Category Archives: Health-Care Fraud

California Man Found Guilty of Health Care Fraud, Identify Theft

Vahe Tahmasian, 36, has been found guilty in United States District Court of one count of conspiracy to commit health care fraud, six counts of health care fraud, and six counts of aggravated identity theft.  A sentencing hearing has been scheduled for June 9, 2014

Evidence shows that between April 2009 and February 2011, Tahmasian operated a Medicare fraud scheme at Orthomed Appliance Inc. in West Hollywood, California.  Tahmasian and his co-conspirator, Eric Mkhitarian, purchased Orthomed and put the company in the name of a straw owner.  The two men then stole personal information and used it to submit a large number of fraudulent claims for services that were never prescribed by a physician or provided to the Medicare beneficiaries.  The conspirators then took out more than $622,000 in cash from the company over a six-week period in 2011. Prosecutors believe that in total, Tahmasian submitted nearly $1.6 million in claims to Medicare and received approximately $994,036 on those claims.

Eric Mkhitarian, Tahmasian’s alleged co-conspirator, remains a fugitive.

The charges are a result of an investigation by the Federal Bureau of Investigation and the Los Angeles Region of HHS-OIG as part of the Medicare Fraud Strike Force.

Assistant Chief Benton Curtis and Trial Attorney Alexander Porter of the Fraud Section led the prosecution of this case.

Nashville Physician Pleads Guilty to Healthcare Fraud

Dr. Edward “Eddie” Hamilton, a prominent Nashville pediatrician, pleaded guilty to a misdemeanor count healthcare fraud last Thursday in United States District Court.  According to the press release, Hamilton is excluded from participation in all federal health care programs for twenty years and is ordered to pay nearly $1.6 million in restitution and FCA damages.

“The penalties set forth in the plea agreement and the civil settlement should send a clear message to those who defraud health care programs, especially those programs intended to help our nation’s most vulnerable people – our children,” United States Attorney David Rivera said in the release.

This settlement resolves allegations that Hamilton knowingly up coded billings for infant auditory screening exams to Tennessee’s Medicaid program TennCare and commercial insurance programs in a scheme that ran from January 2007 through November 2012.  In one example, Hamilton billed for the infant hearing exams that it performed at Baptist Hospital as comprehensive auditory exams, even though it performed less expensive auditory exams.  The investigation revealed that his practice, Centennial Pediatrics, P.C., did not even have equipment capable of performing the comprehensive tests for which it billed.

This matter was investigated by the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, the Tennessee Bureau of Investigation, the Tennessee Attorney General’s Office, and the United States Attorney’s Office for the Middle District of Tennessee.

Assistant United States Attorneys Lisa Rivera and Christopher C. Sabis prosecuted the case.

Psychiatrist and Therapists Charged in Healthcare Fraud Scheme

Roger Rousseau, a practicing psychiatrist in Miami, was arrested last week on charges of conspiring to commit healthcare fraud in a scheme that stole $63 million from the Medicare program.   The former director of a mental health clinic was released on a $375,000 bond after his initial appearance in federal court.

Rousseau, 71, served as the medical director of Health Care Solutions Network in Florida that was owned by Armando “Manny” Gonzalez.  Manny Gonzalez was sentenced to 14 years in prison for Medicare fraud charges earlier this year.  In this spin off case, Rousseau was charged along with six Miami therapists: Doris Crabtree, 61, Angela Salafia, 65, Liliana Marks, 46, Ruben Busquets, 49, Alina Fonts, 47, and Blanca Ruiz, 59.

According to the indictment, Rousseau signed what he knew to be fabricated and altered medical records without reviewing materials.  In most instances, he signed these documents without ever meeting with the patients.

The six therapists are accused of fabricating the clinic’s medical records to back up the fake Medicare claims for psychotherapy services.  The treatments were not required since many of the patients suffered from dementia or Alzheimer’s and would not have benefited from the therapy.

Roger Rousseau was charged with two counts of health care fraud and one count of conspiracy to commit health care fraud.  If guilty, he faces a maximum sentence of 10 years in federal prison.

Three Found Guilty in Medicare Fraud Scheme

An Anaheim physician and two others have been found guilty by a Los Angeles federal jury for their involvement in a Medicare Fraud Scheme involving power wheelchairs.  Officials said that the scheme, which ran from 2007-2012, resulted in over $1.5 million worth of false and fraudulent claims.

At the trial, prosecutors said that Godwin Onyeabor, an officer at Fendih Medical Supply Inc. in San Bernardino, paid kickbacks to a physician named Sri J. Wijegunaratne, and another healthcare professional, Heidi Morishita for fraudulent prescriptions for durable medical equipment.  The scheme ran for 5 years and caused Medicare to pay out nearly $1 million on these false claims.

