Category Archives: Office of Inspector General (OIG)

Transportation Operator Sentenced to 14 Months for Defrauding the State Department

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April 6, 2018

A local transportation operator was sentenced to 14 months today for stealing federal funds intended for a foreign exchange program maintained by the U.S. Department of State.  Acting Assistant Attorney General John P. Cronan of the Department of Justice’s Criminal Division, Acting U.S. Attorney Tracy Doherty-McCormick of the Eastern District of Virginia, Inspector General Steve A. Linick of the U.S. Department of State and Andrew W. Vale, Assistant Director in Charge of the FBI’s Washington Field Office made the announcement.

Denon T. Hopkins, 49, of Germantown, Maryland, was sentenced by Senior U.S. District Judge T.S. Ellis, III of the Eastern District of Virginia.  Hopkins pleaded guilty to a one-count information charging him with conspiracy to commit honest services wire fraud and theft of public money on Dec. 21, 2017.

According to admissions made in connection with his plea, Hopkins was the operator and de facto owner of a transportation company that contracted with the State Department to provide bus and limousine services to a State Department component devoted to sports diplomacy and which sponsored a foreign exchange program for emerging athletes and coaches from various countries.  The exchange program was managed by George Mason University in Fairfax, Virginia, through a federal grant and cooperative agreement with the State Department.  During a time period when Hopkins received $247,200 in grant funds for legitimate transportation services, he and a State Department official conspired to steal portions of the federal money allocated to the exchange program by, among other things, falsifying vendor-related invoices and making fraudulent checks payable to Hopkins.  In total, Hopkins stole approximately $17,335 from the State Department.  He also admitted that he used portions of the funds to pay kickbacks to the State Department official to retain his transportation contract.

The Department of State’s Office of Inspector General and the FBI’s Washington Field Office investigated the case.  Trial Attorney Edward P. Sullivan of the Criminal Division’s Public Integrity Section and Assistant U.S. Attorney Kimberly R. Pedersen of the Eastern District of Virginia are prosecuting the case.

Department of Justice and Health and Human Services Return $2.6 Billion in Taxpayer Savings From Efforts to Fight Healthcare Fraud

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April 6, 2018 Departments Work to Stamp out Pill Mills and Opioid Overprescribing

Health and Human Services Secretary Alex Azar and Attorney General Jeff Sessions today released a fiscal year (FY) 2017 Health Care Fraud and Abuse Control Program report showing that for every dollar the federal government spent on healthcare related fraud and abuse investigations in the last three years, the government recovered $4. Additionally, the report shows that the departments’ FY 2017 Takedown event was the single largest healthcare fraud enforcement operation in history.

In FY 2017, the government’s healthcare fraud prevention and enforcement efforts recovered $2.6 billion in taxpayer dollars from individuals and entities attempting to defraud the federal government and Medicare and Medicaid beneficiaries. Some of these fraudulent practices include:

  • Providers operating “pill mills” out of their medical offices.
  • Providers submitting false claims to Medicare for ambulance transportation services.
  • Clinics submitting false claims to Medicare and Medicaid for physical and occupational therapy.
  • Drug companies paying kickbacks to providers to prescribe their drugs, and pharmacies soliciting and receiving kickbacks from pharmaceutical companies for promoting their drugs.
  • Companies misrepresenting capabilities of their electronic health record software to customers.

“Taxpayers work hard every day to help fund government programs for our fellow Americans,” Attorney General Sessions said. “But too many trusted medical professionals like doctors, nurses and pharmacists have chosen to violate their oaths and exploit this generosity to line their pockets, sometimes for millions of dollars.  At the Department of Justice, we have taken historic new actions to incarcerate these criminals and recover stolen funds, including executing the largest healthcare fraud enforcement action in American history.  These achievements are important, but the department’s work is not finished. We will keep up this pace and continue to prosecute fraudsters so that we can give financial relief to taxpayers.”

