Healthcare fraud probes given more resources
Posted: November 11, 2008 - 3:00 pm EDT
The Justice Department’s inspector general found that U.S. attorneys directed more attorney hours toward healthcare fraud, firearms and organized crime than their offices were allocated, while extra positions Congress funded for counterterrorism went unfilled.Offices in large cities were most likely to dedicate more attorney hours to healthcare fraud, according to an audit report examining the resource management of the Justice Department’s 94 U.S. attorneys’ offices. The offices in Baltimore; Dallas; Detroit; the Eastern District of New York, which includes Brooklyn and Queens; Houston; Los Angeles; Miami; and Washington each dedicated two to five times their allocated number of full-time employees for healthcare.
Beginning in fiscal 2006, Congress allocated an additional 43 full-time-equivalent positions to counterterrorism but the inspector general found roughly the same number of attorneys with that focus through 2007 as in 2003. The Executive Office for U.S. Attorneys told auditors that the numbers were partially a result of the timing of the appropriations, inaccurate time reporting by attorneys and fewer terrorism matters referred to the offices than in previous years. Director Kenneth Melson, in a response to the inspector general, notes that U.S. attorneys are appointed by the president and are “afforded significant discretion to manage his or her office according to locally perceived priorities and needs.”
The report, however, finds fault with the data relied on to make decisions and with individual attorney evaluations that are performed infrequently because of budget constraints. -- by Gregg Blesch
Showing posts with label Medicare Fraud. Show all posts
Showing posts with label Medicare Fraud. Show all posts
Wednesday, November 12, 2008
Wednesday, August 6, 2008
"...masters of Medicare fraud, prosecutors say"
A Rolls-Royce valued at $200,000 once belonged to Eduardo Moreno, a fugitive wanted in connection with Medicare fraud.
Gallery | Fugitives suspected of fraud
The Benitez brothers were masters of Medicare fraud, prosecutors say.
They spent their Medicare millions on Mediterranean-style homes, apartments, hotels, boats, a helicopter, even a water park — all in the resort area of Bavaro, Dominican Republic, court records show.
After they were indicted on fraud charges in late May, Carlos, Jose and Luis Benitez used their Cuban passports to travel from Miami to the Dominican Republic, then to Cuba.
The three brothers are accused of defrauding the U.S. government’s health insurance program by billing $110 million in false claims for HIV drug-infusion treatments at their dozen Miami-Dade clinics. Medicare paid their companies about $84 million in reimbursements between 2001 and 2004, according to federal authorities and court records.
The Benitezes — who came to this country in 1995 and became U.S. citizens five years later — have a lot of company. They are among 56 fugitives charged since 2004 with filing at least $272 million in phony Medicare claims before disappearing from Miami-Dade. Collectively, the fugitives absconded with at least $142 million in taxpayer funds.
Thirty-three of the 36 fugitives whose names have been released by authorities are Cuban immigrants, most of whom came to the United States during the past 15 years, according to FBI, immigration and court records obtained by The Miami Herald. Half of those fugitives have fled to Cuba, according to the FBI, which based its information on travel, customs, passports, bank and computer records.
The majority of some 700 Medicare fraud defendants charged since 2004 are immigrants who share an implicit trust when they join small criminal enterprises in South Florida to defraud the government program, according to perpetrators, prosecutors and investigators.
Timothy Delaney, assistant special agent in charge of the FBI’s office in Miami, said Medicare fraud has spread over the past decade in certain pockets of South Florida’s population of 750,000 Cuban Americans — just as it has in heavily populated immigrant communities in other major cities.
Medicare is seen as an easy mark for fraud because it is built on an honor system that pays claims quickly with scant review. Also, the odds of getting caught are low and the odds of making millions are high.
Delaney said certain segments of Cuban immigrants in Miami and Hialeah — just like Armenians in Los Angeles, West Africans in Houston and Russians in New York — trust one another to form mini-rackets.
‘’We have unscrupulous providers, willing doctors and willing practitioners,'’ said Delaney. “They don’t think they’ve committed a crime.'’
CHASING FUGITIVES
Among the known Medicare fugitives who fled to Cuba: Eduardo Moreno, who came to the United States in 1997.
Moreno, 39, used a network of offices to operate medical equipment and HIV drug-infusion scams totaling $7.2 million in false Medicare claims, according to federal court records. He bought himself a $445,000 southwest Miami-Dade home and a $200,000 Rolls-Royce Phantom.
When the FBI arrested him last year on fraud charges, he made a $250,000 bond, then skipped the country — back to Havana, according to the FBI. Agents tracked him through his travel records and his relatives.
Moreno is among at least 18 identified fugitives suspected of fleeing to Cuba — with another 18 escaping to other parts of Latin America, Europe, Canada, Florida or unknown locations, according to the FBI’s account of travel records and other information.
In addition, there are 20 unidentified fugitives whose names remain under seal until their arrests.
‘’A good number of them are Cuban and they will return to Cuba, where, as you know, there is no extradition policy and we have no way to get them back at this point,'’ said Delaney, who headed the FBI’s national healthcare fraud program before transferring to Miami in 2005.
U.S. Sen. Mel Martinez, R-Florida, a Pedro Pan Cuban exile who benefited like thousands of others from the Cuban Adjustment Act, is pushing legislation in Congress to double the criminal and civil penalties for Medicare fraud offenders. While Martinez said he didn’t think Medicare fraud was strictly a ‘’Cuban issue,'’ he also condemned the Cuban government for harboring the fugitives.
‘’My first thought is, it’s one more reason why the Cuban government is an outlaw state because it allows fugitives of justice to find refuge there,'’ Martinez said.
Cuban leaders Fidel Castro and his brother Raul Castro have rarely turned over fugitives of any kind.
Tracking down Medicare fugitives in countries such as the Dominican Republic, however, can be successful because they have extradition agreements with the United States. Federal authorities are working with the Dominican Republic to pursue the Benitez brothers and seize their extensive assets in Bavaro — including a hotel called Cabañas Singapur.
Other assets include more tourist hotels, a Robinson R44 Raven helicopter, apartment complexes, luxury homes, supermarkets and a rental car agency — registered under shell companies or straw names. Dominican officials started seizing properties and freezing their bank accounts in July in cooperation with the U.S. government, which plans to return the proceeds to Medicare.
On Friday, Justice Department prosecutors filed a proposed restraining order in federal court in Miami to ensure the Benitez brothers’ assets are not sold or transferred to other parties.
The Benitez brothers’ fugitive case has made headlines in the Dominican Republic not only because of the U.S. government’s pursuit of their ill-gotten gains. Over the Fourth of July weekend, Carlos Benitez’s daughter and son-in-law — Yanelkis Benitez Ramirez and Lenin Linares Guerrero — were kidnapped. Days later, Dominican authorities rescued the couple.
Meanwhile, FBI agents have traced the Benitez brothers to Havana, according to federal authorities.
In general, the FBI has had little luck capturing Medicare fugitives abroad in recent years. ‘’We’ve had no one returned on a healthcare fraud warrant that I’m aware of,'’ Delaney said.
The one exception: In June 2004, authorities in the Dominican turned over three Medicare fugitives — Ruben Martinez; his daughter, Adriana Ramos, and her husband, Daniel Ramos — who had fled to that country months before their indictment on fraud charges.
