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.
Showing posts with label FRAUD. Show all posts
Showing posts with label FRAUD. Show all posts
Wednesday, July 22, 2009
Wednesday, July 15, 2009
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.
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.
Friday, May 8, 2009
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.
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.
Tuesday, April 28, 2009
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*
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*
Monday, April 27, 2009
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.
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.
Thursday, April 23, 2009
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.
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.
Wednesday, April 15, 2009
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."
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."
Saturday, April 11, 2009
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.
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.
Sunday, April 5, 2009
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.
###
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.
###
Tuesday, March 3, 2009
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
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
Wednesday, February 25, 2009
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
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
Wednesday, February 11, 2009
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.
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.
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.
Wednesday, January 21, 2009
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.
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.
Friday, December 19, 2008
2 from Athens charged with TennCare fraud; Is this the best Tennessee can do?
Posted: Dec 16, 2008 05:18 PM CST
NASHVILLE (WATE) -- A man and woman from Athens have been charged with 2 from Athens charged with TennCare fraud
Posted: Dec 16, 2008 05:18 PM CST
NASHVILLE (WATE) -- A man and woman from Athens have been charged with TennCare fraud in separate cases.
John V. Davis, 25, is charged with three counts of using TennCare to get controlled substances by doctor shopping.
According to the indictment, Davis failed to disclose to his doctor that he'd seen other doctors within a 30-day period, receiving prescriptions for the painkillers Oxycodone and Hydrocodone.
Investigators say Davis received a prescription for Oxycodone during a visit to a hospital emergency room, which was paid for by TennCare.
They also say Davis used TennCare twice to pay for prescriptions for Hydrocodone.
Kristie Smithers, 31, is charged with three counts of TennCare fraud for using it to pay for fake prescriptions.
Smithers is accused of using TennCare to pay for fake prescriptions written for Hydrocodone three times.
If convicted, each could each spend up to two years per charge in prison.
NASHVILLE (WATE) -- A man and woman from Athens have been charged with 2 from Athens charged with TennCare fraud
Posted: Dec 16, 2008 05:18 PM CST
NASHVILLE (WATE) -- A man and woman from Athens have been charged with TennCare fraud in separate cases.
John V. Davis, 25, is charged with three counts of using TennCare to get controlled substances by doctor shopping.
According to the indictment, Davis failed to disclose to his doctor that he'd seen other doctors within a 30-day period, receiving prescriptions for the painkillers Oxycodone and Hydrocodone.
Investigators say Davis received a prescription for Oxycodone during a visit to a hospital emergency room, which was paid for by TennCare.
They also say Davis used TennCare twice to pay for prescriptions for Hydrocodone.
Kristie Smithers, 31, is charged with three counts of TennCare fraud for using it to pay for fake prescriptions.
Smithers is accused of using TennCare to pay for fake prescriptions written for Hydrocodone three times.
If convicted, each could each spend up to two years per charge in prison.
OIG Releases Reports on Hospital Adverse Events and State Reporting Systems
December 16, 2008
OIG Releases Reports on Hospital Adverse Events and State Reporting SystemsOn December 16, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) released a report entitled "Adverse Events in Hospitals: Overview of Key Issues."
The Tax Relief and Health Care Act of 2006 (Act) mandates that the OIG report to Congress regarding the incidence of "never events" among Medicare beneficiaries, payment by Medicare or beneficiaries for services furnished in connection with such events, and the process that the Centers for Medicare & Medicaid Services uses to identify events and deny payment. According to the OIG, this report is one in a series to fulfill the requirements of the Act.
In this report, the OIG identifies 7 issues critical to understanding adverse events in hospitals. In brief, the 7 issues can be described as follows:
Estimates of the incidence of adverse events in hospitals vary widely and measurement is difficult.
Nonpayment policies for adverse events are gaining in prominence and are viewed as a powerful incentive to reduce incidence but raise potential drawbacks.
Hospitals rely on staff and managers to report adverse events internally, but barriers can inhibit reporting.
Hospitals report adverse events to various oversight entities, although stakeholders suspect substantial underreporting.
Public disclosure of adverse events can benefit patients but also raises legal concerns for patients and providers.
