Health Care Financing Fraud Trial Nears
By ANDREW WELSH-HUGGINS – 18 hours ago
COLUMBUS, Ohio (AP) — Six years after the collapse of the country's biggest health care finance company, a trial is nearing for five executives accused of a $1.9 billion fraud that helped bring the company down.
The case involves one of the largest alleged white-collar crimes after Enron or WorldCom, yet it is largely unknown to the public.
"I tell people all the time, this is the most important case that people have never heard of," said Kathy Patrick, whose Houston firm represents a group of investors that lost a total of $1.6 billion when National Century Financial Enterprises collapsed in 2002.
Two former owners of National Century and three former executives go on trial Monday in federal court in Columbus. The company was based in suburban Dublin.
Federal prosecutors say the officials conspired to defraud investors by diverting money from investors' funds for improper uses, fabricating data in investor reports, and moving money back and forth between accounts to conceal investor fund shortfalls.
The government expects to call 45 witnesses during the trial, which is expected to last six to eight weeks.
Missing from the trial will be National Century's former president and chief executive, Lance Poulsen, a chief target of the government's allegations.
Before his own trial on the fraud charges in August, Poulsen is scheduled for a March trial on charges of witness tampering.
U.S. Attorney Gregory Lockhart said Poulsen, of Port Charlotte, Fla., had a Columbus resident offer a government witness cash in exchange for her not giving damaging testimony against Poulsen. He has pleaded not guilty and is being held in a Ross County jail.
Poulsen is already fighting similar fraud charges in a civil case brought by the Securities and Exchange Commission.
Messages were left for Poulsen's attorney seeking comment.
The five executives going on trial Monday have pleaded not guilty to all charges and maintain their innocence.
Several other National Century executives charged in the scheme have pleaded guilty, and at least four may testify in the trial.
National Century had been the nation's largest source of financing to health care providers. Doctors, hospitals and other providers received money from the company rather than waiting for insurance payments, usually getting 80 or 90 cents on the dollar. National Century was then to collect and keep the full amount of the payments owed by insurance companies.
Providers, by going through National Century, received money owed them earlier than if they waited for full payment from insurance companies.
National Century raised the money to fund its business by selling bonds to investors, who received interest payments followed by a lump-sum payment.
The government alleges National Century executives routinely overpaid some health care providers, many of them entities the executives had a financial interest in. National Century told investors it was making the proper payments, according to the government.
During 2001 and 2002 alone, the government says, company executives provided more than $700 million in investor funds to health care providers.
These advances amounted to high-risk, unsecured loans that were hidden from investors, the government said.
"National Century's business became increasingly dependent upon keeping these certain health care provider clients in business, because the money owed to National Century far exceeded the possible collections from the accounts receivable purchased by National Century," the government said in a Jan. 22 court filing.
National Century's investors say they participated in the program because the investment risks were deemed low. They included the state of Arizona, banks, insurance companies and local governments such as cities and counties.
"These are investors who do not expect or take the risk associated with credit defaults," Patrick said. "These investors were told this was money market equivalent, safe, secure investments, and it evaporated."
Investors represented by Patrick have sued Credit Suisse First Boston over the $1.6 billion they say was lost in the National Century collapse.
Credit Suisse marketed $3 billion of National Century's asset-backed securities. The company declined comment.
Although the focus has been on money lost by investors, people shouldn't discount the blow to doctors and other medical practitioners that relied on National Century to keep their practices running, said W.C. Benton, an Ohio State University business professor who has followed the case.
Some health care companies filed for bankruptcy because of interrupted payments from National Century, and others have filed civil lawsuits against the company.
"It will be a major, major bump in the road in terms of financing health care," Benton said. "A lot of these small practices don't have extra cash. It's going to stop some of the growth in that area."
On the Net:
U.S. Attorney's Office, Southern District of Ohio: http://www.usdoj.gov/usao/ohs
Thursday, January 31, 2008
Six years later..... five executives ...but where is the sixth???
There is one executive missing ......where is he.....the mastermind of this scheme?
Associated Press - January 30, 2008 1:35 PM ET
COLUMBUS, Ohio (AP) - Six years after the collapse of a giant health care finance company, a trial is nearing for five executives accused in a $1.9 billion fraud.
Two former owners of National Century Financial Enterprises and three former executives go on trial in federal court in Columbus Monday.
Federal prosecutors say the officials conspired to defraud investors by diverting money in investors' funds and fabricating data in investor reports.
The officials are also accused of moving money back and forth between accounts to conceal investor fund shortfalls.
The government expects to call 45 witnesses when the trial begins before Judge Algenon Marbley.
The trial is expected to last six to eight weeks.
Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Associated Press - January 30, 2008 1:35 PM ET
COLUMBUS, Ohio (AP) - Six years after the collapse of a giant health care finance company, a trial is nearing for five executives accused in a $1.9 billion fraud.
Two former owners of National Century Financial Enterprises and three former executives go on trial in federal court in Columbus Monday.
Federal prosecutors say the officials conspired to defraud investors by diverting money in investors' funds and fabricating data in investor reports.
The officials are also accused of moving money back and forth between accounts to conceal investor fund shortfalls.
The government expects to call 45 witnesses when the trial begins before Judge Algenon Marbley.
The trial is expected to last six to eight weeks.
Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Thursday, January 24, 2008
$56.6 million MEDICARE FRAUD.....
9 healthcare firm owners sent to prison
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
Owners of nine Miami healthcare companies have been sentenced to prison in the past two weeks in a string of cases that reveal the area still leads the nation in healthcare fraud, federal prosecutors announced Wednesday.
Medicare data shows that Miami-Dade County alone had more paid durable medical equipment claims than 44 states combined. Only the most populous states -- California, Texas, New York, Michigan and Ohio -- bill Medicare more than does Miami-Dade for DME claims.
The average Medicare recipient in Miami-Dade each year is named in paid DME claims worth $6,200. In the rest of the nation, the average is $1,200.
A special Medicare Fraud Task Force has been set up in Miami to cut back on the massive fraud, and it was the task force that brought the cases announced Wednesday.
Together, the nine filed fraudulent claims with Medicare for $56.6 million for unnecessary durable medical equipment and infusion therapy, the U.S. Department of Justice said in a press release.
The defendants:
• Luis Soto, 41, sentenced to seven years, three months for operating Ocean Medical Equipment and 10 other companies that billed Medicare for such items as oxygen concentrators, nebulizers and wheelchairs that were never provided. He was responsible for $47 million in false claims.
• Noel Rodriguez, 50, sentenced to four years, three months, for his operations of OxyCare of Miami that submitted over $1.2 million in false claims for such items as hospital beds and pressure-reducing mattresses.
• Rosabel Gonzalez, 32, sentenced to two years, six months, for using Genesis Associates Group to submit $1.5 million in false claims, much of which were for power air mattresses.
• Christian Vasquez, 22, sentenced to three years, five months. He was the nominal owner of Tamaimi Medical Supply, which submitted $1.2 million in phony claims.
• Maria De La Serna, 55, sentenced to 19 months for owning and operating Respiratory One Equipment, which billed Medicare for $345,000 in fraudulent claims.
• Ariel Betancourt, 35, sentence to two years. She was the named owner of Lincoln Medical Supply, which submitted more than $480,000 in fake claims.
• José Prieto, 58, sentenced to three years, five months for operating Coral Way Medical, an HIV infusion clinic which billed fraudulently in $900,000 worth of claims for expensive infusions. Armando Jorge Herrera, 27, was sentenced to three years for the same operation.
• Reinaldo Lopez, 40, sentenced to three years, 10 months for owning and operating Reny Medical Equipment, which submitted more than $450,000 in false claims.
Prosecutors in the cases were Kirk Ogrosky, Ryan Stumphauser, Randy Katz, John S. Darden, Jerrob Duffy and John Cunningham.
Join the discussion
The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
Owners of nine Miami healthcare companies have been sentenced to prison in the past two weeks in a string of cases that reveal the area still leads the nation in healthcare fraud, federal prosecutors announced Wednesday.
Medicare data shows that Miami-Dade County alone had more paid durable medical equipment claims than 44 states combined. Only the most populous states -- California, Texas, New York, Michigan and Ohio -- bill Medicare more than does Miami-Dade for DME claims.
The average Medicare recipient in Miami-Dade each year is named in paid DME claims worth $6,200. In the rest of the nation, the average is $1,200.
A special Medicare Fraud Task Force has been set up in Miami to cut back on the massive fraud, and it was the task force that brought the cases announced Wednesday.
Together, the nine filed fraudulent claims with Medicare for $56.6 million for unnecessary durable medical equipment and infusion therapy, the U.S. Department of Justice said in a press release.
The defendants:
• Luis Soto, 41, sentenced to seven years, three months for operating Ocean Medical Equipment and 10 other companies that billed Medicare for such items as oxygen concentrators, nebulizers and wheelchairs that were never provided. He was responsible for $47 million in false claims.
• Noel Rodriguez, 50, sentenced to four years, three months, for his operations of OxyCare of Miami that submitted over $1.2 million in false claims for such items as hospital beds and pressure-reducing mattresses.
• Rosabel Gonzalez, 32, sentenced to two years, six months, for using Genesis Associates Group to submit $1.5 million in false claims, much of which were for power air mattresses.
• Christian Vasquez, 22, sentenced to three years, five months. He was the nominal owner of Tamaimi Medical Supply, which submitted $1.2 million in phony claims.
• Maria De La Serna, 55, sentenced to 19 months for owning and operating Respiratory One Equipment, which billed Medicare for $345,000 in fraudulent claims.
• Ariel Betancourt, 35, sentence to two years. She was the named owner of Lincoln Medical Supply, which submitted more than $480,000 in fake claims.
• José Prieto, 58, sentenced to three years, five months for operating Coral Way Medical, an HIV infusion clinic which billed fraudulently in $900,000 worth of claims for expensive infusions. Armando Jorge Herrera, 27, was sentenced to three years for the same operation.
• Reinaldo Lopez, 40, sentenced to three years, 10 months for owning and operating Reny Medical Equipment, which submitted more than $450,000 in false claims.
Prosecutors in the cases were Kirk Ogrosky, Ryan Stumphauser, Randy Katz, John S. Darden, Jerrob Duffy and John Cunningham.
Join the discussion
The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts
$2.5 million on the false claims....law enforcement has recovered more than $1.6 million of the fraud proceeds
WHERE IS THE REST OF THE MONEY??????
Posted On: January 23, 2008 by Robert David Malove
Medicare Fraud Defendant Sentenced in Florida
On January 10, Cesar Romero was sentenced by U.S. District Court Judge Patricia A. Seitz to forty-six months in jail and remanded into immediate custody for his role in a multi-million dollar Medicare billing fraud scheme on which Romero previously had pled guilty. Romero faced a potential sentence range of 46 to 57 months in prison, but was sentenced to the low-end of the advisory guidelines' sentencing range called for under an Adjusted Offense Level of 23. Romero's counsel disputed the 2-level upward departure from the base offense level of 21 with a lower advisory sentencing range of 37 to 46 months incarceration.
Romero took part in a scheme in which a phantom health clinic, named “The Real Group & Associates, Inc.,” was incorporated in South Florida and subsequently billed Medicare for reimbursement for non-existent drug infusion and injection therapies typically prescribed to AIDS and chemotherapy patients. Nearly $17 million of false claims were submitted to Medicare for reimbursement, resulting in payments of more than $2.5 million on the false claims. To date, law enforcement has recovered more than $1.6 million of the fraud proceeds. At sentencing, Romero was held responsible, in part, for recruiting and managing the straw owner of the clinic, and for the creation and control of the clinic’s corporate bank accounts that were used to transfer and disburse the Medicare fraud proceeds through a series of fraudulent financial transactions.
If you or someone you know has been charged with healthcare fraud or is under investigation, for serious legal representation, from border-to-border and coast-to-coast, call attorney Robert Malove.
Posted On: January 23, 2008 by Robert David Malove
Medicare Fraud Defendant Sentenced in Florida
On January 10, Cesar Romero was sentenced by U.S. District Court Judge Patricia A. Seitz to forty-six months in jail and remanded into immediate custody for his role in a multi-million dollar Medicare billing fraud scheme on which Romero previously had pled guilty. Romero faced a potential sentence range of 46 to 57 months in prison, but was sentenced to the low-end of the advisory guidelines' sentencing range called for under an Adjusted Offense Level of 23. Romero's counsel disputed the 2-level upward departure from the base offense level of 21 with a lower advisory sentencing range of 37 to 46 months incarceration.
Romero took part in a scheme in which a phantom health clinic, named “The Real Group & Associates, Inc.,” was incorporated in South Florida and subsequently billed Medicare for reimbursement for non-existent drug infusion and injection therapies typically prescribed to AIDS and chemotherapy patients. Nearly $17 million of false claims were submitted to Medicare for reimbursement, resulting in payments of more than $2.5 million on the false claims. To date, law enforcement has recovered more than $1.6 million of the fraud proceeds. At sentencing, Romero was held responsible, in part, for recruiting and managing the straw owner of the clinic, and for the creation and control of the clinic’s corporate bank accounts that were used to transfer and disburse the Medicare fraud proceeds through a series of fraudulent financial transactions.
If you or someone you know has been charged with healthcare fraud or is under investigation, for serious legal representation, from border-to-border and coast-to-coast, call attorney Robert Malove.
Wednesday, January 23, 2008
FISA BILL......WHAT for`?
Bin laden;s goal was to DESTROY our economy.....
Looks like DICK CHENEY has heled him and of course lets not forget our great PRESIDENT......keep reading my PET GOAT!
Looks like DICK CHENEY has heled him and of course lets not forget our great PRESIDENT......keep reading my PET GOAT!
DICK CHENEY......SHUT UP
YPU ARE A LIAR!
JUST SHUT UP anout your WAR ON TERROR!!!
LIAR!@
BIN LADEN HAS WON!!! HIS GOAL WAS TO DESTROY ALL CAPITAL MARKETS!!!
WELL....just look at the US ECONOMY.....LIAR!
JUST SHUT UP anout your WAR ON TERROR!!!
LIAR!@
BIN LADEN HAS WON!!! HIS GOAL WAS TO DESTROY ALL CAPITAL MARKETS!!!
WELL....just look at the US ECONOMY.....LIAR!
Friday, January 18, 2008
Fraud, assisted by our own COURT SYSTEM....THANKS!
May 24, 2007
11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions
On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations.
The scheme involved transporting patients to the defendants’ pharmacies in exchange for illegal kickbacks for patients and doctors. However, no evidence indicated that Medicare was billed for unnecessary medical procedures. A confidential informant met with the defendants to exchange, for a fee, their checks for cash, admitted on cross-examination that one defendant, Medina, a secretary, was always sent out of the room to avoid her hearing them talk about the kickback scheme.
The Court also vacated the money laundering counts which related to the fraud counts it had set aside, since money laundering involves the proceeds of activity known by the defendants to be illegal.
The Court upheld the convictions of two defendants as to the general conspiracy charge, under 18 U.S.C. § 371, but vacated the secretary’s conviction, finding that her lack of awareness of the kickback conspiracy, and of the conspiracy’s other objectives, left insufficient evidence to
convict.
The Court remanded the case for resentencing and noted that the district court failed to make a sufficient loss calculation, and instead sentenced the defendants for the entire amount Medicare was billed in the period, without explanation. However, in the absence of evidence of Medicare’s payment of unnecessary medical claims, or that the patient kickback scheme resulted in any actual loss to Medicare, this calculation was inadequate.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions
On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations.
The scheme involved transporting patients to the defendants’ pharmacies in exchange for illegal kickbacks for patients and doctors. However, no evidence indicated that Medicare was billed for unnecessary medical procedures. A confidential informant met with the defendants to exchange, for a fee, their checks for cash, admitted on cross-examination that one defendant, Medina, a secretary, was always sent out of the room to avoid her hearing them talk about the kickback scheme.
The Court also vacated the money laundering counts which related to the fraud counts it had set aside, since money laundering involves the proceeds of activity known by the defendants to be illegal.
The Court upheld the convictions of two defendants as to the general conspiracy charge, under 18 U.S.C. § 371, but vacated the secretary’s conviction, finding that her lack of awareness of the kickback conspiracy, and of the conspiracy’s other objectives, left insufficient evidence to
convict.
The Court remanded the case for resentencing and noted that the district court failed to make a sufficient loss calculation, and instead sentenced the defendants for the entire amount Medicare was billed in the period, without explanation. However, in the absence of evidence of Medicare’s payment of unnecessary medical claims, or that the patient kickback scheme resulted in any actual loss to Medicare, this calculation was inadequate.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Just more FRAUD
October 18, 2007
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy
On October 10, 2007 Dmitry Rakovsky was sentenced by United States District Judge Marcia G. Cooke in Miami, Florida. Rakovsky was sentenced to a term of 59 months in prison, to be followed by a term of three years of supervised release. He was also ordered to forfeit property and pay restitution in the amount of $900,000.
Rakovsky, and co-defendants Boris Royzen and his wife Eva Royzen, were charged in a twenty-one (21) defendant, thirty-three (33) count health care fraud Indictment. The Indictment charged doctors, chiropractors, massage therapists, an office manager, and four medical clinics, Vista Mar Medical Rehab Corp., Plantation Medical Recovery Center, Inc., Romana Medical, Inc., and Dial Medical Rehab, Inc., with health care fraud. Rakovsky was the final defendant to be sentenced in this case.
Previously Boris Royzen was sentenced to 40 months in prison, followed by three years supervised release. He was also ordered to forfeit property and pay $1.8 million restitution. His wife, Eva, was previously sentenced to three years of probation, forfeit property and pay restitution in the amount of $1.8 million. The medical clinics were ordered to pay restitution as follows: Vista Mar: $70,674.08; Romana Medical: $20,641.85; Plantation Medical Recovery: $31,292.75; and Dial Medical: $13,818.06.
Continue reading "Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Insurance Fraud
Bookmark:
September 21, 2007
South Florida bills billions for HIV
September 21, 2007
From The Washington Times
By Jim McElhatton - Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
Federal health care regulators call the lopsided billing patterns "egregious" and warn that South Florida — particularly Broward, Miami-Dade and Palm Beach counties — is a potential hotbed for health care fraud, waste and abuse.
"It"s all ultimately part of the money-driven, underground economy in Miami," said Benson B. Weintraub, a health care fraud lawyer based in Fort Lauderdale.
According to a report this week by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.
Continue reading "South Florida bills billions for HIV" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
September 18, 2007
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering
On September 6, 2007, Gianni Suarez Vazquez, a participant in a massive Medicare fraud scheme, pled guilty in federal court in West palm Beach, Florida, to mail fraud and money laundering charges. He is scheduled to be sentenced before U.S. District Judge Donald M. Middlebrooks on November 15, 2007.
According to the court records, between November 2003 and August 2004, Suarez Vazquez incorporated or set up two medical equipment companies, GK Medical, Inc. and Suplident International Corporation, in Palm Beach County. Thereafter, he obtained Medicare provider numbers for both companies to enable the companies to submit claims directly to Medicare. To conceal his ownership and control of the companies, Suarez Vazquez designated "strawmen" as company owners, including his mother, on the corporate documents and Medicare Provider Agreements.
Continue reading "Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicaid Fraud
Bookmark:
September 16, 2007
Miami Defendants Sentenced on Health Care Fraud
On August 31, 2007, defendants Maricel Li and Marta Perez, both residents of Miami, were sentenced by United States District Court Judge James I. Cohn in Fort Lauderdale, Florida.
Li was sentenced to twenty-four (24) months' imprisonment, followed by three (3) years of supervised release. Li was also ordered to pay $556,519.85 in restitution. Perez was sentenced to five (5) months' imprisonment, to be followed by two (2) years of supervised release.
Both defendants had previously pled guilty. Defendant Li had pled guilty to an Information charging her with conspiracy to commit health care fraud violations and conspiracy to commit structuring violations. Defendant Perez had pled guilty to conspiracy to structure financial transactions.
Continue reading "Miami Defendants Sentenced on Health Care Fraud" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam
On August 28, 2007, a federal grand jury indicted the former operations director of A-Care EMS Inc. on charges that he sent fraudulent claims to the Centers for Medicare and Medicaid Services to pull in more money.
The indictment, filed Tuesday in the U.S. District Court for the Southern District of Texas, claims Rodney Lee Ramos, 34, of Weslaco, instructed emergency medical technicians to transport patients for dialysis who were not confined to bed."
According to the indictment, Ramos worked as an EMT coordinator for A-Stat Ambulance Services Inc., which was owned by Guadalupe Garces Jr. and Araceli Garces. Medicaid and Medicare placed a vendor hold on that ambulance provider -- withholding payment to the company -- after federal agents determined that the owners were defrauding the federal and state health insurance programs.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Florida Durable Medical Equipment Owner Convicted of Medicare Fraud
On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida.
