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.