Monthly Archives: March 2018

Miami-Area Man Sentenced to Five Years in Prison for Role in $63 Million Health Care Fraud Scheme

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Thursday, February 22, 2018

A Miami-area man was sentenced to 60 months in prison today for his role in a $63 million health care fraud scheme involving a now-defunct community mental health center located in Miami that purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Benjamin G. Greenberg of the Southern District of Florida, Special Agent in Charge Robert Lasky of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

Samuel Konell, 70, of Boca Raton, Florida, was sentenced by U.S. District Judge Jose E. Martinez of the Southern District of Florida.  Judge Martinez also ordered Konell to pay $9,921,726 in restitution and to forfeit certain substitute assets, including several pieces of jewelry, in partial satisfaction of a personal money judgment entered against the defendant in the amount of $432,829.  Konell pleaded guilty on Nov. 21, 2017, to one count of conspiracy to defraud the United States and receive health care kickbacks.

As part of his guilty plea, Konell admitted that from approximately January 2006 through June 2012, he received kickbacks and/or bribes in return for referring Medicare beneficiaries from the Miami-Dade state court system to Greater Miami Behavioral Healthcare Center Inc. (Greater Miami) to serve as patients.  He admitted that he coordinated with criminal defendants in the state court system to obtain court orders for mental health treatment in lieu of incarceration so that he could refer those individuals to Greater Miami to serve as patients in return for kickbacks and/or bribes.  Konell further admitted that he did so knowing that certain of those individuals were not mentally ill or otherwise did not meet the criteria for PHP treatment.

In addition, Konell admitted that he and his co-conspirators at Greater Miami took steps to disguise the true nature of the kickbacks and/or bribes that Greater Miami paid to Konell and other patient brokers. Specifically, Konell was placed on the Greater Miami payroll to make the kickbacks and/or bribes appear as though they were legitimate salary payments, he admitted.  Konell further admitted that he was originally paid a flat monthly rate that was based on the number of patients he referred to Greater Miami from the state court system, and when Konell referred more patients to Greater Miami, his co-conspirators found ways to pay him over and above his regular kickback payments, including by providing him with holiday bonuses.

In furtherance of the kickback conspiracy, Konell made representations to judges and others in the Miami-Dade state court system that the individuals he referred to Greater Miami received medically necessary PHP services from Greater Miami when in reality such services were not always needed, he admitted.

According to plea documents, Konell’s co-conspirators caused the submission of over $63 million in false and fraudulent claims to Medicare.  These claims were based on kickbacks and/or bribes paid to Konell and others and were for services that were medically unnecessary, were not eligible for Medicare reimbursement or were never provided by Greater Miami.  Konell admitted that his participation in the Greater Miami scheme resulted in the submission of claims to Medicare totaling between at least approximately $9.5 and $25 million.

Eleven other individuals have pleaded guilty and have been sentenced for their roles in the scheme, including the owner of Greater Miami, three administrators and seven patient brokers.

This 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.  Former Senior Trial Attorney Christopher J. Hunter and Trial Attorneys Elizabeth Young and Leslie Wright of the Fraud Section prosecuted the case.  Assistant U.S. Attorney Adrienne Rosen of the Southern District of Florida is handling the forfeiture aspects of the case.

The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  The Medicare Fraud Strike Force operates in nine locations nationwide.  Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

Detroit Doctor Sentenced to Six Years in Prison for Role in $10.4 Million Health Care Fraud Scheme

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Tuesday, February 13, 2018

A Detroit, Michigan-area doctor was sentenced to 72 months in prison today for his role in a $10.4 million conspiracy to defraud the Medicare program.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Matthew Schneider of the Eastern District of Michigan, Acting Special Agent in Charge Timothy Waters of the FBI’s Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.

Mahmoud Rahim, M.D., 65, of West Bloomfield, Michigan, was sentenced by U.S. District Judge Nancy G. Edmonds of the Eastern District of Micihgan.  Judge Edmonds also ordered the defendant to forfeit $1,679,505.  The restitution amount will be determined at a later hearing.

After a one-week trial in September 2017, Rahim was convicted of one count of conspiracy to commit health care fraud and wire fraud, one count of wire fraud, one count of conspiracy to receive health care kickbacks and two counts of receiving healthcare kickbacks.  According to the evidence presented at trial, Rahim accepted kickbacks from his co-conspirators in exchange for referring Medicare patients for electromyogram tests (EMGs), some of which were unnecessary, and physical therapy performed by unlicensed individuals.  Rahim disguised these payments as “rent” and set up a shell company to hide this illegal scheme.