They were part of a Miami-Dade family racket headed by Martinez, 57, that was eventually convicted of bilking $14.5 million from Medicare by charging for bogus medical equipment orders such as hospital beds, oxygen tanks and foot arch supports in 2000-02. Federal authorities recovered $1 million from Dominican bank accounts, $900,000 from U.S. banks, real estate, jewelry and a Porsche Boxster.
‘’It was a classic case of international cooperation,'’ said former federal prosecutor Wifredo Ferrer, the lead attorney in the prosecution of Martinez and 11 others. “The three fugitives were Cuban nationals, not citizens of the Dominican Republic. The Dominican authorities deemed them persona non grata and expelled them to the United States.'’
FEDERAL JUDGES
Still, one Medicare fugitive in that case is still at large: Emilio R. Seijo, who is in Cuba, according to the FBI.
The escalating problem of Medicare fraud defendants who flee has become a sore point for federal judges in South Florida.
This spring, the chief judge of the U.S. District Court in Miami raised the issue in a memo to magistrate judges, cautioning them about flight risks. U.S. District Judge Federico Moreno also reviewed Medicare defendants’ bonds in cases before him, citing the unusual pattern of defendants fleeing after they were charged with Medicare fraud and granted bail.
In June, Moreno said in court that “it seems to me that our thinking has to change — that someone from Cuba can flee back to Cuba just like someone from Mexico.'’
Moreno questioned whether the Cuban Adjustment Act — passed by Congress in 1966 to grant asylum and residency to the first wave of Cuban political refugees — was being abused by a new generation of Medicare fraud suspects. The judge wondered aloud “whether someone can be categorized as a political refugee when you can pick up and go back.'’
Moreno raised the point after learning that a former secretary charged in an $11 million Medicare healthcare scheme fled to Cuba with her son and father.
The judge had given Carmen González a $50,000 bond. Her father, Enrique González, who co-signed it, was indicted in May on separate Medicare fraud charges in a $26.2 million HIV-drug scam at other Miami-Dade clinics.
‘’I don’t know what your client’s situation is, but money goes a lot farther in Cuba,'’ the judge told Gonzalez’s attorney, Joel DeFabio. “Dollars do. And the government’s allegation is that dollars are the result of Medicare fraud.'’
Moreno isn’t the only federal judge to be blindsided.
The case of Medicare fraud felon Gustavo Smith illustrates how easy it is for fugitives to leave the United States.
After Smith was convicted on healthcare fraud charges at trial in April, U.S. District Judge Marcia Cooke allowed him to remain free on a $300,000 bond while he awaited sentencing. Prosecutors insisted that Smith be detained. Cooke placed him on home confinement.
On June 11, Smith, who had surrendered his U.S. passport, took an American Airlines flight to Santo Domingo with his girlfriend. How? Smith used his Cuban passport under the name Gustavo Smith Wong. The FBI and Dominican authorities are tracking him down. In early July, Cooke sentenced him in absentia to 10 years and 10 months in prison.
MEDICARE OUTLAWS
One of the obvious reasons that Medicare defendants can evade prosecution is because they’re routinely allowed to post bond before trial. But most of the Medicare defendants who fled since 2004 left South Florida before federal agents could arrest them, according to the FBI and prosecutors. In some cases, suspects get nervous when a colleague is arrested and flee before they can be implicated.
A typical example: Fermin Rey, 49, who emigrated from Cuba in 1995 and was indicted last year on charges of using a series of healthcare corporations to bill Medicare for $5.2 million in bogus medical equipment claims. Rey, described by authorities as a Santeria high priest who used associates as straw owners of his illegal businesses, failed to appear in court and is believed to be in Mexico.
Why do so many Cuban immigrants become Medicare fraud perpetrators? Andy Gomez, a senior fellow at the University of Miami’s Institute for Cuban and Cuban-American Studies, has a theory.
Gomez said some immigrants came with survival instincts cultivated under the totalitarian regime of Fidel Castro. They distrusted and cheated his communist government as a way of getting around the system, but they did not shed that behavior when they came to Miami simply because they were living in a free country.
‘’They are a product of their element,'’ Gomez said. “It’s a very difficult habit to break.'’
FBI agents not only have a hard time tracking down Medicare fugitives, but also their money.
Law enforcement officials suspect that most Medicare defendants who flee — such as the Benitezes — launder their money offshore.
Prosecutor Eric Bustillo, chief of the economic crimes section at the U.S. attorney’s office in Miami, said that once Medicare money is withdrawn from local banks it’s difficult for federal authorities to follow it.
‘’It’s the opposite of drug trafficking,'’ Bustillo said. “The drug traffickers get paid in cash, so they have to find businesses and other ways to launder it. The Medicare providers must receive all of their payments in checks or wire transfers to a designated bank account. So the money can be tracked down to that bank. But they immediately cash it out. And once they do that, who knows where it goes?'’
Federal authorities and money-laundering experts know some of the Medicare fugitives’ money ends up outside the United States. Case in point: the Benitezes’ assets in the Dominican Republic.
But unless authorities can identify the laundered Medicare millions — bank accounts, real estate, cars, boats — they can’t take legal action to go after the assets.
According to money-laundering experts, it’s easy to move dirty money to certain countries.
For a pittance, Medicare violators can hire lawyers offshore to set up shell companies and assist in the opening of related bank accounts, said Brett Wolf, a U.S. money-laundering analyst with Complinet, a London-based firm that helps financial institutions meet their compliance obligations.
‘’Cash smuggling is almost certainly playing a role,'’ Wolf said. “Considering the heavily state-controlled nature of Cuba’s financial network, it’s very unlikely that these Medicare funds are being moved through the formal banking system.'’
Fugitives, based in a country such as the Bahamas or Mexico where there is regular travel to Cuba, can go back and forth to the island, carrying thousands in cash that can be exchanged for a currency called CUCs (pronounced “kooks'’).
But it would be risky business for fugitives carrying a lot of cash, say $50,000, to attempt to bribe communist government officials unless they have connections.
Still, a Medicare fugitive with hundreds of thousands or even millions of dollars stashed in offshore accounts could live like a tycoon in Cuba, where the monthly salary averages $17.
Source
Gallery | Fugitives suspected of fraud
The Benitez brothers were masters of Medicare fraud, prosecutors say.
They spent their Medicare millions on Mediterranean-style homes, apartments, hotels, boats, a helicopter, even a water park — all in the resort area of Bavaro, Dominican Republic, court records show.
After they were indicted on fraud charges in late May, Carlos, Jose and Luis Benitez used their Cuban passports to travel from Miami to the Dominican Republic, then to Cuba.
The three brothers are accused of defrauding the U.S. government’s health insurance program by billing $110 million in false claims for HIV drug-infusion treatments at their dozen Miami-Dade clinics. Medicare paid their companies about $84 million in reimbursements between 2001 and 2004, according to federal authorities and court records.
The Benitezes — who came to this country in 1995 and became U.S. citizens five years later — have a lot of company. They are among 56 fugitives charged since 2004 with filing at least $272 million in phony Medicare claims before disappearing from Miami-Dade. Collectively, the fugitives absconded with at least $142 million in taxpayer funds.
Thirty-three of the 36 fugitives whose names have been released by authorities are Cuban immigrants, most of whom came to the United States during the past 15 years, according to FBI, immigration and court records obtained by The Miami Herald. Half of those fugitives have fled to Cuba, according to the FBI, which based its information on travel, customs, passports, bank and computer records.
The majority of some 700 Medicare fraud defendants charged since 2004 are immigrants who share an implicit trust when they join small criminal enterprises in South Florida to defraud the government program, according to perpetrators, prosecutors and investigators.
