WASHINGTON—The owner and operator of several Miami health care agencies was sentenced today to serve 120 months in prison for his role in a health care fraud scheme involving defunct home health care company Trust Care Health Services Inc.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; 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; and Acting Special Agent in Charge Michael J. DePalma of the Internal Revenue Service-Criminal Investigation’s (IRS-CI) Miami Field Office made the announcement.
Roberto Marrero, 60, of Miami, was sentenced by U.S. District Judge K. Michael Moore in the Southern District of Florida. In September 2013, Marrero pleaded guilty to conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks.
Marrero was an owner and operator of Trust Care, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.
Co-conspirators Sandra Fernandez Viera, 49; Patricia Morcate, 34; and Enrique Rodriguez, 59, all of Miami, have also pleaded guilty to related charges, including conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks. On November 13, 2013, Fernandez Viera was sentenced to serve 120 months in prison; Morcate was sentenced to serve 60 months; and Rodriguez was sentenced to serve 57 months.
Together with Marrero, Fernandez Viera was an owner and operator of Trust Care. Morcate worked at and was an investor in Trust Care. Rodriguez served as a patient recruiter on behalf of Trust Care.
According to court documents, Marrero and his co-conspirators operated Trust Care for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.
Marrero primarily controlled Trust Care and, in light of that role, oversaw the schemes operating out of the company. Marrero was also responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims to the Medicare program.
Marrero and his co-conspirators paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Trust Care for home health and therapy services that were medically unnecessary and/or not provided. Marrero and his co-conspirators at Trust Care also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation. Marrero and his co-conspirators used these prescriptions, medical certifications, and other documentation to fraudulently bill the Medicare program for home health care services, which Marrero knew was in violation of federal criminal laws.
From approximately March 2007 through at least October 2010, Trust Care submitted more than $20 million in claims for home health services. Medicare paid Trust Care more than $15 million for these fraudulent claims.
Marrero and his co-conspirators have also acknowledged their involvement in similar fraudulent schemes at several other Miami health care agencies in addition to Trust Care with estimated total losses of approximately $50 million. Those agencies include A&B Health Services Inc., Centrum Home Health Care Inc., Global Nursing Home Health Inc., Lovable Home Health Services Corp., New Concepts In Health Inc., Nursemed Home Care Corp., R&M Health Care Inc., Ubieta Health System Inc., and Vital Care Home Health Services Inc.
The case was investigated by the FBI and HHS-OIG, with the assistance of IRS-CI, and was brought as part of the Medicare Fraud Strike Force initiative, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 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.
Showing posts with label illegal kickbacks. Show all posts
Showing posts with label illegal kickbacks. Show all posts
Friday, 22 November 2013
Thursday, 24 October 2013
Owner, Executives, and Physicians at Closed Sacred Heart Hospital Indicted in Alleged Medicare Referral Kickback Conspiracy
CHICAGO―The owner and three other executives of the now-closed Sacred Heart Hospital and four physicians affiliated with the former west side facility were indicted on federal charges alleging that they collectively paid and received hundreds of thousands of dollars in illegal kickbacks in exchange for the referral of hospital patients who were insured by Medicare and Medicaid. Sacred Heart allegedly paid physicians bribes and kickbacks to induce patient referrals and increase the patient census, which, in turn, increased hospital revenue.
Sacred Heart Hospital was a 119-bed acute care facility located at 3240 West Franklin Blvd. in Chicago. The hospital closed and filed for bankruptcy this summer after Medicare payments were suspended in the aftermath of criminal charges that were first filed in April. The indictment charges only conduct involved in the alleged kickback conspiracy while a broader investigation that was outlined in the earlier criminal complaint continues.
The eight defendants were charged in a 17-count indictment that was returned by a federal grand jury late yesterday and announced today by Zachary T. Fardon, United States Attorney for the Northern District of Illinois. Five of the eight defendants were charged and arrested on April 16 this year, while three new defendants were charged in the indictment for the first time. A fifth physician associated with Sacred Heart was indicted separately for illegally prescribing prescription medications. No new arrests occurred in connection with the indictments.
