Category Archives: Fraud

Pain Management Group Agrees To Pay $312,000 To Resolve False Claims Act And Overpayment Allegations

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Monday, July 24, 2017

Pain Management Group P.C. (“PMG”), based in Antioch, Tenn., has agreed to pay $312,000 to settle federal and state False Claims Act and overpayment allegations, announced Jack Smith, Acting United States Attorney for the Middle District of Tennessee.

The settlement resolves allegations that PMG caused the submission of false claims to Medicare and TennCare for medically unnecessary urine drug tests. The settlement also resolves allegations that PMG caused the submission of false claims to Medicare and TennCare for non-Food & Drug Administration (“FDA”) approved pharmaceuticals Botox, Supartz, and Eufflexa, which PMG purchased from foreign-based suppliers. The United States contends that PMG administered the non-FDA approved pharmaceuticals to Medicare and TennCare patients and then billed Medicare and TennCare for the pharmaceuticals.

The United States’ investigation was initiated after extensive data analysis identified PMG as a potential outlier in the provision of urine drug testing to Medicare patients. Over the course of the investigation, the United States discovered information regarding PMG’s administration of non-FDA approved drugs to Medicare and TennCare patients. Once informed of the investigation, PMG cooperated and instituted remedial measures to address the United States’ allegations. The alleged conduct occurred during 2014-2015.

This matter was investigated by U.S. Department of Health and Human Services-Office of Inspector General and the Tennessee Bureau of Investigation. Assistant U.S. Attorney Jason Ehrlinspiel represented the United States.

The claims settled by this agreement are allegations only, and there has been no determination of liability.

Owner Of Tampa Parathyroid Practice Agrees To Pay $4 Million To Resolve False Claims Act Allegations

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Monday, July 24, 2017

Tampa, FL  – Dr. James Norman, the owner and operator of James Norman, MD, PA, a/k/a James Norman, MD, PA Parathyroid Center, d/b/a Norman Parathyroid Center (collectively, Norman) has agreed to pay $4 million to resolve allegations that he violated the False Claims Act by knowingly engaging in various unlawful billing practices with respect to Medicare and other federal health care programs and their beneficiaries.

Specifically, the government alleges that, from April 2008 through December 2016, Dr. Norman submitted fraudulent claims to Medicare, TRICARE, and the Federal Employee Health Benefits Program for pre-operative examinations performed on the day before or the day of surgery, and charged and collected extra fees from federal health care beneficiaries for services for which he had already received payment from the government. These extra fees ranged from $150 to $750 for Florida residents, to $1,750 or more for patients who lived out-of-state. Collectively, Dr. Norman and his practice pocketed hundreds of thousands of dollars as a result of these illicit billing practices.

“Fraudulent billing of the government, while also charging Medicare and other federal health care beneficiaries extra fees for services that the government has already paid for victimizes taxpayers, military veterans, the elderly, and other members of our community, and will not be tolerated,” said Acting U.S. Attorney Muldrow. “This lawsuit and today’s settlement demonstrates our office’s ongoing efforts to safeguard federal health care program beneficiaries from the effects of such illegal conduct.”

In addition to paying $4 million, Norman has also agreed to enter into an integrity agreement with the Inspector General of the U.S. Department of Health and Human Services.

“Physicians who systematically overbill Federal health care programs and their vulnerable patients will be held responsible for this fraudulent behavior,” said Special Agent in Charge Shimon R. Richmond of HHS-OIG. “Those who engage in such schemes can expect a thorough investigation and strong remedial measures such as those in the Integrity Agreement we signed with Dr. Norman.”

The settlement concludes a lawsuit originally filed by a former patient of Dr. Norman, Myra Gross, and her husband, Dr. David Gross, in the United States District Court for the Middle District of Florida. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. Act also allows the government to intervene and take over the action, as it did in this case. Ms. Gross and her husband, Dr. Gross, will receive roughly $600,000 of the proceeds from the settlement with Norman.