“Today’s report highlights the success of HHS and DOJ’s joint fraud-fighting efforts,” said HHS Secretary Azar. “By holding individuals and entities accountable for defrauding our federal health programs, we are protecting the programs’ beneficiaries, safeguarding billions in taxpayer dollars, and, in the case of pill mills, helping stem the tide of our nation’s opioid epidemic.”

The Departments of Justice (DOJ) and Health and Human Services (HHS), through the Health Care Fraud Prevention and Enforcement Action Team (HEAT) effort, use data analytics and surveillance to crack down on, prevent and prosecute healthcare fraud. While the program continues to be very successful, the return on investment fluctuates from year to year, in part because cases resulting in large settlements take multiple years to complete. Additionally, there has been a reduction in large monetary settlements as many of the large pharmaceutical manufacturers have entered into Corporate Integrity Agreements with the HHS Office of the Inspector General to establish protections against fraudulent activities.

With teams comprised of law enforcement agents, prosecutors, attorneys, auditors, evaluators and other staff, last year DOJ opened 967 new criminal healthcare fraud investigations of which federal prosecutors filed criminal charges in 439 cases involving 720 defendants.  A total of 639 defendants were convicted of healthcare fraud related crimes. In FY 2017, the DOJ and HHS joint Medicare Fraud Strike Force filed 253 indictments and charges against 478 defendants who allegedly billed federal healthcare programs more than $2.3 billion. The Strike Force obtained more than 290 guilty pleas, litigated 33 jury trials and won guilty verdicts against 40 defendants. The Fraud Strike Force secured prison sentences for more than 300 defendants, with an average sentence of 50 months. Since its inception in 2007, Strike Force prosecutors filed more than 1,660 cases charging more than 3,490 defendants who collectively billed the Medicare program more than $13 billion.

Beyond criminal prosecution, the HHS Office of Inspector General (OIG) remains vigilant in excluding providers and suppliers who committed fraud or engaged in the abuse or neglect of patients in federal health programs. A total of 3,244 individuals and entities were excluded in FY 2017. Others were excluded as a result of licensure revocations. These exclusions help to safeguard beneficiaries from future harm that could otherwise be inflicted by such convicted individuals or entities. HHS can also suspend Medicare payments to providers during investigations of credible allegations of fraud.  During FY 2017, there were 551 related payment suspensions.  More than 4 million claims are reviewed by Medicare each day; resulting in more than one billion claims processed annually for timely payments to healthcare providers and suppliers. Given the volume of claims processed by Medicare each day and the significant cost associated with conducting medical review of an individual claim, the Centers for Medicare and Medicaid Services uses automated edits to help prevent improper payments without the need for manual intervention.  The National Correct Coding Initiative consists of edits designed to reduce improper payments in Medicare Part B, and this program saved Medicare $186.9 million during the first nine months of FY 2017.

As the opioid epidemic continues to devastate communities and families across the nation, both DOJ and HHS are responding with new approaches. One out of every three beneficiaries received prescription opioids through Medicare Part D in 2016. Additionally, 401 prescribers were found to have questionable prescribing patterns for beneficiaries at serious risk of opioid misuse or overdose, based on an OIG analysis. Last July, DOJ and HHS announced the largest ever healthcare fraud enforcement action, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in healthcare schemes involving approximately $1.3 billion in false billings. Of those charged, more than 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

In August, Attorney General Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit, a new DOJ pilot program that will use data to help combat and prosecute individuals and entities involved in illegal activities that fuel the crisis. As part of that task force, the department funded 12 experienced assistant United States attorneys for a three-year term to focus solely on investigating and prosecuting healthcare fraud related to prescription opioids, including pill mill schemes and pharmacies that unlawfully divert or dispense prescription opioids for illegitimate purposes. Those prosecutors have already charged several with unlawful distribution of opioids, and their continued success is crucial in combatting this deadly epidemic.

For more details on the Health Care Fraud and Abuse Control Program and today’s report, visit: https://oig.hhs.gov/publications/docs/hcfac/FY2017-hcfac.pdf

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.

