Tag: Fraud

MM Summary – An Arizona government employee ran an illegal adoption scheme that paid pregnant immigrants to come to the U.S. and sell their babies. In the process, he stole $800,000 from Medicaid.

 
 

A former Arizona politician must report to prison Thursday to begin serving the first of three sentences for running an illegal adoption scheme

PHOENIX — A former Arizona politician must report to prison Thursday to begin serving the first of three sentences for running an illegal adoption scheme that paid pregnant women from the Marshall Islands to come to the U.S. to give up their babies.

Paul Petersen, a Republican who served as Maricopa County assessor for six years and also worked as an adoption attorney, was sentenced to six years after pleading guilty in federal court in Arkansas to conspiring to commit human smuggling.

Petersen, who has acknowledged running the adoption scheme, is awaiting sentencing in state courts in Arizona for fraud convictions and in Utah for human smuggling and other convictions. Sentencing dates have not yet been set for those cases.

Prosecutors have said Petersen illegally paid women from the Pacific island nation to give up their babies in at least 70 adoption cases in Arizona, Utah and Arkansas. Marshall Islands citizens have been prohibited from traveling to the U.S. for adoption purposes since 2003.

Petersen’s attorney, Kurt Altman, did not immediately respond to phone and email messages seeking comment.

Petersen will serve his sentence in the Arkansas case at a federal prison near El Paso, Texas.

The judge gave him two years longer in prison than sentencing guidelines recommended, describing Petersen’s adoption practice as a “criminal livelihood” and saying Petersen knowingly made false statements to immigration officials and state courts in carrying out the scheme.

Petersen has appealed the punishment.

In Arizona, he pleaded guilty to fraud charges for submitting false applications to the state’s Medicaid system so the birth mothers could receive state-funded health coverage — even though he knew they didn’t live in Arizona — and for providing documents to a juvenile court that contained false information.

Petersen has said he has since paid back to the state $670,000 of more than $800,000 in health care costs that prosecutors cited in his indictment.

Earlier in his life, Petersen, who is a member of The Church of Jesus Christs of Latter-day Saints, had completed a proselytizing mission in the Marshall Islands, a collection of atolls and islands in the eastern Pacific, where he became fluent in the Marshallese language.

He quit his elected job as Maricopa County’s assessor last year amid pressure from other county officials to resign. As assessor, Petersen was responsible for determining property values in the county that encompasses Phoenix.

Clipped from: https://abcnews.go.com/Politics/wireStory/arizona-politician-adoption-scheme-head-prison-75372421

MM Summary – A TX hospice stole $1.8M using a provider kickback scheme.

 
 

The founders of Texas-based Allstate Hospice and Verge Home Health Care have paid more nearly $1.85 million following a fraud investigation pertaining to the Stark Law. Onder Ari and Sedat Necipoglu have been accused of engaging in improper payments to physicians for hospice referrals.
 

The Physician SelfReferral Law, commonly known as the Stark Law, forbids health care providers from billing Medicare for certain services referred by physicians with whom the entity has a financial relationship, unless that relationship satisfies one of the law’s statutory or regulatory exceptions. Also at issue in the case is a law known as the AntiKickback Statute, which prohibits offering or paying remuneration to induce the referral for services covered by Medicare, Medicaid and other federally-funded programs.
 

“Paying physicians to steer patients to one provider over another unacceptably subverts patient choice,” said Special Agent in Charge Miranda Bennett of the U.S. Department of Health and Human Services – Office of Inspector General (OIG). “We will continue to work with our law enforcement partners to investigate improper payments to physicians to protect patients and the integrity of the programs from unscrupulous acts.”
 

OIG conducted the fraud investigation in conjunction with the FBI and the U.S. Attorney’s Office.
 

The U.S. Centers for Medicare & Medicaid Services and the U.S. Department of Justice in recent years have increasingly scrutinized hospice providers for compliance with anti-fraud measures such as the Stark Law and the False Claims Act. because of live discharges and re-certifications. These issues have resulted in an increasing number of CMS audits, OIG investigations and litigation. A 2019 Optima Health survey found that fewer than 50% of hospice providers felt prepared to respond to such scrutiny.