Rahim was charged along with office manager Janet Nahkle, 58, of Dearborn, Michigan, in an indictment returned in June 2016.  Nakhle pleaded guilty to conspiracy to receive health care kickbacks in December 2016 and was sentenced to serve 18 months in prison.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.  Fraud Section Trial Attorneys Jessica Collins and Amy Markopoulos prosecuted the case.

The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  The Medicare Fraud Strike Force operates in nine locations nationwide.  Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

United States Files False Claims Act Complaint Against Compounding Pharmacy, Private Equity Firm, and Two Pharmacy Executives Alleging Payment of Kickbacks

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Friday, February 23, 2018

The United States has filed a complaint in intervention against Diabetic Care Rx LLC d/b/a Patient Care America (PCA), a compounding pharmacy located in Pompano Beach, Florida, alleging that the pharmacy paid illegal kickbacks to induce prescriptions for compounded drugs reimbursed by TRICARE, the Department of Justice announced today.  The government has also brought claims against Patrick Smith and Matthew Smith, two pharmacy executives, and Riordan, Lewis & Haden Inc. (RLH), a private equity firm based in Los Angeles, California, which manages both the pharmacy and the private equity fund that owns the pharmacy, for their involvement in the alleged kickback scheme.

TRICARE is a federally-funded health care program for military personnel and their families.  The government alleges that the Defendants paid kickbacks to marketing companies to target TRICARE beneficiaries for prescriptions for compounded pain creams, scar creams, and vitamins, without regard to the patients’ medical needs.  According to the complaint, the compound formulas were manipulated by the Defendants and the marketers to ensure the highest possible reimbursement from TRICARE.  The Defendants and marketers allegedly paid telemedicine doctors to prescribe the creams and vitamins without seeing the patients, and sometimes paid the patients themselves to accept the prescriptions.  The scheme generated tens of millions of dollars in reimbursements from TRICARE in a matter of months, according to the complaint, which alleges that the Defendants and marketers split the profits from the scheme.

“The Department of Justice is determined to hold accountable health care providers that improperly use taxpayer funded health care programs to enrich themselves,” said Acting Assistant Attorney General for the Justice Department’s Civil Division Chad A. Readler.  “Kickback schemes corrupt the health care system and damage the public trust.”

“Providers and marketers that engage in kickback schemes drive up the cost of health care because they focus on their own bottom line instead of what is in the best interest of patients,” said Executive Assistant Randy Hummel of the United States Attorney’s Office for the Southern District of Florida.  “We will hold pharmacies, and those companies that manage them, responsible for using kickbacks to line their pockets at the expense of taxpayers and federal health care beneficiaries.”

“The Defense Criminal Investigative Service (DCIS) is committed to protecting the integrity of TRICARE, the military health care program that provides critical medical care and services to Department of Defense beneficiaries,” said Special Agent in Charge John F. Khin, of the Southeast Field Office.  “In partnership with DOJ and other law enforcement agencies, DCIS continues to aggressively investigate fraud and corruption to preserve and recover precious taxpayer dollars to best serve the needs of our warfighters, their family members, and military retirees.”

The lawsuit, United States ex rel. Medrano and Lopez v. Diabetic Care Rx, LLC dba Patient Care America, et al., No. 15-CV-62617 (S.D. Fla.), was originally filed in the U.S. District Court for the Southern District of Florida by Marisela Medrano and Ada Lopez, two former employees of PCA.  The lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act, which permit private parties to sue for false claims against of the United States and to receive a share of any recovery.  The Act permits the United States to intervene in such lawsuits, as the United States has done in this case.

This matter was investigated by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Southern District of Florida, the Defense Criminal Investigative Service, the U.S. Food and Drug Administration’s Office of Criminal Investigations, and the U.S. Army Criminal Investigation Command’s Major Procurement Fraud Unit.

The claims asserted against the defendants are allegations only; there has been no determination of liability.