United States Recovers More Than $12 Million In False Claims Act Settlements For Alleged Kickback Scheme

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Monday, August 21, 2017

United States will also pursue claims against Precision Lens, Paul Ehlen and Dr. Jitendra Swarup

Acting United States Attorney Gregory G. Brooker today announced that Sightpath Medical, Inc. (n/k/a Sightpath Medical, LLC) (“Sightpath”), TLC Vision Corporation (n/k/a TLC Vision (USA, LLC)) (“TLC”) (collectively the “Sightpath Entities”) and their former CEO, JAMES TIFFANY, have agreed to pay more than $12 million to the United States to resolve kickback allegations under the False Claims Act (“FCA”). The United States also intervened in an underlying lawsuit against the Cameron-Ehlen Group, Inc. d/b/a Precision Lens (“Precision Lens”), Precision Lens’ owner PAUL EHLEN, and JITENDRA SWARUP.

“Medicare beneficiaries depend on their physicians to make decisions based on sound medical judgment,” said Assistant U.S. Attorney Chad Blumenfield. “Our office will take decisive action to address allegations that medical providers are receiving improper financial benefits that could influence medical decision making. We are grateful to our law enforcement partners for their excellent work in investigating this matter.”

“This settlement is an outstanding result and represents the third major False Claims Act case successfully handled by this Office in the last three months. These types of cases remain a top priority of our Office, I applaud the hard work and dedication of the Civil Frauds Unit and the agencies involved in the case,” said Acting U.S. Attorney Gregory Brooker.

“The FBI together with our law enforcement partners aggressively investigate companies and individuals who engage in kickback schemes at the expense of Medicare and other federal health care programs,” said FBI Special Agent in Charge Richard T. Thornton of the Minneapolis Division. “Those who seek to exploit the nation’s health care system through fraud will be held accountable.”

According to the complaint, brought by a whistleblower, Sightpath and Precision Lens supply intraocular lenses, as well as ophthalmic surgical equipment and services to medical facilities. These products and services are used by ophthalmologists in connection with eye surgeries, including cataract surgeries performed in Ambulatory Surgical Centers and hospitals for which federal payers, such as Medicare, provide reimbursements. The complaint alleges that Precision Lens, EHLEN and the Sightpath Entities paid kickbacks to physicians in various forms, including travel, entertainment and improper consulting agreements. The complaint identifies multiple examples of trips including luxury skiing vacations and high-end fishing, golfing and hunting trips. The complaint also alleges that these various items of value were provided in order to induce the physicians to use Precision Lens’ and the Sightpath Entities’ products and services.

According to the settlement agreements, the United States contends that between January 1, 2006 and January 1, 2015, the Sightpath Entities provided physicians items of value to induce the use of Sightpath Entities’ products and services, which resulted in the submission of false claims to the United States for ophthalmological products and services. These items of value included hunting, skiing, fishing, and golf trips. Additionally, the Sightpath Entities entered into consulting agreements with physicians and physician practices for services that were never performed or not properly tracked, resulting in payments in excess of fair market value.

According to the settlement agreements, the United States further alleged that TIFFANY directed much of the conduct at issue, particularly between 2010 and 2013 when he was CEO of Sightpath and TLC, and that TIFFANY was directly involved in setting up and participating in several of the trips with physicians who were either Sightpath customers or potential customers. In addition, TIFFANY directly participated in establishing and continuing the lucrative consulting agreements with physicians and physician practices. The United States contends that by providing these items of value, the Sightpath Entities and TIFFANY knowingly induced physicians to utilize the Sightpath Entities’ products and services and submit false claims to the federal government. The claims were false because they were tainted by illegal kickbacks to the physicians, in violation of the Anti-Kickback Statute and the False Claims Act.

These settlements resolve allegations filed in a civil lawsuit originally brought by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government for false claims and to share in any recovery. The government often relies on whistleblowers to bring fraud schemes to light that might otherwise go undetected. The whistleblower in this matter, Kipp Fesenmaier, will receive 19.5 percent of the amounts recovered in connection with the settlement agreements.