Timothy Delaney, assistant special agent in charge of the FBI’s office in Miami, said Medicare fraud has spread over the past decade in certain pockets of South Florida’s population of 750,000 Cuban Americans — just as it has in heavily populated immigrant communities in other major cities.
Medicare is seen as an easy mark for fraud because it is built on an honor system that pays claims quickly with scant review. Also, the odds of getting caught are low and the odds of making millions are high.
Delaney said certain segments of Cuban immigrants in Miami and Hialeah — just like Armenians in Los Angeles, West Africans in Houston and Russians in New York — trust one another to form mini-rackets.
‘’We have unscrupulous providers, willing doctors and willing practitioners,'’ said Delaney. “They don’t think they’ve committed a crime.'’
CHASING FUGITIVES
Among the known Medicare fugitives who fled to Cuba: Eduardo Moreno, who came to the United States in 1997.
Moreno, 39, used a network of offices to operate medical equipment and HIV drug-infusion scams totaling $7.2 million in false Medicare claims, according to federal court records. He bought himself a $445,000 southwest Miami-Dade home and a $200,000 Rolls-Royce Phantom.
When the FBI arrested him last year on fraud charges, he made a $250,000 bond, then skipped the country — back to Havana, according to the FBI. Agents tracked him through his travel records and his relatives.
Moreno is among at least 18 identified fugitives suspected of fleeing to Cuba — with another 18 escaping to other parts of Latin America, Europe, Canada, Florida or unknown locations, according to the FBI’s account of travel records and other information.
In addition, there are 20 unidentified fugitives whose names remain under seal until their arrests.
‘’A good number of them are Cuban and they will return to Cuba, where, as you know, there is no extradition policy and we have no way to get them back at this point,'’ said Delaney, who headed the FBI’s national healthcare fraud program before transferring to Miami in 2005.
U.S. Sen. Mel Martinez, R-Florida, a Pedro Pan Cuban exile who benefited like thousands of others from the Cuban Adjustment Act, is pushing legislation in Congress to double the criminal and civil penalties for Medicare fraud offenders. While Martinez said he didn’t think Medicare fraud was strictly a ‘’Cuban issue,'’ he also condemned the Cuban government for harboring the fugitives.
‘’My first thought is, it’s one more reason why the Cuban government is an outlaw state because it allows fugitives of justice to find refuge there,'’ Martinez said.
Cuban leaders Fidel Castro and his brother Raul Castro have rarely turned over fugitives of any kind.
Tracking down Medicare fugitives in countries such as the Dominican Republic, however, can be successful because they have extradition agreements with the United States. Federal authorities are working with the Dominican Republic to pursue the Benitez brothers and seize their extensive assets in Bavaro — including a hotel called Cabañas Singapur.
Other assets include more tourist hotels, a Robinson R44 Raven helicopter, apartment complexes, luxury homes, supermarkets and a rental car agency — registered under shell companies or straw names. Dominican officials started seizing properties and freezing their bank accounts in July in cooperation with the U.S. government, which plans to return the proceeds to Medicare.
On Friday, Justice Department prosecutors filed a proposed restraining order in federal court in Miami to ensure the Benitez brothers’ assets are not sold or transferred to other parties.
The Benitez brothers’ fugitive case has made headlines in the Dominican Republic not only because of the U.S. government’s pursuit of their ill-gotten gains. Over the Fourth of July weekend, Carlos Benitez’s daughter and son-in-law — Yanelkis Benitez Ramirez and Lenin Linares Guerrero — were kidnapped. Days later, Dominican authorities rescued the couple.
Meanwhile, FBI agents have traced the Benitez brothers to Havana, according to federal authorities.
In general, the FBI has had little luck capturing Medicare fugitives abroad in recent years. ‘’We’ve had no one returned on a healthcare fraud warrant that I’m aware of,'’ Delaney said.
The one exception: In June 2004, authorities in the Dominican turned over three Medicare fugitives — Ruben Martinez; his daughter, Adriana Ramos, and her husband, Daniel Ramos — who had fled to that country months before their indictment on fraud charges.
They were part of a Miami-Dade family racket headed by Martinez, 57, that was eventually convicted of bilking $14.5 million from Medicare by charging for bogus medical equipment orders such as hospital beds, oxygen tanks and foot arch supports in 2000-02. Federal authorities recovered $1 million from Dominican bank accounts, $900,000 from U.S. banks, real estate, jewelry and a Porsche Boxster.
‘’It was a classic case of international cooperation,'’ said former federal prosecutor Wifredo Ferrer, the lead attorney in the prosecution of Martinez and 11 others. “The three fugitives were Cuban nationals, not citizens of the Dominican Republic. The Dominican authorities deemed them persona non grata and expelled them to the United States.'’
FEDERAL JUDGES
Still, one Medicare fugitive in that case is still at large: Emilio R. Seijo, who is in Cuba, according to the FBI.
The escalating problem of Medicare fraud defendants who flee has become a sore point for federal judges in South Florida.
This spring, the chief judge of the U.S. District Court in Miami raised the issue in a memo to magistrate judges, cautioning them about flight risks. U.S. District Judge Federico Moreno also reviewed Medicare defendants’ bonds in cases before him, citing the unusual pattern of defendants fleeing after they were charged with Medicare fraud and granted bail.
In June, Moreno said in court that “it seems to me that our thinking has to change — that someone from Cuba can flee back to Cuba just like someone from Mexico.'’
Moreno questioned whether the Cuban Adjustment Act — passed by Congress in 1966 to grant asylum and residency to the first wave of Cuban political refugees — was being abused by a new generation of Medicare fraud suspects. The judge wondered aloud “whether someone can be categorized as a political refugee when you can pick up and go back.'’
Moreno raised the point after learning that a former secretary charged in an $11 million Medicare healthcare scheme fled to Cuba with her son and father.
The judge had given Carmen González a $50,000 bond. Her father, Enrique González, who co-signed it, was indicted in May on separate Medicare fraud charges in a $26.2 million HIV-drug scam at other Miami-Dade clinics.
‘’I don’t know what your client’s situation is, but money goes a lot farther in Cuba,'’ the judge told Gonzalez’s attorney, Joel DeFabio. “Dollars do. And the government’s allegation is that dollars are the result of Medicare fraud.'’
Moreno isn’t the only federal judge to be blindsided.
The case of Medicare fraud felon Gustavo Smith illustrates how easy it is for fugitives to leave the United States.
After Smith was convicted on healthcare fraud charges at trial in April, U.S. District Judge Marcia Cooke allowed him to remain free on a $300,000 bond while he awaited sentencing. Prosecutors insisted that Smith be detained. Cooke placed him on home confinement.
On June 11, Smith, who had surrendered his U.S. passport, took an American Airlines flight to Santo Domingo with his girlfriend. How? Smith used his Cuban passport under the name Gustavo Smith Wong. The FBI and Dominican authorities are tracking him down. In early July, Cooke sentenced him in absentia to 10 years and 10 months in prison.
MEDICARE OUTLAWS
One of the obvious reasons that Medicare defendants can evade prosecution is because they’re routinely allowed to post bond before trial. But most of the Medicare defendants who fled since 2004 left South Florida before federal agents could arrest them, according to the FBI and prosecutors. In some cases, suspects get nervous when a colleague is arrested and flee before they can be implicated.
