Criminal and Civil Enforcement

March 2020

March 31, 2020; U.S. Attorney's Office, Eastern District of Virginia: Former Medical Employees Plead Guilty to Prescription Fraud Scheme
ALEXANDRIA, Va. - Two women pleaded guilty yesterday for their respective roles in helping run a "pill mill," which led to the fraudulent dispensing of thousands of prescription opioid pills.
March 30, 2020; U.S. Attorney's Office, District of New Jersey: Georgia Man Arrested for Orchestrating Scheme to Defraud Health Care Benefit Programs Related to COVID-19 and Genetic Cancer Testing
NEWARK, N.J. - A Georgia man will appear in court today for his alleged role in a conspiracy to defraud federally funded and private health care benefit programs by submitting fraudulent testing claims for COVID-19 and genetic cancer screenings, U.S. Attorney Craig Carpenito announced.
March 30, 2020; U.S. Attorney's Office, District of Montana: Ex-Blackfeet Tribal leader sentenced to prison for Head Start program fraud
GREAT FALLS - The former chairman of the Blackfeet Tribe today was sentenced to 10 months in prison and two years of supervised release along with being ordered to pay $174,000 restitution for his role in an overtime pay scheme that stole federal funds from the tribe's Head Start child assistance program, U.S. Attorney Kurt Alme said.
March 27, 2020; U.S. Attorney's Office, Eastern District of Pennsylvania: Progressions Behavioral Health Services, Inc. and One of its Former Mental Health Therapists Agree to Pay $27,500 to Resolve Potential False Claims Act Liability
PHILADELPHIA - United States Attorney William M. McSwain announced that Progressions Behavioral Health Services, Inc. ("Progressions") andSharmon James, a mental health therapist formerly employed by Progressions, have agreed to pay $27,500 to resolve claims under the False Claims Act set forth in a qui tam complaint filed against them in the United States District Court for the Eastern District of Pennsylvania.
March 27, 2020; U.S. Attorney's Office, Southern District of New York: Manhattan U.S. Attorney Files Civil Fraud Suit Against Anthem, Inc., For Falsely Certifying The Accuracy Of Its Diagnosis Data
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, announced that the United States filed a civil fraud lawsuit today against ANTHEM, INC. ("ANTHEM"), alleging that ANTHEM falsely certified the accuracy of the diagnosis data it submitted to the Centers for Medicare and Medicaid Services ("CMS") for risk-adjustment purposes under Medicare Part C and knowingly failed to delete inaccurate diagnosis codes. As a result of these acts, ANTHEM caused CMS to calculate the risk-adjustment payments to ANTHEM based on inaccurate, and inflated, diagnosis information, which enabled ANTHEM to obtain millions of dollars in Medicare funds to which it was not entitled.
March 26, 2020; U.S. Attorney's Office, Southern District of Florida: CEO, CFO, President, and Owner of Sober Homes Network "Serenity Ranch Recovery" Convicted in $38 Million Fraud Scheme after Six-Week Trial
Fort Lauderdale, Florida -- Sebastian Ahmed, 42, of Delray Beach, Florida, has been convicted of conspiracy to commit health care fraud and wire fraud, five counts of health care fraud, conspiracy to commit money laundering, and eleven counts of money laundering. As part of the scheme, the conspirators exploited vulnerable drug addicts, the majority of whom were 18 to 26 years ago; falsified paperwork; and entered into various kickback arrangements, all in order to receive millions of dollars of falsely and fraudulently obtained funds for their own personal use and benefit. As demonstrated by the trial record, of all the conspirators, no one profited more than Sebastian Ahmed, who netted more than $2.8 million in less than three years.
March 17, 2020; U.S. Attorney's Office, Eastern District of Pennsylvania: Doctor Who Pleaded Guilty to Health Care Fraud for "Goodie Bags" Agrees to Resolve Civil Fraud and Controlled Substance Liability for $2.8 Million
PHILADELPHIA - U.S. Attorney William M. McSwain announced that the United States filed a civil lawsuit against Andrew M. Berkowitz, M.D., of Huntington Valley, PA, for engaging in healthcare fraud and improperly distributing and dispensing controlled substances. The civil complaint relates to criminal charges that were previously filed against Berkowitz and for which he has pleaded guilty. At the same time the new civil suit was filed, the United States also filed a proposed civil judgment, in which Berkowitz has agreed to pay a total of $2.8 million in civil damages and penalties under the False Claims Act, Controlled Substances Act, and in civil forfeiture, committed to never obtaining another controlled substance registration, and consented to a 20-year exclusion from Medicare and Medicaid. The consent judgment remains subject to court approval.
March 13, 2020; U.S. Attorney's Office, Western District of Pennsylvania: Southwestern PA Family Practitioner Charged in 161-Count Superseding Indictment with Dispensing Drugs in Exchange for Sex and Health Care Fraud
PITTSBURGH - A physician who operated private family practices in Perryopolis, Pennsylvania, and Mount Pleasant, Pennsylvania, has been indicted by a federal grand jury in Pittsburgh on charges of unlawfully dispensing controlled substances and health care fraud, United States Attorney Scott W. Brady announced today.
: Villages Dermatologist Agrees To Pay More Than $1.7 Million To Settle False Claims Act Liability For Inflated Medicare Claims
Orlando, FL - United States Attorney Maria Chapa Lopez announces today that Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, L.L.C. have agreed to pay the United States $1.744 million to resolve allegations that they violated the False Claims Act by submitting inflated claims to Medicare for wound repairs related to Mohs surgery.
March 13, 2020; U.S. Attorney's Office, Western District of Pennsylvania: Pittsburgh Resident Pleads Guilty to Conspiracy, Health Care Fraud and Aggravated Identity Theft
PITTSBURGH, Pa. - A resident of Pittsburgh, Pennsylvania, pleaded guilty in federal court to one count each of conspiracy to defraud the Pennsylvania Medicaid program, health care fraud, and aggravated identity theft, United States Attorney Scott W. Brady announced today.
