Articles Tagged with #Medicaidfraud

Middlesex Rheumatology Physician Admits To Medicaid Fraud By Submitting False Claims Regarding Remicade Drug Use

 
Crispin 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.

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.

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.

Three employees of home health care companies, Travis Moriarty, 37, Tiffhany Covington, 41, and Brenda Lowry Horton, 48, all of Pittsburgh, Pennsylvania, pleaded guilty conspiracy to defraud the Pennsylvania Medicaid program. The companies Moriarty Consultants, Inc. (MCI), Activity Daily Living Services, Inc. (ADL), Coordination Care, Inc. (CCI), and Everyday People Staffing, Inc. (EPS). MCI, ADL, and CCI were approved under the Pennsylvania Medicaid program to offer certain services to qualifying Medicaid recipients (“consumers”), including personal assistance services (PAS)  collectively, received more than $87,000,000 in Medicaid payments based on claims submitted for these services, with PAS payments accounting for more than $80,000,000 of the total amount.

The defendants admitted that co-conspirators fabricated timesheets to show in-home PAS care they provided to consumers but that, in fact, never occurred. In addition, at Arlinda Moriarty’s direction, certain co-conspirators stopped using their own names as the attendant on timesheets and instead used the names of “ghost” attendants, some of whom permitted their names to be used in exchange for a kickback of resulting fraudulent salary payments. The defendants also admitted that certain co-conspirators submitted false timesheets for PAS care they never provided during times when they were actually working at other jobs or living out of the area. In some cases, as the defendants acknowledged, Medicaid claims were submitted for PAS care that purportedly occurred while consumers were hospitalized, incarcerated, or deceased, and in other instances, co-conspirators paid kickbacks to consumers in exchange for the consumers’ agreement to participate in the submission of fraudulent timesheets in support of Medicaid claims.

The defendants also admitted that Arlinda Moriarty directed co-conspirators to bill the maximum allowable PAS and service coordination hours for consumers to maximize profits and to ensure that the state did not require MCI, ADL, and CCI to forfeit underutilized consumer hours. Many consumers had no knowledge that their personally identifiable information was being used to bill Medicaid for benefits that the consumers had not exhausted. Moreover, the Court was further advised during the plea hearings that, as part of the conspiracy, Arlinda Moriarty directed employees to fabricate documentation during the course of state audits.