Dr. Arun Sharma and his wife, Dr. Kiran Sharma, M.D.,

For Immediate Release
July 17, 2009 United States Attorney's Office
Southern District of Texas
Contact: (713) 567-9000
Two Houston Area Doctors Charged in Conspiracy to Illegally Distribute Narcotics and Medicare/Medicaid Fraud

HOUSTON—Dr. Arun Sharma and his wife, Dr. Kiran Sharma, M.D., both 54, have been charged in a 29-count indictment alleging conspiracy to unlawfully dispense and distribute controlled substances outside the scope of professional practice and not for a legitimate medical purpose, United States Attorney Tim Johnson, Drug Enforcement Administration (DEA) Special Agent in Charge Zoran B. Yankovich and Texas Attorney General Greg Abbott announced today. The indictment alleges the two doctors illegally distributed 1.3 million tablets of hydrocodone and further charges the two doctors with conspiracy to defraud Medicare, Medicaid and several private health insurance companies of $31 million by filing false claims for medical procedures that were never performed.

"This indictment reflects the DEA's effort to identify and target doctors who discredit the medical health profession who are nothing more than drug peddlers in doctors' gowns motivated by greed with no regard for the well being of the public," said DEA Special Agent in Charge Zorn B. Yankovich. "By obtaining the voluntary surrender of DEA registration's from questionable doctors, the DEA Tactical Diversion Squad is able to put these illegal practices out of business. The DEA will continue to pursue these pain clinic-pill mill operations that have taken root in the Houston area."

According to the allegations in the indictment returned by a federal grand jury late yesterday afternoon, the Sharmas operate the Allergy, Asthma, Arthritis and Pain Centers located at on Cole Street in Webster, Texas, and another on Garth Road in Baytown, Texas. The indictment alleges that Dr. Arun Sharma routinely saw in excess of 70 patients per day and that he routinely wrote prescriptions for hydrocodone that were not for a legitimate medical purpose in exchange for cash payments. Dr. Sharma allegedly received the cash payments for his hydrocodone prescriptions directly from the patient and that he instructed his patients to take the prescriptions to certain pharmacies to be filled.

Arun and Kiran Sharma, according to the indictment, stored large amounts of cash received from the sale of hydrocodone prescriptions at their home. Kiran Sharma allegedly transported large amounts of cash received from the sale of the hydrocodone prescriptions to two safe deposit boxes - one each at Bank of America and Prosperity Bank.

The doctors also were charged with specific counts of illegal drug distribution for hydrocodone prescriptions written to specific patients. In one count, they are charged with prescribing more than 8,000 tablets of hydrocodone to one patient over an eight month period. In two other counts, they are charged with prescribing 540 tablets of hydrocodone to one patient on May 23, 2005, and another 540 tablets to the same patient on Dec. 5, 2005.

Both doctors are also accused of conspiring to defraud Medicare, Medicaid and private healthcare insurers including Blue Cross Blue Shield of Texas, Aetna, Cigna and United Healthcare of more than $31 million for facet joint injections and other medical procedures that were allegedly never performed.

The United States also gave notice in the indictment to the doctors that it intended to forfeit their interest in all of the proceeds of the fraud and the drug distribution.

The court has ordered that a summons issue directing the Sharma's to appear in federal court for arraignment on Aug. 3, 2009.

Upon conviction, each of the 17 health care fraud counts and the healthcare conspiracy charge carries a maximum penalty of 10 years in a federal prison and a $250,000 fine. The drug conspiracy and each of the 10 drug distribution counts carries a penalty of five years imprisonment and a $250,000 fine. Parole has been abolished in the federal prison system.

The criminal charges are the result of a joint investigation being conducted by agents of the FBI, the DEA, the Department of Health and Human Services-Office of Inspector General and the Medicare Fraud Control Unit of the Texas Attorney General's Office in conjunction with the Webster, League City and Baytown Police Departments. The case will be prosecuted by Assistant United States Attorney Al Balboni.

An indictment is an accusation of criminal conduct, not evidence.

A defendant is presumed innocent unless and until convicted through due process of law.

My letter to President Obama– Organizing for America

President – Organizing for America

Remember 1997? Balanced Budget Act of 1997- In 1997, HCA (Hospital Corporation of America) – was the LARGEST HOME HEALTH CARE Company in our country.

HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
Note: Hospital Corporation of America (HCA) was acquired by Columbia in 1994.

Columbia/HCA was a partnership of financier Richard Rainwater of Ft. Worth and lawyer Richard Scott.

Under the Balanced Budget Act of 1997- Home health - was struggling; about 1,400 agencies closed nationwide in 1998.

On Sept 8, 1998 Standard and Poors downgraded the bonds of Charter/HCA

Rainwater also owned a large stake in Magellan Health Care which controls Charter Medical. Magellan, run by Darla Moore, is the largest network of psychiatric hospitals in the country. They are becoming more and more involved in obtaining government money for services formerly not covered as health care, according to Fortune Magazine.

(Note: Rick Scott was terminated by Darla Moore, the wife of Richard Rainwater in 1997. According to Fortune Magazine, the “Toughest Babe in the Business”, Moore created the Corporate Bankruptcy Finance Tool- DIP- (Debtor in Possession), while employed at a Chase bank on Wall Street.


“They are becoming more and more involved in obtaining government money for services formerly not covered as health care, according to Fortune Magazine. “

2003-WWW.USDOJ.GOV - HCA INVESTIGATION - LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED

HCA not only robbed the country’s Medicare/Medicaid system, but the entire Healthcare system and its tentacles.

Connect- Healthcare Finance Fraud, SEC Fraud, Bankruptcy Fraud, Financial Fraud and Mortgage Fraud- all for ‘market driven healthcare’ in America?

2009 - The Wall Street Journal reported that Richard Scott, "the former chief executive of HCA Inc," had formed the non-profit organization Conservatives for Patients' Rights as part of a "lobbying campaign to derail or modify" President Obama's health care proposals,...

In 1997, Rick Scott was terminated by Darla Moore. As part of Richard Scott's severance package from Columbia he was paid $5.13 million and given a five year consulting contract at $950,000 per year.

1997 + 5 = 2002

In 2002 FBI raided the offices of National Century Financial Enterprises in Dublin, Ohio

“This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.

In October 2008- Leo Wise, now at the OCE ---stated "Ladies and gentlemen, this is a case of staggering fraud," 'It is one of the largest frauds the FBI has ever investigated.

Guess where ALL of Richard Scott's & Richard Rainwater’s Columbia/ HCA and certain subsidiaries and joint ventures were?

National Century Financial Enterprises, Inc.! (NCFE).

One prosecutor stated ‘…’NCFE- the largest corporate fraud investigations involving a privately held company and no one has ever heard of.’

NO ONE HAS EVER HEARD OF? (The largest corporate fraud investigation…)

Why is that?

Richard Rainwater was GW Bush’s ex- partner with the Rangers.

October 2008, Leo Wise now at the OCE office prosecuted the CEO and co-founder of National Century Financial Enterprises - CEO Sentenced to 30 Years in Prison

12 Executives/co-Founders already found guilty-

December 18, 2008, almost one month before GW Bush leaves office- the last person to stand trial, the ONE and ONLY acquittal- James K Happ!

Jurors stated 'PROSECUTOR DID NOT DO HIS JOB'-

Prosecutors' case fell short juror says-National Century fraud case produces 1st and only acquittal The "not guilty" verdicts that came in federal court yesterday were not so much a vindication of the last National Century Financial Enterprises executive to stand trial, a juror said.

Instead, they were more a belief that federal prosecutors had not done their job, ...

"He very well may have been guilty. A lot of us thought he was," said the juror who wouldn't give his name...

While Richard Scott was at Columbia in 1997 - James K Happ was CFO of Columbia Homecare Group, Inc.

James K Happ, only acquittal at National Century Financial Enterprises, Inc‘s who just so happened to be the CFO of Columbia Homecare Group.

Cigna Whistleblower to Testify

http://www.pbs.org/moyers/journal/07102009/profile.html
July 10, 2009

Last month, testimony in front of the U.S. Senate Committee on Commerce, Science and Transportation by a former health insurance insider named Wendell Potter made news even before it occurred: CBS NEWS headlined: "Cigna Whistleblower to Testify." After Potter's testimony the industry scrambled to do damage control: "Insurers defend rescissions, take heat for lack of transparency."

