Northfield Place of Whitmore Lake was one of four nursing homes statewide under investigation by authorities for allegations ranging from health care fraud to poor patient care, authorities revealed Monday.
The company that owns those nursing homes - and 30 across Michigan - entered into a settlement agreement announced Monday that includes repaying $1.25 million to Medicare and Medicaid and agreeing to outside monitoring.
The settlement resulted from an investigation by the state Attorney General's Office and U.S. Department of Justice that began around 2001, officials said.
Northfield Place, a 114-bed facility, is owned by Southfield-based Ciena Healthcare Management. The other three nursing homes that were investigated are located in Detroit. Locally, Ciena also owns Riverview of Ann Arbor on Huronview Boulevard.
Harry Slater, administrator for Northfield Place, referred a call from The News to the company's legal counsel. The company issued a statement Monday denying any wrongdoing and said a settlement was reached to avoid expensive and time-consuming litigation.
Gina Balaya, a spokeswoman for the U.S. Attorney's Office in Detroit, and Matt Frendewey, a spokesman for the Attorney General's Office, said they could not reveal specifics on what was alleged or found at Northfield Place.
Friday, August 24, 2007
NY: Home care industry riddled with fraud
New York Attorney General Andrew M. Cuomo is on the warpath when it comes to home health care agencies. The AG issued subpoenas to nearly 60 home health agencies this week, suggesting that not only these agencies, but many others, may be committing fraud.
The investigation previously focused on home health aide training, and vendors who set up contracts between aides and agencies. That investigation found evidence of major fraud within training schools and vendors that link graduates with agencies, Cuomo's office said. The agency arrested several managers and employees associated with Borina Home Care on civil and criminal charges.
Now Cuomo's office is examining whether agencies are billing Medicaid for aides who aren't qualified or are billing for too many hours of service. The probe also targets the vendors supplying the aides' services.
To learn more about the investigation:
- read this piece from The New York Times
The investigation previously focused on home health aide training, and vendors who set up contracts between aides and agencies. That investigation found evidence of major fraud within training schools and vendors that link graduates with agencies, Cuomo's office said. The agency arrested several managers and employees associated with Borina Home Care on civil and criminal charges.
Now Cuomo's office is examining whether agencies are billing Medicaid for aides who aren't qualified or are billing for too many hours of service. The probe also targets the vendors supplying the aides' services.
To learn more about the investigation:
- read this piece from The New York Times
January 2004, through in or around February 2005, United Life billed approximately $7,785,856 ..NOT BAD FOR ONE YEAR..HUH?
MIAMI—A federal grand jury has returned an indictment charging defendants Lester Miranda, 31, of Miami Beach; Ariel Estevez, 32, of Hialeah, Luis Garcia Higgins, 46, of Sunny Isles and Karina Estevez, 32, also of Hialeah with conspiracy to commit health care fraud and substantive health care fraud.
In addition, defendants Miranda and Ariel Estevez are charged with conspiracy to commit money laundering and substantive money laundering.
The defendants are also charged jointly and severally in an accompanying forfeiture count.
The U.S. Attorney’s Office also filed a related criminal information charging defendant Rupert Francis, 66 of Davie, FL, with one count of conspiracy to commit health care fraud. Francis has agreed to waive indictment and plead guilty. As part of his agreement, Francis agreed to voluntarily relinquish his medical license to the State of Florida.
According to the indictment, the above co-defendants established a medical clinic in Hialeah known as United Life Corp., which was used to defraud the Medicare program. Lester Miranda owned the clinic. Ariel Estevez oversaw the operation of the clinic on a day to day basis. Karina Estevez, wife to Ariel, helped manage the business and was a medical assistant.
Luis Garcia Higgins was the physician’s assistant employed by the clinic and Rupert Francis served as the clinic’s physician. Garcia Higgins and Francis had been employed full-time by the U.S. Bureau of Prisons. Francis was employed as a staff physician and Garcia Higgins was employed as a physician’s assistant at the Federal Detention Center-Miami until their resignations in April 2006.
Initially, the United Life clinic saw various patients who were treated for a wide range of ailments and complaints. In or around September 2004, the clinic saw an influx of HIV patients, and eventually HIV patients became the only patients treated at the clinic. The clinic stopped treating patients in February 2005.
