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Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Posted  04/2/20
Human Health Services Office of Inspector General Logo
The HHS OIG recently released the Medicaid Fraud Control Units (MFCUs) Fiscal Year 2019 Annual Report, providing a consolidated accounting of the program’s success. MFCUs investigate and prosecute Medicaid fraud and patient abuse or neglect. MFCUs receive referrals from other agencies, the public, or via data mining with OIG approval. The referral is reviewed, an investigation is conducted, and the decision is...

March 11, 2020

The owner and operator of multiple parcel delivery businesses in Florida has been sentenced to 2 years in prison and ordered to pay $9 million in restitution for withholding over $10.8 million in payroll taxes.  Despite his business earning over $100 million in revenue, and despite withholding taxes from hundreds of employees, Ricardo Betancourt failed to actually pay it to the IRS and instead used those funds to finance personal expenses and other business ventures.  DOJ

March 2, 2020

The owners and operators of Middlesex Rheumatology in Connecticut, Dr. Crispin Abarientos and his wife Dr. Antonieta Abarientos, have agreed to pay $4.9 million to settle allegations of violating federal and state False Claims Act.  Between 2013 to 2017, the Abarientos allegedly billed Medicaid for an injectable prescription drug called Remicade, which is used to treat rheumatoid arthritis, but then failed to administer the drugs on Medicaid patients.  Instead, they administered them on patients covered by Medicare or the Connecticut State Employees Health Plan, then billed the two providers for the drugs again even though the cost had already been covered by Medicaid.  USAO CT

February 26, 2020

The two owners and operators of Royal Care Pharmacy in Los Angeles have been ordered to pay restitution of $11.8 million to Medicare and $17,000 to Cigna after being found guilty of healthcare fraud and money laundering.  Aleksandr Suri and Maxim Sverdlov were also sentenced to 12 years in prison.  From 2012 to 2015, the two had fraudulently billed Medicare and Cigna for prescription medications that were not purchased or dispensed to beneficiaries, hiding the conspiracy and laundering the proceeds through fake invoices.  DOJ

February 21, 2020

Husam Tayeh of Illinois and his Nevada corporations, Dinar Corps., Inc. and My Monex, Inc., have agreed to pay the CFTC more than $22.6 million in disgorgement and civil monetary penalties after being found liable for violations of the Commodity Exchange Act arising from defendants’ alleged registration violations, misappropriation of investor funds, and fraudulent solicitation of customers to engage in financed retail forex transactions involving Iraqi Dinar and Vietnamese Dong.  To settle a related criminal action, Tayeh has been sentenced to 1 year in prison, ordered to forfeit more than $8 million, and ordered to pay more than $150,000 in restitution to victims.  CFTC

February 14, 2020

Veterinary drug distribution company Animal Health International Inc. pled guilty to charges that it introduced misbranded drugs into interstate commerce, including by distributing wholesale veterinary drugs to end users and unlicensed individuals.  AHI's parent company, Patterson Companies, Inc., entered into a deferred prosecution agreement with specific compliance program guidelines.  AHI will forfeit $46.8 million, and pay fines totaling $6 millionUSAO WD VA

February 11, 2020

Property developer Monique Brady of Rhode Island has been sentenced to 8 years in prison and ordered to pay $4.8 million in restitution for defrauding 23 investors of $10.3 million in a Ponzi scheme that ran from 2014 to 2018.  Brady told investors, many of them her own family, friends, and business associates, that her property rehabilitation business, MNB LLC, had secured contracts to perform large scale rehabilitation work on foreclosed properties in Connecticut, Massachusetts, New Hampshire, and Rhode Island.  To entice investors, Brady promised a 50% return on profits and showed forged emails that purported to show the contracts were valid.  In reality, however, the jobs she was hired to do were menial and paid less than $1,000, and she was using investor funds to finance an extravagant lifestyle.  When she became the subject of a federal investigation, she told investors to delete all records of their investments with her company, then met with federal officials to request that they investigate her investors for usury, before attempting to abscond to Vietnam.  DOJ; USAO RI

February 6, 2020

A patient recruiter in Kentucky has been sentenced to 5 years in prison and ordered to pay or forfeit over $1.2 million in total for accepting more than $1 million in kickbacks from home health agencies in exchange for providing information about Medicare beneficiaries.  The owner of Trumbo Consulting Agency in Virginia, Dominic Trumbo recruited and paid others to recruit over 4,000 Medicare beneficiaries for home health services by offering incentives to get them to sign up.  Trumbo then sold the information to home health agencies around the country in exchange for kickbacks, then created fake contracts and invoices to conceal the fraud from Medicare.  DOJ

February 3, 2020

Senthil Kumar Ramamurthy of Texas has been sentenced to 10 years in prison for participating in two fraud schemes that amounted to $9.6 million in losses by Medicare and TRICARE.  In the first scheme, which ran for 10 months in 2014, Ramamurthy and his co-conspirators were paid millions of dollars by compounding pharmacies to get TRICARE beneficiaries to sign up for medically unnecessary compounded prescription drugs.  To get beneficiaries to sign up, defendants had falsely represented that the drugs would be free, when in fact co-payments were required.  In the second scheme, which ran from 2015 onward, Ramamurthy and his co-conspirators paid doctors to refer Medicare beneficiaries—without first examining them—for needless genetic cancer screening tests.  Many of Ramamurthy's co-conspirators have plead guilty and face sentencing later this month.  USAO SDFL
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