In his first extended television interview since leaving the health insurance industry, Wendell Potter tells Bill Moyers why he left his successful career as the head of Public Relations for CIGNA, one of the nation's largest insurers, and decided to speak out against the industry. "I didn't intend to [speak out], until it became really clear to me that the industry is resorting to the same tactics they've used over the years, and particularly back in the early '90s, when they were leading the effort to kill the Clinton plan."

Potter began his trip from health care spokesperson to reform advocate while back home in Tennessee. Potter attended a "health care expedition," a makeshift health clinic set up at a fairgrounds, and he tells Bill Moyers, "It was absolutely stunning. When I walked through the fairground gates, I saw hundreds of people lined up, in the rain. It was raining that day. Lined up, waiting to get care, in animal stalls. Animal stalls."

Looking back over his long career, Potter sees an industry corrupted by Wall Street expectations and greed. According to Potter, insurers have every incentive to deny coverage — every dollar they don't pay out to a claim is a dollar they can add to their profits, and Wall Street investors demand they pay out less every year. Under these conditions, Potter says, "You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations."

You can view Wendel Potter's congressional testimony online or read the text.
You can learn more about Remote Area Medical, the organization that put on the "health care expedition" here.
AHIP Strategy Memos

During the interview, Bill Moyers read from confidential documents drafted by America's Health Insurance Plans (AHIP) in May and June of 2007. The documents outline a unified strategy for AHIP members to prepare for the release of Michael Moore's documentary, SICKO on June 29, 2007.

You can download and read the full AHIP documents by clicking here and here (PDFs).
Red-Flagging and Rescission

Among the other testimony heard by the Committee on Commerce, Science and Transportation was that of Robin Beaton. It reflected some of the insurance company tactics condemned by Potter.

It was a nightmare scenario. The day before she was scheduled to undergo a double mastectomy for invasive breast cancer, Robin Beaton's health insurance company informed her that she was "red flagged" and they wouldn't pay for her surgery. The hospital wanted a $30,000 deposit before they would move forward. Beaton had no choice but to forgo the life-saving surgery.

Beaton had dutifully signed up for individual insurance when she retired from nursing to start a small business. She had never missed a payment, but that didn't matter. Blue Cross cited two earlier, unrelated conditions that she hadn't reported to them when signing up — acne and a fast beating heart — and rescinded her policy.
Beaton pleaded with the company and had her doctors write letters on her behalf to no avail. It was not until Rep. Joe Barton (R-TX) personally called Blue Cross that her policy was reinstated and she could undergo surgery. In that year, Beaton's tumor doubled in size, leading to further complications necessitating the removal of her lymph glands as well.

>>Watch Robin Beaton's testimony to the House Energy and Commerce Subcommittee on Oversight and Investigations.

The practice is called "rescission" and Beaton's is not an isolated case. The House Energy and Commerce Committee found that the major private health insurers had rescinded the policies of approximately 20,000 people in a five year period, to avoid paying out approximately $300 million in benefit claims.
Appearing before the same committee, CEOs of the major health insurance companies stated that they would continue to use rescission, arguing that it is a necessary protection against fraud and abuse.

>>Watch the health care CEOs appear before the House Energy and Commerce Subcommittee on Oversight and Investigations.


Wendell Potter

Wendell Potter has served since May 2009 as the Center for Media and Democracy in Madison, Wisconsin's senior fellow on health care. After a 20-year career as a corporate public relations executive, last year he left his job as head of communications for one of the nation's largest health insurers to try his hand at helping socially responsible organizations — including those advocating for meaningful health care reform — achieve their goals.

Based in Philadelphia, Potter provides strategic communications counsel and planning services as an independent consultant. He also speaks out on both the need for a fundamental overhaul of the American health care system and on the dangers to American democracy and society of the decline of the media as watchdog, which has contributed to the growing and increasingly unchecked influence of corporate PR.
Before his switch, Potter held a variety of positions at CIGNA Corporation over 15 years, serving most recently as head of corporate communications and as the company's chief corporate spokesman.

Prior to joining CIGNA, Potter headed communications at Humana Inc., another large for-profit health insurer and was director of public relations and advertising for The Baptist Health System of East Tennessee. He also has been a partner in an Atlanta public relations firm, a press secretary to a Democratic nominee for governor of Tennessee and a lobbyist in Washington for the organizers of the 1982 World's Fair in Knoxville, Tenn.

Wendell Potter first worked as a journalist. When fresh out of college, he worked for Scripps-Howard's afternoon paper in Memphis. He wrote about Memphis businesses and local government before being sent to Nashville to cover the governor's office and state legislature. Two years later he was promoted to the Scripps-Howard News Bureau in Washington where he covered Congress, the White House and the Supreme Court and wrote a weekly political column.

Wendell Potter is a native of Tennessee and a graduate of the University of Tennessee in Knoxville where he received a B.A. degree in communications and did postgraduate work in journalism and public relations. He holds an APR, which means he is accredited in public relations by the Public Relations Society of America, and is still a dues-paying member of the Society of Professional Journalists and the National Press Club in Washington.

Guest photos by Robin Holland.

EIGHT MORE MIAMI-AREA RESIDENTS

June 28, 2009 by Robert David Malove
EIGHT MORE MIAMI-AREA RESIDENTS CHARGED IN $22 MILLION MEDICARE FRAUD SCHEME INVOLVING HOME HEALTH CARE


MIAMI, FL (June 26) - Gladys Zambrana, Javier Zambrana, Enrique Perez, Alejandro Hernandez Quiros aka Alex Hernandez, Vanessa Estrada, Vicenta Tellechea, Modesto Hidalgo and Carlos Castaneda were indicted in connection with an alleged $22 million Medicare fraud scheme operated out of Miami businesses purporting to specialize in home health care services.

Gladys Zambrana was also charged with four counts of health care fraud. Gladys Zambrana and Hernandez Quiros were charged with three counts each of paying health care kickbacks, while Perez, Hidalgo and Tellechea were charged with one count each of paying health care kickbacks. Gladys Zambrana, Perez, Alejandro Quiros, Tellechea and Castaneda were also charged with conspiracy to launder health care fraud proceeds.

According to the indictment, Gladys Zambrana, Perez and Hernandez Quiros operated ABC Home Health Care Inc. (ABC), listing Javier Zambrana as the owner; and Gladys Zambrana and Castaneda operated Florida Home Health Care Providers Inc. (Florida Home Health), listing Tellechea as the owner. Both ABC and Florida Home Health purported to be home health agencies that catered to Medicare beneficiaries. The indictment alleges that at both agencies, beneficiaries were recruited and paid kickbacks and bribes to arrange for their Medicare beneficiary numbers to be used by their co-conspirators to file claims with Medicare for purported home health care services. The indictment alleges that the services were not provided and were not medically necessary.

The indictment alleges that in addition to exerting ownership and control of the home health agencies, Hernandez Quiros and Castaneda acted as Medicare beneficiary recruiters for ABC and Florida Home Health, respectively; and Hidalgo, a medical assistant, falsified medical tests and records to make it appear that the services were needed. The indictment alleges that ABC billed more than $17 million to the Medicare program for services provided from January 2006 through December 2008 that were medically unnecessary and were not actually provided. During that time frame, Medicare paid more than $11 million on those fraudulent claims submitted by ABC. The indictment also alleges that from October 2007 through March 2009, Florida Home Health billed more than $5 million to the Medicare program for services that were medically unnecessary and not actually provided. During that time frame, Medicare paid more than $4 million on those fraudulent claims submitted by Florida Home Health.

The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. Each charged count of health care fraud carries a maximum prison sentence of 10 years and each count of paying health care kickbacks carries a maximum prison sentence of five years. Conspiracy to launder health care fraud proceeds carries a maximum prison sentence of 10 years per count.

In conjunction with the criminal case, on June 24, 2009, the U.S. Attorney’s Office also filed a civil complaint for injunctive relief under the fraud injunction statute and obtained a temporary restraining order freezing the assets of ABC, Florida Home Health, Gladys Zambrana, Javier Zambrana, Perez, Hernandez Quiros, Castaneda and Tellechea. In addition, that temporary restraining order also freezes certain financial assets of four other companies the defendants owned or controlled and allegedly used to launder money fraudulently obtained from Medicare. The temporary restraining order is intended to preserve the remaining proceeds of the fraud for recovery by the United States as part of the criminal case and any related civil proceedings.

