Tag Archives: Medicare fraud

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.

Click here to read the article.

Comments Off on Clearwater Doctor Pleads Guilty to Medicare Fraud

Filed under Healthcare Fraud, Medicare

Medicare Ban on Non-emergency Ambulance and Home Health Care Agencies Continues

Friday the Centers for Medicare and Medicaid Services extended a temporary ban on nonemergency ambulance and home health care agencies throughout six states, including Florida, as a continued effort to fight fraud.

In continuing the ban on nonemergency ambulance services, the ban on new emergency ambulance services was lifted. The ban, originally only implemented in Miami, Chicago and Houston, was expanded in January of 2014 to combat fraud in other metropolitan areas seen as fraud hotbeds, specifically in Michigan, Pennsylvania and New Jersey. The ban has been expanded for additional six months after being in place for three years so far.

According to CMS, Texas, Florida and Illinois are in the lower third for number of patients per home health care provider. Despite this statistic, these three states have the highest number of home health care providers according to CMS data.

Shantanu Agrawal, CMS’ deputy administrator for program integrity commented on the program:

CMS is continuing its efforts to tackle fraud, waste, abuse and protect benefits and services for those eligible for federal health care programs. . . CMS is also increasing its oversight efforts through the use of heightened screening and investigative tools for new providers in the moratoria areas.

According to the National Health Care Anti-Fraud Association, as much as $60 billion is lost due to fraud, waste and abuse of the federal health care programs.

Click here for full story.

Comments Off on Medicare Ban on Non-emergency Ambulance and Home Health Care Agencies Continues

Filed under Florida, Insurance, Insurance Fraud, Medicare, Uncategorized

Former Fugitive Sentenced to 37 Months for Healthcare Fraud

A Cuban national was sentenced to more than three years in prison after pleading guilty to a $2.6 million healthcare fraud against Medicare, according to the Department of Justice.

Ubert Guillermo Rodriguez, 47, pleaded guilty to conspiracy to commit healthcare fraud in March 2016. Rodriguez, who had been a fugitive since his indictment in 2013 until his arrest in 2015, was also ordered to pay $918,000 in restitution and forfeit another $918,000. When federal authorities served a seizure warrant on Rodriguez’s bank account, they seized more than $243,000.

Rodriguez owned G.R. Services Equipment & Supplies near St. Petersburg. The company was supposed to supply medical equipment to Medicare beneficiaries. Rodriguez admitted his company submitted nearly $2.6 million in false claims to Medicare from May 2013 to June 2013. During that period, Rodriguez was reimbursed for hundreds of thousands of dollars for sterile collagen dressings and negative pressure wound therapy electrical pumps. Yet those items were never prescribed by doctors or given to beneficiaries.

The case was part of the Medicare Fraud Strike Force by the U.S. Attorney’s Office of the Middle District of Florida.

Click here for entire story.

Comments Off on Former Fugitive Sentenced to 37 Months for Healthcare Fraud

Filed under Florida, Insurance, Insurance Fraud, Medicare, Middle District of Florida

Florida Doctor Convicted of 162 Counts of Fraud

A North Florida jury convicted a Gainesville doctor of 162 counts of healthcare fraud. Ona M. Colasante, who was found guilty after a five-week trial, faces up to 10 years in prison at her sentencing in July.

Colasante owned and operated medical businesses known as the Hawthorne Medical Center (from 1998-2009) in Hawthorne, Florida, and the Colasante Clinic (from 2010-2013) in Gainesville. Colasante used a false billing scheme at those businesses to defraud Medicare, Medicaid and Blue Cross Blue Shield of Florida.

The U.S. Attorney’s Office for the Northern District of Florida described Colasante’s scheme as follows: Colasante and her employees ordered non-FDA-approved drugs at drastically reduced prices and administered them to unsuspecting patients. Colasante would then bill the insurance companies for the cost of FDA-approved drugs.

Colasante also billed the insurance companies for medical tests that were unnecessary and submitted false diagnosis codes to support her claims. She also billed insurance companies for counseling, treatment and training that was never performed. One example pointed out by the U.S. Attorney’s Office was that Colasante frequently billed the insurance companies for treatments to stop smoking even though the patients were already nonsmokers.

“Healthcare programs and patients depend on ethical practices from medical providers,” U.S. Attorney Christopher P. Canova said in commending the federal investigators and prosecutors after the trial.

Click here to read full press release.

Comments Off on Florida Doctor Convicted of 162 Counts of Fraud

Filed under Health care, Insurance, Insurance Fraud, Medicare, Northern District of Florida

25 Charged in $26 Million Medicare Fraud in Miami

Twenty-five people were charged in Miami federal court for alleged schemes to defraud Medicare. The three cases totaled about $26 million in false claims through the Medicare Part D program.

U.S. Attorney Wifredo A. Ferrer said the April 28 charges include conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to defraud the United States, and paying and receiving healthcare kickbacks.

In the first indictment, 18 people were charged with filing false claims through eight separate pharmacies. Pedro Torres, 43, of North Bay Village and Antonio Hevia, 53, of Miami are accused of recruiting people to be owners of the pharmacies. Torres and Hevia then allegedly instructed the pharmacy staffs to submit fraudulent claims for $16.7 million for prescription drugs that were not medically necessary and not provided to the Medicare Part D beneficiaries.