Justice Department Reaches Settlement With Henry Ford Allegiance Health on Antitrust Charges

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Friday, February 9, 2018

Settlement Prohibits Allegiance from Agreeing to Limit Marketing and Improperly Communicating with Competing Providers

The Department of Justice announced today that it has reached a settlement with Henry Ford Allegiance Health (“Allegiance”) for conspiring with a rival hospital in a neighboring county to restrict marketing in that rival’s county.  The settlement ends almost three years of litigation and a scheduled March 6 trial relating to agreements to restrict marketing among hospitals in South Central Michigan.

“As a result of Allegiance’s per se illegal agreement to restrict marketing of competing services in Hillsdale County, Michigan consumers were deprived of valuable services and healthcare information,” said Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division.  “By prohibiting further anticompetitive conduct and educating Allegiance executives on antitrust law, this settlement will ensure that consumers receive the fruits of robust competition.”

The proposed settlement, joined by the Michigan Attorney General’s Office, was filed today in the U.S. District Court for the Eastern District of Michigan.  If approved by the court, the settlement will end Allegiance’s unlawful conduct and provide residents of South Central Michigan the full benefits of competition.  The Department’s Antitrust Division previously settled claims against three other South Central Michigan hospitals.  The Department charged Allegiance and these other hospitals with insulating themselves from competition by agreeing to withhold outreach and marketing in each other’s respective counties, so as not to solicit certain customers.  As a result, consumers were denied the benefits of competition, including free screenings and other services, as well as valuable information that informs healthcare choices and opportunities for higher quality care.

The Department’s proposed settlement with Allegiance expands on the terms of the Department’s previous settlements in this action, which the court entered more than two years ago.  Specifically, the proposed settlement prevents Allegiance from engaging in improper communications with competing providers regarding their respective marketing activities and entering into any improper agreement to allocate customers or to limit marketing.  It explicitly prevents Allegiance from continuing to carve out Hillsdale County from its marketing and business development activities.  The proposed settlement further requires Allegiance to report any violations to the Department, and imposes an annual obligation to certify compliance with the terms of the final judgment.  Allegiance must also submit to compliance inspections at the Department’s request.  The proposed settlement requires Allegiance to reimburse the Department and the state of Michigan for certain costs incurred in litigating this case.

Pursuant to Department policy, the settlement includes several new provisions included in all consent decrees designed to improve the effectiveness of the decree and the Division’s future ability to enforce it.  “The proposed settlement will make it easier and more efficient for the Department to enforce the decree by allowing the Department to prove alleged violations by a preponderance of the evidence,” said Assistant Attorney General Delrahim.  “These provisions will encourage a stronger commitment to compliance and will ease the strain on the Department in investigating and enforcing possible violations.”  Similar provisions have been included in a number of recent consent decrees where the Department’s new leadership has sought divestitures as a condition of clearing transactions under Section 7 of the Clayton Act.

Henry Ford Allegiance Health is a 475-bed health system that operates the sole general acute care hospital in Jackson County, Michigan, along with primary care physician offices, physical rehabilitation facilities, and diagnostic centers across several counties in South Central Michigan.  In March 2016, Allegiance became part of the Henry Ford Health System.  Henry Ford Health System is headquartered in Detroit, Michigan, and is the second largest health system in Michigan, operating Allegiance, five other hospitals, several medical centers, and one of the nation’s largest medical group practices.  Its 2016 revenues were over $5 billion.

The proposed settlement, along with the Department’s competitive impact statement, will be published in the Federal Register, consistent with the requirements of the Antitrust Procedures and Penalties Act.  Any person may submit written comments concerning the proposed settlement within 60 days of its publication to Peter Mucchetti, Chief, Healthcare & Consumer Products Section, Antitrust Division, U.S. Department of Justice, 450 Fifth Street, NW, 4th Floor, Washington, DC 20530.  At the conclusion of the 60-day comment period, the court may enter the final judgment upon a finding that it serves the public interest.

Department of Justice’s Antitrust Division Announces New Roundtable Series on Competition and Deregulation

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Monday, March 5, 2018

The Department of Justice’s Antitrust Division will hold a series of three public roundtable discussions to explore the relationship between competition and regulation, and its implications for antitrust enforcement policy. The first roundtable will occur on Wednesday, March 14, 2018 in the Great Hall of the Robert F. Kennedy Department of Justice Building, 950 Pennsylvania Avenue, NW, Washington, D.C. from 10:00 a.m. to 1:00 p.m. EST. The tentative agenda of the first roundtable can be found below.