March 13, 2020; U.S. Attorney's Office, Southern District of Mississippi: Federal Jury finds Defendants Guilty of Submitting False Claims to Medicare under Civil False Claims Act. Jury verdict results in recovery of more than $10.85 million to the Medicare program
Gulfport, Miss. - Following a nine week trial, a federal jury in Gulfport returned a guilty verdict yesterday against Ted and Julie Cain of Ocean Springs, Ted Cain's companies, Stone County Hospital (Wiggins) and Corporate Management, Inc. (Gulfport), and Tommy Kuluz, Chief Financial Officer of Corporate Management, Inc. for violating the Civil False Claims Act, announced U.S. Attorney Mike Hurst and Derrick Jackson, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services.
March 11, 2020; U.S. Attorney's Office, Southern District of Texas: Physicians group pays over $1M to resolve false billing claims
HOUSTON - Millennium Physicians Association PLLC has paid the United States $1,248,964 to resolve claims that they improperly billed the Medicare program for sleep studies, announced U.S. Attorney Ryan K. Patrick.
March 11, 2020; Department of Justice: "Compound King" Convicted in $21 Million Health Care Fraud Scheme
A federal jury sitting in Houston, Texas, found a pharmacist guilty Tuesday of charges related to health care fraud, wire fraud and money laundering. After a six-day trial, George Phillip Tompkins, 75, of Houston, Texas, was convicted on all charges - one count each of conspiracy to pay and receive kickbacks, conspiracy to commit health care fraud, conspiracy to commit money laundering as well as 11 counts of health care fraud and three counts of wire fraud.
March 11, 2020; U.S. Attorney's Office, Northern District of Georgia: Atlanta man sentenced in multi-state health care fraud conspiracy
ATLANTA - Matthew Harrell has been sentenced for his role in organizing and managing a health care fraud scheme that stole millions in Medicaid funds in Georgia, Louisiana, and Florida.
March 10, 2020; Department of Justice: Owner of Detroit-Area Health Care Clinic Sentenced to Prison for a Drug Diversion Scheme
The owner of a Detroit-area physical therapy clinic was sentenced to 11 years in prison today for his role in a drug diversion scheme. Assistant Attorney General Brian A. Benczkowski of the Justice Department's Criminal Division, Special Agent in Charge Timothy J. Plancon of the U.S. Drug Enforcement Administration (DEA)'s Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General's (HHS-OIG) Chicago Regional Office made the announcement.
March 10, 2020; U.S. Attorney's Office, District of New Jersey: Eighteen South Jersey Residents Charged With Trafficking Prescription Drugs
CAMDEN, N.J. - Eighteen alleged members of two drug trafficking operations based in Gloucester City and Camden have been charged in connection with their roles in distributing drugs, including high-dosage oxycodone pills, U.S. Attorney Craig Carpenito announced today.
March 6, 2020; U.S. Attorney's Office, Eastern District of Texas: Houston Nurse Guilty in East Texas Health Care Kickback Scheme
TYLER, Texas - A 54-year-old Houston Registered Nurse has pleaded guilty to federal violations in the Eastern District of Texas, announced U.S. Attorney Joseph D. Brown today.
March 6, 2020; U.S. Attorney's Office, Southern District of Ohio: Marietta doctor convicted of illegally distributing opioid pain meds, health care fraud
COLUMBUS, Ohio - A federal jury has convicted a Southeast Ohio doctor of illegally prescribing controlled substances and defrauding health care programs.
March 5, 2020; U.S. Attorney's Office, District of Oregon: Southern California Man Accused of Health Care Fraud
PORTLAND, Ore.-A southern California man who owned and operated local compounding pharmacies has been indicted by a federal grand jury on allegations that he submitted dozens of fraudulent patient attestations in support of reimbursement claims to CVS Caremark, a national pharmacy benefit manager.
March 5, 2020; Department of Justice: DOJ Files Suit against Spine Device Manufacturer and Executives Alleging Kickbacks to Surgeons through Sham Consulting Payments
The Justice Department announced today that the United States intervened and filed a complaint in two whistleblower cases filed under the False Claims Act against SpineFrontier, Inc. (SpineFrontier) and related entities and executives, alleging that the defendants paid kickbacks to spine surgeons to induce use of SpineFrontier surgical devices, in violation of the Anti-Kickback Statute (AKS). According to the United States' complaint, the defendants paid spine surgeons over $8 million in sham "consulting" payments ostensibly for product evaluations, when in fact the payments were for use of SpineFrontier devices.
March 4, 2020; U.S. Attorney's Office, Middle District of Florida: Lecanto Medical Biller Sentenced In Large Healthcare Fraud Scheme
Tampa, FL - U.S. District Judge Mary S. Scriven today sentenced Teresa Johnson (53, Lecanto) to five years' probation, with four months of home detention, for conspiring with a local doctor to commit health care fraud. As part of her sentence, the court also ordered Johnson to pay restitution to the defrauded federal health care programs and, entered a money judgment of more than $5,700, representing a portion of Johnson's health care fraud proceeds.
March 4, 2020; U.S. Attorney's Office, Northern District of Georgia: Hospice to pay $1.75 million to resolve false claims act allegations
ATLANTA - STG Healthcare of Atlanta, Inc. ("STG Healthcare") and two of its senior executives, Paschal "Pat" Gilley and Mathew Gilley, have agreed to pay $1.75 million to resolve allegations that STG Healthcare, operating as Interim Healthcare of Atlanta, submitted or caused the submission of false claims to Medicare and Medicaid for patients who were not eligible for the hospice benefit and that resulted from STG Healthcare's provision of unlawful payments to a referring physician in violation of the Anti-Kickback Statutes.
March 3, 2020; U.S. Attorney's Office, District of Massachusetts: United States Files False Claims Act Complaint Against Drug Maker Mallinckrodt. Complaint alleges that company avoided paying hundreds of millions of dollars in Medicaid rebates due to significant drug price increases
BOSTON - The U.S. Attorney's Office announced today that it filed a complaint under the False Claims Act against Mallinckrodt ARD LLC (formerly known as Mallinckrodt ARD, Inc. and previously Questcor Pharmaceuticals, Inc.) (collectively "Mallinckrodt"). The government alleges that Mallinckrodt has violated the False Claims Act by underpaying Medicaid rebates due as a result of large increases in the price of its drug H.P. Acthar Gel ("Acthar").
