Category: MM Curator

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: Michael McCormac stole about $5.5M of your tax dollars by paying kickbacks to “marketing companies” that drove prescriptions to his pharmacies.

Clipped from: https://www.kttn.com/former-missouri-pharmacy-owner-pleads-guilty-to-paying-kickbacks-for-prescriptions/

The former owner of a Creve Coeur pharmacy on Monday admitted paying illegal kickbacks to marketing companies to generate prescriptions for expensive medications.

Michael J. McCormac, 55, pleaded guilty in front of U.S. District Judge Rodney W. Sippel to two counts of violations of the Anti-Kickback Statute. 

At the time of the crimes, McCormac owned GoLiveWell Pharmacy, which operated primarily as a mail-order pharmacy supplying customers across the country. McCormac admitted striking deals with marketing companies in which GoLiveWell would illegally kick back a percentage of the pharmacy’s net profit on prescriptions obtained through the marketing companies’ efforts.

In exchange, the pharmacy received prescriptions obtained by the marketing companies in various ways, including by running ads in hopes that patients would “opt in” to receiving prescriptions for expensive drugs. The companies also engaged in the so-called “doctor chase,” in which they fax prescriptions to doctors’ offices in hopes that the doctors sign them.

Those prescriptions included topical creams, oral medications and antibiotic and antifungal “foot bath” drugs. Claims for payment for the drugs were submitted to federal health plans including Medicare and the Missouri Medicaid and Ohio Medicaid programs.

GoLiveWell paid one company 60 percent of the pharmacy’s net profit and another 45 percent. One month, GoLiveWell paid one marketing company $260,836.

In total, the government alleges that Medicare paid GoLiveWell $4.7 million to which it was not entitled, with another $490,000 coming from Missouri Medicaid and $330,000 from Ohio Medicaid.

McCormac is scheduled to be sentenced August 16. Each charge carries a potential penalty of up to 10 years in prison and a $100,000 fine. He will also be ordered to pay restitution.

The case was investigated by the Office of Inspector General for the United States Department of Health and Human Services, the Medicaid Fraud Control Units of Missouri and Ohio, and the Federal Bureau of Investigation.  Assistant U.S. Attorneys Meredith Reiter and Derek Wiseman are prosecuting the case.

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MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: Kyle Perkins stole $16,213.58 of your tax dollars using a mileage reimbursement scam to NH Medicaid.

Clipped from: https://www.doj.nh.gov/news/2023/20230427-kyle-perkins-medicaid-fraud.htm

Concord, NH – Attorney General John M. Formella announces that Kyle Perkins, age 30, of Concord has been indicted on additional charges of theft and Medicaid fraud in connection with fraudulent claims for non-emergency medical transportation services.

On April 11, 2023, the Merrimack County Grand Jury indicted Perkins on charges of Theft by Deception, Medicaid Fraud – False Claims, and Medicaid Fraud – False Records.

The indictments allege that between July 29, 2020 and March 9, 2023, Perkins, pursuant to one scheme or course of conduct, created false documentation to support claims for mileage reimbursement from an address he was not living at, resulting in false claims being filed with Medicaid and Perkins obtaining more than $1,500.00 in Medicaid funds.

Perkins was previously indicted on charges of theft and Medicaid fraud alleging that he submitted documentation to request mileage reimbursement for trips to medical visits that did not actually exist. The Medicaid Fraud Control Unit presented these new charges alleging that Perkins also submitted requests for mileage reimbursement using a false address to increase the reimbursement amount. In total, Perkins is alleged to have received $16,213.58 as a result of these fraudulent claims for mileage reimbursement.

The maximum penalty on the Theft by Deception charge, a class A felony, is 7½ to 15 years in the New Hampshire State Prison. The maximum penalty for the False Claims and False Records charges, both class B felonies, are each 3½ to 7 years in the New Hampshire State Prison.

Perkins will be arraigned in the Merrimack County Superior Court on May 15, 2023. The charges and allegations are merely accusations, and Perkins is presumed innocent unless and until proven guilty.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: Dacheng Lu and Taesung Kim stole $29M of your tax dollars by paying kickbacks to doctors (who took them) and to members (who took them) to help them submit a ton of bogus claims for their 4 pharmacies.

