MM Curator summary

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[MM Curator Summary]: John, Rob and Richard stole $44M using a kickback scheme to drive revenues for their genetic testing lab.

 
 

Clipped from: https://www.upi.com/Top_News/US/2023/01/06/justice-department-charges-fraud-medicare-medicaid/7701673039406/

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Jan. 6 (UPI) — Three men have been charged with conspiring to defraud the federal government out of more than $107 million after submitting fraudulent genetic testing claims to Medicare.

A superseding indictment was opened Friday, charging John Grisham and Rob Wilburn, of Texas, and Richard Speights Jr., of Louisiana, the Justice Department said in a release.

The three men allegedly owned and operated a genetic testing laboratory in Lewisville, Texas between January 2018 and October 2019.

They are accused of acquiring thousands of Medicare beneficiaries’ DNA specimens and corresponding prescriptions, which Trinity Clinical Laboratories then used to fraudulently bill Medicare and Medicare Advantage for genetic testing.

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The sophisticated and nationwide health care kickback scheme allegedly netted some $44 million worth of Medicare reimbursements “due to the defendants’ payment and receipt of kickbacks and bribes,” according to the Justice Department.

Following a multi-agency investigation, all three men are now facing one count of conspiracy to defraud the United States and to pay and receive kickbacks and bribes.

Additionally, Grisham, 49, and Wilburn, 51, are each charged with six counts, and Speights Jr.,52, is charged with two counts of paying and receiving health care kickbacks and bribes.

If convicted, the men face 10 years in prison on each count of paying and receiving health care kickbacks and bribes and five years incarceration on the conspiracy count.

The investigation came under the umbrella of the national Health Care Fraud Strike Force Program.

Since March 2007, the program has charged more than 4,200 defendants who collectively have billed the Medicare program for more than $19 billion.

In November, the Justice Department charged 10 individuals in multiple states for defrauding healthcare providers, insurance companies, Medicare and Medicaid.

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MM Curator summary

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[MM Curator Summary]: Wafa Abboud used her non-profit to steal $1.4M by hiding monthly “consulting” payments to herself.

 
 

Clipped from: https://www.justice.gov/usao-edny/pr/former-executive-director-long-island-charity-sentenced-over-two-years-prison

Defendant and Co-Conspirators Used Multiple Schemes to Steal Over $1 Million from Non-Profit Agency Devoted to Assisting Developmentally Disabled Youth, Spending the Funds on Luxury Items

Earlier today, at the federal courthouse in Brooklyn, Senior United States District Judge Edward R. Korman sentenced Wafa Abboud to a term of imprisonment of 33 months.  As part of the sentence, Judge Korman also ordered Abboud to forfeit $836,000 and pay $1,415,000 in restitution to Human First, Inc. (Human First), the nonprofit agency that Abboud led for more than five years.  Abboud was convicted following a two-week jury trial in July 2019 of theft from programs receiving federal funds, bank fraud, and conspiracies to commit those crimes.  

Breon Peace, United States Attorney for the Eastern District of New York, announced the sentence.

“Stealing taxpayer money earmarked for developmentally disabled youth to pay for vacations, cosmetic surgery, and luxurious vacations is shameful,” stated United States Attorney Peace.  “Today, the defendant has been held accountable for betraying the most vulnerable among us whom she was entrusted to serve and treating the non-profit organization bank accounts as though they were her own.”

Mr. Peace thanked the Federal Bureau of Investigation, New York Field Office, for its investigative work on the case.

From January 2011 until her termination on May 27, 2016, Abboud was the Executive Director of Human First, a non-profit corporation that provided services to individuals with autism and other developmental disabilities. In that capacity, Abboud exercised nearly complete control over the charity’s finances.  During Abboud’s tenure, Human First received tens of millions of dollars annually from the New York State Office for People with Development Disabilities, which is funded in significant part by the Medicaid program.  The money was disbursed to Human First to support its mission of providing residential, rehabilitative, and other services to developmentally disabled youth. 

Abboud entered into an agreement with co-defendant Marcelle Bailey whereby Abboud caused Human First to pay Bailey’s company MPB Management Services LLC (MPB) approximately $16,000 per month in purported “consulting” fees.  Bailey deposited approximately half of each monthly disbursement into bank accounts that were controlled by Abboud, who used the money to fund a lavish lifestyle, including expensive international vacations, visits to luxury spas and high-end beauty salons and restaurants, and elective cosmetic surgeries.  Abboud also withdrew approximately $120,000 from the accounts in cash and wired tens of thousands of dollars in the account overseas. In total, Abboud stole approximately $420,000 between May 2011 and February 2016 through the MPB embezzlement scheme. 

