Forensics Talk

Metro Doctors, Pharmacists Charged in 1 of Largest Drug Scams in Michigan History

Detroit Free Press

     BY TRESA BALDAS

DETROIT FREE PRESS STAFF WRITER

          "A dozen pharmacists. Four doctors. A psychologist and an accountant.

All are targeted in what the government dubbed Tuesday as one of the largest prescription drug scams in Michigan history, triggering criminal charges against 26 people accused of engaging in health care fraud at more than 20 pharmacies statewide.

According to an indictment unsealed in U.S. District Court, the defendants were part of a scheme that billed insurers for millions of dollars worth of bogus prescriptions for OxyContin, Vicodin, Xanax and cough syrup with codeine.

Doctors got kickbacks for writing the prescriptions, and so did patients, who agreed to let their insurers be billed for the drugs, the indictment said.

"These individuals abused their positions of trust and endangered the lives of countless people by illegally distributing more than 6 million doses of opiate painkillers and depressants throughout southeast Michigan and beyond," said Robert Corso, special agent in charge of the Drug Enforcement Administration's Detroit Field Division.

The 34-count indictment alleges that Babubhai (Bob) Patel, 49, a Canton pharmacist, owned and controlled about 26 pharmacies statewide, but hid his ownership and control through the use of straw owners.

According to the indictment, Patel gave kickbacks, bribes and other inducements to doctors in exchange for them writing prescriptions and directing the patients to fill the prescriptions at one of Patel's pharmacies, the indictment said. Patel and his pharmacists would then bill insurers for dispensing the medications, the indictment said. . . " Read More

California Lawsuit Accuses Bristol-Myers Squibb of Fraud, Kickbacks

The Baltimore Sun                                                   

By Duke Helfand and Marc Lifsher, Los Angeles Times                 

March 19, 2011

 "California regulators are taking aim at giant drug maker Bristol-Myers Squibb Co., accusing it of bribing doctors and pharmacists to use its products by offering thousands of cash kickbacks, gifts and "happy hours" with the Los Angeles Lakers.

     The case against the drug company was developed with the help of former Lakers player Lucius Allen and his wife, Eve, who worked for Bristol-Myers and provided access to the basketball team, according to a lawsuit made public Friday. Doctors and family members were invited to Lakers Dream Camps arranged by the company, the lawsuit said.

     Doctors also were treated to tickets and luxury suites for Lakers games, and received pointers, balls and autographs from some of the team's most famous players, the suit alleges.

     New York-based Bristol-Myers vowed to fight the case. "Bristol-Myers Squibb believes this lawsuit has no merit and the company will defend itself vigorously," it said in a statement.

     The California lawsuit was originally filed in March 2007 by Michael Wilson, a former Bristol-Myers employee. It was sealed until last week when a judge granted a request by the state Department of Insurance — which joined the suit — to make it public.

     The case is the latest major legal action against Bristol-Myers over fraud accusations. In 2007, it paid $515 million to settle allegations by the federal government and other states that it used a kickback scheme to defraud the Medicare and Medicaid insurance programs. . . " Read More

Protect Yourself Against Medicare Fraud

Fraudblawg                                                                                  

     "On Oct. 21, officials at a chain of mental healthclinics in Miami were charged with making $200 million in fraudulent claims for group therapy sessions that authorities said were unnecessary or never provided.Medicare scams like these are rampant, costing taxpayers billions of dollars every year. But the schemes are not always so ambitious.