Clipped from: https://www.justice.gov/opa/pr/two-pharmacy-owners-charged-29m-health-care-fraud-scheme

An indictment was unsealed today in Brooklyn charging two New York men for their alleged participation in a scheme to submit false and fraudulent claims to Medicare and Medicaid for medically unnecessary prescriptions and over-the-counter products that were not actually dispensed, to pay illegal kickbacks and bribes, and to launder the proceeds of their scheme. 

According to court documents, Taesung “Terry” Kim, 58, of Purchase, and Dacheng “Bruce” Lu, 44, of Great Neck, partly owned and operated four pharmacies:  888 Pharmacy Inc. and Huikang Pharmacy Inc., located in Brooklyn, and Elmcare Pharmacy Inc. and NY Elm Pharmacy Inc., located in Flushing. Between January 2015 and December 2022, Kim and Lu allegedly conspired with others to submit false and fraudulent claims to Medicare and Medicaid for dispensing pharmaceutical and over-the-counter products that were medically unnecessary, procured by the payment of kickbacks and bribes, or not provided. Further, Kim and Lu allegedly conspired with others who paid illegal kickbacks and bribes, in the form of cash and supermarket gift certificates, to Medicare beneficiaries and Medicaid recipients who filled their prescriptions at their pharmacies. Kim and Lu also conspired with others to pay and paid illegal kickbacks and bribes, in the form of rent and office staff, to the doctors who prescribed the medically unnecessary medications filled at their pharmacies.

Kim and Lu also are alleged to have laundered the proceeds of their fraud through shell entities to generate cash that they could disperse as unrecorded profits to themselves and the pharmacies’ other owners and to pay kickbacks to pharmacy customers. As part of the scheme, Kim and Lu’s pharmacies submitted approximately $29 million in fraudulent claims to Medicare and Medicaid.

Kim and Lu are charged with conspiracy to commit health care fraud, conspiracy to commit money laundering, and conspiracy to pay illegal health care kickbacks and bribes. If convicted, they each face a maximum penalty of 10 years in prison for conspiracy to commit health care fraud, 20 years in prison for conspiracy to commit money laundering, and five years in prison for conspiracy to pay illegal health care kickbacks and bribes.

Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division, U.S. Attorney Breon Peace for the Eastern District of New York, Assistant Director in Charge Michael J. Driscoll of the FBI New York Field Office, and Special Agent in Charge Naomi Gruchacz of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

The FBI and HHS-OIG are investigating the case.

Trial Attorney Patrick J. Campbell and Acting Assistant Chief Miriam Glaser Dauermann of the Criminal Division’s Fraud Section are prosecuting the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at https://www.justice.gov/criminal-fraud/health-care-fraud-unit.

An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

MM Curator summary

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[MM Curator Summary]: This one adds up to $49M of your tax dollars lost. As we march forward into Medicaid paying rent, this is the prototype of many of the fraud stories we will see. Paul Fishbein got rent payments from the NY Housing agencies for properties he didn’t own- but moved people with rental-assistance benefits into.

Clipped from: https://www.justice.gov/usao-sdny/pr/real-estate-investor-convicted-defrauding-government-rental-assistance-and-medicaid

Damian Williams, the United States Attorney for the Southern District of New York, announced today’s conviction in federal court of PAUL FISHBEIN of multiple counts of fraud and aggravated identity theft.  FISHBEIN stole hundreds of thousands of dollars from rental assistance programs administered by New York City’s Human Resources Administration (“HRA”) and New York City’s Housing Preservation & Development (“HPD,” and with HRA, the “Agencies”) by renting out properties throughout the City that he falsely claimed to own and by collecting made-up broker fees.  FISHBEIN was also convicted of Medicaid fraud.  The jury convicted FISHBEIN today following a nearly two-week trial before U.S. District Judge Paul A. Crotty.

