The Neurology Department at Columbia University Medical Center is looking to hire a research technician in the lab of Dr. Sheng-Han Kuo studying the neuropathology of essential tremor and other cerebellar degenerative disorders. Applicants should be science or engineering majors, have some previous research experience, and be interested ultimately in pursuing an MD or MD/PhD. Experience in histology is a plus. The position is full-time and paid, with benefits, and would last at least one full year. Interested applicants should contact Rachel Babij (rab3fw@virginia.edu).
Friday, 31 May 2013
Oklahoma City Doctor Pleads Guilty to Defrauding Medicaid
OKLAHOMA CITY—Amar Nath Bhandry, M.D., 53, of Oklahoma City, has pled guilty to committing health care fraud, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma.
According to the superseding information, Dr. Bhandry submitted claims to Medicaid claiming reimbursement for services that he had not actually provided. Specifically, he filed claims for comprehensive psychiatric examinations between 45-50 minutes in duration when he visited with patients for only 10-20 minutes. Dr. Bhandry pled guilty earlier today to the superseding information.
At sentencing, Dr. Bhandry faces up to 10 years in prison and $250,000 fine. Sentencing will take place in approximately 90 days.
These charges are the result of an investigation conducted by the Federal Bureau of Investigation and the Drug Enforcement Administration. The case was prosecuted by Assistant U.S. Attorneys Randal A. Sengel and David P. Petermann.
Reference is made to court filings for further information.
According to the superseding information, Dr. Bhandry submitted claims to Medicaid claiming reimbursement for services that he had not actually provided. Specifically, he filed claims for comprehensive psychiatric examinations between 45-50 minutes in duration when he visited with patients for only 10-20 minutes. Dr. Bhandry pled guilty earlier today to the superseding information.
At sentencing, Dr. Bhandry faces up to 10 years in prison and $250,000 fine. Sentencing will take place in approximately 90 days.
These charges are the result of an investigation conducted by the Federal Bureau of Investigation and the Drug Enforcement Administration. The case was prosecuted by Assistant U.S. Attorneys Randal A. Sengel and David P. Petermann.
Reference is made to court filings for further information.
It’s Not Too Late to Take a Bridge Year
If as the opening/submission date to your centralized application service nears and you’re starting to feel like you are not as prepared to move forward in this process as you thought, we strongly urge you to consider taking a bridge year (or two). Some reasons why you may want to consider a bridge year (or an additional bridge year) at this time are:
- You have yet to sit for your entrance exam, or you are considering pushing it back even further.
- You have not acquired your letters of recommendation, and are having difficulty connecting with faculty.
- You have not budgeted enough time to complete a quality application and still submit within a reasonable time frame.
- The application process is more expensive than you realized, and it may be difficult for you to secure the funds to apply.
If you would like more information about taking a bridge year (or two) check out our blog post http://uvahpa.blogspot.com/2013/01/interested-in-taking-bridge-year-or-two.html
Wednesday, 29 May 2013
Two Area Women Charged with Submitting Fraudulent Bills for Home Health Services
CORPUS CHRISTI, TX—Sylvia Salinas Ramirez, of Driscoll, and Debra Jean Velasquez, of Robstown, have surrendered to authorities following the return of an indictment alleging they perpetrated a scheme to defraud the Texas Medicaid program through fraudulent home health billings, United States Attorney Kenneth Magidson announced today, along with Texas Attorney General Greg Abbott.
The 14-count indictment was returned Wednesday, May 8, 2013. Ramirez, 51, and Velasquez, 41, were taken into custody this morning and are expected to make an appearance before U.S. Magistrate Judge Janice Ellington this afternoon, at which time the issue of bond will be decided.
Ramirez and Velasquez are charged with one count of conspiracy to commit health care fraud, six counts of health care fraud, four counts of wire fraud, and three counts of aggravated identity theft.
The indictment alleges the women were employed by the Corpus Christi office of MRNG Inc. doing business as Caring Touch Home Health. During that time, Ramirez and Velasquez allegedly submitted false and fraudulent bills to Medicaid and the managed care organizations known as Evercare of Texas LLC and Superior Health Plan Inc. for home health services that had not been provided. Evercare and Superior received funds from Medicaid to manage the home health care of Medicaid beneficiaries. According to the indictment, from on or about August 1, 2009 through on or about June 15, 2010, Ramirez and Velasquez created false and fraudulent time sheets for current and former Caring Touch employees for home health services that were not provided. The indictment accuses Ramirez and Velasquez of then fraudulently billing Medicaid, Evercare, and Superior in the name of Caring Touch for those non-existent services.