A typical example: Fermin Rey, 49, who emigrated from Cuba in 1995 and was indicted last year on charges of using a series of healthcare corporations to bill Medicare for $5.2 million in bogus medical equipment claims. Rey, described by authorities as a Santeria high priest who used associates as straw owners of his illegal businesses, failed to appear in court and is believed to be in Mexico.
Why do so many Cuban immigrants become Medicare fraud perpetrators? Andy Gomez, a senior fellow at the University of Miami’s Institute for Cuban and Cuban-American Studies, has a theory.
Gomez said some immigrants came with survival instincts cultivated under the totalitarian regime of Fidel Castro. They distrusted and cheated his communist government as a way of getting around the system, but they did not shed that behavior when they came to Miami simply because they were living in a free country.
‘’They are a product of their element,'’ Gomez said. “It’s a very difficult habit to break.'’
FBI agents not only have a hard time tracking down Medicare fugitives, but also their money.
Law enforcement officials suspect that most Medicare defendants who flee — such as the Benitezes — launder their money offshore.
Prosecutor Eric Bustillo, chief of the economic crimes section at the U.S. attorney’s office in Miami, said that once Medicare money is withdrawn from local banks it’s difficult for federal authorities to follow it.
‘’It’s the opposite of drug trafficking,'’ Bustillo said. “The drug traffickers get paid in cash, so they have to find businesses and other ways to launder it. The Medicare providers must receive all of their payments in checks or wire transfers to a designated bank account. So the money can be tracked down to that bank. But they immediately cash it out. And once they do that, who knows where it goes?'’
Federal authorities and money-laundering experts know some of the Medicare fugitives’ money ends up outside the United States. Case in point: the Benitezes’ assets in the Dominican Republic.
But unless authorities can identify the laundered Medicare millions — bank accounts, real estate, cars, boats — they can’t take legal action to go after the assets.
According to money-laundering experts, it’s easy to move dirty money to certain countries.
For a pittance, Medicare violators can hire lawyers offshore to set up shell companies and assist in the opening of related bank accounts, said Brett Wolf, a U.S. money-laundering analyst with Complinet, a London-based firm that helps financial institutions meet their compliance obligations.
‘’Cash smuggling is almost certainly playing a role,'’ Wolf said. “Considering the heavily state-controlled nature of Cuba’s financial network, it’s very unlikely that these Medicare funds are being moved through the formal banking system.'’
Fugitives, based in a country such as the Bahamas or Mexico where there is regular travel to Cuba, can go back and forth to the island, carrying thousands in cash that can be exchanged for a currency called CUCs (pronounced “kooks'’).
But it would be risky business for fugitives carrying a lot of cash, say $50,000, to attempt to bribe communist government officials unless they have connections.
Still, a Medicare fugitive with hundreds of thousands or even millions of dollars stashed in offshore accounts could live like a tycoon in Cuba, where the monthly salary averages $17.
Source
Friday, January 18, 2008
Just more FRAUD
October 18, 2007
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy
On October 10, 2007 Dmitry Rakovsky was sentenced by United States District Judge Marcia G. Cooke in Miami, Florida. Rakovsky was sentenced to a term of 59 months in prison, to be followed by a term of three years of supervised release. He was also ordered to forfeit property and pay restitution in the amount of $900,000.
Rakovsky, and co-defendants Boris Royzen and his wife Eva Royzen, were charged in a twenty-one (21) defendant, thirty-three (33) count health care fraud Indictment. The Indictment charged doctors, chiropractors, massage therapists, an office manager, and four medical clinics, Vista Mar Medical Rehab Corp., Plantation Medical Recovery Center, Inc., Romana Medical, Inc., and Dial Medical Rehab, Inc., with health care fraud. Rakovsky was the final defendant to be sentenced in this case.
Previously Boris Royzen was sentenced to 40 months in prison, followed by three years supervised release. He was also ordered to forfeit property and pay $1.8 million restitution. His wife, Eva, was previously sentenced to three years of probation, forfeit property and pay restitution in the amount of $1.8 million. The medical clinics were ordered to pay restitution as follows: Vista Mar: $70,674.08; Romana Medical: $20,641.85; Plantation Medical Recovery: $31,292.75; and Dial Medical: $13,818.06.
Continue reading "Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Insurance Fraud
Bookmark:
September 21, 2007
South Florida bills billions for HIV
September 21, 2007
From The Washington Times
By Jim McElhatton - Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
Federal health care regulators call the lopsided billing patterns "egregious" and warn that South Florida — particularly Broward, Miami-Dade and Palm Beach counties — is a potential hotbed for health care fraud, waste and abuse.
"It"s all ultimately part of the money-driven, underground economy in Miami," said Benson B. Weintraub, a health care fraud lawyer based in Fort Lauderdale.
According to a report this week by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.
Continue reading "South Florida bills billions for HIV" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
September 18, 2007
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering
On September 6, 2007, Gianni Suarez Vazquez, a participant in a massive Medicare fraud scheme, pled guilty in federal court in West palm Beach, Florida, to mail fraud and money laundering charges. He is scheduled to be sentenced before U.S. District Judge Donald M. Middlebrooks on November 15, 2007.
According to the court records, between November 2003 and August 2004, Suarez Vazquez incorporated or set up two medical equipment companies, GK Medical, Inc. and Suplident International Corporation, in Palm Beach County. Thereafter, he obtained Medicare provider numbers for both companies to enable the companies to submit claims directly to Medicare. To conceal his ownership and control of the companies, Suarez Vazquez designated "strawmen" as company owners, including his mother, on the corporate documents and Medicare Provider Agreements.
Continue reading "Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicaid Fraud
Bookmark:
September 16, 2007
Miami Defendants Sentenced on Health Care Fraud
On August 31, 2007, defendants Maricel Li and Marta Perez, both residents of Miami, were sentenced by United States District Court Judge James I. Cohn in Fort Lauderdale, Florida.
Li was sentenced to twenty-four (24) months' imprisonment, followed by three (3) years of supervised release. Li was also ordered to pay $556,519.85 in restitution. Perez was sentenced to five (5) months' imprisonment, to be followed by two (2) years of supervised release.
Both defendants had previously pled guilty. Defendant Li had pled guilty to an Information charging her with conspiracy to commit health care fraud violations and conspiracy to commit structuring violations. Defendant Perez had pled guilty to conspiracy to structure financial transactions.
Continue reading "Miami Defendants Sentenced on Health Care Fraud" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam
On August 28, 2007, a federal grand jury indicted the former operations director of A-Care EMS Inc. on charges that he sent fraudulent claims to the Centers for Medicare and Medicaid Services to pull in more money.
The indictment, filed Tuesday in the U.S. District Court for the Southern District of Texas, claims Rodney Lee Ramos, 34, of Weslaco, instructed emergency medical technicians to transport patients for dialysis who were not confined to bed."
According to the indictment, Ramos worked as an EMT coordinator for A-Stat Ambulance Services Inc., which was owned by Guadalupe Garces Jr. and Araceli Garces. Medicaid and Medicare placed a vendor hold on that ambulance provider -- withholding payment to the company -- after federal agents determined that the owners were defrauding the federal and state health insurance programs.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Florida Durable Medical Equipment Owner Convicted of Medicare Fraud
On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida.
After a jury trial at federal court in Miami, the jury found Marianela Smith guilty on all charged counts including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit health care fraud; and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.
Smith faces a maximum sentence of 30 years in prison. Prior to sentencing the U.S. Probation Office will complete a pre-sentence investigation and submit a Pre-Sentence Report to the judge for consideration. The PSI will contain an advisory guideline sentence which the court must consider in determining what type and length of sentence is sufficient, but not greater than necessary, to comply with the statutory directives set forth in 18 U.S.C. § 3553(a).
