Mass. AG allege Medicaid fraud schemes cost $10M

Now imagine if the state actually went after Medicaid fraud in child welfare.

Mass. AG allege Medicaid fraud schemes cost $10M

BOSTON (AP) — Massachusetts Attorney General Martha Coakley announced indictments Friday against 10 people linked to a series of Medicaid fraud schemes that investigators say cheated taxpayers out of nearly $10 million.
The allegations included billing the state for care provided to dead patients, kickback schemes for unnecessary drug tests and claiming nursing home residents needed help walking and eating when they were able to do both on their own. In each case, investigators said the goal was to bilk MassHealth, the state's Medicaid program.
A total of 118 criminal indictments against 10 individuals have been handed down in the four cases.
Coakley said the indictments were returned Thursday by three grand juries including a special statewide grand jury and are the result of four major criminal investigations by the state Medicaid Fraud unit.
Coakley said the kind of fraud alleged in the indictments ultimately forces up health care costs for everyone in Massachusetts.
"It's like when people are shoplifting in a store, it's passed onto consumers," Coakley said Friday. "They might as well be walking over to MassHealth and taking money out of the state treasury."
The cases involved four private health care providers: Adlife Healthcare; Preventative Medicine Associates; Mitchell Counseling Services; and Wetterberg Nursing Homes, which ran the Pond View Nursing Facility in Boston.
In the case of Adlife, investigators allege that owner Sharon Richardson, 55, of Framingham and two employees billed MassHealth for approximately $5.5 million in services that were not provided.
Adlife is a group adult foster care provider for MassHealth with locations in Framingham, West Springfield, Boston and Hyannis.
Investigators' allege Adlife billed MassHealth for treating deceased individuals and individuals who never received services. Richardson is also accused of falsifying records submitted to MassHealth and working with two employees to destroy internal records to cover up the fraud.
Richardson was arrested Thursday. Her lawyer, Michael Stromsnes, declined comment.
The second set of indictments focus on a Brookline doctor, Punyamurtula Kishore, 61, and his company Preventative Medicine Associates, Inc., with 29 locations statewide.
Investigators said Kishore and three others orchestrated an elaborate drug screening kickback scheme and fraudulently billed MassHealth for nearly $3.8 million.
Coakley's office said Kishore used bribes to induce various so-called "sober homes" to send patients to his laboratories to perform unnecessary urine drug screens — as many as three a week — that were later billed to Medicaid. Investigators said drug screens are generally billed at between $100 and $200 each and Kishore billed MassHealth for tens of thousands of the tests.
Three managers or owners of the "sober homes" — New Horizon House in Boston, Marshall House in Malden and Gianna's House, which operates homes in Wareham, New Bedford and Sandwich — were also indicted.
Kishore was arraigned Wednesday in Malden District Court and later released after surrendering his passport.
Kishore's attorney said Kishore is "an extremely well-regarded member of the community" who denies the allegations.
The third alleged scheme defrauded MassHealth of $160,000 and involved David Benson, 48 of New Bedford and his company Mitchell Counseling Services.
Investigators said Benson, an independent clinical social worker, routinely billed for treatment that exceeded services provided to six patients. Coakley's office said Benson billed as if his patients were in need of acute care multiple times a week when they were being provided minimal care or no care at all.
A call to Mitchell Counseling Services wasn't answered Friday.
The final investigation resulted in an indictment against Carolyn Wetterberg, 70, of Weymouth for allegedly billing MassHealth more than $600,000 for services not provided.
Wetterberg was part owner and sole manager of Wetterberg Nursing Homes, Inc., which ran the Pond View Nursing Facility in the Jamaica Plain neighborhood of Boston. The 43-bed long term care facility was shut down by the Massachusetts Department of Public Health in June for poor quality of care.
Coakley's office said Wetterberg defrauded MassHealth by deliberately overstating the level of disabilities of those who lived in the facility, allowing her to bill for more than their care required.
Investigators said in some cases patients she claimed needed help walking were walking independently and those she claimed needed help eating were eating on their own.
A man who answered the phone at Wetterberg's home said she wasn't available for comment.

