An investigation coordinated by the U.S. Department of Justice Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Miami has resulted in the arrest of Emilio Felipe Lopez, 47, and Orlando Hernandez Estevez, 25, both of Miami-Dade County. The arrests by federal agents stem from two separate indictments charging Estevez and Lopez with health care fraud, in violation of Title 18, United States Code, Section 1347.
According to the indictment, Emilio Felipe Lopez was the president of Charlie RX, Inc., a DME business operating in Hialeah, Florida. The indictment alleges that Charlie RX submitted $689,853 in false claims to Medicare for, among other items – are you ready for this one – male vacuum erection systems for female patients! The company received $370,838 from in Medicare based upon its false billings.
According to a separate indictment returned in March 2010, Orlando Hernandez Estevez was the president of Happy Trips of Miami, Corp., another DME business operating in Hialeah, Florida. The indictment alleges that Happy Trips submitted $1,188,956 in false claims to Medicare for inhalation drugs. The company received $364,120 from Medicare based upon the false billings.
Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 560 individuals who collectively have falsely billed the Medicare program for more than $1.2 billion.
The HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), click: here.
Monthly Archives: August 2010
Illinois Cardiologist Sentenced for $13M Health Care Fraud
The Associated Press reports that on August 12, Sushil Sheth, a suburban Chicago cardiologist was sentenced to five years in prison for bilking Medicare and insurance companies out of more than $13 million for care never provided.
The 5-year sentence falls short of the 94 – 121 month advisory sentence called for by the United States Sentencing Guidelines, for losses that exceed $7M but are less than $20M, by a perpetrator with a special skill who was a leader or organizer of a criminal enterprise.
U.S. attorney’s office says used the proceeds to purchase a mansion, property in Arizona, luxury automobiles, and to invest in various venture capital opportunities.
The U.S. attorney’s office announced Wednesday that Sheth, who pleaded guilty a year ago to one count of health care fraud, was sentenced Tuesday by U.S. District Judge Rebecca Pallmeyer. He’s to begin serving the prison term in two months.
Prosecutors alleged the 50-year-old Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursements.
In June 2007, federal agents seized more than 600 uncashed checks from insurers totaling more than $6.7 million.
Congress Set to Approve $1.7B to Fight Health Care Fraud
Congress is moving forward toward granting the Obama administration’s request for a record $1.7 billion to fight health-care fraud, in part to almost triple investigations into crime rings that steal from Medicare.
The money, included in both House and Senate versions of a fiscal 2011 spending bill for the Health and Human Services Department, amounts to a $250 million increase. Almost half of that, $116 million, would go toward expanding a program of fraud “strike forces” to 20 cities from seven.
The health care fraud strike force program has stopped fraud schemes totaling about $1.9 billion and led to charges against more than 800 people.
The amount of fraud the strike forces have deterred from happening is “far higher but nearly impossible to calculate” according to former United States Department of Justice Kirk Ogrosky, a partner at Arnold & Porter LLP in Washington, who began the strike force program in Miami in 2007.
In the strike force’s first year operating in south Florida, Ogrosky said, the Center for Medicare Services observed a $1.2 billion decrease in claims from the area for purchases of durable medical equipment, the industry targeted.
The Obama administration forecasts that a budget increase for anti-fraud programs will pay for itself and then some, bringing in $10 billion for the government over a decade.
Jay Darden, another former federal prosecutor who is now a partner at Patton Boggs LLP in Washington, said that the government should consider stepping up its law enforcement in places like Miami — a hotbed for health-care fraud — before expanding to more cities.
“I think there’s 20 cities where Medicare fraud is a problem,” Darden said in a phone interview. “I’m not sure you could say there are 20 cities where Medicare fraud is the size of the problem as it is in South Florida and L. A. and in the Southern District of Texas.”
The Southern District of Texas includes Houston and McAllen, a town that was the focus of a New Yorker story last year examining differences in Medicare spending across the U.S.
The legislation carrying the extra money for fraud-fighting is stalled in Congress due to a partisan debate over government spending. Senator Tom Harkin, the Iowa Democrat who is chairman of the appropriations subcommittee that wrote the bill, said last week that it is unlikely to become law before the end of the year. The full Senate Appropriations Committee approved the bill last week on an 18-12 vote. The additional cities weren’t identified.
The legislation is S.3686. It states in relevant part:
Healthcare Fraud and Abuse Control Account
In addition to amounts otherwise available for program integrity and program management, $561,000,000, to remain available through September 30, 2012, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act, of which $376,167,000 shall be for the Centers for Medicare and Medicaid Services Program Integrity Activities, including administrative costs, to conduct oversight activities for Medicare Advantage and the Medicare Prescription Drug Program authorized in title XVIII of the Social Security Act and for activities listed in section 1893 of such Act and for Medicaid and Children’s Health Insurance Program (‘CHIP’) program integrity activities; of which $94,830,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act; and of which $90,003,000 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act: Provided, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year 2011 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and CHIP programs for the funds provided by this appropriation.
For more click: here.