Several Medicare patients testified in court that they were lured to these medical clinics with the promise of free vitamins in juice, only to receive wheelchairs that they did not need.

According to prosecutors, Onyeabor, Wijegunaratne and Morishita face up to 10 years in prison and a $250,000 fine for each count they are guilty of.

The case was investigated by the Federal Bureau of Investigation and the Los Angeles regional office for the United States Department of Health and Human Services inspector general.

Health Care Fraud and Abuse

One of the major statutes regarding health care fraud is a provision of the Social Security Act known as the Anti-Kickback Statute. Enacted in 1972, the statute has been amended six times. Its current version prohibits the payment or receipt of an remuneration that is reimbursable by a Federal health care program in return for patient referrals or business recommendations. Violations carry maximum penalties of a $50,000 fine and 5 years imprisonment.

In order to successfully prosecute under the current statute, the government must prove beyond a reasonable doubt the following six elements:

(1) knowing and willful conduct

(2) consisting of the solicitation, receipt, payment, or offer

(3) of “any remuneration,” whether in cash or in kind, directly or indirectly

(4) to induce or in return for

(5) [a] referring an individual for, [b] purchasing, leasing, ordering, or arranging for or [c] recommending the purchase, order, or lease of

(6) any item or service reimbursable, in whole or in part, by a Federal health care program. Equal liability is imposed by the statute on both participating members of any such deal.

The statute has many purposes. The first is to prevent the overutilization of costly services, which would not occur absent the Federal reimbursement. The second is to protect the freedom of patient choice. Referrals are the main way patients connect with new doctors, and a bought-off referral unfairly affects the patient. Finally, along the same lines, the law is intended to foster provider competition in the health care services industry.

If you find yourself facing criminal charges, it is important to find an experienced white collar attorney to represent you.  The attorneys of Parkman White, LLP have a history of success in the court room and are ready to represent clients nationwide.

Compounding pharmacies raided by FBI

Three pharmacies in the Shoals were raided recently by the FBI for possible over-billing of up to hundreds of thousands of dollars. The Sheffield Pharmacy, Russelville Pharmacy and Franklin Pharmacy are all compounding pharmacies.

Compounding pharmacies are the modern day equivalent to olden day apothecaries where the pharmacist specially mixes medications for individual patients. Patients that may need a compounding pharmacy may require medication in a different form than is readily available (such as a pill rather than a liquid) or may require a dose that is drastically different than the most commonly prescribed (such as a medication for an infant). Compounding pharmacies can also create medications without using dyes or flavors that a patient may not want or may not be able to tolerate (or vice versa, adding flavors to a medication to make it taste better).

Compounding pharmacies have been at the center of debate in the past few years due to the very nature of what they do – mix medications in such a way that the result may differ from the intended use of the drug-makers. But right off the bat, it has been a legal battle determining who is in charge of the oversight of compounding pharmacies: the FDA or Congress via laws and statutes that have been passed.

In 2007, the United States Supreme Court deemed that it was unconstitutional for Congress to restrict advertising done by compounding pharmacies. However, due to language in the Food and Drug Administration Modernization Act (FDAMA), some states may or may not abide by the FDAMA and therefore have different laws about allowing new drugs used for off-label purposes or compounded drugs. In general, compounded drugs are typically legal as long the patient has a valid prescription and the ingredients for making the compounded drug are all FDA-approved.

The investigation for these three Alabama pharmacies could take many months until any information is made public and whether or not any actual healthcare fraud was committed.

Alabama Residents Convicted of Medicare Fraud

A federal judge sentenced three people for running a scheme to overbill Alabama Medicaid this week.

The defendants were Travis Goodwin, Lori Skowronski Brill, and her husband Butch Brill.

Brill ran a patient advocacy business named Hemophilia Management Specialties near Theodore Alabama. Through her contact with patients Brill would convince them to tell doctors that they needed more medication than actually necessary. The patients would then order their medications from two local pharmacies involved in the scheme. Medicaid and private insurance would pay the pharmacies for the medication and the pharmacies would give Brill a percentage of the money from the insurers.

Goodwin is a patient with hemophilia who followed a plot by Lori Brill to request more medication than necessary from his doctor.

Goodwin was sentenced to 3 years of supervised release. He had little connection the conspiracy. As U.S. attorney Adam Overstreet observed, Goodwin received virtually no benefit form the fraud and was only a pawn in Brill’s scheme.

Besides Goodwin, prosecutors say that Brill had her relatives engage in the scheme as well.

Federal authorities alleged that the scheme wasted taxpayer money and medication. In testimony at trial prosecutors showed that the FBI found approximately 300,000 units of the medication spoiling in Brill’s garage.