U.S. Attorney Damian Williams said:  “New York City assists millions of low-income and vulnerable New Yorkers through different types of programs, including rental assistance programs and Medicaid.  These programs were designed to help New Yorkers in need.  But, as a jury has now found, for years, Fishbein abused those programs to enrich himself.  To do that, he told lie after lie after lie.  He stole money, including federal funds, from the City’s rental assistance programs by lying about being the landlord of homes he didn’t actually own.  He stole the identity of a real estate broker to get the City to pay him made-up broker fees.  And he stole Medicaid benefits by lying to the City about how much money he made.  Today, a unanimous jury has held Fishbein accountable for his yearslong fraudulent schemes.”

According to the Indictment, documents previously filed in the case, and the evidence introduced at trial:

From in or about 2013 through May 4, 2021, FISHBEIN rented out properties in New York City to low-income New Yorkers through the Agencies’ rental assistance programs, collecting rent payments from the Agencies as the purported owner of the properties.  In fact, FISHBEIN was never the owner of those properties and lied to the Agencies to collect the rent payments.  In addition, FISHBEIN lied to HRA that he used the services of a real estate broker to rent out certain properties in order to collect broker fee payments from HRA, also through its rental assistance program.  FISHBEIN used an actual real estate broker’s license and name without her authority to collect these made-up broker fees from the City.  In-need New Yorkers were placed in these properties, which FISHBEIN, because he was not actually the owner of the properties, failed to maintain.  In one instance, the ceiling completely collapsed while a tenant and her family were living in a property FISHBEIN claimed to own.  Through these two schemes, FISHBEIN fraudulently obtained hundreds of thousands of dollars from HRA and HPD, including more than $90,000 in federal funds. 

FISHBEIN was also convicted of healthcare fraud because, from 2014 through May 4, 2021, he lied to New York City’s Medicaid program about how much money he made in order to collect Medicaid benefits.  Medicaid is meant for low-income New Yorkers.  FISHBEIN, each year, told the City that he made only $150 a week, or $7,200 a year, when in reality, he was raking in hundreds of thousands of dollars each year from his rental assistance and broker fee schemes described above.  By lying about his income and assets, the defendant received at least approximately $49,524.80 in Medicaid benefits to which he was not entitled.

*                *                *

FISHBEIN, 49, of Queens, New York, was convicted of one count of wire fraud, one count of mail fraud, one count of theft of government funds, one count of aggravated identity theft, and one count of healthcare fraud.  The wire fraud and mail fraud charges each carry a maximum sentence of 20 years in prison; the theft of government funds and healthcare fraud charges each carry a maximum sentence of 10 years in prison; and the aggravated identity theft charge carries a mandatory two-year sentence, which must run consecutive to any other prison term imposed.   

The maximum potential sentences in this case are prescribed by Congress and are provided here for informational purposes only, as any sentencing of the defendant would be determined by the judge.  FISHBEIN is scheduled to be sentenced by Judge Crotty on July 31, 2023.

Mr. Williams praised the outstanding investigative work of the New York City Department of Investigation.

This case is being handled by the Office’s General Crimes Unit.  Assistant U.S. Attorneys Sarah L. Kushner, Christy Slavik, and Jared Lenow are in charge of the prosecution and were assisted at trial by Paralegal Specialist Joseph Magliocco.

MM Curator summary

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[MM Curator Summary]: Julio Alvarado stole $20M of your tax dollars using a Medicaid transportation scheme. The bennies involved were glad to take his kickbacks in exchange for the info needed to bill for bogus trips.

Clipped from: https://www.jdsupra.com/legalnews/fraud-week-ny-transportation-company-5193658/

Transportation fraud isn’t new, but it’s new to Rivkin Rounds. The U.S. Attorney’s Office for the Southern District of New York recently announced that Yonkers resident Julio Alvarado was sentenced to 95 months in prison for leading a scheme that billed Medicaid for fraudulent transportation claims. From 2017 to 2020, KJ Transportation C Services Inc. collected more than $20 million for providing transportation services for Medicaid enrollees in the New York City area, many of which claims were fraudulent.