In the second indictment, Ronald Dias, 28, of Miami used eight pharmacies that he owned and worked with two other Miami residents to defraud the Medicare Part D program of $10.4 million in fraudulently obtained claims. The indictment said the drugs were neither medically necessary nor provided to Medicare beneficiaries.

In the third indictment, four Miami residents are accused of receiving kickbacks and bribes to recruit Medicare beneficiaries to obtain prescriptions for drugs to be used through the OMG Pharmacy Discount with false claims filed to the Medicare Part D Program.

“Those who commit Medicare fraud through the filing of false claims, payment or receipt of kickbacks, or fraudulent medical practices jeopardize the integrity of the government benefit programs that countless citizens rely on for their well-being,” Ferrer said in a statement.

The various charges carry potential sentences each ranging from five years to 20 years in prison.

Since March 2007 in the Southern District of Florida, nearly 900 individuals have been charged in alleged frauds netting $2.5 billion through Medicare billings.

Part D prescription medicine coverage is the fastest-growing area of the Medicare program.  The federal government estimates as much as $10 billion of last year’s $120 billion in Medicare Part D spending may be fraudulent.

Click here for full story.

Comments Off on 25 Charged in $26 Million Medicare Fraud in Miami

Filed under Insurance Fraud, Medicare, Southern District of Florida

Miami Doctor Sentenced To 9 Years For Medicare Fraud

Miami doctor Henry Lora was sentenced to nine years in federal prison and ordered to pay $30.3 million in restitution for his part in a Medicare fraud ring.

U.S. District Judge Federico Moreno in Miami sentenced Lora on Monday after he pleaded guilty in February to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the U.S.

Lora, 51, was the medical director of now-defunct Merfi Corp. when he wrote prescriptions for Medicare beneficiaries that weren’t needed or were never provided, according to Law360. In exchange, Lora received kickbacks and bribes from patient recruiters and home health care operators. Lora also was accused of falsifying patient records so they would qualify for Medicare services.

Merfi’s owner, Isabel Medina, also received a nine-year sentence after pleading guilty in January 2014. Three others, German Martinez, Lerida Labrada and Mayra Flores, received sentences of 24, 37 and 24 months, respectively, for serving as patient recruiters.

The case was part of the Department of Justice’s Medicare Fraud Strike Force, which has charged more than 2,300 people with bilking Medicare out of $7 billion in fraudulent claims.

Click here for full story.

Comments Off on Miami Doctor Sentenced To 9 Years For Medicare Fraud

Filed under Florida, Health care, Insurance, Insurance Fraud, Miami-Dade Fraud

Straw Owner of Clinic Sentenced in $28 Million Medicare Fraud Scheme

Roberto Fernandez Gonzalez, a Florida man who federal prosecutors say served as the “straw owner” of a physical therapy clinic, was sentenced to 30 months in prison for participating in a Medicare fraud scheme, according to a Department of Justice release.

Fernandez was also ordered to forfeit $446,738 and pay the same amount in restitution. He pleaded guilty in June of 2013 to conspiracy to commit health care fraud.

Prosecutors say Fernandez and his co-conspirators used four physical therapy clinics, including Rehab Dynamics in Venice, FL, to submit a total of $28.3 million in fraudulent reimbursement claims to Medicare. Medicare paid roughly $14.4 million on those claims.

Fernandez’s co-conspirators obtained and controlled Rehab Dynamics, then engaged in a sham sale of the clinic to Fernandez. With no background in health care and no money to buy the business, Fernandez was strictly a front man.

The co-conspirators paid Fernandez $20,000 to operate as the straw owner from January 2008 through March 2008. During that period, Rehab Dynamics submitted $1.6 million in fraudulent Medicare claims, of which Medicare paid $446,738, the amount Fernandez was ordered to pay.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion, according to a Department of Justice report.

Comments Off on Straw Owner of Clinic Sentenced in $28 Million Medicare Fraud Scheme

Filed under Insurance Fraud

Volusia County Chiropractor, Joseph Wagner, Sentenced to 15 years and $2 million in Restitution

Wednesday, Volusia County chiropractor, Joseph Wagner, was sentenced to 15 years in federal prison and $2 million in restitution as a result of years of healthcare fraud.  Wagner, in addition to billing insurance companies and Medicare for services never rendered, illegally prescribed controlled substances under another doctor’s name.  Patients who were without insurance paid Wagner $100 cash each month for these prescriptions.

According to the Orlando Sentinel article on Wagner’s sentencing:

Senior U.S. District Judge G. Kendall Sharp said Wagner relegated the trust he had as a chiropractor, and now taxpayers will have to pay the price for his fraud.

The full article is available here.

See also: Volusia County Chiropractor Pleads Guilty to Federal Charges of Illegally Prescribed Drugs, Healthcare Fraud

Comments Off on Volusia County Chiropractor, Joseph Wagner, Sentenced to 15 years and $2 million in Restitution

Filed under Insurance Fraud, Licensing