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 .

One of the Tax Division’s highest priorities is prosecuting people who use stolen identities to steal money from the United States Treasury by filing fake tax returns that claim tax refunds. Working to stop Stolen Identity Refund Fraud, or SIRF, is vital because these schemes threaten to disrupt the orderly administration of the income tax system for hundreds of thousands of law abiding taxpayers and to cost the United States Treasury billions of dollars.

SIRF crimes are complicated to prosecute because they are often perpetrated by large criminal enterprises with individuals at all stages of the scheme: those who steal the Social Security Numbers (SSN) and personal identifying information, those who file false returns with the Internal Revenue Service (IRS), those who facilitate obtaining the refunds, and the masterminds who promote the schemes. These criminal enterprises are able to exploit the speed and relative anonymity of highly automated systems for storing personal information, preparing and filing tax returns electronically, and generating income tax refunds quickly—often in the form of electronic payments.

Identities used in SIRF crimes may be stolen from anywhere. SIRF criminals have used social security numbers stolen from institutions such as hospitals, nursing homes, and public death lists, thereby exploiting some of the most vulnerable members of our communities—the elderly, the infirm, grieving families. However, everyone with a social security number is potentially vulnerable to having their identity stolen. According to the IRS, from 2008 through May of 2012, the Service has identified more than 550,000 taxpayers who have had their identities stolen for the purpose of claiming false refunds in their names.

Click here to read the entire article: http://www.justice.gov/tax/Stolen_Identity_Refund_Fraud.htm

The Tax Division has had considerable success in SIRF prosecutions, which have generated long sentences for those convicted of SIRF crimes. This page contains links to articles, websites, and press releases with information on how the Justice Department and IRS are dealing with SIRF crimes, guidance for citizens whose identities have been stolen and used to file false tax returns, and efforts of the Justice Department to prosecute these crimes – Kathryn Keneally, Assistant Attorney General for the Tax Division   Press Release Announcing SIRF Enforcement Initiative

Connect with Linda at 310-831-4400 or at info@theidentityadvocate.com to mobilize your efforts of protection and recovery when it happens to you!

The National HealthCare Anti-Fraud Association has made some great recommendations for making yourself aware of potential hazards with the onset of  health care reform. You must realize legitimate insurance companies must be licensed to sell insurance of any kind with the state Department of Insurance in each state where they sell insurance. Insurance brokers must be licensed as well. Before you consider buying insurance, you should determine if the company or individual selling the insurance policy is properly licensed.  Every state has  a Department of Insurance where you can check out the company and the independent brokers.

These are some simple steps to follow to help you avoid being the victim of a health insurance scam:

DON’T

• Don’t buy insurance online or over the phone, based on mailers, fliers or ads without investigating first and clearly understanding what you are buying.
• Don’t respond to high pressure or fear tactics from aggressive salespeople.
• Don’t provide your Social Security number, bank account numbers or credit card numbers before confirming that you are dealing with a legitimate company, and don’t give out personal information over the phone.
• Don’t sign blank insurance claims forms.
• Don’t give blanket authorization to a medical provider to bill for services rendered.

DO

• Do take the time to research any company before purchasing a health insurance policy from it-a few minutes invested in searching the Internet is worth your time.
• Do check with your state’s Insurance Department to make sure the company is licensed to do business.
• Do compare insurance coverage.
• Do document your dealings with any company from which you are considering purchasing insurance.
• Do get a list of doctors and other providers that participate with the insurance plan you are considering.
• Do ask LOTS of questions.
• Do report suspected fraud to your state insurance department.

Below are some resources to help you learn more about the Health Care Reform law, what it means to you and how to protect yourself from being the victim of fraudulent health insurance scams.

• The U.S. Department of Health & Human Services manages a robust website intended to inform consumers about the new law: HealthReform.GOV
• The Obama Administration has created a website which aims to explain the new health reform law: Health Reform: What It Means To You
• To determine if a health insurer is licensed to do business in your state, check with your state’s department of insurance (DOI). Plus, most DOI websites provide information and resources on how to report suspected fraud.

