Physician Pleads Guilty for Role in Detroit-area Medicare Fraud Scheme

A Detroit-area physician pleaded guilty today for her role in a $7 million health care fraud scheme.
Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office made the announcement.
Adelina Herrero, 72, of Ann Arbor, Mich., pleaded guilty before U.S. District Judge Paul D. Borman in the Eastern District of Michigan to one count of conspiracy to commit health care fraud.   Sentencing will be scheduled at a later date.
According to court documents, beginning in approximately April 2010 and continuing through approximately April 2013, Herrero and others agreed that she would refer Medicare beneficiaries whom she had never seen or treated to Advance Home Health Care Services Inc. (Advance) and Perfect Home Health Care Services LLP (Perfect), which were both owned by co-conspirators.   Herrero signed medical documents, such as home health care certifications and plans of care for these beneficiaries, falsely certifying that they were under her care and that they required home health care.   Advance, Perfect and other home health agencies then used Herrero’s false documents to support their claims to Medicare for home health services — including physical therapy services — that were never rendered and/or not medically necessary.   Herrero knew the medical documents she signed for her co-conspirators would be used to support false claims to Medicare.   Herrero admitted that in exchange for signing the home health care documents, she accepted kickback payments from a co-conspirator.
The false and fraudulent claims to Medicare arising from Herrero’s conduct total approximately $1,382,208 in billings for home health services and physician services, of which Medicare paid $1,321,372.
This case is being investigated by the FBI and HHS-OIG 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 Eastern District of Michigan.   This case is being prosecuted by Special Trial Attorney Katie R. Fink and Trial Attorney Patrick J. Hurford of the Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The Beneficent Monopolist: Allen Grunes and Maurice Stucke on the Comcast/Time Warner merger.

 

 


Allen P. Grunes 


GeyerGorey LLP

Maurice E. Stucke 


University of Tennessee College of Law

March 26, 2014

Competition Policy International, April 2014, Forthcoming 


Abstract: 

In examining Comcast’s proposed acquisition of Time Warner Cable (TWC), we assess three of the arguments Comcast likely will make to the Department of Justice and FCC. Comcast will likely argue that its acquisition of TWC is unlikely to lessen competition because: (a) the broadband market is becoming more competitive: Google has introduced Google Fiber in a number of markets, and mobile broadband offered by wireless providers like AT&T and Sprint is competitive with fixed broadband; (b) Netflix and traditional media companies have sufficient clout to negotiate with Comcast and the government should not intervene on their behalf; and (c) the “wide array of FCC and antitrust rules and conditions from the NBCUniversal transaction in place . . . more than adequately address any potential vertical foreclosure concerns in the area of video programming.”

We argue that notwithstanding Comcast’s and TWC’s assertions, combining two monopolies does not yield better service, lower retail prices, more innovation, and greater choices for consumers. Nor should the DOJ and FCC simply extend the prior behavioral remedies to this merger. Behavioral remedies are a poor substitute for market competition. Comcast and TWC have not overcome the presumption of illegality for this merger and are unlikely to do so. As was the case with AT&T/T-Mobile, DOJ should just say no.

Long Island Doctor Arrested and Accused of Multi-million Medicare Fraud Scheme

A Long Island, N.Y., doctor was arrested today on charges that he submitted millions of dollars in false billings to Medicare.
The charges were announced by Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, U.S. Attorney Loretta E. Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office and Special Agent in Charge Thomas O’Donnell of the Department of Health and Human Services Office of Inspector General (HHS-OIG).
Dr. Syed Imran Ahmed, 49, was charged with one count of health care fraud by a criminal complaint unsealed this morning in federal court in Brooklyn, N.Y.   A seizure warrant seeking millions of dollars of Ahmed’s alleged ill-gotten gains, including the contents of seven bank accounts, was also unsealed.   In addition, a civil forfeiture complaint was also filed today against Ahmed’s residence located in Muttontown, N.Y., valued at approximately $4 million.   Further, search warrants were executed earlier today at six locations in New York, Michigan and Nevada.   Ahmed’s initial appearance is scheduled this afternoon before U.S. Magistrate Judge Marilyn Go.
“The Medicare system entrusts doctors to provide patients with the care and services they need,” said Acting Assistant Attorney General O’Neil.  “The charges unsealed today allege that Dr. Ahmed billed millions of dollars to Medicare for surgical procedures that he did not actually perform.  These charges are yet another example of the Department of Justice’s determination to hold accountable those who abuse the trust placed in them and steal from the system for personal gain.”
“As alleged, Ahmed created phantom medical procedures to steal very real taxpayer money. The defendant sought to enrich himself and fund his lifestyle through billing Medicare for services he never performed,” stated United States Attorney Lynch.  “We are committed to protecting these taxpayer-funded programs and prosecuting those who steal from them.”
“Fraudulently billing the government defrauds every American taxpayer,” said FBI Assistant Director in Charge Venizelos.   “We will investigate cases of graft and greed to protect important programs for those who need them.”
“For a single physician, the alleged conduct in this case is among the most serious I’ve seen in my law enforcement career,” said HHS-OIG SAC O’Donnell.  “Being a Medicare provider is a privilege, not a right.  When Dr. Ahmed allegedly billed Medicare for procedures he never performed, he violated the basic trust that taxpayers extend to healthcare providers.”
As alleged in the complaint, Ahmed engaged in a scheme to submit claims to Medicare for surgical procedures that were not in fact performed.   The complaint alleges multiple instances in which either patients told law enforcement officers that they never had the procedures that were billed, or hospital medical records did not contain any evidence that the procedures were actually performed.   From January 2011 through mid-December 2013, Medicare was billed at least $85 million for surgical procedures purportedly performed by Ahmed.
The investigation has been conducted by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York.   The case is being prosecuted  by Trial Attorney Turner Buford of the Fraud Section and Assistant U.S. Attorneys William Campos and Erin Argo of the U.S. Attorney’s Office for the Eastern District of New York.
The charges in the complaint are merely allegations, and the defendant is presumed innocent unless and until proven guilty.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 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.

