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
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
"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
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
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
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 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
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
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
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 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; 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
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.
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.
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 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
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 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
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. 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
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 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
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
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.