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USDOJ S.D. Florida: Owner of Miami Home Health Company Sentenced to 37 Months in Prison for $60 Million Health Care Fraud Scheme
The owner of a Miami health care agency was sentenced today to 37 months in prison for his participation in a $60 million home health Medicare fraud scheme, announced U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.
Rodolfo Nieto Jr., 40, of Miami, was sentenced today by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Nieto was sentenced to serve three years of supervised release and ordered to pay $1.1 million in restitution.
On Aug. 14, 2012, Nieto pleaded guilty in the Southern District of Florida to one count of conspiracy to defraud the United States and to receive health care kickbacks.
Nieto was the owner and operator of Ronat Home Health Care Inc. According to court documents, during the time of the conspiracy, Ronat was a Florida home health “staffing agency” that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. Ronat subsequently became a home health agency.
According to court documents, from approximately January 2006 to approximately November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries to be placed at Nany Home Health Inc., a Miami home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. The owners and operators of Nany paid Nieto kickbacks in return for allowing Nany to bill the Medicare program on behalf of the patients Nieto had recruited through Ronat. Specifically, as part of the scheme, Nany billed Medicare for home health services purportedly provided by Ronat.
See on www.justice.gov
USDOJ E.D. California: Third Physician Sentenced To Lengthy Prison Sentence In Medicare Fraud Case
Dr. Ramanathan Prakash, 65, of Northridge, CA, was sentenced today by United States District Judge Morrison C. England, Jr. to a statutory maximum 10 year prison sentence. The defendant had been found guilty of Conspiring to Commit healthcare fraud, and three counts of healthcare fraud by a jury on July 8, 2011. Judge England also imposed a $75,000 fine and ordered Prakash to pay $607,456.80 in restitution.
According to testimony presented at trial, from February 2006 through August 2008, Vardges Egiazarian, 63, of Panorama City, owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael. Egiazarian and others recruited doctors to submit applications to Medicare for billing numbers. Prakash participated in the establishment of a clinic in Sacramento, although he lived in the Los Angeles area. He established the Medicare provider number for the clinic, signed the lease and established a bank account for the clinic. He only visited the clinic twice.According to evidence at trial, Prakash never treated a single patient at the clinic. Clinic patients, almost all of whom were elderly and non-English speaking, were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally $100 per visit. False charts were created stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.
Patient files were then transported to Los Angeles where Prakash signed them indicating he provided or approved the treatments. In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. In return for their roles, Prakash and the other physicians received 20 percent of the billings paid under their provider numbers.
See on www.justice.gov
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USDOJ: Boehringer Ingelheim Pharmaceuticals to Pay $95 Million to Resolve False Claims Act Allegations
Connecticut-based Boehringer Ingelheim Pharmaceuticals Inc. has agreed to pay $95 million to resolve allegations relating to the improper promotion of the stroke-prevention drug Aggrenox, the chronic obstructive pulmonary disease (COPD) drugs Atrovent and Combivent, and the hypertension drug Micardis, the Justice Department announced today.
The Food and Drug Administration (FDA) has approved Aggrenox to prevent secondary strokes, Combivent to treat continued symptoms of bronchospasm in patients with COPD who already are on a bronchodilator and Micardis to treat hypertension. The settlement resolves allegations that Boehringer improperly marketed each of these drugs and caused false claims to be submitted to government health care programs.
According to the government’s allegations, Boehreinger promoted each of the three drugs for uses that were not medically accepted indications and were not covered by federal health care programs. Specifically, the settlement resolves allegations that Boehreinger promoted Aggrenox for certain cardiovascular events such as myocardial infarction and peripheral vascular disease; that Combivent was marketed for use prior to another bronchodilator in treating COPD; and that Micardis was marketed for treatment of early diabetic kidney disease. The uses were not for medically accepted indications and were not covered by federal health care programs.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
OIG Work Plan Will Examine Hospital-Based Physician Practice Billing
The OIG 2013 Work Plan will focus on many topics to make sure health care providers are dotting i’s and crossing t’s.
One topic is will be to determine the effects of nonhospital-owned physician practices billing Medicare as hospital-based physician practices.
[This is very timely given the renewed wave of hospital acquisitions and employment of physicians.]
See on www.bna.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Alzheimer’s News 10/23/2012: Settlement ensures people with Alzheimer’s access to rehabilitative services
As one of the plaintiffs in the federal class action lawsuit Jimmo v. Sebelius, which challenged the Medicare Improvement Standard, the Alzheimer’s Association applauds the recently announced proposed settlement.
The long-practiced Medicare Improvement Standard provided that Medicare beneficiaries must achieve demonstrable improvements in order to receive rehabilitative services, such as physical, speech and occupational therapy. Without these demonstrable improvements, Medicare would not pay for these services. Now, under the settlement agreement, Medicare will pay for these services if they maintain the patient’s current condition or prevent or slow further deterioration.
The Association believes that eliminating the Improvement Standard is very important for the health and well-being of the growing number of Americans with Alzheimer’s disease. As an organization that has advocated for these changes on behalf of the millions of Americans living with Alzheimer’s and the millions more who will face the disease in the future, the Association determined it was important to join this lawsuit to secure these changes.