March 2, 2020; U.S. Attorney's Office, District of Connecticut: Two Connecticut Physicians Pay over $4.9 Million to Settle False Claims Act Allegations
U.S. Attorney John H. Durham, Special Agent in Charge Phillip Coyne of the U.S. Department of Health and Human Services, Office of Inspector General, Special Agent in Charge Brian C. Turner of the New Haven Division of the Federal Bureau of Investigation, and Connecticut Attorney General William Tong today announced that DR. CRISPIN ABARIENTOS and his wife, DR. ANTONIETA ABARIENTOS, have entered into a civil settlement agreement with the federal and state governments in which they will pay $4,927,903 to resolve allegations that they violated the federal and state False Claims Acts.

February 2020

February 28, 2020; Department of Justice: Diversicare Health Services Inc. Agrees to Pay $9.5 Million to Resolve False Claims Act Allegations Relating to the Provision of Medically Unnecessary Rehabilitation Therapy Services
Diversicare Health Services Inc., has agreed to pay $9.5 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled, the Department of Justice announced today.
February 28, 2020; U.S. Attorney's Office, Eastern District of Virginia: Woman Sentenced for Cocaine Conspiracy and Multiple Fraud Schemes
ALEXANDRIA, Va. - A Nigerian woman was sentenced today to 10 years in prison and ordered to pay over $377,000 in restitution for leading a conspiracy to import more than five kilograms of cocaine into the United States, as well as to her role in a separate bank fraud scheme, and to making false statements relating to fraudulent claims submitted to Medicaid for reimbursement.
February 28, 2020; U.S. Attorney's Office, District of Massachusetts: Sanofi Agrees to Pay $11.85 Million to Resolve Allegations That it Paid Kickbacks Through a Co-Pay Assistance Foundation
BOSTON - The U.S. Attorney's Office announced today that pharmaceutical company Sanofi-Aventis U.S., LLC ("Sanofi"), has agreed to pay $11.85 million to resolve allegations that it violated the False Claims Act by paying kickbacks to Medicare patients through a purportedly independent charitable foundation, The Assistance Fund ("TAF").
February 28, 2020; U.S. Attorney's Office, Middle District of Tennessee: Diversicare Health Services, Inc. Agrees To Pay $9.5 Million To Resolve False Claims Act Allegations
NASHVILLE, Tenn. - February 28, 2020 - Diversicare Health Services, Inc., has agreed to pay $9.5 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled, the Department of Justice announced today. The settlement also resolves allegations that Diversicare submitted forged pre-admission evaluations of patient need for skilled nursing services to TennCare, the state of Tennessee's Medicaid Program. Diversicare, based in Brentwood, Tennessee, provides skilled nursing and rehabilitation services at approximately 74 facilities across the country.
February 27, 2020; U.S. Attorney's Office, Southern District of Florida: Five Defendants Sentenced in South Florida to Prison Terms for Their Roles in Tricare and Medicare Fraud Scheme
MIAMI - This week, U.S. District Judge Cecilia M. Altonaga sentenced five defendants, including a doctor, to federal prison terms for their roles in a scheme that defrauded Tricare and Medicare out of more than $9.6 million. The defendants tricked beneficiaries into having the federal health care programs pay for medically unnecessary compounded prescription medicines and cancer genetic tests.
February 27, 2020; United States Attorney, Eastern District of New York: Queens Pharmacy Owner Found Guilty of Health Care Fraud and Money Laundering Charges for Role in Billing Scheme
BROOKLYN, NY - A federal jury in Brooklyn returned a guilty verdict last night against pharmacy owner Yuriy Barayev on one count of health care fraud and seven counts of money laundering for his role in a scheme to defraud Medicare by billing for prescription medications that were not provided to patients. The verdict followed a four-day trial before United States District Judge Edward R. Korman. When sentenced, Barayev faces up to 10 years in prison for health care fraud and up to 20 years in prison on each of the money laundering counts.
February 27, 2020; U.S. Attorney's Office, District of Kansas: Kansas Clinic Agrees to Pay $775,000 To Resolve False Claims Act Allegations
KANSAS CITY, KAN. - Trina Health-Wichita NW, LLC, located in Wichita, Kan., and Jack West of Dallas, Texas, one of the company's principals, agreed to pay the United States $775,000 to resolve allegations that they violated the False Claims Act by submitting false claims to Medicare and TRICARE.
February 26, 2020; Department of Justice: Two Los Angeles Pharmacy Owners Sentenced for Multimillion-Dollar Scheme that Billed Medicare, Cigna $11.8 Million in Fraudulent Medication Claims
Two owners and operators of a Los Angeles pharmacy were both sentenced today to 144 months in prison for their roles in a health care fraud scheme where Medicare and CIGNA were billed more than $11.8 million in fraudulent claims for prescription drugs.
February 26, 2020; U.S. Attorney's Office, Northern District of Georgia: Georgia woman pleads guilty to social security fraud
ATLANTA - Valencia D. Williams has pleaded guilty to Social Security fraud. Williams received Supplemental Security Income (SSI) from the Social Security Administration because she claimed that she was so disabled by anxiety and depression that she spent most of her time in her room and could not work. In fact, she was working as an exotic dancer at a local adult entertainment club under the name "Chrissy the Doll." SSI is a needs-based disability benefits program. Individuals who are over a certain income threshold or are not disabled cannot collect SSI...
..."When individuals are approved for certain Social Security benefits, they automatically become entitled to Medicare and Medicaid," said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. "This case represents how federal agencies can leverage precious resources to protect vital taxpayer-funded programs."
February 26, 2020; Department of Justice: Physician Charged for Alleged Role in an Over $120 Million Health Care Fraud and Money Laundering Conspiracy Involving Sponsorship of Ultimate Fighting Championship Hall of Famers
A physician who from 2016 to 2017 was the top prescriber of oxycodone 30 mg in Michigan was charged in a superseding indictment unsealed today with an over $120 million health care fraud and money laundering scheme that involved the alleged medically unnecessary distribution of over 2.2 million dosage units of controlled substances and the administration of medically unnecessary injections that resulted in patient harm.
