March 8, 2014

Physician With Revoked Medical License Pleads Guilty for Role in Medicare Fraud Scheme

Housecalls.jpgDETROIT, MI (March 5, 2014) - Jose Mercado-Francis, 60, a former Detroit-area physician pleaded guilty today in the U.S. District for the Eastern District of Michigan to one count of conspiracy to commit health care fraud in violation of 1371 for his role in an $11.5 million health care fraud scheme.

Even though Mercado-Francis’ medical license had been revoked and he was not licensed to practice medicine in Michigan, that didn’t stop him. Mercado-Francis admitted in his plea agreement that, from September 2009 and through February 2012, he held himself out to the public as a licensed medical doctor and claimed to provide physician home health services to Medicare beneficiaries.

Court documents allege that Mercado-Francis prepared medical documentation that licensed physicians signed as if they had actually provided services to Medicare beneficiaries, when, in fact, no such services were provided. The phony health services were then submitted to Medicare as if licensed physicians had performed them.

Although Mercado-Francis' faces a maximum penalty of 10 years in prison and a $250,000 fine, his recommended sentencing guidelines range calls for a term of imprisonment from 57 to 71 months.

February 14, 2014

Houston Psychiastrist Indicted for Medicare Fraud

On December 16, 2014, a Houston psychiatrist was arrested on charges related to her alleged participation in a $158 million Medicare fraud scheme involving false claims for mental health treatment.

Sharon Iglehart, 56, of Houston, was charged in the U.S. District Court for the Southern District of Texas by indictment with one count of conspiracy to commit health care fraud and four counts of health care fraud. According to preliminary calculations, the United States Sentencing Guidelines call for a sentence that is more than twice the maximum penalty of 10 years in prison that can be imposed on each count. Without taking Dr. Iglehart’s role in the conspiracy into consideration, the guidelines call for a sentence in the range of 235-293 months.

According to the indictment, Iglehart is alleged to have participated in a scheme to defraud Medicare that started in 2005 and continued until May 2012. Iglehart is accused of having caused the submission of false and fraudulent claims for partial hospitalization program (PHP) services to Medicare through Houston’s Riverside General Hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.

The indictment alleges that Iglehart and her co-conspirators submitted or caused to be submitted approximately $158 million in claims to Medicare for PHP services purportedly provided by the hospital, when in fact the PHP services were medically unnecessary or never provided.

In February 2012, Mohammad Khan, an assistant administrator at the hospital who managed many of the hospital’s PHPs, was indicted for his role in the scheme. Khan pleaded guilty to one count of conspiracy to commit health care fraud, one count of conspiracy to pay illegal kickbacks, and five counts of paying illegal kickbacks. Khan has not yet been sentenced.

In October 2012, Earnest Gibson III, the administrator of the hospital, along with Earnest Gibson IV, William Bullock III, Robert Ferguson, Regina Askew, Leslie Clark and Robert Crane, were indicted for their roles in the scheme. Leslie Clark pleaded guilty to one count of conspiracy to pay and receive illegal kickbacks. Clark has not yet been sentenced.

In January, Iglehart's attorney has filed a motion seeking to have her case transferred to a different judge and joined with the case pending against her co-conspirators on the grounds that the facts and circumstances of the charges filed in both cases are the same.

The case is being prosecuted by Assistant Chief Laura M.K. Cordova of the Criminal Division’s Fraud Section.

December 19, 2013

How to Avoid the 230-year Sentence for Health Care Fraud

LOUISVILLE, KY. - How does a doctor get convicted of money laundering, health care fraud and doling out prescription drugs like jelly beans and then sentenced to 230 years in prison with a fine of $10.2 million? By not having a health care fraud attorney willing to ask his client the tough questions, nor one who will give his client the honest truth, or that will dig in for the fight and not accept the maximum sentence and fine for his client. That is what could happen to a Louisville doctor indicted by a federal grand jury earlier this month.

After a year-long investigation by the police, the FBI, and DEA, the grand jury indicted Dr. George Kudmani.

The indictment alleges that the doctor would see more than 35 patients per day. Earlier this year, the New York Times reported that new doctors average eight minutes per patient. Doctors who have been practicing for a number of years would probably need less time per patient. Thirty-five patients per day would be an easy figure to reach.

The investigation also uncovered that Dr. Kudmani bought a new car, allegedly with money he was pocketing from selling prescriptions. Not a vacation home or several cars or a boat or a race horse. He bought a new car in the time between January 2009 and September 2012.