After a jury trial at federal court in Miami, the jury found Marianela Smith guilty on all charged counts including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit health care fraud; and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.
Smith faces a maximum sentence of 30 years in prison. Prior to sentencing the U.S. Probation Office will complete a pre-sentence investigation and submit a Pre-Sentence Report to the judge for consideration. The PSI will contain an advisory guideline sentence which the court must consider in determining what type and length of sentence is sufficient, but not greater than necessary, to comply with the statutory directives set forth in 18 U.S.C. § 3553(a).
Smith is scheduled to be sentenced November 9, 2007, before U.S. District Court Judge Joan A. Lenard.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
July 12, 2007
Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing DisparityBy
Benson Weintraub [Benson Weintraub is a sentencing lawyer is Of-Counsel to the Law Offices of Robert David Malove, P.A.,in Fort Lauderdale and former Visiting Professor of Law at Hofstra University. While in law school, he worked on the Hoffa litigation under the direction of civil rights lawyer, Leonard Boudin.]
The political implications of Lewis Libby’s commutation of sentence by President Bush continue to reverberate, but this case summons memories of the suspicious circumstances under which President Nixon commuted the sentence of former Teamsters President, James R. Hoffa, 1971.
Hoffa and Libby were both convicted of obstruction of justice, but Hoffa had already served part of his thirteen-year sentence. That was enough to encourage exposure of the links between organized crime, the old International Brotherhood of Teamsters [IBT], and the intersection of such ties with money and politics.
Similarly, Bush and Cheney also appeared to fear that Libby’s imminent incarceration would lead him to cooperate with the Special Prosecutor, perhaps engendering a political scandal making Watergate look like a misdemeanor.
Continue reading "Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing Disparity" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Sentencing Guidelines
Bookmark:
May 25, 2007
Medicare Fraud Defendant Gets 10-Year Prison Term
On May 18, 2007, the US Attorney's Office reported that Jafet Garcia, a defendant in a massive South Florida Medicare fraud scheme, was sentenced in West Palm Beach Federal court to ten (10) years’ imprisonment.
According to the court file, the defendant and his partners purchased four medical equipment companies located in Miami-Dade and Palm Beach Counties, between February 2004 and December 2004. The defendant and his partners recruited individuals to pose as the owners of these companies. After setting up the companies, the defendant and his partners obtained patient and physician information which they used to prepare bogus prescriptions and/or certificates of medical necessity. The bogus prescriptions and certificates purported to authorize the provision of various types of medical equipment for the named Medicare beneficiaries; in truth, the prescriptions and certificates were prepared by the defendant and/or his accomplices and contained forged physicians’ signatures.
The defendant and/or his partners provided the bogus prescriptions and certificates to a Miami billing company for submission to Medicare. The billing company prepared Medicare claims which sought reimbursement for the cost of the equipment listed in the bogus prescriptions and certificates, even though such equipment was never authorized by a physician or provided to the beneficiaries. Medicare processed the fraudulent claims and issued reimbursement checks which the defendant and/or his accomplices cashed at a Miami check cashing store. The defendant and his partners would submit claims through a particular medical equipment company for only two to three months, close it and then begin billing through another company to avoid getting caught.
The four companies used by the defendant and his partners to defraud Medicare were Sunset Medical Corporation, King Medical Service and Supplies Corporation, Travelango Services Corp. and Clear Choice Home Health, Inc. During the course of the scheme, the defendant and his partners submitted more than $9 million in bogus Medicare claims.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 24, 2007
11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions
On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations.
The scheme involved transporting patients to the defendants’ pharmacies in exchange for illegal kickbacks for patients and doctors. However, no evidence indicated that Medicare was billed for unnecessary medical procedures. A confidential informant met with the defendants to exchange, for a fee, their checks for cash, admitted on cross-examination that one defendant, Medina, a secretary, was always sent out of the room to avoid her hearing them talk about the kickback scheme.
The Court also vacated the money laundering counts which related to the fraud counts it had set aside, since money laundering involves the proceeds of activity known by the defendants to be illegal.
The Court upheld the convictions of two defendants as to the general conspiracy charge, under 18 U.S.C. § 371, but vacated the secretary’s conviction, finding that her lack of awareness of the kickback conspiracy, and of the conspiracy’s other objectives, left insufficient evidence to
convict.
The Court remanded the case for resentencing and noted that the district court failed to make a sufficient loss calculation, and instead sentenced the defendants for the entire amount Medicare was billed in the period, without explanation. However, in the absence of evidence of Medicare’s payment of unnecessary medical claims, or that the patient kickback scheme resulted in any actual loss to Medicare, this calculation was inadequate.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 22, 2007
Feds Add More Resourses to Fight Healthcare Fraud
The Centers for Medicare & Medicaid Services Program Integrity Group at recently opened a field office in Santa Ana, California, aimed at preventing and prosecuting health care fraud.
"In the two years since the office has been up and running, we have been able to stop almost $2billion in inappropriate or improper payments from going out the door," program director Kimberly Brandt said.
Like the Medicare Fraud Strike Force office in South Florida that arrested 38 people for defrauding the federal program out of more than $142million, the Santa Ana office uses "data mining" technology to target fraudulent Medicare and Medicaid billings.
According to Assistant U.S. Attorney Consuelo Woodhead, who coordinates federal health care fraud prosecutions in Los Angeles, officials could double the number of law enforcement personnel fighting the problem and still fall short of having enough people to make a significant difference.
Woodhead thinks, that "to really effectively deal with the problem, we're going to have to take a multidisciplinary approach where you look at licensing and certification, how claims are processed, as well as strong criminal and civil enforcement after claims are paid."
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud
Bookmark:
May 10, 2007
Fed Fraud Strike Force Arrests 38 in South Florida Medicare Scam
On May 9, investigators said the arrests of 38 people are the result of an operation conducted by a strike force made up of a team of federal, state and local investigators who have been concentrating on Medicare fraud -- ''especially prevalent'' in South Florida -- since early March.
According to remarks made by Attorney General Alberto R. Gonzales at a press conference with Michael Leavitt, Secretary of Health and Human Services, "the indictments outline various types of fraudulent schemes. Those schemes included compounded aerosol medications -- a process where a pharmacist makes medicine to meet a special medical need for a patient, rather than dispensing less expensive commercial pharmaceuticals. The indictments allege that the homemade medications were not necessary and that they were only prescribed to defraud Medicare.
"In one example, Eduardo Moreno, the owner of multiple DME companies, was arrested on April 7 after being named in a six-count indictment on fraud charges. Two of Moreno's companies - Brenda Medical Supply Inc., and Faster Medical Equipment Inc. - allegedly billed Medicare for more than $1.9 million for services that were not medically necessary. The FBI has seized of some of Moreno's assets, including a new Rolls Royce Phantom worth approximately $200,000.
Gonzales said that some of the 38 defendants allegedly paid Medicare recipients for use of their Medicare card numbers so that the defendants could submit fraudulent claims.
''We believe scores of shell companies have opened and obtained Medicare supplier numbers in Miami-Dade County alone,'' Gonzales said.
“The landscape for fraud in south Florida has changed dramatically over the past two years. CMS has taken aggressive action to curb infusion therapy fraud and other organized fraud actions,” said Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services. “We have opened two satellite offices that are dedicated to combating fraud in high-risk areas and we will soon be opening a third. We are sending a strong message to those who seek to defraud the programs that if they engage in fraudulent activity, they will be caught and no longer able to take advantage of the programs to their own gain.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 9, 2007
Texas Man Sentenced to 46 Months In Federal Prison for Bogus Flu Shot Scam
Iyad Abu El Hawa, who had pleaded guilty to charges of healthcare fraud, was sentenced last Monday to 46 months in federal prison for Medicare fraud and misbranding drugs stemming from an October 2005 health fair at Exxon Mobil, at which 1,100 employees and contractors received what they thought to be flu vaccines.
El Hawa,36, and several assistants filled the syringes with sterile water at the request of Martha Denise Gonzales, an unlicensed nurse who signed a field services contract with Exxon Mobil to deliver the flu vaccines, which at the time were extremely rare. Gonzales had already administered fake vaccines to 14 residents of a Houston-area senior care facility.
El Hawa's attorney had pressed for a lighter sentence — the charges carry a maximum of 10 years in prison and a $250,000 fine — because of El Hawa’s cooperation with federal prosecutors and investigators. However, the Government's motion for downward departure for a sentence below the recommended sentencing guideline range was also denied. The total amount of fine and restitution will be determined on May 14, 2007, the same date that sentencing is set for Gonzales.
Arguing that El Hawa should also bear the cost of the oil company's expenses incurred to screen those who received the bogus flu shots for possible infections, Assistant U.S. Attorney Suzanne Bradley Bradley said “The court has to abide by and embrace relevant conduct.” However, Judge Kenneth Hoyt did not verbally express agreement or disagreement, but he refused to officially take the incurred expenses off the sentencing table. “There has to be some accountability,” Hoyt said.
El Hawa, who carries both Israeli and Jordanian passports and is of Palestinian descent, will not be allowed to live in the United States once he is released from prison.
El Hawa’s wife, brother-in-law and a coworker were at Monday’s sentencing. When the sentence was read, El Hawa’s wife broke into tears, holding her face in her hands. Outside the courthouse, her grief turned to anger at the media, the FBI and Gonzales.
“My husband is a good man,” she said, echoing her husband's attorney's remarks that one episode of misconduct was not representative of El Hawa. Right now “It’s Arabs’ turn to be persecuted. It was just a big rush to judgment. The media reported all these things about me being unlicensed and me not being a citizen, when neither of those things are true. He made a mistake — he just got caught up with the wrong person.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In:
Bookmark: Contact
(954) 745-5840
Free Initial Consultation Topics
Durable Medical Equipment Fraud
HIPAA Violations
Insurance Fraud
Medicaid Fraud
Medicare Fraud
Sentencing Guidelines
Archives
October 2007
September 2007
July 2007
May 2007
April 2007
Subscribe
Subscribe By Email Go Contact Us
Name:
Email:
Phone:
Comments:
Submit Search this Blog
Search Recent Entries
October 18, 2007 10:13 PM
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy On October 10, 2007 Dmitry Rakovsky was sentenced by United...
September 21, 2007 10:05 AM
South Florida bills billions for HIV Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
September 18, 2007 8:30 AM
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering On September 6, 2007, Gianni Suarez Vazquez, a participant in...
September 16, 2007 12:15 PM
Miami Defendants Sentenced on Health Care Fraud On August 31, 2007, defendants Maricel Li and Marta Perez,...
September 7, 2007 4:45 PM
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam On August 28, 2007, a federal grand jury indicted the...
Legal Blogs
Orlando Car Accident Lawyer Blog (Ward & Caggiano)
Cruise Ship Law Blog (Lipcon, Margulies & Alsina)
LawSites (Robert Ambrogi)
New Jersey Criminal Defense Blog (Lependorf & Silverstein)
Michigan Collection Law Blog (Nitzkin & Associates)
Alabama Consumer Law Blog (Watts Law Group & M. Stan Herring)
Stock Broker Fraud Blog (Shepherd, Smith & Edwards)
The Credit Law Group Blog, P.C. (Credit Law Group)
Florida Personal Injury Lawyer Blog (Joseph I. Lipsky)
California Consumer Law Blog (Makler & Baker )
LawLawLaw (Erik Heels)
Orlando Injury Lawyer Blog (Ward & Caggiano)
Florida Injury Lawyer Blog (Flaxman & Lopez)
New Jersey Lemon Law Lawyer Blog (Carton & Rudnick)
Securities Fraud Attorney Blog (Rich & Intelisano)
Investment Fraud Lawyer Blog (Page Perry)
California Credit Law Blog (Kemnitzer, Anderson, Barron, Ogilvie & Brewer)
Miami Injury Lawyer Blog (Gerson & Schwartz)
Florida Injury Attorney Blog (Paige Trop & Ameen)
Expert Witness Blog (JurisPro Expert Witness Directory)
Indiana Consumer Lawyer Blog (Robert Duff)
Florida Criminal Law Blog (M. James Jenkins)
Florida DUI Lawyer Blog (William Ryan Moore)
Justia Law Review (Ken Chan & Tim Stanley)
Justia Legal Marketing Blog (Ken Chan & Tim Stanley)
Indiana Injury Lawyer Blog (Theodore F. Smith, Jr.)
One East Broward Boulevard, Suite 700, Fort Lauderdale, Florida 33301
Phone: (954) 745-5840
Home Website Privacy Policy Disclaimer Contact Us Website Map Blog Posts Copyright © Health Care Fraud Blog Justia Legal Website Design
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy
On October 10, 2007 Dmitry Rakovsky was sentenced by United States District Judge Marcia G. Cooke in Miami, Florida. Rakovsky was sentenced to a term of 59 months in prison, to be followed by a term of three years of supervised release. He was also ordered to forfeit property and pay restitution in the amount of $900,000.
Rakovsky, and co-defendants Boris Royzen and his wife Eva Royzen, were charged in a twenty-one (21) defendant, thirty-three (33) count health care fraud Indictment. The Indictment charged doctors, chiropractors, massage therapists, an office manager, and four medical clinics, Vista Mar Medical Rehab Corp., Plantation Medical Recovery Center, Inc., Romana Medical, Inc., and Dial Medical Rehab, Inc., with health care fraud. Rakovsky was the final defendant to be sentenced in this case.
Previously Boris Royzen was sentenced to 40 months in prison, followed by three years supervised release. He was also ordered to forfeit property and pay $1.8 million restitution. His wife, Eva, was previously sentenced to three years of probation, forfeit property and pay restitution in the amount of $1.8 million. The medical clinics were ordered to pay restitution as follows: Vista Mar: $70,674.08; Romana Medical: $20,641.85; Plantation Medical Recovery: $31,292.75; and Dial Medical: $13,818.06.
Continue reading "Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Insurance Fraud
Bookmark:
September 21, 2007
South Florida bills billions for HIV
September 21, 2007
From The Washington Times
By Jim McElhatton - Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
Federal health care regulators call the lopsided billing patterns "egregious" and warn that South Florida — particularly Broward, Miami-Dade and Palm Beach counties — is a potential hotbed for health care fraud, waste and abuse.
"It"s all ultimately part of the money-driven, underground economy in Miami," said Benson B. Weintraub, a health care fraud lawyer based in Fort Lauderdale.
According to a report this week by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.
Continue reading "South Florida bills billions for HIV" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
September 18, 2007
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering
On September 6, 2007, Gianni Suarez Vazquez, a participant in a massive Medicare fraud scheme, pled guilty in federal court in West palm Beach, Florida, to mail fraud and money laundering charges. He is scheduled to be sentenced before U.S. District Judge Donald M. Middlebrooks on November 15, 2007.
According to the court records, between November 2003 and August 2004, Suarez Vazquez incorporated or set up two medical equipment companies, GK Medical, Inc. and Suplident International Corporation, in Palm Beach County. Thereafter, he obtained Medicare provider numbers for both companies to enable the companies to submit claims directly to Medicare. To conceal his ownership and control of the companies, Suarez Vazquez designated "strawmen" as company owners, including his mother, on the corporate documents and Medicare Provider Agreements.
Continue reading "Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicaid Fraud
Bookmark:
September 16, 2007
Miami Defendants Sentenced on Health Care Fraud
On August 31, 2007, defendants Maricel Li and Marta Perez, both residents of Miami, were sentenced by United States District Court Judge James I. Cohn in Fort Lauderdale, Florida.
Li was sentenced to twenty-four (24) months' imprisonment, followed by three (3) years of supervised release. Li was also ordered to pay $556,519.85 in restitution. Perez was sentenced to five (5) months' imprisonment, to be followed by two (2) years of supervised release.
Both defendants had previously pled guilty. Defendant Li had pled guilty to an Information charging her with conspiracy to commit health care fraud violations and conspiracy to commit structuring violations. Defendant Perez had pled guilty to conspiracy to structure financial transactions.
Continue reading "Miami Defendants Sentenced on Health Care Fraud" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam
On August 28, 2007, a federal grand jury indicted the former operations director of A-Care EMS Inc. on charges that he sent fraudulent claims to the Centers for Medicare and Medicaid Services to pull in more money.
The indictment, filed Tuesday in the U.S. District Court for the Southern District of Texas, claims Rodney Lee Ramos, 34, of Weslaco, instructed emergency medical technicians to transport patients for dialysis who were not confined to bed."
According to the indictment, Ramos worked as an EMT coordinator for A-Stat Ambulance Services Inc., which was owned by Guadalupe Garces Jr. and Araceli Garces. Medicaid and Medicare placed a vendor hold on that ambulance provider -- withholding payment to the company -- after federal agents determined that the owners were defrauding the federal and state health insurance programs.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Florida Durable Medical Equipment Owner Convicted of Medicare Fraud
On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida.
After a jury trial at federal court in Miami, the jury found Marianela Smith guilty on all charged counts including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit health care fraud; and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.
Smith faces a maximum sentence of 30 years in prison. Prior to sentencing the U.S. Probation Office will complete a pre-sentence investigation and submit a Pre-Sentence Report to the judge for consideration. The PSI will contain an advisory guideline sentence which the court must consider in determining what type and length of sentence is sufficient, but not greater than necessary, to comply with the statutory directives set forth in 18 U.S.C. § 3553(a).
Smith is scheduled to be sentenced November 9, 2007, before U.S. District Court Judge Joan A. Lenard.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
July 12, 2007
Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing DisparityBy
Benson Weintraub [Benson Weintraub is a sentencing lawyer is Of-Counsel to the Law Offices of Robert David Malove, P.A.,in Fort Lauderdale and former Visiting Professor of Law at Hofstra University. While in law school, he worked on the Hoffa litigation under the direction of civil rights lawyer, Leonard Boudin.]
The political implications of Lewis Libby’s commutation of sentence by President Bush continue to reverberate, but this case summons memories of the suspicious circumstances under which President Nixon commuted the sentence of former Teamsters President, James R. Hoffa, 1971.
Hoffa and Libby were both convicted of obstruction of justice, but Hoffa had already served part of his thirteen-year sentence. That was enough to encourage exposure of the links between organized crime, the old International Brotherhood of Teamsters [IBT], and the intersection of such ties with money and politics.
Similarly, Bush and Cheney also appeared to fear that Libby’s imminent incarceration would lead him to cooperate with the Special Prosecutor, perhaps engendering a political scandal making Watergate look like a misdemeanor.
Continue reading "Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing Disparity" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Sentencing Guidelines
Bookmark:
May 25, 2007
Medicare Fraud Defendant Gets 10-Year Prison Term
On May 18, 2007, the US Attorney's Office reported that Jafet Garcia, a defendant in a massive South Florida Medicare fraud scheme, was sentenced in West Palm Beach Federal court to ten (10) years’ imprisonment.
According to the court file, the defendant and his partners purchased four medical equipment companies located in Miami-Dade and Palm Beach Counties, between February 2004 and December 2004. The defendant and his partners recruited individuals to pose as the owners of these companies. After setting up the companies, the defendant and his partners obtained patient and physician information which they used to prepare bogus prescriptions and/or certificates of medical necessity. The bogus prescriptions and certificates purported to authorize the provision of various types of medical equipment for the named Medicare beneficiaries; in truth, the prescriptions and certificates were prepared by the defendant and/or his accomplices and contained forged physicians’ signatures.
The defendant and/or his partners provided the bogus prescriptions and certificates to a Miami billing company for submission to Medicare. The billing company prepared Medicare claims which sought reimbursement for the cost of the equipment listed in the bogus prescriptions and certificates, even though such equipment was never authorized by a physician or provided to the beneficiaries. Medicare processed the fraudulent claims and issued reimbursement checks which the defendant and/or his accomplices cashed at a Miami check cashing store. The defendant and his partners would submit claims through a particular medical equipment company for only two to three months, close it and then begin billing through another company to avoid getting caught.
The four companies used by the defendant and his partners to defraud Medicare were Sunset Medical Corporation, King Medical Service and Supplies Corporation, Travelango Services Corp. and Clear Choice Home Health, Inc. During the course of the scheme, the defendant and his partners submitted more than $9 million in bogus Medicare claims.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 24, 2007
11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions
On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations.
The scheme involved transporting patients to the defendants’ pharmacies in exchange for illegal kickbacks for patients and doctors. However, no evidence indicated that Medicare was billed for unnecessary medical procedures. A confidential informant met with the defendants to exchange, for a fee, their checks for cash, admitted on cross-examination that one defendant, Medina, a secretary, was always sent out of the room to avoid her hearing them talk about the kickback scheme.