Abboud also conspired with co-defendant Rami Taha to steal over $400,000 through a scheme in which Abboud deliberately issued overpayments to contractors performing work on Human First properties with the knowledge that the overpayment would be kicked back to her.  The overpayments were disguised through the use of inflated invoices submitted to Human First, and the payments to Abboud were hidden by transferring the funds through a number of sham bank accounts before ultimately depositing them into accounts controlled by Abboud.  Abboud used the stolen money to finance the down payment and renovation of her residence.  To conceal the true source of the funds, Abboud lied to her mortgage lender, falsely claiming that the funds were a settlement payment she had received for damage caused to her previous home. 

Bailey pleaded guilty to embezzlement and bank fraud in December 2017 and was sentenced by Judge Korman in August 2021 to 33 months in prison.  Taha pleaded guilty in May 2019 to embezzlement.  A fourth defendant, Arkadiusz Swiechowicz, pleaded guilty to obstruction of justice in September 2018.  Taha and Swiechowicz are awaiting sentencing. 

The government’s case is being handled by the Office’s Public Integrity Section.  Assistant United States Attorneys Robert Polemeni and Turner Buford are in charge of the prosecution.  Assistant United States Attorney Tanisha Payne of the Office’s Asset Recovery Section is handling forfeiture matters in the case. 

The Defendant:

WAFA ABBOUD
Age:  55
Merrick, NY

E.D.N.Y. Docket No. 16-CR-396 (ERK)

MM Curator summary

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[MM Curator Summary]: Phillips RS North America will pay $24M for its scam that paid DME companies kickbacks in the form of data that was valuable for marketing and sales.

 
 

Clipped from: https://news.delaware.gov/2023/01/11/delaware-to-receive-nearly-56000-for-alleged-false-claims-caused-by-respiratory-related-medical-equipment/

Delaware News

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Delaware has joined with other states and the federal government to reach an agreement in principle with Philips RS North America LLC, (formerly known as Respironics Inc.), a manufacturer of durable medical equipment (DME) based in Pittsburgh, Pennsylvania, to resolve federal False Claims Act and Delaware False Claims and Reporting Act (DFCRA) allegations that it misled federal health care programs by paying kickbacks to DME suppliers.

Respironics has agreed to pay over $24 million to resolve the allegations that affected Medicare, Medicaid and TRICARE, which is the health care program for active military and their families.  Of the total settlement amount, $4,826,250.00 will go to the Medicaid program.  Delaware’s Medicaid program will receive $55,688.54.

“Kickbacks result in improper claims being filed with Medicaid and other healthcare benefit programs, and drain precious resources that Medicaid recipients rely on,” Attorney General Jennings said.  “We will continue fighting against fraud, waste, and abuse against the government.”

The settlement resolves allegations that from November 1, 2014 through April 30, 2020, that Respironics caused DME suppliers to submit false claims to the Medicaid program for ventilators, oxygen concentrators, CPAP and BiPAP machines, and other respiratory-related medical equipment, when such claims were tainted by Respironics’ providing unlawful remuneration to these DME suppliers in the form of physician prescribing data (known as “HMS” or “Health Market Science data”), free of charge, knowing that this data may be of significant value to DME suppliers in their own marketing efforts.

This settlement arises from a qui tam action originally filed in October of 2019 and then amended in November of 2019 in the United States District Court for the District of South Carolina under the federal False Claims Act and various states’ statutes, including the DFCRA.

Delaware, along with representatives from the Offices of the Attorneys General for the states of Florida, Illinois, Indiana, New York, Pennsylvania, Tennessee, and Washington, assisted in leading a National Association of Medicaid Fraud Control Units (NAMFCU) team during the investigation and settlement negotiations with Respironics on behalf of the states.

The Attorney General’s 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 $2,023,800 for Federal FY 2022. The remaining 25 percent, totaling $674,595 for FY 2022, is funded by Delaware.