Some of the purported passengers were deceased or out of the country when KJ claimed it was transporting them to medical appointments. KJ also used stolen identities to bill for transporting people who had never heard of the company, and some Medicaid recipients were paid kickbacks for providing KJ their Medicaid information or allowing KJ to schedule and bill for fake trips for them.

Alvarado supervised more than a dozen other participants in the scheme and was responsible for billing more than $8 million of the fraudulent claims. In addition to the prison term, he was sentenced to three years of supervised release and ordered to pay $8,507,115 in restitution and to forfeit $8,507,115.

In addition, Ismat Farhan of Schenectady and his company, USA Medical Transport, recently agreed to pay $862,500 to settle false claims allegations. According to Attorney General Letitia James’ Office’s press release, Farhan submitted over 2,500 false claims and billed Medicaid for about $400,000 for transportation services that were not provided as described or at all, or did not have required documentation.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: Cornelius Edwards stole some of your tax dollars using bogus BH provider claims, we just don’t know how much yet.

Clipped from: https://www.inquirer.com/news/philly-medicaid-fraud-cornelius-edwards-20230427.html

Cornelius Edwards submitted fraudulent timesheets while working as a mental health professional for children with behavioral and mental health challenges.

File photo.Read moreDreamstime / MCT

A Philadelphia jury has convicted a former city worker of Medicaid fraud for falsely billing for services he did not provide as a mental health professional treating children, Pennsylvania Attorney General Michelle Henry announced Thursday.

Cornelius Edwards, 45, of Philadelphia, was found guilty on Monday of Medicaid fraud, theft by deception, and tampering with public records. Edwards is scheduled to be sentenced on June 26 by Common Pleas Court Judge Nicholas Kamau.

Edwards was released on his own recognizance after his 2019 arrest. A lawyer representing Edwards could not be reached for comment Thursday night.

Henry said in a news release that Edwards repeatedly submitted fraudulent time sheets while working as a mental health professional for children with behavioral and mental health challenges.

Between April 2014 and April 2018, Edwards was working for multiple community behavioral health providers as a licensed behavioral specialist consultant, a mobile therapist, and a lead clinician, Henry said.

He also was employed by the city Parks and Recreation Department during that time frame.

Henry said Edwards billed for individual services for more than one child at a time; individual services to children at their homes when he was providing school-based services; and therapy services for times while he was working for Parks and Recreation.

Henry did not provide a total dollar amount for how much Edwards stole.

“Maintaining mental health and wellness continues to be a challenge for young people. Instead of being part of the solution, Edwards abused this trust and defrauded the system for his own gain,” Henry said in a statement.

“This conduct was very obviously fraudulent and downright theft, and my office will not allow any individual to unlawfully abuse programs designed to help residents of the commonwealth,” Henry said.

MM Curator summary

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[MM Curator Summary]: Stefanie King stole $450k of your tax dollars using a bogus billing scam involving prescriptions that did not happen under the proper physician supervision.

Clipped from: https://www.attorneygeneral.gov/taking-action/case-update-bradford-county-nurse-practitioner-sentenced-to-10-years-of-probation-for-450k-in-prescription-fraud/

HARRISBURG – Attorney General Michelle Henry announced today that a Bradford County nurse practitioner was sentenced to ten years of restrictive probation after pleading guilty last month to prescribing medications without a collaborating doctor and false billing.

Stefanie King, 46, of Ulster, Pa., will serve ten years of probation, with the first six months on home confinement with an electronic monitor, and pay nearly $450,000 restitution.

King was sentenced Monday in Bradford County Court after pleading guilty last month to several felonies. Some of the criminal conduct happened while she was engaged in an inappropriate relationship with a patient.

King previously surrendered her Certified Registered Nurse Practitioner’s license.

“The defendant abused her position of trust by engaging in conduct that served herself and violated a system meant to assist our most vulnerable residents,” said AG Henry. “My office is committed to holding accountable those who put patients at risk and compromise our health care programs.”