A report from Bass, Barry, and Sims indicated that a leading cause of hospice involvement in fraud cases result from allegations that the organization in question billed Medicare for services for which patients were not eligible. This resulted in several multi-million dollar settlements during 2018, with amounts ranging from $1.24 million to $8.5 million.

 
 

The Allstate/Verge investigation began in 2016 and determined that Ari and Necipoglu had compensated physicians who had issued most referrals for those companies, according to the Justice Department. They allegedly made monthly payments to physicians pursuant to medical directorship agreements with Allstate and Verge. Those payments were in excess of fair market value for the services the physicians actually provided, the Justice Department indicated.

“The FBI is committed, along with its partners, to taking action to eliminate improper relationships and inducements that can corrupt the integrity of physician decision-making and increase health care costs,” said Special Agent in Charge Christopher Combs, FBI San Antonio Division. “Along with criminal prosecution, the FBI will also pursue administrative and civil remedies.”
 

Clipped from: https://hospicenews.com/2021/01/20/allstate-hospice-founders-settle-fraud-case-for-1-8-million/

 
 

MM Summary – An Ohio man awaits trial for stealing $2M from Medicare and Medicaid by billing for X-ray services he did not provide.

 
 

 
 

A federal case alleging roughly $2 million in Medicaid and Medicare fraud is still pending for a Lake Township man after more than a year.

Thomas G. O’Lear, 56, was indicted in June 2019 in U.S. District Court in Cleveland on 25 counts of health care fraud and a single count of false statements relating to health care matters.

A pretrial conference/change of plea hearing scheduled for Thursday was continued until April 20, following a series of other delays, most of them requested by defense attorneys because of the COVID-19 pandemic and the need to further review the evidence and discuss a potential plea agreement, according to court records.

A trial also could be scheduled at the April hearing.

Federal prosecutors accuse O’Lear of billing for X-ray services that were not provided by his company, Portable Radiology Services, according to the U.S. Attorney’s Office for the Northern District of Ohio.

O’Lear previously pleaded not guilty to all charges. Judge Dan Aaron Polster is presiding over the case.

Messages seeking comment were left Thursday afternoon with O’Lear’s attorneys with the federal public defender’s office in Cleveland.

COVID-19 cited for extensions

In November, O’Lear was granted a 60-day continuance for a pretrial/change of plea hearing. Federal prosecutors did not oppose the request.

Defense attorneys said in court records that more time was needed for further investigation, including consulting with a forensic expert. Time also was needed for attorneys to meet virtually with their client to discuss the conclusions, according to court records.

“The COVID-19 pandemic has hindered this process significantly,” the defense filing said.

Similar extensions had been granted in March, May, July and September last year. COVID-19 also was cited in those filings both generally and because the pandemic has prevented defense attorneys from meeting with O’Lear.

Accused of fraud scheme

O’Lear was president of Portable Radiology Services (PRS), with locations on 20th Street NW in Canton, Kennemer Circle NW in Lake Township, Coblentz Avenue NW in Lake Township and Cleveland, according to federal court records.

PRS provided portable X-ray related services to residents of nursing homes, skilled nursing facilities and long-term care facilities, according to the indictment.

The false billing is alleged to have occurred between January 2013 and December 2017.

O’Lear is accused of fraudulently billing the Ohio Medicaid Program and Medicare roughly $3.8 million for the claims and the Ohio Medicaid Program and Medicare paid the defendant roughly $2 million, according to the indictment.

O’Lear is accused of submitting false claims to Medicare and the Ohio Medicaid Program for services to beneficiaries at nursing facilities that PRS did not provide, including billing on about 150 occasions for having provided X-ray related services to patients on dates after the person had died.

The defendant is also accused of trying to cover up the health care fraud scheme by forging the signatures of medical professionals and falsely making it appear the billings were tied to services actually provided to patients.

The investigation was conducted by the U.S. Department of Health and Human Services, the Office of the Inspector General, the FBI and a special agent of the Medicaid Fraud Control Unit of the Ohio Attorney General’s Office.

 
 

Clipped from: https://www.cantonrep.com/story/news/2021/01/21/case-has-been-continued-lake-township-man-facing-fraud-charges/4202670001/

MM Summary- A medical equipment company stole $40M from Florida Medicaid by billing for unnecessary ventilators.