Former Army National Guard Soldier Pleads Guilty in Connection with Bribery and Fraud Scheme to Defraud the U.S. Army National Guard Bureau

A former soldier of the U.S. Army National Guard has pleaded guilty for his role in a bribery and fraud scheme that caused approximately $70,000 in losses to the U.S. Army National Guard Bureau, announced Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division and U.S. Attorney Kenneth Magidson of the Southern District of Texas.
Former Sergeant First Class Michael Rambaran, 51, of Pearland, Texas, pleaded guilty today to one count of conspiracy, one count of bribery and one count of aggravated identity theft.   Sentencing is scheduled for June 24, 2014 before U.S. District Judge Lee H. Rosenthal in Houston.
The case arises from an investigation involving allegations that former and current military recruiters and U.S. soldiers in the San Antonio and Houston areas engaged in a wide-ranging corruption scheme to illegally obtain fraudulent recruiting bonuses.   To date, the investigation has led to charges against 25 individuals, 22 of whom have pleaded guilty.
According to court documents, in approximately September 2005, the National Guard Bureau entered into a contract with Document and Packaging Broker Inc. (Docupak) to administer the Guard Recruiting Assistance Program (G-RAP).   The G-RAP was a recruiting program that offered monetary incentives to Army National Guard soldiers who referred others to join the Army National Guard.   Through this program, a participating soldier could receive bonus payments for referring another individual to join the Army National Guard.   Based on certain milestones achieved by the referred soldier, a participating soldier would receive payment through direct deposit into the participating soldier’s designated bank account.   To participate in the program, soldiers were required to create online recruiting assistant accounts.
Rambaran admitted that between approximately February 2008 and August 2011, while he was a recruiter for the National Guard, he obtained the names and Social Security numbers of potential soldiers and provided them to recruiting assistants so that they could use the information to obtain fraudulent recruiting referral bonuses by falsely claiming that they were responsible for referring those potential soldiers to join the Army National Guard, when in fact they were not.   In exchange for the information, Rambaran admitted that he personally received a total of approximately $29,000 in payments from the recruiting assistants.
Co-conspirators  Edia Antoine, Ernest A. Millien III and Melanie Moraida pleaded guilty to conspiracy and bribery in connection to this scheme.   Antoine and Millien are each scheduled to be sentenced on Aug. 24, 2014.   Moraida is scheduled to be sentenced on Aug. 26, 2014.   All of these sentencing hearings are set before U.S. District Judge Rosenthal in Houston.
Another alleged co-conspirator, Christopher Renfro, who was indicted on Aug. 7, 2013, remains charged with two counts of wire fraud and two counts of aggravated identity theft.   Trial is currently scheduled for June 16, 2014, before U.S. District Judge Rosenthal in Houston.   An indictment is only an accusation, and a defendant is presumed innocent unless and until proven guilty.
The cases are being investigated by special agents from the San Antonio Fraud Resident Agency of Army CID’s Major Procurement Fraud Unit.   This case is being prosecuted by Trial Attorneys Sean F. Mulryne, Heidi Boutros Gesch and Mark J. Cipolletti of the Criminal Division’s Public Integrity Section and Assistant U.S. Attorney John Pearson of the Southern District of Texas.

