Category Archives: Healthcare Fraud

Accused Fraudster Uses Delay Taxes While Victims Continue to Pay

According to the Federal Trade Commission, accused health insurance scammer Stephen J. Dorfman, CEO of Hollywood-based Simple Health Plans LLC, is using “procedural maneuvers” to delay turning over his firm to a court-appointed receiver, giving customers an opportunity to cancel their “worthless” insurance policies.

Dorfman and his company are being accused of duping customers into buying what they thought were comprehensive health insurance plans. Many of them are still paying millions of dollars a month for a product comprised of worthless discount plans and limited-benefit hospital indemnity coverage that pays no more than $3,200 a year.

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Stuart OB/GYN Found Guilty in Health Insurance Fraud Scheme

A federal court jury found Dr. Sheetal Kanar Kumar, former Stuart obstetrician and gynecologist, guilty of 23 counts of health insurance fraud. Kumar faces up to 10 years in prison and fines of $250,000 for each charge as a result of her fraudulent claims to Medicare, Medicaid and Blue Cross Blue Shield. Kumar’s claims involved charges for patient office visits involving complex cystometrogram, anorectal manometry, uroflowmetry and voiding pressure studies.

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Physical Assistant Pleaded Guilty for Role in $1B Medicare Fraud Scheme

Arnaldo Carmouze, a former physician assistant, is facing up to 10 years in prison time for his role in a Medicare fraud scheme. Carmouze was one of three defendants who pleaded guilty to conspiracy to commit healthcare fraud while working for a network of skilled nursing homes and assisted living facilities. The scheme involved admitting Medicare and Medicaid patients to these homes and facilities even if they did not qualify for placement and giving them unnecessary medical care as well as referring patients to certain healthcare providers for kickbacks. In addition to prison time, Carmouze is also facing a fine up to $250,000 and three years of supervised release for his role in the $1 billion Medicare fraud scheme.

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Miami Home Health Care Worker Sentenced in Health Care Fraud Scam

Margarita Palomino of Homestead, Florida pleaded guilty to conspiracy to commit health care fraud and wire fraud. Palomino who worked for three home health agencies where she allegedly accepted kickbacks for the referral of Medicare beneficiaries, even ones that did not qualify for home health services and changed claims coding to increase reimbursement by Medicare. Palomino also admitted that she performed home health care nursing visits and prepared related medical records although she does not have a license to do so in the United States.

Medicare made payments of at least $4.65 million as a result of false and fraudulent claims submitted as part of this conspiracy. Palomino was sentenced to over six years in prison to be followed by three years of supervised release for her role in the health care fraud scheme.

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Judge Unfreezes Personal Assets for Defendant in Health Insurance Scheme

Federal Judge Darrin B. Gayles ruled that Steven J. Dorfman, CEO of Simple Health Plans LLC and accused architect of a massive health insurance scheme, can have $75,000 for legal fees and $5,000 a month from his frozen personal assets. Dorman’s funds were seized when the Federal Trade Commission obtained a restraining order against him and his company in late October. He was initially seeking $15,000/month for living expenses and $200,000 for legal representation to fight the FTC’s lawsuit. The FTC wants to close Simple Health Plans permanently.

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Brothers Sentenced In Smart Labs Healthcare Fraud Scheme

H. Hamilton Wayne (CEO) and Justin Wayne (COO) of Smart Labs of Palm Beach have been sentenced to prison for healthcare fraud charges they pleaded guilty to back in August. They were also ordered to pay more than $9.6 million in restitution. H. Wayne was sentenced to 63 months in prison, three years of supervised release and a $50,000 fine. His brother Justin received 46 months in prison, three years of supervised release and a fine of $20,000. Justin was a Florida Marlins pitcher from 2002 to 2004.

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Telemedicine Business Owner Pleads Guilty to Fraud

Scott Gregory Roix, owner of the telemedicine company HealthRight, pleaded guilty to conspiracy to commit health care and wire fraud. Roix and his four alleged conspirators, Florida and Texas pharmacists and pharmacy owners are accused of submitting fraudulent insurance claims for more than $930 million.

Healthright made a lot of money illegally selling suspect, inexpensive drugs like weight-loss pills, skin creams and testosterone supplements at inflated prices. Roix’s company also obstructed doctor-patient relationships with telemarketers posing as “medical personnel.” HealthRight hid drug sales to the partner pharmacies by accounting for the payments as “marketing services.”

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Tampa Bay Businessmen Indicted in Billion Dollar Insurance Fraud Scheme

Four Pinellas County businessmen, Andrew Assad, Peter Bolos, Michael Palso and Larry Everett Smith have been indicted on charges of conspiracy to commit health care fraud, mail fraud and introducing misbranded drugs into interstate commerce. The conspiracy involved using their telemedicine business called HealthRight and compounding pharmacy companies to deceive patients, doctors, insurance carriers by fraudulently soliciting insurance coverage information and prescriptions, mark up the prices of the invalidly prescribed drugs, and bill insurance carriers. One of the compounding pharmacies, Alpha-Omega in Clearwater, allegedly charged $374 for $35-worth of lidocaine – a 969-percent markup.

According to the indictment, the men defrauded Blue Cross Blue Shield of Tennessee out of approximately $174,000,000. Another Bay area man, Scott Roix, already please guilty to felony conspiracy in this case and another case involving wire fraud. Assad, Bolos, Palso, and Smith could face prison terms of over 30 years, fines up to $250,000 and probation for their charges.

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Clearwater Doctor Pleads Guilty to Medicare Fraud

Dr. Jayam Krishna Iyer of Clearwater accepted a plea agreement that will end her medical career. Iyer’s charges include defrauding Medicare by billing for treatments she never delivered and giving written prescriptions for Schedule II narcotics to relatives of patients who never actually stepped foot into her offices.

Iyer’s controversial past includes being sued for malpractice in civil court. She has also been named in death investigations involving narcotics including dilaudid, morphine, oxycodone and fentanyl that she prescribed between 2003 and 2017 in Pinellas County.

Iyer will have to pay $51,000 in restitution for Medicare fraud in addition to giving up her medical career. She was facing up to 10 years in prison and as much as $250,000 in fines, will get a reduced sentence in exchange for her guilty plea.

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Doctor Sent To Prison For Obstructing Medicare Audit

Dr. John Janick of Port Charlotte was sentenced to five months in prison and three years of parole for lying to during a Medicare audit. Dr. Janick lied to a Medicare program integrity contractor about office space that was being utilized by his wife Lisa McLaren Janick who was found guilty of health care fraud in another related case. Mrs. Janick used the office to gain access to sensitive patient data and generate bogus patient referrals from the Janick Medical Group to her third-party employer.

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