Posts Tagged ‘FBI’
DOJ Press Release: Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion
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/.
Medicare Fraud of $5.5 Million in False Claims billed for Unlicensed Massage Therapists billing as Physical Therapy FBI Press release
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.
Arrests made in Unapproved Stem Cell Treatments
FBI Press Release
This is not only scary but potential lethal. Having an incurable disease, seeing these people with great hope, more health care spend…what a dishonor.
Federal Indictments Lead to Arrests in Stem Cell Case
U.S. Attorney’s Office December 28, 2011
Southern District of Texas (713) 567-9000
Three men have been arrested for their participation in a scheme to manufacture, distribute and sell to the public stem cells and stem cell procedures that were not approved by the Food and Drug Administration (FDA), United States Attorney Kenneth Magidson announced today along with Assistant Attorney General Tony West of the Department of Justice’s Civil Division, Special Agent in Charge Patrick J. Holland of the FDA-Office of Criminal Investigations (OCI) and Special Agent in Charge Cory B. Nelson of the FBI.
Francisco Morales, 52, of Brownsville, Texas, was arrested by Customs and Border Protection agents pursuant to a arrest warrant late Dec. 22, 2011. He made his initial appearance the following morning at which time he was ordered held without bond. Alberto Ramon, 48, of Del Rio, Texas, and Vincent Dammai, 40, of Mount Pleasant, S.C., were arrested yesterday. Ramon was arrested as he was about to enter his clinic and has already made his initial appearance in Del Rio, while Dammai was arrested in Florence, S.C., and is expected to make his initial appearance in Charleston, S.C., this morning. Lawrence Stowe, 58, of Dallas, Texas, also charged in relation to this case, is considered a fugitive and a warrant remains outstanding for his arrest. The two indictments in this matter, returned Nov. 9 and 10, 2011, have been unsealed by order of the court.
“Protecting the public from unproven and potentially dangerous drug and medical procedures is very important,” said Magidson. “This office will continue to prosecute violations involving threats to the public health.”
“This investigation identified a scheme whereby the suffering and hopes of victims in extreme medical need were used and manipulated for personal profit,” said Nelson. “The predatory and opportunistic nature of the crimes alleged in this indictment mirrors images from science fiction.”
The defendants allegedly conspired to commit mail fraud and unlawfully distributed stem cells derived from umbilical cord blood. According to the indictment, Morales and the others manufactured, distributed and used stems cells produced from umbilical cord blood to perform procedures not approved by the FDA to treat persons suffering from cancer, amytrophic lateral sclerosis (ALS), multiple sclerosis (MS) and other autoimmune diseases. FDA approval is required before stem cells can be marketed to the public and used to treat incurable diseases and the FDA has not determined that stem cells are safe and effective in treating these diseases.
“This indictment demonstrates the commitment of the FDA to protect the American public from the harms inherent in being exposed to unapproved new drugs,” said Holland. “The FDA will continue to aggressively pursue perpetrators of such acts and ensure that they are punished to the full extent of the law.”
Beginning in March 2007 and continuing through 2010, the indictment alleges Morales falsely represented to the public that he was a physician licensed to practice medicine in the United States and provided medical advice to individuals regarding the benefits of stem cell treatments. Morales also allegedly falsely represented that he operated a medical clinic named Rio Valley Medical Clinic in Brownsville, Texas, in order to convince the public that he specialized in using stem cells to treat incurable diseases. After meeting patients in the United States, Morales would allegedly travel to Mexico to perform the stem cell procedures. The indictment further alleges that Stowe marketed, promoted and sold stem cells along with other drug and biological products for the treatment of cancer, ALS, MS and Parkinson’s Disease that had not been reviewed or approved by the FDA. Stowe operated several entities, including The Stowe Foundation and Stowe Biotherapy Inc., through which he allegedly marketed and sold these products.
