Government Enforcement Actions

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare.  Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic.  Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided.  DOJ

August 14, 2015

Oklahoma-based East Central Family Health Center agreed to pay $825,000 to settle charges it violated the False Claims Act by submitting false Medicaid claims.  Specifically, the government charged East Central, which is a designated federally qualified health center (FQHC), with submitting claims to the Oklahoma Medicaid Program for reimbursement for patients of non-FQHC health care providers and who were not East Central patients.  DOJ

August 14, 2015

Connecticut doctor Okon Umana was sentenced to two years in prison, to pay $6,429,330 in restitution and to forfeit $6,550,036 for his role in a $13 million health care fraud scheme.  From 2009 to 2012, as the medical director of Cropsey Medical Care, Umana admitted submitting more than $13 million in claims to Medicare and Medicaid for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests.  DOJ

August 13, 2015

Two Southwest Missouri health care providers agreed to pay $5.5 million to settle allegations they violated the False Claims Act by engaging in improper financial relationships with referring physicians.  The two providers are Mercy Health Springfield Communities (formerly known as St. John’s Health System Inc.) and its affiliate, Mercy Clinic Springfield Communities (formerly known as St. John’s Clinic).  Specifically, the government charged the hospitals with submitting false claims to Medicare for services rendered to patients referred by physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic.  The allegations first arose in a whistleblower lawsuit filed by Dr. Jean Moore, a physician who is employed by one of the defendants, under the qui tam provisions of the False Claims Act.  Dr. Moore will receive a whistleblower award of $825,000.  DOJ

August 13, 2015

Florida investment advisor Gignesh Movalia pleaded guilty to perpetrating a $9 million investment fraud scheme involving Facebook stock.  Specifically, Movalia, who was the founder and manager of OM Global Investment Fund LLC, solicited investments by falsely touting access to pre-IPO shares of Facebook which he then used for and lost in other investments that he concealed from investors.  DOJ

August 12, 2015

Oswego Hospital will pay $1,456,457.33 to resolve False Claims Act charges stemming from healthcare billing improprieties the hospital self disclosed to the federal government.  Dr. Vilas Patil, a physician formerly working as an independent contractor with Oswego, paid $204,365.97 to resolve False Claims Act liability in connection with a related investigation.  Specifically, Oswego identified claims that were paid by federal and state payors where the supporting medical record documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes.  DOJ

August 11, 2015

Computer Supply company PC Specialists Inc. (d/b/a Technology Integration Group) agreed to pay $5.9 million to settle charges it inflated the price of computers sold through another company to the National Nuclear Security Administration for use at Sandia National Laboratories in Albuquerque, New Mexico.  Specifically, TIG sold Dell computers to Sandia Corporation for resale to the United States under Sandia’s contract with the NNSA.  According to the government, TIG knowingly inflated the amounts it charged Sandia by failing to give credits for rebates and discounts it received from Dell as required by its contract.  The government’s allegations arose from a whistleblower lawsuit filed by Maverick Granger, a former TIG executive in Albuquerque, under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be determined whistleblower award.  Whistleblower Insider

August 11, 2015

California resident Patricia Diane Clark was sentenced to 130 months in prison and to pay $642,032 in restitution and to forfeit the same amount for her role in a half-million dollar Costa Rica-based “sweepstakes fraud” scheme that victimized hundreds of U.S. residents, many of whom were elderly.  DOJ

August 7, 2015

Tamara Esponda, owner of Miami-based Biomax Pharmacy, pleaded guilty to submitting almost $1.6 million in fraudulent claims to Medicare.  Specifically, Esponda admitted that Biomax Pharmacy submitted fraudulent claims to Medicare for prescription drugs not prescribed by physicians, not medically necessary, not purchased by Biomax Pharmacy and not provided to Medicare beneficiaries.  DOJ

August 6, 2015

Leon Benzer, a former construction boss from Las Vegas, was sentenced to 188 months in prison and to pay roughly $13 million in restitution for his role in a $58 million scheme to fraudulently gain control of condominium homeowners’ associations in the Las Vegas area to secure construction and other contracts for himself and others.  DOJ