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Page 137 of 158

March 18, 2015

Paige Okpalobi, the owner and operator of a New Orleans-based medical clinic and her accountant Christopher White pleaded guilty for their roles in a $50 million Medicare fraud scheme, which involved fraudulently billing Medicare for home health care services not needed or provided.  DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

March 16, 2015

Los Angeles pharmacist Rouzbeh Javaherian pleaded guilty to defrauding the Medicare Part D program through his pharmacy called Emoonah Inc. (d/b/a Westaid Pharmacy and Medical Supply).  Specifically, he paid illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid and he submitted fraudulent claims to Medicare Part D plan sponsors for prescriptions he did not actually fill.  DOJ

Tagged in: Part D, Pharma Fraud,

March 13, 2015

Mohammed Sadiq, the owner of two Detroit home health care companies, pleaded guilty to his role in a scheme to fraudulently bill Medicare for $12.6 million in home health services that were not provided or were obtained through illegal kickbacks.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

March 12, 2015

Huey P. Williams Jr., owner of Texas-based Hermann Medical Supply, was convicted for his role in a $3.4 million Medicare fraud scheme.  According to the evidence submitted at trial, Williams submitted claims to Medicare for durable medical equipment, including orthotic devices, which were medically unnecessary or never provided to the patients.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME,

March 10, 2015

Johnson & Johnson subsidiary McNeil-PPC Inc. pleaded guilty to selling adulterated infants’ and children’s over-the-counter liquid medicines, including Infants’ and Children’s Tylenol Motrin.  As part of the criminal resolution, McNeil agreed to pay a criminal fine of $20 million and forfeit $5 million.  DOJ

Tagged in: CGMP Violation, Pharma Fraud,

March 9, 2015

Florida home health care companies Recovery Home Care Inc., Recovery Home Care Services Inc. and National Home Care Holdings LLC have agreed to pay $1.1 million to resolve allegations that Recovery Home Care violated the False Claims Act by improperly paying doctors for referrals of home health care services provided to Medicare patients.  According to the government, the physicians were over-compensated for any actual work they performed and, in reality, they were paid to induce them to refer their patients to Recovery Home Care in violation of the Anti-Kickback Statute and the Stark Law.  The allegations originated in a whistleblower lawsuit filed by former Recovery Home Care employee Gregory Simony under the qui tam provisions of the False Claims Act.  Simony will receive a whistleblower award of $198,000.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Whistleblower Case, Whistleblower Rewards,

March 6, 2015

New York physician Roman Johnson pleaded guilty for his involvement in a scheme to fraudulently bill Medicare for $14.2 million in claims for medically unnecessary treatments.  Johnson admitted that he and other medical providers at his clinic submitted claims to Medicare for medically unnecessary vitamin infusions, physical therapy, and occupational therapy that did not qualify for reimbursement by Medicare.  Johnson agreed to pay $5,386,363 in restitution which represents the total amount of money Medicare paid as the result of the fraudulent claims.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

March 2, 2015

Patient safety consultant Dr. Charles Denham and his consulting company Health Care Concepts Inc. and his research organization Texas Medical Institute of Technology agreed to pay $1 million to settle allegations they violated the False Claims Act by soliciting and accepting kickbacks.  According to the government, Denham received monthly payments from CareFusion Corporation while serving as the co-chair of the Safe Practices Committee of the National Quality Forum which reviews, endorses and recommends standardized healthcare performance measures and practices, and Denham received these payments in exchange for recommending, promoting and/or arranging for the purchase of CareFusion’s product, ChloraPrep, in violation of the Federal Anti-Kickback Statute.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Medical Devices and DME,

February 27, 2015

Miami residents Blanca Ruiz and Alina Fonts were sentenced to serve 72 months in prison for their roles in a $63M Medicare fraud scheme involving intensive mental health treatment programs.  According to the evidence, Ruiz and Fonts were employed at Health Care Solutions Network Inc. which purported to provide intensive treatment for severe mental illness but instead billed Medicare and Medicaid for treatment not medically necessary and often not provided at all.  DOJ

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

February 27, 2015

Gerald R. Funderburg Jr., owner of Funderburg Clinical & Community Services, was sentenced to 87 months in prison and to pay $1.45M in restitution for violating the False Claims Act through his submission of false claims to Medicare for purported psychotherapy services.  Specifically, Funderburg admitted he used the Medicare information and identities of hundreds of Medicare beneficiaries without their consent to submit claims for psychotherapy services not actually provided.  DOJ

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

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