The Court also vacated the money laundering counts which related to the fraud counts it had set aside, since money laundering involves the proceeds of activity known by the defendants to be illegal.
The Court upheld the convictions of two defendants as to the general conspiracy charge, under 18 U.S.C. § 371, but vacated the secretary’s conviction, finding that her lack of awareness of the kickback conspiracy, and of the conspiracy’s other objectives, left insufficient evidence to
convict.
The Court remanded the case for resentencing and noted that the district court failed to make a sufficient loss calculation, and instead sentenced the defendants for the entire amount Medicare was billed in the period, without explanation. However, in the absence of evidence of Medicare’s payment of unnecessary medical claims, or that the patient kickback scheme resulted in any actual loss to Medicare, this calculation was inadequate.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 22, 2007
Feds Add More Resourses to Fight Healthcare Fraud
The Centers for Medicare & Medicaid Services Program Integrity Group at recently opened a field office in Santa Ana, California, aimed at preventing and prosecuting health care fraud.
"In the two years since the office has been up and running, we have been able to stop almost $2billion in inappropriate or improper payments from going out the door," program director Kimberly Brandt said.
Like the Medicare Fraud Strike Force office in South Florida that arrested 38 people for defrauding the federal program out of more than $142million, the Santa Ana office uses "data mining" technology to target fraudulent Medicare and Medicaid billings.
According to Assistant U.S. Attorney Consuelo Woodhead, who coordinates federal health care fraud prosecutions in Los Angeles, officials could double the number of law enforcement personnel fighting the problem and still fall short of having enough people to make a significant difference.
Woodhead thinks, that "to really effectively deal with the problem, we're going to have to take a multidisciplinary approach where you look at licensing and certification, how claims are processed, as well as strong criminal and civil enforcement after claims are paid."
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud
Bookmark:
May 10, 2007
Fed Fraud Strike Force Arrests 38 in South Florida Medicare Scam
On May 9, investigators said the arrests of 38 people are the result of an operation conducted by a strike force made up of a team of federal, state and local investigators who have been concentrating on Medicare fraud -- ''especially prevalent'' in South Florida -- since early March.
According to remarks made by Attorney General Alberto R. Gonzales at a press conference with Michael Leavitt, Secretary of Health and Human Services, "the indictments outline various types of fraudulent schemes. Those schemes included compounded aerosol medications -- a process where a pharmacist makes medicine to meet a special medical need for a patient, rather than dispensing less expensive commercial pharmaceuticals. The indictments allege that the homemade medications were not necessary and that they were only prescribed to defraud Medicare.
"In one example, Eduardo Moreno, the owner of multiple DME companies, was arrested on April 7 after being named in a six-count indictment on fraud charges. Two of Moreno's companies - Brenda Medical Supply Inc., and Faster Medical Equipment Inc. - allegedly billed Medicare for more than $1.9 million for services that were not medically necessary. The FBI has seized of some of Moreno's assets, including a new Rolls Royce Phantom worth approximately $200,000.
Gonzales said that some of the 38 defendants allegedly paid Medicare recipients for use of their Medicare card numbers so that the defendants could submit fraudulent claims.
''We believe scores of shell companies have opened and obtained Medicare supplier numbers in Miami-Dade County alone,'' Gonzales said.
“The landscape for fraud in south Florida has changed dramatically over the past two years. CMS has taken aggressive action to curb infusion therapy fraud and other organized fraud actions,” said Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services. “We have opened two satellite offices that are dedicated to combating fraud in high-risk areas and we will soon be opening a third. We are sending a strong message to those who seek to defraud the programs that if they engage in fraudulent activity, they will be caught and no longer able to take advantage of the programs to their own gain.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 9, 2007
Texas Man Sentenced to 46 Months In Federal Prison for Bogus Flu Shot Scam
Iyad Abu El Hawa, who had pleaded guilty to charges of healthcare fraud, was sentenced last Monday to 46 months in federal prison for Medicare fraud and misbranding drugs stemming from an October 2005 health fair at Exxon Mobil, at which 1,100 employees and contractors received what they thought to be flu vaccines.
El Hawa,36, and several assistants filled the syringes with sterile water at the request of Martha Denise Gonzales, an unlicensed nurse who signed a field services contract with Exxon Mobil to deliver the flu vaccines, which at the time were extremely rare. Gonzales had already administered fake vaccines to 14 residents of a Houston-area senior care facility.
El Hawa's attorney had pressed for a lighter sentence — the charges carry a maximum of 10 years in prison and a $250,000 fine — because of El Hawa’s cooperation with federal prosecutors and investigators. However, the Government's motion for downward departure for a sentence below the recommended sentencing guideline range was also denied. The total amount of fine and restitution will be determined on May 14, 2007, the same date that sentencing is set for Gonzales.
Arguing that El Hawa should also bear the cost of the oil company's expenses incurred to screen those who received the bogus flu shots for possible infections, Assistant U.S. Attorney Suzanne Bradley Bradley said “The court has to abide by and embrace relevant conduct.” However, Judge Kenneth Hoyt did not verbally express agreement or disagreement, but he refused to officially take the incurred expenses off the sentencing table. “There has to be some accountability,” Hoyt said.
El Hawa, who carries both Israeli and Jordanian passports and is of Palestinian descent, will not be allowed to live in the United States once he is released from prison.
El Hawa’s wife, brother-in-law and a coworker were at Monday’s sentencing. When the sentence was read, El Hawa’s wife broke into tears, holding her face in her hands. Outside the courthouse, her grief turned to anger at the media, the FBI and Gonzales.
“My husband is a good man,” she said, echoing her husband's attorney's remarks that one episode of misconduct was not representative of El Hawa. Right now “It’s Arabs’ turn to be persecuted. It was just a big rush to judgment. The media reported all these things about me being unlicensed and me not being a citizen, when neither of those things are true. He made a mistake — he just got caught up with the wrong person.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In:
Bookmark: Contact
(954) 745-5840
Free Initial Consultation Topics
Durable Medical Equipment Fraud
HIPAA Violations
Insurance Fraud
Medicaid Fraud
Medicare Fraud
Sentencing Guidelines
Archives
October 2007
September 2007
July 2007
May 2007
April 2007
Subscribe
Subscribe By Email Go Contact Us
Name:
Email:
Phone:
Comments:
Submit Search this Blog
Search Recent Entries
October 18, 2007 10:13 PM
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy On October 10, 2007 Dmitry Rakovsky was sentenced by United...
September 21, 2007 10:05 AM
South Florida bills billions for HIV Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
September 18, 2007 8:30 AM
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering On September 6, 2007, Gianni Suarez Vazquez, a participant in...
September 16, 2007 12:15 PM
Miami Defendants Sentenced on Health Care Fraud On August 31, 2007, defendants Maricel Li and Marta Perez,...
September 7, 2007 4:45 PM
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam On August 28, 2007, a federal grand jury indicted the...
Legal Blogs
Orlando Car Accident Lawyer Blog (Ward & Caggiano)
Cruise Ship Law Blog (Lipcon, Margulies & Alsina)
LawSites (Robert Ambrogi)
New Jersey Criminal Defense Blog (Lependorf & Silverstein)
Michigan Collection Law Blog (Nitzkin & Associates)
Alabama Consumer Law Blog (Watts Law Group & M. Stan Herring)
Stock Broker Fraud Blog (Shepherd, Smith & Edwards)
The Credit Law Group Blog, P.C. (Credit Law Group)
Florida Personal Injury Lawyer Blog (Joseph I. Lipsky)
California Consumer Law Blog (Makler & Baker )
LawLawLaw (Erik Heels)
Orlando Injury Lawyer Blog (Ward & Caggiano)
Florida Injury Lawyer Blog (Flaxman & Lopez)
New Jersey Lemon Law Lawyer Blog (Carton & Rudnick)
Securities Fraud Attorney Blog (Rich & Intelisano)
Investment Fraud Lawyer Blog (Page Perry)
California Credit Law Blog (Kemnitzer, Anderson, Barron, Ogilvie & Brewer)
Miami Injury Lawyer Blog (Gerson & Schwartz)
Florida Injury Attorney Blog (Paige Trop & Ameen)
Expert Witness Blog (JurisPro Expert Witness Directory)
Indiana Consumer Lawyer Blog (Robert Duff)
Florida Criminal Law Blog (M. James Jenkins)
Florida DUI Lawyer Blog (William Ryan Moore)
Justia Law Review (Ken Chan & Tim Stanley)
Justia Legal Marketing Blog (Ken Chan & Tim Stanley)
Indiana Injury Lawyer Blog (Theodore F. Smith, Jr.)
One East Broward Boulevard, Suite 700, Fort Lauderdale, Florida 33301
Phone: (954) 745-5840
Home Website Privacy Policy Disclaimer Contact Us Website Map Blog Posts Copyright © Health Care Fraud Blog Justia Legal Website Design
Tuesday, January 15, 2008
Sentenced to More Than 12 Years in Prison for conspiring to defraud Medicare, taking kickbacks and other related charges
Florida Pharmacy and Medicare Equipment Company Owner Sentenced to More Than 12 Years in Prison for Medicare Fraud (07-773)
WASHINGTON – The owner and operator of a Florida pharmacy and Durable Medicare Equipment (DME) company has been sentenced to 151 months in prison for Medicare fraud, (Read more)
FOR IMMEDIATE RELEASE
FRIDAY, SEPTEMBER 28, 2007
WWW.USDOJ.GOVCRM
(202) 514-2007
TDD (202) 514-1888
Florida Pharmacy and Medicare Equipment Company Owner Sentenced
to More Than 12 Years in Prison for Medicare Fraud
Medicare Fraud Strike Force Has Charged 120 Defendants With Medicare Fraud Since March
WASHINGTON – The owner and operator of a Florida pharmacy and Durable Medicare Equipment (DME) company has been sentenced to 151 months in prison for Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.
Nelson Valdes was sentenced yesterday by U.S. District Judge Cecilia M. Altonaga in Miami. Judge Altonaga also ordered Valdes to pay almost $3.5 million in restitution for the money he received in false claims. A federal jury in Miami convicted Valdes of conspiring to defraud Medicare, taking kickbacks and other related charges, after a five-day trial in July 2007. The guilty verdict represented the third time Valdes had been convicted of Medicare fraud.
Valdes owned Florida Pharmacy and Discount and F & M Medical Rentals Inc. from March of 2000 to July 2007. In September of 2001, Valdes conspired with the owners of Med-Pro Billing and Unimed Pharmacy to refer paid patients in exchange for half of what Medicare paid for “compounded” aerosols. Compounding refers to the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer.
After Unimed Pharmacy was shut down in 2003 by the FBI, Valdes obtained a pharmacy license through the assistance of Benjamin Metsch, an attorney convicted of Medicare fraud in 2006, and continued to compound medication for his paid patients. From 2001 to 2003, Unimed collected $7 million for aerosols, and from 2000 to 2007, Valdes' pharmacy and DME company collected in excess of $3 million for aerosols and equipment.
The compounding aerosol scheme was one of the most common health care frauds in south Florida. In 2006, the Medicare program paid for over $155 million worth of aerosol medications in Miami-Dade County, making it the single most common item billed to Medicare Part B. From 2005 to 2006, claims for these aerosol medications increased over 100 percent. In addition, according to Medicare data, Miami-Dade County alone accounted for more paid DME claims than every state in the country except California, Texas, New York, Michigan and Ohio.
The case was prosecuted by Deputy Chief Kirk Ogrosky and Trial Attorney John S. Darden from the Fraud Section of the Criminal Division, with the investigative assistance of the U.S. Department of Health and Human Services, Office of the Inspector General, the FBI, and the Medicaid Fraud Control Unit of the Florida Attorney General’s Office.
Since beginning operations in March of 2007, the strike force teams have indicted approximately 80 cases and 120 defendants in Miami-Dade County alone. The strike force teams are led by a federal prosecutor supervised by both the Criminal Division’s Fraud Section in Washington and the U.S. Attorney’s Office of the Southern District of Florida.
###
07-773
WASHINGTON – The owner and operator of a Florida pharmacy and Durable Medicare Equipment (DME) company has been sentenced to 151 months in prison for Medicare fraud, (Read more)
FOR IMMEDIATE RELEASE
FRIDAY, SEPTEMBER 28, 2007
WWW.USDOJ.GOVCRM
(202) 514-2007
TDD (202) 514-1888
Florida Pharmacy and Medicare Equipment Company Owner Sentenced
to More Than 12 Years in Prison for Medicare Fraud
Medicare Fraud Strike Force Has Charged 120 Defendants With Medicare Fraud Since March
WASHINGTON – The owner and operator of a Florida pharmacy and Durable Medicare Equipment (DME) company has been sentenced to 151 months in prison for Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.
Nelson Valdes was sentenced yesterday by U.S. District Judge Cecilia M. Altonaga in Miami. Judge Altonaga also ordered Valdes to pay almost $3.5 million in restitution for the money he received in false claims. A federal jury in Miami convicted Valdes of conspiring to defraud Medicare, taking kickbacks and other related charges, after a five-day trial in July 2007. The guilty verdict represented the third time Valdes had been convicted of Medicare fraud.
Valdes owned Florida Pharmacy and Discount and F & M Medical Rentals Inc. from March of 2000 to July 2007. In September of 2001, Valdes conspired with the owners of Med-Pro Billing and Unimed Pharmacy to refer paid patients in exchange for half of what Medicare paid for “compounded” aerosols. Compounding refers to the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer.
After Unimed Pharmacy was shut down in 2003 by the FBI, Valdes obtained a pharmacy license through the assistance of Benjamin Metsch, an attorney convicted of Medicare fraud in 2006, and continued to compound medication for his paid patients. From 2001 to 2003, Unimed collected $7 million for aerosols, and from 2000 to 2007, Valdes' pharmacy and DME company collected in excess of $3 million for aerosols and equipment.
The compounding aerosol scheme was one of the most common health care frauds in south Florida. In 2006, the Medicare program paid for over $155 million worth of aerosol medications in Miami-Dade County, making it the single most common item billed to Medicare Part B. From 2005 to 2006, claims for these aerosol medications increased over 100 percent. In addition, according to Medicare data, Miami-Dade County alone accounted for more paid DME claims than every state in the country except California, Texas, New York, Michigan and Ohio.
The case was prosecuted by Deputy Chief Kirk Ogrosky and Trial Attorney John S. Darden from the Fraud Section of the Criminal Division, with the investigative assistance of the U.S. Department of Health and Human Services, Office of the Inspector General, the FBI, and the Medicaid Fraud Control Unit of the Florida Attorney General’s Office.
Since beginning operations in March of 2007, the strike force teams have indicted approximately 80 cases and 120 defendants in Miami-Dade County alone. The strike force teams are led by a federal prosecutor supervised by both the Criminal Division’s Fraud Section in Washington and the U.S. Attorney’s Office of the Southern District of Florida.
###
07-773
More Than $515 Million to Resolve Allegations
September 28, 2007
Bristol-Myers Squibb to Pay More Than $515 Million to Resolve Allegations of Illegal Drug Marketing and Pricing (07-782)
Bristol-Myers Squibb to Pay More Than $515 Million to Resolve Allegations of Illegal Drug Marketing and Pricing (07-782)
27 hospitals, including two in Chicago, improperly charged Medicare for tens of millions of dollars in what the government says were non-approved, exp
Dec. 18, 2002
By Christine Woolsey
Subscribe to an RSS feed on this topic
Hospitals cited in Medicare suits
The Justice Department is intervening in dozens of lawsuits that allege 27 hospitals, including two in Chicago, improperly charged Medicare for tens of millions of dollars in what the government says were non-approved, experimental procedures performed from 1986 to 1995.
Among the facilities coming under fire are Northwestern Memorial Hospital and Foster G. McGaw Hospital of Loyola University of Chicago.
In a statement Tuesday, Northwestern said the care it provided Medicare patients between 1990 and 1993 involved medical devices that were "improvements or minor modifications of devices previously approved" by the U.S. Food and Drug Administration. The hospital said treatment protocols for the patients met Medicare's standard of reasonable and necessary care.
What's more, Northwestern said, the FDA ultimately approved the devices it used to treat the patients in question and "Medicare routinely pays for all these devices today."
The lawsuits were originally filed by whistleblower Kevin Cosens, a former medical device salesman, under the False Claims Act, which permits private citizens to file suit on behalf of the government and share in any recovery.
The actions announced Tuesday bring to 40 the number of hospitals the government is pursuing. Federal authorities have previously reached settlements with 31 hospitals for a total of roughly $42 million.
Northwestern said it will "vigorously defend" its treatment of the patients cited in the dispute.
By Christine Woolsey
Subscribe to an RSS feed on this topic
Hospitals cited in Medicare suits
The Justice Department is intervening in dozens of lawsuits that allege 27 hospitals, including two in Chicago, improperly charged Medicare for tens of millions of dollars in what the government says were non-approved, experimental procedures performed from 1986 to 1995.
Among the facilities coming under fire are Northwestern Memorial Hospital and Foster G. McGaw Hospital of Loyola University of Chicago.
In a statement Tuesday, Northwestern said the care it provided Medicare patients between 1990 and 1993 involved medical devices that were "improvements or minor modifications of devices previously approved" by the U.S. Food and Drug Administration. The hospital said treatment protocols for the patients met Medicare's standard of reasonable and necessary care.
What's more, Northwestern said, the FDA ultimately approved the devices it used to treat the patients in question and "Medicare routinely pays for all these devices today."
The lawsuits were originally filed by whistleblower Kevin Cosens, a former medical device salesman, under the False Claims Act, which permits private citizens to file suit on behalf of the government and share in any recovery.
The actions announced Tuesday bring to 40 the number of hospitals the government is pursuing. Federal authorities have previously reached settlements with 31 hospitals for a total of roughly $42 million.
Northwestern said it will "vigorously defend" its treatment of the patients cited in the dispute.
$3.2 MILLION TO SETTLE MEDICARE
FOR IMMEDIATE RELEASE
CIV
WEDNESDAY, AUGUST 23, 2000
(202) 514-2007
WWW.USDOJ.GOV
TDD (202) 514-1888
PENNSYLVANIA HOSPITAL TO PAY UNITED STATES
$3.2 MILLION TO SETTLE MEDICARE
BILLING ALLEGATIONS
WASHINGTON, D.C. -- Allegheny General Hospital in Pittsburgh, Pennsylvania, has agreed to pay $3.2 million to the United States to settle allegations that the facility billed Medicare for surgical procedures utilizing medical devices which had not been approved by the Food and Drug Administration (FDA), the Justice Department announced today.
The United States alleges that Allegheny had violated the False Claims Act by knowingly seeking payment for services that the hospital was aware were non-covered by Medicare and for which reimbursement was not permitted. Allegheny, together with the physicians who actually performed the procedures, submitted claims for more than 170 procedures performed on Medicare beneficiaries between September 1, 1988 and February 7, 1994, all of which involved so-called "investigational" or experimental devices.
"Today's settlement again demonstrates the United States' commitment to protecting its citizens from fraud and abuse," said David W. Ogden, Assistant Attorney General in charge of the Civil Division. "The Medicare system operates on the good faith and honesty of its providers, and we cannot tolerate misuse of the reimbursement system by facilities and practitioners who seek payment for non-covered services."
As part of the settlement, Allegheny will be required to conduct compliance activities related to procedures involving investigational devices for a period of five years. The compliance activities will include the education and training of Allegheny personnel in policies for the billing of investigational devices and procedures. Allegheny will be required to provide annual reports of its compliance activities.
"The rules for coverage limitations provide important protection to patients against fraud and abuse," said U.S. Attorney Harry Litman. "We will continue to be vigilant to keep providers from attempting to circumvent the requirements of federal law."
The settlement announced today stems from a qui tam or whistleblower lawsuit filed by a former medical device salesman. The whistleblower or "Relator" will receive a 20% share of the settlement amount.
The government's investigation was led by the Civil Division of the United States Attorney's Office for the Western District of Pennsylvania, in collaboration with the Commercial Litigation Branch of the Civil Division of the Department of Justice, and the Office of Inspector General of the Department of Health and Human Services.
###
00-497
CIV
WEDNESDAY, AUGUST 23, 2000
(202) 514-2007
WWW.USDOJ.GOV
TDD (202) 514-1888
PENNSYLVANIA HOSPITAL TO PAY UNITED STATES
$3.2 MILLION TO SETTLE MEDICARE
BILLING ALLEGATIONS
WASHINGTON, D.C. -- Allegheny General Hospital in Pittsburgh, Pennsylvania, has agreed to pay $3.2 million to the United States to settle allegations that the facility billed Medicare for surgical procedures utilizing medical devices which had not been approved by the Food and Drug Administration (FDA), the Justice Department announced today.
