Articles Posted in Medicare Fraud

IMG_0368-300x200Frederick Gooding, a physician of Wilmington, Delaware, was charged in an indictment with 11 counts of health care fraud following an investigation into his participation in a $12.7 million scheme that sought to defraud Medicare.

According to the Department of Justice, Gooding submitted claims to Medicare for injections and aspirations that had either never been received or had no necessary medical purpose. Gooding continued this scheme from January 2015 to August 2018, stealing a total of $12.7 million during that time. To cover-up the health care fraud scheme, Gooding allegedly falsified numerous medical documents to show that the prescriptions and services he billed Medicare for were medically necessary.

Gooding was arrested for these allegations on August 1st, 2019, and the indictment was announced on August 2nd, 2019 by Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Jessie K. Liu of the District of Columbia, Acting Assistant Director in Charge John P. Selleck of the FBI’s Washington Field Office, Special Agent in Charge Maureen Dixon of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Philadelphia Regional Office and District of Columbia’s Inspector General Daniel W. Lucas.

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_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.

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.

social-security-300x170We recently published a blog on the impending crisis concerning funding of Medicare and Social Security benefits. The numbers of inquiries on this were substantial so I am writing additional information on the problem.

One issue is that Congress appears reluctant to address the issue especially given the coming Presidential election and the obvious effect changes would have on the deficit budget if the present systems are maintained. Government officials that oversee the future of Medicare and Social Security have discovered troubling facts concerning the future of these essential programs. Medicare is likely to become insolvent by the year 2026, while the insolvency of Social Security is estimated for some time in 2035. No solutions have been proposed as of this date but concerns are increasing because any structural changes must be well planned and funded which will require consensus building and focus on details.

Medicare and Social Security are both factors of the United States financial support system that use government reserves in order to provide vital assistance to those in need, in particular, the sick and elderly.

big-pharma-300x196Jazz Pharma, Alexion, and Lundbeck were the subject of SOJ lawsuits asserting kickbacks and committing general violations of Medicare laws. The United States Department of Justice has decided to agree to a settlement of $122.6 million in total from these three alleged Medicare violators.

The drug companies were accused of offering remuneration in hopes of encouraging patients to purchase their medications. They would pay kickbacks, a form of negotiated bribery, to patients of Medicare and Civilian Health and Medical Program (ChampVA) under the guise of charitable organizations that subsidized the co-pays. This is not an uncommon practice, but it is one many law enforcement programs are attempting to discontinue.

The DOJ states that in this case, the companies violated the Federal False Claims Act. This act is a way of imposing liability onto anyone, be it a group or individual, that has been discovered interfering with government-funded programs such as in this case with Medicare. This is one of the government’s main tools in defending against fraudulent acts.

Medicare-fraud-300x200Rossana Ramirez, a once certified nursing assistant, was discovered to be helping run a business in West Miami-Dade that is responsible for $7 million in health care fraud. After pleading guilty Ramirez was stripped of her license permanently through an Emergency Suspension Order and is now serving time at a federal detention center with a release date of June 2022.

Rossana Ramirez was registered in the state corporation registration as the vice president of a company titled F&E Home Health Care. While Rossana Ramirez is currently taking the heat from the Florida Department of Health, her husband Evelio Ramirez Jr. is also involved as the president of F&E. He will soon be starting his sentence of three years and ten months in federal prison himself. Both husband and wife are 59 and will both serve their time. Their pleas of guiltily were fairly straightforward and show that this act of fraud is not very uncommon from what has already been seen from healthcare fraud schemes in South Florida.

F&E is accused of paying kickbacks, a form of negotiated bribery in which a commission of sorts is given in return for services rendered, to those who receive Medicare and Medicaid to become F&E patients. Additionally, some of these patients did not even require home healthcare and the services promised were not often necessary or even provided at times. F&E is also accused of paying recruiters of Medicare and Medicaid recipients to promote their health services for them.

pharmacy-fraud-300x199The pharmaceutical industry in Pasadena is much like the rest of the United States. There are certainly an influx of individuals who receive Medicare using these services for particular ailments and diseases that accompany being older than 65 years old. However, a local Pasadena pharmacy, Akhtamar Pharmacy, was abusing the Medicare funds provided for those particular individuals. Although the pharmacy owner did not act alone, she was able to steal $1.3 million dollars from the Medicare system.

Pasadena Pharmacy Owner Convicted for Medicare Fraud

Although the pharmaceutical industry is driven by a purpose to help those who need medication, it can also be a place for fraudulent acts to occur. With so much paperwork to be completed, many individuals find themselves taking advantage of the system by falsifying numbers or providing inaccurate invoices. Unfortunately, this was the case in a Pasadena pharmacy. A 39-year-old pharmacy owner, Tamar Tatarian, was convicted on one count of healthcare fraud and two counts of wire fraud at Akhtamar Pharmacy in Pasadena. It is believed that she committed the fraudulent acts which amounted to $1.3 million dollars in total.

j-300x198Steven M. Butcher, 39, owner of MedMax LLC, which provided marketing services for compounded medications, pleaded guilty before U.S. District Judge John Michael Vazquez in Newark federal Court for conspiracy to commit healthcare fraud and violate the Anti-Kickback Statute.

Butcher used his company, MedMax,  to convince people to obtain unneeded compound medications and then bill the costs to various private and federal healthcare insurance plans.  MedMax was a marketing company for compound medications.  Butcher also paid several kickbacks from 2014 to 2015 for many individuals to fraudulently bill a health care benefit program that primarily serviced military families, called TRICARE, for unnecessary compound medications.

Compounded pharmacies prepare personalized medications based on specific prescriptions that include instructions for exact strength and dosage.