February 24, 2020; U.S. Attorney, Central District of California: Urologist Sentenced to Nearly Six Years in Prison for Fraudulent Billings of Nonexistent Patient Visits and Unnecessary Tests
LOS ANGELES - A urologist was sentenced today to 71 months in federal prison for submitting fraudulent billings totaling more than $700,000 to Medicare for medically unnecessary and nonexistent treatments, sometimes billing for purported patient visits miles apart and occurring at the exact same time.
February 21, 2020; Connecticut State Division of Criminal Justice: Waterbury Woman Charged in Scheme to Defraud Medicaid
A Waterbury woman who worked as a personal care assistant to a developmentally disabled man was arrested and charged billing Medicaid for his care after she had stopped providing services. ADRIEONNA FISHER, age 26, of Grilleytown Road in Waterbury, was arrested Thursday by Inspectors from the Medicaid Fraud Control Unit (MFCU) in the Office of the Chief State's Attorney and charged with one count each of Larceny in the First Degree By Defrauding A Public Community, Criminal Attempt to Commit Larceny in the Second Degree and Health Insurance Fraud.
February 21, 2020; Department of Justice: Ohio Doctor Pleads Guilty to Unlawful Distribution of Opioids
An Ohio physician who owned a Dayton-area medical practice pleaded guilty today for illegally distributing opioids. Assistant Attorney General Brian A. Benczkowski of the Justice Department's Criminal Division, U.S. Attorney David DeVillers of the Southern District of Ohio, Special Agent in Charge Keith Martin of the Drug Enforcement Administration's (DEA) Detroit Division, Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General's (HHS-OIG) Chicago Regional Office and Special Agent in Charge William C. Hoffman of the FBI's Cincinnati Field Office made the announcement. Morris Brown, M.D. 75, of Dayton, pleaded guilty to one count of unlawful distribution of controlled substances before U.S. District Judge Walter Rice of the Southern District of Ohio. Brown is scheduled to be sentenced by Judge Rice on May 8.
February 19, 2020; Department of Justice: Guardian Elder Care Holdings and Related Entities Agree to Pay $15.4 Million to Resolve False Claims Act Allegations for Billing for Medically Unnecessary Rehabilitation Therapy Services
Guardian Elder Care Holdings Inc., and related companies Guardian LTC Management Inc., Guardian Elder Care Management Inc., Guardian Elder Care Management I Inc., and Guardian Rehabilitation Services Inc., (Guardian) agreed to pay $15,466,278 to resolve False Claims Act allegations that they knowingly overbilled Medicare and the Federal Employees Health Benefits Program for medically unnecessary rehabilitation therapy services, the Department of Justice announced today. Guardian operates more than 50 nursing facilities throughout Pennsylvania, as well as in Ohio and West Virginia.
February 19, 2020; U.S. Attorney; Eastern District of Pennsylvania: Montgomery County "Pill Mill" Doctor Sentenced to Four Years in Prison for Illegal Opioid Distribution
PHILADELPHIA - United States Attorney William M. McSwain announced that Dr. Spiro Y. Kassis, 66, of Plymouth Township, PA was sentenced to 48 months' incarceration, two years' supervised release and a $25,000 fine by United States District Judge Gene E. K. Pratter after pleading guilty to 14 counts of distributing controlled substances outside the course of professional practice and without a legitimate medical purpose. Separately, in a related civil case which reached settlement in November 2019, the defendant agreed to pay $1.4 million to resolve similar allegations.
February 19, 2020; Connecticut State Division of Criminal Justice: New Haven Woman Charged with Medicaid Fraud
A Philadelphia-area doctor was sentenced to 12 months and one day in prison and ordered to pay a $100,000 fine yesterday for the illegal distribution of oxycodone.
Thursday, February 13, 2020; Department of Justice: Former Caregiver Pleads Guilty to Obstructing Investigation Related to Violation of Disabled Resident's Civil Rights
Anthony R. K. Flores, a former employee of a Missouri residential treatment facility, pleaded guilty in federal court in the Western District of Missouri to criminal charges arising from a civil rights investigation into the death of C.D., a Missouri ward of the state with developmental disabilities. Flores pleaded guilty to one count of obstructing justice by knowingly falsifying a document with the intent to impede, obstruct, and influence an investigation related to the death of C.D.
Friday, February 14, 2020; Department of Justice: Chicago Woman Found Guilty for Role in $7 Million Scheme to Defraud Medicare
A federal jury found a Chicago woman guilty today for her role in a scheme to defraud Medicare of approximately $7 million between 2011 and 2017.
February 12, 2020; Kansas Attorney General: Two Sedgwick County residents found guilty of Medicaid fraud
WICHITA - (February 12, 2020) - Two Sedgwick County residents have been found guilty of Medicaid fraud, Kansas Attorney General Derek Schmidt said today.
February 12, 2020; District of Maine: Owner of Lewiston Counseling Agency Sentenced for Health Care Fraud
Portland, Maine: A Lewiston woman was sentenced today in federal court in Portland for conspiring to commit health care fraud, U.S. Attorney Halsey B. Frank announced.
February 11, 2020; Department of Justice: Tenet Healthcare and Affiliated California Hospital to Pay $1.41 Million to Settle False Claims Act Allegations for Implanting Unnecessary Cardiac Monitors
Tenet Healthcare Corporation and its affiliated hospital Desert Regional Medical Center (DRMC), a general medical and surgical hospital located in Palm Springs, California, have agreed to pay $1.41 million to resolve allegations that they violated the False Claims Act by knowingly charging Medicare for implanting unnecessary cardiac monitors, the Justice Department announced today.
February 11, 2020; Southern District of West Virginia: Raleigh County Woman Enters Guilty Plea to Health Care Fraud
Defendant fraudulently obtained over $300,000
CHARLESTON, W.Va. - Julie M. Wheeler entered a guilty plea for federal health care fraud, announced United States Attorney Mike Stuart. Wheeler, 43, of Beckley, faces up to 10 years of incarceration, a $250,000 fine, and three years of supervised release when sentenced on May 20, 2020. She will also be subject to an order of restitution in an amount ranging from $302,131 to $469,983, with the final determination to be made by the Court at sentencing.
