Archive

June 13, 2016

Ubert Guillermo Rodriguez, former owner of Florida-based durable medical equipment maker G.R. Services Equipment & Supplies Inc., was sentenced to 37 months in prison and to pay $918,402 in restitution for his role in a multimillion-dollar health care fraud scheme in the greater Tampa, Florida, area.  Rodriguez admitted that from May 2013 through July 2013, his company submitted approximately $2.6 million in fraudulent claims to Medicare seeking reimbursement for durable medical equipment not legitimately prescribed by doctors and not provided to beneficiaries.  DOJ

June 20, 2016

New York announced the arrest of Joseph Wright, 52, of Middletown NY, for allegedly stealing over $5 million dollars from Medicaid. Prosecutors allege that Wright, as owner of a purportedly not-for-profit organization “Assistance By Improv II, Inc.” (ABI), located at 953 Southern Boulevard in the Bronx, lured thousands of low-income New Yorkers to ABI with the promise of affordable housing, arranged to have them subjected to unnecessary medical tests and then filed false claims for reimbursement with the State Medicaid program. Prosecutors alleged in papers filed in court that Wright unlawfully owns and operates ABI as a medical mill that masquerades as a charitable housing organization. Prosecutors allege that Wright ignored ABI’s professed charitable mission and duped potential clients, most of whom were Medicaid recipients, into surrendering their personal health care information and undergoing purported medical screening to qualify for housing. NY

May 31, 2016

Newark, New Jersey-based Saint Michael’s Medical Center Inc. agreed to pay $450,000 to resolve allegations it violated the False Claims Act by falsely billing Medicare and Medicaid for medically unnecessary cardiac procedures.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act.  DOJ (DNJ)

May 5, 2016

The City of New York agreed to pay $4.3 million to settle charges of violating the False Claims Act through the New York City Fire Department's receipt of reimbursements for claims for emergency ambulance services that did not meet Medicare’s medical necessity requirement.  This matter was brought to the attention of the U.S. Attorney’s Office through a voluntary disclosure by the City.  DOJ (SDNY)

April 18, 2016

Miami physician Henry Lora was sentenced to 108 months in prison for his role in a Medicare fraud scheme that caused approximately $30 million in losses.  Lora was the medical director of Miami-area clinic Merfi Corporation and admitted that in exchange for kickbacks and bribes, he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided.  He also admitted falsifying patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Merfi owner was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ

April 13, 2016

Florida Pain Medicine Associates, Inc. and its owners, Drs. Bart Gatz, Alexis Renta, and Albert Rodriguez, agreed to pay $1.1 million to resolve allegations they violated the False Claims Act by billing Medicare for medically unnecessary nerve conduction studies.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Rosa Gomez, who had worked in Florida Pain Medicine’s billing department.  She will receive a whistleblower award of $242,000 from the proceeds of the government's recovery.  DOJ (SDFL)

April 11, 2016

Tennessee-based drug urine screening company PremierTox 2.0, Inc. (previously called Nexus) agreed to pay $2.5 million to resolve allegations it violated the False Claims Act by submitting false claims when billing Medicare, TennCare and Kentucky Medicaid for drug urine screening services.  According to the government, PremierTox had a swapping arrangement under which Nexus gave below cost discounts on its urine drug screen tests to patients in Tennessee without insurance, in exchange for physicians’ referring their patients with Medicare or TennCare coverage to Nexus. The government also contended that in Tennessee Nexus submitted excessive claims to Medicare and TennCare for laboratory testing that was beyond what was medically reasonable and necessary.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by a former office manager of a pain clinic and the former CEO of PremierTox.  The office manager will receive a whistleblower award of $361,250, and the former CEO will receive a whistleblower award of $56,250.  DOJ (MDTN)

April 11, 2016

Naseem Minhas, the owner and operator of Detroit-area home health care agency TriCounty Home Care Services Inc. pleaded guilty today for his participation in a $4 million health care fraud scheme.  According to admissions made as part of his plea agreement, Minhas paid a physician and recruiters to refer Medicare beneficiaries to TriCounty and sign medical documents falsely certifying that they required home health care.  Minhas, a licensed physical therapist, also admitted that he assisted in creating fake patient files to make it appear as though the patients needed and received services that were unnecessary or not provided.  DOJ

March 25, 2016

Damian Mayol, the president of Miami-based transportation company Transportation Services Providers Inc. was sentenced to 60 months in prison and to pay $26.8 million in restitution (and forfeit the same amount) for his role in a health care fraud scheme involving three mental health centers that resulted in the submission of approximately $70 million in false Medicare claims.  According to evidence presented at trial, Mayol and his co-conspirators used his company to coordinate the payment of illegal kickbacks to recruiters, who in return referred patients to three now-defunct community mental health centers -- R&S Community Mental Health Inc., St. Theresa Community Mental Health Center Inc. and New Day Community Mental Health Center LLC -- for costly partial hospitalization program services that were not medically necessary or not actually provided.  DOJ

March 18, 2016

A federal jury in New Orleans convicted Elaine Davis and Dr. Pramela Ganji for their roles in a $34 million Medicare fraud scheme.  The jury found that Davis, who owned Christian Home Health Care Inc., together with Ganji caused the healthcare company to bill Medicare for home health care services that were not needed and/or not actually provided.  Davis paid employees to recruit new patients and then sent their Medicare information to doctors, including Ganji, to obtain their signatures to certify that the patients qualified to receive home health care services, which trial evidence showed they did not qualify for or need.  DOJ