The stem cells referenced in the indictment were created and manufactured from umbilical cord blood obtained from birth mothers who were patients of Ramon—a licensed midwife who operated The Maternity Care Clinic in Del Rio, Texas. Ramon allegedly sold the cord blood to a company called Global Laboratories located in Scottsdale, Ariz. After obtaining the cord blood from Ramon, the indictment alleges Global Laboratories would send the tissue to Dammai—a professor of pathology and laboratory medicine in Charleston, S.C. Dammai, without obtaining approval from FDA or University authorities, allegedly used university facilities to create stem cells that were later sold by Global Laboratories. As a result of this fraudulent scheme, the public was mislead into believing that stem cells and other drug and biological products sold by defendants had been approved by the FDA to treat cancer, ALS, MS and Parkinson’s Disease, The defendants allegedly received more than $1.5 million from patients suffering from incurable diseases.
The case is being prosecuted by Assistant United States Attorneys Samuel Louis and Cedric Joubert with the assistance of Carol Wallack with the Consumer Protection Branch in the Department of Justice’s Civil Division. The case was investigated by the FDA-OCI, FBI and Internal Revenue Service-Criminal Investigations.
An indictment is a formal accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.
Press Release: Department of Justice Disrupts International Cyber Crime Rings Distributing Scareware
U.S. Department of Justice June 22, 2011
Office of Public Affairs (202) 514-2007/TDD (202) 514-1888
WASHINGTON—Today the Department of Justice and the FBI, along with international law enforcement partners, announced the indictment of two individuals from Latvia and the seizure of more than 40 computers, servers and bank accounts as part of Operation Trident Tribunal, an ongoing, coordinated enforcement action targeting international cyber crime. The operation targeted international cyber crime rings that caused more than $74 million in total losses to more than one million computer users through the sale of fraudulent computer security software known as “scareware.”
Scareware is malicious software that poses as legitimate computer security software and purports to detect a variety of threats on the affected computer that do not actually exist. Users are then informed they must purchase what they are told is anti-virus software in order to repair their computers. The users are then barraged with aggressive and disruptive notifications until they supply their credit card number and pay for the worthless “anti-virus” product. The product is, in fact, fake.
Warrants obtained from the U.S. District Court for the Western District of Washington and elsewhere throughout the United States led to the seizure of 22 computers and servers in the United States that were involved in facilitating and operating a scareware scheme. In addition, 25 computers and servers located abroad were taken down as part of the operation, including equipment in the Netherlands, Latvia, Germany, France, Lithuania, Sweden and the United Kingdom.
The first of the international criminal groups disrupted by Operation Trident Tribunal infected hundreds of thousands of computers with scareware and sold more than $72 million of the fake antivirus product over a period of three years. The scareware scheme used a variety of ruses to trick consumers into infecting their computers with the malicious scareware products, including web pages featuring fake computer scans. Once the scareware was downloaded, victims were notified that their computers were infected with a range of malicious software, such as viruses and Trojans and badgered into purchasing the fake antivirus software to resolve the non-existent problem at a cost of up to $129. An estimated 960,000 users were victimized by this scareware scheme, leading to $72 million in actual losses. Latvian authorities also executed seizure warrants for at least five bank accounts that were alleged to have been used to funnel profits to the scam’s leadership.
A second international crime ring disrupted by Operation Trident Tribunal relied on online advertising to spread its scareware products, a tactic known as “malvertising.” An indictment unsealed today in U.S. District Court in Minneapolis charges the two operators of this scareware scheme with two counts of wire fraud, one count of conspiracy to commit wire fraud and computer fraud. The defendants, Peteris Sahurovs, 22, and Marina Maslobojeva, 23, were arrested yesterday in Rezekne, Latvia on the charges out of the District of Minnesota. According to the indictment, the defendants created a phony advertising agency and claimed that they represented a hotel chain that wanted to purchase online advertising space on the Minneapolis Star Tribune’s news website, startribune.com. The defendants provided an electronic version of the advertisement for the hotel chain to the Star Tribune, and technical staff at startribune.com tested the advertising and found it to operate normally.