HILL-ROM COMPANY, INC. WILL PAY $41.8 MILLION TO RESOLVE FEDERAL HEALTH CARE FRAUD INVESTIGATION

HILL-ROM COMPANY, INC. WILL PAY $41.8 MILLION TO RESOLVE FEDERAL HEALTH CARE FRAUD INVESTIGATION

KNOXVILLE, Tenn. - Hill-Rom Company, Inc., one of the largest national suppliers of durable medical equipment, has agreed to pay $41.8 million to settle alleged violations of the federal False Claims Act and other federal laws and regulations. This is the largest civil fraud recovery ever by the U.S. Attorney's Office for the Eastern District of Tennessee.

The United States' investigation revealed that for a number of years Hill-Rom knowingly submitted numerous and repeated false claims to the Medicare program for certain specialized medical equipment – bed support surfaces for treatment of pressure ulcers or bed sores – for patients who did not qualify for this equipment. Hill-Rom submitted these false claims for patients for whom the equipment was not medically necessary, including claims for patients who had died or were no longer using the equipment. Hill-Rom had a practice of automatically billing for patients over long periods of time without making any reasonable effort to determine if the patients for whom it submitted the claims continued to meet Medicare conditions for payment. At the time it submitted these false claims, Hill-Rom was well aware of the Medicare laws and rules regarding coverage and claims for this equipment and its ongoing obligation to reasonably follow the condition of its patients.

The federal False Claims Act is intended to provide a means for the United States to recover moneys paid by federal programs to persons and companies who have knowingly sought and received funds to which they were not entitled. The payment Hill-Rom must now make in connection with this settlement is to compensate the Medicare trust fund for the moneys paid out of that fund which Hill-Rom improperly claimed and received during the period from 1999 through 2007. As part of this overall settlement, Hill-Rom has also entered into a comprehensive five-year Corporate Integrity Agreement with the U. S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) to ensure its future compliance with federal health care benefit program requirements.

"Today's settlement is an example of the determination of both the Justice Department and the Department of Health and Human Services to enforce the federal False Claims Act and to protect the Medicare trust funds to ensure that the Medicare program remains viable to provide health care for today's seniors and disabled citizens as well as for the next generation," said U.S. Attorney Bill Killian.

"Too many giant corporations make business decisions believing that they are immune from charges of Medicare fraud," said Derrick Jackson, Special Agent in Charge of the federal Health and Human Services Department, Office of Inspector General's region covering Tennessee. "This settlement puts companies on notice that, no matter their size, violating Medicare regulations will lead to investigation and prosecution."

U.S. Attorney Killian further noted that this settlement resolves a comprehensive investigation into Hill-Rom's Medicare billing practices which began as a result of allegations brought by two Hill-Rom former and current employees. Laurie Salmons and Lisa Brocco, both trained nurses who served as sales representatives for Hill-Rom, through their attorney David Burkhalter, filed an action on behalf of the United States under the qui tam, commonly-known as whistle-blower, provisions of the federal False Claims Act. Under the terms of the settlement agreement and as authorized by the False Claims Act, Salmons and Brocco are to receive jointly over $8 million from the proceeds of the settlement for their role in filing the qui tam complaint and actively assisting with the investigation.

The investigative team whose diligent efforts resulted in this settlement was comprised of representatives from the HHS-OIG, Federal Bureau of Investigation (FBI), Railroad Retirement Board Office of Inspector General (RRB-OIG), U.S. Attorney's Offices for the Eastern District of Tennessee (USAO-TNE) and the District of South Carolina (USAO-SC), and U.S. Department of Justice (DOJ). Assistant U.S. Attorneys (AUSAs) Betsy Tonkin, Rob McConkey and Will Mackie represented the United States.

