Category Archives: Insurance Fraud

Pain Management Doctor Pleads Guilty in Health Care Fraud Case

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Thursday, August 31, 2017

Acting United States Attorney Steve Butler of the Southern District of Alabama announced today that Dr. Rassan M. Tarabein, 58, a neurologist residing in Fairhope, Alabama, pled guilty before Chief United States District Judge Kristi K. DuBose to one count of health care fraud and one count of unlawful distribution of a schedule II controlled substance.  As part of his plea agreement, Dr. Tarabein will no longer be able to practice medicine and prescribe controlled substances in the United States.  Chief Judge DuBose has scheduled sentencing for March 2, 2018.  Dr. Tarabein faces up to ten years in prison for health care fraud and up to twenty years in prison for unlawfully distributing a controlled substance.

On June 28, 2017, a federal grand jury for the Southern District of Alabama returned a 22–count superseding indictment against Dr. Tarabein, charging him with health care fraud, making false statements relating to health care matters, lying to a federal agent, unlawfully distributing schedule II controlled substances, and money laundering.   He was arrested two days later.

Dr. Tarabein previously operated the Eastern Shore Neurology and Pain Center, a private clinic in Daphne, Alabama where he offered services relating to neurology and pain management, such as spinal injections.  In his plea agreement, Dr. Tarabein admitted that from around 2004 to May 2017, he ran an insurance scam in which he induced patients to visit his clinic so that he could bill health care benefit programs for medically unnecessary tests and procedures.  The purpose of Dr. Tarabein’s admitted scheme was to maximize personal financial gain by fraudulently seeking payments from health care benefit programs such as Medicare, Medicaid, Blue Cross Blue Shield of Alabama, Humana, UnitedHealthcare, and other private insurers.  As part of his guilty plea, Dr. Tarabein admitted to violating the traditional standards of care in his medical practice by, for example, failing to provide informed consent to patients about procedures, discriminating against Alabama Medicaid patients in services rendered, fraudulently documenting patient records, submitting false claims to insurance companies, and issuing prescriptions for schedule II controlled substances without a legitimate medical purpose.

Dr. Tarabein has pending state criminal charges in Montgomery County, Alabama.  On June 16, 2017, a state grand jury returned a 2–count indictment against Dr. Tarabein, charging him with Medicaid fraud and theft of property in the first degree, each a felony offense.  On September 20, 2017, Dr. Tarabein is expected to plead guilty in state court to Medicaid fraud.

Acting United States Attorney Butler stated, “Today’s guilty plea reinforces our office’s dedication to protecting the public from corrupt physicians.  Doctors who exploit patients through medically unnecessary services to line their own pockets have no place in our health care system.  I commend the investigators who unraveled Dr. Tarabein’s scam for their commitment to uproot health care fraud.”

Attorney General Steve Marshall stated, “I am pleased that my Medicaid Fraud Control Unit had the opportunity to team with our federal law enforcement colleagues to investigate and bring to justice this defendant who not only violated his oath to his patients, but stole taxpayer money set aside to provide care for our most vulnerable citizens.  I am grateful to the U.S. Attorney’s Office for the Southern District of Alabama for its speedy resolution of the federal charges, as this defendant is held to account for his actions.”

Federal Bureau of Investigation (FBI) Special Agent in Charge Robert E. Lasky stated, “The FBI stands ready to work alongside our state, local, and federal partners to eliminate prescription drug abuse.  When doctors place money before the well-being of their patients, this task becomes nearly impossible.  This guilty plea is a testament to all the hard work and cooperation between the agencies that conducted this investigation.”

“The abuse of prescription drugs is a serious problem in our communities.  All too often, this abuse leads to addiction, shattered lives, and even death.  For the health and safety of our citizens, DEA and our law enforcement partners will continue to target those who illegally distribute these potentially dangerous drugs.  We hope that the conviction of Dr. Tarabein serves as a reminder to anyone who might illegally divert pharmaceuticals that they will be held accountable for the harm they cause,” said Stephen G. Azzam, Special Agent in Charge of DEA’s New Orleans Field Division.

