Medicare
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February 1, 2019
Ali Jama, co-owner of Alpha Star Health Care Inc., was sentenced to 18 months in prison for health care fraud and tax fraud schemes against Medicare and Medicaid. Jama billed the government for services performed by unqualified individuals with criminal backgrounds who were prohibited from providing direct care. Jama also billed for services provided by untrained home health aides and provided false documents and false records for his taxes to reduce his company’s tax liability from approximately $680,000 to $81,000. Jama has been ordered to forfeit $300,000 and pay $392,000 in restitution to Medicaid. He must also pay the IRS $311,000 in restitution. DOJJanuary 29, 2019
Two doctors and a health clinic owner in the Houston area have each been sentenced to decades in prison following their convictions for Medicare fraud. In one case involving three defendants—clinic owner Ann Shepherd, doctor John Ramirez, and Yvette Nwoko—Medicare paid over $17 million in fraudulent claims resulting from false certifications related to services not medically necessary or properly provided. Defendants Shepherd was sentenced to 30 years in prison, and ordered to pay $20 million; Ramirez was sentenced to 25 years in priosn and ordered to pay $26 million; Nwoko awaits sentencing. In a second case, related case, doctor Anh Do was sentenced to three years in prison and ordered to pay almost $2 million in restitution on similar charges. DOJ 1; DOJ 2January 29, 2019
Tennessee-based home dialysis provider WellBound of Memphis agreed to pay $3,246,000 to the State of Tennessee and the United States for allegedly submitting false claims to Medicare, TRICARE, and Tenncare from 2016 to 2018. According to a qui tam complaint filed by whistleblower Dr. Darryl Quarles, the claims resulted from illegal inducements for patient referrals, which violated the anti-kickback statute (AKS) and are not payable under state or federal laws. USAO WDTNJanuary 28, 2019
Avanti Hospitals LLC and six of its owners will pay $8.1 million to settle claims that they violated the False Claims Act by submitting, or causing Avanti’s subsidiary, Memorial Hospital of Gardena, to submit false claims to the Medicare and Medicaid programs for medical services referred by a physician who received kickbacks and other improper payments from Gardena and other Avanti affiliates. The settlement partially resolves allegations originally brought in a whistleblower lawsuit filed by Dr. Joshua Luke, the former C.E.O. of Gardena Hospital. DOJJanuary 28, 2019
Ademola O. Adebayo, of Odessa, FL, was convicted for his role in a massive compounding pharmacy fraud scheme through which he submitted false and fraudulent claims for compounded drugs and other prescription medications that were not medically necessary, never provided, or both. The evidence established that in his role as the pharmacist at A to Z Pharmacy, now-defunct, Adebayo conspired to submit or cause the submission of claims that often amounted to several thousands of dollars for a single tube of pain or scar cream. When the fraud was uncovered, Adebayo became the straw owner of Havana Pharmacy & Discount in Miami, where Adebayo and his co-conspirators continued the fraud. Adebayo personally benefited from the fraud and received $1.5 million. DOJJanuary 28, 2019
Norma Zayas, of Miami, was sentenced to 51 months in prison for her role in a $4.66 million health care fraud scheme involving several Miami-area home health agencies, including Sunshine Home Health Services Inc., Empire Home Health Agency Inc., Mildred & Marce Home Health Care Services Inc., and Nursing Care PRN Inc., which purported to provide home health services to Medicare patients. Zayas must also pay $4,658,241.00 in restitution and forfeit $186,650.50. Zayas admitted that from approximately January 2010 through approximately January 2014, she operated Sunshine, Empire, and Mildred & Marce Home Health and paid kickbacks to patient recruiters in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services. She also paid kickbacks to patient recruiters who referred Medicare beneficiaries to Nursing Care PRN. As a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of nearly $4.66 million. DOJTop Ten Healthcare Recoveries of 2018
Posted 01/15/19
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