Smith is scheduled to be sentenced November 9, 2007, before U.S. District Court Judge Joan A. Lenard.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
July 12, 2007
Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing DisparityBy
Benson Weintraub [Benson Weintraub is a sentencing lawyer is Of-Counsel to the Law Offices of Robert David Malove, P.A.,in Fort Lauderdale and former Visiting Professor of Law at Hofstra University. While in law school, he worked on the Hoffa litigation under the direction of civil rights lawyer, Leonard Boudin.]
The political implications of Lewis Libby’s commutation of sentence by President Bush continue to reverberate, but this case summons memories of the suspicious circumstances under which President Nixon commuted the sentence of former Teamsters President, James R. Hoffa, 1971.
Hoffa and Libby were both convicted of obstruction of justice, but Hoffa had already served part of his thirteen-year sentence. That was enough to encourage exposure of the links between organized crime, the old International Brotherhood of Teamsters [IBT], and the intersection of such ties with money and politics.
Similarly, Bush and Cheney also appeared to fear that Libby’s imminent incarceration would lead him to cooperate with the Special Prosecutor, perhaps engendering a political scandal making Watergate look like a misdemeanor.
Continue reading "Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing Disparity" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Sentencing Guidelines
Bookmark:
May 25, 2007
Medicare Fraud Defendant Gets 10-Year Prison Term
On May 18, 2007, the US Attorney's Office reported that Jafet Garcia, a defendant in a massive South Florida Medicare fraud scheme, was sentenced in West Palm Beach Federal court to ten (10) years’ imprisonment.
According to the court file, the defendant and his partners purchased four medical equipment companies located in Miami-Dade and Palm Beach Counties, between February 2004 and December 2004. The defendant and his partners recruited individuals to pose as the owners of these companies. After setting up the companies, the defendant and his partners obtained patient and physician information which they used to prepare bogus prescriptions and/or certificates of medical necessity. The bogus prescriptions and certificates purported to authorize the provision of various types of medical equipment for the named Medicare beneficiaries; in truth, the prescriptions and certificates were prepared by the defendant and/or his accomplices and contained forged physicians’ signatures.
The defendant and/or his partners provided the bogus prescriptions and certificates to a Miami billing company for submission to Medicare. The billing company prepared Medicare claims which sought reimbursement for the cost of the equipment listed in the bogus prescriptions and certificates, even though such equipment was never authorized by a physician or provided to the beneficiaries. Medicare processed the fraudulent claims and issued reimbursement checks which the defendant and/or his accomplices cashed at a Miami check cashing store. The defendant and his partners would submit claims through a particular medical equipment company for only two to three months, close it and then begin billing through another company to avoid getting caught.
The four companies used by the defendant and his partners to defraud Medicare were Sunset Medical Corporation, King Medical Service and Supplies Corporation, Travelango Services Corp. and Clear Choice Home Health, Inc. During the course of the scheme, the defendant and his partners submitted more than $9 million in bogus Medicare claims.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 24, 2007
11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions
On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations.
The scheme involved transporting patients to the defendants’ pharmacies in exchange for illegal kickbacks for patients and doctors. However, no evidence indicated that Medicare was billed for unnecessary medical procedures. A confidential informant met with the defendants to exchange, for a fee, their checks for cash, admitted on cross-examination that one defendant, Medina, a secretary, was always sent out of the room to avoid her hearing them talk about the kickback scheme.
The Court also vacated the money laundering counts which related to the fraud counts it had set aside, since money laundering involves the proceeds of activity known by the defendants to be illegal.
The Court upheld the convictions of two defendants as to the general conspiracy charge, under 18 U.S.C. § 371, but vacated the secretary’s conviction, finding that her lack of awareness of the kickback conspiracy, and of the conspiracy’s other objectives, left insufficient evidence to
convict.
The Court remanded the case for resentencing and noted that the district court failed to make a sufficient loss calculation, and instead sentenced the defendants for the entire amount Medicare was billed in the period, without explanation. However, in the absence of evidence of Medicare’s payment of unnecessary medical claims, or that the patient kickback scheme resulted in any actual loss to Medicare, this calculation was inadequate.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 22, 2007
Feds Add More Resourses to Fight Healthcare Fraud
The Centers for Medicare & Medicaid Services Program Integrity Group at recently opened a field office in Santa Ana, California, aimed at preventing and prosecuting health care fraud.
"In the two years since the office has been up and running, we have been able to stop almost $2billion in inappropriate or improper payments from going out the door," program director Kimberly Brandt said.
Like the Medicare Fraud Strike Force office in South Florida that arrested 38 people for defrauding the federal program out of more than $142million, the Santa Ana office uses "data mining" technology to target fraudulent Medicare and Medicaid billings.
According to Assistant U.S. Attorney Consuelo Woodhead, who coordinates federal health care fraud prosecutions in Los Angeles, officials could double the number of law enforcement personnel fighting the problem and still fall short of having enough people to make a significant difference.
Woodhead thinks, that "to really effectively deal with the problem, we're going to have to take a multidisciplinary approach where you look at licensing and certification, how claims are processed, as well as strong criminal and civil enforcement after claims are paid."
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud
Bookmark:
May 10, 2007
Fed Fraud Strike Force Arrests 38 in South Florida Medicare Scam
On May 9, investigators said the arrests of 38 people are the result of an operation conducted by a strike force made up of a team of federal, state and local investigators who have been concentrating on Medicare fraud -- ''especially prevalent'' in South Florida -- since early March.
According to remarks made by Attorney General Alberto R. Gonzales at a press conference with Michael Leavitt, Secretary of Health and Human Services, "the indictments outline various types of fraudulent schemes. Those schemes included compounded aerosol medications -- a process where a pharmacist makes medicine to meet a special medical need for a patient, rather than dispensing less expensive commercial pharmaceuticals. The indictments allege that the homemade medications were not necessary and that they were only prescribed to defraud Medicare.
"In one example, Eduardo Moreno, the owner of multiple DME companies, was arrested on April 7 after being named in a six-count indictment on fraud charges. Two of Moreno's companies - Brenda Medical Supply Inc., and Faster Medical Equipment Inc. - allegedly billed Medicare for more than $1.9 million for services that were not medically necessary. The FBI has seized of some of Moreno's assets, including a new Rolls Royce Phantom worth approximately $200,000.
Gonzales said that some of the 38 defendants allegedly paid Medicare recipients for use of their Medicare card numbers so that the defendants could submit fraudulent claims.
''We believe scores of shell companies have opened and obtained Medicare supplier numbers in Miami-Dade County alone,'' Gonzales said.
“The landscape for fraud in south Florida has changed dramatically over the past two years. CMS has taken aggressive action to curb infusion therapy fraud and other organized fraud actions,” said Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services. “We have opened two satellite offices that are dedicated to combating fraud in high-risk areas and we will soon be opening a third. We are sending a strong message to those who seek to defraud the programs that if they engage in fraudulent activity, they will be caught and no longer able to take advantage of the programs to their own gain.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 9, 2007
Texas Man Sentenced to 46 Months In Federal Prison for Bogus Flu Shot Scam
Iyad Abu El Hawa, who had pleaded guilty to charges of healthcare fraud, was sentenced last Monday to 46 months in federal prison for Medicare fraud and misbranding drugs stemming from an October 2005 health fair at Exxon Mobil, at which 1,100 employees and contractors received what they thought to be flu vaccines.
