Category Archives: HHS-OIG

Death Charge Added To Indictment Against Pill Mill Doc/ USAO-EDPA

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Death Charge Added To Indictment Against Pill Mill Doc

FOR IMMEDIATE RELEASE
November 29, 2012

PHILADELPHIA – A third superseding indictment was unsealed today against Dr. Norman Werther, 73, of Horsham, adding nine new defendants and dozens more charges, most notably distribution of a controlled substance resulting in death, announced First Assistant United States Attorney Louis D. Lappen. It is the first such case in the Eastern District of Pennsylvania. Werther was originally indicted on August 10, 2011 with 51 co-defendants. The charges allege a multi-million dollar drug conspiracy involving illegal prescriptions, phony patients, and a drug trafficking organization. At the time, Werther was a Montgomery County physician, running a physical therapy and rehabilitation practice in Willow Grove. According to the third superseding indictment, Werther conspired with six separate groups of drug dealers. In addition to the count of causing a death, he is charged in multiple counts of conspiracy to distribute controlled substances, distribution of controlled substances, maintaining a drug-involved premises, and money laundering. He faces a mandatory 20 years and maximum sentence of life in prison if convicted of all charges.

New defendants charged in the third superseding indictment are: Troy Brinkley, 44; Edward Jackson, 49; Edward Dominick, Sr., 53; Frederick Kelsey, 51; Kyle Jones, 30; Ali Armstead, 31; Terrell Jackson, 27; Bernard Jackson, 33; and Ronald Campbell, 35, all of Philadelphia. Dominick, Sr., is still at-large; all others are in custody.

The charges allege that Werther worked with six alleged drug traffickers who recruited large numbers of pseudo-patients. Werther set aside a specific block of time each business day to see the pseudo-patients recruited by Troy Brinkley, Ronald Campbell, Anthony DiPasquale, Angel DuPrey, Kyle Jones, and William Stukes (charged earlier). With the help of Werther’s office staff, those “patients” were transported to Werther’s medical office, at 301 Davisville Road in Willow Grove, PA, for cursory examinations. The “patients” paid an office visit fee, usually $150, by cash, check, or money order, and Werther would write prescriptions for them to obtain oxycodone-based drugs without there being a legitimate medical purpose for the prescription and outside the usual course of professional practice. The “patients” were then driven to various pharmacies, including Northeast Pharmacy, to have their prescriptions filled. The drugs were then turned over to the alleged drug dealers so their organizations could sell the narcotics to numerous drug dealers, also charged, who would also then resell the drugs on the street.

According to the third superseding indictment, in September 2010, Werther knowingly dispensed approximately 150 pills containing 30 milligrams each of oxycodone, and 30 pills containing 15 milligrams each of oxycodone, to N. B., a person known to the grand jury, for no legitimate medical purpose and N. B.’s death resulted from the use of that substance.

According to the third superseding indictment, Werther’s wife sent a memo to the office staff in July 2011: “When Angel (referring to defendant Angel Duprey) calls… Dr. has told us to tell him that a Consultant was in and reviewed our charts. He and Fernando (referring to defendant Ferdinand Nieves) were arrested… this created a big problem for us. It is a big “red flag” …we don’t want the government reviewing us. The DEA checks on physicians dispensing narcotics. Dr. could lose his license. He has sent away more than 100 people in the last few weeks. He cannot see their people under any circumstances. Be firm… no arguing.”

The alleged drug conspiracy involving Dr. Werther operated between February 2009 and August 2011 and resulted in the alleged illegal distribution of more than 700,000 pills containing oxycodone. At least one of the drug trafficking organizations allegedly working with Werther trafficked pills valued at more than $5 million that Werther is alleged to have illegally prescribed.

A total of 67 defendants have been charged in the case. Additional charges contained in the third superseding indictment include Conspiracy (6 counts), Distribution of Controlled Substances Causing Death, Maintaining a Drug-Involved Premises, Distribution of Controlled Substances (196 counts), Possession with the Intent to Distribute (3 counts), Money Laundering (117 counts), and Health Care Fraud (44 counts).

Other defendants previously charged and awaiting trial are: Kim Carter, 44, Angel Duprey, 33, Ferdinand Nieves, 45, and Anthony DiPasquale, 46, all of Philadelphia.

All others have pleaded guilty.

