Friday, October 28, 2011

Seven People Charged with Medicaid Fraud and Identify Theft

MADISON - Attorney General J.B. Van Hollen announced today that seven people have been charged with Medicaid Fraud and Identity Theft related to payment of claims for durable medical equipment.

Medicaid Fraud Control Unit Arrests Avondale Woman

Avondale-An Avondale woman has been arrested and charged with 13-counts of Medicaid fraud for filing false claims, announced Louisiana Attorney General Buddy Caldwell.

AG Reaches Additional $6.2 Million Settlements in AWP Cases

Jackson, MS--Attorney General Jim Hood today announced two more settlements in the ongoing Average Whole Price (AWP) litigation. The Attorney General's Office successfully negotiated these two settlements, involving three pharmaceutical manufacturers, which will put $6,032,000 into the State's coffers.

Attorney General Koster reaches settlement with St. Louis County in-home personal care company

Jefferson City, Mo.- Attorney General Chris Koster today announced a settlement with Delmar Gardens Private Services (DGPS), a Chesterfield, Missouri, company that arranges for the provision of in-home personal care services for qualified individuals. The settlement resolves allegations that DGPS submitted claims to Medicaid for in-home health services that were not eligible for reimbursement under Medicaid rules and state regulations.

Authorities Arrest 16 Linked to $18 Million Health Care Fraud Scheme Involving Bogus Prescriptions for Expensive Anti-Psychotic Drugs

LOS ANGELES - Sixteen people associated with a Glendale medical clinic, including a doctor and the owners of a San Marino pharmacy, were arrested this morning on criminal charges related to an $18 million scheme to defraud Medicare and Medi-Cal by, among other things, fraudulently prescribing expensive anti-psychotic medications, and then re-billing the government for those drugs over and over.

California-Based DFine Inc. to Pay U.S. More Than $2.3 Million to Settle Claims That Company Paid Kickbacks to Physicians

WASHINGTON - DFine Inc. of San Jose, Calif., has agreed to pay the United States $2.39 million to resolve allegations under the False Claims Act (FCA) that the company paid kickbacks to induce physicians to use certain of the company's devices that are used in treating spinal fractures, the Justice Department announced today.

Major Principals of DME Company Sentenced for Medicare and Medicaid Fraud

TAMPA, FL-U.S. Attorney Robert E. O'Neill announces that U.S. District Judge Virginia Hernandez Covington sentenced Gregory Bane (41, Valrico), the vice president for operations and IT manager of Bane Medical Services and Oxygen and Respiratory Therapy to three years in federal prison for conspiracy to commit health care fraud, health care fraud, and submitting false claims. Tracy Bane (41, Valrico), the billing supervisor, was sentenced to six months in federal prison, and 18 months of house arrest for conspiracy to commit health care fraud, health care fraud, and submitting false claims.

Pfizer to Pay $14.5 Million for Illegal Marketing of Drug Detrol

WASHINGTON - American pharmaceutical company Pfizer Inc. has agreed to pay $14.5 million to resolve False Claims Act allegations related to its marketing of the drug Detrol, the Justice Department announced today. The settlement resolves the last of a group of 10 qui tam, or whistleblower, suits that were filed in the District of Massachusetts and two other districts, beginning in 2003. The other nine suits were settled or dismissed in 2009 as part of the government's global resolution with Pfizer, under which the company agreed to pay $2.3 billion dollars to resolve civil claims and criminal charges regarding multiple drugs.

Twenty-Four Defendants Charged In Health Care Billing Scams That Defrauded Insurance Companies, Medicare, And Medicaid Out Of Millions Of Dollars

Preet Bharara, the United States Attorney for the Southern District of New York, Janice K. Fedarcyk, the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation ("FBI"), Raymond W. Kelly, the Police Commissioner of the City of New York ("NYPD"), Thomas O'Donnell, the Special Agent-in-Charge of the New York Office of the Inspector General, Department of Health and Human Services ("HHS"), and Benjamin M. Lawsky, the Superintendent of the New York Department of Financial Services ("NY DFS"), announced today the unsealing of three separate Indictments, charging 24 defendants with health care fraud. Two of the Indictments charge a total of 22 defendants with participating in fraudulent billing scams that caused no-fault insurance carriers to pay out millions of dollars in reimbursements for medical treatments that were never provided to patients or that were medically unnecessary.