The United States alleges that Allegheny had violated the False Claims Act by knowingly seeking payment for services that the hospital was aware were non-covered by Medicare and for which reimbursement was not permitted. Allegheny, together with the physicians who actually performed the procedures, submitted claims for more than 170 procedures performed on Medicare beneficiaries between September 1, 1988 and February 7, 1994, all of which involved so-called "investigational" or experimental devices.
"Today's settlement again demonstrates the United States' commitment to protecting its citizens from fraud and abuse," said David W. Ogden, Assistant Attorney General in charge of the Civil Division. "The Medicare system operates on the good faith and honesty of its providers, and we cannot tolerate misuse of the reimbursement system by facilities and practitioners who seek payment for non-covered services."
As part of the settlement, Allegheny will be required to conduct compliance activities related to procedures involving investigational devices for a period of five years. The compliance activities will include the education and training of Allegheny personnel in policies for the billing of investigational devices and procedures. Allegheny will be required to provide annual reports of its compliance activities.
"The rules for coverage limitations provide important protection to patients against fraud and abuse," said U.S. Attorney Harry Litman. "We will continue to be vigilant to keep providers from attempting to circumvent the requirements of federal law."
The settlement announced today stems from a qui tam or whistleblower lawsuit filed by a former medical device salesman. The whistleblower or "Relator" will receive a 20% share of the settlement amount.
The government's investigation was led by the Civil Division of the United States Attorney's Office for the Western District of Pennsylvania, in collaboration with the Commercial Litigation Branch of the Civil Division of the Department of Justice, and the Office of Inspector General of the Department of Health and Human Services.
###
00-497
HCA - The Healthcare Company
FOR IMMEDIATE RELEASE
CIV
FRIDAY, JUNE 1, 2001
(202) 514-2007
WWW.USDOJ.GOV
TDD (202) 514-1888
JUSTICE DEPARTMENT ANNOUNCES SETTLEMENTS
AGAINST SEVEN HOSPITALS FOR OVER $5 MILLION
WASHINGTON, DC - Seven hospitals located around the country have agreed to pay the United States $5,476,637 to settle claims that they unlawfully charged federal health care programs for surgical procedures using experimental cardiac devices, the Justice Department announced today.
The devices had not been approved for marketing by the Food and Drug Administration (FDA) at the time the procedures were performed between 1987 and 1994. The United States maintained that the hospitals violated the False Claims Act by knowingly seeking federal reimbursement for services when they knew that Medicare and TRICARE, the military health care program, considered the procedures to be non-reimbursable.
Holy Cross Hospital in Ft. Lauderdale, Florida, will pay $2,830,208. HCA - The Healthcare Company, which operated Green Hospital of Scripps Clinic in San Diego, California, until November, 1991, and also owned Healthwest Regional Medical Center in Phoenix, Arizona; West Florida Regional Medical Center in Pensacola, Florida; and Miami Heart Institute in Miami, will pay $1,929,255. South Miami Hospital will pay $450,000 and Mt. Sinai Hospital, also in Miami, will pay $267,174.
The government had previously entered into settlements with other hospitals engaged in similar conduct. These other settlements resulted in payments of almost $13 million.
"Taxpayer-funded health insurers have a right and a duty to set responsible limits on the goods and services they will pay for," said Acting Assistant Attorney General Stuart Schiffer. "The hospitals in this case disregarded clear government coverage limitations in order to bill federal health care programs for procedures that they knew were not reimbursable. The Justice Department intends to pursue other hospitals that have engaged in the same conduct."
The settlement announced today stems from a qui tam or whistleblower lawsuit filed by Kevin Cosens, a former medical device salesman. Under the False Claims Act, private citizens can bring suit on behalf of the government and share in any awards that are obtained through that legal action. Mr. Cosens will receive $1,095,327. His attorneys will also receive reimbursement for legal fees from the settling hospitals.
The government's investigation was conducted by the Civil Division of the Department of Justice; the United States Attorney's Offices in the Southern District of Florida, the Southern District of California, and the Western District of Washington; the Office of Inspector General of the Department of Health and Human Services, and the Defense Criminal Investigative Service.
###
01-242
CIV
FRIDAY, JUNE 1, 2001
(202) 514-2007
WWW.USDOJ.GOV
TDD (202) 514-1888
JUSTICE DEPARTMENT ANNOUNCES SETTLEMENTS
AGAINST SEVEN HOSPITALS FOR OVER $5 MILLION
WASHINGTON, DC - Seven hospitals located around the country have agreed to pay the United States $5,476,637 to settle claims that they unlawfully charged federal health care programs for surgical procedures using experimental cardiac devices, the Justice Department announced today.
The devices had not been approved for marketing by the Food and Drug Administration (FDA) at the time the procedures were performed between 1987 and 1994. The United States maintained that the hospitals violated the False Claims Act by knowingly seeking federal reimbursement for services when they knew that Medicare and TRICARE, the military health care program, considered the procedures to be non-reimbursable.
Holy Cross Hospital in Ft. Lauderdale, Florida, will pay $2,830,208. HCA - The Healthcare Company, which operated Green Hospital of Scripps Clinic in San Diego, California, until November, 1991, and also owned Healthwest Regional Medical Center in Phoenix, Arizona; West Florida Regional Medical Center in Pensacola, Florida; and Miami Heart Institute in Miami, will pay $1,929,255. South Miami Hospital will pay $450,000 and Mt. Sinai Hospital, also in Miami, will pay $267,174.
The government had previously entered into settlements with other hospitals engaged in similar conduct. These other settlements resulted in payments of almost $13 million.
"Taxpayer-funded health insurers have a right and a duty to set responsible limits on the goods and services they will pay for," said Acting Assistant Attorney General Stuart Schiffer. "The hospitals in this case disregarded clear government coverage limitations in order to bill federal health care programs for procedures that they knew were not reimbursable. The Justice Department intends to pursue other hospitals that have engaged in the same conduct."
The settlement announced today stems from a qui tam or whistleblower lawsuit filed by Kevin Cosens, a former medical device salesman. Under the False Claims Act, private citizens can bring suit on behalf of the government and share in any awards that are obtained through that legal action. Mr. Cosens will receive $1,095,327. His attorneys will also receive reimbursement for legal fees from the settling hospitals.
The government's investigation was conducted by the Civil Division of the Department of Justice; the United States Attorney's Offices in the Southern District of Florida, the Southern District of California, and the Western District of Washington; the Office of Inspector General of the Department of Health and Human Services, and the Defense Criminal Investigative Service.
###
01-242
JUSTICE DEPARTMENT INTERVENES IN MEDICARE FRAUD CASE
FOR IMMEDIATE RELEASE
TUESDAY, APRIL 23, 2002
WWW.USDOJ.GOV
CIV
(202) 514-2007
TDD (202) 514-1888
JUSTICE DEPARTMENT INTERVENES IN MEDICARE FRAUD CASE
AGAINST DUKE UNIVERSITY MEDICAL CENTER
WASHINGTON, DC – The government has intervened in a suit that accuses Duke University Medical Center of defrauding the Medicare program, the Justice Department announced today. The suit alleges that the Durham, North Carolina hospital defrauded the federal health care program by charging Medicare for millions of dollars worth of procedures involving experimental cardiac devices that were not properly reimbursable. The allegations in the suit run from 1987 to 1994.
The qui tam or whistleblower lawsuit was originally filed by Kevin Cosens against a number of hospitals around the country. Under the False Claims Act, private citizens can file suit on behalf of the government and share in any recovery.
The government has previously entered into settlements with a number of hospital defendants in this case, recovering a total of over $29 million. The Justice Department continues to investigate a number of additional hospitals.
The case will be litigated jointly by the Justice Department's Civil Division and the United States Attorney's Office in the Middle District of North Carolina in Greensboro.
###
02-245
TUESDAY, APRIL 23, 2002
WWW.USDOJ.GOV
CIV
(202) 514-2007
TDD (202) 514-1888
JUSTICE DEPARTMENT INTERVENES IN MEDICARE FRAUD CASE
AGAINST DUKE UNIVERSITY MEDICAL CENTER
WASHINGTON, DC – The government has intervened in a suit that accuses Duke University Medical Center of defrauding the Medicare program, the Justice Department announced today. The suit alleges that the Durham, North Carolina hospital defrauded the federal health care program by charging Medicare for millions of dollars worth of procedures involving experimental cardiac devices that were not properly reimbursable. The allegations in the suit run from 1987 to 1994.
The qui tam or whistleblower lawsuit was originally filed by Kevin Cosens against a number of hospitals around the country. Under the False Claims Act, private citizens can file suit on behalf of the government and share in any recovery.
The government has previously entered into settlements with a number of hospital defendants in this case, recovering a total of over $29 million. The Justice Department continues to investigate a number of additional hospitals.
The case will be litigated jointly by the Justice Department's Civil Division and the United States Attorney's Office in the Middle District of North Carolina in Greensboro.
###
02-245
U.S. has previously reached settlements hospitals improperly charged Medicare for millions of dollars
JOHNS HOPKINS HOSPITAL AND METHODIST HOSPITALS OF MEMPHIS
ACCUSED OF MISCHARGING MEDICARE
WASHINGTON, DC – The United States has intervened in lawsuits alleging that Johns Hopkins Hospital in Baltimore, Maryland and Methodist Hospitals of Memphis mischarged the Medicare program, the Justice Department announced today. The suits allege that between 1986 and 1995, these hospitals improperly charged Medicare for millions of dollars worth of procedures involving experimental cardiac devices that had not been determined to be safe and effective, and were not properly reimbursable.
The lawsuits were originally filed by a whistleblower under the False Claims Act, which permits private citizens to file suit on behalf of the government and share in any recovery. The government intervened in both cases in August 2002 and filed its own complaints in December 2002, but the cases remained under seal until recently.
The government has previously announced its intervention in several dozen related lawsuits. Also, the U.S. has previously reached settlements with 31 hospitals for a total of roughly $42 million and is in the process of finalizing settlements with several other hospitals.
The cases will be litigated jointly by the Civil Division of the Department of Justice and the United States Attorney's Offices in the District of Maryland and the Western District of Tennessee.
###
03-016
ACCUSED OF MISCHARGING MEDICARE
WASHINGTON, DC – The United States has intervened in lawsuits alleging that Johns Hopkins Hospital in Baltimore, Maryland and Methodist Hospitals of Memphis mischarged the Medicare program, the Justice Department announced today. The suits allege that between 1986 and 1995, these hospitals improperly charged Medicare for millions of dollars worth of procedures involving experimental cardiac devices that had not been determined to be safe and effective, and were not properly reimbursable.
The lawsuits were originally filed by a whistleblower under the False Claims Act, which permits private citizens to file suit on behalf of the government and share in any recovery. The government intervened in both cases in August 2002 and filed its own complaints in December 2002, but the cases remained under seal until recently.
The government has previously announced its intervention in several dozen related lawsuits. Also, the U.S. has previously reached settlements with 31 hospitals for a total of roughly $42 million and is in the process of finalizing settlements with several other hospitals.
The cases will be litigated jointly by the Civil Division of the Department of Justice and the United States Attorney's Offices in the District of Maryland and the Western District of Tennessee.
###
03-016
Ohio hospitals mischarged the Medicare program millions of dollars
FOR IMMEDIATE RELEASE
TUESDAY, JULY 1, 2003
WWW.USDOJ.GOV
CIV
(202) 514-2007
TDD (202) 514-1888
JUSTICE DEPARTMENT INTERVENES IN MEDICARE
CASE AGAINST TWO CLEVELAND HOSPITALS
WASHINGTON, D.C. - The government has intervened and filed a complaint in a suit alleging that two Cleveland, Ohio hospitals mischarged the Medicare program, the Justice Department announced today. The suit alleges that between 1990 and 1995, Cleveland Clinic and University Hospitals of Cleveland improperly charged Medicare for millions of dollars worth of procedures involving experimental cardiac devices that were not properly reimbursable. The qui tam or whistleblower lawsuit was originally filed by Kevin Cosens, a former medical device salesman, against a number of hospitals around the country. Under the False Claims Act, private citizens can file suit on behalf of the government and share in any recovery.
By intervening, the government has joined Mr. Cosens in alleging that the two Cleveland hospitals improperly sought and received millions of dollars in Medicare reimbursement for these experimental procedures. The government intervened in this case in June 2002, but the case remained under seal until recently. The government has also intervened against 38 other hospitals in related cases that, with the Cleveland case, have now been consolidated for pre-trial purposes in Multidistrict Litigation in Connecticut. The government has also entered into settlements with thirty-four other hospital defendants, recovering a total of over $45 million.
The case will be litigated jointly by the Civil Division of the Department of Justice and the United States Attorney's Offices in the Northern District of Ohio and the District of Connecticut.
###
TUESDAY, JULY 1, 2003
WWW.USDOJ.GOV
CIV
(202) 514-2007
TDD (202) 514-1888
JUSTICE DEPARTMENT INTERVENES IN MEDICARE
CASE AGAINST TWO CLEVELAND HOSPITALS
WASHINGTON, D.C. - The government has intervened and filed a complaint in a suit alleging that two Cleveland, Ohio hospitals mischarged the Medicare program, the Justice Department announced today. The suit alleges that between 1990 and 1995, Cleveland Clinic and University Hospitals of Cleveland improperly charged Medicare for millions of dollars worth of procedures involving experimental cardiac devices that were not properly reimbursable. The qui tam or whistleblower lawsuit was originally filed by Kevin Cosens, a former medical device salesman, against a number of hospitals around the country. Under the False Claims Act, private citizens can file suit on behalf of the government and share in any recovery.
By intervening, the government has joined Mr. Cosens in alleging that the two Cleveland hospitals improperly sought and received millions of dollars in Medicare reimbursement for these experimental procedures. The government intervened in this case in June 2002, but the case remained under seal until recently. The government has also intervened against 38 other hospitals in related cases that, with the Cleveland case, have now been consolidated for pre-trial purposes in Multidistrict Litigation in Connecticut. The government has also entered into settlements with thirty-four other hospital defendants, recovering a total of over $45 million.
The case will be litigated jointly by the Civil Division of the Department of Justice and the United States Attorney's Offices in the Northern District of Ohio and the District of Connecticut.
###
TEXAS, WASHINGTON, OREGON & FLORIDA HOSPITALS
FOR IMMEDIATE RELEASE
FRIDAY, FEBRUARY 21, 2003
WWW.USDOJ.GOV
CIV
202) 514-2007
TDD (202) 514-1888
TEXAS, WASHINGTON, OREGON & FLORIDA HOSPITALS
TO PAY U.S. $4.9 MILLION IN CARDIAC DEVICES LITIGATION
WASHINGTON, D.C. – The United States has reached settlements with five hospitals in Texas, Washington, Oregon and Florida to pay the United States $4.9 million for the alleged billing of Medicare for medical procedures involving experimental cardiac devices, the Justice Department announced today. The suits allege that between 1986 and 1995, the hospitals unlawfully charged Medicare for procedures using the experimental devices which had not been approved by the Food and Drug Administration, in violation of the False Claims Act.
The case was originally brought by whistleblower Kevin Cosens, a former medical device salesman, against more than 100 hospital defendants. The government and Mr. Cosens have previously settled with 29 other defendants and continue to pursue their claims against 40 hospital defendants.
The Methodist Hospital and St. Luke's Episcopal Hospital in Houston, Texas agreed to pay the United States $2.75 million and $575,000, respectively. Deaconess Medical Center - Spokane in Washington will pay $775,000. Legacy Good Samaritan Hospital and Medical Center in Portland, Oregon will pay $410,000. Orlando Regional Medical Center in Florida agreed to pay $390,000. This latest group of settlements brings to over $45 million the total settlements collected in the nationwide cardiac devices false claims litigation.
Mr. Cosens will receive almost $1 million of the settlements announced today. Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in any recovery obtained by the government.
This case was handled by the Justice Department's Civil Division; the United States Attorneys' Offices in Houston, Texas; Spokane, Washington; Portland, Oregon; and Orlando, Florida; as well as the Office of Inspector General of the Department of Health and Human Services.
###
03-103
FRIDAY, FEBRUARY 21, 2003
WWW.USDOJ.GOV
CIV
202) 514-2007
TDD (202) 514-1888
TEXAS, WASHINGTON, OREGON & FLORIDA HOSPITALS
TO PAY U.S. $4.9 MILLION IN CARDIAC DEVICES LITIGATION
WASHINGTON, D.C. – The United States has reached settlements with five hospitals in Texas, Washington, Oregon and Florida to pay the United States $4.9 million for the alleged billing of Medicare for medical procedures involving experimental cardiac devices, the Justice Department announced today. The suits allege that between 1986 and 1995, the hospitals unlawfully charged Medicare for procedures using the experimental devices which had not been approved by the Food and Drug Administration, in violation of the False Claims Act.
The case was originally brought by whistleblower Kevin Cosens, a former medical device salesman, against more than 100 hospital defendants. The government and Mr. Cosens have previously settled with 29 other defendants and continue to pursue their claims against 40 hospital defendants.
The Methodist Hospital and St. Luke's Episcopal Hospital in Houston, Texas agreed to pay the United States $2.75 million and $575,000, respectively. Deaconess Medical Center - Spokane in Washington will pay $775,000. Legacy Good Samaritan Hospital and Medical Center in Portland, Oregon will pay $410,000. Orlando Regional Medical Center in Florida agreed to pay $390,000. This latest group of settlements brings to over $45 million the total settlements collected in the nationwide cardiac devices false claims litigation.
Mr. Cosens will receive almost $1 million of the settlements announced today. Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in any recovery obtained by the government.
This case was handled by the Justice Department's Civil Division; the United States Attorneys' Offices in Houston, Texas; Spokane, Washington; Portland, Oregon; and Orlando, Florida; as well as the Office of Inspector General of the Department of Health and Human Services.
###
03-103
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED
FOR IMMEDIATE RELEASE
THURSDAY, JUNE 26, 2003
WWW.USDOJ.GOV
CIV
(202) 514-2007
TDD (202) 514-1888
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED
HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION
WASHINGTON, D.C. - HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today.
This settlement marks the conclusion of the most comprehensive health care fraud investigation ever undertaken by the Justice Department, working with the Departments of Health and Human Services and Defense, the Office of Personnel Management and the states. The settlement announced today resolves HCA's civil liability for false claims resulting from a variety of allegedly unlawful practices, including cost report fraud and the payment of kickbacks to physicians.
Previously, on December 14, 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. Combined with today's separate administrative settlement with the Centers for Medicare & Medicaid Services (CMS), under which HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices, the government will have recovered $1.7 billion from HCA, by far the largest recovery ever reached by the government in a health care fraud investigation.
"Health care providers and professionals hold a public trust, and when that trust is violated by fraud and abuse of program funds, and by the payment of kickbacks to the physicians on whom patients and the programs rely for uncompromised medical judgment, health care for all Americans suffers," Robert D. McCallum, Jr., Assistant Attorney General for the Civil Division said. "This settlement brings to a close the largest multi-agency investigation of a health care provider that the United States government has ever undertaken and demonstrates the Department of Justice's ongoing resolve and commitment to pursue all types of fraud on American taxpayers, and health care program beneficiaries."
"Let this case be a continuing reminder to all that in the fight against health care fraud this office will not be deterred," said Acting Principal Deputy Inspector General Dara Corrigan. “Medicare dollars paid to provide ever more expensive health care services to the country's taxpayers should never be fraudulently diverted. This is our job and our trust and we take these duties very seriously," Corrigan concluded.
This latest settlement resolves fraud allegations against HCA and HCA hospitals in nine False Claims Act qui tam or whistleblower lawsuits pending in federal court in the District of Columbia. Under the federal False Claims Act, private individuals may file suit on behalf of the United States and, if the case is successful, may recover a share of the proceeds for their efforts. Under the settlement, the whistleblowers will receive a combined share of $151,591,500, the highest combined qui tam award ever paid out by the government.
"We are grateful for the assistance given by the whistleblowers over the course of the past nine years of investigation and litigation,” McCallum said. “And we are proud of the work of government personnel as well as counsel for the whistleblowers, who together pursued these matters through investigation and strenuous litigation. This result demonstrates the commitment of the Department to the qui tam statute and that the statute works as Congress intended."
Under the first of three agreements announced today, which becomes effective upon the court's dismissal of the lawsuits, HCA will pay nearly $620 million to resolve eight whistleblower lawsuits in which the government had intervened alleging that HCA systematically defrauded Medicare, Medicaid and other federally funded health care programs through schemes dating back to the late 1980s. HCA will pay an additional $11 million to resolve separate allegations of improper HCA billing practices.
