Seven People Charged with Medicaid Fraud and Identify Theft

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

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

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

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.

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

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

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 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

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.

Hogsett Announces Indianapolis Man Charged With Medicaid Fraud

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

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

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.

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

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.

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

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.

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.

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

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.