The series of roundtable discussions will help the Department pursue effective and appropriate competition policy and identify related regulatory burdens on the American economy. The first roundtable will examine exemptions and immunities from the antitrust laws, and their impact on the free market and consumers. It will also include a discussion of the appropriate role of the state action doctrine in light of the broader federal policy favoring competition in interstate commerce.

“Our nation’s antitrust laws contribute to a well-functioning free market economy, and appropriate enforcement minimizes the need for burdensome regulatory intervention in the free markets,” said Assistant Attorney General Makan Delrahim. “Broad, bipartisan agreement for over half a century recognizes that the unrestrained interaction of competitive forces yields the best allocation of economic resources, the lowest prices, the highest quality, and the most innovation. I look forward to a robust exchange of ideas on these important topics.”

The roundtables will provide a forum for industry participants, academics, think tanks, and other interested parties to discuss the economic and legal analyses of competition and deregulation. The Antitrust Division plans to invite panelists from a variety of organizations, including American Antitrust Institute, American Bar Association Section of Antitrust Law, American Enterprise Institute, Association of Corporate Counsel, Business Roundtable, Cato Institute, Consumers Union, Federalist Society, Heritage Foundation, National Association of Attorneys General, Open Markets Institute, Public Knowledge, and the U.S. Chamber of Commerce.

The Department of Justice welcomes comments in advance of each of the roundtables. The Department will accept public comments (not to exceed 20 pages) regarding the first roundtable until March 13, 2018. Interested parties may submit comments to: [email protected]. Submitted comments will be made publicly available on the Department of Justice website.

The second roundtable, which will focus on antitrust consent decrees, will be held on April 26, 2018. The third roundtable will be held on May 31, 2018, and will assess the consumer costs of anticompetitive regulations. Agendas for upcoming roundtables will be posted on the Department of Justice website, along with instructions for submitting public comments for those roundtables.

The roundtables will be open to the public. Individuals wishing to attend must register for each roundtable on the Department’s website, at http://www.justice.gov/atr/CompReg/.

Reasonable accommodations for people with disabilities are available upon request. Requests should be submitted via email to Jeremy Edwards in the Office of Public Affairs at [email protected] or by calling 202-307-2016. Requests should be made in advance. Please include a detailed description of the accommodation needed and provide contact information.

CCC’s: Recommended Article/Book About Tom Hayes and the LIBOR Scandal

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I recommend reading an interview with author David Enrich who wrote a book “The Spider Network:  The Wild Story of a Math Genius, and a Gang of Backstabbing Bankers, And One of The Greatest Scams in Financial History.”  Below are excerpts of comments made by Mr. Enrich during the interview, “What’s Behind One of the Biggest Financial Scams in History.”  The interview appeared on February 19, 2017 in Knoweldge@Wharton.[1]

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  • “The mastermind of the LIBOR scandal was a guy named Tom Hayes, a mildly autistic mathematician who was a star trader at some of the world’s biggest banks.”
  • “[m]y iPhone buzzed with a text message from a number I didn’t recognize. And it said, “This goes much, much higher than me. Not even the Justice Department knows the full story. I’m willing to talk to you, but I need to make sure I can trust you.” It was Tom Hayes.”
  • “He felt like he was doing something that was really just false and misleading. And he took solace in the fact that the bosses knew about and generally approved of what he was doing. But as most of us learn from a very early age, just because everyone is doing something bad doesn’t mean it’s OK for you to do something bad yourself. That’s a message that was really lost on an entire generation of people in the financial industry, I think.”
  • “And prosecutors, instead of going after people at the top of the food chain — the CEOs and business leaders who are responsible for setting the culture at their institution, responsible for in many cases the practices of their institutions — instead of going after those guys, they uniformly went after a small group of relatively low-level people. Don’t get me wrong, Hayes in particular did things that were wrong, he knew they were wrong, or at least should have known they were wrong, and deserves to be punished. But what is crazy to me is that Tom Hayes is currently serving an 11-year sentence in a maximum-security prison. And as far as I can tell, he is the only banker currently in jail for crimes committed during the financial crisis.”
  • “The thing is, prosecutors do not like to lose cases, so they’ve taken, in general, a very conservative approach to what cases they’re going to bring because they don’t want to gamble on losing. They’ve built up these very impressive win/loss records as prosecutors. Some of them are undefeated. And they boast about that.”
  • “To me, that’s a really unhealthy sign, because the thing that would scare some of these bank CEOs is not losing some money or losing their jobs; it’s the prospect of being perp-walked in front of TV cameras in handcuffs, or the prospect of possibly losing your liberty in front of a jury of your peers. That is a terrifying thing. To me, the great missed opportunity of the financial crisis was that prosecutors didn’t do that a single time with a CEO or a top executive of any major financial institution. They might have lost those cases, but at least it would have struck some fear in the hearts of people.”
  • “Again, I’ve developed a lot of sympathy for them [Hayes and his family] and their situation there. I do want to make clear that he is not an innocent victim here. He is someone who was participating, and he was not acting properly. He was acting illegally, and I think deserves to be punished. I just find it galling that he is alone in being punished.”
  • “My concern is that as memories of these massive penalties [fines] fade and memories of the crisis fade, the pressure is going to return for banks to amp up their profits. As that becomes the priority among shareholders, it’s going to become the priority among senior executives. At that point, the cultural stuff goes out the window, and the No. 1 priority once again becomes just making as much money as quickly as you can.”

