NEWARK, N.J. – Dr. Michael P. Stein, 63, a New Jersey doctor, was sentenced today to 24 months in prison for defrauding Blue Cross Blue Shield for approximately three-quarters of a million dollars by submitting false claims for services never performed.

Between August 2004 and September 2010 Stein owned and operated Randolph Otolaryngology. Stein purportedly treated a patient with the initials J.F. for nasal problems and billed Blue Cross Blue Shield for the services.

However, investigators determined that Stein submitted fraudulent claims with Blue Cross Blue Shield for procedures that were not performed. Evidence revealed that Stein submitted claims for approximately 900 nasal endoscopies he purportedly conducted, when only a few were actually performed. Stein also admitted he filed false claims for office visits and medical procedures that occurred while he was out of the country on vacation.

Blue Cross Blue Shield paid Stein $725,156.45 from as a result of the fraudulent false claims submitted, and, under the plea agreement, Stein agreed to pay restitution and forfeiture for the entire amount.

In addition to the prison term, restitution and forfeiture, Stein was ordered to serve three years of supervised release. His medical license has been surrendered.

Stories Like this Illustrate Why You need a Medicare Fraud Attorney familiar with health care fraud and abuse on YOUR side!

With the government dedicating the necessary financial and human resources to prosecuting these types of crimes, you need a Medicare Fraud Attorney familiar with health care fraud and abuse on your side. From his law offices in Ft. Lauderdale and Miami, Florida, Robert Malove provides legal representation to doctors, medical clinics, hospitals, DME providers and other health care companies.

Health care laws are highly complex and are constantly changing, leaving doctors, pharmacists, chiropractors, nurses and health care organizations subject to criminal investigations and serious criminal charges.

If you are a physician or business owner accused of health care fraud, you need professional legal representation from an experienced Medicare Fraud familiar with the intricacies of the laws regarding health care health care fraud and abuse. Miami and Fort Lauderdale Attorney Robert Malove can expertly handle every aspect of your unique legal situation.

Excerpt From The Washington Post:

Health executive lobbied in Washington to advance Medicare fraud scheme

By Dan Eggen, Published: October 5

Miami health-care executive Larry Duran orchestrated one of the largest Medicare frauds in U.S. history, submitting more than $205 million in phony claims and landing a record-breaking 50-year prison sentence for his crimes.

But another piece of Duran’s scheme also caught the eye of prosecutors. They say he extended his fraud through his lobbying efforts, all aimed at getting official Washington to make it easier for mental-health centers such as his to make money.

An advocacy group he helped set up, the National Association for Behavioral Health (NABH), has spent more than $750,000 on lobbying efforts over the past five years, including staging “fly-ins” on Capitol Hill and providing advice to group members on how to get around Medicare denials, according to the Justice Department. The group also held fundraisers for key lawmakers such as Sen. Mary Landrieu (D-La.) and former congressman Kendrick B. Meek (D-Fla.), records show.

Read More.

Continue reading "Health Care Fraud and Medicare Fraud Charges in Florida Require a Medicare Fraud Attorney Familiar with These Complicated Laws" »

Criminal Defense and Health Care Fraud Attorney Robert Malove is referenced in this October 16th article that appeared in the Louisville, KY Courier-Journal. Below is an excerpt from that article. Read more below.

Kentucky addicts who travel to Florida for easy access to prescription painkillers are facing new roadblocks — laws targeting rogue pain clinics, a prescription-drug monitoring system and tougher police enforcement.

And while ending Florida’s reign as the unofficial pain-pill capital of America is an uphill fight that is far from won, there are signs of progress. Registered pain clinics in Florida have dropped from 930 last year to 736 now as the state begins to crack down.

A new state law that took effect in July strengthens penalties for doctors who over-prescribe painkillers, tightens rules for prescriptions and pain-treatment regimens, and shortens the time dispensers have to log the sale of prescription drugs into an electronic monitoring system that began operating Sept. 1. The law also gives police more ammunition as they pursue pain clinics and doctors that prescribe to addicts and dealers.

To Read the Rest of the Article Click HERE.

Continue reading "Health Care Fraud: Florida fights back in the battle against prescription-drug abuse" »

DAYTONA BEACH, FLORIDA (AUGUST 23, 2011) - Joseph Wagner, 61, can no longer practice in the State of Florida. The surgeon general for the Florida Department of Health, Dr. Frank Farmer, issued the emergency suspension order.

Wagner, billed insurance companies for services he never performed and treated two patients with controlled substances, exceeding the scope of his license. Wagner faked insurance reimbursement claims and called prescriptions into pharmacies using another doctor's name without ever examining or meeting the patients. The license of the other doctor, John P. Christensen of West Palm Beach, was also suspended.

The FBI along with the Florida Department of Law Enforcement and other agencies raided Wagner's clinic earlier in the month and confiscated patient records. In addition, Wagner's son, a chiropractor at a separate clinic is under investigation for his role in the scheme.

BOSTON, MASSACHUSETTS (AUGUST 29, 2011) - Massachusetts State Attorney General Martha Coakley’s office released information that it had recovered $69 million in Medicaid fraud during the fiscal year 2011. The previous record was $14 million in 2009.

Since she took office in 2007, AG Coakley’s office has added $200 million in Medicaid fraud back to the state fund’s coffers. The $69 million figure alone represents more than the total previously collected in the ten years prior to Coakley’s tenure. For every dollar the AG’s Medicaid Fraud Division has allocated to its budget, $18 is recovered to the taxpayer.

SOUTH FLORIDA (AUGUST 17, 2011) - Despite new legislative efforts with stricter regulations on pain clinics and dispensing of narcotic painkillers, deaths from oxycodone overdoses continue to rise in South Florida. Governor Rick Scott believed the state's effort to make it harder for pill mills to operate in the state would decrease the number of deaths from narcotic painkillers. The numbers continue to rise.