The investigation resulted from a patient that claimed that she almost died at the hands of the good doctor because while performing a hysterectomy, the doctor nicked her bowel. This event could indeed, have killed the patient, but it didn’t. She lived and needed to undergo several more surgeries.

The patient stated the doctor told her that “as long as I'm in practice you will never need pain medication...straight out.”

She also claimed, "he was basically making people addicted to this medication."

And lastly, "I'm only one voice, one person and there may be several hundred that he's done this to."

So far, no other patients have come forth to make claims against the doctor.

The case has not yet gone to trial.

Get the Legal Representation You Need

Allegations of health care fraud and conviction carry serious consequences that impact your practice, your reputation and the rest of your life. Your family suffers and possibly your friends, employees and professional colleagues as well. This doesn’t have to happen! Contact Fort Lauderdale Criminal Attorney Robert Malove, Esq. with 30 years of experience in aggressively defending his clients against allegations of health care fraud and money laundering knows the ins and outs of criminal defense. Give him a call today at 954-861-0384 or email him at: CriminalDefenseFL@gmail.com

October 29, 2013

The Physician Self-Referral Law

Also known as the “Stark Law,” physician self-referral is a type of health care fraud that a physician may run into when he or she or a family member has a vested interest in another designated health service (DHS). It prohibits a physician from making referrals to these conflicting entities and violations can result in civil money and other penalties.

The Three Points of the Physician Self-Referral Law

The purpose of this law is to prevent a physician from making referrals based upon self-interest rather than the patent’s best interest. When first introduced in 1989 the law only applied to physician referrals to clinical laboratory services. Over the years, Congress has expanded the restrictions to include more designated health services and applied much of the law to the Medicaid program.

Currently, Section 1877 of the Social Security Act prohibits a physician from referring patients to certain DHS that are payable by Medicare to an entity with which he/she, or an immediate family member has a financial relationship unless certain exceptions apply. A financial relationship is considered ownership, investment, or compensation from a DHS provider.

The second point of the physician self-referral law is that the DHS provider cannot present a claim or cause a claim to be presented to Medicare for the referred service. This also applies to billing another individual, entity or third party payer.

The final point of the law is to establish specific exceptions to financial relationships that do not pose a risk of Medicare program or patient abuse. It also grants the Secretary of Health & Human Services the authority to create the necessary regulatory exceptions to protect these exempt relationships.

Protecting Your Practice from Physician Self-Referral Health Care Fraud

As part of the Patient Protection and Affordable Care Act, the Center for Medicare & Medicaid Services helped establish the Medicare self-referral disclosure protocol (SRDP). This protocol created a process for providers of services and suppliers to self-disclose violations – actual and potential – of the physician self-referral law. By doing so, service providers or suppliers may be able to reduce monetary penalties levied against them for violations of the self-referral law.

Physicians must take action in their own practice to ensure they are not breaching any of the law. This means maintaining records of your and immediate family members’ financial connections to the following designated health services:

• clinical laboratory services;
• physical therapy services;
• occupational therapy services;
• outpatient speech-language pathology services;
• radiology and certain other imaging services;
• radiation therapy services and supplies;
• durable medical equipment and supplies;
• parenteral and enteral nutrients, equipment, and supplies;
• prosthetics, orthotics, and prosthetic devices and supplies;
• home health services;
• outpatient prescription drugs; and
• inpatient and outpatient hospital services.

Don’t Face Health Care Fraud Charges Alone

Attorney Robert Malove helps the health care community of Florida address accusations and charges of Medicare and health care fraud. If your practice or business is in jeopardy, contact our office at 954-861-0384 to schedule a consultation regarding your rights.

August 27, 2013

Mobile Doctors’ CEO and Doctor Arrested For Medicare Fraud

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpgCHICAGO (August 27) — DIKE AJIRI, 42, of Wilmette, CEO of Mobile Doctors, a Chicago-based business which manages physicians who make house calls in six states, and BANIO KOROMA, 63, of Tinley Park, a physician one of its physicians in Chicago were arrested on Medicare fraud charges. The charges allege a scheme to fraudulently increase (also known as “upcoding”) Medicare bills for in-home patient visits that Mobile Doctors falsely claimed were more extensive and lasted longer than they did. The charges also allege that Mobile Doctors’ physicians falsely certified that patients were confined to their homes, paving the way for home health care agencies to seek Medicare reimbursement for fees for additional services for patients who were not qualified to receive them.

