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sebelius-holder-announcementWASHINGTON, D.C. (May 14,2013) A nation-wide takedown by the Medicare Fraud Strike resulted in charges being filed against 89 health care providers including doctors, nurses and other licensed medical professionals, for committing Medicare fraud to the tune of approximately $223 million in false claims billings.

In Miami, a total of 25 people were charged for participating in various fraud schemes to submit false billings for home health care, mental health services, occupational and physical therapy, DME and HIV infusion services. Among those arrested were two nurses, a paramedic and a radiographer were charged with crimes for involving a total of $44 million.

In one case, involving Trust Care Health Services, three people – including Roberto Marrero, a Miami actor and local cable TV station owner, were charged with health care fraud and violations of the anti-kick back statute for their involvement in a $20 million home health fraud scheme concerning the treatment of diabetic patients. Court documents accuse the defendants of bribing Medicare beneficiaries to turn over their Medicare information, which was used to bill for services that were not rendered or were medically unnecessary.

OIG-LogoWASHINGTON (March 26) – The Office of the Inspector General of the Health and Human Services Department has issued a Special Fraud Alert that physician-owned distributorships (PODs) are “inherently suspect” under the anti-kickback statute (AKS) and has listed suspicious characteristics that may increase the risk of fraud and abuse.

The alert focused on physician-owned businesses / PODs that obtain revenue from selling implantable medical devices ordered by their physician owners to use in procedures they perform on their patients at hospitals or ambulatory surgical centers.

“The opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute,” said the IG alert .

doc-thumbHOUSTON (March 13) – A Texas doctor who was convicted of conspiracy to commit health care fraud and six counts of false statements relating to health care matters was sentenced today to serve 63 months behind bars.

Ben Harris Echols, 63, of Houston, was convicted late last year of conspiring to commit health care fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat, as part of a $17.3 million Medicare fraud scheme. Upon completion of his prison term, Echols was ordered to serve three years of supervised release and pay restitution in the amount of $2,918,830.

According to evidence presented at trial, Echols signed plans of care for Medicare beneficiaries who were not under his care and about whose conditions he had no knowledge. In many instances, Echols signed plans of care even though other doctors were listed as the attending physician on the documents.

Breuer_Official_Portrait.jpgWashington (Jan. 30) — Assistant attorney general of the Criminal Division, Lanny Breuer, is leaving the Justice Department. Breuer gained notoriety for defending president Bill Clinton against impeachment and for defending four-time Cy Young award winner, Roger Clemens.

“Serving as assistant attorney general for the Criminal Division has been the greatest privilege of my professional life,” Breuer said in a statement. “From my first day on this job nearly four years ago, I have loved it, and I am so proud of what the Criminal Division has accomplished over the past four years,” Breuer said.

The announcement came the day after a federal judge in New Orleans approved the largest package of criminal fines and penalties in U.S. history. In 2010, Attorney General Eric Holder had named Breuer to oversee the Deepwater Horizon Task Force. The record amount of the settlement in the guilty plea will cost BP $4 billion and lets Breuer to depart the Justice Department on a positive note.

sebelius-holder-announcementWASHINGTON, D.C. (October 4,2012) Today, U.S. Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced at a joint press conference that Medicare Fraud Strike Force operations conducted one of the largest health care fraud takedowns in history.

Charges have been brought in seven cities from Brooklyn to Los Angeles against 91 individuals – including doctors, nurses, and other licensed medical professionals – for their alleged participation in fraud schemes involving nearly $430 million in false billings.

Charges include health care fraud, conspiracy to commit health care fraud, wire fraud, violations of the anti-kickback statutes, aggravated identity theft, and money laundering charges are based on a variety of alleged activities involving treatments and services that were medically unnecessary or never actually rendered.