Mr. Fardon announced the charges with Lamont Pugh, III, Special Agent in Charge of the Chicago Region of the U.S. Department of Health and Human Service Office of Inspector General, and Robert J. Shields, Jr., Acting Special Agent in Charge of the Chicago Office of the Federal Bureau of investigation.
The five defendants charged previously in the conspiracy case are: Edward J. Novak, 58, of Park Ridge, Sacred Heart’s owner and chief executive officer; Roy M. Payawal, 64, of Burr Ridge, executive vice president and chief financial officer; and Drs. Percy Conrad May, Jr., 75, of Chicago, Subir Maitra, 73, of Chicago, and Shanin Moshiri, also known as “Shawni Moshiri,” 58, of Chicago. All five of these defendants remain free on various bonds after they were arrested in April.
The three new defendants are: Dr. Rajiv Kandala, 41, of Chicago; Anthony J. Puorro, 57, formerly of Chicago, who was Sacred Heart’s chief operating officer; and Noemi Velgara, 64, of Chicago, who was Sacred Heart’s vice president of geriatric services and was responsible for overseeing the Golden L.I.G.H.T. medical clinics, including managing employees responsible for marketing, and recruiting and transporting patients.
All eight defendants will be ordered to appear for arraignment in U.S. District Court.
Four defendants―Novak, Payawal, Puorro, and Velgara―were each charged with one count of conspiracy to violate the federal healthcare anti-kickback statute by offering and paying kickbacks and bribes, directly and indirectly, from Sacred Heart to Drs. May, Maitra, Moshiri, and Kandala and other physicians to induce them to refer patients to the hospital for services that would be reimbursed by Medicare and Medicaid. Sacred Heart’s chief operating officer before Puorro, identified as “Administrator A,” is named as an unindicted co-conspirator.
In addition, Novak and Payawal were each charged with eight substantive counts of paying kickbacks for patients, while Drs. May, Maitra, Moshiri, and Kandala were charged with two counts each of accepting kickbacks for patient referrals. The indictment also seeks forfeiture of illegal proceeds from Novak, Payawal, and the four physicians, including the unspecified total amount of Medicare and Medicaid reimbursements made on claims submitted on behalf of hospital patients whose referral involved kickbacks and the total amount of kickbacks paid to the four physicians.
According to the indictment, Sacred Heart’s owner, executives, and administrators conspired between 2004 and April 2013 to pay physicians bribes concealed as consulting, employment, and personal services compensation, rent, and instructional stipends in return for referrals of Medicare and Medicaid patients. Although styled as payments for legitimate services, the payments actually contained disguised bribes paid to and for the benefit of Drs. May, Maitra, Moshiri, and Kandala in exchange for patient referrals.
The indictment alleges that Novak, Payawal, Puorro, and Administrator A caused Sacred Heart to pay May hundreds of thousands of dollars in bribes disguised as rent and Moshiri more than $150,000 in bribes disguised as payments for purportedly teaching podiatric surgery residents. Novak, Payawal, and Puorro allegedly caused Sacred Heart to pay Maitra at least $68,000 in bribes disguised as payments for purportedly teaching medical students at the hospital; and Kandala at least $32,000 in bribes disguised as compensation for consulting and instructional services purportedly provided to the hospital and its staff.
Payawal, Puorro, and Velgara allegedly agreed to have Sacred Heart offer to pay bribes to the hospital’s transportation staff to recruit and refer patients to the hospital, and those three defendants, together with Novak, also caused Sacred Heart to pay individuals employed as “marketers” to recruit patients.