The book, The Spider Network: The Wild Story of a Math Genius, a Gang of Backstabbing Bankers, and One of the Greatest Scams in Financial History is available on Amazon here.

Thanks to my friend Toni Hill who forwarded the Wharton@Knowledge interview to me.  Toni and I worked together in the Philadelphia Field Office of the Antitrust Division on several high profile (and many low-profile but fascinating) cartel cases.

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[1]   The Wharton@Knowledge interview recap had this introduction:

David Enrich followed the story while he was working for The Wall Street Journal and got close to the central figure in the scandal — star derivatives trader Tom Hayes. In the book, The Spider Network: The Wild Story of a Math Genius, a Gang of Backstabbing Bankers, and One of the Greatest Scams in Financial History, Enrich, now with The New York Times, shares the tale of this brazen scam on the Knowledge@Wharton show on Sirius XM channel 111.

Owner of Numerous Miami-Area Home Health Agencies Sentenced to 20 Years in Prison for Role in $66 Million Medicare Fraud Conspiracy

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Wednesday, February 28, 2018

The owner and operator of numerous Miami, Florida-area home health agencies was sentenced to 240 months in prison today for his role in a $66 million conspiracy to defraud the Medicare program.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Benjamin G. Greenberg of the Southern District of Florida, Special Agent in Charge Robert F. Lasky of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Field Office made the announcement.

Rafael Arias, 52, of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga of the Southern District of Florida, who ordered Arias to pay $66.4 million in restitution and to forfeit the gross proceeds traced to the offense.  Arias pleaded guilty on Nov. 30, 2017, to one count of conspiracy to commit health care fraud and wire fraud.

“Today’s sentencing sends a clear message to anyone who is considering defrauding the Medicare system:  You will not only be caught, prosecuted, and sent to prison, but you will also have to pay back all of your ill-gotten gains,” said Acting Assistant Attorney General Cronan.

“Arias assumed that in Medicare fraud lay a path to riches,” said Special Agent in Charge Richmond. “Instead he discovered that we are working tirelessly with our law enforcement partners to protect patients and taxpayers while holding criminals accountable for their unlawful actions.”

As part of his guilty plea, Arias admitted that, between December 2007 and September 2015, he was the owner and operator of more than 20 home health agencies.  In many cases, however, Arias recruited nominee owners to falsely and fraudulently represent themselves as the agencies’ owners to hide his identity and ownership interest.  Arias and his co-conspirators paid illegal bribes and kickbacks to patient recruiters to refer patients to these agencies, and submitted false and fraudulent home health care claims to Medicare for beneficiaries who, in many cases, did not qualify or for whom the services were never provided.  In addition, Arias provided checks to other individuals and entities to cash so that Arias and his co-conspirators could obtain fraud proceeds to benefit themselves and further the fraudulent scheme.

Arias was charged along with Aylen Gonzalez, 39, of Hialeah, Florida; Ana Gabriela Mursuli Caballero, 51, of Miami; and Rafael Cabrera, 51, of Miami, in a July 2017 indictment.  Gonzalez, a patient recruiter who owned a medical clinic and co-owned two home health agencies, pleaded guilty in November 2017 to one count of conspiracy to commit health care fraud and wire fraud and was sentenced to 180 months in prison.  Mursuli Caballero, a patient recruiter and owner of two home health agencies, pleaded guilty in October 2017 to one count of conspiracy to commit health care fraud and wire fraud and was sentenced to 115 months in prison.  Cabrera, who participated in laundering and concealing the proceeds from the fraud, pleaded guilty in November 2017 to one count of conspiracy to commit money laundering and was sentenced to 71 months in prison.