Today Maurice Stucke will be presenting “In Search of Effective Ethics & Compliance Programs” before the Harvard European Law Association and its Program on Informal Enforcement of Competition Law

Preliminary Program

Harvard European Law Association

Informal Enforcement of Competition Law: Perspectives from the U.S. And Europe

March 24, Center for European Studies, Harvard University

Welcome: Pieter-Augustijn Van Malleghem (HELA) (9-9.10)

Opening SpeechAn Enforcer’s View: Prof. Jacques Steenbergen (Belgian CA), The Informal Competition Policy of the Belgian Competition Authority  (9.10-9.30)

 

  1. Informal Enforcement and Cartels (9.30-10.50AM)

Chair: Prof. Jacques Steenbergen

Anna-Louise Hinds (NUI Galway), Cartel Settlement in EU Competition Law – A Potential Compliance Impact?

Niels Baeten (Linklaters), Combined Lenience/Settlement Cases as the new normal in EU Cartel Enforcement: challenges & opportunities

Georges Georgiev (UCLA), The EU’s 2013 Proposal for a Directive on Antitrust Damages Actions: A Comparative Assessment

 

Coffee Break: 10.50 – 11.05AM

 

Keynote 1: Prof. Damien Geradin (11.05-11.25AM)

 

  1. Informal Enforcement and Unilateral Conduct (11.25-12.45PM)

Chair: Prof. Damien Geradin

Giovanna Massarotto (Criterion Economics), Antitrust Enforcement – The Crucial Role of Consent Decrees

Urska Petrovcic (EUI), Antitrust Settlements in Innovative Industries – The Case of Standard Essential Patents

Yane Svetiev (UBocconi/EUI), Settling or Learning: Commitment Decisions as a New Competition Enforcement Paradigm in the EU

 

Lunch: 12.45-1.45PM

 

Keynote 2: Prof. Einer Elhauge (1.45-2.05PM)

 

  1. Alternative Approaches to Informal Enforcement (2.05-3.25PM)

Chair: prof. E. Elhauge

Maurice Stucke (UTK), In Search of Effective Ethics & Compliance Programs

Matthew Jennejohn (BYU), Innovating Merger Review Outcomes

Mislav Mataija, (Uzagreb/EUI), Regulating the Regulators through Competition Law: Voluntary Private Regulation as an Alternative to Direct Enforcement?

 

Coffee Break: 3.25-3.40PM

 

  1. Informal Enforcement: A Legitimate Tool? (3.40-5PM)

Chair: Prof. D. Geradin

Damien Gerard, (UCLouvain/CGSH), Negotiated Remedies in the modernization era: the limits of effectiveness

Florian Wagner von Papp (UCL), Out-Lawing Antitrust

Georges Vallindas (ECJ), Is a Triple Cheeseburger easy to eat? EU’s Architecture facing non-litigation competition enforcement

Closing Remarks: Prof. Damien Geradin

Crossing the Rubicon: Why the Comcast/Time Warner merger should be blocked. Global Competition Review, 25 February 2014

http://globalcompetitionreview.com/news/article/35322/crossing-rubicon-why-comcasttime-warner-merger-blocked/

Comcast and Time Warner Cable say their proposed $45 billion merger would not raise prices – and would lead instead to real benefits – for cable customers across the country. But the deal raises serious concerns of a creeping monopolist and the ability of a powerful media buyer to harm rivals, write University of Tennessee professor and GeyerGorey of counsel Maurice E Stucke and GeyerGorey partner Allen P Grunes.

 

It seems fair to ask: Is this merger a done deal?

 

Quite a few financial analysts and some antitrust lawyers think so. They have publicly suggested that the Department of Justice and the Federal Communications Commission likely will approve Comcast’s acquisition of Time Warner Cable (TWC), subject to a few conditions, such as the extension of the Comcast/NBC Universal modified final judgment.

 

In a press call, both Comcast and TWC CEOs voiced confidence that the transaction would receive the necessary approvals, pointing to the absence of any break-up fee (or reverse break-up fee) as evidence of their confidence. Comcast has also argued that the combination would not reduce competition because the two cable providers do not compete in local markets. So is the only unanswered question what, if any, modifications will there be to Comcast’s obligations under the existing NBC Universal Final Judgment?

 

One thought experiment is to suppose that the predictions are correct. Suppose the merger, while not sailing through the regulatory process, is likely to remain relatively intact. If true, ask the following question: if Comcast can acquire TWC, what prevents Comcast from extending its footprint across America by acquiring all the remaining cable companies?

 

That was our initial query. And it seems difficult to discern a limiting principle, since the same justification for the Comcast/TWC transaction could easily be offered for a Comcast/TWC/Charter deal. Cable companies tend not to compete with one another for customers.

