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.

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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.

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Posted In: Medicare Fraud

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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.

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Posted In: Durable Medical Equipment Fraud , Medicaid Fraud

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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.

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Posted In: Durable Medical Equipment Fraud , Medicare Fraud

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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.

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Posted In: Medicaid Fraud , Medicare Fraud

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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.

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Posted In: Durable Medical Equipment Fraud , Medicare Fraud

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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" »

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Posted In: Sentencing Guidelines

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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.

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Posted In: Medicare Fraud

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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.

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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."

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Posted In: Medicaid Fraud

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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.”

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Posted In: Medicare Fraud

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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.”

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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...
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