Department of Justice

A Southern California man who ran a durable medical equipment (DME) supply company has been found guilty by a federal jury in Los Angeles for his role in a $1.5 million Medicare fraud scheme.

Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, U.S. Attorney André Birotte Jr. of the Central District of California, Assistant Director in Charge Bill Lewis of the FBI’s Los Angeles Field Office and Special Agent in Charge Glenn R. Ferry of the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

Vahe Tahmasian, 36, of Glendale, Calif., was found guilty on March 21, 2014, in U.S. District Court in the Central District of California of one count of conspiracy to commit health care fraud, six counts of health care fraud and six counts of aggravated identity theft.   Sentencing is set for June 9, 2014.

The evidence introduced at trial showed that between April 2009 and February 2011, Tahmasian operated a Medicare fraud scheme at Orthomed Appliance Inc. (Orthomed), a DME supply company in West Hollywood, Calif.   Tahmasian and his co-conspirator, Eric Mkhitarian, purchased Orthomed from the previous owners and put the company in the name of a straw owner.   The defendant and his co-conspirator then stole the personal identifying information of Medicare beneficiaries and doctors in the company’s patient files and used that information to submit a large volume of fraudulent claims to Medicare.   The evidence showed that during a three-month period in late 2010, Tahmasian submitted more than $1.2 million in fraudulent claims to Medicare for services that were never prescribed by a physician and never provided to the Medicare beneficiaries.   Tahmasian and his co-conspirator then took out more than $622,000 in cash from the company over a six-week period in early 2011.   The evidence at trial showed that Tahmasian used a fake California driver’s license during the course of the fraudulent scheme.   Tahmasian submitted a total of $1,584,640 in claims to Medicare and received approximately $994,036 on those claims.

Mkhitarian, Tahmasian’s alleged co-conspirator, remains a fugitive.

The case was investigated by the FBI and the Los Angeles Region of HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.  The case is being prosecuted by Assistant Chief Benton Curtis and Trial Attorney Alexander Porter of the Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion.   In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is 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), go to: www.stopmedicarefraud.gov .

You know how I’m continually nagging you about shredding your documents….whether I am giving an in-service, or talking to friends. Guess what! I have a resource that you’re going to love. In fact, it’s someone I use myself and here’s why – as a private investigator and I keep files as long as required by law, when I get ready to dispose of them, I need guaranteed destruction and security. When I review my own health records or explanation of benefits or the bills and utility charges,  or  catalogs I receive, I want to make sure no one else is privy to my personal information!!

So these are the questions to ask your shredding organization:

1. Do you do a complete background check on all your employees?

2. Do you video tape all shredding areas in company?

3. Are all personnel fingerprinted and run through the DOJ (Dept. of Justice) data base?

4. Are the employees knowledgeable  in security and or  law enforcement?

5. Do they specialize in cross cut technology vs. tear and grind which is cheaper?

6. What is their liability coverage?

In my opinion, a minimum of 1mil/2mil is mandatory

Therefore I recommend 2shred here in Southern California…check their website:

2Shred (http://www.2shred.com/Pages/default.aspx )

Do you want to know more? Contact me at www.the identityadvocate.com or 310-831-4400.

Have a safe day!

The FTC noted that in 2012 they received over 52,000 complaints of ID theft from consumers that were 60 and above. That’s up from 32,907 two years earlier when this age group accounted for 13 percent of all ID theft complaints. Identity fraud has become one of the most reported complaints  by seniors. Checking your credit reports is a must. You can sign up  for  a free service to receive  monthly credit monitoring at www.creditkarma.com

