Nine Miami-Dade Assisted Living Facility Owners Sentenced to Federal Prison for Receipt of Health Care Kickbacks

Wednesday, July 19, 2017

Miami-Dade County assisted living facility owners, Marlene Marrero, 60, of Miami, Norma Casanova, 67, of Miami Lakes, Yeny De Erbiti, 51, of Miami, Rene Vega, 57, of Miami, Maribel Galvan, 43, of Miami Lakes, Dianelys Perez, 34, of Miami Gardens, Osniel Vera, 47, of Hialeah, Alicia Almeida, 56, of Miami Lakes, and Jorge Rodriguez, 57, of Hialeah, were sentenced to prison for receiving health care kickbacks. United States District Judge Marcia G. Cooke imposed sentences upon the nine defendants ranging from eight months to one year and one day, in prison. One assisted living facility owner, Blanca Orozco, 69, of Miramar, was sentenced to home confinement. In addition to their federal convictions, all ten defendants were also ordered to serve three years of supervised release, pay restitution and are subject to forfeiture judgments.

Benjamin G. Greenberg, Acting United States Attorney for the Southern District of Florida, Pam Bondi, Florida Attorney General, Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), and George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, made the announcement.

All ten defendants previously pled guilty to receipt of kickbacks in connection with a federal health care program, in violation of Title 42, United States Code, Section 1320a-7b(b)(1)(A). According to court documents, these assisted living facility owners conspired with the former owner of Florida Pharmacy to receive kickbacks and bribes in exchange for referring beneficiaries living in their facilities for prescription medication and durable medical equipment paid for by Medicare and Medicaid. The assisted living facility owners participated in the fraudulent scheme, in violation of their Medicaid provider agreement as well as federal and state anti-kickback rules and regulations.

Mr. Greenberg commended the investigative efforts of the Medicare Fraud Strike Force participating partners, including HHS-OIG, the State of Florida’s Medicaid Fraud Control Unit, and the FBI. The case was prosecution by Special Assistant United States Attorney Hagerenesh Simmons.

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.

In addition, 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.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

District Man Sentenced to Year in Prison For Carrying Out Bank Fraud Scheme

Monday, July 17, 2017

Admitted Filing Forged Documents, Leading to Nearly $340,000 in Ill-Gotten Gains

WASHINGTON – David Tyrone Johnson, 48, of Washington, D.C., was sentenced today to a year and a day in prison on federal charges arising from a real estate scheme involving forged mortgage satisfaction documents, announced U.S. Attorney Channing D. Phillips and Andrew Vale, Assistant Director in Charge of the FBI’s Washington Field Office.

Johnson pled guilty in April 2017, in the U.S. District Court for the District of Columbia, to charges of bank fraud and making false statements. He was sentenced by the Honorable Ketanji Brown Jackson. Following his prison term, Johnson will be placed on two years of supervised release. He also must pay $337,105 in restitution to Fidelity National Title Insurance Company, as well as a forfeiture money judgment of $170,688.

According to a statement of offense submitted at the time of the guilty plea, SunTrust Mortgage, Inc. loaned a friend of Johnson’s approximately $470,000 in 2008 to purchase residential real estate in the 100 block of 57th Street SE. By 2009, the friend had failed to repay the mortgage loans, and in 2010, SunTrust Mortgage filed a notice of foreclosure with the District of Columbia’s Recorder of Deeds. In April 2013, SunTrust Mortgage began the process of foreclosing on the mortgage and taking possession of the property, due to the friend’s failure to make good and timely payments on the mortgage loans.

Sometime before Oct. 2, 2013, Johnson caused the creation of two phony and forged certificates of satisfaction, which falsely represented that the SunTrust Mortgage loans at the property on 57th Street SE had been paid and that his friend owned the property “free and clear.” According to the statement of offense, on Oct. 2, 2013, Johnson filed these two phony certificates of satisfaction with the Recorder of Deeds.

In or about December 2013, after the fake certificates of satisfaction allowed the friend to sell the property without paying the outstanding mortgages, the title and escrow company wired out the sales proceeds of $337,105, of which approximately $170,688 was obtained by Johnson.

In addition, in 2015, Johnson was required to submit a financial disclosure form to his government agency employer; however, on that form, Johnson failed to disclose the money he obtained from the sales proceeds of the property, knowing that he had obtained the money. This failure to inform his government agency employer was material or important to his employer, and one that resulted in a false statement on his financial disclosure form.