Information to help prevent adverse events is widely available, but some hospitals and clinicians may be slow to adopt or routinely apply recommended practices.
Interviews and literature reveal strategies that may accelerate progress in reducing the incidence of adverse events in hospitals.
On December 16, 2008, the OIG has also released a related report entitled "Adverse Events in Hospitals: State Reporting Systems" in which the OIG identifies and describes state adverse event reporting systems and how states use the reported information. In brief, the OIG reports the following:
As of January 2008, 26 states had hospital adverse event reporting systems and another state had taken action to develop one.
Reporting systems varied in terms of what events were reported, criteria used for selection, and type of information reported.
Most states with systems reported having mechanisms to identify underreporting and strategies to improve reporting.
23 states reported using data to hold individual hospitals accountable and 18 states reported using data to promote learning and prevent adverse events.
In this report, the OIG concludes that state systems are disparate making state adverse event reporting systems data unsuitable for use in the aggregate to identify national incidence and trends. However, the OIG reports that most states use the reported data in similar ways. For instance, states use reports to assess individual hospitals' responses to adverse events, and to promote learning and prevent adverse events.
For purposes of the OIG reports, the OIG expanded beyond the term "never events" to address "adverse events," which describe patient harm resulting from medical ca
http://medicareupdate.typepad.com/medicare_update/2008/12/oigadverseeventreports.html
OIG Releases Reports on Hospital Adverse Events and State Reporting SystemsOn December 16, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) released a report entitled "Adverse Events in Hospitals: Overview of Key Issues."
The Tax Relief and Health Care Act of 2006 (Act) mandates that the OIG report to Congress regarding the incidence of "never events" among Medicare beneficiaries, payment by Medicare or beneficiaries for services furnished in connection with such events, and the process that the Centers for Medicare & Medicaid Services uses to identify events and deny payment. According to the OIG, this report is one in a series to fulfill the requirements of the Act.
In this report, the OIG identifies 7 issues critical to understanding adverse events in hospitals. In brief, the 7 issues can be described as follows:
Estimates of the incidence of adverse events in hospitals vary widely and measurement is difficult.
Nonpayment policies for adverse events are gaining in prominence and are viewed as a powerful incentive to reduce incidence but raise potential drawbacks.
Hospitals rely on staff and managers to report adverse events internally, but barriers can inhibit reporting.
Hospitals report adverse events to various oversight entities, although stakeholders suspect substantial underreporting.
Public disclosure of adverse events can benefit patients but also raises legal concerns for patients and providers.
Information to help prevent adverse events is widely available, but some hospitals and clinicians may be slow to adopt or routinely apply recommended practices.
Interviews and literature reveal strategies that may accelerate progress in reducing the incidence of adverse events in hospitals.
On December 16, 2008, the OIG has also released a related report entitled "Adverse Events in Hospitals: State Reporting Systems" in which the OIG identifies and describes state adverse event reporting systems and how states use the reported information. In brief, the OIG reports the following:
As of January 2008, 26 states had hospital adverse event reporting systems and another state had taken action to develop one.
Reporting systems varied in terms of what events were reported, criteria used for selection, and type of information reported.
Most states with systems reported having mechanisms to identify underreporting and strategies to improve reporting.
23 states reported using data to hold individual hospitals accountable and 18 states reported using data to promote learning and prevent adverse events.
In this report, the OIG concludes that state systems are disparate making state adverse event reporting systems data unsuitable for use in the aggregate to identify national incidence and trends. However, the OIG reports that most states use the reported data in similar ways. For instance, states use reports to assess individual hospitals' responses to adverse events, and to promote learning and prevent adverse events.
For purposes of the OIG reports, the OIG expanded beyond the term "never events" to address "adverse events," which describe patient harm resulting from medical ca
http://medicareupdate.typepad.com/medicare_update/2008/12/oigadverseeventreports.html
Thursday, December 18, 2008
Federal agents raid convalescent home headquarters
Federal agents raid convalescent home headquarters
By TONY SAAVEDRA and RONALD CAMPBELL
The Orange County Register
Wednesday, December 17, 2008
Federal agents on Wednesday raided the Mission Viejo headquarters of a national chain of convalescent homes in what company officials said appears to be an investigation into suspected Medicare fraud.