This case was investigated by the FBI and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.  Trial Attorneys Angela Adams and Jessica Collins of the Criminal Division’s Fraud Section prosecuted the case.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,500 defendants who have collectively billed the Medicare program for more than $12.5 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Two New Orleans-Area Psychiatrists and a Health Care Marketer Charged for Roles in Kickback Scheme; Psychiatrists Also Charged With Health Care Fraud

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Thursday, February 8, 2018

Two New Orleans, Louisiana-area psychiatrists and a third individual were charged in an indictment filed today for their alleged participation in a health care kickback scheme.  The two psychiatrists were also charged for their roles in a home health care fraud scheme.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Duane A. Evans of the Eastern District of Louisiana, Special Agent in Charge Eric J. Rommal of the FBI’s New Orleans Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office made the announcement.

Muhammad Kaleem Arshad, M.D., 62, of New Orleans, Louisiana, Padmini Nagaraj, M.D., 60, of Kenner, Louisiana, and Joseph A. Haynes, 61, of New Orleans, were each charged with one count of conspiracy to receive illegal health care kickbacks and three counts of receiving illegal health care kickbacks.  Arshad and Nagaraj were also charged with one count of conspiracy to commit health care fraud and five counts of health care fraud.

The indictment alleges that the defendants, who were affiliated with a company that provides outpatient psychiatric services, conspired with the owner of a New Orleans home health agency to take bribes in exchange for referring psychiatric patients for medically unnecessary home health services. Haynes, who worked at the company as a marketer, allegedly helped to negotiate and enforce the bribes and kickbacks for the doctors.  The indictment further alleges that the New Orleans home health agency then submitted the fraudulent claims to Medicare to receive payment.

An indictment is merely an allegation and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

The case was investigated by the FBI and HHS-OIG.  Trial Attorney Kate Payerle of the Criminal Division’s Fraud Section is prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  The Medicare Fraud Strike Force operates in nine locations nationwide.  Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

Former Employee of U.S. Government Contractor in Afghanistan Pleads Guilty to Accepting Kickbacks From Subcontractor

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Monday, March 5, 2018

A former employee of a U.S. government contractor in Afghanistan pleaded guilty today to accepting illegal kickbacks from an Afghan subcontractor in return for his assistance in obtaining subcontracts on U.S. government contracts.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division; U.S. Attorney Byung J. Pak of the Northern District of Georgia; Special Agent in Charge John Khin of the Defense Criminal Investigative Service’s (DCIS) Southeast Field Office, Atlanta Resident Agency; Special Inspector General for Afghanistan Reconstruction (SIGAR) John F. Sopko; Director Frank Robey of the U.S. Army Criminal Investigation Command’s (CID) Major Procurement Fraud Unit (MPFU); Special Agent in Charge David J. LeValley of the FBI Atlanta Resident Agency and Special Agent in Charge Wendell W. Palmer of Air Force Office of Special Investigations (OSI), made the announcement.

Christopher McCray, 55, of Jonesboro, Georgia and Chattanooga, Tennessee, pleaded guilty to one count of accepting illegal kickbacks before U.S. District Judge Mark H. Cohen of the Northern District of Georgia.  He is scheduled to be sentenced by Judge Cohen on June 14 at 10:00 a.m. EST.  McCray was charged in an indictment filed on April 25, 2017 in the Northern District of Georgia with one count of conspiracy to accept kickbacks and 14 counts of accepting illegal kickbacks.

As part of his plea, McCray admitted that he was employed as the country manager for a subcontractor of an American company that was moving cargo for the Army and Air Force Exchange Service from Bagram Airfield to military bases through Afghanistan.  When the prime contractor needed McCray’s employer to take a much bigger role in the distribution, McCray had the chance to influence the choice of the necessary Afghan trucking company as a subcontractor to his employer.  McCray’s employer entered into a subcontract with an Afghan company but before the choice of the subcontractor was made, the Afghan trucking company secretly agreed to kick back to McCray 15 percent of the revenues it would receive on the contract, he admitted.  McCray thereafter remained as the only representative of his employer in Afghanistan for the duration of the subcontract and was responsible for checking the accuracy of the invoices submitted to McCray’s employer and the quality of the Afghan company’s work, all while secretly receiving the kickbacks, he admitted.