El Hawa,36, and several assistants filled the syringes with sterile water at the request of Martha Denise Gonzales, an unlicensed nurse who signed a field services contract with Exxon Mobil to deliver the flu vaccines, which at the time were extremely rare. Gonzales had already administered fake vaccines to 14 residents of a Houston-area senior care facility.
El Hawa's attorney had pressed for a lighter sentence — the charges carry a maximum of 10 years in prison and a $250,000 fine — because of El Hawa’s cooperation with federal prosecutors and investigators. However, the Government's motion for downward departure for a sentence below the recommended sentencing guideline range was also denied. The total amount of fine and restitution will be determined on May 14, 2007, the same date that sentencing is set for Gonzales.
Arguing that El Hawa should also bear the cost of the oil company's expenses incurred to screen those who received the bogus flu shots for possible infections, Assistant U.S. Attorney Suzanne Bradley Bradley said “The court has to abide by and embrace relevant conduct.” However, Judge Kenneth Hoyt did not verbally express agreement or disagreement, but he refused to officially take the incurred expenses off the sentencing table. “There has to be some accountability,” Hoyt said.
El Hawa, who carries both Israeli and Jordanian passports and is of Palestinian descent, will not be allowed to live in the United States once he is released from prison.
El Hawa’s wife, brother-in-law and a coworker were at Monday’s sentencing. When the sentence was read, El Hawa’s wife broke into tears, holding her face in her hands. Outside the courthouse, her grief turned to anger at the media, the FBI and Gonzales.
“My husband is a good man,” she said, echoing her husband's attorney's remarks that one episode of misconduct was not representative of El Hawa. Right now “It’s Arabs’ turn to be persecuted. It was just a big rush to judgment. The media reported all these things about me being unlicensed and me not being a citizen, when neither of those things are true. He made a mistake — he just got caught up with the wrong person.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In:
Bookmark: Contact
(954) 745-5840
Free Initial Consultation Topics
Durable Medical Equipment Fraud
HIPAA Violations
Insurance Fraud
Medicaid Fraud
Medicare Fraud
Sentencing Guidelines
Archives
October 2007
September 2007
July 2007
May 2007
April 2007
Subscribe
Subscribe By Email Go Contact Us
Name:
Email:
Phone:
Comments:
Submit Search this Blog
Search Recent Entries
October 18, 2007 10:13 PM
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy On October 10, 2007 Dmitry Rakovsky was sentenced by United...
September 21, 2007 10:05 AM
South Florida bills billions for HIV Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
September 18, 2007 8:30 AM
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering On September 6, 2007, Gianni Suarez Vazquez, a participant in...
September 16, 2007 12:15 PM
Miami Defendants Sentenced on Health Care Fraud On August 31, 2007, defendants Maricel Li and Marta Perez,...
September 7, 2007 4:45 PM
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam On August 28, 2007, a federal grand jury indicted the...
Legal Blogs
Orlando Car Accident Lawyer Blog (Ward & Caggiano)
Cruise Ship Law Blog (Lipcon, Margulies & Alsina)
LawSites (Robert Ambrogi)
New Jersey Criminal Defense Blog (Lependorf & Silverstein)
Michigan Collection Law Blog (Nitzkin & Associates)
Alabama Consumer Law Blog (Watts Law Group & M. Stan Herring)
Stock Broker Fraud Blog (Shepherd, Smith & Edwards)
The Credit Law Group Blog, P.C. (Credit Law Group)
Florida Personal Injury Lawyer Blog (Joseph I. Lipsky)
California Consumer Law Blog (Makler & Baker )
LawLawLaw (Erik Heels)
Orlando Injury Lawyer Blog (Ward & Caggiano)
Florida Injury Lawyer Blog (Flaxman & Lopez)
New Jersey Lemon Law Lawyer Blog (Carton & Rudnick)
Securities Fraud Attorney Blog (Rich & Intelisano)
Investment Fraud Lawyer Blog (Page Perry)
California Credit Law Blog (Kemnitzer, Anderson, Barron, Ogilvie & Brewer)
Miami Injury Lawyer Blog (Gerson & Schwartz)
Florida Injury Attorney Blog (Paige Trop & Ameen)
Expert Witness Blog (JurisPro Expert Witness Directory)
Indiana Consumer Lawyer Blog (Robert Duff)
Florida Criminal Law Blog (M. James Jenkins)
Florida DUI Lawyer Blog (William Ryan Moore)
Justia Law Review (Ken Chan & Tim Stanley)
Justia Legal Marketing Blog (Ken Chan & Tim Stanley)
Indiana Injury Lawyer Blog (Theodore F. Smith, Jr.)
One East Broward Boulevard, Suite 700, Fort Lauderdale, Florida 33301
Phone: (954) 745-5840
Home Website Privacy Policy Disclaimer Contact Us Website Map Blog Posts Copyright © Health Care Fraud Blog Justia Legal Website Design
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy
On October 10, 2007 Dmitry Rakovsky was sentenced by United States District Judge Marcia G. Cooke in Miami, Florida. Rakovsky was sentenced to a term of 59 months in prison, to be followed by a term of three years of supervised release. He was also ordered to forfeit property and pay restitution in the amount of $900,000.
Rakovsky, and co-defendants Boris Royzen and his wife Eva Royzen, were charged in a twenty-one (21) defendant, thirty-three (33) count health care fraud Indictment. The Indictment charged doctors, chiropractors, massage therapists, an office manager, and four medical clinics, Vista Mar Medical Rehab Corp., Plantation Medical Recovery Center, Inc., Romana Medical, Inc., and Dial Medical Rehab, Inc., with health care fraud. Rakovsky was the final defendant to be sentenced in this case.
Previously Boris Royzen was sentenced to 40 months in prison, followed by three years supervised release. He was also ordered to forfeit property and pay $1.8 million restitution. His wife, Eva, was previously sentenced to three years of probation, forfeit property and pay restitution in the amount of $1.8 million. The medical clinics were ordered to pay restitution as follows: Vista Mar: $70,674.08; Romana Medical: $20,641.85; Plantation Medical Recovery: $31,292.75; and Dial Medical: $13,818.06.
Continue reading "Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Insurance Fraud
Bookmark:
September 21, 2007
South Florida bills billions for HIV
September 21, 2007
From The Washington Times
By Jim McElhatton - Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
Federal health care regulators call the lopsided billing patterns "egregious" and warn that South Florida — particularly Broward, Miami-Dade and Palm Beach counties — is a potential hotbed for health care fraud, waste and abuse.
"It"s all ultimately part of the money-driven, underground economy in Miami," said Benson B. Weintraub, a health care fraud lawyer based in Fort Lauderdale.
According to a report this week by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.
Continue reading "South Florida bills billions for HIV" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
September 18, 2007
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering
On September 6, 2007, Gianni Suarez Vazquez, a participant in a massive Medicare fraud scheme, pled guilty in federal court in West palm Beach, Florida, to mail fraud and money laundering charges. He is scheduled to be sentenced before U.S. District Judge Donald M. Middlebrooks on November 15, 2007.
According to the court records, between November 2003 and August 2004, Suarez Vazquez incorporated or set up two medical equipment companies, GK Medical, Inc. and Suplident International Corporation, in Palm Beach County. Thereafter, he obtained Medicare provider numbers for both companies to enable the companies to submit claims directly to Medicare. To conceal his ownership and control of the companies, Suarez Vazquez designated "strawmen" as company owners, including his mother, on the corporate documents and Medicare Provider Agreements.