 

But upon closer examination, we wonder whether Comcast even would need to acquire other cable companies after acquiring TWC, which Comcast’s CEO described as the “premier pure play cable company in the US”. In acquiring TWC, according to one analysis, Comcast’s services would become available to 70 per cent of the US population (up from its current potential reach of 42 per cent of the US population). After TWC, Comcast’s remaining conquests are Nevada and even-less-populated regions, like North Dakota. With due respect to those states’ citizens, why bother? But suppose Comcast later seeks to acquire a local cable company. After letting this merger through, can the DoJ seriously argue that Comcast’s expansion into Iowa may somehow “substantially lessen competition or tend to create a monopoly?” Hardly. Thus this deal with TWC is critical. Comcast is crossing the regulatory Rubicon.

As noted, Comcast principally argues that it does not compete with TWC in the same geographic markets. Without any competitive overlap, according to Comcast, the acquisition does not really change anything. But this is wrong for several reasons.

 

First, a merger can violate section 7 of the Clayton Act without the parties competing in the same geographic market. Suppose each state had its own cable monopoly. Comcast, under its logic, could legally acquire every cable company in the US. Even if New York consumers were unaffected when Comcast acquires other Midwest cable monopolies, Comcast’s acquisition of local monopolies affects the overall competitive landscape. Moreover, if Comcast’s rivals compete throughout the US, and if Comcast can disadvantage its rivals by raising their costs, then consumers can be adversely affected far beyond Comcast’s local cable monopolies.

 

The intent under section 7, as in other parts of the Clayton Act, is as courts recognised to cope with monopolistic tendencies in their incipiency – well before they have attained such effects as would justify a Sherman Act proceeding. Congress sought to prevent situations where “several large enterprises [were] extending their power by successive small acquisitions”.  Here Comcast is extending its power through a significant acquisition – one that expands its reach to most of the US population.

 

As the DoJ found, Comcast and TWC already have market power for both video and broadband services in numerous local geographic markets. Comcast is the nation’s largest provider of video services (22 million residential customers at the end of 2012), internet services (19.4 million customers), and voice services (10 million customers). At the end of 2012, 41 per cent of the homes and businesses in the geographic areas Comcast served subscribed to Comcast’s video services; 36 per cent of the homes and businesses subscribed to Comcast’s internet services. As the largest video content distributor in many areas of the country, Comcast controls the pipes. But it also creates content through its national cable networks (including CNBC, MSNBC, and USA Network), regional sports networks, broadcast television (including NBC and Telemundo broadcast networks) and movie studio Universal Pictures, which produces, acquires, markets and distributes filmed entertainment worldwide.

 

In acquiring TWC, the second-largest cable provider of video, high-speed data and voice services in the US, Comcast extends its market power in five geographic areas: New York State (including New York City), the Carolinas, the Midwest (including Ohio, Kentucky and Wisconsin), Southern California (including Los Angeles), and Texas. This aggregation of important local markets, we submit, has antitrust significance.

 

Second, the Congressional command for section 7 is to “preserve competition among many small businesses by arresting a trend toward concentration in its incipiency before the trend developed to the point that a market was left in the grip of a few big companies”, as the Supreme Court said in Von’s Grocery. It was fashionable before the economic crisis for antitrust technocrats to scoff at Von’s, and at considering any trend toward concentration and the incipiency standard in merger review.

 

But after the havoc caused by financial institutions too big to fail (or to criminally prosecute), the incipiency standard has reappeared in the DoJ and FTC’s horizontal merger guidelines. One potential consequence of this merger is to accelerate the trend toward concentration among content providers and cable companies. Indeed, the chairman of DISH Network reportedly commented that this deal, if approved, “certainly doesn’t hurt the case for consolidation” of satellite TV providers, notwithstanding the fact that the US blocked a deal between Dish and DirecTV in 2002.

 

Third, one reason Congress sought to thwart a market dominated by a few firms is to prevent coordination or collusion. With fewer competitors, coordination, either express or tacit, becomes easier. We are already beyond that point. The DoJ and New York recently charged Comcast, TWC, Cox, and Bright House Networks of agreeing to restrain competition with Verizon.