      "Thieves may simply offer unsuspecting patients medical supplies and equipment they do not need, or do not qualify for, to collect Medicare numbers, said Julie Schoen, director of the California Senior Medicare Patrol, part of a federally financed antifraud program that operates in every state. . . " Read More

 

$18M+ Home Health Fraud Results in Prison Sentence for 8 Nurses; Doctor Awaits Trial

   FraudBlawg

by fraudblawg on February 7, 2011

      "A conspiracy to bill Medicare for patients who did not qualify for home health services cost the taxpayers $18.7 million, says DoJ, and will cost at least some of the healthcare professionals involved in the scheme their liberty.  Eight Miami-area nurses were sentenced to prison today for their roles in the home health Medicare fraud scheme in connection with Miami-based home health companies, ABC Home Health, Inc. and Florida Home Health Providers, Inc.:

• Diana Sanabia, 36, registered nurse (R.N.), was sentenced to 30 months in prison, three years of supervised release and ordered to pay $594,000 in restitution;
• Daisy Santos, 43, R.N., was sentenced to 30 months in prison, three years of supervised release and ordered to pay $699,000 in restitution;
• Roberto Rodriguez, 44, R.N., was sentenced to 30 months in prison, three years of supervised release and ordered to pay $603,900 in restitution;
• Marlene Magadan, 36, R.N., was sentenced to 24 months in prison, three years of supervised release and ordered to pay $334,200 in restitution;
• Maria Perez, 49, R.N., was sentenced to 18 months in prison, three years of supervised release and ordered to pay $180,600 in restitution;
• Alberto Alvarez, 55, R.N., was sentenced to 15 months in prison, three years of supervised release and ordered to pay $101,800;
• Yanisley Chao, 32, licensed practical nurse (L.P.N.), was sentenced to 5 months in prison, two years of supervised release and ordered to pay $66,800 in restitution; and
• Leonardo Malagon, 40, L.P.N., was sentenced to 5 months in prison, two years of supervised release and ordered to pay $65,900 in restitution.

Additionally, a doctor allegedly involved in the conspiracy, Jorge Dieppa, M.D., was charged in July of last year and awaits trial."

To report home health fraud, contact Frohsin & Barger.

 

 

 

 

 

 

Discovery and Social Networking Sites: Want a Judge Reading Your Posts?

   Here's another excellent post by Mr. Stratton on why people need to be cautious when posting on social media networks:

Insurance Defense Blog 

by David B. Stratton, Esq. of Jordan Coyne & Savits LLP.

February 6, 2011

     "DRI's online newsletter, E-Discovery Connection, vol 5, issue 3, has a number of worthwhile articles on discovery of information on social networking sites.  I like the case where a federal judge offered to do an in camera review of a party's Facebook account by "friending" the party.  Think about whether you would want a federal judge reviewing all of your Facebook pages, which would include things you didn't even write."

The following cases are among those discussed in that newsletter:

EEOC v. Simply Storage Mgmt. (courtesy of Indiana Law Blog)

O'Grady v. Superior Court

Romano v. Steelcase

Barnes v. CUS Nashville

McMillen v. Hummingbird Speedway

 Dexter v. Dexter

Moreno v. Handford Sentinel

Rehberg v. Paulk

McCann v. Harleysville

Crispin v. Audigier

Posted by David B. Stratton on February 06, 2011 at 01:38 PM

From e-Discovery Connection by John D Martin:

  "... Federal Rule of Civil Procedure 34 (A)(1)(a) was amended in 2006 to include "electronically

stored information" ("ESI") in the definition of what is subject to a request for production."

See Fed. R. Civ. P. 34 advisory

committee's note (2006).

" . . Although social networking sites were in their infancy when the 2006  rules revision process began, the language of Rule 34 is broad enough to include the content on 

any type of internet site, as long as the content is stored. Messages, status updates, pictures, videos, contact information, and all other content posted on social networking sites fits the Rule 34 definition of "data compilations stored in any medium from which information can be obtained."