According to Acting U.S. Attorney Jeffrey H. Sloman, the “[c]oordinated criminal and civil action delivers an effective one-two punch to health care fraudsters: they were not only caught and criminally charged, but they are also being stripped of their illegal proceeds.”

Posted by Robert David Malove | Permalink | Email This Post

Posted In: Home Health Care Fraud

Fraud ran for seven years

By JACK HEALY
Published: June 18, 2009

Four years ago, Richard M. Scrushy, the former chief executive of HealthSouth, walked out of a federal courthouse in Alabama and thanked God that he had been acquitted of criminal charges that he defrauded the company. But on Thursday, a state judge still found Mr. Scrushy responsible for the fraud and ordered him to pay $2.9 billion to the company’s shareholders.

In his decision, the judge, Allwin E. Horn, declared that Mr. Scrushy knew about and took part in concocting false financial statements that inflated HealthSouth’s earnings to meet Wall Street’s expectations and to buoy the stock.

The fraud ran for seven years, totaled $2.7 billion and was “remarkable and perhaps unique” in its size and scope, the judge wrote.

“Scrushy was the C.E.O. of the fraud,” Judge Horn wrote.

The ruling was a coda on an era of scandals at companies like Enron, WorldCom, Tyco International and ImClone.

“This is the last chapter in the great epic drama of major corporate scandals that we saw in the last 10 years,” said Robert J. Mintz, a former federal prosecutor who followed Mr. Scrushy’s criminal trial. “It in some ways closes the book on the wave of unprecedented corporate fraud we saw. This one has dragged out even longer than Enron.”

For prosecutors who failed to win a conviction of Mr. Scrushy and shareholders whose HealthSouth shares crumbled after the fraud was unmasked, the judge’s decision offered a belated, if anticlimactic, vindication.

“He was the orchestrator of this fraud,” said Alice H. Martin, the United States attorney who unsuccessfully prosecuted Mr. Scrushy on 36 criminal counts. Ms. Martin is retiring on Friday. “That’s what I’m calling my retirement gift.”

While Mr. Scrushy’s criminal trial in 2005 was a five-month drama that fascinated many in Alabama and drew throngs of reporters to the courtroom, this civil trial was a quieter proceeding. It lasted two weeks and was decided by a judge, and Mr. Scrushy was often not even present.

Mr. Scrushy had already been sentenced to nearly seven years in prison for bribing a former governor of Alabama, and he spent much of the civil trial in a holding cell away from the courtroom, lawyers said. He appeared in court only to testify in his own defense.

Lawyers said the judgment was the first time that Mr. Scrushy had been found liable in any courtroom for his actions at HealthSouth, which operates dozens of rehabilitation clinics and hospitals across the country. He has already been ordered to pay fines and to repay millions of dollars in bonuses. Several other executives of HealthSouth have been convicted in the case.

Mr. Scrushy has maintained his innocence and has said he knew nothing about the fraud. His lawyers did not return calls for comment on Thursday, but other lawyers connected to the case said they expected Mr. Scrushy to appeal. He is appealing his criminal conviction in the bribery case.

Lawyers for HealthSouth and shareholders said they were poised to go after Mr. Scrushy’s assets, but it is doubtful they will ever squeeze anything close to $2.9 billion from him. Mr. Scrushy has sold his shares of HealthSouth — which closed at $13.02 on Thursday — and was estimated to have $275 million in assets in 2005, said John Haley, a lawyer for shareholders.

“The only thing that remains now is collecting on it,” said Donald Q. Cochran, a law professor at Samford University in Birmingham, Ala.

HCA International- Conservatives for Patients Rights

Conservatives for Patients' Rights commercial with the Doctor in England?

2008--- HCA International

Welcome to London's leading private hospitals- HCA International

Why we are London's No. 1 private hospital group- HCA International

� More than 3,000 top London and UK specialists in private practice- HCA International

No. 1 private hospital?- HCA International

This is what STUPID AMERICA gets:

LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED; HCA INVESTIGATION
Note: Hospital Corporation of America (HCA) was acquired by Columbia in 1994.

1997- As part of Richard Scott's severance package from Columbia he was paid $5.13 million and given a five year consulting contract at $950,000 per year.

1997+5 years consulting =2002

In 2002 FBI raided the offices of National Century Financial Enterprises in Dublin, Ohio.

National Century Financial Enterprises

Guess where ALL of Rick Scott’s Columbia homecare units were? National Century Financial Enterprises.

Largest fraud case the FBI has ever investigated-one acquittal- James K Happ, the ex-CFO of Columbia Homecare Group, Inc.

Jurors stated; "PROSECUTOR DID NOT DO HIS JOB"�hmm

Leo Wise , now at the ethics CBO ---jurors stated 'PROSECUTOR DID NOT DO HIS JOB'

"Ladies and gentlemen, this is a case of staggering fraud," 'It is one of the largest frauds the FBI has ever investigated. (Leo Wise )

The ONLY acquittal; James K Happ--the CFO of Columbia Homecare Group.
Leo Wise , (now at the ethics CBO) stated "Ladies and gentlemen, this is a case of staggering fraud," 'It is one of the largest frauds the FBI has ever investigated.

Then- low and behold: December 18, 2008 The ONLY acquittal; James K Happ!...belief that federal prosecutors had not done their job, the juror said.

Columbia/HCA is a partnership of financier Richard Rainwater of Ft. Worth and lawyer Richard Scott. Scott was recently terminated by Darla Moore, the wife of Richard Rainwater.

Richard Rainwater, ex-partner of GW Bush with the Rangers

Leo Wise, now at the ethics CBO ---jurors stated 'PROSECUTOR DID NOT DO HIS JOB'

In 2002 FBI raided the offices of National Century Financial Enterprises in Dublin, Ohio

"This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America," said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.

Richard Scott -- sometimes called "the Bill Gates of health care" -- quit as chairman of Columbia/HCA Healthcare Corp. amid a massive federal investigation into the Medicare billing, physician recruiting and home-care practices of the nation's largest for-profit health care company.

Columbia/HCA is a partnership of financier Richard Rainwater of Ft. Worth and lawyer Richard Scott. Scott was recently terminated by Darla Moore, the wife of Richard Rainwater.

Rainwater also owned a large stake in Magellan Health Care which controls Charter Medical. Magellan, run by Darla Moore, is the largest network of psychiatric hospitals in the country. They are becoming more and more involved in obtaining government money for services formerly not covered as health care, according to Fortune Magazine.

1997 - Columbia/HCA Healthcare Corp. - the nation's largest for-profit health care company

Congressional Budget Office

Leo Wise , now at the ethics CBO said:

"Ladies and gentlemen, this is a case of staggering fraud," 'It is one of the largest frauds the FBI has ever investigated.

Then- low and behold: December 18, 2008 The ONLY acquittal; James K Happ!...belief that federal prosecutors had not done their job, the juror said.


In 2002 FBI raided the offices of National Century Financial Enterprises in Dublin, Ohio

"This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America," said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.


The ONLY acquittal; James K Happ- the CFO of Columbia Homecare Group.

Hospital Corporation of America - LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY

2009-The Wall Street Journal reported that Richard Scott, "the former chief executive of HCA Inc," had formed the non-profit organization Conservatives for Patients' Rights as part of a "lobbying campaign to derail or modify" President Obama's health care proposals, but failed to note that Scott resigned from HCA in 1997 amid a federal investigation into the company's Medicare billing, physician recruiting, and home-care practices. HCA eventually pleaded guilty to fraud charges and paid approximately $1.7 billion in fines and penalties.

THURSDAY, JUNE 26, 2003; WWW.USDOJ.GOV;
WASHINGTON, D.C.
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED; HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION
Note: Hospital Corporation of America (HCA) was acquired by Columbia in 1994.

Why does this matter? The wrath of Richard Scott and friends is to this day still affecting main street America.

Who is Richard Scott? More importantly, who are Richard Rainwater & his wife, Darla Moore?

Before GW Bush was affiliated with Richard Rainwater may I remind you-Richard Scott was the ex-partner of Richard Rainwater with Columbia Homecare Group.