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August 15, 2013

Detroit-Area Physical Therapist and Home Health Agency Owner Pleads Guilty to Medicare Fraud Scheme

WASHINGTON, D.C. (August 15) - On August 14, 2013, a Detroit-area physical therapist who was also an owner of a home health agency entered a guilty plea to one count of conspiracy to commit health care fraud in the U.S. District Court for the Eastern District of Michigan regarding his role in a $22 million home health care fraud scheme. Bhagat faces a maximum penalty of 10 years in prison and a $250,000 fine. Sentencing is scheduled for November 12, 2013.

According to information contained in plea documents, Bhagat admitted that over about a year and a half period beginning May 2009, he conspired with others to commit health care fraud through billing Medicare for home health care services that were either not actually rendered or not medically necessary.

Bhagat admitted that his co-conspirators paid kickbacks to patient recruiters to obtain the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare. Bhagat and his cohorts then created phony therapy files to falsely document physical therapy services were provided to Medicare beneficiaries, when in fact no such services had ever been provided and if provided were not medically necessary in the first place.

Bhagat signed fictitious documents including physical therapy evaluations, supervisory patient visits, and patient discharge forms to indicate that he and others had provided physical therapy services to Medicare beneficiaries, when in fact they had not. Bhagat admitted to knowing that the documents he created would be used to support false claims submitted to Medicare. Bhagat submitted or caused the submission of claims to Medicare for services that were not medically necessary and/or not provided, which in turn caused Medicare to pay approximately $4,767,359.03.

Section 2B1.1 is the guideline section of the federal sentencing guidelines to consult for determining the correct sentencing range. Section 2B1.1 calls for the calculation to start a base offense level 6. Because the actual loss is alleged to be $4.76, an additional 18 level increase applies. There is also an enhancement under §2B1.1 for health care fraud, which says, “If (A) the defendant was convicted of a Federal health care offense involving a Government health care program; and (B) the loss under subsection (b)(1) to the Government health care program was (i) more than $1,000,000, increase by 2 levels[.]” It is not certain whether Bhagat will role enhancement; however, it looks like one is coming. Under §3B1.1(b) or (c) it looks like Bhagat should be getting either a 2, 3 or 4 level increase. The government is seeking a sentence between 70-87 months behind bars. Bhagat is seeking a sentence between 63 – 78 months.

If you or someone you know has been accused of medicare fraud, contact attorney Robert Malove. He can help.

May 14, 2013

25 People Arrested Medicare Crackdown

WASHINGTON, D.C. (May 14,2013) A nation-wide takedown by the Medicare Fraud Strike resulted in charges being filed against 89 health care providers including doctors, nurses and other licensed medical professionals, for committing Medicare fraud to the tune of approximately $223 million in false claims billings.

In Miami, a total of 25 people were charged for participating in various fraud schemes to submit false billings for home health care, mental health services, occupational and physical therapy, DME and HIV infusion services. Among those arrested were two nurses, a paramedic and a radiographer were charged with crimes for involving a total of $44 million.

In one case, involving Trust Care Health Services, three people - including Roberto Marrero, a Miami actor and local cable TV station owner, were charged with health care fraud and violations of the anti-kick back statute for their involvement in a $20 million home health fraud scheme concerning the treatment of diabetic patients. Court documents accuse the defendants of bribing Medicare beneficiaries to turn over their Medicare information, which was used to bill for services that were not rendered or were medically unnecessary.

According to court documents, the lead defendant spent much of the money from the scheme, and purchased multiple luxury vehicles, including two Lamborghinis, a Ferrari and a Bentley.

If you or someone you know has been accused of medicare fraud, contact attorney Robert Malove. He can help.

March 26, 2013

OIG Issues Special Fraud Alert - PODs "Inherently Suspect"

WASHINGTON (March 26) – The Office of the Inspector General of the Health and Human Services Department has issued a Special Fraud Alert that physician-owned distributorships (PODs) are “inherently suspect” under the anti-kickback statute (AKS) and has listed suspicious characteristics that may increase the risk of fraud and abuse.
The alert focused on physician-owned businesses / PODs that obtain revenue from selling implantable medical devices ordered by their physician owners to use in procedures they perform on their patients at hospitals or ambulatory surgical centers.

“The opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute,” said the IG alert .

