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August 25, 2015

A federal jury in Miami convicted Roger Rousseau, former medical director of Health Care Solutions Network Inc. (HCSN), and three HCSN therapists for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.  HCSN is a now-defunct partial hospitalization program that purported to provide intensive treatment for mental illness.  According to the evidence presented at trial, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided and paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

August 19, 2015

Yaroslav (Steven) Proshak, former owner of Southern California ambulance company ProMed Medical Transportation, was convicted of health care fraud charges in connection with a Medicare fraud scheme of at least $2.4 million.  According to the evidence, Proshak and two of his managers conspired to bill Medicare for ambulance transportation services for individuals whom the defendants knew did not need such services.  They also instructed EMTs who worked at ProMed to conceal the true medical conditions of patients they were transporting by altering requisite paperwork and creating fraudulent documents to justify the transportation services.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

August 19, 2015

Arizona physician Dr. Bashir Azher agreed to pay $207,988 to resolve allegations he violated the False Claims Act by submitting false bills to Medicare for prostate laser ablation procedures, commonly known as Green Light prostatectomies.  Specifically, the government charged Dr. Azher with submitting false claims for reimbursement for prostate laser ablation procedures that were too short to generate a therapeutic benefit, failed to meet professionally recognized standards of care, were medically unnecessary, and/or violated applicable Medicare regulations.  The government’s allegations originated in a whistleblower lawsuit filed by Dr. Arnaldo Trabucco under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare.  Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic.  Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided.  DOJ

Tagged in: Anti-Kickback and Stark, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

August 14, 2015

Oklahoma-based East Central Family Health Center agreed to pay $825,000 to settle charges it violated the False Claims Act by submitting false Medicaid claims.  Specifically, the government charged East Central, which is a designated federally qualified health center (FQHC), with submitting claims to the Oklahoma Medicaid Program for reimbursement for patients of non-FQHC health care providers and who were not East Central patients.  DOJ

Tagged in: FCA Federal, Medicaid, Medical Billing Fraud, Provider Fraud,

August 14, 2015

Connecticut doctor Okon Umana was sentenced to two years in prison, to pay $6,429,330 in restitution and to forfeit $6,550,036 for his role in a $13 million health care fraud scheme.  From 2009 to 2012, as the medical director of Cropsey Medical Care, Umana admitted submitting more than $13 million in claims to Medicare and Medicaid for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests.  DOJ

Tagged in: Healthcare Fraud, Provider Fraud,

August 13, 2015

Two Southwest Missouri health care providers agreed to pay $5.5 million to settle allegations they violated the False Claims Act by engaging in improper financial relationships with referring physicians.  The two providers are Mercy Health Springfield Communities (formerly known as St. John’s Health System Inc.) and its affiliate, Mercy Clinic Springfield Communities (formerly known as St. John’s Clinic).  Specifically, the government charged the hospitals with submitting false claims to Medicare for services rendered to patients referred by physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic.  The allegations first arose in a whistleblower lawsuit filed by Dr. Jean Moore, a physician who is employed by one of the defendants, under the qui tam provisions of the False Claims Act.  Dr. Moore will receive a whistleblower award of $825,000.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

August 12, 2015

Oswego Hospital will pay $1,456,457.33 to resolve False Claims Act charges stemming from healthcare billing improprieties the hospital self disclosed to the federal government.  Dr. Vilas Patil, a physician formerly working as an independent contractor with Oswego, paid $204,365.97 to resolve False Claims Act liability in connection with a related investigation.  Specifically, Oswego identified claims that were paid by federal and state payors where the supporting medical record documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud,

August 7, 2015

Tamara Esponda, owner of Miami-based Biomax Pharmacy, pleaded guilty to submitting almost $1.6 million in fraudulent claims to Medicare.  Specifically, Esponda admitted that Biomax Pharmacy submitted fraudulent claims to Medicare for prescription drugs not prescribed by physicians, not medically necessary, not purchased by Biomax Pharmacy and not provided to Medicare beneficiaries.  DOJ

Tagged in: Healthcare Fraud, Medicare, Pharma Fraud,

August 3, 2015

Rouzbeh Javaherian, owner of Los Angeles-based Westaid Pharmacy and Medical Supply, was sentenced to 18 months in prison and to pay $644,060 in restitution for his role in a fraud scheme involving the Medicare Part D prescription drug program.  Specifically, Javaherian paid illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid.  Javaherian then filled some of those prescriptions, but also submitted false claims to Medicare Part D plan sponsors for prescriptions that he did not actually fill.  DOJ

Tagged in: Drug and DME Pricing, Medical Billing Fraud, Part D, Pharma Fraud,

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