The settlement requires HCA to pay:
$356 million to resolve whistleblower lawsuits alleging that HCA engaged in a series of schemes to defraud Medicare, Medicaid and TRICARE, the military’s health care program, through hospital cost reports, the year end claims submitted by hospitals to the government to reconcile payments received throughout the year with amounts they claim are actually owed. In 2001, a subsidiary of Nashville-based HCA, Columbia Management Companies, Inc., pled guilty in the Middle District of Florida to related charges on eight counts of making false statements to the United States and paid $22.6 million in criminal fines. An additional amount of $20 million of the settlement is being paid toward a resolution of cost reporting fraud allegations pursued separately by James Alderson and John Schilling, the relators who filed the lawsuits. In total, the two relators are to receive a total of $100 million as their statutory share of the settlement.
$225.5 million to resolve lawsuits alleging that HCA hospitals and home health agencies unlawfully billed Medicare, Medicaid and TRICARE for claims generated by the payment of kickbacks and other illegal remuneration to physicians in exchange for referral of patients. In 2001, Columbia Management Companies, Inc., pled guilty to one count of conspiracy to pay kickbacks and other monetary benefits to doctors in violation of the Medicare Antikickback Statute and paid a $30 million criminal fine. Dr. James Thompson, a doctor who filed suit against the company in 1995, will receive $41.5 million as his statutory share of the settlement. Gary King, a former HCA employee, will receive $5 million and Ann Mroz, a former HCA nurse, will receive a share of $837,500.
$17 million to resolve allegations that certain company-owned hospitals billed Medicare for unallowable costs incurred by a contractor that operated HCA wound care centers, and for a non-covered drug that the contractor manufactured and sold to hospital patients. The 2001 Columbia Management Companies' guilty plea concerning cost report fraud included a charge related to wound care center costs. HCA's wound care center management contractor, Curative Healthcare Services, Inc., previously paid $16.5 million to resolve related allegations pending at one time in these same lawsuits. Joseph "Mickey" Parslow, a former HCA financial officer, will receive $2,990,000 and Francesco Lanni, a former Reimbursement Manager at the Wound Care Center at New York Methodist Hospital in Brooklyn, New York, will receive a share of $680,000.
$5 million to resolve allegations concerning the transfer of patients from HCA facilities to other facilities and the claiming of excessive costs for those transfers.
$5 million to resolve allegations that HCA's Lawnwood Regional Medical Center in Fort Pierce, Florida submitted false claims in Medicare cost reports by inflating its entitlement to funds to treat indigent patients and by shifting employee salary costs in order to increase its reimbursement from the federal health care program.
$950,000 to settle allegations made by Michael Marine that HCA improperly shifted its home office costs to hospitals. Marine will receive a share of $116,500.
Today's settlement agreement incorporates the terms of a Corporate Integrity Agreement executed by HCA and the Office of the Inspector General, Department of Health and Human Services in December 2000 that obligated the company to engage in significant and comprehensive compliance efforts into 2009.
In a separate agreement, HCA agreed to pay $1.5 million to resolve allegations that an Atlanta, Georgia hospital, West Paces Medical Center, paid kickbacks for the referral of diabetes patients. Those allegations had been pursued since 1996 by a whistleblower in a case in which the United States had declined to intervene, captioned U.S. ex rel. Pogue v. American Healthcorp, Inc. et al.. Pogue, a former employee of a co-defendant in the case, Diabetes Treatment Centers of America, will receive a share of $405,000 from the HCA settlement. Pogue continues to litigate claims against his former employer and a group of Atlanta physicians.
Additionally, a state negotiating team appointed by the National Association of Medicaid Fraud Control Units has reached agreement with HCA to resolve related issues with affected state Medicaid plans for $17.5 million, representing direct state losses. The terms of that agreement are being finalized by the parties and are not part of today's settlement.
Today's administrative agreement between HCA and CMS will require HCA to pay CMS $250 million in order to resolve claims they maintained against each other arising from HCA's hospital cost reports and home office cost statements for cost reporting periods ending July 31, 2001. These claims resulted from HCA cost reports that were not processed since 1997 as a result of the government's investigation.
###
03-386
THURSDAY, JUNE 26, 2003
WWW.USDOJ.GOV
CIV
(202) 514-2007
TDD (202) 514-1888
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED
HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION
WASHINGTON, D.C. - HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today.
This settlement marks the conclusion of the most comprehensive health care fraud investigation ever undertaken by the Justice Department, working with the Departments of Health and Human Services and Defense, the Office of Personnel Management and the states. The settlement announced today resolves HCA's civil liability for false claims resulting from a variety of allegedly unlawful practices, including cost report fraud and the payment of kickbacks to physicians.
Previously, on December 14, 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. Combined with today's separate administrative settlement with the Centers for Medicare & Medicaid Services (CMS), under which HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices, the government will have recovered $1.7 billion from HCA, by far the largest recovery ever reached by the government in a health care fraud investigation.
"Health care providers and professionals hold a public trust, and when that trust is violated by fraud and abuse of program funds, and by the payment of kickbacks to the physicians on whom patients and the programs rely for uncompromised medical judgment, health care for all Americans suffers," Robert D. McCallum, Jr., Assistant Attorney General for the Civil Division said. "This settlement brings to a close the largest multi-agency investigation of a health care provider that the United States government has ever undertaken and demonstrates the Department of Justice's ongoing resolve and commitment to pursue all types of fraud on American taxpayers, and health care program beneficiaries."
"Let this case be a continuing reminder to all that in the fight against health care fraud this office will not be deterred," said Acting Principal Deputy Inspector General Dara Corrigan. “Medicare dollars paid to provide ever more expensive health care services to the country's taxpayers should never be fraudulently diverted. This is our job and our trust and we take these duties very seriously," Corrigan concluded.
This latest settlement resolves fraud allegations against HCA and HCA hospitals in nine False Claims Act qui tam or whistleblower lawsuits pending in federal court in the District of Columbia. Under the federal False Claims Act, private individuals may file suit on behalf of the United States and, if the case is successful, may recover a share of the proceeds for their efforts. Under the settlement, the whistleblowers will receive a combined share of $151,591,500, the highest combined qui tam award ever paid out by the government.
"We are grateful for the assistance given by the whistleblowers over the course of the past nine years of investigation and litigation,” McCallum said. “And we are proud of the work of government personnel as well as counsel for the whistleblowers, who together pursued these matters through investigation and strenuous litigation. This result demonstrates the commitment of the Department to the qui tam statute and that the statute works as Congress intended."
Under the first of three agreements announced today, which becomes effective upon the court's dismissal of the lawsuits, HCA will pay nearly $620 million to resolve eight whistleblower lawsuits in which the government had intervened alleging that HCA systematically defrauded Medicare, Medicaid and other federally funded health care programs through schemes dating back to the late 1980s. HCA will pay an additional $11 million to resolve separate allegations of improper HCA billing practices.
The settlement requires HCA to pay:
$356 million to resolve whistleblower lawsuits alleging that HCA engaged in a series of schemes to defraud Medicare, Medicaid and TRICARE, the military’s health care program, through hospital cost reports, the year end claims submitted by hospitals to the government to reconcile payments received throughout the year with amounts they claim are actually owed. In 2001, a subsidiary of Nashville-based HCA, Columbia Management Companies, Inc., pled guilty in the Middle District of Florida to related charges on eight counts of making false statements to the United States and paid $22.6 million in criminal fines. An additional amount of $20 million of the settlement is being paid toward a resolution of cost reporting fraud allegations pursued separately by James Alderson and John Schilling, the relators who filed the lawsuits. In total, the two relators are to receive a total of $100 million as their statutory share of the settlement.
$225.5 million to resolve lawsuits alleging that HCA hospitals and home health agencies unlawfully billed Medicare, Medicaid and TRICARE for claims generated by the payment of kickbacks and other illegal remuneration to physicians in exchange for referral of patients. In 2001, Columbia Management Companies, Inc., pled guilty to one count of conspiracy to pay kickbacks and other monetary benefits to doctors in violation of the Medicare Antikickback Statute and paid a $30 million criminal fine. Dr. James Thompson, a doctor who filed suit against the company in 1995, will receive $41.5 million as his statutory share of the settlement. Gary King, a former HCA employee, will receive $5 million and Ann Mroz, a former HCA nurse, will receive a share of $837,500.
$17 million to resolve allegations that certain company-owned hospitals billed Medicare for unallowable costs incurred by a contractor that operated HCA wound care centers, and for a non-covered drug that the contractor manufactured and sold to hospital patients. The 2001 Columbia Management Companies' guilty plea concerning cost report fraud included a charge related to wound care center costs. HCA's wound care center management contractor, Curative Healthcare Services, Inc., previously paid $16.5 million to resolve related allegations pending at one time in these same lawsuits. Joseph "Mickey" Parslow, a former HCA financial officer, will receive $2,990,000 and Francesco Lanni, a former Reimbursement Manager at the Wound Care Center at New York Methodist Hospital in Brooklyn, New York, will receive a share of $680,000.
$5 million to resolve allegations concerning the transfer of patients from HCA facilities to other facilities and the claiming of excessive costs for those transfers.
$5 million to resolve allegations that HCA's Lawnwood Regional Medical Center in Fort Pierce, Florida submitted false claims in Medicare cost reports by inflating its entitlement to funds to treat indigent patients and by shifting employee salary costs in order to increase its reimbursement from the federal health care program.
$950,000 to settle allegations made by Michael Marine that HCA improperly shifted its home office costs to hospitals. Marine will receive a share of $116,500.
Today's settlement agreement incorporates the terms of a Corporate Integrity Agreement executed by HCA and the Office of the Inspector General, Department of Health and Human Services in December 2000 that obligated the company to engage in significant and comprehensive compliance efforts into 2009.
In a separate agreement, HCA agreed to pay $1.5 million to resolve allegations that an Atlanta, Georgia hospital, West Paces Medical Center, paid kickbacks for the referral of diabetes patients. Those allegations had been pursued since 1996 by a whistleblower in a case in which the United States had declined to intervene, captioned U.S. ex rel. Pogue v. American Healthcorp, Inc. et al.. Pogue, a former employee of a co-defendant in the case, Diabetes Treatment Centers of America, will receive a share of $405,000 from the HCA settlement. Pogue continues to litigate claims against his former employer and a group of Atlanta physicians.
Additionally, a state negotiating team appointed by the National Association of Medicaid Fraud Control Units has reached agreement with HCA to resolve related issues with affected state Medicaid plans for $17.5 million, representing direct state losses. The terms of that agreement are being finalized by the parties and are not part of today's settlement.
Today's administrative agreement between HCA and CMS will require HCA to pay CMS $250 million in order to resolve claims they maintained against each other arising from HCA's hospital cost reports and home office cost statements for cost reporting periods ending July 31, 2001. These claims resulted from HCA cost reports that were not processed since 1997 as a result of the government's investigation.
###
03-386
HCA INC/TN ; subpoenas requesting records
ITEM 3. LEGAL PROCEEDINGS.
FEDERAL AND STATE INVESTIGATIONS
In March 1997, various facilities of the Company's El Paso, Texas operations
were searched by federal authorities pursuant to search warrants, and the
government removed various records and documents. In February 1998, an
additional warrant was executed and a single computer was seized. The Company
believes it may be a target in this investigation.
In July 1997, various Company affiliated facilities and offices were
searched pursuant to search warrants issued by the United States District
Court in several states. During July, September and November 1997, the Company
was also served with subpoenas requesting records and documents related to laboratory billing, diagnosis related group ("DRG") coding and home health operations in various states. In January 1998, the Company received a subpoena which requested records and documents relating to physician relationships.
Also, in July 1997, the United States District Court for the Middle District
of Florida, in Fort Myers, issued an indictment against three employees of a
subsidiary of the Company. The indictment relates to the alleged false
characterization of interest payments on certain debt resulting in Medicare
and CHAMPUS overpayments since 1986 to Columbia Fawcett Memorial Hospital, a
Port Charlotte, Florida hospital that was acquired by the Company in 1992. The
Company has been served with subpoenas for various records and documents.
The Company is cooperating in these investigations and understands it is a
target in these investigations.
In addition, several hospital facilities affiliated with the Company have
received individual governmental inquiries, both informal and formal,
requesting information related to reimbursement from government programs.
While it is too early to predict the outcome of any of the ongoing
investigations or the initiation of any additional investigations, were the
Company to be found in violation of federal or state laws relating to
Medicare, Medicaid or similar programs, the Company could be subject to
substantial monetary fines, civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Any such sanctions could
have a material adverse effect on the Company's financial position and results
of operations. See NOTE 15 of the notes to consolidated financial statements.
The Company is the subject of a formal order of investigation by the
Securities and Exchange Commission (the "Commission"). The Company understands
that the investigation includes the anti-fraud, periodic reporting and
internal accounting control provisions of the federal securities laws.
QUI TAM ACTIONS
Several qui tam actions have been brought by private parties ("relators") on
behalf of the United States of America. To the best of the Company's
knowledge, the actions allege, in general, that the Company and certain
subsidiaries and/or affiliated partnerships violated the False Claims Act for
improper claims submitted to the government for reimbursement. The government
has declined to intervene in any qui tam actions filed to date.
21
The matter of United States of America, ex rel. Scott Pogue v. American
Healthcorp, Inc., et al. (Civil Action No. 3-94-0515) was filed under seal on
June 23, 1994, in the United States District Court for the Middle District of
Tennessee. On February 6, 1995, the United States filed its Notice of Non-
Intervention and on that same date, the District Court ordered the Complaint
unsealed. The relator contends that sums paid to Medical Directors by the
Diabetes Treatment Centers of America and those who served as Medical
Directors at a hospital or facility affiliated with the Company, were, in
fact, unlawful payments for the referrals of their patients.
A lawsuit captioned United States of America ex rel. James Thompson v.
Columbia/HCA Healthcare Corporation, et al, was filed on March 10, 1995 in the
United States District Court for the Southern District of Texas, Corpus
Christi Division (Civil Action No. C-95-110). The relator claims that the
defendants (the Company and certain subsidiaries and affiliated partnerships)
engaged in a widespread strategy to pay physicians money for referrals and
engaged in other conduct to induce referrals, such as: (i) offering physicians
equity interests in hospitals; (ii) offering loans to physicians; (iii) paying
money under the guise of "consultation fees" to physicians to guarantee their
capital investment; (iv) paying consultation fees, rent or other monies to
physicians; (v) providing free or reduced rate rents for office space; (vi)
providing free or reduced-rate vacations and trips; (viii) providing income
guarantees; and (ix) granting physicians exclusive rights to perform
procedures in particular fields of practice. The lawsuit is premised on
alleged violations of the False Claims Act, 31 U.S.C. (S)3729 et seq. The
complaint seeks damages of three times the amount of all Medicare or Medicaid
claims (involving false claims) presented by the defendants to the federal
government, a civil penalty of not less than $5,000 nor more than $10,000 for
each such Medicare or Medicaid claim, attorneys' fees and costs. Although
expressly permitted to do so, the United States has thus far declined to
intervene in the case and assume prosecution of the claims asserted by the
relator. The defendants filed a Motion to Dismiss the Second Amended Complaint
on November 29, 1995, which was granted by the Court on July 22, 1996. On
August 20, 1996, the relator appealed to the United States Court of Appeals
for the Fifth Circuit and, on October 23, 1997, the Fifth Circuit affirmed in
part and vacated and remanded in part the Trial Court's rulings.
On or around December 21, 1995, a matter entitled United States of America,
ex rel. Roy Meidinger v. Lee Memorial Health Systems, Case No. 95-423-FTM-99D,
was filed in the United States District Court for the Middle District Court of
Florida, Fort Myers Division. In this matter, the plaintiff filed under seal,
a False Claims Act case against approximately 2,500 health care providers and
insurance companies, including Columbia Southwest Regional Medical Center. On
December 16, 1996, the United States declined to intervene. In June 1997, the
District Court entered an order directing plaintiff to serve the defendants.
In late November and early December 1997, each of the six defendants moved to
dismiss the Complaint. On January 20, 1998, plaintiff filed his opposition to
the defendant's motion to dismiss. The Court has not yet ruled on the
defendant's motions.
The matter of United States of American, ex rel. Sandra Russell; and Sandra
Russell in her own right v. EPIC Healthcare Management Group, and Hearthstone
Home Health, Inc. d/b/a Continue Care Health Services, No. H-95-00151, was
filed in the United States District Court for the Southern District of Texas,
Houston Division, in January, 1995. This matter was filed under seal. The
Complaint alleges that the relator was required to submit claims, records
and/or statements for Medicare reimbursement which were false. The government
declined to intervene in May 1996, and the defendant moved to dismiss in May
1997. No ruling has been made on the motion to dismiss.
The Company intends to pursue the defense of the Qui Tam actions vigorously.
22
SHAREHOLDER DERIVATIVE AND CLASS ACTION COMPLAINTS FILED IN THE U.S.
DISTRICT COURTS
Since April 8, 1997, numerous securities class action and derivative
lawsuits have been filed in the United States District Court for the Middle
District of Tennessee against the Company and a number of its current and
former directors, officers and employees.
On August 26, 1997, the Court entered an order consolidating all of the
securities class action claims into a single-captioned case, Morse v.
McWhorter, Case No. 3-97-0370. All of the other individual securities class
action lawsuits were administratively closed by the Court. The consolidated
Morse lawsuit is a purported class action seeking the certification of a class
of persons or entities who acquired the Company's common stock from April 9,
1994 to September 9, 1997. The consolidated lawsuit is brought against the
Company, Richard Scott, David Vandewater, Thomas Frist, Jr., R. Clayton
McWhorter, Carl E. Reichardt, Magdalena Averhoff, M.D., T. Michael Long, and
Donald S. MacNaughton. The lawsuit alleges, among other things, that the
defendants committed violations of the federal securities laws by materially
inflating the Company's revenues and earnings through a number of practices,
including upcoding, maintaining reserve cost reports, disseminating false and
misleading statements, cost shifting, illegal reimbursements, improper
billing, unbundling, and violating various Medicare laws. The lawsuit seeks
compensatory damages, costs, and expenses. Plaintiffs filed their Motion for
Class Certification on February 11, 1998. The defendants' motions to dismiss
and motion for oral argument have been referred to the Magistrate Judge for
consideration.
On August 26, 1997, the Court entered an order consolidating all of the
derivative law claims into a single-captioned case, McCall v. Scott, No. 3-97-
0838. All of the other derivative lawsuits were administratively closed by the
Court. The consolidated McCall lawsuit is brought against the Company, Thomas
Frist, Jr., Richard L. Scott, David T. Vandewater, R. Clayton McWhorter,
Magdalena Averhoff, M.D., Frank S. Royal, M.D., T. Michael Long, William T.
Young and Donald S. MacNaughton. The lawsuit alleges, among other things,
derivative claims against the individual defendants that they intentionally or
negligently breached their fiduciary duties to the Company by authorizing,
permitting, or failing to prevent the Company from engaging in various schemes
to improperly increase revenue, upcoding, improper cost reporting, improper
referrals, improper acquisition practices, and overbilling. In addition, the
lawsuit asserts a derivative claim against some of the individual defendants
for breaching their fiduciary duties by engaging in insider trading. The
lawsuit seeks restitution, damages, recoupment of fines or penalties paid by
the Company, restitution and pre-judgment interest against the alleged insider
trading defendants, and costs and disbursements. In addition, the lawsuit
seeks orders: (i) prohibiting the Company from paying individual defendants
employment benefits, (ii) terminating all improper business relationships with
individual defendants, and (iii) requiring the Company to implement effective
corporate governance and internal control mechanisms designed to monitor
compliance with federal and state laws and ensure reports to the Board of
Material Violations.
The matter of Landgraff v. Columbia/HCA Healthcare Corporation was filed on
November 7, 1997, in the United States District Court for the Northern
District of Georgia, Atlanta Division, Civil Action No. 97-CV-3381. The suit
seeks certification of a class of all participants in the Columbia/HCA Stock
Bonus Plan, alleging violations of ERISA. The suit alleges the Company
breached its fiduciary duty to plan participants, fraudulently concealed
information from the public and fraudulently inflated the Company's stock
price through billing fraud and illegal kickbacks for physician referrals. On
January 9, 1998, the parties stipulated to transfer venue of the case to the
United States District Court for the Middle District of Tennessee. Defendants
filed a Motion to Dismiss on March 6, 1998.
The Company intends to pursue the defense of these Shareholder Derivative
and Class Action Complaints vigorously.
23
SHAREHOLDER DERIVATIVE ACTIONS FILED IN STATE COURTS
Several derivative actions have been filed in State Court by certain
purported stockholders of the Company against certain of the Company's current
and former officers and directors alleging breach of fiduciary duty, and
failure to take reasonable steps to ensure that the Company did not engage in
illegal practices thereby exposing the Company to significant damages. The
Company intends to pursue the defense of these shareholder derivative actions
vigorously.
