What is wrong with this picture?
And they are allowed to still OPERATE and BILL MEDICARE/MEDICAID!!!
As part of the $60 million settlement, Cox has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services (HHS) Office of Inspector General. The Corporate Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
Missouri Health Care System to Pay U.S. $60 Million to Settle False Claims Act Allegations
July 23, 2008
Lester E. Cox Medical Centers, a health care system headquartered in Springfield, Mo., has agreed to pay the United States to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute between 1996 and 2005, by entering into certain financial relationships with referring doctors at a local physician group and engaging in improper billing practices with respect to Medicare. Cox, a not-for-profit healthcare organization, will pay the United States $60 million to resolve these claims.
Under the Stark Statute, Medicare providers like Cox are prohibited from billing the federal health care program for referrals from doctors with whom the providers have a financial relationship, unless that relationship falls within certain exceptions. The United States contended that certain relationships between Cox and physicians ran afoul of the Anti-Kickback Statute, which prohibits offering inducements to providers in return for patient referrals, and the Stark statute. Additional claims being resolved concern Cox’s inclusion of non-reimbursable costs on its Medicare cost reports and improper billings for services provided to dialysis patients.
“The Justice Department is committed to ensuring that the best interests of federal health care program patients are not compromised by unlawful payments to physicians,” said Gregory G. Katsas, Assistant Attorney General for the Justice Department’s Civil Division. “The resolution of this matter resulted in a significant recovery for taxpayers, and it exemplifies our dedication to vigorous enforcement of the Stark and Anti-Kickback Statutes.”
As part of the $60 million settlement, Cox has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services (HHS) Office of Inspector General. The Corporate Integrity Agreement contains measures to ensure compliance with Medicare regulations and policies in the future.
“Today’s settlement furthers both our commitment to protecting patients from improper billing practices and the continued ability of Cox to provide quality medical care in Springfield and the Ozarks,” said John F. Wood, U.S. Attorney in Kansas City, Mo. “I am pleased that we were able to resolve this matter without litigation.”
The settlement with Cox was the result of a coordinated effort by the Commercial Litigation Branch of the Justice Department’s Civil Division; the U.S. Attorney’s Office for the Western District of Missouri; HHS’ Office of Inspector General, Office of Counsel to the Inspector General, and Office of Audit Services; and the FBI.
Source: DoJ
Thursday, July 24, 2008
Monday, July 21, 2008
James K. Happ
JULY 16, 2008 11:43AM
Healthcare co. exec sells in Palm Beach Gardens
by C.J. Marks, BlockShopper Staff
42 Bermuda Lake Dr.James K. Happ and his wife, Julie, sold a home at 42 Bermuda Lake Drive in Palm Beach Gardens to Charles and Andrea Hirsch for $789,000 on June 23.
The Happs paid $590,000 for the property in Sept. 2003.
Mr. Happ, a certified public accountant, has served as president of Med Diversified, Inc., a provider of home healthcare services based in Andover, Mass. He was named to the position in 2002.
Before he joined Med Diversified, he served as executive vice president of National Century Financial Enterprises, a healthcare financing company and major lender of Med Diversified. He has also served as chief financial officer of Dallas-based Columbia Homecare Group, Inc.
He earned a B.S. in business administration from Miami University in Oxford, Ohio. He holds an M.B.A. from Nova University in Ft. Lauderdale.
The Haps bought a home at 112 Via Escobar Place in Palm Beach Gardens for $540,000 on June 24.
Home sales in Palm beach Gardens dropped nearly 14 percent in 2008 versus sales in 2007. The median sales price also fell from $320,000 to $290,000.
Address: 42 Bermuda Lake Drive
Buyer(s): Charles J Hirsch and Andrea F Hirsch
Seller(s): James K Happ and Julie K Happ
Sale date: 2008-06-23
Healthcare co. exec sells in Palm Beach Gardens
by C.J. Marks, BlockShopper Staff
42 Bermuda Lake Dr.James K. Happ and his wife, Julie, sold a home at 42 Bermuda Lake Drive in Palm Beach Gardens to Charles and Andrea Hirsch for $789,000 on June 23.
The Happs paid $590,000 for the property in Sept. 2003.
