Monday, August 6, 2007

Six Southeast Texans have been indicted for health care fraud

Six indicted for health care fraud scheme


8/3/2007 7:00 PM
S.E. Texas' Legal Journal


U.S. Attorney John L. Ratcliffe announced Aug. 3 that six Southeast Texans have been indicted for health care fraud in the Eastern District of Texas.

The federal indictment was returned this week naming the following individuals:

BRIAN KEITH WILSON, 34, of Orange
JOSEPH DUANE ARMSTRONG, 58, of Orange
KENESAW LANDUS BERNSEN, JR., 56, of Beaumont
ARMANDO MARTINEZ CARMONA, 52, of Vidor
NICOLA JANE HOLTZMAN, 39, of Beaumont
JIMMIE ADAMS, 56, of Beaumont

According to information presented in court, from September 2004 until August 2005, Assessment Professionals, owned by Armstrong, submitted claims to Medicaid for individual and group therapeutic sessions allegedly conducted and provided to Medicaid-eligible adolescents for drug and alcohol abuse.

Under the direction of the manager, Wilson, parties were held in low income neighborhoods, complete with food and entertainment, where Wilson and employees of Assessment Professionals would obtain the Medicaid numbers of attendees. Those numbers were then used to fraudulently bill Medicaid for drug and alcohol counseling.

Assessment Professionals billed Medicaid $3,500,972.93 and was paid $1,789,333.94. Wilson and Armstrong used this money, in part, to buy things for themselves, such as Rolex watches and cosmetic surgery.

In an effort to make the billing appear legitimate, Wilson had counselors, Adams, Carmona, Bernsen and Holtzman create and sign progress notes for each patient.

When the Texas Attorney General Medicaid Fraud Control Unit began an audit of Assessment Professionals, copies of these files were turned over to investigators.

All six defendants were indicted on 29 counts of health care fraud. Wilson, Adams, Carmona, Bernsen and Holtzman were indicted on one count of obstruction of a health care investigation. Wilson and Armstrong were indicted on two counts of money laundering.

If convicted, the defendants each face up to 10 years in federal prison for each count and a fine of up to $250,000.00, as well as restitution.

This case is being investigated by the Texas Attorney General's Office and the Federal Bureau of Investigation and prosecuted by Special Assistant United States Attorney Christopher T. Tortorice.

It is important to note that an indictment should not be considered as evidence of guilt and that all persons charged with a crime are presumed innocent until proven guilty beyond a reasonable doubt.

2 comments:

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