Tag Archives: US Department of Justice

Two Patient Recruiters Sentenced in Miami for Roles in $50 Million Medicare Fraud Scheme (USAO-SDFL)

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Department of Justice

Office of Public Affairs
FOR IMMEDIATE RELEASE
Friday, November 16, 2012
11/16/2012: Two Patient Recruiters Sentenced in Miami for Roles in $50 Million Medicare Fraud Scheme (USAO-SDFL)

WASHINGTON – Two former patient recruiters for Miami-based mental health clinic Biscayne Milieu Health Care Inc. were sentenced today for their participation in a Medicare fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

Anthony Roberts, 45, and Derek Alexander, 39, both of Miami, were each sentenced today by U.S. District Judge Robert N. Scola Jr. in the Southern District of Florida.  Roberts was sentenced to serve 87 months in prison and ordered to pay $887,085 in restitution.  Alexander was sentenced to serve 42 months in prison and ordered to pay $300,876 in restitution.

Roberts and Alexander were each convicted of one count of conspiracy to commit a health care kickback scheme and a substantive kickback charge on Aug. 24, 2012, after a two-month trial.

Various owners, doctors, managers, therapists, patient brokers and other employees of Biscayne Milieu were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed in September 2011 and June 2012.  Biscayne Milieu, its owners and more than 25 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial.  Antonio and Jorge Macli, and Sandra Huarte, the owners and operators of Biscayne Milieu, and Dr. Gary Kushner, its medical director, were each convicted of various offenses at trial and will be sentenced on Dec. 20, 2012.

Evidence at trial demonstrated that the defendants and their co-conspirators caused the submission of millions of dollars in false and fraudulent claims to Medicare through Biscayne Milieu, a Florida corporation headquartered in Miami that operated a purported partial hospitalization program (PHP) in Miami.  A PHP is a form of intensive treatment for severe mental illness.  Biscayne Milieu purported to provide PHP services for Medicare beneficiaries suffering from mental illnesses. In fact, however, the co-conspirators devised a scheme in which they paid patient recruiters, such as Roberts and Alexander, to refer ineligible Medicare beneficiaries to Biscayne Milieu for purported PHP services that were never provided. Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia or Alzheimer’s disease and would not benefit from group therapy, or had no mental health diagnosis at all but were seeking fraudulent mental health treatment in order to be declared exempt from certain requirements for their applications for United States citizenship.  The evidence at trial showed that Alexander and Roberts solicited and received illegal kickbacks in exchange for sending ineligible patients to Biscayne Milieu.

The criminal case was prosecuted by Assistant U.S. Attorneys Michael Davis and Marlene Rodriguez of the Southern District of Florida, and by Trial Attorney James V. Hayes of the Criminal Division’s Fraud Section.  The investigation was led by the FBI with the assistance of HHS-OIG, and was brought by the U.S. Attorney’s Office for the Southern District of Florida in coordination with the Medicare Fraud Strike Force, supervised by the Criminal Division’s 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 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Chicago Psychiatrist Allegedly Submitted At Least 190,000 False Claims to Medicare and Medicaid; Lawsuit Alleges Kickbacks to Prescribe Antipsychotic Medication for Nursing Home Patients

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Mississippi Resident Pleads Guilty To Medicare Fraud Scheme Involving Power Mobility Devices

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November 15, 2012

Memphis, TN – Tess Gurley Rouse, 41, of Corinth, Mississippi, pleaded guilty today to one count of defrauding Medicare of more than $368,000, announced United States Attorney Edward L. Stanton III.

Using her company, Eagle Eye Durable Medical Equipment in Counce, Tennessee, Rouse falsified claims electronically for Power Mobility Devices for Medicare beneficiaries in West Tennessee, North Mississippi and elsewhere. Many of the recipients would not have qualified for these devices under the criteria established by Medicare.

To further her scheme, Rouse supplied false documents including prescriptions, written orders, face-to face examinations, and detailed product descriptions purported to have the signature of the treating and referring physician.

Rouse is scheduled to be sentenced on March 21, 2013, at 1:30 p.m., by Judge J. Daniel Breen. She could receive up to 10 years in federal prison, up to a $250,000 fine, and be forced to pay restitution. There is no parole in the federal prison system.

These cases were investigated by the Department of Health and Human Services-Office of Inspector General. These cases were prosecuted by Assistant United States Attorney Stuart Canale on behalf of the government.

