Archive

January 29, 2016

Florida arrested three individuals for allegedly defrauding Medicaid out of more than half a million dollars. Two more defendants are being sought by authorities for arrest. According to the investigation, Matthew, Micah and Jimmie Harrell, along with Kenneith Durden and Keith Daly, billed Medicaid for services not provided and fraudulently used a licensed mental health provider’s information without that provider’s knowledge or consent to become accepted as a Medicaid provider. Matthew Harrell and Kenneith Durden allegedly set up parallel, fraudulent business operations in Florida, Georgia and Louisiana that all engaged in similar criminal activities. The businesses operated under the names Revive Athletics Florida, Divine Consulting Services, and Durden Consulting Services of Florida. FL

January 14, 2016

Nery Cowan, a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center Inc., pleaded guilty in connection with a $63 million health care fraud and money laundering scheme.  Behavioral Healthcare is a now-defunct Miami-area partial hospitalization program (PHP) that purported to provide intensive treatment for severe mental illness.  Specifically, Cowan directed the payment of kickbacks to patient brokers and others in exchange for Medicare beneficiary referrals and admitted concealing the kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida.  Cowan and her co-conspirators disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc., a sham staffing company.  DOJ

December 18, 2015

Ohio cardiologist Dr. Harold Persaud, with hospital privileges at Fairview Hospital, St. John’s Medical Center and Southwest General Hospital, was sentenced to 20 years in prison for performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $29 million.  DOJ

December 18, 2015

21st Century Oncology, a Florida-based provider of integrated cancer care services, agreed to pay $19.75 million to resolve allegations it violated the False Claims Act by billing federal health care programs for laboratory tests that were not medically necessary.  The tests involved were fluorescence in situ hybridization (or “FISH”) tests which are laboratory tests performed on urine that can detect genetic abnormalities associated with bladder cancer.  The government alleged that 21st Century submitted claims for unnecessary FISH tests that were ordered by four of its urologists, Dr. Meir Daller, Dr. Steven Paletsky, Dr. David Spellberg and Dr. Robert Scappa.  The government further alleged the company encouraged these physicians to order unnecessary FISH tests by offering bonuses that were based in part on the number of tests referred to 21st Century’s laboratory.  The allegations first arose in a whistleblower lawsuit filed by a former 21st Century medical assistant under the qui tam provisions of the False Claims Act.  The whistleblower will receive a whistleblower award of $3.2 million from the proceeds of the government’s recovery.  DOJ

November 24, 2015

The former CFO of Long Beach, California-based Pacific Hospital, two orthopedic surgeons and two others have been charged in long-running health care fraud schemes that illegally referred thousands of patients for spinal surgeries and generated nearly $600 million in fraudulent billings.  The wide-ranging kickback scheme, which involved dozens of surgeons, orthopedic specialists, chiropractors, marketers and other medical professionals, involved improper referrals to Pacific Hospital and Hawaiian Hospital.  The most recent targets of the government’s investigation, all of whom have agreed to plead guilty, include: former Pacific Hospital CFO James L. Canedo; orthopedic surgeons Philip Sobol and Mitchell Cohen; chiropractor Alan Ivar; and health care marketer Paul Richard Randall, previously affiliated with Pacific Hospital and Tri-City Regional Medical Center in Hawaiian Gardens.  Under the terms of their plea agreements, Sobol faces a federal prison term of up to 10 years; Canedo, Ivar and Randall face up to five years in prison; and Cohen faces up to three years in prison.  All of them will be required to pay restitution to the victims of the scheme, which in Canedo’s case will be at least $20 million.  Whistleblower Insider

November 6, 2015

Roger Rousseau, former medical director of defunct health provider Health Care Solutions Network Inc. (HCSN) was sentenced to 192 months in prison for his role in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.  Also sentenced to prison for their role in the scheme were therapists Liliana Marks for 72 months and Doris Crabtree and Angela Salafia, each for 60 months.  According to evidence presented at trial, HCSN purported to provide intensive mental health services to Medicare and Medicaid beneficiaries but these services were not medically necessary and were often never even provided.  HCSN also paid kickbacks to assisted living facility owners and operators who in exchange referred beneficiaries to HCSN.  In support of this scheme, Rousseau routinely signed what he knew to be fabricated and altered medical records.  And Crabtree, Salafia and Marks fabricated HCSN medical records to support the fraudulent claims.  In total, HCSN submitted roughly $63.7 million in false and fraudulent claims to Medicare.  DOJ

October 26, 2015

Valentina Kovalienko, the owner of two Brooklyn medical clinics, pleaded guilty to, and agreed to forfeit almost $30 million for, her role in a $55 million health care fraud and money laundering conspiracy.  According to her admissions, from approximately February 2008 to February 2011, Kovalienko and others executed a scheme in which patients were paid cash kickbacks to subject themselves to medically unnecessary physical and occupational therapy, diagnostic tests and office visits that were not performed by licensed professionals, and for which the clinics billed Medicare and Medicaid.  Kovalienko also admitted that to support the fraudulent claims she paid occupational and physical therapists to falsify patient charts and billing records.  DOJ

October 15, 2015

Shreveport, Louisiana community mental health center Westwood Mental Health LLC, and its parent company MedSouth LLC, agreed to pay $3.5 million to settle False Claims Act and Anti-Kickback Statute allegations that Westwood falsified patient records, billed for services not medically necessary, billed for services that were not rendered, provided bribes to Medicare beneficiaries who did not qualify for partial hospitalization services and provided bribes and/or kickbacks to employees to further or conceal the fraud.  DOJ (WDLA)

October 14, 2015

Santiago Borges, Erik Alonso and Cristina Alonso, all of Miami, pleaded guilty to federal healthcare fraud charges.  Borges owned the now-defunct mental health centers R&S Community Mental Health Inc. and St. Theresa Community Mental Health Center Inc., and was an investor in New Day Community Mental Health Center LLC .  Erik Alonso was the clinical director of all three centers.  Cristina Alonso was a therapist at R&S.  They admitted the clinics billed Medicare for costly partial hospitalization program services that were not medically necessary or not provided to patients.  Borges also admitted he paid kickbacks to patient recruiters who, in exchange, referred beneficiaries to the centers.  DOJ

September 29, 2015

Juan Carlos Delgado and Nereyda Infante, who owned and operated several Orlando-based health care clinics under variations of the name Prestige Medical, were sentenced to five years in prison and to pay $1,520,850 in restitution and forfeit $1,520,850 for their role in a $2.4 million health care fraud scheme.  According to admissions made in connection with their guilty pleas, between February 2012 and September 2014, the defendants fraudulently billed Medicare on behalf of the Prestige clinics for services never provided and for medications not prescribed or administered.  In particular, Delgado and Infante admitted to billing Medicare for pentostatin, an expensive anticancer chemotherapeutic medication used to treat Leukemia, despite never administering the drug.  DOJ