Mr. Happ, a certified public accountant, has served as president of Med Diversified, Inc., a provider of home healthcare services based in Andover, Mass. He was named to the position in 2002.
Before he joined Med Diversified, he served as executive vice president of National Century Financial Enterprises, a healthcare financing company and major lender of Med Diversified. He has also served as chief financial officer of Dallas-based Columbia Homecare Group, Inc.
He earned a B.S. in business administration from Miami University in Oxford, Ohio. He holds an M.B.A. from Nova University in Ft. Lauderdale.
The Haps bought a home at 112 Via Escobar Place in Palm Beach Gardens for $540,000 on June 24.
Home sales in Palm beach Gardens dropped nearly 14 percent in 2008 versus sales in 2007. The median sales price also fell from $320,000 to $290,000.
Address: 42 Bermuda Lake Drive
Buyer(s): Charles J Hirsch and Andrea F Hirsch
Seller(s): James K Happ and Julie K Happ
Sale date: 2008-06-23
The largest prosecution of a home-health-care agency in Virginia
OK!!
GET THIS!!
Nurse pleads guilty to Medicaid fraud
Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million
Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
($500,000.+$250,000 = $750,000) Where is the MONEY? $14 MILLION in Billing (remember, we are reading about THIEVES and very Cunning People.)
Hmm.....$14MILLION minus $750,000 = GOOD WORK FOR HOW MNAY YEARS IN PRISON?
TEN? I doubt it. Will be very interesting to see how many years for this PROFIT!
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia
Nurse pleads guilty to Medicaid fraud
Billings exceeded $14 million; husband dismissed from case
Saturday, Jul 19, 2008 - 12:08 AM
TIMES-DISPATCH STAFF WRITER
The largest prosecution of a home-health-care agency in Virginia ended in guilty pleas yesterday in federal court.
Rina Zavelsky, 40, a nurse, and her company, Renaissance Inc., pleaded guilty to one count of conspiracy to commit health-care fraud before U.S. District Judge Richard L. Williams.
They will be sentenced Oct. 24. Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia.
They were indicted this year for conspiracy to commit health-care fraud and money laundering. In pleading guilty yesterday, Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
She acknowledged providing services through unqualified and untrained personal care aides and making false training certificates to cover up the lack of training. The Virginia Department of Medical Assistance discovered the violations in 2003 and 2007.
From 2002 to its closing in 2008, Renaissance employed more than 350 aides acting as independent contractors and made billings for more than 250 Medicaid recipients in the Richmond, Tidewater, Harrisonburg and Northern Virginia areas.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million.
The case was investigated by the FBI, the U.S. Internal Revenue Service and the Virginia Attorney General's Office.
Virginia Attorney General Bob McDonnell said, "This is an important step forward in ensuring the future of the Medicaid system in the commonwealth."
Chuck Rosenberg, the U.S. attorney for the Eastern District of Virginia, lauded the close work of state and federal agencies in investigating the case. It was prosecuted by Brian Whisler, an assistant U.S. attorney, and Assistant Virginia Attorneys General Dale Mullen and Eric Atkinson.
Contact Frank Green at (804) 649-6340 or fgreen@timesdispatch.com.
GET THIS!!
Nurse pleads guilty to Medicaid fraud
Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million
Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
($500,000.+$250,000 = $750,000) Where is the MONEY? $14 MILLION in Billing (remember, we are reading about THIEVES and very Cunning People.)
Hmm.....$14MILLION minus $750,000 = GOOD WORK FOR HOW MNAY YEARS IN PRISON?
TEN? I doubt it. Will be very interesting to see how many years for this PROFIT!
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia
Nurse pleads guilty to Medicaid fraud
Billings exceeded $14 million; husband dismissed from case
Saturday, Jul 19, 2008 - 12:08 AM
TIMES-DISPATCH STAFF WRITER
The largest prosecution of a home-health-care agency in Virginia ended in guilty pleas yesterday in federal court.
Rina Zavelsky, 40, a nurse, and her company, Renaissance Inc., pleaded guilty to one count of conspiracy to commit health-care fraud before U.S. District Judge Richard L. Williams.
They will be sentenced Oct. 24. Zavelsky is facing a maximum of 10 years in prison and a $250,000 fine. Renaissance faces a fine of up to $500,000.