Indictment: Kidney Dialysis Patients Received Misbranded Drugs

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TOPEKA, KAN. – A Tennessee pharmacist is charged with substituting a cheaper drug imported from China for the iron sucrose that the Federal Drug Administration has approved for kidney dialysis patients, U.S. Attorney Barry Grissom said today.

Robert Harshbarger, Jr., 53, Kingsport, Tenn., doing business as American Inhalation Medication Specialists, Inc., is charged with one count of selling misbranded drugs, one count of mail fraud and five counts of health care fraud.

The indictment alleges that as a result of fraud by Harshbarger kidney dialysis patients treated by Kansas Dialysis Services, L.C., received iron sucrose that had not been certified by the FDA to meet quality and safety standards.

“Although there are no reports of patient harm associated with the drugs that are alleged to be misbranded in this indictment, patient health was put at risk,” said U.S. Attorney Barry Grissom. “The FDA cannot assure the safety and effectiveness of products that are not FDA approved and come from unknown sources and foreign locations, or that may not have been manufactured under proper conditions. These unknowns put patients’ health at risk because of uncertainty concerning the product’s content, purity and source.”

Grissom said there is no reason for current or former patients of Kansas Dialysis to be concerned at this time. The events outlined in the indictment ended in 2009. Any significant iron deficiencies would have been addressed during the course of a patient’s dialysis treatments. Nevertheless, any questions should be addressed to a physician, Grissom said.

The indictment alleges that Harhbarger’s company, American Inhalation Medication Specialists, Inc., of Kingsport, Tenn., received more than $875,000 from Kansas Dialysis and more than $845,000 from health care benefit programs including Medicare and Medicaid for misbranded iron sucrose sold from 2004 to 2009. Harshbarger misrepresented the iron sucrose drug as Venofer, which is the only iron sucrose drug approved by the FDA for both pre-dialysis and post-dialysis patients.

Harshbarger purchased iron sucrose from Chinese companies including Qingdao Shenbang Chemical Company in Qingdao, China, and Shanghai Rory Fine Chemicals Co., Ltd., in Shanghai, China. The iron sucrose from China was cheaper than purchasing Venofer.

If convicted, Harshbarger faces a maximum penalty of 20 years in federal prison and a fine up to $250,000 on the mail fraud count; a maximum penalty of 10 years and a fine up to $250,000 on each of the health care fraud counts; and a maximum penalty of three years and a fine up to $250,000 on the charge of selling a misbranded drug. The Food and Drug Administration and the Dept. of Health and Human Services, Office of Inspector General, investigated. Assistant U.S. Attorney Tanya Treadway is prosecuting.

OTHER INDICTMENTS

Two men who were executives of the Brooke Companies, a now defunct insurance franchising business in Kansas, have been indicted on federal financial fraud charges.

Robert D. Orr, 59, Denver, Colo., and Leland G. Orr, 50, Phillipsburg, Kan., are charged with one count of conspiracy to defraud the Securities and Exchange Commission and three counts of making false statements in filings to the SEC. In addition, Robert Orr is charged with two more counts of making false statements in SEC filings and one count of bankruptcy fraud.

The Orrs were executives of Brooke Corporation, a holding company headquartered in Overland Park and Phillipsburg, Kan., that was engaged primarily in insurance franchising, insurance agency financing and banking. Brook Corporation owned a majority interest in Brooke Capital, Aleritas and Brooke’s Savings Bank. Brooke Capital sold insurance agency franchises and provided bookkeeping and other support services for franchises. Aleritas sold the majority of loans it made to franchisees and typically remained responsible for loan servicing. The companies were known collectively as the Brooke Companies.

The indictment alleges that in 2007 and 2008 the Brooke Companies experienced increasingly dire liquidity conditions and rapidly declining franchise financial health. In attempting to conceal financial problems, Brooke Companies’ management misrepresented the number of viable franchises, the health of Aleritas’ loan portfolio and other material financial information to the SEC, investors and lenders. They conspired to present a false aggregate picture of the Brooke Companies’ financial condition and thereby to obtain money, dividend payments and cash transfers for themselves.

If convicted, they face a maximum penalty of 20 years in federal prison and a fine up to $5 million on each count of making a false statement in SEC filings; and a maximum of five years and a fine up to $250,000 on each of the other counts. The FBI investigated. Assistant U.S. Attorney Mike Warner is prosecuting.