For other information and further education connect with Linda at 310-831-4400 or Linda@theidentityadvocate.com

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.

Former Miami Clinic Director Sentenced to 70 Months in Prison for Role in HIV Infusion Fraud Scheme
U.S. Department of Justice January 23, 2013

Office of Public Affairs (202) 514-2007/TDD (202) 514-1888

WASHINGTON—A former Miami HIV infusion clinic director was sentenced today to serve 70 months in prison for his role in a $26.2 million HIV infusion fraud scheme, announced Assistant Attorney General Lanny Breuer of the Criminal Division, U.S. Wifredo A. Ferrer of the Southern District of Florida, Acting Special Agent in Charge Michael B. Steinbach 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.

Enrique Gonzalez, 67, formerly of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Judge Altonaga sentenced Gonzalez to serve three years of supervised release and ordered him to pay $17,590,896 in restitution to HHS.

On November 13, 2012, Gonzalez pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims, and to pay health care kickbacks, and one count of conspiracy to commit health care fraud.

Gonzalez admitted that between August 2002 and March 2004, he conspired with co-defendant Ronald Harris, a Miami physician, and alleged co-conspirators to operate Physicians Med-Care and Physicians Health (together the “Physicians Clinics”), two Miami HIV infusion clinics. According to court documents, the Physicians Clinics were owned and controlled by alleged co-conspirators Carlos Benitez and his brother Luis Benitez. The Physicians Clinics purported to specialize in treating patients with HIV but were operated for the sole purpose of committing Medicare fraud, according to court documents. Gonzalez was a director of Physicians Med-Care and, at the direction of his co-conspirators, was responsible for the finances of the Physicians Clinics.

Gonzalez admitted that he agreed with his co-conspirators to handle the finances for the Physicians Clinics, moving the money paid by the Medicare program out of the Physicians Clinics’ accounts and into accounts owned and controlled by his co-conspirators. According to court documents, Harris signed blank checks that Gonzalez used to transfer funds to various Benitez-owned entities and others, as directed by his co-conspirators. In addition, Gonzalez agreed to provide cash to various co-conspirators at the Physicians Clinics to be used to pay bribes and kickbacks to the Medicare beneficiaries in return for those beneficiaries allowing the Physicians Clinics to bill the Medicare program for HIV infusion services that were not medically necessary and often not provided.

Gonzalez admitted that during his association with Physicians Med-Care, the clinic billed the Medicare program approximately $24.5 million in HIV infusion therapy claims, for which the clinic received $16.7 million in payments. Gonzalez also admitted that during his time with Physicians Health, the clinic billed Medicare approximately $1.7 million and received approximately $800,000 in payment from the Medicare program for fraudulent services.

Gonzalez was a fugitive from justice from the time of his indictment in 2008, until he was located and detained in Peru in late 2011. Gonzalez was extradited to the United States in July of 2012. Gonzalez’s daughter, Carmen Gonzalez, was indicted in a related case and is currently a fugitive.

Co-defendant Harris pleaded guilty on August 26, 2008, to one count of conspiracy to defraud the United States, to cause the submission of false claims and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims to the Medicare program. Harris pleaded guilty in connection with his role as the medical director for the Physicians Clinics. On November 4, 2008, Harris was sentenced to serve 84 months in prison for his role in the scheme.

Carlos and Luis Benitez and Thomas McKenzie were charged separately with health care fraud and money laundering crimes in an indictment unsealed on June 11, 2008. According to the separate indictment, the defendants provided the money and staff necessary to open the Physicians Clinics, the Medicare patients that the clinics needed to bill the Medicare program and transportation for the HIV patients who visited the clinics. Carlos and Luis Benitez and McKenzie were charged for their role in committing approximately $109 million in HIV infusion fraud and money laundering through the Physicians Clinics and nine other HIV infusion clinics.