 

The Medicare Hospice Benefit: “Sure Was a Good Idea ‘Til Greed Got in the Way”

Fraud Blawg

by fraudblawg on January 29, 2011

     "Hospice – dignity-focused, palliative treatment for the terminally-ill and their families — has unquestionably improved the care of countless patients who might otherwise have died in isolation, fear, and pain. Likewise it has provided much-needed hope and encouragement to the bereaved. An absolute entitlement under the Medicare program, it has also heavily-lined the pockets of venturers and investors and spawned perhaps the ugliest and most eg … Read More

Protect Yourself Against Medicare Fraud (via Health)

Fraud Blawg

  by fraudblawg on January 28, 2011

     "On Oct. 21, officials at a chain of mental health clinics in Miami were charged with making $200 million in fraudulent claims for group therapy sessions that authorities said were unnecessary or never provided. Medicare scams like these are rampant, costing taxpayers billions of dollars every year. But the schemes are not always so ambitious.Thieves may simply offer unsuspecting patients medical supplies and equipment they do not need, or do not qua …" Read More

 

 

Widespread Fraud in Connecticut Nursing Homes

Fraud Blawg

        "Last week, the United States Attorney for the District of Connecticut announced the latest conviction: Regional Accounts Receivable Manager, Serena Sylvia, pleaded guilty to healthcare fraud and embezzlement. According to court documents and statements made in court:

From 2005 to 2008, Sylvia embezzled funds from nursing home resident trust fund accounts. The nursing homes affected by SYLVIA’s embezzlement include Haven Health Center of Jewett City, Haven Health Center of Norwich, Haven Health Center of Waterford, and Haven Health Center of Soundview in West Haven. As part of her plea, SYLVIA admitted taking more than $53,000 from the trust fund accounts, and admitted that she did not pay income tax on the money she stole.

According to other reports, the large nursing home operator has had financial difficulties and problems with patient care for years. " Read More

Health Care Fraud No Longer a Faceless Crime

USA Today Posted 1h 8m ago |  Comment    |  Recommend   E-mail | Save | Print |

Enlarge by Alan Diaz, AP FILE - In this July 16, 2010, file photo Health and Human Services Secretary Kathleen Sebelius, right, talks to reporters during a news conference as Attorney General Eric Holder looks on in Miami, where federal authorities said they were conducting a large Medicare fraud bust in five different states, and arresting dozens of suspects accused in scams totaling $251 million. Medicare and Medicaid scams cost taxpayers more than $60 billion a year, but the average bank holdup is likely to get more attention. (AP Photo/Alan Diaz, File) By Ricardo Alonso-Zaldivar, Associated Press WASHINGTON — Health care fraud used to be a faceless crime -- until now.Medicare and Medicaid scams cost taxpayers more than $60 billion a year, but the average bank holdup is likely to get more attention. Seeking the public's help to catch more than 170 fugitive fraudsters, the government has launched a new health care most-wanted list, with its own website.      Among those featured is Leonard Nwafor, convicted a couple of years ago in Los Angeles of billing Medicare more than $1 million for motorized wheelchairs that beneficiaries didn't need. One of those who got a wheelchair was a blind man who later testified he couldn't see to operate it.      Facing time in federal prison, Nwafor disappeared before his sentencing.      "We're looking for new ways to press the issue of catching fugitives," said Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department. "If someone walks into a bank and steals $3,000 or $4,000, it would be all over the newspaper. These people manage to do it from a less high profile position, but they still have a tremendous impact.      "Even though motorized wheelchairs can run from under $1,000 to $7,000 apiece, Nawfor's scam was on the low end when compared to others who made the most-wanted list."      "Sisters Clara and Caridad Guilarte allegedly submitted $9 million to Medicare in false and fraudulent claims for pricey infusion drugs that were never provided to patients. They are accused of offering cash and other rewards for beneficiaries to visit their clinic in Dearborn, Mich., and sign forms that said they received services that they never got."       "They take advantage of ethnic communities based on language barriers or lack of knowledge about how the Medicare system works. These folks are exploiting low-income communities . . ." Read More

Whistleblowers First Line of Defense Against Healthcare Fraud

FraudBlawg

    " Dan Rather speaks with Taxpayers Against Fraud Communication’s Director Patrick Burns about the billions of healthcare dollars lost to fraud and abuse every year and how big pharmaceutical companies — the largest offenders — apparently view paying fines as the cost of doing business. Frohsin & Barger is a member of Taxpayers Against Fraud, a nonprofit public interest organization dedicated to combating fraud against the Federal Government through the promotion and use of the federal False Claims Act and its qui tam provisions. . . " Read More

To report healthcare fraud, contact Frohsin & Barger.