The government’s action in this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).

The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida and the U.S. Department of Health and Human Services – Office of Inspector General. It was handled Assistant U.S. Attorney Christopher Tuite.

The case is captioned United States ex rel. Gross, et al. v. James Norman, MD, PA, et al., Case No. 8:14-cv-978-T-33EAJ. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.

Former Employee Of Commercial Supply Company Admits Fraud, False Testimony Before Grand Jury

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Monday, July 24, 2017

TRENTON, N.J. – A former salesman at Bayway Lumber, a Linden, New Jersey, company that sold commercial and industrial products to numerous public and private entities, today admitted his role in a scheme to defraud customers and lying to a federal grand jury, Acting U.S. Attorney William E. Fitzpatrick announced.

Adam Martignetti, 43, of South River, New Jersey, pleaded guilty before U.S. District Judge Peter G. Sheridan in Trenton federal court to Counts 1 and 6 of an indictment charging him with conspiracy to commit wire fraud and making false declarations before a grand jury.

According to documents filed in this case and statements made in court:

Martignetti admitted that from 2011 through 2013 he conspired with others to defraud certain Bayway Lumber customers by providing free items to customers’ employees and then recouping the cost of the items (plus additional revenue for Bayway Lumber) by overbilling and fraudulently billing the customers. Martignetti also admitted to supplying lower-quality, less expensive plywood to a customer, but charging for the more expensive, higher-quality plywood the customer had ordered.

Martignetti gave a variety of personal items to employees of some of Bayway Lumber’s customers, including Amtrak, the City of Elizabeth, and the Plainfield Board of Education.  These items included a laptop, several iPads, a camera and sound system, patio furniture, and other merchandise. Under the supervision of Robert Dattilo, president and partial owner of Bayway Lumber, Martignetti then overbilled and fraudulently billed those customers. Dattilo kept a running tally of how much Martignetti and others overbilled and fraudulently billed customers, which many at Bayway Lumber referred to as the “Bank,” to ensure that Bayway Lumber recovered the full cost of the free items. Dattilo previously pleaded guilty to conspiracy to commit mail and wire fraud and was sentenced in July 2016 to 48 months in prison and ordered to pay $708,386 in restitution.

Martignetti also conspired to provide one Bayway Lumber customer, Consolidated Edison Co. of New York Inc. (Con Edison), with lower-quality wood than it ordered and paid for. When Con Edison ordered graded plywood, a type of plywood graded by mills that had met a certain set of specifications, Martignetti, at Dattilo’s instruction, routinely sent plywood that was of a lower grade or not graded at all, including “reject” plywood, but charged Con Edison for the higher-quality plywood that it ordered.

Martignetti also pleaded guilty to falsely testifying before a federal grand jury while appearing as a witness under oath in March 2013 that he had never given Bayway Lumber items to City of Elizabeth employees for free, and that Elizabeth was never charged for items that were for Elizabeth employees’ personal use.

The conspiracy to commit wire fraud charge to which Martignetti pleaded guilty carries a maximum penalty of 20 years in prison. The charge of knowingly making false statements before a grand jury guilty carries a maximum penalty of five years in prison. Each count also carries a maximum fine of $250,000 or twice the gross gain or loss associated with the offense, whichever is greatest. Sentencing is scheduled for Sept. 28, 2017.

Acting U.S. Attorney Fitzpatrick credited special agents with the Office of Inspector General, U.S. Department of Housing and Urban Development, under the direction of Special Agent in Charge Christina Scaringi; the Office of Inspector General, Amtrak, under the direction of Special Agent in Charge Michael Waters; and the FBI, under the direction of Special Agent in Charge Timothy Gallagher, with the investigation leading to today’s guilty plea.

The government is represented by Assistant U.S. Attorney Cari Fais of the U.S. Attorney’s Office Special Prosecutions Division, and Assistant U.S. Attorney Barbara R. Llanes, Chief, General Crimes Unit, of the U.S. Attorney’s Criminal Division, in Newark.

