Archive

February 24, 2015

Angel M. Mirabal, owner of Houston-based medical equipment supplier Quick Solutions Medical Supplies Inc., pleaded guilty to a $5M scheme to defraud Medicare.  Mirabel admitted he and his co-conspirators operated Quick Solutions for the purpose of billing Medicare for medical equipment not medically necessary or not provided.  DOJ

February 18, 2015

Hospice services provider Compassionate Care Hospice Group agreed to pay $6.7M to settle charges it violated the federal and New York False Claims Acts by submitting claims to Medicare and Medicaid for hospice nursing services not actually or adequately provided.  Specifically, the government alleged CCH nurses routinely missed their required visits and then falsified nursing notes in patients’ files to make it appear as though the visits had been performed.  The charges originated in a whistleblower lawsuit filed by a former employee under the qui tam provisions of the False Claims Act.  Whistleblower Insider, NY

February 13, 2015

Illinois physician Dr. Michael J. Reinstein pleaded guilty to the crime of receiving illegal kickbacks and benefits totaling nearly $600,000 from pharmaceutical manufacturer Teva Pharmaceuticals USA Inc. and its subsidiary IVAX LLC in exchange for regularly prescribing the anti-psychotic drug clozapine to his patients.  Reinstein also agreed to pay $3.79M to settle a parallel civil lawsuit alleging he violated the False Claims Act for causing the submission of false claims to Medicare and Medicaid for the clozapine he prescribed for thousands of elderly and indigent patients in at least 30 Chicago-area nursing homes and other facilities.  In March 2014, Teva Pharmaceuticals and IVAX paid $27.6M million for their role in the kickback scheme. DOJ

February 10, 2015

Orelvis Olivera, the owner of Miami home health care agency Acclaim Home Healthcare Inc., pleaded guilty for his role in a $6.9M Medicare fraud scheme.  Olivera admitted he and his co-conspirators billed Medicare for expensive physical therapy and home health care services not medically necessary and paid kickbacks and bribes to patient recruiters in exchange for patient referrals.  DOJ

February 9, 2015

Wesley Harlan Kingsbury, general manager of California-based Alpha Ambulance Inc., was sentenced to 78 months in prison for his role in a $5.5M Medicare fraud scheme under which his company billed Medicare for ambulance transportation services for individuals that did not need them.  DOJ

February 6, 2015

Oklahoma-based Hospice care provider Good Shepherd Hospice Inc.agreed to pay $4M to resolve allegations it submitted false claims for hospice patients who were not terminally ill. Specifically, the government contended Good Shepherd pressured staff to meet admissions and census targets and paid bonuses to staff, including hospice marketers, admissions nurses and executive directors, based on the number of patients enrolled even if they were not eligible for hospice care. The settlement resolves allegations first raised by former Good Shepherd employees Kathi Cordingley and Tracy Jones in a whistleblower lawsuit they filed under the qui tam provisions of the False Claims Act. They will receive a whistleblower award of approximately $680,000. DOJ

February 3, 2015

Ernesto Fernandez pleaded guilty and was sentenced to 10 years in prison in connection with a long-running $6.2M Medicare fraud scheme involving Miami-based home health care agency Professional Medical Home Health LLC. Fernandez was an owner and operator of Professional Home Heath and also the owner and operator of two other South Florida home health agencies where he caused patient documentation to be falsified, and planned, organized and oversaw the submission of fraudulent claims to the Medicare program. Juan Valdes also pleaded guilty to the same scheme and was sentenced to 2 years in prison. He was a patient recruiter for Professional Home Health and solicited kickbacks and bribes from the owners and operators of Professional Home Health in exchange for providing beneficiaries to allow Professional Home Health to bill Medicare for home health services that were not medically necessary or not provided. Fernandez and Valdes are the seventh and eighth defendants to be sentenced in connection with the fraudulent schemes at Professional Home Health. DOJ

January 29, 2015

Four South Florida residents were sentenced in connection with a long-running $6.2M Medicare fraud scheme involving Professional Medical Home Health LLC, a Miami home health care agency operated for the purpose of billing the Medicare program for expensive physical therapy and home health services that were not medically necessary or actually provided. Dennis Hernandez was sentenced to 120 months in prison and to pay $1,438,186; Jose Alvarez was sentenced to 120 months in prison and to pay $2,972,570; Joel San Pedro was sentenced to 97 months in prison and to pay $4,938,432; Alina Hernandez was sentenced to 24 months in prison and to pay $204,526.05. DOJ

January 26, 2015

Ramon Regueira, the owner and operator of a Miami home health care agency Nation’s Best Care Home Health Corp. was sentenced to 106 months in prison and to pay $21M for his participation in a $30M Medicare fraud scheme. Regueira admitted he and his co-conspirators operated Nation’s Best for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary or not provided. He further admitted he and his co-conspirators paid kickbacks and bribes to patient recruiters who provided patients to Nation’s Best, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.DOJ

January 26, 2015

Kentucky-based ambulance services company Lafferty Enterprises, LLC(d/b/a Trans-Star Ambulance Services) agreed to pay $948,000 to settle charges it violated the False Claims Act by billing federal health care programs for medically unnecessary services over the course of several years. According to the government, from February 2006 until December 2012, the company transported Medicare patients to and from dialysis clinics by ambulance when an ambulance transport was not medically necessary. The charges originated from a whistleblower lawsuit filed by Kevin Fairlie under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $189,600. DOJ