The indictment also alleges that in order to personally profit from their fraudulent billings, Ramirez and Velasquez allegedly created payroll records from the fraudulent time sheet that they sent to Caring Tough’s payroll staff. According to the indictment, Ramirez and Velasquez obtained the payroll checks generated from the false and fraudulent time records, forged the signatures of the payees, and then cashed the checks and divided the money among themselves. The indictment does not accuse Caring Touch or the employees whose names were used on the false time sheets and checks of any wrongdoing.
The indictment alleges that from or about August 1, 2009 through on or about June 15, 2010, Ramirez and Velasquez submitted and or caused others to submit approximately 628 false and false and fraudulent claims in the approximate aggregate sum of $345,393.41 for home health services that were not provided. As a result, Texas Medicaid, Evercare, and Superior paid the approximate aggregate sum of $155,127.72, according to allegations.
Conspiracy to commit health care fraud and each of the six counts of health care fraud carry a maximum punishment of 10 years in federal prison without parole, upon conviction, while the four counts of wire fraud each carries a possible 20 year sentence. All of these charges also include a possible $250,000 fine. If convicted of aggravated identity theft, the defendants will serve a mandatory two-year additional prison term on each count which must be served consecutive to any other prison sentence imposed.
The charges were the result of a joint investigation conducted by officers and agents of the Corpus Christi Police Department, the FBI, Department of Health and Human Services-Office of Inspector General, and the Texas Attorney General’s Medicaid Fraud Control Unit. Special Assistant United States Attorney Rex Beasley and Assistant United States Attorney Jeffery Preston are prosecuting the case.
An indictment is an accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.
The 14-count indictment was returned Wednesday, May 8, 2013. Ramirez, 51, and Velasquez, 41, were taken into custody this morning and are expected to make an appearance before U.S. Magistrate Judge Janice Ellington this afternoon, at which time the issue of bond will be decided.
Ramirez and Velasquez are charged with one count of conspiracy to commit health care fraud, six counts of health care fraud, four counts of wire fraud, and three counts of aggravated identity theft.
The indictment alleges the women were employed by the Corpus Christi office of MRNG Inc. doing business as Caring Touch Home Health. During that time, Ramirez and Velasquez allegedly submitted false and fraudulent bills to Medicaid and the managed care organizations known as Evercare of Texas LLC and Superior Health Plan Inc. for home health services that had not been provided. Evercare and Superior received funds from Medicaid to manage the home health care of Medicaid beneficiaries. According to the indictment, from on or about August 1, 2009 through on or about June 15, 2010, Ramirez and Velasquez created false and fraudulent time sheets for current and former Caring Touch employees for home health services that were not provided. The indictment accuses Ramirez and Velasquez of then fraudulently billing Medicaid, Evercare, and Superior in the name of Caring Touch for those non-existent services.
The indictment also alleges that in order to personally profit from their fraudulent billings, Ramirez and Velasquez allegedly created payroll records from the fraudulent time sheet that they sent to Caring Tough’s payroll staff. According to the indictment, Ramirez and Velasquez obtained the payroll checks generated from the false and fraudulent time records, forged the signatures of the payees, and then cashed the checks and divided the money among themselves. The indictment does not accuse Caring Touch or the employees whose names were used on the false time sheets and checks of any wrongdoing.
The indictment alleges that from or about August 1, 2009 through on or about June 15, 2010, Ramirez and Velasquez submitted and or caused others to submit approximately 628 false and false and fraudulent claims in the approximate aggregate sum of $345,393.41 for home health services that were not provided. As a result, Texas Medicaid, Evercare, and Superior paid the approximate aggregate sum of $155,127.72, according to allegations.
Conspiracy to commit health care fraud and each of the six counts of health care fraud carry a maximum punishment of 10 years in federal prison without parole, upon conviction, while the four counts of wire fraud each carries a possible 20 year sentence. All of these charges also include a possible $250,000 fine. If convicted of aggravated identity theft, the defendants will serve a mandatory two-year additional prison term on each count which must be served consecutive to any other prison sentence imposed.
The charges were the result of a joint investigation conducted by officers and agents of the Corpus Christi Police Department, the FBI, Department of Health and Human Services-Office of Inspector General, and the Texas Attorney General’s Medicaid Fraud Control Unit. Special Assistant United States Attorney Rex Beasley and Assistant United States Attorney Jeffery Preston are prosecuting the case.
An indictment is an accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.
Tuesday, 28 May 2013
Milwaukee Doctor Indicted on Health Care Fraud Charges
James L. Santelle, the United States Attorney for the Eastern District of Wisconsin, announced that on May 14, 2013, a federal grand jury in Milwaukee returned an indictment charging Dr. Cully R. White (age 44). Dr. White is charged with 13 counts of health care fraud in violation of Title 18, United States Code, Section 1347. Dr. White, who is a doctor of osteopathic medicine, is the owner and operator of Dr. Cully R. White, Neurosurgery & Spine, SC, located in Milwaukee, Wisconsin.