As part of the FCA Agreement and in exchange for a release of OIG’s permissive exclusion authority, Sightpath has agreed to enter into a 5-year corporate integrity agreement (CIA) with OIG. Although not a signatory to the CIA, TLC is participating in the CIA as a “covered person.”

The United States has declined to intervene in the case against the other defendants named in the complaint. The claims resolved by these settlements are allegations only; there has been no determination of liability or wrongdoing.

The case was handled by Assistant U.S. Attorney Chad A. Blumenfield of the Civil Frauds Unit of the U.S. Attorney’s Office for the District of Minnesota with assistance from the Office of Inspector General of the U.S. Department of Health and Human Services and the Federal Bureau of Investigation.

The case is United States ex rel. Fesenmaier v. Sightpath Medical, Inc. TLC Vision Corporation, The Cameron Ehlen Group, Inc. dba Precision Lens, et al., Civil No. 13-CV-3003 (RHK/FLN).

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Five Plea Agreements Lead to Repayment to TennCare

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Wednesday, August 23, 2017

NASHVILLE, Tenn. – Five people, including residents of Arkansas and Alabama, have been ordered to make restitution to TennCare after they were each charged separately with TennCare fraud.

The Office of Inspector General (OIG) today announced the plea agreements, which include repayment of $147,000 to TennCare for healthcare insurance payments made on their behalf.

  • Keily Phillips, of Bridgeport, Alabama received four years’ probation in Marion County and was ordered to repay TennCare $48,340.80 and was ordered to repay the food stamp program a total of $12,015.00. She was arrested in October of 2014 and again in October 2015 stemming from charges she falsely reported her residency, family composition and marital income in order to render herself eligible for TennCare and the SNAP food stamp program. District Attorney General J. Michael Taylor prosecuted both cases.
  • Jann Cooke, of Jonesboro, Arkansas received 11 months 29 days supervised probation and is ordered to repay the state $19,952.37. She was also ordered to remain in supervision until the full amount is repaid. Cooke was charged in January of this year with claiming her family lived in Tennessee – when they actually resided in Arkansas – in order to receive TennCare benefits. At the time of arrest, Cooke was living in Gulf Breeze, Florida. With the assistance of the Shelby County Sheriff’s Office, Cook was extradited back to Tennessee. District Attorney General Amy T. Weirich prosecuted this case.
  • In Marshall County, Patricia Lindsay of Chapel Hill received six years judicial diversion and was ordered to repay a total of $37,070.96. She was charged in May of this year with failing to disclose her income to the state in order to illegally obtain TennCare benefits. District Attorney General Robert Carter prosecuted this case.
  • Carla A. Gonzalez of Clarksville received two years judicial diversion and was ordered to repay the state a total of $12,273.00. She was charged in October of 2016 with obtaining TennCare healthcare insurance by claiming a minor child as a dependent; otherwise, she would not have been eligible for TennCare. District Attorney General John W. Carney prosecuted this case.
  • Tasha Isaac of Chattanooga received six years state probation and is ordered to repay the state $18,000. She was charged in July of last year with not fully reporting her income to the state in order to obtain TennCare benefits. The judge also ordered supervised state probation until restitution is paid in full, a special condition. District Attorney General Neal Pinkston prosecuted this case.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to more than $3 million being repaid to TennCare, with a total estimated cost avoidance of more than $163.6 million for TennCare, according to latest figures. To date, 2,889 people have been charged with TennCare fraud.

Through the OIG Cash for Tips Program established by the Legislature, Tennesseans can get cash rewards for TennCare fraud tips that lead to convictions. Anyone can report suspected TennCare fraud by calling 1-800-433-3982 toll-free from anywhere in Tennessee, or visit the website and follow the prompts that read “Report TennCare Fraud.”

Woman Pleads Guilty To Theft Concerning Programs Receiving Federal Funds

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Thursday, July 27, 2017

SAN JUAN, P.R. – Zoraida Velázquez-Bracero plead guilty to an information charging her with theft concerning programs receiving federal funds, announced Rosa Emilia Rodríguez-Vélez, United States Attorney for the District of Puerto Rico. The U.S. Department of Education, Office of Inspector General was in charge of the investigation.