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpgMIAMI, FL – A Weston psychiatrist was sentenced on Monday to 10 years in for his role in what United States Department of Justice Health Care Fraud Strike Force prosecutor Jennifer Saulino called “one of the largest and most brazen health care fraud conspiracies in recent memory.”

Dr. Mark Willner, who practiced in Fort Lauderdale and Boca Raton, was convicted of conspiracy to commit health care fraud after a six-week trial earlier this year. Prosecutors said Willner, 56, was part of a broader conspiracy involving American Therapeutic Corp., which billed the taxpayer-funded Medicare program for more than $205 million in fraudulent claims.

In her submission to U.S. District Court Judge Patricia Seitz, United States Department of Justice Heath Care Fraud Strike Force prosecutor Jennifer Saulino wrote “This massive fraud was committed by manipulating the proper treatment of Alzheimer’s and dementia patients, substance abusers seeking treatment, and others convinced or cajoled into spending time at ATC.”

Photobucket BATON ROUGE, La. (AP – Karen Rayburn, a 47-year-old Baton Rouge woman, who worked as a patient recruiter for several Louisiana durable medical equipment (DME) companies has been sentenced to 18 months in prison for her role in a Medicare fraud scheme. Rayburn pleaded guilty to one count of conspiracy to commit health care fraud In January.

The companies linked to the scheme allegedly submitted more than $21 million in bogus Medicare claims. Prosecutors say bogus prescriptions for leg braces, wheel chairs and other equipment that Rayburn obtained were used to submit fraudulent claims to the Medicare program.

The United States Probation office conducted a Pre-Sentence Investigation and determined that Rayburn’s advisory guidelines offense level was 23 with a criminal history category of I. Her advisory guideline imprisonment range is 46 to 57 months.

doc-thumbCHICAGO (September 25) – Two owners of Rosner home health care agency near Chicago and two physicians were among nine people charged in a 27-count indictment with federal offenses for paying and receiving kickbacks in exchange for the referral of Medicare patients for home health care services.

Three defendants were charged with one count of conspiracy to pay illegal kickbacks for Medicare patient referrals. Eight of the nine defendants were charged with two or more counts of violating the anti-kickback statute.

According to the indictment between January 2008 and July 2012, three defendants conspired with others to pay kickbacks and bribes to doctors. The amount of kickbacks varied from $300 to $600 for each new patient’s completion of five home health visits in one cycle and ranged between the same amounts for the repeat admission of a previous patient in a new cycle of home health care.

money-pile.jpgWESTON, FL (August 16 ) – At a news conference at DEA offices in Weston, FL, on Thursday regarding in the latest crackdown on South Florida pill mills – Phase II of the two-year Operation Pill Nation – it was announced that, seven doctors, three pain clinic owners at the Pompano Beach Medical Corp., and one owner’s relative have been arrested for crimes including racketeering, trafficking in a controlled substance, money laundering among others.

The allegations are that beginning in April 2010 and continuing up until as recent as last month, undercover investigators visited the clinic and were prescribed controlled substances despite the fact that none of the agents were suffering from any infirmity that required medication.

“The DEA does not target doctors; we target drug traffickers,” DEA Special Agent in Charge Mark Trouville said.

money-pile.jpgMIAMI (June 21) – Two Miami home health care agency owners of a were sentenced to 73 and 74 months in prison for their participation in a $20 million home health Medicare fraud scheme.

Ariel Rodriguez was to 73 months in prison and three years of supervised release and Reynaldo Navarro was sentenced to 74 months in prison followed by three years of supervised release and were ordered to pay $14 million in restitution. Rodriguez, 41, Navarro, 37, were the owners of Serendipity Home Health Inc., a Miami home health agency that was supposed to provide home health care and physical therapy services to qualifying Medicare beneficiaries.

According to court records, Rodriguez and Navarro paid kickbacks and bribes to patient recruiters in exchange for the recruiters providing patients to their home health care agency, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. The prescriptions, POCs and medical certifications were then submitted to Medicare for reimbursement.

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