Defense Counsel: Michael Armstrong Esq., Willingboro, New Jersey

Newark Police Officer Admits Conspiracy To Commit Fraud Against Housing Assistance Program

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Monday, July 24, 2017

NEWARK, N.J. – A Newark police officer today admitted conspiring to fraudulently obtain payments under the federal public housing assistance program known as “Section 8,” Acting U.S. Attorney William E. Fitzpatrick announced.

Luis Cancel, 50, pleaded guilty before U.S. District Judge Jose L. Linares in Newark federal court to an information charging him with one count of agreeing with another individual to obtain Section 8 public housing benefits to which they were not entitled.

According to documents filed in this case and statements made in court:

The Section 8 Program is a federal public housing assistance program administered by the U.S. Department of Housing and Urban Development (HUD). It provides rent subsidies to qualified low-income individuals. HUD provided federal grant money to the Newark Housing Authority (NHA) for the Section 8 Program. Under the NHA’s Section 8 Program, a tenant’s rental assistance was based upon the tenant’s anticipated family gross income. Tenants receiving Section 8 assistance from the NHA had to inform the NHA of all members of the household and the annual household income.

From January 2010 to May 2015, Cancel, then a Newark police officer, lived with another person (Individual 1) who was receiving Section 8 benefits. Cancel and the other individual agreed not to disclose to the NHA that they were living together or that Cancel was a Newark police officer, and, also, a security guard with the Robert Treat Hotel. Individual 1 submitted fraudulent documents to the NHA that failed to disclose these facts. Cancel also submitted letters to the NHA falsely indicating that he lived at a separate residence. Based upon their misrepresentations, Cancel and Individual 1 received approximately $74,000 in Section 8 subsidies to which they were not entitled.

The count to which Cancel pleaded guilty carries a maximum penalty of five years in prison and a $250,000 fine. Sentencing is scheduled for Nov. 6, 2017.

Acting U.S. Attorney Fitzpatrick credited special agents of the U.S. Department of Housing and Urban Development, Office of Inspector General, under the direction of Special Agent in Charge Christina Scaringi, with the investigation leading to today’s plea.

The government is represented by Assistant U.S. Attorney Rahul Agarwal of the U.S. Attorney’s Office Special Prosecutions Division in Newark.

Defense counsel: Joseph D. Rotella Esq., Newark

Passaic County Man Admits Defrauding Clifton-Based Trucking Company of $900,000

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Monday, July 24, 2017

NEWARK, N.J. – A Passaic County, New Jersey, man today admitted his role in a scheme to defraud a trucking company out of more than $900,000, Acting U.S. Attorney William E. Fitzpatrick announced.

Angel D. Vidal, 25, of Paterson, New Jersey, pleaded guilty before U.S. District Judge Madeline Cox Arleo in Newark federal court to Count 1 of an indictment charging him with wire fraud.

According to documents filed in this and other cases and statements made in court:

Lisa Popewiny, 55, of Clifton, New Jersey, was the payroll clerk at Clifford B. Finkle Jr. Inc., a Clifton-based company that provided transportation and freight services to various public and private entities located in New Jersey, New York, and elsewhere. From June 2012 to April 2015, Popewiny, Vidal, and his two brothers, Angel Gabriel Vidal, 23, and Miguel Vidal, 23, a former truck driver for the company, engaged in a scheme to defraud the company out of $920,380. On June 26, 2017, Angel Gabriel Vidal pleaded guilty before Judge Arleo to Count 2 of an indictment charging him with wire fraud. On March 30, 2017, Miguel Vidal pleaded guilty to an information charging him with wire fraud. Popewiny is scheduled to stand trial on Oct. 2, 2017.

