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Thursday 28 June 2018
York Man Sentenced to One Month for Making False Statements to a Federal AgentRead the Press Release
Bangor, Maine: United States Attorney Halsey B. Frank announced that Mark Elkhorn, 58, of York, Maine was sentenced today in U.S. District Court by Judge Jon D. Levy to one month in prison and three years of supervised release for making false statements to a federal agent. Elkhorn pleaded guilty to the offense on January 18, 2018.
According to court records, in October 2015, a witness provided a tip to law enforcement that Elkhorn was illegally trapping animals in Petit Manan National Wildlife Refuge. An investigation confirmed the tip and uncovered additional wrongdoing. As a result, Elkhorn was convicted of state and federal charges. In December 2016, Elkhorn sent a threatening text message from his cellular telephone to the witness. In January 2017, Elkhorn lied to a federal agent when he denied sending the threatening text message to the witness.
The investigation was conducted by the U.S. Fish and Wildlife Service, the FBI, and the Maine Department of Inland Fisheries & Wildlife.
Wiregrass Farmer Pleads Guilty to Fraudulently Obtaining Federal Crop Insurance FundsRead the Press Release
Montgomery, Alabama – On Wednesday, June 27, 2018, Dexter Day Gilbert, 40, of Campbellton, Florida pleaded guilty to one count of theft of government property, announced United States Attorney Louis Franklin and Special Agent in Charge Karen Citizen-Wilcox, with the U.S. Department of Agriculture, Office of Inspector General. The offense related to the fraudulent acquisition of crop assistance programs funded by the United States Department of Agriculture’s Farm Service Agency.
According to court documents, during 2016 Gilbert leased farmland in Houston County, Alabama. There, Gilbert carried out a scheme through which he fraudulently obtained over $900,000 in crop insurance funds through the Noninsured Crop Disaster Assistance Program (NAP). That program exists to provide farmers of certain crops with financial protection in case of losses due to unforeseen natural disasters. Each farmer can obtain up to approximately $115,000 per year in NAP assistance, regardless of whether a farmer’s actual losses exceed that amount.
In order to bypass the program’s individual payment limit, Gilbert obtained numerous policies in the names of friends and family members. Gilbert falsely reported to the Farm Service Agency that those friends and family members would be farming land, even though Gilbert was the only one actually leasing the land. Gilbert attempted to grow tomatoes and summer squash on the land and, when a drought hit and the crops failed, he filed claims on behalf of the individuals he had obtained insurance policies. As a result, Gilbert was able to receive almost nine times the maximum amount allowed under the NAP program. He used the federal funds to repay a creditor.
“Farming has long been a vital part of life in this district,” stated United States Attorney Franklin. “Farmers across the country depend on federal programs like the one in this case to survive when disaster strikes. I want the entire farming community to know that my office will investigate and prosecute all who seek to cheat the government out of crop insurance money.”
At sentencing, Gilbert will face a maximum sentence of 10 years’ imprisonment, as well as substantial monetary penalties and restitution.
This case was investigated by the United States Department of Agriculture’s Office of Inspector General. Assistant United States Attorney Jonathan S. Ross is prosecuting the case.
Western District of Pennsylvania Participated in Largest Health Care Fraud Enforcement Action in Department of Justice HistoryRead the Press Release
PITTSBURGH – United States Attorney Scott W. Brady today announced, as part of a nationwide health care fraud enforcement action, three Pittsburgh-area doctors were charged and two medical professionals – a doctor and a Suboxone clinic manager – pleaded guilty to unlawfully dispensing and distributing controlled substances and health care fraud. U.S. Attorney Brady’s announcement followed a national announcement by Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, of the largest ever health care fraud takedown by the Medicare Fraud Strike Force which involved 601charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.
"Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer," said Attorney General Sessions. "In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever."
"Every single day, 91 Americans and 13 Pennsylvanians die from an opioid overdose. To attack this scourge, the U.S. Attorney’s Office is aggressively prosecuting corrupt doctors and medical professionals who unlawfully distribute painkillers and other prescription narcotics," stated U.S. Attorney Brady. "If you are a doctor who is exploiting your patients’ addiction to feed your greed, you are hereby on notice: first we will take away your livelihood and then we will take away your liberty."
"These were trusted health care professionals. They had an obligation to prescribe an appropriate amount of opioid medications and only what was necessary," said Acting Special Agent in Charge Chad Yarbrough. "Instead, they betrayed that trust and contributed to the growing opioid epidemic. The FBI wants to make it clear: dishonest medical professionals will be held accountable for their crimes."
According to U.S. Attorney Brady, the following five cases were part of the national health care fraud takedown:
1. United States v. Peter James Ridella: Dr. Peter James Ridella was charged with one count of conspiracy to unlawfully dispense and distribute oxycodone and Percocet and one count of health care fraud. Ridella conspired to create and submit unlawful prescriptions for oxycodone and Percocet, and then unlawfully dispensed over 24,000 mg of controlled substances to other persons. Ridella is also charged with health care fraud for allegedly submitting fraudulent claims to Highmark, for payments to cover the costs of the unlawfully prescribed oxycodone and Percocet.
2. United States v. Michael Cash: Dr. Michael Cash was charged with one count of unlawfully dispensing and distributing a Schedule III controlled substance, one count of conspiracy to unlawfully dispense and distribute Schedule III controlled substances, and one count of health care fraud. Cash conspired to create and submit unlawful prescriptions for buprenorphine, known as Subutex and Suboxone, and then unlawfully dispensed 32,000 doses of buprenorphine to other persons. Cash is also charged with health care fraud for allegedly submitting fraudulent claims to Medicare, for payments to cover the costs of the unlawfully prescribed buprenorphine.
3. United States v. Ruth Jones: Dr, Ruth Jones was charged with one count of unlawfully dispensing and distributing a Schedule III controlled substance, one count of conspiracy to unlawfully dispense and distribute Schedule III controlled substances, and one count of health care fraud. Jones conspired to create and submit unlawful prescriptions for buprenorphine, and then unlawfully dispensed 22,382 doses of buprenorphine to other persons. Jones is also charged with health care fraud for allegedly submitting fraudulent claims to Medicare, for payments to cover the costs of the unlawfully prescribed buprenorphine. Dr. Jones is scheduled to plead guilty on Friday, June 29, 2018, at 10:30 a.m.
4. United States v. Christopher Handa: Suboxone clinic operations manager Christopher Handa pleaded guilty today, June 28, 2018, to two counts of unlawfully dispensing and distributing a Schedule III controlled substance, one count of conspiracy to unlawfully dispense and distribute Schedule III controlled substances, and one count of health care fraud. Handa was employed by Redirections Treatment Advocates, a Suboxone clinic located in Washington, Pennsylvania. Handa and others conspired together to create and submit unlawful prescriptions for buprenorphine, and then unlawfully dispensed 18,146 doses of buprenorphine to other persons. Handa also committed health care fraud by causing fraudulent claims to be submitted to Medicaid for payments to cover the costs of the unlawfully prescribed buprenorphine.
5. United States v. Omar Almusa: Dr. Omar Almusa pleaded guilty yesterday, June 27, 2018, to one count of unlawfully dispensing and distributing Schedule II controlled substances, one count of conspiracy to unlawfully distribute Schedule II controlled substances, and one count of health care fraud. Almusa conspired to create and submit unlawful prescriptions for Vicodin, and then unlawfully dispensed 39,600 mg of Vicodin to other persons. Almusa also committed health care fraud by submitting fraudulent claims to UPMC Health Plan, for payments to cover the costs of the unlawfully prescribed Vicodin.
These cases are being prosecuted by Assistant U.S. Attorney Robert S. Cessar.
Since Attorney General Sessions announced the formation of Opioid Fraud and Abuse Detection Units throughout the country in August 2017, the Western Pennsylvania
OFADU has been one of the national leaders in attacking opioid diversion by medical professionals. Following its formation, the Western Pennsylvania OFADU filed the first indictment against a doctor in the nation, and has filed charges against 15 doctors and medical professionals. Further, a total of ten DEA Registrations, which allow doctors to prescribe controlled substances, and seven doctors’ licenses to prescribe Medication Assisted Treatment have been surrendered; and five medical licenses have been suspended by the Pennsylvania Department of State.
The investigations leading to the filing of charges in these cases were conducted by the Western Pennsylvania Opioid Fraud and Abuse Detection Unit, which combines personnel and resources from the following agencies to combat the growing prescription opioid epidemic: Federal Bureau of Investigation, U.S. Health and Human Services – Office of Inspector General, Drug Enforcement Administration, Internal Revenue Service-Criminal Investigations, Pennsylvania Office of Attorney General - Medicaid Fraud Control Unit, United States Postal Inspection Service, U.S. Attorney’s Office – Criminal Division, Civil Division and Asset Forfeiture Unit, Department of Veterans Affairs-Office of Inspector General, Food and Drug Administration-Office of Criminal Investigations and the Pennsylvania Bureau of Licensing.
Today’s national enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units.
A complaint, Information, or Indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law. The filing of an Information generally indicates that the defendant intends to enter a guilty plea.
Waterloo Man Who Slipped and Fell on the Ice While Running from the Police Convicted of Trafficking Crack CocaineRead the Press Release
A Waterloo man who ran from police while in possession of crack cocaine and who was involved in a large drug trafficking operation in Waterloo was convicted by a jury on June 27, 2018, after a two-day trial in federal court in Cedar Rapids.
Willie Junior Carter, age 45, was convicted of conspiracy to distribute cocaine and crack cocaine and possession of crack cocaine with the intent to distribute it. The verdicts were returned following about six hours of jury deliberations.
The evidence at trial showed that Carter was intercepted on a wiretap investigation of the distribution of cocaine and crack cocaine in Waterloo during late 2016 and early 2017. On January 12, 2017, the police stopped Carter as he was driving and he got out of his car and ran from police. He was apprehended after he slipped and fell on the ice. Officers found over 12 grams of crack cocaine in his pocket. Evidence at trial showed that Carter was delivering large quantities of crack cocaine for other drug dealers. Carter’s criminal history includes four prior convictions for drug trafficking offenses.
Sentencing before United States District Court Judge Linda R. Reade will be set after a presentence report is prepared. Carter will face a mandatory minimum sentence of 20 years’ imprisonment and a possible maximum sentence of life imprisonment, a $20,000,000 fine, and 10 years of supervised release following any imprisonment.
The case is being prosecuted by Assistant United States Attorney Emily K. Nydle and was investigated by the Drug Enforcement Administration, the Federal Bureau of Investigation, the Bureau of Alcohol, Tobacco, Firearms, and Explosives, the Iowa Division of Narcotics Enforcement, the Tri-County Drug Enforcement Task
Force, the Waterloo Police Department, the Black Hawk County Sheriff’s Office, the Cedar Falls Police Department, the Cedar Rapids Police Department, the Iowa City Police Department, the Linn County Sheriff’s Office, and the Iowa State Patrol.
Court file information at https://ecf.iand.uscourts.gov/cgi-bin/login.pl.
The case file number is 17-cr-2045.
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Washington Park Man Sentenced to 12 Years in Prison on Carjacking and Gun ChargesRead the Press Release
St. Louis, MO – Quavo Delmontae Williams was sentenced to 12 years in prison for attempted carjacking and gun charges.
In the early morning hours of July 15, 2016, the owner of a local restaurant in the City of St. Louis was walking to his vehicle after work when Williams approached him and asked for directions. After the Victim gave him directions, Keonta Douglas and Stephen Reed, came from around the corner. All three were armed with firearms. They demanded all that the Victim had including his car keys. The Victim handed them the keys to his car and the three entered his car but could not figure out how to start it and asked for assistance from the victim. The Victim gave them instructions on how to start the car but took that opportunity to run from the scene.
Williams then told Redd to “get him” and Redd exited the car and fired one shot striking the victim in the leg. The Victim was able to get away from the scene.
As the three robbers were unable to start the car, they ran from the attempt carjacking. Douglas accidently left his phone in the Victim’s car. The FBI was able to trace the phone to Douglas. Williams admitted to participation in the attempt carjacking and brandishing his firearm.
Williams, 22, of Washington Park, IL, pleaded guilty on March 28, 2108, to one felony count of attempted carjacking and one felony count of brandishing a firearm in furtherance of a crime of violence. He appeared today for sentencing before United States District Judge Ronnie White.
Co-defendants Keonta Carnell Douglas and Stephen Redd were sentenced in April to 102 and 144 months in prison, respectively.
This case was investigated by the St. Louis Metropolitan Police Department and Federal Bureau of Investigation.
Varicose Vein Treatment Company Agrees to Pay $1,205,000 to Resolve False Claims Act AllegationsRead the Press Release
PITTSBURGH – Circulatory Centers of America, LLC, a Pennsylvania company that provided treatments for varicose veins in several states, together with related subsidiaries, its former owner and chief executive officer Thomas E. Certo, president David Gilpatrick, chief financial officer Everett Burns, and medical director Dr. Louis Certo, M.D., (collectively "Defendants"), agreed to pay the United States $1,205,000.00 to settle False Claims Act allegations, United States Attorney Scott W. Brady announced today.
The settlement resolves allegations in a whistleblower lawsuit filed in federal court in Pittsburgh, Pennsylvania. The United States contended that Defendants submitted claims to the Medicare program to receive reimbursement for services purportedly performed by non-physicians "incident to" the supervision of a physician when, in fact, no physician was present in the office. Billing services as "incident to" a physician’s supervision commands a higher reimbursement rate than billing those same services without physician supervision. The Complaint also alleged that Defendants submitted claims to the federal government for medically unnecessary and unreasonable ultrasound services performed by technicians who did not have the requisite license, certification, and/or training; and ultrasound services that were not actually provided.
"Inflating the cost of healthcare services defrauds taxpayers and depletes the limited funds available to provide medical care to deserving patients," said U.S. Attorney Brady. "Today’s settlement signals our commitment to aggressively pursue entities and individuals who attempt to cheat American taxpayers."
This matter was investigated by the Office of Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigation. Assistant United States Attorneys Colin J. Callahan, Rachael L. Mamula and Jill L. Locnikar handled this matter on behalf of the United States.
This case is captioned United States ex rel. Paul Shields, et al. v. Circulatory Centers of America, LLC, et al., Civil Action No. 15-cv-229 (W.D. Pa.). The claims resolved by the settlement are allegations only, and there has been no determination of liability.
Upstate New York Urgent Care Practice and its Physician Owner to Pay $110,000 for Submitting False Claims to MedicareRead the Press Release
ALBANY, NEW YORK – Mountain Medical Services (Mountain Medical) and its owner, Michael Pond, M.D., have agreed to pay $110,000 under the False Claims Act to resolve allegations that they knowingly billed the federal government for services at a higher rate than appropriate, announced United States Attorney Grant C. Jaquith.
From January 2013 through October 2015, Mountain Medical employed physician assistants and nurse practitioners at its urgent care facilities in Lake Placid, Saranac Lake, Malone, and Massena, New York. Most of these facilities operated seven days a week, for several hours each day, often without a physician present. Nevertheless, during this period, Mountain Medical billed more than 99% of its Medicare services as though the services had been rendered or directly supervised by a physician. Medicare reimbursement rules provide higher levels of reimbursement for services rendered by a physician, and for services rendered by a non-physician practitioner who is directly supervised by a physician who both remains actively involved in the patient’s treatment and is present in the office suite when services are rendered, than for services rendered by a non-physician operating with less physician supervision and involvement.
“The continued vitality of our federal health care system depends on honest billing for services,” said United States Attorney Jaquith. “As this settlement illustrates, we are committed to ensuring that providers who knowingly violate Medicare requirements are held accountable.”
“Mountain Medical Services and Dr. Pond, like all health care providers, must be held to a high standard of ethical behavior,” said Scott J. Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s New York Region (HHS-OIG). “HHS-OIG will continue to ensure that providers who bill federal health care programs do so in an honest manner.”
This settlement was entered in connection with a nationwide law enforcement operation targeting health care fraud, announced today by Attorney General Jeff Sessions and other officials in Washington, D.C.
The investigation and settlement were the result of a coordinated effort among the U.S. Attorney’s Office for the Northern District of New York, HHS-OIG, and the Federal Bureau of Investigation. The United States was represented by Assistant United States Attorney Adam J. Katz.
Union Man Sentenced on Child Pornography ChargesRead the Press Release
St. Louis, MO – Corey Murphy, 26, of Union, Missouri was sentenced to 78 months imprisonment to be followed by lifetime supervision for receiving child pornography in 2016. Murphy pleaded guilty in March and appeared before U.S. District Court Judge Catherine D. Perry for sentencing.
According to his plea agreement, Murphy first came to the attention of law enforcement on suspicion of statutory rape of a 15-year-old in Pacific in 2016. Initial investigation by that victim’s aunt and the Pacific Police Department through social media confirmed the encounter and revealed that Murphy was in contact via social media accounts with numerous 14 and 15-year-old girls. Murphy’s smart phone was seized when Murphy was arrested on unrelated charges and searched pursuant to Murphy’s consent. On Murphy’s smartphone, police found text communications with the victim and a locked app containing images of child pornography which Murphy admitted he had obtained through a communication app on his smartphone. Forensic analysis of Murphy’s smartphone also revealed search histories consistent with a child pornography seeker.
As the investigation continued, Murphy admitted to the FBI he had carried on an inappropriate relationship with another 14-year-old girl during which he provided the second victim with marijuana.
“This case was born out of the vigilance and the bravery of a concerned family member. All parents should be aware of the dangers lurking for children in the world of social media. I applaud the work of the Pacific Police Department, the St. Louis County Internet Crimes Against Children Task Force, the FBI and all partners in the Justice Department’s Project Safe Childhood for their good work in this case,” said U.S. Attorney Jeff Jensen.
U.S. Attorney’s Office Prosecutes Five Individuals Responsible for over $15 Million in Health Care Fraud and Three Members of South Jersey Oxycodone Ring as Part of National TakedownRead the Press Release
Defendants Include a New Jersey Doctor, an Anesthesiology Technologist for a Philadelphia Hospital, and the Owner of a Medical Billing Company
NEWARK, N.J. – The largest health care fraud and opioid enforcement action ever taken by the Justice Department resulted in three guilty pleas and five arrests in New Jersey involving a South Jersey-Philadelphia drug trafficking ring that sold over 1,100 oxycodone pills and multiple individuals who used phony claims to steal millions from state and private insurers, U.S. Attorney Craig Carpenito announced today.
The national takedown targeted over 601 charged defendants across 58 federal districts, including more than 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the Department of Health and Human Services (HHS) announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
As part of the national takedown, the New Jersey U.S. Attorney’s Office filed five separate cases this week charging four defendants with conspiracy to commit health care fraud and three defendants with conspiracy to distribute oxycodone.
Robert Agresti, 61, a doctor from Essex Fells, New Jersey, and Brian Catanzarite, 42, a former gym owner from Cedar Grove, New Jersey, pleaded guilty on June 26, 2018 to their roles in separate conspiracies to attain phony compounded medication prescriptions on behalf of companies that marketed those products. Enver Kalaba, 36, a Metropolitan Transportation Authority (MTA) bus driver from Old Bridge, New Jersey, pleaded guilty June 27, 2018 to a similar scheme targeting his employer.
Tiffany Marsh, 40, a medical billing company owner from West Orange, New Jersey, and Keasam Johnson, 34, a telecommunications company employee from East Orange, New Jersey, were arrested on June 26, 2018 for their alleged roles in a conspiracy to collect insurance reimbursements for chiropractic services that were never rendered.
Anthony Pepe III, 40, of Cherry Hill, New Jersey, an anesthesiology technologist for a Philadelphia hospital, along with Daniel Watson, 39, of Bellmawr, New Jersey, and Prussia Hing, 35, of Philadelphia, were arrested on June 26, 2018 for their alleged roles in an oxycodone distribution ring.
“At a time when many Americans worry about securing health insurance for their families, we’ve seen far too many instances where public and private insurance providers are raided for millions in phony reimbursements for compounded medications or non-existent therapy services,” U.S. Attorney Carpenito said. “On top of that, we are in the midst of an opioid crisis perpetuated by both rogue health care professionals and street-level dealers seeking to profit from the addiction of others. This national takedown seeks to address both fronts, and thanks to the efforts of our federal and local law enforcement partners right here in the New Jersey area, eight individuals will now answer for these crimes in federal court.”
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Jeff Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation – and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money – it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Alex M. Azar III. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
Agresti
Agresti admitted that from November 2014 through September 2017, he participated in a scheme to defraud health insurance plans, including New Jersey state and local employee health benefit programs, by prescribing medically unnecessary compounded prescriptions on behalf of a company that marketed those products.
Agresti was paid $300 in cash for every prescription he authorized for compounded medication, regardless of medical necessity. Agresti signed the prescriptions brought to him by other conspirators without examining or speaking with the patients. Multiple health benefit programs paid more than $8.9 million as a result of Agresti’s phony prescriptions.
“Health care fraud adversely impacts our overburdened health care system, draining valuable funds away from those in need into the greedy coffers of the conspirators,” said Special Agent in Charge Gregory W. Ehrie of the Newark FBI Field Office. “The FBI will continue to vigorously investigate these so called 'victimless crimes,' which deplete our nation's resources."
Catanzarite
Catanzarite admitted that from March 2015 through January 2017, he conspired to defraud New Jersey state benefit programs. Catanzarite was recruited by one of his former gym members to become a sales representative of a company that marketed compounded medications. The marketing company received a percentage of every prescription that its sales representatives steered toward a particular compounding pharmacy.
To maximize his profit, Catanzarite convinced state beneficiaries to obtain compounded medications regardless of their medical necessity. On several occasions, Catanzarite even paid an advanced nurse practitioner, introduced to him by the marketing company, or used a telemedicine service that was paid for by the marketing company, to fraudulently obtain compounded medication prescriptions. Altogether, Catanzarite caused losses of at least $3.5 million and personally made over $1.1 million from the scheme.
“One of the Defense Criminal Investigative Service’s (DCIS) top priorities is to protect the integrity of TRICARE, the DOD’s healthcare system for military members, retirees and their dependents,” stated Special Agent in Charge Leigh-Alistair Barzey of the DCIS Northeast Field Office. “This plea is the result of a joint effort and DCIS will continue to coordinate with the DOJ, FBI, HHS-OIG, MTA-OIG and other law enforcement partners to combat health care fraud.”
Kalaba
Kalaba admitted that from April 2016 through August 2017, he conspired to defraud the MTA’s health benefits plan using fraudulent claims for medically unnecessary compounded medications. Kalaba was recruited into the scheme by another former MTA bus driver, Christopher Frusci. Both Frusci and Kalaba acted as sales representatives of a company that marketed compounded medications.
Kalaba paid MTA beneficiaries monthly cash bribes, including $100 per phony prescription. To ensure physicians prescribed compounded medications regardless of medical necessity, Kalaba referred MTA beneficiaries to telemedicine physicians who were paid by the marketing company or its affiliates. Altogether, Kalaba caused losses of $2.9 million and made $138,629 from the scheme.
“Our investigation is ongoing to determine the extent to which additional MTA employees may have participated in this fraudulent scheme,” said Inspector General Barry Kluger of the MTA Office of the Inspector General. “I applaud and am pleased to support the efforts of the U.S. Attorney, along with the FBI and the Department of Defense Office of Inspector General, to combat this nationwide epidemic of health care fraud that unfortunately, and at great cost, has infected the MTA as well.”
Marsh and JohnsonMarsh, the owner and operator of TJB Medical Billing Consultants LLC, provided medical billing to two New Jersey chiropractors. Johnson worked as a supervisor in the New Jersey office of a large telecommunications company.
Marsh used her access to the billing software at the chiropractor offices to generate false claims for out-of-network chiropractic services that were never performed. The claims were made pursuant to an agreement between Marsh and Johnson, who recruited other employees to allow false claims to be made in their names in exchange for a portion of the proceeds. From June 2016 through November 2017, Marsh submitted approximately 800 fraudulent claims seeking approximately $850,000 in reimbursements, which resulted in the payment of approximately $333,000 for chiropractic services that were never rendered.
Pepe, Watson, and Hing
Between January 2018 and May 2018, Pepe, Watson, and Hing engaged in a conspiracy which resulted in the trafficking of 1,180 oxycodone pills – 680 of which were unadulterated oxycodone and 500 of which were pressed pills mixed with hydrocodone, codeine, and methylphenidate. As part of the investigation, law enforcement observed eight controlled purchases, three of which were carried out by the defendants – including Pepe dressed in his work scrubs – in front of the Philadelphia hospital where Pepe was employed.
“Philadelphia and Camden are awash in opioids, with the human toll mounting steadily, day by day,” said Michael T. Harpster, Special Agent in Charge of the FBI’s Philadelphia Division. “The idea of a medical professional taking a work break to push pills on the street, as alleged in the complaint, is at once disheartening and infuriating. The FBI will continue to doggedly investigate and bring to justice traffickers contributing to our area’s opioid crisis.”
“The individuals involved in these schemes are feeding this country’s opioid crisis,” said Scott J. Lampert, Special Agent in Charge for the Department of Health & Human Services Office of Inspector General. “This takedown sends a clear message that those suspected of engaging in health care fraud will be caught and face consequences for their actions.”
Agresti, Kalaba, Catanzarite, Marsh and Johnson each face a potential 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing for Agresti, Catanzarite, and Kalaba is scheduled for Oct. 30, 2018. Pepe, Watson, and Hing each face a potential 20 years in prison and a $1 million fine. The charges and allegations against Marsh, Johnson, Pepe, Watson, and Hing are merely accusations, and they are considered innocent unless and until proven guilty.
U.S. Attorney Carpenito credited special agents of the FBI Newark Field Office, under the direction of Special Agent in Charge Ehrie; the FBI’s South Jersey Resident Agency, under the direction of Special Agent in Charge Harpster in Philadelphia; the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Lampert; the U.S. Department of Defense, Defense Criminal Investigative Service, under the direction of Special Agent in Charge Barzey; the MTA Office of the Inspector General, under the direction of Inspector General Kluger, and special agents of the U.S. Attorney’s Office with the investigations that yielded this week’s guilty pleas and arrests. He also thanked the Camden County Police Department, under the direction of Chief J. Scott Thomson, and the Cherry Hill Police Department, under the direction of William Monaghan, for their assistance.
The government is represented in these cases by Assistant U.S. Attorney Erica Liu, Chief of the U.S. Attorney's Office Opioid Abuse Prevention and Enforcement Unit in Newark, and Assistant U.S. Attorneys Lauren E. Repole, Christina O. Hud and Diana Carrig of the U.S. Attorney’s Office Criminal Division.
U.S. Attorney Bart M. Davis Urges Public to Report Jury Duty Phone ScamsRead the Press Release
BOISE – U.S. Attorney for the District of Idaho Bart M. Davis is alerting the public of several nationwide imposter scams involving individuals claiming to be U.S. Marshals, court officers, or other law enforcement officials. U.S. Attorney Davis is urging people to report the calls their local FBI office (https://www.fbi.gov/contact-us), and file a consumer complaint with the Federal Trade Commission, which has the ability to detect patterns of fraud from the information collected and share that data with law enforcement.
During these calls, scammers attempt to collect a fine in lieu of arrest for failing to report for jury duty or other offenses. They then tell victims they can avoid arrest by purchasing a prepaid debit card such as a Green Dot card or gift card and read the card number over the phone to satisfy the fine.
Scammers use many tactics to sound credible. They sometimes provide information like badge numbers, names of actual law enforcement officials and federal judges, and courthouse addresses. They may also spoof their phone numbers to appear on caller ID as if they are calling from the court or a government agency.
If you believe you were a victim of such a scam, you are encouraged to report the incident to your local FBI office and to the FTC.
Things to remember:
- U.S. Marshals will never ask for credit/debit card/gift card numbers, wire transfers, or bank routing numbers for any purpose.
- Don’t divulge personal or financial information to unknown callers.
- Report scam phone calls to your local FBI office and to the FTC.
- You can remain anonymous when you report.
- Authenticate the call by calling the clerk of the court’s office of the U.S. District Court in your area and verify the court order given by the caller.
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U.S. Attorney Announces Lawsuit Against the City of Mount Vernon for Clean Water Act ViolationsRead the Press Release
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, and Peter D. Lopez, Regional Administrator of the U.S. Environmental Protection Agency (“EPA”), announced today that the United States has filed a civil lawsuit against the City of Mount Vernon, New York (“Mount Vernon”) for violating the Clean Water Act. The lawsuit alleges that Mount Vernon has long failed to comply with Clean Water Act storm sewer permit requirements designed to prevent raw sewage and other illicit pollutants from flowing from the City’s storm sewer system to the Hutchinson and Bronx Rivers.
U.S. Attorney Geoffrey S. Berman stated: “For years, Mount Vernon has discharged raw sewage and other illicit pollutants from its storm sewer system into the Hutchinson and Bronx Rivers. Mount Vernon has consistently failed to comply with permit requirements intended to prevent these discharges, and has flouted EPA administrative orders intended to address the problem. Today’s lawsuit will protect the waters of this district by obtaining a judicial order compelling Mount Vernon to bring its sewers into compliance with the Clean Water Act.”
EPA Regional Administrator Peter D. Lopez said: “The City of Mount Vernon must take the appropriate actions to protect its residents and downstream communities from threats posed by raw sewage and other pollutants. EPA and New York State will continue to work together with the city to ensure that Mount Vernon understands how to fix the problems with its storm sewer system. In addition, we support efforts by the city to seek funding to assist Mount Vernon in getting the necessary work completed. This complaint gets to the core of EPA’s mission of protecting people’s health, and we will continue to work with the state and city to carry out that mission.”
As alleged in the complaint filed today in White Plains federal court, the Clean Water Act generally prohibits discharges of pollutants into navigable waters, absent a permit. Many municipalities, like Mount Vernon, operate “municipal separate storm sewer systems” that carry storm water and discharge it without treatment into nearby waters. Because separate storm sewer systems do not treat the water they discharge, a municipality is required by its Clean Water Act permit to maintain a program for identifying and eliminating any sewage or other illicit pollutants that are flowing into the storm sewers.
