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Criminal and Civil Enforcement

January 2008 Criminal Enforcement Report

Practitioners
In New Jersey, a podiatrist was sentenced to 24 months in prison and ordered to pay $350,000 in restitution for his guilty plea to health care fraud. An investigation revealed that the podiatrist performed routine foot care on residents in community rooms of low-income buildings then billed the Medicare program as if he performed more complex procedures. In fact, residents were only getting their nails clipped. In August 2007, the podiatrist agreed to pay $868,000 to resolve his false claims act liability for the same conduct.
Medicaid Fraud
In Maryland, an employee of the Association for Retarded Citizens (ARC) was sentenced to 2 years incarceration, all but 6 days suspended, for neglect of vulnerable adults. In addition, she was placed on 2 years of probation during which time she cannot work with vulnerable adults. Investigation revealed that on a cold day in December 2006, the ARC employee left two developmentally disabled women in the company's minivan, unsupervised, at a local shopping mall while she shopped for over an hour. ARC received reimbursement from the Maryland Medicaid for services provided to the vulnerable adults.
Child Support Enforcement
In Nevada, a man was sentenced to 5 years probation and ordered to pay over $78,000 in restitution for failure to pay child support. Ordered to pay child support as part of his 1992 divorce, the man failed to pay for the support of his daughter now emancipated. In March 2007, the man was located and arrested in Nevada based on a warrant issued from the Western District of Michigan. The case was transferred to the State of Nevada where he subsequently pled guilty.

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February 2008 Criminal Enforcement Report

Practitioners
In California, a physician was sentenced to 30 months in prison and ordered to pay $558,000 in restitution for his involvement in a conspiracy to defraud the Medicare program. The physician wrote prescriptions and signed certificates of medical necessity for enteral nutrition products, motorized wheelchairs, and hospital beds that were not necessary and, in most cases, were not provided to beneficiaries. The physician received kickbacks from a DME company for each fraudulent prescription. In addition, the physician billed Medicare for treating patients who were recruited to come to his clinic with the promise of receiving free ensure products. Patients were then referred for ancillary services for which the physician received kickbacks from companies he referred patients to. In Illinois, a psychologist was sentenced to 22 months in prison and ordered to pay $170,000 in restitution for health care fraud. The psychologist billed Medicare for group and individual psychotherapy services that he did not provide. An investigation revealed that the psychologist, who visited facilities once or twice a week to conduct assessments, billed Medicare for psychotherapy services provided to patients 4 to 5 days a week that were either not performed as billed or were for dates of service when he was not actually present at the facilities. In 2005, the psychologist fled the U.S. to Israel. In April 2007, he was arrested by Israeli National Police and in September he was extradited back to the U.S. where he pled guilty.
Medicaid Fraud
In New Jersey, the owner/operator of several adult day care centers and his brother, who worked at the facilities, were sentenced to 6 months and 55 months in prison, respectively, for conspiracy to commit health care fraud. An investigation revealed that the brothers knowingly submitted inflated attendance figures causing the Medicaid program to pay for beneficiaries who never attended the day care centers. In February 2007, a $5.5 million civil settlement was reached with Horizon and its associated entities for the false billings to Medicaid.
Prescription Drug Fraud
In Washington D.C., a man was sentenced to 57 months imprisonment and ordered to forfeit $11,700 in cash and his vehicle for unlawful distribution of Oxycodone within 1000 feet of a school. In 2006, the man sold Oxycodone in front of an elementary school. After a search of the man's home, hundreds of pills of controlled substances were recovered.