In 1997, Fortune magazine ran a cover story on successful business executive Darla Moore, titled "The Toughest Babe in Business."….She created the corporate bankruptcy finance tool, DIP, debtor in possession while at a Wall Street bank.

Columbia/HCA is a partnership of financier Richard Rainwater of Ft. Worth and lawyer Richard Scott. Scott was recently terminated by Darla Moore, the wife of Richard Rainwater and according to Fortune Magazine, the “Toughest Babe in the Business”.
As part of Richard Scott's severance package from Columbia he was paid $5.13 million and given a five year consulting contract at $950,000 per year. His former president, Mr. Vandewater was paid $3.24 million and given a five year consulting contract at $600,000 per year.

Both former executives are allowed to exercise vested stock options within 90 days. Scott owned or had options on 9.4 million shares of Columbia stock as of May, 1997. Vanderwater controlled 617,375 shares. Columbia has agreed to pay attorney's fees and any fines or judgments against the two. In addition, the two former executives get their office expenses paid for two years including secretaries. If they move within the next two years their moving expenses are paid by Columbia/HCA. Not a bad deal for someone who just got fired! Wow! What a surprise!

Rainwater also owned a large stake in Magellan Health Care which controls Charter Medical. Magellan, run by Darla Moore, is the largest network of psychiatric hospitals in the country. They are becoming more and more involved in obtaining government money for services formerly not covered as health care, according to Fortune Magazine.

Columbia just decided to sell its home health-care business and its head announced she is forming a company of her own. The home care unit is valued at $ 450 million. At least two other top executives of Columbia have resigned.

On Sept 8, 1998 Standard and Poors downgraded the bonds of Charter/HCA to negative bases on poor earnings. Looks like Rainwater and his Crescent Cos' have finally stumbled. One source within the company said it would be a long while before any new high-ticket acquisitions would take place. A previous deal with Prudential is in danger of being jettisoned.

Why does this matter- September 8, 1998?

We must review the case that just ended in December 2008 in Columbus Ohio with National Century Financial Enterprises which was headquartered in Dublin, Ohio. It began in 2002 when FBI raided the offices of National Century Financial Enterprises Dublin, Ohio

National Century Financial Enterprises:
“This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.

Just a reminder relating to the need for ‘healthcare financial service’ i.e. (NCFE) National Century Financial Enterprises; home health - which was struggling under the Balanced Budget Act of 1997; about 1,400 agencies closed nationwide in 1998.

3/9/2006
10-K SEC Filing, filed by J P MORGAN CHASE & CO on 3/9/2006: Enron litigation. JPMorgan Chase and certain of its officers and directors are involved in a number of lawsuits arising out of its banking relationships with Enron Corp.; the three current or former Firm employees are sued in their roles as former members of NCFE's board of directors

Just a reminder relating to the need for ‘healthcare financial service’ i.e. (NCFE) National Century Financial Enterprises; home health - which is struggling under the Balanced Budget Act of 1997; about 1,400 agencies closed nationwide in 1998.

March 26, 2008; By Jodi Andes; THE COLUMBUS DISPATCH
Nine other executives have been convicted or pleaded guilty in National Century's collapse. Only Poulsen and executive James Happ still await trial.
Only Poulsen and executive James Happ still await trial?

December 18, 2008 - The ONE AND ONLY acquittal; James K Happ!
By Jodi Andes THE COLUMBUS DISPATCH
Prosecutors' case fell short, juror says National Century fraud case produces 1st acquittal ; The "not guilty" verdicts that came in federal court yesterday were not so much a vindication of the last National Century Financial Enterprises executive to stand trial, a juror said.

Instead, they were more a belief that federal prosecutors had not done their job, the juror said after he and his fellow jurors acquitted James K. Happ of five counts after 12 hours of deliberation. "He very well may have been guilty. A lot of us thought he was," said the juror who wouldn't give his name. "But if he was, you gotta have the evidence."

To unravel this massive fraud that links FRAUD intertwined with Healthcare, Corporate Bankruptcy and Financial Institutes we can go back to 1979-but I will start with 1997:

July 26, 1997, Los Angeles Times article:
A controversial deal maker whose hard-nosed business tactics have reshaped the medical industry resigned Friday as scandal engulfed the vast hospital empire he had assembled over the last decade.

Richard Scott -- sometimes called "the Bill Gates of health care" -- quit as chairman of Columbia/HCA Healthcare Corp. amid a massive federal investigation into the Medicare billing, physician recruiting and home-care practices of the nation's largest for-profit health care company.

Though the federal probe focuses on other states, Columbia's aggressive expansion has included California, where the company operates 15 hospitals, 13 surgery centers and 10 home-health-care agencies, employing more than 11,000.


July 26, 1997- Where was James K Happ?
SEC Form September 9, 2003 Annual Meeting of Stockholders, Med Diversified Inc.:
Previously, Mr. Happ served for three years as executive vice president of NCFE, during which time he restructured the servicer department to improve operational performance and accelerated the utilization of technology to increase operational efficiency.

Mr. Happ also served as chief financial officer of the Dallas-based Columbia Homecare Group, Inc.,
… In this role, he directed the company through the challenging reimbursement climate, known as the interim payment system, and participated in the divestiture of all of Columbia/HCA's home care operations

Who purchased the majority of this divestiture in late ’98 & early ’99?
Medshares, Inc. of Memphis, Tennessee
Who financed this divestiture?
National Century Financial Enterprises, Inc.

Sherry Gibson pleaded guilty in 2003 to a lesser charge of securities fraud in exchange for helping prosecutors. Gibson told jurors she told investors "absolutely nothing" about National Century's practices of advancing cash to Memphis, Tenn.-based Medshares, a home-health care provider… July 30, 1999 MEDSHARES INC: Health Care Services Provider Files Chapter 11

Largest corporate fraud investigations

December 2008, are you aware of the largest private financial fraud case in our country's history?

National Century Financial Enterprises:
“This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.

3/9/2006- 10-K SEC Filing, filed by J P MORGAN CHASE & CO on 3/9/2006: Enron litigation. JPMorgan Chase and certain of its officers and directors are involved in a number of lawsuits arising out of its banking relationships with Enron Corp.; the three current or former Firm employees are sued in their roles as former members of NCFE's board of directors...

Just a reminder relating to the need for ‘healthcare financial service’ i.e. (NCFE) National Century Financial Enterprises; home health - which was struggling under the Balanced Budget Act of 1997; about 1,400 agencies closed nationwide in 1998.
Guess one of the publicly traded healthcare companies that were involved in this ‘private’ financial institution that was used for the divestiture of the losing assets of the home healthcare units?

On Sept 8, 1998 Standard and Poors downgraded the bonds of Charter/HCA to negative bases on poor earnings. Looks like Rainwater and his Crescent Cos' have finally stumbled.

Columbia just decided to sell its home health-care business and its head announced she is forming a company of her own. The home care unit is valued at $ 450 million. At least two other top executives of Columbia have resigned.

March 26, 2008
By Jodi Andes
THE COLUMBUS DISPATCH

Nine other executives have been convicted or pleaded guilty in National Century's collapse. Only Poulsen and executive James Happ still await trial.
Only Poulsen and executive James Happ still await trial?

December 18, 2008 - The ONE AND ONLY acquittal; James K Happ!
By Jodi Andes
THE COLUMBUS DISPATCH

Prosecutors' case fell short, juror says ….Instead, they were more a belief that federal prosecutors had not done their job, the juror said after he and his fellow jurors acquitted James K. Happ of five counts after 12 hours of deliberation. "He very well may have been guilty. A lot of us thought he was," said the juror who wouldn't give his name. "But if he was, you gotta have the evidence."
Who was James K Happ?

SEC Form September 9, 2003 Annual Meeting of Stockholders, Med Diversified Inc.:
Previously, Mr. Happ served for three years as executive vice president of NCFE, during which time he restructured the servicer department to improve operational performance and accelerated the utilization of technology to increase operational efficiency.

Mr. Happ also served as chief financial officer of the Dallas-based Columbia Homecare Group, Inc.,

… In this role, he directed the company through the challenging reimbursement climate, known as the interim payment system, and participated in the divestiture of all of Columbia/HCA's home care operations

Who purchased the majority of this divestiture in late ’98 & early ’99?

