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.

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.

Oaks Diagnostics of Beverly Hills, California, has paid the federal government $647,000 to settle allegations that it filed false claims with Medicare for unnecessary radiological tests, reported the U.S. Attorney’s Office Central District of California. They have settled without admitting any wrong doing. See article at HealthImaging.com:
http://www.healthimaging.com/index.php?option=com_articles&view=article&id=23030:california-rad-provider-settles-whistleblower-case-for-647k