Charlotte Woman Sentenced To 92 Months In Prison For Medicaid Fraud

CHARLOTTE, N.C. - Sarah Lavonne Willis, 49, of Charlotte, was sentenced on Monday, October 17, 2011, to serve 92 months in federal prison, to be followed by three years of supervised release for committing healthcare fraud, money laundering, failure to file tax returns, and possession of a firearm by a convicted felon, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. U.S. District Judge Max O. Cogburn, Jr. also ordered Willis to pay restitution in the amount of $1,085,041.78 to the North Carolina Medicaid Program and $145,197 to the Internal Revenue Service.

Owner Of Charlotte Health Care Company Sentenced To Prison For $1.9 Million Medicaid Fraud

CHARLOTTE, N.C. - The owner of a Charlotte mental and behavioral health services company was sentenced on Tuesday, October 18, 2011, to serve 15 months in federal prison, to be followed by three years of supervised release for his role in a Medicaid fraud scheme, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.

Miami-Area Halfway House Owner Pleads Guilty to Fraud and Kickback Scheme

WASHINGTON - The owner and president of a Miami-area halfway house company pleaded guilty today for her role in a kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), and its related company, the American Sleep Institute (ASI), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

United States Attorney's Office Recovers $578,820 From Louisville Company In Indiana Health Care Fraud Case

JEFFERSONVILLE - Joseph H. Hogsett, United States Attorney, announced today that civil claims against Premier Home Care, a durable medical equipment provider operating in southern Indiana, as well as central and southeastern Kentucky, have been resolved. Premier has agreed to pay $578,820 to the United States and $21,180 to the State of Indiana, more than twice the estimated damages resulting from the fraudulent acts.

Kittery Respiratory Therapist and Business Plead Guilty to Health Care Fraud Offenses

Portland, Maine -- United States Attorney Thomas E. Delahanty II announced today that Seacoast Sleep Solutions, LLC, and its President, Peter Enzinger, of Kittery, each pled guilty in U.S. District Court in Portland to committing health care fraud.

FDA Chemist Pleads Guilty to Using Insider Information to Trade on Pharmaceutical Stocks Resulting in Almost $4 Million in Profits

WASHINGTON - A Food and Drug Administration chemist pleaded guilty today before U.S. District Court Judge Deborah K. Chasanow in the District of Maryland to one count of securities fraud and one count of making false statements, related to a $3.7 million insider trading scheme that spanned nearly five years.

Hogsett Announces Indianapolis Man Charged With Medicaid Fraud

INDIANAPOLIS - Joseph H. Hogsett, United States Attorney, announced today that Ahmed Mohamed Abugroon, 56, of Indianapolis, Indiana, was charged with health care fraud\ following an investigation by the Federal Bureau of Investigation and the Indiana Attorney General's Medicaid Fraud Control Unit.

Montgomery, Alabama, Woman Pleads Guilty to Two Tax Fraud and Identity Theft Conspiracies - Multi-Million Dollar Fraud Schemes Used Stolen Information of Medicaid Recipients

WASHINGTON - Veronica Dale, a resident of Montgomery, Ala., pleaded guilty today to two tax fraud and identity theft conspiracies, the Justice Department and the Internal Revenue Service (IRS) announced. In addition to pleading guilty to two counts of conspiracy to defraud the government with respect to claims, Dale pleaded guilty to two counts of filing false, fictitious or fraudulent claims with the United States; two counts of theft of government money, property or records; one count of wire fraud; and one count of aggravated identity theft.