Medshares, Inc. of Memphis, Tennessee

Who financed this divestiture?
National Century Financial Enterprises, Inc.

Sherry Gibson pleaded guilty in 2003 to a lesser charge of securities fraud in exchange for helping prosecutors. Gibson told jurors she told investors "absolutely nothing" about National Century's practices of advancing cash to Memphis, Tenn.-based Medshares, a home-health care provider… July 30, 1999

1999- Who filed the largest corporate bankruptcy in the Western Tennessee Federal Bankrutpcy Court?

Medshares, Inc. of Memphis, Tennessee

Doctor pleads guilty to health care fraud- Illinois, Elmwood Park

Elmwood Park, Illinois

Doctor pleads guilty to health care fraud

May 7, 2009 11:03 PM

A 47-year-old Elmwood Park doctor pleaded guilty this afternoon to federal health care fraud charges, admitting he submitted hundreds of thousands of dollars in false health insurance claims, the Chicago Sun-Times reports.

Dr. Otto Garcia Montenegro admitted he submitted about $500,000 worth of phony insurance claims between 2003 and 2007.

May 7, 2009

BY NATASHA KORECKI Federal Courts Reporter

An Elmwood Park doctor pleaded guilty this afternoon to federal health care fraud charges, admitting he submitted hundreds of thousands of dollars in false health insurance claims.

Dr. Otto Garcia Montenegro, 47, admitted he submitted about $500,000 worth of phony insurance claims between 2003 and 2007.

He did it while he worked as a general practice physician out of his own clinic, Montenegro Clinic Inc. Federal prosecutors say he treated dozens of patients each week.

Prosecutors said he created hundreds of phony bills and charged insurers for visits and treatments that never happened.

“He is extremely remorseful for his conduct, the extent of which will be revealed at sentencing,” said his attorney, Lawrence Beaumont.

Montenegro is scheduled to be sentenced Aug. 20.

The case was investigated by the FBI and the Labor Department’s Office of Inspector General.

Bigger then Enron- Richard Scott

New Commercial for Richard Scott

Conservatives for Patients' Rights


Remember who Richard is:

The Epitome of Fraud- Waste-Abuse:

2009 - WSJ reported that Richard Scott, "the former CEO of HCA Inc," had formed the non-profit organization-

Conservatives for Patients' Rights

as part of a "lobbying campaign to derail or modify" health care reform.


non-profit? What a joke.

Not this thief: THURSDAY, JUNE 26, 2003; WWW.USDOJ.GOV;
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED; HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION
Note: Hospital Corporation of America (HCA) was acquired by Columbia in 1994.

He features a doctor from England. I wonder why?

HCA International
242 Marylebone Road London, NW1 6JL
News & Events Careers Sitemap Legal

2008-

Welcome to London's leading private hospitals
Text size: A A
With six world-class hospitals and four outpatient medical centres in London, we are the private hospitals of choice for the successful treatment of serious and complex medical conditions. We also achieve some of the highest patient outcome and survival rates in the UK and our hospitals are virtually MRSA-free*

President and CEO of Doctor’s Hospital in Bremen--Fraud

Two medical offices got surprise visits today from federal agents. That’s because two doctors are being investigated for major healthcare fraud.

U.S. Attorney Donald Schmid says for over a year, federal authorities have been investigating Dr. Jamie Gottlieb and Dr. Cameron Gilbert. Schmid says the doctors are suspected of health care billing fraud, improper patient referrals and illegal kickbacks to doctors.
Federal officials took an “evidence collecting” tour of Michiana today, stopping at the doctors’ officers and homes.

Gilbert is the President and CEO of Doctor’s Hospital in Bremen. We found agents walking in the hospital with folded boxes and out of the hospital with full ones.

Doctor’s Hospital CEO John Day says in a written statement, “We appreciate the process and we are respectfully cooperating with the Department of Health and Human Services. We intend to continue our business of providing quality patient care and feel confident in the outcome of this situation.”

Newscenter 16 contacted the Department of Health and Human Services and officials there did confirm the agency is part of the investigation and the search.

Investigators also stopped at Gilbert’s two homes in Knox and Mishawaka.

"I got here at about a quarter until eight this morning and there was about six police officers here and they were trying to get access into one of the homes,” explains Jeff Bavar, housing project manager for Kamm Island Park, where Gilbert lives. “They produced a search warrant. And with that, I figured it was better to let them in the building than let them knock the door down."

Officials also made their way to Dr. Jamie Gottlieb’s home off Roosevelt in South Bend. You can see tire marks in the grass from cars driving around the gate.

Gottlieb is an orthopedic surgeon and founded I-Spine Institute in Elkhart. Inside the doors there is a sign that reads, “I-Spine is closed due to a sudden emergency.”

It isn’t clear if the two doctors are connected, but Dr. Jamie Gottlieb is part owner of Doctor’s Hospital and is listed as a physician on the hospital’s website. That’s the facility owned by the other doctor, Cameron Gilbert.

A variety of schemes to defraud Medicaid.

For Immediate Release
April 22, 2009 United States Attorney's Office
Southern District of Indiana
Contact: (317) 226-6333
Indiana Man Sentenced for Medicaid Fraud

Timothy M. Morrison, United States Attorney for the Southern District of Indiana, and Greg Zoeller, Indiana Attorney General, announced that DENNIS LENNARTZ, 55, Anderson, Indiana, was sentenced to 43 months imprisonment today by U.S. District Judge William T. Lawrence following his guilty plea to medicaid fraud. This case was the result of a six month investigation by the Health and Human Services Administration, Office of Inspector General, and the Federal Bureau of Investigation.

From August of 2006 through December of 2008, LENNARTZ, submitted false and misleading representations regarding transportation services he or his agents had purportedly provided to Medicaid patients of approximately $964,852.59.

The investigation of LENNARTZ revealed a variety of schemes to defraud Medicaid.

For example LENNARTZ was billing Medicaid for transporting patients receiving radiation treatments claiming that the distance was 300 miles per trip when, in fact, the trip was 31 miles. LENNARTZ also billed Medicaid for transporting a patient for rehabilitation claiming the distance was 220 miles when, in fact, it was only 33 miles. Another medicaid recipient LENNARTZ transported to Riley Hospital once a month resulted in Medicaid being billed for mileage claims 42 times in a period of three months.

"As this sentencing demonstrates yet again, those who would defraud taxpayers by preying on government health care programs can expect the scales of justice to weigh heavily against them," said Lamont Pugh III, Special Agent in Charge for the Chicago region of the U.S. Department of Health and Human Services Office of Inspector General which oversees the State of Indiana.

"This case was a joint effort by our state investigators and attorneys of the Indiana Medicaid Fraud Control Unit of the Office of the Attorney General and by the federal government. I want to commend all involved for their hard work in unraveling this scheme to drain funds away from legitimate Medicaid purposes," Indiana Attorney General Greg Zoeller said. "At a time when every public dollar is precious, we are sending a strong message that overbilling is an affront to the taxpayers and will be dealt with seriously."

Indiana Medicaid pays for the transportation services of its beneficiaries to and from Medicaid covered services. Transportation providers who bill for services to Indiana Medicaid must first undergo an enrollment process, agree to abide by the program's rules and regulations, and then become approved providers. These approved providers receive provider manuals which detail the Indiana Medicaid Program's rules and regulations as well as provide instruction on how to appropriately bill for services. These providers also receive periodic regulation "bulletins" from the Indiana Medicaid Program which are designed to remind providers of existing regulations or inform them of any changes.

Non-emergency transportation services are generally billed as either a Commercial / Common Ambulatory Service (CAS) or as a Non-Ambulatory Service (NAS). Indiana Medicaid regulations state that CAS services are to be billed when beneficiaries are ambulatory. That is, they are able to walk. This service is billed under a particular procedure code and providers are paid $10.00 for each one-way transport. However, in addition to billing this code, CAS providers can bill separately for mileage, as well as waiting time, and receive additional reimbursement. Mileage is reimbursed based on the amount of "loaded miles" which are the miles driven when the patient is in the transportation vehicle.

FBI Indianapolis Special Agent in Charge Michael S. Welch said, "The FBI is addressing Health Care Fraud through investigations just like this one. We will continue to work with partnering law enforcement agencies to ensure that we are safeguarding taxpayers' money."