The lawsuit filed today alleges that since at least January 2012, Mount Vernon has failed to comply with these permit obligations and, as a result, has allowed raw sewage to flow into its storm sewer system, and then to be discharged into the Hutchinson and Bronx Rivers. Mount Vernon has also failed to comply with two EPA Administrative Orders issued to compel the City’s compliance with these requirements.
The lawsuit seeks an injunction compelling Mount Vernon to comply with applicable Clean Water Act requirements and an order imposing civil penalties for Mount Vernon’s violations to date.
The State of New York and the Commissioner of the New York State Department of Environmental Conservation are co-plaintiffs in this lawsuit, asserting parallel claims under state law.
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Mr. Berman thanked EPA for its invaluable efforts in this matter.
This case is being handled by the Office’s Environmental Protection Unit. Assistant United States Attorney Natasha W. Teleanu is in charge of the case.
Two Utah Cases Included in Significant National Health Care Fraud Enforcement ActionRead the Press Release
SALT LAKE CITY – Two Utah cases are included in a national health care fraud enforcement action announced Thursday morning by the U.S. Department of Justice.
“We take these health care cases very seriously in Utah. Patients must be able to rely on their doctors to provide them with proper care and legitimate, FDA-approved drugs,” U.S. Attorney John W. Huber said today. “Additionally, health care providers who submits claims to government programs like Medicare and Medicaid must abide by the rules and regulations those programs have in place, including maintaining treatment records and conducting accurate billing. These crimes exploit patients and fleece American taxpayers,” Huber said.
Federal prosecutors in Salt Lake City filed a one-count misdemeanor information Tuesday charging Living for Life MD, LLC, doing business as SLC Med Spa, with receipt and delivery of adulterated devices. The Information alleges the Salt Lake City business imported non-FDA approved drugs manufactured overseas from an unauthorized distributor and administered them to patients. The foreign-sourced devices, specifically products labeled as Juvederm Ultra 2 were adulterated and lacked pre-market approval required under federal law.
The Information includes a notice of intent to seek a forfeiture money judgment of $250,000 representing the value of the misbranded devices. A summons will be issued to the company to appear in federal court on the charges. Special agents with the FDA Office of Criminal Investigations are investigating the case.
In the second case, a grand jury returned an indictment Wednesday charging Colette Krum Kolesar, age 48, of Spanish Fork, Utah, with one count of destruction, alteration, or falsification of records in a federal investigation. Kolesar worked for a home health and hospice center with an office in Provo.
The indictment alleges the defendant altered medical records, including therapy notices from nursing visits, with the intent to impede, obstruct, or influence an investigation being conducted by the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services.
The potential maximum penalty for the charge in the indictment is 20 years in prison and a fine of $250,000. A summon will be issued to Kolesar to appear on the charges in the indictment. The Utah Attorney General’s Medicaid Fraud Control Unit and special agents with the FBI and U.S. Department of Health and Human Services are investigating the case.
Informations and indictments are not findings of guilt. Individuals charged in these documents are presumed innocent unless or until proven guilty in court.
NATIONAL HEALTH CARE FRAUD TAKEDOWN RESULTS IN CHARGES AGAINST 601 INDIVIDUALS RESPONSIBLE FOR OVER $2 BILLION IN FRAUD LOSSES
Largest Health Care Fraud Enforcement Action in Department of Justice History Resulted in 76 Doctors Charged and 84 Opioid Cases Involving More Than 13 Million Illegal Dosages of Opioids
WASHINGTON - Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.
Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director of the Center for Program Integrity Alec Alexander and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
“Healthcare fraud touches every corner of the United States and not only costs taxpayers money, but also can have deadly consequences,” said FBI Deputy Director Bowdich. “Through investigations across the country, we have seen medical professionals putting greed above their patients’ well-being and trusted doctors fanning the flames of the opioid crisis. I want to thank the agents, analysts and our law enforcement partners in every field office who work each and every day to stop these criminals and hold them accountable for their actions.”
“DEA is committed to ending the opioid crisis occurring in our communities and preventing prescription drug misuse,” said DEA Assistant Administrator Martin. “DEA will continue to work with our partners every day to protect our citizens while ensuring that patients have adequate access to these critical medications.”
“This year’s operations, focusing on opioid-related schemes, spotlight the far-reaching impact of health care fraud,” said HHS Deputy Inspector General Cantrell. “Such crimes threaten the vitally important Medicare and Medicaid programs and the beneficiaries they serve. Though we have made significant progress in our fight against health care fraud; our efforts are not complete. We will continue to work with our partners to protect the health and safety of millions of Americans.”
“It takes a special kind of person to prey on the sick and vulnerable as happened in many of these health care fraud schemes,” said Deputy Chief Hylton. “Medical professionals and others callously placed individuals and vital healthcare services in harm’s way simply because of greed. IRS-CI special agents continue to work side-by-side with other federal, state and local law enforcement officers to uncover these schemes and hold these criminals accountable for their actions.”
“CMS makes it a top priority to protect the health and safety of millions of beneficiaries who depend on vital federal healthcare programs,” said Alec Alexander, deputy administrator and director of the Center for Program Integrity. “CMS’ Center for Program Integrity collaborates closely with our law enforcement partners to safeguard precious taxpayer dollars. Under Administrator Seema Verma, we will continue to strengthen this partnership with law enforcement in order to ensure the integrity and sustainability of these essential programs that serve millions of Americans.”
“Heath care fraud wounds our service members and veterans alike, as they rely upon and rightfully expect uncompromised care through the Department of Defense’s TRICARE Program,” said DCIS Director O’Reilly. “Investigations that culminated in enforcement actions over the past several days underscore the steadfast commitment of the Defense Criminal Investigative Service and our investigative partners to vigorously investigate fraud impacting TRICARE. We remain vigilant in our efforts to ensure the high standards of care our service members, military retirees, and their dependents deserve while safeguarding American taxpayer dollars.”
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in 10 locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
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For the Strike Force locations, in the Southern District of Florida, 124 defendants were charged with offenses relating to their participation in various fraud schemes involving over $337 million in false billings for services including home health care and pharmacy fraud. In one case, an owner, medical director, and two employees of a sober living facility were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, and substantive counts of money laundering. The indictment alleges a scheme that illegally recruited patients, paid kickbacks, and defrauded health care benefit programs for widespread fraudulent urine testing. During the course of the fraudulent scheme, the facility submitted more than $106 million in claims for substance abuse treatment services.
In the Central District of California, 33 defendants were charged for their roles in schemes to defraud insurance programs out of more than $660 million. For example, one indictment in a compounding pharmacy fraud case alleges an attorney/marketer paid kickbacks and offered incentives such as prostitutes and expensive meals to two podiatrists in exchange for prescriptions written on pre-printed prescription pads, regardless of the medical need for the prescriptions. Once the prescriptions were filled, members of the conspiracy submitted approximately $250 million in fraudulent claims to federal, state, and private insurers for the compounded drugs.
In the Southern District of Texas, 48 individuals were charged in cases involving more than $291 million in alleged fraud. Among these defendants are a pharmacy chain owner, managing partner, and lead pharmacist charged with a drug and money laundering conspiracy. According to the indictment, the coconspirators used fraudulent prescriptions to fill bulk orders for over one million pills of hydrocodone and oxycodone, which the pharmacy, in turn, sold to drug couriers for millions of dollars. In the Northern District of Texas, a home health agency owner was arrested on a criminal complaint for a $2.6 million health care fraud scheme.
In the Eastern District of Michigan, 35 defendants face charges for their alleged roles in fraud, kickback, money laundering and drug diversion schemes involving approximately $197 million in false claims for services that were medically unnecessary or never rendered. In one case, a physician was charged in separate kickback conspiracies with two home health agency owners, which resulted in more than $12 million in fraudulent insurance billings.
In the Northern District of Illinois, 21 individuals were charged for various fraud schemes involving home health and dental services. These schemes involved allegedly over $54 million in fraudulent billing. One case alleges a home health fraud and kickback conspiracy, which resulted in more than $32 million paid by Medicare based on the fraudulent billings.
In the Eastern District of New York, 13 individuals were charged with participating in a variety of schemes including kickbacks, services not rendered, identity theft and money laundering involving over $38 million in fraudulent billings. For example, the owner of a Brooklyn ambulette company was charged in a $7 million conspiracy stemming from the alleged payment of kickbacks for the referral of patients, who subjected themselves to purported physical and occupational therapy and other services, and were transported by the ambulette company.
In the Middle District of Florida, 13 individuals were charged with participating in a variety of schemes involving more than $21 million in fraudulent billings. In one case, a physician and clinic owner were charged with a conspiracy to defraud Medicare of more than $2.8 million for fraudulent home health billings.
In the Southern Louisiana Strike Force, operating in the Middle and Eastern Districts of Louisiana as well as the Southern District of Mississippi, 42 defendants were charged in connection with health care fraud, drug diversion, and money laundering schemes involving more than $16 million in fraudulent billings. One case alleges that three pharmacy owners and a nurse practitioner conspired to unlawfully dispense controlled substances and defraud TRICARE and private insurance companies out of $12 million.
In the Corporate Strike Force, five defendants were charged in the Middle District of Tennessee with a kickback conspiracy at a durable medical equipment company, which allegedly resulted in more than $1 million in kickbacks and over $2.5 million in fraudulent billings to Medicare.
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In addition to the Strike Force locations, today’s enforcement actions include cases and investigations brought by an additional 46 U.S. Attorney’s Offices, including the execution of search warrants in various investigations conducted by the Central and Northern Districts of California, Middle District of Florida, Southern District of Georgia, Western District of Kentucky, Eastern District of Michigan, Western District of North Carolina, Eastern and Western Districts of Texas, Eastern and Western Districts of Virginia, and Western District of Washington.
In the Northern and Southern Districts of Alabama, 15 defendants were charged for their roles in eight health care fraud schemes involving compounding pharmacy fraud and unlawful distribution of controlled substances.
In the Eastern District of California, four defendants were charged for their roles in two health care fraud schemes, one of which included forged prescriptions.
In the Southern District of California, seven defendants, including a physician, were charged for their roles in three health care fraud schemes and one scheme involving identity theft and services that were not rendered.
In the District of Colorado, a defendant was charged with health care fraud related to billings to Medicaid and Medicare.
In the District of Connecticut, three defendants, including two medical professionals, were charged for their roles in two schemes involving compounding drugs and unlawful distribution of Schedule II and IV controlled substances.
In the District of Delaware, a physician/owner of a pain management clinic was charged with unlawfully prescribing more than two million dosage units of Oxycodone products.
In the District of Columbia, a durable medical equipment company owner was charged with defrauding Medicaid of $9.8 million.
In the Northern District of Florida, four defendants were charged in a scheme to defraud TRICARE and other private insurance companies out of over $8 million for medically unnecessary compounded creams and pills.
In the Northern, Middle, and Southern Districts of Georgia, 12 defendants, including two physicians, were charged in nine health care fraud, drug diversion, or compounding pharmacy schemes involving over $13.5 million in fraudulent billings.
In the District of Idaho, three defendants, all of who are medical professionals, were charged for their roles in three separate fraud schemes involving controlled substances.
In the Central and Southern Districts of Illinois, seven defendants were charged in six separate schemes to defraud the Medicaid program.
In the Northern District of Indiana, eight defendants were charged in various health care fraud schemes to defraud both the Medicare and Medicaid programs.
In the Northern District of Iowa, two defendants – both medical professionals – were charged for their roles in two opioid-related schemes.
In the Districts of Kansas and the Northern and Western Districts of Oklahoma, 12 defendants, including four physicians, were charged in various unlawful distribution of controlled substances schemes. In the Western District of Oklahoma, one case marks the district’s first time charging unlawful distribution of controlled substances resulting in a death.
In the Eastern and Western Districts of Kentucky, 12 defendants, including five medical professionals, were charged in various schemes involving health care fraud, unlawful distribution of controlled substances, aggravated identity theft, and money laundering. One case involved the operation of two false-front medical clinics.
In the Districts of Maine and Vermont, two defendants were charged for their roles in two schemes to defraud various government programs including Medicare, Medicaid, and ones run by the HHS’ Administration for Children and Families.
In the District of Nebraska, seven defendants, including one physician, were charged in five separate schemes to defraud Medicare, Medicaid, and various HHS programs.
In the District of Nevada, four defendants, including three medical professionals were charged with conspiracies to commit health care fraud and distribute controlled substances.
In the District of New Jersey, eight defendants, including a New York doctor, an anesthesiology technologist for a Philadelphia hospital, and the owner of a medical billing company, were charged for their roles in five schemes to defraud private insurance companies of over $16 million.
In the Southern District of New York, two defendants were charged in schemes involving health care fraud or drug diversion.
In the Middle District of North Carolina, two defendants were charged with a conspiracy to defraud Medicare out of over $4 million.
In the Southern District of Ohio, three defendants – all medical professionals – were charged for their roles in two health care fraud schemes, one of which involved illegal drug distribution and kickbacks.
In the Eastern and Middle Districts of Pennsylvania, 12 defendants were charged for their roles in three drug diversion schemes.
In the Western District of Pennsylvania, four defendants – all physicians – were charged in various health care fraud and drug diversion schemes. One scheme involved 32,000 dosage units of buprenorphine.
In the District of Rhode Island, one defendant was charged for participating in a theft and aggravated identity theft scheme.
In the District of South Carolina, three defendants were charged for their separate roles in a conspiracy to possess with the intent to distribute fentanyl.
In the District of South Dakota, two defendants were charged in separate cases, one of which involved a scheme to defraud the Indian Health Service.
In the Middle District of Tennessee, 10 defendants were charged in two separate schemes, including a conspiracy to fraudulently obtain oxycodone.
In the Eastern District of Texas, two defendants were charged for their role in health care fraud schemes to defraud the Medicare and Medicaid programs.
In the Western District of Virginia, eight defendants were charged for their alleged roles in health care fraud schemes. One $45 million scheme to defraud Medicaid involved falsification of documents in patient files.
In the Eastern District of Washington, a dentist and another individual were indicted for distributing and conspiring to distribute hydrocodone and tramadol without a legitimate medical purpose.
In the Eastern District of Wisconsin, three defendants were charged in a scheme involving the unlawful distribution of controlled substances and aggravated identity theft.
In addition, in the states of Arizona, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maine, Michigan, Missouri, Mississippi, Nevada, New York, Oklahoma, Pennsylvania, Texas, Vermont, and Washington, 97 defendants have been charged with defrauding the Medicaid program out of over $27 million. These cases were investigated by each state’s respective Medicaid Fraud Control Units. In addition, the Medicaid Fraud Control Units of the states of California, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Nevada, North Carolina, Ohio, Texas, Tennessee, and Virginia participated in the investigation of many of the federal cases discussed above.
The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section and from the U.S. Attorney’s Offices in the District of Utah, Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois, Middle District of Louisiana, and the Middle District of Florida; and agents from the FBI, HHS-OIG, DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and state Medicaid Fraud Control Units.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Additional documents related to this announcement will shortly be available here:
https://www.justice.gov/opa/documents-and-resources-june-28-2018.
This operation also highlights the great work being done by the Department of Justice’s Civil Division. In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2 billion in judgments and settlements related to matters alleging health care fraud.
Two Men Charged in White Plains Federal Court with Mail Theft SpreeRead the Press Release
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, and Peter Rendina, Inspector-in-Charge of the New York Office of the U.S. Postal Inspection Service (“USPIS”), announced today the arrest of STEVEN CARSON and DEREK BROWN, both of whom were charged in a complaint with stealing mail from Postal Service mailboxes. In addition, CARSON was charged with using a stolen mail box key to steal mail. Both CARSON and BROWN will be presented today in White Plains federal court before the Honorable Judith C. McCarthy.
U.S. Attorney Geoffrey S. Berman stated: “Thanks to the work of the United States Postal Inspection Service and U.S. Postal Service Office of Inspector General, Brown and Carson’s alleged mail theft spree has come to an end.”
USPIS Inspector-in-Charge Peter Rendina stated: “The crime of mail theft is a violation of the trusted tradition our customers place in the delivery and receipt of the U.S. Mail. No matter how long it takes or the rhetoric spoken, Postal Inspectors are watching and always on the investigative forefront in keeping the U.S. Mail safe from theft.”
According to the allegations in the Complaint unsealed in White Plains federal court:[1]
On April 2, 2018, BROWN redeemed a stolen gift card at a Gap store the same day that a Bronxville victim mailed the card. Two days later, on April 4, 2018, CARSON deposited two money orders stolen from the mail into an account in BROWN’s name. Then, on April 20, 2018, CARSON and BROWN fled from police officers during a traffic stop in Eastchester, New York, after the officers recovered a bag full of mail in their car. In total, the bag contained more than $66,000 in stolen checks and money orders taken from the mail. CARSON was also captured on video surveillance on four separate occasions – April 18, 19, 20 and May 4, 2018 – opening locked Postal Service boxes and stealing mail in Bronxville. The investigation is continuing.
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CARSON, 27, and BROWN, 28, of Yonkers, New York, are each charged with one count of mail theft, which carries a maximum sentence of five years in prison. CARSON is also charged with one count of stealing a Postal Service key, which carries a maximum sentence of 10 years in prison. The maximum potential sentences in this case are prescribed by Congress and are provided here for informational purposes only, as any sentencing of the defendants will be determined by the judge.
Mr. Berman praised the outstanding work of the U.S. Postal Inspection Service, U.S. Postal Service Office of Inspector General, the U.S. Secret Service, the Yonkers Police Department, the Bronxville Police Department, the Eastchester Police Department, and the Westchester County District Attorney’s Office.
This case is being handled by the Office’s White Plains Division. Assistant United States Attorney Sam Adelsberg is in charge of the prosecution.
The charges contained in the Complaint are merely accusations, and the defendants are presumed innocent unless and until proven guilty.
[1] As the introductory phrase signifies, the entirety of the text of the Complaint and the description of the Complaint set forth herein constitute only allegations, and every fact described should be treated as an allegation.
Two Men Arrested for Business Loan SchemeRead the Press Release
BOSTON – Two men were arrested today and charged in federal court in Boston in connection with illegally using the identity of another individual to apply for two business loans.
Igor Mosieev, 59, of Newton, was indicted on two counts of bank fraud and one count of aggravated identity theft. Alexander Grinis, 47, of Jamaica Plain, was charged in the same indictment with one count of false statements on loan applications. Mosieev and Grinis were arrested this morning and will appear this afternoon in federal court in Boston.
According to the indictment, Grinis was the manager of Eastern Bank in Auburndale. Among his responsibilities were assisting customers with opening and closing accounts and applying for loans and lines of credit. In approximately February 2015, Grinis assisted Mosieev in opening a checking and savings account at Eastern Bank with the license and Social Security card of another individual, without the knowledge or consent of that person. Later that year, Grinis assisted Mosieev in adding the individual to a business account in the name of TFC Enterprises, LLC. Thereafter, Moiseev forged the individual’s name on applications for two purported business loans. On each loan application, Grinis falsely certified that he had complied with all bank procedures and, as a result, the loans were approved. The proceeds of the two loans were subsequently distributed to the business checking account and Moiseev forged the individual’s name on checks and withdrew money from the account to pay for his own personal expenses. In addition, Moiseev, with Grinis’ assistance, caused proceeds from the business checking account to be wire transferred to Russia, Canada, and elsewhere overseas using the individual’s name. Both loans defaulted and were never paid back to Eastern Bank, resulting in a loss of over $90,000.
The charges of bank fraud and false statements provide for a sentence of no greater than 30 years in prison, five years of supervised release, and up to a $1 million fine. The aggravated identity theft charge provides for a mandatory sentence of two years in prison, to be served consecutive to any other sentence imposed, up to three years of supervised release, and a fine of $250,000. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors.
United States Attorney Andrew E. Lelling and Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division, made the announcement today. Assistant U.S. Attorney Laura J. Kaplan of Lelling’s Organized Crime and Gang Unit is prosecuting the case.
The details contained in the indictment are allegations. The defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
Two Healthcare Providers Agree to Pay over $100,000 to Settle Civil Claims of Improper Opioid PrescribingRead the Press Release
PHILADELPHIA – United States Attorney William M. McSwain announced today that Stephen Humbert, D.O. and Raymond Ferraro, P.A., who both work in Havertown, Pennsylvania, have agreed to pay the United States a total of $112,500 to resolve allegations that they improperly prescribed opioids to one of their former patients.
The Drug Enforcement Administration (DEA) conducted an investigation regarding oxycodone and fentanyl that were prescribed to a deceased patient. The investigation revealed that Humbert and Ferraro collectively prescribed approximately 4,000 pills of oxycodone and over 200 patches of fentanyl to the deceased patient for over a year.
After the DEA launched the investigation, Humbert and Ferraro cooperated with federal investigators. In addition to the monetary settlement, Humbert and Ferraro have agreed to an administrative agreement with the DEA that requires regular reporting of their prescriptions for controlled substances and new policies for their opioid patients.
“Given the opioid epidemic that our society is facing, it is critical for practitioners to prescribe opioids with caution and discretion,” said U.S. Attorney McSwain. “While our Office appreciates the cooperation that these two healthcare providers gave in the midst of the investigation, this resolution serves as an important reminder to all healthcare providers that they must exercise caution and judgment in prescribing these dangerous substances.”
“The DEA will continue to investigate any report of a doctor or other registrant misusing or abusing their privilege to prescribe controlled substances,” said Jon Wilson, Special Agent in Charge of the Drug Enforcement Administration’s (DEA) Philadelphia Field Division. “In addition to criminal sanctions, the DEA can impose administrative restrictions and pursue civil fines against registrants that are involved in the improper prescription of controlled substances as was done in this investigation.”
The case was investigated by the Drug Enforcement Administration. Assistant United States Attorney Anthony D. Scicchitano handled the matter.
Two Defendants Sentenced for Fatal 2012 Home Invasion RobberyRead the Press Release
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, announced that JUDIE OLIVERA was sentenced today to a term of 40 years in prison for her role in the May 2012 home-invasion robbery of victim Miles Klein, which resulted in Klein’s death. On June 26, 2018, GIBRON LOPEZ was sentenced to a term of 40 years in prison, which must run consecutively to a prior prison sentence of five years, for his role in the home-invasion robbery. Both sentences were imposed by United States District Judge Katherine Polk Failla. LOPEZ and OLIVERA were convicted of Hobbs Act robbery and Hobbs Act robbery conspiracy following a jury trial in October 2017 before Judge Failla.
U.S. Attorney Geoffrey S. Berman said: “The defendants committed a violent home-invasion robbery, resulting in the brutal death of Miles Klein. Having been convicted at trial, the defendants will now spend decades in prison for this horrific crime. We thank our remarkable partners at the ATF and NYPD for their tireless efforts to bring these defendants to justice.”
According to the Indictment, other filings in Manhattan federal court, and the evidence admitted at trial:
In May 2012, OLIVERA, who had a preexisting relationship with Klein, set up a home invasion robbery, which targeted Klein’s drugs and drug proceeds. OLIVERA recruited LOPEZ and another man to commit the robbery. On May 15, 2012, OLIVERA gained access to Klein’s apartment in the Bronx, and LOPEZ and the other man, armed with a wrench and a rubber mallet, respectively, followed her there. LOPEZ and the other man struggled with Klein at the door, striking him in the head repeatedly with the wrench and the mallet, binding his eyes and mouth with duct tape, and gagging him. During the assault, OLIVERA stole a safe containing cash, among other items, from Klein’s apartment. LOPEZ and the other man then dragged Klein’s body to the bathroom, where they left him. They discarded the murder weapons and their bloody clothes in a sewer, and later split the proceeds of the robbery. Police responded to the scene on May 16, 2012, after receiving a 911 call from concerned family members. Klein was ultimately pronounced dead as a result of the blunt force trauma to the head and obstruction of his airway.
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In addition to prison terms, LOPEZ, 37, and OLIVERA, 40, both of the Bronx, New York, were each sentenced to three years of supervised release.
Mr. Berman praised the outstanding investigative work of the Bureau of Alcohol, Tobacco, Firearms, and Explosives, the Strategic Pattern Armed Robbery Task Force, and the New York City Police Department.
This case is being prosecuted by the Office’s Violent and Organized Crime Unit. Assistant United States Attorneys Gina M. Castellano, Christopher J. DiMase, and Justina L. Geraci are in charge of the prosecution.
Three from Northeast Ohio indicted for firearms crimesRead the Press Release
Three people from Northeast Ohio were indicted in federal court on firearms charges.
Charged with being felons in possession of firearms and ammunition are: Jared M. Sebaugh, 30, of Olmsted Falls; Jose Colon, 34, of Cleveland; Calvin C. Cody, 36, of Cleveland;
Sebaugh on May 15 possessed a Smith and Wesson, Model M&P-15, 5.56 mm caliber rifle, two 40-round capacity rifle magazines, a 30-round capacity rifle magazine, a Ruger, Model SR40, .40 caliber pistol, and 11 rounds of .40 caliber ammunition, after having been previously convicted of aggravated robbery with a firearm specification, according to the indictment.
Colon possessed a Bryco Arms 9 mm pistol and six rounds of ammunition on May 29, despite a prior conviction for aggravated robbery with a firearms specification, according to the indictment.
Cody possessed a Taurus 9mm handgun on May 30 after having been convicted of prior felonies in Cuyahoga County, including attempted robbery, drug trafficking and drug possession, according to the indictment.
If convicted, the defendant’s sentence will be determined by the Court after review of factors unique to his case, including the defendant’s prior criminal record, if any, the defendant’s role in the offense, and the characteristics of the violation. In all cases, the sentence will not exceed the statutory maximum and in most cases it will be less than the maximum.
These cases were investigated by the Bureau of Alcohol, Tobacco, Firearms and Explosives, the Cleveland Division of Police, and the Ohio Adult Parole Authority. They are being prosecuted by Assistant U.S. Attorney Ranya Elzein, Kathryn Andrachik and Brad Beeson.
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
Three Men Arrested, Charged with CSX Railcar TheftsRead the Press Release
CONTACT: Barbara Burns
PHONE: (716) 843-5817
FAX: (716) 551-3051BUFFALO, N.Y.—U.S. Attorney James P. Kennedy, Jr. announced today that Paul Krieger, Ray Chrostowski, and Nicholas Birdwell, all of Buffalo, NY, were arrested and charged by criminal complaint with breaking into a railcar to commit larceny, and conspiracy to break into a railcar to commit larceny. The charges carry a maximum penalty of 10 years in prison and a $250,000 fine.
Assistant U.S. Attorney Laura A. Higgins, who is handling the case, stated that according to the complaint, in April 2018, the FBI was alerted to thefts being committed on CSX rail line property from multiple sources. According to CSX officials, the thefts had been taking place in Buffalo, on CSX property, since approximately 2000.
The defendants were believed to be surveying the CSX rail lines from a high ground position in the vicinity of Broadway Street and Bailey Avenue. When a train stopped in the Buffalo railyard to re-crew, the defendants headed to the area, mounted the train, opened a railcar, and removed packages for resale or personal use. On at least 15 separate occasions since May 2018, 2-4 individuals have been observed on video surveillance stealing items from CSX trains in a similar manner.
On June 26, 2018, at approximately 7:21 p.m., defendants Krieger and Chrostowski were observed mounting a train while defendant Birdwell remained on the ground next to train. The locks on a railcar were cut and a large package was downloaded to Birdwell who put the package in nearby bushes. As Krieger and Chrostowski were getting ready to cut the locks on another railcar, Birdwell was taken into custody. Krieger and Chrostowski attempted to flee on foot but were apprehended after a brief foot chase with law enforcement.
Some of the items recovered at the scene included bolt cutters, a portion of the wire seal believed to be from a railcar, a pipe with a sharp edge which could aid in breaking the seals on trains, numerous packages hidden in bushes, believed to be items from thefts on dates prior to June 26, 2018, and the large package that was observed being taken off the train that evening.
During the execution of a search warrant at a residence on June 27, 2018, a number cases of bourbon, believed to have been previously stolen from a railcar, were seized.
The complaint is the result of an investigation by the Federal Bureau of Investigation, under the direction of Special Agent-in-Charge Gary Loeffert; the CSX Police, under the direction of Chief Sean Douris; the West Seneca Police Department, under the direction of Chief Daniel Denz; and the Buffalo Police Department, under the direction of Commissioner Byron Lockwood.
The fact that a defendant has been charged with a crime is merely an accusation and the defendant is presumed innocent until and unless proven guilty.
Three Doctors, a Pharmacist, and a Business Owner Charged in Opioid IndictmentsRead the Press Release
OKLAHOMA CITY – A federal grand jury has returned two indictments involving the illegal distribution of and fraudulent billing for prescription opioids by health care professionals, announced Robert J. Troester, Acting United States Attorney for the Western District of Oklahoma.
United States v. Robison and Hallaba
On June 20, 2018, the grand jury charged Melvin Lee Robison, D.O., 64, and Moheb Hallaba, M.D., 89, for conspiracy, distributing opioids illegally, and billing Medicare fraudulently. According to the indictment, in 2015 the Oklahoma State Board of Osteopathic Examiners began to investigate the prescription writing of Dr. Robison, who practiced in Sayre, Oklahoma. The grand jury alleges that in September 2015, Dr. Robison hired Dr. Hallaba to write prescriptions at his clinic. From September 2015 to April 2017, both doctors are alleged to have signed hundreds of prescriptions per week without reviewing patient files or seeing the patients. In particular, they are charged with 54 counts of distributing controlled substances—including in particular Schedule II opioids such as Oxycodone, OxyContin, and fentanyl—outside the usual course of professional medical practice and without legitimate medical purpose.
According to the indictment, their criminal distribution of these drugs resulted in five patient deaths.