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March 2008

Practitioners
In Washington, a pharmacist was sentenced to 18 months in prison and ordered to pay $1.6 million in restitution for conspiracy to commit health care fraud and money laundering. The pharmacist and her husband owned a retail pharmacy with locations in Bellevue, Kent and Tacoma. The couple, who pled guilty to their involvement in the scheme, fraudulently billed the Medicaid program for drugs, diapers, gloves and incontinence supplies that were never provided to beneficiaries. As part of the conspiracy, the couple recruited Medicaid patients to their pharmacy by offering them gift certificates for free goods, and then created false records including physician prescriptions and delivery receipts. The pharmacist's husband was sentenced in November 2007 to 63 months in prison and is held jointly responsible for the $1.6 million restitution amount. In addition, the couple's former attorney and their business partner were sentenced related to their involvement in the scheme. In Michigan, a doctor was sentenced to 20 months in prison and ordered to pay $73,000 in restitution for his scheme to defraud Medicare and a private insurer. As part of the scheme, the doctor waited one year before he submitted claims, used original progress notes to generate additional claims, and then submitted the fraudulent claims for dates of service when no service was rendered. The doctor, who is a foreign national, faces possible deportation at the conclusion of his prison sentence.
Misuse of Grant Funds
In Ohio, a man was sentenced to 27 months in prison and ordered to pay over $557,000 in restitution for mail fraud and aiding and abetting. The man was the owner of a non-profit agency that contracted with counties in Ohio to provide foster care services. The agency received Administration for Children and Families grant funds from the State of Ohio. The investigation revealed that the man diverted money from the non-profit agency into a for-profit business that he controlled. Money that he claimed paid for foster case services was actually routed to his own personal investment accounts. In addition, the man concealed his ownership in the business and provided false documentation to auditors.
Durable Medical Equipment
In Texas, two durable medical equipment (DME) company owners were sentenced for their scheme to defraud the Government. One defendant was sentenced to 37 months in prison and ordered to pay $458,000 in restitution; the other defendant was sentenced to 30 months in prison and ordered to pay $446,000 in restitution. As part of their guilty pleas, the defendants admitted to conspiring with others to pay illegal kickbacks to a Dallas physician for fraudulent certificates of medical necessity (CMNs). The defendants paid the physician $200 for each fraudulent CMN which were then used to bill the Medicare program for power wheelchairs and accessories. The physician received a 16-month prison sentence for his role in a similar conspiracy to defraud Medicare.
In Kentucky, a former owner of a durable medical equipment (DME) company pled guilty and was sentenced to 1 year of probation and ordered to pay $79,000 in restitution for false statements. In addition, the owner pled guilty on behalf of his company for false statements relating to health care matters. The investigation revealed that the DME company provided nearly all of its customers with a 3-piece back brace but billed Medicare and Medicaid for a more expensive post-surgical back brace. As part of the scheme, prescriptions for back braces were altered and then submitted to Medicare and Medicaid to support the claim for payment.
Medicaid Fraud
In Oregon, a woman was sentenced to 39 months imprisonment and ordered to pay $108,000 in restitution after being convicted for charges of making false claims and theft. During the 3-day trial, evidence showed that the woman engaged in a scheme whereby she claimed to be providing in-home care to a Medicaid recipient who was actually only pretending to be disabled. The woman's co-defendant died prior to trial. For seven years, the women billed Medicaid for phantom services and then split the Medicaid payments.

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April 2008 Criminal Enforcement Report

Durable Medical Equipment
In Texas, the owner of a medical equipment supplier was sentenced to 24 months in prison and ordered to pay $4.4 million in restitution for her role in a health care fraud kickback scheme. The woman paid runners between $800 and $1,000 for each certificate of medical necessity (CMN) that physicians signed. She then used the fraudulent CMNs to bill Medicare and Medicaid for power wheelchairs provided to beneficiaries that were not medically necessary.
Transportation Fraud
In Washington, D.C., the owner of a non-emergency transportation company was sentenced to 1 year and 1 day in prison, 6 months home detention and ordered to forfeit over $211,000 for health care fraud. The man billed Medicaid for 6,660 transportation services for D.C. Medicaid recipients that were not provided.
Other Cases of Interest
In Ohio, a man was sentenced to 2 years imprisonment and ordered to pay $155,000 in restitution, including over $94,000 to Medicaid, for aggravated identity theft. The investigation revealed that the man stole the identity of a Texas Medicare beneficiary more than 20 years ago and began using the identity in 1998 to obtain Medicaid and public assistance benefits. In 2004, the man began using the identity to obtain services covered by Medicare including an extended stay in a skilled nursing facility and for wound care services that he received while living in a homeless shelter for which Medicare paid over $61,000.
Medicaid Fraud
In New Jersey, a pharmacy owner was sentenced to 5 months in prison, 5 months in home detention and ordered to pay a $5,000 fine for adulteration of drugs and filing a false tax return. The man, who owned several pharmacies in New Jersey, billed Medicaid for prescription drugs provided to beneficiaries that were obtained on the black market from illicit sources. He also used his pharmacies to launder money and to transfer funds out of the country.
Child Support Enforcement
In Indiana, a man was sentenced to 8 years incarceration with 4 years suspended, 4 years probation and ordered to pay over $58,000 in restitution for failure to pay child support. The man, who was residing in Kentucky, was arrested in October 2007 and subsequently pled guilty to 2 counts of failure to pay child support.