U. S. Attorney Killian commended the dedication and diligence of all who played a role in this complex investigation, in particular lead HHS-OIG Special Agent Tony Maffei, FBI Forensic Accountant/Certified Fraud Examiner LeAnn Lanz, RRB-OIG Special Agent Tom Tamburello, USAO -TNE paralegal Susan Page, USAO-TNE contract paralegal Renee Lange, and AUSAs Betsy Tonkin, Rob McConkey and Will Mackie for their oversight of the parallel civil and criminal investigation for the U.S. Attorney's Office. U.S. Attorney Killian also recognized the assistance of AUSAs Jennifer Aldrich and Fran Trapp from the USAO-SC, HHS-OIG Senior Counsel Tonya Keusseyan and DOJ Trial Counsel Tom Morris.

HHS False Claims Reports Nothing On Child Welfare Fraud

Below, is a few examples of Medicaid fraud schemes where individuals are employed who were not eligible because they had been previously busted for Medicaid fraud.

Of all the years in existence, the U.S. Department of Health and Human Services Office of Inspector General has never, ever, ever brought forth violations of the Civil Monetary Penalties Law against any child welfare entity.

Never.

Not only that, no one from the child welfare industry has been placed on the OIG Exclusionary Database.

The reason it is never enforced is because it would shut down the entire child welfare system.

08-09-2011

After it self-disclosed conduct to the OIG, Kmart Corporation (Kmart), Indiana, agreed to pay $945,021.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Kmart employed four individuals that it knew or should have known were excluded from participation in Federal health care programs

07-22-2011

After it self-disclosed conduct to the OIG, Health Management Services, Inc. (HMS), Louisiana, agreed to pay $6,545.61 for allegedly violating the Civil Monetary Penalties Law. Specifically, HMS disclosed the alteration of continuous positive airway pressure downloads for patients by two individuals at HMS in order to obtain Federal health care program reimbursement.

06-06-2011

After it self-disclosed conduct to the OIG, University of North Texas Health Science Center at Fort Worth (UNTHSC), Texas, agreed to pay $859,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that UNTHSC submitted claims for physicians' services provided to beneficiaries of Federal health care programs using the provider identification numbers of 103 physicians who neither furnished the service nor personally supervised the services rendered.

08-30-2010

After it self-disclosed conduct to the OIG, Catholic Healthcare West, Bakersfield Memorial Hospital, and Community Hospital of San Bernardino (collectively CHW), CA, agreed to pay $243,819.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHW employed five individuals that it knew or should have known were excluded from participation in Federal health care programs.

Stop Child Medicaid Fraud

Termination of 1945 Merck Consent Agreement And Medco History

Below, there is a bit of history between Merck and Medco which came about from the 1945 wartime seizure agreement with the Department of Justice.
MEMORANDUM OF THE UNITED STATES IN RESPONSE TO THE MOTION OF MERCK & CO., INC. TO TERMINATE THE CONSENT DECREE

Where is Medco stock traded and what is its ticker symbol and CUSIP number?
	We trade on the New York Stock Exchange under the ticker symbol: MHS. Medco's CUSIP number is 58405U102.

When did Medco go public?
	Medco stock started trading on August 20, 2003.

What is the relationship between Merck and Medco?

Medco was a wholly owned subsidiary of Merck & Co., Inc., a global pharmaceutical company, from 1993 until Medco was spun-off as an independent publicly traded entity in August 2003. Merck is one of the many major pharmaceutical manufacturer's with whom Medco has a customary rebate agreement. On February 28, 2006, following arms-length negotiations, the managed care agreement that the Company had entered into with Merck while it was a wholly-owned subsidiary of Merck was terminated as of April 1, 2006. The liquidated damages provisions contained in the managed care agreement, under which the Company could have been required to pay liquidated damages if the Company's Merck-related market share declined below specified levels, will no longer apply.

Why did Merck separate Medco from its business?