Prosecutors say that from in or around January 2004, through in or around February 2005, United Life billed approximately $7,785,856 and received approximately $2,042,633 in Medicare reimbursements based upon claims for alleged treatments of intravenous immune globulin medications that purportedly were administered to treat the HIV patients who attended the clinic. 9-22-07
In addition, defendants Miranda and Ariel Estevez are charged with conspiracy to commit money laundering and substantive money laundering.
The defendants are also charged jointly and severally in an accompanying forfeiture count.
The U.S. Attorney’s Office also filed a related criminal information charging defendant Rupert Francis, 66 of Davie, FL, with one count of conspiracy to commit health care fraud. Francis has agreed to waive indictment and plead guilty. As part of his agreement, Francis agreed to voluntarily relinquish his medical license to the State of Florida.
According to the indictment, the above co-defendants established a medical clinic in Hialeah known as United Life Corp., which was used to defraud the Medicare program. Lester Miranda owned the clinic. Ariel Estevez oversaw the operation of the clinic on a day to day basis. Karina Estevez, wife to Ariel, helped manage the business and was a medical assistant.
Luis Garcia Higgins was the physician’s assistant employed by the clinic and Rupert Francis served as the clinic’s physician. Garcia Higgins and Francis had been employed full-time by the U.S. Bureau of Prisons. Francis was employed as a staff physician and Garcia Higgins was employed as a physician’s assistant at the Federal Detention Center-Miami until their resignations in April 2006.
Initially, the United Life clinic saw various patients who were treated for a wide range of ailments and complaints. In or around September 2004, the clinic saw an influx of HIV patients, and eventually HIV patients became the only patients treated at the clinic. The clinic stopped treating patients in February 2005.
Prosecutors say that from in or around January 2004, through in or around February 2005, United Life billed approximately $7,785,856 and received approximately $2,042,633 in Medicare reimbursements based upon claims for alleged treatments of intravenous immune globulin medications that purportedly were administered to treat the HIV patients who attended the clinic. 9-22-07
Thursday, August 23, 2007
SIX INDICTED FOR HEALTH CARE FRAUD SCHEME IN SOUTHEAST TEXAS
(BEAUMONT, TX) United States Attorney John L. Ratcliffe announced today that six Southeast Texans have been indicted for health care fraud in the Eastern District of Texas.
The federal indictment was returned this week naming the following individuals:
BRIAN KEITH WILSON, 34, of Orange, Texas
JOSEPH DUANE ARMSTRONG, 58, of Orange, Texas
KENESAW LANDUS BERNSEN, JR., 56, of Beaumont, Texas
ARMANDO MARTINEZ CARMONA, 52, of Vidor, Texas
NICOLA JANE HOLTZMAN, 39, of Beaumont, Texas
JIMMIE ADAMS, 56, of Beaumont, Texas
According to information presented in court, from September 2004 until August 2005, Assessment Professionals, owned by Armstrong, submitted claims to Medicaid for individual and group therapeutic sessions allegedly conducted and provided to Medicaid-eligible adolescents for drug and alcohol abuse. Under the direction of manager, Wilson, parties were held in low income neighborhoods, complete with food and entertainment, where Wilson and employees of Assessment Professionals would obtain the Medicaid numbers of attendees. Those numbers were then used to fraudulently bill Medicaid for drug and alcohol counseling. Assessment Professionals billed Medicaid $3,500,972.93 and was paid $1,789,333.94. Wilson and Armstrong used this money, in part, to buy things for themselves, such as Rolex watches and cosmetic surgery.
In an effort to make the billing appear legitimate, Wilson had counselors, Adams, Carmona, Bernsen, and Holtzman create and sign progress notes for each patient. When the Texas Attorney General Medicaid Fraud Control Unit began an audit of Assessment Professionals, copies of these files were turned over to investigators.
All six defendants were indicted on 29 counts of health care fraud. Wilson, Adams, Carmona, Bernsen and Holtzman were indicted on one count of obstruction of a health care investigation. Wilson and Armstrong were indicted on two counts of money laundering.
If convicted, the defendants each face up to 10 years in federal prison for each count and a fine of up to $250,000.00, as well as restitution.
This case is being investigated by the Texas Attorney General’s Office and the Federal Bureau of Investigation and prosecuted by Special Assistant United States Attorney Christopher T. Tortorice.