The indictment alleges that during the period from approximately November 2010 through October 2011, White carried out a scheme to defraud health insurance companies. As part of his scheme, White allegedly recruited another physician to dictate reports making it appear that the second physician had conducted interoperative nerve monitoring during surgeries performed by White. The second physician had no training or experience in, nor did he conduct interoperative nerve monitoring during White’s surgeries. The indictment further alleges White paid the second physician $150 for each report he dictated. White then used the reports prepared by the second physician to submit claims to insurance companies seeking payment for the second physician’s services.
According to the indictment, White submitted claims to insurance companies totaling more than $265,000 and ultimately received approximately $82,000. White paid the second physician a total of $14,850 for dictating the reports.
Each of the charges contained in the indictment carries a maximum possible penalty of up to 10 years in prison and a fine of up to $250,000, or both.
This matter was investigated by the Federal Bureau of Investigation and has been assigned to Assistant United States Attorney Matthew L. Jacobs for prosecution.
The public is cautioned that an indictment is merely the formal method of presenting charges in federal court and does not constitute evidence of the defendant’s guilt. The defendant is presumed innocent until such time, if ever, as the government establishes his guilt beyond a reasonable doubt.
The indictment alleges that during the period from approximately November 2010 through October 2011, White carried out a scheme to defraud health insurance companies. As part of his scheme, White allegedly recruited another physician to dictate reports making it appear that the second physician had conducted interoperative nerve monitoring during surgeries performed by White. The second physician had no training or experience in, nor did he conduct interoperative nerve monitoring during White’s surgeries. The indictment further alleges White paid the second physician $150 for each report he dictated. White then used the reports prepared by the second physician to submit claims to insurance companies seeking payment for the second physician’s services.
According to the indictment, White submitted claims to insurance companies totaling more than $265,000 and ultimately received approximately $82,000. White paid the second physician a total of $14,850 for dictating the reports.
Each of the charges contained in the indictment carries a maximum possible penalty of up to 10 years in prison and a fine of up to $250,000, or both.
This matter was investigated by the Federal Bureau of Investigation and has been assigned to Assistant United States Attorney Matthew L. Jacobs for prosecution.
The public is cautioned that an indictment is merely the formal method of presenting charges in federal court and does not constitute evidence of the defendant’s guilt. The defendant is presumed innocent until such time, if ever, as the government establishes his guilt beyond a reasonable doubt.
Friday, 24 May 2013
Federal Medicare Fraud Strike Force Charges Chicago-Area Defendants with Defrauding Medicare and Other Health Insurers
CHICAGO—Two area physicians and three health clinic co-owners are among seven defendants charged here with engaging in five separate, unrelated health care fraud schemes to defraud the Medicare program and/or private health insurers of millions of dollars, federal law enforcement officials announced today.
Four of the five cases here are part of a nationwide takedown by Medicare Fraud Strike Force operations in eight cities, announced today by the Departments of Justice and Health and Human Services, resulting in charges against 89 defendants, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes collectively involving approximately $233 million in false billing.
In Chicago, the defendants were charged in two criminal complaints and two informations filed today and yesterday, and an indictment that was unsealed today following the arrest of one defendant in Miami. All seven defendants were charged with health care fraud for allegedly defrauding the Medicare program, or violating the anti-kickback statute, which makes it illegal to offer, pay, solicit, or receive payments in exchange for referrals of Medicare patients. The charges involve various medical treatments and services, as well as durable medical equipment.
“Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems,” said Attorney General Eric Holder. “These significant actions build on the remarkable progress that the HEAT has enabled us to make—alongside key federal, state, and local partners—in identifying and shutting down fraud schemes. They are helping to deter would-be criminals from engaging in fraudulent activities in the first place. And they underscore our ongoing commitment to protecting the American people from all forms of health-care fraud, safeguarding taxpayer resources, and ensuring the integrity of essential health care programs,” he added.
“Today’s charges are part of our continuing efforts not only to deprive dishonest healthcare providers of their illegal profits but to demonstrate to the broader medical services community that health care fraud will be found out and prosecuted with all of our resources. In short, we will not tolerate medical professionals and providers who abuse our healthcare system,” said Gary S. Shapiro, United States Attorney for the Northern District of Illinois.
Details of the Chicago cases follow:
United States v. Ankur Roy, Akash Patel, and Dipen Desai
Ankur Roy, Akash Patel, and Dipen Desai, who owned and operated Selectcare Health Inc., which provided outpatient physical and respiratory therapy in Park Ridge and Skokie, were charged with submitting more than $4 million in false billings to Medicare between March and July 2011. Each defendant was charged with six counts of health care fraud in an indictment that was returned by a federal grand jury last Wednesday and unsealed today.