The number of oxycodone-related deaths rose from 2009 by about 8 percent. Jim Hall, director of the Center for the Study & Prevention of Substance Abuse at Nova Southeastern University in Davie, feels there won't be much improvement in the numbers until late in the year.

HOUSTON, TEXAS (AUGUST 16, 2011) - A Houston area nursing home administrator was arrested in connection with an indictment handed down by a grand jury in which he was charged with conspiracy, health care fraud and violations of the anti-kickback statute.

Kelvin Washington, 47, ran a Sugar land area nursing home and was purported to have received payments for referring dialysis patients to a specific ambulance transport service between 2003 and 2007. Washington also conspired to have doctors sign transport orders for dialysis patients. The patients whose names he used, however, were never admitted to that nursing home. By the time investigators compiled their case, Washington had helped amass over $1 million in false claims to Medicare. For his part in the scheme, Washington received over $20,000.

LOUISVILLE, KENTUCKY (AUGUST 15, 2011) - Although their durable medical equipment company was based in Florida, Yunior Lopez, 34, of Miami, Florida and Arturo Esquivel, 39, of Hialeah, Florida, had a 13-count indictment leveled against them regarding their false billings to Medicare on behalf of Kentucky patients.

The defendants allegedly used two Kentucky doctors' names when submitting the false claims to Medicare for products never provided to the patients. Investigators found the defendants' two businesses, Universal of Work Services and Steel Quality Medical had none of the supplies they were claiming to have provided to patients.

If convicted, the defendants face a maximum sentence of 35 years imprisonment. Arraignment for both defendants is scheduled for August 23, 2011 before the U.S. Magistrate Judge in Louisville, Kentucky.

WASHINGTON (AUGUST 12, 2011) - The Office of the Inspector General of the Department of Health and Human Services says more than 60 percent of all power wheelchairs, which are usually covered 100 percent by Medicare or private insurance, are not necessary for patients. The high cost of these chairs make them an attractive sales product for slick salesmen eager to make a buck.

Past investigations show that Medicare has paid close to four times the average $1,048 cost, making Medicare responsible for more than $4,000 for each chair. In many cases, the chairs won't work in the patient's home because doorways are too narrow or there is simply not enough room in the house to maneuver the chair. In Marvin Rosen's Coral Springs home it's become something he sits in occasionally to watch television because the chair isn't supposed to be used outside, and his home is too small to use it inside. The company who provided him with the chair failed to measure his home, which is a requirement before a patient can receive one.

WEST PALM BEACH, FLORIDA, (AUGUST 10, 2011) - In a raid that seized patient files, computers and the license of a West Palm Beach physician, authorities alleged that Dr. John Peter Christensen had been doling out prescriptions for painkillers without performing patient exams.

Christensen, under investigation since 2008, worked with a father and son team of chiropractors, Joseph Wagner and John Wagner, in Daytona Beach to bill insurance companies for exams that were never performed. The chiropractors asked patients to sign blank insurance forms which would later be filled in to reflect a patient exam by Christensen.

Records from the Palm Beach County Medical Examiner's Office show that Christensen gave out prescriptions to six young men who later died of drug overdoses. Parents of two former patients who died of drug overdoses have also sued Christensen, with one case settled and one still pending.

WASHINGTON D.C. (AUGUST 9, 2011) - The U.S. Department of Justice has announced it is intervening in a lawsuit filed under the qui tam provisions of the False Claims Act against Nurses' Registry and Home Health Corporation brought in the U.S. District Court for the Eastern District of Kentucky.

Under the qui tam provisions of the Act, individuals can initiate lawsuits on behalf of the United States and share in any monies received as the result of the suit. In this case, two former employees of Nurses' Registry, Alicia Robinson-Hill and David Price, accused the home health agency of exaggerating medical conditions and needs of patients in order to increase the dollar amount of claims presented to Medicare and making false claims to Medicare for unnecessary home health services.

The government has asked the court to allow 45 days in order to present its complaint against Nurses' Registry and Home Health Corporation.

HARRISBURG, PENNSYLVANIA (AUGUST 8, 2011) - Dr. Rajendra Yanda, 47, who ran an osteopathic medicine practice out of his home, was charged with 11 counts of drug device and cosmetic act violations, four counts of dealing in proceeds of unlawful activity and one count of provider prohibited acts.

As part of their investigations, undercover agents were able to secure 50 prescriptions for a total of 2,180 narcotic pills. The precriptions for the incredibly addictive medications, included Percocet, Vyvanse, Adderal, Hydrocodone, Halcion, Valium and Xanax. Patient "visits" occurred in Dr. Yande's living room, exercise room or kitchen. No exam table was present, and the doctor did no type of physical exam; not even a blood pressure was taken.

Yande did not take any type of insurance, but instead had posted a price list in the waiting room, which set out his fee based on the number of narcotic prescriptions he would write. Patient visits could range from $70 to $250.

Pennsylvania Attorney General Linda Kelly stated that their investigation of Dr. Yande is ongoing.

DETROIT, MICHIGAN (AUGUST 5, 2011) - The United States Attorney's Office for the Eastern District of Michigan unsealed an indictment, which charges 26 individuals including 12 pharmacists, 4 doctors, an accountant and a psychologist in a massive scheme to defraud Medicare, Medicaid and private insurance companies.

The indictment, containing 34 counts, alleges that a Canton pharmacist, Babubhai Patel, owned and controlled 26 pharmacies throughout Michigan and that he hid his ownership and control by using "straw owners." It is alleged that Patel paid kickbacks, bribes and other incentives to doctors who would then write prescriptions for insured patients and direct those patients to one of Patel's pharmacies to get their medications. The medications were not medically necessary, and in some cases, never provided. Patient recruiters also paid kickbacks to patients participating in the scheme.

The indictment also contains allegations regarding the alleged illegal distribution of controlled substances, including Oxycontin, Vicodin, Xanax and cough syrup with codeine. Distribution of these drugs were part of the kickbacks paid to patients and recruiters for their cooperation.