Officials from Ensign Group Inc. said the Department of Justice has been investigating the company since 2006. Greg Stapley, corporate vice president and legal counsel, said the firm may have inherited the problem from its strategy of acquiring troubled group homes.
"We take in a lot of facilities that are in trouble and turn them around," Stapley said.
The U.S. Attorney's Office in Los Angeles could not be reached for comment.
Founded in 1999, The Ensign Group owns and leases 61 convalescent centers in six states, including three in Orange County: Palm Terrace Health Care Center in Laguna Woods; Sea Cliff Health Care Center in Huntington Beach; and Victoria Health Care Center in Costa Mesa. Ensign has a total of 7,400 beds and raised $411 million in revenue in 2007.
According to documents filed by the company with the Security Exchange Commission, the Department of Justice has been looking into the billing and reimbursement practice of some of the firm's subsidiaries.
In 2007, federal attorneys in Los Angeles subpoenaed the firm's bank documents, but later rescinded the demand. The subpoena asked for financial transactions involving Ensign, 10 subsidiaries, an outside investor group and some company officers, said the SEC report.
Later that year, the U.S. Attorney's office sought a meeting with an Ensign employee regarding an investigation into Medicare claims with the federal Department of Health and Human Services Office. The request for a meeting was rescinded, according to the SEC report.
In December 2007, the firm's accounting contractor was subpoenaed and, later, another employee was contacted.
"We believe that the U.S. Attorney may be conducting parallel criminal, civil and administrative investigations involving the Ensign Group and one or more of our skilled nursing facilities," the company said in SEC documents.
The raid on Wednesday was the first formal confirmation of the federal probe.
In November 2006, the company conducted its own internal investigation into Medicare reimbursements and found that documentation was missing for $224,000 in Medicare claims, documents said. These claims have been reported to the federal government, according to SEC statements.
Contact the writer: tsaavedra@ocregister.com or 714-796-6930
By TONY SAAVEDRA and RONALD CAMPBELL
The Orange County Register
Wednesday, December 17, 2008
Federal agents on Wednesday raided the Mission Viejo headquarters of a national chain of convalescent homes in what company officials said appears to be an investigation into suspected Medicare fraud.
Officials from Ensign Group Inc. said the Department of Justice has been investigating the company since 2006. Greg Stapley, corporate vice president and legal counsel, said the firm may have inherited the problem from its strategy of acquiring troubled group homes.
"We take in a lot of facilities that are in trouble and turn them around," Stapley said.
The U.S. Attorney's Office in Los Angeles could not be reached for comment.
Founded in 1999, The Ensign Group owns and leases 61 convalescent centers in six states, including three in Orange County: Palm Terrace Health Care Center in Laguna Woods; Sea Cliff Health Care Center in Huntington Beach; and Victoria Health Care Center in Costa Mesa. Ensign has a total of 7,400 beds and raised $411 million in revenue in 2007.
According to documents filed by the company with the Security Exchange Commission, the Department of Justice has been looking into the billing and reimbursement practice of some of the firm's subsidiaries.
In 2007, federal attorneys in Los Angeles subpoenaed the firm's bank documents, but later rescinded the demand. The subpoena asked for financial transactions involving Ensign, 10 subsidiaries, an outside investor group and some company officers, said the SEC report.
Later that year, the U.S. Attorney's office sought a meeting with an Ensign employee regarding an investigation into Medicare claims with the federal Department of Health and Human Services Office. The request for a meeting was rescinded, according to the SEC report.
In December 2007, the firm's accounting contractor was subpoenaed and, later, another employee was contacted.
"We believe that the U.S. Attorney may be conducting parallel criminal, civil and administrative investigations involving the Ensign Group and one or more of our skilled nursing facilities," the company said in SEC documents.
The raid on Wednesday was the first formal confirmation of the federal probe.
In November 2006, the company conducted its own internal investigation into Medicare reimbursements and found that documentation was missing for $224,000 in Medicare claims, documents said. These claims have been reported to the federal government, according to SEC statements.