The crimes of conspiracy, distribution of controlled substance, possession with intent to distribute, and money laundering each carry a maximum possible sentence of 20 years in prison; health care fraud and aggravated structuring each carry a maximum sentence of 10 years in prison; structuring financial transactions carries a maximum possible sentence of five years in prison. Each defendant also faces possible fines, periods of supervised release, and special assessments.

This case was investigated by the Drug Enforcement Administration, the U.S. Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the Bureau of Alcohol, Tobacco, Firearms and Explosives, with assistance from the Philadelphia Police Department, the North Coventry Police Department, the Upper Moreland Police Department, and the Montgomery Township Police. It is being prosecuted by Assistant United States Attorneys Michelle Rotella and Nancy Beam Winter.

UNITED STATES ATTORNEY’S OFFICE, EASTERN DISTRICTof PENNSYLVANIA
Suite 1250, 615 Chestnut Street, Philadelphia, PA 19106
PATTY HARTMAN, Media Contact, 215-861-8525

Two Brooklyn Clinic Employees Plead Guilty in Connection with $71 Million Medicare Fraud Scheme

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Two Brooklyn Clinic Employees Plead Guilty in Connection with $71 Million Medicare Fraud Scheme
Co-Defendant Pleaded Guilty Yesterday for Role in Scheme

11/28/2012

WASHINGTON—Two Brooklyn, New York residents pleaded guilty today for their roles in a $71 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of New York Loretta E. Lynch; Acting Assistant Director in Charge Mary E. Galligan of the FBI’s New York Field Office; and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

Katherina Kostiochenko, 34, pleaded guilty today before U.S. District Judge Nina Gershon in the Eastern District of New York to one count of conspiracy to commit health care fraud, one count of health care fraud, and one count of conspiracy to pay kickbacks. Sergey V. Shelikhov, 51, pleaded guilty today before Judge Gershon to one count of conspiracy to commit health care fraud.

Co-conspirator Leonid Zheleznyakov, 28, pleaded guilty yesterday before Judge Gershon to one count of conspiracy to commit health care fraud for his role in the scheme.

Kostiochenko, Shelikhov, and Zheleznyakov were employees of a clinic in Brooklyn that operated under three corporate names: Bay Medical Care PC, SVS Wellcare Medical PLLC, and SZS Medical Care PLLC (Bay Medical clinic). According to court documents, owners, operators, and employees of the Bay Medical clinic paid cash kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for more than $71 million in services that were medically unnecessary or never provided. The defendants billed Medicare for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy, and diagnostic tests.

According to the criminal complaint, the co-conspirators allegedly paid kickbacks to corrupt Medicare beneficiaries in a room at the clinic known as the “kickback room,” in which the conspirators paid approximately 1,000 kickbacks totaling more than $500,000 during a period of approximately six weeks from April to June 2010.

Kostiochenko, Shelikhov, and Zheleznyakov pleaded guilty to conspiring to commit health care fraud for their roles in the Bay Medical scheme. Kostiochenko also pleaded guilty to paying cash kickbacks to Medicare beneficiaries as part of the scheme.

At sentencing, Kostiochenko faces a maximum penalty of 25 years in prison, and Shelikhov and Zheleznyakov both face a maximum penalty of 10 years in prison. Kostiochenko and Zheleznyakov are scheduled for sentencing on March 12, 2013, and Shelikhov is scheduled for sentencing March 13, 2013.

In total, 16 individuals have been charged in the Bay Medical scheme, including two doctors, nine clinic owners/operators/employees, and five external money launderers. To date, 10 defendants have pleaded guilty for their roles in the conspiracy. Six individuals await trial before Judge Gershon on January 22, 2013.

The case is being prosecuted by Trial Attorney Sarah M. Hall of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Shannon Jones of the Eastern District of New York. The case was investigated by the FBI and HHS.

The case 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 Eastern District of New York. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 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.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Palmview Siblings Sentenced for Health Care Fraud Conspiracy

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Palmview Siblings Sentenced for Health Care Fraud Conspiracy

Nov. 28, 2012

McALLEN, Texas – Velma Alaniz, 31, and her brother Valente Alaniz, 27, both of Palmview, have been sentenced to federal prison for their roles in a scheme to defraud Medicare and Medicaid through fraudulent billings for power wheelchairs, incontinent supplies and other medical items, United States Attorney Kenneth Magidson announced today along with and Texas Attorney General Greg Abbott.

Velma Alaniz, an owner of Ace Medical Equipment and Supplies, a McAllen-area durable medical equipment (DME) business, and her brother Valente, manager of Ace Medical, were both convicted of conspiracy to commit health care fraud on Dec. 7, 2011, after pleading guilty before U.S. District Judge Randy Crane.