 
 

 
 

Apria Healthcare, a medical equipment provider with more than 300 offices across the U.S., will pay $40 million to settle billing fraud allegations, the Florida attorney general’s office said.

According to prosecutors, Apria submitted false claims to state Medicaid programs for noninvasive ventilators that patients didn’t use or were not medically necessary. The alleged billing fraud took place from January 2014 to December 2019. 

The allegations were originally brought under the whistleblower provisions of the federal False Claims Act.

“We will not allow bad actors to falsify forms or blatantly bill Florida taxpayers for services never rendered or not medically necessary. I am proud of the role my Medicaid Fraud Control Unit played in investigating this multimillion dollar fraudulent billing scheme inflicted on taxpayers in Florida and across our country, and the recovery of more than $40 million,” said Florida Attorney General Ashley Moody.

“We are pleased to have resolved this civil matter and fully cooperated throughout the review. This settlement relates primarily to whether patients made sufficient use of non-invasive ventilators, prescribed by physicians for use in patients’ homes, and was based largely on data from the early years of the company’s NIV program. Prior to becoming aware of the government’s interest in the matter in 2017, Apria had already made a number of changes to the NIV program’s processes and procedures relating to patient usage in the home. As always, our patients are our top priority and we remain committed to providing outstanding care and exceptional service,” an Apria spokesperson told Becker’s Hospital Review. 

 
 

Clipped from: https://www.beckershospitalreview.com/legal-regulatory-issues/apria-healthcare-to-pay-40m-to-settle-billing-fraud-allegations.html

MM Summary- A Maryland woman stole $250,000 from D.C. Medicaid by submitting false timesheets for home care services.

 
 

 
 

            WASHINGTON – Janet Olatimbo Akindipe, 62, of Laurel, Maryland, was sentenced today to 13 months in prison for defrauding the D.C. Medicaid program out of more than a quarter million dollars.

            The announcement was made by Acting U.S. Attorney Michael R. Sherwin; James A. Dawson, Special Agent in Charge, FBI Washington Field Office, Criminal Division; Maureen R. Dixon, Special Agent in Charge of the U.S. Department of Health and Human Services’ Office of Inspector General for the region that includes Washington, D.C.; and Daniel W. Lucas, Inspector General for the District of Columbia.

            At various times between November 2014 and June 2020, Akindipe was employed by six different home health agencies to serve as a personal care aide for D.C. Medicaid beneficiaries. The home health agencies employed Akindipe to assist Medicaid beneficiaries in performing activities of daily living, such as getting in and out of bed, bathing, dressing, and eating. Akindipe was supposed to document the care she provided to the Medicaid beneficiaries on timesheets and then submit the timesheets to the home health agencies, which would in turn bill Medicaid for the services that she rendered.

            Between January 2015 and June 2020, Akindipe caused the D.C. Medicaid Program to issue payments totaling $269,808 for services that she did not render. As part of her fraud scheme, she submitted false timesheets to different home health agencies purporting that she provided personal care aide services that she did not provide. She claimed she provided such services during times when she actually was working her shift as a full-time employee at the National Institutes of Health. She claimed to work more than twenty hours in a given day on more than 300 occasions. She also claimed to provide personal care aide services in the District of Columbia on days when she was not even in the United States. As part of her fraud scheme, she paid kickbacks to get Medicaid beneficiaries to sign falsified timesheets.

            In addition to sentencing Akindipe to 13 months in prison, she was also ordered to serve three years of supervised release and pay restitution in the amount of $269,808 and a forfeiture money judgment for $119,773.

            The FBI, the Department of Health and Human Services’ Office of Inspector General, the District of Columbia’s Office of the Inspector General’s Medicaid Fraud Control Unit, and the U.S. Attorney’s Office are committed to investigating and prosecuting individuals who defraud the D.C. Medicaid program. Since October 2019, six former personal care aides, including Akindipe, have been sentenced in U.S. District Court for defrauding Medicaid. A seventh former personal care aide is expected to plead guilty. Cases against two other personal care aides remain outstanding. 

