Archive

October 20, 2014

A federal jury in Houston convicted Earnest Gibson III, the president of Riverside General Hospital, his son, and two others for their participation in a $158M Medicare fraud scheme involving false claims for mental health treatment. Ten defendants have now been convicted in connection with the Riverside fraud scheme. DOJ

October 17, 2014

Two groups of Houston-based diagnostic centers agreed to pay more than $2.6M to settle allegations they violated the False Claims Act by engaging in improper financial relationships with referring physicians in violation of the Stark Statute. One group of centers, which operates under the name One Step Diagnostic, agreed to pay $1.2M. The other group of centers, consisting of Complete Imaging Solutions LLC doing business asHouston Diagnostics, Deerbrook Diagnostics & Imaging Center LLC,Elite Diagnostic Inc., Galleria MRI & Diagnostic LLC, Spring Imaging Center Inc. and West Houston MRI & Diagnostics LLC agreed to pay about $1.5M. The allegations originated from a whistleblower lawsuit filed by three whistleblowers under the qui tam provisions of the False Claims Act, who will receive an undisclosed award. DOJ

October 10, 2014

Extendicare Health Services Inc., an operator of a chain of skilled nursing facilities, and its subsidiary Progressive Step Corporation (ProStep), agreed to pay $38 million that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient they were effectively worthless and billed Medicare for medically unreasonable and unnecessary rehabilitation therapy services. It is the largest failure of care settlement with a chain-wide skilled nursing facility in the Justice Department’s history. The government’s charges originated from two whistleblower lawsuits filed by Tracy Lovvron and Donald Gallick under the qui tam provisions of the False Claim Act. They will receive whistleblower awards of more than $1.8 million and $250,000, respectively. DOJ

October 8, 2014

Usman Butt, a former owner and manager of two Detroit-area home health care agencies, Home Health Services Inc. and Royal Home Health Care Inc., pleaded guilty for his role in a $22 million Medicare fraud conspiracy. Specifically, Butt admitted that beginning in 2008 and continuing through January 2013, he conspired with others to bill Medicare for home health care services that were not actually rendered, not medically necessary, and procured through paying illegal kickbacks. He also admitted that he fabricated patient files to give the false appearance that the services were medically necessary and actually provided. DOJ

October 1, 2014

A federal jury in Detroit convicted Felicar Williams, the operator of Haven Adult Day Care Center LLC, and Abdul Malik Al-Jumail and his daughter Jamella Al-Jumail, owners of a network of home health care companies, for their participation in a $29 million Medicare fraud scheme. According to evidence presented at trial, at Williams’s direction, Haven billed Medicare for sophisticated mental health services purportedly provided by other, unlicensed staff members. And the Jumails’ companies — including ABC Home Care Inc., Associates in Home Care Inc., Accessible Home Care Inc., Swift Home Care LLC, and Be Well Home Care LLC — billed Medicare for home health services that were not needed or not provided. Abdul Malik Al-Jumail also paid kickbacks to Williams to obtain billing information about patients at Haven. He then used the information to bill Medicare for home health care services that were never provided. DOJ

September 26, 2014

Detroit-area physician Dr. Vicha Janviriya pleaded guilty for making fraudulent referrals for home health care in a $1.3 million Medicare fraud scheme. He admitted that he falsified medical documentation which would be used to support false claims to Medicare for services that were never rendered or not medically necessary, or where the Medicare beneficiary referrals were obtained through the payment of kickbacks. DOJ

September 22, 2014

Akinola Afolabi, former owner of Long Beach, California medical supply company Emmanuel Medical Supply was sentenced to serve 30 months in prison and ordered to pay $1.5 million in restitution for his role in a scheme to provide unnecessary power wheelchairs to Medicare patients, resulting in $2.6 million in fraudulent claims to Medicare.DOJ

September 18, 2014

Three patient recruiters were sentenced to prison for their participation in a $20 million health care fraud scheme involving defunct home health care company Trust Care Health Services. Estrella Perez was sentenced to 37 months and ordered to pay $1.2 million; Solchys Perez was sentenced to 30 months and ordered to pay $746,000; and Abigail Aguila was sentenced to 30 months and ordered to pay $491,000. According to court documents, Estrella Perez, Solchys Perez, and Aguila recruited patients for Trust Care, a Miami home health care agency, in exchange for kickbacks paid in cash or by check to the defendants or their shell companies. In turn, Trust Care billed the Medicare program for home health care and therapy services that were not medically necessary or were not provided. DOJ

September 17, 2014

Fort Lauderdale based home health care company A Plus Home Health Care, and its owners Tracy and Stephen Nemerofsky, agreed to pay $1.65 million to settle charges A Plus violated the False Claims Act by paying spouses of referring physicians for sham marketing positions to induce patient referrals. According to the government, the company allegedly hired at least seven spouses and one boyfriend of physicians to perform marketing duties but required them to do little if any real work. Their salaries instead were allegedly for the purpose of inducing and rewarding the physicians’ referrals of Medicare patients to A Plus. Whistleblower Insider

September 16, 2014

Wesley Harlan Kingsbury, general manager of the Southern California ambulance company Alpha Ambulance Inc., pleaded guilty to conspiracy to commit Medicare fraud. According to court documents, Kingsbury conspired with Alex Kapri and Aleksey (Russ) Muratov, the owners of Alpha Ambulance, as well as the training supervisor Danielle Medina, to bill Medicare for ambulance transportation services for individuals that Kingsbury knew did not need to be transported by ambulance. In addition, he instructed emergency medical technicians that worked at Alpha Ambulance to conceal the true medical condition of patients they were transporting by altering requisite paperwork and creating false reasons to justify the transportation services. DOJ