Dr. Robison is also charged with 51 counts of fraudulent Medicare billing. These offenses involved billing for services when he is alleged to have been out of the country and for patient visits allegedly conducted by a nurse practitioner rather than by Dr. Robison himself.
If convicted of conspiracy or of distributing controlled substances illegally, each defendant could be imprisoned for up to twenty years. If convicted of any of the five distribution counts alleged to have resulted in deaths, however, each defendant would face a sentence of not less than twenty years and up to life. Any of these counts could result in a fine of up to $1,000,000 and a term of supervised release of at least three years. Each count of health care fraud against Dr. Robison would carry a sentence of up to ten years in prison, a fine of up to $250,000, and not more than three years of supervised release, in addition to restitution. The indictment also seeks forfeiture of the proceeds of the offenses.
This case is the result of an investigation by the Drug Enforcement Administration; the Department of Health and Human Services, Office of Inspector General; the FBI; and the Oklahoma Bureau of Narcotics and Dangerous Drugs. Assistant U.S. Attorneys David P. Petermann, Jacquelyn M. Hutzell, and Amanda Green are prosecuting the case.
The public is reminded these charges are merely accusations and that Robison and Hallaba are presumed innocent unless proven guilty beyond a reasonable doubt. Reference is made to court filings for further information.
United States v. Ferris, Dossey, and Isbell
Also on June 20, a federal grand jury returned a 103-count indictment against James Ferris, M.D., 44, Katherine Dossey, 49, and Sherry Isbell, 48. All three defendants are charged with drug distribution and Medicare fraud. According to the indictment, Isbell owned a company in Wellston, Oklahoma, called Physicians At Home, which employed Dr. Ferris and several physician assistants and nurse practitioners. It is alleged that Isbell owned and operated Mid-Oklahoma Medical Access Clinic ("MOMAC"), for which Ferris also worked. Dossey is alleged to have been a pharmacist who owned and operated Wellston Clinic Pharmacy.
The grand jury alleges that from September 1 to December 9, 2015, Dr. Ferris signed stacks of blank Physicians At Home and MOMAC prescription pads and gave them to Dossey, who completed them by filling in the date, patient information, drug type, and drug dosage. According to the indictment, Dossey completed and filled approximately 1,711 prescriptions for Schedule II controlled substances by using blank prescription pads that Dr. Ferris had signed.
All three defendants are charged with 62 counts of distributing Schedule II controlled substances—hydrocodone, fentanyl, and similar opioids—outside the usual course of professional medical practice. They are also charged with 41 counts of Medicare fraud for billing Medicare for invalid prescriptions.
If convicted of distributing controlled substances illegally, each defendant would face imprisonment up to twenty years and a fine of up to $1,000,000, plus not less than three years of supervised release. Each count of Medicare fraud could result in a sentence of up to ten years, a fine of up to $250,000, and up to three years of supervised release. The indictment also seeks forfeiture of the proceeds of the crimes, including real property Dossey is alleged to own in Wellston.
This case is the result of an investigation by the Drug Enforcement Administration; the Department of Health and Human Services, Office of Inspector General; the FBI; the Oklahoma Bureau of Narcotics and Dangerous Drugs; the Oklahoma Pharmacy Board; and the Oklahoma Medical Board. Assistant U.S. Attorney Amanda Green is prosecuting the case.
The public is reminded these charges are merely accusations and that Ferris, Dossey, and Isbell are presumed innocent unless proven guilty beyond a reasonable doubt. Reference is made to court filings for further information.
Both of these cases are part of the National Health Care Fraud Takedown, announced by Attorney General Jeff Sessions this morning in Washington. The largest health care fraud enforcement action in Department of Justice history, the takedown—focused particularly on opioid offenses—included criminal charges against 76 doctors and involved more than $2 billion in false billings.
A New Opioid Enforcement Team
These two cases are also part of a larger law enforcement effort to focus on the prosecution of opioid-related offenses in the Western District of Oklahoma. Today Acting U.S. Attorney Troester formally announced that state and federal agencies are combining forces to address the opioid crisis as the Western Oklahoma Opioid Enforcement Team. Making the announcement with Troester were:
- Mike Hunter, Oklahoma Attorney General
- John Scully, Director of the Oklahoma Bureau of Narcotics and Dangerous Drugs
- Clyde Shelley, Special Agent-in-Charge for the Drug Enforcement Administration
- Dennis Passerman, Assistant Special Agent-in-Charge for the FBI
- Jason Meadows, Assistant Special Agent-in-Charge of the Department of Health and Human Service, Office of Inspector General
- Rick Adams, Incoming Director of the Oklahoma State Bureau of Investigation
- Kevin Caramucci, Assistant Special Agent-in-Charge for the Internal Revenue Service—Criminal Investigations
Other members of the team include the District Attorney’s Office for Oklahoma County; the District Attorney’s Office for Cleveland, Garvin, and McClain Counties; the Defense Criminal Investigative Service; and the Office of Personnel Management, Office of Inspector General.
This enforcement team will take advantage of all legal tools—criminal, civil, and administrative—to protect citizens from the illegal distribution and use of opioids, whether through health care providers or street dealers. It will consider prosecution and other litigation in both federal and state court to maximize effectiveness.
Three Convicted in Manhattan Federal Court for the Fraudulent Issuance and Sale of More Than $60 Million of Tribal BondsRead the Press Release
ROBERT KHUZAMI, Attorney for the United States, Acting Under Authority Conferred by 28 U.S.C. § 515, announced that JOHN GALANIS, a/k/a “Yanni,” DEVON ARCHER, and BEVAN COONEY were each convicted today of conspiracy to commit securities fraud and securities fraud, following a five and half week trial before U.S. District Judge Ronnie Abrams.
Mr. Khuzami said: “As a unanimous jury swiftly found, these defendants orchestrated a highly complex scheme to defraud a Native American community and multiple pension funds, all to corruptly bankroll their own personal and business interests. This Office remains steadfast in its commitment to prosecuting the most complex financial frauds and protecting the investing public.”
According to the allegations in the charging documents and statements made in court proceedings:
From March 2014 through April 2016, JOHN GALANIS, ARCHER, and COONEY, along with their co-conspirators Jason Galanis, Hugh Dunkerley, Gary Hirst, and Michelle Morton, engaged in a fraudulent scheme that involved (a) causing the Wakpamni Lake Community Corporation (“WLCC”), a Native American tribal entity, to issue a series of bonds (the “Tribal Bonds”) through lies and misrepresentations; (b) deceptively causing clients of asset management firms controlled by Morton and others to purchase the Tribal Bonds, which the clients were then unable to redeem or sell because the bonds were illiquid and lacked a ready secondary market; and (c) misappropriating the proceeds resulting from those bond sales.
The WLCC was convinced to issue the Tribal Bonds through false and fraudulent representations by JOHN GALANIS. Simultaneously, Jason Galanis, with the backing of ARCHER and COONEY, worked to acquire Hughes Capital Management (“Hughes”), a registered investment adviser. Morton and Hirst were installed respectively as Hughes’ chief executive officer and chief investment officer. Within weeks of taking control of Hughes, Morton and Hirst caused the entire $28 million first series of Tribal Bonds to be purchased by Hughes clients, primarily pension funds, but never disclosed to these clients material facts about the Tribal Bonds, including the fact that the Tribal Bonds fell outside the investment parameters set forth in the investment advisory contracts of certain Hughes clients. In addition, Hughes’s clients were not told about substantial conflicts of interest with respect to the issuance and placement of the Tribal Bonds before the Tribal Bonds were purchased on these clients’ behalf.
After securing the sale of the Tribal Bonds to these unwitting clients, the defendants and their co-conspirators then misappropriated the proceeds of first Tribal Bond issuance. Specifically, although the Tribal Bonds were supposed to be invested in an annuity, Hugh Dunkerley, at the direction of Jason Galanis, transferred significant amounts of the bond proceeds to support the defendants’ business and personal interests. JOHN GALANIS, for example, secretly received $2.35 million in proceeds of the first bond issuance, which he spent on a variety of personal expenses and luxury items, including cars, jewelry, and hotel expenses. Similarly, Jason Galanis used a portion of the proceeds of the first Tribal Bond issuance to finance the purchase of a $10 million luxury apartment in Tribeca.
In addition, after JOHN GALANIS induced the WLCC to issue a second round of Tribal Bonds, ARCHER and COONEY used $20 million of bond proceeds from the first issuance to buy the entirety of the second issuance. As a result of the use of recycled proceeds to purchase additional issuances of Tribal Bonds, the face amount of Tribal Bonds outstanding increased and the amount of interest payable by the WLCC increased, but the actual bond proceeds available for investment on behalf of the WLCC did not increase. The bonds purchased by ARCHER and COONEY were then used to meet net capital requirements at two broker dealers in which ARCHER and COONEY had interests. COONEY also obtained a $1.2 million loan based on his purported ownership of the bonds, a loan he subsequently failed to repay. In addition, millions of dollars in bond proceeds from the first and second issuances were used finance the acquisition of companies that the defendants and their co-conspirators acquired as part of a strategy to build a financial services conglomerate.
In the spring of 2015, JOHN GALANIS induced the WLCC to issue an additional $16 million worth of Tribal Bonds. Simultaneously, Jason Galanis, ARCHER, and others purchased a second investment adviser, Atlantic Asset Management (“Atlantic”), and again installed Morton as the chief executive officer. Within days of obtaining control of Atlantic, Morton placed the entirety of the $16 million Tribal Bond with an Atlantic client, without the client’s consent and without disclosing the fact that the Tribal Bonds were outside the client’s investment parameters and that numerous conflicts of interest existed. The proceeds of the $16 million issuance were again not invested in an annuity as promised, but instead were diverted to, among other things, finance the defendants’ acquisition of another company in furtherance of their plan to build a financial services conglomerate and make payments to one of the broker dealers in which ARCHER and COONEY had interests.
Jason Galanis, Michelle Morton, Gary Hirst, and Hugh Dunkerley each pled guilty prior to trial to participation in the scheme.
* * *
Defendants’ Ages and Residences
Defendant
Residence
Age
John Galanis
Oceanside, California
74
Devon Archer
Brooklyn, New York
44
Bevan Cooney
Missoula, Montana
45
Mr. Khuzami praised the work of the Federal Bureau of Investigation and the United States Postal Inspection Service, and thanked the U.S. Securities and Exchange Commission.
This case is being handled by the Office’s Securities and Commodities Fraud Task Force. Assistant U.S. Attorneys Rebecca Mermelstein, Brendan F. Quigley, and Negar Tekeei are in charge of the prosecution.
The former police chief of a village in Mahoning County sentenced to five years in prison for child pornography crimesRead the Press Release
The former police chief of a village in Mahoning County was sentenced to five years in prison for child pornography crimes.
Andrew M. Soloman, 37, pleaded guilty earlier this year to one count of receiving and possessing visual depictions of minors engaged in sexually explicit conduct.
Soloman was the police chief of Craig Beach Village when he committed the crimes. He met the juvenile victim when responding to her residence for calls about harassment and a juvenile runaway. During their interactions, the victim sat in Soloman’s cruiser for several hours and talked. He provided her with his work email address, according to court documents.
The two continued to communicate via text and email. The victim sent Soloman sexually explicit photographs of herself and Soloman responded by sending sexually explicit photographs via his work email account. This took place from Oct. 24 through Dec. 7, 2017 according to court documents.
This case is being prosecuted by Assistant U.S. Attorney Michael A. Sullivan following an investigation by the Federal Bureau of Investigation, the Ohio Bureau of Criminal Investigation, the Mahoning County Sheriff’s Office and the Austintown Police Department.
Ten Charged in Western District of Kentucky, as Part of the National Health Care Fraud TakedownRead the Press Release
LOUISVILLE, Ky. –United States Attorney Russell M. Coleman today announced the results of a health care fraud sweep in the Western District of Kentucky as part of the national health care fraud takedown led by the Justice Department. The law enforcement takedown, in the Western District of Kentucky, resulted in charges against ten individuals for their alleged participation in health care fraud schemes, to include unlawful dispensing of controlled substances, including opioids.
“Healthcare fraud is nothing more than theft and drug dealing, though using complex techniques on a large scale” stated United States Attorney Russell Coleman. “Today’s announcement evidences a commitment across law enforcement to hold these offenders accountable for the harm they visit upon Kentucky families and taxpayer resources.
U.S. Attorney Coleman was joined in the announcement by:
Amy Hess, Special Agent in Charge, Louisville Division, Federal Bureau of Investigation stated, “Health care fraud is a growing and serious crime that impacts every city and small town in the Commonwealth. The FBI is dedicated to working with our federal, state, and local partners to seek justice for the victims of health care professionals who have abandoned their oath to do no harm.”
“Doctors have a duty to do no harm and provide competent care to their patients,” said D. Christopher Evans, Special Agent In Charge of the Drug Enforcement Administration’s Louisville Field Division. “The message we are sending today is clear. We will not tolerate drug dealers in lab coats. If you’re a doctor and you’re prescribing dangerous narcotics in a reckless or irresponsible manner, we’re coming after you.”
“Health care fraud costs taxpayers billions of dollars and places our most vulnerable citizens at risk for harm and neglect,” said Special Agent in Charge Derrick L. Jackson, of the U.S. Department of Health and Human Services, Office of Inspector General. “Working with our law enforcement partners, we are dedicated to protecting patients and the federal health care programs intended to serve them.”
“This operation by our federal partners and my office is critical each year in stopping those who would harm Kentuckians and our health care system, especially those accused of unlawful distribution and dispensing of controlled substances given our state’s drug epidemic,” Attorney General Andy Beshear said. “I want to thank the offices of our U.S. Attorneys, FBI, DEA, neighboring states' Medicaid Fraud units and others for continuing to fight back against those who defraud our people and our critical government programs.”
“Medicaid fraud leaves in its wake many victims,” Indiana Attorney General Curtis Hill said. “Any licensed providers who commit this offense are taking advantage of those for whom they are supposed to provide care, including the disabled and less fortunate who rely on Medicaid. In addition, they are also fleecing taxpayers whose hard-earned money is used to fund these programs. The investigators and lawyers in our Medicaid Fraud Control Unit are doing good work to help bring lawbreakers to justice. At the same time, we respect the due process to which all are entitled, and all those who stand accused of crimes are certainly presumed innocent until a court finds otherwise.”
“Health care fraud affects every American and today’s announcement illustrates that the IRS and our law enforcement partners are steadfast in our commitment to detecting and dismantling health care fraud schemes and holding perpetrators of these crimes accountable,” said Ryan L. Korner, Special Agent in Charge, IRS Criminal Investigation. “Waste, fraud and abuse take critical resources out of our health care system, contribute to the rising cost of health care and degrades the integrity of our health care system and legitimate patient care.”
Anthony S. Gooden, Senior Supervisory Agent, Louisville Division, U.S. Postal Inspection Service. “The United States Postal Inspection Service is dedicated to protecting the United States Mail from criminal attack and criminal misuse. This includes protecting all businesses and postal customers from any form of fraud utilizing the mails. We continuously work with other local, state and federal law enforcement agencies to identify and prosecute anyone utilizing the mail in furtherance of a fraud scheme.”
Steve Conrad, Chief, Louisville Metro Police Department. “This is yet another example of how collaboration between State, Local, and Federal law enforcement strengthens our effectiveness and works to hold people violating the law accountable.”
In the Western District of Kentucky, four separate cases were indicted on June 25, 2018, and two cases were indicted on May 24, 2018, where the defendants made initial appearances yesterday. The charges included unlawful distribution and dispensing of controlled substances, health care fraud, theft from a health care benefit program, paying or offering health care kickbacks, mail fraud, money laundering, conspiracy, and aggravated identity theft.
Specifically, in United States v. Chandra Dundumalla Reddy and Vinodini Dundumalla Reddy: Dr. Chandra Reddy, a licensed physician and Vinodini Reddy, his wife, were charged with two counts conspiracy to commit health care fraud and one count conspiracy for making false statements relating to health care matters. Dr. Reddy was also charged with one count of conspiracy for unlawfully allowing his nurse practitioners to use his DEA number to prescribe controlled substances. The charges stem from defendants’ role in a $390,000 upcoding medical services and “incident to” billing scheme. In addition, Dr. Reddy pre-signed a large number of controlled substance prescriptions for his nurse practitioners, who did not have DEA numbers or had limited prescription writing authority, in order to allow the nurse practitioners to distribute controlled substances to patients while Dr. Reddy was either out of the country or out of the office.
In United States v. Monica Berry and Brandon Gordon: Monica Berry, a medical assistant in Dr. Chandra Reddy’s medical office, and Brandon Gordon, a patient, were charged with one count of conspiracy to unlawfully distribute controlled substances, three counts conspiracy to commit health care fraud, and three counts aggravated identity theft. The charges stem from Monica Berry using Dr. Reddy’s DEA number to issue Schedule II-IV controlled substances in which Brandon Gordon diverted the prescriptions to the street. Some of the people who purchased and/or filled the prescriptions used their insurance, causing insurance carriers to pay for medically unnecessary drugs. The defendants diverted approximately 17,750 units of Hydrocodone, 2,580 units of oxycodone, 1,895 units of Xanax, 210 unit of Ambien, 570 unit of Phentermine, and 600 units of Soma to the street.
In United States v. Yesdel Acosta and Eduardo Chinea-Martinez: Defendants were charged with one count of conspiracy to commit health care fraud, sixteen counts health care fraud, thirteen counts theft from a health care benefit program, thirteen counts aggravated identity theft, ten counts money laundering, and four counts mail fraud. The charges stem from defendants’ role in operating three false-front medical clinics where defendants stole the identity of five physicians, four of which were Kentucky physicians, and numerous patients to unlawfully bill for services never rendered, resulting in $4,700,000 in false medical billings submitted to three insurance companies and $258,000 paid in false medical billings.
In United States v. Osmaro Ruiz: Defendant was charged with one count of conspiracy to commit health care fraud, seven counts health care fraud, seven counts aggravated identity theft, and ten counts of money laundering. The charges stem from defendant operating a false-front pharmacy where he stole and used the identity of patients and doctors to bill for prescriptions the patients never received. The scheme resulted in approximately $858,000 being paid out in fraudulent proceeds.
In United States v. Dr. Peter Steiner: Dr. Steiner, psychiatrist, was charged with one count conspiracy to unlawfully distribute Schedule II-IV controlled substances, thirteen counts to distribute Schedule II controlled substances, and twelve counts to distribute Schedule III controlled substances. The charges stem from Dr. Steiner operating Kentuckiana Mental Health Associates, a mental health and opioid addiction practice, where Dr. Steiner prescribed medically unnecessary drugs that were also prescribed outside the usual course of professional practice. He prescribed thousands of units of stimulants and Buprenorphine. He unlawfully distributed opiates as well.
In United States v. Dr. Bingston Crosby and Lacy Black: Dr. Crosby, chiropractor and owner of Crosby Chiropractic Center, Inc., and Lacy Black, Crosby’s runner/marketer, were charged with one count of conspiracy to commit health care fraud, and each one count of paying or offering health care kickbacks. Crosby is also charged with eight counts health care fraud, seven counts of money laundering, and seven counts mail fraud. Dr. Crosby paid Black to recruit Kentucky Medicaid and private auto insurance patients to treat at his chiropractic clinic. Black promised the patients cash or other remunerations to receive treatment at the chiropractic clinic. Crosby billed for services not rendered when he added charges for treatment patients did not receive.
In addition, our law enforcement partners executed multiple search warrants over the last four weeks related to alleged health care fraud and opiate overprescribing offenses. On Monday, May 21, 2018, a search warrant was executed at Ft. Knox, Kentucky at a pediatrician’s office. On Tuesday, June 12, 2018, six search warrants were executed at six different locations around Louisville, Kentucky, including four pain clinics and one residence. Finally, two warrants were executed on June 22, 2018, at an Oncologist’s practice in Elizabethtown, Kentucky and the doctor’s residence in Louisville, Kentucky.
These cases are being handled by Assistant United States Attorneys Joe Ansari, Lettricea Jefferson-Webb, and Robert Bonar. U.S. Attorney Coleman acknowledged and credited the law enforcement agencies investigating these cases: Federal Bureau of Investigation (FBI), U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG), U.S. Drug Enforcement Administration (DEA), U.S. Department of Labor (DOL), United States Postal Inspection Service (USPIS), Internal Revenue Service Criminal Investigation (IRS-CI), Defense Criminal Investigative Service (DCIS), Louisville Metro Police Department (LMPD), Kentucky State Police (KSP), Barren River Drug Task Force, Indiana and Kentucky Medicaid Fraud Control Units, Kentucky Cabinet for Health and Family Services – Office of Inspector General (CHFS-OIG), and the Kentucky Department of Insurance (KYDOI).
Earlier today, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar II, announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving over 590 charged defendants across 58 federal districts, including over 150 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving over $2 billion in false billings. Of those charged, today’s action also involved charges against over 150 defendants, including doctors, for their roles in prescribing and distributing opioids and other dangerous narcotics, amounting to more than 13 million illegal dosages of opioids. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from June 2017 to the present, 587 providers have been served with exclusion notices for conduct related to opioid diversion and abuse.
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The indictment of a person by a Grand Jury is an accusation only and that person is presumed innocent until and unless proven guilty.
St. Louis Man Taken to the Cleaners in Connection with an Armed RobberyRead the Press Release
St. Louis, MO – Victor Mora, 33, of St. Louis, was charged in a federal indictment charging him with one felony count of interference with commerce by threats or violence.
According to the indictment, on or about May 29, 2018, Robbery victims “T.D.” and “A.A.” were employees at the Goodfellow Laundromat, 5950 Goodfellow Boulevard when they were robbed at gunpoint by Mora. Mora threatened physical violence to the two victims in order to obtain cash.
If convicted, the charge of interference with commerce by threat or violence carries a maximum penalty of 20 years in prison and a $250,000 fine. In determining the actual sentences, a judge is required to consider the U.S. Sentencing Guidelines, which provide recommended sentencing ranges.
Mora is currently in state custody and will be brought to federal court shortly to answer the new charges. The prosecution of Mora is being coordinated with the St. Louis Circuit Attorney’s Office.
As is always the case, charges set forth in the indictment are merely accusations and do not constitute proof of guilt. Every defendant is presumed to be innocent unless and until proven guilty.
This case is being investigated by the St. Louis Metropolitan Police Department. Assistant United States Attorney Jennifer Roy is handling the case for the U.S. Attorney’s Office.
St. Francis Woman Sentenced for Escape from CustodyRead the Press Release
United States Attorney Ron Parsons announced that a St. Francis, South Dakota, woman convicted of Escape from Custody was sentenced by Chief Judge Jeffrey L. Viken, U.S. District Court.
Aprielle Poitra, age 22, was sentenced on June 25, 2018, to 2 months in federal prison and ordered to pay a $100 special assessment to the Federal Crime Victims Fund.
The charge related to Poitra escaping from the custody of the Bureau of Prisons at the Community Education Centers, previously known as Community Alternatives of the Black Hills, where she was in custody on December 19, 2017.
This case was investigated by the U.S. Marshals Service. Assistant U.S. Attorney Eric Kelderman prosecuted the case.
Poitra was immediately turned over to the custody of the U.S. Marshals Service.
Southern District of Florida Charges 124 Individuals Responsible for $337 Million in False Billing as Part of National Healthcare Fraud TakedownRead the Press Release
Largest National Health Care Fraud Enforcement Action in Department of Justice History Resulted in Total of 76 Doctors Charged and 84 Opioid Cases Involving More Than 13 Million Illegal Dosages of Opioids
Benjamin G. Greenberg, U.S. Attorney for the Southern District of Florida; Robert F. Lasky, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General (HHS-OIG), Miami Regional Office; John F. Khin, Special Agent in Charge, Department of Defense, Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southeast Field Office; Brian Swain, Special Agent in Charge, U.S. Secret Service (USSS), Miami Field Office; Pam Bondi, Florida Attorney General (Florida Medicaid Fraud Control Unit); Michael J. DePalma, Acting Special Agent in Charge, Internal Revenue Service, Criminal Investigation (IRS-CI); Christopher Cave, Special Agent in Charge, U.S. Postal Service Office of Inspector General (USPS OIG), Southern Area Field Office; Frank Robey, Director, U.S. Army Criminal Investigation Command’s Major Procurement Fraud Unit; Scott Gottlieb, M.D., Commissioner, U.S. Food and Drug Administration (FDA); Jimmy Patronis, Florida Chief Financial Officer, Division of Investigative and Forensic Services (DIFS); Tom Howard, Inspector General, Amtrak Office of Inspector General (Amtrak-OIG); Isabel Colon, Atlanta Regional Director, U.S. Department of Labor’s Employee Benefits Security Administration (DOL-EBSA); Norbert E. Vint, Acting Inspector General, U.S. Office of Personnel Management, Office of Inspector General (OPM-OIG); and Dennis Russo, Director of Operations, National Insurance Crime Bureau (NICB), announced that in the Southern District of Florida a total of 124 defendants were charged with offenses relating to their alleged participation in various fraud schemes involving over $337 million in false billings for services including home health care, substance abuse treatment, lab testing, and pharmacy fraud.
The South Florida charges are part of the largest ever national health care fraud enforcement action by the Medicare Fraud Strike Force. Attorney General Jeff Sessions announced today that more than 601 defendants were charged, across 58 federal districts, including 76 doctors, as well as nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 162 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department of Justice (DOJ). According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
“Today’s takedown sends a clear message that those who steal our tax dollars and divert money from much needed government programs to line their own pockets will be brought to justice,” stated U.S. Attorney Benjamin Greenberg. The same is true of those individuals who facilitate these crimes by enabling the perpetrators to financially benefit from their misdeeds. The South Florida based schemes involved hundreds of millions of dollars in fraud, and in some cases resulted in significant harm to patients in need of substance abuse treatment. When that treatment is withheld because of someone’s greed, the very people who are supposed to help the addicts end up enabling their addiction. Side by side with our great partners, we will continue to fight against all forms of healthcare fraud in South Florida.”
“Health care fraud and opioid abuse are threats to this country, both in terms of the well-being of patients and the viability of government health care programs,” said Shimon R. Richmond, Special Agent in Charge, HHS-OIG. “This takedown sends a clear message that criminals who engage in health care fraud schemes and illicit opioid distribution will be caught. Working collaboratively with our state and federal partners, we will continue to bring these criminals to justice.”
John F. Khin, Special Agent in Charge, DCIS-Southeast Field Office, stated, “As part of the National Health Care Fraud multi-agency joint effort, the DCIS-Southeast Field Office contributed significant resources and efforts to achieve a successful operation to effectively combat widespread fraud and abuse, and preserve the integrity of TRICARE, a vital DoD program serving U.S. service members, retirees, and their families.”
“Health care fraud costs taxpayers billions of dollars, increases medical costs and even helps fuel the national opioid crisis,” stated Florida Attorney General Pam Bondi. “Our law enforcement partners and my Medicaid Fraud Control Unit aggressively investigate fraud in Florida, and as part of this massive nationwide effort, we were able to arrest some of the worst offenders and stop the illegal sale of prescription opioids—and hopefully safe lives.”
“Today’s local announcement reinforces law enforcement’s continued commitment to combat healthcare fraud in South Florida. IRS-CI is proud to participate in these cases and be part of the Greater Palm Beach County Health Care Fraud Task Force where we can provide our expertise to conduct financial analysis and unravel the complex financial transactions involved in these fraudulent schemes. IRS-CI will continue to allocate resources to fight the battle against healthcare fraud and will investigate individuals who are committing crimes while motivated by greed,” stated Michael J. DePalma, Acting Special Agent in Charge, IRS-CI.
“This historic announcement marks a significant effort by the National Healthcare Fraud Takedown task force and should send a clear message that these crimes will not be tolerated,” said Special Agent in Charge, Christopher Cave, USPS OIG. “The USPS Office of Inspector General, along with our law enforcement partners, will continue to aggressively pursue these investigations in order to ensure continued oversight and protection of the Postal Service and federal benefits programs.”
“We applaud the coordinated efforts of our federal law enforcement partners in this action today. The FDA is proud to play a role in supporting these investigations,” said U.S. Food and Drug Administration Commissioner Scott Gottlieb, M.D. “A key aspect of the FDA’s mission to protect public health is creating a regulatory framework that helps ensure that compounded drugs are dispensed to patients who have a legitimate medical need for them.”
“Insurance fraud has seeped into our opioid treatment homes in Florida, impacting countless families and communities,” said CFO Jimmy Patronis. “The collaborative efforts of national, state and local law enforcement are essential for combatting this type of activity. My office, along with the U.S. Attorney’s Office for the Southern District of Florida and our law enforcement partners remains committed to safeguarding Floridians while reminding those who seek to deceive and defraud – they will be held accountable for their actions.”
“These cases reinforce our commitment and determination to pursue those who would defraud Amtrak’s health care programs and target such vulnerable populations,” said Amtrak Inspector General Tom Howard. “Our agents will continue to hold perpetrators accountable and to protect Amtrak, its employees and their dependents.”
“Today’s announcement is a reflection of federal, state, and local partners joining forces to root out fraud and abuse in the healthcare system,” said Atlanta Regional Director for DOL-EBSA Isabel Colon. “The department will continue to take all actions necessary to put a stop to those who would defraud workers and their families of hard-earned employee benefits.”
“The OPM-OIG will continue to work with the Department of Justice and our other law enforcement partners to protect the integrity of the Federal Employees Health Benefits Program and ensure that Federal employees, annuitants, and their families receive unbiased medical care from ethical professionals,” said Norbert E. Vint, Acting OPM Inspector General.