Roy, 36, of Miami was arrested today in south Florida, while Patel, 33, of Morton Grove, and Desai, 33, of Chicago, will be ordered to appear for arraignment on a later date in U.S. District Court in Chicago.
According to the indictment, the defendants submitted false claims to Medicare and Blue Cross Blue Shield on behalf of Selectcare patients for respiratory therapy services that were never provided. The alleged false billings sought reimbursement for services purportedly provided on days that Selectcare’s sole respiratory therapist was not working; for time periods in which the patients were not receiving care from Selectcare; and for treatment seven days a week for three hours per day, a schedule well in excess of any schedule prescribed for patients at Selectcare.
Roy, Patel, and Desai used a third-party billing service to forward the alleged false claims to Medicare, as well as to private insurers such as Blue Cross if the patient had supplemental private insurance, including insurance funded by labor union health and welfare plans.
Between March and July 2011, the defendants allegedly submitted $4,009,094 in false billings for services that were purportedly provided between April 2010 and April 2011, resulting in payments totaling approximately $2,214,424 from Medicare and $320,881 from Blue Cross Blue Shield. The indictment seeks forfeiture of $2,535,305 in alleged fraud proceeds, including $446,974 in funds withdrawn by cashiers’ checks that were seized by the FBI in July 2012.
The government is represented by Assistant U.S. Attorney Maureen Merin. The case was investigated by the FBI, the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), and the U.S. Department of Labor Office of Inspector General (DOL-OIG).
United States v. Cecilia Ibrahim
Dr. Cecilia Ibrahim, an internal medicine physician who operated Sunrise Medical Center in Flossmoor, was charged with one count of health care fraud for allegedly engaging in a $1.7 million Medicare and private insurance false billing scheme.
Ibrahim, 50, of Frankfort, was charged in an information filed today in U.S. District Court. She will be arraigned on a date to be determined.
Between March 2006 and August 2009, Ibrahim allegedly submitted more than 3,200 false claims to Medicare and Blue Cross Blue Shield using a billing code for spinal decompression neuroplasty, a surgical procedure that she did not perform, when she only performed intervertebral differential dynamics therapy (IDD), a non-surgical procedure. As a result, she allegedly caused a loss of at least $300,000 to Medicare and $550,000 to Blue Cross Blue Shield. The indictment seeks forfeiture of at least $882,500 in alleged fraud proceeds.
The government is represented by Assistant U.S. Attorney Samuel B. Cole. The case was investigated by the FBI, HHS-OIG, and the Railroad Retirement Board Office of Inspector General.
United States v. Ellyse Lamon
Elysse Lamon, an account executive at a company that sold durable medical equipment, including back braces and transcutaneous electrical nerve stimulation units, also known as tens units, was charged with one count of health care fraud for allegedly engaging in a $350,000 Medicare false billing scheme.
Lamon, 30, of Elmhurst, was charged in an information filed today in U.S. District Court. She will be arraigned on a date to be determined.
Between October 2010 and May 2011, Lamon allegedly caused her company to submit false claims to Medicare representing that a physician had prescribed back braces and tens units when she knew that no physician had done so and the items were not medically necessary. In order to provide written support for the false claims, Lamon allegedly obtained patient records without a physician’s permission and added false information reflecting that a physician had ordered the equipment for the patients. She allegedly forged doctors’ signatures on documents, including false treatment records she created. Lamon further used patient information she had inappropriately accessed at a pain medicine center in Chicago to set up patient meetings where she falsely told patients that doctors had prescribed the equipment for them, according to the charges.
Lamon allegedly submitted false claims to Medicare totaling $352,685, resulting in payment of at least $206,233 to her medical equipment company. She allegedly profited from these false claims by receiving increased commissions and other benefits from her company.
The government is represented by Assistant U.S. Attorney Kruti Trivedi. The case was investigated by the FBI and is not part of the Medicare Fraud Strike Force operation.
United States v. Nalini Ahluwalia
Dr. Nalini Ahluwalia was charged with one count of violating the anti-kickback law for allegedly receiving $1,000 in exchange for referring two patients to a home health care agency in August 2012.
Ahluwalia, 58, of Burr Ridge, was charged in a complaint filed today in U.S. District Court. She will be ordered to appear on a date to be determined.
According to the complaint, a confidential informant who worked at a home health care company in Chicago, told agents that the confidential informant had previously paid kickbacks to Ahluwalia of $400 to $500 per patient in exchange for her referral of Medicare patients to the home health care company.
