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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On November 17, 2016, Satellite Press Releases and News reported the arrest of 21-year-old Eduardo Arango Chongo in connection with the arrests of 31-year-old Osmaro Ruiz and 25-year-old Raymel Betancourt for conspiracy to commit health care fraud.
According to the complaint, the co-conspirators had established fake medical facilities in Union County, New Jersey and were fraudulently billing insurance companies for services that were never rendered. The “phantom providers” allegedly submitted false claims for services worth more than $6 million, raking in hundreds of thousands of dollars from insurance companies. The defendants also utilized an electronic healthcare network used by medical practices to access the health insurance information of individuals who were not aware of their fraudulent activities.
The defendants could face up to 10 years in prison and a $250,000 fine if found guilty of the crimes they were accused of. U.S. Attorney Paul J. Fishman credits special agents of the U.S. Postal Inspection Service and special agents of the FBI with the investigation leading to the charges.
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Isabel Medina, the owner and operator of Merfi Corp., pleaded guilty to conspiracy to commit health care fraud before U.S. District Judge Ursula Ungaro of the Southern District of Florida. The 49-year old Miami resident was tied to several fraud schemes that totaled more than $20 million.
Merfi was a medical clinic that employed physicians, physician assistants and other medical professionals who were authorized to write prescriptions for home health care services. According to court documents, Medina and her co-conspirators channeled those prescriptions and other pertinent medical documentation to area home health agencies, including Flores Home Health Care, and patient recruiters in return for kickbacks and bribes.
As previously reported in our blog on December 4, it was discovered that Flores Home Health actually operated for the sole purpose of billing the Medicare program for expensive physical therapy and home health care services that were not medically necessary or were not provided, similar to what was found with the other home health care agencies’ operations.
Medina has acknowledged her involvement in the fraudulent schemes. She could receive a maximum penalty of 10 years in prison. Sentencing has been scheduled for March 14, 2014.