According to Assistant U.S. Attorney Bradley P. Shepard who prosecuted the case for the government, Judge Lawrence also imposed three years supervised release following LENNARTZ’s release from imprisonment.

Miami forensic accountant - Rachlin Fraud on the Fraud...incredible

A federal judge has sharply criticized a Miami forensic accountant overseeing a massive forfeiture stemming from a health care fraud, saying she placed her firm's financial interests ahead of her role as court-appointed receiver.

U.S. District Court Judge B. Avant Edenfield in Savannah, Ga., also criticized Miami-based Rachlin, saying the firm purposely refused to file tax returns until it was paid, racking up fines and penalties.

Marta Alfonso, a partner in the firm's advisory services division, was appointed receiver after Edenfield ordered convicted officials of Miami-based Bio-Med Plus to pay forfeiture, fines and restitution following their convictions for bilking state and federal agencies on expensive AIDS and hemophilia treatments that were never administered.

Alfonso became involved in the case early, testifying as a defense expert, and made the unusual transition to receiver. She did well, recovering $54.1 million thus far on the forfeiture order.

She hired Miami attorney Thomas Tew, one of Tew Cardenas' name partners, as her lawyer in the receivership and farmed out the tax services to her firm.

Alfonso ran into trouble with the judge after filing an emergency motion Feb. 4 to pay Rachlin. The motion was filed after a court-appointed monitor overseeing the forfeiture refused to pay the bill for tax preparation. The monitor cited cost overruns and late filings.

Alfonso told the court that Rachlin should be paid $191,354, of which $127,397 is outstanding. The monitor had set a $76,500 budget cap for the tax returns prepared by Rachlin.

In an April 7 order to show cause, Edenfield said that Alfonso demonstrated a clear conflict of interest by lobbying the monitor on behalf of her firm. "The receiver's conflict has burdened the receivership not only by enabling an excessive budget overrun and the incurrence of unnecessary expenses, but also by causing additional receiver's fees, monitor's fees and attorney fees," the judge wrote.

The judge issued the order after asking both the receiver and monitor to file detailed explanations. Edenfield said the monitor's response was supported by affidavits and other documentation while the receiver's filing by Tew Cardenas attorney Dennis Nowak "was both untimely and unresponsive."

A call to Rachlin for comment was not returned by deadline.

Alfonso is a salaried Rachlin employee who does not share in the firm's profits. She did not return phone calls for comment.

In his order, the judge noted that Alfonso defended her firm, acknowledging mistakes may have been made but saying it was an internal Rachlin issue. She also said the services were reasonably priced even though invoices were $100,000 over budget and late.

Speaking on her behalf, Tew said this is the first dispute between Alfonso and the monitor in three years since she was appointed. He said the receivership would respond to the show cause order by Friday.

Tew said it is commonplace for receivers to tap their own firms for tax services.

Attorneys who are appointed receivers regularly hire their own firms as legal counsel.

"There has been no wrongdoing," Tew said. "We do not believe there is a conflict."

The judge set a hearing for next Tuesday, April 21, so Alfonso can show cause why she should not be removed as receiver and why the court should not seek to recover any wasted assets.

Rachlin bills itself as one of the largest independent public accounting and advisory service firms in the Southeast with 25 partners and more than 225 professionals in South and Central Florida.

Bio-Med Plus was a medical supply company based in Miami and Savannah with about 100 employees. It was acquired by Novis Pharmaceuticals in 2007 after three top Bio-Med officials were accused of cheating users of life-saving blood products. The officials were prosecuted for health care fraud in Georgia, Florida and California.

In his order, Edenfield chastised Alfonso for submitting several bills from Rachlin, ranging from $98,992 to $171,379 for the same tax services. Rachlin filed late tax returns for the receivership for 2006 and 2007, incurring $231,226 in interest and penalties.

The monitor, Madison Associates of Woodbridge, Va., raised questions about the bills after a routine review from April through mid-September 2008.

"Through e-mails, memoranda, revised, re-revised and thrice-revised invoices, the receiver and Rachlin offered a stream of unresponsive and obfuscatory answers to the monitor's inquirers reminiscent of the 'Who's on First?' Abbott and Costello comedy routine," Edenfield wrote in his order.

In a series of e-mails last year, Alfonso declared "we have been paid nothing" for the 2007 tax services after giving blanket approval for a series of misstated and miscalculated Rachlin invoices. She later conceded invoices had been paid, Edenfield said.

Edenfield concluded Rachlin did little from April to July 2008.

"This inactivity suggests that Rachlin negligently allowed late penalties and interest to accrue while it waited for the receiver's collection of its fees in excess of the [$76,500] cap," Edenfield wrote.

The monitor suggested last September that an outside arbiter be engaged in resolving the conflict over the tax return issue with Rachlin, but Alfonso declined the recommendation, the judge's order said.

Alfonso proposed an independent review earlier this month of Rachlin's work to render an opinion on reasonable fees, Tew said.

Edenfield responded in his order, "The opportunity for such review, however, has come and gone."

Rachlin- Accounting frim in on it- really? Is that a surprise?

Federal Judge Raps Court-Appointed Receiver for Conflict of Interest
April 15, 2009

A federal judge has sharply criticized a Miami forensic accountant overseeing a massive forfeiture stemming from a health care fraud, saying she placed her firm's financial interests ahead of her role as court-appointed receiver.

The judge also criticized Miami-based accounting firm Rachlin, which, with the receiver, "offered a stream of unresponsive and obfuscatory answers to the monitor's inquirers reminiscent of the 'Who's on First?' Abbott and Costello comedy routine," the judge wrote in his order.

fined Urciuoli $30,000 and ordered him to perform eight hours a week of community service during two years of court supervision following his release

October, a federal jury found Urciuoli guilty of conspiracy and 35 counts of mail fraud.

Not a bad deal.....

News Release
U.S. Department of Justice
United States Attorney
District of Rhode Island

FOR IMMEDIATE RELEASE
April 10, 2009
WWW.USDOJ.GOV/USAO/MAContact: Thomas Connell
PHONE: 401-709-5032
E-MAIL: Thomas.connell@usdoj.gov

FORMER HOSPITAL OFFICIAL URCIUOLI IS SENTENCED FOR CORRUPTLY HIRING A STATE SENATOR
A federal judge today sentenced Robert A. Urciuoli, the former president of Roger Williams Medical Center, to three years in federal prison for corruptly employing former Rhode Island Senator John Celona to advance the Medical Center’s interests in the General Assembly.

United States Attorney Robert Clark Corrente announced the sentence, which Chief U.S. District Court Judge Mary M. Lisi imposed in U.S. District Court, Providence. Judge Lisi also fined Urciuoli $30,000 and ordered him to perform eight hours a week of community service during two years of court supervision following his release from prison.

In October, a federal jury found Urciuoli guilty of conspiracy and 35 counts of mail fraud. During the trial, First Assistant U.S. Attorneys Luis M. Matos and Assistant U.S. Attorney Dulce Donovan presented evidence that Urciuoli hired Celona in 1998, ostensibly to work for the Village at Elmhurst, an assisted living center affiliated with Roger Williams. The evidence showed, however, that Urciuoli actually hired Celona to advance the Medical Center’s political agenda and by doing so, deprived the citizens of Rhode Island of their right to Celona’s honest services.

Between 1998 and 2004, Roger Williams paid Celona approximately $260,000 in consultant fees and, in return, Celona took steps to kill bills deemed harmful to Roger Williams and to advance legislation that Urciuoli considered favorable.

Celona worked to kill legislation that would have prohibited Medical Center officials from serving on the board of a for-profit hospital in the event of a merger. Celona also helped Urciuoli pressure medical insurance companies to increase their reimbursements to Roger Williams for health care services.

The trial in October was the second one stemming from a 2006 indictment. Convictions in October 2006 were reversed by the Court of Appeals for the First Circuit on an issue of how broadly to define the scope of honest services.

In September 2005, Celona pleaded guilty to federal fraud charges. He recently completed a 30-month prison sentence.

The Federal Bureau of Investigation and the Rhode Island State Police conducted the investigation.

