January 5, 2016

Top-10 Prison Sentences For Medicare Fraud In 2015

By the C|C Whistleblower Lawyer Team

Here is our look-back at the top-10 prison sentences for Medicare fraud in 2015.

10.  SYLVIA WALTER-EZE — The former owner of medical equipment supply company Ezcor Medical Supply was sentenced to 97 months (and to pay roughly $2 million in restitution) for billing more than $3.5 million to Medicare and Medi-Cal for products not medically necessary and paying illegal kickbacks to patient recruiters in exchange for patient referrals. Click here for more.

9.  RAMON REGUEIRA — The owner and operator of Miami home health care agency Nation’s Best Care Home Health Corp. was sentenced to 106 months (and to pay $21 million) for his participation in a $30 million Medicare fraud scheme involving expensive physical therapy and home health care services that were not medically necessary or not provided, and paying kickbacks and bribes to patient recruiters who provided patients to Nation’s Best, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services. Click here for more.

8.  YAROSLAV PROSHAK — The former owner of Southern California ambulance company ProMed Medical Transportation was sentenced to 108 months for billing Medicare for $1.5 million worth of ambulance transportation services for individuals that did not need the services. Click here for more.

7.  FELIX GONZALEZ — The owner of Miami home health care company AA Advanced Care Inc. was sentenced to 113 months (and to pay $21.4 million in restitution) for billing Medicare for $32 million worth of expensive physical therapy and home health care services that were not medically necessary or provided at all and for providing kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care and certifications for medically unnecessary therapy and home health services. Click here for more.

6.  ERNESTO FERNANDEZ — The owner and operator of Miami-based home health care agency Professional Medical Home Health and two other South Florida home health agencies was sentenced to 10 years in prison for his role in a long-running $6.2 million Medicare fraud scheme involving kickbacks and bribes for expensive physical therapy and home health services that were not medically necessary or actually provided. Several other owners, managers and supervisors of Professional Medical were also sentenced to prison for their role in the scheme, including Dennis Hernandez who was also sentenced to 10 years.  Click here and here for more.

5.  ALEXANDER LARA — The owner of Miami home health care company Longcare Home Health Corporation was sentenced to 10 years (and to pay $13.8 million in restitution and forfeit $13.8 million) for his leading role in a $13 million Medicare fraud scheme that involved paying kickbacks and bribes to patient recruiters, Medicare beneficiaries and others in South Florida doctors’ offices and medical clinics, and for billing Medicare for expensive physical therapy and home health care services that were not medically necessary or not provided at all. Click here for more.

4.  ROGER ROUSSEAU — The former medical director of defunct health provider Health Care Solutions Network was sentenced to 16 years for his role in a scheme to bill Medicare and Medicaid for roughly $63 million worth of intensive mental health services that were not medically necessary or never even provided. HCSN also paid kickbacks to assisted living facility owners and operators who in exchange referred beneficiaries to HCSN.  Also sentenced as part of the scheme were therapists Liliana Marks (72 months), Doris Crabtree (60 months) and Angela Salafia (60 months).  Click here for more.

3.  HAROLD PERSAUD — The Ohio cardiologist, with hospital privileges at Fairview Hospital, St. John’s Medical Center and Southwest General Hospital, was sentenced to 20 years for performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $29 million. Click here for more.

2.  EARNEST GIBSON — Earnest Gibson III, the former president of Houston’s Riverside General Hospital, was sentenced to 45 years (and to forfeit $46.8 million) for his role in a Medicare fraud scheme involving billing Medicare more than $158 million for partial hospitalization program (PHP) services that were not medically necessary or never provided, and paying kickbacks to patient recruiters and to owners and operators of group care homes in exchange for which those individuals delivered ineligible Medicare beneficiaries to the hospital’s PHPs. Also sentenced as part of the scheme were Mohammad Khan, the former assistant administrator of the hospital (40 years), Earnest Gibson IV, the operator of Devotions Care Solutions, a Riverside satellite psychiatric facility (20 years), and Regina Askew, the owner of Safe and Sound group home (12 years).  Click here and here for more.

1.  FARID FATA — The Detroit area doctor was sentenced to 45 years (and to forfeit $17.6 million) for his role in a health care fraud scheme that included administering medically unnecessary infusions or injections to 553 individual patients and submitting to Medicare and private insurance companies approximately $34 million in fraudulent claims. Click here for more.

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