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May 2008

May 29, 2008, U.S. Attorney, Northern District of OH
Four federal indictments charging seven individuals with various health care fraud-related offenses

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June 2008 Report

June 30, 2008, US Attorney District of NJ
Another Cardiologist Settles with Government over Improper Patient Referrals to UMDNJ (PDF)
June 28, 2008, U.S. Attorney, Central District of CA
Interdent and Dedicated Dental Pay More than $375,000 to Settle Civil Allegations of Defrauding Medi-Cal Program
June 27, 2008, U.S. Attorney District of KS
Trial Set for Wichita Daycare Provider Charged with $300,000 Theft of Government Funds
June 19, 2008, Middle District of PA
U.S. Marshal-Led Efforts Result in 181 Arrests in Northeast and Central Pennsylvania Stolen Firearm is Recovered/Drugs and Cash Seized
June 18, 2008, City of New York Department of Investigation
Joint Investigation by DOI and Federal Authorities Leads to The Arrest of Three Individuals on Charges of Participating in a Medicaid Card Fraud Scheme -- Today's arrests are the result of an ongoing probe into Medicaid fraud (PDF)
June 10, 2008, U.S. Attorney Eastern District of PA
U.S. Attorney Announces First Settlement Involving Personal Care Homes (PDF)

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July 2008 Report

July 2, 2008, U.S. Attorney Southern District of FL
DME Defendants Plead Guilty to $148 Million Medicare Fraud Scheme

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August 2008 Report

August 29, 2008, U.S. Department of Justice
Convicted Medicare Fraud Defendant Pleads Guilty to Laundering More Than $3 Million in Fraudulent Proceeds
 
August 28, 2008, U.S. Attorney, Southern District of FL
DME Defendants Sentenced in Multi-Million Dollar Medicare Fraud Scheme
 
August 26, 2008, U.S. Department of Justice
Miami Physician and HIV Clinic Administrator Plead Guilty for Their Roles in a $37 Million Medicare Fraud Scheme
 
August 20, 2008, U.S. Attorney, Eastern District of Louisiana
Four Plead Guilty in Tangipahoa Parish Childcare Program Fraud Probe
 
August 20, 2008, U.S. Attorney, Western District of Kentucky
More Guilty Pleas Entered By Louisville Men For Health Care Fraud
 
August 18, 2008 U.S. Attorney, Southern District of Indiana
Indianapolis Woman Charged in $1.8 Million Health Care Fraud Scheme (PDF)
 
August 14, 2008, U.S. Department of Justice
Amerigroup Settles Federal & State Medicaid Fraud Claims for $225 Million
 
August 6, 2008, U.S. Attorney, Central District of CA
Two Men Arrested in Scheme that Recruited Homeless from 'Skid Row' and Fraudulently Billed Government Health Programs for Unnecessary Services
 
August 4, 2008, U.S. Attorney, Northern District of Georgia
Medical Supply Executive Imprisoned for Defrauding Medicare (PDF)
 