The federal indictment was returned this week naming the following individuals:
BRIAN KEITH WILSON, 34, of Orange, Texas
JOSEPH DUANE ARMSTRONG, 58, of Orange, Texas
KENESAW LANDUS BERNSEN, JR., 56, of Beaumont, Texas
ARMANDO MARTINEZ CARMONA, 52, of Vidor, Texas
NICOLA JANE HOLTZMAN, 39, of Beaumont, Texas
JIMMIE ADAMS, 56, of Beaumont, Texas
According to information presented in court, from September 2004 until August 2005, Assessment Professionals, owned by Armstrong, submitted claims to Medicaid for individual and group therapeutic sessions allegedly conducted and provided to Medicaid-eligible adolescents for drug and alcohol abuse. Under the direction of manager, Wilson, parties were held in low income neighborhoods, complete with food and entertainment, where Wilson and employees of Assessment Professionals would obtain the Medicaid numbers of attendees. Those numbers were then used to fraudulently bill Medicaid for drug and alcohol counseling. Assessment Professionals billed Medicaid $3,500,972.93 and was paid $1,789,333.94. Wilson and Armstrong used this money, in part, to buy things for themselves, such as Rolex watches and cosmetic surgery.
In an effort to make the billing appear legitimate, Wilson had counselors, Adams, Carmona, Bernsen, and Holtzman create and sign progress notes for each patient. When the Texas Attorney General Medicaid Fraud Control Unit began an audit of Assessment Professionals, copies of these files were turned over to investigators.
All six defendants were indicted on 29 counts of health care fraud. Wilson, Adams, Carmona, Bernsen and Holtzman were indicted on one count of obstruction of a health care investigation. Wilson and Armstrong were indicted on two counts of money laundering.
If convicted, the defendants each face up to 10 years in federal prison for each count and a fine of up to $250,000.00, as well as restitution.
This case is being investigated by the Texas Attorney General’s Office and the Federal Bureau of Investigation and prosecuted by Special Assistant United States Attorney Christopher T. Tortorice.
PHYSICIAN SENTENCED TO PRISON FOR DEFRAUDING INSURANCE COMPANIES OF $10 MILLION
(HOUSTON) Dr. Ira Klein, a physician who specialized in treating Hepatitis C patients, has been sentenced to more than 11 years in federal prison, without parole, for health care and mail fraud, United States Attorney Don DeGabrielle announced today.
February 2006, Dr. Klein specialized in treating patients diagnosed with Hepatitis C and billed insurance companies for services he did not provide A federal jury convicted Dr. Ira Klein, 61, of Houston, Texas, in November 2006 of 18 counts of mail fraud and 26 counts of health care fraud in connection with a scheme to defraud various insurance companies of $10 million. Today, U. S. District Judge David Hittner sentenced Dr. Klein to 135 months in prison to be followed by a three-year term of supervised release. Klein was also ordered to pay $11,590,784 in restitution.
At this morning’s hearing, the Court found Dr. Klein had obstructed justice when he allegedly conspired with jailhouse inmates to murder the Assistant United States Attorney prosecuting the case, one of the Federal Bureau of Investigation Special Agents investigating the case and his wife. The court found that while in federal custody Klein met three inmates to discuss his plan. Later, Klein met with an individual and discussed the payment of $250,000 to kill his wife and the payment of an undetermined amount at a later date to kill the agent. Klein wired $250,000 from a bank account to the individual. What Dr. Klein did not know at the time was that the individual he discussed ad sent payment to was a federal undercover agent. Prior to pronouncing sentence, Judge Hittner noted that the state of Florida has a pending indictment against Klein accusing him of arson in an alleged attempted to murder his wife and that Klein could face possible federal charges for the alleged plot to murder the prosecuting AUSA and the FBI agent.
Indicted in February 2006, Dr. Klein specialized in treating patients diagnosed with Hepatitis C and billed insurance companies for services he did not provide to patients and misrepresented services that were actually provided. The fraudulent scheme involved ordering large quantities of medications used to treat Hepatitis C and providing medications to patients to self administer at home and then billing the insurance companies as if the injections had been administered by him or his staff in his office. Trial evidence proved Klein ordered Hepatitis C treatment kits containing both interferon and ribavirin at a cost of $695 each, but would unbundle the kit and submit claims to the insurance company for more than $3,840 for the components of the kits. The majority of the claims filed for services provided were for dates when patients were not in his office.
Klein also billed insurance companies for injecting his patients with the prescription drugs epoetin and neupogen during office visit, but again the evidence proved no office visit had occurred, and his patients were, in fact, self-administering those medications at home. Klein purchased epoetin at a cost of approximately $1,246 for 10 units of medication but in turn billed insurance companies $39,500 for the same 10 units. The Nuepogen was purchased at a cost of $1,885 for 10 units of medication, yet Dr. Klein billed insurance companies $32,700 for the same 10 units.