MIAMI, FLORIDA (AUGUST 4, 2011) - A former convicted drug trafficker who served five years now stands accused of defrauding Medicare of more than $11 million through his Miami-Dade home health care agency. Luis Alejandro Sanz billed Medicare for treatment to supposed diabetics who did not suffer from the disease or need home care nurses to inject insulin.

Sanz and his wife, Elizabeth Acosta Sanz, are charged with conspiring to commit health care fraud and money laundering. The pair were also charged with paying kickbacks to recruiters who provided the couple's agency, Ideal Home Health, with Medicare patients. U.S. Magistrate Patrick White viewed their alleged crimes as so egregious that at their arraignment he denied the defendants' bids for bond stating they were a flight risk.

Investigators found evidence of 40 separate bank accounts through which the couple divided the millions they received from Medicare, and still have not been able to trace all the funds received.

CLEARWATER, FLORIDA (AUGUST 3, 2011) - The operator of a Clearwater pain clinic didn't know a doctor for whom she submitted $457,000 in Medicare claims had been banned from participating in the federally-funded insurance program, due to a prior felony conviction. Jayam Krishna Iyer had been accused of six counts of fraud and after a week-long trial was found not guilty.

The not guilty verdict does not, however, end Iyer's legal troubles. She's facing two more lawsuits in conjunction with a patient death from an accidental overdose. Court documents allege Iyer was negligent in prescribing medications, which ultimately led to the death of Theresa Ann Kincaid. Iyer's insurance company at the same time is seeking to void Iyer's malpractice insurance policy under the pretense that Iyer submitted her insurance application using false information.

NEWARK, NEW JERSEY (AUGUST 2, 2011) - The FBI wants the public's help in preventing health care fraud and they're putting up advertisements in malls and on highways to bring attention to their campaign. Digital ads went up in malls in Paramus, Wayne, Hackensack and Atlantic City, as well as on the Jersey Turnpike near the Lincoln Tunnel and several major highway systems.

The Newark office of the FBI is credited with the idea for the program. For the next two months that the ads are up, the Bureau hopes to see an increase in the number of tips reporting health care fraud. If the New Jersey campaign is successful, the Bureau will turn it into a national program with the help of Clear Channel, who also assists on the "Most Wanted" digital billboards.

Health care fraud costs the American taxpayer approximately $60 billion a year, and in New Jersey the loss was $8 million in 2010. As the number of reported health care fraud cases has fallen off in recent years, the FBI hopes to educate the public on how much they're losing by not reporting fraud. Agent Sean Keyes says "all of the best criminal investigations are human-source driven."

JERSEY CITY, NEW JERSEY (JULY 28, 2011) - Arrested for a second time in connection with fraud, Dr. Madgy Elamir was charged with health care claims fraud, Medicaid fraud and practicing medicine without a license. Elamir continued to write prescriptions despite his license having been suspended in connection with a previous arrest.

The defendant also has a trial date scheduled in September in an earlier case for his alleged role in a major narcotics trafficking and Medicaid fraud ring with connections in Hudson, Bergen, Ocean, Morris and Monmouth counties. Elamir allegedly wrote prescriptions for medically unnecessary prescriptions and illegally distributed the controlled drugs, Xanex and Percocet, in exchange for cash.

Elamir's bail on the new charges has been set at $1 million.

MIAMI, FLORIDA (JULY 26, 2011) - The Government Accountability Office recently issued a report stating the federal government's analysis systems for Medicare and Medicaid are "inadequate and underused." The report further reveals that the systems don't even analyze Medicaid data, and of the 639 analysts targeted for training with the system, only 41 have received it. The technology slated to save $21 million in Medicare and Medicaid lacks the formal planning for implementation, even though $150 million has been invested in the technology.

When the new system went live in 2009, it was intended for use by the Center for Medicare and Medicaid Services (CMS), contractors, law enforcement and state agencies, with access to the information shared across all states. Because funding for the software was delayed, the rollout date has been pushed to November 2011.

In the meantime, CMS has another fraud prevention technology program in the works, similar to the system that screens for credit card fraud. That contract came with a $77 million price tag. With approximately 4.5 million claims processed on a daily basis, rollout of these programs can't come fast enough for the taxpayer's wallet.

WASHINGTON D.C. (JULY 13, 2011) - In an effort to prevent billions lost each year in fraudulent Medicare claims, a nationwide computer system for tracking claims was launched in South Florida. The system is designed to examine the millions of daily claims for reimbursement using "predictive modeling," which can identify suspected hot beds of suspicious activity throughout the country.

To avoid detection, business owners who intend to defraud the Medicare system will often move their business to other areas of the country and begin working the same scam in the new locale. In June, law enforcement charged 21 alleged fraudsters in a $23 million scam; 15 of which were from Michigan, the other six from Florida. Strike force investigators have located Medicare criminal fraud networks extending from Miami to Detroit and Houston to Los Angeles. Since March 2007, strike force investigators have identified that $1.85 billion in fraudulent claims originated in South Florida, which represented the largest portion of the total $2.3 billion nationwide. Officials estimate that Medicare fraud could total as much as $60 billion per year.

In the past, Medicare reimbursements paid first and then examined the claims for discrepancies, which investigators dubbed "pay and chase." The new system will screen and analyze claims first before payouts are made. If any healthcare providers are found to be submitting suspicious claims, they will first be excluded from participating in the Medicare system and then turned over to law enforcement.

ORLANDO, FLORIDA - The U.S. Department of Justice announced that Alberto Laborde, 48, of Miami, was sentenced to six years and nine months in prison for conspiring to commit health care fraud and committing aggravated identity theft. His sentencing included repayment of the proceeds he received from Medicare, which amount to more than $3 million.

Laborde owned three separate shell companies, which billed Medicare for medical equipment in excess of $8.3 million. The equipment was not prescribed by a doctor as is required, nor did the Medicare beneficiary ever receive the equipment. Laborde used Medicare beneficiaries and medical doctors' names and identification numbers.

