Author Archives: John Leinicke, Esq. HCRM

Five People Charged in Mail-order Prescriptions Patient-Brokering Kickbacks

Five people have been charged with patient brokering, insurance fraud, money laundering, and racketeering in connection with a scam that raked in hundreds of thousands of dollars in kickbacks. Authorities allege that hundreds of prescriptions, many of them fraudulent, were sent to Express Care Pharmacy with prices ranging from $646 to $5,614. Many of the prescriptions were forged, unnecessary, or submitted without the patients or treating physician’s consent, according to the police report.

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Filed under Fraud, Healthcare

Pharmacy Owner Arraigned On Charges of Healthcare & Wire Fraud

Andrew Fisher, the president and part-owner of Physician Specialty Pharmacy, is being accused of conspiracy to commit health care fraud, wire fraud, and money laundering. Allegedly, Fisher and five co-conspirators submitted more than $4.8 million in fraudulent claims for prescriptions for compounded pain cream, scar cream, and wellness capsules. According to the indictment, Fisher agreed to fill prescriptions at his pharmacy while using drug formations that would maximize the amount his pharmacy could bill to insurance companies.

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Filed under Fraud, Healthcare

Land o’ Lakes Medical Marketing Company Owner Found Guilty in $2M Medicare Fraud Scheme

David Brock Lovelace, the owner of the medical marketing company DBL Management LLC, was found guilty of Medicare fraud. After a four-day trial, Lovelace was found guilty of conspiracy to pay health care kickbacks and structuring currency transactions to avoid the reporting requirement.

Lovelace paid cash kickback and bribes in exchange for the referral of Medicare beneficiaries’ DNA swabs. He was then paid a percentage of the reimbursements from the $2.2 million in claims submitted by a clinical lab.

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Filed under Fraud, Healthcare

Arcadia Man Arrested and Charged with Insurance Fraud

Frank David Berry III of Arcadia was arrested and charged with insurance fraud after an investigation by State Department of Financial Services, Division of Investigative and Forensic Services. A man in a van backed out of a parking spot, collided with a Mercury which struck a Cadillac parked nearby. After the accident, Berry called the insurance company claiming that he was in the Cadillac at the time of the collision. He claimed he went to the hospital due to pain in his neck and back as a result of the violent crash.

The driver of the van and a witness, however, say Berry was not in the Cadillac at the time of the crash. Berry is captured on security video footage from the parking lot leaving his vehicle and walking into the store over a minute before the collision of the three cars. Berry is facing charges of insurance fraud and three counts of using a communication device to facilitate a felony.

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Geico Seeks To Recover $20M in Racketeering Suit

As reported by Law360, Geico is seeking to recover at least $20 million in compensatory damages, in addition to costs, fees and punitive damages from a Florida chiropractor and his network of clinics.

On Thursday, May 30th, the insurer filed suit in Florida federal court against Mark A. Cereceda claiming civil racketeering violations and unjust enrichment as well as common law fraud and other claims.

According to the complaint, Geico says Mark A. Cereceda and his various Ceda Orthopedics clinics in Miami billed for services that were unnecessary, never provided and performed by people who were not properly licensed. Geico paid for physical therapy services performed by unsupervised massage therapists who are unqualified to perform physical therapy and who, under Florida law, cannot be reimbursed under PIP insurance. The insurer is also requesting a declaration from the court that it is not legally obligated to pay reimbursement of more than $75,000 in pending fraudulent PIP claims submitted by Cereceda’s clinics.

Cereceda has been sued by insurers at least three times over fraudulent medical billing and coding, delivering medically unnecessary chiropractic care and engaging in an unlawful referral scheme.

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Filed under Fraud

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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Filed under Fraud, Healthcare

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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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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Former NFL Player & Coach arrested for Insurance Fraud

Marlon McCree, former Jacksonville Jaguar football player and assistant coach, has been arrested for an insurance fraud scheme totaling nearly $78,000. McCree allegedly submitted fraudulent invoices from a dental office he’d never been a patient of to his Health Reimbursement Account (HRA) with intentions of defrauding the fund. He could be facing a prison sentence up 30 years and a hefty fine if found guilty.

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