From June 2005 until July, 2015, Velázquez-Bracero was the Purchasing Director at Pontifical Catholic University of Puerto Rico, an entity that receives in excess of $10,000.00 in federal funding in a one year period. In this position, Defendant was issued a University corporate credit card for purchasing goods and supplies for the University as well as arranging official travel for University professors. However, in 2008 Defendant started using this corporate credit card for personal expenses not authorized by the University.

Through direct charges and cash advances, Velázquez-Bracero used this corporate credit card to pay for school tuition, household utility bills and other items, and vacations to Disney World, New York City, Atlanta, Indianapolis, Canada, and France. Defendant concealed the use of this corporate credit card by altering and/or creating fictitious credit card statements wherein she hid the charges by increasing the amounts of other legitimate charges to the card, or by deleting the charges altogether before submitting the statement to the finance department for payment.

Although the original limit on this corporate credit card was $80,000.00, Velázquez-Bracero obtained numerous credit limit increases by forging her supervisor’s signature on letters to the credit card company requesting said increases. Defendant knew that she was affecting federal grants when she illegally used this corporate credit card. The total amount of unauthorized charges by Velázquez-Bracero was $655,432.00.

“The defendant misappropriated funds intended to aid University students, for her illegal personal gain,” said US Attorney Rosa Emilia Rodríguez-Vélez. “At the U.S. Attorney’s Office we will continue to aggressively investigate and prosecute financial crimes. This arrest should discourage those who get involved in these types of schemes before it’s too late, because we will continue investigating and prosecuting these offenses.”

“Federal education funds exist to provide students with educational opportunities and help students make their dreams of higher education a reality, it’s not a personal slush fund,” said Yessyka Santana, Special Agent in Charge of the U.S. Department of Education Office of Inspector General Southeast Regional Office. “I’m proud of the work of OIG special agents, our law enforcement partners, and the PCUPR staff for holding Ms. Velázquez accountable for her alleged criminal actions.”

As a result of the guilty plea, the defendant may be sentenced to a term of eight to fourteen months in prison, a fine not to exceed two hundred fifty thousand dollars ($250,000.00), and/or a term of supervised release of not more than three (3) years. Assistant United States Attorney Scott H. Anderson is in charge of the prosecution of the case.

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Former Worksource DeKalb Supervisor Charged with Bribery

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Wednesday, July 19, 2017

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

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

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

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

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

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

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

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

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

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

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

Putnam Co. Woman Charged with TennCare Drug Fraud

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Friday, July 14, 2017

NASHVILLE, Tenn. – A middle Tennessee woman is charged with TennCare fraud involving the sale of prescription drugs which were obtained through TennCare benefits.

The Office of Inspector General (OIG) today announced the arrest of Kimberly Ann Smith, 31, of Cookeville, after a joint investigation with the Baxter Police Department.

Smith is charged with TennCare fraud for allegedly obtaining a prescription for the painkiller Oxycodone during a clinical visit paid for by TennCare, and later selling a portion of the drugs.

“We are working with municipal and county police officers across the state, as they often discover a connection to TennCare during local drug investigations,” Inspector General Manny Tyndall said.  “Local police are clearly committed to eliminating prescription drug abuse, and we’re doing our part to stop abusers who are supporting this lifestyle with TennCare.”

District Attorney General Bryant C. Dunaway is prosecuting. TennCare fraud is now a Class D felony punishable by up to four years in prison per charge.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to more than $3 million being repaid to TennCare, with a total estimated cost avoidance of more than $163.6 million for TennCare, according to latest figures. To date, 2,871 people have been charged with TennCare fraud.

Through the OIG Cash for Tips Program established by the Legislature, Tennesseans can get cash rewards for TennCare fraud tips that lead to convictions. Anyone can report suspected TennCare fraud by calling 1-800-433-3982 toll-free from anywhere in Tennessee, or visit the website and follow the prompts that read “Report TennCare Fraud.”