February 11, 2020; Northern District of Illinois: Federal Jury Convicts Doctor on Fraud Charges for Approving Medically Unnecessary Tests
CHICAGO - A federal jury in Chicago has convicted a physician on fraud charges for approving medically unnecessary tests that were billed to Medicare.
February 10, 2020; District of New Jersey: Former Pharmacy Employee Admits Role in Multi-Million Dollar Illegal Kickback Scheme
NEWARK, N.J. - A Bergen County, New Jersey, man today admitted participating in a conspiracy to pay and accept kickbacks in exchange for medically unnecessary prescriptions, U.S. Attorney Craig Carpenito announced.
February 6, 2020; Department of Justice: Patient Recruiter Sentenced to Prison for Role in More than $1 Million Illegal Kickback Conspiracy
A patient recruiter was sentenced to 60 months in prison yesterday for receiving more than $1 million in illegal kickback payments from numerous home health agencies from around the country in exchange for providing information on Medicare beneficiaries to home health agencies, who then used that information to submit fraudulent claims to Medicare.
February 6, 2020; Eastern District of California: Sacramento Man Pleads Guilty to Medicare Kickback Scheme
SACRAMENTO, Calif. - Jai Vijay, 54, of Sacramento, pleaded guilty today to conspiring with the owners of home health care agencies and a hospice agency to pay and receive illegal kickbacks in exchange for Medicare beneficiary referrals.
February 5, 2020; District of Maryland: Former Employee of Walter Reed National Military Medical Center Facing Federal Indictment in Maryland.
Maryland - A federal grand jury has indicted David Laufer, age 63, of Pittsburgh, Pennsylvania, formerly of Bethesda, Maryland, on five counts of the federal charge of making false statements. The indictment was returned on December 16, 2019, and was unsealed upon his arrest on January 28, 2020. Laufer had his initial appearance yesterday in U.S. District Court in Greenbelt and was released pending trial.
February 5, 2020; Department of Justice: Two Owners of Telemedicine Companies Charged for Roles in $56 Million Conspiracy to Defraud Medicare and Receive Illegal Kickbacks in Exchange for Orders of Orthotic Braces
WASHINGTON - The owners of two telemedicine companies were charged in an indictment unsealed yesterday for allegedly orchestrating a nationwide scheme to receive kickbacks and bribes in exchange for the ordering of medically unnecessary orthotic braces (braces) for beneficiaries of Medicare.
February 4, 2020; Department of Justice: U. S. Settles False Claims Act Allegations Against Southeastern Retina Associates
Knoxville, Tenn. - Southeastern Retina Associates ("SERA") has paid $1.5 million to resolve False Claims Act allegations in the United States District Court for the Eastern District of Tennessee.
February 4, 2020; U.S. Department of Justice: Four Detroit-Area Physicians Found Guilty of Health Care Fraud Charges for Role in Over $150 Million Health Care Fraud Scheme
A federal jury found four Detroit-area physicians guilty today of health care fraud charges for their roles in a scheme to administer unnecessary back injections to patients in exchange for prescriptions of over 6.6 million doses of medically unnecessary opioids. Patients were required to get the injections in order to get the prescriptions, some of which were resold on the street by drug dealers, the evidence at trial showed.
February 4, 2020; Central District of California: Returned Fugitive Sentenced to 2 1/2 Years in Federal Prison for Role in Medicare Fraud Scheme Featuring Bogus Physical Therapy Claims
SANTA ANA, California - A former chiropractor who was on a federal "Most Wanted" list of fugitives was sentenced today to 30 months in federal prison for his role in a $15 million Medicare fraud scheme in which claims were submitted for physical therapy services that either were not reimbursable or were not provided.
February 4, 2020; Western District of Pennsylvania: Doctor Sentenced to Probation and Home Confinement for Health Care Fraud
PITTSBURGH, PA - A resident of DuBois, Pennsylvania has been sentenced for health care fraud, United States Attorney Scott W. Brady announced today. In March 2019, David James Girardi pleaded guilty to one count of health care fraud. In connection with the guilty plea, Girardi admitted to committing health care fraud by submitting fraudulent claims to Highmark for six Oxycodone and Hydrocodone prescriptions that Girardi wrote for his wife, but which were in fact intended for his own use.
February 3, 2020; Western District of Pennsylvania: Greensburg Doctor Charged with Conspiring to Receive Kickbacks for Prescribing Fentanyl, and Then Causing Insurers to Pay for the Unlawful Prescriptions
PITTSBURGH - A Westmoreland County physician has been indicted by a federal grand jury in Pittsburgh, Pennsylvania, on charges of conspiracy to violate the Anti-Kickback Statute, conspiracy to distribute fentanyl, health care fraud, and conspiracy to distribute phentermine hydrochloride and diethylpropion, United States Attorney Scott W. Brady announced today.

January 2020

January 31, 2020; Western District of Virginia: Pennsylvania Physician Sentenced for Drug Charge
CLARKSBURG, WEST VIRGINIA - Dr. Parth Bharill, a Pittsburgh and Morgantown physician, was sentenced today to five years probation, with the first six months on home confinement, for a drug charge, U.S. Attorney Bill Powell announced.
January 29, 2020, District of Maryland: Two Baltimore Men Convicted After Three-Week Federal Trial for Witness Retaliation and Tampering Resulting in the Murder of a Baltimore Woman. Both Defendants Face Mandatory Life Sentences in Federal Prison
Baltimore, Maryland - A federal jury in Baltimore, today convicted Davon Carter, age 39, and Clifton Mosley, age 41, both of Baltimore, for two counts of conspiracy to murder a witness and one count each of witness retaliation murder and witness tampering murder, related to the murder of Latrina Ashburne, age 41, on May 27, 2016. Carter was also convicted of a federal narcotics conspiracy charge, two counts of using a cellular telephone to facilitate the commission of a felony, and possession with intent to distribute marijuana. Mosley was also convicted of distribution of marijuana.
January 27, 2020; U.S. Department of Justice: Electronic Health Records Vendor to Pay $145 Million to Resolve Criminal and Civil Investigations. Practice Fusion Inc. Admits to Kickback Scheme Aimed at Increasing Opioid Prescriptions.