The board of directors of Merck believes that the separation of Medco from Merck will enhance the success of both Merck and Medco, and thereby maximize stockholder value over the long term for each company, by: enabling each company to continue to pursue its unique and focused strategy; and enabling investors to evaluate the financial performance, strategies and other characteristics of Merck and Medco separately in comparison to companies within their respective industries

Does Medco plan to pay dividends?
	Medco currently does not pay dividends and does not plan to pay dividends in the foreseeable future.

Can I purchase or sell shares directly through Medco?
	Medco does not have a direct purchase or sales plan.

How many shares of Medco did I receive as a result of the Spin-Off from Merck?
	Merck's board of directors set a record date of August 12, 2003 for the transaction. If you owned Merck shares as of this date, you automatically received .1206 shares of Medco common stock for every one share of Merck common stock held on the record date.

What are the U.S. federal income tax consequences of the distribution to Merck stockholders (cost basis)?

For Important U.S. Federal Income Tax Information concerning the Medco Health Solutions, Inc. Stock Distributionplease click here for the shareholder letter. Based on the ruling that Merck received from the U.S. Internal Revenue Service, or IRS, you will not recognize a gain or loss on the receipt of shares of Medco common stock in the spin-off, except to the extent you receive cash in lieu of fractional shares. Your tax basis in your Merck common stock will be apportioned between your Merck common stock and the Medco common stock received in the distribution in accordance with their relative fair market values.

Avecia Mandated To Return $31 Million To U.S. Treasury

The contract was to develop a massive Anthrax vaccine.  The contract was with a company out of the United Kingdom.

NIAID funded the Contract in compliance with the purpose requirements of appropriations statutes. However, NIAID did not comply with the time and amount requirements specified in the statutes. NIAID funded only $40.0 million of the $71.3 million initial Contract obligation with fiscal year 2003 appropriations. NIAID obligated a total of $31.3 million in violation of the bona fide needs rule: $26.0 million of fiscal year 2004 appropriated funds and $5.3 million of fiscal year 2005 appropriated funds. Because the Contract was for nonseverable services, NIAID was required to record the full amount of the Contract using fiscal year 2003 appropriated funds. By not doing so, NIAID potentially violated the Antideficiency Act. 

To remedy the bona fide needs rule violation, NIAID will need to deobligate the fiscal years 2004 and 2005 appropriations. To remedy the potential Antideficiency Act violation, NIAID would have needed to record an obligation of $31.3 million ($71.3 million less $40.0 million) using fiscal year 2003 appropriations. However, because fiscal year 2003 funds are no longer available to record the obligation, NIAID may be able to fund the deficiency by using $31.3 million of current fiscal year appropriations provided the conditions of 31 U.S.C §§ 1553 and 1554 are met. If NIAID does not have $31.3 million of current fiscal year appropriations or the amount exceeds the lesser of 1 percent of the current appropriation or the unexpended balance of the closed appropriation, NIAID will violate the Antideficiency Act. 

NIAID correctly funded the two modifications for additional work with $8.4 million of fiscal year 2006 appropriated funds and $38.0 million of fiscal year 2007 appropriated funds. In April 2009, NIAID transferred the remaining Contract balance totaling $32.5 million of fiscal year 2007 funds to BARDA, and BARDA correctly obligated those funds to the Contract.

RECOMMENDATIONS 

We recommend that NIAID: 

• deobligate $26.0 million of fiscal year 2004 appropriations and return the canceled funds to the Treasury; 

• deobligate $5.3 million of fiscal year 2005 appropriations and return the canceled funds to the Treasury; 

• record the remaining $31.3 million of the $71.3 million Contract obligation against current fiscal year appropriations; 

• report an Antideficiency Act violation if sufficient current year appropriations are not available; and 

• report, in accordance with 31 U.S.C. § 1554, the adjustment to the Contract using current fiscal year appropriations. 

Appropriations Funding for National Institute of Allergy and Infectious Diseases Contract N01-AI-3-0052 Wit...