 
 

 
 

 
 

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Delaware to Receive Nearly $56,000 for Alleged False Claims Caused by Respiratory-Related Medical Equipment

Featured Posts | News | Date Posted: Wednesday, January 11, 2023
 

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Delaware has joined with other states and the federal government to reach an agreement in principle with Philips RS North America LLC, (formerly known as Respironics Inc.), a manufacturer of durable medical equipment (DME) based in Pittsburgh, Pennsylvania, to resolve federal False Claims Act and Delaware False Claims and Reporting Act (DFCRA) allegations that it misled federal health care programs by paying kickbacks to DME suppliers.

Respironics has agreed to pay over $24 million to resolve the allegations that affected Medicare, Medicaid and TRICARE, which is the health care program for active military and their families.  Of the total settlement amount, $4,826,250.00 will go to the Medicaid program.  Delaware’s Medicaid program will receive $55,688.54.

“Kickbacks result in improper claims being filed with Medicaid and other healthcare benefit programs, and drain precious resources that Medicaid recipients rely on,” Attorney General Jennings said.  “We will continue fighting against fraud, waste, and abuse against the government.”

The settlement resolves allegations that from November 1, 2014 through April 30, 2020, that Respironics caused DME suppliers to submit false claims to the Medicaid program for ventilators, oxygen concentrators, CPAP and BiPAP machines, and other respiratory-related medical equipment, when such claims were tainted by Respironics’ providing unlawful remuneration to these DME suppliers in the form of physician prescribing data (known as “HMS” or “Health Market Science data”), free of charge, knowing that this data may be of significant value to DME suppliers in their own marketing efforts.

This settlement arises from a qui tam action originally filed in October of 2019 and then amended in November of 2019 in the United States District Court for the District of South Carolina under the federal False Claims Act and various states’ statutes, including the DFCRA.

Delaware, along with representatives from the Offices of the Attorneys General for the states of Florida, Illinois, Indiana, New York, Pennsylvania, Tennessee, and Washington, assisted in leading a National Association of Medicaid Fraud Control Units (NAMFCU) team during the investigation and settlement negotiations with Respironics on behalf of the states.

The Attorney General’s 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 $2,023,800 for Federal FY 2022. The remaining 25 percent, totaling $674,595 for FY 2022, is funded by Delaware.

 
 

 
 

 
 

Keep up to date by receiving a daily digest email, around noon, of current news release posts from state agencies on news.delaware.gov.

Here you can subscribe to future news updates.

MM Curator summary

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[MM Curator Summary]: Stephanie, Quinetta and Bobby stole $134k claiming Quinetta was providing home health services while she was in jail.

 
 

 
 

Clipped from: https://www.denver7.com/news/local-news/3-colorado-woman-charged-in-medicaid-scheme-claiming-inmate-was-providing-in-home-care

 
 

DENVER — Three Colorado women were charged in an alleged Medicaid fraud scheme in which they claimed one provided home healthcare services to the others from prison. The total value of the theft is $134,235.25, according to the Colorado Attorney General’s Office.

Attorney General Phil Weiser today announced Monday that all three suspects — Stephanie Hudgins, 50, Quinetta Hunter, 40, and Bobby Hunter, 68 — were charged with several felony counts, including violation of the Colorado Organized Crime Control Act, money laundering, theft, and forgery.

According to Weiser, the alleged fraud occurred between Aug. 1, 2020, and June 6, 2022, when Quinetta Hunter was in custody at the La Vista Correctional Facility in Pueblo. The charges allege Hudgins and Bobby Hunter filed claims and received Medicaid reimbursement for home care services that did not occur.

Hudgins and Bobby Hunter claimed that Quinetta Hunter provided those services, but she was, and remains, in the custody of the Colorado Department of Corrections, according to a news release from the Colorado Attorney General’s Office.

Quinetta Hunter had previously worked for a Northglenn-based home care business that provided Medicaid-funded home services to patients.

All three suspects “worked together to submit falsified work timesheets and cash checks under Quinetta Hunter’s name, and then to pocket money paid by the business out of Colorado Medicaid funds,” the release read.

MM Curator summary

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[MM Curator Summary]: Richard Reid ran a kickback scheme that stole $6.5M for two labs.