On September 18, 2008, McKenzie pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program and admitted to his role in a $119 million HIV infusion fraud scheme. On December 18, 2008, McKenzie was sentenced to serve 14 years in prison.

Carlos and Luis Benitez are also fugitives. Anyone with information regarding the whereabouts of the fugitives is urged to contact HHS-OIG fugitive reporting phone line at 888-476-4453.

The defendants who have not been convicted are presumed innocent unless and until proven guilty.

The Physicians Med-Care and Physicians Health case is being prosecuted by Trial Attorney N. Nathan Dimock of the Criminal Division’s Fraud Section. The case was investigated by the FBI and the DHS Office of Inspector General.

The case 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. The Department also thanks the Peruvian National Police Interpol Unit for their assistance.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and 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.

Forty Defendants Charged in Separate Schemes that Resulted in Thousands of Identities Stolen and Millions of Dollars in Identity Theft Tax Filings
U.S. Attorney’s Office October 10, 2012

Southern District of Florida (313) 226-9100

MIAMI—Federal charges were filed today against 40 defendants in 20 separate cases, dealing with thousands of stolen identities and millions of dollars of fraudulent identity theft tax filings. Today’s cases reaffirm the joint federal and local commitment to crack-down on stolen identity tax refund (SITR) fraud perpetrators.

The charges were announced by Wifredo A. Ferrer, U.S. Attorney for the Southern District of Florida; Richard Weber, Chief, Internal Revenue Service-Criminal Investigation Division (IRS-CI); Paula Reid, Special Agent in Charge, U.S. Secret Service (USSS); Michael B. Steinbach, Acting Special Agent in Charge, FBI, Miami Field Office; Antonio J. Gomez, Acting Inspector in Charge; U.S. Postal Inspection Service (USPS), Miami Division; Guy Fallen, Special Agent in Charge, Social Security Administration, Office of Inspector General (SSA-OIG); Kelly R. Jackson, Special Agent in Charge, IRS-CI, St. Paul Field Office; Steven Steinberg, Chief, Aventura, Fla., Police Department; Larry Gomer, Interim Chief, North Miami Beach Police Department; and Juan Santana, Chief, Miami-Dade Police Department.

According to the Federal Trade Commission, Florida had the highest rate of identity theft in the United States in 2011. While identity theft in Florida ranks highest in the United States, the identity theft rate in Miami has reached near epidemic proportions. Florida’s rate of 178 complaints per 100,000 residents—the highest in the United States—is dwarfed by the Miami rate of 324.1 complaints per 100,000 residents.

Moreover, a September 2012 report by the U.S. Treasury Inspector General for Tax Administration (TIGTA) determined that Florida has the highest rate of stolen identity tax refund fraud in the United States. The report identified 74,496 potentially fraudulent returns filed in Miami resulting in more than $280 million in bogus refunds. Miami’s per capita number of false returns based on identity theft was 46 times the national average, and its per capita SITR fraud dollar value was more than 70 times the national average. This problem is projected to grow: the TIGTA report estimates that the IRS could issue as much as $21 billion in fraudulent tax refunds over the next five years.

In an attempt to combat the rising wave of stolen identity refund scams, and armed with newly enhanced investigative and prosecutorial tools under the Department of Justice’s Tax Directive 144, the U.S. Attorney’s Office for the Southern District of Florida established the South Florida Identity Theft Tax Fraud Strike Force. The members of the strike force include IRS-CI, U.S. Secret Service, FBI, USPS, City of Aventura Police Department, Miami-Dade Police Department, North Miami Beach Police Department and the SSA-OIG. The focus of the strike force is to investigate and prosecute SITR fraud in the Southern District of Florida. Today, U.S. Attorney Ferrer, joined by members of the Identity Theft Tax Fraud Strike Force, announced the most recent results of their investigative efforts.