 

Basically the cable companies sought to extend their “triple play” of voice, video, and broadband services into a “quad play” that included Verizon’s wireless services. Verizon, however, offered its competing “triple play” of voice, video, and broadband FiOS services. Under their agreement, in regions where Verizon’s FiOS competed with the defendant cable companies, Verizon would have sold two “quad play” products – its own and its competitors.  Verizon further agreed not to offer consumers a better price for its own quad play product. Not surprisingly the competitors’ agreement, the DoJ alleged, would have diminished Verizon’s incentives and ability to compete against Comcast, TWC, and the other cable providers. Why did Verizon hamstring itself? The cable companies agreed not to partner with a competing wireless company. And Verizon received a commission from selling its competitors’ products. This recent enforcement action shows how highly concentrated markets are susceptible to coordination.

 

Fourth, Comcast’s “no-competitive-overlap” argument considers only cable and internet subscribers. It ignores how the competition laws were also enacted to protect sellers from powerful buyers. One concern that arose in the recent joint hearings between the DoJ and Department of Agriculture is anti-competitive buyer power, namely monopsony. The complaint was that tepid antitrust enforcement over the past 30 years has left farmers and ranchers at the whim of powerful buyers. The emerging academic scholarship suggests that monopsony power can occur at lower market shares than monopoly power. Thus another concern is how the acquisition increases Comcast’s power to disadvantage sellers of television content (and raise the costs of Comcast’s rivals).

 

Fifth, in investigating Comcast’s deal with General Electric that ultimately enabled Comcast to control NBC Universal, the DoJ discussed various ways Comcast could disadvantage its traditional competitors (direct broadcast satellite and telephone companies) plus the emerging online video programming distributors (OVDs). Netflix and other OVDs rely on internet service providers like Comcast and TWC to deliver their television shows and movies to subscribers. Thus the growth of OVDs, as the DoJ found, “depends, in part, on how quickly [internet service providers] expand and upgrade their broadband facilities and the preservation of their incentives to innovate and invest”. In acquiring TWC, Comcast will have even more power to thwart Netflix or other emerging OVD rivals by impairing or delaying the delivery of their content. (Although Netflix recently sought to contractually resolve this issue with Comcast, other OVDs may lack the clout.)

 

Comcast might respond that whatever these concerns’ validity, its current Final Judgments with the DoJ ameliorate them. Comcast will likely extend net neutrality to TWC subscribers, promise to increase its broadband speed, and expand in rural and low-income areas. Comcast has also expressed a willingness to divest certain systems serving approximately three million managed cable subscribers, to be below 30 per cent of nationwide multichannel video subscribers. Why is that not good enough?

 

The FCC’s 30 per cent limit on nationwide multichannel video subscribers that any single cable provider can serve was vacated in 2009 by the US Court of Appeals for the DC Circuit; in its recent 10-K, TWC “is unable to predict when the FCC will take action to set new limits, if any”. So that is hardly a barrier. At what point does the DoJ become concerned and wonder whether its NBCU Final Judgment will protect suppliers and consumers? The judgment, for example, requires Comcast to maintain its internet access speed above a certain level. But the DoJ cannot know what a competitive market could bring.

 

That is a fatal flaw of behavioural remedies. Comcast continues to deliver expensive and (according to some critics) inferior broadband. In the US, it lags Google Fibre and other internet service providers. And there is less incentive for Comcast, after acquiring TWC, to innovate and compete.

 

AT&T, like Comcast, described its proposed acquisition of T-Mobile as somehow pro-consumer, pro-innovation, and pro-investment. AT&T apocryphally predicted that if its merger in a highly concentrated industry were blocked, consumers would suffer from lower output, worse quality, and higher prices. But AT&T and T-Mobile abandoned their merger after the DoJ’s challenge, and consumers now benefit from the competition by T-Mobile. Generally, antitrust views competition, not its reduction, as the remedy for allocating scarce resources. This deal is by no means done.

 

Copyright 2014 Global Competition Review

 

Marubeni Corporation Agrees to Plead Guilty to FCPA Charges and to Pay an $88 Million Fine

Marubeni Corporation, a Japanese trading company involved in the handling of products and provision of services in a broad range of sectors around the world, including power generation, entered a plea of guilty today for its participation in a scheme to pay bribes to high-ranking government officials in Indonesia to secure a lucrative power project.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, Acting U.S. Attorney Michael J. Gustafson of the District of Connecticut and Assistant Director in Charge Valerie Parlave of the FBI’s Washington Field Office made the announcement.

“Marubeni pleaded guilty to engaging in a seven-year scheme to pay – and conceal – bribes to a high-ranking member of Parliament and other foreign officials in Indonesia,” said Acting Assistant Attorney General Raman.  “The company refused to play by the rules, then refused to cooperate with the government’s investigation.  Now Marubeni faces the consequences for its crooked business practices in Indonesia .”

