Tag Archives: Medicare fraud

Tallahassee Doctor Accused of Billing Insurers for Phony Medical Procedures

Dr. Moses D. Degraft-Johnson of the Heart and Vascular Institute of Northern Florida in Tallahassee is accused of taking $26 million from health insurance agencies for phony medical procedures. According to federal prosecutors, Dr. Degraft-Johnson allegedly went to hospitals, scheduled patients for unnecessary visits, and billed for the services that never occurred. In some cases, the doctor was traveling when he claims to have done procedures in his office.

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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

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

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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Filed under Fraud

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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Filed under Fraud, Healthcare

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.

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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.

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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.

Filed under Healthcare

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.

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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.

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Filed under Healthcare