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March 6, 2015

New York physician Roman Johnson pleaded guilty for his involvement in a scheme to fraudulently bill Medicare for $14.2 million in claims for medically unnecessary treatments.  Johnson admitted that he and other medical providers at his clinic submitted claims to Medicare for medically unnecessary vitamin infusions, physical therapy, and occupational therapy that did not qualify for reimbursement by Medicare.  Johnson agreed to pay $5,386,363 in restitution which represents the total amount of money Medicare paid as the result of the fraudulent claims.  DOJ

February 27, 2015

Miami residents Blanca Ruiz and Alina Fonts were sentenced to serve 72 months in prison for their roles in a $63M Medicare fraud scheme involving intensive mental health treatment programs.  According to the evidence, Ruiz and Fonts were employed at Health Care Solutions Network Inc. which purported to provide intensive treatment for severe mental illness but instead billed Medicare and Medicaid for treatment not medically necessary and often not provided at all.  DOJ

February 27, 2015

Gerald R. Funderburg Jr., owner of Funderburg Clinical & Community Services, was sentenced to 87 months in prison and to pay $1.45M in restitution for violating the False Claims Act through his submission of false claims to Medicare for purported psychotherapy services.  Specifically, Funderburg admitted he used the Medicare information and identities of hundreds of Medicare beneficiaries without their consent to submit claims for psychotherapy services not actually provided.  DOJ

February 24, 2015

Acadiana Cardiology LLC, Acadiana Cardiovascular Center and convicted doctor Mehmood Patel agreed to pay $650,000 to settle charges they violated the False Claims Act through unnecessary cardiovascular, endovascular and related procedures that Patel performed at Our Lady of Lourdes Hospital, Lafayette General Medical Center, Acadiana Cardiology and Acadiana Cardiovascular Center.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Christopher Mallavarapu, a cardiologist who formerly practiced with Patel.  DOJ

February 24, 2015

Louisiana oncologist Prabhjit S. Purewal agreed to pay $550,000 to settle allegations he defrauded Medicare, Tricare and Medicaid in violation of the False Claims Act by billing for chemotherapy drugs not approved by the FDA.  Dr. Purewal purchased the drugs from UK-based drug distributor Warwick Healthcare Solutions, Inc. (also known as Richard’s Pharma), which did not have a license to distribute drugs in the US.  DOJ

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 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

A federal jury in Detroit convicted unlicensed Detroit physician Wilfred Griffith for his participation in a nearly $4.7M fraud scheme. According to evidence presented at trial, Griffith worked as an unlicensed physician at Phoenix Visiting Physicians in 2010 and 2011 where he treated Medicare beneficiaries and used prescription pads pre-signed by Dr. Dwight Smith to prescribe medicine. He also referred Medicare beneficiaries to Detroit-area home health company Cherish Home Health Services Inc. in exchange for kickbacks. Griffith used the names and signatures of Dr. Smith and two other Detroit-area physicians to certify the beneficiaries were homebound and needed home health services when they did not. 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

January 9, 2015

Felix Gonzalez, owner of Miami-based home health care company AA Advanced Care Inc. pleaded guilty in connection with a $32 million Medicare fraud scheme. Specifically, Gonzalez admitted he and his co-conspirators operated AA Advanced for the purpose of billing Medicare for, among other things, expensive physical therapy and home health care services not medically necessary or not provided at all. He also admitted he paid kickbacks and bribes to patient recruiters in exchange for patient referrals, prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services. DOJ
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