The IRS suggests that older taxpayers  should file early each to  protect themselves before a thief can access their personal information and file as owner of that social security number. All taxpayers can order their transcript online at irs.gov. This is a great plan especially  if they do not make enough income to file taxes regularly.
Seniors tend to be vulnerable to medical identity theft as they are using their health care dollars more regularly, which means their information is more likely to be in the health care system and exploited. Also, most seniors carry their Medicare Card with them, which, of course, is their social security number. When visiting the doctors office, they make copies of the Medicare cards, drivers license, and I bet you haven’t asked if they have completed a background check on their employees? Do that next time you are in the office. See what kind of response you get!
Four things to do in protecting you information

1. Always check your EOB (explanation of benefits) – dispute what is not yours

2. Shred everything that has your name and other information (even your utility bills)

3. Never take part in any  “free” offers if it includes giving your Medicare or health care information

4 Request copies of medical records on every visit.

It is important to always be aware that there is someone who can use and then abuse your information! The identity Advocate is here is to educate and offer solutions for Identity and Medical Identity Theft.  Connect with them here.

FOR IMMEDIATE RELEASE

Contact: HHS Press Office
(202) 690-6343
Departments of Justice and Health and Human Services announce record-breaking recoveries resulting from joint efforts to combat health care fraud

Government Teams Recovered $4.2 Billion in FY 2012

WASHINGTON – Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $7.90. This is the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse (HCFAC) Program.

The government’s health care fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012, up from nearly $4.1 billion in FY 2011, from individuals and companies who attempted to defraud federal health programs serving seniors and taxpayers or who sought payments to which they were not entitled. Over the last four years, the administration’s enforcement efforts have recovered $14.9 billion, up from $6.7 billion over the prior four-year period. Since 1997, the HCFAC Program has returned more than $23 billion to the Medicare Trust Funds.

These findings, released today in the annual HCFAC Program report, are a result of President Obama making the elimination of fraud, waste and abuse, particularly in health care, a top priority for the administration.

The success of this joint Department of Justice and HHS effort was made possible by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs and to crack down on individuals and entities that are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with new tools and resources provided by the Affordable Care Act.

“This was a record-breaking year for the Departments of Justice and Health and Human Services in our collaborative effort to crack down on health care fraud and protect valuable taxpayer dollars,” said Attorney General Holder. “In the past fiscal year, our relentless pursuit of health care fraud resulted in the disruption of an array of sophisticated fraud schemes and the recovery of more taxpayer dollars than ever before. This report demonstrates our serious commitment to prosecuting health care fraud and safeguarding our world-class health care programs from abuse.”

“Our historic effort to take on the criminals who steal from Medicare and Medicaid is paying off: We are gaining the upper hand in our fight against health care fraud,” said Secretary Sebelius. “This fight against fraud strengthens the integrity of our health care programs and helps us fulfill our commitment to our seniors.”

About $4.2 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2012. This is an unprecedented achievement for the HCFAC Program, a joint Justice Department and HHS effort to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.

The administration is also using tools authorized by the Affordable Care Act to fight fraud, including enhanced screenings and enrollment requirements, increased data sharing across the government, expanded recovery efforts for overpayments and greater oversight of private insurance abuses.

Since 2009, the Justice Department and HHS have improved their coordination through HEAT and increased the number of Medicare Fraud Strike Force teams to nine. The Justice Department’s enforcement of the civil False Claims Act and the Federal Food, Drug and Cosmetic Act have produced similar record-breaking results. These combined efforts coordinated under HEAT have expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. In FY 2012, the two departments continued their series of regional fraud prevention summits, and the Justice Department hosted a training conference for federal prosecutors, FBI agents, HHS Office of Inspector General agents and others.

The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes as well as with chronic fraud by criminals masquerading as health care providers or suppliers. In July, Attorney General Holder and Secretary Sebelius announced the launch of a ground-breaking partnership among the federal government, state officials, leading private health insurance organizations and other health care anti-fraud groups to share information and best practices to improve detection of and prevent payments to scams that cut across public and private payers.

In FY 2012, the Justice Department opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants, and a total of 826 defendants were convicted of health care fraud-related crimes during the year. The department also opened 885 new civil investigations.