Dope Smok’n Largo Psych in Trouble with the Department of Health

Dope Smok’n Largo Psych in Trouble with the Department of Health

Sep 20th, 2011 | By admin | Category: Drug Use, Joel Voss

Largo Psychiatrist
Ronald Lee Knaus

Psych News
By Joel Voss

Largo, Florida psychiatrist Ronald Knaus was arrested on July 2, 2010 in nearby Clearwater for possession of marijuana. The police initially approached him due to a handgun in his waistband, per the police report. He pleaded no-contest in open court and was sentenced.

But the story does not end there. In Florida, all licensed health care professionals must report any and all criminal cases against them to the Florida Department of Health within 30 days unless they are acquitted or the charges are dismissed. Also, all physicians must update their profile on the department’s website to reflect any criminals convictions.

The Citizens Commission on Human Rights, Tampa, Florida Chapter found out about Knaus’s case and reported it to the department.

Earlier this month the Florida Department of Health filed their own administrative complaint against him, charging Knaus with withholding his drug case and not updating his online profile on their website. They are seeking discipline ranging from fines to revocation of his license.

In March 2008 a mother attacked her 15 year old son with a dagger and drywall knife at Kanus’ clinic at 1301 Seminole Blvd, Bldg B, Suite 112 in Largo.
The boy survived but was hospitalized. Knaus’ clinic was hired to provide a safe & supervised visitation of the mother and son. The boy’s father filed a lawsuit that is ongoing at this time.

Knaus was reported to be one of the Kings of the Baker Act, the Florida law governing involuntary commitment. It was reported in 1995 by the St Petersburg Times that Knaus was one of 3 psychiatrists in Pinellas County, Florida that accounted for half of the all involuntary commitments to mental hospitals in the county. Knaus committed people to a hospital that he was an investor in, the report stated.

Former President of Fraudulent Florida Physical Therapy Company Sentenced to 24 Months in Prison for Medicare Fraud Scheme

Former President of Fraudulent Florida Physical Therapy Company Sentenced to 24 Months in Prison for Medicare Fraud Scheme

WASHINGTON – The former president and administrator of a fraudulent physical therapy company in Lakeland, Fla., was sentenced today to 24 months in prison for his role in a scheme to defraud Medicare, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Miami-area resident Adrian Chalarca, 24, also was sentenced by U.S. District Judge James D. Whittemore of the Middle District of Florida to serve three years of supervised release following his prison term and ordered to pay $82,765 in restitution, jointly and severally with his co-defendants.  Chalarca pleaded guilty on June 10, 2011, before U.S. Magistrate Judge Mark A. Pizzo in Tampa, Fla., to one count of conspiracy to commit health care fraud.

According to court documents, Chalarca and his co-conspirators purchased Dynamic from its prior owners and transformed it into a fraudulent enterprise.  Under Chalarca and others, Dynamic purported to provide physical therapy services to Medicare beneficiaries. 

According to court documents, from fall 2009 to summer 2010, Chalarca submitted and caused the submission of $757,654 in fraudulent claims by Dynamic to the Medicare program.  Chalarca admitted that he paid and caused the payment of kickbacks and bribes to Medicare beneficiaries in order to obtain their Medicare billing information and used it to submit claims to Medicare for physical therapy services that were never provided.  Chalarca admitted that he knew the Medicare beneficiaries, on whose behalf claims were submitted to Medicare, never received the services. 

All five defendants charged for their roles in the scheme at Dynamic have pleaded guilty.  On Aug. 29, 2011, co-defendant Andres Cespedes was sentenced to 21 months in prison for his participation in the fraud scheme. 

Today’s sentencing was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Robert E. O’Neill of the Middle District of Florida; Steven E. Ibison, Special Agent-in-Charge of the FBI’s Tampa Division; and Christopher Dennis, Special Agent-in-Charge of the HHS Office of Inspector General (HHS-OIG), Office of Investigations’ Miami Office.

This case was prosecuted by Acting Assistant Chief Benjamin D. Singer of the Criminal Division’s Fraud Section and Special Assistant U.S. Attorney Christina M. Burden of the Middle District of Florida.  The case was investigated by the HHS-OIG, Defense Criminal Investigative Service and FBI, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants that collectively have billed the Medicare program for more than $2.9 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go towww.stopmedicarefraud.gov.