In announcing the sentence, U.S. Attorney Phillips and Assistant Director in Charge Vale expressed appreciation for the work performed by those who investigated the case and assisted in preparing it for trial from the FBI, including the Washington Field Office and the FBI Laboratory. They also acknowledged the efforts of those working on the case from the U.S. Attorney’s Office, including Paralegal Specialist Christopher Toms; former Paralegal Specialists Corinne Kleinman and Kaitlyn Krueger; Litigation Tech Specialist Ron Royal, and Assistant U.S. Attorney Thomas Swanton, who assisted with forfeiture issues. Finally, they commended the work of Assistant U.S. Attorney Virginia Cheatham, who prosecuted the case.

Senior Executives Of Medical Drug Re-Packager Plead Guilty To Defrauding Healthcare Providers

Friday, July 14, 2017

President and Pharmacist-in-Charge Distributed Cancer Drugs Contaminated With Mold

Earlier today, in federal court in Brooklyn, Gerald Tighe, the president and owner of Med Prep Consulting Inc. (Med Prep), and Stephen Kalinoski, its director of pharmacy and registered pharmacist-in-charge, pleaded guilty to wire fraud conspiracy in connection with their operation of the now-defunct Tinton Falls, New Jersey-based medical drug re-packager and compounding pharmacy. The pleas were entered before United States District Judge I. Leo Glasser.

The guilty pleas were announced by Bridget M. Rohde, Acting United States Attorney for the Eastern District of New York, and Mark McCormack, Special Agent-in-Charge of the U.S. Food and Drug Administration’s Office of Criminal Investigations, Metropolitan Washington Field Office (FDA/OCI).

According to court filings and facts presented during the plea proceeding, Med Prep processed numerous drugs, including oncology and dialysis drugs, pain medications, anesthesia drugs, and operating room drugs, in purportedly aseptic conditions. In an effort to gain market share, Med Prep repeatedly misrepresented to its customers, who consisted of hospitals and other healthcare providers, that it adhered to, and in some areas exceeded, industry standards and laws applicable to sterile drug preparation. In fact, Med Prep produced drugs in a facility that fell far short of basic industry standards of cleanliness, creating a risk to the health of already ill patients. Tighe and Kalinoski lied to healthcare providers about Med Prep’s failures to comply with basic sterility practices. Med Prep halted its production of drug products in the summer of 2013, following an incident in which it had distributed intravenous drugs containing visible mold to a Connecticut hospital.

“Today’s guilty pleas mark an important step in our continuing effort to hold accountable those who pursue corporate profits over the health and safety of vulnerable patients suffering from disease,” said Acting United States Attorney Rohde. In announcing the guilty plea, Ms. Rohde gratefully acknowledged the assistance and cooperation of the United States Department of Health and Human Services, Office of the Inspector General, Office of Investigations; the United States Office of Personnel Management, Office of the Inspector General; the Department of Justice, Civil Division, Consumer Protection Branch and Commercial Litigation Branch; the FDA’s Office of the Chief Counsel; the Office of the Attorney General of New Jersey; and the New Jersey Board of Pharmacy.

“Producing unsafe and contaminated drugs poses a serious threat to the U.S. public health and cannot be tolerated,” stated FDA/OCI Special Agent-in-Charge McCormack. “The FDA remains fully committed to aggressively pursuing those who place unsuspecting American consumers at risk by distributing adulterated drugs.”

The sentencing, Tighe and Kalinoski each face up to five years in prison, a fine and the forfeiture of criminal proceeds. They will also be required to make full restitution to their victims.

The case is being prosecuted by Assistant United States Attorneys Alixandra E. Smith, Ameet B. Kabrawala and Erin E. Argo.

The Defendants:

GERALD TIGHE

Age: 59

West Long Branch, New Jersey

STEPHEN KALINOSKI

Age: 53

Middletown, New Jersey

E.D.N.Y. Docket No. 15-CR-62 (ILG)

Surgical Practice Office Manager’s Boyfriend Sentenced to Nearly 6 Years in Prison for Embezzlement Conspiracy

Friday, July 14, 2017

BIRMINGHAM – A federal judge this week sentenced a Mississippi man to nearly six years in prison for conspiring with his girlfriend to steal more than $1 million from the Birmingham surgical practice where she worked, announced Acting U.S. Attorney Robert O. Posey and FBI Acting Special Agent in Charge David W. Archey.

