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Page 19 of 40

October 18, 2018

Dr. Felmor Agatep, a Florida-based doctor, has plead guilty to receiving kickbacks and defrauding TRICARE over prescriptions to outrageously expensive and medically unnecessary pain and scar creams. According to the DOJ press release, a one month supply of the creams in question cost more than $16,000 when made by a compounding pharmacy. At some point in late 2014, Agatep agreed to receive kickbacks from a marketing group of $100 per TRICARE patient in exchange for writing prescriptions for these creams. In just a month and a half, Agatep allegedly wrote a total of 265 prescriptions, which amounted to a bill of $4.4 million for TRICARE. He now faces a maximum penalty of 10 years in prison. USAO MDFL

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

October 15, 2018

The CEO of Tri-County Wellness Group, Mashiyat Rashid, has plead guilty and agreed to forfeit millions of dollars worth of ill-gotten funds and property in connection with a $150 million healthcare fraud. Over the course of almost 10 years, Rashid and physicians working in his pain clinics allegedly prescribed millions of units of medically unnecessary painkillers to Medicare beneficiaries, whom they also subjected to medically unnecessary but expensive injections. A similar fraud was repeated at laboratories owned by Rashid, with medically unnecessary but expensive urine tests for drugs. When Medicare realized that none of the claims were reimbursable, Rashid and others created fake companies to perpetuate the fraud. DOJ

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

October 12, 2018

The owner of a small chain of hospices has plead guilty to healthcare fraud in one of the largest hospice fraud cases ever to come out of Mississippi. Charline Brandon is alleged to have submitted fraudulent claims worth $11 million to Medicare and $2 million to Medicaid for services not rendered or needed, as well as illegally soliciting patients who were not eligible for hospice services. USAO NDMS

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

October 9, 2018

A Florida-based pharmacy owner has plead guilty to defrauding Medicare of $8.4 million. In order to generate income for his pharmacy, Valles Pharmacy Discount, Antonio Perez Jr. allegedly paid kickbacks to Medicare beneficiaries and submitted claims on their behalf for medically unnecessary prescriptions that were not purchased by the pharmacy or provided to the beneficiaries. DOJ

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

October 9, 2018

The former CFO and COO of Houston-area Atrium Medical Center and Pristine Healthcare, Starsky Bomer, has been convicted for his role in a $16 million Medicare kickback scheme.  Bomer and others paid illegal kickbacks to group home owners and patient recruiters in exchange for the referral of Medicare patients for outpatient mental health treatment through the hospitals' partial hospitalization program (PHP).  While the hospitals billed Medicare $16 million for these patients, the evidence at trial demonstrated that Bomer knew that PHP services were not necessary for most of the patients, and that the patients were not, in fact, provided with such services.   DOJ

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

October 4, 2018

Mercy Ainabe of Houston, Texas, was sentenced to nine years in prison for her role in a $3.6 million home healthcare Medicare fraud scheme.  Ainabe served as a patient recruiter, selling patient information to home healthcare companies, including Texas Tender Care, which then submitted claims to Medicare for home health services that were not medically necessary, were not provided, or both. USAO SDTX

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

September 27, 2018

Millicent Traylor, M.D., of Detroit, Michigan was sentenced to over 11 years in prison today for her part in a health care scheme against Medicare from 2011 to 2016. Traylor and her co-conspirators defrauded Medicare of an estimated $8.9 million during that period. They submitted fraudulent claims for home health care services and other services which were not provided or not medically necessary. At times, the physician services which were provided were provided by Dr. Traylor, though she was unlicensed during that period. Furthermore, evidence presented during the four-day trial showed that Traylor forged the signature of licensed physicians on prescriptions for opioid medications, oxycodone for instance, as a way to encourage patient participation in the scheme. Traylor’s three co-conspirators will also serve time in prison.  DOJ  

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

September 24, 2018

The owner and operator of several Superdrugs pharmacies in Queens, New York, was charged with submitting false claims to Medicare Part D and Medicaid for prescription drugs that were not dispensed, were not prescribed as claimed, or not medically necessary.  The pharmacies allegedly received $7.9 million from Medicare and Medicaid based on the fraudulent claims.  DOJ

Tagged in: Lack of Medical Necessity, Medical Billing Fraud, Part D, Pharma Fraud,

September 19, 2018

A physician and two clinic operators were convicted after trial for charges arising from a $17 million Medicare fraud scheme.  The doctor, John Ramirez, provided medical orders falsely certifying the need for home-health services, which the other defendants then sold to to home-health agencies in the Houston, Texas area.  These agencies then used the false and fraudulent paperwork signed by Ramirez to submit false claims to Medicare for medical services that were not medically necessary or not provided.  DOJ

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

September 4, 2018

Houston psychiatrist Riyaz Mazcuri was sentenced to 12.5 years in prison following his conviction at trial for defrauding Medicare and Medicaid through the submission of $155 million in false and fraudulent claims for "partial hospitalization program" services, a form of intensive outpatient treatment for patients with mental illness.  Mazcuri falsified records to make it appear as if patients admitted to the PHPs qualified for, required, and actually received the intensive psychiatric services. DOJ

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

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