"Changing the World One Adventure at a Time"
Do you want to experience field clinical work firsthand in villages of Costa Rica, Belize, or Tanzania? Interested in medicine, public health, or nursing? Travel to Costa Rica, Belize, or Tanzania for 1-2 weeks over summer break, setting up medical clinics in underprivileged villages with doctors and fellow UVA students!
Email isl.at.uva@gmail.com with questions and to learn more about International Service Learning.
Thursday, 28 February 2013
DAT Info
Pre-Dents!
Please see the following message from the American Dental Association (which hosts the DAT):
"In an effort to improve the services we provide, the Department of Testing Services (DTS) will be moving to a new software system. In December of 2012, communities of interest were informed that testing services would be interrupted during this transition, which was anticipated to take place in early 2013. This service interruption has now been scheduled to take place from March 14 through April 3, 2013. The following services will be unavailable during the transfer:
• Updates/retrievals/requests involving personal information/DENTPIN®
• Application processing
• Score report requests
• Score processing
Please see the following message from the American Dental Association (which hosts the DAT):
"In an effort to improve the services we provide, the Department of Testing Services (DTS) will be moving to a new software system. In December of 2012, communities of interest were informed that testing services would be interrupted during this transition, which was anticipated to take place in early 2013. This service interruption has now been scheduled to take place from March 14 through April 3, 2013. The following services will be unavailable during the transfer:
• Updates/retrievals/requests involving personal information/DENTPIN®
• Application processing
• Score report requests
• Score processing
This service interruption could impact individuals seeking to create a DENTPIN or to retrieve their DENTPIN, delay student receipt of score reports, and delay processing of DAT registrations. The ADA indicates that this transfer process is anticipated to require up to 3 weeks. The DAT will continue to be administered at Prometric Testing Centers throughout this time—it is test registration and test score processing that will be delayed.
Please contact the ADA Department of Testing Services (hinshawk@ada.org) if you have questions."
Upcoming Opportunities
Spring Mental Wellness Screening
March 5, 11 a.m. to 3 p.m., Newcomb 360.
Free pizza, first-come, first-served.
How’s your mood? Problems with anxiety and depression can make it hard to function and enjoy college. A recent survey (Healthy Minds, 2009) reported that 38 percent of U.Va. students thought they needed help for mental health problems in the past year. At U.Va.’s Student Health, Counseling and Psychological Services (CAPS), nearly 2,000 students sought assistance last year.
Mental wellness screening is free, fast and anonymous. You will receive immediate feedback about the results. Feel free to bring a friend along. If you can’t attend on March 5, go online for anonymous online screenings and information about emotional well-being.
If you would like to speak with a mental health professional, call CAPS at 434-243-5150 and request a phone screening appointment. Additionally, if you are dealing with a mental health emergency after 5 p.m. or on weekends, either on your own or with someone you know, a CAPS clinician is available through the Student Health answering service at 434-972-7004.
March 5, 11 a.m. to 3 p.m., Newcomb 360.
Free pizza, first-come, first-served.
How’s your mood? Problems with anxiety and depression can make it hard to function and enjoy college. A recent survey (Healthy Minds, 2009) reported that 38 percent of U.Va. students thought they needed help for mental health problems in the past year. At U.Va.’s Student Health, Counseling and Psychological Services (CAPS), nearly 2,000 students sought assistance last year.
Mental wellness screening is free, fast and anonymous. You will receive immediate feedback about the results. Feel free to bring a friend along. If you can’t attend on March 5, go online for anonymous online screenings and information about emotional well-being.
If you would like to speak with a mental health professional, call CAPS at 434-243-5150 and request a phone screening appointment. Additionally, if you are dealing with a mental health emergency after 5 p.m. or on weekends, either on your own or with someone you know, a CAPS clinician is available through the Student Health answering service at 434-972-7004.
Pre-Dental Society (PDS): Meeting and Lecture
Feb. 28, 7 p.m., Clark 102.
Dr. Giuseppe “Joe” Rebellato will speak to PDS about his experiences in dentistry. Additionally, Career Peer Educator Molly Cudahy will speak about the Parents Committee Internship Grants and the Simpson Internship Scholarship, and she will answer any general UCS questions you have. She will have materials about procuring summer internships and funding opportunities. We will also sell PDS T-shirts for $14 and give out information on how to get involved with presentations to local children regarding proper dental hygiene. For more information, see the website or email tsp3ag@virginia.edu.
Feb. 28, 7 p.m., Clark 102.
Dr. Giuseppe “Joe” Rebellato will speak to PDS about his experiences in dentistry. Additionally, Career Peer Educator Molly Cudahy will speak about the Parents Committee Internship Grants and the Simpson Internship Scholarship, and she will answer any general UCS questions you have. She will have materials about procuring summer internships and funding opportunities. We will also sell PDS T-shirts for $14 and give out information on how to get involved with presentations to local children regarding proper dental hygiene. For more information, see the website or email tsp3ag@virginia.edu.
Med School Admissions Article
Med School Without the MCAT
by Zach Budryk
http://www.insidehighered.com/
by Zach Budryk
http://www.insidehighered.com/
Philadelphia College of Osteopathic Medicine Open House
On behalf of the students, faculty and staff at Philadelphia College of Osteopathic Medicine, it is a pleasure to extend an invitation for students to join them at their DO Open House on Sunday, April 14th. Details are as follows:
Sunday, April 14, 2013
Registration: 12:00pm - 1:30pm EST
Program: 1:30pm - 4:00pm EST
Evans Hall
4170 City Avenue
Philadelphia, PA 19131
Registration: 12:00pm - 1:30pm EST
Program: 1:30pm - 4:00pm EST
Evans Hall
4170 City Avenue
Philadelphia, PA 19131
Join the PCOM community to learn more about the DO program. You will have the opportunity to:
Receive a campus tour
Observe Osteopathic Manipulative Medicine
Speak with faculty and students
Speak with Admissions, Financial Aid and Student Affairs representatives
Observe Osteopathic Manipulative Medicine
Speak with faculty and students
Speak with Admissions, Financial Aid and Student Affairs representatives
Registration for the event can be found on line at pcom.edu.
Exploring Health Careers
Interested in a health career, but don't know where to start?
www.explorehealthcareers.org
Find out about degree requirements, industry salaries, and financing your education for careers from dentistry to pharmacy to allied health.
www.explorehealthcareers.org
Find out about degree requirements, industry salaries, and financing your education for careers from dentistry to pharmacy to allied health.
Wednesday, 27 February 2013
Veterinary Medical Career Fair
The Association of American Veterinary Medical Colleges proudly presents its 9th Annual Veterinary Medical Career Fair and Information Sessions on Sunday, March 10, 2013 at the Westin Alexandria in Alexandria, Virginia. This free event is for any high school and undergraduate student with an interest in the veterinary medical profession.
This premier event features sessions on applying to a variety of topics related to veterinary profession and how to prepare for vet school. We also feature an exhibit hall with many of AAVMC’s member institutions on hand to answer your institution specific questions.
Students will not want to miss this once-a-year event!
Registration is now open! (Just click the link to visit our event page.)
This year’s information session topics include: practicing in an underserved community, careers in public health, applying to vet school, and more!
Veterinary Medical Career Fair
& Information Sessions
Sunday March 10, 2013
2:30 PM—5:00 PMWestin Alexandria
400 Courthouse Square
Alexandria, VA 22314
2:30 PM—5:00 PMWestin Alexandria
400 Courthouse Square
Alexandria, VA 22314
This event is generously supported by the American Veterinary Medical Association.
For additional questions please send an email to diversitymatters@aavmc.org.
Former Owners of Los Angeles-Area Medical Equipment Wholesaler Plead Guilty to Conspiring with Customers to Defraud Medicare
WASHINGTON—Two former owners of a Los Angeles-area medical equipment wholesale supply company pleaded guilty today to conspiring with their customers to defraud Medicare.
The pleas were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney André Birotte, Jr. of the Central District of California; Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); Bill L. Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office; and Joseph Fendrick, Special Agent in Charge of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse (Cal-DOJ).
Rajinder Singh Paul, 69, and Baljit Kaur Paul, 65, of Redlands, California, each pleaded guilty before U.S. District Judge Percy Anderson in the Central District of California to one count of conspiracy to commit health care fraud.
In court documents, Rajinder and Baljit Paul admitted that they were the president and vice president, respectively, and shareholders of AHPK Inc., a medical equipment wholesale supply company located in Redlands and Ontario, California, and formally known as Major’s Wholesale Medical Supply Inc. The Pauls later sold Major’s Wholesale Medical Supply Inc. to Major’s Wholesale Medical Supply LLC (collectively, “Major’s”) and, according to court documents, remained employed at Major’s Wholesale Medical Supply LLC as consultants until they were terminated in February 2009.
During the time the Pauls either owned or worked as consultants for Major’s, Major’s sold durable medical equipment (DME) almost exclusively to customers who owned and operated DME supply companies, according to court documents. A majority of Major’s customers were Medicare providers and relied on Medicare to make money, which they did by billing Medicare for the DME that they purchased from Major’s.
One of the more popular items of DME that the Pauls sold at Major’s were power wheelchairs. Court documents indicate that to attract customers, the Pauls sold power wheelchairs to Major’s customers wholesale for between $850 to $1,000 each. Major’s customers, however, billed these power wheelchairs to Medicare at a rate of between $3,000 to $6,000 per wheelchair.