According to court documents, after the advertisement began running on the website, the defendants changed the computer code in the ad so that the computers of visitors to the startribune.com were infected with a malicious software program that launched scareware on their systems. The scareware caused users’ computers to “freeze up” and then generate a series of pop-up warnings in an attempt to trick users into purchasing purported “antivirus” software, which was in fact fake. Users’ computers “unfroze” if the users paid the defendants for the fake antivirus software, but the malicious software remained hidden on their computers. Users who failed to purchase the fake antivirus software found that all information, data and files stored on the computer became inaccessible. The scam allegedly led to at least $2 million in losses. If convicted, the defendants face penalties of up to 20 years in prison and fines of up to $250,000 on the wire fraud and conspiracy charges, and up to 10 years in prison and fines of up to $250,000 on the computer fraud charge. The defendants also face restitution and forfeiture of their illegal profits. An indictment is merely a charge and defendants are presumed innocent until proven guilty.
“Today’s operation targets cybercrime rings that stole millions of dollars from unsuspecting computer users,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division. “These criminal enterprises infected the computers of innocent victims with malicious scareware, and then duped them into purchasing fake anti-virus software. Cyber crime is profitable, and can prey upon American consumers and companies from nearly any corner of the globe. We will continue to be aggressive and innovative in our approach to combating this international threat. At the same time, computer users must be vigilant in educating themselves about cyber security and taking the appropriate steps to prevent dangerous and costly intrusions.”
“This case shows that strong national and global partners can ensure there is no sanctuary for cyber-crooks,” said U.S. Attorney Jenny A. Durkan of the Western District of Washington. “We will continue to work with the public and the computer industry, to fortify our cyber defenses. A combination of safe on-line habits and smart technology will help reduce the threat posed by these organized criminal groups.”
“The global reach of the Internet makes every computer user in the world a potential victim of cyber crime,” said U.S. Attorney B. Todd Jones of the District of Minnesota. “Addressing cybercrime requires international cooperation; and in this case, the FBI, collaborating with our international law enforcement and prosecution partners, have worked tirelessly to disrupt two significant cybercriminal networks. Their efforts demonstrate that no matter the country, Internet criminals will be pursued, caught and prosecuted.”
Assistant Director Gordon M. Snow of the FBI’s Cyber Division said, “Scareware is just another tactic that cyber criminals are using to take money from citizens and businesses around the world. This operation targeted a sophisticated business enterprise that had the capacity to steal millions. Cyber threats are a global problem, and no single country working alone can be effective against these crimes. The FBI thanks the participating foreign law enforcement agencies for their ongoing partnership and commitment in disrupting this threat.”
Operation Trident Tribunal was conducted by the FBI’s Cyber Division, Seattle Field Office and Minneapolis Field Office; the Computer Crime and Intellectual Property Section and the Asset Forfeiture and Money Laundering Section of the Justice Department’s Criminal Division; the U.S. Attorney’s Office for the District of Minnesota; and the U.S. Attorney’s Office for the Western District of Washington. Operation Trident Tribunal was the result of significant international cooperation and substantial assistance from the Criminal Division’s Office of International Affairs. Multiple foreign law enforcement partners provided invaluable assistance in this operation, including the Cyprus National Police in cooperation with its Unit for Combating Money Laundering (MOKAS); German Federal Criminal Police (BKA); Latvian State Police; Security Service of Ukraine; Lithuanian Criminal Police Bureau; French Police Judiciare; the Netherlands’ National High-Tech Crime Unit; the Cyber Unit of the Swedish National Police; London Metropolitan Police; Romania’s Directorate for Combating Organized Crime; and the Royal Canadian Mounted Police.
To avoid falling victim to a scareware scheme, computer users should avoid purchasing computer security products that use unsolicited “free computer scans” to sell their products. It is also important for users to protect their computers by maintaining an updated operating system and using legitimate, up-to-date antivirus software, which can detect and remove fraudulent scareware products.
Additional tips on how to spot a scareware scam include:
Scareware advertising is difficult to dismiss. Scareware purveyors employ aggressive techniques and badger users with pop-up messages into purchasing their products. These fake alerts are often difficult to close and quickly reappear.
Fake anti-virus products are designed to appear legitimate, and can use names such as Virus Shield, Antivirus or VirusRemover. Only install software from trusted sources that you seek out. Internet service providers often make name-brand anti-virus products available to their customers for free.