On August 23, 2012, at the direction of agents, the confidential informant met with Ahluwalia at the doctor’s office in Chicago and paid her $1,000 for the two Medicare patient referrals in an exchange that was reflected on an audio/video recording, according to the complaint affidavit. In October 2012 and February 2013, the informant allegedly made two additional $500 payments to Ahluwalia in exchange for Medicare patient referrals.
The government is represented by Assistant U.S. Attorney Samuel B. Cole. The case was investigated by the FBI and the HHS-OIG.
United States v. Joseph Dickson
Joseph Dickson, the president and owner of JD Medical Consultants Inc., a medical marketing company, was charged with one count of violating the anti-kickback law for allegedly receiving $4,200 in exchange for referring patients to a home health care agency in October 2012.
Dickson, 65, of Lansing, was charged in a complaint filed yesterday in U.S. District Court. He will be ordered to appear on a date to be determined.
According to the complaint, a confidential informant who owned a home health care company in the Chicago area, told agents that the confidential informant had previously paid kickbacks to Dickson, among others, for referring Medicare patients to another home health care company where s/he previously worked. Dickson was described as a “middle man” who arranged the referral of patients from a physician to a home health care company, and the confidential informant told agents that the confidential informant had paid Dickson approximately $15,000 for referring about 30 patients between 2006 and 2008.
On October 3, 2012, at the direction of agents, the confidential informant met with Dickson at his office in Chicago and paid him $4,200 for seven Medicare patient referrals, at $600 each, in an exchange that was reflected on an audio/video recording, according to the complaint affidavit. In December 2012, the informant allegedly made an additional $1,800 payment to Dickson in exchange for Medicare patient referrals and re-certifications.
The government is represented by Assistant U.S. Attorney Joseph H. Thompson. The case was investigated by the FBI and the HHS-OIG.
The charges in these cases carry the following maximum penalties on each count: health care fraud—10 years in prison and a $250,000 fine, or an alternate fine totaling twice the loss or twice the gain, whichever is greater; and violating the anti-kickback statute—five years in prison and a $250,000 fine. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The Medicare Fraud Strike Force began operating in Chicago in February 2011 and consists of agents from the FBI and HHS-OIG working together with prosecutors from the U.S. Attorney’s Office and the Justice Department’s Fraud Section. The strike force is are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since their inception in March 2007, strike force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
The nationwide takedown was announced today by Attorney General Holder, HHS Secretary Kathleen Sebelius and other federal law enforcement officials. Mr. Shapiro announced the Chicago charges with Cory B. Nelson, Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation; Lamont Pugh, III, Special Agent in Charge of the Chicago Regional Office of the HHS-OIG; and James Vanderberg, Special Agent in Charge of the Labor Department Office of Inspector General in Chicago. The Railroad Retirement Board Office of Inspector General assisted in the Ibrahim investigation.
The public is reminded that indictments, informations, and complaints contain only charges and are not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Four of the five cases here are part of a nationwide takedown by Medicare Fraud Strike Force operations in eight cities, announced today by the Departments of Justice and Health and Human Services, resulting in charges against 89 defendants, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes collectively involving approximately $233 million in false billing.
In Chicago, the defendants were charged in two criminal complaints and two informations filed today and yesterday, and an indictment that was unsealed today following the arrest of one defendant in Miami. All seven defendants were charged with health care fraud for allegedly defrauding the Medicare program, or violating the anti-kickback statute, which makes it illegal to offer, pay, solicit, or receive payments in exchange for referrals of Medicare patients. The charges involve various medical treatments and services, as well as durable medical equipment.
“Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems,” said Attorney General Eric Holder. “These significant actions build on the remarkable progress that the HEAT has enabled us to make—alongside key federal, state, and local partners—in identifying and shutting down fraud schemes. They are helping to deter would-be criminals from engaging in fraudulent activities in the first place. And they underscore our ongoing commitment to protecting the American people from all forms of health-care fraud, safeguarding taxpayer resources, and ensuring the integrity of essential health care programs,” he added.
“Today’s charges are part of our continuing efforts not only to deprive dishonest healthcare providers of their illegal profits but to demonstrate to the broader medical services community that health care fraud will be found out and prosecuted with all of our resources. In short, we will not tolerate medical professionals and providers who abuse our healthcare system,” said Gary S. Shapiro, United States Attorney for the Northern District of Illinois.
Details of the Chicago cases follow:
United States v. Ankur Roy, Akash Patel, and Dipen Desai
Ankur Roy, Akash Patel, and Dipen Desai, who owned and operated Selectcare Health Inc., which provided outpatient physical and respiratory therapy in Park Ridge and Skokie, were charged with submitting more than $4 million in false billings to Medicare between March and July 2011. Each defendant was charged with six counts of health care fraud in an indictment that was returned by a federal grand jury last Wednesday and unsealed today.