Owner of Miami-Area Mental Health Company Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme

Owner of Miami-Area Mental Health Company Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme

WASHINGTON – Miami resident Marianella Valera, the owner of a mental health care company, American Therapeutic Corporation (ATC), was sentenced today to 35 years in prison for orchestrating a $205 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Valera, 40, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida.   Judge King ordered Valera to pay more than $87 million in restitution, jointly and severally with her co-defendants.   Valera was also sentenced to three years of supervised release following her prison term.   Lawrence Duran, another owner of ATC, was sentenced on Sept. 16, 2011, to 50 years in prison for his role in the fraud scheme.   Duran’s sentence is the longest prison sentence ever imposed in a Medicare Fraud Strike Force case.

On April 14, 2011, Valera and Duran pleaded guilty to all counts charged in a superseding indictment, which was unsealed on Feb. 15, 2011.   The superseding indictment charged Valera with 21 felony counts and Duran with 38 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements.   Valera and Duran were remanded to the custody of the U.S. Marshals Service after their arrest on Oct.   21, 2010, and have been detained since that time.   Their assets were restrained at the time of their arrests through civil proceedings.  

In pleading guilty, Duran and Valera admitted that they orchestrated and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010.   Duran and Valera submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando.   A PHP is a form of intensive treatment for severe mental illness.   Duran and Valera also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to court documents, Duran, Valera and others paid bribes and kickbacks to recruit Medicare beneficiaries to attend ATC and ASI and billed Medicare for treatments purportedly provided to these recruited patients.   According to court documents, the treatments were medically unnecessary or never provided at all.   Duran and Valera supported the kickbacks through an extensive money laundering scheme that aimed to conceal the illicit conversion of Medicare payments to cash.   The defendants and their co-conspirators used sophisticated measures to conceal their fraudulent activities from Medicare and from law enforcement.  

As part of the fraud scheme, Duran, Valera and others paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI.   In some cases, the patients received a portion of those kickbacks.  The defendants and their co-conspirators actively recruited ALF and halfway house owners and operators and patient brokers to participate in the scheme.   Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $205 million in medically unnecessary services.

According to the superseding indictment to which they pleaded guilty, Duran, Valera and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments.   According to court documents, Duran and Valera also instructed employees and doctors to alter diagnoses and medication types and levels to make it falsely appear that ATC patients qualified for PHP services.   Duran, Valera and co-conspirators caused doctors to refer ATC patients to ASI even though the patients did not qualify for sleep studies.  

According to the superseding indictment to which they pleaded guilty, the defendants also engaged in a money laundering conspiracy to enrich themselves and to provide cash for the millions of dollars in kickbacks paid to recruit Medicare beneficiaries.   According to court documents, Duran and Valera used another company they owned and operated, Medlink Professional Management Inc., to conceal the health care fraud and kickbacks from Medicare and law enforcement.   Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera and others transferred millions of dollars to Medlink.   They and others opened phony corporations to receive checks and wire transfers from both ATC and Medlink to convert that money into cash for their personal enrichment and for the payment of kickbacks.   According to court documents, Duran, Valera and others cashed checks at different bank branches and different locations to conceal the true purpose of their activities and to evade reporting requirements.

On Aug. 23, 2011, a jury found co-conspirator Judith Negron, the third owner and operator of ATC, guilty of all 24 felony counts charged in the February 2011 superseding indictment.   Co-conspirator Margarita Acevedo, also charged in the February 2011 superseding indictment, pleaded guilty on April 7, 2011, for her role in the fraud scheme.  Today, Judge King sentenced Acevedo to 91 months in prison and three years of supervised release following her prison term.  Avecedo was also sentenced to pay more than $72 million in restitution, jointly and severally with her co-defendants. 

ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud.   ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.  On Sept. 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million.   Both corporations have been defunct since their owners were arrested in October 2010.

Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent-in-Charge John V. Gillies of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

The case was prosecuted by Trial Attorney Jennifer Saulino of the Criminal Division’s Fraud Section.   The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants that collectively have billed the Medicare program for more than $2.9 billion.   In addition, HHS’s 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go towww.stopmedicarefraud.gov.

FAKE DOCTOR PLEADS GUILTY TO HEALTH CARE FRAUD AND CRIMINAL HIPAA VIOLATIONS

FOR IMMEDIATE RELEASE
September 14, 2011
http://www.jusice.gov/usao/gan/

CONTACT:  Patrick Crosby
(404)581-6016
FAX (404)581-6160

Matthew Paul Brown Impersonated a Doctor,
Treated Over 1,000 Patients, and Wrongfully Disclosed Their Health Information

            ATLANTA, GA - MATTHEW PAUL BROWN, 30, formerly of Atlanta, Georgia and Nashville, Tennessee, pleaded guilty today in federal district court to charges of health care fraud and wrongful disclosure of individually identifiable health information.  

            United States Attorney Sally Quillian Yates said, “Medicare and Medicaid provide treatment for some of  our community’s most vulnerable citizens: the elderly, young children and the financially needy.  These vulnerable citizens deserve to be treated by medical personnel who have been duly trained and licensed and not by someone impersonating a doctor.  This defendant’s crime defrauded over a thousand people of the care they deserved and defrauded Medicare, Medicaid and private health insurance companies of funds intended and needed for legitimate health care.”

            Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said: “The reckless conduct displayed by the defendant not only displayed a total disregard for the patients that he was improperly and illegally treating but also for those individuals who could have legitimately benefitted from the federal medicaid/medicare funds. The FBI works hard to ensure that these healthcare based federal funds are used as intended and dedicates substantial investigative resources to bringing such activities as Mr. Brown's to justice.”

            According to United States Attorney Yates and the charges:  From November 2009 through April 5, 2011, BROWN carried out a health care fraud scheme in the metro Atlanta and Nashville, Tennessee areas.  While operating in the Atlanta area, from November 2009 through August 2010, BROWN approached numerous practicing physicians and persuaded them to bill Medicare, Medicaid, and private health insurers under their own provider numbers for allergy-related care provided by BROWN.  The care was provided both at the physicians’ own offices and at health fairs, with the physicians agreeing to pay BROWN between fifty and eight-five percent of a total of approximately $1.2 million they received from the health care benefit programs. BROWN has never been licensed in Georgia as a physician, physician assistant, nurse practitioner, or clinical nurse specialist.

                The United States is not aware of any patients who were seriously injured by care received from BROWN.  BROWN purchased the needles and allergy shots he used from a commercial pharmacy.  The United States is not aware of any evidence that BROWN ever used unsterile needles for the shots.  The U.S. Attorney’s Office has notified the individuals treated by BROWN, to the extent it was possible to identify and locate them.

            BROWN also pleaded guilty to wrongful disclosure of individually identifiable health information, in violation of the Health Insurance Portability and Accountability Act (“HIPAA”). The individually identifiable health information wrongfully disclosed by BROWN was a spreadsheet he created with information concerning each person he treated.  BROWN sent the spreadsheet to an undercover FBI agent, who BROWN believed to be an investor considering a large investment in BROWN’s business.

            BROWN was indicted in April  2011. He pleaded guilty to the indictment today.  The indictment charges 17 counts of health care fraud, each of which carries a maximum sentence of 10 years in prison and a fine of up to $250,000. The HIPAA charge also carries a maximum sentence of 10 years in prison and a fine of up to $250,000.  In determining the actual sentence, the Court will consider the United States Sentencing Guidelines, which are not binding, but provide appropriate sentencing ranges for most offenders.

                Sentencing for BROWN is scheduled for November 22, 2011, at 11 a.m., before United States District Judge Amy Totenberg.