Continue reading "Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicaid Fraud
Bookmark:
September 16, 2007
Miami Defendants Sentenced on Health Care Fraud
On August 31, 2007, defendants Maricel Li and Marta Perez, both residents of Miami, were sentenced by United States District Court Judge James I. Cohn in Fort Lauderdale, Florida.
Li was sentenced to twenty-four (24) months' imprisonment, followed by three (3) years of supervised release. Li was also ordered to pay $556,519.85 in restitution. Perez was sentenced to five (5) months' imprisonment, to be followed by two (2) years of supervised release.
Both defendants had previously pled guilty. Defendant Li had pled guilty to an Information charging her with conspiracy to commit health care fraud violations and conspiracy to commit structuring violations. Defendant Perez had pled guilty to conspiracy to structure financial transactions.
Continue reading "Miami Defendants Sentenced on Health Care Fraud" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam
On August 28, 2007, a federal grand jury indicted the former operations director of A-Care EMS Inc. on charges that he sent fraudulent claims to the Centers for Medicare and Medicaid Services to pull in more money.
The indictment, filed Tuesday in the U.S. District Court for the Southern District of Texas, claims Rodney Lee Ramos, 34, of Weslaco, instructed emergency medical technicians to transport patients for dialysis who were not confined to bed."
According to the indictment, Ramos worked as an EMT coordinator for A-Stat Ambulance Services Inc., which was owned by Guadalupe Garces Jr. and Araceli Garces. Medicaid and Medicare placed a vendor hold on that ambulance provider -- withholding payment to the company -- after federal agents determined that the owners were defrauding the federal and state health insurance programs.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud , Medicare Fraud
Bookmark:
September 7, 2007
Florida Durable Medical Equipment Owner Convicted of Medicare Fraud
On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida.
After a jury trial at federal court in Miami, the jury found Marianela Smith guilty on all charged counts including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit health care fraud; and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.
Smith faces a maximum sentence of 30 years in prison. Prior to sentencing the U.S. Probation Office will complete a pre-sentence investigation and submit a Pre-Sentence Report to the judge for consideration. The PSI will contain an advisory guideline sentence which the court must consider in determining what type and length of sentence is sufficient, but not greater than necessary, to comply with the statutory directives set forth in 18 U.S.C. § 3553(a).
Smith is scheduled to be sentenced November 9, 2007, before U.S. District Court Judge Joan A. Lenard.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Durable Medical Equipment Fraud , Medicare Fraud
Bookmark:
July 12, 2007
Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing DisparityBy
Benson Weintraub [Benson Weintraub is a sentencing lawyer is Of-Counsel to the Law Offices of Robert David Malove, P.A.,in Fort Lauderdale and former Visiting Professor of Law at Hofstra University. While in law school, he worked on the Hoffa litigation under the direction of civil rights lawyer, Leonard Boudin.]
The political implications of Lewis Libby’s commutation of sentence by President Bush continue to reverberate, but this case summons memories of the suspicious circumstances under which President Nixon commuted the sentence of former Teamsters President, James R. Hoffa, 1971.
Hoffa and Libby were both convicted of obstruction of justice, but Hoffa had already served part of his thirteen-year sentence. That was enough to encourage exposure of the links between organized crime, the old International Brotherhood of Teamsters [IBT], and the intersection of such ties with money and politics.
Similarly, Bush and Cheney also appeared to fear that Libby’s imminent incarceration would lead him to cooperate with the Special Prosecutor, perhaps engendering a political scandal making Watergate look like a misdemeanor.
Continue reading "Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing Disparity" »
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Sentencing Guidelines
Bookmark:
May 25, 2007
Medicare Fraud Defendant Gets 10-Year Prison Term
On May 18, 2007, the US Attorney's Office reported that Jafet Garcia, a defendant in a massive South Florida Medicare fraud scheme, was sentenced in West Palm Beach Federal court to ten (10) years’ imprisonment.
According to the court file, the defendant and his partners purchased four medical equipment companies located in Miami-Dade and Palm Beach Counties, between February 2004 and December 2004. The defendant and his partners recruited individuals to pose as the owners of these companies. After setting up the companies, the defendant and his partners obtained patient and physician information which they used to prepare bogus prescriptions and/or certificates of medical necessity. The bogus prescriptions and certificates purported to authorize the provision of various types of medical equipment for the named Medicare beneficiaries; in truth, the prescriptions and certificates were prepared by the defendant and/or his accomplices and contained forged physicians’ signatures.
The defendant and/or his partners provided the bogus prescriptions and certificates to a Miami billing company for submission to Medicare. The billing company prepared Medicare claims which sought reimbursement for the cost of the equipment listed in the bogus prescriptions and certificates, even though such equipment was never authorized by a physician or provided to the beneficiaries. Medicare processed the fraudulent claims and issued reimbursement checks which the defendant and/or his accomplices cashed at a Miami check cashing store. The defendant and his partners would submit claims through a particular medical equipment company for only two to three months, close it and then begin billing through another company to avoid getting caught.
The four companies used by the defendant and his partners to defraud Medicare were Sunset Medical Corporation, King Medical Service and Supplies Corporation, Travelango Services Corp. and Clear Choice Home Health, Inc. During the course of the scheme, the defendant and his partners submitted more than $9 million in bogus Medicare claims.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 24, 2007
11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions
On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations.
The scheme involved transporting patients to the defendants’ pharmacies in exchange for illegal kickbacks for patients and doctors. However, no evidence indicated that Medicare was billed for unnecessary medical procedures. A confidential informant met with the defendants to exchange, for a fee, their checks for cash, admitted on cross-examination that one defendant, Medina, a secretary, was always sent out of the room to avoid her hearing them talk about the kickback scheme.
The Court also vacated the money laundering counts which related to the fraud counts it had set aside, since money laundering involves the proceeds of activity known by the defendants to be illegal.
The Court upheld the convictions of two defendants as to the general conspiracy charge, under 18 U.S.C. § 371, but vacated the secretary’s conviction, finding that her lack of awareness of the kickback conspiracy, and of the conspiracy’s other objectives, left insufficient evidence to
convict.
The Court remanded the case for resentencing and noted that the district court failed to make a sufficient loss calculation, and instead sentenced the defendants for the entire amount Medicare was billed in the period, without explanation. However, in the absence of evidence of Medicare’s payment of unnecessary medical claims, or that the patient kickback scheme resulted in any actual loss to Medicare, this calculation was inadequate.
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 22, 2007
Feds Add More Resourses to Fight Healthcare Fraud
The Centers for Medicare & Medicaid Services Program Integrity Group at recently opened a field office in Santa Ana, California, aimed at preventing and prosecuting health care fraud.
"In the two years since the office has been up and running, we have been able to stop almost $2billion in inappropriate or improper payments from going out the door," program director Kimberly Brandt said.
Like the Medicare Fraud Strike Force office in South Florida that arrested 38 people for defrauding the federal program out of more than $142million, the Santa Ana office uses "data mining" technology to target fraudulent Medicare and Medicaid billings.
According to Assistant U.S. Attorney Consuelo Woodhead, who coordinates federal health care fraud prosecutions in Los Angeles, officials could double the number of law enforcement personnel fighting the problem and still fall short of having enough people to make a significant difference.