“For several years, the Marubeni Corporation worked in concert with a Connecticut company, among others, to bribe Indonesian officials in order to secure a contract to provide power-related services in Indonesia,” said Acting U.S. Attorney Michael J. Gustafson.  “Today’s guilty plea by Marubeni Corporation is an important reminder to the business community of the significant consequences of participating in schemes to bribe government officials, whether at home or abroad.”

“Companies that wish to do business in the United States or with U.S. companies must adhere to U.S. law, and that means bribery is unacceptable,” said Assistant Director in Charge Parlave.  “The FBI continues to work with our international law enforcement partners as demonstrated in this case to ensure that companies are held accountable for their criminal conduct.  I want to thank the agents, analysts and prosecutors who brought this case to today’s conclusion.”

Marubeni entered a plea of guilty to an eight-count criminal information filed today in the U.S. District Court for the District of Connecticut, charging Marubeni with one count of conspiracy to violate the anti-bribery provisions of the Foreign Corrupt Practices Act (FCPA) and seven counts of violating the FCPA.   Marubeni admitted its criminal conduct and has agreed to pay a criminal fine of $88 million, subject to the district court’s approval.  Sentencing has been scheduled for May 15, 2014.

As part of the plea agreement, Marubeni has agreed to maintain and implement an enhanced global anti-corruption compliance program and to cooperate with the department’s ongoing investigation.   The plea agreement cites Marubeni’s decision not to cooperate with the department’s investigation when given the opportunity to do so, its lack of an effective compliance and ethics program at the time of the offense, its failure to properly remediate and the lack of its voluntary disclosure of the conduct as some of the factors considered by the department in reaching an appropriate resolution.

Frederic Pierucci, who was the vice president of global boiler sales at Marubeni’s consortium partner, pleaded guilty on July 29, 2013, to one count of conspiring to violate the FCPA and one count of violating the FCPA.   David Rothschild, a former vice president of regional sales at the consortium partner, pleaded guilty on Nov. 2, 2012, to one count of conspiracy to violate the FCPA.   Lawrence Hoskins, a former senior vice president for the Asia region for the consortium partner, and William Pomponi, a former vice president of regional sales at the consortium partner, were charged in a second superseding indictment on July 30, 2013.   The charges against Hoskins and Pomponi are merely allegations, and the defendants are presumed innocent unless and until proven guilty.

According to court filings, Marubeni and its employees, together with others, paid bribes to officials in Indonesia – including a high-ranking member of the Indonesian Parliament and high-ranking members of Perusahaan Listrik Negara (PLN), the state-owned and state-controlled electricity company in Indonesia – in exchange for assistance in securing a $118 million contract, known as the Tarahan project, for Marubeni and its consortium partner to provide power-related services for the citizens of Indonesia.   To conceal the bribes, Marubeni and its consortium partner retained two consultants purportedly to provide legitimate consulting services on behalf of the power company and its subsidiaries in connection with the Tarahan project.   The primary purpose for hiring the consultants, however, was to use the consultants to pay bribes to Indonesian officials.

As admitted in court documents, Marubeni and its co-conspirators retained the first consultant in the fall of 2002.   However, in the fall of 2003, before the Tarahan contract had been awarded, Marubeni and its co-conspirators determined that the first consultant was not bribing key officials at PLN effectively.   One e-mail between employees of the power company’s subsidiary in Indonesia described a meeting between Marubeni employees, employees of its consortium partner, and PLN officials during which the PLN officials expressed “concern” that if Marubeni and its consortium partner win the project, whether the agent would give the officials “rewards” that they would consider “satisfactory,” or “only give them pocket money and disappear.  Nothing has been shown by the agent that the agent is willing to spend money.”   Shortly thereafter, a Marubeni employee sent an e-mail to other employees at Marubeni and its consortium partner stating that “unfortunately our agent almost did not execute his function at all, so far.   In case we don’t take immediate action now now [sic], we don’t have any chance to get this project forever.”

As a result, Marubeni and its consortium partner decided to reduce the first consultant’s commission from three percent of the total contract value to one percent, and pay the remaining two percent to a second consultant who could more effectively bribe officials at PLN.  In an e-mail between two employees of Marubeni’s consortium partner, they discussed a meeting between Marubeni, an executive from the consortium partner, and the first consultant, stating that the first consultant “committed to convince [the member of Parliament] that ‘one’ [percent] is enough.”

Marubeni and its co-conspirators were successful in securing the Tarahan project and subsequently made payments to the consultants for the purpose of bribing the Indonesian officials.   Marubeni and its co-conspirators paid hundreds of thousands of dollars into the first consultant’s bank account in Maryland to be used to bribe the member of Parliament. The consultant then allegedly transferred the bribe money to a bank account in Indonesia for the benefit of the official.