The following are some of the recent health care fraud cases that have been charged in the Southern District of Florida:
I. SUBSTANCE ABUSE TREATMENT FRAUD AND ILLEGAL DISTRIBUTION OF OPIOIDS
The U.S. Attorney’s Office for the Southern District of Florida continues to partner with federal, state and local law enforcement agencies and the Greater Palm Beach Health Care Fraud Task Force (“Task Force”) to target fraud and other criminal practices in the substance abuse treatment/medical industry, including: money laundering; billing for treatment and laboratory testing that was not actually provided and not medically necessary; submission of claims that were solicited through the payment of kickbacks and bribes to patients, sober home owners, and treatment center owners; and the illegal distribution of opioids. To date, at least 34 individuals have been charged federally, 19 have been convicted, $20,292,916.37 in restitution has been ordered, and more than $4 million in restitution has been collected.
A. Health Care Fraud and Money Laundering
1. United States v. Kenneth Bailynson, et al.,
Case No. 18-80124-CR-Rosenberg
On June 22, 2018, Kenneth Bailynson, 45, of West Palm Beach, Florida, owner of GDSL, Inc., a/k/a Good Decisions Sober Living, Inc. (“GDSL”) in West Palm Beach, Stephanie Curran, 35, of Lake Worth, Florida, an employee of GDSL, Mark Agresti, 55, of Palm Beach, Florida, the Medical Director of GDSL, and Matthew Noel, 32, of Louisville, Kentucky, an employee of GDSL, were charged by indictment. The defendants were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, and substantive counts of money laundering for their involvement in a scheme at GDSL to illegally recruit patients, pay kickbacks, and defraud health care benefit programs by billing for widespread fraudulent urine testing that was not medically necessary. The indictment alleges that during the course of the fraudulent scheme, from September 2011 through December 2015, GDSL submitted claims for substance abuse treatment services in excess of approximately $106,576,358 to the insurance plans, and received insurance payments of approximately $31,356,527.
This case is being prosecuted by DOJ Trial Attorney James V. Hayes, formerly an Assistant U.S. Attorney in the Southern District of Florida.
2. United States v. Anthony Jackson,
Case No. 18-80040-CR-Middlebrooks
On June 21, 2018, following his guilty plea to conspiracy to commit health care fraud, Anthony Jackson, 51, of Lantana, Florida, a Certified Addiction Counselor at Reflections Treatment Center in Margate, Florida and owner of Pantherview Sober Home in Boynton Beach, Florida was sentenced to 42 months in prison, to be followed by 3 years of supervised release. Jackson also was ordered to pay $5,122,886.86 in restitution.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
3. United States v. Eric Snyder, et al.,
Case No. 18-80111-CR-Rosenberg
On June 7, 2018, Eric Snyder, 31, of Delray Beach, Florida, an owner of Halfway There Florida, LLC/A Safe Place (“HWT”), a Delray Beach sober home, and Real Life Recovery Delray LLC (“RLR”), a substance abuse treatment facility, Paul R. Materia, 43, of Port St. Lucie, Florida, the CEO of RLR, and patient brokers Joseph Lubowitz, 29, of Pennsylvania and West Palm Beach, Florida, and Christopher Fuller, 33, of West Palm Beach, Florida, were charged by indictment. The defendants were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, substantive counts charging a violation of the Travel Act, conspiracy to commit money laundering, and substantive counts of money laundering for their involvement in a scheme to illegally recruit patients, pay kickbacks, and defraud health care benefit programs by billing for urine testing and substance abuse treatment that was medically unnecessary, and that was never provided. During the course of the alleged fraudulent scheme, from January 2011 through September 2015, HWT/RLR submitted claims for substance abuse treatment services in excess of approximately $58,209,385 to insurance plans, and received insurance payments of approximately $20,190,941. Eric Snyder and Christopher Fuller were previously charged with conspiracy to commit health care fraud in this case, in a criminal complaint filed in July 2017 (Case No. 17-MJ-08268-Brannon).
This case is being prosecuted by DOJ Trial Attorney James V. Hayes, formerly an Assistant U.S. Attorney in the Southern District of Florida.
4. United States v. Mark Jeffrey Hollander,
Case No. 18-80102-CR-Rosenberg
On May 21, 2018, Mark Jeffrey Hollander, 44, of Miami, Florida, was charged by an information with laundering the proceeds of health care fraud, that is, monies he received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase
5. United States v. Lawrence Weisberg,
Case No. 18-80108-CR-Rosenberg
On May 29, 2018, Lawrence Weisberg, 51, of Boca Raton, Florida, was charged by an information with laundering the proceeds of health care fraud, that is, monies he received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
6. United States v. Lanny Fried,
Case No. 18-80100-CR-Rosenberg
On May 21, 2018, Lanny Fried, 41 of Miami, Florida, was charged by an information with conspiracy to commit money laundering of proceeds from health care fraud, that is, monies he and others received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
7. United States v. Bosco Vega,
Case No. 18-80101-CR-Middlebrooks
On May 22, 2018, Bosco Vega, 52, of Miami, Florida, was charged by an information with laundering the proceeds of health care fraud, that is, monies he received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
B. Illegal Distribution of Opioids
8. United States v. Arman Abovyan and Tina Marie Barbuto,
Case No. 18-80122-CR-Middlebrooks
On June 19, 2018, Arman Abovyan, 44, of Boca Raton, Florida, former Medical Director of Reflections Treatment Center in Margate and Journey to Recovery in Boca Raton, and Tina Marie Barbuto, 39 of Boca Raton, Florida, former Clinical Director of Reflections Treatment Center in Margate were charged by indictment with one count of conspiracy to distribute and dispense controlled substances outside the course of medical practice and two counts of distribution of controlled substances outside the course of medical practice.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
9. United States v. Kenneth Rivera-Kolb,
Case No. 18-80121-CR-Cohn
On June 19, 2018, Kenneth Rivera-Kolb, 66, of Largo, Florida, was charged by indictment with one count of conspiracy to distribute controlled substances in relation to his employment with Angel’s Recovery, a substance abuse treatment facility located in Palm Beach County, Florida. Rivera-Kolb was a licensed physician in the State of Florida. In 2013, he was hired as the Medical Director for Angel’s Recovery. As the Medical Director of Angel’s Recovery, Rivera-Kolb prescribed controlled substances for patients. From approximately February 17, 2015 through September 2, 2015, after the suspension of his medical license, Rivera-Kolb allegedly continued to prescribe controlled substances to patients of Angel’s Recovery.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
10. United States v. Scott Novick,
Case No. 18-20563-CR-Moore
On June 27, 2018, Scott Novick, 50, of Broward County, Florida, was charged by information with one count of conspiracy to dispense and distribute controlled substances. According to the information, Novick was the owner of American Pain Management, a pain management clinic located in Tamarac, Florida. He also owed Pacific Pharmacy, a Miami-area pharmacy. Between July 2016 and March 2018, Novick allegedly engaged in a conspiracy to dispense and distribute Schedule II substances, including oxycodone and morphine.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Timothy P. Loper.
Agencies involved with the Greater Palm Beach County Health Care Fraud Task Force include the FBI, IRS-CI, DIFS, Amtrak-OIG, DOL-EBSA, OPM-OIG, and NICB.
II. CHECK CASHING FRAUD SCHEMES
11. United States v. Evelio Suarez,
Case No. 18-MJ-2965-Torres
On June 21, 2018, Evelio Suarez, 53, of Miramar, Florida, was charged by criminal complaint with conspiracy to commit money laundering, bribery of a bank employee, and obstruction of justice.
According to allegations contained in the criminal complaint, Suarez controlled three check-cashing stores in Hialeah, Florida, in the name of nominee owners. From 2013 to 2014, Suarez’s check-cashing stores cashed nearly $500 million in checks, which were allegedly primarily funded by healthcare fraud, mortgage fraud, identity theft tax refund fraud, and other fraudulent activity. Suarez allegedly knowingly cashed checks made payable to individuals who were not present at the stores, including individuals whose identities had been stolen or individuals who had been paid to flee to Cuba. Suarez allegedly did not require real identification documents to cash the fraudulent checks and, if necessary, Suarez would make fake identification documents. Suarez allegedly charged a personal fee of approximately ten percent to cash healthcare fraud and mortgage fraud checks and thirty percent for identity theft tax refund fraud checks, on top of the fee charged by the check-cashing stores. On numerous occasions, Suarez allegedly cashed individual fraudulent Medicare checks exceeding $200,000 and individual U.S. Treasury tax refund checks exceeding $150,000.
Mr. Greenberg commends the investigative efforts of IRS-CI and FBI in this matter. The case is being handled by Assistant U.S. Attorney Michael Berger and DOJ Trial Attorney Yisel Valdes.
12. United States v. Enrique Indalecio Iglesias,
Case No. 18-MJ-2973-Torres
On June 22, 2018, Enrique Iglesias, 44, of Homestead, Florida, was charged by criminal complaint with conspiracy to commit money laundering, money laundering, and structuring transactions to avoid reporting requirements justice.
According to allegations contained in the complaint, Iglesias controlled two check-cashing stores in Miami, in the name of nominee owners. From 2013 to 2015, Iglesias’ check-cashing stores cashed nearly $150 million in checks, which were allegedly funded primarily from health-care fraud, mortgage fraud, and other fraudulent activity. Iglesias allegedly did not require the payee on the check to be present and, on many occasions, the actual payee had been paid to flee to Cuba. Iglesias typically charged personal fees between eight to fifteen percent, for allegedly cashing health-care and mortgage-fraud checks. On numerous occasions, Iglesias allegedly cashed fraudulent individual health care fraud checks exceeding $50,000.
Mr. Greenberg commended the investigative efforts of the FBI, HHS-OIG and IRS-CI in this matter. The case is being handled by Assistant U.S. Attorney Michael Berger and DOJ Trial Attorney Yisel Valdes.
III. DRUG AND PHARMACY FRAUD SCHEMES – Medicare Part D
A. TRICARE Fraud
13. United States v. Alap Shah,
Case No. 18-20526-CR-Ungaro
On June 19, 2018, Alap Shah, 44, of Columbus, Georgia, was charged by indictment with one count of conspiracy to defraud the United States and receive health care kickbacks and three counts of receiving health care kickbacks.
According to the indictment, Shah was a State of Georgia licensed podiatrist who allegedly received kickback payments from PGRX, a Weston, Florida based business that recruited and paid doctors to prescribe compounded medications for TRICARE and private commercial insurance beneficiaries. During the course of the conspiracy the defendant and his co-conspirators allegedly signed false Medical Director and Speaker agreements in order to conceal the fact that PGRX was paying the defendant for writing prescriptions. As a result of these prescriptions TRICARE made payments to Atlantic Pharmacy, a pharmacy located in the Southern District of Florida.
Mr. Greenberg commends the investigative efforts of DCIS, U.S. Army Criminal Investigation Command, FDA-Office of Criminal Investigations (FDA-OCI) and USPS-OIG. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.
14. United States v. Christopher Liva, et al.,
Case No. 18-60167-CR-Middlebrooks
On June 14, 2018, Christopher Liva, 39, of Boca Raton, Florida, Elaina Liva, 66, of Pompano Beach, Florida, and Stephen Chalker, 42, of Wellington, Florida, were charged by indictment with one count of conspiracy to commit health care fraud. Chalker was also charged with three counts of health care fraud.
According to the indictment, the Livas were the owners/operators of, and Chalker was the pharmacist in charge at Pop’s Pharmacy, LLC (“Pop’s Pharmacy”), a pharmacy located in Deerfield Beach, Florida. The indictment alleges that from approximately September 2014 to October 2016, the defendants and their co-conspirators caused Pop’s Pharmacy to submit false and fraudulent claims to Medicare, TRICARE, and Medicaid for compounded drugs and other prescription medications, including expensive pain and scar creams, that were not medically necessary and/or were never provided. As a result of these false and fraudulent claims, Medicare, TRICARE, and Medicaid made payments totaling nearly $5 million.
Mr. Greenberg commends the investigative efforts of the FBI, HHS-OIG, DCIS, and the State of Florida Medicaid Fraud Control Unit in this matter. This case is being prosecuted by DOJ Trial Attorney Leslie Wright.
15. United States v. Ryan Long and Billy Burton,
Case. Nos. 18-60144-CR-Dimitrouleas; 18-60164-CR-Dimitrouleas
On May 24, 2018, Ryan Long, 47, of Dunnelon, Florida, was charged by indictment with conspiracy to receive healthcare kickbacks along with six counts of receiving healthcare kickbacks. Billy Burton, 28, of Louisville, Kentucky, was charged by information on June 12, 2018, with causing the misbranding of drugs while held for sale. These charges stem from Long and Burton’s alleged involvement in a $40 million compounding pharmacy fraud scheme, involving TRICARE, spearheaded by Monty Ray Grow, 47, of Tampa, Florida, who was convicted earlier this year in United States v. Monty Ray Grow, Case No. 16-20893-CR-Moreno(s), and recently sentenced to 22 years in prison.
Mr. Greenberg commends the investigative efforts of DCIS, FDA-OCI, and U.S. Army Criminal Investigation Command. This case is being prosecuted by Assistant U.S. Attorney Kevin Larsen.
16. United States v. Asif Uddin and Karl Voeller,
Case Nos. 18-20546-CR-Gayles and 18-20549-CR-Moreno
On June 25, 2018, Asif Uddin, 31, of Kansas City, Missouri, was charged by information with conspiracy to pay and receive healthcare kickbacks in connection with a multi-million dollar fraud scheme purportedly perpetrated on the TRICARE military health benefit program. Uddin, along with Karl Voeller, 33, of Boynton Beach, Florida, who was charged by a separate information on the same date, allegedly conspired with a company based in Miami, Florida to recruit and refer TRICARE beneficiaries to receive prescriptions from pharmacies in Florida and Oklahoma in exchange for kickbacks.
Attorney for the United States Randy A. Hummel commends the investigative efforts of DCIS. These cases are being prosecuted by Assistant U.S. Attorney Kevin J. Larsen.
B. Limited Income Newly Eligible Transition (“LINET”) Program Fraud
According to the criminal charges, filed in the following cases, the defendants allegedly defrauded the Limited Income Newly Eligible Transition (“LINET”) Program of Medicare Part D. The LINET Program exists to ensure that certain low-income individuals who are newly eligible for Medicare benefits receive immediate Part D coverage until they are enrolled in a traditional Medicare Part D prescription drug plan.
17. United States v. Orelbis Gonzalez,
Case No. 18-20477-CR-Gayles
On June 5, 2018, Orelbis Gonzalez, 32, of Miami, Florida, was charged by indictment with conspiracy to commit health care fraud, four counts of health care fraud, conspiracy to commit money laundering and four counts of money laundering.
According to the indictment, the defendant targeted the LINET program of Medicare Part D. Gonzalez was the president and registered agent of Universal Pharmacy Group Inc. (“Universal Pharmacy”), a Miami pharmacy that purportedly provided prescription drugs to Medicare beneficiaries. From June 2015 through September 2015, the defendant submitted and caused the submission of approximately $411,760 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by Universal Pharmacy. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of Universal Pharmacy in the approximate amount of $354,979.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
18. United States v. Dalia Hernandez,
Case No. 18-20474-CR-Altonaga
On June 5, 2018, Dalia Hernandez, 50, of Miami, Florida, was charged by indictment with conspiracy to commit health care fraud and three counts of health care fraud. According to the indictment, the defendant targeted the LINET program of Medicare Part D. Hernandez was the president and registered agent of AAP Pharmacy in Miami Springs, a pharmacy that purportedly provided prescription drugs to Medicare beneficiaries. From April 2014 through July 2014, the defendant submitted and caused the submission of approximately $1,267,368 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by AAP Pharmacy. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of AAP Pharmacy in the approximate amount of $322,331.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
19. United States v. Georvanys Rodriguez Pineda,
Case No. 18-20428-CR-Cooke
On May 22, 2018, Georvanys Rodriguez Pineda, 43, of Miami, Florida, was charged by indictment with conspiracy to commit health care fraud and four counts of health care fraud.
According to the indictment, the defendant targeted the LINET program of Medicare Part D. Pineda was the president and registered agent of Urantia Pharmacy Inc., a Miami pharmacy that purportedly provided prescription drugs to Medicare beneficiaries. From June 2015 through November 2015, the defendant submitted and caused the submission of approximately $1,111,820 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by Urantia Pharmacy. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of Urantia Pharmacy in the approximate amount of $310,490.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
20. United States v. Alexander Sarduy Fuentes, et al.,
Case No. 18-20475-CR-Moreno
On June 5, 2018, Alexander Sarduy Fuentes, 47, and Jorge Victor O’Reilly, 56, both of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and six counts of health care fraud.
Fuentes owned Hello Pharmacy & Discount Inc. (“Hello Pharmacy”), a Miami Gardens pharmacy that purportedly provided prescription drugs to Medicare beneficiaries. O’Reilly owned @ All Pharmacy & Supplies LLC (“All Pharmacy”), a Miami pharmacy that purportedly provided prescription drugs to Medicare beneficiaries. Fuentes, O’Reilly, and others conspired to fraudulently bill the LINET program. From August 2015 through October 2015, the defendants submitted and caused the submission of approximately $539,711 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by All Pharmacy. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of All Pharmacy in the approximate amount of $539,711. From August 2015 through October 2015, the defendants submitted and caused the submission of approximately $346,095 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by Hello Pharmacy. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of Hello Pharmacy in the approximate amount of $274,052.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
C. Additional Pharmacy Fraud Schemes
21. United States v. Antonio Perez, Jr.,
Case No. 18-20528-CR-Moreno
On June 25, 2018, Antonio Perez, Jr., 48, of Miami Beach, Florida, was charged by indictment with one count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud, one count of conspiracy to commit money laundering and two counts of money laundering.
According to the indictment, Perez owned a Miami-area pharmacy called ARA Medical Services Inc., which did business under the name Valles Pharmacy. Between January 2011 and August 2017, Perez allegedly engaged in a conspiracy and scheme to defraud Part D of the Medicare program by causing Valles Pharmacy to be paid approximately $8 million in claims for prescription medications that were not medically necessary, not eligible for reimbursement, and were not provided. As alleged in the indictment, Perez and his co-conspirators carried out the fraudulent scheme by, among other things, paying kickbacks to beneficiaries in exchange for access to their identifying information, which Valles Pharmacy used to submit false and fraudulent claims to Medicare.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Timothy P. Loper.
22. United States v. Maria E. Inda and Ileana Rodriguez,
Case No. 18-20453-CR-Ungaro
On May 31, 2018, Maria E. Inda, 65, and Ileana Rodriguez, 45, both of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and wire fraud and eight counts of health care fraud. Rodriguez was also charged with two counts of money laundering.
According to the indictment, the defendants defrauded the Medicare Part D prescription drug program through two Miami pharmacies. Inda was the president and registered agent of Caribbean Pharmacy Inc. (“Caribbean”), a retail pharmacy that purportedly provided prescription drugs to Medicare beneficiaries. Rodriguez was a pharmacy technician at Caribbean. Later, Rodriguez opened Aqua Pharma Inc. (“Aqua”), a retail pharmacy she controlled with Inda. From May 2009 through September 2016, the defendants allegedly submitted and caused the submission of fraudulent claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that prescription drugs were medically necessary and had been provided by Caribbean and Aqua. The scheme operated through the payment of kickbacks to patient recruiters in exchange for the referral of fraudulent prescriptions. As a result of the fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to Caribbean and Aqua pharmacies in the approximate amount of $6.8 million. The indictment further charges Rodriguez with money laundering based on her purchase of a home and Mercedes Benz, allegedly with proceeds of the Medicare fraud scheme.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.
23. United States v. Ascanio Serna,
Case No. 18-20561-CR-Altonaga
On June 27, 2018, Ascanio Serna, formerly a co-owner of A.S.C. Pharmacy, Inc. ("ASC"), a now-defunct Miami pharmacy, was charged by information with one count of conspiracy to commit health care fraud for his role in a $3.6 million compounding scheme at ASC. As alleged in the information, ASC formulated compounded medications without regard to medical necessity, but rather to maximize profits by increasing the amount that ASC could bill to insurance companies for reimbursement of the specific combinations of ingredients in each compounded cream. To obtain prescriptions for its compounded formulas, ASC paid kickbacks and bribes to marketers and doctors, and waived co-pays to patients.
Mr. Greenberg commends the investigative efforts of HHS-OIG, FBI and DCIS. This case is being prosecuted by DOJ Trial Attorney David Snider.
24. United States v. David Espinosa, Sandy Basulto and Aracelis Basilia Lopez,
Case No. 18-20435-CR-Middlebrooks
On May 24, 2018, David Espinosa, 61, Sandy Basulto, 34, and Aracelis Lopez, 59, all of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and wire fraud and eight counts of health care fraud.
According to the indictment, the defendants defrauded the Medicare Part D prescription drug program through Ultra Pharmacy Discount Corp. (“Ultra Pharmacy”), a retail pharmacy located in Miami. Espinosa was the president and registered agent of Ultra Pharmacy, while Basulto and Lopez served as licensed pharmacy technicians. From March 2013 through February 2015 the defendants allegedly submitted and caused the submission of fraudulent claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that prescription drugs were medically necessary and had been provided by Ultra Pharmacy. The indictment also alleges that the scheme involved payment of kickbacks to patient recruiters in exchange for the referral of fraudulent prescriptions. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to Ultra Pharmacy in the approximate amount of $2.4 million.
Mr. Greenberg commends the investigative efforts of the HHS-OIG, FBI, and U.S. Customs and Border Protection (CBP) Air and Marine. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.
25. United States v. Carlos Garcia, Heidy Garcia and Gisell Aberasturia,
Case No. 18-20514-CR-Moore
On June 14, 2018, Carlos Garcia, 51, of Lake Worth, Florida and Heidy Garcia, 24, and Gisell Aberastria, 52, both of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and wire fraud and nine counts of health care fraud.
According to the indictment, the defendants defrauded the Medicare Part D prescription drug program through retail pharmacies Capital Drugs in Miami, Green Hope Pharmacy in Miami and American Drugs Pharmacy in Lake Worth. Garcia was the president and registered agent of Capital Drugs and a beneficial owner of Green Hope Pharmacy and American Drugs, while Aberasturia was the president and registered agent for Green Hope Pharmacy. Garcia served as a licensed pharmacy technician at Capital Drugs, Green Hope Pharmacy and American Drugs Pharmacy. From March 2013 through June 2018 the defendants allegedly submitted and caused the submission of fraudulent claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that prescription drugs were medically necessary and had been provided by Capital Drugs, Green Hope and American Drugs. The indictment also alleges that the scheme involved payment of kickbacks to patient recruiters in exchange for the referral of fraudulent prescriptions. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to Capital Drugs, Green Hope Pharmacy and American Drugs Pharmacy in the approximate amount of $2.5 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.
26. United States v. Gregory Sanchez,
Case No. 18-20513-CR-Ungaro
On June 14, 2018, Gregory Sanchez, 43, of Miami, Florida, a co-owner of Med Health Equipment, LLC (“Med Health”), a now-defunct Miami pharmacy, was charged by indictment with one count of conspiracy to commit health care fraud, six counts of health care fraud, one count of conspiracy to commit money laundering, and six counts of money laundering, for his alleged role in a scheme that caused Part D of the Medicare program to pay Med Health $2.5 million for prescription drugs that the pharmacy never actually purchased or provided to Medicare beneficiaries. As alleged in the indictment, Sanchez and his co-conspirators carried out the fraudulent scheme by, among other things, paying kickbacks to patient recruiters in exchange for Medicare beneficiaries’ identifying information, which Med Health used to submit false and fraudulent claims to Medicare. To generate the cash needed to pay the patient recruiters, Sanchez allegedly laundered the proceeds of the fraud by cashing checks disguised as compensation.
Mr. Greenberg commends the investigative efforts of HHS-OIG and FBI. This case is being prosecuted by DOJ Trial Attorney David Snider.
27. United States v. Arturo Paez Martinez,
Case No. 18-20545-CR-Scola
On June 25, 2018, Arturo Paez Martinez, 65, of Miami, Florida, was charged by information with one count of conspiracy to commit health care fraud and wire fraud and four counts of health care fraud.
According to the information, Martinez owned a Miami-area pharmacy called Versalles Pharmacy. Between March 2014 and June 2015, Perez allegedly engaged in a conspiracy and scheme to defraud Part D of the Medicare program by causing Versalles Pharmacy to be paid approximately $1.2 million in claims for prescription medications that were not medically necessary, not eligible for reimbursement, and not provided. As alleged in the indictment, Martinez and his co-conspirators carried out the fraudulent scheme by, among other things, paying kickbacks to patient recruiters in exchange for Medicare beneficiaries’ identifying information, which Versalles Pharmacy used to submit false and fraudulent claims to Medicare.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Timothy P. Loper.
28. United States v. Augustine Oranusi and Daylet Martinez,
Case No. 18-20527-CR-Ungaro
On June 19, 2018, Augustine Oranusi, 52, and Daylet Martinez, 35, both of Miami, Florida, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud, five counts of health care fraud, and conspiracy to commit money laundering.
According to the indictment, Oranusi was a pharmacist and Martinez was a pharmacy technician, and together they owned a Miami-area pharmacy called Evergreen Pharmacy. Between March 2013 and October 2016, Oranusi and Martinez engaged in a conspiracy and scheme to defraud Part D of the Medicare program by causing Evergreen Pharmacy to be paid approximately $1.6 million in claims for prescription medications that were never actually purchased or provided to Medicare beneficiaries. As alleged in the indictment, Oranusi, Martinez, and their co-conspirators carried out the fraudulent scheme by, among other things, paying kickbacks to patient recruiters in exchange for Medicare beneficiaries’ identifying information, which Evergreen Pharmacy used to submit false and fraudulent claims to Medicare.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Timothy P. Loper.
29. United States v. Alian Miranda,
Case No. 18-20434-CR-Williams
On May 24, 2018, Alian Miranda, 30, of Miami, Florida, was charged by indictment with conspiracy to commit health care fraud and wire fraud and nine counts of health care fraud.
According to the indictment, the defendant defrauded the Medicare Part D prescription drug program through Rodriguez Pharmacy Corp (“Rodriguez Pharmacy”), a retail pharmacy owned by Miranda and located in Miami, Florida. From October 2014 through July 2017 the defendant allegedly submitted and caused the submission of fraudulent claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that prescription drugs were medically necessary and had been provided by Rodriguez Pharmacy. The indictment also alleges that the scheme involved payment of kickbacks to Medicare beneficiaries and other co-conspirators in exchange for the referral of fraudulent prescriptions. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to Rodriguez Pharmacy in the approximate amount of $1.3 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.
30. United States v. Oscar Guardarrama, Sandy Basulto and Noemi Delgado,
Case No. 18-20508-CR-Altonaga
On June 14, 2018, Oscar Guardarrama, 62, Sandy Basulto, 34, and Noemi Delgado, 27, all of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and wire fraud and eleven counts of health care fraud.
According to the indictment, the defendants defrauded the Medicare Part D prescription drug program through Antares Pharmacy Discount Corp. (“Antares Pharmacy”), a retail pharmacy located in Miami. Guardarrama was the president and registered agent of Antares Pharmacy, while Basulto and Delgado served as licensed pharmacy technicians. From February 2014 through June 2018 the defendants allegedly submitted and caused the submission of fraudulent claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that prescription drugs were medically necessary and had been provided by Antares Pharmacy. The indictment also alleges that the scheme involved payment of kickbacks to patient recruiters, including Delgado, in exchange for the referral of fraudulent prescriptions. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to Antares Pharmacy in the approximate amount of $1.7 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.
31. United States v. Nieves Suarez, et al.,
Case No. 18-20175-CR-Cooke(s)
On June 12, 2018, Nieves Suarez, 48, Arlety Guerra Prieto, 45, and Mariela Quintana, 49, all of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and four counts of health care fraud.
According to the indictment, Suarez was the president and registered agent of Golden Owl Pharmacy & Discount Corp. (“Golden Owl Pharmacy”), a Miami pharmacy that purportedly provided prescription drugs to Medicare beneficiaries, from January 3, 2011 to November 30, 2012, and secretary from November 30, 2012, to on or about March 10, 2015. Prieto was president and registered agent of Golden Owl Pharmacy from November 30, 2012, until the dissolution of the corporation on September 25, 2015. Quintana was a co-owner of Golden Owl Pharmacy. From October 2012 through March 2015, the defendants submitted and caused the submission of approximately $915,784 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by Golden Owl Pharmacy. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of Golden Owl Pharmacy in the approximate amount of $915,784.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
32. United States v. Raiza Del Carmen De Leon and Julio Cesar De Leon,
Case No. 18-20436-CR-Scola
On May 24, 2018, Raiza Del Carmen De Leon, 38, and Julio Cesar De Leon, 42, a husband and wife of Miami Springs, Florida, were charged by indictment with conspiracy to commit health care fraud and wire fraud and eight counts of health care fraud.
According to the indictment, the defendants defrauded the Medicare Part D prescription drug program through Miramar Pharmacy and Discount Inc. (“Miramar Pharmacy”), a retail pharmacy co-owned by the De Leons and located in Miramar, Florida. From October 2014 through November 2015 the defendants submitted and caused the submission of fraudulent claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that prescription drugs were medically necessary and had been provided by Miramar Pharmacy. The indictment also alleges that the scheme involved payment of kickbacks to patient recruiters in exchange for the referral of fraudulent prescriptions. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to Miramar Pharmacy in the approximate amount of $700,000.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.
33. United States v. Yordanka Pedroso,
Case No. 18-20451-CR-Scola
On May 31, 2018, Yordanka Pedroso, 41, of Miami, Florida, was indicted on one count of conspiracy to defraud the United States and pay and receive healthcare kickbacks.
According to the indictment, Pedroso allegedly participated in the fraudulent scheme by agreeing with the owners and operators of pharmacies to receive kickbacks and bribes in exchange for providing her own personal Medicare information, as well as the personal information of a co-conspirator Medicare beneficiary who she recruited. The pharmacies then allegedly used this information to bill Medicare for medical items and services that were medically unnecessary, not provided to the defendant and her co-conspirator, and never purchased. The defendant also paid her co-conspirator Medicare beneficiary kickbacks and bribes. As a result of Pedroso’s participation in the scheme, Medicare paid approximately $134,799 to the pharmacies.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Yisel Valdes.