Woodhead thinks, that "to really effectively deal with the problem, we're going to have to take a multidisciplinary approach where you look at licensing and certification, how claims are processed, as well as strong criminal and civil enforcement after claims are paid."
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicaid Fraud
Bookmark:
May 10, 2007
Fed Fraud Strike Force Arrests 38 in South Florida Medicare Scam
On May 9, investigators said the arrests of 38 people are the result of an operation conducted by a strike force made up of a team of federal, state and local investigators who have been concentrating on Medicare fraud -- ''especially prevalent'' in South Florida -- since early March.
According to remarks made by Attorney General Alberto R. Gonzales at a press conference with Michael Leavitt, Secretary of Health and Human Services, "the indictments outline various types of fraudulent schemes. Those schemes included compounded aerosol medications -- a process where a pharmacist makes medicine to meet a special medical need for a patient, rather than dispensing less expensive commercial pharmaceuticals. The indictments allege that the homemade medications were not necessary and that they were only prescribed to defraud Medicare.
"In one example, Eduardo Moreno, the owner of multiple DME companies, was arrested on April 7 after being named in a six-count indictment on fraud charges. Two of Moreno's companies - Brenda Medical Supply Inc., and Faster Medical Equipment Inc. - allegedly billed Medicare for more than $1.9 million for services that were not medically necessary. The FBI has seized of some of Moreno's assets, including a new Rolls Royce Phantom worth approximately $200,000.
Gonzales said that some of the 38 defendants allegedly paid Medicare recipients for use of their Medicare card numbers so that the defendants could submit fraudulent claims.
''We believe scores of shell companies have opened and obtained Medicare supplier numbers in Miami-Dade County alone,'' Gonzales said.
“The landscape for fraud in south Florida has changed dramatically over the past two years. CMS has taken aggressive action to curb infusion therapy fraud and other organized fraud actions,” said Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services. “We have opened two satellite offices that are dedicated to combating fraud in high-risk areas and we will soon be opening a third. We are sending a strong message to those who seek to defraud the programs that if they engage in fraudulent activity, they will be caught and no longer able to take advantage of the programs to their own gain.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In: Medicare Fraud
Bookmark:
May 9, 2007
Texas Man Sentenced to 46 Months In Federal Prison for Bogus Flu Shot Scam
Iyad Abu El Hawa, who had pleaded guilty to charges of healthcare fraud, was sentenced last Monday to 46 months in federal prison for Medicare fraud and misbranding drugs stemming from an October 2005 health fair at Exxon Mobil, at which 1,100 employees and contractors received what they thought to be flu vaccines.
El Hawa,36, and several assistants filled the syringes with sterile water at the request of Martha Denise Gonzales, an unlicensed nurse who signed a field services contract with Exxon Mobil to deliver the flu vaccines, which at the time were extremely rare. Gonzales had already administered fake vaccines to 14 residents of a Houston-area senior care facility.
El Hawa's attorney had pressed for a lighter sentence — the charges carry a maximum of 10 years in prison and a $250,000 fine — because of El Hawa’s cooperation with federal prosecutors and investigators. However, the Government's motion for downward departure for a sentence below the recommended sentencing guideline range was also denied. The total amount of fine and restitution will be determined on May 14, 2007, the same date that sentencing is set for Gonzales.
Arguing that El Hawa should also bear the cost of the oil company's expenses incurred to screen those who received the bogus flu shots for possible infections, Assistant U.S. Attorney Suzanne Bradley Bradley said “The court has to abide by and embrace relevant conduct.” However, Judge Kenneth Hoyt did not verbally express agreement or disagreement, but he refused to officially take the incurred expenses off the sentencing table. “There has to be some accountability,” Hoyt said.
El Hawa, who carries both Israeli and Jordanian passports and is of Palestinian descent, will not be allowed to live in the United States once he is released from prison.
El Hawa’s wife, brother-in-law and a coworker were at Monday’s sentencing. When the sentence was read, El Hawa’s wife broke into tears, holding her face in her hands. Outside the courthouse, her grief turned to anger at the media, the FBI and Gonzales.
“My husband is a good man,” she said, echoing her husband's attorney's remarks that one episode of misconduct was not representative of El Hawa. Right now “It’s Arabs’ turn to be persecuted. It was just a big rush to judgment. The media reported all these things about me being unlicensed and me not being a citizen, when neither of those things are true. He made a mistake — he just got caught up with the wrong person.”
Posted by Robert David Malove | Permalink | Email This Post
Posted In:
Bookmark: Contact
(954) 745-5840
Free Initial Consultation Topics
Durable Medical Equipment Fraud
HIPAA Violations
Insurance Fraud
Medicaid Fraud
Medicare Fraud
Sentencing Guidelines
Archives
October 2007
September 2007
July 2007
May 2007
April 2007
Subscribe
Subscribe By Email Go Contact Us
Name:
Email:
Phone:
Comments:
Submit Search this Blog
Search Recent Entries
October 18, 2007 10:13 PM
Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy On October 10, 2007 Dmitry Rakovsky was sentenced by United...
September 21, 2007 10:05 AM
South Florida bills billions for HIV Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
September 18, 2007 8:30 AM
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering On September 6, 2007, Gianni Suarez Vazquez, a participant in...
September 16, 2007 12:15 PM
Miami Defendants Sentenced on Health Care Fraud On August 31, 2007, defendants Maricel Li and Marta Perez,...
September 7, 2007 4:45 PM
Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam On August 28, 2007, a federal grand jury indicted the...
Legal Blogs
Orlando Car Accident Lawyer Blog (Ward & Caggiano)
Cruise Ship Law Blog (Lipcon, Margulies & Alsina)
LawSites (Robert Ambrogi)
New Jersey Criminal Defense Blog (Lependorf & Silverstein)
Michigan Collection Law Blog (Nitzkin & Associates)
Alabama Consumer Law Blog (Watts Law Group & M. Stan Herring)
Stock Broker Fraud Blog (Shepherd, Smith & Edwards)
The Credit Law Group Blog, P.C. (Credit Law Group)
Florida Personal Injury Lawyer Blog (Joseph I. Lipsky)
California Consumer Law Blog (Makler & Baker )
LawLawLaw (Erik Heels)
Orlando Injury Lawyer Blog (Ward & Caggiano)
Florida Injury Lawyer Blog (Flaxman & Lopez)
New Jersey Lemon Law Lawyer Blog (Carton & Rudnick)
Securities Fraud Attorney Blog (Rich & Intelisano)
Investment Fraud Lawyer Blog (Page Perry)
California Credit Law Blog (Kemnitzer, Anderson, Barron, Ogilvie & Brewer)
Miami Injury Lawyer Blog (Gerson & Schwartz)
Florida Injury Attorney Blog (Paige Trop & Ameen)
Expert Witness Blog (JurisPro Expert Witness Directory)
Indiana Consumer Lawyer Blog (Robert Duff)
Florida Criminal Law Blog (M. James Jenkins)
Florida DUI Lawyer Blog (William Ryan Moore)
Justia Law Review (Ken Chan & Tim Stanley)
Justia Legal Marketing Blog (Ken Chan & Tim Stanley)
Indiana Injury Lawyer Blog (Theodore F. Smith, Jr.)
One East Broward Boulevard, Suite 700, Fort Lauderdale, Florida 33301
Phone: (954) 745-5840
Home Website Privacy Policy Disclaimer Contact Us Website Map Blog Posts Copyright © Health Care Fraud Blog Justia Legal Website Design
Subscribe to:
Posts (Atom)