Laborde used nominee owners of the shell companies in order to hide his identity. Duniesky Hurtado, 28, also of Miami, was one of those owner nominees and received a 37-month prison sentence for conspiracy to commit health care fraud.

HARTFORD, CONNECTICUT - Dr. Mark Izard, 78, decided to end his medical career after 50 years of practice and settle a lawsuit brought by the U.S. Department of Health and Human Services for $2.2 million. Under the terms of the settlement the doctor did not have to admit any wrongdoing.

Investigators alleged that Izard submitted claims to Medicare and Medicaid for services he never performed. The investigation uncovered claims where Izard billed for care provided to nursing home patients that had been transferred to hospitals. At Hartford Hospital the doctor filed claims for services that were actually performed by residents and hospital staff. A detailed analysis of the billing records also indicated that Izard sometimes billed for more than 24 hours of medical services in a day.

Along with the financial arrangement, the settlement, deemed a "civil billing dispute", includes a ban on Dr. Izard and his practice from participating in federal health care programs for the next seven years. Dr. Izard, although not barred from practicing medicine, has chosen instead to retire after a 50-year career.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement activity in the area of health care fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

NASHVILLE, TENNESSEE - Renal Care Group and Fresenius thought they were done with the long-running whistle-blower case when the judge handed down a ruling stating Fresenius, who owns Renal Care, owed the government restitution in the amount of $19.3 million. But then a few more facts came to light. U.S. District Court Judge William J. Haynes Jr. reevaluated his previous ruling and handed down a new one.... to the tune of $86.2 million.

Before Fresenius bought Renal Care, a dialysis treatment center, Renal Care submitted fraudulent claims to Medicare for a higher tier of reimbursements than it was allowed. From 1999 to 2005, Renal Care filed claims for at-home equipment at the higher level while operating dialysis centers, but that reimbursement level is not available to companies who do both.

After Fresenius bought Renal Care and was later sued, Fresenius asserted that Medicare knew of the dialysis company's structure and still paid claims. Jane Kramer, Fresenius spokesperson stated that Fresenius had received word from the Department of Health and Human Services that the billing practices used by Renal Care were in accordance with Medicare's rules.

Kramer stated Fresenius will appeal the ruling to the 6th U.S. Circuit Court of Appeals and request a jury trial. "We are confident that, after a full jury trial with testimony and evidence, no liability will be imposed," Kramer stated.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement activity in the area of health care fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

FORT LAUDERDALE, FLORIDA - Florida's Governor Rick Scott signed the "pill mill bill" into effect last Friday. The legislation is aimed at the pill pushing clinics that spawn drug addicts, dealers and deaths. Scott wants to end Florida's "dubious distinction" as the "Oxycodone Capital" of the nation.

Particulars of the bill, effective July 1, include a ban on pill sales at doctor's offices and clinics, an automatic suspension of six months for doctors who overprescribe, and penalties for pharmacies and drug wholesalers who fail to report suspicious prescribing activities. By October, the state will have a computer database to log all pain pill prescriptions, making it easier for doctors, pharmacists and law enforcement to monitor illegal activity.

The bill is not without its flaws and exempts pain clinic doctors and anesthesiologists with extra training in pain therapy. Some of these professionals have participated in pill mill activities in the past. Present at the bill signing (done at several different police stations throughout Florida), were members of law enforcement as well as political leaders, including the Mayor of Orange County, Theresa Jacobs and Dr. Jan Garavaglia, the Orange-Osceola Medical Examiner. Also in attendance, relatives who had lost loved ones to pain pill overdoses.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

HOUSTON, TX - Taking advantage of a tragic situation, a Houston federal jury returned a verdict finding a patient recruiter guilty of health care fraud. Marion Beverly Metoyer was convicted of one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries and two counts of receiving illegal kickbacks for those referrals.

According to the Indictment, Helen Etinfoh owned and operated Luant & Odera, Inc., a supplier of durable medical equipment, doing business as Tonni Medical Equipment & Supplies. Metoyer recruited patients for Luant and received kickbacks when she provided the company with Medicare beneficiaries who could be billed for services rendered.

Etinfoh, along with other co-conspirators, falsely billed Medicare for wheelchairs, wheelchair accessories and power scooters. Based on Metoyer's and other's representations to the company, Luant falsely billed Medicare using a special code designating that the power wheelchairs were replacements for wheelchairs lost during the 2008 hurricanes that Houston suffered.

Some Medicare beneficiaries testified that they had never even had a power wheelchair before Luant provided them with one. Hurricane damage claims for durable medical equipment can be made to Medicare without a doctor's order. Beneficiaries further testified that Metoyer and others offered them free power wheelchairs in exchange for their Medicare information.

This is not Etinfoh's first brush with health care fraud. In April 2010, she was convicted by a federal jury and sentenced to 41 months in prison. Other patient recruiters of Luant, including Paula Whitfield, Melvin Barnes, Johnnie Lee Andrews and Monica Rene Perry, also have several convictions of health care fraud.

Metoyer's convictions could result in a total of 30 years in prison. A sentencing date has not been set.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement in the area of health care fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

WASHINGTON, D.C. - Two related sleep medicine and durable health equipment companies have agreed to repay the United States $650,000 in false claims made to Medicare. The companies, Areté Sleep Therapy LLC and Areté Holdings LLC, with facilities in Arizona and Texas, billed the claims as part of sleep diagnostic studies performed by technicians who did not hold the proper licensure or certification according to Medicare policies. The amount to be reimbursed also includes claims made for provision of durable medical equipment as a result of those tests.

In January 2011, Areté filed for Chapter 11 in the U.S. Bankruptcy Court and agreed to pay the False Claims Act settlement from monies received following the sale of its assets. The allegations came as a result of a whistleblower lawsuit, and as a result, the person reporting the fraud will receive a portion of monies repaid, which in this case total $107,250.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement in the area of health care fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

MIAMI, FL - The Departments of Justice and Health and Human Services announced that Obel Martinez and Damaris Gil, a married couple, entered into plea agreements and admitted to committing health care fraud. According to the factual proffer filed in court at the the of the guilty plea, Martinez and Gil agreed that it was their scheme to bilk Medicare of $1,089,234 in fraudulent claims. The defendants owned and operated a durable medical equipment company, OM Best Help Corp., which provided equipment as well as prescription drugs to Medicare beneficiaries.