McCray received the secret payments from December 2012 to May 2014.  He and the Afghan trucking company also maintained a separate set of invoices, which showed the amounts charged to McCray’s employer and the amounts kept by the Afghan company and the amounts sent to McCray.  McCray was first paid in cash, then by wires sent to his bank in Atlanta and then by Western Union payments sent to his mother, who would deposit the funds, mostly in cash, into McCray’s bank accounts, he admitted.

DCIS, SIGAR, Army CID-MPFU, the FBI and Air Force OSI investigated this matter.  Trial Attorney James Gelber of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Brian Pearce of the Northern District of Georgia are prosecuting the case.

New York Doctor Sentenced to 13 Years in Prison for Multi-Million Dollar Health Care Fraud

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Wednesday, February 7, 2018

A New York surgeon who practiced at hospitals in Brooklyn and Long Island was sentenced today to 156  months in prison for his role in a scheme that involved the submission of millions of dollars in false and fraudulent claims to Medicare.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Richard P. Donoghue of the Eastern District of New York, Assistant Director in Charge William F. Sweeney Jr. of the FBI’s New York Field Office and Special Agent in Charge Scott Lampert of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations made the announcement.

Syed Imran Ahmed M.D., 51, of Glen Head, New York, was sentenced by U.S. District Judge Dora L. Irizarry of the Eastern District of New York, who also ordered Ahmed to pay $7,266,008.95 in restitution, to forfeit $7,266,008.95, and to pay a $20,000 fine.  Ahmed was convicted in July 2016 after an 11-day trial of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering.

“Medicare is a crucial program for many of the most vulnerable people in our society – American seniors and those with disabilities,” said Acting Assistant Attorney General Cronan.  “In this case, Syed Ahmed put his own greed ahead of the trust we put in our medical professionals, draining over $7 million in precious funding from our Medicare program.  His conviction and the sentence imposed in this case demonstrate the Department of Justice’s unwavering commitment to protecting public funds and the integrity of our health care system.”

“Dr. Syed Ahmed treated Medicare like a personal piggy bank, stealing over $7.2 million by making fraudulent claims for medical procedures he never performed,” stated U.S. Attorney Donoghue.  “Dr. Ahmed will now pay the price for violating the trust that Medicare places in doctors.  His 13-year prison sentence and the heavy payments imposed should send a powerful message of deterrence to other medical professionals who would seek to defraud vital taxpayer-funded programs like Medicare for personal enrichment.  This Office, together with our law enforcement partners, will remain vigilant in rooting out health care fraud.”

“Health care fraud is often billed as a victimless crime, but that couldn’t be further from the truth,” said Assistant Director in Charge Sweeney.  “Someone is always left to foot the bill. Insurers, the insured, and others are the ones who pay the price. Those who employ these schemes will most certainly be brought to justice, as we’ve proven here today.”

“The fraud scheme that Dr. Ahmed engaged in was motivated by pure greed,” said Special Agent in Charge Lampert.  “HHS OIG and our law enforcement partners will continue to aggressively pursue all those who seek to unlawfully enrich themselves by victimizing participants of the Medicare program.”

According to evidence presented at trial, Ahmed, a surgeon who practiced at Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center in Brooklyn, Franklin Hospital in Valley Stream, and Mercy Medical Center in Rockville Centre, New York, billed the Medicare program for incision-and-drainage and wound debridement procedures that he did not perform.  Ahmed wrote out lists of phony surgeries and sent the lists to his billing company in Michigan with instructions that they be billed to Medicare.  Ahmed also directed that the surgeries be billed as though they had taken place in an operating room so as to increase the payout for the fraudulent scheme, the evidence showed.

The evidence introduced at trial showed that Medicare paid over $7 million to Ahmed for fraudulent claims.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York.  Trial Attorney Debra Jaroslawicz of the Fraud Section, Assistant U.S. Attorney F. Turner Buford, formerly a Fraud Section trial attorney, and Senior Litigation Counsel Patricia Notopoulos of the Eastern District of New York are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,500 defendants who have collectively billed the Medicare program for more than $12.5 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.