Roy, 36, of Miami was arrested today in south Florida, while Patel, 33, of Morton Grove, and Desai, 33, of Chicago, will be ordered to appear for arraignment on a later date in U.S. District Court in Chicago.
According to the indictment, the defendants submitted false claims to Medicare and Blue Cross Blue Shield on behalf of Selectcare patients for respiratory therapy services that were never provided. The alleged false billings sought reimbursement for services purportedly provided on days that Selectcare’s sole respiratory therapist was not working; for time periods in which the patients were not receiving care from Selectcare; and for treatment seven days a week for three hours per day, a schedule well in excess of any schedule prescribed for patients at Selectcare.
Roy, Patel, and Desai used a third-party billing service to forward the alleged false claims to Medicare, as well as to private insurers such as Blue Cross if the patient had supplemental private insurance, including insurance funded by labor union health and welfare plans.
Between March and July 2011, the defendants allegedly submitted $4,009,094 in false billings for services that were purportedly provided between April 2010 and April 2011, resulting in payments totaling approximately $2,214,424 from Medicare and $320,881 from Blue Cross Blue Shield. The indictment seeks forfeiture of $2,535,305 in alleged fraud proceeds, including $446,974 in funds withdrawn by cashiers’ checks that were seized by the FBI in July 2012.
The government is represented by Assistant U.S. Attorney Maureen Merin. The case was investigated by the FBI, the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), and the U.S. Department of Labor Office of Inspector General (DOL-OIG).
United States v. Cecilia Ibrahim
Dr. Cecilia Ibrahim, an internal medicine physician who operated Sunrise Medical Center in Flossmoor, was charged with one count of health care fraud for allegedly engaging in a $1.7 million Medicare and private insurance false billing scheme.
Ibrahim, 50, of Frankfort, was charged in an information filed today in U.S. District Court. She will be arraigned on a date to be determined.
Between March 2006 and August 2009, Ibrahim allegedly submitted more than 3,200 false claims to Medicare and Blue Cross Blue Shield using a billing code for spinal decompression neuroplasty, a surgical procedure that she did not perform, when she only performed intervertebral differential dynamics therapy (IDD), a non-surgical procedure. As a result, she allegedly caused a loss of at least $300,000 to Medicare and $550,000 to Blue Cross Blue Shield. The indictment seeks forfeiture of at least $882,500 in alleged fraud proceeds.
The government is represented by Assistant U.S. Attorney Samuel B. Cole. The case was investigated by the FBI, HHS-OIG, and the Railroad Retirement Board Office of Inspector General.
United States v. Ellyse Lamon
Elysse Lamon, an account executive at a company that sold durable medical equipment, including back braces and transcutaneous electrical nerve stimulation units, also known as tens units, was charged with one count of health care fraud for allegedly engaging in a $350,000 Medicare false billing scheme.
Lamon, 30, of Elmhurst, was charged in an information filed today in U.S. District Court. She will be arraigned on a date to be determined.
Between October 2010 and May 2011, Lamon allegedly caused her company to submit false claims to Medicare representing that a physician had prescribed back braces and tens units when she knew that no physician had done so and the items were not medically necessary. In order to provide written support for the false claims, Lamon allegedly obtained patient records without a physician’s permission and added false information reflecting that a physician had ordered the equipment for the patients. She allegedly forged doctors’ signatures on documents, including false treatment records she created. Lamon further used patient information she had inappropriately accessed at a pain medicine center in Chicago to set up patient meetings where she falsely told patients that doctors had prescribed the equipment for them, according to the charges.
Lamon allegedly submitted false claims to Medicare totaling $352,685, resulting in payment of at least $206,233 to her medical equipment company. She allegedly profited from these false claims by receiving increased commissions and other benefits from her company.
The government is represented by Assistant U.S. Attorney Kruti Trivedi. The case was investigated by the FBI and is not part of the Medicare Fraud Strike Force operation.
United States v. Nalini Ahluwalia
Dr. Nalini Ahluwalia was charged with one count of violating the anti-kickback law for allegedly receiving $1,000 in exchange for referring two patients to a home health care agency in August 2012.
Ahluwalia, 58, of Burr Ridge, was charged in a complaint filed today in U.S. District Court. She will be ordered to appear on a date to be determined.
According to the complaint, a confidential informant who worked at a home health care company in Chicago, told agents that the confidential informant had previously paid kickbacks to Ahluwalia of $400 to $500 per patient in exchange for her referral of Medicare patients to the home health care company.
On August 23, 2012, at the direction of agents, the confidential informant met with Ahluwalia at the doctor’s office in Chicago and paid her $1,000 for the two Medicare patient referrals in an exchange that was reflected on an audio/video recording, according to the complaint affidavit. In October 2012 and February 2013, the informant allegedly made two additional $500 payments to Ahluwalia in exchange for Medicare patient referrals.