The defendants also used Medicare provider numbers of licensed medical doctors without prior authorization and represented to Medicare that the doctors had written prescriptions for the durable medical equipment, when in fact, they did not. The pair also never provided the equipment to the Medicare beneficiaries after filing the false claims.

Sentencing is scheduled for August 23, 2011, and each defendant could receive up to a maximum of 10 years in prison.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement in the area of health care fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

Fort Pierce, FL - Homero Izquierdo Ruiz could have been imprisoned for a maximum of 10 years for violating Title 18, Section 1347 of the United States Code. Instead, he was sentenced to serve two 39-month incarceration terms (which will run concurrently) on two counts of health care fraud. At the conclusion of his imprisonment, Ruiz will also have three years of supervised release. As restitution, Mr. Ruiz will also pay more than $1,000,000 to Medicare. Click here to read the official court judgment.

Stipulations of Fact in the Guilty Plea

According to the Criminal Complaint filed in US District Court for the Southern District of Florida, Fort Pierce Division, after purchasing Physical Therapy and Fitness in Martin County, Homero Izquierdo Ruiz, 46, of Miami, initiated fraudulent billing practices. The physical therapy practice received reimbursement for its rehabilitation services from Medicare Part A. In eight months from January to August 2010, the practice netted more than $500,000 in reimbursements from Medicare.

Additionally, Ruiz also bought Ebenezer Medical Services, Inc., in Miami Dade, which at one time operated as a pharmacy and received reimbursements from Medicare Part D as prescription drug coverage. When Ruiz purchased Ebenezer in May 2010, it was no longer operating as a pharmacy. Records from Medicare demonstrate that Ebenezer received more than $587,000 during the period of May 14, 2010 to August 13, 2010. Further, 16 doctors attest that Ebenezer filed false claims using their names and National Provider Identification numbers. Four other Medicare beneficiaries also filed complaints that bills listed prescription drugs that they never received.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement targeting healthcare fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

BROOKLYN, NEW YORK - A New York therapist pled guilty to five counts of Medicare fraud for submitting false claims for physical therapy services that were either unnecessary or never performed. The Justice Department indicted Aleksandr Kharkover on charges with billing Medicare for $11.9 million in services from January 2005 to July 2010; received $7.3 million in Medicare reimbursements.

The Wall Street Journal played a part in the investigation stemming from a December 2010 profile it ran on Kharkover after mining the Medicare claims database. The Journal suspected financial abuse after discovery that Kharkover billed far more than the norm. Another allegation states that he billed for services performed during the time period in which he was actually away on vacation. Click here to read the December 2010 WSJ article.

According to Mr. Kharkover's lawyer, there was no plea deal; his client simply "pled guilty to all charges listed in the indictment," according to the Journal.

Mr. Kharkover is currently awaiting sentencing.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement activity targeting healthcare fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

Continue reading "BROOKLYN THERAPIST PLEADS GUILTY TO MEDICARE FRAUD" »

MIAMI-DADE, FLORIDA (May 19, 2011) - A fraudulent billing scam masterminded by Gregory Campbell, the 28-year-old son of State Rep. Daphne Campbell, has brought first-degree felony charges of grand theft, organized fraud and Medicaid fraud down on Mr. Campbell's head. He stands accused of billing the joint state and federally funded Medicaid program for $299,000 for services he never provided.

It appears Campbell billed for the same patients at two separate adult care facilities. Investigators also found Campbell billed for patients that did not live at either facility, and he offered kickbacks to the owner of one of the care sites.

Campbell was being held in the Miami-Dade county jail following his arrest on May 12. When contact by the press regarding her son's arrest, Rep. Campbell had no comment.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

WASHINGTON D.C. - Peter Budetti, Washington's watchdog for Medicare and Medicaid fraud warns would-be program fraudsters that he's cracking down and plans to use technology and a new long-range, far-reaching strategy to do it.

The FBI estimates figures in the double- to possible triple-digit billions are lost annually to healthcare fraud, and the State of Florida, due to its high elderly population, leads the country in Medicare scams. Medicare fraud isn't limited to criminal practices by healthcare professionals, including nurses, doctors and pharmacists, but also business owners, Medicare beneficiaries, drug dealers and even organized crime groups defraud the fund.

The Crackdown

New applications to become Medicare healthcare providers will be subject to tighter screening, including fingerprinting and criminal background checks by the FBI, if the applicant demonstrates a high-risk potential. Budetti feels a new computer payment system, complete with new software and payment algorithms, will leave the Medicare/Medicaid programs far less open to fraudulent practices. Built into this new system is the capability of immediately suspending payments to providers when fraud allegations prove to be credible.

Budetti believes that smarter computers can outwit the would-be frauders of Medicare and Medicaid thereby saving the American taxpayers and the U.S. government billions of dollars per year.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of Medicare fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

JACKSONVILLE, FLORIDA (May 9, 2011) - A Jacksonville doctor will be spending 28 months behind bars following her conviction of Medicare and Medicaid fraud. Janet Johnson-Hunter pled guilty to "conspiracy to conceal material facts in connection with the delivery of and payment for health care benefits, items and services."

Johnson-Hunter owns a private ambulance service which receives reimbursement for Medicare and Medicaid in accordance with the non-ambulatory condition of its patients. If a patient is able to walk or ride in a wheelchair, Medicare and Medicaid is less likely to reimburse the company for the patient's transportation. Johnson-Hunter told her employees to change patients' medical records to reflect a non-ambulatory condition.