U.S. Attorney Ferrer said, “So far this year, we have charged a total of 79 individuals responsible for almost $40 million in fraudulent tax refunds obtained through identity theft. The cases being investigated and prosecuted include victims from all walks of life, including police officers, potential U.S. Marine recruits, members of the Armed Forces, holocaust survivors, school children, hospital patients, the elderly and infirm, incarcerated prisoners, and even the dead. In addition, our cases show a troubling change in the nature of these cases, away from traditional white collar criminals to more violent criminals, like gang members and narco-traffickers, who are using stolen identity refund scams to fuel their other, violent, criminal activities. We will continue to crack down on identity thieves who are lining their pockets with our tax dollars and using violence to obtain the personal identification information of others.”

“Today’s announcement should reassure American taxpayers that IRS Criminal Investigation has put into action our pledge to make investigating identify theft and refund fraud a top priority,” said IRS-CI Chief Weber. “Be assured that we are serious about investigating these crimes and, as we capitalize on the collective strength of the Identity Theft Tax Fraud Strike Force, we will succeed in vigorously pursuing the criminals who steal from the American taxpayer.”

“The U.S. Secret Service is glad to be an integral part of the Strike Force coordinated between the U.S. Attorney’s Office and the Internal Revenue Service to combat this fraud scheme that is plaguing South Florida,” said USSS Special Agent in Charge Reid.

“Identity theft tax fraud has reached an epidemic level and these cases demonstrate that the FBI and its law enforcement partners will devote considerable resources to address the issue,” said FBI Acting Special Agent in Charge Steinbach. “Prevention by way of educating the public is also key to reducing the amount of this type fraud. Consequently, we urge the public to visit www.ftc.gov or www.ic3.gov, as it provides detailed information on how to help deter, detect, and defend against identity theft.”

Acting Inspector in Charge of the Miami Division of the USPS Gomez said, “As a member of the Identity Theft Tax Fraud Strike Force, the U.S. Postal Inspection Service will work diligently with the U.S. Attorney’s Office and with law enforcement at the federal, state and local level to protect American citizens from suspects who prey on their identification for financial gain. Our commitment to the South Florida community is to continue to pursue these cases under Mr. Ferrer’s leadership and guidance so that the U.S. Mails are never used as a conduit to defraud unknowing victims of this type of crime.”

Special Agent in Charge of the SSA-OIG Fallen said, “Assuming the identity of another to commit fraud, unfortunately, is a common occurrence. SSA-OIG special agents are well-trained to detect, investigate, and locate identity thieves, and SSA/OIG, in concert with the U.S. Attorney’s Office, will investigate and prosecute those who commit identity theft and defraud Social Security trust funds.”

“It is through the collaborative efforts of our agencies that we have been successful in investigating and prosecuting tax fraud in Miami-Dade County. We are pleased with the outcome and will continue to work together with our partner agencies in order to make positive impacts on our community,” said Miami-Dade Police Department Chief Santana.

An indictment is only an accusation, and a defendant is presumed innocent unless and until proven guilty.

The cases announced today include:

United States v. Serge St-Vil, et al., Case No. 12-20768-CR-Scola
United States v. Rodney Saint Fleur, Case No. 12-20772-CR-Scola
United States v. Lineten Belizaire, et al., Case No. 12-20763-CR-Altonaga
United States v. Frantz Pierre, et al., Case No. 12-20696-CR-Cooke
United States v. Jean Noel, et al., Case No. 12-20740-CR-Dimitrouleas
United States v. Douglas Michael Young, et al., Case No. 12-20767-CR-Dimitrouleas
United States v. Bridgette Piedra and Jane Piedra, Case No. 12-20761-CR-Ungaro
United States v. Rose Mary Steed and Demetrice Nicole Steed, Case No. 12-20773-CR-Huck
United States v. Michael Wilson, Case No.12- 60253-CR-Cohn
United States v. Johnny Alexander Melo, Case No. 12-20762-CR-Graham
United States v. Arthy Icart and Charlton Escarmant, Case No. 12-20764-CR-Lenard
United States v. Michlson LaRochelle, Case No. 12-14074-CR-Graham
United States v. Alexander Louis, Case No. 12-60250-CR-Williams
United States v. Vildeon Sajouse, Case No. 12-3364-MJ-Palermo
United States v. Frantz Auguste, Case No. 12-3363-MJ-Palermo
United States v. Cesar Coureaux, Case No. 12-20708-CR-Altonaga
United States v. Math Benjamin, Case No. 12-20707-CR-Cooke
United States v. Thierry Audren, Case No. 12-20738-CR-Williams
United States v. Natoya Mashea Handy, Case No. 12-20771-CR-Rosenbaum
United States v. Luis Enrique Ledee Bernard a/k/a Luis L. Bernard, Case No. 12-20776- CR-Moreno