As part of the plea agreement, Zavelsky's husband, Ilya Zavelsky, 46, a physician, was dismissed from the case. The couple live in Glen Allen, and their company provided respite care and other services to Russian-speaking communities in Virginia.
They were indicted this year for conspiracy to commit health-care fraud and money laundering. In pleading guilty yesterday, Zavelsky admitted she defrauded Medicaid by submitting false claims for payment.
She acknowledged providing services through unqualified and untrained personal care aides and making false training certificates to cover up the lack of training. The Virginia Department of Medical Assistance discovered the violations in 2003 and 2007.
From 2002 to its closing in 2008, Renaissance employed more than 350 aides acting as independent contractors and made billings for more than 250 Medicaid recipients in the Richmond, Tidewater, Harrisonburg and Northern Virginia areas.
Total billings for Renaissance to Virginia Medicaid totaled more than $14 million.
The case was investigated by the FBI, the U.S. Internal Revenue Service and the Virginia Attorney General's Office.
Virginia Attorney General Bob McDonnell said, "This is an important step forward in ensuring the future of the Medicaid system in the commonwealth."
Chuck Rosenberg, the U.S. attorney for the Eastern District of Virginia, lauded the close work of state and federal agencies in investigating the case. It was prosecuted by Brian Whisler, an assistant U.S. attorney, and Assistant Virginia Attorneys General Dale Mullen and Eric Atkinson.
Contact Frank Green at (804) 649-6340 or fgreen@timesdispatch.com.
Medicaid False Claims Act Amendment Stalls ....
Posted On: July 19, 2008 by David L. Haron
Michigan Medicaid False Claims Act Amendment Stalls Because of Petty Legislative Political Bickering
As I reported earlier, the Michigan Medicaid False Claims Act was amended effective January 1, 2006 through the efforts of Attorney General Mike Cox and Representative David Law (R., Commerce). I worked actively for passage of the amendment and testified before the Michigan House of Representative Judiciary committee, then chaired by Rep. Law..
The State of Michigan can recoup extra funds from combined state/federal recoveries because of the provisions of the federal Deficit Reduction Act of 2005 ('DRA"). To explain, shortly after the the Michigan Medicaid False Claims Act amendment passed the Michigan Legislature and Governor Granholm signed the Act, the U.S. Congress passed the DRA providing for a 10% incentive to States which enacted a "compliant" Qui Tam statute addressing Medicaid fraud. Specifically, the Medicaid program is a joint federal/state program. Thus, in Michigan, the federal government pays about 56% and the state 44% of the costs of the Medicaid program and fraud recoveries are divided on the same percentage.
If the state has a "compliant" Qui Tam statute, the state receives an extra 10% of the recovery--that is, 54% in Michigan--of the recovery--instead of 44%--a significant amount of money since most recoveries are in the tens of millions of dollars or more!!
However, on December 21, 2006, the U.S, Department of Health and Human Services/Office of Inspector General ("HHS/OIG") advised the state, by letter, that its Medicaid False Claims Act was NOT "DRA compliant" (that is, a mirror image of the federal False Claims Act).
In order to comply, all that was needed was a simple bill adding civil monetary penalties of at least $5000 for each violation and making one other technical amendment. Since the revisions would not have had any negative fiscal impact on the state and would have had a potentially tremendous positive impact in the event of any recovery, one would have expected Representative Law to quickly introduce a clarification/modification bill and obtain quick passage--after all, the State would most certainly not turn down the opportunity to reverse the flow of funds from Michigan to Washington??
Unfortunately, in 2006 and 2007, petty partisan bickering was rampant in the Michigan Legislature--we were paralyzed by the absurd budget fight and leadership was non-existent.
Rep. Law, finally, on September 17, 2007, introduced a one-page bill. The date of introduction is significant. In addition to being a Saturday, the day of the Notre Dame-UM football game (a game, I suspect, Rep. Law, a Notre Dame grad, was attending), it was three days before Ray Sayeh, then a WXYZ-TV investigative reporter, had scheduled (at my request) an interview with the representative to discuss the failure to take action on the revisions.
Unfortunately, again because of partisanship and Democratic control of the House of Representatives, the bill went nowhere while the Attorney General continued to obtain recoveries from fraud-feasors and the unclaimed 10% incentive was lost to Washington.
