Over 33 cases have been closed during the month of November 2011. Some of these cases reminded me of the “not me” effect as we all try to do our best to follow Government regulations, however, I’m the first one to admit that I don’t know it all. Yet I learned that the next case, even if I try to do everything right could be me so in order to avoid these pitfalls I study, try to learn from others mistakes and look for assistance when I’m in doubt. The one thing I know is that this is not the time to be lazy on my compliance and operational efforts. So as we tell others; don’t be an statistic and make sure to follow this simple checklist: 1. Conduct a gap analysis (billing, operations, medical records, HIPAA Privacy & Security, OSHA, Human Resources) to identify weaknesses and actions; 2. Update your policies; 3. Train your people; 4. Document all actions; 5. Ask for assistance. Above all, pay attention so your name won’t be in lists like the one below. November 28, 2011; U.S. Attorney; Eastern District of Michigan Southfield Family Practice Doctor, Dr. Gwendolyn Washington, Sentenced To 120 Months For Public Corruption, Illegal Prescription Drug Trafficking And Health Care Fraud Dr. Gwendolyn Washington, M.D., age 67, was sentenced today to 120 months imprisonment for public corruption, health care fraud, and conspiring to illegally distribute prescription drugs, United States Attorney Barbara L. McQuade announced. McQuade was joined in the announcement by Andrew G. Arena, Special Agent in Charge, Federal Bureau of Investigation, Detroit Field Division and Lamont Pugh, III, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General. Dr. Washington was sentenced by the Honorable Paul D. Borman. November 22, 2011; U.S. Department of Justice Detroit-Area Foot Doctor Pleads Guilty to Medicare Fraud Scheme WASHINGTON – A Detroit-area foot doctor pleaded guilty today for his participation in a Medicare fraud scheme, announced the Department of Justice, FBI and the Department of Health and Human Services (HHS). November 22, 2011; U.S. Department of Justice U.S. Pharmaceutical Company Merck Sharp & Dohme to Pay Nearly One Billion Dollars Over Promotion of Vioxx® WASHINGTON – American pharmaceutical company Merck, Sharp & Dohme has agreed to pay 950 million to resolve criminal charges and civil claims related to its promotion and marketing of the painkiller Vioxx® (rofecoxib), the Justice Department announced today. Under the terms of the resolution, Merck will plead guilty to a one-count information charging a single violation of the Food Drug and Cosmetic Act (FDCA) for introducing a misbranded drug, Vioxx�, into interstate commerce. Under the terms of its plea agreement with the United States, Merck will plead guilty to a misdemeanor for its illegal promotional activity and will pay a 321,636,000 criminal fine. November 22, 2011; U.S. Department of Justice United States Files Complaint Against BestCare Laboratory Services Alleging False Claims for Medicare Funds WASHINGTON – The United States filed a complaint against BestCare Laboratories, Inc. and its founder and principal, Karim A. Maghareh, in the U.S. District Court for the Southern District of Texas, the Justice Department announced today. The suit alleges that the defendants knowingly misrepresented the distances traveled by its lab technicians to artificially increase reimbursement from Medicare for mileage-based technician travel allowance fees. November 21, 2011; U.S. Attorney; Southern District of Florida Miami Man Sentenced For Stealing Identity Information From DCF Computers For Use In Medicare Fraud Scam Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Henry Gutierrez, Postal Inspector in Charge, United States Postal Inspection Service, Miami Division, Vance Luce, Acting Special Agent in Charge, U.S. Secret Service, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and James K. Loftus, Director, Miami-Dade Police Department, announced today’s sentencing of Yenky Sanchez, 25, of Miami, for conspiring to commit health care fraud, in violation of Title 18, United States Code, Section 1349; conspiring to commit authentication feature fraud, in violation of Title 18, United States Code, Sections 1028(a)(3) and (f); and aggravated identity theft, in violation of Title 18, United States Code, Section 1028A(a)(1). U.S. District Judge Cecilia M. Altonaga sentenced Sanchez to 65 months in prison, followed by three years of supervised release. Judge Altonaga also imposed a 5,000.00 fine. November 21, 2011; U.S. Attorney; District of New Jersey Former Maxim Healthcare Services Senior Manager Sentenced to Prison for Health Care Fraud TRENTON, N.J. – A former senior manager and 13-year employee of Maxim Healthcare Services, Inc. (“Maxim”), was sentenced today to five