The Pauls admitted they knew that Major’s customers were dependent on Medicare for their revenue and that Major’s customers could not pay Major’s unless Medicare paid the customers first. To foster customer loyalty, the Pauls engaged in a variety of conduct over a period of six years that helped Major’s customers defraud Medicare, including by providing Major’s customers with false inventory purchase agreements that showed they had higher credit limits than they really did. Major’s customers submitted these false inventory purchase agreements to Medicare to prove, as required by Medicare, the ability to purchase the volume of DME they billed.
The Pauls also admitted they provided Major’s customers with backdated invoices, knowing customers were billing Medicare for power wheelchairs and DME before the customers actually purchased or delivered the equipment. The Pauls admitted that by backdating these invoices, they provided Major’s customers with the paper trail the customers needed to prove to Medicare that they had both purchased the DME and purchased it before they submitted their claims to Medicare. According to court documents, the Pauls backdated or falsified invoices for more than 100 different customers.
Court documents indicate that two of many customers who conspired with the Pauls to defraud Medicare owned and operated a number of fraudulent DME supply companies in the Los Angeles area, including one customer who used “straw,” or nominee, owners to operate the customer’s companies. The Pauls admitted they provided these two customers with false inventory purchase agreements and backdated invoices that the customers used to defraud Medicare. The Pauls admitted that as a result of their conduct, these two customers were able to use their fraudulent DME supply companies to submit approximately $16,662,143 in false claims to and receive approximately $9,743,609.42 in ill-gotten reimbursement payments from Medicare.
At sentencing, scheduled for July 8, 2013, the Pauls each face a maximum penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Jonathan T. Baum of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG, and Cal DOJ and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov
The pleas were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney André Birotte, Jr. of the Central District of California; Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); Bill L. Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office; and Joseph Fendrick, Special Agent in Charge of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse (Cal-DOJ).
Rajinder Singh Paul, 69, and Baljit Kaur Paul, 65, of Redlands, California, each pleaded guilty before U.S. District Judge Percy Anderson in the Central District of California to one count of conspiracy to commit health care fraud.
In court documents, Rajinder and Baljit Paul admitted that they were the president and vice president, respectively, and shareholders of AHPK Inc., a medical equipment wholesale supply company located in Redlands and Ontario, California, and formally known as Major’s Wholesale Medical Supply Inc. The Pauls later sold Major’s Wholesale Medical Supply Inc. to Major’s Wholesale Medical Supply LLC (collectively, “Major’s”) and, according to court documents, remained employed at Major’s Wholesale Medical Supply LLC as consultants until they were terminated in February 2009.
During the time the Pauls either owned or worked as consultants for Major’s, Major’s sold durable medical equipment (DME) almost exclusively to customers who owned and operated DME supply companies, according to court documents. A majority of Major’s customers were Medicare providers and relied on Medicare to make money, which they did by billing Medicare for the DME that they purchased from Major’s.
One of the more popular items of DME that the Pauls sold at Major’s were power wheelchairs. Court documents indicate that to attract customers, the Pauls sold power wheelchairs to Major’s customers wholesale for between $850 to $1,000 each. Major’s customers, however, billed these power wheelchairs to Medicare at a rate of between $3,000 to $6,000 per wheelchair.
The Pauls admitted they knew that Major’s customers were dependent on Medicare for their revenue and that Major’s customers could not pay Major’s unless Medicare paid the customers first. To foster customer loyalty, the Pauls engaged in a variety of conduct over a period of six years that helped Major’s customers defraud Medicare, including by providing Major’s customers with false inventory purchase agreements that showed they had higher credit limits than they really did. Major’s customers submitted these false inventory purchase agreements to Medicare to prove, as required by Medicare, the ability to purchase the volume of DME they billed.
The Pauls also admitted they provided Major’s customers with backdated invoices, knowing customers were billing Medicare for power wheelchairs and DME before the customers actually purchased or delivered the equipment. The Pauls admitted that by backdating these invoices, they provided Major’s customers with the paper trail the customers needed to prove to Medicare that they had both purchased the DME and purchased it before they submitted their claims to Medicare. According to court documents, the Pauls backdated or falsified invoices for more than 100 different customers.
Court documents indicate that two of many customers who conspired with the Pauls to defraud Medicare owned and operated a number of fraudulent DME supply companies in the Los Angeles area, including one customer who used “straw,” or nominee, owners to operate the customer’s companies. The Pauls admitted they provided these two customers with false inventory purchase agreements and backdated invoices that the customers used to defraud Medicare. The Pauls admitted that as a result of their conduct, these two customers were able to use their fraudulent DME supply companies to submit approximately $16,662,143 in false claims to and receive approximately $9,743,609.42 in ill-gotten reimbursement payments from Medicare.
At sentencing, scheduled for July 8, 2013, the Pauls each face a maximum penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Jonathan T. Baum of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG, and Cal DOJ and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov
Old Saybrook Physical Therapist Sentenced, Agrees to Pay $328,828 to Resolve False Claims Act Liability
The United States Attorney for the District of Connecticut announced that Todd Roberts, 47, of Old Saybrook, was sentenced today by United States District Judge Stefan R. Underhill in Bridgeport to three years of probation for obstructing a federal audit. Roberts and his physical therapy practice, Roberts Physical and Aquatics Therapy, also have entered into a civil settlement agreement with the government in which they will pay $328,828 to resolve allegations that they violated the False Claims Act.
According to court documents and statements made in court, on January 23, 2009, a Medicare contractor informed Roberts Physical and Aquatics Therapy, located at 210 Main Street in Old Saybrook, that the contractor was performing an audit of the practice. Roberts instructed an employee to delay the audit by telling the contractor that medical records were stored at a nonexistent storage facility. Roberts then rented a storage unit at a local facility and used the delay to alter and augment patient records. Specifically, Roberts and an employee at his direction created and added patient progress notes when no notes had been created at the time of service. The notes made it appear as though Medicare beneficiaries had obtained direct, one-on-one service from a licensed physical therapist when, in fact, some of the services had been rendered by unlicensed auxiliary personnel.
On September 25, 2012, Roberts waived his right to indictment and pleaded guilty to one count of obstructing a federal audit.
The civil allegations against Roberts and Roberts Physical and Aquatics Therapy involve improper billing to Medicare for physical and aquatic therapy services between April 2007 and March 2010. The Medicare program only pays for outpatient therapy services that are provided by qualified personnel. Personnel qualified to provide outpatient therapy services are limited to physicians, licensed physical therapists, and licensed physical therapy assistants. The Medicare program does not pay for physical therapy services provided by supportive personnel, such as physical therapy aides, athletic trainers, or student trainees. In addition, Medicare regulations and policies make it clear that therapeutic procedures require direct, one-on-one contact between the licensed therapist and the patient.
The government alleges that Roberts and Roberts Physical and Aquatics Therapy regularly billed Medicare for direct, one-on-one therapeutic procedures when such services were not provided. At the clinic, physical therapists and physical therapy assistants would routinely provide therapy services to multiple patients at the same time. Nevertheless, the services provided to each patient were billed as if the physical therapist or physical therapy assistant had provided direct, one-on-one care. For example, patients were routinely left alone to perform exercises in the aquatic therapy pool, with no direct, one-on-one contact with licensed personnel.
In addition, Medicare regulations and policies make it clear that physical therapy services must be thoroughly and accurately documented in the patients’ medical chart. Therapy services are only payable when the medical record consistently and accurately records the covered therapy services. The government alleges that Roberts and Roberts Physical and Aquatics Therapy routinely failed to document their therapy services. This was particularly egregious during the first six months of its operation, when the clinic did not have any documentation at all showing that the services in question were actually provided.
To resolve their liability under the False Claims Act, Roberts Physical and Aquatics Therapy will pay $328,828 for conduct occurring between April 5, 2007 and March 31, 2010.
In addition, Roberts and Roberts Physical and Aquatics Therapy have entered into a six-year Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of the Medicare program, including the proper rendering of therapy services and the submission of only valid claims to Medicare for payment.
In entering into the civil settlement agreement, Roberts and Roberts Physical and Aquatics Therapy did not admit liability.
Judge Underhill required Roberts, as conditions of his probation, to comply with the terms of the Integrity Agreement and to pay the entire $328,828.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the Office of the Inspector General for the Department of Veterans Affairs. The case was prosecuted by Assistant United States Attorneys David J. Sheldon and Richard M. Molot, and Auditor Susan Spiegel.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.
According to court documents and statements made in court, on January 23, 2009, a Medicare contractor informed Roberts Physical and Aquatics Therapy, located at 210 Main Street in Old Saybrook, that the contractor was performing an audit of the practice. Roberts instructed an employee to delay the audit by telling the contractor that medical records were stored at a nonexistent storage facility. Roberts then rented a storage unit at a local facility and used the delay to alter and augment patient records. Specifically, Roberts and an employee at his direction created and added patient progress notes when no notes had been created at the time of service. The notes made it appear as though Medicare beneficiaries had obtained direct, one-on-one service from a licensed physical therapist when, in fact, some of the services had been rendered by unlicensed auxiliary personnel.
On September 25, 2012, Roberts waived his right to indictment and pleaded guilty to one count of obstructing a federal audit.