U.S. Department of Justice October 04, 2012
WASHINGTON—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.”

Dozens of charged individuals were arrested or surrendered in the last 24 hours as indictments were unsealed across the country. Together, those indictments charge more than $230 million in home health care fraud; more than $100 million in mental health care fraud; more than $49 million in ambulance transportation fraud; and millions more in other frauds.

HHS also suspended or took other administrative action against 30 health care providers following a data-driven analysis and based upon credible allegations of fraud. Under the Affordable Care Act, HHS is able to suspend payments until the resolution of an investigation.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques. More than 500 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown.

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes, and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and ambulance services.

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of conspiring to submit a total of approximately $429.2 million in fraudulent billing.

“Today’s coordinated actions represent one of the largest Medicare fraud takedowns in Department of Justice history, as measured by the amount of alleged fraudulent billings,” said Assistant Attorney General Breuer. “We have made it one of the department’s missions to hold accountable those who abuse the Medicare program for personal profit. And there are Medicare fraudsters in prisons across the country—some who will be there for decades—who can attest to our determination and our effectiveness.”

“Health care fraud leads to higher health care costs and makes quality care more difficult to obtain,” said FBI Associate Deputy Director Perkins. “Working together to stop fraud, as we did today, will ensure that Americans’ hard-earned dollars are used to care for the sick—not to line the pockets of criminals.”

“Today’s coordinated operation demonstrates that law enforcement is flexible enough to address health care fraud in its many evolving forms,” said HHS Inspector General Levinson. “When home health agencies, durable medical equipment companies, pharmacies, or other health care providers are suspected of breaking the law, they can expect to be caught and held accountable.”

“This is the result of coordinated anti-fraud efforts—including Medicare flagging suspicious activity, efforts between agencies to investigate this criminal activity, and today’s actions by law enforcement and HHS,” said CMS Deputy Administrator for Program Integrity Budetti. “As we stop payments to these providers suspected of fraud, we continue our efforts to move from a pay-and-chase model to one where we stop fraudsters before they can successfully bill Medicare and Medicaid.”

In Miami, a total of 33 defendants are charged for their alleged participation in various fraud schemes involving a total of $204.5 million in false billings for home health care, mental health services, occupational and physical therapy, and DME. In one case, three defendants are charged for participating in a fraud scheme at LTC Professional Consultants and Professional Home Care Solutions Inc., which led to approximately $74 million in fraudulent billing for home health care. In another case, five defendants are charged for participating in a fraud scheme at Hollywood Pavilion, which led to $67 million in fraudulent billing for mental health services.

Sixteen individuals, including three doctors and one licensed physical therapist, are charged in Los Angeles with participating in various fraud schemes involving a total of $53.8 million in false billings. In one case, four defendants are charged for allegedly participating in a fraud scheme at Alpha Ambulance Inc., which led to approximately $49.2 million in fraudulent billing for ambulance transportation. The case represents the largest ambulance fraud scheme ever prosecuted by the Medicare Fraud Strike Force. According to court documents, the defendants provided beneficiaries ambulance rides that were medically unnecessary.