34. United States v. Ricardo Vento,
Case No. 18-CR-20559-Williams
On June 27, 2018, Ricardo Vento, 71, of Miami, Florida, was charged by information with one count of soliciting and receiving illegal health care bribes and kickbacks in connection with a federal health care program. The information alleges Vento received approximately $16,200 in kickbacks. In total, Medicare paid more than $95,000 but less than $150,000 for services purportedly provided to the Medicare beneficiaries referred by Vento.
Mr. Greenberg commends the investigative efforts of the FBI, HHS-OIG and USSS. This case is being prosecuted by DOJ Trial Attorney Adam G. Yoffie.
35. United States v. Alexandria Suhanov,
Case No. 18-20560-CR-Martinez
On June 27, 2018, Alexandria Suhanov, 37, of Cornelius, North Carolina, was charged by information with one count of conspiracy to commit health care fraud. According to the information, Suhanov was the receptionist of American Pain Management, a pain management clinic located in Tamarac, Florida. She later worked at Pacific Pharmacy, a Miami-area pharmacy. Both American Pain Management and Pacific Pharmacy were owned by Scott Novick, who was simultaneously charged by separate information with one count of conspiracy to dispense and distribute controlled substances (Case No. 18-20563-CR-Moore). According to the information filed against Suhanov, between January 2009 through April 2018, American Pain Management and Pacific Pharmacy submitted false and fraudulent claims to Medicare, including claims for controlled substances and office visits that lacked any legitimate medical necessity. American Pain Management submitted approximately $785,420 in claims to Medicare, and Pacific Pharmacy submitted approximately $1,035,969 in claims to Medicare.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Trial Attorney Timothy P. Loper.
IV. HOME HEALTH CARE FRAUD – Medicare Part A
36. United States v. Berto Arias Carrasco,
Case No. 18-20558-CR-Moreno
On June 27, 2018, Berto Arias Carrasco, 55, of Pembroke Pines, Florida, was charged by information with one count of conspiracy to commit health care fraud. The charge arises from Arias Carrasco’s role as the nominee owner and operator of a Miami home health care agency, New Life Home HealthCare Inc. (“New Life”).
The information alleges that Arias Carrasco falsely represented himself as the true owner of New Life, which was in fact owned by a co-conspirator. It further alleges that Arias Carrasco and a co-conspirator paid kickbacks to patient recruiters in exchange for referring Medicare beneficiaries, many of whom did not qualify for or need home health services, to New Life, and that Arias Carrasco and a co-conspirator issued checks to be cashed in order to pay kickbacks. As a result of this scheme, Medicare paid over $15 million in false and fraudulent claims.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright. Maryland Assistant U.S. Attorney Jessica Collins, formerly of the Fraud Section, assisted in charging this case.
37. United States v. Maricela P. Chavez et al.,
Case No. 18-20501-CR-Altonaga
On June 12, 2018, Maricela P. Chavez, 57, of Miami, Florida, Rene Guerra, 57, of Miami Beach, Florida, Esther Aguilera Escalona, 60, of Miami, Florida, Ricardo Fajardo, a/k/a “Evelyn Tiffany,” 63, of Miami, Florida, Yurisday Hernandez, 45, of Miami, Florida, and Arelys Perez Cuesta, 50, of Hialeah, Florida, were charged by indictment with conspiracy to commit health care fraud, conspiracy to defraud the U.S. and pay and receive healthcare kickbacks and payment of kickbacks in connection with a federal health care program. Guerra was also charged with conspiracy to commit health care fraud and conspiracy to defraud the U.S. and pay and receive healthcare kickbacks.
According to the indictment, the defendants participated in a scheme to defraud Medicare using their connections to ACM Home Health Corp., located in Miami, and TC Home Health Care, Inc., located in Hialeah, home health agencies. The indictment alleges that Guerra was the registered owner of TC Home Health Care, Inc., while Chavez was the operator of, and Escalona, Fajardo, Hernandez, and Cuesta were patient recruiters for, ACM Home Health Corp. and TC Home Health Care, Inc.
The defendants allegedly conspired to defraud Part A of the Medicare program of $14 million by billing for home health services that were not rendered and paying kickbacks to patient recruiters and patients in exchange for patient referrals.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. Assistant U.S. Attorney Miesha Shonta Darrough is prosecuting this case.
38. United States v. Alexander Ros Lazo and Misleidy Ibarra,
Case No. 18-CR-20536-Martinez
On June 21, 2018, Alexander Ros Lazo, 53, of Homestead, Florida, an owner and operator of T.L.C. Health Services, Inc. (“T.L.C.”), a home health agency in Miami-Dade County, and Misleidy Ibarra, 45, of Homestead, Florida, a licensed massage therapist, were indicted on one count of conspiracy to commit health care fraud and wire fraud. Misleidy Ibarra was also indicted on three counts of health care fraud. Ros Lazo was also indicted on four counts of health care fraud, one count of conspiracy to defraud the United States and pay and receive health care kickbacks, and two counts of payment of bribes and kickbacks in connection with a federal health care program.
The charges stem from Ros Lazo’s alleged role in a fraud scheme where he paid kickbacks and bribes to his co-conspirators in exchange for home health services prescriptions and the referral of Medicare beneficiaries to T.L.C. Ros Lazo and Ibarra also agreed with their co-conspirators to commit health care fraud by arranging for Ibarra to render physical and occupational therapy services to Medicare beneficiaries when Ibarra was not licensed to provide these services. As a result of the defendants’ role in the fraudulent scheme, Medicare paid approximately $8.6 million to T.L.C.
Mr. Greenberg commends the investigative efforts of FBI and HHS-OIG and U.S. Customs and Border Protection (CBP) Air and Marine. The case is being handled by DOJ Trial Attorney Yisel Valdes.
39. United States v. Evelio Ramirez and Rossana P. Ramirez,
Case No. 18-20534-CR-Cooke
On June 21, 2018, Evelio Ramirez, 58, and Rossana P. Ramirez, 58, both of Miami, Florida, were charged by information with conspiracy to commit health care fraud. The charge stems from their alleged roles at F&E Home Health Care, Inc., a home health agency in Miami that defrauded Part A of the Medicare program of $7.1 million and Medicaid of $368,972 by billing for home health services that were not provided to Medicare and Medicaid beneficiaries and paying kickbacks to patient recruiters in exchange for patient referrals.
Mr. Greenberg commends the investigative efforts of the FBI, HHS-OIG and the State of Florida Medicaid Fraud Control Unit. Assistant U.S. Attorney Miesha Shonta Darrough is prosecuting this case.
40. United States v. Nelson Anzardo Calzadilla, et al.,
Case No. 18-20512-CR-Martinez
On June 14, 2018, Nelson Anzardo Calzadilla, 55, and Milena Gonzalez, 53, both of Miami, were charged by indictment in connection with their alleged roles in a home health care fraud and kickback scheme involving numerous Miami-area home health agencies. Calzadilla was charged with one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to defraud the United States and to pay and receive health care kickbacks. Gonzalez was charged with one count of conspiracy to defraud the United States and to pay and receive health care kickbacks and three counts of receiving health care kickbacks.
The indictment alleges that Calzadilla, who owned three home health agencies, concealed the ownership interest of his co-owner, paid kickbacks to patient recruiters in return for referring Medicare beneficiaries, and caused the submission of false and fraudulent claims for services that were not medically necessary, not rendered, and procured through kickbacks and bribes. The indictment alleges that Gonzalez referred Medicare beneficiaries to various Miami-area home health agencies in exchange for kickbacks and that she paid kickbacks to the owners and operators of a Miami-area medical clinic in order to purchase home health therapy prescriptions. The indictment further alleges that, as a result of false and fraudulent claims submitted as part of the charged conspiracy to commit health care fraud and wire fraud, Medicare made payments of at least $6.1 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright. Maryland Assistant U.S. Attorney Jessica Collins, formerly of the Fraud Section, assisted in charging this case.
41. United States v. Margarita Palomino, et al.,
Case No. 18-20487-CR-Martinez
On June 7, 2018, Margarita Palomino, 54, of Homestead, Florida, and Norma Zayas, 29, of Miami, Florida, were indicted in connection with their alleged roles in several home health care fraud and kickback schemes involving at least six Miami-area home health agencies, which fraudulently billed Medicare for claims that were not necessary, for services not rendered, and for claims procured through kickbacks and bribes.
Palomino and Zayas were charged with conspiracy to commit health care fraud and wire fraud, arising from their involvement with several home health agencies, including Sunshine Home Health Care Services, Inc., Empire Home Health Agency, Inc., and Mildred & Marce Home Hea1th Care Services, Inc. The indictment alleges that, as a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of at least $4.65 million.
Palomino was also charged with one count of conspiracy to commit health care fraud and wire fraud, one count of conspiracy to defraud the United States and to pay and receive health care kickbacks, and two counts of making false statements relating to health care matters arising from her conduct involving Summer Health Care, Inc. and Excellent Home Health Care, Inc. The indictment further alleges that, as a result of this health care and wire fraud conspiracy, Medicare made payments of at least $1.89 million.
Finally, Zayas was also charged with one count of conspiracy to defraud the United States and to pay and receive health care kickbacks and two counts of paying health care kickbacks arising from her involvement with Nursing Care PRN, Inc. As a result of this kickback conspiracy, the indictment alleges that Medicare paid Nursing Care PRN, Inc. at least approximately $1.12 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright. Maryland Assistant U.S. Attorney Jessica Collins, formerly of the Fraud Section, assisted in charging this case.
42. United States v. Daymi Arias Bofill,
Case No. 18-20562-CR-Cooke
On June 27, 2018, Daymi Arias Bofill, 41, of Miami, Florida, was charged by information with one count of conspiracy to commit health care fraud. The charge arises from Arias Bofill’s role as an operator of New Life Home HealthCare Inc. (“New Life Home Health”), Empire Home Health Agency, Inc. (“Empire Home Health”), City of Angels Home Health Care, LLC (“City of Angels Home Health”), and Miami-Dade Home Health Care Inc. (“Miami-Dade Home Health”). The information alleges that Arias Bofill falsely and fraudulently represented herself as the owner of City of Angels Home Health and Miami-Dade Home Health, which in fact were owned by a co-conspirator. The information further alleges that Arias Bofill and a co-conspirator paid kickbacks to patient recruiters in return for the referral of Medicare beneficiaries, many of whom did not qualify for or need home health services, to New Life Home Health, Empire Home Health, City of Angels Home Health, and Miami-Dade Home Health. As a result of false and fraudulent claims submitted in connection with the scheme, Medicare made payments totaling over $4.6 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright. Maryland Assistant U.S. Attorney Jessica Collins, formerly of the Fraud Section, assisted in charging this case.
43. United States v. Liannelys Gonzalez,
Case No. 18-20450-CR-Moore
On May 31, 2018, Liannelys Gonzalez, 28, of Miami, Florida, was charged by indictment with conspiracy to commit health care fraud and wire fraud and ten counts of health care fraud. According to the indictment, Gonzalez was the owner of Exclusive Home Care, Inc. (“Exclusive”). The indictment alleges that Gonzalez and her co-conspirators submitted claims to Medicare via interstate wire transfers which fraudulently and falsely represented that home health care services were medically necessary, prescribed by a doctor, and provided to Medicare beneficiaries when, in fact, they were not medically necessary and not provided. As a result of these false and fraudulent claims, Medicare made approximately $4,460,679 in payments to Exclusive.
Mr. Greenberg commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney James V. Hayes, formerly an Assistant U.S. Attorney in the Southern District of Florida.
44. United States v. Juliette Anais Tamayo,
Case No. 18-20535-CR-Altonaga
On June 21, 2018, Juliette Anais Tamayo, 53 of Miami, Florida, was charged by indictment with one count of conspiracy to pay and receive illegal health care bribes and kickbacks in connection with a federal health care program, one count of conspiracy to commit health care fraud, and two counts of health care fraud. The indictment charges Tamayo with participating in a conspiracy that allegedly caused a loss of approximately $3.6 million to the Medicare program. The charges arise from Tamayo’s ownership of Sunshine Medical Care Group, Inc., which submitted claims to Medicare for services that did not occur, and unlawfully sold prescriptions for medically unnecessary home health services.
Mr. Greenberg commends the investigative efforts of the FBI, HHS-OIG and USSS. This case is being prosecuted by DOJ Trial Attorneys Drew Bradylyons and Adam G. Yoffie.
45. United States v. Gilberto Hernandez,
Case No. 18-20488-CR-Gayles
On June 7, 2018, Gilberto Hernandez, 43, of Miami, Florida, was charged by indictment with three counts of health care fraud. According to the indictment, Hernandez was the owner of Advance Home Care Services, Inc. (“Advance”). The indictment alleges that Hernandez submitted claims to Medicare which fraudulently and falsely represented that home health care services were medically necessary, prescribed by a doctor, and provided to Medicare beneficiaries when, in fact, they were not medically necessary and not provided. As a result of these false and fraudulent claims, Medicare made approximately $3,386,162 in payments to Advance.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted DOJ Trial Attorney James V. Hayes, formerly an Assistant U.S. Attorney in the Southern District of Florida.
46. United States v. Jaqueline Monteserin, et al.,
Case No. 18-20537-CR-Martinez
On June 21, 2018, Jaqueline Monteserin, 45, of Homestead, Florida, and Cela Loaces Hernandez, 54, and Alejandro Fernandez, 47, both of Miami, Florida, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud, one count of conspiracy to defraud the United States and pay and receive health care kickbacks, and two counts each of receiving health care kickbacks. The charges stem from the defendants’ involvement with D&Y Pharmacy Discount, Corp. (“D&Y Pharmacy”) and Florida Pharmacy, Inc. (“Florida Pharmacy”), which fraudulently billed Medicare for prescription drugs that were medically unnecessary, not eligible for reimbursement, and never provided.
The indictment alleges that from approximately February 2014 to July 2016, the defendants accepted kickbacks in return for referring Medicare beneficiaries to D&Y Pharmacy and Florida Pharmacy to serve as patients. The indictment further alleges that the defendants provided fraudulent prescriptions obtained from medical clinics, including two clinics operated by Monteserin and Loaces – Double R Therapy Center, Inc. (“Double R”) and Mediglez Wellness Center, Inc. (“Mediglez”) – for the recruited beneficiaries.
The indictment also charges Monteserin and Loaces with an additional count of conspiracy to commit health care fraud and wire fraud, based on their roles in a home health care fraud scheme. The indictment alleges that from approximately December 2014 to June 2015, Monteserin and Loaces accepted kickbacks in return for home health prescriptions from Double R and Mediglez for Medicare beneficiaries, many of whom did not need or qualify for home health services. The indictment further alleges that Monteserin and Loaces accepted kickbacks in return for referring Medicare beneficiaries to D&D&D Home Health Care, Inc. (“D&D&D”) to serve as patients, and that they provided falsified prescriptions for the beneficiaries they referred to D&D&D. According to the indictment, as a result of false and fraudulent claims submitted by D&D&D and other Miami-area home health agencies in connection with the scheme, Medicare made payments of at least $3.2 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright. Maryland Assistant U.S. Attorney Jessica Collins, formerly of the Fraud Section, assisted in charging the case.
47. United States v. Israel Rodriguez Medina,
Case No. 18-20551-CR-Scola
On June 26, 2018, Israel Rodriguez Medina, 40, of Miami, Florida, the owner of First RN, Inc., a home health agency located in Miami, was charged by indictment with one count of conspiracy to commit health care fraud and three counts of health care fraud for his alleged role in a $1.6 million scheme. The charges arise from his ownership of First RN, which billed Medicare for home health services that were not medically necessary and/or not provided to Medicare beneficiaries.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. The case is being prosecuted by Assistant U.S. Attorney Karen Stewart and DOJ Trial Attorney Adam Yoffie.
48. United States v. Tania Gudin,
Case No. 18-20505-CR-Moore
On June 12, 2018, Tania Gudin, 54, of Miami, Florida, was charged by indictment with one count of conspiracy to commit health care fraud, one count of conspiracy to defraud the United States and pay and receive health care kickbacks, and five counts of receiving health care kickbacks. The indictment alleges that from approximately July 2011 to November 2014, Gudin accepted kickbacks in return for referring Medicare beneficiaries to various Miami-area home health agencies to serve as patients. The indictment further alleges that Gudin and her co-conspirators caused the submission of false and fraudulent claims to Medicare for home health services purportedly provided to the recruited beneficiaries, as a result of which Medicare made payments of at least $1.36 million.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright. Maryland Assistant U.S. Attorney Jessica Collins, formerly of the Fraud Section, assisted in charging this case.
49. United States v. Niurka Herrera,
Case No. 18-20539-CR-Moore
On June 21, 2018, Niurka Herrera, 49, of Hialeah, Florida, a patient recruiter was indicted on one count of conspiracy to defraud the United States and pay and receive healthcare kickbacks, and three counts of receipt of kickbacks in connection with a federal health care program. The charges stem from the defendant’s alleged role in a scheme where she agreed with her co-conspirators to pay and receive kickbacks and bribes in exchange for referring Medicare beneficiaries to home health agencies and a medical clinic. As a result of the defendant’s role in the scheme, Medicare paid approximately $153,772.28 to various home health agencies.
Mr. Greenberg commends the investigative efforts of FBI and HHS-OIG. The case is being handled by DOJ Trial Attorney Yisel Valdes.
50. United States v. Rosa Maria Baez,
Case No. 18-20428-CR-Ungaro
On May 22, 2018, Rosa Maria Baez, 44, of Hialeah, Florida, the owner of home health agency Eternity Life Health Care, Inc., in Miami Lakes, was charged by indictment with conspiracy to defraud the United States and pay health care kickbacks and payment of kickbacks in connection with a federal health care program. The charges stem from her involvement in a home health fraud scheme involving kickback payments to patient recruiters, patients, and clinic owners in exchange for patient referrals. The loss amount is approximately $253,049.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. Assistant U.S. Attorney Miesha Shonta Darrough is prosecuting this case.
51. United States v. Yamilet Diaz,
Case No. 18-20473-CR-Cooke
On June 5, 2018, Yamilet Diaz, 50, of Hialeah, Florida, was charged by indictment with one count of conspiracy to defraud the United States and receive health care kickbacks and four counts of receiving health care kickbacks. The charges stem from Diaz’s alleged role as a patient recruiter for Good Friends Services, Inc. (“Good Friends”), a now-defunct home health agency located in Hialeah Gardens, Florida. The indictment alleges that from approximately October 2012 to June 2013, Diaz received kickbacks in return for referring Medicare beneficiaries to Good Friends to serve as patients. The indictment further alleges that Diaz and her co-conspirators caused Medicare to make over $600,000 in payments to Good Friends based upon claims for home health services submitted on behalf of the beneficiaries recruited by Diaz.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright.
52. United States v. Miriam Pardo,
Case No. 18-20504-CR-Moreno
On June 12, 2018, Miriam Pardo, 72, of Miami, Florida, was charged by indictment with one count of conspiracy to pay and receive health care kickbacks. The indictment alleges that from approximately July 2009 to at least November 2013, Pardo accepted kickbacks in return for referring Medicare beneficiaries from her clinic, Gables Medical Care Inc. (“Gables Medical Care”), to various Miami-area home health agencies to serve as patients. The indictment further alleges that Pardo accepted kickbacks in return for prescriptions for home health care and related medical records signed by a physician who worked at Gables Medical Care.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Leslie Wright.
V. PRIVATE INSURANCE FRAUD (NON-MEDICARE)
53. United States v. Carlos Aguilar and Lyzt de Dios,
Case No. 18-20382-CR-Lenard
On May 8, 2018, Carlos Aguilar, M.D., 75, and Lyzt de Dios, 32, both of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud health care fraud and four counts of health care fraud.
According to the indictment, Star Relief Center, LLC was a Miami medical clinic that purportedly provided private insurance beneficiaries with various medical treatments and services. Carlos Aguilar was a practicing physician. From January 2016 through September 2017, Dr. Aguilar and Lyzt de Dios submitted and caused the submission of claims, via interstate wires, totaling approximately $1,170,570 which allegedly falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by caused Star Relief Center to insurance beneficiaries of BCBS. As a result of such false and fraudulent claims, BCBS made payments to the corporate bank accounts of caused Star Relief Center in the approximate amount of $748,632.
Mr. Greenberg commends the investigative efforts of the FBI. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
54. United States v. Frederick J. Baptista and Rafael Andres Cepeda,
Case No. 18-20476-CR-Ungaro
On June 5, 2018, Frederick Jose Baptista, 42, and Rafael Andres Cepeda, 48, both of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and six substantive counts of health care fraud.
According to the indictment, Baptista was the registered agent and president and Cepeda the vice-president of B&C Rehabilitation Center, a Miami medical clinic that purportedly provided private insurance beneficiaries with various medical treatments and services. From January 2014, through April 2017, Baptista and Cepeda submitted and caused the submission of claims, via interstate wires, totaling approximately $3,404,524, which allegedly falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by B&C Rehabilitation Center to insurance beneficiaries of BCBS. As a result of such false and fraudulent claims, BCBS made payments to the corporate bank accounts of B&C Rehabilitation Center in the approximate amount of $568,175.
Mr. Greenberg commends the investigative efforts of the FBI. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
55. United States v. Pavel Hernandez Merino, et al.,
Case No. 18-20381-CR-Altonaga
On May 8, 2018, Pavel Luis Hernandez Merino, 36, Pablo Armando Orozco, 42, Pablo D. Orozco, 66, Carlos Ernesto Aguilar, 75, Juan Francisco Nin, 32, and Yosniel Blanco Salcines, 35, all of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud health care fraud and eighteen counts of health care fraud.
According to the indictment, Merino, Pablo A. Orozco, and Pablo D. Orozco owned medical clinics that purportedly provided private insurance beneficiaries with various medical treatments and services. Aguilar was a practicing physician. Nin and Salcines recruited patients that were referred to BBB Medical, Michael Professional, Anthony Professional, Sun Medical, and Americare, Miami medical clinics that purportedly provided private insurance beneficiaries with various medical treatments and services. From July 2014 through July 2017, Merino, Pablo A. Orozco, Pablo D. Orozco, Aguilar, Nin, and Salcines submitted and caused the submission of claims, via interstate wires, totaling approximately $30,365,060 which allegedly falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by BBB Medical, Michael Professional, Anthony Professional, Sun Medical, and Americare to insurance beneficiaries of BCBS. As a result of such false and fraudulent claims, BCBS made payments to the corporate bank accounts of BBB Medical, Michael Professional, Anthony Professional, Sun Medical, and Americare in the approximate amount of $13,615,398.
Mr. Greenberg commends the investigative efforts of the FBI. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
56. United States v. Sergio Lemus Carratala, Francel Rodriguez,
Case No. 18-20368-CR-Williams
On May 8, 2018, Sergio Lemus Carratala, 30, and Francel Rodriguez, 39, both of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and six counts of health care fraud.
According to the indictment, Carratala and Rodriguez were employees of Billing USA, Corp., a medical billing company that served as an intermediary between medical offices and clinics, and insurance companies. From January 2013 through February 2017, Carratala and Rodriguez, together with unindicted conspirators, submitted and caused the submission of claims, via interstate wires, totaling approximately $5,692,102, which allegedly falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by Blue Diamond Medical Center Inc. (“Blue Diamond”), to insurance beneficiaries of BCBS. Blue Diamond was a Miami medical clinic that purportedly provides private insurance beneficiaries with various medical treatments and services. As a result of such false and fraudulent claims, BCBS made payments to the corporate bank accounts of Blue Diamond in the approximate amount of $653,893.
The indictment additionally alleged that Carratala and Rodriguez, along with unindicted conspirators, submitted and caused the submission of claims, via interstate wires, totaling approximately $5,943,053, which falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by Salvus, LLC, to insurance beneficiaries of BCBS. Salvus, LLC was a Miami medical clinic that purportedly provides private insurance beneficiaries with various medical treatments and services. As a result of such false and fraudulent claims, BCBS made payments to the corporate bank accounts of Salvus, LLC in the approximate amount of $1,638,378.
Mr. Greenberg commends the investigative efforts of the FBI. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
57. United States v. Yosbel Otano Melendez and Yareli Paula,
Case No. 18-20502-CR-Martinez
On June 12, 2018, Yosbel Otano Melendez, 39, and Yareli Paula, 41, both of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and eight counts of health care fraud.
According to the indictment, Melendez and Paula allegedly recruited patients that were referred to Atlantic Mobile Services, Inc., a Miami medical clinic that purportedly provided private insurance beneficiaries with various medical treatments and services. From February 2013 through May 2016, Yosbel Otano Melendez and Yareli Paula submitted and caused the submission of claims, via interstate wires, totaling approximately $1,517,600, which falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by Atlantic Mobile Services to insurance beneficiaries of BCBS. As a result of such false and fraudulent claims, BCBS made payments to the corporate bank accounts of Atlantic Mobile Services in the approximate amount of $980,243.
Mr. Greenberg commends the investigative efforts of the FBI. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
58. United States v. Clara Salazar-Vust, et al.,
Case No. 18-201243-CR-Altonaga
On April 3, 2018, Clara Salazar-Vust, 68, Olga Alvarado, 47, and Roberto Perez, 47, all of Miami, Florida, were charged by indictment with conspiracy to commit health care fraud and four substantive counts of health care fraud.
According to the indictment, Salazar-Vust, Alvarado, and Perez owned Salvus, LLC, a medical Miami clinic that purportedly provided private insurance beneficiaries with various medical treatments and services. From January 2013 through March 2018, the defendants allegedly submitted and caused the submission of claims, via interstate wires, totaling approximately $5,943,053, which falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by Salvus, LLC, to insurance beneficiaries of BCBS. As a result of such false and fraudulent claims, BCBS made payments to the corporate bank accounts of Salvus, LLC in the approximate amount of $1,638,378.
Mr. Greenberg commends the investigative efforts of the FBI. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
59. United States v. Ivan Sierra,
Case No. 18-20548-CR-Gayles
On June 25, 2018, Ivan Sierra, 54, of Miami, Florida, was charged by information with one count of conspiracy to commit money laundering. The information charges Sierra with laundering approximately $937,000 for various physical therapy clinics in the Miami area. The cash generated from the laundering activity was allegedly used to pay kickbacks to patients for whom the clinics billed physical therapy services that were not medically necessary to private insurance companies.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Timothy P. Loper.
A criminal complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov
Six men indicted for crimes related to child pornography or child exploitationRead the Press Release
Six people were indicted in federal court for crimes related to child pornography or child exploitation.
Indicted are Jason Warner, 27, of Massillon; Austin Lloyd, 31, of Ravenna; Nicholas Snyder, 36, of Wooster; Andrew Pitts, 36, of Youngstown; Justin McKnight, 36, of North Canton, and Allen Bernhardt, 30, of Canton. Their cases are not otherwise related.
Warner was charged with transporting visual depictions of minors engaged in sexually explicit conduct. Warner in October 2016 used a computer to transport numerous computer files which contained visual depictions of real minors engaged in sexually explicit conduct, according to the indictment.
Lloyd was charged with receiving, distributing and possessing visual depictions of minors engaged in sexually explicit conduct. He knowingly received and distributed numerous computer files between 2015 and 2018 which contained visual depictions of real minors engaged in sexually explicit conduct. Lloyd possessed a cellular phone on June 7 which contained child pornography, according to the indictment.
Snyder was charged with receiving, distributing and possessing visual depictions of minors engaged in sexually explicit conduct. In June 2017, Snyder knowingly received and distributed numerous computer files which contained visual depictions of real minors engaged in sexually explicit conduct. Snyder on July 18, 2017, also possessed a cellular phone which contained child pornography, according to the indictment.
Pitts was charged with enticement. The Indictment charges from around Feb. 25-26, 2018, Pitts did knowingly use facilities and means of interstate and foreign commerce, that is, a cell phone, to attempt to persuade, induce, entice and coerce an individual who had not attained the age of 18 years, that is, a 12-year-old boy to engage in illegal sexual activity with him, according to the indictment.
McKnight was charged with receiving, distributing and possessing visual depictions of minors engaged in sexually explicit conduct. The Indictment charges that from Jan. through March 30, 2018, McKnight knowingly received and distributed numerous computer files which contained visual depictions of real minors engaged in sexually explicit conduct. The indictment also charges that on or about April 24, 2018, Richards possessed a Samsung cellphone and an HP Blue laptop computer that contained child pornography.
Bernhardt was charged with receiving, distributing and possessing visual depictions of minors engaged in sexually explicit conduct. The Indictment charges from Dec. 29, 2017 through March 22, 2018, Bernhardt knowingly received and distributed numerous computer files which contained visual depictions of real minors engaged in sexually explicit conduct. The indictment also charges that on or about March 23, 2018, Bernhardt possessed a Motorola Droid cell phone that contained child pornography.
If convicted, the defendant’s sentence will be determined by the Court after review of factors unique to this case, including the defendant’s prior criminal record, if any, the defendant's role in the offense and the characteristics of the violation. In all cases the sentence will not exceed the statutory maximum and in most cases it will be less than the maximum.
The cases are being prosecuted by Assistant U.S. Attorneys Michael A. Sullivan and Carole Skutnik following investigations by the Federal Bureau of Investigation and the Ohio Internet Crimes Against Children Task Force, Ohio Bureau of Criminal Investigation and the Mahoning Valley Human Trafficking Task Force
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
Sioux Falls Man Sentenced for Failure to RegisterRead the Press Release
United States Attorney Ron Parsons announced that a Sioux Falls, South Dakota, man convicted of Failure to Register as a Sex Offender was sentenced on June 27, 2018, by U.S. District Judge Roberto A. Lange.
Michael Lovejoy, Jr., age 35, was sentenced to 16 months in federal prison, followed by 5 years of supervised release, and a special assessment to the Federal Crime Victims Fund in the amount of $100.