Become familiar with the brand, look and functionality of the legitimate anti-virus software that is installed on your computer. This will assist you in identifying scareware.
Computer users who think they have been victimized by scareware should file a complaint with the FBI’s Internet Crime Complaint Center, www.ic3.gov.
FBI Offers 10 Tips on Avoiding Fraudulent Charitable Contribution Schemes
FBI National Press Office (202) 324-3691
In response to the recent tornadoes that affected several Southern states and caused loss of life and flooding that has damaged property, the Federal Bureau of Investigation and National Center for Disaster Fraud remind the public to be aware of and report any instances of alleged fraudulent activity related to relief operations and funding for victims. Unfortunately, criminals can exploit these tragedies for their own gain by sending fraudulent e-mails and creating phony websites designed to solicit contributions. The FBI has already received complaints alleging fraudulent schemes.
Tips should be reported to the National Center for Disaster Fraud, (866) 720-5721. The line is staffed 24 hours a day, seven days a week. Additionally, e-mails can be sent to disaster@leo.gov, and information can be faxed to (225) 334-4707.
The National Center for Disaster Fraud was created by the Department of Justice to investigate, prosecute, and deter fraud in the wake of Hurricane Katrina, when billions of dollars in federal disaster relief poured into the Gulf Coast region. Its mission has expanded to include suspected fraud from any natural or manmade disaster. More than 20 federal agencies, including the FBI, participate in the National Center for Disaster Fraud, which allows the center to act as a centralized clearinghouse of information related to disaster relief fraud.
The FBI reminds the public to perform due diligence before giving contributions to anyone soliciting donations or individuals offering to provide assistance to those affected by the tornadoes. Solicitations can originate from e-mails, websites, door-to-door collections, flyers, mailings, telephone calls, and other similar methods.
Before making a donation of any kind, consumers should adhere to certain guidelines, including:
*Do not respond to any unsolicited (spam) incoming e-mails, including clicking links contained within those messages, because they may contain computer viruses.
*Be skeptical of individuals representing themselves as members of charitable organizations or officials asking for donations via e-mail or social networking sites.
*Beware of organizations with copy-cat names similar to but not exactly the same as those of reputable charities.
*Rather than follow a purported link to a website, verify the legitimacy of nonprofit organizations by utilizing various Internet-based resources that may assist in confirming the group’s existence and its nonprofit status.
*Be cautious of e-mails that claim to show pictures of the disaster areas in attached files because the files may contain viruses. Only open attachments from known senders.
*To ensure contributions are received and used for intended purposes, make contributions directly to known organizations rather than relying on others to make the donation on your behalf.
*Do not be pressured into making contributions; reputable charities do not use such tactics.
*Be aware of whom you are dealing with when providing your personal and financial information. Providing such information may compromise your identity and make you vulnerable to identity theft.
*Avoid cash donations if possible. Pay by credit card or write a check directly to the charity. Do not make checks payable to individuals.
*Legitimate charities do not normally solicit donations via money transfer services. Most legitimate charities’ websites end in .org rather than .com.
Consumers can also report suspicious e-mail solicitations or fraudulent websites to the FBI’s Internet Crime Complaint Center, www.ic3.gov
Identity Theft of the Dead
I tell you the dead are not safe from Identity theft. Read the following FBI press release.
Doctor Pleads Guilty to Billing Medicare and Medicaid for Counseling Sessions with Dead Patients
Dr. Williams Claimed $2 Million in Phony Health Treatments, Saying It Was Group Therapy
U.S. Attorney’s Office June 06, 2011
Northern District of Georgia (404) 581-6000
ATLANTA—ROBERT WILLIAMS, 72, of Atlanta, Georgia, pleaded guilty today in federal district court on two counts of health care fraud as part of a scheme to bill for group psychological therapy that WILLIAMS never provided.
United States Attorney Sally Quillian Yates said, “With so many elderly citizens and others who need specialized psychological care, this defendant ignored his duty as a doctor and became a billing machine who claimed to treat patients who were in fact dead. This blatant attempt to rip off the system took funds and care away from real live patients with real problems. Medicare and Medicaid need all the money they can get for legitimate patient care and this physician will get none of that money.”