Finally, on February 19, 2008, Representative Marc Courveau (D., Northville) introduced HB 5757. The amended FCA, as presented in HB 5757, would allow the Michigan FCA to become DRA compliant. Once again, the small changes made by HB 5757, as required by the federal HHS/OIG., would cost the state nothing in administrative or other costs and would bring millions of dollars in the future back from Washington.
HB 5757 quickly passed the House with NO opposition and was sent to the Senate.
Tragically, because of continued political maneuvering, the Bill sits in the Judiciary Committee.
It seems that Rep. Courveau was elected at the expense of a Republican and the leadership of the Judiciary Committee and Senate Majority Leader, Mike Bishop will not allow this largely unopposed, fiscally responsible bill, to be brought up at the committee or floor level because it would give "points" to Rep. Courveau!!!!
The State of Michigan is in a deep recession/depression, unemployment sits at 8.5%, the highest in the nation, GM is in deep trouble, the City of Detroit is selling assets and landmarks--such at the Detroit-Windsor tunnel--and the Legislature cannot pass a one-page bill that will bring money to the state and its Medicaid recipients.
This Bill is under the radar, unfortunately--Ray (now Rez) Sayeh has joined CNN International and is posted in Pakistan, columnists such as Brian Dickerson and others have been unresponsive despite my entreaties, my solicitations to the Legislature and the use of my contacts have been unavailing.
I am frustrated. Medicaid fraud is rampant, the Attorney General is acting diligently in pursuing the cheaters, and we have been filing qui tam cases under the new Act, but even if all of these activities are successful--and they will be--the State will not receive the full benefit of its recoveries!!!
Michigan Medicaid False Claims Act Amendment Stalls Because of Petty Legislative Political Bickering
As I reported earlier, the Michigan Medicaid False Claims Act was amended effective January 1, 2006 through the efforts of Attorney General Mike Cox and Representative David Law (R., Commerce). I worked actively for passage of the amendment and testified before the Michigan House of Representative Judiciary committee, then chaired by Rep. Law..
The State of Michigan can recoup extra funds from combined state/federal recoveries because of the provisions of the federal Deficit Reduction Act of 2005 ('DRA"). To explain, shortly after the the Michigan Medicaid False Claims Act amendment passed the Michigan Legislature and Governor Granholm signed the Act, the U.S. Congress passed the DRA providing for a 10% incentive to States which enacted a "compliant" Qui Tam statute addressing Medicaid fraud. Specifically, the Medicaid program is a joint federal/state program. Thus, in Michigan, the federal government pays about 56% and the state 44% of the costs of the Medicaid program and fraud recoveries are divided on the same percentage.
If the state has a "compliant" Qui Tam statute, the state receives an extra 10% of the recovery--that is, 54% in Michigan--of the recovery--instead of 44%--a significant amount of money since most recoveries are in the tens of millions of dollars or more!!
However, on December 21, 2006, the U.S, Department of Health and Human Services/Office of Inspector General ("HHS/OIG") advised the state, by letter, that its Medicaid False Claims Act was NOT "DRA compliant" (that is, a mirror image of the federal False Claims Act).
In order to comply, all that was needed was a simple bill adding civil monetary penalties of at least $5000 for each violation and making one other technical amendment. Since the revisions would not have had any negative fiscal impact on the state and would have had a potentially tremendous positive impact in the event of any recovery, one would have expected Representative Law to quickly introduce a clarification/modification bill and obtain quick passage--after all, the State would most certainly not turn down the opportunity to reverse the flow of funds from Michigan to Washington??
Unfortunately, in 2006 and 2007, petty partisan bickering was rampant in the Michigan Legislature--we were paralyzed by the absurd budget fight and leadership was non-existent.
Rep. Law, finally, on September 17, 2007, introduced a one-page bill. The date of introduction is significant. In addition to being a Saturday, the day of the Notre Dame-UM football game (a game, I suspect, Rep. Law, a Notre Dame grad, was attending), it was three days before Ray Sayeh, then a WXYZ-TV investigative reporter, had scheduled (at my request) an interview with the representative to discuss the failure to take action on the revisions.
Unfortunately, again because of partisanship and Democratic control of the House of Representatives, the bill went nowhere while the Attorney General continued to obtain recoveries from fraud-feasors and the unclaimed 10% incentive was lost to Washington.