months in prison and five months of home confinement with electronic monitoring for his involvement in the unlicensed operation of Maxim office that billed nearly a million dollars to government health care programs, J. Gilmore Childers, First Assistant U.S. Attorney announced. November 17, 2011; U.S. Attorney; District of Rhode Island Nationwide Supplier of Medical Equipment Pleads Guilty to Health Care Fraud, Money Laundering & Selling Adulterated and Misbranded Medical Devices PROVIDENCE, R.I. – The owner of Planned Eldercare, a nationwide supplier of durable medical equipment located in Buffalo Grove, Ill., pled guilty today in U.S. District Court in Providence, R.I., to defrauding the Medicare program by targeting arthritic and/or diabetic Medicare beneficiaries, and ensuring that his company ordered and shipped medical equipment and supplies to Medicare beneficiaries that they did not order and/or were not medically necessary. November 17, 2011; U.S. Department of Justice Houston Patient Recruiter Sentenced to 21 Months in Prison for Medicare Fraud Scheme Involving Claims of Hurricane Damage to Power Wheelchairs WASHINGTON – A patient recruiter for a Houston durable medical equipment (DME) company was sentenced today to 21 months in prison for her role in a health care fraud scheme involving power wheelchairs, announced the Department of Justice, FBI and the Department of Health and Human Services. November 17, 2011; U.S. Attorney; Northern District of California Three Bay Area Residents Charged With Oxycodone Trafficking SAN FRANCISCO – A federal grand jury in San Francisco returned an indictment in which three Bay Area residents are charged variously with conspiracy; possession with intent to distribute oxycodone and oxymorphone; distribution of oxycodone and oxymorphone; and possession of a firearm by a felon, United States Attorney Melinda Haag announced. The prosecution is the result of a seven month, multi-district investigation by the Federal Bureau of Investigation, Drug Enforcement Agency, and Health and Human Services. November 17, 2011; U.S. Department of Justice Fort Lauderdale, Fla.-Area Assisted Living Facility Manager Pleads Guilty to Fraud and Kickback Scheme WASHINGTON – The manager of a Fort Lauderdale, Fla.-area assisted living facility and owner of a purported community mental health center pleaded guilty yesterday for his role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services. November 16, 2011; U.S. Attorney; District of New Jersey Top New Jersey Prescriber of Drugs to Medicaid Patients Sentenced to 43 Months in Prison for Fraud Scheme Involving Fake Physicians NEWARK, N.J. – A doctor with a practice in Elizabeth, N.J., was sentenced today to 43 months in prison for operating a health care fraud scheme in which patients were exposed to treatment during 20,000 patient visits from individuals who made as little as 10 an hour to pose as licensed physicians, U.S. Attorney Paul J. Fishman announced. November 16, 2011; U.S. Attorney; Southern District of
Texas Houston Man Arrested for Health Care Fraud HOUSTON – Endurance Iyamu, 47, of Houston, has been indicted and arrested for devising and executing a scheme to commit health care fraud, United States Attorney Kenneth Magidson announced today. Iyamu will appear for his arraignment and detention hearing on Friday, Nov. 18. November 16, 2011; U.S. Attorney; Southern District of Texas Arrested in Florida, Couple to Appear in Houston on Charges of Bankruptcy Fraud HOUSTON – Husband and wife Michael Giventer and Julia Shvabskaya have been arrested for devising and executing a scheme to commit bankruptcy fraud and defrauding several creditors in Texas and elsewhere, U.S. Attorney Kenneth Magidson announced today. Giventer and Shvabskaya orchestrated the formation of multiple business entities allegedly dedicated to providing healthcare services. November 15, 2011; U.S. Attorney; Northern District of Texas Owner And Associates Of Euless Healthcare Corporation Arrested On Conspiracy And Health Care Fraud Charges DALLAS – Three defendants who have been charged in a federal indictment, unsealed today, with various offenses related to their involvement in the operation of Euless Healthcare Corporation, were arrested this morning by special agents with the FBI and the U.S. Department of Health and Human Services – Office of the Inspector General, announced U.S. Attorney Sarah R. Salda�a of the Northern District of Texas. November 15, 2011; U.S. Attorney; Western District of North Carolina Monroe Physician To Pay 950,000 To Settle Government Civil Fraud Allegations Millicent Francis-Lane, M.D. has agreed to pay 950,000 to the North Carolina Medicaid Program to resolve False Claims Act allegations, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina and North Carolina Attorney General Roy Cooper. Dr. Francis-Lane owns Union County Women’s Care, which has offices in Monroe, N.C. November 14, 2011; U.S. Department of Justice U.S. Attorney General Holder and Dominican Prosecutor General Jiménez Sign Agreement to Share 7.5 Million in Forfeited Assets as Countries Agree to Share Assets Forfeited in Medicare Fraud Case SANTO DOMINGO – Attorney General Eric Holder joined today with Dominican Prosecutor General Radhamés Jiménez Peña in Santo Domingo, Dominican Republic, to announce the signing of a case-specific agreement to share approximately 7.5 million in forfeited assets between the United States and the Dominican Office of the Prosecutor General. The United States expects to recover an additional approximately 30 million in forfeited assets as part of the agreement. November 14, 2011; U.S. Department of Justice Miami-Area Patient Recruiter Pleads Guilty to Fraud and Kickback Scheme WASHINGTON – The owner and president of a Miami-area transportation company pleaded guilty today for her role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services. November 14, 2011; U.S. Attorney; District of New Jersey Fugitive Returned From Pakistan After 13 Years Sentenced To Prison For 1997 Health Care Fraud TRENTON, N.J. – A Jersey City, N.J., man who fled to Pakistan to avoid prosecution over a decade ago was sentenced today to 21 months in prison for defrauding Medicare of approximately 126,000 by submitting false claims in 1997, U.S. Attorney Paul J. Fishman announced. November 14, 2011; U.S. Attorney; Southern District of Texas Former Houston Doctor Sentenced to Federal Prison HOUSTON – A former Houston physician has been sentenced to 70 months in prison following his convictions for conspiracy to commit mail fraud and mail fraud, United States Attorney Kenneth Magidson announced today. November 10, 2011; U.S. Attorney; Western District of Washington South Sound Doctor Convicted Of Multiple Counts Of Healthcare Fraud, Tax Crimes And Drug Distribution Antoine Johnson, 40, a former resident of Aberdeen, Washington, and his mother, Lawanda Johnson, were convicted today in U.S. District Court in Tacoma of more than two dozen federal felonies connected with their operation of four health care clinics in Western Washington. Following the three week jury trial, Antoine Johnson and Lawanda Johnson were convicted of 24 counts of health care fraud. Antoine Johnson was also convicted of 4 counts of filing false income tax returns and five counts of illegal drug distribution. Lawanda Johnson was convicted of six counts of filing false income tax returns. The jury deliberated about two and a half days before returning the guilty verdicts. U.S. District Judge Ronald B. Leighton scheduled sentencing for February 3, 2012. November 10, 2011; U.S. Attorney; District of Maryland Salisbury Cardiologist Sentenced To Over 8 Years In Prison For Implanting Unnecessary Cardiac Stents Baltimore, Maryland – U.S. District Judge William D. Quarles, Jr. sentenced cardiologist John R. McLean, age 59, of Salisbury, Maryland, today to 97 months in prison followed by three years of supervised release for six health care fraud offenses in connection with a scheme in which Dr. McLean submitted insurance claims for inserting unnecessary cardiac stents, ordered unnecessary tests and made false entries in patient medical records, in order to defraud Medicare, Medicaid and private insurers. Judge Quarles also ordered that McLean pay restitution to Medicare and the other health insurance programs of 579,070. Judge Quarles also ordered McLean to forfeit 579,070 as proceeds of the crime. November 10, 2011; U.S. Department of Justice Fort Lauderdale-area Halfway House Owners Plead Guilty to Kickback Scheme WASHINGTON – The two managers and operators of a Fort Lauderdale, Fla.-area halfway house company pleaded guilty today for their role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services. November 8, 2011; U.S. Department of Justice Miami-Area Patient Recruiter Pleads Guilty in 25 Million Health Care Fraud Scheme WASHINGTON – A patient recruiter of a Miami health care agency pleaded guilty yesterday for her participation in a 25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services. November 8, 2011; U.S. Attorney; Middle District of Tennessee Vanguard Health Care, Vanguard Health Care Ancillary to Pay two Million Dollars to Settle False Claims Act Allegations Vanguard and its wholly owned subsidiary, Vanguard Health Care Ancillary, have agreed to pay the United States and the State of Tennessee two million dollars to settle False Claims Act allegations, announced Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee. November 4, 2011; U.S. Attorney; Middle District of North Carolina