In Dallas, 14 individuals—including two doctors and two registered nurses—are charged for their alleged participation in various fraud schemes involving a total of $103.3 million in false billings. In one case, three defendants—a medical doctor and two registered nurses—are charged with participating in a fraud scheme at Raphem Medical Practice and PTM Healthcare Services which led to approximately $100 million in fraudulent billing for home health care services. According to court documents, Dr. Joseph Megwa signed approximately 33,000 prescriptions for more than 2,000 unique Medicare beneficiaries from 2006 to 2011. Many of these Medicare beneficiaries had primary care physicians who never certified home health care services for them. In order to handle the volume of prescriptions, Megwa allegedly signed stacks of documents without reviewing them.

Seven individuals are charged in Houston for their participation in a fraud scheme at a hospital which led to $158 million in fraudulent billing for community mental health center services. According to court documents, the defendants who served as administrators at the hospital paid kickbacks—in the form of cigarettes, food, and coupons redeemable for items available at the hospital’s “country stores”—to Medicare beneficiaries in exchange for those beneficiaries’ attendance at the hospital’s partial hospitalization programs (PHP). Allegedly, beneficiaries watched television, played games, and engaged in other non-PHP activities rather than receiving the services for which the hospital billed Medicare. Previously, on February 22, 2012, the assistant administrator of the hospital, Mohammad Kahn, pleaded guilty to conspiracy to commit health care fraud and paying kickbacks related to $116 million worth of fraudulent claims submitted to Medicare. After his guilty plea, an additional $42 million in fraudulent claims were discovered that are included in today’s totals.

In Brooklyn, 15 individuals, including one doctor and four chiropractors, are charged for their alleged participation in various fraud schemes involving a total of $23.2 million in false billings. In one case, nine defendants, including a medical doctor, are charged with participating in a fraud scheme at Cropsey Medical Care PLLC which led to approximately $13.8 million in fraudulent billing for physical therapy and related services. According to court documents, the defendants paid cash kickbacks to Medicare beneficiaries in exchange for physical therapy that was not medically necessary and on some occasions never provided to beneficiaries.

In Baton Rouge, four defendants, including a licensed practical nurse, are charged for their roles in fraud schemes involving approximately $2.4 million in false claims for medically unnecessary durable medical equipment.

In Chicago, two defendants, including a dermatologist and a psychologist, are charged for their roles in fraud schemes involving, according to court documents, millions of dollars in false claims for medically unnecessary laser treatments and psychotherapy services.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, 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.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprising attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorneys’ Offices for the Southern District of Florida, the Southern District of Texas, the Northern District of Texas, the Central District of California, the Middle District of Louisiana, the Northern District of Illinois, and the Eastern District of New York; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units; with assistance from the Justice Department’s Civil Division and the IRS.

The charges and allegations contained in the indictments are merely accusations, and the defendants are presumed innocent unless and until proven guilty.

Office of Public Affairs (202) 514-2007/TDD (202)514-1888

To learn more about HEAT, go to www.stopmedicarefraud.gov.

Miami-Area Resident Pleads Guilty to Participating in $63 Million Medicare Fraud Scheme
U.S. Department of Justice June 27, 2012

Office of Public Affairs (202) 514-2007/TDD (202) 514-1888

WASHINGTON—A Miami-area resident pleaded guilty today in U.S. District Court in Miami for her role in a health care fraud scheme that resulted in the submission of more than $63 million in fraudulent claims to Medicare and Medicaid, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Sarah Da Silva Keller, 27, pleaded guilty before U.S. District Judge Marcia G. Cooke in Miami to one count of conspiracy to commit health care fraud. Keller admitted to participating in a fraud scheme that was orchestrated by the owner and operators of Health Care Solutions Network (HCSN), which operated purported partial hospitalization programs (PHPs), a form of intensive mental health treatment for severe mental illness.

According to an indictment unsealed on May 2, 2012, HCSN paid kickbacks to owners and operators of assisted living facilities in exchange for referring Medicare beneficiaries to HCSN for PHP treatment that was unnecessary and, in many instances, not provided. According to court documents, Keller admitted that she falsified records at the direction of others so that HCSN could bill Medicare for patients who did not receive the services from HCSN. Keller knew that the falsification of these records was part of a plan for HCSN to commit health care fraud.