The civil allegations against Roberts and Roberts Physical and Aquatics Therapy involve improper billing to Medicare for physical and aquatic therapy services between April 2007 and March 2010. The Medicare program only pays for outpatient therapy services that are provided by qualified personnel. Personnel qualified to provide outpatient therapy services are limited to physicians, licensed physical therapists, and licensed physical therapy assistants. The Medicare program does not pay for physical therapy services provided by supportive personnel, such as physical therapy aides, athletic trainers, or student trainees. In addition, Medicare regulations and policies make it clear that therapeutic procedures require direct, one-on-one contact between the licensed therapist and the patient.
The government alleges that Roberts and Roberts Physical and Aquatics Therapy regularly billed Medicare for direct, one-on-one therapeutic procedures when such services were not provided. At the clinic, physical therapists and physical therapy assistants would routinely provide therapy services to multiple patients at the same time. Nevertheless, the services provided to each patient were billed as if the physical therapist or physical therapy assistant had provided direct, one-on-one care. For example, patients were routinely left alone to perform exercises in the aquatic therapy pool, with no direct, one-on-one contact with licensed personnel.
In addition, Medicare regulations and policies make it clear that physical therapy services must be thoroughly and accurately documented in the patients’ medical chart. Therapy services are only payable when the medical record consistently and accurately records the covered therapy services. The government alleges that Roberts and Roberts Physical and Aquatics Therapy routinely failed to document their therapy services. This was particularly egregious during the first six months of its operation, when the clinic did not have any documentation at all showing that the services in question were actually provided.
To resolve their liability under the False Claims Act, Roberts Physical and Aquatics Therapy will pay $328,828 for conduct occurring between April 5, 2007 and March 31, 2010.
In addition, Roberts and Roberts Physical and Aquatics Therapy have entered into a six-year Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of the Medicare program, including the proper rendering of therapy services and the submission of only valid claims to Medicare for payment.
In entering into the civil settlement agreement, Roberts and Roberts Physical and Aquatics Therapy did not admit liability.
Judge Underhill required Roberts, as conditions of his probation, to comply with the terms of the Integrity Agreement and to pay the entire $328,828.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the Office of the Inspector General for the Department of Veterans Affairs. The case was prosecuted by Assistant United States Attorneys David J. Sheldon and Richard M. Molot, and Auditor Susan Spiegel.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.
Miami Pharmacy Owner Sentenced to 14 Years in Prison in $23 Million Health Care Fraud Scheme
WASHINGTON—A co-owner and operator of three Miami discount pharmacies was sentenced today to 168 months in prison for his role in a health care fraud scheme that submitted more than $23 million in false claims to Medicare.
The sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.
Jose Carlos Morales, 55, of Miami, was sentenced by U.S. District Judge Joan A. Lenard in the Southern District of Florida. In addition to his prison term, Morales was sentenced to serve three years of supervised release and to pay a $100,000 fine. A hearing to determine the amount of restitution Morales will pay has been scheduled for April 29, 2013.
On December 6, 2012, Morales pleaded guilty in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and pay illegal health care kickbacks.
According to court documents, Morales was the co-owner of Pharmovisa Inc. and PharmovisaMD Inc., which operated a total of three pharmacies in Miami. Morales paid illegal health care kickbacks to co-conspirators in return for a stream of beneficiary information to be used to submit claims to Medicare and Medicaid. The beneficiaries who were referred to the pharmacies in exchange for kickback payments resided at assisted living facilities (ALFs) located in Miami. Morales and his alleged co-conspirators also paid illegal health care kickbacks to physicians in exchange for prescription referrals, which the pharmacies ultimately billed to Medicare.
Court documents also reveal that beginning in approximately 2007, drivers working for Morales’ pharmacies, at his direction, delivered “bingo cards” containing pop-out medications to ALFs located throughout the Southern District of Florida. Morales instructed the drivers to pick up any unused “bingo cards” so that Morales pharmacy personnel could put the medications back into pill bottles. Unused and partially used medications were eventually re-billed to Medicare and Medicaid, and a majority of the previously submitted claims to Medicare and Medicaid were never reversed. Morales also instructed Morales pharmacy personnel to place unused and partially used medications into bottles to be sold directly to the general public from the “community” pharmacy shelves.
Morales and his alleged co-conspirators also engaged in sham financial transactions to facilitate and conceal the fraud schemes and the flow of fraud proceeds, according to court documents. In most instances, the sham transactions involved shell entities owned and/or controlled by Morales or his alleged co-conspirators.
According to court documents, Morales and his co-conspirators submitted and caused to be submitted approximately $23,367,755 in false and fraudulent claims to the Medicare and Florida Medicaid programs.
The case is being prosecuted by Trial Attorney Allan J. Medina and Special Trial Attorney William Parente of the Criminal Division’s Fraud Section. This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
The sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.
Jose Carlos Morales, 55, of Miami, was sentenced by U.S. District Judge Joan A. Lenard in the Southern District of Florida. In addition to his prison term, Morales was sentenced to serve three years of supervised release and to pay a $100,000 fine. A hearing to determine the amount of restitution Morales will pay has been scheduled for April 29, 2013.
On December 6, 2012, Morales pleaded guilty in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and pay illegal health care kickbacks.
According to court documents, Morales was the co-owner of Pharmovisa Inc. and PharmovisaMD Inc., which operated a total of three pharmacies in Miami. Morales paid illegal health care kickbacks to co-conspirators in return for a stream of beneficiary information to be used to submit claims to Medicare and Medicaid. The beneficiaries who were referred to the pharmacies in exchange for kickback payments resided at assisted living facilities (ALFs) located in Miami. Morales and his alleged co-conspirators also paid illegal health care kickbacks to physicians in exchange for prescription referrals, which the pharmacies ultimately billed to Medicare.
Court documents also reveal that beginning in approximately 2007, drivers working for Morales’ pharmacies, at his direction, delivered “bingo cards” containing pop-out medications to ALFs located throughout the Southern District of Florida. Morales instructed the drivers to pick up any unused “bingo cards” so that Morales pharmacy personnel could put the medications back into pill bottles. Unused and partially used medications were eventually re-billed to Medicare and Medicaid, and a majority of the previously submitted claims to Medicare and Medicaid were never reversed. Morales also instructed Morales pharmacy personnel to place unused and partially used medications into bottles to be sold directly to the general public from the “community” pharmacy shelves.
Morales and his alleged co-conspirators also engaged in sham financial transactions to facilitate and conceal the fraud schemes and the flow of fraud proceeds, according to court documents. In most instances, the sham transactions involved shell entities owned and/or controlled by Morales or his alleged co-conspirators.
According to court documents, Morales and his co-conspirators submitted and caused to be submitted approximately $23,367,755 in false and fraudulent claims to the Medicare and Florida Medicaid programs.
The case is being prosecuted by Trial Attorney Allan J. Medina and Special Trial Attorney William Parente of the Criminal Division’s Fraud Section. This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Manhattan Doctor Pleads Guilty to $8.5 Million Medicare Fraud Scheme
Preet Bharara, the United States Attorney for the Southern District of New York, announced that Dr. Roberto Aymat, a medical doctor, pled guilty today in Manhattan federal court to participating in a scheme to defraud Medicare out of approximately $8.5 million through the use of fraudulent HIV/AIDS clinics in New York. As part of the scheme, Aymat and others billed Medicare for medications that were never administered or that were administered but were medically unnecessary. He pled guilty before U.S. District Judge George B. Daniels. Three other participants in the scheme, Asmed Barrera, Augusto Guzman, and Jorge Rivero, previously pled guilty.
Manhattan U.S. Attorney Preet Bharara said, “Roberto Aymat used his medical license to perpetrate a multi-million-dollar fraud on Medicare—a program that provides a lifeline to its beneficiaries and that is struggling financially to stay afloat. His exploitation of this vital, taxpayer-funded program was egregious and with his plea today, he has been held to account.”
According to the complaint and the indictment filed in this case:
Aymat, along with Barrera, Guzman, Rivero, also a medical doctor, and others operated three medical clinics in New York City that purported to provide drug treatments to Medicare-eligible HIV/AIDS patients, but that were, in reality, health care fraud mills.
The defendants executed the fraudulent scheme by recruiting HIV/AIDS patients eligible for Medicare and paying them kickbacks in exchange for signing on as patients at the clinics. The defendants then used these patients’ status as Medicare beneficiaries to submit claims for reimbursement to Medicare for drugs that had been prescribed to these patients. In fact, these medications were never purchased and never administered, or were administered, but were medically unnecessary.
From January 2007 to April 2009, Aymat and his co-conspirators billed Medicare for more than 10 times the number of units of prescription drugs they actually purchased, defrauding the Medicare system of at least $8.5 million.
Aymat, 44, a resident of Manhattan, pled guilty to conspiring to commit fraud in connection with a health care benefits program and to committing healthcare fraud and mail fraud. He faces a penalty of up to 50 years in prison and is scheduled to be sentenced by Judge Daniels on June 18, 2013.
Mr. Bharara praised the investigative work of the Federal Bureau of Investigation and the Department of Health and Human Services, Office of Inspector General, New York Region.
The prosecution is being handled by the Office’s Complex Frauds Unit. Assistant United States Attorneys Kan M. Nawaday and Jason H. Cowley are in charge of the prosecution.
Manhattan U.S. Attorney Preet Bharara said, “Roberto Aymat used his medical license to perpetrate a multi-million-dollar fraud on Medicare—a program that provides a lifeline to its beneficiaries and that is struggling financially to stay afloat. His exploitation of this vital, taxpayer-funded program was egregious and with his plea today, he has been held to account.”
