Articles Posted in Healthcare Fraud

IMG_0429-300x200Terry Anderson and his son, Rocky Anderson, were found guilty of multiple counts of health care fraud and aggravated identity theft following a 10-day trial in 2018. On Thursday, August 5th, 2019, it was announced that the duo would serve eight and seven years in prison, respectively. In total, Terry Anderson and Rocky Anderson were found to have submitted more than $27 million in fraudulent hearing aid claims to Blue Cross and Blue Shield of Texas.

According to the Department of Justice, the Andersons ran a business called Anderson Optical & Hearing Aids Center, which had multiple locations in Texas. This business was used to submit the defendants’ fraudulent claims to Blue Cross and Blue Shield, although many of the patients did not require hearing aids or never received them.

In an effort to gain additional patients for more claims, the defendants performed multiple marketing tactics, including the promise of free high-end sunglasses, gift cards, or prescription eyeglasses for participating in a complimentary hearing test. Upon completing the hearing test, many patients were told that they suffered from mild hearing loss and required the use of hearing aids. Patients were then asked to sign a consent form for the ordering of the hearing aids, which would also be provided at no cost. The Anderson pair also told patients that copayments and deductibles would be waived.

IMG_0403-300x169On Tuesday, August 13th, 2019, Peter Frazzano, 46, admitted to participating in a health care fraud scheme involving the submission of fraudulent claims for compounding prescriptions. Frazzano pleaded guilty to conspiracy to commit health care fraud, which is punishable by up to 10 years in prison and a $250,000 fine. Frazzano has also agreed to forfeit over $270,000 and pay a restitution fee of nearly $3 million.

According to the Department of Justice, Frazzano and an additional individual involved in the scheme recruited a physician to sign prescriptions for compounding drugs. These prescriptions were ordered for unsuspecting individuals who were never examined or spoken to regarding the drugs.

Once the prescriptions were issued, Frazzano fraudulently billed multiple health insurance organizations, including the New Jersey State Health Benefits plan. The compound prescriptions Frazzano billed these plans for were mainly pain creams, scar creams, and metabolic supplements.

IMG_0367-300x200Michael Bang, of Mesa, Arizona, was indicted on 20 counts of health care fraud, aggravated identity theft, and wire fraud following the investigation of a health care fraud scheme targeting the Colorado Public Employees Retirement Association (COPERA).

According to the Department of Justice, Bang was able to steal around $300,000 through his health care fraud scheme. An investigation by the Federal Bureau of Investigation discovered that Bang had been taking advantage of COPERA’s health insurance program, PERACare, for his role as a retired public employee of Colorado. PERACare utilized Express Scripts to administer the prescription coverage of its patients. Although Bang received prescriptions from the program, he filed for reimbursements for more expensive versions of the drugs he had received or for prescriptions he had not received at all. For several years, the health care fraud scheme orchestrated by Bang was successful and grew to involve three pharmacies.

As part of his health care fraud scheme, Bang forged the signatures of pharmacists, while falsifying the prescription numbers on the submitted reimbursement forms. Bang also requested reimbursements for out-of-pocket expenses that had never been utilized.

IMG_0366-300x200Dr. Antonio Reyes-Vizcarrondo was indicted for one count of conspiracy to commit health care fraud and one count of health care fraud following allegations that he submitted false claims to both Medicare and Medicaid.

According to the Department of Justice, Reyes-Vizcarrondo submitted a total of 8,159 claims between 2008 and 2015, resulting in profits of nearly $900,000. Out of these funds, Medicare and Medicaid was defrauded for almost $602,000 with the remaining funds having been paid out by other health care organizations.

As part of his health care fraud scheme, Reyes-Vizcarrondo would submit claims for services performed by other physicians, and then conceal the profits by diverting them to his personal accounts.

IMG_0355-300x201Michael Burton, of Decatur, Georgia, was sentenced to 96 months in federal prison for his participation in a scheme that defrauded TRICARE and other insurers a combined $6.5 million. According to the Department of Justice, Burton plead guilty to charges of conspiracy to commit health care fraud, conspiracy to commit money laundering, and money laundering.

From 2014 to 2015, Burton and his team of conspirators defrauded TRICARE and other private insurance companies through the submission of fraudulent claims for prescriptions including scar creams, pain creams, and wellness capsules. Sales representatives were recruited to obtain personal and insurance coverage information from individuals in exchange for commission payments. Co-defendant, Brad Hodgson, would then use the information to prescribe the compounded drugs without a necessary medical purpose. These individuals were not the patients of Hodgson, and he was not licensed to write prescriptions.

Once the prescriptions were forged, fraudulent claims for the reimbursement of these drugs were submitted to TRICARE and other insurers. These claims totaled $6.5 million, with Burton’s participation in the scheme profiting him a total of $1.4 million in the form of commission payments.