At sentencing, scheduled for Oct. 17, 2012, Keller faces a maximum of 10 years in prison and a $250,000 fine for each count.

Nine other charged defendants, including the owner and operators of HCSN, await trial before U.S. District Judge Cecilia M. Altonaga. Defendants are presumed innocent until proven guilty at trial.

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; Xanthi C. Mangum, Acting 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, William Parente and Allan Medina of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG and Medicaid Fraud Control Unit 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 their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Citadel Malware Delivers Reveton Ransomware in Attempts to Extort Money

05/30/12—The IC3 has been made aware of a new Citadel malware platform used to deliver ransomware, named Reveton. The ransomware lures the victim to a drive-by download website, at which time the ransomware is installed on the user’s computer. Once installed, the computer freezes and a screen is displayed warning the user they have violated United States federal law. The message further declares the user’s IP address was identified by the Computer Crime & Intellectual Property Section as visiting child pornography and other illegal content.

To unlock the computer, the user is instructed to pay a $100 fine to the U.S. Department of Justice using prepaid money card services. The geographic location of the user’s IP address determines what payment services are offered. In addition to the ransomware, the Citadel malware continues to operate on the compromised computer and can be used to commit online banking and credit card fraud.

This is an attempt to extort money with the additional possibility of the victim’s computer being used to participate in online bank fraud. If you have received this or something similar, do not follow payment instructions.

It is suggested that you:

Contact your banking institutions.
File a complaint at www.IC3.gov.

U.S. Department of Justice February 14, 2012

Office of Public Affairs (202) 514-2007/TDD (202)514-1888

WASHINGTON—Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in fiscal year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.

These findings, released today in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste, and abuse a top priority in his administration. The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.

“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder. “We can all be proud of what’s been achieved in the last fiscal year by the department’s prosecutors, analysts and investigators—and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”

“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said Secretary Sebelius. “Our efforts strengthen the integrity of our health care programs, and meet the President’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”

Approximately $4.1 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 2011. This is an unprecedented achievement for HCFAC, a joint effort of the two departments to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.

The recently enacted Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities. The administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts, and greater oversight of private insurance abuses.

Since 2009, the Departments of Justice and HHS have enhanced their coordination through HEAT and have increased the number of Medicare Fraud Strike Force teams. During FY 2011, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. The departments hosted a series of regional fraud prevention summits around the country, provided free compliance training for providers and other stakeholders and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud.

In FY 2011, the total number of cities with strike force prosecution teams was increased to nine, all of which have teams of investigators and prosecutors from the Justice Department, the FBI and the HHS Office of Inspector General, dedicated to fighting fraud. 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 along with chronic fraud by criminals masquerading as health care providers or suppliers. In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.

Including strike force matters, federal prosecutors filed criminal charges against a total of 1,430 defendants for health care fraud related crimes. This is the highest number of health care fraud defendants charged in a single year in the department’s history. Including strike force matters, a total of 743 defendants were convicted for health care fraud-related crimes during the year.

In criminal matters involving the pharmaceutical and device manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution and disgorgement under the Food, Drug and Cosmetic Act. These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity or quality required by the FDA.

The departments also continued their successes in civil health care fraud enforcement during FY 2011. Approximately $2.4 billion was recovered through civil health care fraud cases brought 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 FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. This marked the second year in a row that more than $2 billion has been recovered in FCA health care matters and, since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal health care dollars.

The fraud prevention and enforcement report announced today coincides with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face a deadline for returning taxpayers’ money. Thanks to the Affordable Care Act, there will be a specific timeframe by which self-identified overpayments must be returned. The Obama Administration has made prevention and recollection of overpayments a government-wide priority. These announcements today are just the latest in a series of steps that the administration is taking to protect taxpayer dollars and keep money in the pockets of Americans.

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