Finally, on February 19, 2008, Representative Marc Courveau (D., Northville) introduced HB 5757. The amended FCA, as presented in HB 5757, would allow the Michigan FCA to become DRA compliant. Once again, the small changes made by HB 5757, as required by the federal HHS/OIG., would cost the state nothing in administrative or other costs and would bring millions of dollars in the future back from Washington.
HB 5757 quickly passed the House with NO opposition and was sent to the Senate.
Tragically, because of continued political maneuvering, the Bill sits in the Judiciary Committee.
It seems that Rep. Courveau was elected at the expense of a Republican and the leadership of the Judiciary Committee and Senate Majority Leader, Mike Bishop will not allow this largely unopposed, fiscally responsible bill, to be brought up at the committee or floor level because it would give "points" to Rep. Courveau!!!!
The State of Michigan is in a deep recession/depression, unemployment sits at 8.5%, the highest in the nation, GM is in deep trouble, the City of Detroit is selling assets and landmarks--such at the Detroit-Windsor tunnel--and the Legislature cannot pass a one-page bill that will bring money to the state and its Medicaid recipients.
This Bill is under the radar, unfortunately--Ray (now Rez) Sayeh has joined CNN International and is posted in Pakistan, columnists such as Brian Dickerson and others have been unresponsive despite my entreaties, my solicitations to the Legislature and the use of my contacts have been unavailing.
I am frustrated. Medicaid fraud is rampant, the Attorney General is acting diligently in pursuing the cheaters, and we have been filing qui tam cases under the new Act, but even if all of these activities are successful--and they will be--the State will not receive the full benefit of its recoveries!!!
RAC Contractors to be Identified, Recovery Asset Contractor
RAC Contractors to be Identified
Posted on July 19, 2008 by Executive-Post
CMS Aims to Reduce Fraud
Staff Writers
This month, the Centers for Medicare and Medicaid Services [CMS] will name the auditing firms that will review hospitals’ books for payment mistakes, while hospital officials say results in other states suggest the auditors will give priority to recovering overpayments.
The RAC Program
Under the so-called Recovery Asset Contractor [RAC] program, CMS pays auditors a fee based on the amount of improper payments discovered.
Hospital officials worry this “bounty hunter” approach - the second for CMS after medical practice audits - will create a bias in auditors to focus only on collecting government overpayments, reported the Pittsburgh Business Times on June 16, 2008.
Pilot Program Results
Some hospitals point to a pilot audit program in New York, Florida and California, which found $357.2 million in overpayments and just $14.3 million in underpayments. Medicare estimates its error rate at 3.9 percent in 2007, down from 9.8 percent in 2003, but still totaling $10.8 billion in improper payments
Conclusion
Your thoughts and comments are appreciated. Is this another instance of brute intimidation or just honest review
Posted on July 19, 2008 by Executive-Post
CMS Aims to Reduce Fraud
Staff Writers
This month, the Centers for Medicare and Medicaid Services [CMS] will name the auditing firms that will review hospitals’ books for payment mistakes, while hospital officials say results in other states suggest the auditors will give priority to recovering overpayments.
The RAC Program
Under the so-called Recovery Asset Contractor [RAC] program, CMS pays auditors a fee based on the amount of improper payments discovered.
Hospital officials worry this “bounty hunter” approach - the second for CMS after medical practice audits - will create a bias in auditors to focus only on collecting government overpayments, reported the Pittsburgh Business Times on June 16, 2008.
Pilot Program Results
Some hospitals point to a pilot audit program in New York, Florida and California, which found $357.2 million in overpayments and just $14.3 million in underpayments. Medicare estimates its error rate at 3.9 percent in 2007, down from 9.8 percent in 2003, but still totaling $10.8 billion in improper payments
Conclusion
Your thoughts and comments are appreciated. Is this another instance of brute intimidation or just honest review
Saturday, July 19, 2008
$1.75 million as a result of fraudulent billings
July 17, 2008 in Health Fraud by Dave Westheimer
In Washington on Friday, US District Court Judge Colleen Kotar-Kotelly sentenced Martin McLaren of Bethesda, Maryland to 37 months in prison for making false statements in relation to health care matters. McLaren, an anesthesiologist who owned the Pain Management Center based in Hyattsville, admitted to receiving at least $1.75 million as a result of fraudulent billings submitted to Medicare, Medicaid and private carriers between 2000 and 2006 (Washington Times, DOJ).