            The government counts on the public for tips and assistance in helping stop health care fraud. If you have information about individuals committing health care fraud, please call the Department of Health and Human Services’ Office of Inspector General hotline at (800) HHSTIPS [(800) 447-8477].

            Assistant U.S. Attorney Kondi Kleinman of the Fraud Section prosecuted the case.

 
 

Clipped from: https://www.justice.gov/usao-dc/pr/maryland-woman-sentenced-committing-health-care-fraud-government-continues-crackdown

MM Summary – A NY couple hid their income so they could get SNAP benefits and stole $17,000.00

 
 

 
 

STATEN ISLAND, N.Y. — A couple formerly from Great Kills accused of welfare fraud is on the hook for over $17,000 in restitution after reaching a plea agreement with prosecutors.

But Yousef Shihadeh and Rihana Musleh would avoid jail if they pony up the cash.

The defendants carried out the scheme between January 2012 and September 2015, an indictment said.

The couple was living on the 100 block of Sandalwood Drive then, said a criminal complaint.

They resided in New Springville when arrested in March 2019, police said.

The complaint said Musleh submitted documents containing false information to obtain Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits.

SNAP benefits were previously known as food stamps.

Musleh failed to report Shihadeh’s income and financial resources to secure the benefits, said the complaint.

Shihadeh, 51, and Musleh, 43, were accused of grand larceny, welfare fraud and offering a false instrument for filing.

Shihadeh pleaded guilty on Tuesday in state Supreme Court, St. George, to a felony count of offering a false instrument for filing.

Musleh pleaded guilty to felony and misdemeanor counts of that charge.

Under their agreements, the defendants must fork over $17,139 to the city Human Resources Administration.

If they pay up by Aug. 1, 2022, the felony charge against Musleh will be vacated, and she’ll be sentenced to a conditional discharge on the misdemeanor conviction.

Shihadeh would also be sentenced to a conditional discharge, but on the felony conviction.

The couple potentially faced up to 28 months to seven years in prison had they gone to trial and been convicted of the top grand-larceny or welfare-fraud charge.

Biju Koshy, Musleh’s lawyer, declined comment on the case.

Matthew Santamauro, Shihadeh’s attorney, could not immediately be reached for comment.

Assistant District Attorney Joshua Freeman is prosecuting the case.

 
 

Clipped from: https://www.silive.com/crime/2021/01/former-great-kills-couple-agree-to-fork-over-to-resolve-welfare-fraud-case.html

MM Summary- A Mississippi man stole $287M from Tri-Care using his compounding pharmacy scheme to get paid for prescriptions that were not medically necessary. He also paid doctors kickbacks to participate in the scheme.

 
 

 
 

A Mississippi businessman was sentenced today for his role in a multimillion-dollar scheme to defraud TRICARE, the health care benefit program serving U.S. military, veterans, and their respective family members, as well as private health care benefit programs.

Wade Ashley Walters, 54, of Hattiesburg, a co-owner of numerous compounding pharmacies and pharmaceutical distributors, was sentenced today on his guilty plea to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. U.S. District Judge Keith Starrett of the Southern District of Mississippi ordered Walters to serve a total of 18 years in prison and to pay $287,659,569 in restitution. Walters was remanded into custody following the sentencing hearing. Walters was further ordered to forfeit $56,565,963, representing the proceeds he personally derived from the fraud scheme.

“The fraud committed by Walters and others in this investigation wasted hundreds of millions of taxpayer dollars and deprived individuals of needed medical care,” said David P. Burns, Acting Assistant Attorney General of the Justice Department’s Criminal Division. “Today’s significant sentence signifies that we will continue to stand with our agency partners to root out health care fraud schemes and see their perpetrators brought to justice.”

Between 2012 and 2016, Walters orchestrated a scheme to defraud TRICARE and other health care benefit programs by distributing compounded medications that were not medically necessary. As part of the scheme, Walters and his co-conspirators, among other things, adjusted prescription formulas to ensure the highest reimbursement without regard to efficacy; solicited recruiters to procure prescriptions for high-margin compounded medications and paid those recruiters commissions based on the percentage of the reimbursements paid by pharmacy benefit managers and health care benefit programs, including commissions on claims reimbursed by TRICARE; solicited (and at times paying kickbacks to) practitioners to authorize prescriptions for high-margin compounded medications; routinely and systematically waived and/or reduced copayments to be paid by beneficiaries and members, including utilizing a purported copayment assistance program to falsely make it appear as if the pharmacies were collecting copayments.