This case is being investigated by FBI agents from the Washington Field Office, with assistance from the Resident Agency of the FBI in Meriden, Conn.   Significant assistance was provided by the Criminal Division’s Office of International Affairs.   In addition, the department greatly appreciates the significant cooperation provided by its law enforcement colleagues in Indonesia at the Komisi Pemberantasan Korupsi (Corruption Eradication Commission), the Office of the Attorney General in Switzerland and the Serious Fraud Office in the United Kingdom.

The case is being prosecuted by Assistant Chief Daniel S. Kahn of the Criminal Division’s Fraud Section and Assistant U.S. Attorney David E. Novick of the District of Connecticut.

Former Employee of Navy Contractor Pleads Guilty in International Navy Bribery Scandal

Alex Wisidagama, a citizen of Singapore formerly employed by Glenn Defense Marine Asia (GDMA), pleaded guilty today to one count of conspiracy to defraud the United States for his role in a scheme to overbill the U.S. Navy for ship husbanding services.   Wisidagama’s plea is the second in an expanding investigation into acts of alleged fraud and bribery committed by GDMA and several United States Navy officers and personnel.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Laura E. Duffy of the Southern District of California, Director Andrew Traver of the Naval Criminal Investigative Service (NCIS) and Deputy Inspector General for Investigations James B. Burch of the U.S. Department of Defense Office of the Inspector General made the announcement after the plea was accepted by U.S. Magistrate Judge Jan M. Adler of the Southern District of California.   The plea is subject to acceptance by U.S. District Judge Janis Sammartino.   Sentencing is set for June 13, 2014, before Judge Sammartino.
Wisidagama, who was arrested in San Diego, Calif., on Sept. 16, 2013, served as the general manager of global government contracts for GDMA, which was owned and operated by his cousin, Leonard Glenn Francis .   GDMA was a multi-national corporation with headquarters in Singapore and operating locations in other countries, including Japan, Thailand, Malaysia, Korea, India, Hong Kong, Indonesia, Australia, Philippines, Sri Lanka and the United States.   GDMA provided the U.S. Navy with hundreds of millions of dollars in husbanding services, which involve the coordinating, scheduling and procurement of items and services required by ships and submarines when they arrive at port.   These services included providing tugboats; paying port authority and customs fees; furnishing security and transportation; supplying provisions, fuel and water; and removing trash and collecting liquid waste.
In his plea agreement, Wisidagama admitted to conspiring to defraud the U.S. Navy in different ways.   Wisidagama and other GDMA employees generated bills charging the U.S. Navy for port tariffs that were far greater than the tariffs that GDMA actually paid.   In some cases, Wisidagama and others created fictitious port authorities for ports visited by U.S. Navy ships, and in other cases, Wisidagama and GDMA created fake invoices from legitimate port authorities purporting to bill the U.S. Navy at inflated tariff rates.   Wisidagama and GDMA also overbilled the U.S. Navy for fuel by creating fraudulent invoices which represented that GDMA acquired fuel at the same cost that it charged the U.S. Navy when in fact GDMA sold the fuel to the U.S. Navy for far more than it actually paid.   Wisidagama and GDMA also defrauded the U.S. Navy on the provision of incidental items by creating fake price quotes purportedly from other vendors to make it appear that the other vendors’ offering prices were greater than GDMA’s prices.
Wisidagama is the second defendant to plead guilty as part of this investigation.   On Dec. 17, 2013, former NCIS Supervisory Special Agent John Bertrand Beliveau Jr. pleaded guilty to conspiracy to commit bribery after admitting to providing Francis with sensitive law enforcement information in exchange for things of value such as cash, travel accommodations, lavish dinners, and prostitutes.   In addition to Beliveau and Wisidagama, Francis and U.S. Navy Commanders Michael Vannak Khem Misiewicz and Jose Luis Sanchez have been charged as part of a bribery and fraud scheme designed to defraud the U.S. Navy.   The charges against Misiewicz, Sanchez and Francis are merely allegations, and the defendants are presumed innocent unless and until proven guilty.
The ongoing investigation is being conducted by NCIS, the Defense Criminal Investigative Service and the Defense Contract Audit Agency.   Significant assistance was provided by the Criminal Division’s Office of International Affairs, as well as the Drug Enforcement Administration, U.S. Immigration and Customs Enforcement’s Homeland Security Investigations, the Royal Thai Police and the Corrupt Practices Investigation Bureau in Singapore.
The case is being prosecuted by Assistant U.S. Attorneys Mark Pletcher and Robert Huie of the Southern District of California, Director of Procurement Fraud Catherine Votaw and Trial Attorney Brian Young of the Criminal Division’s Fraud Section, and Trial Attorney Wade Weems, on detail to the Fraud Section from the Special Inspector General for Afghan Reconstruction.