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September 2008 Report

September 30, 2008, U.S. Attorney, Southern District of Florida
U.S. Attorney Announces Health Care Fraud Charges against Forty-one Defendants 
September 29, 2008, Department of Justice
Biopharmaceutical Company, Cephalon, to Pay $425 Million & Enter Plea to Resolve Allegations of Off-Label Marketing 
September 29, 2008, Department of Justice
Walgreens Pays U.S. $9.9 Million to Settle Medicaid Prescription Drug Allegations 
September 26, 2008, U.S. Attorney, Western District of Virginia
Luray Doctor Pleads Guilty to Wire Fraud, Tax Perjury 
September 24, 2008, Department of Justice
New Jersey Hospital to Pay $3.85 Million to Resolve Allegations of Inflating Charges to Obtain Higher Medicare Reimbursement 
September 23, 2008, U.S. Attorney, District of New Jersey
Owners of Newark Medical Business Admit Defrauding Medicare (PDF) 
September 23, 2008, U.S. Attorney, Southern District of Georgia
Three South Florida Men Sentenced for Medicare Fraud (PDF) 
September 22, 2008, Department of Justice
Los Angeles Jury Convicts Defendant of Fraud Involving more than $1.1 Million in False Billing to Medicare 
September 18, 2008, Department of Justice
Medicare Strike Force Indicts 18 Los Angeles Area Residents for Health Care Related Fraud 
September 18, 2008, Department of Justice
Miami Physician's Assistant Pleads Guilty to Role in $119 Million HIV Infusion Fraud Scheme 
September 15, 2008, U.S. Attorney, Western District of Kentucky
HealthEssentials Solutions, Inc. Sentenced to Pay Restitution in the Amount of $3,105,931 for Submitting False Statements Relating to Health Care Matters 
September 15, 2008, U.S. Attorney, Eastern District of New York
Staten Island University Hospital to Pay the U.S. $74 Million to Settle Claims of Defrauding Federal Health Care Programs 
September 5, 2008, U.S. Attorney, District of South Dakota
Rapid City Woman Pleads Guilty to Illegally Taking Pills from Sioux San Hospital 
September 5, 2008, U.S. Attorney, Western District of Kentucky
Louisville, Kentucky Opthamologist and Wife Agree to Pay over $460,000 to Settle Federal False Claims and Civil Fraud Claims 

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October 2008 Report

October 30, 2008, U.S. Attorney, Western District of Missouri
Physician Group Signs $1 Million Settlement Agreement
October 24, 2008, U.S. Attorney, Central District of California
Pasadena Doctor with Practice in Orange County Indicted in $2.3 Million Medicare
Fraud Scheme
October 23, 2008, U.S. Attorney, District of Maryland
Severna Park Health Care Provider Sentenced to Three Years in Prison in Billing Fraud Scheme
October 22, 2008, U.S. Attorney, District of Minnesota
Former State Employee Indicted for Health Care Fraud, Theft of more than $900,000 in Funds (PDF)
October 20, 2008, U.S. Attorney, District of Minnesota
Two Blain Women Sentenced for Health Care Fraud (PDF)
October 20, 2008, U.S. Attorney, Southern District of New York
St. Vincent's Midtown Hospital and Operator of Clinic Settle Civil Charges for Submitting False Claims to Medicare for Work Performed by Unlicensed Foreign Doctors (PDF)
October 17, 2008, Department of Justice
Jury Convicts Miami Physician and Nurse of $11 Million HIV Infusion Medicare Fraud
October 17, 2008, Department of Justice
New Orleans Area Hospital to Pay $3.3 Million to Resolve Medicaid Fraud Allegations
October 16, 2008, Department of Justice
Los Angeles Area Health Care Company Owner Pleads Guilty to Medical Identity Theft and Medicare Fraud
October 16, 2008, U.S. Attorney, District of Maryland
Owings Mills Orthopaedic Group and Physical Therapy Group Settle Anti-Kickback Claims
October 14, 2008, U.S. Attorney, Southern District of Texas
Man Convicted of Defrauding Medicare Sentenced to Prison
October 9, 2008, U.S. Attorney, Southern District of Florida
Chiropractor and Two Others Charged in Medicare Fraud Scheme
October 9, 2008, U.S. Attorney, Southern District of Georgia
Kingsland Woman Charged With Stealing Prescription Drugs from Elderly (PDF)
October 8, 2008, U.S. Attorney, Middle District of North Carolina
Medical Practice Pleads Guilty to Health Care Fraud
October 7, 2008, U.S. Attorney, District of Kansas
California Man Pleads Guilty to Federal Charge of Failing to Make Support Payments for Child in Kansas
October 7, 2008, U.S. Attorney, Southern District of Florida
Medicare Fraud Strike Force Indicts Eight Miami-Dade Residents for AIDS/HIV Infusion Fraud
October 6, 2008, U.S. Attorney, Western District of Kentucky
Louisville Physician Pleads Guilty to Selling Drug Samples
October 6, 2008, U.S. Attorney, Middle District of Florida
Guilty Plea Unsealed-Man Acknowledges Role in Conspiracy to Defraud Florida Medicaid Program (PDF)
October 6, 2008, U.S. Attorney, Southern District of Florida
DME Company Owner Convicted in Medicare Fraud Scheme

