While it is unfair to brand entire nationalities for the crimes of extreme minorities of those groups, certain ethnic groups come to be associated with certain crimes. Much has been made in lore about the Italian Mafia’s association with organized crime generally, others include Jamaican drug gangs in the 1980s, Chinese gangs in the slave trade, Nigerian credit card frauds. One other is the Miami-Cuban connection to Medicare Fraud schemes.

Such is the perception that the recent Florida Anti-Health Care Fraud legislation created a provision requiring immigrants to obtain a bond prior to obtaining a clinic license. A Miami Herald article addresses the issue of the Cuban connection to Medicare Fraud, with an interesting aside thrown in, an often raised but not yet proven allegation as to whether the Cuban government itself is involved in Medicare fraud. To read the Herald article and comments posted there, click here.

For more on this click here.

In this, as in many of the ongoing prosecutions related to this subject matter, the allegation was that expensive drugs related to the treatment of HIV symptoms were claimed to have been administered to patients, many of whom did not have HIV. Most of the drugs were not purchased by the clinics at all. To read the indictment, click here.

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FORT LAUDERDALE, FL (June 29) After conducting a nationwide search, Thompson-West, the leader in legal information solutions, has selected Fort Lauderdale lawyers, Benson Weintraub and Robert David Malove to develop a guide and treatise in the area of Health Care Fraud law as part of a multi-topic initiative to expand West's coverage of white collar crime. The practice guide is tentatively entitled Health Care Fraud Practice Guide.

In 2007, the United Stats Department Justice created the Medicare Fraud Strike Force and launched operations in Miami, Florida. Since then, two more divisions of the Medicare Fraud Strike Force have commenced operations in Houston and Los Angeles. The proliferation of health care fraud cases being prosecuted by the federal government has triggered the need for criminal defense attorneys to be brought up to date with the latest strategies and techniques in order to bring about the best result possible for their clients.

The Healthcare Practice Guide will be a single volume addressing the practical and unique aspects of litigating health care fraud cases. Coverage will include information on strategies and principles used in the prosecution, defense and settlement of a criminal health care fraud case.

Thompson-West’s selection of Weintraub and Malove to author the Health Care Fraud Practice Guide comes as no surprise and is in recognition of their legal expertise, scholarship and dedication to staying on the cutting edge of issues pertaining to health care fraud defense.

BENSON WEINTRAUB is known in the profession as a “lawyer’s lawyer” based on the depth of his comprehensive expertise in practice in US District Courts, US Courts of Appeals, and the US Supreme Court, particularly with respect to corporate and individual defendant sentencing and post-conviction remedies, including appellate practice of unparallel effectiveness. He has been practicing law exclusively in the federal courts since 1981; took a leave of absence from active practice in 2004 to serve as a full-time Visiting Professor of Law at Hofstra University School of Law, from which he graduated in 1979 after attending graduate school at the Center for Administration of Justice at The American University, which also conferred a baccalaureate degree upon him in 1974 from its distinguished School of Government & Public Administration.

Professor Weintraub’s federal practice represents a wide array of legal disciplines ranging from the exclusively complex federal criminal and civil matters: concentrating on allegations of individual and/or corporate health care offenses, financial crimes, i.e., money laundering, fraud, securities violations; conspiracy; internet-based crimes; product substitution (nuclear and NASA components); obstruction of justice; official corruption; large scale narcotics Corporate/individual distribution cases; civil rights violations; constitutional issues; international extradition and multinational treaties; civil litigation and agency representation; and, quashing subpoenas/protective orders. The Firm provides advice, counsel, and representation to corporations and business entities regarding Compliance Programs, preventive maintenance through the design, implementation, monitoring and training of employees with respect to industry-specific compliance requirements to avoid the investigation or pursuit of civil, regulatory or criminal violations.

Professor Weintraub was appointed by the first Chairman of the US Sentencing Commission to help draft the ‘organizational’ and ‘individual’ Federal Sentencing Guidelines and he is proficient in the requirements of the Sarbanes-Oxley Act, HIPAA, the Stark Act, other business statutes and the Code of Federal Regulations (CFR). This experience enhances the firm’s ability to defend corporations/individuals to mitigate potential financial and other sanctions under the Sentencing Guidelines, particularly if settled by agency agreement. Even if criminally pursued, the Firm will ensure your company’s increased candidacy for a Deferred Prosecution Agreement (DPA).