Practice Fusion Inc. (Practice Fusion), a San Francisco-based health information technology developer, will pay $145 million to resolve criminal and civil investigations relating to its electronic health records (EHR) software, the Department of Justice announced today.
January 27, 2020; Southern District of West Virginia: HOPE Clinic Physician Pleads Guilty
BECKLEY, W.Va. - A North Carolina physician pled guilty to a drug crime, announced United States Attorney Mike Stuart. Roswell Tempest Lowry, M.D., 85, pled guilty to interstate travel in aid of a racketeering enterprise.
January 27, 2020; Southern District of New York: Manhattan Doctor Sentenced To Nearly Five Years In Prison For Accepting Bribes And Kickbacks In Exchange For Prescribing Fentanyl Drug.
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, announced today that ALEXANDRU BURDUCEA, a doctor who practiced in Manhattan, was sentenced today in Manhattan federal court to 57 months in prison for conspiring to violate the Anti-Kickback Statute, in connection with a scheme to prescribe Subsys, a potent fentanyl-based spray, in exchange for bribes and kickbacks from Subsys's manufacturer, Insys Therapeutics. BURDUCEA pled guilty on February 14, 2019, and was sentenced by United States District Judge Kimba M. Wood.
January 24, 2020; U.S. Department of Justice: Columbus Pain Clinic and Owner Agree to Pay $650,000 to Resolve Allegations of Unnecessary Procedures
Comprehensive Pain Management Institute and its owner, Leon Margolin, M.D., have agreed to pay the United States $650,000 to resolve False Claims Act allegations that they knowingly billed Medicare for nerve conduction studies and alcohol/substance abuse assessments and interventions (SBIRT) that were medically unnecessary or not provided as billed, the Justice Department announced today. Margolin is a pain management physician in Columbus, Ohio.
January 24, 2020; District of Connecticut: Waterbury Licensed Professional Counselor Pays $39K to Settle False Claims Allegations
John H. Durham, United States Attorney for the District of Connecticut, today announced that CHANNA SONTAG, LPC, and her business, CHILDREN'S BEHAVIORAL THERAPY LLC, have entered into a civil settlement agreement with the federal and state governments and will pay more than $39,000 to resolve allegations that they violated the federal and state False Claims Acts.
January 24, 2020; Eastern District of Tennessee: Family Physician Pays $285,000 To Settle False Claims Act Allegations Of Billing Services At Inflated Rate
Knoxville, Tenn. - Family physician Dr. Chang-Wen Chen and his practice Chang-Wen Chen, M.D., P.C. paid $285,000 to resolve allegations that they violated the False Claims Act by improperly charging government health care programs the physician's rate for services that were provided by nurse practitioners. The allegations challenged billings submitted to Medicare, Medicaid ("TennCare") and TRICARE from 2013 through 2019.
January 23, 2020; U.S. Attorney; Southern District of California: San Diego's Arch Health Pays $2.9 Million to Resolve False Claims Act Allegations
SAN DIEGO - Arch Health Partners, Inc. ("Arch Health") has agreed to pay the United States $2,910,370 to resolve allegations that it violated the False Claims Act by submitting false claims to Medicare. Arch Health is a San Diego-based medical organization that contracts with physician groups to provide care through the Palomar Health system.
January 22, 2020; U.S. Attorney; District of Massachusetts: Former CEO of Insys Therapeutics Sentenced for Racketeering Scheme
BOSTON - The former CEO and President of Insys Therapeutics was sentenced today in federal court in Boston for bribing practitioners to prescribe Subsys, a fentanyl-based pain medication, often when medically unnecessary.
January 22, 2020; U.S. Attorney; Northern District of Ohio: Braking Point Recovery Center Owner Sentenced to 7 1/2 Years in Prison for Health Care Fraud and Drug Crimes
Ryan P. Sheridan, 39, the owner and operator of Braking Point Recovery Center, which operated in the Youngstown and Columbus areas, was sentenced to 7 ½ years in prison for crimes related to a health care fraud conspiracy where Medicaid was billed $48 million for drug and alcohol recovery services, much of which were not provided, not medically necessary, lacked proper documentation, or had other issues that made them ineligible for reimbursement.
January 21, 2020; U.S. Department of Justice: Patient Services Inc. Agrees to Pay $3 Million for Allegedly Serving as a Conduit for Pharmaceutical Companies to Illegally Pay Patient Copayments
Patient Services Inc. (PSI), a foundation based in Midlothian, Virginia, has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by acting as a conduit to enable certain pharmaceutical companies to provide kickbacks to Medicare patients taking the companies' drugs by paying the patients' copayments, the Department of Justice announced today. The amount of the settlement announced today was determined based on analysis of PSI's ability to pay after review of its financial condition.
January 21, 2020; U.S. Department of Justice: Patient Services Inc. Agrees to Pay $3 Million for Allegedly Serving as a Conduit for Pharmaceutical Companies to Illegally Pay Patient Copayments
Patient Services Inc. (PSI), a foundation based in Midlothian, Virginia, has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by acting as a conduit to enable certain pharmaceutical companies to provide kickbacks to Medicare patients taking the companies' drugs by paying the patients' copayments, the Department of Justice announced today. The amount of the settlement announced today was determined based on analysis of PSI's ability to pay after review of its financial condition.
January 21, 2020; U.S. Department of Justice: Pennsylvania Doctor Pleads Guilty to Unlawfully Distributing Oxycodone to His Patients
A Pennsylvania doctor pleaded guilty today to unlawfully distributing oxycodone to his patients.
January 21, 2020; U.S. Attorney; Southern District of California: "Pill Mill" Doctor Pleads Guilty to Opioid Distribution, Admits Signing Prescriptions for Dead and Jailed Patients
SAN DIEGO - Egisto Salerno, a medical doctor practicing in San Diego, pleaded guilty to opioid distribution in federal court today, admitting that he signed bogus prescriptions for multiple deceased or incarcerated patients.