Bryan K. Carter, 32, Topeka, Kan., is charged with unlawful possession of a firearm after a felony conviction. The crime is alleged to have occurred Dec. 13, 2011, in Shawnee County, Kan.

If convicted, he faces a maximum penalty 10 years and a fine up to $250,000. The Bureau of Alcohol, Tobacco, Firearms and Explosives investigated. Assistant U.S. Attorney Duston Slinkard is prosecuting.

Omar Romero Salgado, 18, currently in custody in the Shawnee County Jail, is charged with one count of possession with intent to distribute methamphetamine, one count of possession with intent to distribute Clonazepam, one count of possession of a firearm in furtherance of drug trafficking and one count of possession of a stolen firearm. The crimes are alleged to have occurred Oct. 30, 2012, in Shawnee County, Kan.

If convicted, he faces a maximum penalty of 20 years and a fine up to $1 million on the methamphetamine charge; a maximum penalty of five years and a fine up to $250,000 on the Clonazepam charge; a penalty of not less than five years and a fine up to $250,000 on the charge of possessing a firearm in furtherance of drug trafficking; and a maximum penalty of 10 years and a fine up to $250,000 on the charge of possession of a stolen firearm. The FBI investigated. Assistant U.S. Attorney Jared Maag is prosecuting.

Xavier Patrick McCullough, 24, currently in custody in the Shawnee County Jail, and Ryan Cole Palmer, 25, currently in custody in the Shawnee County Jail, are charged with one count of possession with intent to distribute marijuana, one count of possession with intent to distribute methamphetamine and one count of possession of a firearm in furtherance of drug trafficking.

If convicted, they face a maximum penalty of 20 years and a fine up to $1 million on the methamphetamine charge; not less than five years and a fine up to $250,000 on the firearm charge; and a maximum penalty of five years and a fine up to $250,000 on the marijuana charge. The Topeka Police Department and the FBI investigated. Assistant U.S. Attorney Jared Maag is prosecuting.

In all cases, defendants are presumed innocent until and unless proven guilty. The indictments merely contain allegations of criminal conduct.

DME Owner Convicted of Health Care Fraud and Aggravated Identity Theft

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11/14/2012

HOUSTON – Abdul Waheed Alex Shittu, 54, a naturalized United States citizen from the Federal Republic of Nigeria, has pleaded guilty today to one count of conspiracy to commit health care fraud and one count of aggravated identity theft, United States Attorney Kenneth Magidson announced today.

Shittu, the owner of S & S Medical Supply Etc. located in Stafford, admitted at his re-arraignment today that he began purchasing physician orders for durable medical equipment (DME), including wrist, back, foot, ankle, knee, elbow and shoulder braces as well as wheelchairs around Dec. 1, 2008. Shittu further acknowledged he had at least five recruiters working for him whom he paid $200 – $300 for physician orders which often contained forged physician signatures. The orders were for Medicare and Medicaid beneficiaries who had not been seen or treated by the identified physicians.

Shittu further admitted he billed Medicare and Medicaid for delivery of all the DME on the purchased orders, even though he did not deliver all the DME and he delivered DME to Medicare and Medicaid beneficiaries he knew did not want or need the supplies. Shittu also gave his billing agent the incorrect coding information so he would receive more money from Medicare and Medicaid for each DME claim. Between Dec. 1, 2008, and Sept. 30, 2009, Shittu submitted approximately $1,154,025 in fraudulent claims to Medicare and Medicaid and received $597,865.19 for those claims.

Shittu faces up to 10 years in prison and a $250,000 fine as well as an additional two-year-term of imprisonment for aggravated identity theft which must be served consecutively to any other term imposed. He has been permitted to remain on bond pending his sentencing, set for Jan. 20, 2013.

The investigation into Shittu was the result of a joint investigation conducted by agents from the Department of Health and Human Services-Office of Inspector General and the Texas Attorney General’s Office-Medicaid Fraud Control Unit. Assistant United States Attorney Julie Redlinger prosecuted the case.

Mental Health Service Provider Sentenced to 48 Months for Conspiracy to Commit Health Care Fraud

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11/13/2012

RICHMOND, Va. – Joseph T. Hackett, 32, of Asheville, N.C., was sentenced today to 48 months in prison, followed by a term of three years of supervised release, for Conspiracy to Commit Health Care Fraud. He also agreed to forfeit $1,570,041.60 and pay $1,570,041.60 in restitution to the Virginia Department of Medical Assistance Services.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia; and Kenneth T. Cuccinelli, Attorney General of Virginia, made the announcement after sentencing by United States District Judge Henry E. Hudson. Hackett pled guilty on August 13, 2012.