Lovejoy was indicted by a federal grand jury on February 14, 2018. He pled guilty on April 30, 2018.
Between May 23, 2017, and September 17, 2017, Lovejoy, a person required to register under the Sex Offender Registration and Notification Act, and sex offender by reason of a conviction under state law, did not register as a sex offender or update his sex offender registration to reflect his new address.
This case was investigated by the U.S. Marshals Service. Assistant U.S. Attorney Jay Miller prosecuted the case.
Lovejoy was immediately turned over to the custody of the U.S. Marshals Service.
Shaker Heights man sentenced to three years in prison for defrauding investor out of $287,000Read the Press Release
A Shaker Heights man was sentenced to three years in prison for defrauding an investor out of more than $287,000.
James M. Unger, 51, previously pleaded guilty to two counts of wire fraud and five counts of filing false tax returns.
Unger worked as a securities broker and investment advisor who provided financial advice to clients. Between 2006 and 2014, Unger devised a scheme to defraud an investor identified in court documents as E.C., according to court documents.
E.C. executed a durable power of attorney in 2007, which gave Unger control of her financial affairs. A few months later, Unger convinced E.C. to invest in a high-risk international casino project based on Unger’s assurances that it was a safe, lucrative investment opportunity. Unger and others provided E.C. with promissory notes guaranteeing a 15 percent annual rate of return, according to court documents.
E.C. invested approximately $407,000 in the project between 2008 and 2009. By 2012, Unger had wired money from E.C.’s bank account, without her knowledge or consent, to another client. He converted her investment to stock in a new company and convinced E.C. to invest an additional $79,985, according to court documents.
In 2014, E.C. told Unger she wanted to liquidate her investment in the casino project. She believed her investment, including earnings, totaled approximately $1.9 million, but her total investment was actually lost, according to court documents.
Unger had actually embezzled funds from E.C.’s bank accounts to enrich himself and pay for his own personal expenses, including pay his daughter’s college expenses, according to court documents.
In total, Unger embezzled approximately $287,464 from E.C. He also failed to claim some of this income on his tax returns between 2011 and 2015, according to court documents.
This case is being prosecuted by Assistant U.S. Attorneys Robert J. Patton and Alejandro A. Abreu following an investigation by the FBI and IRS – Criminal Investigations.
Serial Armed Robber and Accomplice Plead GuiltyRead the Press Release
Tampa, Florida – United States Attorney Maria Chapa Lopez announces that Antwan Williams (34, Bradenton) has pleaded guilty to two counts of brandishing a firearm during a robbery in connection with a series of armed robberies he committed in Manatee County. Williams faces a minimum mandatory penalty of 32 years, and up to life, in federal prison. Williams’s accomplice, Tronesh Sparkels Ackerman (24, Palmetto), has pleaded guilty to conspiracy to commit robbery and to aiding and abetting Williams in brandishing the firearm in connection with one of the robberies. Ackerman faces a minimum mandatory penalty of 7 years, and up to life, in federal prison.
According to their plea agreements, Williams and Ackerman robbed five businesses in Manatee County in August 2017. These businesses included four fast food restaurants and a convenience store. During each robbery, Williams entered the business, pointed a handgun at the employees and customers inside, and forced the employees to give him money from the business’s registers and safes. Ackerman acted as Williams’s getaway driver for each robbery.
Investigators identified Williams as a suspect based on a fingerprint obtained from the fifth robbery and then began surveillance of Williams and Ackerman. Within a few hours, as the officers watched, Williams and Ackerman attempted to rob another fast food restaurant, at which point the officers arrested them.
This case was investigated by Bureau of Alcohol, Tobacco, Firearms and Explosives, the Manatee County Sheriff’s Office, and the Bradenton Police Department. It is being prosecuted by Assistant United States Attorney Taylor G. Stout.
This case was brought as part of Project Safe Neighborhoods (PSN), a program that has been successful in bringing together all levels of law enforcement to reduce violent crime and make our neighborhoods safer for everyone. In October 2017, Attorney General Jeff Sessions announced the reinvigoration of PSN and directed all U.S. Attorneys’ Offices to develop districtwide crime reduction strategies, incorporating the lessons learned since the program’s inception in 2001. In the Middle District of Florida, U.S. Attorney Maria Chapa Lopez coordinates PSN efforts in cooperation with various federal, state, and local law enforcement officials.
Sentencings for June 25 & June 26, 2018Read the Press Release
ASHLEY MARIE GONZALES, 27, of Cheyenne, Wyoming was sentenced by Federal District Court Judge Nancy D. Freudenthal on June 25, 2018 for seize, confine, kidnap, carry away, and hold as well as possession of a firearm in furtherance of a crime of violence. Gonzales was arrested in Cheyenne, Wyoming. She received one hundred twenty months of imprisonment, to be followed by sixty months of supervised release, and ordered to pay a $200.00 special assessment. The Cheyenne Police Department, Weld County Colorado Sheriff’s Office, Wyoming Division of Criminal Investigation, and the U.S. Bureau of Alcohol, Tobacco, Firearms, and Explosives investigated this case.
This case is part of Project Safe Neighborhoods (PSN), a program bringing together all levels of law enforcement and the communities they serve to reduce violent crime and make our neighborhoods safer for everyone. Attorney General Jeff Sessions reinvigorated PSN in 2017 as part of the Department’s renewed focus on targeting violent criminals, directing all U.S. Attorney’s Offices to work in partnership with federal, state, local, and tribal law enforcement and the local community to develop effective, locally based strategies to reduce violent crime.
DUSTIN RAY TEEPLES, 43, of Orem, Utah was sentenced by Federal District Court Judge Nancy D. Freudenthal on June 26, 2018 for conspiracy to distribute heroin. Teeples was arrested in Washakie County, Wyoming. He received forty months of imprisonment, to be followed by thirty-six months of supervised release, and ordered to pay a $900.00 in community restitution and a $100.00 special assessment. The Washakie County Sheriff’s Office investigated this case.
CALEB ALLEN ROOT, 38, with no known permanent address, was sentenced by Federal District Court Judge Nancy D. Freudenthal on June 26, 2018 for possession with intent to distribute methamphetamine and felon in possession of firearms and ammunition. Root was arrested in Sheridan, Wyoming. He received fifty-four months of imprisonment, to be followed by thirty-six months of supervised release, and ordered to pay a $200.00 special assessment. The Sheridan Police Department, Wyoming Division of Criminal Investigation, and the US Bureau of Alcohol, Tobacco, Firearms, and Explosives investigated this case.
St. Louis Sex Offender Pleads Guilty to Accessing with the Intent to View Child PornographyRead the Press Release
St. Louis - Rolf Rathmann, 53, of St. Louis, already a registered sex offender by virtue of a 2003 conviction for eight counts of statutory sodomy in Missouri state court, admitted to accessing numerous images and videos of child pornography, including images of children involved in sadistic and masochistic conduct.
Rathmann admitted to visiting an online "meeting room" within an online video conferencing application during 2015 and 2016. In the meeting room, Rathmann repeatedly viewed and commented on images and videos of child pornography. Rathmann also repeatedly professed his preference for pre-teen and early teen boys.
Rathmann was identified as the individual behind the username "hi" from the online meeting room and a search warranted was obtained for his residence in the City of St. Louis. A search of the residence revealed electronic hardware and storage containing additional evidence of his possession and receipt of child pornography. Forensic analysis of Rathmann’s computer equipment revealed saved Skype chats that appeared to be between him and underage boys and in which he appeared to admit to historical sexual misconduct against underage boys.
"This is a serious case of misconduct by a convicted sexual offender. Rathmann is a threat to the community and I believe this plea agreement reflects that serious threat," said U.S. Attorney Jeff Jensen.
Due to his criminal history, Rathmann faces a mandatory minimum term of imprisonment of ten years. The statutory maximum term of imprisonment for accessing with the intent to view child pornography is twenty years. Rathmann also faces lifetime court supervision when released from prison.
This case is being investigated by the U.S. Department of Homeland Security – HIS. Assistant United States Attorney Rob Livergood is handling the case for the U.S. Attorney’s Office. Project Safe Childhood is the Justice Department’s multiagency response to crimes against children.
Repeat Offender Admits Distributing Child Pornography While on Federal Supervised ReleaseRead the Press Release
CAMDEN, N.J. – A Camden County, New Jersey, man today admitted distributing images of child sexual abuse and violating the conditions of his supervised release imposed in connection with a previous child pornography conviction, U.S. Attorney Craig Carpenito announced.
Barnaby Hewsen, 43, of Pennsauken, New Jersey, pleaded guilty before U.S. District Judge Noel L. Hillman in Camden federal court to an information charging him with one count of distributing child pornography as well as a petition charging him with violating the conditions of federal supervised release by committing another crime while under supervision.
According to documents filed in this case and statements made in court:
In May 2017, Hewsen uploaded three images containing images of child sexual abuse to a website. On June 2, 2017, law enforcement officers conducted a search of his residence and discovered seven videos and 373 images on his computer, some of which depicted prepubescent children and sadistic masochistic conduct involving the sexual abuse of infants and toddlers. In connection with the plea, Hewsen also admitted that he took these actions while on federal supervised release for a prior federal conviction for possessing child pornography.
The count of distribution of child pornography carries a mandatory minimum term of 15 years in prison and a maximum of 40 years in prison; the violation of supervised release carries a mandatory term of five years in prison, which may be imposed consecutively. Sentencing is scheduled for Oct. 5, 2018.
U.S. Attorney Carpenito credited special agents of U.S. Immigration and Customs Enforcement (ICE) Homeland Security Investigations (HSI), under the direction of Special Agent in Charge Brian A. Michael; and the Camden County Prosecutor’s Office, under the direction of Prosecutor Mary Eva Colalillo, with the investigation leading to today’s guilty plea.
The government is represented by Assistant U.S. Attorney Gabriel J. Vidoni of the U.S. Attorney’s Office’s Criminal Division in Camden.
Postal employee from Warrensville Heights indicted for stealing more than 250 gift cards from postal station in ClevelandRead the Press Release
A grand jury returned an indictment charging a U.S. Postal Service employee with stealing more than 250 gift cards from the mail while working at 2400 Orange Avenue in Cleveland.
Monique Wheeler, 54, of Warrensville Heights, was indicted on one count of theft of mail. Wheeler knowingly stole or took letters, postal cards, packages, bags, or mail and numerous gift cards of varying monetary amounts between July 2017 and September 2017, according to the indictment.
Wheeler stole from the mail gift cards to dozens of stores or services, including Aldi, Amazon, Applebee’s, Best Buy, Bob Evans, Buffalo Wild Wings, Chick Fil A, Chipotle, DSW, Game Stop, Home Depot, Kohl’s, Lowe’s, MasterCard, Panera, Red Lobster, Starbucks, Target, Victoria’s Secret, Visa, Xbox and others.
U.S. Attorney Justin Herdman said: “This defendant is accused of stealing hundreds of gift cards worth thousands of dollars over three months. Presumably some of these were birthday presents or other gifts that people entrusted to the postal service for delivery. Those who steal mail will be held accountable for their actions, just like any other criminal.”
U.S. Postal Service Office of Inspector General Special Agent in Charge Kenneth F. Cleevely stated: “The vast majority of the 600,000 Postal Service employees nationwide are hard working individuals worthy of America’s trust. However, when one of them decides to violate that trust, special agents of the USPS OIG will conduct an aggressive and thorough investigation, as was done in this case. Special agents will seek federal prosecution and the individual’s removal from the Postal Service. When an employee steals from the mail, they risk loss of employment, loss of their retirement, and loss of their freedom. To report postal employees involved in criminal activity, contact USPS OIG special agents at www.uspsoig.gov or 888-USPS-OIG.”
If convicted, the defendant’s sentence will be determined by the Court after review of factors unique to her case, including the defendant’s prior criminal record, if any, the defendant’s role in the offense, and the characteristics of the violation. In all cases, the sentence will not exceed the statutory maximum and in most cases it will be less than the maximum.
The case is being prosecuted by Assistant U.S. Attorney Ranya Elzein and was investigated by the United States Postal Service Office of Inspector General.
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
Pierre Man Charged with Being a Felon in Possession of a FirearmRead the Press Release
United States Attorney Ron Parsons announced that a Pierre, South Dakota, man has been indicted by a federal grand jury for being a Felon in Possession of a Firearm.
Michael Schmidt, age 43, was indicted on June 12, 2018. He appeared before U.S. Magistrate Judge Mark A. Moreno on June 26, 2018, and pled not guilty to the Indictment.
The maximum penalty upon conviction is up to 10 years in federal prison and/or a $250,000 fine, 3 years of supervised release, and $100 to the Federal Crime Victims Fund. Restitution may also be ordered.
The Indictment alleges that on or about January 31, 2018, Schmidt, having been convicted of a crime punishable by imprisonment for a term exceeding one year, knowingly possessed and received a .22 long rifle and a 12 gauge shotgun, which both had been shipped and transported in interstate and foreign commerce.
The charge is merely an accusation and Schmidt is presumed innocent until and unless proven guilty.
This case is part of Project Safe Neighborhoods (PSN), a program bringing together all levels of law enforcement and the communities they serve to reduce violent crime and make our neighborhoods safer for everyone. Attorney General Jeff Sessions reinvigorated PSN in 2017 as part of the Department’s renewed focus on targeting violent criminals, directing all U.S. Attorney’s Offices to work in partnership with federal, state, local, and tribal law enforcement and the local community to develop effective, locally-based strategies to reduce violent crime.
The investigation is being conducted by the Bureau of Alcohol, Tobacco, Firearms, and Explosives, the Lyman County Sheriff’s Office, and the U.S. Forest Service. Assistant U.S. Attorney Troy R. Morley is prosecuting the case.
Schmidt was released on bond pending trial, which has been set for August 21, 2018.
Philadelphia Pharmacy Employee Charged with Conspiring to Distribute Thousands of Oxycodone TabletsRead the Press Release
PHILADELPHIA – U.S. Attorney William M. McSwain announced that an indictment was unsealed today charging a Philadelphia pharmacy employee with conspiring to distribute controlled substances, including opioid painkillers.
Anmol Singh Kamra, 25, of Newtown Square, is charged with one count of conspiring with a doctor and another individual to distribute tens of thousands of tablets of oxycodone, a Schedule II controlled substance, in violation of federal drug law. Schedule II controlled substances have a high potential for abuse and may lead to severe psychological and physical dependence.
This case is part of a nationwide Department of Justice initiative targeting individuals who contribute to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics. According to the Centers for Disease Control and Prevention, approximately 91 Americans die every day of an opioid related overdose.
“We have to do everything in our power to make sure those who contribute to the destructive and deadly opioid crisis are held accountable,” said U.S. Attorney McSwain. “Too many Americans are dying. That’s why prosecuting those who traffic in opioids is a priority for the Department of Justice and for our Office.”
The indictment alleges the following:
Kamra worked at Campus Pharmacy at 4027 Market Street in Philadelphia, Pennsylvania. From about December 2012 through March 2016, Kamra filled hundreds of prescriptions for oxycodone knowing that the prescriptions were fraudulent.
Frank D. Brown, charged elsewhere, frequented a doctor’s office to obtain multiple sham prescriptions for controlled substances, including oxycodone, under both his own name and the names of others. Brown paid cash for these sham prescriptions. In December 2012, after purchasing the sham prescriptions, Brown began going to Campus Pharmacy, where Kamra would fill these sham prescriptions in exchange for cash.
Kamra, Brown, and the doctor used over 30 different names when filling and dispensing prescriptions at Campus Pharmacy. After obtaining the oxycodone tablets from Kamra, Brown sold the pills on the street to drug users in exchange for cash. Over time, Kamra provided oxycodone pills even when Brown failed to provide any prescription for those pills.
If convicted, Kamra faces a maximum possible sentence of 20 years’ imprisonment, a minimum of 3 years up to a lifetime of supervised release, a $1,000,000 fine, and a $100 special assessment.
The unsealing of today’s indictment was coordinated with the Criminal Division, Fraud Section’s Health Care Fraud Unit as part of its National Health Care Fraud Takedown. The case was investigated by the Federal Bureau of Investigation and the Drug Enforcement Administration Diversion Unit. It is being prosecuted by Assistant United States Attorney Jessica Natali.
Oklahoma Man Sentenced to 22 Years in Prison for Six Armed RobberiesRead the Press Release
BOISE – Camron D. Brown, 21, of Oklahoma City, Oklahoma, was sentenced on Wednesday to 22 years in federal prison for six counts of interference with commerce by robbery and one count of brandishing a firearm during and in relation to a crime of violence, U.S. Attorney Bart M. Davis announced. Brown was indicted by a federal grand jury in Boise on May 9, 2017. He plead guilty to the offenses on March 13, 2018. He was sentenced by Chief U.S. District Judge B. Lynn Winmill at the Federal Courthouse in Boise.
According to court records, in early 2017, Brown robbed six different businesses using a gun, holding a total of ten people at gunpoint, and stealing in all almost $7,000. Specifically, Brown robbed the following businesses on the following dates:
- February 20, 2017, Brown robbed the Jackson’s Food Store at 897 S. Cole Road in Boise.
- February 20, 2017, twelve minutes after robbing the Jackson’s Food Store, Brown robbed Elements Massage at 7447 Emerald Street in Boise.
- February 21, 2017, Brown robbed the Human Bean Coffee stand at 2100 Broadway in Boise.
- February 25, 2017, Brown robbed the Game Stop store at 2025 12th Avenue in Nampa.
- March 8, 2017, Brown robbed the Continental Loans suite at 10530 Fairview Avenue in Boise.
- March 13, 2017, Brown robbed the Motel 6 at 2323 Airport Road in Boise.
Brown was arrested after a lengthy investigation. Police eventually interviewed Brown, who provided a false alibi. Police also discovered a social media posting in which Brown bragged about his crimes.
In addition to the prison sentence, Judge B. Lynn Winmill ordered Brown to pay $6,808.26 in restitution, as well as serve five years of federal supervised release. The supervised release will be served after Brown completes his 22-year sentence.
This case was investigated through the cooperation of the Boise Police Department, Nampa Police Department, Mountain Home Police Department, and the Bureau of Alcohol, Tobacco, Firearms and Explosives.
This case was brought as part of Project Safe Neighborhoods (PSN), a program that has been historically successful in bringing together all levels of law enforcement to reduce violent crime and make our neighborhoods safer for everyone. Attorney General Jeff Sessions has made turning the tide of rising violent crime in America a top priority. In October 2017, as part of a series of actions to address this crime trend, Attorney General Sessions announced the reinvigoration of PSN and directed all U.S. Attorney’s Offices to develop a district crime reduction strategy that incorporates the lessons learned since PSN launched in 2001.
# # #
- February 20, 2017, Brown robbed the Jackson’s Food Store at 897 S. Cole Road in Boise.
Operator of Dallas Physician Housecall Practice Arrested in Connection with Largest Health Care Fraud Enforcement Action in Department of Justice HistoryRead the Press Release
DALLAS – Nehaj Rizvi, 29, from Carrollton, Texas, was arrested today on a federal complaint charging her with health care fraud in connection with a $2.5 million home health care fraud scheme. The announcement was made today by U.S. Attorney Erin Nealy Cox of the Northern District of Texas.
According to documents filed in the case, Life Spring Housecall Physicians, Inc., (Life Spring), generated hundreds of fraudulent home health orders and certifications for multiple home health agencies in the DFW area. Life Spring is operated by Rizvi and owned by her husband, Mohsin Raza.
Rizvi used a physician’s signature stamp to sign home health orders and home health certifications for patients that the physician had never seen and who were not qualified for home health care. In reality, far from being homebound, many of the patients were able to drive and carry out normal functions of everyday life. More than 100 home health agencies obtained physician orders and certifications from Life Spring, which enabled the agencies to claim their patients were homebound and gave the appearance that their services were justified. Life Spring’s false documents led to home health agencies billing Medicare approximately $2,500,000 in fraudulent claims.
“The charges announced today in Dallas are an example of the outstanding investigative work by this district’s Healthcare Fraud Strike Force that has been in operation since 2011,” stated U.S. Attorney Nealy Cox. “Home health care fraud continues to plague the DFW area. This office will continue to aggressively investigate and prosecute anyone trying to defraud Medicare and other public health care programs.”
“This takedown is a warning to fraudsters that their crimes will be uncovered,” said C.J. Porter, Special Agent in Charge of the Dallas Regional Office of the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Along with our law enforcement partners, we will work to ensure that criminals who orchestrate these schemes are brought to justice.”
A federal criminal complaint is a written statement of the essential facts of the offense charged, and must be made under oath before a magistrate judge. A defendant is entitled to the presumption of innocence until proven guilty. The U.S. Attorney’s office has 30 days to present the matter to a grand jury for indictment. The maximum statutory penalty for the health care fraud offense charged against Rizvi is 10 years in federal prison and a $250,000 fine. The investigation is being conducted by Special Agents with HHS. Assistant U.S. Attorney Douglas Brasher is in charge of the prosecution.
Rizvi’s arrest is part of the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, announced today by Attorney General Jeff Sessions and HHS Secretary Alex M. Azar III. Today’s enforcement actions involves 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings to Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies. Of those charged, over 162 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
Additional documents related to this announcement are available at: https://www.justice.gov/opa/documents-and-resources-june-28-2018
# # #
North Versailles Man Sentenced to Prison for Violating Drug and Firearms LawsRead the Press Release
PITTSBURGH, Pa. – A resident of North Versailles, Pennsylvania, has been sentenced in federal court to 13 months incarceration and three years supervised release on his conviction of conspiracy to possess and distribute oxycodone, an opiate, and violating federal firearms laws, United States Attorney Scott W. Brady announced today.
United States District Judge Mark R. Hornak imposed the sentence yesterday on John Zurick, 41, of 506 Porter Street.
According to information presented to the court, Zurick participated in a criminal network of drug dealers that obtained opiate pain killers and then illegally distributed them to users in the Pittsburgh area. Zurick helped transport Antoinette Adair, one of the key dealers in the criminal network, to buy and sell opiate pills. While transporting Adair, Zurick was armed with a firearm, in violation of federal law.
Assistant United States Attorney Brendan T. Conway prosecuted this case on behalf of the government.
United States Attorney Brady commended the Federal Organized Crime Drug Enforcement Task Force (OCDETF) investigation led by the Federal Bureau of Investigation, the Drug Enforcement Administration, the Pennsylvania Office of the Attorney General, the Pittsburgh Bureau of Police, and the Allegheny County Police Department for the investigation leading to the successful prosecution of Zurick.
New York Lawyer Pleads Guilty to over $9 Million in Illegal Money Transfers Between the U.S. and MexicoRead the Press Release
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, and Angel M. Melendez, Special Agent in Charge of Immigration and Customs Enforcement’s Homeland Security Investigations (“HSI”), announced today that IGNACIO FONCILLAS pled guilty to operating an unlicensed money transmitting business in connection with his transfer of over $9 million between the United States and Mexico. This illegal scheme allowed FONCILLAS’s customers to secretly send money to Mexico while avoiding anti-money laundering safeguards and obligations imposed upon legal money services businesses. FONCILLAS surrendered to federal agents this morning and his plea was taken by U.S. District Judge George B. Daniels.
U.S. Attorney Geoffrey S. Berman said: “As he admitted today, Ignacio Foncillas, an attorney, established an illegal money transmitting service between the U.S. and Mexico. Foncillas did not register his company with FinCEN, the regulatory agency that oversees the U.S. financial system and reports suspicious financial transactions. Attempts by individuals or corporations to circumvent their regulatory obligations will be met with swift justice.”
HSI Special Agent in Charge Angel M. Melendez said: “Foncillas operated a transnational money transmitting business, moving millions without ever ensuring he had the proper licensing. The movement of money is regulated to limit fraudulent and criminal activity, which is why law enforcement is paying close attention to those operating without a license, and looking even more closely at money transactions crossing borders.”
According to the Information and statements made during proceedings in Manhattan federal court:
IGNACIO FONCILLAS is a lawyer in New York, New York. Between approximately September 2013 and September 2014, FONCILLAS used a company he had previously incorporated in Delaware (the “Company”) to transfer millions of dollars from the United States to Mexico. During this time, the Company was not registered with the Financial Crimes Enforcement Network (FinCEN), a component of the U.S. Department of the Treasury, or any of the states in which the Company operated, including New York, Delaware, or California, as required by both state and federal laws applicable to money transmitting businesses like the Company.
Unlicensed money transmitting businesses like the Company enable entities and individuals to move money into and through the U.S. financial system while avoiding licensed U.S. financial institutions that monitor for suspicious activity and report it to U.S. authorities, including through suspicious activity reports, or SARs. Instead, by going through unlicensed entities like the Company, foreign businesses ensure that suspicious patterns of transmissions will not be detected and reported as potential money laundering activity or other financial crime.
In order to move money in this manner, FONCILLAS opened bank accounts in the name of the Company at banks including Bank of America, Citibank, and Wells Fargo. When opening these accounts, FONCILLAS provided false and contradictory descriptions of the Company’s business, including investment, consulting, and wholesale trade. On many occasions, individuals around the country, mainly in the Southern California region, who had no affiliation with FONCILLAS or the Company, deposited cash into the Company’s bank accounts. On other occasions, FONCILLAS deposited cash he had received from others into the Company’s bank accounts in New York. At times, FONCILLAS lied to the banks about the purpose of these large cash deposits, including telling a bank teller that a cash deposit of over $150,000 was money he had been paid for a loan.
Following these deposits, FONCILLAS directed the transfer of that money to individuals and entities in Mexico, minus a fee. This fee was retained by FONCILLAS as payment for this money transmitting service and used to pay personal expenses such as credit cards and other bills. Through this conduct, the defendant and the Company have functioned as an unregulated financial institution, allowing others to move funds through and out of the U.S. with impunity, including not being subject to the filing of SARs that licensed transmitting businesses are required to file.
* * *
FONCILLAS, 50, of New York, New York, pled guilty to one count of operating an unlicensed money transmitting business. The charge carries a maximum penalty of five years in prison. The maximum potential sentence in this case are prescribed by Congress and is provided here for informational purposes only, as any sentencing of the defendant will be determined by the judge.
FONCILLAS is scheduled to be sentenced November 8, 2018.
Mr. Berman praised the outstanding investigative work of the Department of Homeland Security, Homeland Security Investigations.
This case is being handled by the Office’s Money Laundering and Asset Forfeiture Unit. Assistant U.S. Attorneys Daniel M. Tracer and Niketh V. Velamoor are in charge of the prosecution.
New Orleans Men Sentenced After Pleading Guilty to Drug Conspiracy and Firearms OffensesRead the Press Release
U.S. Attorney Duane A. Evans announced that ELTON WELLS, age 39, and JUSTIN CRAFT, age 29, of New Orleans, were sentenced today after pleading guilty to several drug charges, including conspiracy to distribute and possession with intent to distribute one hundred grams or more of heroin. CRAFT also pled guilty to firearms offenses, including felon in possession of a firearm and possession of firearms in furtherance of a drug trafficking crime. WELLS was sentenced to 120 months incarceration and eight years supervised release. CRAFT was sentenced to 180 months incarceration and eight years supervised release.
According to court documents, In March of 2017, members of the NOPD/HIDTA Task Force received information from a source of information that three individuals, including WELLS and CRAFT, were heroin distributors in the area of Mandeville Street and Derbigny Street in New Orleans. Based on that information, officers conducted surveillance in that area.
On April 5, 2017, surveillance officers in the area of Mandeville and Derbigny Streets observed WELLS conduct a hand-to-hand drug transaction and return to his vehicle. Officers arrested WELLS and seized a quantity of heroin from WELLS.
On April 11, 2017, officers conducted surveillance in the same area and observed CRAFT conduct a hand-to-hand narcotics transaction with an individual. Officers arrested the individual and seized heroin that he purchased from CRAFT. A second individual who was also arrested after purchasing heroin in the area, informed officers that he regularly called one telephone that was shared by CRAFT, WELLS and another individual, and that any one of them would sell him an ounce of heroin.
Officers and DEA Special Agents obtained a search warrant for CRAFT’S residence at 14070 Wales Street in New Orleans. During the search, officers and agents seized 4.9 grams of heroin and several firearms, including two semi-automatic rifles, a semi-automatic pistol, and a shotgun.
U.S. Attorney Evans praised the work of the Drug Enforcement Administration, the New Orleans Police Department, and the St. Bernard Parish Sheriff’s Office in investigating this matter. Assistant United States Attorney André Jones was in charge of the prosecution.
National healthcare fraud takedown results in charges against 590+ individuals, including one in Georgia, who are responsible for $2+ billion in fraud lossesRead the Press Release
ATLANTA – The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 590+ charged defendants across 56 federal districts, including 150+ doctors, nurses, and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 150 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Twenty-nine state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 587 providers, including doctors, nurses and pharmacists.
The charges announced today aggressively target schemes billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid related overdose.
“Health care fraud steals valuable resources from individuals who are most in need of the funds that support medical services and programs,” said U. S. Attorney Byung J. Pak. “We will continue to focus our efforts on aggressively investigating and prosecuting medical professionals and others who defraud our healthcare system”
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes.”
“Health care fraud costs taxpayers billions of dollars and places our most vulnerable citizens at risk for harm and neglect,” said Derrick L. Jackson, Special Agent in Charge for the U.S. Department of Health & Human Services - Office of Inspector General. “Working with our law enforcement partners, we are dedicated to protecting patients and the federal health care programs intended to serve them.”
“The FBI is dedicated to protecting federally funded health care programs from those driven by greed, those who divert funds to their own pockets, taking them away from those who desperately need them,” said J. C. Hacker, Acting Special Agent in Charge (A/SAC) of FBI Atlanta. “The scope of this case is an indication of how widespread the problem is, but also an indication of how determined we are to stop it.”