Blog Published By
Wisenberg & Wisenberg PLLC: White Collar Criminal Defense Attorneys
In Washington on Friday, US District Court Judge Colleen Kotar-Kotelly sentenced Martin McLaren of Bethesda, Maryland to 37 months in prison for making false statements in relation to health care matters. McLaren, an anesthesiologist who owned the Pain Management Center based in Hyattsville, admitted to receiving at least $1.75 million as a result of fraudulent billings submitted to Medicare, Medicaid and private carriers between 2000 and 2006 (Washington Times, DOJ).
Blog Published By
Wisenberg & Wisenberg PLLC: White Collar Criminal Defense Attorneys
Ten individuals associated with a Brooklyn-based medical clinic ...charges of conspiracy to commit health care and mail fraud.
NEW YORK—Ten individuals associated with a Brooklyn-based medical clinic — including the clinic’s owners and several of its medical practitioners – have been arrested on Three other individuals remain at large, although one was expected to surrender later Thursday.
Samuel Vilshanetski, aka “Dima,” Sviatoslav Jadan, aka “Slava,” and a third individual owned and operated a medical clinic located at 3003 Avenue K in Brooklyn, New York. The Avenue K Clinic was primarily engaged in the treatment of individuals who filed no-fault automobile insurance claims with insurance companies. Under New York State Law, no-fault insurance enables the driver and passengers of a vehicle registered and insured in New York to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, regardless of fault.
Prosecutors say the Avenue K Clinic was a medical fraud mill which routinely billed automobile insurance companies under the no-fault program for medical “treatments” which were either never provided or unnecessary, because the person being “treated” did not medically need the treatments.
According to the complaints, the operators of the Avenue K Clinic paid thousands of dollars to “runners” who would recruit patients who were in car accidents — sometimes staged solely to commit insurance fraud — but who often suffered little or no injury from the accidents. These patients would undergo weeks or months of unnecessary “treatments” — such as physical therapy, chiropractory and acupuncture — at the Avenue K Clinic. The Avenue K Clinic then billed automobile insurance companies under the no-fault program for these unnecessary medical treatments, prosecutors said.
In the first two years of its operation, the Avenue K Medical Clinic billed insurance companies a total of approximately $3.6 million for no-fault medical services on behalf of more than 500 patients and, as of June 2008, had received approximately $1.2million from these insurance companies.
Vilshanetski, Jadan and the third individual owned and operated the Avenue K Clinic – making the initial financial investments and supervising the Clinic’s medial staff and operations. The owners of the Avenue K Clinic engaged so-called “runners,” including defendants Roman Satler, aka “Roma”, Shamil Tagiev, aka “Sammy”, Emmanuel Kelly, aka “Kevin”, Vladimir Deupont, aka “Vlad” and Feliks Khatsela, to recruit patients for the clinic for treatment.
According to the complaints, the owners paid the runners an average of approximately $2,000 per patient but paid them only after the referred patients had received enough treatments for the patient to be profitable. The recruited patients were required to attend the clinic for treatment regularly, sometime daily, and to agree to receive multiple MRIs. Even greater payments were offered to the runners when a patient was accepted as a client at one of several law offices associated with the clinic because the law offices paid fees to the clinic for each patient signed up as a client.
The owners relied on various means to obtain cash to pay the clinic runners. For example, the owners of the Avenue K Clinic laundered money through defendant Mark Pogoriler, aka “Lobster” by writing checks drawn on the accounts of clinic medical practitioners to Pogoriler’s medical transportation companies. In fact, Pogoriler provided no transportation services to the clinic and instead simply returned 90 percent of the value of the checks as cash.
The owners also obtained cash from kickbacks provided by outside medical suppliers and practitioners in exchange for the referral of business. Medical supply companies associated with Radion Aminov, the defendant, billed insurance companies for overpriced and often unnecessary medical supplies provided to Avenue K Clinic patients, and in return provided kickbacks to the Avenue K Clinic.