“Today’s plea should serve as a wake-up call to those who intend to bill the government for medically unnecessary services and thereby enriching their own bottom line,” said Special Agent in Charge Derrick L. Jackson of the U.S. Department of Health and Human Services Office of Inspector General (OIG).  “The nation is facing a very serious prescription drug crisis and the OIG, along with our state and federal law enforcement partners, take allegations such as these very seriously.”

The FBI, DEA, OIG, and Alabama Medicaid Fraud Control Unit are investigating the federal case.  Assistant United States Attorneys Sinan Kalayoglu and Gregory A. Bordenkircher are prosecuting the federal case in coordination with the Office of the Alabama Attorney General, Medicaid Fraud Control Unit.  Assistant Attorney General Bruce M. Lieberman is prosecuting the state case.

Owner of Hudson County Medical Equipment Supply Store Pleads Guilty To $100,000 from Medicaid Fraud Scam

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TRENTON –Attorney General Christopher S. Porrino and the Office of the Insurance Fraud Prosecutor (OIFP) announced today that the owner of a Hudson County medical equipment supply store has pleaded guilty to fraudulently billing the Medicaid program more than $100,000 for medical supplies never provided to patients.

Alfredo Valdes, Jr., who owns T-N-T medical supplies in West New York, pleaded guilty to second-degree charges of health care claims fraud and theft by deception in a hearing before Superior Court Judge Mitzy Galis-Menendez in Hudson County. Under the terms of the plea agreement, the State will recommend that the 42-year-old Clifton resident be sentenced to four years in state prison. Valdes will also pay $101,000 in restitution to Horizon New Jersey Health, and sign a consent order agreeing to lifetime disbarment from participation as a provider in the New Jersey Medicaid program.

“Stealing from a program that provides financial assistance to those who cannot afford health insurance or health care services is not only a crime, it’s a disgrace,” said Attorney General Porrino. “This guilty plea ensures that the defendant will be held accountable for his actions and will never again be in a position to divert resources from those who truly need it.”

“Every dollar lost to Medicaid fraud is one less dollar available to help some of the most vulnerable citizens of our state,” said Acting Insurance Fraud Prosecutor Christopher Iu. “Our Medicaid Fraud Control Unit will continue to aggressively investigate and punish those exploit the Medicaid system for their personal enrichment.”

In pleading guilty, Valdes admitted that between January 2008 and March 2016 he fraudulently submitted claims totaling more than $100,000 to Horizon NJ Health, a provider of Medicaid services in the state. The claims falsely stated that Valdes had distributed durable medical equipment – including compression stockings, diapers and other items – to patients who, in fact, had died prior to the dates of the purported distributions.

Valdes is scheduled to be sentenced on January 5, 2018.

Deputy Attorney General Melissa Simsen represented the State in the plea hearing. Detectives Anthony Iannice and Kylie Mattis coordinated the investigation with assistance from Det. Megan Brennan of the Special Investigation Unit at Horizon New Jersey Health, and Analysts Keira McRae-Wiggins and Kelly Celenza. Acting Insurance Fraud Prosecutor Iu thanked the SIU Unit at Horizon for referring the matter to the Office of the Insurance Fraud Prosecutor.

John Lynch, Esq. represented Valdes at the plea hearing.

Acting Insurance Fraud Prosecutor Iu noted that some important cases have started with anonymous tips. People who are concerned about insurance cheating and have information about a fraud can report it anonymously by calling the toll-free hotline at 1-877-55-FRAUD, or visiting the Web site at www.NJInsurancefraud.org. State regulations permit a reward to be paid to an eligible person who provides information that leads to an arrest, prosecution and conviction for insurance fraud.

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