The strike force coordinated a takedown in May 2012 that involved the highest number of false Medicare billings in the history of the strike force program. The takedown involved 107 individuals, including doctors and nurses, in seven cities, who were charged for their alleged participation in Medicare fraud schemes, involving about $452 million in false billings. As a part of the May 2012 takedown, HHS also suspended or took other administrative action against 52 providers using authority under the health care law to suspend payments until an investigation is complete.

Strike force operations in the nine cities where teams are based resulted in 117 indictments, informations and complaints involving charges against 278 defendants who allegedly billed Medicare more than $1.5 billion in fraudulent schemes. In FY 2012, 251 guilty pleas and 13 jury trials were litigated, with guilty verdicts against 29 defendants, in strike force cases. The average prison sentence in these cases was more than 48 months.

The new authorities under the Affordable Care Act granted to HHS and the Centers for Medicare & Medicaid Services (CMS) were instrumental in clamping down on fraudulent activity in health care. In FY 2012, CMS began the process of screening all 1.5 million Medicare-enrolled providers through the new Automated Provider Screening system that quickly identifies ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation to verify the data. As a result, nearly 150,000 ineligible providers have already been eliminated from Medicare’s billing system.

CMS also established the Command Center to improve health care-related fraud detection and investigation, drive innovation and help reduce fraud and improper payments in Medicare and Medicaid.

From May 2011 through the end of 2012, more than 400,000 providers were subject to the new screening requirements and nearly 150,000 lost the ability to bill the Medicare program due to the Affordable Care Act requirements and other proactive initiatives.

The Department of Justice and HHS also continued their successes in civil health care fraud enforcement during FY 2012. The Justice Department’s Civil Division Fraud Section, with their colleagues in U.S. Attorneys’ offices throughout the country, obtained settlements and judgments of more than $3 billion in FY 2012 under the False Claims Act (FCA). These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. This marked the third year in a row that more than $2 billion has been recovered in FCA health care matters. Additionally, the Civil Division’s Consumer Protection Branch, working with U.S. Attorneys’ offices, obtained nearly $1.5 billion in fines and forfeitures, and obtained 14 convictions in matters pursued under the Federal Food, Drug and Cosmetic Act.

The HCFAC annual report is available at www.oig.hhs.gov/publications/hcfac.asp. For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.

For more information on the fraud prevention accomplishments under the Affordable Care Act visit: www.healthcare.gov/news/factsheets/2012/02/medicare-fraud02142012a.html.

Nearly 284,000 Medicare beneficiaries who have been victims of identity theft are facing difficulties accessing health care services because the federal government has not given them replacement ID cards, according to a report released Wednesday by the HHS Office of Inspector General, USA Today reports.

Medicare officials cited cost and the required involvement of multiple agencies as reasons for not replacing the cards, HHS OIG investigators said. According to USA Today, Medicare ID numbers are directly linked to beneficiaries’ Social Security numbers, which the government cannot reissue for the identity theft victims.

Beneficiaries can only report misuse of their Medicare IDs, and the government does not provide updates about the ID theft investigation or amend victims’ records with accurate billing information, factors that prevent patients from easily accessing care, the report says.

Read more: http://www.californiahealthline.org/articles/2012/10/10/report-cms-not-issuing-new-medicare-id-cards-to-identity-theft-victims.aspx#ixzz29a4YUV6O

How to Prevent Homecare and Hospice Medical Identity Theft

As more and more baby boomers reach their golden years, more and more of them need the services of homecare and hospice agencies. This rapid influx is good for the industry, but agencies need to be as vigilant as ever in their hiring practices of caregivers.

Why? Because medical identity theft is on the rise, and homecare and hospice agencies are easy targets. You need to take immediate action to safeguard your agency, reputation, and clients from the growing threat of medical identity theft.