 
 

Clipped from: https://www.justice.gov/usao-wdwa/pr/former-co-owner-and-sales-manager-defunct-medical-testing-lab-sentenced-prison

Illegally profited from kick-backs for referring government funded lab testing business

Seattle – A resident of Astoria, Oregon was sentenced today in U.S. District Court in Seattle to two years in prison for five federal felonies connected to his scheme to profit from illegal kickbacks in the medical testing industry, announced U.S. Attorney Nick Brown.  Richard Reid, 53, was convicted in March 2022, following a six-day jury trial.  At today’s sentencing hearing, U.S. District Judge John C. Coughenour denied a defense motion to postpone the prison sentence while Reid appeals his conviction.

“Mr. Reid was the architect of a scheme to illegally profit on toxicology tests that were paid for by government insurance,” said U.S. Attorney Brown. “The web of referrals and kick-backs led to significant profits for NWPL and its owners.  Such illegal kick-backs simply inflate medical costs for the rest of us.”

The activities of Bellevue-based Northwest Physicians Laboratory (NWPL) have been the subject of extensive civil and criminal litigation.  Richard Reid was one of the owners and the Vice President of Sales for NWPL.  Reid helped NWPL obtain more than $3.7 million in kickback payments by steering urine drug test specimens to two labs that could bill the government for testing. This resulted in government payments to those two labs of more than $6.5 million.

According to records filed in the case between January 2013 and July 2015, two labs, that were not physician owned, made payments to NWPL in exchange for referrals of Medicare and TRICARE program business, in violation of the Anti-Kickback Statute.  Paying remuneration to medical providers or provider-owned laboratories in exchange for referrals encourages providers to order medically unnecessary services.  The Anti-Kickback Statute functions, in part, to discourage such behavior. NWPL was physician-owned, and for that reason could not test urine samples for patients covered by government health programs such as Medicare, Medicaid, and TRICARE.  In order to conceal the payment of the kickbacks, Reid and other co-conspirators involved described the fees as being for marketing services; however, no marketing services were performed. 

In the sentencing memo asking that Reid receive the same two-year sentence as CEO Jae Lee, prosecutors described his role writing, “Reid hid the truth and kept the cover story in place by lying to his sales force, lying to providers, and sharing fraudulent opinion letters from attorneys.  NWPL grew and the money – including illegal kickbacks – rolled in.  The kickbacks increased as time went on, and totaled almost $5 million.  As the proceeds of the crime rose, so did Reid’s monthly distributions — from $10,000 in 2013 to $50,000 in 2015.” 

Reid was convicted of one count of conspiracy to solicit and receive kickbacks involving health care programs and four counts of receipt of kickbacks.

The company, NWPL, pleaded guilty in February 2021 and was sentenced to pay $8,114,417 in restitution joint and several with the other criminal defendants.  NWPL has dissolved. To date, the labs and individuals involved in this investigation have paid more than $14 million to settle related civil allegations. 

In addition to Reid, three other defendants have pleaded guilty and await sentencing.  Former NWPL CEO Jae Lee was sentenced to two years in prison in May 2022.  Kevin Puls, the former Executive Director of NWPL was sentenced to 90 days in prison and a year of supervised release.

“Mr. Reid’s sentencing culminates his part in a years-long investigation wherein he was convicted last year for actively orchestrating and personally benefiting from a scheme to corrupt and defraud the healthcare system, including the Department of Defense’s TRICARE program,” said Bryan D. Denny, the Special Agent in Charge of the DoD Office of Inspector General, Defense Criminal Investigative Service (DCIS), Western Field Office.  “DCIS will continue to work with its partners to root out fraudulent activities, like those in this particular investigation, that weaken TRICARE and inevitably increase costs unnecessarily.”

“Mr. Reid let his greed get in the way of doing what was right by taxpayers” said Richard A. Collodi, Special Agent in Charge of the FBI’s Seattle field office. “He solicited and received hundreds of thousands of dollars in kickbacks. Ultimately, frauds like these inflate health care costs for the rest of us. I applaud the work of our investigators and partners to hold Mr. Reid accountable, provide justice to the victims, and bring his crimes to an end.”

The case was investigated by the FBI, Health and Human Services Office of Inspector General (HHS-OIG), and the Defense Criminal Investigative Service (DCIS).

The case was prosecuted by Assistant United States Attorney Michael Dion and former Assistant United States Attorney Brian Werner.

MM Curator summary

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[MM Curator Summary]: In which the author says things we don’t want to hear.