Protect Yourself Against Medicare Fraud (Via Health )

FraudBlawg

     " On Oct. 21, officials at a chain ofmental healthclinics in Miami were charged with making $200 million in fraudulent claims for group therapy sessions that authorities said were unnecessary or never provided.

Medicare scams like these are rampant, costing taxpayers billions of dollars every year. But the schemes are not always so ambitious.

Thieves may simply offer unsuspecting patients medical supplies and equipment they do not need, or do not qualify for, to collect Medicare numbers, said Julie Schoen, director of the California Senior Medicare Patrol, part of a federally financed antifraud program that operates in every state.

The swindlers then bill for other supplies and services the patients never received and pocket the reimbursements. Another common ruse is to offer free services, such ascholesterolordiabetesscreenings, to get Medicare numbers.

Medicare recipients caught up in these crimes rarely face financial liability, but compromised medical andinsurancerecords may cause them problems later.

“One woman called me saying her father needed a wheelchair but Medicare denied it, saying he had already had a wheelchair for five years,” said Makeba Huntington-Symons, program manager for the Florida Senior Medicare Patrol in St. Petersburg.“His Medicare number and his records were compromised, and he didn’t know it. . . ” Read More

Top 10 Health Fraud False Claims Settlements of 2010

Fraudblawg 

by fraudblawg on January 2, 2011

"

9 out of 10 of the largest healthcare fraud settlements in 2010 were paid by pharmaceutical companies. 7 out of 10 involved allegations of illegal kickbacks to physicians. 5 out of 10 involved off-label marketing of drugs.  The total amount recovered through the top ten federal False Claims Act healthcare settlements in 2010 was over $4 billion. Below in descending order are the settling defendants alleged to have committed the biggest federal healthcare frauds of 2010:

#1

The Company: GlaxoSmithKline. The Settlement: $750 Million ($600M False Claims Act settlement + $150 in criminal fines and forfeitures). The Allegations: Selling contaminated drugs to Medicaid and other government health programs.

#2

The Company: Allergan. The Settlement: $600 Million ($375M False Claims Act settlement + $225M criminal fines). The Allegations: Illegally marketing Botox for unapproved uses and paying kickbacks to prescribing physicians.

#3

The Company: AstraZeneca. The Settlement: $520 million. The Allegations: Illegally marketing antipsychotic Seroquel for insomnia and paying kickbacks to prescribing physicians.

#4

The Company: Novartis Pharmaceuticals. The Settlement: $422.5 million. The Allegations: Illegally marketing Trileptal and other drugs for off-label uses and paying kickbacks to prescribing physicians.

#5

The Company: Forest Pharmaceuticals. The Settlement: $313+ million. The Allegations: Paying kickbacks to prescribing physicians. . . " Read More

 

Doctor Arrested in Whistle-Blowing Case

NY Times

By KEVIN SACK

Published: December 23, 2010

    " Texas officials have filed criminal charges against a West Texas physician over accusations that they say he orchestrated against two nurses who had filed a complaint against him with the state medical board.

The physician, Dr. cr., who practices at Winkler County Memorial Hospital in Kermit, Tex., was charged late Tuesday by the state attorney general’s office with retaliation and misuse of official information, the latter being the same charge that was leveled against the nurses. Both of the charges against Dr. Arafiles are third-degree felonies that carry a maximum sentence of 10 years in prison and a $10,000 fine.

In a case that alarmed advocates for whistle-blower protections, the two nurses were fired by the hospital and prosecuted in 2009 after anonymously reporting Dr. Arafiles for a variety of surgical and prescribing practices. After learning of the Texas Medical Board investigation, Dr. Arafiles consulted the sheriff in Winkler County, a personal friend, who seized the nurses’ computers and found their letter to the board, which included patient case numbers. Kermit, a town of 7,000 people about 400 miles west of Dallas, is the county seat.

