Articles Tagged with Healthcare Fraud

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_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_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.

cryptocurrency Despite its cons, cryptocurrency has introduced powerful technologies to the market, including blockchain protocols which essentially act as an advanced ledger for cryptocurrency exchanges. However, this technology is now being utilized for the protection of numerous industries, including the healthcare industry by preventing counterfeit pharmaceuticals from entering the market.

A paper published by Portland University researchers outlined how blockchain technology could be used as an anti-counterfeiting system for numerous industries. But, understanding how this technology can be applied to various markets means taking a closer look at its use in cryptocurrency.

Essentially, cryptocurrency platforms utilize blockchain technology to store and track the incoming and outgoing transactions that they facilitate. These transactions are stored across numerous computers that are linked by a peer-to-peer network. The history of transactions stored on the blockchain is extensive, and allow those in control to view a detailed account of exactly what is going on with each transaction.

Pharmacy fraudHolly Blakely, a former San Antonio pharmaceutical rep in Texas, plead guilty and confessed her involvement in an $8.8 million healthcare fraud scheme.

Initially, Holly Blakely was charged in a 30-count indictment. This allegedly means that she paid more than $400,000 in bribes and kickbacks to clinicians for prescribing compounded medications. Compound medication is basically personalized medications produced in order to fit an individual’s exact medical needs. In this case, these compound medications, in particular, were designed to ease pain, but the people these were being given to did not require them.

Blakely confessed that she worked with two compounding pharmacies in order to push prescriptions for compound drugs. The pharmacies would then submit claims to health plans such as Tricare. In exchange for her part of the fraud, Blakely was paid $1.15 million.

David Williams called himself Dr. Dave and claimed he served clients in Las Vegas, Denver, Orlando, Seattle and Tucson.

In reality, he is a  fitness expert from Fort Worth, has been charged by federal authorities with fraudulently billing health insurance companies more than $25 million and billing for medical services while impersonating a certified healthcare provider. He was arrested in October, and a jury convicted him Wednesday on four counts of health care fraud, each count punishable by a 10-year prison sentence and a $250,000 fine. Williams is scheduled for sentencing in August, according to a news release from the U.S. Attorney’s Office Between November 2012 and August 2017, Williams advertised on his website, getfitwithdave.com, that he could deliver in-home fitness training and therapy through his company, “Kinesiology Specialists,” the release said.

On a website, he told potential clients he accepted most health care insurance coverage plans. In order to bill insurance companies for his services, Williams registered as a health care provider with the Centers for Medicare and Medicaid Services, according to federal authorities.Williams falsely certified that he was a health care provider on his applications to federal authorities, according to the release. Using different names or variations of his name and his company names, Williams enrolled as a health care provider at least 20 times and falsely certified that he was a health care provider in each application, the release stated.

Medicare-fraud-300x200Fake Treatments and Paperwork Lead to Arrest in Medicare Fraud Case

A physician has been indicted for stealing nearly $1 million in Medicare fraud scheme that also included private insurance. Dr. Pranav Patel, of the Chicago area, allegedly submitted fake insurance claims for medical tests and exams that were never conducted.

The Scam

 
A New Jersey man is facing fraud charges after a federal grand jury agreed he took advantage of senior citizens. The man is accused of operating a nonprofit with the intention of defrauding people with unnecessary tests. According to Tapinto.net, Seth Rehfuss, 43, of Somerset NJ, used a nonprofit agency called Good Samaritans of America to commit “health care fraud and conspiracy to wrongfully access individually identifiable health information and to pay illegal remunerations to health care professionals.” The fraud lasted from July 2014 through December 2015, while he managed to deceive low-income seniors. The victims were told Good Samaritans of America was a nonprofit that helps seniors understand the federal benefit programs. But, the article says, the organization was a fraud. He actually used the nonprofit to scare victims into genetic testing. The indictment says Rehfuss used fear-based tactics by suggesting the seniors could be at risk for heart attacks, strokes, or cancer and even suicide if they did not have the genetic testing. He told them he was offering “personalized medicine.”

The article says that Rehfuss took DNA swabs from senior citizens in their homes and community rooms during fear-based presentations designed to get their personal information. He apparently tried to recruit healthcare providers on Craigslist. Once they signed a contract the healthcare providers received requisition forms that often included a patient’s personal information, Medicare information, medication lists, and diagnosis codes. The healthcare providers that choose to cooperate were paid to sign-off on requisition forms authorizing testing for patients “they never examined”.

The fraudulent scheme racked up over $1 million in Medicare costs at two laboratories. He also shared his commissions with a co-conspirator, Sheila Kahl. Together authorities say they were planning to expand to Georgia, Delaware, Virginia, Maryland, Pennsylvania, South Carolina, Michigan, Mississippi, Florida, Tennessee, and Arizona. The healthcare fraud conspiracy means he could be put away for a decade and pay a $250,000 fine, or twice the gross gain or loss from the offense. The conspiracy charge carries a possible 5-year sentence and a $250,000 fine, or twice the gross gain or loss from the offense. His co-conspirator, Sheila Kahl pleaded guilty and is awaiting sentencing.

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.

healthcare-fraud-300x180Wyoming Psychologist Will Serve Prison Time for Health Care Fraud

A Wyoming Psychologist has admitted he committed health care fraud by falsely filing Medicaid claims. Gibson Buckley Condie, 57, of Powell, Wyoming has been sentenced to three years in prison and ordered to approximately $2.28 million in restitution, according to Justice.gov.

The Scheme