According to Court documents, Hackett owned and operated Access Regional Taskforce (“ART”), a Richmond-based Medicaid contracted provider of Intensive In-home Therapy Services for children and adolescents. Intensive In-home Therapy Services, one of the many mental health services offered by Medicaid in Virginia, are designed to assist youth and adolescents who are at risk of being removed from their homes, or are being returned to their homes after removal, because of significant mental health, behavioral, or emotional issues. Medicaid requires that Intensive In-home Therapy Service providers employ qualified mental health workers to provide a medically necessary service to at-risk children and adolescents.
In a statement of facts filed with the plea agreement, Hackett acknowledged that, through ART, he billed Medicaid for services that were not reimbursable because the services did not address a child’s specific mental health issues, were not provided by qualified mental health workers, and were not provided to children who were in actual need of the offered service. Hackett acknowledged that Medicaid paid ART at least $1,570,041.60 that ART was not entitled to receive. In addition, he admitted in the statement of facts that Hackett paid Creed Xtreme Marketing Concepts, a.k.a. Creed Extreme Marketing, $545,410.00 for patient referrals. The owner of Creed, Lorie T. Monroe, was sentenced on June 12, 2012 to 37 months of imprisonment for receiving these referral payments.
The case was investigated by the Virginia Attorney General’s Medicaid Fraud Control Unit and the Federal Bureau of Investigation, with assistance from the Virginia Department of Medical Assistance. Special Assistant United States Attorney Joseph E.H. Atkinson and Assistant United States Attorney Jessica Aber Brumberg prosecuted the case on behalf of the United States.

A copy of this press release may be found on the website of the United States Attorney’s Office for the Eastern District of Virginia at http://www.justice.gov/usao/vae. Related court documents and information may be found on the website of the District Court for the Eastern District of Virginia at http://www.vaed.uscourts.gov or on https://pcl.uscourts.gov.

Owner of Chantilly Pain Clinic Sentenced to 180 Months for Drug-Trafficking, Fraud Charges

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11/9/2012

ALEXANDRIA, Va. – Paul Boccone, 56, was sentenced today to 180 months in prison, followed by three years of supervised release, for turning his Chantilly-based pain clinic into a haven for drug addicts, servicing thousands of customers traveling hundreds of miles to illegally obtain large amounts of oxycodone and other prescription pain medicine. Charles Brown, Jr., 52, the lead nurse practitioner at Chantilly Specialists, was also sentenced today to 60 months in prison, followed by three years of supervised release, for his role in distributing oxycodone.

Neil H. MacBride, United States Attorney for the Eastern District of Virginia; Kenneth T. Cuccinelli, Attorney General of Virginia; James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office; Richard A. Raven, Special Agent in Charge of the Washington Field Office of IRS-Criminal Investigation; and Nick DiGuilio, Special Agent in Charge for the Inspector General’s Office of the United States Department of Health and Human Services in Philadelphia, made the announcement after sentencing by United States District Judge Claude M. Hilton.

Boccone was convicted on Aug. 3, 2012, of conspiring to distribute and distributing oxycodone, healthcare fraud, and payroll tax evasion. According to court records and evidence at trial, Boccone was the owner and president of Chantilly Specialists, a pain management clinic in Chantilly, Va. Lacking any medical education, qualifications, or licensing, Boccone hired medical professionals with no background or specialized training in pain management. He treated patients and prescribed narcotics by directing medical practitioners to endorse prescriptions that he wrote.

Over the course of the conspiracy, evidence showed that at least four Chantilly Specialists patients died of overdoses related to the drugs they obtained from the practice. Brown, at Buccone’s direction, altered one of the patient’s files after Chantilly Specialists learned of that patient’s death.

Evidence showed that Brown provided 600 customers more than 800,000 oxycodone-based pills, including 14,400 to a single addict.

This case was investigated by the FBI Washington Field Office; IRS-Criminal Investigation; and the Department of Health and Human Services’ Office of the Inspector General, with assistance from the Fairfax County Police Department.

Assistant United States Attorney Michael P. Ben’Ary and Special Assistant United States Attorney and Virginia Assistant Attorney General Marc J. Birnbaum are prosecuting the case on behalf of the United States.