            This case is being investigated by Special Agents of the Federal Bureau of Investigation. Assistance has been provided by the City of Duluth Police Department.

            Assistant United States Attorney Alana R. Black is prosecuting the case.

                For further information please contact Sally Q. Yates, United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney's Office, at (404) 581-6016.  The Internet address for the HomePage for the U.S. Attorney's Office for the Northern District of Georgia is www.justice.gov/usao/gan.

JURY CONVICTS MIAMI MAN FOR STEALING IDENTITY INFORMATION FROM DCF COMPUTERS FOR USE IN MEDICARE FRAUD SCAM

JURY CONVICTS MIAMI MAN FOR STEALING IDENTITY INFORMATION FROM DCF COMPUTERS FOR USE IN MEDICARE FRAUD SCAM

September 14, 2011

FOR IMMEDIATE RELEASE

Co-conspirator convicted and sentenced for buying and using stolen DCF patient information to commit Medicare fraud

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Henry Gutierrez, Postal Inspector in Charge, United States Postal Inspection Service, Miami Division, Michael K. Fithen, Special Agent in Charge, U.S. Secret Service, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, Dawn E. Case, Inspector General, Florida Department of Children and Families, and James K. Loftus, Director, Miami-Dade Police Department, announced that a jury returned a verdict of guilty on September 12, 2011 against Yenky Sanchez, 25, of Miami. Sanchez was found guilty on one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349; one count of conspiracy to commit authentication feature fraud, in violation of Title 18, United States Code, Sections 1028(a)(3) and (f); and ten counts of aggravated identity theft, in violation of Title 18, United States Code, Section 1028A(a)(1). The guilty verdict against Sanchez follows on the heels of the guilty plea by his co-conspirator, Raul Lazaro Diaz-Perera, 43, of Miami, for the same charges.

According to the evidence at trial against Sanchez, and in the factual proffer filed with the court during Diaz-Perera’s plea hearing, Diaz-Perera was a former supervisor at the Florida Department of Children and Families’ call center in downtown Miami. On the day he was fired, October 28, 2010, Diaz-Perera negotiated with a cooperating subject to sell the Medicare numbers of elderly and disabled Floridians who had applied to DCF for food stamps, cash benefits, and Medicaid. The intent was for those numbers to be used to fraudulently bill Medicare for services that were never provided to the DCF beneficiaries. Diaz-Perera obtained the Medicare numbers from the DCF computer system through a contact he had at DCF.

That contact was defendant Yenky Sanchez, who was then working as an employee at DCF’s call center in downtown Miami. Sanchez used his access to the DCF internal computer system to obtain the names, addresses, telephone numbers, dates of birth, Social Security numbers, and Medicare numbers of 148 elderly and disabled Floridians. Sanchez then gave the personal identification information to Diaz-Perera, who sold it to the cooperating subject on December 15, 2010.

Diaz-Perera negotiated a second time with the cooperating subject to sell additional Medicare numbers. Diaz-Perera again turned to Sanchez to obtain the numbers. Sanchez again used his access to the DCF computer system to steal the names and other identification information, including Medicare numbers of more than 400 beneficiaries. Sanchez then gave these additional numbers to Diaz-Perera, who attempted to sell it to the cooperating subject on January 18, 2011.

On June 30, 2011, U.S. District Court Judge Cecilia M. Altonaga sentenced Diaz-Perera to 36 months in prison, to be followed by three years of supervised release. Sentencing for Sanchez is scheduled for November 21, 2011. At sentencing, Sanchez faces a maximum of ten years in prison on the health care fraud charge, five years on the authentication feature fraud charge, and two years each for the aggravated identity theft charges.

This case was investigated by the United States Postal Inspection Service’s Identity Theft and Economic Crimes Task Force, the U.S. Secret Service, the FBI, and the Miami-Dade County Police Department, and prosecuted by Assistant United States Attorneys Robert J. Luck and Adam M. Schwartz. The Office commends the Florida Department of Children and Families for its cooperation in the investigation and prosecution of two of its former employees.