Clipped from: https://www.nationalreview.com/2022/12/medicaids-improper-payments/

 
 

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Progressive health policy over the past decade has centered on expanding Medicaid. Unfortunately, this drive has undermined the original purpose of Medicaid and compromised the program’s integrity. Improper payments have spiraled out of control even as the government has systematically undercounted them.

The Centers for Medicare and Medicaid Services (CMS) recently released a report estimating $132 billion in annual improper payments in federal health-care programs. Over 60 percent of reported improper payments are from Medicaid, and CMS estimates that about 16 percent of Medicaid payments don’t follow program rules.

The operative word is “reported.” That’s because the actual level of improper payments is much higher than what the government is counting.

Efforts to uncover problems with eligibility have been notably lacking, even though eligibility problems are the primary reason for Medicaid’s improper payments. Since Medicaid is a welfare program only lawfully available to low-income Americans, verifying eligibility is vital.

From 2014 to 2017, as Obamacare’s expansion of the program began, the Obama administration halted Medicaid-eligibility reviews. In 2018, those reviews restarted, and the reported improper-payment rate soared. But CMS only did meaningful reviews for two years.

Between April and August 2020, it entirely halted improper-payment assessments. CMS has cited “COVID-19 flexibilities,” such as postponed eligibility determinations, as a factor in the decrease of reported improper payments from $99 billion in last year’s report (22 percent of all Medicaid payments) to $81 billion this year.

In short, Medicaid has become prone to improper payments while the government refuses to measure them accurately.

The government’s failure to confirm Medicaid eligibility before enrollment is egregious, particularly since expanded eligibility over the past decade has transformed the program. Medicaid was originally designed to assist the most vulnerable Americans: low-income pregnant women, children, seniors, and individuals with disabilities. However, Obamacare offered states generous financial incentives to expand Medicaid to able-bodied, working-age adults. These incentives resulted in massive increases in Medicaid enrollment and spending in states that adopted the Obamacare expansion — accompanied by a significant increase in improper payments.

Covid-19 policies have caused the program to swell further. Congress explicitly forbade states from updating their eligibility criteria or removing ineligible Medicaid enrollees during the Covid-19 public-health emergency. Once again, it deployed federal subsidies to entice them to comply. Even though the pandemic is over, the Biden administration has refused to end the official emergency; Medicaid rolls continue to swell, with one-in-four Americans on this welfare program.

Just from the Obamacare expansion, Medicaid already had a flood of spending on ineligible individuals. An Inspector General audit from 2014 to 2015 estimated that just two states (California and New York) made more than $6 billion in Medicaid payments for 5.4 million enrollees who were either ineligible or did not have their eligibility adequately reviewed. And the problem is much worse today.

This disregard for taxpayer dollars is particularly scandalous as the country grapples with ballooning deficits and 40-year high inflation. But it isn’t just a matter of dollars and cents.

Medicaid expansion has devoted more resources to able-bodied working-age adults rather than the neediest people for whom Medicaid was originally intended. In a program where long wait times are nothing new, this means a further deterioration in quality. The combination of improper payments and deficient audits point to deep programmatic mismanagement, not to mention broken policy priorities.

There is much to fix in Medicaid, and the task is so much more arduous when the federal government downplays the problem. Eligible recipients, as well as taxpayers footing the bill for Medicaid, deserve better than this mismanagement and careless spending. The new Republican House majority should investigate the Biden administration’s policies that have contributed to improper payments and the steps taken to downplay the problem.

Brian Blase, who served as a special assistant to President Trump at the National Economic Council, is president of Paragon Health Institute. Joe Albanese is a policy analyst at Paragon Health Institute.

MM Curator summary

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[MM Curator Summary]: The NY home health agency pocketed the extra money it was supposed to give to workers. $2M of it.

 
 

Clipped from: https://ag.ny.gov/press-release/2022/attorney-general-james-secures-over-3-million-home-health-agency-cheating-workers

White Glove Community Care Fraudulently Obtained More Than $1 Million
in Medicaid Funds and Failed to Pay Required Wages to Employees

Company Agrees to Pay $1.2 Million to Medicaid Program
and
Return $2 Million to Current and Former Employees

NEW YORK – New York Attorney General Letitia James today announced two agreements with White Glove Community Care, Inc. (White Glove), a Brooklyn-based home health agency, for causing false claims to be submitted to Medicaid and cheating employees out of hard-earned wages. Under the agreements, one reached with the Office of the Attorney General’s (OAG) Labor Bureau and the other with OAG’s Medicaid Fraud Control Unit (MFCU), White Glove will return $2 million in unpaid wages to workers and pay $1.2 million to the New York State Medicaid Program (Medicaid). White Glove has admitted to wrongful conduct. The United States Attorney’s Office for the Eastern District of New York (EDNY) is also party to the settlement resolving White Glove’s Medicaid fraud liability.