U.S. District Court Judge Madeline Hughes Haikala sentenced ANTHONY T. MICHAEL, 43, of Jackson, Miss., to five years and 10 months in prison for conspiracy, bank fraud and aggravated identity theft. Michael pleaded guilty to the charges in March. The judge ordered him to pay $1.2 million in restitution and to forfeit the same amount to the government as proceeds of illegal activity.

Michael conspired with Anntwine Moss, 51, of Bessemer, to steal from Thoracic and Cardiovascular Surgery of Alabama between 2006 and 2013. Moss was office manager for the practice during that time and she and Michael were romantically involved.

U.S. District Court Judge Karon O. Bowdre sentenced Moss in May to three years and five months in prison on five counts of wire fraud and four counts of tax evasion in the case. The judge ordered Moss to pay $987,375 in restitution to the practice and to forfeit the same amount to the government.

According to court documents, Moss stole from the surgical practice by using her authority as office manager to write unauthorized checks to herself and to Michael, make unauthorized direct deposits into her account, and use the company’s credit cards for unauthorized personal purchases for herself and Michael. Moss had authority over several key functions at the surgical practice including payroll, accounting, bookkeeping and managing the office’s budget. She falsified her personal tax returns for several years by failing to report to the IRS the illicit income she stole from the practice.

The FBI and IRS investigated the case, which Assistant U.S. Attorney Xavier O. Carter Sr. prosecuted.

U.S. Attorney Charges NW Alabama Compounding Pharmacy Sales Representatives in Prescription Fraud Conspiracy

Thursday, July 13, 2017

BIRMINGHAM – The U.S. Attorney’s Office on Wednesday charged two sales representatives for a Haleyville, Ala.,-based compounding pharmacy for participating in a conspiracy to generate prescriptions and defraud health care insurers and prescription drug administrators out of tens of millions of dollars in 2015.

Acting U.S. Attorney Robert O. Posey, FBI Acting Special Agent in Charge David W. Archey, U.S. Postal Inspector in Charge, Houston Division, Adrian Gonzalez, U.S. Department of Health and Human Services, Office of Inspector General, Special Agent in Charge Derrick L. Jackson, Defense Criminal Investigative Service Special Agent in Charge John F. Khin, and Internal Revenue Service, Criminal Investigation, Acting Special Agent in Charge James E. Dorsey announced the charges as part of a nationwide Department of Justice Health Care Fraud Takedown.

Attorney General Jeff Sessions and Department of Health and Human Services Secretary Tom Price, M.D., earlier today announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving about $1.3 billion in false billings. Of those charged, more than 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s nationwide arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.

In the Northern District of Alabama, the U.S. Attorney’s Office filed separate informations charging KELLEY NORRIS, also known as KELLEY NORRIS-HARTLEY, 41, of Tuscaloosa, and BRIDGET McCUNE, 41, of Destin, Fla., with conspiracy to commit health care fraud, wire fraud and mail fraud. McCune’s information also charges her with conspiring to solicit and receive kickbacks in return for referring prescriptions under Medicare and TRICARE, a U.S. Department of Defense health care program, and with money laundering for spending proceeds of the crimes. Both women face various counts of health care fraud for submitting fraudulent prescription reimbursement claims to Blue Cross Blue Shield of Alabama.

In conjunction with the charges, prosecutors also filed plea agreements with Norris and McCune.

“In this case, a pharmacy used a marketing scheme that increased sales of expensive medications without regard for patient need or medical necessity,” Posey said. “Schemes like this defraud Medicare and other health insurance systems by pushing unnecessary medications and driving up the costs of health care.”

Norris and McCune both worked for Northside Pharmacy, an Alabama company doing business as Global Compounding Pharmacy. Global’s compounding and shipping facility was in Haleyville. The pharmacy did its prescription processing, billing and customer service at its “call center” in Clearwater, Fla.

Global hired sales representatives, including Norris and McCune, who were located in various states and were responsible for generating prescriptions from physicians and other prescribers. To bill insurance providers, including Blue Cross Blue Shield of Alabama, Medicare and TRICARE, for these prescriptions, Global contracted to enter the pharmacy networks of their third-party administrators, known as “pharmacy benefit managers” or “PBMs. These PBMs included Prime Therapeutics, Express Scripts Incorporated and CVS/Caremark.