Jury Convicts Former Director Of The Louisiana Governor's Program On Abstinence Of Mail Fraud

BATON ROUGE, LA - United States Attorney Donald J. Cazayoux, Jr. announced that a federal jury has returned a guilty verdict against Gail Ray Dignam, age 64, currently of Diamondhead, Mississippi, and formerly of Baton Rouge, convicting the defendant of two counts of mail fraud. The verdict followed a three-day trial before United States District Judge James J. Brady.

Owners of Fraudulent Lakeland, Florida, Physical Therapy Company Sentenced to 42 and 46 Months in Prison

WASHINGTON - Miami-area residents Angel Gonzalez and Jorge Zamora, who were the owners and operators of a fraudulent physical therapy company in Lakeland, Fla., were sentenced yesterday and today to 42 months in prison and 46 months in prison, respectively, for their leading roles in a scheme to defraud Medicare, announced the Department of Justice, the FBI and the Department of Health and Human Services.

Grand Jury Indicts 14 in L.A.-Based OxyContin Ring that Allegedly Distributed Over 1 Million Pills of the Highly Addictive Painkillers

LOS ANGELES - Federal and state authorities this morning arrested 10 defendants - including two doctors - who are named in a federal indictment that alleges members of a drug trafficking organization illegally obtained and distributed more than 1 million OxyContin pills obtained largely through fraud against public insurance programs such as Medicare.

Owner of Houston Health Care Company Sentenced To 33 Months in Prison for Medicare Fraud

WASHINGTON - The owner and operator of a Houston durable medical equipment (DME) company was sentenced yesterday in Houston federal court to 33 months in prison for his role in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services.

Hospice Owner Charged In$14 Million Health Care Fraud Scheme

Hospice Owner Charged In Health Care Fraud Scheme

PHILADELPHIA - An indictment1 was unsealed today charging Matthew Kolodesh, a/k/a "Matvei Kolodech", with conspiracy to defraud Medicare of more than $14 million through his home hospice business, announced United States Attorney Zane David Memeger. Kolodesh was arrested this morning.

Twenty-Four Indicted In Oxycodone Trafficking And Health Care Fraud Scheme

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Mark R. Trouville, Special Agent in Charge, Drug Enforcement Administration, Christopher B. Dennis, Special Agent in Charge, Health and Human Services, Office of Inspector General, Jos� A. Gonzalez, IRS Special Agent in Charge, Director James K. Loftus, Miami-Dade Police Department, Al Lamberti, Sheriff, Broward Sheriff's Office, and H. Frank Farmer, M.D., State Surgeon General, Florida Department of Health (DOH), announced the unsealing of a federal indictment charging twenty four defendants for their participation in, among other things, conspiracy to distribute oxycodone and oxymorphone, and conspiracy to defraud Medicare. Twenty-one of the defendants, including a doctor, a pharmacist and two pain clinic operators are currently in custody after a multi-agency takedown was executed early this morning. Three defendants, Hattie Mae Green, Eliezer Salgado and Ronald Regains, remain at large.

Home Health Care Agency Owner Pleads Guilty To Aggravated Identity Theft Related To Health Care Fraud

MINNEAPOLIS-Recently in federal court, the operator of Universal Home Health, a home health care agency located in Golden Valley, pleaded guilty to an offense related to defrauding Medicaid. On October 7, 2011, Mustafa Hassan Mussa, age 56, of Minnetonka, pleaded guilty to one count of aggravated identity theft. Mussa, who was charged on August 18, 2011, entered his plea before United States District Court Judge Susan Richard Nelson.

Former Medical Equipment Supplier Pleads Guilty To Health Care Fraud

Little Rock - Christopher R. Thyer, United States Attorney for the Eastern District of Arkansas, announced today the guilty plea of Archibong Edem-Effoing, age 58, of Houston, Texas. Edem-Effoing pled guilty to one count of health care fraud in violation of Title 18, United States Code, Section 1347. At the plea hearing held before United States District Judge Brian S. Miller, Edem-Effoing admitted that no later than December 22, 2007 and continuing through March 1, 2009, he engaged in a scheme to defraud Medicare by stealing the identity of a young Nigerian which he then used to apply for a Medicare Durable Medical Equipment (DME) supplier number. After receiving the DME number, he billed Medicare for arthritis kits and power wheelchairs that, in some cases, were not ordered by a physician, and which in other cases were never delivered.