One purpose of the anti-kickback statute (AKS) is to protect patients from inappropriate medical referrals or recommendations made by health care professionals who may be unduly influenced by financial incentives. It a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce, or in return for, referrals of items or services reimbursable by a Federal health care program. When remuneration is paid purposefully to induce or reward referrals of items or services payable by a Federal health care program, the AKS is violated. Parties on either side of an impermissible “kickback” transaction are exposed to criminal liability. Violation of the AKS statute is a felony punishable by up to 5 years imprisonment, a maximum fine of $25,000 or both. Individuals convicted of violating the AKS are excluded from Federal health care programs, including Medicare and Medicaid. OIG also has the right initiate an administrative action to exclude persons from the Federal health care programs or to impose civil money penalties for fraud, kickbacks, and other prohibited activities under sections 1128(b)(7) and 1128A(a)(7) of the Act.

The financial incentives that PODs offer to their physician owners may influence them to perform medically unnecessary procedures and to use the devices the PODs sell instead of other more appropriate devices.

According to the Special Fraud Alert, the OIG is “particularly concerned about the presence of such financial incentives in the implantable medical device context because such devices typically are ‘physician preference items,’ meaning that both the choice of brand and the type of device may be made or strongly influenced by the physician, rather than being controlled by the hospital or ambulatory surgical center where the procedure is performed.”

If you or someone you know has been accused of violating the anti-kickback statute, for serious health care fraud defense, contact attorney Robert Malove (954)861-0384.

March 13, 2013

Convicted Houston Doctor Sentenced to More than 5 Years Behind Bars

HOUSTON (March 13) - A Texas doctor who was convicted of conspiracy to commit health care fraud and six counts of false statements relating to health care matters was sentenced today to serve 63 months behind bars.

Ben Harris Echols, 63, of Houston, was convicted late last year of conspiring to commit health care fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat, as part of a $17.3 million Medicare fraud scheme. Upon completion of his prison term, Echols was ordered to serve three years of supervised release and pay restitution in the amount of $2,918,830.

According to evidence presented at trial, Echols signed plans of care for Medicare beneficiaries who were not under his care and about whose conditions he had no knowledge. In many instances, Echols signed plans of care even though other doctors were listed as the attending physician on the documents.

Echols was prosecuted by the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Southern District of Texas.

If you or someone you know is facing prosecution as a result of aggressive law enforcement activity in the area of Medicare or Medicaid fraud, call Board Certified Criminal Trial Lawyer Robert Malove, co-author of the noted treatise, White Collar Crime: Health Care Fraud (Thompson West 2012-2013 ed.)

January 30, 2013

Deputy AG Lanny Breuer Leaves Justice Department

Breuer_Official_Portrait.jpgWashington (Jan. 30) -- Assistant attorney general of the Criminal Division, Lanny Breuer, is leaving the Justice Department. Breuer gained notoriety for defending president Bill Clinton against impeachment and for defending four-time Cy Young award winner, Roger Clemens.

"Serving as assistant attorney general for the Criminal Division has been the greatest privilege of my professional life," Breuer said in a statement. "From my first day on this job nearly four years ago, I have loved it, and I am so proud of what the Criminal Division has accomplished over the past four years," Breuer said.

The announcement came the day after a federal judge in New Orleans approved the largest package of criminal fines and penalties in U.S. history. In 2010, Attorney General Eric Holder had named Breuer to oversee the Deepwater Horizon Task Force. The record amount of the settlement in the guilty plea will cost BP $4 billion and lets Breuer to depart the Justice Department on a positive note.

Many have criticized Breuer for failing to bring major prosecutions against the nation's largest financial institutions responsible for financial crisis in 2008 and 2009. Breuer maintained that the banks and their employees needed to be protected against an implosion that could cause greater problems.

Breuer was the top administration official who faced criticism for ATF's Operation Fast and Furious. Breuer ultimately apologized for an inaccurate letter to a senator in which the Justice Department denied the ATF allowed guns to be smuggled to Mexican drug cartels.

October 4, 2012

Medicare Fraud Strike Force Arrests 91 - 33 in South Florida

WASHINGTON, D.C. (October 4,2012) Today, U.S. Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced at a joint press conference that Medicare Fraud Strike Force operations conducted one of the largest health care fraud takedowns in history.

Charges have been brought in seven cities from Brooklyn to Los Angeles against 91 individuals – including doctors, nurses, and other licensed medical professionals – for their alleged participation in fraud schemes involving nearly $430 million in false billings.

Charges include health care fraud, conspiracy to commit health care fraud, wire fraud, violations of the anti-kickback statutes, aggravated identity theft, and money laundering charges are based on a variety of alleged activities involving treatments and services that were medically unnecessary or never actually rendered.