As part of the same investigation, a fifth physician associated with Sacred Heart was indicted separately this month for allegedly illegally prescribing hydrocodone or lorazepam to four different patients without having a valid license and registration to prescribe controlled substances. The defendant, Dr. Kenneth S. Nave, 51, of Chicago, who also was arrested and charged last April, allegedly illegally used the Drug Enforcement Administration registration number of another physician when he prescribed the prescription narcotics between October and December 2012. Nave pleaded not guilty at his arraignment this week.
Each count in the eight-defendant Novak indictment carries a maximum penalty of five years in prison and a $250,000 fine and restitution is mandatory. Each count in the Nave indictment carries a maximum penalty of four 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 government is being represented by Assistant U.S. Attorneys Joel Hammerman, Ryan Hedges, and Terra Reynolds.
The public is reminded that an indictment is 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.
The case falls under the umbrella of the Medicare Fraud Strike Force, which expanded operations to Chicago in February 2011 and is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Dozens of defendants have been charged in health care fraud cases since the strike force began operating in Chicago.
To report health care fraud to learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
Sacred Heart Hospital was a 119-bed acute care facility located at 3240 West Franklin Blvd. in Chicago. The hospital closed and filed for bankruptcy this summer after Medicare payments were suspended in the aftermath of criminal charges that were first filed in April. The indictment charges only conduct involved in the alleged kickback conspiracy while a broader investigation that was outlined in the earlier criminal complaint continues.
The eight defendants were charged in a 17-count indictment that was returned by a federal grand jury late yesterday and announced today by Zachary T. Fardon, United States Attorney for the Northern District of Illinois. Five of the eight defendants were charged and arrested on April 16 this year, while three new defendants were charged in the indictment for the first time. A fifth physician associated with Sacred Heart was indicted separately for illegally prescribing prescription medications. No new arrests occurred in connection with the indictments.
Mr. Fardon announced the charges with Lamont Pugh, III, Special Agent in Charge of the Chicago Region of the U.S. Department of Health and Human Service Office of Inspector General, and Robert J. Shields, Jr., Acting Special Agent in Charge of the Chicago Office of the Federal Bureau of investigation.
The five defendants charged previously in the conspiracy case are: Edward J. Novak, 58, of Park Ridge, Sacred Heart’s owner and chief executive officer; Roy M. Payawal, 64, of Burr Ridge, executive vice president and chief financial officer; and Drs. Percy Conrad May, Jr., 75, of Chicago, Subir Maitra, 73, of Chicago, and Shanin Moshiri, also known as “Shawni Moshiri,” 58, of Chicago. All five of these defendants remain free on various bonds after they were arrested in April.
The three new defendants are: Dr. Rajiv Kandala, 41, of Chicago; Anthony J. Puorro, 57, formerly of Chicago, who was Sacred Heart’s chief operating officer; and Noemi Velgara, 64, of Chicago, who was Sacred Heart’s vice president of geriatric services and was responsible for overseeing the Golden L.I.G.H.T. medical clinics, including managing employees responsible for marketing, and recruiting and transporting patients.
All eight defendants will be ordered to appear for arraignment in U.S. District Court.
Four defendants―Novak, Payawal, Puorro, and Velgara―were each charged with one count of conspiracy to violate the federal healthcare anti-kickback statute by offering and paying kickbacks and bribes, directly and indirectly, from Sacred Heart to Drs. May, Maitra, Moshiri, and Kandala and other physicians to induce them to refer patients to the hospital for services that would be reimbursed by Medicare and Medicaid. Sacred Heart’s chief operating officer before Puorro, identified as “Administrator A,” is named as an unindicted co-conspirator.
In addition, Novak and Payawal were each charged with eight substantive counts of paying kickbacks for patients, while Drs. May, Maitra, Moshiri, and Kandala were charged with two counts each of accepting kickbacks for patient referrals. The indictment also seeks forfeiture of illegal proceeds from Novak, Payawal, and the four physicians, including the unspecified total amount of Medicare and Medicaid reimbursements made on claims submitted on behalf of hospital patients whose referral involved kickbacks and the total amount of kickbacks paid to the four physicians.