Brill made approximately $191,182 from the illegal scheme; which cost Alabama Medicaid roughly $2.1 million from September 2007 to August 2009. The pharmacies involved made approximately $424,839 on the medication.

Prosecutors say that Brill used $20,000 of the Medicaid kickback money to purchase a truck for her husband, Butch, who also worked at Hemophilia Management Specialties. Butch’s attorneys argued that he should be exempt from prosecution because he knew nothing about how his wife was being paid. However, Butch was sentenced to 15 months in prison for involvement in the scheme. Although, his attorney said that Butch would appeal the decision.

Medicaid fraud schemes like Brills are multi-billion dollar problems. In response the U.S. government has escalated their enforcement mechanisms by establishing qui tam whistle blower provisions in false government claims law. The qui tam provision allows persons with evidence of fraud in government contracts or programs to sue on behalf of the government to recover stolen funds.

Types of fraud that can be prosecuted under the qui tam provision of the false claims act include schemes like Brill’s where the following take place:

  • Billing the government for goods and services never delivered.
  • Submitting false records to show better than actual performance.
  • Performing inappropriate or unnecessary medical procedures to increase Medicare reimbursement.
  • Charging more than once for the same goods or service.
  • Inflating bills by using billing codes that suggest a more expensive treatment or illness.
  • Billing for unlicensed or unapproved drugs.
  • Forging physician signatures when a signature is required for a Medicare or Medicaid reimbursement.

Cases like Brill’s represent the increased oversight on government funded programs and special investigations of health care fraud designed to prosecute medical professionals, and individuals like Brill from unjustly profiting off tax payer money.

 

 

Former Alabama Organ Center Executive Sentenced for Fraud

The former director of the Alabama Organ Center was sentenced to 13 months in prison for his role in a scheme to take kickbacks from a funeral home that did business with the organ center.  U.S. District Judge R. David Proctor sentenced Demosthenes Lalisan, 45, to the prison sentence and also ordered him to pay $489,551 in restitution to the University of Alabama Health Services Foundation and to forfeit $242,344 to the federal government as proceeds of illegal activity.

The judge then ordered Lalisan to remain on supervised release for three years after his sentence in prison is completed.  If, when Lalisan is released, he seeks employment in any occupation involving the rendering of health services, he must inform the prospective employer of his conviction and provide a copy of his plea agreement.

Richard Alan Hicks, 40, was Lalisan’s co-defendant, and both men pleaded guilty last November to one count each of conspiracy to commit health care fraud, health care fraud, and mail fraud.  Hicks is the former associate director of the Organ Center and he will be sentenced on June 5.

From around March 2007 until June 2011, Lalisan solicited and received kickbacks totaling $242,344 and Hicks received kickbacks totaling $256,207 from a local funeral home, according to court records.  Both Lalisan and Hicks promoted the funeral home and recommended its hiring by the organ center for services paid for by the Health Services Foundation in exchange for the kickbacks.  They did not disclose to the organ center or the foundation that they were receiving payments from the funeral home.

The investigation revealed no evidence that proved the defendants’ conduct endangered the public or donors or recipients of organs or tissue.

The FBI investigated the case and Assistant U.S. Attorney Elizabeth A. Holt prosecuted the case.

 

Two Arizona Couples in Court for Health-Care Fraud

A Douglas, Arizona couple has been sentenced to probation and ordered to pay more than $60,000 in restitution for defrauding Arizona’s health-care program.

Fernando Tomas Garcia and Anay Ariana Becerra collected benefits while raking in thousands of dollars from drug trafficking, stated Arizona State prosecutors.  According to  the state Attorney General’s Office, Garcia was sentenced Monday in Cochise County Superior Court to three year’s probation.  Beccera was sentenced to five year’s probation for fraud charges involving the Arizona Health Care Cost Containment System.  Garcia pleaded guilty to two counts of securing the proceeds of an offense, while Becerra pleaded guilty to one count of money laundering and one count of fraud.  The married couple is required to pay restitution plus about $10,000 in fines and fees as part of their plea agreement.

A former Arizona couple, Daniel and Esther Obrzut face charges of fraud, theft and conspiracy for bilking $1 million from one of the state’s largest health insurance companies. The couple is scheduled to appeared in the Maricopa County Superior Court in April.  The couple now reside in California, but lived in Phoenix during the time of the alleged crimes.

Daniel and Esther filed 4,000 false claims with Cigna Health and Life Insurance for chiropractic treatment between 2003 and 2011, stated Attorney General Tom Horne.  Horne said the Obrzuts owned both the medical billing company and the chiropractic practice.

The Arizona Department of Insurance Fraud Unit, the Attorney General’s Financial Remedies Section, the National Insurance Crime Bureau, and the Phoenix Police Department all investigated the case.

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