Violating the Food, Drug and Cosmetic Act,

FOR IMMEDIATE RELEASE
MARCH 30, 2009
WWW.USDOJ.GOV/USAO/MA

CONTACT: CHRISTINA DiIORIO-STERLING
PHONE: (617)748-3356
E-MAIL: USAMA.MEDIA@USDOJ.GOV


PHARMACEUTICAL COMPANY MANAGER PLEADS GUILTY TO OFF-LABEL MARKETING

BOSTON, MA - A Branchburg, NJ, woman agreed to plead guilty to violating the Food, Drug and Cosmetic Act, for marketing the drug Bextra for uses and dosages that were not approved by the Food and Drug Administration.

United States Attorney Michael J. Sullivan; Warren T. Bamford, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; Susan J. Waddell, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General; Leigh-Alistair Barzey, Resident Agent in Charge of the Defense Criminal Investigative Service; Kim Rice, Special Agent in Charge of the Food and Drug Administration, Office of Criminal Investigations; Jeffrey Hughes, Special Agent in Charge of the U.S. Department of Veterans Affairs, Office of Inspector General, Office of Investigations - Northeast Field Office; Joseph Finn, Special Agent in Charge of the United States Postal Service, Office of Inspector General, Boston Field Office; and Drew Grimm, Special Agent in Charge of the U.S. Office of Personnel Management, Office of Inspector General - Eastern Operations, announced today that MARY HOLLOWAY, age 47, of Branchburg, New Jersey, has plead guilty to a one count Information charging her with distribution of a misbranded drug.

According to the Information from approximately November 2001, through April 2005, HOLLOWAY was employed as a Regional Manager at a pharmaceutical company and was responsible for sales in her region of the drug Bextra. Bextra was a Cox-II inhibitor and had been approved in by the Food and Drug Administration (FDA) in November 2001 for the signs and symptoms of osteoarthritis, adult rheumatoid arthritis, at 10 mgs and primary dysmennorhea at 20 mgs, twice a day as needed. The Information charges that, in 2001, the FDA specifically denied the request of the pharmaceutical company to approve it for acute pain, including the pain of surgery. The FDA told the pharmaceutical company that it could not approve it for these other indications because the safety in these other uses had not been established. Specifically, the FDA was concerned about the results of a study in which there was an excess of cardiovascular events in patients who had undergone coronary artery bypass graft surgery and used Bextra. Bextra was withdrawn from the market in April 2005.

HOLLOWAY was aware of the FDA’s safety concerns, but that she nonetheless had her sales staff of approximately 100 employees sell Bextra for precisely the uses that the FDA refused to approve. For example, HOLLOWAY trained and encouraged her sales teams to promote Bextra by obtaining protocols from doctors that instructed that Bextra be used for the pain of surgery, an unapproved use, and at 20 mgs, an unapproved dose. HOLLOWAY also instructed her staff to market Bextra for use before, during and after surgery to reduce the risk of deep vein thrombosis, which is a form of life threatening blood clots, even though she knew there were no studies showing that Bextra was safe and effective for this use. Finally, HOLLOWAY encouraged her staff to make false safety claims about Bextra in order to sell the drug.

HOLLOWAY faces up to six months’ imprisonment, to be followed by not more than 3 years of supervised release and a maximum fine of $100,000 or twice the amount of gross loss or gross gain.

The case was investigated by the Federal Bureau of Investigation, the Office of Inspector General for the Department of Health and Human Services, Special Prosecutions Staff for the Food and Drug Administration, the Office of Inspector General for the Department of Veterans Affairs, the Defense Criminal Investigative Service, the Office of Inspector General for the United States Postal Service and the Office of Inspector General for the U.S. Office of Personnel Management. It is being prosecuted by Assistant U.S. Attorneys Sara Miron Bloom and Susan M. Poswistilo of Sullivan’s Health Care Fraud Unit.

###

Medical Mutual of Ohio catches $6.2 million in fraudulent claims
Posted by Sarah Jane Tribble/Plain Dealer Reporter January 07, 2009 18:20PM
Categories: Business Impact, Impact, Insurance, Real Time News, Sarah Jane Tribble
Updated at 6:20 p.m.

Medical Mutual of Ohio, the state's largest health insurer, said it caught a record $6.2 million in fraudulent health-care claims last year, up from nearly $5 million the year before.

The company credits its computer software and a diligent investigative unit, which includes ex-police officers, for the increase.

The privately owned Cleveland-based company, which has 2,700 employees and serves about 1.6 million customers, is one of a growing number of insurers fighting fraud in the hopes of controlling health-care costs in a weak economy.

Health-care fraud typically occurs when doctors and other providers inaccurately bill the insurer or write unneeded prescriptions and perform unneeded procedures, said Lou Saccoccio, executive director of the National Health Care Anti-Fraud Association.

"It drives up cost -- absolutely it does," Saccoccio said. "Three to 5 percent of what insurers pay out in health benefits is fraudulent and that's going to be reflected in the premiums."

Medical Mutual's news of recovered dollars comes during a difficult time for health insurers. Two of the nation's largest health insurers plan job cuts in the wake of investment losses and a weak economy in which employers and consumers are reducing health care coverage. Cigna said earlier this week that it would cut 1,100 jobs, or 4 percent of its work force, by mid-2009; Aetna said last month that it would cut 1,000 jobs, or 3 percent of its work force.

Medical Mutual, the oldest health insurer in Ohio and one of Cleveland's largest employers, has no plans for layoffs -- though it is always "cautious on hiring," said Jared Chaney, Medical Mutual's chief communications officer.

Unlike some publicly traded competitors, the company does not answer to Wall Street, Chaney said.

"We don't have the pressure to meet quarterly targets set by analysts and year-over-year growth goals," Chaney said. "We want to turn a small profit because that profit goes into a surplus."

Medical Mutual has an operating surplus of nearly $1 billion, he said.

It's not all about money for John Shoemaker, manager of the 11-person financial investigations unit at Medical Mutual. "Not only do they steal," Shoemaker said. "In a lot of cases the services that they [doctors] render become questionable and I wonder if they're not hurting patients."


Tags: health care fraud, health costs, Medical Mutual of Ohio, National Health Care Anti-Fraud Association
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Who is Jay Grinney ? Largest in the NATION?? Give me a break!

HEALTHSOUTH....LARGEST in the NATION!!!! OMG!

BIRMINGHAM, Ala., March 2 /PRNewswire-FirstCall/ -- HealthSouth Corporation (NYSE: HLS) today announced it will participate in the Barclays Capital Global Healthcare Conference on March 10-11, 2009, at the Loews Miami Beach Hotel in South Beach, Fla.


HealthSouth President and Chief Executive Officer Jay Grinney and Executive Vice President and Chief Financial Officer John Workman will be speaking on Tuesday, March 10, at 9:30 a.m. EDT. The presentation will be webcast live and will be available at http://investor.healthsouth.com by clicking on an available link.


OMG!! ANOTHER LARGEST in the NATION!!!!
Pay attention AMERICANS!


About HealthSouth

HealthSouth is the nation's largest provider of inpatient rehabilitative healthcare services. Operating in 26 states across the country and in Puerto Rico, HealthSouth serves patients through its network of inpatient rehabilitation hospitals, long-term acute care hospitals, outpatient rehabilitation satellites, and home health agencies. HealthSouth strives to be the nation's preeminent provider of inpatient rehabilitative healthcare services and can be found on the Web at www.healthsouth.com.


Media Contact
Andy Brimmer, 205-410-2777

Investor Relations Contact
Mary Ann Arico, 205-969-6175
maryann.arico@healthsouth.com

Health Care Fraud Fugitive Gets 27 Months

Health Care Fraud Fugitive Gets 27 Months

POSTED: 2:56 pm MST February 24, 2009
UPDATED: 3:22 pm MST February 24, 2009
PHOENIX -- A former Phoenix woman was sentenced to 27 months in federal prison Monday, according to the U.S. Attorney’s Office.

Sheri Dawn Blackburn, 46, was also ordered to pay restitution in the amount of $88,441.30.

Blackburn was a fugitive for almost five years and pleaded guilty to one count of theft or embezzlement in connection with a health care benefit program on July 23, 2008, said Sandy Raynor of the District of Arizona Office of the U.S. Attorney.

Blackburn had been indicted in August 2003 on one count of theft in connection with a health care benefit program and one count of false statements relating to health care matters, but never appeared in court and became a fugitive, said Raynor.