Straw Owner of Clinic Sentenced in Medicare Fraud Scheme

A Florida man who had been the straw owner of a physical therapy rehabilitation facility has been sentenced to serve 30 months in prison for his role in a $28.3 million Medicare fraud scheme.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney for the Middle District of Florida A. Lee Bentley III, Special Agent in Charge Paul Wysopal of the FBI’s Tampa Field Office and Acting Special Agent in Charge Brian P. Martens of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Florida region made the announcement.
Roberto Fernandez Gonzalez, 63, formerly of southwest Florida, was sentenced by U.S. District Judge Susan C. Bucklew in the Middle District of Florida and was ordered to forfeit $446,738 and pay the same amount in restitution.   Fernandez pleaded guilty on June 24, 2013, to conspiracy to commit health care fraud.
According to court documents, Fernandez and his co-conspirators used various physical therapy clinics and other business entities throughout Florida – including Rehab Dynamics Inc. in Venice, Fla. – to submit approximately $28.3 million in fraudulent reimbursement claims to Medicare from 2005 through 2009.   Medicare paid approximately $14.4 million on those claims.
Fernandez’s co-conspirators obtained and controlled Rehab Dynamics.   They engaged in a sham sale of Rehab Dynamics to Fernandez, a Cuban immigrant with no background in the health care industry.   Fernandez did not have the money to buy Rehab Dynamics.   Instead, the co-conspirators paid Fernandez approximately $20,000 to serve as the straw owner of Rehab Dynamics from January 2008 through March 2008.   During that time, Rehab Dynamics submitted approximately $1.6 million in fraudulent claims to Medicare seeking reimbursement for rehabilitation therapy services that were not provided.   Medicare paid approximately $446,738 on those false claims.
This case is being investigated by the FBI and HHS-OIG 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 Middle District of Florida.   This case is being prosecuted by Trial Attorneys Christopher J. Hunter and Andrew H. Warren of the Criminal Division’s Fraud Section and Assistant United States Attorney Simon A. Gaugush of the U.S. Attorney’s Office for the Middle 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 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion.   In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

American Family Care Inc. to Pay $1.2 Million to Settle Allegations of Inflated Medicare Claims

American Family Care Inc. has agreed to pay the government $1.2 million to resolve allegations under the False Claims Act that it knowingly submitted claims to Medicare for outpatient office visits that were billed at a higher rate than was appropriate, the Justice Department announced today.  American Family Care is a network of walk-in medical clinics headquartered in Birmingham, Ala., with offices in Alabama, Tennessee and Georgia.

“Mischarging the government for office visits wastes valuable government resources that could be used to care for other patient needs,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery.  “At a time of increasing concern about the cost of medical care, it is especially important to ensure that health care providers are not overbilling the government by improperly inflating their claims.”

Following guidance adopted by the Centers for Medicare and Medicaid Services, health clinics such as American Family Care bill Medicare for their services by selecting a corresponding Evaluation and Management code.  The codes are divided into five different levels – from basic (level 1) to most complex (level 5).  Higher level codes result in higher reimbursement from Medicare than lower level codes.  The government alleged that American Family Care knowingly selected Evaluation and Management codes for a level of services that exceeded those actually provided in order to artificially increase the amount of reimbursement it received for those visits.

“The False Claims Act is a critical tool for weeding out fraud and protecting the taxpayers,” said U.S. Attorney for the Northern District of Alabama Joyce White Vance.  “My office will continue to return funds, like the $1.2 million in this case, to the taxpayers by proceeding against those who abuse our public health programs.

“Billing the government for services not provided as claimed cheats both taxpayers and patients,” said Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General, U.S. Department of Health and Human Services region including Alabama.  “We will pursue aggressively providers like American Family Care alleged to have improperly maximized reimbursements.”

The civil settlement resolves a lawsuit filed by Anita C. Salters, a former employee of American Family Care, under the whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the government for false claims and to obtain a portion of the government’s recovery.  Salters’ share has not yet been determined.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius.  The partnership between the two departments has focused on efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.

This settlement with American Family Care was the result of a coordinated effort among the U.S. Attorney’s Office for the Northern District of Alabama; the Department of Justice’s Civil Division, Commercial Litigation Branch; the Office of Inspector General of the U.S. Department of Health and Human Services and the Federal Bureau of Investigation.

The lawsuit is captioned United States ex rel. Anita C. Salters v. American Family Care Inc. (N.D. Ala.).  The claims resolved by this settlement are allegations only, and there has been no determination of liability.