Professor Weintraub is a highly esteemed academic whose numerous articles have been published or cited in The Yale Law Journal, Federal Sentencing Reporter, Federal Probation (Journal of Admin. Office of US Courts), Harvard Law Review, by Federal District and Appellate Judges, Notre Dame Law Review, Stanford Journal of Law & Social Policy and myriad other distinguished academic forums. His work has also been republished in a law school text book, “Sentencing, Sanctions, and Corrections.” He maintains an AV rating by Martindale Hubble.

Most recently, Mr. Weintraub has been involved with international cases with respect to anti-terrorism, counter-intelligence, and critical national security matters for the benefit of the United States. Mr. Weintraub has developed a unique and unparalleled manner of practice characterized by tenacity, relentless client dedication, consistently employing the power of optimal engagement in each case.

Mr. Weintraub has been qualified by federal and State Judges as an “expert witness” (Federal/State) in matters relating to sentencing, civil rights actions involving prisoners’ rights, and post-conviction remedies, e.g., habeas corpus.

ROBERT DAVID MALOVE is Board Certified as a specialist in criminal trial law by the Florida Bar Board of Legal Education and Specialization. Mr. Malove is distinguished trial lawyer with 25 years of experience in federal and state courts. He concentrates on legal issues relating to the white collar crime defense and healthcare fraud defense for which his Health Care Fraud Blog has received widespread recognition. In 2007, Mr. Malove completed post-graduate studies in Healthcare Corporate Compliance at George Washington University and furthered his comprehensive knowledge in the various state and federal laws regarding healthcare fraud and corporate compliance. Also, in 2007, Mr. Malove attended the Health Care Compliance Association’s Compliance Academy has successfully completed the Certified in Healthcare Compliance Examination, thus earning the "CHC" designation.

Prior to serving as an Assistant Public Defender in cases ranging from murder, fraud, to DUI, he graduated with a Doctor of Jurisprudence from Pepperdine University School of Law. Consistent with staying on the cutting edge of developments in criminal defense, one of Mr. Malove’s signature trademarks, he earned a Masters Degree in Forensic Science, from the George Washington University in 1981 - long before forensic science became part of our everyday lexicon. Before that, Mr. Malove was conferred a BS in the Administration of Justice from The American University School of Justice.

Mr. Malove has served as a guest commentator on COURT-TV and maintains membership in the National Association of Criminal Defense lawyers and Florida Association of Criminal Defense Lawyers. Mr. Malove is rated AV by Martindale-Hubble® as a pre-eminent lawyer.

Gladys Zambrana was also charged with four counts of health care fraud. Gladys Zambrana and Hernandez Quiros were charged with three counts each of paying health care kickbacks, while Perez, Hidalgo and Tellechea were charged with one count each of paying health care kickbacks. Gladys Zambrana, Perez, Alejandro Quiros, Tellechea and Castaneda were also charged with conspiracy to launder health care fraud proceeds.

According to the indictment, Gladys Zambrana, Perez and Hernandez Quiros operated ABC Home Health Care Inc. (ABC), listing Javier Zambrana as the owner; and Gladys Zambrana and Castaneda operated Florida Home Health Care Providers Inc. (Florida Home Health), listing Tellechea as the owner. Both ABC and Florida Home Health purported to be home health agencies that catered to Medicare beneficiaries. The indictment alleges that at both agencies, beneficiaries were recruited and paid kickbacks and bribes to arrange for their Medicare beneficiary numbers to be used by their co-conspirators to file claims with Medicare for purported home health care services. The indictment alleges that the services were not provided and were not medically necessary.

The indictment alleges that in addition to exerting ownership and control of the home health agencies, Hernandez Quiros and Castaneda acted as Medicare beneficiary recruiters for ABC and Florida Home Health, respectively; and Hidalgo, a medical assistant, falsified medical tests and records to make it appear that the services were needed. The indictment alleges that ABC billed more than $17 million to the Medicare program for services provided from January 2006 through December 2008 that were medically unnecessary and were not actually provided. During that time frame, Medicare paid more than $11 million on those fraudulent claims submitted by ABC. The indictment also alleges that from October 2007 through March 2009, Florida Home Health billed more than $5 million to the Medicare program for services that were medically unnecessary and not actually provided. During that time frame, Medicare paid more than $4 million on those fraudulent claims submitted by Florida Home Health.

The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. Each charged count of health care fraud carries a maximum prison sentence of 10 years and each count of paying health care kickbacks carries a maximum prison sentence of five years. Conspiracy to launder health care fraud proceeds carries a maximum prison sentence of 10 years per count.