According to the complaint and the indictment filed in this case:
Aymat, along with Barrera, Guzman, Rivero, also a medical doctor, and others operated three medical clinics in New York City that purported to provide drug treatments to Medicare-eligible HIV/AIDS patients, but that were, in reality, health care fraud mills.
The defendants executed the fraudulent scheme by recruiting HIV/AIDS patients eligible for Medicare and paying them kickbacks in exchange for signing on as patients at the clinics. The defendants then used these patients’ status as Medicare beneficiaries to submit claims for reimbursement to Medicare for drugs that had been prescribed to these patients. In fact, these medications were never purchased and never administered, or were administered, but were medically unnecessary.
From January 2007 to April 2009, Aymat and his co-conspirators billed Medicare for more than 10 times the number of units of prescription drugs they actually purchased, defrauding the Medicare system of at least $8.5 million.
Aymat, 44, a resident of Manhattan, pled guilty to conspiring to commit fraud in connection with a health care benefits program and to committing healthcare fraud and mail fraud. He faces a penalty of up to 50 years in prison and is scheduled to be sentenced by Judge Daniels on June 18, 2013.
Mr. Bharara praised the investigative work of the Federal Bureau of Investigation and the Department of Health and Human Services, Office of Inspector General, New York Region.
The prosecution is being handled by the Office’s Complex Frauds Unit. Assistant United States Attorneys Kan M. Nawaday and Jason H. Cowley are in charge of the prosecution.
Women's Center Internship
Looking for an internship? Consider working at the Women's Center!
The application is here and submissions are being accepted on a rolling basis until April 1, 2013. Interviews will follow, and internships will be announced shortly thereafter. Please email your application with a résumé to Jen Merritt, Director of Mentoring and Diversity at jmerritt@virginia.edu.
For more information, please visit:
http://womenscenter.virginia.edu/interns-info-2013-2014.php
The U.Va. Women’s Center is accepting applications for the 2012-2013 Internship Program. Interns receive 3 hours of course credit (EDLF 5500) during the first semester while enrolled in the Women's Center class, "Women, Peace and Justice," and are required to engage in 6 hours of internship activity per week in one of the following positions for the entire school year. An additional 3 hours of independent study credit in the Curry School may be obtained in the second semester if desired.
The application is here and submissions are being accepted on a rolling basis until April 1, 2013. Interviews will follow, and internships will be announced shortly thereafter. Please email your application with a résumé to Jen Merritt, Director of Mentoring and Diversity at jmerritt@virginia.edu.
For more information, please visit:
http://womenscenter.virginia.edu/interns-info-2013-2014.php
Tuesday, 26 February 2013
Occupational Therapist Impersonator Sentenced to Prison for Mail Fraud and Identity Theft
ORLANDO—U.S. District Judge Roy Dalton sentenced James Lewis, a/k/a James Lee Lewis (44, Kissimmee), today to five years and five months in federal prison for mail fraud and aggravated identity theft. Lewis pleaded guilty on December 18, 2012.
According to court documents, in March 2009, Lewis fraudulently obtained a temporary occupational therapist (OT) license from the Florida Department of Health. To obtain the temporary license, Lewis used a false name and Social Security number and fabricated his education credentials. Between March 2009 and July 2011, Lewis worked as an OT at various health care facilities in Central Florida and New Mexico and received his wages using Electronic Funds Transfers. On January 17, 2013, Lewis’ bond was revoked after the government discovered that he had again applied to work as an occupational therapist in Central Florida, using fraudulent information.
This case was investigated by the Federal Bureau of Investigation, the Florida Department of Law Enforcement, and the Florida Department of Health’s Division of Medical Quality Assurance, Orlando Unlicensed Activity Office. It was prosecuted by Assistant United States Attorney David Haas.
According to court documents, in March 2009, Lewis fraudulently obtained a temporary occupational therapist (OT) license from the Florida Department of Health. To obtain the temporary license, Lewis used a false name and Social Security number and fabricated his education credentials. Between March 2009 and July 2011, Lewis worked as an OT at various health care facilities in Central Florida and New Mexico and received his wages using Electronic Funds Transfers. On January 17, 2013, Lewis’ bond was revoked after the government discovered that he had again applied to work as an occupational therapist in Central Florida, using fraudulent information.
This case was investigated by the Federal Bureau of Investigation, the Florida Department of Law Enforcement, and the Florida Department of Health’s Division of Medical Quality Assurance, Orlando Unlicensed Activity Office. It was prosecuted by Assistant United States Attorney David Haas.
Old Saybrook Physical Therapist Sentenced, Agrees to Pay $328,828 to Resolve False Claims Act Liability
The United States Attorney for the District of Connecticut announced that Todd Roberts, 47, of Old Saybrook, was sentenced today by United States District Judge Stefan R. Underhill in Bridgeport to three years of probation for obstructing a federal audit. Roberts and his physical therapy practice, Roberts Physical and Aquatics Therapy, also have entered into a civil settlement agreement with the government in which they will pay $328,828 to resolve allegations that they violated the False Claims Act.
According to court documents and statements made in court, on January 23, 2009, a Medicare contractor informed Roberts Physical and Aquatics Therapy, located at 210 Main Street in Old Saybrook, that the contractor was performing an audit of the practice. Roberts instructed an employee to delay the audit by telling the contractor that medical records were stored at a nonexistent storage facility. Roberts then rented a storage unit at a local facility and used the delay to alter and augment patient records. Specifically, Roberts and an employee at his direction created and added patient progress notes when no notes had been created at the time of service. The notes made it appear as though Medicare beneficiaries had obtained direct, one-on-one service from a licensed physical therapist when, in fact, some of the services had been rendered by unlicensed auxiliary personnel.
On September 25, 2012, Roberts waived his right to indictment and pleaded guilty to one count of obstructing a federal audit.
The civil allegations against Roberts and Roberts Physical and Aquatics Therapy involve improper billing to Medicare for physical and aquatic therapy services between April 2007 and March 2010. The Medicare program only pays for outpatient therapy services that are provided by qualified personnel. Personnel qualified to provide outpatient therapy services are limited to physicians, licensed physical therapists, and licensed physical therapy assistants. The Medicare program does not pay for physical therapy services provided by supportive personnel, such as physical therapy aides, athletic trainers, or student trainees. In addition, Medicare regulations and policies make it clear that therapeutic procedures require direct, one-on-one contact between the licensed therapist and the patient.
The government alleges that Roberts and Roberts Physical and Aquatics Therapy regularly billed Medicare for direct, one-on-one therapeutic procedures when such services were not provided. At the clinic, physical therapists and physical therapy assistants would routinely provide therapy services to multiple patients at the same time. Nevertheless, the services provided to each patient were billed as if the physical therapist or physical therapy assistant had provided direct, one-on-one care. For example, patients were routinely left alone to perform exercises in the aquatic therapy pool, with no direct, one-on-one contact with licensed personnel.
In addition, Medicare regulations and policies make it clear that physical therapy services must be thoroughly and accurately documented in the patients’ medical chart. Therapy services are only payable when the medical record consistently and accurately records the covered therapy services. The government alleges that Roberts and Roberts Physical and Aquatics Therapy routinely failed to document their therapy services. This was particularly egregious during the first six months of its operation, when the clinic did not have any documentation at all showing that the services in question were actually provided.
To resolve their liability under the False Claims Act, Roberts Physical and Aquatics Therapy will pay $328,828 for conduct occurring between April 5, 2007 and March 31, 2010.
In addition, Roberts and Roberts Physical and Aquatics Therapy have entered into a six-year Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of the Medicare program, including the proper rendering of therapy services and the submission of only valid claims to Medicare for payment.
In entering into the civil settlement agreement, Roberts and Roberts Physical and Aquatics Therapy did not admit liability.
Judge Underhill required Roberts, as conditions of his probation, to comply with the terms of the Integrity Agreement and to pay the entire $328,828.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the Office of the Inspector General for the Department of Veterans Affairs. The case was prosecuted by Assistant United States Attorneys David J. Sheldon and Richard M. Molot, and Auditor Susan Spiegel.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.
According to court documents and statements made in court, on January 23, 2009, a Medicare contractor informed Roberts Physical and Aquatics Therapy, located at 210 Main Street in Old Saybrook, that the contractor was performing an audit of the practice. Roberts instructed an employee to delay the audit by telling the contractor that medical records were stored at a nonexistent storage facility. Roberts then rented a storage unit at a local facility and used the delay to alter and augment patient records. Specifically, Roberts and an employee at his direction created and added patient progress notes when no notes had been created at the time of service. The notes made it appear as though Medicare beneficiaries had obtained direct, one-on-one service from a licensed physical therapist when, in fact, some of the services had been rendered by unlicensed auxiliary personnel.
On September 25, 2012, Roberts waived his right to indictment and pleaded guilty to one count of obstructing a federal audit.
The civil allegations against Roberts and Roberts Physical and Aquatics Therapy involve improper billing to Medicare for physical and aquatic therapy services between April 2007 and March 2010. The Medicare program only pays for outpatient therapy services that are provided by qualified personnel. Personnel qualified to provide outpatient therapy services are limited to physicians, licensed physical therapists, and licensed physical therapy assistants. The Medicare program does not pay for physical therapy services provided by supportive personnel, such as physical therapy aides, athletic trainers, or student trainees. In addition, Medicare regulations and policies make it clear that therapeutic procedures require direct, one-on-one contact between the licensed therapist and the patient.