“Today’s sentencing is another mile marker on the long road to justice for victims, our veterans, our military, and all American taxpayers, as the mastermind of the largest healthcare fraud scheme in Mississippi history has been held to answer for his crimes,” said Mike Hurst, U.S. Attorney for the Southern District of Mississippi. “I want to commend our prosecutors, Justice Department trial attorneys, and every member of this incredible team of federal, state, and local law enforcement agencies for discovering this scheme and bringing all of these criminals to justice. While there is more work to do, the public can rest assured that we will continue to hold evildoers to account and that justice will always be done in the Southern District of Mississippi.”

“This scheme to defraud TRICARE out of hundreds of millions of dollars not only diverted taxpayer money from essential services and medical care but victimized the brave men and women who selflessly serve or have served our country,” said Michelle Sutphin, Special Agent in Charge of the FBI’s Jackson Field Office. “The investigation into this specific scheme, which now spans across multiple states and FBI field offices, began in the FBI’s Jackson Field Office. I am incredibly proud of the relentless efforts made by our Special Agents, Intelligence Analysts and professional support staff, but also the assistance from our partner agencies which make cases like this successful. The FBI and our law enforcement partners are committed to seeking those that intend to steal from others for their own financial gain.”

“IRS Criminal Investigation provides financial investigative expertise in our work with our law enforcement partners, said James E. Dorsey, Special Agent in Charge of IRS Criminal Investigation (CI), Atlanta Field Office. “Pooling the skills of each agency makes a formidable team as we investigate allegations of wrong-doing. Today’s sentencing demonstrates our collective efforts to successfully enforce the law and ensure public trust.”

“The Defense Health Agency (DHA) works to set the standard in care for our military, families and veterans,” said Cyndy Bruce, Special Agent in Charge with the Defense Criminal Investigative Service (DCIS), Southeast Field Office. “With full knowledge, Mr. Walters aggressively exploited DHA for personal enrichment. I want thank the U.S. Department of Justice and our investigative team for their tireless work to bring these crimes to light. There is no victimless crime, these significant funds were stolen from each and every tax payer and I am pleased that today, this defendant is being held accountable for his actions.”

“The sentencing of Walters highlights continued cooperation among law enforcement agencies at the local, state, and federal levels to ensure public safety throughout Mississippi,” said Colonel Steven Maxwell, Director of the Mississippi Bureau of Narcotics (MBN). “Protecting the public from individuals like Walters is a priority for MBN and is a mainstay in accomplishing our agency’s mission.”

Walters and his numerous co-conspirators effectuated a scheme to defraud health care benefit programs, including the TRICARE program, in an amount exceeding $287 million. Walters further conspired with others to launder the proceeds of his fraud scheme by engaging in monetary  transactions in amounts of over $10,000 in proceeds from the fraud scheme, including transactions relating to his participation in a sham intellectual property scheme.

The FBI’s Jackson Field Office investigated the case with assistance from the IRS-CI, DCIS, and MBN. Principal Assistant Deputy Chief Dustin M. Davis, Assistant Deputy Chief Katherine E. Payerle, and Trial Attorney Sara E. Porter of the Criminal Division’s Fraud Section, Trial Attorneys Emily Cohen and Steven Brantley of the Criminal Division’s Money Laundering and Asset Recovery Section, and Assistant U.S. Attorney Kathlyn R. Van Buskirk of the Southern District of Mississippi are prosecuting the case.

The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for approximately $19 billion. In addition, the Health and Human Services (HHS) Centers for Medicare & Medicaid Services, working in conjunction with the HHS-Office of Inspector General, are taking steps to increase accountability and decrease the presence of fraudulent providers.

 
 

Clipped from: https://www.justice.gov/opa/pr/compounding-pharmacy-mogul-sentenced-multimillion-dollar-health-care-fraud-scheme