Two purported derivative actions entitled Evelyn Barron, et al. v. Magdalena
Averhoff, et al. (Civil Action No. 15822NC) and John Kovalchick v. Magdalena
Averhoff, et al. (Civil Action No. 15829NC) have been filed in the Court of
Chancery of the State of Delaware in and for New Castle County. The actions
were brought on behalf of the Company by certain purported shareholders of the
Company against certain of the Company's current and former officers and
directors. On approximately August 14, 1997, a similar purported derivative
action entitled State Board of Administration of Florida v. Magdalena
Averhoff, et al. (No. 97-2729) was filed in the Circuit Court in Davidson
County, Tennessee on behalf of the Company by certain purported shareholders
of the Company against certain of the Company's current and former directors
and officers.
The matter of Louisiana State Employees Retirement System v. Averhoff, et al
and Columbia/HCA Healthcare Corporation, another derivative action, was filed
on March 20, 1998, in the Circuit Court of the Eleventh Judicial Circuit, Dade
County, Florida, General Jurisdiction Division, Case No. 98-6050 CA04. The
Louisiana State Employees Retirement System is the public pension fund of the
State of Louisiana. The suit alleges breach of fiduciary duties resulting in
damage to the Company's good will, business reputation and the ability to
consummate future mergers and acquisitions.
PATIENT/PAYER ACTIONS
The Company has from time to time received several purported class action
lawsuits which have been filed by patients or payers against the Company
and/or certain of its current and former officers and directors alleging, in
general, improper and fraudulent billing, coding and physician referrals, as
well as other violations of law.
The matter of Boysen v. Columbia/HCA Healthcare Corporation was filed
September 8, 1997, in the United States District Court for the Middle District
of Tennessee, Nashville Division, (Civil Action No. 3-97-0936). The lawsuit,
which seeks certification of a national class comprised of all persons or
entities who have paid for medical services provided by the Company, alleges,
among other things, that the Company has engaged in a pattern and practice of
(i) inflating diagnosis and medical treatments of its patients to receive
larger payments from the purported class members; (ii) providing unnecessary
medical care; and (iii) billing for services never rendered. The lawsuit seeks
equitable relief in the form of an accounting, as well as damages, attorneys'
fees and costs of suit. The Company filed its Answer on November 17, 1997.
Plaintiff has filed a Motion for Class Certification, and the Company's
opposition to this motion was filed in March 1998.
The matter of Brown v. Columbia/HCA Healthcare Corporation was filed on
November 28, 1995, in the Circuit Court of Palm Beach County, Florida, Case
No. 95-9102 AD. This suit alleges that the hospital has charged excessive
amounts for pharmaceuticals, medical supplies, laboratory tests, medical
equipment and related medical services such as x-rays. The suit seeks
certification of a nationwide class, and damages for patients who have paid
bills containing allegedly excessive amounts for the allegedly unreasonable
portion of the charges and attorneys' fees. The Company filed a Motion to
Dismiss on December 18, 1995, and an Amended Motion to Dismiss on January 3,
1996. Plaintiff amended the Complaint and the Company filed an Answer and
defenses on June 19, 1996. On October 15, 1997, Harald Jackson moved to
intervene in the lawsuit. The Court denied Jackson's Motion on December 19,
1997. No class has been certified. Discovery is ongoing.
24
On October 27, 1997, Colville v. Columbia/Palm Drive Hospital was filed in
the Sonoma County Superior Court, California, Case No. 217646. The suit seeks
certification of a class comprised of uninsured patients treated at the
Company's hospitals and entities in California who have been treated and
charged different fees than any other patient. The suit alleges that the
Company fraudulently overcharged the plaintiffs and that it unlawfully charges
uninsured patients at a higher rate for the same services, compared to
patients with insurance or Medicare. On March 6, 1998, the Company filed a
Demurrer Motion and Motion to Quash. A hearing is set for May 13, 1998.
Doe v. HCA Health Services of Tennessee, Inc. dba Donelson Hospital fka
Summit Medical Center is a class action suit filed on August 17, 1992 in the
First Circuit Court for Davidson County, Tennessee. This suit claims the
Company's charges for hospital services and supplies for medical services (a
hysterectomy in the plaintiff's case) exceeded the reasonable costs of its
goods and services, that the overcharges constitute a breach of contract and
an unfair or deceptive trade practice within the meaning of the Tennessee
Consumer Protection Act, and a breach of the duty of good faith and fair
dealing under Tennessee statute and common law. In 1997, this case was
certified as a class action consisting of all past, present and future
patients at Summit Medical Center. Defendant filed a Motion for Summary
Judgment relying upon the favorable decision of another Nashville Circuit
Judge in a factually similar case. In March 1997, the Court denied the Motion
for Summary Judgment and has ordered the parties into mediation.
The matter of Douglas v. Columbia/HCA Healthcare Corporation is a class
action filed on March 5, 1998, in the Circuit Court of Cook County, Illinois,
County Department, Chancery Division, Case No. 98 02942. This suit alleges
that defendants were involved in fraudulent and deceptive acts including
wrongful billing, unnecessary treatment and wrongful diagnosis of patients
with illnesses that necessitate higher medical fees for financial gain. This
matter was served on March 18, 1998 and no answer has been filed at this time.
Ferguson v. Columbia/HCA Healthcare Corporation was filed on September 16,
1997, in the Circuit Court for Washington County, Tennessee, Civil Action No.
18679. This lawsuit seeks certification of a national class comprised of all
those who paid or were responsible for payment of any portion of a bill for
medical care or treatment provided by the Company and alleges, among other
things, that the Company engaged in billing fraud by excessively billing
patients for services rendered, billing patients for services not rendered or
not medically necessary, uniformly using improper codes to report patient
diagnosis, and improperly and illegally recruiting doctors to refer patients
to the Company's hospitals. Plaintiff filed a Motion for Class Certification
on September 16, 1997. On December 15, 1997, the Company filed a Motion for
Summary Judgment. On January 28, 1998, plaintiff filed a Motion for Leave to
File a Second Amended Class Action Complaint to Add an Additional Class
Representative.
The matter of Hoop v. Columbia/HCA Healthcare Corporation was filed on
August 18, 1997, in the District Court of Johnson County, Texas, Civil Action
No. 249-171-97. This suit seeks certification of a class in Texas comprised of
persons who paid for any portion of an improper or fraudulent bill for medical
services rendered by any Texas facility owned or operated by the Company. The
lawsuit alleges the Company perpetrated a fraudulent scheme that consisted of
systematic and routine overbilling through false and inaccurate bills,
including padding, billing for services never provided, and exaggerating the
seriousness of patients' illnesses. The lawsuit alleges the Company
systematically entered into illegal kickback schemes with doctors for patient
referrals. The Company filed its answer on November 7, 1997.
The matter of Jackson v. Columbia/HCA Healthcare Corporation was filed on
December 23, 1997, in the Circuit Court, Palm Beach County, Florida, Civil
Action No. 97-011419. The suit seeks certification of a national class of
persons or entities that have paid for medical services,
25
alleging the Company systematically and unlawfully inflated prices, concealed
its practice of inflating prices and engaged in and concealed a uniform
practice of overbilling.
The matter of Johnson v. Plantation General Hospital was filed on August 5,
1991, in the Circuit Court for the Seventeenth Judicial Circuit, State of
Florida, Broward County, Case No. 92-06823 Div. 2. The suit alleges the
hospital charged excessive amounts for pharmaceuticals, medical supplies and
laboratory tests. The suit sought certification of a class, a price reduction
on all outstanding bills in the amount of the allegedly excessive portion of
the charges, damages for patients who have paid bills containing allegedly
excessive amounts for the alleged unreasonable portion of the charges and
attorneys' fees. On September 18, 1995, the trial court certified the class
and the Fourth District Court of Appeal affirmed. On October 22, 1996, the
hospital filed a Motion for Summary Judgment on Counts II and III on the basis
of the voluntary payment defense. The Court granted the motion on November 19,
1997. Count I is still pending. Trial has been set for June 29, 1998.
The matter of Operating Engineers Local No. 312 Health & Welfare Fund v.
Columbia/HCA Healthcare Corporation was filed on October 6, 1997 in the United
States District Court for the Eastern District of Texas, Civil Action No.
597CV203. The suit alleges four counts of violations of RICO. The alleged RICO
violations are based on allegations that the Company has employed one or more
schemes or artifices to defraud the plaintiff and purported class members
through fraudulent billing for services not performed, fraudulent overcharging
in excess of correct rates and fraudulent concealment and misrepresentation.
On October 22, 1997, the Company filed a Motion to Transfer Venue and to
Dismiss the Lawsuit on Jurisdiction and Venue Grounds because the RICO claims
are deficient. The motion to transfer was denied on January 23, 1998. The
motion to dismiss has not yet been ruled upon.
The Company denies the aforementioned allegations and intends to pursue the
defense of these actions vigorously.
While it is premature to predict the outcome of the qui tam, shareholder
derivative and class action lawsuits, the amounts claimed may be substantial.
It is possible that an adverse resolution, individually or in the aggregate,
could have a materially adverse impact on the Company's liquidity, financial
position and results of operations. See NOTE 15 of the notes to consolidated
financial statements.
The Company believes the ongoing investigations, qui tam, shareholder cases,
class action overcharging cases and related media coverage are having a
negative effect on the Company's financial position and results of operations.
However, the Company is unable to measure the effect or predict the magnitude
that these matters and the related media coverage could have on the Company's
future results of operations and financial position.
GENERAL LIABILITY CLAIMS
The Company is subject to claims and suits arising in the ordinary course of
business, including claims for personal injuries or for wrongful restriction
of, or interference with, physicians' staff privileges. In certain of these
actions the claimants have asked for punitive damages against the Company,
which are usually not covered by insurance. In the opinion of management, the
ultimate resolution of these pending claims and legal proceedings will not
have a material adverse effect on the Company's results of operations or
financial position.
A class action styled Mary Forsyth, et al v. Humana, Inc., et al, Case No.
CV-S-89-249-DWH, was filed on March 29, 1989, in the United States District
Court for the District of Nevada (the "Forsyth" case). Plaintiffs are two
classes of individuals who paid for, or received coverage under, group
insurance policies sold in the State of Nevada by Humana Insurance. They
allege violations
26
of antitrust laws, ERISA and RICO which arise from the sale of the policies
and from incentives provided under the policies for insureds to use Humana
Sunrise Hospital in Las Vegas. In 1993, the United States District Court
granted summary judgment dismissing most of plaintiff's claims but granted
plaintiffs judgment on one claim that the client assesses as having a maximum
exposure of under $4 million, plus attorney's fees. Plaintiffs appealed to the
United States Court of Appeals for the Ninth Circuit which, on May 23, 1997,
affirmed the judgment on the ERISA claims; reversed as to the antitrust
claims; and reversed in part as to the RICO claims, but affirmed the District
Court's grant of summary judgment limiting RICO damages to three times the
ERISA damages, with exposure assessed at under $12 million. Plaintiffs claim
approximately $133 million in antitrust damages that is subject to statutory
trebling. Humana has petitioned the Supreme Court for a Writ of Certiorari on
the RICO claims, which is pending. The antitrust claims have been remanded to
the United States District Court in Nevada. Trial of these claims is stayed
pending a decision on the Petition for Writ of Certiorari. Humana has filed a
Motion for Summary Judgment on all remaining antitrust claims raising issues
that were not reached by the District Court. The court vacated the February
trial date and set oral argument for January 30, 1998. The Court has ordered
that a status report be filed on March 23, 1998.
On December 4, 1997, a lawsuit captioned Florida Software Systems, Inc., a
Florida corporation v. Columbia/HCA Healthcare Corporation, a Delaware
corporation, was filed in the United States District Court for the Middle
District of Florida (Civil Action No. 97-2866-C.V.-T-17b). The lawsuit alleges
that the Company breached an agreement under which Florida Software Systems,
Inc. was allegedly granted the exclusive right to provide medical claims
management for certain claims made by the Company for payment to any third
party payors in connection with the rendition of medical care or services. The
lawsuit alleges claims for fraud, breach of implied contract, and breach of
contract. The lawsuit seeks compensatory and punitive damages, attorney's fees
and costs of the suit. The Company believes that the allegations in the
Complaint are without merit and intends to pursue the defense of this action
vigorously.
FEDERAL AND STATE INVESTIGATIONS
In March 1997, various facilities of the Company's El Paso, Texas operations
were searched by federal authorities pursuant to search warrants, and the
government removed various records and documents. In February 1998, an
additional warrant was executed and a single computer was seized. The Company
believes it may be a target in this investigation.
In July 1997, various Company affiliated facilities and offices were
searched pursuant to search warrants issued by the United States District
Court in several states. During July, September and November 1997, the Company
was also served with subpoenas requesting records and documents related to laboratory billing, diagnosis related group ("DRG") coding and home health operations in various states. In January 1998, the Company received a subpoena which requested records and documents relating to physician relationships.
Also, in July 1997, the United States District Court for the Middle District
of Florida, in Fort Myers, issued an indictment against three employees of a
subsidiary of the Company. The indictment relates to the alleged false
characterization of interest payments on certain debt resulting in Medicare
and CHAMPUS overpayments since 1986 to Columbia Fawcett Memorial Hospital, a
Port Charlotte, Florida hospital that was acquired by the Company in 1992. The
Company has been served with subpoenas for various records and documents.
The Company is cooperating in these investigations and understands it is a
target in these investigations.
In addition, several hospital facilities affiliated with the Company have
received individual governmental inquiries, both informal and formal,
requesting information related to reimbursement from government programs.
While it is too early to predict the outcome of any of the ongoing
investigations or the initiation of any additional investigations, were the
Company to be found in violation of federal or state laws relating to
Medicare, Medicaid or similar programs, the Company could be subject to
substantial monetary fines, civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Any such sanctions could
have a material adverse effect on the Company's financial position and results
of operations. See NOTE 15 of the notes to consolidated financial statements.
The Company is the subject of a formal order of investigation by the
Securities and Exchange Commission (the "Commission"). The Company understands
that the investigation includes the anti-fraud, periodic reporting and
internal accounting control provisions of the federal securities laws.
QUI TAM ACTIONS
Several qui tam actions have been brought by private parties ("relators") on
behalf of the United States of America. To the best of the Company's
knowledge, the actions allege, in general, that the Company and certain
subsidiaries and/or affiliated partnerships violated the False Claims Act for
improper claims submitted to the government for reimbursement. The government
has declined to intervene in any qui tam actions filed to date.
21
The matter of United States of America, ex rel. Scott Pogue v. American
Healthcorp, Inc., et al. (Civil Action No. 3-94-0515) was filed under seal on
June 23, 1994, in the United States District Court for the Middle District of
Tennessee. On February 6, 1995, the United States filed its Notice of Non-
Intervention and on that same date, the District Court ordered the Complaint
unsealed. The relator contends that sums paid to Medical Directors by the
Diabetes Treatment Centers of America and those who served as Medical
Directors at a hospital or facility affiliated with the Company, were, in
fact, unlawful payments for the referrals of their patients.
A lawsuit captioned United States of America ex rel. James Thompson v.
Columbia/HCA Healthcare Corporation, et al, was filed on March 10, 1995 in the
United States District Court for the Southern District of Texas, Corpus
Christi Division (Civil Action No. C-95-110). The relator claims that the
defendants (the Company and certain subsidiaries and affiliated partnerships)
engaged in a widespread strategy to pay physicians money for referrals and
engaged in other conduct to induce referrals, such as: (i) offering physicians
equity interests in hospitals; (ii) offering loans to physicians; (iii) paying
money under the guise of "consultation fees" to physicians to guarantee their
capital investment; (iv) paying consultation fees, rent or other monies to
physicians; (v) providing free or reduced rate rents for office space; (vi)
providing free or reduced-rate vacations and trips; (viii) providing income
guarantees; and (ix) granting physicians exclusive rights to perform
procedures in particular fields of practice. The lawsuit is premised on
alleged violations of the False Claims Act, 31 U.S.C. (S)3729 et seq. The
complaint seeks damages of three times the amount of all Medicare or Medicaid
claims (involving false claims) presented by the defendants to the federal
government, a civil penalty of not less than $5,000 nor more than $10,000 for
each such Medicare or Medicaid claim, attorneys' fees and costs. Although
expressly permitted to do so, the United States has thus far declined to
intervene in the case and assume prosecution of the claims asserted by the
relator. The defendants filed a Motion to Dismiss the Second Amended Complaint
on November 29, 1995, which was granted by the Court on July 22, 1996. On
August 20, 1996, the relator appealed to the United States Court of Appeals
for the Fifth Circuit and, on October 23, 1997, the Fifth Circuit affirmed in
part and vacated and remanded in part the Trial Court's rulings.
On or around December 21, 1995, a matter entitled United States of America,
ex rel. Roy Meidinger v. Lee Memorial Health Systems, Case No. 95-423-FTM-99D,
was filed in the United States District Court for the Middle District Court of
Florida, Fort Myers Division. In this matter, the plaintiff filed under seal,
a False Claims Act case against approximately 2,500 health care providers and
insurance companies, including Columbia Southwest Regional Medical Center. On
December 16, 1996, the United States declined to intervene. In June 1997, the
District Court entered an order directing plaintiff to serve the defendants.
In late November and early December 1997, each of the six defendants moved to
dismiss the Complaint. On January 20, 1998, plaintiff filed his opposition to
the defendant's motion to dismiss. The Court has not yet ruled on the
defendant's motions.
The matter of United States of American, ex rel. Sandra Russell; and Sandra
Russell in her own right v. EPIC Healthcare Management Group, and Hearthstone
Home Health, Inc. d/b/a Continue Care Health Services, No. H-95-00151, was
filed in the United States District Court for the Southern District of Texas,
Houston Division, in January, 1995. This matter was filed under seal. The
Complaint alleges that the relator was required to submit claims, records
and/or statements for Medicare reimbursement which were false. The government
declined to intervene in May 1996, and the defendant moved to dismiss in May
1997. No ruling has been made on the motion to dismiss.
The Company intends to pursue the defense of the Qui Tam actions vigorously.
22
SHAREHOLDER DERIVATIVE AND CLASS ACTION COMPLAINTS FILED IN THE U.S.
DISTRICT COURTS
Since April 8, 1997, numerous securities class action and derivative
lawsuits have been filed in the United States District Court for the Middle
District of Tennessee against the Company and a number of its current and
former directors, officers and employees.
On August 26, 1997, the Court entered an order consolidating all of the
securities class action claims into a single-captioned case, Morse v.
McWhorter, Case No. 3-97-0370. All of the other individual securities class
action lawsuits were administratively closed by the Court. The consolidated
Morse lawsuit is a purported class action seeking the certification of a class
of persons or entities who acquired the Company's common stock from April 9,
1994 to September 9, 1997. The consolidated lawsuit is brought against the
Company, Richard Scott, David Vandewater, Thomas Frist, Jr., R. Clayton
McWhorter, Carl E. Reichardt, Magdalena Averhoff, M.D., T. Michael Long, and
Donald S. MacNaughton. The lawsuit alleges, among other things, that the
defendants committed violations of the federal securities laws by materially
inflating the Company's revenues and earnings through a number of practices,
including upcoding, maintaining reserve cost reports, disseminating false and
misleading statements, cost shifting, illegal reimbursements, improper
billing, unbundling, and violating various Medicare laws. The lawsuit seeks
compensatory damages, costs, and expenses. Plaintiffs filed their Motion for
Class Certification on February 11, 1998. The defendants' motions to dismiss
and motion for oral argument have been referred to the Magistrate Judge for
consideration.
On August 26, 1997, the Court entered an order consolidating all of the
derivative law claims into a single-captioned case, McCall v. Scott, No. 3-97-
0838. All of the other derivative lawsuits were administratively closed by the
Court. The consolidated McCall lawsuit is brought against the Company, Thomas
Frist, Jr., Richard L. Scott, David T. Vandewater, R. Clayton McWhorter,
Magdalena Averhoff, M.D., Frank S. Royal, M.D., T. Michael Long, William T.
Young and Donald S. MacNaughton. The lawsuit alleges, among other things,
derivative claims against the individual defendants that they intentionally or
negligently breached their fiduciary duties to the Company by authorizing,
permitting, or failing to prevent the Company from engaging in various schemes
to improperly increase revenue, upcoding, improper cost reporting, improper
referrals, improper acquisition practices, and overbilling. In addition, the
lawsuit asserts a derivative claim against some of the individual defendants
for breaching their fiduciary duties by engaging in insider trading. The
lawsuit seeks restitution, damages, recoupment of fines or penalties paid by
the Company, restitution and pre-judgment interest against the alleged insider
trading defendants, and costs and disbursements. In addition, the lawsuit
seeks orders: (i) prohibiting the Company from paying individual defendants
employment benefits, (ii) terminating all improper business relationships with
individual defendants, and (iii) requiring the Company to implement effective
corporate governance and internal control mechanisms designed to monitor
compliance with federal and state laws and ensure reports to the Board of
Material Violations.