The court documents describe a conspiracy at Global that centered on generating and billing PBMs for fraudulent, often high-reimbursement prescriptions. To generate prescriptions, Global hired sales representatives who were married or related to doctors and other prescribers. Global also encouraged sales representatives to volunteer at doctors’ offices where they would review patient files and push Global’s products to patients. Global executives also frequently instructed employees to obtain high-reimbursing prescriptions that Global would fill and bill for reimbursement. Each of the plea agreements describes a Global executive instructing sales representatives to obtain certain prescriptions and, shortly after, Norris and McCune obtained those prescriptions for themselves and their dependents.

When billing, Global engaged in various fraudulent practices, including splitting drug quantities to evade PBM billing safeguards and automatically refilling and billing for prescriptions regardless of patient need. Global routinely waived co-pays to encourage patients to accept unnecessary medications and refills.

As part of their plea agreements, Norris and McCune agree to forfeit money to the government as proceeds of illegal activity. Norris agrees to forfeit $287,698 and McCune $401,628.

Global paid the defendants a base salary plus a monthly commission for prescriptions that they obtained, according to court documents.

Norris worked out of Tuscaloosa as a sales representative for Global’s Alabama region from August 2014 to July 2016. She was closely related to an Alabama physician. That relative and a second physician, described in her plea agreement as a family friend, wrote a significant number of the prescriptions Norris obtained for Global to fill.

McCune began as a sales representative for Global’s Florida region in September 2014, working from Destin. Global promoted her to national field trainer in January 2015, but she also continued to function as a sales representative until she left the company in July 2016. McCune had a “close familial relationship” with a Florida physician, according to her plea agreement. “The overwhelming majority of prescriptions she obtained” were issued under her family member’s signature, her plea agreement states.

The charges against Norris and McCune follow charges brought by the U.S. Attorney’s Office in May against Global sales representative Robin Gary Lowry, 49, of Columbus, Miss. Lowry was charged with conspiracy to defraud BCBS of Alabama and Prime Therapeutics. She also faced three counts of health care fraud for submitting fraudulent claims for payment to BCBS of Alabama.

Lowry pleaded guilty to the charges in June. She is scheduled for sentencing Nov. 7.

FBI, U.S. Postal Inspection Service, U.S. Department of Health and Human Services Office of Inspector General, U.S. Defense Criminal Investigative Service and Internal Revenue Service, Criminal Investigation investigated the cases, which Assistant U.S. Attorneys Chinelo Dike-Minor and Nicole Grosnoff are prosecuting.

Former Aurora Business Owner Indicted for $26 Million Fraud Schemes

Thursday, July 13, 2017

SPRINGFIELD, Mo. – Tom Larson, Acting United States Attorney for the Western District of Missouri, announced today that a former Aurora, Mo., business owner has been indicted by a federal grand jury today for fraud schemes by which he stole more than $26 million, as well as money laundering and other charges.

Russell Grundy, 48, of Hilton Head Island, S. Carolina, formerly of Aurora, was charged in a 30-count indictment returned by a federal grand jury in Springfield, Mo., on Tuesday, July 11, 2017. Grundy was arrested today.

Grundy was the owner of several companies that focused on advanced technologies, ranging from software development to computer security to addressing the software and hardware technological needs of its clientele. Grundy’s companies included Innovative Objects, LLC, PILR Technology, LLC, Choice Technologies, LLC, Wyerless, LLC, and Audio Input, LLC.

Land O’Lakes/Nutra Blend Fraud Scheme

Grundy (through his company Innovative Objects) was contracted by Land O’Lakes, Inc., and its subsidiary, Nutra Blend, LLC, from January 2004 to Sept. 27, 2015, to create propriety software to inventory, track, and coordinate the disbursement of products. Grundy also contracted with Land O’Lakes and Nutra Blend to provide equipment and technical support for the use, upkeep and maintenance of the software.

The indictment alleges that Grundy falsely told Land O’Lakes and Nutra Blend that third party software programs were built into that proprietary software and were essential to the successful operation of the software. Grundy allegedly claimed that some of the payments made to Innovative Objects were remitted to third party license holders. In reality, the indictment says, there were no third party licensee fees; instead, Grundy kept those payments for his personal or unrelated expenses.

The indictment charges Grundy with six counts of wire fraud related to a series of payments from August 2013 to April 2015, totaling $862,856.