“Our Medicaid Fraud Control Unit is committed to protecting the integrity of the Georgia Medicaid program, its members and the taxpayer dollars used to provide this service,” said Georgia Attorney General Chris Carr. “We will remain vigilant in our efforts to identify and detect fraud, abuse or waste and aggressively recover all funds spent inappropriately. We are grateful to work with our partners at the U.S. Attorney’s Office and law enforcement to protect Georgians.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
Specifically, the Northern District of Georgia case announced as part of the nationwide Medicare Strike Force takedown:
United States v Rosa Fitzhugh
According to U.S. Attorney Pak, the indictment, and other information presented in court: Rosa Fitzhugh owned and operated Casa Luisa, Inc. with locations in Decatur, Georgia. Fitzhugh was a licensed professional counselor (“LPC”) that purportedly provided mental health counseling. In 2014, Fitzhugh and Casa Luisa, Inc. were terminated from several Medicaid funded care management organizations (“CMOs”). After termination, Fitzhugh continued to fraudulently bill these CMOs by contracting with enrolled LPCs. Fitzhugh solicited LPCs to work as independent contractors with companies she controlled and then fraudulently billed CMOs using the LPCs provider numbers for services that were not provided.
Beginning in January 2015, and continuing until October 2017, Fitzhugh billed or directed others to fraudulently bill over $2.4 million to Medicaid CMOs by billing for individual and family psychotherapy services that were not provided, not provided as billed, and not entitled to reimbursement.
The case is being investigated by the U.S. Department of Health & Human Services, Office of the Inspector General, the Federal Bureau of Investigation, and the Georgia State Attorney General’s Medicaid Fraud Control Unit.
Jeffrey Brown, Deputy Chief of the Complex Frauds Section and Assistant Attorney General Elizabeth Grofic are prosecuting the case.
Members of the public are reminded that the indictment only contains charges. The defendants are presumed innocent of the charges and it will be the government’s burden to prove the defendants’ guilt beyond a reasonable doubt at trial.
For further information please contact the U.S. Attorney’s Public Affairs Office at [email protected] or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.
National Healthcare Fraud Takedown Results in Charges of Medicaid Fraud Against Pair in Southern IllinoisRead the Press Release
Southern District of Illinois Indictment Part of Largest Health Care Fraud Enforcement Action in Department of Justice History
United States Attorney Donald S. Boyce announced today that a federal grand jury in East St. Louis, Illinois, has returned an indictment charging Elizabeth A. Schwarz, 55, of Highland, and Frank Coleman Stroehmer III, 62, of Granite City, with defrauding the Illinois Medicaid Home Services Program. The indictment comes as part of a larger coordinated effort led by the Department of Justice and the Department of Health and Human Services (HHS) to combat health care fraud nationwide.
Earlier today, U.S. Attorney General Jeff Sessions and HHS Secretary Alex M. Azar III announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force. The coordinated takedown was led by the Criminal Division, Fraud Section’s Health Care Fraud Unit and resulted in charges against 601 defendants across 55 federal districts. The charges cover a wide variety of health care fraud schemes that together total more than $2 billion in false billings.
According to the Southern District indictment, Schwarz was a beneficiary of the Illinois Home Services Program funded by Medicaid, and Stroehmer was one of her personal assistants in the same program. The pair were charged with felony health care fraud for claiming and receiving payments for services (hourly wages for supporting activities of daily living) that were never performed.
Schwarz and Stroehmer are scheduled to be arraigned on July 9, 2018, at the federal courthouse in East St. Louis, Illinois. Under federal law, each count of health care fraud is punishable by as much as ten years in prison and a $250,000 fine.
The case against Schwarz and Stroehmer is being investigated by HHS-OIG agents and the Illinois State Police Medicaid Fraud Control Bureau. The case is being prosecuted by Assistant United States Attorney Michael J. Quinley.
An indictment is a formal charge against a defendant. Under the law, that charge is merely an accusation and the defendant is presumed innocent unless proven guilty.
National Healthcare Fraud Takedown Results in Charges against 601 Individuals Responsible for over $2 Billion in Fraud LossesRead the Press Release
CEDAR RAPIDS - Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Inspector General Daniel R. Levinson of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation, Administrator Seema Verma of the Centers for Medicare and Medicaid Services (CMS), and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
The United States Attorney for the Northern District of Iowa, Peter E. Deegan, Jr., lauded the enforcement actions. “Our office will aggressively fight health care fraud and prosecute those individuals who contribute to the opioid epidemic. We will seek out and prosecute those medical professionals who abuse the trust that society places in them by unlawfully diverting opioids and other controlled substances.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. Because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims, aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
United States Attorney Deegan announced two criminal prosecutions in the Northern District of Iowa. The prosecutions are:
United States v. James Moorehead: James Moorehead, a registered nurse, was charged with three counts of acquiring a controlled substance by misrepresentation, fraud, deception, or subterfuge, and seven counts of false statements relating to health care matters. The charges stem from Moorehead using the identities of multiple hospital patients with prescriptions for pain medications containing hydrocodone to dispense and divert the pills to his own personal use, and falsely indicating in Medicare beneficiaries’ medical records that those medications were administered to the patients. This case is being handled by AUSA Lyndie Freeman and was investigated by the Iowa Medicaid Fraud Control Unit.
United States v. Lacey Staveley: Lacey Staveley, also a nurse, was charged with one count of acquiring a controlled substance by misrepresentation, fraud, deception, and subterfuge, and three counts of false statements relating to health care matters. The charges stem from Staveley allegedly making false entries in the electronic medical records of a Cedar Falls, Iowa, nursing home with respect to two residents. It is alleged that Staveley indicated she had administered oral tablets containing hydrocodone, which was paid for by Medicare, to the nursing home residents when in truth Staveley diverted those oral tablets for her own use. This case is being handled by AUSA Tim Vavricek and was investigated by the Iowa Medicaid Fraud Control Unit.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Additional documents related to this announcement will be available here: https://www.justice.gov/opa/documents-and-resources-june-28-2018.
This operation also highlights the great work being done by the Department of Justice’s Civil Division. In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2 billion in judgements and settlements related to matters alleging health care fraud.
Court file information at https://ecf.iand.uscourts.gov/cgi-bin/login.pl. The case file numbers are 18-CR-2031-LRR and 18-CR-3021-LRR.
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National Healthcare Fraud Takedown Results in Charges Against 590+ Individuals Responsible for $2+ Billion in Fraud LossesRead the Press Release
WASHINGTON - Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 590+ charged defendants across 56 federal districts, including 150+ doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 150 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Twenty-nine state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from June 2017 to the present, 587 providers have been served with exclusion notices for conduct related to opioid diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Inspector General Daniel R. Levinson of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Director Alec Alexander of the Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
Cases within the Eastern District of Louisiana include:
United States v. Luis Cabrera, Jr., et al. (E.D. La) (Opioids): On June 22, 2018, Luis R. Cabrera, Jr., Victoria J. Skeldon, Bennie R. Harris, Jesse J. Wildenfils, Stephanie N. Free, Jarrod A. Doubleday, John A. Doubleday, Whitney J. Swan, III, Stephanie M. Faciane, and Cynthia B. Foret, were charged in a twelve-count indictment related to their roles in violating the Controlled Substances Act. Cabrera, Jr., Skedon, Harris, Wildenfils, Free, Jarrod Doubleday, John Doubleday, Swan, III, and Faciane were charged with a dual-object conspiracy to acquire and obtain oxycodone by fraud and to possess oxycodone with the intent to distribute. Cabrera, Jr., and Skeldon were each charged with one count of possession of oxycodone with the intent to distribute. Harris, Wildenfils, Free, Jarrod Doubleday, John Doubleday, Swan, III, and Faciane were each charged with one count of obtaining oxycodone through fraud. Cabrera, Jr. and Foret were charged with a dual-object conspiracy to acquire and possess oxycodone through fraud and to possess oxycodone with the intent to distribute. Cabrera, Jr. and Foret were also charged with one count of possession of oxycodone with the intent to distribute.
The charges stem from the defendant’s involvement in a prescription drug ring in the greater New Orleans area where the defendants used stolen fraudulent prescriptions to obtain and sell oxycodone pills. U.S. Attorney Evans praised the investigative work by the Federal Bureau of Investigation, HHS-OIG, the Drug Enforcement Administration, and the Jefferson Parish Sheriff’s Office. The case is being handled by DOJ Trial Attorney Jared Hasten and Assistant United States Attorney Myles Ranier (AUSA).
United States v. Wayne Jerome Celestine (E.D. La) (Opioids): On June 27, 2018, U.S. Attorney Duane A. Evans announced the unsealing of a superseding indictment against Wayne Jerome Celestine, age 57, a physician who practices in Gretna, Louisiana and resides in the New Orleans area. The superseding indictment contained the original charge of distribution of controlled substances, plus a money laundering charge involving approximately $1.6 million.
On Monday, April 30, 2018, Dr. Celestine was arrested. According to court records, Dr. Celestine illegally dispensed and conspired with others to illegally dispense controlled substances, including oxycodone, oxycodone/acetaminophen, oxycontin HCL, oxymorphone HCL, hydromorphone, opana, fentanyl, suboxone, and morphine sulfate, a Schedule II drug controlled substances; hydrocodone/acetaminophen, a Schedule III drug controlled substance until October 6, 2014, thereafter, a Schedule II drug controlled substance; and alprazolam, diazepam, and carisoprodol, Schedule IV drug controlled substances.
Celestine made his initial appearance on the original indictment before U.S. Magistrate Court Judge Daniel E. Knowles, III, on Monday, April 30, 2018. A detention hearing was held on May 1, 2018, and he was detained.
If convicted of the original charge (Count 1), Celestine will face a maximum of not more than 20 years in prison on the drug conspiracy charge, pursuant to Title 21, United States Code, Sections 841(a)(1) and 846. Celestine will also be subject to a fine of not more than one million dollars and a minimum term of supervised release of three years, following any term of imprisonment.
If convicted on the new additional charge (Count 2), Celestine faces not more than 20 years in prison, a $500,000 fine or twice the value of property involved, and three years of supervised release.
U.S. Attorney Evans praised the work of the Special Agents of the Drug Enforcement Administration, Internal Revenue Service, Jefferson Parish Sheriff’s Office, Harahan Police Department, Westwego Police Department, Louisiana State Police, St. Bernard Parish Sheriff’s Office, New Orleans Police Department, and New Orleans District Attorney’s Office in investigating this matter. Assistant United States Attorney John F. Murphy is in charge of the prosecution.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
# # #
National Healthcare Fraud Takedown Results in Charges Against over 600 Individuals, Including Several Chicago-Area Medical ProfessionalsRead the Press Release
CHICAGO — Several Chicago-area medical professionals, including four physicians, are facing federal criminal charges as part of the largest health care fraud enforcement action in Department of Justice history, federal authorities announced today.
The national enforcement action taken by the Medicare Fraud Strike Force involved over 600 defendants charged throughout the country, including more than 150 physicians, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Several of the doctors were charged for their alleged roles in prescribing and distributing opioids and other dangerous narcotics. In addition, the Department of Health and Human Services has initiated suspension actions against numerous providers, including doctors, nurses and pharmacists.
The national enforcement action was announced by Attorney General Jeff Sessions; HHS Secretary Alex M. Azar III; Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division; Deputy Director David L. Bowdich of the Federal Bureau of Investigation; Assistant Administrator John Martin of the U.S. Drug Enforcement Administration; Inspector General Daniel R. Levinson of the HHS Office of Inspector General; Deputy Chief Eric Hylton of the Internal Revenue Service’s Criminal Investigation Division; Director Alec Alexander of the Centers for Medicare and Medicaid Services; and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service.
Today’s enforcement actions were led and coordinated by the DOJ Criminal Division Fraud Section’s Health Care Fraud Unit, in conjunction with the Medicare Fraud Strike Force – a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. The operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units.
"Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer," said Attorney General Sessions. "In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever."
"Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need," said HHS Secretary Azar. "This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work."
"Medicare and Medicaid are significant health care programs that pay for vital medical services," said John R. Lausch, Jr., United States Attorney for the Northern District of Illinois. "Our office will continue to investigate and prosecute any medical professional who knowingly violates the rules and abuses the trust placed in them by the government and their patients."
"Our nation’s opioid epidemic has no boundaries, and today’s actions highlight just that," said Brian M. McKnight, Special Agent-in-Charge of the Chicago Field Division of the DEA. "Opioid addiction and the criminal activity driving it extend far beyond the cartels and gang violence to the rogue medical professionals identified today."
Several Chicago-area medical professionals, including four doctors, were charged as part of investigations in the Northern District of Illinois. The local charges were announced by U.S. Attorney Lausch; Jeffrey S. Sallet, Special Agent-in-Charge of the Chicago office of the FBI; James Vanderberg, Special Agent-in-Charge of the Chicago Regional Office of the U.S. Department of Labor, Office of Inspector General; DEA Chicago SAC McKnight; Gabriel L. Grchan, Special Agent-in-Charge of the IRS Criminal Investigation Division in Chicago; and Lamont Pugh III, Special Agent-in-Charge of the Chicago Regional Office of HHS-OIG.
Two of the Illinois cases involved licensed physicians who allegedly falsely certified patients for home-health services reimbursed by Medicare. The indictments against DR. FLORENTINO LEONG and DR. RUBEN INOCENCIO allege that the doctors authorized in-home services even though they knew the patients were not confined to their homes and did not require such services. Dr. Leong, 78, of Orland Park, and Dr. Inocencio, 77, of Skokie, are charged with health care fraud and making false statements in a health care matter. Arraignment for Dr. Leong is set for today at 10:00 a.m. before U.S. District Judge Manish S. Shah, while arraignment for Dr. Inocencio has not yet been scheduled. Their cases are being prosecuted by Assistant U.S. Attorney Stephen Chahn Lee.
Another Illinois case involves a licensed psychiatrist, DR. KIRK HOPKINS, who allegedly earned more than $5.5 million by falsely billing Medicaid and Medicare for psychotherapy services that were never performed. Dr. Hopkins, 44, of Chicago, pleaded not guilty to five counts of wire fraud during his arraignment Wednesday before U.S. District Judge Joan H. Lefkow. A status hearing is set for July 25, 2018, at 9:00 a.m. The case is being prosecuted by Assistant U.S. Attorney Sheri H. Mecklenburg. Substantial investigative assistance was provided by the Illinois State Police Medicaid Fraud Control Bureau – North.
The fourth Illinois physician charged as part of the enforcement action is DR. SYED ATHER, who owned two home-visiting physician companies in Lincolnwood – Mobile Physicians S.C. and M&F Medical Services Ltd. Dr. Ather allegedly billed Medicare for at least $2.8 million of unnecessary and "up-coded" home-physician visits from 2010 to 2018. Dr. Ather, 44, of Lincolnwood, pleaded not guilty to 14 counts of health care fraud during his arraignment Wednesday before U.S. District Judge Matthew F. Kennelly. A status hearing is set for Sept. 24, 2018. The case is being prosecuted by Trial Attorney Leslie S. Garthwaite of the Justice Department’s Criminal Division Fraud Section.
Federal charges were also filed in Illinois against a patient marketer, LINDA HAWKINS, who recruited home-health patients on behalf of at least four agencies in the Chicago area. Hawkins allegedly promoted the services of her home-health agency clients at churches and senior buildings, and received more than $180,000 in bribes and kickbacks from the agencies from 2010 to 2016. An indictment charges Hawkins, of Robbins, with one count of conspiracy to solicit and receive health care kickbacks, and six counts of soliciting and receiving health care kickbacks. She is scheduled to be arraigned today at 1:30 p.m. before U.S. Magistrate Judge Michael T. Mason. The case is being prosecuted by Trial Attorney Patrick Mott of the Justice Department’s Criminal Division Fraud Section.
The owner of a home health agency was also charged as part of the Chicago-area investigations. YURI LUDVINSKY, 55, of Chicago, was charged with three counts of violating the Anti-Kickback Statute, stemming from alleged kickback payments Ludvinsky made to a physician for referring patients to Ludvinsky’s agency. Arraignment in federal court in Chicago has not yet been scheduled. The case is being prosecuted by Assistant U.S. Attorney Nathalina Hudson.
The Medicare Fraud Strike Force operates in nine locations nationwide. Its operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force has charged more than 3,700 defendants who collectively have falsely billed the Medicare program for more than $14 billion.
The public is reminded that charges are merely allegations, and all defendants are presumed innocent until proven guilty.
National Healthcare Fraud Takedown Results in Charges Against 601 Individuals Responsible for over $2 Billion in Fraud LossesRead the Press Release
Tampa, FL – U.S. Attorney Maria Chapa Lopez; Attorney General Jeff Sessions; Shimon R. Richmond, Special Agent in Charge for the U.S. Department of Health & Human Services Office of Inspector General; A.D. Wright, Special Agent in Charge of the DEA Miami Division; John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service-Southeast Field Office; Eric W. Sporre, Special Agent in Charge of the FBI Tampa Division; and Social Security Acting Inspector General Gale Stallworth Stone announced today that 21 individuals were charged in the Middle District of Florida for their alleged participation in various fraud schemes involving, among other things, health care fraud, distributing and dispensing controlled substances not for a legitimate medical purpose and outside the usual course of professional practice, conspiracy to solicit and receive health care kickbacks, and theft of government funds.
These charges are part of the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE, and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, including medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“As patients, individuals place great confidence in their healthcare providers to ensure that the treatment and care they receive is delivered at the highest level,” said U.S. Attorney Chapa Lopez. “As taxpayers, our citizens expect that the programs they fund are utilized as they are intended, in a safe and prudent manner, free from fraud and deception. We will continue to work with our partners to ensure that these expectations are met.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
“Health care fraud and opioid abuse are threats to this country, both in terms of the well-being of patients and the viability of government health care programs,” said Shimon R. Richmond, Special Agent in Charge for the U.S. Department of Health & Human Services Office of Inspector General. “This takedown sends a clear message that criminals who engage in health care fraud schemes and illicit opioid distribution will be caught. Working collaboratively with our state and federal partners, we will continue to bring these criminals to justice.”
“DEA is committed to ending the opioid crisis that continues to plague Florida and endanger the welfare of our communities. We are equally committed to preventing prescription drug abuse which facilitates addiction and too often results in death,” said DEA Miami Field Division Deputy Special Agent in Charge Jaime Camacho. “The DEA Miami Field Division will continue to work with our law enforcement partners to protect our communities and ensure that medical professionals do not abuse their authority by over-prescribing unnecessary controlled medications.”
John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service-Southeast Field Office stated, "As part of the National Health Care Fraud multi-agency joint effort, the DCIS-Southeast Field Office contributed significant resources and efforts to achieve a successful operation to effectively combat widespread fraud and abuse, and preserve the integrity of TRICARE, a vital DoD program serving U.S. service members, retirees, and their families."
“The FBI Tampa Division is committed to working collaboratively with our federal, state and local partners to address the opioid crisis and health care fraud in our communities. The tireless efforts put forth by the investigators and attorneys in this investigation will have a significant impact and we will continue to work with a sense of urgency to identify others involved in similar schemes,” said Eric W. Sporre, Special Agent in Charge of the FBI Tampa Division.
“We often find that people who try to defraud Social Security are also taking advantage of other government benefit programs,” said Social Security Acting Inspector General Gale Stallworth Stone. “That’s why we maintain strong partnerships with other Federal, State, and local agencies, because our responsibility to taxpayers doesn’t end at Social Security. SSA OIG will continue to work closely with our law enforcement partners to detect and prevent benefit fraud across the country.”
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in 10 locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
This operation also highlights the great work being done by the Department of Justice’s Civil Division. In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2 billion in judgements and settlements related to matters alleging health care fraud.
Middle District of Florida Case Summaries
Tampa
Dr. Charles Gerardi has been charged with conspiracy, health care fraud, and obstruction of a federal audit. Gerardi is a licensed psychologist who was formerly associated with a group practice known as Geriatric Psychological Specialists (GPS). According to court documents, GPS contracted with nursing homes and other long-term care facilities to provide psychological services to residents. For years, Gerardi impermissibly billed Medicare for providing medically unnecessary psychotherapy to Medicare beneficiaries who suffered from severe dementia and, at times, he billed for psychotherapy when he was actually performing medication management, a non-covered service when performed by a psychologist. First Coast initiated an audit of Gerardi’s practices in 2012. Gerardi tried to obstruct the audit by creating phony patient records and providing those records to the auditor. Finally, when First Coast placed Gerardi on prepayment review for the 20-minute billing code he had used for years, Gerardi changed his submitted billing code to reflect 45-minute sessions but continued to provide patients only 20-minute sessions.
Dr. Zachary Bird was charged in a six-count indictment with distributing and dispensing controlled substances not for a legitimate medical purpose and outside the usual course of professional practice. Bird is an anesthesiologist that operated a pain management clinic called Physicians Wellness and Pain Specialists (PWPS) in Tampa. According to court documents, this clinic functioned as a “pill mill” where Bird prescribed large quantities of opiates to his patients. Specifically, from January 2015 to the end of May 2018, Bird prescribed approximately 5.2 million tablets of hydrocodone, methadone, morphine, and oxycodone at PWPS. Bird was arrested on June 25, 2018.
Dr. Jeffrey Abraham has pleaded guilty to a one-count information charging him with distribution of controlled substances not specified by his DEA registration. Abraham was previously employed at two local Veterans Affairs hospitals in the Tampa-area. As a VA physician, he was authorized by the DEA to write prescriptions for controlled substances only as part of official federal duties. According to the plea agreement, Abraham resigned from the VA to work at a pain management clinic in Tampa. His official federal duty registration was not transferable, and Abraham did not obtain a new DEA registration to write controlled substance prescriptions to the patients he saw while employed at the clinic. From August 2017 to March 2018, while at the clinic, Abraham wrote over 2,000 prescriptions for controlled substances, including more than 600 prescriptions for hydromorphone and over 1,000 prescriptions for oxycodone. On March 8, 2018, Abraham admitted to federal agents that he knew his official federal duty DEA registration number could not be used at the clinic, and agreed to surrender his DEA registration.
Alcira Mercedes Wells and her former husband, Edward Leonard Wells, Jr., have been charged with conspiracy, healthcare fraud, and aggravated identity theft. According to the indictment, between May 2014 and February 2015, Centurion Compounding, Inc., a marketing firm that was located in Florida, employed representatives to market compounded medications for conditions like pain and scars to beneficiaries of health care benefit programs, especially TRICARE. Lifecare and Oldsmar Pharmacies billed the beneficiaries’ health care benefit plans for these creams, which ranged in price from approximately $900 to $21,000 for a one-month supply. Lifecare and Oldsmar, at various times, paid Centurion a portion, approximately 50%, of each claim paid by the health care benefit programs, minus expenses, for each prescription. Centurion, in turn, paid its marketing representatives a percentage of each paid claim, which ranged from 15-30% of the total claim amount after expenses. From September 2014 to February 2015, Alcira Wells was a Connecticut-based Centurion marketing representative married to Edward L. Wells, Jr., who was in the Army stationed at Ft. Bragg in North Carolina. Alcira Wells obtained from her mother-in-law, a nurse at a Navy hospital in Jacksonville, Florida, signed prescription forms prescribing Centurion-marketed compounded creams to Edward Wells and his brother. These prescriptions featured Alcira Wells’s Centurion rep number and the signature of a physician in Jacksonville. After receiving these signed prescription forms, Alcira Wells, with Edward Wells’s knowledge and consent, photocopied or otherwise duplicated them. The Wellses then submitted numerous fraudulent prescriptions for Centurion-marketed compounded medications for U.S. Army personnel stationed at Ft. Bragg and others living in Connecticut, which prescriptions the Jacksonville-based physician never wrote, authorized, or knew about. Edward Wells handed out Centurion prescription forms to personnel stationed with him in North Carolina, most of whom were subordinate in rank, and paid and offered to pay these TRICARE beneficiaries to obtain the compounded creams. After the soldiers filled out or provided their identifiers, Edward transmitted the beneficiaries’ information to Alcira Wells in Connecticut; she then transferred it onto forms with the doctor’s duplicated signature. Alcira Wells submitted these prescriptions first to Centurion and then to Lifecare or Oldsmar Pharmacy for filling, and all were billed to TRICARE. Centurion paid and promised to pay Alcira Wells and those working with her commissions for each filled prescription. The total claimed amount or intended loss was at least $1,246,787.00 and the total amount paid by TRICARE was $1,061,137.16.
Dion Gregory Fisher and Samuel Blaine Huffman have been charged with conspiracy to possess with the intent to manufacture and distribute, and possession with the intent to distribute, counterfeit oxycodone pills made with fentanyl and a fentanyl analogue. Fisher is also charged with multiple counts of distributing the counterfeit oxycodone pills and engaging in money laundering-illegal monetary transactions using proceeds of the drug crimes.
Phillip Morose has been charged with conspiracy to possess with the intent to distribute and to distribute counterfeit oxycodone pills made with fentanyl and a fentanyl analogue.
Christopher McKinney has agreed to plead guilty to conspiring with Fisher, Morose and others to manufacture and distribute counterfeit oxycodone pills made with fentanyl and a fentanyl analogue. According to the plea agreement, Fisher and McKinney manufactured and sold counterfeit oxycodone pills. Fisher supplied the fentanyl and pill processing materials, and pressed the powder fentanyl into counterfeit oxycodone pills with the help of Huffman. McKinney sold the pills to Morose, using the U.S. Mail to exchange packages of pills and currency. His change of plea hearing is set for July 2, 2018.
Konrad Guzewicz has entered pleas of guilty to four counts of money laundering. According to the plea agreement, Guzewicz engaged in illegal monetary transactions involving proceeds of the drug crimes with which Fisher has been charged. Guzewicz admitted that Fisher recruited him to launder large sums of cash generated by the distribution of counterfeit oxycodone pills made with fentanyl and other controlled substances or analogues, and he personally participated in the laundering of at least $120,000 in drug proceeds for Fisher.
Caridad Limberg-Gonzalez and Dr. Thomas Carpenter have been charged with one count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud and three counts of making false statements in connection with heath care matters. According to the indictment, Limberg-Gonzalez owned Foundational Health, a Tampa-area clinic, and Carpenter was the medical director there. Between May 2011 and October 2016, Limberg-Gonzalez caused Foundational Health to submit $1.8 million in claims to Part B of the Medicare program listing Carpenter as the rendering physician. In truth, the services were provided by nurse practitioners, physician’s assistants, and medical doctors who were not enrolled in the Medicare program, all without any supervision by Carpenter. In addition, Limberg-Gonzalez gave Carpenter plans of care and face-to-face encounter forms authorizing home health services to sign. Carpenter signed the documents, even though he never saw or cared for the patients identified in those documents. According to the indictment, Accurate Home Health, a Tampa-area home health agency, relied on the documents that Carpenter signed to submit approximately $762,000 in claims to Part A of the Medicare program.
Roselle Fitzgerald has been charged with one count of theft of government funds, two counts of false statement to a federal agency, seven counts of counterfeit or forged securities, and three counts of fraudulent use of a means of identification. According to the indictment, Fitzgerald worked as a title closer at various law firms while simultaneously obtaining Social Security Disability Insurance and Medicare benefits to which she was not entitled. She also made material false statements to employees of the Social Security Administration regarding her work activity. In addition, Fitzgerald possessed counterfeit or forged checks from the law firms at which she was employed and used the means of identification of others in connection with the counterfeit or forged checks. The indictment also notifies Fitzgerald that the United States is seeking a money judgement in the amount of $192,091.20, the proceeds of theft of government funds and the counterfeit or forged securities.
Orlando
Erving Rodriguez was charged by information with one count of conspiracy to solicit and receive health care kickbacks. The charge stems from Rodriguez’s role as the owner of ER Pro Corp., a marketing company that purportedly provided marketing services to pharmacies. According to court documents, from approximately January 2015 through August 2015, Rodriguez was involved in a scheme whereby he was paid by Life Worth Living Pharmacy for sending prescriptions for expensive compounded creams to the pharmacy that were ultimately billed to TRICARE. Rodriguez received approximately $3,185,155.96 in kickback payments for prescriptions that were ultimately billed to TRICARE for approximately $7,625,263.38.
Homer Zulaica was charged by information with conspiracy to offer and pay health care kickbacks stemming from his role as a sales representative for QMedRX, a compounding pharmacy. According to court documents, from approximately May 2013 through April 2014, Zulaica paid health care kickbacks to, among others, a physician and TRICARE beneficiaries in return for prescribing and receiving expensive compounded prescriptions that were billed to TRICARE. As a result of these kickbacks, TRICARE paid QMedRX approximately $1,271,198.68.
Dr. Christopher Devine was indicted on one count of conspiracy to commit health care fraud and wire fraud and two counts of health care fraud for his role in prescribing medically unnecessary compounded creams for TRICARE beneficiaries. According to the indictment, from approximately May 2013 through March 2015, Devine provided these prescriptions for medically unnecessary compounded drugs to a sales representative, Homer Zulaica, and in return received health care kickbacks. The compounded drugs were ultimately billed to TRICARE and resulted in a loss of approximately $1,640,363.98.
Omar Zoobi, a pharmacist and co-owner of Metro Pharmacy (“Metro”) and Metro RX Pharmacy LLC (“Metro RX”), and Gregory Sikorski, a physician’s assistant, were indicted in a 10-count indictment charging each with one count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud, and one count of conspiracy to defraud the United States and pay and receive health care kickbacks. Zoobi was also charged with two counts of paying health care kickbacks and Sikorski was charged with two counts of receiving health care kickbacks. The charges stem from a scheme whereby Zoobi and another co-conspirator allegedly paid kickbacks to Sikorski in return for prescribing medically unnecessary compounded creams that were billed by Metro and Metro RX to Medicare. Metro and Metro RX also billed Medicare for prescription drugs that were not dispensed or were not dispensed as prescribed. As a result of these actions, from approximately January 2012 through February 2018, Medicare paid Metro and Metro RX approximately $5,511,963.53.
