Jessica Linton of Clearwater and Juan Rodriguez of Tampa are two of 10 people who were charged in an indictment alleging over $200 million in insurance fraud. Linton is facing 24 charges in the indictment while Rodriguez is facing 6 charges including health care fraud, mail fraud and aggravated identity theft. The scheme included altering prescriptions to add non-prescribed drugs including Tramadol and ketamine.
Click here to read the article.
Filed under Fraud, Healthcare
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.
Click here to read the article.
Filed under Fraud, Healthcare
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.
Click here to read the article.
Filed under Fraud, Healthcare
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.
Click here for the press release.
Filed under Fraud, Healthcare
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.
Click here to read the story.
Filed under Fraud, Healthcare
James Durkin, owner of a Boynton Beach opioid treatment facility The Hope Center of Recovery, has been arrested for insurance fraud. Durkin was charged for allegedly submitting fraudulent insurance billing for over $104,000.
CFO Jimmy Patronis said, “Insurance fraud at crooked addiction treatment centers fuels the ongoing opioid epidemic in Florida.” An investigation revealed Durkin’s was falsified billings to Cigna and United Health Care for addiction recovery treatments that were never performed.
Durkin faces up to 30 years in prison.
Click here to read the press release.
Filed under Fraud, Healthcare
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.”
Click here to read the article.
Click here for related article.
Filed under Fraud, Healthcare
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.
Click here to read the article.
Filed under Fraud, Healthcare
Jill Jaynes of Absolute Integrated Medicine in Vero Beach has been arrested and charged with insurance fraud totaling nearly $1.5 million, racketeering and more. If Jaynes is convicted, she could face up to 135 years in prison and millions of dollars in fines.
Click here to read the article.
Filed under Uncategorized
According to the report, Billings USA received or created fabricated bills for its clinic customers. The clinics would then bill insurance companies for allowable amounts and create records to back up the charges. Billings USA collected a 6% fee on the reimbursement from insurers. Palma’s company filed $5.7 million in fraudulent claims to Blue Cross Blue Shield with one clinic and then an additional $5.9 million in fraudulent claims to Blue Cross and Cigna with another clinic.
Mauricio Palma, the owner of medical billing office Billing USA in Miami, pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to eight years in prison. Palma faces $2.1 million in restitution lost $1.8 million in forfeiture.
Click here to read the article.
Filed under Uncategorized