Following the sentencing hearing that began on Nov. 19-20 and concluded today, Judge Crane ordered Velma and Valente Alaniz to serve 24 and 37 months in prison, respectively. Both will be placed on supervision for a period of three years following their release from prison. Judge Crane also ordered them to repay Medicare and the Texas Medicaid program the sum of $159,557.43.

At their plea hearing in December 2011, Velma and Valente Alaniz admitted to conspiring to submit false and fraudulent claims to the Medicare and Medicaid programs related to Ace Medical’s purported sale of power wheelchairs to Medicare and Medicaid patients. In numerous claims for a power wheelchairs, the defendants represented to Medicare and Medicaid that the items were prescribed by the patients’ physicians and had been delivered to the patients when, in fact, the defendants knew that both of these representations were false. In other instances, the defendants submitted false claims to Medicare and Medicaid that represented that power wheelchairs had been delivered to patients when, instead, less expensive scooters were delivered to the patients. The defendants also billed for incontinent and other medical supplies which had not been prescribed by the patients doctors.

The defendants also admitted that, in an attempt to conceal and cover up their fraud, they falsified and forged physicians’ medical orders and examination reports, as well as a variety of other Medicare and Medicaid-related documents that were kept in Ace Medical’s patients’ files. In addition, in 2010 when investigators requested patient files from Ace Medical pertaining to a number of Medicare and Medicaid patients, Velma Alaniz instructed Valente Alaniz to “fix” the patients’ files to make the fraudulent power wheelchair claims appear to be mere billing errors.

Judge Crane allowed the pair to remain on bond and to voluntarily surrender to the United States Marshals Service on Jan. 4, 2013.

The investigation leading to the charges was conducted by the U.S. Department of Health and Human Services—Office of Inspector General, the U.S. Secret Service and the Texas Attorney General’s Medicaid Fraud Control Unit. Special Assistant United States Attorney Rex Beasley and former Assistant United States Attorney Greg Saikin prosecuted the case.

Baylor University Medical Center to Pay More Than $900,000 for False Medicare Claims for Radiation Oncology Services

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Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Tuesday, November 27, 2012
Baylor University Medical Center to Pay More Than $900,000 for False Medicare Claims for Radiation Oncology Services

 

Baylor University Medical Center, Baylor Health Care System and HealthTexas Provider Network (collectively, Baylor) have agreed to pay the United States $907,355 to settle allegations that Baylor submitted false claims to Medicare, the Civilian Health and Medical Program of the Uniformed Services (TRICARE) and the Federal Employees Health Benefit Program (FEHBP) for various radiation oncology services, including intensity modulated radiation therapy, the Justice Department announced today. Intensity modulated radiation therapy is a sophisticated radiation treatment indicated for specific types of cancer where extreme precision is required to spare patients’ surrounding organs or healthy tissue.

The government alleges that Baylor submitted improper claims to Medicare from 2006 through May 2010 in which Baylor double billed Medicare for several procedures affiliated with radiation treatment plans, billed for certain high reimbursement radiation oncology services when a different, less expensive service should have been billed, billed for procedures without supporting documentation in the medical record, and improperly billed for radiation treatment delivery without corroboration of physician supervision.

“Physicians who participate in Medicare must bill for their services accurately and honestly,” said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Justice Department’s Civil Division. “The Department of Justice is committed to ensuring that federal health care funds are spent appropriately.”

Principal Deputy Assistant Attorney General Delery also noted that the settlement with Baylor was the result of a coordinated effort among the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Northern District of Texas, the Department of Health and Human Services’ Office of Inspector General, FBI and Defense Criminal Investigative Services.

 

U.S. Attorney for the Northern District of Texas Sarah R. Saldaña praised these investigative efforts and said, “this civil recovery is a testament to the efforts of the Department of Justice to hold all parties, regardless of position, accountable for the submission of improper claims to federal health care programs.”

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.8 billion.

The claims settled by this a gre ement are alle gations onl y, and the re has b een no det ermination of liability.

Los Angeles-Area Doctor Pleads Guilty to Conspiring to Defraud Medicare of Over $11 Million

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FOR IMMEDIATE RELEASE
Monday, November 26, 2012
Los Angeles-Area Doctor Pleads Guilty to Conspiring to Defraud Medicare of Over $11 Million

WASHINGTON— A Los Angeles-area doctor pleaded guilty today to conspiring to defraud Medicare of over $11 million, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney André Birotte Jr. of the Central District of California; Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); Bill L. Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office; and Tony Sidley, Assistant Chief of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.

