Garza and Beatriz Ramos face a 22 count indictment that includes one count of conspiracy to commit health care fraud, six counts of health care fraud, five counts of wire fraud and ten counts of aggravated identity theft.

Federal prosecutors state that between 80 percent and 90 percent of all RGV DME’s billings to Medicare and Medicaid submitted between 2004 and 2010 were fraudulent claims.  The defendants billed for medical equipment that was never prescribed by doctors, never delivered to the patients and in some instances the patients that were to receive the DME were deceased.  Additionally, the indictment alleges that the defendants made illegal payments to “”marketers”” who obtained Medicare and Medicaid identification numbers and information for beneficiaries which the defendants used to submit the fraudulent claims.  The defendants also forged documents, and patients’ and doctors’ identities on the fraudulently submitted claims.

The defendants received approximately 7.1 million dollars in reimbursements from Medicare and Texas Medicaid.”

Posted in Healthcare Fraud, Medicare Fraud, Medicare WhistleblowerNo Comments

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