Owner of Home Health Agency and Employee Arrested for Allegedly Stealing Nearly $2.7 Million From MassHealth

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July 11, 2017

Defendants Charged with Routinely Overbilling MassHealth, Falsely Billing for Unauthorized Services that Were Never Provided

BOSTON – The owner of a Boston-based home health agency and an employee have been arrested in connection with allegedly stealing nearly $2.7 million from the state’s Medicaid program (MassHealth) by routinely overbilling and falsely billing for services that were not authorized or provided to patients, Attorney General Maura Healey announced today.

Elena Kurbatzky, age 44, of Boston, and Natan Zalyapin, age 43, of Burlington, were arrested last night by Massachusetts State Police assigned to the AG’s Office. A Suffolk County Grand Jury returned indictments charging Kurbatzky, Zalyapin and the company, Harmony Home Health Care, LLC (Harmony), on Monday.

“We allege that these defendants stole millions of MassHealth funds meant to provide health care for those in need,” said AG Healey. “My office is committed to protecting Medicaid from fraud and abuse.”

Kurbatzky was indicted on charges of Medicaid False Claims (3 counts), Larceny over $250 by False Pretenses (3 counts), and Medicaid Member Eligibility Fraud (1 count). Zalyapin was indicted on charges of Medicaid False Claims (2 counts) and Larceny over $250 by False Pretenses (2 counts). Harmony was indicted on charges of Medicaid False Claims (3 counts) and Larceny over $250 by False Pretenses (3 counts).

Kurbatzky and Zalyapin were arraigned in Suffolk Superior Court today where they pleaded not guilty to the charges. Zalyapin was released on personal recognizance and Kurbatzky was transferred to Boston Municipal Court on an outstanding warrant.

As conditions of their release, they must surrender their passports, be monitored by GPS, not travel outside of the state, check in weekly with the Probation Department, stay away from witnesses in the case, and not provide or bill for MassHealth services. They are scheduled to appear in Suffolk Superior Court for a hearing on Aug. 8.

The company will be arraigned in Suffolk Superior Court on Aug. 8.

Harmony is a home health agency located on Albany Street in Boston and Kurbatzky is the sole owner. The agency was established to provide home health services to individuals covered by the MassHealth program, including skilled nursing, home health aide visits and physical, occupational, and speech therapies. Kurbatzky and Zalyapin are both registered nurses and allegedly provided the majority of nursing services to Harmony’s patients.

The AG’s Office began an investigation after the matter was referred by MassHealth, which suspected misconduct and fraudulent billing practices.

The AG’s investigation revealed that between February 2015 and October 2016, Harmony billed MassHealth for home health services allegedly provided to 38 patients, but either provided no services to those patients or billed for more services than were actually provided.

Specifically, authorities allege that on numerous instances, Harmony billed MassHealth for nurses who allegedly provided services to several patients in different locations at the exact same time, so those services could not physically have been performed as claimed.

The defendants also billed MassHealth for services that were not authorized by physicians and, in many cases, forged physician signatures on the patient plans of care in an attempt to show the services were authorized.

The defendants allegedly billed for services never provided to MassHealth members, including instances where the company billed for home health services while members were at inpatient facilities. Kurbatzky and Zalyapin also billed MassHealth for services that were not provided while they were traveling or while Zalyapin was working at other jobs.

The defendants billed for physical, occupational, and speech therapy for the majority of Harmony’s MassHealth patients even though the services were not authorized by the patients’ physicians and Harmony did not employ licensed therapists to perform the alleged services.

Kurbatzky also allegedly made false statements or failed to disclose material facts in order to make herself eligible for MassHealth. She then allegedly billed MassHealth for services she purportedly received from Harmony that were not authorized by a physician.

Based on these various schemes, the AG’s Office alleges that the defendants defrauded MassHealth of nearly $2.7 million dollars.

MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.

All of these charges are allegations and defendants are presumed innocent until proven guilty.