In conjunction with the criminal case, on June 24, 2009, the U.S. Attorney’s Office also filed a civil complaint for injunctive relief under the fraud injunction statute and obtained a temporary restraining order freezing the assets of ABC, Florida Home Health, Gladys Zambrana, Javier Zambrana, Perez, Hernandez Quiros, Castaneda and Tellechea. In addition, that temporary restraining order also freezes certain financial assets of four other companies the defendants owned or controlled and allegedly used to launder money fraudulently obtained from Medicare. The temporary restraining order is intended to preserve the remaining proceeds of the fraud for recovery by the United States as part of the criminal case and any related civil proceedings.

According to Acting U.S. Attorney Jeffrey H. Sloman, the “[c]oordinated criminal and civil action delivers an effective one-two punch to health care fraudsters: they were not only caught and criminally charged, but they are also being stripped of their illegal proceeds.”

WASHINGTON (June 24, 2009) – According to a joint press release issued by the Department of Justice Press U.S. Department of Health and Human Services, fifty-three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit, Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and FBI Director Robert Mueller announced today. The Strike Force in Detroit is the third phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.

While the indictments were returned by a grand jury in Detroit, individuals were arrested in Detroit, Miami and Denver as a result of phase three operations of the Strike Force. The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

The Strike Force operations in Detroit are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a renewed effort announced in May 2009 between the Department of Justice and HHS to focus their joint efforts to prevent fraud and enforce current anti-fraud laws around the country. Last month, Attorney General Holder and Secretary Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars.

Today, federal agents from the FBI and the HHS Office of Inspector General (HHS-OIG) began executing arrest warrants in Detroit, Miami and Denver as part of a concentrated effort to address fraud in the metro-Detroit area. Charges were unsealed today against 53 individuals who are accused of various Medicare fraud offenses, including conspiracy to defraud the Medicare program, criminal false claims and violations of the anti-kickback statutes. The Strike Force operations in Detroit have identified two primary areas – infusion therapy and physical/occupational therapy providers – in which schemes were allegedly orchestrated to defraud the Medicare program.

According to the indictments, the defendants charged today participated in schemes to submit claims to Medicare for treatments that were in fact medically unnecessary and oftentimes, never provided. In many cases, indictments allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the unnecessary and not provided treatments. Collectively, the physicians, medical assistants, patients, company owners and executives charged in the indictments are accused of conspiring to submit more than $50 million in false claims to the Medicare program.

The work of the Detroit Strike Force is another important step in the multi-phase enforcement and regulatory HEAT initiative designed to reduce the potential for Medicare and Medicaid fraud. Since its inception in March 2007 with phase one in South Florida and expansion to phase two in Los Angeles in May 2008, the Strike Force has obtained indictments of more than 250 individuals and organizations that collectively have billed the Medicare program for more than $600 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the three Detroit Strike Force teams is led by a federal prosecutor supervised by the Justice Department’s Criminal Division’s Fraud Section in Washington, D.C., and the U.S. Attorney’s Office for the Eastern District of Michigan. Each team has four to six agents, with at least one agent from the FBI and HHS-OIG.

According to government prosecutors: From approximately November 2001, through April 2005, HOLLOWAY was employed as a Regional Manager at a pharmaceutical company and was responsible for sales in her region of the drug Bextra. Bextra was a Cox-II inhibitor and had been approved in by the Food and Drug Administration (FDA) in November 2001 for the signs and symptoms of osteoarthritis, adult rheumatoid arthritis, at 10 mgs and primary dysmennorhea at 20 mgs, twice a day as needed. In 2001, the FDA specifically denied the request of the pharmaceutical company to approve it for acute pain, including the pain of surgery. The FDA told the pharmaceutical company that it could not approve it for these other indications because the safety in these other uses had not been established. Specifically, the FDA was concerned about the results of a study in which there was an excess of cardiovascular events in patients who had undergone coronary artery bypass graft surgery and used Bextra.

HOLLOWAY was aware of the FDA’s safety concerns, but that she nonetheless had her sales staff of approximately 100 employees sell Bextra for precisely the uses that the FDA refused to approve. For example, HOLLOWAY trained and encouraged her sales teams to promote Bextra by obtaining protocols from doctors that instructed that Bextra be used for the pain of surgery, an unapproved use, and at 20 mgs, an unapproved dose. HOLLOWAY also instructed her staff to market Bextra for use before, during and after surgery to reduce the risk of deep vein thrombosis, which is a form of life threatening blood clots, even though she knew there were no studies showing that Bextra was safe and effective for this use. Finally, HOLLOWAY encouraged her staff to make false safety claims about Bextra in order to sell the drug.

