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Medicare Fraud in New Jersey: Diakon agrees to pay federal government $10.5 million

Diakon agrees to pay federal government $10.5 million

 Diakon Hospice Saint John, which operates hospice care at facilities in Hazleton, Allentown, and Wyomissing, has agreed to resolve its liability for violations of the False Claims Act by paying the United States $10.56 million.

The announcement was made today by the United States Attorney’s Office for the Middle District of Pennsylvania and the U.S. Department of Health and Human Services‘ Office of the Inspector General.

According to those offices, from Oct. 1, 2004 through Oct. 1, 2010, Diakon erroneously submitted claims to the Medicare Program for hospice care provided to Medicare beneficiaries during periods of time in which the beneficiaries were not eligible for hospice benefits under the Medicare regulations.

Earlier this year, Diakon voluntarily disclosed to federal authorities that it had received improper Medicare and Medicaid payments. By voluntarily disclosing improper billing practices, Diakon
avoided a government lawsuit under the FCA and was able to negotiate a settlement.

The FCA provides that parties who voluntarily disclose violations of the act are liable for double damages, instead of triple damages and civil penalties between $5,500 and $11,000 for each violation.

“Health care providers that make billing compliance, self policing, and self reporting a priority foster trust in the health care industry” said Nick DiGiulio, special agent in charge for the United States Department of Health and Human Services’ Office of Inspector General. “These actions demonstrate that Diakon Hospice Saint John cares about returning money, incorrectly attained, to our federal health payment programs.”

To read the complete story, see Friday’s Times Leader.

Read more: http://www.timesleader.com/news/Diakon-agrees-to-pay-federal-government-105-million.html#ixzz1fWV2t82Y

Patient Recruiter Pleads Guilty in Connection with $5.4 Million Medicare Fraud Scheme in Detroit

Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Tuesday, November 29, 2011
Patient Recruiter Pleads Guilty in Connection with $5.4 Million Medicare Fraud Scheme in Detroit

WASHINGTON – A patient recruiter pleaded guilty today for his participation in a Medicare fraud scheme operated out of three Detroit-area health care clinics, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

 

Santiago Villa-Restrepo, 33, of Miami, pleaded guilty before U.S. District Judge Arthur J. Tarnow in the Eastern District of Michigan to one count of conspiracy to commit health care fraud.   At sentencing, Villa-Restrepo faces a maximum penalty of 10 years in prison and a $250,000 fine.

 

According to the plea documents, Villa-Restrepo recruited Medicare beneficiaries for three Detroit-area health care clinics owned by co-conspirators.   In exchange for cash bribes paid by Villa-Restrepo and others, the beneficiaries agreed to attend the clinics where they provided their Medicare provider numbers and other information, which allowed the clinics to bill for diagnostic tests that were medically unnecessary, and in some cases, not provided at all.  According to court documents, Medicare was billed $5.4 million for medically unnecessary diagnostic tests by the clinics associated with the scheme.

 

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

This case is being prosecuted by Assistant U.S. Attorney Philip A. Ross of the Eastern District of Michigan, with assistance from Acting Assistant Chief Benjamin D. Singer of the Criminal Division’s Fraud Section.   The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

 

Since their inception in March 2007, the Medicare Fraud Strike Force operations in nine districts have charged more than 1,140 individuals who collectively have falsely billed the Medicare program for more than $2.9 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Pompano Beach, Fla.-Area Assisted Living Facility Owner Pleads Guilty to Fraud and Kickback Scheme

Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Wednesday, November 30, 2011
Pompano Beach, Fla.-Area Assisted Living Facility Owner Pleads Guilty to Fraud and Kickback Scheme

WASHINGTON – The owner and operator of a Pompano Beach, Fla.-area assisted living facility pleaded guilty today for his role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company and a Medicaid fraud scheme that billed for assisted living services that were never provided, announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS) and the Medicaid Fraud Control Unit (MFCU) of the Florida Office of the Attorney General.

 

Joseph B. Williams, 41, pleaded guilty before U.S. District Judge Jose E. Martinez in Miami to two counts of conspiracy to commit health care fraud.  Williams was the owner and operator of Avondale Manors Retirement Home, an assisted living facility operating in Pompano Beach, and a company called Diversified Marketing Group Inc.

 

Williams admitted that in exchange for illegal health care kickbacks, he agreed to provide Medicare beneficiaries who resided at Avondale to American Therapeutic Corporation (ATC) for intensive mental health treatment called partial hospitalization program services.  ATC purported to operate partial hospitalization programs in seven different locations throughout south Florida and Orlando.  According to court documents, Williams was paid approximately $30 per beneficiary per day the beneficiary attended ATC.  ATC paid the kickbacks mostly by check made out to Diversified.

 

According to his plea, Williams knew that ATC fraudulently billed Medicare for the partial hospitalization program treatment that his referrals purportedly received.

 

According to court documents, ATC’s principals paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI).  In some cases, the patients received a portion of those kickbacks.  Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for partial hospitalization program services.  Ultimately, ATC and ASI billed Medicare for more than $200 million in medically unnecessary services.

Williams also admitted that he billed Medicaid for assisted living services purportedly provided at Avondale when, in fact, those services were never provided.   Williams paid owners and operators of halfway houses to obtain the personal identifiers of Medicaid enrollees who resided in those halfway houses and used that information to bill Medicaid fraudulently.   Williams also billed Medicaid for assisted living services provided to residents of Avondale at times when they were not receiving any services.