This matter was handled by Assistant Attorneys General Jennifer Goldstein and Kevin Lownds and Investigators Christine Baker and Megan Corrigan, all of AG Healey’s Medicaid Fraud Division, with assistance from the Massachusetts State Police assigned to the AG’s Office, Victim Witness Advocate Amber Anderson, of the AG’s Victim Services Division, and the Office of the Inspector General. MassHealth provided invaluable assistance during this investigation.

12 Debarred Over Role in Syria Humanitarian Aid Fraud Scheme

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May 26, 2017

Washington, D.C.—The U.S. Agency for International Development (USAID) Office of
Inspector General (OIG) announced the debarment of 12 companies and individuals over their participation in a fraud scheme affecting humanitarian aid in Syria. USAID officials made the decision in April barring Orhan Senkardes, the Senkardes Company, and certain related individuals and companies from future business with the
U.S. Government for 5 years.

USAID OIG, which has been investigating corruption in cross-border humanitarian aid programs in Syria since 2015, provided information that led to USAID’s debarment action. “OIG’s pursuit of corrupt actors in Syria and the surrounding region remains as critical as ever as we work to protect life-saving aid programs from fraud, waste, and abuse,” said Ann Calvaresi Barr, USAID Inspector General. “I commend our special agents for their tenacity, insight, and continued dedication to our investigative efforts and recognize USAID’s willingness to take decisive action to protect taxpayer resources based on OIG’s work.” The OIG’s investigation is open and ongoing.

USAID’s debarment of the 12 companies and individuals applies across the U.S. Government. OIG’s investigative work contributed to the decision, establishing that Orhan Senkardes, the Senkardes Company, and Mr. Senkardes’ affiliated companies or personnel participated in a procurement fraud scheme with corrupt nongovernmental organization staff, including Luan Meraku, who implemented USAID-funded programs. Further, investigative results revealed that although the Senkardes Company, Selkas, Forvet, and Yigit Motorlu companies were all under Mr. Senkardes’ control, they bid against each other for U.S.-funded procurements under the appearance of fair and open competition. The debarred companies and affiliated individuals are:

  • Senkardes Gida San ve Tic Ltd.
  • Selcuk Benli
  • Forvet
  • Ismet Kalin
  • Selkas
  • Hecran Kalin
  • Yigit Motorlu
  • Zerrin Nalbanoglu
  • Orhan Senkardes
  • Erol Senkardes
  • Luan Meraku
  • Erdal Senkardes

The U.S. Government’s System for Award Management (SAM), www.sam.gov, provides further information on each of the debarred entities and individuals, which are currently excluded from transactions with U.S. Government departments, agencies, and contractors.

To date, OIG’s investigations in Syria and the surrounding region have identified a
network of commercial vendors and nongovernmental organizations employees who
colluded to engage in bid-rigging and multiple kickback schemes related to Syrian
humanitarian aid awards. The investigations to date have led to $239 million in
suspended program funds; 35 agency suspension or debarment decisions; 19 personnel resignations, terminations, or suspensions; and $19.6 million in savings for USAID.

Throughout the course of investigations, OIG coordinates closely with USAID’s Bureau
for Management, Office of Management Policy, Budget, and Performance, Compliance
Division. The division is responsible for making recommendations on potential
suspension and debarment actions to the agency.

Protecting humanitarian operations from organized crime is a top priority for USAID
OIG’s Office of Investigations. In addition to aggressively investigating allegations,
USAID OIG has also published a fraud awareness handbook and is actively engaged in providing fraud awareness training within the industry. The handbook, Compliance and Fraud Prevention: A Pocket Guide for the Middle East Crisis Humanitarian Response, can be found on OIG’s web site.

Anyone with information about suspected fraud, waste, or abuse in USAID programs in Syria and around the world is urged to contact USAID OIG directly.
Telephone
+1 (800) 230-6539 or +1 (202) 712-1023
Email
Syria Investigations Team: [email protected]

General: [email protected]

Online, via OIG’s public web site
https://oig.usaid.gov/content/oig-hotline
Information reported to OIG is treated in confidence and OIG protects the identity of
each person providing information to the maximum extent provided by law.
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