Contact the writer: tsaavedra@ocregister.com or 714-796-6930
Friday, December 5, 2008
HHS and DOJ Health Care Fraud and Abuse Control Program
HHS and DOJ Health Care Fraud and Abuse Control Program
Annual Report For FY 2007
The Department of Health and Human Services And The Department of Justice Health Care Fraud and Abuse Control Program
Annual Report For FY 2007,
November 2008
"The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS)1, acting through the Department’s Inspector General (HHS/OIG), designed to coordinate Federal, state and local law enforcement activities with respect to health care fraud and abuse. In its eleventh year of operation, the Program’s continued success again confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud or abuse, and to protect program beneficiaries."
Permanent Link Topic(s): E-Government, Government Documents
Annual Report For FY 2007
The Department of Health and Human Services And The Department of Justice Health Care Fraud and Abuse Control Program
Annual Report For FY 2007,
November 2008
"The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS)1, acting through the Department’s Inspector General (HHS/OIG), designed to coordinate Federal, state and local law enforcement activities with respect to health care fraud and abuse. In its eleventh year of operation, the Program’s continued success again confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud or abuse, and to protect program beneficiaries."
Permanent Link Topic(s): E-Government, Government Documents
Thursday, October 23, 2008
former Minnesota Department of Health and Human Services (DHS) employee ...FRAUD
Aug. 5, 2003, through Sept. 10, 2008, ...$903,896.54 from the State of Minnesota through Medicaid health care fraud.
Hudsonite indicted for health care fraud in Minnesota
Hudson Star-Observer
Published Wednesday, October 22, 2008
A former Minnesota Department of Health and Human Services (DHS) employee was recently indicted by a federal grand jury for health care fraud and for the alleged theft of more than $900,000 in Medicaid funds.
Kim Joann Austen, 47, Hudson was charged Oct. 7 in Minneapolis with one count of health care fraud and 22 counts of theft of health care funds. Her indictment was unsealed Wednesday following her initial appearance in Minneapolis.
Austen turned herself in to authorities Tuesday. Austen remains in custody, and a detention hearing is scheduled for 4:30 p.m. Thursday at the United States Courthouse in Minneapolis.
Austen's indictment alleges that from Aug. 5, 2003, through Sept. 10, 2008, she knowingly and willfully executed a scheme to defraud Medicaid, a federal health care benefit program. It also alleges that Austen used her position to receive $903,896.54 from the State of Minnesota through Medicaid.
Austen had been a state employee since 1981, and had worked in several positions within the DHS since that time. Since approximately August 1997, Austen had been the supervisor of the Medicaid Management Information System (MMIS). The MMIS is a computerized system that processes submitted Medicaid claims for payment.
For more information see the Oct. 30 edition of the Star-Observer.
Hudsonite indicted for health care fraud in Minnesota
Hudson Star-Observer
Published Wednesday, October 22, 2008
A former Minnesota Department of Health and Human Services (DHS) employee was recently indicted by a federal grand jury for health care fraud and for the alleged theft of more than $900,000 in Medicaid funds.
Kim Joann Austen, 47, Hudson was charged Oct. 7 in Minneapolis with one count of health care fraud and 22 counts of theft of health care funds. Her indictment was unsealed Wednesday following her initial appearance in Minneapolis.
Austen turned herself in to authorities Tuesday. Austen remains in custody, and a detention hearing is scheduled for 4:30 p.m. Thursday at the United States Courthouse in Minneapolis.
Austen's indictment alleges that from Aug. 5, 2003, through Sept. 10, 2008, she knowingly and willfully executed a scheme to defraud Medicaid, a federal health care benefit program. It also alleges that Austen used her position to receive $903,896.54 from the State of Minnesota through Medicaid.
Austen had been a state employee since 1981, and had worked in several positions within the DHS since that time. Since approximately August 1997, Austen had been the supervisor of the Medicaid Management Information System (MMIS). The MMIS is a computerized system that processes submitted Medicaid claims for payment.
For more information see the Oct. 30 edition of the Star-Observer.
Wednesday, October 8, 2008
'Going door to door to sniff out fraud' We must!
Rampant Medicare fraud suspected in Miami
Miami may be ground zero,however this has been going on for years!