Area Dentist Pleads Guilty To Health Care Fraud GREENSBORO, N.C. – United States Attorney Ripley Rand announced that Greensboro dentist Tung Thai Nguyen pleaded guilty yesterday to health care fraud charges in connection with false claims submitted to Medicaid. November 3, 2011; U.S. Department of Justice Former “Most Wanted” Health Care Fraud Fugitives Sentenced to 14 Years in Prison for 9.1 Million Detroit Medicare Fraud Scheme WASHINGTON – Two sisters who owned a fraudulent Detroit-area medical clinic and who are former “Most Wanted” health care fraud fugitives were each sentenced in Miami today to 14 years in prison for their leading roles in a 9.1 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS). November 3, 2011; U.S. Attorney; Southern District of West Virginia Federal Jury Convicts Man On Charges Related To Health Care Fraud Scheme CHARLESTON, W.Va. – Sargis Tadevosyan, 42, an Armenian citizen, was convicted today by a federal jury in connection with a health care fraud scheme that intended to defraud millions of dollars from Medicare, announced U.S
. Attorney Booth Goodwin. After a four-day trial, Tadevosyan was found guilty of two felony counts: conspiracy to commit health care fraud and wire fraud and aggravated identity theft. November 3, 2011; U.S. Department of Justice Detroit-Area Man Arrested In Connection With 30 Million Medicare Home Health Scheme WASHINGTON – A Detroit-area resident was charged and arrested today in the Eastern District of Michigan for his alleged leading role in a 30 million Medicare fraud scheme involving home health services, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS-Office of Inspector General (OIG). In addition to the arrest, law enforcement agents executed search warrants at five locations, seizure warrants for 31 bank accounts related to the scheme and suspended Medicare payments to 16 health care companies associated with the scheme. November 2, 2011; U.S. Attorney; Southern District of Texas Medical Equipment Business Owner and Manager Arrested for Health Care Fraud and Aggravated Identity Theft McALLEN, Texas – A co-owner and manager of a McAllen-area durable medical equipment (DME) business have been indicted by a federal grand jury and charged with conspiracy to commit health care fraud, multiple counts of health care fraud and aggravated identity theft for their alleged roles in a scheme to defraud Medicare and Medicaid through fraudulent billings for power wheelchairs, United States Attorney Kenneth Magidson announced today. Both were arrested approximately an hour and a half ago without incident. November 2, 2011; U.S. Attorney; District of Rhode Island R.I. Ambulance Company Owner Sentenced To 24 Months In Federal Prison For Health Care Fraud; Ordered To Pay More Than 700,000 In Restitution PROVIDENCE, R.I. – The owner and president of a Warwick, R.I., ambulance company was sentenced today to 24 month in federal prison, 3 years supervised release and 1,000 hours of community service for defrauding health care programs administered by Medicare and Blue Cross Blue Shield of Rhode Island of more than 700,000. November 2, 2011; U.S. Department of Justice Brooklyn, N.Y., Medicare Fraud Strike Force Charges 12 Individuals for Participating in Health Care Fraud Schemes Totaling More Than 95 Million WASHINGTON – Twelve individuals, including three medical doctors, a doctor of osteopathy and a chiropractor, were charged today in the Eastern District of New York for their roles in separate health care fraud schemes that resulted in the submission of more than 95 million in false claims to the Medicare program, announced the Department of Justice, the FBI and the Department of Health and Human Services. November 1, 2011; U.S. Attorney; Southern District of Texas Medical Equipment Business Owner and Manager Arrested for Health Care Fraud and Aggravated Identity Theft McALLEN, Texas – A co-owner and manager of a McAllen-area durable medical equipment (DME) business have been indicted by a federal grand jury and charged with conspiracy to commit health care fraud, multiple counts of health care fraud and aggravated identity theft for their alleged roles in a scheme to defraud Medicare and Medicaid through fraudulent billings for power wheelchairs, United States Attorney Kenneth Magidson announced today. Both were arrested approximately an hour and a half ago without incident. November 1, 2011; U.S. Attorney; Southern District of Texas Home Healthcare Nurse Sentenced to Federal Prison McALLEN, Texas – A former home healthcare nurse has been sentenced to federal prison without parole for making false statements relating to health care matters, United States Attorney Kenneth Magidson announced today. http://www.oig.hhs.gov/fraud/enforcement/criminal/index.asp