A copy of this press release may be found on the website of the United States Attorney’s Office for the Eastern District of Virginia at http://www.justice.gov/usao/vae. Related court documents and information may be found on the website of the District Court for the Eastern District of Virginia at http://www.vaed.uscourts.gov or on http://pacer.uspci.uscourts.gov.

US Government Intervenes in Whistleblower Lawsuit Against Fluor Companies

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FOR IMMEDIATE RELEASE
Thursday, November 8, 2012
US Government Intervenes in False Claims Lawsuit Against Fluor Companies
Texas-based Company Allegedly Used Federal Funds for Lobbying Activities

The government has intervened in a lawsuit against Fluor Hanford Inc. and its parent company, Fluor Corporation (collectively Fluor), in the U.S. District Court for the Eastern District of Washington, the Justice Department announced today.   Fluor Hanford, Inc. is a subsidiary of Fluor Corporation, a Texas-based corporation that provides a wide variety of services to government and private customers.   The False Claims Act lawsuit was originally filed by whistleblower Loydene Rambo, a former employee of Fluor.

 

Between 1999 and 2008, Fluor had a prime contract with the Department of Energy (DOE) to provide a wide variety of security, maintenance and operational services at the DOE’s Hanford Nuclear Site in southeastern Washington State.   As part of its contract, Fluor was responsible for managing and operating the Hazardous Materials Management and Emergency Response (HAMMER) Center, a federally-funded facility established to train Hanford site workers as well as first responders and law enforcement personnel.

The whistleblower complaint alleges that, as a condition of receiving its DOE contract, Fluor was required to certify that it would not use federal funds for lobbying activities.   The complaint further alleges that between 2005 and 2008, Fluor ignored these restrictions and used DOE funding to lobby Congress and executive branch officials for more funding for HAMMER.   The complaint alleges that Fluor, and two lobbying firms hired by Fluor and paid using DOE funds, Secure Horizons LLC and Congressional Strategies LLC, lobbied members of Congress and executive branch agencies to include additional funds for HAMMER in agency appropriations.  The United States intervened in the lawsuit with respect to Fluor, but declined to intervene with respect to additional defendants, including Secure Horizons LLC and Congressional Strategies LLC.

“The taxpayer money Congress allocated for this program was for training federal emergency response personnel and first responders, not to lobby Congress and others for more funding,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division of the Department of Justice.   “When public funds are misused, as alleged in this case, the Justice Department will work to restore them to the Treasury.”

“The allegations set forth in the whistleblower complaint are troubling and very serious,”

said Michael C. Ormsby, U.S. Attorney for the Eastern District of Washington. “My Office will continue to work with the Justice Department to ensure a just resolution of these alleged violations of federal law.”

Ms. Rambo’s lawsuit was filed under the False Claims Act, which authorizes private parties to sue on behalf of the United States and share in any recovery.   The act authorizes the United States to intervene in such a suit and take over the responsibility for litigating it.   The United States has informed the court that it intends to file its own complaint in the action.

The case is being handled by the Civil Division of the Department of Justice and the U.S. Attorney’s Office for the Eastern District of Washington, with the assistance of the Department of Energy Office of Inspector General.

Ms. Rambo’s lawsuit is captioned U.S. ex rel. Rambo v. Fluor Hanford, et al., cv-11-5037.   The claims asserted in this case are allegations only, and there has been no determination of liability.

Indictments Returned in Hammond Federal Court (USAO-NDIN)

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HAMMOND, IN—The United States Attorney’s Office announced that the following Indictments were returned on November 8, 2012:

  • Hoosier EMS Roy Dunn, 59, and Kahley Vergon-Mayotte, 27, both of Winimac, Indiana; and Anthony Bitterling, 39, of Monticello, Indiana, were charged in an indictment with conspiracy to commit health care fraud. These charges were filed as the result of an investigation by the Federal Bureau of Investigation, the United States Department of Health and Human Services, and the Indiana Medicaid Fraud Control Unit. This case has been assigned to and will be prosecuted by Assistant United States Attorney Diane Berkowitz.
  • Edwin Tollinchi-Rodriguez, 27, of East Chicago, Indiana, was charged in an indictment with aggravated sexual abuse. This case resulted from an investigation by members of the Indiana Internet Crimes Against Children Task Force, including the Federal Bureau of Investigation; the East Chicago Police Department; and the Lansing, Illinois Police Department. This case has been assigned to and will be prosecuted by Assistant United States Attorney Jill Koster.
  • Kevin Paul Brewster, 40, of Portage, Indiana, was charged in an indictment with four counts of production of child pornography, one count of receipt of child pornography, and one count of possession of child pornography. This case resulted from an investigation by members of the Indiana Internet Crimes Against Children Task Force, including the Federal Bureau of Investigation and the Portage Police Department. This case has been assigned to and will be prosecuted by Assistant United States Attorney Jill Koster.
  • Austin Nwaka, dba Service Above Self, of Canby, Indiana, and Phyllis Lark, dba Absolute Care, of Hammond, Indiana, were charged in an indictment with health care fraud. Lark was also charged with making false statements to a federal agent. These charges were filed as the result of an investigation by the Federal Bureau of Investigation and the Indiana Medicaid Fraud Control Unit. This case has been assigned to and will be prosecuted by Assistant United States Attorney Diane Berkowitz.
  • Daron Moten, 23, of Gary, Indiana, was charged in an indictment with possession of a firearm by a convicted felon. These charges were filed as the result of an investigation by the by the Bureau of Alcohol, Tobacco, Firearms, and Explosives and the Gary Police Department. This case has been assigned to and will be prosecuted by Special Assistant United States Attorney Armando Salinas, Jr.
  • Michael J. Plake, 47, of Lafayette, Indiana, and Paul Cardwell, 46, formerly of Monticello, Indiana, were charged in an indictment with conspiracy to commit mail fraud. These charges were filed as the result of an investigation by the Federal Bureau of Investigation. This case has been assigned to and will be prosecuted by Assistant United States Attorney Diane Berkowitz.

The United States Attorney’s Office emphasized that an indictment is merely an allegation and that all persons charged are presumed innocent until and unless proven guilty in court.

If convicted in court, any specific sentence to be imposed will be determined by the judge after a consideration of federal sentencing statutes and the Federal Sentencing Guidelines.

Detroit-area Physician Sentenced to 60 Months for Health Care Fraud (USAO-EDMI)

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11/6/2012

Jonathan Agbebiyi, 63, of Sterling Heights, Michigan, was sentenced yesterday for his role in a $5.4 million Medicare fraud scheme, announced United States Attorney Barbara L. McQuade. McQuade was joined in the announcement by Assistant Attorney General Lanny A Breuer of the Criminal Division in Washington, DC, Special Agent-In-Charge, Robert Foley, III, Federal Bureau of Investigation and Special Agent in Charge Lamont Pugh III of the Health and Human Services – Office of Inspector General’s (OIG) Chicago Regional Office.

Agbebiyi was sentenced by United States District Judge Arthur J. Tarnow to 60 months in prison, followed by 2 years supervised release, and ordered to pay $2,982,029.19 in restitution.

In May, 2012, Jonathan Agbebiyi, 63, of Sterling Heights, Michigan, was convicted of one count of conspiracy to commit health care fraud, and six counts of health care fraud. Agbebiyi was a staff physician at three clinics which operated in Livonia, Michigan, between 2007 and 2010: Blessed Medical Clinic, Alpha and Omega Medical Clinic, and Manuel Medical Clinic.

According to the evidence presented during the one week trial, Jonathan Agbebiyi, an obstetrician/gynecologist, joined a conspiracy to bill Medicare for medically unnecessary neurological tests. Some of the tests involved sending an electrical current through the arms and legs of the patients. Clinic employees, who lacked any meaningful training, administered the diagnostic tests. The patients never received any follow up treatment by neurologists.
Evidence at trial showed that the patients were not referred to the clinics by their primary care physicians, or for any other legitimate purpose, but rather were recruited with prescriptions for controlled substances, cash payments, and fast food. The three clinics then billed the Medicare program for various diagnostic tests that were medically unnecessary.

United States Attorney Barbara L. McQuade stated, “This doctor exposed patients to electrical currents for neurological testing solely to generate money for himself at the expense of the Medicare program. We hope that cases like this one will deter other doctors from using patients as commodities for personal gain.”

This case was prosecuted by Assistant U.S. Attorneys Frances Lee Carlson and Philip A. Ross of the Eastern District of Michigan, with assistance from Assistant Chief Gejaa T. Gobena of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since their inception in March 2007, strike force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 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.