Johnson-Hunter was fined $10,000 and ordered to pay $428,929 to Medicare and $46,165 to Medicaid as restitution for the fraud.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

PALM BEACH COUNTY, FLORIDA (May 14, 2011) - South Florida, usually a premier destination for those desiring beautiful beaches, fine dining and luxury accommodations has become a major draw for out-of-state drug traffickers seeking, among other drugs, the popular narcotic painkiller, Oxycodone.

The out-of-towners, called "pillbillies" because of their connection to the Appalachian region, buy large quantities of prescription drugs, then head back to their home state to sell them. Local law enforcement resources have become overtaxed due to the large number of these out-of-state defendants frequently caught during a routine traffic stop.

Florida's past lax regulations regarding prescription meds may have been to blame for the illegal trade gaining a foothold in the state. Florida legislators just recently tightened its grip on the pain management "pill mills," which may be netting more drug traffickers.

Miami doctor Bernd Wollschlager, past president of the Florida Academy of Family Physicians and staunch opponent of pill mills, reported that a pill mill doctor can make as much as $5,000 per day just writing prescriptions.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mill defense, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

WASHINGTON D.C. (May 15, 2011) - A District of Columbia health care provider was indicted by a federal grand jury on "one count of health care fraud and 39 counts of false statements in a health care matter." Jacqueline Wheeler faces a possible maximum sentence of 10 years incarceration and $250,000 in fines. Wheeler, a registered naturopath with the District of Columbia Department of Health, Health Professional Licensing Administration is not a medical doctor licensed to practice medicine.

Wheeler acted as CEO of Health Advocacy Center, Inc., which is a registered Medicaid provider. She also owns Sheridan Rehabilitative and Wellness Centers, Inc, which is not a registered Medicaid provider. Wheeler did all the billing for Health Advocacy and controlled the finances of both facilities. At Health Advocacy, Wheeler worked with a licensed medical doctor and billed D.C. Medicaid for $6.2 million as reimbursement of therapy services. Wheeler claimed 22 patients each received 20 continuous hours of therapy in one 24-hour period. There are 1,440 minutes in a day and sometimes Wheeler would bill for as many as 2,910 minutes (equal to more than 48 hours) for a single patient, for a single visit.

Wheeler used the proceeds from the fraud to buy property in Florida, North Carolina and the D.C. area. The United States Attorney's Office is prosecuting the case, and the investigation is ongoing at this time.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

TALLAHASSEE, FLORIDA (May 10, 2011) - Florida's legislature scored a big win with the passage of the bill to target pill mills, prescription drug dealers and users. Supporters of the bill consider the loopholes minor.

House Bill 7095 bill makes provisions for a state prescription database and requires drugstores to log the sale of every prescription pain pill. It does not, however, require doctors and pharmacists to check the database before handing the patient their pills. Mandating a database check could catch abusers through cross-referencing all places where they fill prescriptions.

Certain doctors and practices also fall under an exemption for registration with the database. Board-certified pain specialists, such as anesthesiologists, neurologists and surgeons can dispense pain meds without registering the transaction. Non-exempt physicians must register their office, have an inspection and follow set standards of patient care. With more than one-half of Florida's pain clinics run by board-certified pain doctors, potential for abuse runs high. State officials offer that the class of exempted doctors generally are much less likely to abuse the system.

The last loophole concerns the lack of drug testing for patients. The medical board wanted patients to undergo regular drug screenings if they receive pain medications, but lawmakers struck down the idea in order to get the bill passed. Regular testing could cost patients $44, each or $60 million, collectively, per year.

Loopholes aside, the bill provides stiff penalties for abusers. An automatic six-month license suspension and $10,000 fine awaits doctors found guilty of prescription abuse.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mill defense, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

COLUMBUS, OHIO (May 9, 2011) - Joining other states with similar legislation, Ohio's licensed doctors support the passage of regulations to curb the 'pill mill' problem and cut the rapid growth of the painkiller-addiction problem in the state. The physicians are also concerned, however, that patients with legitimate pain relief needs could find it harder to come by their drugs, if doctors are worried they'll be targeted for investigation. "Nothing about anything that we're doing is meant to dissuade good physicians," states Richard Whitehouse, executive director of the State Medical Board. Instead, the aim is to give the board more authority to target pill mills.

Ohio House Bill 93 seeks pharmaceutical licensure of free-standing pain management clinics, which is where the majority of patients receive the narcotic pain killers. In addition, doctors would be required to have an affiliation with a local hospital and be board-certified in pain management. Doctors would also have to report any narcotic pain prescriptions written to a state-monitored automated reporting system.

In the past, physicians prescribed strong pain killers mostly to their cancer patients. After reevaluation of pain as the "fifth" vital sign, doctors began to more freely write for pain killer medications. "Now, there's a crisis of drug abuse and diversion," states Dr. Robert Taylor of Ohio State University Medical Center.

Getting rid of the pill mills reduces the problem in part, but addicts and drug dealers may simply shop harder and use out-of-state sources. Taylor feels that although the legislation will help reduce the supply, the demand side of the problem will still be there.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

MONROE, MICHIGAN - Dr. Oscar Linares's DEA registration was suspended for illegally distributing millions of doses of Schedule II and III narcotics and for fraudulently billing Medicare for $5.7 million. Dr. Linares faces up to 20 years in prison and a $1 million fine and was arrested at his office in Monroe, Michigan following a search of the premises. Law enforcement also seized several of the physician's assets, including four bank accounts, two watercraft and seven luxury vehicles.

Dr. Linares allegedly prescribed narcotics for approximately 250 patients per day and even paid employee bonuses anytime he had more than 200 patient appointments in a single day. The Complaint alleges misconduct based on patient accounts, employee interviews and patient visits by undercover operatives. Reportedly, Dr. Linares viewed his actions as that of a man "building an empire."

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of pill mill and health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

MONROE, NORTH CAROLINA (May 7, 2011) - A gynecologist accused of billing Medicaid for services that patients never received, settled her case for double of what she billed the insurance provider. From 2003 to 2008, Dr. Latika Patel filed false claims for more than 1,000 patients.