 

According to the plea agreement, Williams’s participation in the fraud resulted in more than $2 million in fraudulent billing to the Medicare and Medicaid programs.  At sentencing, scheduled for Feb. 8, 2012, Williams faces a maximum of 10 years in prison and a $250,000 fine for each count.

 

ATC, its management company Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011.  ATC, Medlink and nine of the individual defendants have pleaded guilty or have been convicted at trial.  Other defendants are scheduled for trial April 9, 2012, before U.S. District Judge Patricia A. Seitz.

 

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher B. Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

 

The case is being prosecuted by Trial Attorneys Steven Kim and Jennifer L. Saulino of the Criminal Division’s Fraud Section.  The case was investigated by the FBI, HHS-OIG and MFCU and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

 

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants that collectively have billed the Medicare program for more than $2.9 billion.  In addition, HHS’s 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.

 

Health Care Fraud Strike Force in Baton Rouge LA Catches 4 Louisiana Physicians Writing Hundreds of Bogus Prescriptions

BATON ROUGE, La. — Four Louisiana physicians wrote hundreds of bogus prescriptions that powered multimillion-dollar health-care frauds in the Baton Rouge area, according to evidence amassed by the nearly two-year-old local Medicare Fraud Strike Force.

Yet all four physicians remain licensed to practice medicine, including two who pleaded guilty and a third convicted at a jury trial in August. The fourth doctor, who had previous probations of his license, is fighting the charges in his indictment.

In a similar case that dates from before creation of the Strike Force, the Advocate reports (http://bit.ly/uTiKlA ) a Louisiana physician in 2009 retained his medical license even though he was convicted of health care fraud.

Officials of the Louisiana State Board of Medical Examiners declined to comment on the targeted physicians — three of whom had their licenses suspended or placed on probation for questionable prescription practices before being charged in the Medicare fraud cases. Doctors can continue practicing medicine while their licenses are on probation, but cannot during a suspension.

The Medicare Strike Force fraud cases are not related to the medical board’s previous disciplinary actions against the four physicians, court and board records show.

The license of Dr. Sofjan Lamid, 82, of Mandeville, was twice suspended in the 1990s for alleged over-prescription of painkillers.

Lamid was ordered by the Board of Medical Examiners in 1991 to surrender “for life his DEA permit for prescription and dispensation of controlled drugs,” according to the board order.

But Lamid retained authority to prescribe Medicare-funded power wheelchairs for patients. In August of 2011, Lamid was convicted by a federal jury in Baton Rouge on charges he accepted kickbacks for writing unnecessary prescriptions for power wheelchairs that resulted in fraudulent Medicare costs of $2.5 million. He has not yet been sentenced.

Rita Arceneaux, the Board of Medical Examiners’ executive assistant, said board officials could not talk about any physicians charged in the Medicare investigations, including those already convicted.

The medical license of Dr. Anthony S. Jase, 41, of New Orleans, was placed on probation for three years in October 2010 for his failure to control prescription pads used to obtain amphetamines, codeine, Hydrocodone and Lomotil. Jase also was ordered by the Board of Medical Examiners to cease the practice of medicine in the field of “management of non-malignant chronic or intractable pain.”

Those penalties were imposed before Jase completed a prior three-year period of license probation ordered in 2008 for what the board described as his acceptance of “cash for office-visit fees calculated … on the amount of medications prescribed.”

Jase pleaded guilty this year in a federal case that alleges he and others bilked Medicare out of more than $470,000 for unnecessary equipment or services. He agreed he owes restitution of $230,963 to Medicare.

Another Louisiana physician, now waiting for his Baton Rouge trial on Medicare fraud charges, had his license placed on probation for five years by the Board of Medical Examiners in May 2010.

That physician, Dr. Michael Selwyn Hunter, 54, of New Orleans, also was stripped of his right to practice in the “management of non-malignant chronic or intractable pain or in the treatment of obesity.” The board ordered Hunter not to prescribe any medications for weight control or weight reduction.

Now, Hunter is accused in a federal indictment in Baton Rouge of providing bogus prescriptions for home health care services that fueled an alleged illegal scheme that netted $14.9 million from Medicare.

Dr. Dahlia Kirkpatrick, 63, of LaPlace, remains licensed to practice medicine in Louisiana even though she is serving a 30-month prison term for providing unnecessary prescriptions to a medical equipment retailer who defrauded Medicare of $302,811. She pleaded guilty in October 2010 and was informed at sentencing that she and the retailer are jointly responsible for repayment of Medicare’s loss.

Rita Arceneaux, the Board of Medical Examiners’ executive assistant, said board officials could not talk about any physicians charged in the Medicare investigations, including those already convicted.

Miami Health Care Fraud: ALF operators, recruiters plead guilty in major Medicare fraud case

Operators of South Florida assisted-living facilities and halfway houses charged in one of the nation’s biggest Medicare fraud cases are rushing to plead guilty rather than face risky trials and long prison sentences.

Six defendants are now looking at shorter federal sentences because of their plea agreements.

And a seventh defendant, Joseph B. Williams, 41, who ran an assisted-living facility in Pompano Beach, plans to plead guilty next week to defrauding the taxpayer-funded Medicare program, court records show.

Those seven are among 10 residential operators and recruiters charged in September with supplying patients to Miami-based American Therapeutic Corp., whose owners pleaded guilty earlier this year. Lawrence Duran and Marianella Valera, are serving 50-year and 35-year prison sentences for running a racket to rip off $200 million from Medicare for purported therapy at their chain of seven mental health clinics in South Florida and Orlando.

Among their patient suppliers: Ramchand Ramrup, who ran an assisted-living facility in Palm Beach County with a recent history of state violations.