The government alleges that Roberts and Roberts Physical and Aquatics Therapy regularly billed Medicare for direct, one-on-one therapeutic procedures when such services were not provided. At the clinic, physical therapists and physical therapy assistants would routinely provide therapy services to multiple patients at the same time. Nevertheless, the services provided to each patient were billed as if the physical therapist or physical therapy assistant had provided direct, one-on-one care. For example, patients were routinely left alone to perform exercises in the aquatic therapy pool, with no direct, one-on-one contact with licensed personnel.
In addition, Medicare regulations and policies make it clear that physical therapy services must be thoroughly and accurately documented in the patients’ medical chart. Therapy services are only payable when the medical record consistently and accurately records the covered therapy services. The government alleges that Roberts and Roberts Physical and Aquatics Therapy routinely failed to document their therapy services. This was particularly egregious during the first six months of its operation, when the clinic did not have any documentation at all showing that the services in question were actually provided.
To resolve their liability under the False Claims Act, Roberts Physical and Aquatics Therapy will pay $328,828 for conduct occurring between April 5, 2007 and March 31, 2010.
In addition, Roberts and Roberts Physical and Aquatics Therapy have entered into a six-year Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of the Medicare program, including the proper rendering of therapy services and the submission of only valid claims to Medicare for payment.
In entering into the civil settlement agreement, Roberts and Roberts Physical and Aquatics Therapy did not admit liability.
Judge Underhill required Roberts, as conditions of his probation, to comply with the terms of the Integrity Agreement and to pay the entire $328,828.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the Office of the Inspector General for the Department of Veterans Affairs. The case was prosecuted by Assistant United States Attorneys David J. Sheldon and Richard M. Molot, and Auditor Susan Spiegel.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.
Medical Center Hour - February 27, 2013
Wednesday, 27 February 2013
12:30-1:30 pm
Jordan Conference Center Auditorium
University of Virginia School of Medicine
______________
A John F. Anderson Memorial Lecture
The Last Walk:
Our Companion Animals at the End of Their Lives
Jessica Pierce PhD MDiv, Independent Bioethics Scholar and author, The Last Walk: Reflections on Our Pets at the End of Their Lives, Lyons CO
Susan Bauer-Wu PhD RN FAAN, Kluge Professor of Contemplative End-of-Life Care, School of Nursing, UVA
Unfortunately, the love we feel for our animals can inure us to their suffering. We may wait for our animal to “tell us she is ready,” but our love can make it hard to hear her cries. –Jessica Pierce, “Deciding When a Pet Has Suffered Enough,” The New York Times, 22 Sept 2012
As our companion animals grow old and infirm, veterinarians and human caregivers alike face a complex and confusing array of choices and decisions. This Medical Center Hour explores some of the central moral challenges in end-of-life care for animals, from pain management and quality-of-life assessments to palliative treatment, hospice care, and making that final decision to hasten an animal’s death. Considering this “last walk” with our pets, bioethicist Jessica Pierce and compassionate care advocate Susan Bauer-Wu borrow some ethical guideposts from the field of human bioethics (and offer a few in return).
Co-presented with the Institute for Practical Ethics and Public Life, UVA ______________________________
This program is free and open to the entire university and the public. Health professionals who attend may apply for continuing education credit. Medical Center Hour counts toward first-year medical students’ SIM requirements.
The Medical Center Hour is produced weekly throughout the academic year by the Center for Biomedical Ethics and Humanities of the University of Virginia School of Medicine. Our series includes History of the Health Sciences Lectures, which we produce together with Historical Collections in the Claude Moore Health Sciences Library.
For information, call 434.924.5974 or see
Watch Medical Center Hour on YouTube at http://www.youtube.com/uvamch. Videos are posted a week after the program.
Summer Optometry Programs!
Illinois College of Optometry, Focus on Your Future
July 15-19, 2013
The Illinois College of Optometry is pleased to announce our annual summer program for underrepresented minority undergraduate students. The program is a weeklong experience that will expose undergraduate students to the profession of optometry in a variety of settings. Participants will have the opportunity to meet and work with current optometry students, ICO Faculty & Staff, as well as practicing optometrists. Students will be housed at no charge in our Residential Complex. There is no cost to participate in this program. Participants are responsible for their travel expenses and/or transportation cost to and from ICO.
For more information, please visit: http://www.ico.edu/
Program Contact: Teisha Johnson, 312.949.7407, tjohnson@ICO.EDU
The Ohio State University, I-DOC
June 17-19, 2013
The Improving Diversity in Optometric Careers program is an intensive three-day program for people from an underrepresented ethnicity (American Indian or Alaskan Native; Asian or Pacific Islander; African-American, not of Hispanic origin; or Hispanic) interested in finding out more about an optometric career. The program provides information about optometry through hands-on experiences, and it aims to increase the number of underrepresented ethnic minority optometrists. Thanks to underwriting by the Vision Service Plan (VSP), there is no cost to attend the program and includes all meals and activities. There are also a limited number of scholarships for airfare reimbursement (up to $500) and accommodations for out-of-state college applicants.
For more information about the program and information regarding the application process, please visit the I-DOC webpage:
Program Contact: Justin Griest, 614.292.8825, JGriest@optometry.osu.edu
University of California, Berkeley, Opto-Camp
Session I, June 17-19, 2013
Session II, July 15-17, 2013
The goal of Berkeley Optometry's Opto-Camp is to introduce underrepresented pre-health science majors to Optometry as a potential future career track and to prepare them to be successful applicants to optometry school. The objective of Berkeley Optometry's Opto-Camp is to present a three-day in residence experience that will provide participants with opportunities to learn about the profession of optometry and the process of becoming an optometrist.
Program specifics and the application, available in March, 2013, are linked here:
Cost: $125 program fee; limited amount of scholarships to waive program fee per session, as demonstrated by financial need.
Program Contact: Heather Iwata, 510.642.9537, hiwata@berkeley.
OSU College of Optometry Virtual Open House!
When: Wednesday, March 13 - 2pm or 6pm EST
Discover the many opportunities a career in optometry has to offer! Join for an online look at the OSU College of Optometry. High school and college students, as well as alumni, practitioners, and academic and career counselors, are welcome. Just pre-register using the online RSVP page!
For more information, contact:
Discover the many opportunities a career in optometry has to offer! Join for an online look at the OSU College of Optometry. High school and college students, as well as alumni, practitioners, and academic and career counselors, are welcome. Just pre-register using the online RSVP page!
For more information, contact:
Justin Griest
Manager, Admission & Financial Aid
The Ohio State University College of Optometry
email: griest.6@osu.edu
http://optometry.osu.edu
Manager, Admission & Financial Aid
The Ohio State University College of Optometry
email: griest.6@osu.edu
http://optometry.osu.edu
Friday, 22 February 2013
Augusta Optometrist Pleads Guilty to Health Care Fraud Charge
AUGUSTA, GA—Jeffrey Sponseller, 47, of Augusta, Georgia, pleaded guilty today before United States District Court Judge J. Randal Hall to submitting over $800,000 in fraudulent claims to Medicare.
Evidence presented at today’s guilty plea hearing showed that Sponseller, an optometrist and an owner of Eye Care One, located at 3152 Washington Road in Augusta, Georgia, submitted claims to Medicare for payment for eye examinations of nursing home patients. Instead of billing Medicare for the actual service he was providing at the nursing homes, Sponseller claimed that he was conducting the most expensive type of eye examination, which typically lasts 45 minutes. An example of this health care fraud presented at today’s guilty plea hearing involved a July 27, 2009 visit by Sponseller to a nursing home in Americus, Georgia, where Sponseller billed Medicare for 177 patients that he claimed to have examined individually for 45 minutes each during that one-day visit. As a result of this type of fraudulent billing, Medicare paid Sponseller for that type of eye exam more than any other doctor in the United States in 2009.
United States Attorney Edward J. Tarver said, “Health care fraud is a cancer on the financial health of our nation. In many cases, such as with this defendant, it is committed by professionals who are well educated and highly regarded. Whether that fraud is perpetrated by an optometrist willing to claim that he worked the equivalent of five-and-a-half days during a one-day visit to a nursing home—like this defendant did—or a medical equipment supplier that bills Medicare without authorization, the ultimate injury is to the American taxpayer. The United States Attorney’s Office and its law enforcement partners will actively pursue those who abuse our country’s health care programs for financial gain.”
Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region, said, “Any time false claims are submitted for payment, our nation’s health insurance programs and beneficiaries suffer. Protecting precious Medicare funds remains a top priority for the Inspector General and our law enforcement partners.”
Sponseller faces a maximum penalty of five years’ imprisonment and a fine of up to $250,000, in addition to paying restitution. The date for Sponseller’s sentencing hearing has not yet been scheduled.
FBI Special Agents Paul Kubala and Jason Gustin, U.S. Attorney’s Office Investigator Kimberly Reinken, HHS-OIG Special Agent David Graupner, and IRS Special Agents Roger Garland and Jeffrey Hale participated in the investigation of this case. Assistant United States Attorney David Stewart is prosecuting in this case. For additional information, please contact First Assistant United States Attorney James D. Durham at (912) 201-2547.