The alleged fraudulent schemes range from home health care and mental health services, to psychotherapy, physical and occupational therapy, durable medical equipment services, and the largest ambulance fraud scheme ever prosecuted by the Medicare Fraud Strike Force.

The joint press release by the Department of Justice and Department of Health and Human Services announced that "in Miami, a total of 33 defendants are charged for their alleged participation in various fraud schemes involving a total of $204.5 million in false billings for home health care, mental health services, occupational and physical therapy, and DME.

In one case, three defendants are charged for participating in a fraud scheme at LTC Professional Consultants and Professional Home Care Solutions Inc. which led to approximately $74 million in fraudulent billing for home health care."

In another South Florida case, according to the indictment, the owners and operators of Hollywood Pavilion, psychiatric hospital, have been charged with paying cash kickbacks to owners and operators of assisted living facilities and halfway houses to obtain patients, and then billing Medicare for over $67 million in mental health services that were unnecessary or never even provided. The indictment alleges a scheme that is not new to South Florida and will feature a number of government witnesses who have previously testified in some of those cases.

In another Miami case, the government is restraining 40 bank accounts, and 16 residences valued at approximately $4.6 million, that belong to the owners and operators of a home health agency charged with defrauding Medicare to the tune of approximately $74 million.

October 1, 2012

Psychiatrists Sentenced to 10 Years in Prison for Medicare Fraud

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpgMIAMI, FL - A Weston psychiatrist was sentenced on Monday to 10 years in for his role in what United States Department of Justice Health Care Fraud Strike Force prosecutor Jennifer Saulino called "one of the largest and most brazen health care fraud conspiracies in recent memory."

Dr. Mark Willner, who practiced in Fort Lauderdale and Boca Raton, was convicted of conspiracy to commit health care fraud after a six-week trial earlier this year. Prosecutors said Willner, 56, was part of a broader conspiracy involving American Therapeutic Corp., which billed the taxpayer-funded Medicare program for more than $205 million in fraudulent claims.

In her submission to U.S. District Court Judge Patricia Seitz, United States Department of Justice Heath Care Fraud Strike Force prosecutor Jennifer Saulino wrote "This massive fraud was committed by manipulating the proper treatment of Alzheimer's and dementia patients, substance abusers seeking treatment, and others convinced or cajoled into spending time at ATC."

"Without Willner and other doctors signing thousands of false and fraudulent patient documents – documents that stated he was personally directing the patients' treatment plans and having 'face-to-face' contact with the patients – ATC could not have succeeded on such an immense scale," Saulino wrote.

Psychiatrist Dr. Alberto Ayala, 68, of Coral Gables, who was also convicted at trial was sentenced to 10 years in federal prison. Willner's attorney, Sam Rabin, said he intends to appeal.

Dr. Alan Gumer, M.D., who after being unable to post his own $1 million bond to secure his release from jail following his arrest, was one of the witnesses the government called to the witness stand to testify at trial. After at least five debriefings with prosecutors in the week after his arrest, Gumer's bond was cut in half before he could be released.

Rabin's cross-examination of Gumer at trial was classic. Even Judge Seitz at one point referred to Rabin as "the honorable Mr. Rabin." Attorneys interested in learning about how to cross-examine a cooperating witness would do themselves a service by studying (as have I in preparation for a pending Medicare fraud case) Mr. Rabin's, and Miami criminal defense attorney extraordinaire, Jose Quinon's cross of Gumer.

Gumer was into bookies for gambling debts and hadn't paid federal income taxes for at least 10-years. Yet despite the clear implication that Gumer's cooperation was all about saving his own neck and that he would have said just about anything on the stand in hopes of earning a significant sentencing reduction at the government's request, in the end the evidence proved to be too much for the defense to overcome.

Prosecutors said Dr. Willner and Dr. Ayala caused false and fraudulent claims to be submitted to Medicare for partial hospitalization programs.

According to prosecutor Saulino, "These co-conspirators, including Dr. Willner, victimized the most vulnerable members of our society so they could have nicer homes and fancy artwork."

More than 30 people have been charged and more than half have pleaded guilty or been convicted at trial. Last year, Lawrence Duran, the president of ATC was sentenced by U.S. District Judge Lawrence King to 50-years behind bars; ATC vice-president Judith Negron was sentenced
to 35 years. Dr. Gumer also testified at Negron's trial.