January 21, 2020; U.S. Department of Justice: Patient Services Inc. Agrees to Pay $3 Million for Allegedly Serving as a Conduit for Pharmaceutical Companies to Illegally Pay Patient Copayments
Patient Services Inc. (PSI), a foundation based in Midlothian, Virginia, has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by acting as a conduit to enable certain pharmaceutical companies to provide kickbacks to Medicare patients taking the companies' drugs by paying the patients' copayments, the Department of Justice announced today. The amount of the settlement announced today was determined based on analysis of PSI's ability to pay after review of its financial condition.
January 21, 2020; U.S. Attorney; District of Massachusetts: Fourth Foundation Resolves Allegations that it Conspired with Pharmaceutical Companies to Pay Kickbacks to Medicare Patients
BOSTON - The U.S. Attorney's Office announced today that Patient Services, Inc. ("PSI"), a foundation based in Midlothian, Va., has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by enabling certain pharmaceutical companies to pay kickbacks to Medicare patients taking the companies' drugs.
January 21, 2020; U.S. Attorney; Southern District of Florida: Three South Florida Residents Sentenced to Prison for Their Roles in $21 Million Sober Homes Fraud Scheme
MIAMI, FL - Three former co-owners and clinical directors of a group of purported substance abuse treatment centers and sober homes were sentenced to prison today for their roles in a conspiracy to commit health care fraud and wire fraud that resulted in an actual loss of more than $3.8 million, and through which the conspirators sought to obtain more than $21 million.
January 21, 2020; U.S. Attorney; Eastern District of New York: Medical Doctor Settles Civil Fraud Allegations in Adult Homes Investigation
Dr. Rajendra Bhayani, an otolaryngologist, has agreed to pay the United States $1,109,000 to resolve civil allegations that he and his practice - New York Otolaryngology & Aesthetic Surgery, P.C. in Brooklyn and Queens - paid kickbacks and submitted false claims to federal healthcare programs for services provided to residents in adult homes in violation of the False Claims Act.
January 17, 2020; State of Alaska Department of Law: Anchorage Dentist Seth Lookhart Convicted of Medical Assistance Fraud, Illegal Practice of Dentistry, Reckless Endangerment
The Alaska Department of Law, Medicaid Fraud Control Unit (MFCU), announces that in a verdict issued today by Superior Court Judge Michael Wolverton, following a five-week bench trial, Seth Lookhart was convicted of 46 counts of felony Medical Assistance Fraud, felony Scheme to Defraud, and misdemeanor counts of Illegal Practice of Dentistry, and Reckless Endangerment. Judge Wolverton also found Lookhart's corporation "Lookhart Dental LLC, d/b/a Clear Creek Dental," guilty of all 40 counts alleged against it. Lookhart's office manager, Shauna Cranford, had previously pled guilty to all of the conduct underlying the counts pursuant to a plea agreement. Judge Wolverton found that the State's evidence was "simply overwhelming" as to each count.

The prosecution acknowledges the many law enforcement agencies and civilians who assisted in the prosecution of this case, especially the former patients who testified during the trial. The State extends a special thanks to the "hoverboard video" patient, the patient whose teeth were pulled out without consent, and the patient who was forced to repeatedly return to Lookhart for remedial care. The State acknowledges the thorough work of the federal agents with the federal Department of Health and Human Services, Office of Inspector General, who provided substantial litigation assistance with this case. The prosecution also expresses thanks to the agents of the FBI Anchorage Field Office, the federal DEA, the State Department of Health and Social Services, the six doctors who provided extensive testimony at trial, and the many, many hours spent by the Medicaid Fraud Control Unit's investigators and staff. The State extends a special thanks to Dr. Eric Nordstrom for his many hours of hard work as the State's primary expert in this case.
January 17, 2020; U.S. Attorney; District of South Carolina: ResMed Corp. to Pay the United States $37.5 Million to Settle Allegations Under the False Claims Act
Columbia, South Carolina --- Acting United States Attorney A. Lance Crick announced today that ResMed Corp., a manufacturer of durable medical equipment (DME) for sleep apnea and other sleep-related disorders, has agreed to pay more than $37.5 million to resolve allegations under the False Claims Act for paying kickbacks to DME suppliers, sleep labs, and other health care providers.
January 16, 2020; U.S. Attorney; Eastern District of Virginia: Psychiatrist Sentenced to Prison for Healthcare Fraud Scheme
NORFOLK, Va. - A Virginia Beach doctor was sentenced today to 27 months in prison for defrauding Medicare, Medicaid, and Tricare, and other health care benefits programs out of hundreds of thousands of dollars.
January 16, 2020; U.S. Attorney; Northern District of Iowa: Northern Iowa Doctor Sentenced to Federal Prison for Making False Statements and Will Pay More Than $315,000 to Resolve False Claims Act Allegations Relating to Nursing Facility Residents
Dr. Joseph X. Latella, a primary care doctor in Webster City, Iowa, was sentenced today to two months in prison and to pay a fine after previously pleading guilty to making false statements related to health care matters. Dr. Latella has also agreed to pay $316,438.96 to resolve False Claims Act allegations relating to claims he submitted for routine visits for nursing facility residents between January 1, 2014, and November 30, 2018. The United States alleged that Dr. Latella submitted claims to Medicare and Medicaid for the most intensive and expensive claim code for such visits when, in fact, he was not performing services sufficient to justify use of that code.
January 16, 2020; U.S. Attorney; Eastern District of Louisiana: Metairie Woman Pleads Guilty to Conspiracy to Obtain Oxycodone by Fraud and to Distribute Oxycodone
NEW ORLEANS - U.S. Attorney Peter G. Strasser announced that CHRISTIE LYNN BROWNING, age 42, a resident of Metairie, Louisiana pled guilty on January 15, 2020 to a dual object conspiracy to obtain possession of oxycodone by fraud and to unlawfully distribute oxycodone.
January 16, 2020; U.S. Attorney; District of Massachusetts: Two Dentists and Office Manager Indicted for Medicaid Fraud Scheme
One defendant also indicted for tax evasion and aggravated identity theft
BOSTON - A federal grand jury in Boston has indicted a Worcester dentist, a Chelmsford dentist, and a Worcester office manager for their participation in a scheme to defraud the Massachusetts Medicaid program, commonly known as MassHealth.