King of Prussia Man Indicted on Health Care Fraud and Aggravated Identity Theft Charges

Elissa Jo Benoit was charged today by indictment with a total of 75 counts involving health care fraud, aggravated identity theft, aiding and abetting the distribution of controlled substances and distribution of controlled substances by a person at least 18 years of age to persons under 21 years of age, announced United States Attorney Zane David Memeger.

Tuesday, October 11, 2011

Detroit-Area Clinic Owner Sentenced to 10 Years in Prison for Role in $9.1 Million Medicare Fraud Scheme

WASHINGTON – Martin Tasis was sentenced today to 10 years in prison for his leading role in a $9.1 million Detroit-area Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Tasis was sentenced by U.S. District Judge Arthur Tarnow in the Eastern District of Michigan. In addition to his prison term, Tasis was sentenced to three years of supervised release and was ordered to pay $6 million in restitution, jointly and severally with his co-conspirators.

Martin Tasis and co-defendants Joaquin Tasis and Leoncio Alayon were convicted by a jury in May 2011 after a five-day trial. Evidence presented at trial showed that the Tasis brothers and their co-conspirators helped relocate a highly lucrative infusion therapy fraud scheme to Michigan from South Florida after increased law enforcement scrutiny there.

According to evidence presented at trial, Martin and Joaquin Tasis were the owners of a Detroit-area clinic called Dearborn Medical Rehabilitation Center (DMRC). Evidence at trial showed that Medicare beneficiaries were not referred to DMRC by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of cash kickbacks. DMRC then billed Medicare for expensive and exotic medications, purportedly administered to treat HIV and Hepatitis-C. However, the medications were never administered.

Once Medicare started paying the co-conspirators, Martin Tasis enlisted Alayon, a family friend, to help him launder the proceeds of the fraud through a shell corporation in Florida called Infinity Research Corp. Evidence at trial showed that Infinity Research Corp. had no employees, did no research and was based at Alayon’s residence. Alayon, after taking a commission for himself, distributed the laundered proceeds to Martin and Joaquin Tasis and their co-conspirators.

Between November 2005 and March 2007, DMRC billed approximately $9.1 million in claims to Medicare for injection therapy services that were never provided and/or were not medically necessary. Medicare paid approximately $6 million of those claims. Evidence at trial showed that DMRC purchased only $36,000 in medication and medical supplies.

Martin Tasis was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay health care kickbacks, three counts of health care fraud, one count of conspiracy to commit money laundering and one count of money laundering.

Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (HHS-OIG) Chicago Regional Office.

The case was prosecuted by Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section and Assistant U.S. Attorney for the Eastern District of Michigan Philip Ross. The FBI and HHS-OIG conducted the investigation.

Since its inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 individuals and organizations 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 to:www.stopmedicarefraud.gov

What is Single Payer

What is Single Payer?

Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor’s office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers—it’s very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.

What is Single Audit?

Each year, the Federal Government provides over $400 billion in grants to State, local and tribal governments, colleges, universities and other non-profit organizations (non-Federal entities). The Single Audit Act of 1984 (with amendment in 1996) and OMB Circular A-133 ("Audits of State, Local Governments, and Non-Profit Organizations") provide audit requirements for ensuring that these funds are expended properly. All non-Federal entities that expend $500,000 or more of Federal awards in a year ($300,000 for fiscal year ending on or before December 30, 2003) are required to obtain an annual audit in accordance with the Single Audit Act Amendments of 1996 (pdf), OMB Circular A-133, the OMB Circular Compliance Supplement and Government Auditing Standards. A single audit is intended to provide a cost-effective audit for non-Federal entities in that one audit is conducted in lieu of multiple audits of individual programs. The Single Audit provides the Federal government with assurance that these recipients comply with such directives by having anindependent external source (the CPA) report on such compliance.

OMB Circular A-133 Compliance Supplement 2009