IMG_0315-300x200A civil health care fraud lawsuit has been filed against Life Spine Inc., as well as its founder and president, Michael Butler, and Vice President of development, Richard Greiber, for allegedly paying millions of dollars in kickbacks to surgeons for using their spinal implants, equipment, and other devices. According to the lawsuit, the surgeons who received kickbacks from Life Spine Inc. accounted for half of the company’s total sales from 2012-2018.

Life Spine Inc. is headquartered out of Huntley, Illinois and specializes in the development and manufacturing of devices used in spinal surgeries. This includes spinal implants and instruments under the Life Spine Products line.

In 2012, Butler and Greiber began aggressively recruiting surgeons to act as paid consultants for the company. Butler and Greiber also promised surgeons that any patent applications that were transferred to Life Spine Inc. would result in the related products being brought to market. However, these agreements were contingent on the surgeons’ continued use of Life Spine Products. In exchange, the surgeons received up-front intellectual property acquisition fees for their patent transfers, as well as royalties for sales from the patented products, and regular consulting fees.

IMG_0307-300x200According to the Department of Justice, Patricia Waible, of Nashua, NH, plead guilty to two counts of making false statements during the investigation of a patient’s death. The defendant allegedly claimed that she had conducted the required hourly bed checks on the patient the night of his death, but investigators later found that this was not the case.

On July 3rd, 2016, Waible was working as a nursing assistant at the Veterans Affairs Medical Center in Bedford. Her shift was scheduled from midnight to 8 am in the nursing home unit. During that shift, Waible was responsible for performing hourly bed checks to ensure that patients were breathing. One of these patients was known to suffer from multiple health complications and was found unresponsive early that morning.

The patient was transferred to the facility’s emergency room, where he was soon pronounced dead. An investigation followed, where Waible stated on multiple occasions that she had performed the required hourly bed checks on the patients when she had not.

IMG_0264-1-300x200Dr. Patrick Ifediba, 60, and his sister, Ngozi Ozuligbo, were convicted for health care fraud, unlawful drug distribution, and money laundering revolving around a massive scheme that garnered nearly $8 million in fraudulent funds.

According to the Department of Justice, Ifediba was operating as a doctor of internal medicine and the owner of Care Complete Medical Clinic (CCMC). Evidence presented at trial showed that Ifediba used the facility as a “pill mill”, regularly prescribing a range of highly addictive opioids with the goal of creating repeat office visits for their renewal. The trial found that Ifediba not only overprescribed the drugs intentionally but also offered dangerous combinations of the drugs. One of these combinations was referred to as “the holy trinity” and was known for creating a high similar to that of heroin. The high risk of overdose using this cocktail was well-known, yet continued to be prescribed by Ifediba routinely.

In total, 85% of Ifediba’s patients were written prescriptions for opioids, despite the fact that Ifediba was not a pain specialist and CCMC was not operating as a pain management facility.

IMG_0265-300x200Daniel Ferguson, John Frohrip, and Kevin Partin, pleaded guilty to violating federal anti-kickback statutes following allegations that they paid illegal kickbacks and recruited doctors to write prescriptions for expensive drugs as part of their health care fraud scheme.

According to the Department of Justice, the defendants recruited physicians to write prescriptions for complex drugs that would qualify for lucrative reimbursements from insurance programs. After the drugs were prescribed to patients, the defendants would then apply for reimbursements through various federal health care insurance programs and use the profits for their personal expenses.

Each of the defendants admitted to offering to pay kickbacks to the physicians they were attempting to recruit in their scheme. On many occasions they were successful in their recruitment, including the payment of $15,000 to Dr. John Main of Tulsa for his participation in the scheme.

IMG_0264-300x200Andrew M. Berkowitz, M.D., is facing an indictment of 19 counts of healthcare fraud and 23 counts of distributing oxycodone outside of medical treatment following allegations that he provided each of his patients with a “goodie bag” of prescription drugs after each visit, despite their individual ailments. It is also alleged that Berkowitz fraudulently submitted claims for a variety of treatments and prescriptions that were either never performed or were unnecessary.

Berkowitz ran the Philadelphia-based medical practice, A+ Pain Management, where he offered a variety of treatments including physical therapy, chiropractic services, acupuncture, and general pain management. After each patients’ visit they were provided with a tote filled with a wide range of pain-relieving drugs. This included topical analgesics, muscle relaxers, anti-inflammatories, and strong insomnia and anxiety prescriptions. From each goodie bag, Berkowitz was able to claim $4,000 of reimbursements by submitting claims to insurers, for a total of $3.2 million from 2015 to 2018.

The Affirmative Civil Enforcement Strike Force of the U.S. Attorney’s Office is also taking action in this case by filing a civil suit to freeze Berkowitz’s assets until the investigations have been completed.