“This case sends a strong message that Medicare and Medicaid fraud will not be tolerated in Georgia,” said Georgia Attorney General Sam Olens. “At a time when our state budget is heavily strained, every dollar intended for the needy must reach the recipient. We will continue to work with our partners, the U.S. Attorney’s Office, and the FBI, to weed out fraud in Georgia.”
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “Dr. Williams had for years, enjoyed a position of trust within the medical and health provider industry. He chose to abandon that trust and instead displayed a level of greed that will not be tolerated. Medicare fraud should be promptly reported to the nearest FBI field office so that the much needed federal health care benefits will be there for those individuals who truly need them.”
According to United States Attorney Yates, the charges, and other information presented in court: WILLIAMS was a licensed physician, practicing in the Atlanta area. From approximately July 2007 through October 2009, he contracted with a medical services company to provide group psychological therapy to nursing home patients in a variety of nursing homes. Under his signature, thousands of claims were submitted to Medicare and Georgia Medicaid seeking reimbursement for group psychological therapy that WILLIAMS purportedly provided to beneficiaries at several nursing homes in the Atlanta area. In many instances, however, WILLIAMS did not actually provide the therapy.
Specifically, from July 2007 through October 2009, Medicare claims data indicated that over 55,000 claims were submitted using WILLIAMS’ provider number for group psychological therapy. Those claims sought reimbursement for over $2,000,000, and ultimately caused Medicare to reimburse WILLIAMS over $750,000. For the same time period, over 40,000 Medicaid claims were submitted by WILLIAMS for group psychological therapy, causing Georgia Medicaid to pay out over $225,000.
An investigation of WILLIAMS’ claims showed that, in many cases, he sought payment for services provided to beneficiaries who were deceased at the time he purportedly rendered the care. In two cases, the patient died over a year before he was allegedly seen by WILLIAMS in the nursing home. Numerous claims were submitted to Medicare and Medicaid for group psychological therapy when the beneficiary was hospitalized at the time of service and, consequently, could not have received care at the nursing home as represented.
WILLIAMS was indicted on February 22, 2011 on 10 counts of health care fraud. Today WILLIAMS pleaded guilty to two of those counts. He could receive a maximum sentence of 10 years in prison and a fine of up to $250,000 for each count. 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.
Sentencing has been scheduled for August 23, 2011, at 11:30 a.m. before United States District Judge Richard W. Story.
This case is being investigated by special agents of the Federal Bureau of Investigation and the Georgia Medicaid Fraud Control Unit.
Assistant United States Attorneys Kurt R. Erskine and Nick Oldham, and Senior Assistant Attorney General Nancy Alstrom from the Georgia Medicaid Fraud Control Unit, are 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.
Medicare Fraud and Identity Theft – walking hand in hand DOJ Press Release
Department of Justice Press Release
For Immediate Release
March 29, 2011 U.S. Department of Justice
Office of Public Affairs
(202) 514-2007/TDD (202) 514-1888
Los Angeles Woman Pleads Guilty to Participating in a Medicare Fraud Scheme Using Fraudulent Medical Clinics and Stolen Doctor Identities to Defraud Medicare of More Than $6.2 Million
WASHINGTON—A Los Angeles woman has pleaded guilty to using fraudulent medical clinics and the stolen identities of physicians to defraud Medicare of more than $6.2 million, the Departments of Justice and Health and Human Services (HHS) announced.
Carolyn Ann Vasquez, 46, pleaded guilty yesterday before U.S. District Judge Terry J. Hatter Jr. in the Central District of California. Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. According to court documents, physician assistants recruited to work at the clinics by Vasquez and working at her direction performed these services and prescribed and ordered the wheelchairs, medical equipment, and diagnostic tests.
According to court documents, Vasquez told the physicians she recruited that they would be the medical directors of the clinics, but that if they did not want to work full time, the clinics would hire physician assistants. Vasquez assisted the physicians in obtaining Medicare provider numbers and entering into management agreements that gave Vasquez’s co-conspirators authority to operate and manage the clinics in exchange for 75 percent of the reimbursement payments the physicians received from Medicare.