The charge against one of the nurses, Vickilyn Galle, was dropped before trial. A jury took less than an hour to acquit the other nurse, Anne Mitchell, in February. The nurses agreed this summer to split a $750,000 financial settlement from the county.

The medical board has already charged Dr. Arafiles, 58, with a number of civil violations related to the substandard care the nurses described. He is accused of suturing a rubber scissor tip to a patient’s finger, using an unapproved olive oil solution on a patient with a highly resistant bacterial infection, failing to diagnose a case of appendicitis and conducting a skin graft without surgical privileges. . . " Read More

Senate Passes Whistleblower Protection Bill

Washington Post

By Joe Davidson

The Senate has passed enhanced protections for government employees and contractors who report cases of waste, fraud and abuse.

The Whistleblower Protection Enhancement Act was approved using the Senate's unanimous consent procedure late Friday. Whistleblower advocates have long pushed for legislation to strengthen the 1989 Whistleblower Protection Act, which whistleblowers criticized as largely ineffective. The enhancement bill now moves to the House.

One significant section of the current legislation would allow jury trials, with certain limitations, for employees who take legal action against agencies for allegedly retaliating against workers who expose wrongdoing. This is a pilot provision, however, that would automatically expire in five years unless renewed.

"For the first time in history, the law will have structural reforms including normal access to appeals courts for whistleblowers and the right to a trial," said the Make It Safe Coalition, a group of organizations advocating the bill.

Under the 1989 law, the U.S. Circuit Court of Appeals is the only court permitted to hear appeals by whistleblowers in cases of retaliation against them.

"The Court has single-handedly gutted the WPA, leading to a 3-210 record against whistleblowers for decisions on the merits since October 1994," the coalition said.

Whistleblowers who prove retaliation either in court or through administrative channels would be eligible for compensation under the legislation.. . " Read More

"Couple Get Long Prison Terms in Kansas 'Pill Mill' Case"

Sentencing Law and Policy

October 21, 2010

     "The title of this post is the headline of this local article providing the outcome in a high-profile federal health care fraud case.  Here are the details:

Linda Schneider should carry most of the responsibility for her husband’s patients who overdosed and died, said a federal judge who described the deaths as “an avoidable tragedy motivated by greed.” But Stephen Schneider, a former physician, could have stopped it, U.S. District Judge Monti Belot said Wednesday as he sentenced the couple.

Belot gave Linda Schneider 33 years in prison and Stephen Schneider 30 years for their practices of prescribing painkillers at their Haysville clinic. Stephen Schneider is 57; Linda Schneider is 52. There is no parole from federal prison.

Belot said Linda Schneider, a licensed practical nurse who managed the clinic, set up an operation to make money off the quantity of patients, not the quality of care. “I have the distinct belief that had she not been involved in the operation of the clinic, or had she approached her role there in a professional and responsible way, none of us would be here,” Belot said, explaining her higher sentence.

Instead, Belot said, the evidence had shown her to be “a scheming, manipulative, uncaring criminal who believed, erroneously, that she was smart enough to get away with it.”' Read More

U.S. Attorney for Northern District of Georgia Sues Alabama Doctor for Alleged False Claims Act Violations

Fraudblawg

August 29, 2010                                                                                         

     "“This lawsuit shows what happens when a doctor puts money before the health and safety of his patients,” said Sally Quillian Yates, U.S. Attorney for the Northern District of Georgia earlier this month after her office filed suit against Dr. Robert M. Ritchea.  According to allegations in the Complaint:

       “[Dr. Ritchea] allowed an unlicensed medical assistant to administer injections that are required to be administered by a physician; assigned treatment codes improperly in order to increase the amount of Medicare reimbursement he received; prescribed and administered the pain treatment protocol in situations where it was not medically necessary; and billed Medicare for procedures that were not reimbursable by Medicare.” Read More

    From DOJ Press Release:

     "The complaint alleges RITCHEA over-billed Medicare by more than $2.2 million in over 4300 separate claims. Pursuant to the False Claims Act, if RITCHEA is found liable, the government is entitled to treble damages and civil monetary penalties ranging from $5,500-$11,000 per claim.