Ashraf Badr, a pharmacist and co-owner of Metro Pharmacy (“Metro”) and Metro RX Pharmacy LLC (“Metro RX”), was charged by information with one count of conspiracy to commit health care fraud stemming from his role in a scheme whereby Badr and a co-conspirator paid a physician’s assistant kickbacks in return for prescribing medically unnecessary compounded creams that were billed to Medicare. Metro and Metro RX also billed Medicare for prescription drugs that were not dispensed. As a result of these actions, from approximately January 2012 through February 2018, Medicare paid Metro and Metro RX approximately $1,812,499.64.
Andres Arteaga Perez has been charged with one count of theft of government property and one count of aggravated identity theft. According to court documents, Perez applied for and received Social Security Disability Insurance Benefits, Supplemental Security Income, and Medicare benefits under a stolen identity. He received $423,602.80 in Social Security and Medicare benefits to which he was not entitled.
Ft. Myers
Dr. Michael Frey has pleaded guilty to two counts of conspiracy to receive healthcare kickbacks. In addition to his guilty plea, Frey has agreed to a civil settlement under which he will pay $2.8 million to the United States to resolve allegations that he violated the False Claims Act in a number of ways, including receiving illegal kickbacks and by ordering medically unnecessary laboratory tests. During the relevant period, Frey was a practicing interventional pain management specialist and one of the two principal owners of Advanced Pain Management Specialists, P.A., which is located in Fort Myers. Beginning in 2010, Frey conspired with the owners of A&G Spinal Solutions, LLC, a durable medical equipment provider, to receive compensation in exchange for referrals to A&G Spinal. Frey was paid a percentage of A&G Spinal’s profits based on his referrals and referrals from other providers at Advanced Pain. A&G Spinal rewarded Frey through checks made payable to his wife, creating the impression that Mrs. Frey was an employee of A&G Spinal, when she was not. The two principals of A&G Spinal, Ryan Williamson and William Pierce, have pleaded guilty to conspiring to pay healthcare kickbacks to Frey and are currently awaiting sentencing. In addition, from 2013 to 2015, Frey also received cash payments from Ryan Williamson in exchange for referrals of compound pharmaceutical pain cream prescriptions. Williamson has also pleaded guilty for his role in this arrangement. In his plea agreement, Frey also admitted that he had received kickbacks in the form of speaker fees paid to him in connection with his participation in largely bogus Insys Therapeutics, Inc. speaker event programs. Insys manufactures a fentanyl sublingual spray known as SUBSYS. Insys paid kickbacks to Frey to induce him to write prescriptions for their product. The civil settlement also resolves allegations that, between 2013 and 2016, Frey caused the submission of false claims to Medicare and TRICARE by ordering definitive Urine Drug Testing (“UDT”) in circumstances where such testing was not reasonable and medically necessary. In addition, the civil settlement resolves kickback allegations associated with anesthesia services provided by Anesthesia Partners of SWFL, LLC that was owned by Frey and his partner Dr. Jonathan Daitch. Anesthesia Partners provided anesthesia services exclusively for the procedures performed by the Advanced Pain physicians. They contracted with Certified Registered Nurse Anesthetists (“CRNAs”) to provide the anesthesia services. These CRNAs were paid a contracted rate, and Anesthesia Partners would bill Medicare and TRICARE directly for the anesthesia services they provided. This arrangement resulted in improper reimbursements to Frey as one of the owners of Anesthesia Partners.
The Middle District of Florida cases are being prosecuted by Assistant U.S. Attorneys Kelley Howard-Allen, Rachel Jones, Greg Pizzo, Amanda Riedel, Daniel Baeza, Simon Eth, and Gregory Nolan, Trial Attorneys Alexander Kramer and Timothy Loper of the Criminal Division’s Fraud Section, and Special Assistant U.S. Attorney Suzanne Huyler.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Additional documents related to today's national announcement are available here: https://www.justice.gov/opa/documents-and-resources-june-28-2018.
National Healthcare Fraud Takedown Results in Charges Against 601 Individuals Responsible for $2 Billion in Fraud LossesRead the Press Release
HARRISBURG - Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 587 providers, including doctors, nurses and pharmacists.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Inspector General Daniel R. Levinson of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation, Administrator Seema Verma of the Centers for Medicare and Medicaid Services (CMS), and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“The level of this public health crisis demands extraordinary efforts in the areas of Health Care Fraud and Drug Diversion,” said United States Attorney David J. Freed. “We will not waver in our efforts to reduce the amount of drugs on our streets and the deaths that so often follow their over prescription and misuse. Today’s nationwide takedown involving substantial cooperation across federal and state agencies helps us send a strong message: This must stop.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
“Health care fraud is not a victimless crime – it affects every one of us,” said Maureen Dixon, Special Agent in Charge for the U.S. Department of Health & Human Services Office of Inspector General. “We will continue to work with our law enforcement partners to bring these criminals to justice, return stolen dollars back to our government health care programs, and protect our most vulnerable citizens.”
“The distribution of controlled substance medications for no legitimate medical purpose by a registrant and individuals seeking to obtain them by fraud or forgery is a tremendous threat to the community in which these medications are diverted,” said Jon Wilson, Special Agent in Charge of the Drug Enforcement Administration’s (DEA) Philadelphia Field Division. “The DEA will continue to investigate any registrant suspected of misusing or abusing their privileges as well as any individual that is seeking to obtain these medications by fraud or other unlawful means. DEA greatly appreciates the coordinated efforts of all the agencies participating in this investigation.”
“Not only did Doctor Stremmel prescribe controlled substances to patients outside of medical necessity, he also falsified records in order to cover his tracks in patient files,” Attorney General Josh Shapiro said. “Thanks to U.S. Attorney David Freed’s office and cooperation with our other law enforcement partners, this man will be held accountable.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. Because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims, aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
The United States Attorney's Office for the Middle District of Pennsylvania charged Robert L. Stremmel, age 74, of York, Pennsylvania on June 27, 2018, with dispensing opiates and amphetamines outside the course of a professional practice and not for a legitimate medical purpose. The indictment alleges that between July 2013 and January 2018, Stremmel distributed to one person more than 21,000 tablets of oxycodone and dextroamphetamine-amphetamine, both Schedule II controlled substances. The indictment also charges Stremmel with prescribing Xanax, codeine, and Tramadol, Schedule IV and V controlled substances. It is alleged that Stremmel intentionally prescribed these controlled substances outside the usual course of professional practice and not for a legitimate medical purpose. The indictment further charged Stremmel with making a false statement related to a health care matter for allegedly falsifying medical records in conjunction with a Medicare claim.
Diversion Investigators with the Drug Enforcement Administration, Special Agents with the Office of Inspector General for the Department of Health and Human Services and Special Agents with the Pennsylvania Office of Attorney General-Medicaid Fraud Control Section conducted this investigation with assistance from the East Lampeter Township Police Department.
Also charged in four indictments were ten residents of Cumberland and Perry County with obtaining possession of oxycodone, a Schedule II Controlled Substance, by misrepresentation, fraud and forgery. Charged in the indictments are:
- Pauline M. Wolfe, age 62, of Carlisle, PA;
- Bruce A. Greenwald, age 40, Mechanicsburg, PA;
- Angela L. Greenwald, age 40, Mechanicsburg, PA;
- Charles J. Greenwald, age 31, of Carlisle, PA;
- Heather Amanda Wolfe, age 27, of Carlisle, PA;
- Megan Nico Bergstresser, age 31, Carlisle, PA;
- Amy Beth Jones, age 32, Mechanicsburg, PA;
- Joseph Benjamin Shatto, age 28, of Carlisle, PA;
- Melissa L. Hunsicker, age 43, of Enola, PA;
- David Allen Hunsicker, age 48, of Dillsburg, PA.
The indictments allege that between December 2016, and June 2017, the defendants conspired with each other and others to create false, fraudulent and forged prescriptions for oxycodone. Several of the defendants were also charged with making false statements in connection with payment of health care benefits. The indictment also alleges several defendants used the Medicare and Medicaid program benefits to pay for the forged prescriptions they filled at area pharmacies. At least three of the defendants stole the identities of Medicare and Medicaid beneficiaries to obtain payment for the fraudulently obtained opioids. The conspiracy is alleged to have resulted in the unlawful possession of approximately 10,000 oxycodone tablets.
Special Agents of the Office of Inspector General (OIG) for the United States Department of Health and Human Services and Diversion Investigators with the Drug Enforcement Administration (DEA) conducted this investigation. On June 26, 2018, OIG, DEA, Carlisle Police Department, Mechanicsburg Police Department, Marysville Police Department, West Shore Regional Police Department, Pennsylvania State Police, Perry County Sheriff’s Department, BNI and Cumberland County Sheriff’s Department searched for and executed arrest warrants for the defendants. Assistant United States Attorney Joseph Terz is prosecuting both cases.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
# # #
National Health Care Fraud Takedown Results in Charges Against 601 Individuals Responsible for over $2 Billion in Fraud LossesRead the Press Release
Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director of the Center for Program Integrity Alec Alexander and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
“Healthcare fraud touches every corner of the United States and not only costs taxpayers money, but also can have deadly consequences,” said FBI Deputy Director Bowdich. “Through investigations across the country, we have seen medical professionals putting greed above their patients’ well-being and trusted doctors fanning the flames of the opioid crisis. I want to thank the agents, analysts and our law enforcement partners in every field office who work each and every day to stop these criminals and hold them accountable for their actions.”
“DEA is committed to ending the opioid crisis occurring in our communities and preventing prescription drug misuse,” said DEA Assistant Administrator Martin. “DEA will continue to work with our partners every day to protect our citizens while ensuring that patients have adequate access to these critical medications.”
“This year’s operations, focusing on opioid-related schemes, spotlight the far-reaching impact of health care fraud,” said HHS Deputy Inspector General Cantrell. “Such crimes threaten the vitally important Medicare and Medicaid programs and the beneficiaries they serve. Though we have made significant progress in our fight against health care fraud; our efforts are not complete. We will continue to work with our partners to protect the health and safety of millions of Americans.”
“It takes a special kind of person to prey on the sick and vulnerable as happened in many of these health care fraud schemes,” said Deputy Chief Hylton. “Medical professionals and others callously placed individuals and vital healthcare services in harm’s way simply because of greed. IRS-CI special agents continue to work side-by-side with other federal, state and local law enforcement officers to uncover these schemes and hold these criminals accountable for their actions.”
“CMS makes it a top priority to protect the health and safety of millions of beneficiaries who depend on vital federal healthcare programs,” said Alec Alexander, deputy administrator and director of the Center for Program Integrity. “CMS’ Center for Program Integrity collaborates closely with our law enforcement partners to safeguard precious taxpayer dollars. Under Administrator Seema Verma, we will continue to strengthen this partnership with law enforcement in order to ensure the integrity and sustainability of these essential programs that serve millions of Americans.”
“Heath care fraud wounds our service members and veterans alike, as they rely upon and rightfully expect uncompromised care through the Department of Defense’s TRICARE Program,” said DCIS Director O’Reilly. “Investigations that culminated in enforcement actions over the past several days underscore the steadfast commitment of the Defense Criminal Investigative Service and our investigative partners to vigorously investigate fraud impacting TRICARE. We remain vigilant in our efforts to ensure the high standards of care our service members, military retirees, and their dependents deserve while safeguarding American taxpayer dollars.”
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in 10 locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
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For the Strike Force locations, in the Southern District of Florida, 124 defendants were charged with offenses relating to their participation in various fraud schemes involving over $337 million in false billings for services including home health care and pharmacy fraud. In one case, an owner, medical director, and two employees of a sober living facility were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, and substantive counts of money laundering. The indictment alleges a scheme that illegally recruited patients, paid kickbacks, and defrauded health care benefit programs for widespread fraudulent urine testing. During the course of the fraudulent scheme, the facility submitted more than $106 million in claims for substance abuse treatment services.
In the Central District of California, 33 defendants were charged for their roles in schemes to defraud insurance programs out of more than $660 million. For example, one indictment in a compounding pharmacy fraud case alleges an attorney/marketer paid kickbacks and offered incentives such as prostitutes and expensive meals to two podiatrists in exchange for prescriptions written on pre-printed prescription pads, regardless of the medical need for the prescriptions. Once the prescriptions were filled, members of the conspiracy submitted approximately $250 million in fraudulent claims to federal, state, and private insurers for the compounded drugs.
In the Southern District of Texas, 48 individuals were charged in cases involving more than $291 million in alleged fraud. Among these defendants are a pharmacy chain owner, managing partner, and lead pharmacist charged with a drug and money laundering conspiracy. According to the indictment, the coconspirators used fraudulent prescriptions to fill bulk orders for over one million pills of hydrocodone and oxycodone, which the pharmacy, in turn, sold to drug couriers for millions of dollars. In the Northern District of Texas, a home health agency owner was arrested on a criminal complaint for a $2.6 million health care fraud scheme.
In the Eastern District of Michigan, 35 defendants face charges for their alleged roles in fraud, kickback, money laundering and drug diversion schemes involving approximately $197 million in false claims for services that were medically unnecessary or never rendered. In one case, a physician was charged in separate kickback conspiracies with two home health agency owners, which resulted in more than $12 million in fraudulent insurance billings.
In the Northern District of Illinois, 21 individuals were charged for various fraud schemes involving home health and dental services. These schemes involved allegedly over $54 million in fraudulent billing. One case alleges a home health fraud and kickback conspiracy, which resulted in more than $6.2 million paid by Medicare based on the fraudulent billings.
In the Eastern District of New York, 13 individuals were charged with participating in a variety of schemes including kickbacks, services not rendered, identity theft and money laundering involving over $38 million in fraudulent billings. For example, the owner of a Brooklyn ambulette company was charged in a $7 million conspiracy stemming from the alleged payment of kickbacks for the referral of patients, who subjected themselves to purported physical and occupational therapy and other services, and were transported by the ambulette company.
In the Middle District of Florida, 21 individuals were charged with participating in a variety of schemes involving more than $21 million in fraudulent billings. In one case, a physician and clinic owner were charged with a conspiracy to defraud Medicare of more than $2.8 million for fraudulent home health billings.
In the Southern Louisiana Strike Force, operating in the Middle and Eastern Districts of Louisiana as well as the Southern District of Mississippi, 42 defendants were charged in connection with health care fraud, drug diversion, and money laundering schemes involving more than $16 million in fraudulent billings. One case alleges that three pharmacy owners and a nurse practitioner conspired to unlawfully dispense controlled substances and defraud TRICARE and private insurance companies out of $12 million.
In the Corporate Strike Force, five defendants were charged in the Middle District of Tennessee with a kickback conspiracy at a durable medical equipment company, which allegedly resulted in more than $1 million in kickbacks and over $2.5 million in fraudulent billings to Medicare.
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In addition to the Strike Force locations, today’s enforcement actions include cases and investigations brought by an additional 46 U.S. Attorney’s Offices, including the execution of search warrants in various investigations conducted by the Central and Northern Districts of California, Middle District of Florida, Southern District of Georgia, Western District of Kentucky, Eastern District of Michigan, Western District of North Carolina, Eastern and Western Districts of Texas, Eastern and Western Districts of Virginia, and Western District of Washington.
In the Northern and Southern Districts of Alabama, 15 defendants were charged for their roles in eight health care fraud schemes involving compounding pharmacy fraud and unlawful distribution of controlled substances.
In the Eastern District of California, four defendants were charged for their roles in two health care fraud schemes, one of which included forged prescriptions.
In the Southern District of California, seven defendants, including a physician, were charged for their roles in three health care fraud schemes and one scheme involving identity theft and services that were not rendered.
In the District of Colorado, a defendant was charged with health care fraud related to billings to Medicaid and Medicare.
In the District of Connecticut, three defendants, including two medical professionals, were charged for their roles in two schemes involving compounding drugs and unlawful distribution of Schedule II and IV controlled substances.
In the District of Delaware, a physician/owner of a pain management clinic was charged with unlawfully prescribing more than two million dosage units of Oxycodone products.
In the District of Columbia, a durable medical equipment company owner was charged with defrauding Medicaid of $9.8 million.
In the Northern District of Florida, four defendants were charged in a scheme to defraud TRICARE and other private insurance companies out of over $8 million for medically unnecessary compounded creams and pills.
In the Northern, Middle, and Southern Districts of Georgia, 12 defendants, including two physicians, were charged in nine health care fraud, drug diversion, or compounding pharmacy schemes involving over $13.5 million in fraudulent billings.
In the District of Idaho, three defendants, all of who are medical professionals, were charged for their roles in three separate fraud schemes involving controlled substances.
In the Central and Southern Districts of Illinois, seven defendants were charged in six separate schemes to defraud the Medicaid program.
In the Northern District of Indiana, eight defendants were charged in various health care fraud schemes to defraud both the Medicare and Medicaid programs.
In the Northern District of Iowa, two defendants – both medical professionals – were charged for their roles in two opioid-related schemes.
In the Districts of Kansas and the Northern and Western Districts of Oklahoma, 12 defendants, including four physicians, were charged in various unlawful distribution of controlled substances schemes. In the Western District of Oklahoma, one case marks the district’s first time charging unlawful distribution of controlled substances resulting in a death.
In the Eastern and Western Districts of Kentucky, 12 defendants, including five medical professionals, were charged in various schemes involving health care fraud, unlawful distribution of controlled substances, aggravated identity theft, and money laundering. One case involved the operation of two false-front medical clinics.
In the Districts of Maine and Vermont, two defendants were charged for their roles in two schemes to defraud various government programs including Medicare, Medicaid, and ones run by the HHS’ Administration for Children and Families.
In the District of Nebraska, seven defendants, including one physician, were charged in five separate schemes to defraud Medicare, Medicaid, and various HHS programs.
In the District of Nevada, four defendants, including three medical professionals were charged with conspiracies to commit health care fraud and distribute controlled substances.
In the District of New Jersey, eight defendants, including a New York doctor, an anesthesiology technologist for a Philadelphia hospital, and the owner of a medical billing company, were charged for their roles in five schemes to defraud private insurance companies of over $16 million.
In the Southern District of New York, two defendants were charged in schemes involving health care fraud or drug diversion.
In the Middle District of North Carolina, two defendants were charged with a conspiracy to defraud Medicare out of over $4 million.
In the Southern District of Ohio, three defendants – all medical professionals – were charged for their roles in two health care fraud schemes, one of which involved illegal drug distribution and kickbacks.
In the Eastern and Middle Districts of Pennsylvania, 12 defendants were charged for their roles in three drug diversion schemes.
In the Western District of Pennsylvania, four defendants – all physicians – were charged in various health care fraud and drug diversion schemes. One scheme involved 32,000 dosage units of buprenorphine.
In the District of Rhode Island, one defendant was charged for participating in a theft and aggravated identity theft scheme.
In the District of South Carolina, three defendants were charged for their separate roles in a conspiracy to possess with the intent to distribute fentanyl.
In the District of South Dakota, two defendants were charged in separate cases, one of which involved a scheme to defraud the Indian Health Service.
In the Middle District of Tennessee, 10 defendants were charged in two separate schemes, including a conspiracy to fraudulently obtain oxycodone.
In the Eastern District of Texas, two defendants were charged for their role in health care fraud schemes to defraud the Medicare and Medicaid programs.
In the District of Utah, two defendants were charged in two cases, one of which involved a $31 million scheme to defraud Medicare and Medicaid.
In the Western District of Virginia, eight defendants were charged for their alleged roles in health care fraud schemes. One $45 million scheme to defraud Medicaid involved falsification of documents in patient files.
In the Eastern District of Washington, a dentist and another individual were indicted for distributing and conspiring to distribute hydrocodone and tramadol without a legitimate medical purpose.
In the Eastern District of Wisconsin, three defendants were charged in a scheme involving the unlawful distribution of controlled substances and aggravated identity theft.
In addition, in the states of Arizona, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maine, Michigan, Missouri, Mississippi, Nevada, New York, Oklahoma, Pennsylvania, Texas, Vermont, and Washington, 97 defendants have been charged with defrauding the Medicaid program out of over $27 million. These cases were investigated by each state’s respective Medicaid Fraud Control Units. In addition, the Medicaid Fraud Control Units of the states of California, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Nevada, North Carolina, Ohio, Texas, Tennessee, and Virginia participated in the investigation of many of the federal cases discussed above.
The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section and from the U.S. Attorney’s Offices in the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois, Middle District of Louisiana, and the Middle District of Florida; and agents from the FBI, HHS-OIG, DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and state Medicaid Fraud Control Units.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Additional documents related to this announcement will shortly be available here:
https://www.justice.gov/opa/documents-and-resources-june-28-2018.
This operation also highlights the great work being done by the Department of Justice’s Civil Division. In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2 billion in judgements and settlements related to matters alleging health care fraud.
National Health Care Fraud Takedown Results in Charges Against 601 Individuals Responsible for over $2 Billion in Fraud LossesRead the Press Release
WASHINGTON - Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director of the Center for Program Integrity Alec Alexander and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE, and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“We will continue to prosecute criminal acts that contribute to the opioid abuse crisis and that undermine our healthcare system in our district,” said Richard W. Moore, United States Attorney for the Southern District of Alabama. “We have skilled prosecutors and diligent special agents who know how to present these cases to juries who we will ask to convict these defendants.”
“The abuse of prescription drugs remains a significant problem in communities across the nation, to include Alabama. For the health and safety of our citizens, DEA will continue to target the illegal diversion of these pharmaceuticals, which can destroy lives. We hope that these indictments and arrest will serve as a reminder to anyone who might illegally divert pharmaceuticals that they will be held accountable for the harm they cause,” said Stephen G. Azzam, Special Agent in Charge of the Drug Enforcement Administration’s New Orleans Field Division.
“DEA is committed to ending the opioid crisis occurring in our communities and preventing prescription drug misuse,” said DEA Assistant Administrator Martin. “DEA will continue to work with our partners every day to protect our citizens while ensuring that patients have adequate access to these critical medications.”
Nine defendants were arrested this week in the Southern District of Alabama for their roles in the unlawful distribution of opioids. They were charged with the distributions of controlled substances to include, Morphine, Hydrocodone, Oxycodone, Oxymorphone, OxyContin, or Fentanyl. Three of the defendants are from Selma and the remaining six are from Mobile.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.National Health Care Fraud Takedown Results in Charges Against 601 Individuals Responsible for More than $2 Billion in Fraud Losses; Seven Charged in San DiegoRead the Press Release
Assistant U. S. Attorney Valerie Chu (619) 546-6750
NEWS RELEASE SUMMARY – June 28, 2018
SAN DIEGO – Seven defendants, including a physician and two chiropractors, were charged in San Diego as part of the largest healthcare fraud enforcement action in Department of Justice history.
The national takedown involved 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants (including 76 doctors) were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
In San Diego, the cases include:
- Marco Antonio Chavez, a licensed medical doctor specializing in psychiatry, was charged with 30 counts of health care fraud in connection with over $928,000 in bills he submitted to TRICARE for services he never provided. He was also charged with five counts of aggravated identity theft and one count of obstruction of a federal audit. According to the indictment, he misappropriated the personal identifying information of TRICARE beneficiaries to submit fraudulent bills to TRICARE, and then lied during the course of a subsequent federal audit. Chavez allegedly used the proceeds of his scheme to purchase, among other luxury items, a 2016 Jaguar F-type and tens of thousands of dollars in David Yurman jewelry. On June 26, 2018, agents executed a search warrant at Chavez’s residence, and seized the Jaguar. The United States is seeking to forfeit all proceeds of Chavez’s illegal activity.
- Four defendants, including two chiropractors, a physical therapist and an acupuncturist, were charged with conspiracy to commit health care fraud and honest services fraud and to pay unlawful kickbacks stemming from their operation of R.I.S.E. Medical Center. According to the indictment, R.I.S.E. operated several “Wellness Centers” in San Diego County, including Bonita and Oceanside, and offering a range of services including physical therapy, diagnostic tests, massages, chiropractic treatments, and acupuncture. Since TRICARE and Medicare do not cover most of those benefits, the defendants misrepresented acupuncture, chiropractic, and massage services as “physical therapy,” and billed TRICARE and Medicare as if “physical therapy” had been provided. Joserodel Zavala Candelario, a chiropractor and owner of R.I.S.E., imposed quotas for non-reimbursable services and treatments, allegedly telling staff that they were expected to provide a certain number of diagnostic tests, “no matter what”; to “grab patients in lobbies to put into provider schedules”; and to ply patients with complimentary treatments so R.I.S.E. could continue to fraudulently bill TRICARE and Medicare. According to the indictment, the defendants fraudulently billed over $23 million to TRICARE, and over $9 million to Medicare.
- In addition, Candelario was also charged with paying a patient recruiter over $18,000 to refer TRICARE patients to the R.I.S.E. clinic. The recruiter, Mariam Reyes, was charged separately with conspiring to solicit and receive kickbacks.
- In a separate indictment, Candelario was charged with participating in a scheme to defraud California Workers’ Compensation insurers and R.I.S.E. patients by receiving illegal kickbacks and bribes to refer patients to certain providers. According to the indictment, Candelario paid kickbacks to his co-schemers through a front company in exchange for referrals of Workers’ Compensation patients, and then concealed these kickbacks through sham “marketing” agreements. One of Candelario’s co-schemers, Boris Dadiomov, was charged separately for his role in the fraudulent conspiracy. As a result of their unlawful cross-referral kickback scheme, Candelario and the other schemers received over 500 illegal patient referrals and submitted over $6.6 million in false billings to insurance companies.
“With healthcare costs skyrocketing, and with patients’ well being on the line, we cannot afford the financial and physical costs of fraud,” said U.S. Attorney Adam Braverman. “Doctors are especially culpable as they are violating the sacred trust they should have with their patients. We are working hard every day to protect patients, taxpayers, ratepayers who are being exploited by those members of the medical community who prefer purchasing power over principle.”
“The FBI is fully committed to protecting our nation’s health care programs that have an impact on San Diegans,” said FBI Special Agent in Charge John Brown. “As evidenced by the broad range of health care fraud cases announced today, the FBI and our partners have shown that we will uncover fraud affecting our public health insurance programs whether committed by a mental health professional, a chiropractor, physical therapist, acupuncturist, physician, ancillary medical service provider or a medical marketer….the health and safety of our citizens depend on it.”
“Public health insurance programs, such as Medicare and TRICARE, are not a personal pocketbook for criminals seeking to exploit government programs designed to help those who need these plans the most,” stated R. Damon Rowe, Special Agent in Charge of IRS Criminal Investigation’s Los Angeles Field Office. “Taxpayers rightly expect individuals working in the healthcare industry that receive payments from taxpayer-funded programs to scrupulously follow the rules. IRS Criminal Investigation will continue to protect the integrity of public health insurance programs and ensure that doctors, chiropractors, and medical service providers who profit from these illicit schemes are held accountable.”
The national takedown was announced today by Attorney General Jeff Sessions. The cases aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in 10 locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
DEFENDANT Case Number 18cr2930
Marco Antonio Chavez
SUMMARY OF CHARGES
(Counts 1-30)
Health Care Fraud – Title 18, United States Code, Section 1347
Maximum Penalty: Twenty years’ imprisonment, $250,00 fine, restitution, forfeiture
(Counts 31-36)
Aggravated Identity Theft – Title 18, U.S.C., Section 1028A
Maximum Penalty: Mandatory two years’ imprisonment, consecutive (per count)
(Count 37)
Obstruction of Federal Audit – Title 18, U.S.C., Section 1516
Maximum Penalty: Five years’ imprisonment, $250,000 fine
DEFENDANT Case Number 18cr3015
Boris Dadiomov
SUMMARY OF CHARGES
Conspiracy to Commit Honest Services Mail Fraud and Healthcare Fraud – Title 18, U.S.C., Section 1349
Maximum penalty: Twenty years’ imprisonment and $250,000 fine
DEFENDANTS Case Number 18cr3057
Joserodel Zavala Candelario (1)
James Ward, Jr. (2)
Robert Cohen (3)
Antony Y. Lim (4)
SUMMARY OF CHARGES
Conspiracy to Commit Offenses– Title 18, U.S.C., Section 371
Maximum Penalty: Five years’ imprisonment, $250,000 fine, restitution, forfeiture
Honest Services Mail Fraud – Title 18, U.S.C., Section 1341, 1346
Maximum penalty: Twenty years’ imprisonment and $250,000 fine, restitution, forfeiture
Health Care Fraud – Title 18, U.S.C., Section 1347
Maximum penalty: Twenty years’ imprisonment and $250,000 fine
Honest Services Wire Fraud - Title 18, U.S.C., Section 1341, 1346
Maximum penalty: Twenty years’ imprisonment and $250,000 fine
DEFENDANT Case Number 18cr3016
Meriam Reyes
SUMMARY OF CHARGES
Conspiracy to Solicit and Receive Kickbacks – Title 18, U.S.C., Section 371
Maximum penalty: Five years’ imprisonment and $250,000 fine, restitution, forfeiture
AGENCIES
Federal Bureau of Investigation
Internal Revenue Service
Defense Criminal Investigative Service
California Department of Insurance
San Diego County District Attorney's Office
*The charges and allegations contained in an indictment or complaint are merely accusations, and the defendants are considered innocent unless and until proven guilty.
- Marco Antonio Chavez, a licensed medical doctor specializing in psychiatry, was charged with 30 counts of health care fraud in connection with over $928,000 in bills he submitted to TRICARE for services he never provided. He was also charged with five counts of aggravated identity theft and one count of obstruction of a federal audit. According to the indictment, he misappropriated the personal identifying information of TRICARE beneficiaries to submit fraudulent bills to TRICARE, and then lied during the course of a subsequent federal audit. Chavez allegedly used the proceeds of his scheme to purchase, among other luxury items, a 2016 Jaguar F-type and tens of thousands of dollars in David Yurman jewelry. On June 26, 2018, agents executed a search warrant at Chavez’s residence, and seized the Jaguar. The United States is seeking to forfeit all proceeds of Chavez’s illegal activity.