According to court documents, Vasquez’s involvement in the recruitment of the physicians gave her access to their personal and Medicare information, which Vasquez stole to further the fraud scheme at the medical clinics. Vasquez admitted that in approximately 2007, a physician contacted her about a job at one of the fraudulent medical clinics, but the physician decided not to accept the job. Nevertheless, Vasquez’s co-conspirators printed prescription pads with the physician’s name and Medicare provider number on them. Vasquez admitted that she instructed a physician assistant working at one of the fraudulent medical clinics to use the prescription pads to write fraudulent prescriptions and medical documentation for diagnostic tests, power wheelchairs and other medical equipment in the physician’s name even through Vasquez knew that the physician did not work at the clinic. Vasquez admitted that as a result of her conduct, Medicare was defrauded of approximately $6,268,899.
At sentencing, scheduled for July 11, 2011, Vasquez faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in court documents in this case, Vasquez pleaded guilty in 1993 to participating in a health care fraud scheme. According to court documents, Vasquez and others used telemarketing or “boiler room” schemes to defraud government-funded health care benefit programs of approximately $41 million.
The guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney André Birotte Jr. for the Central District of California; Tony Sidley, Assistant Chief of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse; Glenn R. Ferry, Special Agent-in-Charge for the Los Angeles Region of the HHS Office of Inspector General (HHS-OIG); and Steven Martinez, Assistant Director in Charge of the FBI’s Los Angeles Field Office.
The case is being prosecuted by Trial Attorney Jonathan T. Baum of the Criminal Division’s Fraud Section. Former Special Trial Attorney Joseph Hudzik participated in the prosecution. The case is being investigated by the FBI.
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 Central District of California. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & 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 districts have charged 1,000 defendants who collectively have falsely billed the Medicare program for more than $2.3 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.
To learn more about HEAT, go to: www.stopmedicarefraud.gov.
Press Releases | Los Angeles Home
Texas Pain Management Physician Sentenced for Fraud – FBI Press Release
Department of Justice Press Release
For Immediate Release
February 1, 2011 United States Attorney’s Office
Southern District of Texas
Contact: (713) 567-9000
Dr. Arun Sharma Sentenced to Prison and Ordered to Forfeit More Than $43 Million in Cash/Property Gained Through Fraud
HOUSTON—Dr. Arun Sharma, 56, of Kemah, Texas, has been sentenced to 15 years for engaging in a conspiracy with his wife, Dr. Kiran Sharma, to commit health care fraud and committing health care fraud over a 10-year-period in the Southern District of Texas, United States Attorney José Angel Moreno announced today.
United States District Judge David Hittner handed down the prison sentence today and further ordered Sharma to forfeit more than $43 million, including their $700,000 home in Kemah, Texas, numerous parcels of real property, more than $700,000 in cash found during a search of their Kemah home, more than $800,000 in cash found in two safe deposit boxes and a number of investment accounts funded with the proceeds of their fraudulent scheme. At the conclusion of the sentencing, Sharma was remanded back into the custody of the U.S. Marshals Service.
Arun Sharma (Dr. A) pleaded guilty to one count of conspiracy and one count of health care fraud before United States District Judge David Hittner on April 26, 2010. During his plea, Dr. A admitted that from Jan. 1, 1998, through June 10, 2009, he and Kiran Sharma (Dr. K) fraudulently billed Medicare, Medicaid and various private health care providers for medical procedures that were not performed.
During the time period of the conspiracy, the defendants owned and operated multiple medical clinics operating under the name Allergy, Asthma, Arthritis Pain Center, with two principle locations in Baytown and Webster, Texas. While some of patients at the clinics were referred by other medical doctors, approximately 50 percent of the patients came to the clinics through word of mouth. Dr. A Sharma was known as an easy touch for prescribing the “pain cocktail” of hydrocodone, Xanax and Soma. As time went on, Dr. A began prescribing stronger narcotics such as Oxycontin, morphine, methadone, and fentanyl patches.