The matter of Landgraff v. Columbia/HCA Healthcare Corporation was filed on
November 7, 1997, in the United States District Court for the Northern
District of Georgia, Atlanta Division, Civil Action No. 97-CV-3381. The suit
seeks certification of a class of all participants in the Columbia/HCA Stock
Bonus Plan, alleging violations of ERISA. The suit alleges the Company
breached its fiduciary duty to plan participants, fraudulently concealed
information from the public and fraudulently inflated the Company's stock
price through billing fraud and illegal kickbacks for physician referrals. On
January 9, 1998, the parties stipulated to transfer venue of the case to the
United States District Court for the Middle District of Tennessee. Defendants
filed a Motion to Dismiss on March 6, 1998.
The Company intends to pursue the defense of these Shareholder Derivative
and Class Action Complaints vigorously.
23
SHAREHOLDER DERIVATIVE ACTIONS FILED IN STATE COURTS
Several derivative actions have been filed in State Court by certain
purported stockholders of the Company against certain of the Company's current
and former officers and directors alleging breach of fiduciary duty, and
failure to take reasonable steps to ensure that the Company did not engage in
illegal practices thereby exposing the Company to significant damages. The
Company intends to pursue the defense of these shareholder derivative actions
vigorously.
Two purported derivative actions entitled Evelyn Barron, et al. v. Magdalena
Averhoff, et al. (Civil Action No. 15822NC) and John Kovalchick v. Magdalena
Averhoff, et al. (Civil Action No. 15829NC) have been filed in the Court of
Chancery of the State of Delaware in and for New Castle County. The actions
were brought on behalf of the Company by certain purported shareholders of the
Company against certain of the Company's current and former officers and
directors. On approximately August 14, 1997, a similar purported derivative
action entitled State Board of Administration of Florida v. Magdalena
Averhoff, et al. (No. 97-2729) was filed in the Circuit Court in Davidson
County, Tennessee on behalf of the Company by certain purported shareholders
of the Company against certain of the Company's current and former directors
and officers.
The matter of Louisiana State Employees Retirement System v. Averhoff, et al
and Columbia/HCA Healthcare Corporation, another derivative action, was filed
on March 20, 1998, in the Circuit Court of the Eleventh Judicial Circuit, Dade
County, Florida, General Jurisdiction Division, Case No. 98-6050 CA04. The
Louisiana State Employees Retirement System is the public pension fund of the
State of Louisiana. The suit alleges breach of fiduciary duties resulting in
damage to the Company's good will, business reputation and the ability to
consummate future mergers and acquisitions.
PATIENT/PAYER ACTIONS
The Company has from time to time received several purported class action
lawsuits which have been filed by patients or payers against the Company
and/or certain of its current and former officers and directors alleging, in
general, improper and fraudulent billing, coding and physician referrals, as
well as other violations of law.
The matter of Boysen v. Columbia/HCA Healthcare Corporation was filed
September 8, 1997, in the United States District Court for the Middle District
of Tennessee, Nashville Division, (Civil Action No. 3-97-0936). The lawsuit,
which seeks certification of a national class comprised of all persons or
entities who have paid for medical services provided by the Company, alleges,
among other things, that the Company has engaged in a pattern and practice of
(i) inflating diagnosis and medical treatments of its patients to receive
larger payments from the purported class members; (ii) providing unnecessary
medical care; and (iii) billing for services never rendered. The lawsuit seeks
equitable relief in the form of an accounting, as well as damages, attorneys'
fees and costs of suit. The Company filed its Answer on November 17, 1997.
Plaintiff has filed a Motion for Class Certification, and the Company's
opposition to this motion was filed in March 1998.
The matter of Brown v. Columbia/HCA Healthcare Corporation was filed on
November 28, 1995, in the Circuit Court of Palm Beach County, Florida, Case
No. 95-9102 AD. This suit alleges that the hospital has charged excessive
amounts for pharmaceuticals, medical supplies, laboratory tests, medical
equipment and related medical services such as x-rays. The suit seeks
certification of a nationwide class, and damages for patients who have paid
bills containing allegedly excessive amounts for the allegedly unreasonable
portion of the charges and attorneys' fees. The Company filed a Motion to
Dismiss on December 18, 1995, and an Amended Motion to Dismiss on January 3,
1996. Plaintiff amended the Complaint and the Company filed an Answer and
defenses on June 19, 1996. On October 15, 1997, Harald Jackson moved to
intervene in the lawsuit. The Court denied Jackson's Motion on December 19,
1997. No class has been certified. Discovery is ongoing.
24
On October 27, 1997, Colville v. Columbia/Palm Drive Hospital was filed in
the Sonoma County Superior Court, California, Case No. 217646. The suit seeks
certification of a class comprised of uninsured patients treated at the
Company's hospitals and entities in California who have been treated and
charged different fees than any other patient. The suit alleges that the
Company fraudulently overcharged the plaintiffs and that it unlawfully charges
uninsured patients at a higher rate for the same services, compared to
patients with insurance or Medicare. On March 6, 1998, the Company filed a
Demurrer Motion and Motion to Quash. A hearing is set for May 13, 1998.
Doe v. HCA Health Services of Tennessee, Inc. dba Donelson Hospital fka
Summit Medical Center is a class action suit filed on August 17, 1992 in the
First Circuit Court for Davidson County, Tennessee. This suit claims the
Company's charges for hospital services and supplies for medical services (a
hysterectomy in the plaintiff's case) exceeded the reasonable costs of its
goods and services, that the overcharges constitute a breach of contract and
an unfair or deceptive trade practice within the meaning of the Tennessee
Consumer Protection Act, and a breach of the duty of good faith and fair
dealing under Tennessee statute and common law. In 1997, this case was
certified as a class action consisting of all past, present and future
patients at Summit Medical Center. Defendant filed a Motion for Summary
Judgment relying upon the favorable decision of another Nashville Circuit
Judge in a factually similar case. In March 1997, the Court denied the Motion
for Summary Judgment and has ordered the parties into mediation.
The matter of Douglas v. Columbia/HCA Healthcare Corporation is a class
action filed on March 5, 1998, in the Circuit Court of Cook County, Illinois,
County Department, Chancery Division, Case No. 98 02942. This suit alleges
that defendants were involved in fraudulent and deceptive acts including
wrongful billing, unnecessary treatment and wrongful diagnosis of patients
with illnesses that necessitate higher medical fees for financial gain. This
matter was served on March 18, 1998 and no answer has been filed at this time.
Ferguson v. Columbia/HCA Healthcare Corporation was filed on September 16,
1997, in the Circuit Court for Washington County, Tennessee, Civil Action No.
18679. This lawsuit seeks certification of a national class comprised of all
those who paid or were responsible for payment of any portion of a bill for
medical care or treatment provided by the Company and alleges, among other
things, that the Company engaged in billing fraud by excessively billing
patients for services rendered, billing patients for services not rendered or
not medically necessary, uniformly using improper codes to report patient
diagnosis, and improperly and illegally recruiting doctors to refer patients
to the Company's hospitals. Plaintiff filed a Motion for Class Certification
on September 16, 1997. On December 15, 1997, the Company filed a Motion for
Summary Judgment. On January 28, 1998, plaintiff filed a Motion for Leave to
File a Second Amended Class Action Complaint to Add an Additional Class
Representative.
The matter of Hoop v. Columbia/HCA Healthcare Corporation was filed on
August 18, 1997, in the District Court of Johnson County, Texas, Civil Action
No. 249-171-97. This suit seeks certification of a class in Texas comprised of
persons who paid for any portion of an improper or fraudulent bill for medical
services rendered by any Texas facility owned or operated by the Company. The
lawsuit alleges the Company perpetrated a fraudulent scheme that consisted of
systematic and routine overbilling through false and inaccurate bills,
including padding, billing for services never provided, and exaggerating the
seriousness of patients' illnesses. The lawsuit alleges the Company
systematically entered into illegal kickback schemes with doctors for patient
referrals. The Company filed its answer on November 7, 1997.
The matter of Jackson v. Columbia/HCA Healthcare Corporation was filed on
December 23, 1997, in the Circuit Court, Palm Beach County, Florida, Civil
Action No. 97-011419. The suit seeks certification of a national class of
persons or entities that have paid for medical services,
25
alleging the Company systematically and unlawfully inflated prices, concealed
its practice of inflating prices and engaged in and concealed a uniform
practice of overbilling.
The matter of Johnson v. Plantation General Hospital was filed on August 5,
1991, in the Circuit Court for the Seventeenth Judicial Circuit, State of
Florida, Broward County, Case No. 92-06823 Div. 2. The suit alleges the
hospital charged excessive amounts for pharmaceuticals, medical supplies and
laboratory tests. The suit sought certification of a class, a price reduction
on all outstanding bills in the amount of the allegedly excessive portion of
the charges, damages for patients who have paid bills containing allegedly
excessive amounts for the alleged unreasonable portion of the charges and
attorneys' fees. On September 18, 1995, the trial court certified the class
and the Fourth District Court of Appeal affirmed. On October 22, 1996, the
hospital filed a Motion for Summary Judgment on Counts II and III on the basis
of the voluntary payment defense. The Court granted the motion on November 19,
1997. Count I is still pending. Trial has been set for June 29, 1998.
The matter of Operating Engineers Local No. 312 Health & Welfare Fund v.
Columbia/HCA Healthcare Corporation was filed on October 6, 1997 in the United
States District Court for the Eastern District of Texas, Civil Action No.
597CV203. The suit alleges four counts of violations of RICO. The alleged RICO
violations are based on allegations that the Company has employed one or more
schemes or artifices to defraud the plaintiff and purported class members
through fraudulent billing for services not performed, fraudulent overcharging
in excess of correct rates and fraudulent concealment and misrepresentation.
On October 22, 1997, the Company filed a Motion to Transfer Venue and to
Dismiss the Lawsuit on Jurisdiction and Venue Grounds because the RICO claims
are deficient. The motion to transfer was denied on January 23, 1998. The
motion to dismiss has not yet been ruled upon.
The Company denies the aforementioned allegations and intends to pursue the
defense of these actions vigorously.
While it is premature to predict the outcome of the qui tam, shareholder
derivative and class action lawsuits, the amounts claimed may be substantial.
It is possible that an adverse resolution, individually or in the aggregate,
could have a materially adverse impact on the Company's liquidity, financial
position and results of operations. See NOTE 15 of the notes to consolidated
financial statements.
The Company believes the ongoing investigations, qui tam, shareholder cases,
class action overcharging cases and related media coverage are having a
negative effect on the Company's financial position and results of operations.
However, the Company is unable to measure the effect or predict the magnitude
that these matters and the related media coverage could have on the Company's
future results of operations and financial position.
GENERAL LIABILITY CLAIMS
The Company is subject to claims and suits arising in the ordinary course of
business, including claims for personal injuries or for wrongful restriction
of, or interference with, physicians' staff privileges. In certain of these
actions the claimants have asked for punitive damages against the Company,
which are usually not covered by insurance. In the opinion of management, the
ultimate resolution of these pending claims and legal proceedings will not
have a material adverse effect on the Company's results of operations or
financial position.
A class action styled Mary Forsyth, et al v. Humana, Inc., et al, Case No.
CV-S-89-249-DWH, was filed on March 29, 1989, in the United States District
Court for the District of Nevada (the "Forsyth" case). Plaintiffs are two
classes of individuals who paid for, or received coverage under, group
insurance policies sold in the State of Nevada by Humana Insurance. They
allege violations
26
of antitrust laws, ERISA and RICO which arise from the sale of the policies
and from incentives provided under the policies for insureds to use Humana
Sunrise Hospital in Las Vegas. In 1993, the United States District Court
granted summary judgment dismissing most of plaintiff's claims but granted
plaintiffs judgment on one claim that the client assesses as having a maximum
exposure of under $4 million, plus attorney's fees. Plaintiffs appealed to the
United States Court of Appeals for the Ninth Circuit which, on May 23, 1997,
affirmed the judgment on the ERISA claims; reversed as to the antitrust
claims; and reversed in part as to the RICO claims, but affirmed the District
Court's grant of summary judgment limiting RICO damages to three times the
ERISA damages, with exposure assessed at under $12 million. Plaintiffs claim
approximately $133 million in antitrust damages that is subject to statutory
trebling. Humana has petitioned the Supreme Court for a Writ of Certiorari on
the RICO claims, which is pending. The antitrust claims have been remanded to
the United States District Court in Nevada. Trial of these claims is stayed
pending a decision on the Petition for Writ of Certiorari. Humana has filed a
Motion for Summary Judgment on all remaining antitrust claims raising issues
that were not reached by the District Court. The court vacated the February
trial date and set oral argument for January 30, 1998. The Court has ordered
that a status report be filed on March 23, 1998.
On December 4, 1997, a lawsuit captioned Florida Software Systems, Inc., a
Florida corporation v. Columbia/HCA Healthcare Corporation, a Delaware
corporation, was filed in the United States District Court for the Middle
District of Florida (Civil Action No. 97-2866-C.V.-T-17b). The lawsuit alleges
that the Company breached an agreement under which Florida Software Systems,
Inc. was allegedly granted the exclusive right to provide medical claims
management for certain claims made by the Company for payment to any third
party payors in connection with the rendition of medical care or services. The
lawsuit alleges claims for fraud, breach of implied contract, and breach of
contract. The lawsuit seeks compensatory and punitive damages, attorney's fees
and costs of the suit. The Company believes that the allegations in the
Complaint are without merit and intends to pursue the defense of this action
vigorously.
Monday, January 14, 2008
Friday, January 11, 2008
U S Attorney.....FRAUD......about time
US Attorney Reports Indictment Unsealed Against Diagnostic Exam Operators In Health Care Fraud
Posted on Tuesday, January 08, 2008
LAWFUEL - US Litigation - R. Alexander Acosta, United States Attorney for the Southern District of Florida; Melody Jackson, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General, Atlanta Region; Michael K. Fithen, Special Agent in Charge, United States Secret Service; and Chief Carlos Noriega, Miami Beach Police Department, announced that two defendants charged in a health care fraud ring were arrested earlier today.
The indictment, which was unsealed this morning upon the defendants’ arrests, charges Joaquin Alonso, a/k/a “Kiki Alonso,” and Luis Polanco with conspiracy to defraud the Medicare program, in violation of 18 U.S.C. § 1349, and using and trafficking in a counterfeit access device, in violation of 18 U.S.C. § 1029(a)(1). The indictment also charges Polanco with aggravated identity theft, in violation of 18 U.S.C. § 1028A(a)(1). The case has been assigned to United States District Judge Donald M. Middlebrooks.
The defendants made their initial appearance today, Tuesday, January 8, 2008, before a federal magistrate judge in Miami. A third defendant, Jose Ramon Alonso Barcelo, will have his initial appearance on Wednesday, January 9, 2008.
According to the indictment, Prestige Diagnostic Corporation was a diagnostic examination company located in Miami-Dade County. Through this company, the three defendants billed Medicare for diagnostic examination procedures in the amount of approximately $1,228,857 for reimbursement. In fact no diagnostic examinations or any other health care benefits were provided as the defendants claimed to Medicare. From March through July 2007, Medicare paid approximately $600,930.38 on the defendants’ allegedly fraudulent reimbursement claims.
Mr. Acosta commended the joint investigative efforts of the Department of Health and Human Services’ Office of Inspector General, the United States Secret Service, and the Miami Beach Police Department. This case is being prosecuted by Assistant United States Attorney Jeffrey Tsai.
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at www.usdoj.gov/usao/fls . Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on .
Posted on Tuesday, January 08, 2008
LAWFUEL - US Litigation - R. Alexander Acosta, United States Attorney for the Southern District of Florida; Melody Jackson, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General, Atlanta Region; Michael K. Fithen, Special Agent in Charge, United States Secret Service; and Chief Carlos Noriega, Miami Beach Police Department, announced that two defendants charged in a health care fraud ring were arrested earlier today.
The indictment, which was unsealed this morning upon the defendants’ arrests, charges Joaquin Alonso, a/k/a “Kiki Alonso,” and Luis Polanco with conspiracy to defraud the Medicare program, in violation of 18 U.S.C. § 1349, and using and trafficking in a counterfeit access device, in violation of 18 U.S.C. § 1029(a)(1). The indictment also charges Polanco with aggravated identity theft, in violation of 18 U.S.C. § 1028A(a)(1). The case has been assigned to United States District Judge Donald M. Middlebrooks.
The defendants made their initial appearance today, Tuesday, January 8, 2008, before a federal magistrate judge in Miami. A third defendant, Jose Ramon Alonso Barcelo, will have his initial appearance on Wednesday, January 9, 2008.
According to the indictment, Prestige Diagnostic Corporation was a diagnostic examination company located in Miami-Dade County. Through this company, the three defendants billed Medicare for diagnostic examination procedures in the amount of approximately $1,228,857 for reimbursement. In fact no diagnostic examinations or any other health care benefits were provided as the defendants claimed to Medicare. From March through July 2007, Medicare paid approximately $600,930.38 on the defendants’ allegedly fraudulent reimbursement claims.
Mr. Acosta commended the joint investigative efforts of the Department of Health and Human Services’ Office of Inspector General, the United States Secret Service, and the Miami Beach Police Department. This case is being prosecuted by Assistant United States Attorney Jeffrey Tsai.
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at www.usdoj.gov/usao/fls . Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on .
More FRAUD!....what a surprise!!
Health care fraud charge yields guilty plea in Washington County
By The Tribune-Review
Wednesday, January 9, 2008
A Washington County man pleaded guilty in federal court for his role in an insurance scheme headed by a former chiropractor in Westmoreland County.
John Slimick, 49, of New Eagle pleaded guilty to one count of health care fraud for cooperating with Douglas Henderson, the former owner of Burrell Chiropractic Clinic and Henderson Automotive in Lower Burrell.
From January 1996 through December 2002, Slimick was paid $20,390.79 for helping Henderson submit false claims to Highmark Blue Cross/Blue Shield worth $156,058.63 in his name. Prosecutors say Henderson paid kickbacks to at least 16 people who submitted more than $7 million in bogus claims to Highmark.
By The Tribune-Review
Wednesday, January 9, 2008
A Washington County man pleaded guilty in federal court for his role in an insurance scheme headed by a former chiropractor in Westmoreland County.
John Slimick, 49, of New Eagle pleaded guilty to one count of health care fraud for cooperating with Douglas Henderson, the former owner of Burrell Chiropractic Clinic and Henderson Automotive in Lower Burrell.
From January 1996 through December 2002, Slimick was paid $20,390.79 for helping Henderson submit false claims to Highmark Blue Cross/Blue Shield worth $156,058.63 in his name. Prosecutors say Henderson paid kickbacks to at least 16 people who submitted more than $7 million in bogus claims to Highmark.
Thursday, January 10, 2008
Largest Government Fraud Settlement in U S History
FOR IMMEDIATE RELEASE
CRM/CIV
THURSDAY, DECEMBER14, 2000
(202) 514-2007
WWW.USDOJ.GOV
TDD (202) 514-1888
HCA - THE HEALTH CARE COMPANY & SUBSIDIARIES
TO PAY $840 MILLION IN CRIMINAL FINES
AND CIVIL DAMAGES AND PENALTIES
Largest Government Fraud Settlement
in U.S. History
WASHINGTON, D.C. - HCA-The Healthcare Company (formerly known as Columbia-HCA), the largest for-profit hospital chain in the United States, has agreed to plead guilty to criminal conduct and pay more than $840 million in criminal fines, civil penalties and damages for alleged unlawful billing practices, Attorney General Janet Reno announced today.
Today's agreement is the largest government fraud settlement ever reached by the Justice Department.
"Health care fraud impacts every American citizen. When a company defrauds our nation's health care programs, it takes money out of the pockets of the American taxpayers. It is wrong," said Attorney General Reno. "This investigation has been the largest multi-agency investigation of a health care provider ever undertaken by the U.S. and reflects our commitment to vigorously pursuing all types of health care fraud schemes."
Under today's agreement, which is subject to review by the court, HCA will pay a total of $745 million to resolve five allegations regarding the manner in which it bills the U.S. government and the states for health care costs. The agreement does not resolve allegations that HCA unlawfully charged for the costs of running its hospitals on cost reports submitted to the government, and that it paid kickbacks to physicians to get Medicare and Medicaid patients referred to its facilities.