Popewiny allegedly falsified payroll records in order to generate fraudulent paychecks payable to non-existent employees, including the Vidal brothers. All of the Vidal brothers have admitted to allowing the use of their personal identifying information to generate the fraudulent paychecks. The three men then converted the checks, many of which were deposited into their bank accounts and then funneled out of the accounts in cash. Miguel Vidal admitted to recruiting other individuals to provide their personal information so that Popewiny could allegedly falsely add them to the payroll. Over the course of the scheme, Popewiny allegedly input false hours for at least 12 different individuals. The scheme came to light when owners of the company, in an effort to investigate suspected fraud, distributed the payroll checks to employees – a task normally completed by Popewiny. After all of the payroll checks had been distributed, several paychecks remained unclaimed that turned out to be fraudulently issued.

The charge to which Angel D. Vidal and his brothers pleaded guilty carries a maximum punishment of 20 years in prison and a fine of $250,000 or twice the gross gain or loss from the offense. Sentencing is scheduled for Nov. 17, 2017.

Acting U.S. Attorney William E. Fitzpatrick credited criminal investigators in the U.S. Attorney’s Office and postal inspectors from the U.S. Postal Inspection Service, under the direction of Inspector in Charge James V. Buthorn, with the investigation leading to the guilty pleas.

The government is represented by Assistant U.S. Attorney Cari Fais of the U.S. Attorney’s Office Special Prosecutions Division.

The charges and allegations against Popewiny are merely accusations, and she is presumed innocent unless and until proven guilty.

Houston Physician Convicted of Conspiracy in $1.5 Million Medicare Fraud Scheme

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Friday, July 21, 2017

A federal jury convicted a Houston physician today for his role in a scheme involving approximately $1.5 million in fraudulent Medicare claims for home health care services and various medical testing and services.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Abe Martinez of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, 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 Region and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.

After a four-day trial, Ronald F. Kahn, M.D., 62, of Harris County, Texas, was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive illegal kickbacks. Sentencing has been scheduled for September 25, before U.S. District Judge Kenneth M. Hoyt, who presided over the trial.

According to evidence presented at trial, from approximately 2006 until 2013, Kahn and others engaged in a scheme to defraud Medicare out of approximately $1.5 million in fraudulent claims for home heath care services in connection with Allied Covenant Home Health, Inc., a Houston home healthcare agency (Allied).  Kahn fraudulently admitted patients for home health care with Allied when they did not qualify for such services, the evidence showed. To make it appear that these patients did qualify, Kahn falsified medical records and signed false documents purporting to show that patients admitted to Allied’s home health program satisfied Medicare’s requirements for admission, the evidence showed.

The evidence also showed that Kahn paid illegal kickbacks for patients from Harris Health Care Group, a Houston medical clinic (Harris). Kahn paid illegal kickbacks to the owner of Harris in order to bill Medicare for facet injections that were medically unnecessary, not provided or both, the evidence showed.

The case was investigated by the FBI, HHS-OIG and Texas MFCU, 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 Texas. The case is being prosecuted by Assistant Chief Ashlee McFarlane and Trial Attorney Scott Armstrong of the Fraud Section.

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.

Baton Rouge Home Health Company Settles False Claims Act Case For $1.7 Million

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Friday, July 21, 2017

BATON ROUGE, LA – Acting United States Attorney Corey R. Amundson announced that CHARTER HOME HEALTH, a Baton Rouge-based healthcare company, has agreed to settle a civil fraud complaint filed under the federal False Claims Act by paying the United States $1.7 million and entering into a Corporate Integrity Agreement.

The settlement arises from an investigation into allegations that Charter Home Health, through its officers, paid Veronica Green and others for patient referrals from 2006 through 2012, in violation of Medicare’s Anti-Kickback provisions. The settlement resolves the matter as to Charter Home Health and its officers, Wandell Rogers and Allison Williams.

As part of the settlement, Charter Home Health has agreed to enter into a Corporate Integrity Agreement (CIA). The CIA promotes compliance with the statutes, regulations, program requirements, and written directives of Medicare and all other federal health care programs, specifically dealing with, among other things, proper billing and submission of reimbursement claims by Charter Home Health.