“Home health aides work tirelessly to provide critical care for our most vulnerable neighbors, and they deserve to receive adequate and fair compensation for their hard work,” said Attorney General James. “White Glove cheated their employees, and they cheated the everyday New Yorkers whose tax dollars fund the Medicaid program. My office will always stand up against bad actors, and ensure all workers get fair pay for their work.”

“The arduous work that these aides do, day after day, ensures that some of our most vulnerable neighbors receive the care and are shown the dignity that they deserve,” said United States Attorney Peace. “This settlement — the third in our continuing investigation of certain licensed home care service agencies — reflects this Office’s ongoing commitment to providing home health aides the hard-earned benefits guaranteed them under New York law and the Medicaid program.”

The New York Wage Parity Act sets wage and benefit minimums that state-licensed home care services agencies (LHCSAs) are required to pay to employees who perform home health aide and personal care services to Medicaid recipients. Under the law, workers are entitled to a base wage of $17.00 per hour, paid by the agencies, in New York City, Nassau, Suffolk, and Westchester counties, or $15.20 per hour for the remainder of the state, and an additional fringe benefit of $4.09 per hour in New York City or $3.22 per hour in Nassau, Suffolk, and Westchester counties. The Medicaid program reimburses LHCSAs for the cost of services provided to Medicaid recipients, and reimbursement is conditional on the agency’s compliance with the requirements of the Wage Parity Act.

The joint investigation by OAG and EDNY found that White Glove failed to pay its home health aides and personal care aides the required wages and benefits owed to them pursuant to the Wage Parity Act; sought payment from Medicaid and received money for care performed by aides who were underpaid; and falsely certified compliance with the Wage Parity Act.

Between March 2012 and December 2018, White Glove underpaid its home care aides. As a result of the settlement announced today, White Glove will pay a total of $2 million to OAG for distribution to current and former employees.

White Glove will also revise company policies and procedures; train personnel on updated policies subject to OAG’s approval; and regularly report staff wages and policy implementations to OAG for a period of three years. If White Glove fails to comply with these terms or properly compensate its aides, OAG has the authority to bring a civil action against the agency and demand $15,000 in damages for violating its legal obligations.

White Glove will also pay more than $1.2 million to the Medicaid Program, of which $758,425.47 will go to New York state. The remaining $505,616.98 will be paid to the federal government.

The OAG and EDNY commenced these investigations after whistleblowers filed a complaint under the qui tam provisions of the New York False Claims Act and the federal False Claims Act in the United States District Court for the Eastern District of New York. The New York False Claims Act allows individuals to file actions on behalf of the government and share in any recovery. The state has since filed a notice of intervention against White Glove for the purposes of settling its Medicaid fraud claims.

Attorney General James thanks United States Attorney Peace and EDNY for their collaboration on this matter.

MFCU’s total funding for federal fiscal year (FY) 2023 is $65,717,936. Of that total, 75 percent, or $49,288,452, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $16,429,484 for FY 2023, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.

This matter was handled for MFCU by Special Assistant Attorneys General Ting Ting Tam, Jill D. Brenner, and Hillary G. Chapman under the supervision of MFCU Civil Enforcement Division Chief Alee N. Scott. The cases were investigated by Principal Auditor Investigator Milan Shah and Auditor-Investigator Khristian Diaz under the supervision of Regional Chief Auditor Stacey Millis. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. MFCU is a part of the Division for Criminal Justice, led by Chief Deputy Attorney General José Maldonado.

This matter was handled for the Labor Bureau by Assistant Attorneys General Anielka Sanchez Godinez and Kristen Ferguson with the assistance of Civil Enforcement Section Chief Fiona J. Kaye and Former Civil Enforcement Section Chief Ming-Qi Chu, under the supervision of former Deputy Bureau Chief Julie Ulmet and Bureau Chief Karen Cacace. Additional Assistance was provided by Data Scientist Chansoo Song and Deputy Director Megan Thorsfeldt of the Research and Analytics Department. The Labor Bureau is a part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux.