Dr. Juan Tomas Van Putten, 66, of Ladera Heights, Calif., pleaded guilty today before U.S. District Judge George Wu in the Central District of California to one count of conspiracy to commit health care fraud.

Van Putten pleaded guilty to obtaining patients for his medical clinic, Greater South Bay Medical Group, which was located in Carson, Calif., and a nursing home where he also saw patients from street-level patient recruiters or “marketers” who illegally solicited patients with Medicare benefits for expensive, highly-specialized power wheelchairs and other durable medical equipment (DME) that the patients did not need.  According to the indictment to which Van Putten pleaded guilty, some of the marketers worked for the operators of fraudulent DME supply companies, including Van Putten’s co-defendants Charles Agbu, a church pastor, and his daughter Obiageli Agbu, who both operated Bonfee Inc. d/b/a “Bonfee Medical Supplies” and Ibon Inc., which were located in Carson.

Van Putten admitted that operators of fraudulent DME supply companies paid him cash kickbacks to write prescriptions for power wheelchairs and other DME that Van Putten knew the patients did not need.  Van Putten admitted that he exaggerated the symptoms and diagnoses that he wrote on the prescriptions to make it appear as if the patients met both the medical and Medicare requirements for the power wheelchairs and DME.  Van Putten admitted that he knew when he provided the prescriptions to the DME company operators that they would use the prescriptions to submit false claims to Medicare.  Van Putten also admitted that he submitted claims to Medicare for services that he provided to the patients at Greater South Bay and the nursing home even though he knew it was illegal for him to provide services to patients who had been recruited by marketers.

As a result of this scheme, court documents indicate that Van Putten and his co-defendants submitted approximately $11,094,918 in false claims to Medicare and received approximately $5,788,725 on those claims.

Charles Agbu and Obiageli Agbu are scheduled for trial on Feb. 26, 2013, for their alleged roles in the conspiracy.  Co-defendants Dr. Emmanuel Ayodele, Alejandro Maciel and Candalaria Estrada have also been charged for their alleged roles in the conspiracy.

Defendants are presumed innocent until proven guilty at trial.

At sentencing, scheduled for March 28, 2013, Van Putten faces a maximum penalty of 10 years in prison and a $250,000 fine.

The case is being prosecuted by Trial Attorney Jonathan T. Baum of the Criminal Division’s Fraud Section.  The case is being investigated by the FBI, HHS-OIG, the California Department of Justice and the Internal Revenue Service.

The case 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 Central District of California.  The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 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.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

South Carolina-based Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton to Pay U.S. $1.286 Million to Resolve False Claims Act Allegations

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FOR IMMEDIATE RELEASE
Tuesday, November 20, 2012
South Carolina-based Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton to Pay U.S. $1.286 Million to Resolve False Claims Act Allegations

Harmony Care Hospice Inc. (Harmony) and Harmony owner and chief executive officer Daniel J. Burton have agreed to pay the United States $1,286,999.32 to settle allegations that the South Carolina-based company submitted false claims to Medicare for patients under care at its hospice facilities, the Justice Department announced today.

 

Hospices provide palliative care – medical treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis of six months or less. The United States alleged that Harmony and Burton knowingly submitted or caused to be submitted false claims for patients who did not have such a prognosis and thus were not eligible for hospice care. Under today’s agreement, Burton is individually liable for $200,000 of the settlement amount.

 

“Billing Medicare for unnecessary or inappropriate end-of-life care contributes to the soaring costs of health care for everyone. Today’s settlement demonstrates the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries,” said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Civil Division.
Today’s settlement with Harmony and Burton resolves a lawsuit filed by former Harmony employees Mona Singletary and Lynda Fulton under the qui tam, or whistleblower, provisions of the False Claims Act. Under the False Claims Act, private citizens can bring suit for false claims on behalf of the United States and share in any recovery. Together, Singletary and Fulton will receive $244,529.87 as their share of the government’s recovery.

 

As part of the settlement, Harmony and Burton will enter into a Corporate Integrity Agreement with the Office of Inspector General (OIG), Department of Health and Human Services (HHS), to address the allegations raised in the qui tam complaint.

 

“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “The company and its owner have agreed to Federal monitoring and reporting requirements designed to avoid such problems in the future.”

 

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.9 billion.