According to the indictment, Sacred Heart’s owner, executives, and administrators conspired between 2004 and April 2013 to pay physicians bribes concealed as consulting, employment, and personal services compensation, rent, and instructional stipends in return for referrals of Medicare and Medicaid patients. Although styled as payments for legitimate services, the payments actually contained disguised bribes paid to and for the benefit of Drs. May, Maitra, Moshiri, and Kandala in exchange for patient referrals.
The indictment alleges that Novak, Payawal, Puorro, and Administrator A caused Sacred Heart to pay May hundreds of thousands of dollars in bribes disguised as rent and Moshiri more than $150,000 in bribes disguised as payments for purportedly teaching podiatric surgery residents. Novak, Payawal, and Puorro allegedly caused Sacred Heart to pay Maitra at least $68,000 in bribes disguised as payments for purportedly teaching medical students at the hospital; and Kandala at least $32,000 in bribes disguised as compensation for consulting and instructional services purportedly provided to the hospital and its staff.
Payawal, Puorro, and Velgara allegedly agreed to have Sacred Heart offer to pay bribes to the hospital’s transportation staff to recruit and refer patients to the hospital, and those three defendants, together with Novak, also caused Sacred Heart to pay individuals employed as “marketers” to recruit patients.
As part of the same investigation, a fifth physician associated with Sacred Heart was indicted separately this month for allegedly illegally prescribing hydrocodone or lorazepam to four different patients without having a valid license and registration to prescribe controlled substances. The defendant, Dr. Kenneth S. Nave, 51, of Chicago, who also was arrested and charged last April, allegedly illegally used the Drug Enforcement Administration registration number of another physician when he prescribed the prescription narcotics between October and December 2012. Nave pleaded not guilty at his arraignment this week.
Each count in the eight-defendant Novak indictment carries a maximum penalty of five years in prison and a $250,000 fine and restitution is mandatory. Each count in the Nave indictment carries a maximum penalty of four 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 government is being represented by Assistant U.S. Attorneys Joel Hammerman, Ryan Hedges, and Terra Reynolds.
The public is reminded that an indictment is 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.
The case falls under the umbrella of the Medicare Fraud Strike Force, which expanded operations to Chicago in February 2011 and is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Dozens of defendants have been charged in health care fraud cases since the strike force began operating in Chicago.
To report health care fraud to learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
Friday, 13 September 2013
Physician-Owned Hospital Agrees to Resolve Its Civil and Criminal Liability for Benefiting from Illegal Kickbacks to Physicians
DALLAS—Forest Park Medical Center LLC (FPMC), a North Texas physician-owned hospital, paid over $258,000 to settle allegations that it violated the civil False Claims Act, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas. The United States contends that a FPMC representative paid illegal kickbacks to area physicians to obtain referrals for Tricare patients, a federally funded health care program, in violation of the federal law, between 2008 and 2012. Based on the same allegations, FPMC entered into a non-prosecution agreement with the United States and agreed to certain conditions, as well as a federally imposed monitor for not more than 24 months. FPMC fully cooperated with the investigation and, by settling civilly and criminally, did not admit any wrong-doing or liability.
FPMC, located in Dallas, did not seek reimbursement from any federal sources such as Medicare and Medicaid but only commercial payors and self-pay. Federal and state law usually limits the amount of compensation paid to physicians and their ability to refer certain patients under federally insured programs. Because FPMC believed it did not accept federal funds, its representatives, to the benefit of FPMC’s behalf, offered and paid excessive remuneration and other things of value to actual and potential referring physicians or others, including amounts for “marketing” or “advertising.” Payments also were made in the form of cash and giftcards/coupons for luxury items. The United States alleges such payments were made to obtain federal health care program patients, such as TRICARE, a program for military retirees and their dependents. The United States contends such payments were unlawful kickbacks for the referral of federal health care program patients in violation of the federal Anti-Kickback Statute between January 1, 2008 and October 31, 2012. The United States initiated the investigation in response to numerous complaints.
