Healthcare Fraud Archives - Page 115 of 128

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

Tagged in: Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Provider Fraud, Upcoding,

October 8, 2015

Evelio Fernandez Penaranda, owner of Miami-based Naranja Pharmacy Inc., was sentenced to 46 months in prison and to pay $1,876,241 in restitution for his role in the submission of more than $1.8 million in fraudulent claims to Medicare. According to his guilty plea, Naranja Pharmacy submitted fraudulent claims to Medicare for prescription drugs not prescribed by physicians, not medically necessary and not provided to Medicare beneficiaries. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud,

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

Tagged in: Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

September 18, 2015

Mary Talaga, the primary medical biller at Medicall Physicians Group Ltd., a Chicago-area visiting physician practice, was sentenced to 45 months in prison and to pay $1 million in restitution for her role in a $4 million health care fraud scheme. The evidence at trial showed that Talaga and her co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely provided the service. DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud,

September 11, 2015

A federal jury convicted Houston psychiatrist Sharon Iglehart of participating in a $158 million Medicare fraud scheme involving false claims for mental health treatment. According to evidence presented at trial, from 2006 until June 2012, Iglehart and others engaged in a scheme to defraud Medicare by submitting, through Riverside General Hospital, approximately $158 million in false and fraudulent claims for partial hospitalization program services to Medicare beneficiaries who did not actually receive the services. DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

August 25, 2015

A federal jury in Miami convicted Roger Rousseau, former medical director of Health Care Solutions Network Inc. (HCSN), and three HCSN therapists for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million. HCSN is a now-defunct partial hospitalization program that purported to provide intensive treatment for mental illness. According to the evidence presented at trial, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided and paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

August 19, 2015

Yaroslav (Steven) Proshak, former owner of Southern California ambulance company ProMed Medical Transportation, was convicted of health care fraud charges in connection with a Medicare fraud scheme of at least $2.4 million. According to the evidence, Proshak and two of his managers conspired to bill Medicare for ambulance transportation services for individuals whom the defendants knew did not need such services. They also instructed EMTs who worked at ProMed to conceal the true medical conditions of patients they were transporting by altering requisite paperwork and creating fraudulent documents to justify the transportation services. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

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

Tagged in: Healthcare Fraud, Provider Fraud,

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

Tagged in: Healthcare Fraud, Medicare, Pharma Fraud,

July 24, 2015

California oncologist Dr. Neelesh Bangalore has paid $736,000 to settle allegations that he improperly billed Medicare, Medicaid, and Tricare for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical distributor, Warwick Healthcare Solutions Inc., also known as Richards Pharma, a former United Kingdom-based drug distributer that did not have a license to distribute drugs in the United States. DOJ

Tagged in: Healthcare Fraud, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud, Provider Fraud,

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