Medical identity theft is an insidious crime in which an identity thief uses someone else’s identity to gain access to medical services, treatment, or equipment. Since elderly patients are particularly vulnerable to the dangers of medical identity theft, your agency must take extra precautions. This includes stringent hiring protocols and foolproof IT policies and procedures.

Most agencies consult with experts to ensure their entire operation is protected from medical identity theft. Through a comprehensive review of the organization, medical identity theft experts ensure that homecare and hospice agencies:
• Perform thorough background checks on all employees: Employees are the first line of defense to prevent medical identity theft, so it’s critical that homecare and hospice agencies put employees through a rigorous screening process. A medical identity theft expert assists with criminal background checks, speaking with references, and setting up a system for maintaining extensive employee records.
• Create medical identity theft policies and procedures: Professional agencies need to have a strict set of policies and procedures in place to safeguard protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA).
• Ensure patient records are secure: Agencies should also have a secure IT network that only allows authorized users to access sensitive patient information. A medical identity thief can run rampant and ruin lives with the push of a button unless safeguards are built into the system. Complex passwords should be implemented only for those employees who need access to patient records.
• Make sure both the doctors and patients are “real”: Many medical identity thieves prey on the system by actually impersonating doctors and patients for monetary gain. This includes pretending to be a doctor to prescribe medication for the thief and/or his cohorts, as well as using another person’s insurance card to obtain medical services. Do your homework to ensure that physicians have professional references and admitting privileges to medical facilities.

As a homecare or hospice agency, you can significantly reduce your vulnerability to medical identity theft by working with a medical ID theft expert. Visit www.TheIdentityAdvocate.com or call 310.831.4400 to schedule your comprehensive medical identify theft review. And, don’t forget to ask how you can safeguard your agency with an eye-opening “Lunch and Learn” for your employees.

Owner of Doraville Medical Clinic Indicted for Health Care Fraud
Atlanta Hope Medical Group Billed Medicare for Doctor Services Never Performed
U.S. Attorney’s Office January 18, 2012

Northern District of Georgia (404) 581-6000

ATLANTA—DAVID SONG SEN CUI, 43, of Duluth, Georgia, has been indicted by a federal grand jury on charges of health care fraud.

United States Attorney Sally Quillian Yates said of the case, “Medicare dollars provide critical medical services for elderly and disabled persons. This defendant is charged with defrauding Medicare by repeatedly billing for ‘physical therapy’ that in truth was only massages given by unlicensed massage therapists. Medicare and our taxpayers cannot afford such criminal abuse of health care dollars.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “The FBI, in conjunction with its various law enforcement partners, is committed to the protection of such federally funded programs. Individuals engaged in such fraudulent acts, as is alleged in this indictment, demonstrate a lack of compassion and greed that simply cannot and will not be tolerated. The FBI urges anyone with information regarding healthcare fraud activity to contact its nearest FBI field office.”

According to United States Attorney Yates, the charges, and other information presented in court: From November 2008 through August 2011, CUI operated the Atlanta Hope Medical Group, Inc., a clinic located in Doraville, Georgia. The clinic purported to provide physical therapy services for elderly patients. However, the clinic actually offered massage services, which were performed by unlicensed massage therapists. CUI allegedly billed the massages fraudulently to Medicare as “physical therapy” under a doctor’s name who did not render the services and was not even present at the clinic. As part of the scheme, Atlanta Hope employed a doctor who was present at the clinic only two days a week. The indictment alleges that, during the operation of the clinic, CUI fraudulently billed over $5.5 million in false claims to Medicare.

The indictment charges 11 counts of health care fraud. Each count carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.

Members of the public are reminded that the indictment contains only allegations. A defendant is presumed innocent of the charges and it will be the government’s burden to prove a defendant’s guilt beyond a reasonable doubt at trial.

This case is being investigated by special agents of the Federal Bureau of Investigation.

Assistant United States Attorney Shanya J. Dingle is prosecuting the case.

For further information, please contact Sally Q. Yates, United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney’s Office, at (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.