Holloway was sentenced by United States Magistrate Judge Judith Dein to pay a $75,000 fine and twenty-four months of probation after pleading guilty to an Information charging her with distribution of a misbranded drug.

DAVIS was charged in July 2008 in a one-count indictment and later plead guilty to concealment or falsification of records in a federal investigation. After being served with a subpoena for documents from the Department of Health and Human Services (HSS), Office of Inspector General (OIG), on July 23, 2003, the defendant personally destroyed, concealed, covered up, and falsified records and documents, including physician service logs, with the intent to impede, obstruct, and influence an investigation into Medicare fraud by Aging Care Home Health Care ACHH. The investigation revealed that DAVIS produced documents that she created after receipt of the OIG subpoena and that many of ACHH’s doctors did not perform the services indicated in the records.

JANICE DAVIS has owned and operated ACHH, a Monroe-based company, since 1991 until its closure in 2005. ACHH provided nursing and therapy services to patients in their homes. Clinic-based doctors monitored the patients’ home health services by updating treatment plans and prescribing medications. Normally, a physician would bill Care Plan Oversight services directly to Medicare. Payment is made by Medicare directly to the physician for services rendered to home health and hospice patients.

The subpoena issued by HSS-OIG to Aging Care Home Health was a result of an October 2002 False Claims Act suit which alleged that ACHH tracked physicians “Care Plan Oversight” services and billed Medicare as a means to induce patient referrals from physicians. In November of 2004, the United States intervened in that suit alleging that Janice Davis, her husband Otis Davis and her company violated federal Stark and Anti-Kickback statutes by creating a sham physician advisory board and paying its members not for legitimate duties actually performed, but instead for Medicare referrals, which is illegal. The False Claims Act lawsuit ended in 2008 when U.S. District Judge Robert James granted several motions for summary judgment against Janice Davis, Otis Davis and Aging Care and awarded almost $5,000,000 in damages and penalties to the United States. In that suit, Judge James also found that Janice Davis had destroyed company records which were responsive to the federal subpoena and attempted to replace them with false records she fabricated in an attempt to mislead federal regulators and law enforcement.

The South Florida chapter of the Society of Professional Journalists awarded The Herald nine first-place honors among large newspapers, including two of the organization's most coveted citations.

Special congratulations go out to Herald reporter Jay Weaver, who won the Sunshine State Award in the category of Medical/Health Care/Science Reporting for his exposé: ''South Florida's Medicare Racket,'' detailing massive fraud among recipients of Medicare dollars.

In a modification of the theme, the State of Florida Agency For Health Care Administration (AHCA) decided to conduct an auditing sweep of durable medical equipment (DME) providers in Bay County, Florida. AHCA is the Florida Medicaid program administrator, and has the authority under Florida law to initiate overpayment actions or terminate a program provider, but is not a law enforcement authority, referring instances of fraud to the Attorney General’s Medicaid Fraud Control Unit. The probe was directed to supplies of oxygen to patients with COPD under the Medicaid program.

To read more click here.

According to a press release, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder launched an interagency high-level task force to help detect and prevent health-care fraud, which robs the nation's coffers of billions of dollars each year.

The Department of Justice and Department of Health and Human Services directed federal investigators and prosecutors to expand special strike forces to Detroit and Houston, where "erratic" billing data suggest high levels of fraud, waste and abuse in Medicare and Medicaid programs. The first of these task forces was launched in Miami and then expanded to Houston and Los Angeles.

The new task force, the Health Care Fraud Prevention and Enforcement Action Team, or HEAT, would be run from the highest levels of government. The Health Care Fraud Prevention and Enforcement Action Team will be composed of senior-level officials at the Justice Department and HHS. The group will use electronic claims data, as well as the threat of federal prosecution, to look for unusual billing problems.

To read more about about the HEAT initiative, click here and here.

To read more, click here.

Previously, defendants were able to be released on minimal restrictions. However, over the last year judges in the Southern District have been denying bond and placing significant restrictions on defendants to assure the presence of Medicare fraud defendants.

In another very good article, Jay Weaver of the Miami Herald, breaks down the fugitive life of one such defendant, Alcides Garcia, originally believed to have fled to Cuba but who had traveled to Mexico, Spain and was eventually arrested in the Canary Islands.

To read more click here.

To read more, click here.

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