The investigation leading to this settlement also resulted in Veronica Green’ s conviction for Social Security benefits fraud in the Middle District of Louisiana. Green had fraudulently concealed her receipt of the Charter referral payments from the Social Security Administration in order to continue receiving Social Security disability income. As a result, Green received $152,627 in social security benefits to which she otherwise would not have been eligible.

Acting U.S. Attorney Amundson stated, “We will continue to use all civil and criminal tools at our disposal to protect our tax dollars. I appreciate the hard work of the attorneys and investigators who handled this important matter on behalf of the United States. This settlement rightly results in the return of money to the federal government, along with a Corporate Integrity Agreement to help prevent any future improprieties.”

“Home health care providers who pay kickbacks in exchange for patient referrals will be held responsible at the settlement table. We will continue to crack down on such illegal, wasteful business kickback arrangements, which undermine medical judgement, corrode the public’s trust in the health care system, and divert scarce Medicare funding,” said Special Agent-in-Charge C.J. Porter, U.S. Department of Health and Human Services Office of Inspector General.

This matter was handled by the United States Attorney’s Office for the Middle District of Louisiana, through Assistant United States Attorney Catherine Maraist; the Dallas Regional Office of the United States Department of Health and Human Services, Office of Inspector General; and the Baton Rouge Office of the Social Security Administration.

Former Worksource DeKalb Supervisor Charged with Bribery

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Wednesday, July 19, 2017

ATLANTA – Roderick L. Wyatt, 61, of Stone Mountain, Ga., has been charged with accepting bribe payments in exchange for approving the enrollment of almost 20 students to a local college, through a federal workforce program in DeKalb County. The federal indictment alleges that Wyatt agreed to accept payments from the college president for each student sent to the college through Worksource DeKalb, a federally funded program.

“Wyatt allegedly sold his supervisory position with WorkSource DeKalb for cash. In doing so, he allegedly accepted a “bounty” for each student sent to a specific college,” said U. S. Attorney John A. Horn.

“An important mission of the Office of Inspector General is to investigate allegations of fraud relating to Workforce Innovation and Opportunity Act grants issued by the U.S. Department of Labor. We will continue to work with our law enforcement partners to investigate these types of allegations,” said Rafiq Ahmad, Special Agent in Charge, Atlanta Region, U.S. Department of Labor, Office of Inspector General.

Public corruption is the FBI’s top criminal investigative priority because it takes a significant toll on the public’s pocketbooks by siphoning off tax dollars,” said FBI Special Agent in Charge David J. LeValley. “This case is another example of our commitment to combat corruption by investigating public officials who choose to abuse federally funded programs.”

According to United States Attorney Horn, the charges, and other information presented in court: the Workforce Innovation and Opportunity Act is a federal public law designed to improve and modernize America’s workforce development system by providing dislocated and low-income individuals with the skills and education needed to obtain employment and by providing employers with trained and qualified workers to fill employment vacancies.

WorkSource DeKalb (formerly DeKalb Workforce Development) was a DeKalb County department funded exclusively by the federal Workforce Innovation and Opportunity Act. WorkSource DeKalb (“WSD”) served the unemployed and underemployed citizens of DeKalb County by providing work readiness programs, services, and activities necessary to obtain sustainable wages. Using federal funds, WSD paid the cost for unemployed and underemployed individuals to attend pre-screened schools or programs where the individuals gained the technical or vocational skills needed to obtain employment in fields such as nursing, truck driving, or welding. After reviewing the unemployed individuals’ career aspirations and educational interests, WSD staff members recommended the individuals to particular pre-screened schools or programs.

From 2013 to April 2017, Wyatt served as a WSD Employment and Training Supervisor. As a supervisor, Wyatt reviewed and approved the school/program recommendations made by WSD staff members.