 

The investigation was jointly handled by the U.S. Attorney’s Office for the District of South Carolina, the Justice Department’s Civil Division and the Office of the Inspector General of the Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability.

 

The qui tam case is captioned United States ex rel. Singletary, et al. v. Harmony Care Hospice, Inc., et al., Case No. 2:10-cv-01404-PMD (D.S.C.).

Group of Owned and Affiliated Florida Hospitals Agree to Pay US $10.1 Million to Resolve False Claims Act Allegations

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FOR IMMEDIATE RELEASE
Tuesday, November 20, 2012
Group of Owned and Affiliated Florida Hospitals Agree to Pay US $10.1 Million to Resolve False Claims Act Allegations

Morton Plant Mease Health Care Inc. and its affiliated hospitals (Morton Plant) have agreed to pay $10,169,114 to the federal government to resolve allegations that they violated the False Claims Act by submitting false claims for services rendered to Medicare patients, the Justice Department announced today. Morton Plant owns and operates, or is affiliated with, Morton Plant Hospital, St. Joseph’s Hospital, Morton Plant North Bay Hospital, St. Anthony’s Hospital, Mease Countryside Hospital and Mease Dunedin Hospital. These hospitals are part of the BayCare Health System in Florida’s Pinellas, Hillsborough and Pasco counties.

 

The settlement announced today resolves allegations that, between July 1, 2006 and July 31, 2008, Morton Plant improperly billed for certain interventional cardiac and vascular procedures as inpatient care when those services should have been billed as less costly outpatient care or as observational status.

 

“Overbilling the government for routine procedures wastes valuable resources that could be used to care for other patients,” said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Justice Department’s Civil Division. “At a time when we are trying to reduce public spending, it is especially important to ensure that hospitals do not overcharge the government by improperly inflating their billing.”

 

“We hold medical providers to a high standard in our district, and we will not hesitate to hold them to account when we find evidence of serious misconduct,” said Robert O’Neill, U.S. Attorney for the Middle District of Florida. “This settlement should send a strong message that health care fraud enforcement is a growing priority in our office.”

 

Today’s settlement resolves a qui tam, or whistleblower, lawsuit filed by Randi Ferrare, a former director of Health Management Services at Morton Plant Hospital. Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and

share in any recovery. Ms. Ferrare will receive over $1.8 million as her share of the government’s recovery.

 

“When hospitals attempt to boost profits with improper inpatient admissions, they squander scarce dollars from Medicare and Medicaid,” said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. “Our corporate integrity agreements hold providers accountable for preventing such abuse of government health care programs.”

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.8 billion

 

The United States’ investigation was conducted by the U.S. Attorney’s Office for the Middle District of Florida, the Civil Division of the Department of Justice, the FBI and the Department of Health and Human Services, Office of Inspector General.

 

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

 

The case is docketed as United States ex rel. Randi Ferrare v. Morton Plant Mease Health Care, Inc., No. 08:cv:01689-T-266MSS (M.D. Fl.).

Mission Woman Indicted on Health Care Fraud Charges

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Mission Woman Indicted on Health Care Fraud Charges

FOR IMMEDIATE RELEASE

11/12/2012

US Attorney Brendan V. Johnson announced that a Mission woman has been indicted by a federal grand jury for two counts of health care fraud and one charge of larceny.

Tisha Leader Charge, age 33, was indicted by a federal grand jury on November 15, 2012, for Acquiring and Obtaining a Controlled Substance by Fraud, Deception, and Subterfuge; Theft in Connection with Health Care; and Larceny. She appeared before US Magistrate Judge Mark A. Moreno on November 15, 2012, and pled not guilty to the indictment. The maximum penalty upon conviction is 4 years in custody, a $250,000 fine, or both. The charges are merely accusations, and Leader Charge is presumed innocent until and unless proven guilty.

The investigation is being conducted by the Special Investigations Branch of the Office of Inspector General, Department of Health and Human Services. Assistant US Attorney Jay Miller is prosecuting the case. Leader Charge was released on bond pending trial. A trial date has not yet been set.

Two Plead Guilty in Miami for Roles in $63 Million Mental Health Care Fraud Scheme

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FOR IMMEDIATE RELEASE
Tuesday, November 20, 2012
Two Plead Guilty in Miami for Roles in $63 Million Mental Health Care Fraud Scheme
Two Health Care Professionals Pleaded Guilty This Week for Roles in Multi-State Scheme

WASHINGTON –A registered nurse pleaded guilty today and a former program coordinator pleaded guilty yesterday in connection with a health care fraud scheme involving defunct health provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent-in-Charge of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

John Thoen, 53, of Miami, pleaded guilty today before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering.  Alexandra Haynes, 36, of Taylor, S.C., pleaded guilty yesterday before Judge Altonaga to one count of conspiracy to commit health care fraud in the same case.