The United States’ complaint is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $3 billion nationwide since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in other types of False Claims Act cases have topped $4 billion since January 2009. . . " Read More

ER Visits For Pain Reliever Abuse Up 111% In 4 Years

  AN interesting article, just out in USA Today, points to the increase of prescription drug abusers showing up in the hospital ER's lately y - a staggering 111%!

   The thing is, showing up in the ER, with multiple complaints, in an attempt to obtain prescription drugs, is not something new. It's been going on for a long, long time.

    I've either seen it, or been aware of it, throughout most of my nursing career. It's great that the public is now being made aware of it but I feel more attention should have been paid long before now and better steps taken to prevent and investigate such abuse.

   And, let's face it, it's not just about the abuse alone, which is often costly in terms of family relationships, and problems at work. But in terms of health care costs too, as many of these patients don't pay their hospital bills. That, in turn, puts a hefty financial burden on the rest of us. Health care fraud such as this needs to be investigated thoroughly. Please read below:

   USA Today

By Mary Brophy Marcus, USA TODAY

 

    "Emergency room visits for non-medical use of pain relievers have increased at a striking rate over the last five years, according to a new study.

Between 2004 and 2008, the estimated number of emergency department visits linked to prescription pain relievers — including Oxycodone- and Hydrocodone-containing products, and methadone drugs — jumped 111%, from 144,644 visits to 305,885 visits a year, according to a study out Thursday by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC).

ON THE WEB: CDC report

"These drugs are being prescribed more often. As the number of prescriptions increase, we have seen an increase in ERvisits involving the use of the drugs in a non-medical way," says Len Paulozzi, a medical epidemiologist at the CDC's Injury Center. . . " Read More

US House Bill To Double Medicare Fraud Penalties

Business Week.com

April 14, 2010

" Medicare fraud suspects would face longer prison sentences under a U.S. House bill proposed Tuesday that also advocates biotechnology such as fingerprint scanning to ensure patients are getting the goods the government is billed for.

Authorities have warned Medicare fraud, an estimated $60 billion annual crime, is now more lucrative than dealing drugs. Until now the penalties have been far less severe.

For example, a Medicare scammer could easily net at least $25,000 a day while risking 5-10 years in prison if convicted on a single count. A cocaine dealer could take weeks to make that amount while risking up to life in prison.

The bill is sponsored by U.S. Representatives Ileana Ros-Lehtinen, R-FL, and U.S. Rep. Ron Klein, D-FL, both from South Florida, which has long been ground zero for the fraud. Miami-Dade County alone generates more than $3 billion a year.

The Medicare Fraud Enforcement and Prevention Act will double prison sentences from 5 to 10 years and fines from $25,000 to $50,000 for Medicare fraud-related crimes.

The bill would also create a new crime for illegally distributing patients' Medicare or Medicaid IDs or billing information, which would carry a maximum 3-year sentence. . . " Read More

Detroit Clinic Owner Sentenced to Prison for Role in $18 Million Medicare Fraud Scheme

Criminal Justice Online

April 8, 2010 - Washington

   " A Michigan man was sentenced today in Detroit to 81 months in prison for his role in a wide-ranging conspiracy to defraud the Medicare program, announced the Departments of Justice and Health and Human Services (HHS). U.S. District Court Judge Sean F. Cox also ordered Suresh Chand, of Warren, Mich., to pay $9,769,113 in restitution, jointly with co-defendants, and to serve three years of supervised release following his prison term.