Evidence presented at today’s guilty plea hearing showed that Sponseller, an optometrist and an owner of Eye Care One, located at 3152 Washington Road in Augusta, Georgia, submitted claims to Medicare for payment for eye examinations of nursing home patients. Instead of billing Medicare for the actual service he was providing at the nursing homes, Sponseller claimed that he was conducting the most expensive type of eye examination, which typically lasts 45 minutes. An example of this health care fraud presented at today’s guilty plea hearing involved a July 27, 2009 visit by Sponseller to a nursing home in Americus, Georgia, where Sponseller billed Medicare for 177 patients that he claimed to have examined individually for 45 minutes each during that one-day visit. As a result of this type of fraudulent billing, Medicare paid Sponseller for that type of eye exam more than any other doctor in the United States in 2009.
United States Attorney Edward J. Tarver said, “Health care fraud is a cancer on the financial health of our nation. In many cases, such as with this defendant, it is committed by professionals who are well educated and highly regarded. Whether that fraud is perpetrated by an optometrist willing to claim that he worked the equivalent of five-and-a-half days during a one-day visit to a nursing home—like this defendant did—or a medical equipment supplier that bills Medicare without authorization, the ultimate injury is to the American taxpayer. The United States Attorney’s Office and its law enforcement partners will actively pursue those who abuse our country’s health care programs for financial gain.”
Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region, said, “Any time false claims are submitted for payment, our nation’s health insurance programs and beneficiaries suffer. Protecting precious Medicare funds remains a top priority for the Inspector General and our law enforcement partners.”
Sponseller faces a maximum penalty of five years’ imprisonment and a fine of up to $250,000, in addition to paying restitution. The date for Sponseller’s sentencing hearing has not yet been scheduled.
FBI Special Agents Paul Kubala and Jason Gustin, U.S. Attorney’s Office Investigator Kimberly Reinken, HHS-OIG Special Agent David Graupner, and IRS Special Agents Roger Garland and Jeffrey Hale participated in the investigation of this case. Assistant United States Attorney David Stewart is prosecuting in this case. For additional information, please contact First Assistant United States Attorney James D. Durham at (912) 201-2547.
Golden Heart Executive Director Sentenced to Almost Four Years in Federal Prison for Conspiracy
CHARLESTON, WV—U.S. Attorney Booth Goodwin announced today that the founder and executive director of a St. Albans-based in-home care business was sentenced to 46 months in federal prison for conspiracy in connection with a health care fraud investigation. Shida S. Jamie, 63, owner of Golden Heart In Home Care, LLC (Golden Heart), previously pleaded guilty in October 2012. Jamie admitted that in or about August or early September 2009, she altered and falsified records and documents of Golden Heart. Golden Heart specialized in providing in-home care services to the elderly and disabled under a contract with Putnam Aging Inc., an authorized West Virginia Medicaid provider.
U.S. Attorney Booth Goodwin said, “Today’s sentencing underscores my office’s commitment to not only protect the nation’s health care services, but also to vigorously pursue the criminals who steal from it.”
Jamie admitted that she directed office staff to review the personnel files of caregivers who provided personal care services and directed staff members to place newly created and altered documents into personnel files that contained missing training documents. Jamie further admitted that she agreed with known Golden Heart employees to falsify signatures on training documents to make it appear as if caregivers had received training in compliance with the personal care program guidelines. Jamie also directed that those files be provided to Putnam Aging so that Putnam Aging would allow the Medicaid program to be billed for personal care services provided by Golden Heart.
Jamie also admitted that in late December and early January 2010, she learned about a West Virginia Department of Health and Human Resources Medicaid Fraud Control Unit (MFCU) investigation regarding transportation hours and mileage expenses that had been claimed by Golden Heart under the Aged and Disabled Waiver Program. Jamie admitted that she was aware that a known employee of Golden Heart lacked a valid driver’s license and she agreed to alter existing records to make it appear as if another known employee with a valid driver’s license had performed the services. The altered records were then provided to a MFCU investigator. By the defendant’s actions, she intended to prevent the MFCU from learning that Golden Heart had claimed transportation and mileage expenses to which it was not entitled to be reimbursed under Medicaid.
The court recognized that entitlement programs are a significant portion of the federal budget, funded by taxpayers. The court also noted that health care fraud is one of the reasons the country is in financial trouble and today’s sentencing must serve as a deterrent to others who attempt to defraud entitlement programs. The court further acknowledged that the government is not only justified but required to aggressively pursue such fraud, as they have done here.
In October 2012, the United States settled three civil cases that had been filed against Jamie and Golden Heart to recover losses associated with the fraud against Medicaid, to freeze assets to preserve them for restitution, and to forfeit assets derived from the proceeds of the fraud. The civil settlement resolves all three civil actions by recovering all known assets of Jamie and Golden Heart which represent proceeds of the fraud. The money derived from the settlement will be used to make restitution to Medicaid for the losses it sustained from Jamie and Golden Heart’s fraudulent conduct.
The United States Department of Health and Human Services, the Federal Bureau of Investigation, the West Virginia State Police, and the MFCU conducted the investigation. Assistant United States Attorneys Meredith George Thomas, Philip Wright, and Eumi Choi handled the prosecution. The sentence was imposed by United States District Judge Thomas E. Johnston.
U.S. Attorney Booth Goodwin said, “Today’s sentencing underscores my office’s commitment to not only protect the nation’s health care services, but also to vigorously pursue the criminals who steal from it.”
Jamie admitted that she directed office staff to review the personnel files of caregivers who provided personal care services and directed staff members to place newly created and altered documents into personnel files that contained missing training documents. Jamie further admitted that she agreed with known Golden Heart employees to falsify signatures on training documents to make it appear as if caregivers had received training in compliance with the personal care program guidelines. Jamie also directed that those files be provided to Putnam Aging so that Putnam Aging would allow the Medicaid program to be billed for personal care services provided by Golden Heart.
Jamie also admitted that in late December and early January 2010, she learned about a West Virginia Department of Health and Human Resources Medicaid Fraud Control Unit (MFCU) investigation regarding transportation hours and mileage expenses that had been claimed by Golden Heart under the Aged and Disabled Waiver Program. Jamie admitted that she was aware that a known employee of Golden Heart lacked a valid driver’s license and she agreed to alter existing records to make it appear as if another known employee with a valid driver’s license had performed the services. The altered records were then provided to a MFCU investigator. By the defendant’s actions, she intended to prevent the MFCU from learning that Golden Heart had claimed transportation and mileage expenses to which it was not entitled to be reimbursed under Medicaid.
The court recognized that entitlement programs are a significant portion of the federal budget, funded by taxpayers. The court also noted that health care fraud is one of the reasons the country is in financial trouble and today’s sentencing must serve as a deterrent to others who attempt to defraud entitlement programs. The court further acknowledged that the government is not only justified but required to aggressively pursue such fraud, as they have done here.
In October 2012, the United States settled three civil cases that had been filed against Jamie and Golden Heart to recover losses associated with the fraud against Medicaid, to freeze assets to preserve them for restitution, and to forfeit assets derived from the proceeds of the fraud. The civil settlement resolves all three civil actions by recovering all known assets of Jamie and Golden Heart which represent proceeds of the fraud. The money derived from the settlement will be used to make restitution to Medicaid for the losses it sustained from Jamie and Golden Heart’s fraudulent conduct.
The United States Department of Health and Human Services, the Federal Bureau of Investigation, the West Virginia State Police, and the MFCU conducted the investigation. Assistant United States Attorneys Meredith George Thomas, Philip Wright, and Eumi Choi handled the prosecution. The sentence was imposed by United States District Judge Thomas E. Johnston.
Local Home Health Care Agency Owners Sentenced for Roles in Nearly $1.3 Million Health Care Fraud Conspiracy
DALLAS—Two owners of Alliance Healthcare Services, L.P., a Dallas home health care agency, were sentenced today by U.S. District Judge Jane J. Boyle for their roles in a nearly $1.3 million health care fraud conspiracy, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas. Richardson, Texas residents George Opurum, 62, and his wife, Agatha Opurum, 55, were each sentenced to 37 months in federal prison. They were ordered to surrender to the Bureau of Prisons on March 27, 2013.
George Opurum was the chief financial officer and alternate administrator of Alliance. Edith Opurum was the director of nursing at Alliance. Co-conspirator Ernest Amadi, 55, was the chief executive officer of Alliance, and his wife, Edith Amadi, 52, was a nurse at Alliance. Alliance was located on Estate Lane in Dallas.
The Amadis, residents of Wylie, Texas, also pleaded guilty to conspiracy to commit health care fraud. Edith Amadi was sentenced to 37 months in federal prison; a sentencing date has not been set for Ernest Amadi. Another co-conspirator in the case, Ollie Futrell, 57, of Garland, Texas, pleaded guilty to her role in the conspiracy and is currently serving a 33-month federal prison sentence.
The five defendants in the case billed a total of $1,296,357, and were ordered to pay restitution in the amount of $853,702.
According to documents filed in the case, as part of the conspiracy, from November 2008 through mid-February 2011, Alliance submitted claims to Medicare for home health services purportedly provided to Medicare beneficiaries. Alliance employees, including the owners, falsified Medicare documentation and skilled nursing notes indicating that the patients were homebound and eligible for home health care services. In fact, the majority of Alliance patients were not eligible for the services because they were not homebound. Alliance employees and owners falsified time sheets and patient visit logs for services that were not adequately rendered or were never provided at all. Alliance then billed Medicare as if the services were adequately provided.