The case against Blackburn was based on an investigation by the U.S. Department of Labor’s Employee Benefits Security Administration, said Raynor. It indicated that in 1998 Blackburn was hired by Eldorado Claims Services, a benefit claims processing company, to supervise health care claims processing.

While working here, Blackburn created a fictitious doctor and paid claims to this doctor for services that were never rendered. Blackburn then cashed 14 checks issued to this false identity, totaling $88,441.30, according to the U.S. Attorney’s Office.

After failing to appear in court for her indictment, Blackburn was a fugitive for nearly five years, said Raynor.

In March 2008, the Employee Benefits Security Administration found Blackburn in Iowa and alerted the U.S. Marshals Service, according to the U.S. attorney’s Office.

Blackburn was arrested in Eddyville, Iowa and was extradited to Arizona, where she has remained in federal custody, said Raynor.
Copyright 2009 by KPHO.com

University Pain Specialists, a clinic where prosecutors said he participated in a $12 million Medicare scam in which mentally ill and elderly adults r

Thursday, August 21, 2008
Newport Beach doctor surrenders license in fraud case
Dr. Paul Lessler pleaded guilty to Medicare fraud.
BY COURTNEY PERKES
The Orange County Register
Comments | Recommend

A Newport Beach doctor who last year pleaded guilty to committing Medicare fraud surrendered his medical license today, the California Medical Board reported.

Dr. Paul Lessler operated University Pain Specialists, a clinic where prosecutors said he participated in a $12 million Medicare scam in which mentally ill and elderly adults received unnecessary respiratory treatments. In May 2007, he pleaded guilty to three counts of conspiracy and health care fraud charges.

According to medical board documents made public today, Lessler hired recruiters who found patients at board and care facilities in Orange County from 2000 to 2006. Recruiters lured them with soda, candy and doughnuts. The lung treatments were provided without supervision at the boarding facilities. Documents say the medical office billed Medicare for the services, even though those services were not provided in the doctor's office, as required by Medicare.

Lessler, 70, agreed to give up his license and signed an agreement with the medical board to do so in July. Santa Ana attorney Raymond McMahon, who represented him in the proceeding, is on vacation and could not be reached for comment.

Federal records indicate Lessler was to be sentenced last month, but the computer system does not indicate the disposition. Neither his defense attorney nor prosecutors could be reached late today.

According to U.S. Attorney Patrick Fitzgerald's office

Cardiologist charged with health care fraud

Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursement ...
49-year-old Dr. Sushil Sheth faces up to 10 years in prison and a $250,000 fine for one count of health care fraud.

CHICAGO -- Federal authorities have charged a cardiologist from the southern Chicago suburbs with bilking Medicare and insurance companies out of more than $13 million for care they say he never provided.

According to U.S. Attorney Patrick Fitzgerald's office, 49-year-old Dr. Sushil Sheth faces up to 10 years in prison and a $250,000 fine for one count of health care fraud.
Fitzgerald's office alleged Friday that Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursement for high levels of cardiac care that the office says the doctor never performed.

Sheth allegedly used his hospital access to obtain patient information.

Wachovia recommended that CHS take part in a securities-lending program. 2003

CHS determined that the securities-lending program was proving too risky,

Wachovia Corp Sued by Carolinas Health Care System for More than $19 Million in “Bad” Investments

Posted On: January 19, 2009 by Shepherd Smith & Edwards
Wachovia Corp Sued by Carolinas Health Care System for More than $19 Million in “Bad” InvestmentsCarolinas Healthcare System (CHS) is suing Wachovia Corp for alleged bad investments that resulted in losses valued at over $19 million. CHS is also accusing the bank of “directly misleading” it, misrepresenting the risks associated with the investments, and failing to follow the hospital system's orders that it be withdrawn from the securities-lending program. Wachovia spokesperson Mary Eshet says that the company disagrees about the allegations, was always in compliance, and only made appropriate investments for CHS.

In 2003, according to the investment fraud lawsuit, Wachovia recommended that CHS take part in a securities-lending program. As a participant, a third party would borrow securities from CHS's portfolio in return for collateral that would be invested by Wachovia until the securities were returned. This would also hopefully result in additional returns.

Per the agreement, Wachovia was only supposed to invest in safe, liquid, quality securities. Any time CHS opted to withdraw from the program, the hospital system was supposed to get all of its investments back within five business days. Also, Wachovia would be allowed to keep 40% of the profits on one account and 35% on the other account.

Last summer, CHS determined that the securities-lending program was proving too risky, especially with the markets collapsing. In September, CHS notified Wachovia to return all borrowed securities right away.

Wachovia couldn’t return all of the securities immediately. Wachovia had invested for CHS $14.9 million in Sigma Finance Corp-issued floating rate notes (now worth $750,000) and $5 million in Pricoa Global Funding floating-rate notes (now worth $4.95 million).

The lawsuit contends that Wachovia never notified Carolinas HealthCare System that the investments were not appropriate until CHS decided to end its participation in the securities-leading program. 5 days after Sigma went into receivership last October, Wachovia told the hospital system for the first time that its investment was, at that time, worth just $1.8 million. CHS says there is no market for the Pricoa notes.

CHS contends that Wachovia gained 40% of the profits but did not suffer any of the losses. The hospital system is solely responsible for returning the lost collateral to its securities borrowers.

CHS sues Wachovia over investment advice, Charlotte Observer, January 15, 2009

CHS files suit vs. Wachovia over losses on investments, Charlotte Business Journal, January 9, 2009


Related Web Resources:
Carolinas HealthCare System

Wachovia Corp

Call or e-mail Shepherd Smith Edwards and Kantas LLP today.

SouthernCare Inc., $24.7 million to settle charges it made false claims

SouthernCare Inc., based in Birmingham, Alabama, has agreed to pay $24.7 million to settle charges it made false claims to the government concerning medicare reimbursements for patients who did not qualify. The case brought against SouthernCare was the result of two qui tam suits filed by two former SouthernCare employees, Tanya Rice and Nancy Romeo, both registered nurses, who will receive $4.9 million as their share in filing the cases. The prosecutor in the case, Alice H. Martin, U.S. Attorney for the Northern District of Alabama is quoted as saying, "Our investigation showed a pattern and practice to falsely admit patients to hospice care who did not qualify and to bill Medicare for that care.

United Health Group, Cuomo goes after United Health

Cuomo goes after United Health
Updated: 01/13/2009 09:26 PM
By: Erin Billups

NEW YORK STATE -- "I'm putting all the other healthcare insurance companies on notice today. This is the first step today with United," said Attorney General Andrew Cuomo.

After an investigation into allegations of unfair insurance reimbursement rates, United Health Group, one of the country's largest health insurers, has agreed to shut down its subsidiary, Ingenix, the nation's largest provider of health care billing information. Cuomo says Ingenix intentionally skewed the rates used when patients saw a doctor out of their coverage network.

"The system basically forced consumers to write a blank check to the doctor. They had no other guidance," Cuomo said.

Many large and small insurance providers use Ingenix, giving the company customer's billing information and all receiving the same reimbursement rate.

"Everyone bought into the system, everyone agreed, everyone has the same numbers. It was very difficult to detect," Cuomo said.

So customers would go to out-of-network doctors thinking they'd get, say, 80 percent back of what they were billed, only to find out that Ingenix would give back 10 to 28 percent less, calling that, the quote, usual and customary cost.

Mary Jerome, is being treated for advanced stage ovarian cancer. After she discovered her reimbursements were too low, she reported it to Cuomo's office.

"I felt like I had to battle twice, I had to battle cancer and I then felt I had to battle my insurance company,” said Jones. “It was almost too much to bear."

Now fewer people will have to bear that burden. United has also agreed to pay $50 million to a qualified nonprofit organization that will create a new independent database and reimbursement system. It will also develop a website where customers can find out, in advance, how much they'll pay before they go to the doctors.

But the investigation continues. Cuomo says one by one, they'll be investigating other insurance companies.

"I believe all these companies that have been involved with Ingenix, that there's a very strong case that they were perpetrating consumer frauds. And we are going to aggressively pursue those cases," Cuomo said.

In a press release, United Health's president said they're confident "the agreement will enhance the transparency of information" for consumers. But it seems this was just the tip of the iceberg.