The government is represented by Assistant U.S. Attorney Samuel B. Cole. The case was investigated by the FBI and the HHS-OIG.
United States v. Joseph Dickson
Joseph Dickson, the president and owner of JD Medical Consultants Inc., a medical marketing company, was charged with one count of violating the anti-kickback law for allegedly receiving $4,200 in exchange for referring patients to a home health care agency in October 2012.
Dickson, 65, of Lansing, was charged in a complaint filed yesterday in U.S. District Court. He will be ordered to appear on a date to be determined.
According to the complaint, a confidential informant who owned a home health care company in the Chicago area, told agents that the confidential informant had previously paid kickbacks to Dickson, among others, for referring Medicare patients to another home health care company where s/he previously worked. Dickson was described as a “middle man” who arranged the referral of patients from a physician to a home health care company, and the confidential informant told agents that the confidential informant had paid Dickson approximately $15,000 for referring about 30 patients between 2006 and 2008.
On October 3, 2012, at the direction of agents, the confidential informant met with Dickson at his office in Chicago and paid him $4,200 for seven Medicare patient referrals, at $600 each, in an exchange that was reflected on an audio/video recording, according to the complaint affidavit. In December 2012, the informant allegedly made an additional $1,800 payment to Dickson in exchange for Medicare patient referrals and re-certifications.
The government is represented by Assistant U.S. Attorney Joseph H. Thompson. The case was investigated by the FBI and the HHS-OIG.
The charges in these cases carry the following maximum penalties on each count: health care fraud—10 years in prison and a $250,000 fine, or an alternate fine totaling twice the loss or twice the gain, whichever is greater; and violating the anti-kickback statute—five years in prison and a $250,000 fine. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The Medicare Fraud Strike Force began operating in Chicago in February 2011 and consists of agents from the FBI and HHS-OIG working together with prosecutors from the U.S. Attorney’s Office and the Justice Department’s Fraud Section. The strike force is are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since their inception in March 2007, strike force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
The nationwide takedown was announced today by Attorney General Holder, HHS Secretary Kathleen Sebelius and other federal law enforcement officials. Mr. Shapiro announced the Chicago charges with Cory B. Nelson, Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation; Lamont Pugh, III, Special Agent in Charge of the Chicago Regional Office of the HHS-OIG; and James Vanderberg, Special Agent in Charge of the Labor Department Office of Inspector General in Chicago. The Railroad Retirement Board Office of Inspector General assisted in the Ibrahim investigation.
The public is reminded that indictments, informations, and complaints contain only charges and are not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
A-C-E Your Application Advising Opportunity
On Tuesday, May 28th, Wednesday May 29nd and Thursday, May 30th Susan and Rebecca will be available at Monroe Hall 263 from 1:30pm to 4:30 pm to assess health professions application materials for any applicant who is interested in having aspects of their candidacy reviewed.
We require that any applicant participating in this program have tangible application materials that can be reviewed by an advisor at the time of their visit. These materials can include: personal statements, centralized application materials (including activity section write-ups), school lists, or transcripts for review. If you would like to have a discussion regarding the state of your candidacy please calculate your science GPA based on the requirements of the health profession you are interested in applying to before you arrive. To learn more about GPA calculations for various programs visit http://uvahpa.blogspot.com/2012/03/calculating-science-gpa.html and also check out our Helpful Tips and Commonly Asked Questions Guide (attached to this listserv) Applicants will be met with on a first come- first serve basis for 15 minutes.
If you feel you need more time with an advisor, or do not have materials to be reviewed at that time, please schedule a 30 minute appointment at our Bryant Hall office by calling 434-924-8900.
Wednesday, 22 May 2013
Virtual Fair for Physician Assistants
The Physician Assistant Education Association is teaming up again with CareerEco to bring you an encore virtual fair for physician assistants. Please share this link with your programs, students, advisees, and advisors, and join us on July 16 & 17 for the second annual physician assistant virtual fair! There is no cost to participants.
Register for the Fair Here: http://caspa.careereco.net/students-alumni/virtual-fair-registration/
If you have questions about the fair, please contact caspa@careereco.com
Tuesday, 21 May 2013
Leader of $29.1 Million Medicare Fraud Scheme Pleads Guilty in Detroit
WASHINGTON—The mastermind of a $29.1 million Medicare fraud scheme involving approximately 30 purported medical clinics pleaded guilty today in Detroit for his role in the scheme.
The guilty plea was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office; Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office; and Special Agent in Charge Erick Martinez of the Internal Revenue Service Criminal Investigation (IRS-CI) Detroit Field Office.
Sachin Sharma, 37, of Detroit, pleaded guilty before U.S. District Judge Denise P. Hood in the Eastern District of Michigan to one count of conspiracy to commit health care fraud and one count of tax evasion.