In addition to the prescription of narcotics, a large part of the practice conducted at the clinics was to provide patients with injections of lidocaine combined with steroids which at times provided temporary relief of various joint and muscle pain. Although the injections given to the patients were superficial, they were billed falsely to the insurance companies as facet joint injections, paravertebral injections, sacroiliac nerve injections, sciatic nerve injections, and various nerve block injections.
The pain management practice at the clinics grew quickly during the time period of the conspiracy. Dr. A and Dr. K went from seeing an average of 50-60 patients per day in 1998 to more than 100 per day beginning in 2003 with a high of 279 on Jan. 6, 2005. From 1998 through 2002, Dr. K saw pain patients at the clinics in addition to her own allergy patients. Dr. K, who maintained a modest allergy practice, would sign patient procedure forms and superbills, falsely indicating that she had administered facet joint injections or other paravertebral injections when in reality she did not. She also prescribed the pain cocktail when she saw pain management patients.
Nearly every patient was prescribed one or more controlled substances and put on a regimen of shots every two weeks. The patients were required to sign the medical progress and procedure notes in their patient chart to prove they were at the clinic and received the shots. Dr. A tried to convince all patients to have shots at every visit, but many of the patients did not want the shots every two weeks. For those patients who ultimately refused the shots, Dr. A regularly required the patients to sign the progress and procedure notes even though they received only a prescription for controlled substances and did not receive any injections. By the beginning of 2000, Dr. A was having certain patients sign blank procedure/progress notes and then using those forms to generate a superbill in order to bill the insurance companies for injection procedures on days when the patient was not in the clinic.
Dr. K hired several foreign medical graduates (FMGs) over the course of the conspiracy to assist in the movement of patients through the clinics. Several of the FMGs helped add fictitious patient examination information to the blank progress/procedure notes after Dr. A had added non-existent medical procedures to the blank forms so that insurance companies could be billed as if the person had been in the clinic when in reality they had not. Dr. K witnessed the FMGs creating the fictitious patient progress/procedure notes and knew that their ultimate purpose was to bill the insurance companies for procedures that never occurred.
Demonstrative of the implausibility of the volume of patients who allegedly received injections is the fact that the defendants’ own records purport to show that more than 100 patients purportedly received injections on 708 different days during the conspiracy. Further, the defendants’ billings showed that as many as 279 patients allegedly received injections on Jan. 6, 2005.
Dr. Kiran Sharma, who also has been convicted of conspiracy and health care fraud after pleading guilty in April 2010, is scheduled to be sentenced on Feb. 23, 2011. She remains in custody at the Federal Detention Center in Houston pending sentencing.
The criminal charges are the result of a joint investigation conducted by agents of the FBI, the United States Department of Health and Human Services-Office of Inspector General, the Medicaid Fraud Control Unit of the Texas Attorney General’s Office, the Office of Personnel Management-Office of Inspector General, the Railroad Retirement Board-Office of Inspector General, the Drug Enforcement Administration and the National Insurance Crime Bureau. The case is being prosecuted by Assistant United States Attorneys Al Balboni and Jason Varnado.
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DOJ Press Release: Identity Theft Ring ran from Federal Prison in Ohio
Department of Justice Press Release
For Immediate Release
January 18, 2011 United States Attorney’s Office
Northern District of Ohio
Contact: (216) 622-3600
Inmate Who Ran a Quarter-Million-Dollar Identity Theft Ring from Inside Federal Prison Receives an Additional 14.5 Years in Prison
The man who led an identity-theft ring that ran up a quarter-million dollars worth of charges from inside a federal prison was sentenced to more than 14 years in prison, Steven M. Dettelbach, United States Attorney for the Northern District of Ohio, announced today.
“The defendant thought he found a way to occupy his time in prison,” Dettelbach said. “With this prosecution and this sentence, he’ll have lots more time to learn to follow the rules.”
Dimorio McDowell, age 34, of Atlanta, Georgia, previously pled guilty to aggravated identity theft and conspiracy to commit wire fraud and bank fraud. McDowell was an inmate at Fort Dix Federal Correctional Institution at the time of the scheme, which took place between August 2009 and April 2010. U.S. District Judge Donald Nugent ordered McDowell’s 174-month sentence on this case begin in 2014, when he completes the current sentence that resulted in his incarceration at Fort Dix.
