Medicaid

June 7, 2017

New York announced that Kester Atumonyogo, of Valley Stream, NY, and his company Monack Medical Supply, Inc. were arraigned on an indictment charging Atumonyogo and Monack with billing Medicaid and Healthfirst, a Medicaid managed care organization, for an expensive nutritional formula while supplying patients with a lower-priced substitute and stealing over $1 million in the process. Atumonyogo, 49, was arraigned in New York Supreme Court, Kings County, by the Honorable Danny K. Chun. According to the indictment, Atumonyogo used a fraudulent social security number to enroll Monack as a Medicaid-participating provider of medical supplies. The company then allegedly filed false claims to Medicaid and Healthfirst that Monack had dispensed to pediatric patients a highly specialized and expensive enteral nutritional formula, which is prescribed by physicians for patients who must obtain nutrients via a feeding tube and cannot metabolize dietary nutrients from substantive food. NY

May 2, 2017

Maine dentist Joseph W. Griffin agreed to pay $90,000 to resolve allegations he violated the False Claims Act by submitting submitted false claims to MaineCare (Maine’s Medicaid program) for dental services not rendered, were medically unnecessary, or were so inadequately documented in the patient’s medical record as to be unreviewable. DOJ (DME)

March 30, 2017

Godwin Oriakhi, owner of five Houston-area home health agencies pleaded guilty to conspiring to defraud Medicare and the State of Texas’s Medicaid-funded Home and Community-Based Service and Primary Home Care programs of more than $17 million.  According to his plea, Oriakhi admitted that he, his daughter and co-defendant Idia Oriakhi, and other members of his family owned and operated: Aabraham Blessings LLC, Baptist Home Care Providers Inc., Community Wide Home Health Inc., Four Seasons Home Healthcare Inc. and Kis Med Concepts Inc., and that they obtained patients for these home health agencies by paying illegal kickback payments to patient recruiters and his office employees for hundreds of patient referrals.  Oriakhi also admitted that they paid Medicare and Medicaid patients by cash, check, Western Union and Moneygram for receiving services from his family’s home health agencies in exchange for the ability to use their Medicare and Medicaid numbers to bill the programs for home healthcare. DOJ

April 20, 2017

California announced a $9.8 million settlement with Walgreens, one of the largest drugstore chains in the United States. The settlement involved allegations that Walgreens failed to adhere fully to requirements imposed by California law for the dispensing of certain prescriptions drugs under Medi‑Cal. The settlement is the result of lawsuits filed by whistleblowers and investigated and resolved by federal and state prosecutors. The lawsuits alleged that for more than five years, Walgreens falsely certified that it had complied with diagnosis-related requirements for the lawful dispensing of prescriptions to Medi‑Cal patients. Through the Bureau of Medi‑Cal Fraud and Elder Abuse (BMFEA), the Attorney General’s office regularly works with whistleblowers and law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi‑Cal program. False claims lawsuits pursued by the Attorney General in the last two years have recovered tens of millions of dollars from some of the nation’s largest pharmaceutical companies for allegations of improper marketing, falsifying reports to inflate prices, and other wrongful practices. CA

March 2, 2017

New York announced the sentencing of two pharmacy owners, a supervising pharmacist and ten corporations for defrauding several government-funded healthcare programs, including Medicaid and Medicare. An investigation revealed that on at least eight separate occasions between November 2013 and February 2014, the defendants paid patients hundreds of dollars in cash to forgo their prescription medications, the vast majority of which were to treat HIV. The defendants then submitted false claims to Medicare, Medicaid and Medicaid-managed care organizations and were reimbursed for distributing the medications, despite the fact that they were never dispensed to patients. Tarek Elsayed, 50, of Elmhurst Queens, the co-owner of 184th Street Pharmacy in the Bronx, was sentenced in Bronx County Supreme Court by the Honorable Stephen Barrett to one to three years in state prison. Previously, in August of 2016, Ahmed Hamed, 39, of Elmhurst Queens, the second co-owner of 184th Street Pharmacy, was sentenced to two to six years in state prison. In October of 2016, Mohamed Hassan Ahmed, 38, of Bayside, the supervising pharmacist at 184th Street Pharmacy, was sentenced to one to three years in state prison and was required to surrender his license to practice pharmacy. Collectively, the three defendants stole over $10 million from government-funded health care programs. In addition, the Attorney General’s Medicaid Fraud Control Unit (MFCU) reached a $4.1 million civil settlement agreement with defendant Elsayed and a $3.8 million civil settlement agreement with defendant Hamed. NY