Former patients testified that when their insurance company refused to pay Klein the exorbitant fees, he cut off their treatment or told them to contact their respective insurance companies and demand that Dr. Klein be paid.
Patient files introduced during the trial showed Klein did not have doctors notes for the majority of the claims submitted for reimbursement. Moreover, where notes existed they uniformly documented the same blood pressure and pulse recorded for every patient -- 120/80 and 80 beats per minute – a virtual impossibility according to several physician’s who testified at the trial.
Representative from the Texas State Board of Medical Examiners and the Texas Board of Pharmacy testified Klein violated board rules and state law by acting as a pharmacy and ordering large quantities of prescription drugs that were available by prescription from a pharmacy. As a result of his fraudulent scheme, Klein billed insurance companies over $16 million and was paid $10 million. Today, U. S. District Judge David Hittner, who presided over the three-week trial in November 2006, also entered a final order directing Dr. Klein forfeit $10 million to the United States.
February 2006, Dr. Klein specialized in treating patients diagnosed with Hepatitis C and billed insurance companies for services he did not provide A federal jury convicted Dr. Ira Klein, 61, of Houston, Texas, in November 2006 of 18 counts of mail fraud and 26 counts of health care fraud in connection with a scheme to defraud various insurance companies of $10 million. Today, U. S. District Judge David Hittner sentenced Dr. Klein to 135 months in prison to be followed by a three-year term of supervised release. Klein was also ordered to pay $11,590,784 in restitution.
At this morning’s hearing, the Court found Dr. Klein had obstructed justice when he allegedly conspired with jailhouse inmates to murder the Assistant United States Attorney prosecuting the case, one of the Federal Bureau of Investigation Special Agents investigating the case and his wife. The court found that while in federal custody Klein met three inmates to discuss his plan. Later, Klein met with an individual and discussed the payment of $250,000 to kill his wife and the payment of an undetermined amount at a later date to kill the agent. Klein wired $250,000 from a bank account to the individual. What Dr. Klein did not know at the time was that the individual he discussed ad sent payment to was a federal undercover agent. Prior to pronouncing sentence, Judge Hittner noted that the state of Florida has a pending indictment against Klein accusing him of arson in an alleged attempted to murder his wife and that Klein could face possible federal charges for the alleged plot to murder the prosecuting AUSA and the FBI agent.
Indicted in February 2006, Dr. Klein specialized in treating patients diagnosed with Hepatitis C and billed insurance companies for services he did not provide to patients and misrepresented services that were actually provided. The fraudulent scheme involved ordering large quantities of medications used to treat Hepatitis C and providing medications to patients to self administer at home and then billing the insurance companies as if the injections had been administered by him or his staff in his office. Trial evidence proved Klein ordered Hepatitis C treatment kits containing both interferon and ribavirin at a cost of $695 each, but would unbundle the kit and submit claims to the insurance company for more than $3,840 for the components of the kits. The majority of the claims filed for services provided were for dates when patients were not in his office.
Klein also billed insurance companies for injecting his patients with the prescription drugs epoetin and neupogen during office visit, but again the evidence proved no office visit had occurred, and his patients were, in fact, self-administering those medications at home. Klein purchased epoetin at a cost of approximately $1,246 for 10 units of medication but in turn billed insurance companies $39,500 for the same 10 units. The Nuepogen was purchased at a cost of $1,885 for 10 units of medication, yet Dr. Klein billed insurance companies $32,700 for the same 10 units.
Former patients testified that when their insurance company refused to pay Klein the exorbitant fees, he cut off their treatment or told them to contact their respective insurance companies and demand that Dr. Klein be paid.
Patient files introduced during the trial showed Klein did not have doctors notes for the majority of the claims submitted for reimbursement. Moreover, where notes existed they uniformly documented the same blood pressure and pulse recorded for every patient -- 120/80 and 80 beats per minute – a virtual impossibility according to several physician’s who testified at the trial.
Representative from the Texas State Board of Medical Examiners and the Texas Board of Pharmacy testified Klein violated board rules and state law by acting as a pharmacy and ordering large quantities of prescription drugs that were available by prescription from a pharmacy. As a result of his fraudulent scheme, Klein billed insurance companies over $16 million and was paid $10 million. Today, U. S. District Judge David Hittner, who presided over the three-week trial in November 2006, also entered a final order directing Dr. Klein forfeit $10 million to the United States.