According to court documents, HCSN operated community mental health centers (CMHC) at three locations Miami-Dade County, Fla., and one location in Hendersonville, N.C.  HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness.  A PHP is a form of intensive treatment for severe mental illness.

According to an indictment unsealed on May 2, 2012, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not even provided.  HCSN obtained those beneficiaries in Miami by paying kickbacks to owners and operators of assisted living facilities.

According to court documents, Thoen was a licensed registered nurse in both Florida and North Carolina.  In Florida, Thoen participated in the admission to HCSN of patients who were ineligible for PHP services.  Thoen participated in the routine fabrication of patient medical records that were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Medicaid.

In North Carolina, Thoen, according to court documents, routinely submitted fraudulent PHP claims for Medicare patients who were not even present at the CMHC on days PHP services were purportedly rendered.  Thoen also caused the submission of fraudulent Medicare claims on days the CMHC was closed due to snow.

Thoen also admitted to his role in a money laundering scheme, involving Psychiatric Consulting Network Inc. (PCN), a Florida corporation that was utilized by HCSN as a shell corporation to launder health care fraud proceeds.  According to court documents, Thoen was president of PCN.

According to court documents, Haynes was employed in Miami as an intake specialist and routinely fabricated patient medical records.  In North Carolina, Haynes was employed as a program coordinator and conducted group therapy sessions and fabricated corresponding group therapy notes even though she was not licensed to provide mental health services in the state.

According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services.

Nine defendants have been charged for their alleged roles in the HCSN health care fraud scheme.  Six defendants have pleaded guilty, and three defendants are scheduled for trial on Jan. 14, 2013, before U.S. District Judge Altonaga in Miami. Defendants are presumed innocent until proven guilty at trial.

The cases are being prosecuted by Special Trial Attorney William Parente and Trial Attorney Allan J. Medina of the Criminal Division’s Fraud Section.  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.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

COVENTRY HEALTH CARE, INC. AGREES TO PAY $3 MILLION TO THE U.S. AS PART OF A NON-PROSECUTION AGREEMENT

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COVENTRY HEALTH CARE, INC. AGREES TO PAY $3 MILLION TO THE U.S. AS PART OF A NON-PROSECUTION AGREEMENT

Unauthorized Access to Database Gave Coventry Unfair Advantage Over its Competitors

 

Baltimore, Maryland – Coventry Health Care, Inc. (Coventry) has agreed to pay the United States $3 million in return for the agreement by the United States Attorney’s Office for the District of Maryland not to prosecute Coventry criminally for any crimes arising from the unauthorized access by its employees to a Medicare database.

 

The agreement was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services.

 

Coventry provides group and individual health insurance to more than five million members in the United States. Coventry administers Medicare Advantage plans for some of its members, and some of its employees have access to the computerized database maintained by the Centers for Medicare and Medicaid Services (CMS) that contains Medicare eligibility information.

 

According to the agreement, from May 2005 to no later than December 29, 2006, some employees of Coventry and/or First Health Priority Services, a subsidiary, inappropriately accessed the Medicare database to obtain Medicare eligibility information for the sale of Medicare set-aside products. A Medicare set-aside is created from a process that allocates a portion of a worker’s compensation settlement to pay future medical expenses that would otherwise be payable by Medicare. Coventry’s actions were intended in part to give Coventry an unfair advantage over its competitors.

 

Several senior employees were aware of the unauthorized access to the Medicare database, including Coventry’s senior vice president for worker’s compensation services, senior vice president for government programs, senior vice president of service operations and the manager of Medicare enrollment department. All of these individuals have terminated their employment with Coventry.

 

In January 2007, the CMS contacted Coventry regarding the unauthorized access. Coventry acknowledged that employees had inappropriately accessed the database, and pledged to take corrective action.

In addition to the monetary settlement, Coventry has agreed to maintain new-hire and annual training for all of its employees who have been granted access to government databases, which include mandatory testing on fraud abuse, privacy and security.

 

United States Attorney Rod J. Rosenstein commended the investigative work performed by Office of Inspector General of the Department of Health and Human Services. The case was handled by Assistant U.S. Attorneys Tonya N. Kelly and Joyce K. McDonald.