Gennady Broytman, aka “Genna,” the defendant, operated an MRI clinic that billed insurance companies for MRIs provided to Avenue K Clinic patients and paid kickbacks to the clinic owners. The Avenue K Clinic also hired doctors and medical
professionals to “treat” the patients recruited for the clinic by the runners, even though the majority of such patients did not need the medical treatments provided.
These medical professionals included defendants Romilla Anwar (a physician), Anatoliy Sunik (an acupuncturist) and Asnodin Dianalan, aka “Dino” (a physica ltherapist)(collectively the “medical staff.”) The medical staff provided unnecessary medical treatments and supplies to clinic patients, and also submitted bills to the insurance companies for more medical services than were in fact provided. 7-17-08
Samuel Vilshanetski, aka “Dima,” Sviatoslav Jadan, aka “Slava,” and a third individual owned and operated a medical clinic located at 3003 Avenue K in Brooklyn, New York. The Avenue K Clinic was primarily engaged in the treatment of individuals who filed no-fault automobile insurance claims with insurance companies. Under New York State Law, no-fault insurance enables the driver and passengers of a vehicle registered and insured in New York to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, regardless of fault.
Prosecutors say the Avenue K Clinic was a medical fraud mill which routinely billed automobile insurance companies under the no-fault program for medical “treatments” which were either never provided or unnecessary, because the person being “treated” did not medically need the treatments.
According to the complaints, the operators of the Avenue K Clinic paid thousands of dollars to “runners” who would recruit patients who were in car accidents — sometimes staged solely to commit insurance fraud — but who often suffered little or no injury from the accidents. These patients would undergo weeks or months of unnecessary “treatments” — such as physical therapy, chiropractory and acupuncture — at the Avenue K Clinic. The Avenue K Clinic then billed automobile insurance companies under the no-fault program for these unnecessary medical treatments, prosecutors said.
In the first two years of its operation, the Avenue K Medical Clinic billed insurance companies a total of approximately $3.6 million for no-fault medical services on behalf of more than 500 patients and, as of June 2008, had received approximately $1.2million from these insurance companies.
Vilshanetski, Jadan and the third individual owned and operated the Avenue K Clinic – making the initial financial investments and supervising the Clinic’s medial staff and operations. The owners of the Avenue K Clinic engaged so-called “runners,” including defendants Roman Satler, aka “Roma”, Shamil Tagiev, aka “Sammy”, Emmanuel Kelly, aka “Kevin”, Vladimir Deupont, aka “Vlad” and Feliks Khatsela, to recruit patients for the clinic for treatment.
According to the complaints, the owners paid the runners an average of approximately $2,000 per patient but paid them only after the referred patients had received enough treatments for the patient to be profitable. The recruited patients were required to attend the clinic for treatment regularly, sometime daily, and to agree to receive multiple MRIs. Even greater payments were offered to the runners when a patient was accepted as a client at one of several law offices associated with the clinic because the law offices paid fees to the clinic for each patient signed up as a client.
The owners relied on various means to obtain cash to pay the clinic runners. For example, the owners of the Avenue K Clinic laundered money through defendant Mark Pogoriler, aka “Lobster” by writing checks drawn on the accounts of clinic medical practitioners to Pogoriler’s medical transportation companies. In fact, Pogoriler provided no transportation services to the clinic and instead simply returned 90 percent of the value of the checks as cash.
The owners also obtained cash from kickbacks provided by outside medical suppliers and practitioners in exchange for the referral of business. Medical supply companies associated with Radion Aminov, the defendant, billed insurance companies for overpriced and often unnecessary medical supplies provided to Avenue K Clinic patients, and in return provided kickbacks to the Avenue K Clinic.
Gennady Broytman, aka “Genna,” the defendant, operated an MRI clinic that billed insurance companies for MRIs provided to Avenue K Clinic patients and paid kickbacks to the clinic owners. The Avenue K Clinic also hired doctors and medical
professionals to “treat” the patients recruited for the clinic by the runners, even though the majority of such patients did not need the medical treatments provided.
These medical professionals included defendants Romilla Anwar (a physician), Anatoliy Sunik (an acupuncturist) and Asnodin Dianalan, aka “Dino” (a physica ltherapist)(collectively the “medical staff.”) The medical staff provided unnecessary medical treatments and supplies to clinic patients, and also submitted bills to the insurance companies for more medical services than were in fact provided. 7-17-08
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