Articles Posted in Medicaid Fraud

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_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.

IMG_0257-300x180Crispin Abarientos, M.D., of Middletown, Connecticut, pleaded guilty to one count of health care fraud in Hartford federal court. According to court statements, Abarientos was a physician that operated out of Middlesex Rheumatology and submitted false claims to Medicaid regarding the use of the drug Remicade on behalf of his patients.

Remicade is primarily used to treat rheumatoid arthritis, and is a drug that was commonly prescribed to Middlesex Rheumatology patients. When Medicaid patients are treated with Remicade the prescribing physician is required to submit claims to their local Medicaid facility, in this case Connecticut Medicaid, on their behalf. Medicaid then pays a partnered pharmacy for the requested drugs, which are then delivered to the prescribing doctor’s facility.

While this was a procedure that Abarientos regularly followed for many of his patients, he admitted to submitting claims to Medicaid for large quantities of the drug that were never intended to be distributed to his patients. He would then submit claims to insurers for reimbursement of the drugs, profiting from the scheme without any out-of-pocket expenses. In total, Abarientos was able to obtain around $895,000 worth of Remicade, which were never distributed to his patients for treatment.

IMG_0222-300x200Following allegations of fraudulent Medicaid claims, Acadia Healthcare has agreed to pay a $17 million settlement, according to a recent press release by the Department of Justice.

CRC Health operates its subsidiary, Acadia Healthcare, located in Tennessee with treatment centers in West Virginia. The treatment centers are certified to perform basic laboratory testing involving blood and urine. However, the settlement alleges that between 2012 and 2018, the treatment centers sent urine and blood samples to a San Diego laboratory for more complex testing. Then, the West Virginia based treatment centers billed Medicaid for the testing performed.

Acadia Healthcare submitted the claims through the Medicaid program in their area and received reimbursement fees for the tests. However, the San Diego laboratory was actually the center performing the tests and charged Acadia for their services. The Medicaid reimbursements were higher than the charges of the San Diego laboratory, resulting in Acadia Healthcare gaining around $8.5 million in the Medicaid scheme.

IMG_0209-300x200A whistleblower in Oklahoma, Jennifferr Baird, filed a complaint against the hospital she worked at as a registered nurse for fraudulent Medicaid billing practices. Following the filing, Oklahoma Heart Hospital agreed to settle the allegations with a $2.8 million fee.

Baird was in charge of a team of seven staff members and alleged that for at least seven years the hospital consistently billed Medicaid at inpatient rates, even if the patient was being treated as an outpatient.

“First, OHH routes almost all of its Medicaid patients to inpatient treatment, when many should be classified as outpatient; in doing so OHH is able to charge significantly larger fees for the same treatment. The fraud is evidenced by the fact that OHH does not treat its Medicare or privately insured patients similarly.”, the lawsuit stated.

IMG_0004-300x200Nabil Fakih, a licensed pharmacist, Michigan Board of Pharmacy member, and owner of a Dearborn Heights drug store, was charged with healthcare and wire fraud and indicted by a grand jury. The Indictment accused Fakih of wrongfully taking millions of United States dollars from Medicare, Medicaid and Blue Cross Blue Shield (BCBS), dating back to 2011.

According to the indictment, Fakih is accused of falsely submitting claims on behalf of Dial Drugs. He was reported to be overbilling Medicaid and Medicare by $569,670 while overcharging BCBS by $558,079.

Fakih and others billed insurance companies for prescription drugs such as the antipsychotic medication, clozapine, and the sedative alprazolam. Claims for these drugs were on behalf of people who had died prior to the claimed date of delivery. This is according to government allegations.

Arkansas Attorney General Leslie Rutledge announced today the arrest of the owner and CEO of New Beginnings Behavioral Health Services LLC, Chirie Bazzelle.

Bazzelle, 46, of Benton, is accused of failing to report contracts with Milton “Rusty” Cranford, Robin Raveendran, and her former husband Michael Grimes who is a convicted felon. She is also accused of continuing the employment of individuals who had been convicted of Medicaid fraud and ignoring additional Medicaid fraud claims of other employees. Bazzelle has been listed as the sole owner of New Beginnings Behavioral Health Services in Pulaski County since 2010. Bazzelle is also accused of attempting to evade taxes from January 2014 through February 2019.

“Bad actors who have their hands in the taxpayer cookie jar must be held accountable,” says Attorney General Rutledge

Medicaid fraudWaveney Blackman, the owner of durable medical equipment company WaveCare Health services, has been charged with one act of healthcare fraud for filing claims to Medicaid for products that were never purchased through her business. Blackman pleaded guilty to these charges after one month and has been sentenced to 42 months in prison and ordered to forfeit $9.4 million, the sum of WaveCare’s proceeds from fraudulent claims.

During the years of 2010 to 2016, Blackman filed multiple claims to Medicaid for incontinence products, wound care supplies, and other pieces of durable medical equipment that resulted in revenue of $9.4 million. None of these products were ever given to Medicaid clients or even requested by one. These fraudulent claims were filed by Blackman herself, along with the assistance of her employees through a WaveCare biller.

Within one month of being charged, Blackman signed a plea agreement that detailed the illegal actions taken, as well as the proceeds she received from them. The government has seized a Mercedes, seven properties, and money traced to two separate bank accounts, and the judge ordered Blackman to pay the total of $9.4 million WaveCare reportedly received in fraudulent claims. She will also be sentenced to 42 months in prison.

NC-health-care-fraud-300x199Mental health company owner, Catinia Denise Farrington of Cyprus, Texas, pleaded guilty to health care fraud and tax evasion in September of 2018. As of March 1st, 2019, she has been sentenced to 60 months in prison after profiting $4 million from Medicaid and just under $400,000 from her tax evasion scheme.

Health Care Fraud Conspiracy

According to prosecutors, Farrington owned a mental health care company out of North Carolina, Durham County Mental Health and Behavioral Health Services, LLC. Through this company, she submitted thousands of fraudulent claims to Medicaid for services that were never performed. These incidents occurred between 2011 and 2015, but this is not the only fraudulent activity that Farrington participated in during this time.

Target Corp. will pay  $3 million to settle  allegations that it violated federal and state law by improperly billing and receiving payments from the state’s Medicaid program (MassHealth), Attorney General Maura Healey announced today.

Under the terms of the settlement, Target Corp. will pay $3 million to resolve allegations that from August 2009 through July 2015, the company operated an unauthorized automatic refill program at their Massachusetts locations.

Current regulations prohibit pharmacies in Massachusetts from automatically refilling prescriptions that were not explicitly requested by a MassHealth patient or caregiver at the time of each filling event. The AG’s Office alleges that Target automatically refilled prescriptions and billed MassHealth inappropriately for them