In 2014, the president and founder of a pre-screened school that offered its students nursing assistant and medical technician certifications approached Wyatt and offered to pay him for each individual that WSD referred to the College. In 2014 and 2015, Wyatt approved the enrollment of approximately 19 students to the College. The College’s president paid Wyatt $100 for each student approved to attend his school. In total, the College received approximately $82,000 in federal funds under the Workforce Innovation and Opportunity Act. The name of the college has not been identified in the Information or any of the court pleadings.

This case is being investigated by the Department of Labor – Office of the Inspector General and Federal Bureau of Investigation.

Assistant United States Attorney Jeffrey W. Davis and Special Assistant United States Attorney Tyler Man prosecuting the case.

For further information please contact the U.S. Attorney’s Public Affairs Office at [email protected] or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.

South Florida Man Charged With Credit Card Fraud And Identity Theft Involving Personal Information From Veterans

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Thursday, July 20, 2017

Jacksonville, Florida – Acting United States Attorney W. Stephen Muldrow announces the return of an indictment charging Dwayne Thomas (21, Miami) with one count of credit card fraud and nine counts of identity theft. If convicted, he faces up to 10 years in federal prison for the credit card fraud count and up to 5 years’ imprisonment on each of the identity theft counts.

According to the indictment and information presented in court, Thomas was in possession of multiple credit card account numbers from Bank of America, Wells Fargo, and USAA. He also possessed the Social Security numbers of multiple former members of the military who were receiving healthcare through the Department of Veterans Affairs.

An indictment is merely a formal charge that a defendant has committed one or more violations of federal criminal law, and every defendant is presumed innocent unless, and until, proven guilty.

This case was investigated by the Department of Veterans Affairs – Office of Inspector General Criminal Investigation Division, the United States Secret Service -Jacksonville Field Office, and the Florida Highway Patrol. It will be prosecuted by Assistant United States Attorney Kevin C. Frein.

Wholesale Jewelry Distributor Charged in Multi-Million Dollar Fraud Scheme

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Thursday, July 20, 2017

PROVIDENCE – Gerald Kent, 51, of Groton, CT, owner and operator of Kent Jewelry in Johnston, RI., made an initial appearance in U.S. District Court in Providence today and was ordered detained in federal custody, charged by way of a criminal complaint with wire fraud and aggravated identity theft.

It is alleged in court documents that Kent, through his company, which primarily sells jewelry on the internet using websites such as Groupon.com and Zulily.com, orchestrated a long running, multi-million dollar fraud scheme that defrauded a debtor finance company of more than $3.6 million dollars.

The charges are announced by Acting United States Attorney Stephen G. Dambruch; Brian Deck, Resident Agent in Charge of the Providence Office of the U.S. Secret Service; and Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation Boston Division.

According to an affidavit in support of the criminal complaint, it is alleged that Kent submitted fraudulent invoices to a factoring (debtor finance) company based in Chicago, Ill., mostly from Groupon and Zulily, which resulted in payments to Kent of nearly $5 million dollars.

According to the affidavit, it is alleged that to execute the fraud scheme, Kent created hundreds of fraudulent invoices which were submitted to the factoring company for which he received payment; created and used a fraudulent clone of Groupon, Inc.’s website; enlisted coconspirators to pose as Groupon employees; and opened bank accounts in the names of Groupon and Zulily, Inc., in order to deceive the debtor finance company into believing it was receiving payments from these companies.

Factoring is a financial transaction and a type of debtor finance in which a business sells its accounts receivable (i.e., invoices) to a third party (called a factor) at a discount.  Factoring companies work with businesses to provide working capital in order to grow their businesses without having to wait for outstanding accounts receivables to be paid.

Kent, who was arrested on Wednesday evening at Foxwoods, appeared today before U.S. District Court Magistrate Judge Patricia A. Sullivan and was ordered detained pending a detention hearing on July 26, 2017.

A criminal complaint is merely an allegation and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.

The case is being prosecuted by Assistant U.S. Attorneys Lee H. Vilker and John P. McAdams.

The matter was investigated by agents from the U.S. Secret Service and the FBI.