McDowell was the ringleader who obtained personal information on people who had credit card accounts at various retailers, including Best Buy, Home Depot, J.C. Penney, Lowe’s, Macy’s, Nordstrom’s, Saks Fifth Avenue, Sears and Staples, according to court documents.
McDowell contacted the retailers and impersonated the true account holders, store employees, or corporate fraud investigators. He used information about the account holders, such as name, address, or Social Security number during those calls to obtain additional information about them and adding co-conspirators names as authorized users of the accounts, thus taking over the accounts, according to court documents.
After taking over the accounts, adding additional users to the accounts and opening new accounts, McDowell communicated with his co-conspirators, all of whom lived in the Cleveland area.
McDowell continued to run his scheme from prison even after he was charged and after he pled guilty. He also posed as a deputy U.S. Marshal over the telephone and attempted to have prisoners moved, according to information presented during the sentencing hearing.
Overall, the ring purchased more than $254,000 worth of merchandise as part of their scheme, according to court documents.
Also charged in the case are: Andre Reese, 37; Jeffery McClain, 39; Kevin McBride, 34; Michael Sailes, 51; Edwin Peavy, 52; Daniel Ashford, 37; James L. Wiggins, 47, and Jay Williams, 27, all of Cleveland, Ohio. All have entered guilty plea to charges against them.
This prosecution is the result of cooperation from a number of law enforcement agencies who identified the defendants, gathered the evidence and prepared the case for prosecution. The investigative team included the Federal Bureau of Investigation’s Cleveland Division and Trenton Resident Agency, the U.S. Bureau of Prisons, the Postal Inspection Service, Bath Township Police Department, Stow Police Department, Mentor Police Department and other state and local law enforcement agencies. The case was prosecuted by Assistant U.S. Attorney Matthew B. Kall.
“This case is a stark reminder about the need to protect yourself from identity theft and fraud,” Dettelbach said. “I want to thank the FBI, the Bureau of Prisons and all our partners who made prosecuting this case possible.”
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FBI PRESS RELEASE. Jan 20.11. Medicare Fraud Scheme ~ Houston Home Health Agency $5.2 million
Department of Justice Press Release
For Immediate Release
January 20, 2011 U.S. Department of Justice
Office of Public Affairs
(202) 514-2007/TDD (202) 514-1888
Two Owners of Houston Health Care Company Plead Guilty to Alleged $5.2 Million Medicare Fraud Scheme
WASHINGTON—Two owners of a Houston health care company pled guilty today in connection with an alleged $5.2 million Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Clifford Ubani, 52, and Princewill Njoku, 51, each pled guilty before U.S. District Court Judge Nancy Atlas in Houston to one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks and 16 counts of payment of kickbacks to Medicare beneficiary recruiters.
According to court documents, Ubani and Njoku were owners and operators of Family Healthcare Group (Family Group), a home health care company. Family Group purported to provide skilled nursing to Medicare beneficiaries. According to court documents, Ubani and Njoku hired co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. Ubani and Njoku admitted that they paid kickbacks to the recruiters for their referrals.
Ubani and Njoku previously pled guilty to conspiracy to commit health care fraud related to their ownership of another Houston health care company, Family Healthcare Services (Family Services). Family Services submitted approximately $1.1 million in fraudulent claims to Medicare for the costs of durable medical equipment.
At sentencing, scheduled for July 19, 2011, Ubani and Njoku each face a maximum sentence of 10 years in prison for each health care fraud conspiracy count, five years in prison for each kickback conspiracy count and five years in prison for each kickback count.
Today’s guilty pleas were announced by Assistant Attorney General of the Criminal Division Lanny A. Breuer; U.S. Attorney José Angel Moreno of the Southern District of Texas; Special Agent-in-Charge Richard C. Powers of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations; and Texas Attorney General Greg Abbott.
This case is being prosecuted by Trial Attorneys Charles D. Reed and Laura Cordova, and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 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
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