See on www.alz.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
SGR Repeal Plea Backed by 110 Physician Groups
Here we go again:
More than 110 physician specialty and state medical society organizations this week renewed what has become an annual plea for Congress to repeal the sustainable growth rate formula.
If implemented according to schedule, the SGR will cut doctors’ Medicare pay 27%, leaving doctors with only 73 cents of every dollar the program pays them today starting on January 1, 2013.
The cost of repealing the SGR to restore those payments would be $245 billion over the next 10 years, according to August projections from the Congressional Budget Office.
See on www.healthleadersmedia.com
USDOJ – NJ: Former director of diagnostic testing center admits bribing doctors in cash-for-patients scheme
In the following post, note that the dollars involved are relatively modest:
The former executive director of Orange Community MRI LLC, today admitted paying bribes to doctors since April 2008 and agreed to forfeit $89,000 in proceeds from the crime, U.S. Attorney Paul J. Fishman announced.Chirag Patel, 37, of Warren, N.J., pleaded guilty to an Information charging him with one count of soliciting and receiving illegal cash kickbacks for patient referrals in violation of the federal health care anti-kickback statute.
According to documents filed in this case and statements made in court:
On Dec. 8, 2011, Patel was arrested and charged with offering and paying cash kickbacks to a New Jersey health care practitioner in exchange for referrals to Orange Community MRI. On Dec. 13, 2011, 13 New Jersey doctors and one nurse practitioner were arrested and charged in separate Complaints with accepting similar cash kickback payments from Orange MRI. Each of the defendants was recorded taking envelopes of cash in exchange for patient referrals.
Patel is the ninth person charged in the December 2011 takedown to plead guilty. Patel is the second member of Orange Community MRI to plead guilty; Ashokkumar Babaria, the former owner and medical director of Orange Community MRI, pleaded guilty on Sept. 27, 2012.
As part of his plea agreement, Patel agreed to forfeit $89,180 that constitutes criminal proceeds of the crime. As part of his guilty plea, Ashokkumar Babaria agreed to forfeit his revenues traceable to corrupt referrals, which the government has estimated could reach as much as $2 million. The seven health care providers that referred patients to Orange MRI who have plead guilty thus far have collectively agreed to forfeit over $150,000 in illegal kickbacks from Orange MRI.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Clinic Owners Plead Guilty in Detroit-Area Infusion Therapy Scheme
Two owners and operators of clinics that claimed to specialize in treating HIV and other conditions pleaded guilty today for their roles in an infusion therapy scheme carried out at two Detroit-area clinics that submitted millions of dollars in fraudulent claims to Medicare.
The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Department of Justice’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Special Agent in Charge Robert Foley III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (HHS-OIG) Chicago Regional Office.
Raymond Arias, 40, and his wife, Emelitza Arias, 25, of Troy, Mich., each pleaded guilty, before U.S. District Judge Paul D. Borman of the Eastern District of Michigan, to one count of conspiracy to commit health care fraud. At sentencing, the defendants each face a maximum potential penalty of 10 years in prison and a $250,000 fine. Sentencing is currently scheduled for Feb. 12, 2013.
According to plea documents, Raymond Arias conceived of and oversaw fraud schemes at two clinics for which he was a beneficial owner: Elite Wellness LLC, and Carefirst Occupational & Rehabilitation Center Inc. He admitted to paying physicians to refer Medicare beneficiaries to Elite Wellness, and to purchasing Medicare beneficiary identifications for the purpose of submitting fraudulent claims to Medicare for expensive infusion therapy services that were not rendered as claimed by Carefirst.
According to court documents, Raymond Arias attempted to hide the Elite Wellness scheme from law enforcement by directing a nominee owner to assume control of the claims submitted and the bank account into which Medicare payments were deposited. After the nominee owner became involved, Raymond Arias and his alleged co-conspirators submitted approximately $10 million in claims over a 3-month period beginning in August 2010.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Guest opinion: Medicare Part D: A success story for Florida’s seniors
Lawmakers in Washington are working hard to reduce entitlement spending and lower the deficit. These are worthy goals. However, during this process, it’s vitally important that policymakers not compromise successful federal programs.
Medicare Part D is such a program. Part D needs to be preserved and protected, as it has dramatically improved seniors’ access to prescription drugs and has cost taxpayers far less than expected.
Part D employs a unique market-based structure that offers enrollees genuine choice in their coverage and harnesses competition to keep prices down. The government doesn’t directly provide coverage through Part D — private insurers do. Seniors are free to choose among a broad range of plans based on their needs. The government monitors the market and provides financial support to enrollees.
See on www.news-press.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Medicare Fraud Strike Force Charges 91 Individuals for Approximately $430 Million in False Billing
Medicare Fraud Strike Force operations in seven cities have led to charges against 91 individuals – including doctors, nurses and other licensed medical professionals – for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.
Attorney General Holder and Secretary Sebelius were joined in the announcement of the nationwide takedown by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, FBI Associate Deputy Director Kevin Perkins, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG) and Dr. Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS).
“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program – they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”
“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said HHS Secretary Sebelius. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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