According to court documents, Sharma oversaw and directed operations of a broad network of home health, psychotherapy, and other purported medical clinics in and around Detroit, including Reliance Home Care LLC, First Choice Home Health Care Services, Inc., and Haven Adult Day Care Center LLC. Working with co-conspirators, Sharma created and/or operated these companies for the purpose of billing Medicare for home health and psychotherapy services that Sharma knew were not provided. Court documents show that Sharma paid kickbacks to patient recruiters in order to obtain the information of Medicare beneficiaries, which he then used at these companies to bill Medicare for services that were not medically necessary and/or were not provided to these beneficiaries.
Court documents show that Sharma trained others on techniques to defraud Medicare and to conceal the fraud and directed employees to fabricate and alter medical documents to give the false impression that home health and psychotherapy services were provided when, in fact, they were not.
Sharma admitted that from 2007 through 2011, he received substantial proceeds of the fraud from these companies, but failed to report these proceeds on his individual federal income tax returns. Sharma admitted that he filed no individual income tax returns from 2007 through 2011.
Court documents allege that between 2007 and 2012, Sharma caused these companies to submit approximately $29,171,017 in claims to Medicare for services that were not medically necessary and/or not provided.
At sentencing, scheduled for August 8, 2013, Sharma faces a maximum penalty of 10 years in prison and a $250,000 fine.
Sachin Sharma’s co-defendants, Dana Sharma, Beverly Cooper, and Clarence Cooper, each previously pleaded guilty to one count of conspiracy to commit health care fraud for their roles in the scheme. Co-defendants Abdul Malik al-Jumail, aka Tony; Felicar Williams; and Jamella al-Jumail are scheduled for trial on June 10, 2013. Co-defendant Firas Alky remains a fugitive. Defendants are presumed innocent unless and until proven guilty at trial.
This case is being prosecuted by Trial Attorney William G. Kanellis and Deputy Chief Gejaa Gobena of the Criminal Division’s Fraud Section, with assistance from the Department of Justice Tax Division. It was investigated by the FBI, HHS-OIG, and IRS-CI, 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 Eastern District of Michigan.
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: www.stopmedicarefraud.gov.
The guilty plea was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office; Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office; and Special Agent in Charge Erick Martinez of the Internal Revenue Service Criminal Investigation (IRS-CI) Detroit Field Office.
Sachin Sharma, 37, of Detroit, pleaded guilty before U.S. District Judge Denise P. Hood in the Eastern District of Michigan to one count of conspiracy to commit health care fraud and one count of tax evasion.
According to court documents, Sharma oversaw and directed operations of a broad network of home health, psychotherapy, and other purported medical clinics in and around Detroit, including Reliance Home Care LLC, First Choice Home Health Care Services, Inc., and Haven Adult Day Care Center LLC. Working with co-conspirators, Sharma created and/or operated these companies for the purpose of billing Medicare for home health and psychotherapy services that Sharma knew were not provided. Court documents show that Sharma paid kickbacks to patient recruiters in order to obtain the information of Medicare beneficiaries, which he then used at these companies to bill Medicare for services that were not medically necessary and/or were not provided to these beneficiaries.
Court documents show that Sharma trained others on techniques to defraud Medicare and to conceal the fraud and directed employees to fabricate and alter medical documents to give the false impression that home health and psychotherapy services were provided when, in fact, they were not.
Sharma admitted that from 2007 through 2011, he received substantial proceeds of the fraud from these companies, but failed to report these proceeds on his individual federal income tax returns. Sharma admitted that he filed no individual income tax returns from 2007 through 2011.
Court documents allege that between 2007 and 2012, Sharma caused these companies to submit approximately $29,171,017 in claims to Medicare for services that were not medically necessary and/or not provided.
At sentencing, scheduled for August 8, 2013, Sharma faces a maximum penalty of 10 years in prison and a $250,000 fine.
Sachin Sharma’s co-defendants, Dana Sharma, Beverly Cooper, and Clarence Cooper, each previously pleaded guilty to one count of conspiracy to commit health care fraud for their roles in the scheme. Co-defendants Abdul Malik al-Jumail, aka Tony; Felicar Williams; and Jamella al-Jumail are scheduled for trial on June 10, 2013. Co-defendant Firas Alky remains a fugitive. Defendants are presumed innocent unless and until proven guilty at trial.
This case is being prosecuted by Trial Attorney William G. Kanellis and Deputy Chief Gejaa Gobena of the Criminal Division’s Fraud Section, with assistance from the Department of Justice Tax Division. It was investigated by the FBI, HHS-OIG, and IRS-CI, 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 Eastern District of Michigan.
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: www.stopmedicarefraud.gov.
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