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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.

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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.”

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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.

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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.

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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.

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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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PhotobucketTAMPA (June 21) – Today, U.S. District Court Judge Virginia Hernandez Covington granted the defendant’s motion for a downward variance from the sentence recommended by the advisory United States Sentencing Guidelines. As I sat in court and listened, I could not help but be very impressed with Judge Covington’s keen insight into the application of the sentencing guidelines.

The defendant, Paul Vincent Rivers, was a pharmacist who twice sold oxycodone to a confidential informant. The advisory United States Sentencing guidelines called for a sentence of 46 – 57 months incarceration. In pronouncing sentence, Judge Covington recognized how the defendant never knew his father and was raised by his mother – which was certaintly no easy task, and that the defendant had served in the U.S. military.

Federal judges are required to take the U.S. Sentencing Guidelines into consideration when fashioning a sentence that is sufficient, but not greater than necessary. In ruling with respect to the sentence, Judge Covington said that the fact that the defendant had suffered the permanent loss of pharmacist’s license and was now a convicted felon merited a downward variance from the guidelines recommended sentence and slashed it almost by 50% down to 24 months imprisonment.

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handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpgWASHINGTON – A Detroit-area patient recruiter pleaded guilty today for his participation in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Daron Elder, 28, of Southfield, Mich., pleaded guilty in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, he faces a maximum penalty of 10 years in prison and a $250,000 fine. However, the advisory sentencing guidelines call for a term of imprisonment of 30-37 months, restitution in the amount of almost $3 million, plus a $1 million fine.
According to the  plea documents, Elder was a patient recruiter for a medical clinic in the Detroit area, Blessed Medical Clinic. Elder paid indigent Medicare beneficiaries cash kickbacks to receive diagnostic tests that he knew were medically unnecessary. In return for the cash kickbacks, the Medicare beneficiaries allowed their identification to be used in the submission of fraudulent claims. The government will argue at sentencing that Elder’s conduct caused the submission of approximately $2.5 million dollars in fraudulent claims to Medicare.

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NEWARK, N.J. – Dr. Michael P. Stein, 63, a New Jersey doctor, was sentenced today to 24 months in prison for defrauding Blue Cross Blue Shield for approximately three-quarters of a million dollars by submitting false claims for services never performed.

Between August 2004 and September 2010 Stein owned and operated Randolph Otolaryngology. Stein purportedly treated a patient with the initials J.F. for nasal problems and billed Blue Cross Blue Shield for the services.

However, investigators determined that Stein submitted fraudulent claims with Blue Cross Blue Shield for procedures that were not performed. Evidence revealed that Stein submitted claims for approximately 900 nasal endoscopies he purportedly conducted, when only a few were actually performed. Stein also admitted he filed false claims for office visits and medical procedures that occurred while he was out of the country on vacation.

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