Chand, 46, pleaded guilty on Sept. 2, 2009, to one count of conspiracy to commit health care fraud and one count of conspiracy to launder money. Between approximately January 2003 and March 2007, Chand and his co-conspirators submitted claims to the Medicare program totaling more than $18 million for physical and occupational therapy services that were never provided. Medicare actually paid approximately $8.5 million on those claims.

In addition, co-conspirator Jose Castro-Ramirez submitted approximately $1.2 million in claims to the Medicare program for “home visits” supposedly provided to beneficiaries recruited into the scheme by Chand and his co-conspirators. Medicare paid approximately $780,000 on those claims. After the proceeds of the fraud were obtained from Medicare, Chand acknowledged that he laundered the funds through a series of transactions using shell companies designed to conceal the nature, source, location, ownership, and control of the tainted funds. . . " Read More

Texas Patient Recruiter Convicted of Health Care Fraud.

Medicare's Most Wanted

Source- http://www.ethiopianreview.com/news/18358

WASHINGTON— "Sylvia Smith, 64, a retired nurse, was convicted today of conspiracy to commit health care fraud and health care fraud, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Tim Johnson of the Southern District of Texas; and Special Agent-in-Charge Mike Fields of the Dallas Regional Office of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG).

At trial, Noel Jhagroo, owner of Trucare Medical Equipment Services (Trucare), a Houston-area durable medical equipment company, testified that he entered into a kickback arrangement with Smith, whereby he agreed to pay her 10 percent of what Medicare paid Trucare for each patient Smith referred. Jhagroo and Smith submitted claims to Medicare for enteral nutrition supplies and for bundles of orthotics, referred to as “artho kits.” Jhagroo also testified that he paid Smith a kickback of $300 per patient in this scheme. In total, Jhagroo and Smith submitted $747,258 in phony claims to Medicare.

In order to bill Medicare for enteral nutrition supplies, Medicare regulations require that a beneficiary have a feeding tube. The forms supplied by Smith indicated that the beneficiaries she referred had such a feeding tube. The evidence at trial, however, showed that none of the patients referred by Smith had a feeding tube. The evidence also showed that Smith provided Jhagroo with high-dollar Medicare codes for specialized enteral food supplements. In fact, Smith and Jhagroo supplied patients with over-the-counter supplements, one of which stated on the bottle that it was “not for tube feeding.”

The evidence at trial showed that Smith also provided Jhagroo with a product list of inexpensive, soft, over-the-counter supplements to be included in the artho kit. The evidence showed that Smith provided Jhagroo with Medicare codes to be used for billing purposes that were actually for expensive, rigid, high-end orthotics, in contrast to the inexpensive products that were actually delivered. After refusing the inexpensive artho kits initially, two Medicare beneficiaries testified that Smith offered them $100 if they would agree to accept the kits.

In addition to referring patients, the evidence at trial showed that Smith supplied Jhagroo with phony certificates of medical necessity signed by a Houston-area physician, so that Trucare could submit claims to Medicare. A Medicare beneficiary testified at trial that she had never heard of the physician who signed the form supplied by Smith to Trucare.

Smith’s sentencing is scheduled for May 12, 1010. Smith faces a maximum prison sentence of 10 years for the conspiracy count, as well as 10 years in prison for each of the six counts of health care fraud for which she was convicted. Smith also faces a maximum fine of $250,000 per count. The maximum fine may be increased to twice the gain derived from the crime or twice the loss suffered by the victims of the crime. Jhagroo pleaded guilty on Nov. 2, 2009, to conspiracy to commit health care fraud for his role in the scheme.

The case was prosecuted by Assistant Chief John S. (Jay) Darden and Trial Attorneys Katherine Houston and Jennifer L. Saulino of the Criminal Division’s Fraud Section, and was investigated by the FBI, HHS-OIG and the Railroad Retirement Board.

The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section. Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for more than $1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers."

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Report Medicare fraud by calling 1-888-482-6825 or by visiting http://www.usawhistleblower.com/.