In the non-prosecution agreement, FPMC acknowledged the United States has sufficient evidence to seek an indictment for the offering and payment of illegal kickbacks in violation of federal law. In return for the non-prosecution of the hospital, FPMC selected and retained an independent monitor to address any compliance issues and the United States’ concerns regarding the allegations of illegal conduct. The monitor will be in place for not more than 24 months and will review and evaluate inpatient and outpatient claims submitted to all payors, not just federal programs. FPMC also agreed to cooperate with the United States’ ongoing investigation into certain individuals. No persons were released under the civil and criminal agreements. The United States’ investigation remains ongoing.
U.S. Attorney Saldaña praised the efforts of the investigating agencies, including the Defense Criminal Investigative Services; FBI; Department of Labor, EBSA; Office of Inspector General of the Office of Personnel Management; and FDA-CI.
“This civil and criminal resolution spares the honest employees and investors of FPMC, while holding the hospital accountable for allowing an environment where its representatives paid illegal kickbacks for referrals,” said U.S. Attorney Saldaña. “This outcome imposes well-deserved measures that we expect will ensure FPMC becomes fully compliant with federal and private health care program requirements. Whether physician-owned, not-for-profit, or for-profit, the Department of Justice expects and requires all providers to be trustworthy and abide by the law,” Saldaña continued.
The case was handled by Assistant U.S. Attorneys Sean McKenna, Errin Martin, and Lynette Wilson and Special Assistant U.S. Attorney Glenn Harrison.
FPMC, located in Dallas, did not seek reimbursement from any federal sources such as Medicare and Medicaid but only commercial payors and self-pay. Federal and state law usually limits the amount of compensation paid to physicians and their ability to refer certain patients under federally insured programs. Because FPMC believed it did not accept federal funds, its representatives, to the benefit of FPMC’s behalf, offered and paid excessive remuneration and other things of value to actual and potential referring physicians or others, including amounts for “marketing” or “advertising.” Payments also were made in the form of cash and giftcards/coupons for luxury items. The United States alleges such payments were made to obtain federal health care program patients, such as TRICARE, a program for military retirees and their dependents. The United States contends such payments were unlawful kickbacks for the referral of federal health care program patients in violation of the federal Anti-Kickback Statute between January 1, 2008 and October 31, 2012. The United States initiated the investigation in response to numerous complaints.
In the non-prosecution agreement, FPMC acknowledged the United States has sufficient evidence to seek an indictment for the offering and payment of illegal kickbacks in violation of federal law. In return for the non-prosecution of the hospital, FPMC selected and retained an independent monitor to address any compliance issues and the United States’ concerns regarding the allegations of illegal conduct. The monitor will be in place for not more than 24 months and will review and evaluate inpatient and outpatient claims submitted to all payors, not just federal programs. FPMC also agreed to cooperate with the United States’ ongoing investigation into certain individuals. No persons were released under the civil and criminal agreements. The United States’ investigation remains ongoing.
U.S. Attorney Saldaña praised the efforts of the investigating agencies, including the Defense Criminal Investigative Services; FBI; Department of Labor, EBSA; Office of Inspector General of the Office of Personnel Management; and FDA-CI.
“This civil and criminal resolution spares the honest employees and investors of FPMC, while holding the hospital accountable for allowing an environment where its representatives paid illegal kickbacks for referrals,” said U.S. Attorney Saldaña. “This outcome imposes well-deserved measures that we expect will ensure FPMC becomes fully compliant with federal and private health care program requirements. Whether physician-owned, not-for-profit, or for-profit, the Department of Justice expects and requires all providers to be trustworthy and abide by the law,” Saldaña continued.
The case was handled by Assistant U.S. Attorneys Sean McKenna, Errin Martin, and Lynette Wilson and Special Assistant U.S. Attorney Glenn Harrison.
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