The doctor admitted that mistakes were made and accepted responsibility for the errors. Dr. Patel contends her staff made the errors and she had been focusing more on patient care and less on the office management side of the business. Investigators believe the doctor knowingly "upcoded" for more involved and more expensive services that were not performed.

Investigators also found the doctor had billed for services performed at one clinic when she was not at that clinic on the day billed. The terms of the settlement include that Dr. Patel does not have to admit liability, and the government does not agree that its claims were not "well-founded." No criminal charges were brought in the matter. Dr. Patel will now also be subject to audits, at her expense, of her practice and all billing will be monitored for five years.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious billing practices, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

DETROIT, MI (May 6, 2011) - Two owners of a Dearborn HIV-infusion clinic were convicted of conspiracy to commit health care fraud, conspiracy to pay health care kickbacks, health care fraud and conspiracy to commit money laundering. Leonio Alayone, the person who helped them launder their financial gains, was convicted of conspiracy to commit money laundering and money laundering.

According to the superseding indictment, the two owners and brothers, Martin and Joaquin Tasis, paid kickbacks to patients when the brothers used the patients' Medicare accounts to bill for services never performed. Evidence showed that the Dearborn Rehabilitation and Medical Center was specifically established for the purpose of defrauding Medicare. From 2005 to 2007, Medicare was billed $9.1 million by the clinic for medically unnecessary treatments or services that were never performed.

Initially, the clinic was located in South Florida. The brothers later moved the clinic to Michigan when law enforcement became suspicious of possible fraudulent practices. So far 12 individuals involved in the case have been convicted for their part in the fraud; two others are awaiting trial.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious HIV infusion defense or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

TAMPA, FLORIDA - Wellness Health Plans saw five of its former executives indicted in a triple-digit million dollar fraud perpetrated on the Florida state Medicaid program. The former executives include Wellcare's CEO, general counsel and CFO. Wellcare allegedly provided false documentation that claimed costs greater than those incurred for behavioral health services.

In October 2007, federal agents descended on the company's Tampa headquarters and confiscated evidence of the alleged fraud. In 2010, Wellcare and the Justice Department reached a "preliminary settlement" of $137 million. A former financial analyst of the company and a company whistleblower, contends the settlement is too low when damages of $400 million are possible.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious billing practices, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

ORANGE COUNTY, FLORIDA - Three employees of an Orange County, Florida health clinic were arrested for allegedly scamming payments of more than $54,000 from Direct General Insurance. The trio, employed by Bethel Health and Rehabilitation Center, concocted a scheme of an intentional motor vehicle accident whereby an SUV of future patients rammed another vehicle. The scammers paid all vehicle passengers for their participation in the accident. Investigators also found that patients had been unaware of the insurance fraud because their signatures has been forged for supposed doctor visits.

Investigators are not certain as to whether or not more arrests will occur in the case as the investigation is ongoing. Presently all three initially-named defendants are free on bond.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of insurance fraud defense.

If you or someone you know is a healthcare provider and in need of serious insurance fraud, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

MIAMI, FLORIDA (May 3, 20100) - American Therapeutic Corporation and Medlink Professional Management Group have closed their doors following guilty pleas in a $200 million Medicare fraud case. The companies could face $80 million in penalties. Both have had their assets frozen.

The companies' owners also admitted guilt to health care fraud conspiracy, illegal health care kickbacks and money laundering crimes. The perpetrators used Medicare sleep studies claims as the avenue for the fraud and falsified patient files to quality for payments.

In addition, assisted living facilities' and half-way houses' personnel, as well as patient brokers sent the company patients that were ineligible to receive Medicare reimbursement for the studies. A few patients also received kickbacks for their participation.

Sentencing for the two corporations is scheduled for this coming July, and the companies face maximum penalties of $80 million.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

NEW ORLEANS, LOUISIANA - Thirty-one counts of Medicare and Medicaid fraud, totaling $12.5 million, were returned by a New Orleans Federal Grand Jury. Health Plus Consulting, Saturn Medical Group, New Millennium Medical Group, plus nine individuals were indicted on counts of health care fraud.

The individuals recruited patients to visit to the clinics for tests that were never performed or necessary. The patients also moved from clinic to clinic, receiving the same unnecessary tests. In exchange for their participation in the scam, the patients received prescription drugs.

Investigators seized two residences deemed "proceeds" from the crimes as well as bank accounts of some of the defendants. Depending on the extent of their individual involvement, defendants face anywhere from 10 years to 230 years imprisonment and fines. The corporations, if found guilty, could be fined as well.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

NEW BERN, NORTH CAROLINA - Dr. Michael K. Nunn pled guilty to health care fraud and money laundering in U.S. District Court on April 25. Nunn received four years of probation and was ordered to pay $297,215 as restitution to the U.S. Department of Health & Human Services and the Veteran's Administration in connection with Medicare fraud. His medical corporation was also fined $700,000.

Nunn's company, Community Wellness Center, located in New Bern, North Carolina, fraudulently billed Medicare for diagnostic and therapy services that were never performed. If performed services were not among those that would receive reimbursement from Medicare, they were coded as services that Medicare would pay. The Veteran's Administration was often billed twice for the same services to the same patients.

Four government agencies participated in the investigation, including the Internal Revenue Service.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of Medicare fraud and money laundering defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

WARREN, NEW JERSEY - The FBI uncovered a scam by a New Jersey physician, Yousef Massod and his office manager wife, Maruk Masood, to bilk Medicare and Medicaid out of millions. The Massods hired persons posing as licensed physicians to conduct more than 20,000 patient visits which were then billed to the government provided insurance funds.

The non-doctor defendants had graduated from medical schools in the Dominican Republic and West Indies, but had not passed their state boards and were not licensed physicians in New Jersey. The Massods paid the non-doctors $10 an hour and found two of the individuals on Craigslist.

The investigation also uncovered that Dr. Masood leads the pack in Medicaid drug billing for the State of New Jersey at $9 million for 2009. The next ranked physician only billed $6 million that year. Dr. Masood enabled the non-doctor hires to prescribe medications by providing them with pre-signed, blank prescription forms to use in their "practice."

