Articles Tagged with #healthcarefraud

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_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_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.

The Centers for Medicare & Medicaid Services is alerting insurers that a drug called Nuedexta may be improperly given to nursing home patients including dementia patients for non approved uses.  The drug alert,  said that CMS is “monitoring the increased utilization of the drug Nuedexta” after allegations of potential use “for non-medically accepted indications.”It reminds Medicare Part D plan sponsors they have a responsibility to ensure that drugs “are only covered when used for a medically-accepted indication.”An investigation by CNN found that sales of Nuedexta grew 400% in four years to reach $300 million in 2016, and that half of the pills Avanir has sold since 2012 have gone to long-term care facilities even though prescribing information acknowledges the drug has not been extensively studied in elderly patients. One study of people with Alzheimer’s, found it seemed to increase the risk of falling.

For years, the Centers for Medicare & Medicaid Services has been hearing concerns that laughing drug Nuedexta was being aggressively pushed by maker Avenair Pharmaceuticals and some doctors for questionable use on dementia patients. Now, the CMS is asking insurers to be on alert for that kind of suspicious prescribing pattern and to let the agency know ASAP if it has concerns.

The drug alert, first reported on by CNN, said that CMS is “monitoring the increased utilization of the drug Nuedexta” after allegations of potential use “for non-medically accepted indications.”It reminds Medicare Part D plan sponsors they have a responsibility to ensure that drugs “are only covered when used for a medically-accepted indication.”The drug, which is one of only two marketed by California-based Avanir Pharmaceuticals, is approved by the FDA for treating pseudobulbar affect disorder (PBA), a neurological condition characterized by sudden outbursts of uncontrollable laughter or crying seemingly unrelated to mood.