Couple gets 7 years for fraud
A Wichita couple who ran a drug and alcohol abuse counseling center were sentenced Friday to more than seven years in federal prison for their roles in a health-care fraud case.
Peggy Franklin-El, 50, and her husband, Johnnie Franklin-El, 53, were sentenced to 92 months in prison each by U.S. District Judge Monti Belot, who ordered them to pay $1.24 million in restitution.
In March, federal jurors found the Franklin-Els guilty of making more than $1.24 million in false claims to Medicaid.
The couple operated The Great Meeting Is On For Your Success Inc. at 1015 E. Ninth St. in Wichita. According to the indictment, the couple defrauded Medicaid by submitting false claims for services that were not provided.
The claims named 67 Medicaid beneficiaries who were supposed to have received services.
Among the claims:
** For treatment reportedly provided to infants and children 12 and younger. In one case, the beneficiary was 36 days old.
** For beneficiaries who had no history of drug or alcohol use and had not been diagnosed as needing community-based drug and alcohol abuse services.
** For services not authorized before claims were submitted and for which they could not bill Medicaid, such as tutoring, anger management counseling, transportation, feeding and baby-sitting.
** For services not documented and for which required assessment tools were not completed.
The couple started the drug and alcohol treatment center, frequently referred to as Success Inc., in the early 1990s. They were credited for helping diminish the drug problem in an area once known as 'crack alley.'
Their work didn't go unrecognized.
For example, in 1994, Peggy Franklin-El was the recipient of the Intrust Bank First Citizen award, for which she received a $6,000 check for Success Inc.
But U.S. Attorney Eric Melgren said in a statement that the couple 'preyed on a community of economically deprived, vulnerable individuals who were lured into giving the defendants their Medicaid numbers, without which the fraud could not have been successful.'
Peggy Franklin-El was convicted on 52 counts of Medicaid fraud and one count of obstruction of justice. Johnnie Franklin-El was convicted on 17 counts of Medicaid fraud and one count of obstruction of justice.
Copyright © 2007 The Wichita Eagle, All Rights Reserved.
Peggy Franklin-El, 50, and her husband, Johnnie Franklin-El, 53, were sentenced to 92 months in prison each by U.S. District Judge Monti Belot, who ordered them to pay $1.24 million in restitution.
In March, federal jurors found the Franklin-Els guilty of making more than $1.24 million in false claims to Medicaid.
The couple operated The Great Meeting Is On For Your Success Inc. at 1015 E. Ninth St. in Wichita. According to the indictment, the couple defrauded Medicaid by submitting false claims for services that were not provided.
The claims named 67 Medicaid beneficiaries who were supposed to have received services.
Among the claims:
** For treatment reportedly provided to infants and children 12 and younger. In one case, the beneficiary was 36 days old.
** For beneficiaries who had no history of drug or alcohol use and had not been diagnosed as needing community-based drug and alcohol abuse services.
** For services not authorized before claims were submitted and for which they could not bill Medicaid, such as tutoring, anger management counseling, transportation, feeding and baby-sitting.
** For services not documented and for which required assessment tools were not completed.
The couple started the drug and alcohol treatment center, frequently referred to as Success Inc., in the early 1990s. They were credited for helping diminish the drug problem in an area once known as 'crack alley.'
Their work didn't go unrecognized.
For example, in 1994, Peggy Franklin-El was the recipient of the Intrust Bank First Citizen award, for which she received a $6,000 check for Success Inc.
But U.S. Attorney Eric Melgren said in a statement that the couple 'preyed on a community of economically deprived, vulnerable individuals who were lured into giving the defendants their Medicaid numbers, without which the fraud could not have been successful.'
Peggy Franklin-El was convicted on 52 counts of Medicaid fraud and one count of obstruction of justice. Johnnie Franklin-El was convicted on 17 counts of Medicaid fraud and one count of obstruction of justice.
Copyright © 2007 The Wichita Eagle, All Rights Reserved.
TEXAS Judge Lynn Hughes awarded $391,000 to an Oklahoma attorney
Judge Lynn Hughes awarded $391,000 to an Oklahoma attorney to cover part of his defense costs after being wrongly prosecuted on 54 counts of health insurance fraud. The court criticized prosecutors for misleading the grand jury and a "reckless disregard for the truth." Again, the government will appeal. (AP/Tulsa World, "U.S. ordered to pay OKC attorney", Aug. 13).
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