Miami Nations Enterprise Fraud Scheme

Grundy engaged Miami Nations Enterprise in negotiations to provide financial assistance in the form of loans, and for Miami Nations Enterprise to purchase a controlling interest in all of Grundy’s technology-based companies.

According to the indictment, Grundy falsely told Miami Nations Enterprise that his companies had been awarded a $3.5 million contract from Wal-Mart Stores, Inc., to develop and provide information technology services. Grundy allegedly presented numerous e-mails, invoices, conditional award letters and other documents to support his false claims. From May 19, 2014, to June 24, 2015, Miami Nations Enterprise loaned Grundy the money to cover the costs associated with software and hardware purchases and training necessary to obtain the $3.5 million Wal-Mart contract.

On Aug. 24, 2014, Miami Nations Enterprise paid an additional amount to purchase a 70 percent interest in Grundy’s companies.

Officials with Miami Nations Enterprise later discovered that neither Grundy nor any of his companies had been awarded any contract with Wal-Mart, and determined that the e-mails, conditional contract award, invoices and bank deposits Grundy had used to support his claims were fraudulently created.

The indictment charges Grundy with 10 counts of wire fraud related to a series of payments from May 19, 2014, to April 12, 2015, totaling $5,990,000.

Additional Charges

In addition to the wire fraud schemes, the indictment charges Grundy with four counts of making a false statement on a loan application. Grundy applied for three loans from UMB Bank on Oct. 17, 2014, totaling $11,390,800. Grundy applied for a $1,850,000 loan from the People’s Bank of Seneca on Aug. 27, 2015. Grundy allegedly made material false statements in each of those loan applications.

Grundy is also charged with 10 counts of money laundering.

The indictment also contains a forfeiture allegation, which would require Grundy to forfeit to the government any property obtained as a result of the alleged wire fraud violations, including a money judgment of at least $26,060,000.

Larson cautioned that the charges contained in this indictment are simply accusations, and not evidence of guilt.

This case is being prosecuted by Assistant U.S. Attorneys Patrick Carney and Casey Clark. It was investigated by the FBI and IRS-Criminal Investigation.

Federal Grand Jury Indicts Union Official for Allegedly Extorting Cash Payments from Local Business

Wednesday, July 12, 2017

CHICAGO — A high-ranking official in a Chicago-area labor union threatened a local business with economic loss if it didn’t pay him quarterly cash payments of $25,000, according to a federal indictment returned today.

JOHN T. COLI SR. used the threat of economic harm to extort quarterly payments of $25,000 from a local company, according to the indictment. The attempted extortion occurred from approximately October 2016 to April 2017, while Coli served as President of Teamsters Joint Council 25, a labor organization that represents more than 100,000 workers in the Chicago area and northwest Indiana. The organization has approximately 26 local union affiliates, including Teamsters Local Union 727, where Coli also served as Secretary-Treasurer during the time period referenced in the indictment.

The indictment was returned today in U.S. District Court in Chicago. It charges Coli, 57, of Chicago, with one count of attempted extortion and five counts of demanding and accepting a prohibited payment as a union official. The indictment seeks forfeiture from Coli of at least $100,000.

Arraignment in federal court in Chicago will be held at a future time to be set by the Court.

The indictment was announced by Joel R. Levin, Acting United States Attorney for the Northern District of Illinois; Michael J. Anderson, Special Agent-in-Charge of the Chicago office of the Federal Bureau of Investigation; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor’s Office of Inspector General in Chicago.

According to the charges, Coli accepted a $25,000 cash payment on July 7, 2016; two cash payments totaling $25,000 on Oct. 4, 2016, and Nov. 29, 2016; and $25,000 cash payments on Dec. 22, 2016, and April 4, 2017. The indictment does not identify the individual who made the payments nor the company Coli allegedly extorted.

Coli previously served as International Vice President of the Central Region of the International Brotherhood of Teamsters, the indictment states.

The public is reminded that an indictment is not evidence of guilt. The defendant is presumed innocent and entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

Attempted extortion is punishable by a maximum penalty of 20 years in prison. Each count of demanding and accepting a prohibited payment is punishable by up to five years in prison. If convicted, the Court must impose a reasonable sentence under federal statutes and the advisory U.S. Sentencing Guidelines.

The government is represented by Assistant U.S. Attorneys Amarjeet S. Bhachu and Abigail Peluso.