Further, according to documents filed in the case, Alliance owners conspired with Futrell to recruit Medicare patients for the company so Alliance could increase its Medicare billing and revenue. Futrell, who was paid in cash by Alliance owners, recruited Medicare beneficiaries in a variety of ways and initiated Alliance services for them. She agreed to pay kickbacks—sometimes $100 a month—to patients so that they would continue to use Alliance. Alliance owners knew about, and at times facilitated, these kickbacks.
The case was investigated by the FBI, the Department of Health and Human Services Office of Inspector General (HHS OIG), and the Texas Attorney General’s Medicaid Fraud Control Unit.
Assistant U.S. Attorney Katherine E. Pfeifle of the U.S. Attorney’s Office in Dallas and Trial Attorney Benjamin A. O’Neil of the Fraud Section in the Justice Department’s Criminal Division are in charge of the prosecution.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: http://www.stopmedicarefraud.gov/
George Opurum was the chief financial officer and alternate administrator of Alliance. Edith Opurum was the director of nursing at Alliance. Co-conspirator Ernest Amadi, 55, was the chief executive officer of Alliance, and his wife, Edith Amadi, 52, was a nurse at Alliance. Alliance was located on Estate Lane in Dallas.
The Amadis, residents of Wylie, Texas, also pleaded guilty to conspiracy to commit health care fraud. Edith Amadi was sentenced to 37 months in federal prison; a sentencing date has not been set for Ernest Amadi. Another co-conspirator in the case, Ollie Futrell, 57, of Garland, Texas, pleaded guilty to her role in the conspiracy and is currently serving a 33-month federal prison sentence.
The five defendants in the case billed a total of $1,296,357, and were ordered to pay restitution in the amount of $853,702.
According to documents filed in the case, as part of the conspiracy, from November 2008 through mid-February 2011, Alliance submitted claims to Medicare for home health services purportedly provided to Medicare beneficiaries. Alliance employees, including the owners, falsified Medicare documentation and skilled nursing notes indicating that the patients were homebound and eligible for home health care services. In fact, the majority of Alliance patients were not eligible for the services because they were not homebound. Alliance employees and owners falsified time sheets and patient visit logs for services that were not adequately rendered or were never provided at all. Alliance then billed Medicare as if the services were adequately provided.
Further, according to documents filed in the case, Alliance owners conspired with Futrell to recruit Medicare patients for the company so Alliance could increase its Medicare billing and revenue. Futrell, who was paid in cash by Alliance owners, recruited Medicare beneficiaries in a variety of ways and initiated Alliance services for them. She agreed to pay kickbacks—sometimes $100 a month—to patients so that they would continue to use Alliance. Alliance owners knew about, and at times facilitated, these kickbacks.
The case was investigated by the FBI, the Department of Health and Human Services Office of Inspector General (HHS OIG), and the Texas Attorney General’s Medicaid Fraud Control Unit.
Assistant U.S. Attorney Katherine E. Pfeifle of the U.S. Attorney’s Office in Dallas and Trial Attorney Benjamin A. O’Neil of the Fraud Section in the Justice Department’s Criminal Division are in charge of the prosecution.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: http://www.stopmedicarefraud.gov/
Wednesday, 20 February 2013
Philadelphia Heath Corps
The Philadelphia Health Corps is a 2011-12 Service Impact award-winning AmeriCorps program that promotes the health and wellbeing of those living in Philadelphia’s underserved communities. As a public health focused program of AmeriCorps, Corps members serve at city health centers, non-profit community organizations, and other sites across the city. Members provide services such as health education, insurance expertise, prescription drug assistance, case management, and fitness information and classes.
In addition to service, the Philadelphia Health Corps offers training opportunities in the health care field, such as medical interpretation and HIV prevention counseling. Members serving at city health centers, also have an exclusive look at community medicine and access to shadowing experiences under qualified and dedicated physicians. Outside of direct service, members also participate in committees. The committees allow members to work together while planning events such as service projects and professional development opportunities for their fellow Corps members.
The Philadelphia Health Corps seeks individuals who are interested in the healthcare, public health and social work fields, and are willing to dedicate their time and energy for communities in need. Typical members are post-college graduates looking for experience in the healthcare field. Potential members should demonstrate emotional maturity, enthusiasm, and a strong commitment to serve. While experience in health care or social work may be a benefit when applying to the program, dedication and passion are ultimately what makes a successful Corps member.
Applications to become a Philadelphia Health Corps member for the 2013-2014 program year can be sent through the AmeriCorps website (www.americorps.gov) starting in May 2013. After reviewing applications, interviews are conducted by phone or in person, and placements are made during the summer. In September 2013, 28 members will begin their 11 months of service. Along with this letter, I have included brochures to share with students. Please feel free to contact the Program Director Sara Grainger at sgrainger@healthfederation.org or 215-567-8001 with any questions. You can also visit the website at www.philadelphiahealthcorps.org to find additional information about Philadelphia Health Corps, links to the blog and community sites, and more.
Brochure: https://docs.google.com/file/d/1bRGKg258NSmail4_g3TyseVZv5b91YNS39nEeP4bLVLwJrLs-FoW_xKZaunT/edit?usp=sharing
Ligon-Lamsam Opportunity Fund 2013
Below please find information regarding the The Ligon-Lamsam Opportunity Fund, which is open to 1st, 2nd and 3rd year UVa students who qualify for full grant support through Student Financial Services. This fund provides provide additional monies for academically-related endeavors. Awards are typically up to $2,500, and students are chosen based on the quality of their proposals. Read on for more info!
Ligon-Lamsam Opportunity Fund 2013
What: The purpose of this fund (generously provided by a donor to the Unversity) is to provide additional funds for academically-related endeavors, allowing students the freedom to follow their academic interests without accruing debt.
Who: The application process is open to first-, second-, or third-year AccessUVa students who qualify for full grant-in-aid support.
For: Applicants are encouraged to think broadly about the type of academic experiences in which they would like to participate. Students may propose a wide range of activities including:
- Research projects with a faculty advisor
- Fine and performing arts projects with a faculty advisor
- Study-abroad opportunities
- Unpaid internships
- Public service (including the Jefferson Public Citizens Program)
- The opportunity to supplement other awards (such as Harrison Undergraduate Research Grants)
How: In a maximum of 500 words describe the project or opportunity in which you wish to participate. Send your application as an email attachment to Laurie Casteen, Associate Dean of Students, Laurie@virginia.edu. In your email message please include your name, your current mailing address, and your phone number (which should also be listed on your additional materials as listed below). A complete application should include the following (as PDF attachments):
- Proposal narrative
- Unofficial (free) transcript printed from SIS self-service
- Letter of recommendation of your project from a faculty advisor (request that the faculty advisor email the letter directly to Dean Casteen)
- Itemized estimated budget (including all other sources of funding sought and/or received)
When: The priority deadline for completed proposals is 5:00 p.m. on February 28, 2013. Proposals received after February 28th will be reviewed on a rolling basis.
Questions? Contact Laurie Casteen: Laurie@virginia.edu
Tuesday, 19 February 2013
Two Clinic Owners Plead Guilty for Their Roles in Massive No-Fault Insurance Fraud Scheme
Preet Bharara, the United States Attorney for the Southern District of New York, announced today that five defendants have pled guilty for their roles in a systematic scheme to defraud private insurance companies of more than $400 million under New York’s no-fault automobile insurance law. The case is the largest single no-fault automobile insurance fraud scheme ever charged. Earlier today, Andrey Anikeyev, an owner and controller of various acupuncture clinics, pled guilty before U.S. District Judge J. Paul Oetken to conspiracy to commit mail fraud and health care fraud. Yesterday, Dmitry Slobodyansky, who owned and controlled chiropractic clinics, also pled guilty before Judge Oetken to conspiracy to commit mail fraud and health care fraud. Sergey Gabinsky, a medical doctor, pled guilty before Judge Oetken earlier this month, and Pavel Poznansky, an acupuncturist, and Constantine Voytenko, a chiropractor, pled guilty before Judge Oetken in December 2012. All five were arrested in February 2012 with 31 other defendants, some of whom were also charged with racketeering and money laundering. The 36 defendants include 10 doctors and three attorneys.
Manhattan U.S. Attorney Preet Bharara said, “These five defendants piled up fraud to the tune of $400 million in a scheme to exploit New York’s no-fault auto insurance laws. We remain committed to ensuring that all their alleged co-conspirators, including the corrupt medical and legal professionals charged with using their professional licenses and training to facilitate this brazen fraud, see justice.”
According to the indictment, superseding informations, and other publicly filed information in the case:
Under New York State law, every vehicle registered in New York State is required to have no-fault automobile insurance, which enables the driver and passengers of a registered and insured vehicle to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, regardless of fault (the “No-Fault Law”). The No-Fault Law requires prompt payment for medical treatment, thereby obviating the need for claimants to file personal injury lawsuits in order to be reimbursed. Under the No-Fault Law, patients can assign their right to reimbursement from an insurance company to others, including medical clinics that provide treatment for their injuries. New York State law also requires that all medical clinics in thesState be incorporated, owned, operated, and/or controlled by a licensed medical practitioner in order to be eligible for reimbursement under the No-Fault Law. Insurance companies will not honor claims for medical treatments from a medical clinic that is not actually owned, operated, and controlled by a licensed medical practitioner.