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November 2008 Report

November 26, 2008, U.S. Attorney for the District of Columbia
The United States and the District of Columbia Reach $2 Million Settlement with Grant Park Care Center to Settle Allegations Regarding Fraudulent Billings to Medicare & Medicaid
November 25, 2008, Department of Justice
Bayer Healthcare to Pay U.S. $97.5 Million to Settle Allegations of Paying Kickbacks to Diabetic Suppliers
November 18, 2008, U.S. Attorney, Southern District of Florida
Miami HIV Clinic Administrator and Two Miami Residents Sentenced for Their Roles in a $14 million Medicare Fraud Scheme
November 14, 2008, U.S. Attorney, District of North Dakota
Former Grand Forks Man Sentenced for Failure to Pay Child Support (PDF)
November 13, 2008, U.S. Attorney, Eastern District of New York
Former Employee of Hanger Orthopedic Group, Inc. Indicted for Destroying and Falsifying Records in Connection with Federal Investigation
November 12, 2008, Department of Justice
Miami Clinic Owner Sentenced to 30 Months in Prison for $10.9 Million Medicare Fraud
November 10, 2008, U.S. Attorney, Southern District of Indiana
Miami Man Sentenced to 41 Months in Prison for Health Care Fraud Scheme (PDF)
November 5, 2008, U.S. Attorney, Southern District of Georgia
South Florida Woman Sentenced for Medicare Fraud (PDF)
November 5, 2008, U.S. Attorney, Eastern District of California
Merced Audiologist Guilty of Mail Fraud and Health Care Fraud (PDF)
November 4, 2008, U.S. Attorney, Southern District of Florida
Miami Physician Sentenced to 84 Months in Prison for $26.2 Million Medicare Fraud

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December 2008 Report

December 23, 2008, U.S. Attorney, District of Connecticut
Yale University to Pay $7.6 Million to Resolve False Claims Act and Common Law Allegations
December 17, 2008, Department of Justice
Miami Physician Sentenced to 30 Years in Prison for $11 Million Medicare Fraud Scheme
December 16, 2008, U.S. Attorney, Southern District of Texas
Sleep Lab and Its Owner Settle Allegations of Medicare Violations
December 12, 2008, U.S. Attorney, Central District of California
Former Hospital C.E.O. Pleads Guilty to Paying Kickbacks In 'Skid Row' Healthcare Fraud Scheme
December 12, 2008, U.S. Attorney, Western District of Texas
Former Oakland Athletics First Baseman Arrested and Charged with Failure to Pay Over $724,000 in Child Support (PDF)
December 9, 2008, U.S. Attorney, Northern District of Alabama
Marie King Sentenced for Medicare Fraud
December 8, 2008, U.S. Attorney, Western District of Wisconsin
Dr. Malcolm Bridgen Reaches Settlement with United States (PDF)
December 5, 2008, U.S. Attorney, Southern District of Illinois
Mercy Regional Health System and Its Former President Sentenced in Federal Court
December 5, 2008, U.S. Attorney, District of Maryland
Former National Institutes of Health Official Pleads Guilty to Lying About Outside Employment
December 3, 2008, Department of Justice
New Jersey-based MedQuist Pays U.S. $6.6 Million to Resolve False Claims Act Allegations
December 1, 2008, U.S. Attorney, Southern District of Texas
Houston Businessman Sentenced for Defrauding Medicare of Millions
December 1, 2008, U.S. Attorney, Western District of Tennessee
Jackson Madison General Hospital to Pay $2,567,280.00 and Milan General Hospital to Pay $5,309,494.00 to Settle False Claims Allegations
December 1, 2008, U.S. Attorney, Northern District of Illinois
Condell Health Network and Medical Center to Pay $36 Million Settlement after Self-Reporting Possible Health-Care Fraud (PDF)

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