January 15, 2020; U.S. Department of Justice: Texas Doctor Found Guilty for Role in $325 Million Health Care Fraud Scheme Involving False Diagnoses of Life-Long Diseases
A federal jury found a Texas rheumatologist guilty today for his role in a $325 million health care fraud scheme in which he falsely diagnosed patients with life-long diseases and treated them with toxic medications on the basis of that false diagnosis.
January 15, 2020; U.S. Attorney; Eastern District of New York: ResMed Corp. to Pay the United States $37.5 Million for Allegedly Causing the Filing of False Claims Related to the Sale of Equipment for Sleep Apnea and Other Sleep-Related Disorders
WASHINGTON - The Department of Justice announced today that ResMed Corp., a manufacturer of durable medical equipment (DME) based in San Diego, California, has agreed to pay more than $37.5 million to resolve alleged False Claims Act violations for paying kickbacks to DME suppliers, sleep labs and other health care providers.
January 15, 2020; U.S. Attorney; Eastern District of Wisconsin: TMJ & Orofacial Pain Treatment Centers of Wisconsin Agree to Pay $1 Million to Resolve False Claims Act Allegations
United States Attorney Matthew D. Krueger announced today that L.M.G., Inc., which does business as TMJ & Orofacial Pain Treatment Centers of Wisconsin, agreed to pay $1,000,000 to the United States to resolve allegations that TMJ & Orofacial Pain Treatment Centers of Wisconsin submitted false claims to Medicare and TRICARE for oral appliances used to treat temporomandibular joint disorder.
January 14, 2020; U.S. Attorney; Middle District of Tennessee: Mid-State Physician Charged In $7 Million Healthcare Fraud Conspiracy
NASHVILLE, Tenn. - January 14, 2020 - James L. Crabb, M.D., 78, of Loretto, Tennessee, is facing federal charges for his role in a $7 million healthcare fraud conspiracy, announced U.S. Attorney Don Cochran for the Middle District of Tennessee. Crabb was charged in a criminal Information on December 20, 2019, and appeared before a U.S. Magistrate Judge yesterday.
January 14, 2020; U.S. Attorney; Western District of Pennsylvania: Pittsburgh Resident Pleads Guilty to Conspiracy and Health Care Fraud
PITTSBURGH, Pa. - A resident of Pittsburgh, Pennsylvania, pleaded guilty in federal court yesterday to one count each of conspiracy to defraud the Pennsylvania Medicaid program and health care fraud, United States Attorney Scott W. Brady announced today.
January 13, 2020; U.S. Attorney; Eastern District of Michigan: Metro Detroit Psychologist Sentenced to 51 Months for Health Care Fraud and Money Laundering
A psychologist with multiple clinic locations throughout Metro Detroit, will spend 51 months in prison for the commission of health care fraud and money laundering offenses, U.S. Attorney Matthew Schneider announced today.
January 10, 2019; U.S. Attorney; Eastern District of Arkansas: Doctor and Sales Rep Charged in $12 Million Fraud Scheme Targeting Tricare and Extensive Cover Up
LITTLE ROCK-A doctor and a medical sales representative have been charged in a scheme to pay and receive kickbacks to generate expensive prescriptions for compounded drugs. TRICARE, the military's health insurer, paid over $12 million for the prescriptions, which the indictment alleges were rubber stamped without examining patients or regard to medical necessity. The 43-count indictment alleges the scheme also encompassed widespread efforts to obstruct the ensuing investigation.
January 10, 2020; U.S. Attorney; Western District of Pennsylvania: Pittsburgh-Area Lab Owner Pleads Guilty To Multiple Kickback Conspiracies In Connection With Almost $130 Million In Medicare Claims For Genetic Testing
PITTSBURGH, Pa. - A resident of Monroeville, Pennsylvania, pleaded guilty in federal court to three conspiracy counts and one substantive count related to the payment and receipt of unlawful kickbacks, United States Attorney Scott W. Brady announced today.
January 8, 2020; U.S. Department of Justice: Philadelphia-Area Doctor Sentenced to 12 Months in Prison for Unlawfully Distributing Oxycodone
A Philadelphia-area doctor was sentenced to 12 months and one day in prison and ordered to pay a $100,000 fine yesterday for the illegal distribution of oxycodone.
January 8, 2020; U.S. Attorney; Eastern District of Pennsylvania: Philadelphia-Based Personal Injury Law Firm Agrees to Resolve Allegations of Unpaid Medicare Debts
PHILADELPHIA - United States Attorney William M. McSwain announced that a Philadelphia-based personal injury law firm, Simon & Simon, P.C., has entered into a settlement agreement with the United States to resolve allegations that it failed to reimburse the United States for certain Medicare payments. The government had made these payments to medical providers for the firm's clients.
January 8, 2020; U.S. Attorney; Eastern District of Pennsylvania: Montgomery County Doctor Sentenced to 12 Months in Prison for Unlawfully Distributing OxyCodone
PHILADELPHIA - United States Attorney William M. McSwain and Assistant Attorney General Brian A. Benczkowski of the Justice Department's Criminal Division announced that Richard Ira Mintz, D.O., 69, of Dresher, Pennsylvania was sentenced to one year and one day imprisonment, three years' supervised release, and $100,000 fine by United States District Court Judge Michael Baylson for illegally distributing controlled substances.
January 6, 2019; U.S. Department of Justice: Former Los Angeles-Area Physician Sentenced to Two Years in Federal Prison for Defrauding Medicare and Illegally Prescribing Opioid Drugs
A former Los Angeles-area physician was sentenced today to 24 months in prison and three years of supervised release for engaging in a multi-faceted Medicare fraud scheme and for illegally prescribing thousands of opioid painkillers and muscle relaxers.
January 2, 2020; U.S. Attorney; Southern District of California: San Diego Eye Doctors Pay $950,000 to Settle Medicare Billing Fraud Allegations
SAN DIEGO - Mark D. Smith and Fane Robinson, two San Diego-area physicians, have paid the United States $948,768.18 to resolve allegations that they violated the federal False Claims Act by knowingly submitting false claims to Medicare.

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