In order to mislead New York authorities and private insurers, some of the defendants in this case who were the true owners of these medical clinics (“No-Fault Clinic Controllers”) paid licensed medical practitioners, including doctors, to use the practitioners’ licenses to incorporate the professional corporations through which the medical clinics billed the private insurers for the bogus medical treatments. Gabinsky was one such doctor who admitted in open court to prescribing unnecessary medical treatments and to allowing co-conspirators to use his medical license to unlawfully open medical clinics in order to defraud insurance companies. Poznansky and Voytenko were medical practitioners who billed insurance companies for treatments to patients that were unnecessary.
The No-Fault Clinic Controllers also instructed the clinic doctors to prescribe excessive and unwarranted referrals for various “modality treatments” for nearly every patient they saw. The treatments included physical therapy, acupuncture, and chiropractic treatments—as much as five times per week for each—and treatments for psychology, neurology, orthopedics, and audiology. Clinic doctors also prescribed unnecessary MRIs, X-rays, orthopedics, and medical supplies. The No-Fault Clinic Controllers received thousands of dollars in kickbacks for patient referrals from the owners of the modality clinics (“modality controllers”). Anikeyev and Slobodyansky were two such Modality Controllers who admitted to billing insurance companies for treatments that patients did not need.
***
Anikeyev, 38, of Fort Lee, New Jersey; Slobodyansky, 42, of Brooklyn, New York; Gabinsky, 55, of Brooklyn, New York; Poznansky, 53, of Brooklyn, New York; and Voytenko, 41, of Brooklyn, New York, each face a maximum penalty of five years’ imprisonment, a maximum fine of $250,000, a maximum term of supervised release of three years, and a mandatory special assessment of $100. Poznansky, Voytenko, Gabinsky, Anikeyev, and Slobodyansky are scheduled to be sentenced by Judge Oetken on April 23, 2013; April 24, 2013; June 12, 2013; June 28, 2013; and June 13, 2013, respectively.
U.S. Attorney Preet Bharara thanked the Federal Bureau of Investigation and the New York City Police Department for their continued outstanding work in this investigation.
The case is being prosecuted by the Office’s Organized Crime Unit. Assistant U.S. Attorneys Daniel S. Goldman, Nicholas L. McQuaid, Carolina A. Fornos, and Daniel Noble are in charge of the prosecution. Assistant U.S. Attorneys Jason L. Cowley and Martin Bell of the Office’s Asset Forfeiture Unit are responsible for the forfeiture of assets.
Manhattan U.S. Attorney Preet Bharara said, “These five defendants piled up fraud to the tune of $400 million in a scheme to exploit New York’s no-fault auto insurance laws. We remain committed to ensuring that all their alleged co-conspirators, including the corrupt medical and legal professionals charged with using their professional licenses and training to facilitate this brazen fraud, see justice.”
According to the indictment, superseding informations, and other publicly filed information in the case:
Under New York State law, every vehicle registered in New York State is required to have no-fault automobile insurance, which enables the driver and passengers of a registered and insured vehicle to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, regardless of fault (the “No-Fault Law”). The No-Fault Law requires prompt payment for medical treatment, thereby obviating the need for claimants to file personal injury lawsuits in order to be reimbursed. Under the No-Fault Law, patients can assign their right to reimbursement from an insurance company to others, including medical clinics that provide treatment for their injuries. New York State law also requires that all medical clinics in thesState be incorporated, owned, operated, and/or controlled by a licensed medical practitioner in order to be eligible for reimbursement under the No-Fault Law. Insurance companies will not honor claims for medical treatments from a medical clinic that is not actually owned, operated, and controlled by a licensed medical practitioner.
In order to mislead New York authorities and private insurers, some of the defendants in this case who were the true owners of these medical clinics (“No-Fault Clinic Controllers”) paid licensed medical practitioners, including doctors, to use the practitioners’ licenses to incorporate the professional corporations through which the medical clinics billed the private insurers for the bogus medical treatments. Gabinsky was one such doctor who admitted in open court to prescribing unnecessary medical treatments and to allowing co-conspirators to use his medical license to unlawfully open medical clinics in order to defraud insurance companies. Poznansky and Voytenko were medical practitioners who billed insurance companies for treatments to patients that were unnecessary.
The No-Fault Clinic Controllers also instructed the clinic doctors to prescribe excessive and unwarranted referrals for various “modality treatments” for nearly every patient they saw. The treatments included physical therapy, acupuncture, and chiropractic treatments—as much as five times per week for each—and treatments for psychology, neurology, orthopedics, and audiology. Clinic doctors also prescribed unnecessary MRIs, X-rays, orthopedics, and medical supplies. The No-Fault Clinic Controllers received thousands of dollars in kickbacks for patient referrals from the owners of the modality clinics (“modality controllers”). Anikeyev and Slobodyansky were two such Modality Controllers who admitted to billing insurance companies for treatments that patients did not need.
***
Anikeyev, 38, of Fort Lee, New Jersey; Slobodyansky, 42, of Brooklyn, New York; Gabinsky, 55, of Brooklyn, New York; Poznansky, 53, of Brooklyn, New York; and Voytenko, 41, of Brooklyn, New York, each face a maximum penalty of five years’ imprisonment, a maximum fine of $250,000, a maximum term of supervised release of three years, and a mandatory special assessment of $100. Poznansky, Voytenko, Gabinsky, Anikeyev, and Slobodyansky are scheduled to be sentenced by Judge Oetken on April 23, 2013; April 24, 2013; June 12, 2013; June 28, 2013; and June 13, 2013, respectively.
U.S. Attorney Preet Bharara thanked the Federal Bureau of Investigation and the New York City Police Department for their continued outstanding work in this investigation.
The case is being prosecuted by the Office’s Organized Crime Unit. Assistant U.S. Attorneys Daniel S. Goldman, Nicholas L. McQuaid, Carolina A. Fornos, and Daniel Noble are in charge of the prosecution. Assistant U.S. Attorneys Jason L. Cowley and Martin Bell of the Office’s Asset Forfeiture Unit are responsible for the forfeiture of assets.
Doctor Enters Guilty Plea in Obstruction Case
Dr. Mahmoud Yassin, 60, of Robinson, Illinois, pled guilty in federal district court for obstructing a criminal health care fraud investigator, the United States Attorney for the Southern District of Illinois, Stephen R. Wigginton, announced today. Dr. Yassin will be sentenced for this felony offense on May 30, 2013, in Benton, Illinois, at which time he may be sentenced to up to 10 years in prison, a fine of up to $250,000, a special assessment of $100, and a period of up to three years of supervised release following prison.
Court proceedings revealed that the felony obstruction occurred on March 2, 2012, when an FBI agent, having served a subpoena for patient records on Dr. Yassin, was given a patient progress note that had been altered by the doctor to show an in-office examination previously claimed to an insurance carrier, but which had not taken place.
The case was investigated by agents of the Federal Bureau of Investigation, the Department of Health and Human Services Office of Inspector General, the Drug Enforcement Administration, and the Illinois State Police Medicaid Fraud Control Bureau. The case is assigned to Assistant United States Attorney Michael Quinley.
Court proceedings revealed that the felony obstruction occurred on March 2, 2012, when an FBI agent, having served a subpoena for patient records on Dr. Yassin, was given a patient progress note that had been altered by the doctor to show an in-office examination previously claimed to an insurance carrier, but which had not taken place.
The case was investigated by agents of the Federal Bureau of Investigation, the Department of Health and Human Services Office of Inspector General, the Drug Enforcement Administration, and the Illinois State Police Medicaid Fraud Control Bureau. The case is assigned to Assistant United States Attorney Michael Quinley.
Monday, 18 February 2013
Scribe Program at Inova Fair Oaks Hospital in Fairfax, Virginia
Virginia Emergency Medical Associates is recruiting applicants to join our highly competitive
scribe program at Inova Fair Oaks Hospital in Fairfax, Virginia. We are seeking motivated
and hardworking individuals who are eager to work as medical scribes. Our scribes gain
significant first-hand exposure to patient care in a fast-paced emergency room setting.
This is a full-time, paid position for individuals seeking admission to medical or PA school
and have already completed their Bachelor’s degree or are graduating in May 2013. If you
are able to commit one year to the program and have taken the MCAT/GRE with no plans
of re-taking the exam, we invite you to apply. Applications for the 2013-2014 cycle are now
available on our website.
The role of the scribe:
- Recording patient histories in an electronic medical record (EMR)
- Transcribing details of the physical exam and patient orders in the EMR
- Documenting procedures performed by the physician
- Ordering laboratory tests, imaging studies, and other patient evaluation studies and continuously monitoring results/progress
- Recording physician dictated diagnoses, prescriptions, and instructions
Our scribes accompany ER physicians to the bedside for the evaluation and treatment of
all patients. Scribes observe medical resuscitation for cases of cardiac and respiratory arrest
as well as other emergency procedures including central lines, lumbar punctures, conscious
sedations, and chest tube placements.
Our program offers the advantage of working with a small group of physicians. VEMA
scribes build close relationships with our physicians who offer mentorship, teaching, and
insights into a career in medicine. Our physicians are open to conducting mock interviews
to help scribes prepare for admissions season. As a VEMA scribe, you will be able to
strengthen your application with letters of recommendation from physicians who know you
personally and have worked with you extensively.
Thank you for your interest in our program.
Contact Information
Lead Scribe: Mona Yazdani
Email: scribeprogram@gmail.com
Website/Appliccation: http://erscribe.wordpress.com
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