Of the $745 million, the settlement requires HCA to pay:
more than $95 million to resolve civil claims arising from the company's outpatient laboratory billing practices, which included billing to Medicare, Medicaid, the Defense Department's TRICARE health care program, and the Federal Employees' Health Benefits Program, for lab tests that were not medically necessary, not ordered by physicians, as well as other billing violations;
more than $403 million to resolve civil claims arising from "upcoding," where false diagnosis codes were assigned to patient records in order to increase reimbursement to the hospitals by Medicare, Medicaid, TRICARE and the Federal Employees' Health Benefits Program. The guilty plea includes one count relating to this upcoding practice;
$50 million to resolve civil claims that the company illegally claimed non-reimbursable marketing and advertising costs it disguised as community education. Medicare reimburses providers for "community education" - costs to educate the community at large about public health issues - but not for advertising and marketing a hospital's services;
$90 million to resolve civil claims that HCA illegally charged Medicare for non-reimbursable costs incurred in the purchase of home health agencies owned by the Olsten Corporation, as well as other agencies in Florida, Georgia and Alabama. According to the government, HCA devised an elaborate scheme to hide these costs in reimbursable "management fees" paid to third parties. In 1999, a subsidiary of Olsten Corporation, Kimberly Quality Care, entered into criminal plea agreements in three districts and paid more than $10 million in criminal fines. Olsten paid nearly $41 million as part of a civil settlement arising from its collusion with HCA for that conduct. HCA has now agreed to pay $90 million to settle this issue, and;
$106 million to resolve civil claims for billing Medicare, Medicaid and TRICARE for home health visits for patients who did not qualify to receive them or were not performed and for committing other billing violations.
Many of the civil issues resolved as part of today's agreement arose from lawsuits filed by relators, commonly known as "whistleblowers," under the False Claims Act. This law allows whistleblowers who qualify under the statute to receive up to 25 percent of the settlement recovery in cases the government pursues. Under the civil settlement announced today, whistleblower shares remain undetermined pending further negotiations or court proceedings.
In addition to the civil settlement, two subsidiaries of Tennessee-based HCA, Columbia Homecare Group Inc. and Columbia Management Companies Inc. entered into a criminal plea agreement in which they agreed to pay $95,336,432 in criminal fines and plead guilty to several charges involving a wide range of criminal conduct which occurred at HCA's hospitals nationwide. The plea agreement and the sentences are subject to the approval of federal courts.
According to the terms of the plea agreement, the companies will plead guilty to charges involving cost report fraud, fraudulent billing of Medicare for personnel who worked at home health agencies and at wound care centers, fraudulent billing to Medicare for patients diagnosed with pneumonia, paying kickbacks and other remuneration to doctors to induce referrals, paying kickbacks in connection with the purchase and sale of home health agencies and fraudulent billing of Medicare for fees paid to manage those agencies. The guilty pleas will be filed in five district courts and, with the courts' permission, consolidated for plea and sentencing in the district courts in the Middle District of Florida and the Western District of Texas (El Paso).
The subsidiaries will plead guilty to the following criminal charges, which will be filed in five District Courts and will be consolidated for sentencing in District Courts in Tampa and El Paso:
Southern District of Florida (Miami) Columbia Homecare Group Inc., a subsidiary of Columbia, will plead guilty to one count of conspiracy to defraud the U.S. and to violate the Medicare Anti-kickback Statute involving its fraudulent business in the purchase and operation of home health agencies and fraudulent billing of Medicare for management and personnel costs. The criminal fine is $3.36 million;
Northern District of Georgia (Atlanta) Columbia Homecare Inc. will plead guilty to one count of violating the Medicare Anti-kickback Statute related to purchase of home health agencies. The criminal fine is $3.36 million;
Department of Justice Criminal Fraud Section Another subsidiary, Columbia Management Companies Inc., will plead guilty to one count of conspiracy to defraud the U.S. and to make and use false writings and documents in connection with its fraudulent "upcoding" of bills to Medicare for patients diagnosed with certain types of pneumonia. The criminal fine is $27.5 million. This investigation was based in Nashville, Tennessee;
Middle District of Florida (Tampa) Columbia Homecare Group will plead guilty to one count of conspiring to defraud the U.S. and one count of conspiracy to violate the Medicare Anti-kickback Statute in connection with the purchase and operation of home health agencies. The criminal fine is $8.4 million. Also, Columbia Management Companies will plead guilty to eight counts of making false statements to the U.S. in connection with the submission of false cost reports to Medicare. The fine amount is $22.6 million; and,
Western District of Texas (El Paso). Columbia Homecare Group will plead to a conspiracy to pay kickbacks and other monetary benefits to doctors in violation of the Medicare Anti-kickback Statute. The criminal fine is $30,116,592.
Today's plea agreement resolves only corporate criminal liability. The government has the option to investigate and prosecute any individuals as the plea agreement specifically requires the companies to cooperate with the government in ongoing investigations. As a further result of the plea agreement, two subsidiaries will be excluded from participating in the Medicare Program.
In addition to today's agreement, Inspector General June Gibbs Brown announced that HCA is entering into two agreements with HHS - a Corporate Integrity Agreement and a divestiture agreement.
The Corporate Integrity Agreement, which requires the company to engage in significant compliance efforts over the next eight years, calls for the health care company and independent review organizations to conduct audits and reviews of HCA and its hospitals' inpatient coding, laboratory billing, hospital outpatient billing, and financial relationships with physicians.
The agreement also requires HCA to:
maintain a code of conduct and compliance policies and procedures;
conduct training of its employees on general compliance matters and substantive federal health care program requirements;
ensure that certain employees and committees are responsible for compliance at all levels of the organization from the Board of Directors to individual facilities;
promptly report and pay back all overpayments,
maintain means for employees and other individuals to report on suspected misconduct; and,
screen prospective and present employees and contractors to ensure that they are not excluded from federal health care programs.
"This settlement includes an extensive corporate integrity agreement that is intended to ensure HCA's strict compliance with the laws of doing business with the federal health care programs," said HHS Inspector General Brown. "The agreement will be in force for a period of eight years and includes audit and other compliance provisions that are unprecedented in their scope and level of detail."
Throughout the term of the integrity agreement, HCA will be required to report to the Office of the Inspector General at HHS annually and with respect to certain events.
The divestiture agreement will bar any HCA subsidiary that is entering a guilty plea to Medicare-related offenses from participating in Medicare and other federal health care programs. The Inspector General has agreed to delay the exclusion for a limited time to allow the subsidiary to divest itself of the hospital it operates in order to minimize the risk of disruption to patient care.
In exchange, HCA is obligated to take certain measures to ensure that quality services are provided at the hospital and that the new operator is approved by appropriate government agencies prior to divestiture. The agreement provides the OIG with multiple remedies other than exclusion, including financial penalties and the right to appoint a trustee to divest the hospital, if HCA fails to meet the deadlines to divest the facility.
Finally, a state negotiating team appointed by the National Association of Medicaid Fraud Control Units consisting of representatives from Tennessee, Nevada, Washington and Ohio, has reached an agreement in principle with HCA to resolve related issues with affected Medicaid programs. The Medicaid program, which is funded by the federal and state governments, represents approximately $36.3 million of today's $745 million settlement; of this, the states will receive about $13.6 million, representing their share of Medicaid funds. The state negotiating team will send proposed settlement agreements to 33 states and recommend that those states become part of the settlement.
"Today's developments stand as a testament to our success in the fight against health care fraud and abuse," said Attorney General Reno. "Federal health care programs operate on the good faith and honesty of health care providers. The government will not tolerate misuse of the reimbursement systems for financial gain and will hold the responsible parties accountable for their conduct."
The Attorney General was joined in today's announcement of the criminal and civil agreements by Assistant Attorney General David W. Ogden of the Civil Division; Richard Deane, U.S. Attorney in Georgia; Donna Bucella, U.S. Attorney in Tampa; June Gibbs Brown, Inspector General of the Department of Health and Human Services (HHS); Thomas Kubic , Deputy Assistant Director, Criminal Investigative Division of the FBI; Carol Levy, Director of the Defense Criminal Investigative Service and Assistant Inspector General for Investigations of the Department of Defense; Patrick McFarland, Inspector General of the Office of Personnel Management; Dr. James Sears, TRICARE; and Barbara Zelner, Counsel to the National Association of Medicaid Fraud Control Units.
The Attorney General recognizes the prosecutors in the following divisions and districts that assisted in bringing this case to a successful resolution: Department of Justice, Civil Division, Commercial Litigation Branch, Fraud Section; Department of Justice, Criminal Division, Fraud Section; Middle District of Alabama; Eastern District of Arkansas; Western District of Arkansas; Central District of California; District of Colorado; District of Columbia; Middle District of Florida; Southern District of Florida; Middle District of Georgia; Northern District of Georgia; Northern District of Illinois; District of Kansas; Eastern District of Kentucky; Eastern District of Louisiana; Middle District of Louisiana; Western District of Louisiana; District of Massachusetts; District of Nevada; District of New Hampshire; Eastern District of North Carolina; Western District of North Carolina; Northern District of Ohio; Northern District of Oklahoma; Eastern District of Pennsylvania; District of South Carolina; Eastern District of Tennessee; Middle District of Tennessee; Eastern District of Texas; Northern District of Texas; Southern District of Texas Western District of Texas; District of Utah; Eastern District of Virginia; Western District of Virginia; and District of Wyoming. She also wishes to acknowledge the extensive assistance provided by agents, investigators, and auditors for the Federal Bureau of Investigation, the HHS Office of the Inspector General, the Health Care Financing Administration, the Defense Criminal Investigative Service, the Office of Personnel Management Inspector General, and State Medicaid Fraud Control Units.
CRM/CIV
THURSDAY, DECEMBER14, 2000
(202) 514-2007
WWW.USDOJ.GOV
TDD (202) 514-1888
HCA - THE HEALTH CARE COMPANY & SUBSIDIARIES
TO PAY $840 MILLION IN CRIMINAL FINES
AND CIVIL DAMAGES AND PENALTIES
Largest Government Fraud Settlement
in U.S. History
WASHINGTON, D.C. - HCA-The Healthcare Company (formerly known as Columbia-HCA), the largest for-profit hospital chain in the United States, has agreed to plead guilty to criminal conduct and pay more than $840 million in criminal fines, civil penalties and damages for alleged unlawful billing practices, Attorney General Janet Reno announced today.
Today's agreement is the largest government fraud settlement ever reached by the Justice Department.
"Health care fraud impacts every American citizen. When a company defrauds our nation's health care programs, it takes money out of the pockets of the American taxpayers. It is wrong," said Attorney General Reno. "This investigation has been the largest multi-agency investigation of a health care provider ever undertaken by the U.S. and reflects our commitment to vigorously pursuing all types of health care fraud schemes."
Under today's agreement, which is subject to review by the court, HCA will pay a total of $745 million to resolve five allegations regarding the manner in which it bills the U.S. government and the states for health care costs. The agreement does not resolve allegations that HCA unlawfully charged for the costs of running its hospitals on cost reports submitted to the government, and that it paid kickbacks to physicians to get Medicare and Medicaid patients referred to its facilities.
Of the $745 million, the settlement requires HCA to pay:
more than $95 million to resolve civil claims arising from the company's outpatient laboratory billing practices, which included billing to Medicare, Medicaid, the Defense Department's TRICARE health care program, and the Federal Employees' Health Benefits Program, for lab tests that were not medically necessary, not ordered by physicians, as well as other billing violations;
more than $403 million to resolve civil claims arising from "upcoding," where false diagnosis codes were assigned to patient records in order to increase reimbursement to the hospitals by Medicare, Medicaid, TRICARE and the Federal Employees' Health Benefits Program. The guilty plea includes one count relating to this upcoding practice;
$50 million to resolve civil claims that the company illegally claimed non-reimbursable marketing and advertising costs it disguised as community education. Medicare reimburses providers for "community education" - costs to educate the community at large about public health issues - but not for advertising and marketing a hospital's services;
$90 million to resolve civil claims that HCA illegally charged Medicare for non-reimbursable costs incurred in the purchase of home health agencies owned by the Olsten Corporation, as well as other agencies in Florida, Georgia and Alabama. According to the government, HCA devised an elaborate scheme to hide these costs in reimbursable "management fees" paid to third parties. In 1999, a subsidiary of Olsten Corporation, Kimberly Quality Care, entered into criminal plea agreements in three districts and paid more than $10 million in criminal fines. Olsten paid nearly $41 million as part of a civil settlement arising from its collusion with HCA for that conduct. HCA has now agreed to pay $90 million to settle this issue, and;
$106 million to resolve civil claims for billing Medicare, Medicaid and TRICARE for home health visits for patients who did not qualify to receive them or were not performed and for committing other billing violations.
Many of the civil issues resolved as part of today's agreement arose from lawsuits filed by relators, commonly known as "whistleblowers," under the False Claims Act. This law allows whistleblowers who qualify under the statute to receive up to 25 percent of the settlement recovery in cases the government pursues. Under the civil settlement announced today, whistleblower shares remain undetermined pending further negotiations or court proceedings.
In addition to the civil settlement, two subsidiaries of Tennessee-based HCA, Columbia Homecare Group Inc. and Columbia Management Companies Inc. entered into a criminal plea agreement in which they agreed to pay $95,336,432 in criminal fines and plead guilty to several charges involving a wide range of criminal conduct which occurred at HCA's hospitals nationwide. The plea agreement and the sentences are subject to the approval of federal courts.
According to the terms of the plea agreement, the companies will plead guilty to charges involving cost report fraud, fraudulent billing of Medicare for personnel who worked at home health agencies and at wound care centers, fraudulent billing to Medicare for patients diagnosed with pneumonia, paying kickbacks and other remuneration to doctors to induce referrals, paying kickbacks in connection with the purchase and sale of home health agencies and fraudulent billing of Medicare for fees paid to manage those agencies. The guilty pleas will be filed in five district courts and, with the courts' permission, consolidated for plea and sentencing in the district courts in the Middle District of Florida and the Western District of Texas (El Paso).
The subsidiaries will plead guilty to the following criminal charges, which will be filed in five District Courts and will be consolidated for sentencing in District Courts in Tampa and El Paso:
Southern District of Florida (Miami) Columbia Homecare Group Inc., a subsidiary of Columbia, will plead guilty to one count of conspiracy to defraud the U.S. and to violate the Medicare Anti-kickback Statute involving its fraudulent business in the purchase and operation of home health agencies and fraudulent billing of Medicare for management and personnel costs. The criminal fine is $3.36 million;
Northern District of Georgia (Atlanta) Columbia Homecare Inc. will plead guilty to one count of violating the Medicare Anti-kickback Statute related to purchase of home health agencies. The criminal fine is $3.36 million;
Department of Justice Criminal Fraud Section Another subsidiary, Columbia Management Companies Inc., will plead guilty to one count of conspiracy to defraud the U.S. and to make and use false writings and documents in connection with its fraudulent "upcoding" of bills to Medicare for patients diagnosed with certain types of pneumonia. The criminal fine is $27.5 million. This investigation was based in Nashville, Tennessee;
Middle District of Florida (Tampa) Columbia Homecare Group will plead guilty to one count of conspiring to defraud the U.S. and one count of conspiracy to violate the Medicare Anti-kickback Statute in connection with the purchase and operation of home health agencies. The criminal fine is $8.4 million. Also, Columbia Management Companies will plead guilty to eight counts of making false statements to the U.S. in connection with the submission of false cost reports to Medicare. The fine amount is $22.6 million; and,
Western District of Texas (El Paso). Columbia Homecare Group will plead to a conspiracy to pay kickbacks and other monetary benefits to doctors in violation of the Medicare Anti-kickback Statute. The criminal fine is $30,116,592.
Today's plea agreement resolves only corporate criminal liability. The government has the option to investigate and prosecute any individuals as the plea agreement specifically requires the companies to cooperate with the government in ongoing investigations. As a further result of the plea agreement, two subsidiaries will be excluded from participating in the Medicare Program.
In addition to today's agreement, Inspector General June Gibbs Brown announced that HCA is entering into two agreements with HHS - a Corporate Integrity Agreement and a divestiture agreement.
The Corporate Integrity Agreement, which requires the company to engage in significant compliance efforts over the next eight years, calls for the health care company and independent review organizations to conduct audits and reviews of HCA and its hospitals' inpatient coding, laboratory billing, hospital outpatient billing, and financial relationships with physicians.
The agreement also requires HCA to:
maintain a code of conduct and compliance policies and procedures;
conduct training of its employees on general compliance matters and substantive federal health care program requirements;
ensure that certain employees and committees are responsible for compliance at all levels of the organization from the Board of Directors to individual facilities;
promptly report and pay back all overpayments,
maintain means for employees and other individuals to report on suspected misconduct; and,
screen prospective and present employees and contractors to ensure that they are not excluded from federal health care programs.
"This settlement includes an extensive corporate integrity agreement that is intended to ensure HCA's strict compliance with the laws of doing business with the federal health care programs," said HHS Inspector General Brown. "The agreement will be in force for a period of eight years and includes audit and other compliance provisions that are unprecedented in their scope and level of detail."
Throughout the term of the integrity agreement, HCA will be required to report to the Office of the Inspector General at HHS annually and with respect to certain events.
The divestiture agreement will bar any HCA subsidiary that is entering a guilty plea to Medicare-related offenses from participating in Medicare and other federal health care programs. The Inspector General has agreed to delay the exclusion for a limited time to allow the subsidiary to divest itself of the hospital it operates in order to minimize the risk of disruption to patient care.
In exchange, HCA is obligated to take certain measures to ensure that quality services are provided at the hospital and that the new operator is approved by appropriate government agencies prior to divestiture. The agreement provides the OIG with multiple remedies other than exclusion, including financial penalties and the right to appoint a trustee to divest the hospital, if HCA fails to meet the deadlines to divest the facility.
Finally, a state negotiating team appointed by the National Association of Medicaid Fraud Control Units consisting of representatives from Tennessee, Nevada, Washington and Ohio, has reached an agreement in principle with HCA to resolve related issues with affected Medicaid programs. The Medicaid program, which is funded by the federal and state governments, represents approximately $36.3 million of today's $745 million settlement; of this, the states will receive about $13.6 million, representing their share of Medicaid funds. The state negotiating team will send proposed settlement agreements to 33 states and recommend that those states become part of the settlement.
"Today's developments stand as a testament to our success in the fight against health care fraud and abuse," said Attorney General Reno. "Federal health care programs operate on the good faith and honesty of health care providers. The government will not tolerate misuse of the reimbursement systems for financial gain and will hold the responsible parties accountable for their conduct."
The Attorney General was joined in today's announcement of the criminal and civil agreements by Assistant Attorney General David W. Ogden of the Civil Division; Richard Deane, U.S. Attorney in Georgia; Donna Bucella, U.S. Attorney in Tampa; June Gibbs Brown, Inspector General of the Department of Health and Human Services (HHS); Thomas Kubic , Deputy Assistant Director, Criminal Investigative Division of the FBI; Carol Levy, Director of the Defense Criminal Investigative Service and Assistant Inspector General for Investigations of the Department of Defense; Patrick McFarland, Inspector General of the Office of Personnel Management; Dr. James Sears, TRICARE; and Barbara Zelner, Counsel to the National Association of Medicaid Fraud Control Units.
The Attorney General recognizes the prosecutors in the following divisions and districts that assisted in bringing this case to a successful resolution: Department of Justice, Civil Division, Commercial Litigation Branch, Fraud Section; Department of Justice, Criminal Division, Fraud Section; Middle District of Alabama; Eastern District of Arkansas; Western District of Arkansas; Central District of California; District of Colorado; District of Columbia; Middle District of Florida; Southern District of Florida; Middle District of Georgia; Northern District of Georgia; Northern District of Illinois; District of Kansas; Eastern District of Kentucky; Eastern District of Louisiana; Middle District of Louisiana; Western District of Louisiana; District of Massachusetts; District of Nevada; District of New Hampshire; Eastern District of North Carolina; Western District of North Carolina; Northern District of Ohio; Northern District of Oklahoma; Eastern District of Pennsylvania; District of South Carolina; Eastern District of Tennessee; Middle District of Tennessee; Eastern District of Texas; Northern District of Texas; Southern District of Texas Western District of Texas; District of Utah; Eastern District of Virginia; Western District of Virginia; and District of Wyoming. She also wishes to acknowledge the extensive assistance provided by agents, investigators, and auditors for the Federal Bureau of Investigation, the HHS Office of the Inspector General, the Health Care Financing Administration, the Defense Criminal Investigative Service, the Office of Personnel Management Inspector General, and State Medicaid Fraud Control Units.
Subscribe to:
Posts (Atom)