By Julie Appleby, USA TODAY
Home health care costs charged to Medicare in the Miami area have risen 20 times the national average in the past five years, prompting a federal investigation of suspected fraudulent billing.
Miami-Dade County is on track to cost Medicare a projected $1.3 billion for home health care services this fiscal year, up 1,300% in just five years, government data show.
SLEUTHS: Going door to door to sniff out fraud
Investigators suspect that fraud is helping to drive the increase because the population of Medicare beneficiaries in the county grew only 10.2% between 2004 and 2007, the latest government data show.
"You definitely have a problem down here," says Randall Culp, an FBI supervisory special agent who oversees a team that works with a Medicare Fraud Strike Force in Miami.
In South Florida, investigators say, some agencies are billing Medicare for millions of dollars in services that are unnecessary, overused or not provided at all.
Investigators elsewhere are paying attention because South Florida is a bellwether for scams that later surface in other large cities, such as Los Angeles and Houston. Scams involving fake AIDS treatments, for example, popped up in Detroit and several other cities after a crackdown in Miami, Culp and others say.
"Typically, Miami is ground zero. Then we see it move to the other high-fraud areas," says Suzanne Bradley, an investigator with the Centers for Medicare and Medicaid Service's field office in Miami.
Home health agencies send nurses and aides to assist homebound elderly and disabled beneficiaries. Nationally, Medicare expects to spend $16.5 billion on home health care this year, up 65% from five years ago.
Medicare spent six times more on home health care services in Miami-Dade County during the first five months of this year than in Los Angeles County, where the Medicare population is three times larger, agency data show.
"It jumps off the page as out of proportion," says Kirk Ogrosky, deputy chief in the Criminal Division's Fraud Section of the Justice Department.
Today, acting Medicare chief Kerry Weems says he will announce new anti-fraud efforts, some targeted at home care agencies in Miami.
"It does affect everyone because everyone is paying into Medicare," says Peggy Sposato, a nurse investigator with the U.S. attorney in the Southern District of Florida, who combs through data looking for unusual billings.
Miami may be ground zero,however this has been going on for years!
By Julie Appleby, USA TODAY
Home health care costs charged to Medicare in the Miami area have risen 20 times the national average in the past five years, prompting a federal investigation of suspected fraudulent billing.
Miami-Dade County is on track to cost Medicare a projected $1.3 billion for home health care services this fiscal year, up 1,300% in just five years, government data show.
SLEUTHS: Going door to door to sniff out fraud
Investigators suspect that fraud is helping to drive the increase because the population of Medicare beneficiaries in the county grew only 10.2% between 2004 and 2007, the latest government data show.
"You definitely have a problem down here," says Randall Culp, an FBI supervisory special agent who oversees a team that works with a Medicare Fraud Strike Force in Miami.
In South Florida, investigators say, some agencies are billing Medicare for millions of dollars in services that are unnecessary, overused or not provided at all.
Investigators elsewhere are paying attention because South Florida is a bellwether for scams that later surface in other large cities, such as Los Angeles and Houston. Scams involving fake AIDS treatments, for example, popped up in Detroit and several other cities after a crackdown in Miami, Culp and others say.
"Typically, Miami is ground zero. Then we see it move to the other high-fraud areas," says Suzanne Bradley, an investigator with the Centers for Medicare and Medicaid Service's field office in Miami.
Home health agencies send nurses and aides to assist homebound elderly and disabled beneficiaries. Nationally, Medicare expects to spend $16.5 billion on home health care this year, up 65% from five years ago.
Medicare spent six times more on home health care services in Miami-Dade County during the first five months of this year than in Los Angeles County, where the Medicare population is three times larger, agency data show.
"It jumps off the page as out of proportion," says Kirk Ogrosky, deputy chief in the Criminal Division's Fraud Section of the Justice Department.
Today, acting Medicare chief Kerry Weems says he will announce new anti-fraud efforts, some targeted at home care agencies in Miami.
"It does affect everyone because everyone is paying into Medicare," says Peggy Sposato, a nurse investigator with the U.S. attorney in the Southern District of Florida, who combs through data looking for unusual billings.
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