The investigation found that King falsely billed in excess of $300,000 to private insurers, as well as $100,000 to the Commonwealth, for services below acceptable medical treatment standards. Additionally, she wrote over 3,750 prescriptions to patients while not meeting the requirements to prescribe under Pennsylvania law.

King entered into a sexual relationship with a patient beginning in November 2016 at her Athens practice and billed a private insurer for time they spent together not related to medical care. King later entered into a second relationship with a different patient and continued to prescribe controlled substances to him, despite discontinuing medical care after the relationship began.

Under Pennsylvania law, nurse practitioners are required to enter into collaborative agreements with Pennsylvania licensed physicians in order to perform medical diagnoses and to prescribe controlled substances. Investigators also found that King misled past physician collaborators and renewed previous agreements without their knowledge.

In all, King pleaded guilty to one felony count of violating the Controlled Substance Act- Obtained by Subterfuge; one felony count of Medicaid Fraud; one felony count of Insurance Fraud; and one felony count of violating the Controlled Substance Act- Delivery by Practitioner. She has agreed not to practice as a nurse for the duration of her sentence and voluntarily surrendered her license to practice as a Certified Registered Nurse Practitioner. She will pay restitution of $348,760 to Highmark and $100,425 to Community Care Behavioral Health Organization.

This case was prosecuted by Senior Deputy Attorney General Mark Bellavia and Senior Deputy Attorney General Christopher R. Sherwood.

The Pennsylvania Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $9,781,180 for Federal fiscal year (FY) 2023. The remaining 25 percent, totaling $3,260,392 for FY 2023, is funded by Pennsylvania.

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MM Curator summary

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[MM Curator Summary]: Aljihad Shabazz stole $4.7M of your tax dollars by stealing Medicaid member info to submit bogus claims for “community outreach programs” and other services that were never provided.

Clipped from: https://greensboro.com/community/rockingham_now/news/greensboro-clinic-owner-indicted-medicaid-fraud/article_d3b671a0-e7fa-11ed-987e-9ff1bbe1a5c2.html

AnnetteAyres

A Kernersville man who owns a Greensboro health care clinic was indicted for his alleged involvement in defrauding the North Carolina Medicaid Program of more than $4.7 million, according to Dena J. King, U.S. Attorney for the Western District of North Carolina.

The 10-count indictment charges Aljihad Shabazz, 44, with health care-fraud conspiracy, health care fraud, money-laundering conspiracy, and money laundering.

The federal indictment alleges that Shabazz owned and operated Reign & Inspirations, LLC (R&I), a Greensboro clinic that purportedly provided outpatient behavioral services in Greensboro and surrounding areas.

A summons has been issued and Shabazz will make an initial appearance in federal court. The health care fraud conspiracy and health care fraud offenses carry a maximum penalty of 10 years in prison per count. The money-laundering conspiracy and money laundering offenses carry a maximum penalty of 20 years in prison per count, according to information provided by the U.S. Attorney’s Office.

Shabazz could not be immediately reached Friday afternoon for comment. When someone answered a call placed to the publicly-listed phone number of the clinic, they said it was the “wrong number” for Shabazz.

According to allegations contained in the indictment, Shabazz allegedly conspired with other people between 2017 and 2020 to carry out an extensive health care fraud scheme involving the submissions of fake reimbursement claims to Medicaid, for services that were never provided to Medicaid beneficiaries.

Shabazz allegedly obtained the personal identifying information (PII) of Medicaid beneficiaries through community outreach programs, including football and mentoring programs, and misused the beneficiaries’ PII to create and submit hundreds of fraudulent reimbursement claims and to receive payment for services that were never in fact provided by R&I.

Shabazz and his co-conspirators allegedly used the beneficiaries’ PII to submit more than 1,500 fraudulent reimbursement claims to Medicaid, some of which claimed that R&I provided services that exceeded 24 hours in a single day.

The indictment also alleges that the reimbursement payments made by Medicaid were deposited in bank accounts under Shabazz’s control. Shabazz used a portion of the fraudulent proceeds to pay kickbacks to his co-conspirators and to cover personal expenses, including to pay for personal travel, luxury items, and timeshares, and to make cash withdrawals, among other things.