Both the Division for Criminal Justice and the Division for Social Justice are overseen by First Deputy Attorney General Jennifer Levy.

MM Curator summary

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[MM Curator Summary]: States (and their counties) continue to not use the fraud fighting tools available to them.

 
 

 
 

Clipped from: https://www.13abc.com/2022/12/13/ohio-medicaid-ripped-off-millions-counties-could-have-stopped-it-auditor-says/

 
 

A report from the Ohio Auditor of State found that county offices are not reacting to alerts, that Medicaid recipients may be getting payments and benefits from multiple states.

CLEVELAND, Ohio (WOIO) –The Ohio Auditor of State released a report Tuesday looking into Ohio Medicaid recipients who have been getting payments and or benefits, from multiple states which is not allowed.

Auditor Keith Faber says counties, who sign up and review Medicaid recipients had been getting alerts from the federal level when people were identified as “double dippers.”

Alerts are sent to each county by a program called Public Assistance Reporting Information System (PARIS), a monitoring program aimed to catch people enrolled in multiple states.

Since following the alerts in July of 2022, the auditor’s office claims 59% of the alerts were not acted upon meaning several Ohio Medicaid recipients continued to get benefits from multiple states.

According to the report, failure to act cost Ohio and taxpayers somewhere between $5.3 million and $24.5 million annually.

“There continue to be ongoing oversight issues in Ohio’s Medicaid programs that should have been addressed,” Auditor Faber said. “It’s past time to deal with these problems.”

There are approximately 2.9 million Ohioans enrolled in Medicaid who are lower income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others.

According to a news release from the auditor’s office, “Tuesday’s report follows a separate audit released in January 2022 that found the Ohio Department of Medicaid (ODM) failed to recoup more than $118.5 million in erroneous duplicate payments or improperly paid for the managed care of prison inmates and deceased residents over a three-year period.”

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[MM Curator Summary]: You paid $2.6M for this guy in CT to bill Medicaid for services not rendered, including to dead patients, or patients who were in the hospital at the time and could not receive his services. Oh yeah- he got kicked out of Medicare 15 years ago for fraud, but Medicaid was happy to pay him.

 
 

Clipped from: https://www.justice.gov/usao-ct/pr/greenwich-psychologist-admits-defrauding-medicaid-medicare-and-private-insurers

Vanessa Roberts Avery, United States Attorney for the District of Connecticut, Phillip Coyne, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of Inspector General, and David Sundberg, Special Agent in Charge of the New Haven Division of the Federal Bureau of Investigation, today announced that MICHAEL LONSKI, 71, of Greenwich, waived his right to be indicted and pleaded guilty yesterday before U.S. District Judge Sarala V. Nagala in Hartford to health care fraud.

According to court documents and statements made in court, Lonski is a licensed psychologist who, along with another licensed psychologist (“Individual 1”), has operated a practice out of his home office in Old Greenwich.  Lonski and Individual 1 were authorized providers for the Connecticut Medicaid program (“Medicaid”), Medicare and other health care benefit programs.  Lonski assumed responsibility for submitting claims for reimbursement for services allegedly provided by himself and by Individual 1, both at their home office and at various skilled nursing facilities within Connecticut.

In pleading guilty, Lonski admitted that he billed insurers for services that he knew were not rendered, including by billing for patients who were deceased, for dates of service when he was out of the country, for dates of service when Individual 1 was out of the country, and for dates of service when he was hospitalized.  These fraudulent claims resulted in a loss of over $2,651,296, including a loss of $1,157,292 to the Connecticut Medicaid program and a loss of $119,092 Medicare.

Health care fraud carries a maximum term of imprisonment of 10 years.  Judge Nagala scheduled sentencing for March 10.  As part of his plea, Lonski has agreed to pay full restitution.

Lonski is released on bond pending sentencing.

In 2002, Lonski settled a federal lawsuit alleging health care fraud offenses, which was brought by the government in the Southern District of New York.  Lonski agreed to pay $4 million in restitution and was excluded from participating in the Medicare program from April 2003 to November 2007.  He was reinstated to the Medicare program in approximately December 2008.

This investigation has been conducted by the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG), and the Federal Bureau of Investigation. The case is being prosecuted by Assistant U.S. Attorney Susan L. Wines.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.