Dr. Masood agreed to pay $1.8 million as restitution and forfeiture for the fraudulent billings. Sentencing for the Masoods will take place on July 27 in U.S. District Court. The charges to which they pled guilty carry a possible 10 years in prison and $250,000 fine.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

Healthcare providers have been subjected to increased scrutiny by the Drug Enforcement Administration (DEA) policing the medical profession’s prescriptive and dispensing policies with respect to Schedule II narcotics, including Vicodin, Percocet, OxyContin.

The IOS — Immediate Order of Suspension — is an emergency provision of federal law that permits the Attorney General to suspend a practitioner’s license to dispense narcotics without a hearing or presentation of evidence.

Under 21 U.S.C. §§ 823-824, the DEA has authority to shut down a medical provider’s practice. The IOS imposes a presumption of guilt and places the burden of establishing medical necessity on the practitioner.

Chronic pain is a condition affecting vast numbers of patients nationwide. The DEA largely misunderstands complex set of circumstances regarding the treatment of chronic pain and often times punishes health care providers for the exercise of sound professional medical judgment.

It probably goes without saying that there are unscrupulous health care providers that flaunt the law and properly fall within the scope of the statute’s broad reach. However, when there is direct physician/patient interaction, a medical history, and physical examination, it is reminiscent of Orwell's "Big Brother" and an abuse of government power to conclude as a matter of law that such conduct is intended to skirt federal and state statutes and DEA administrative regulations.

Healthcare providers must be vigilant in properly documenting the need for administration of opioids to patients and attentive to patients’ drug seeking behavior with no evidence to support medical necessity. Otherwise, the vast reach of the DEA may find otherwise ethical and dedicated and law-abiding physicians trapped within the wide net cast upon unscrupulous providers by the government second-guessing proper medical judgment.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of pill mill defense. Criminal defense attorney Robert Malove represents the Florida Academy of Pain Medicine, Florida Academy of Physician Assistants, American Academy of Pain Management, and Florida Society of Neurology and has filed an amicus curiae brief in federal court challenging the constitutionality of the Florida statutes regulating the operation of pain clinics, i.e., pill mills.

If you or someone you know is a healthcare provider and in need of serious pill mill defense or healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

Defendants Owned and Worked at Seven Area Clinics that Prescribed over 660,000 Pills, Profited More than $22 Million

FORT LAUDERDALE, FL - The United States Attorney for the Southern District, Drug Enforcement Administration (DEA), Internal Revenue Service (IRS) Criminal Investigation, announce the indictment of six South Florida residents for their participation in the illegal distribution of pain killers.

Today’s case, dubbed Operation Snake Oil, is a result of the ongoing efforts by the Organized Crime Drug Enforcement Task Force (OCDETF), a partnership between federal, state and local law enforcement agencies. The OCDETF mission is to identify, investigate, and prosecute high level members of drug trafficking enterprises, bringing together the combined expertise and unique abilities of federal, state and local law enforcement.

This prosecution targets the owners and operator of seven pain clinics located in Broward and Miami-Dade Counties. Charged in the indictment are Vincent Colangelo, 42, of Davie, Nicholaus Thomas, 28, of Fort Lauderdale, Rachel Bass, 27, of Pompano Beach, Michael Plesak, 26, of Plantation, Jeremiah Flowers, 31, of Fort Meyers, and Wayne Richards, 45, of Lighthouse Point. Five of the six have been arrested. Defendant Flowers remains at-large. To read the indictment, click here.

All of the defendants have been charged with conspiring to distribute and dispense more than 660,000 dosage units of oxycodone. Three defendants (Colangelo, Plesak and Bass) are also charged with one count of conspiring to launder the proceeds of the pain clinics and twenty-six counts of money laundering. In addition, the indictment seeks forfeiture of more than $22 million in cash and assets. Among the assets sought to be forfeited are more than 46 vehicles and vessels, including a Mercedes-Benz SLR Mclaren, numerous Dodge Vipers, and two Lamborghinis, as well as expensive real estate and a trailer park in Okeechobee.

The indictment alleges that the defendants operated the pain clinics as pill mills that offered patients prescriptions for oxycodone and other controlled substances where there was no legitimate medical purpose and not within the usual course of professional medical practice. The indictment says that the defendants marketed the clinics through more than 1,600 internet sites, required immediate cash payments from patients for a clinic “visit fee,” directed the patients to obtain MRIs that the defendants knew to be inferior, over-aggressively interpreted MRIs in order to justify prescriptions, and falsified patients’ urine tests for a fee to justify the highly addictive pain medications.

“According to recent estimates, Florida prescribes ten times more oxycodone pills than all other states combined. Operation Snake Oil is part of our concerted effort to keep South Florida from drowning in pill mills. Working together with our state and local partners, we are shutting down these shady storefronts through the systematic prosecution of doctors, clinic owners and operators who deal drugs while hiding behind a medical license,” said U.S. Attorney Wifredo A. Ferrer.

“Prescription drug abuse is our country’s fastest growing drug problem, and pill mills such as those in Florida are fueling much of that growth. As a result, citizens in communities across Florida and around the nation are faced with growing drug addiction that is accompanied by pain, suffering, and even death,” said DEA Administrator Michele M. Leonhart.

IRS Special Agent in Charge Daniel W. Auer stated, “We are pleased to have lent our financial investigative expertise to this investigation. IRS- Criminal Investigations’ role was to trace the flow of the monies derived from the illegal operation of these pill mills, to identify the individuals who profited from these illegal activities and to help seize any assets purchased using the ill-gotten gains.”

According to the indictment, demand of oxycodone has grown to epidemic proportions in South Florida and other parts of the United States, where drug dealers can sell a 30 mg Oxycodone pill on the street for $10 to $30 or more. Oxycodone has a high potential for abuse and can be crushed snorted, or dissolved and injected, to get an immediate high. This abuse can lead to addiction, overdose, and sometimes death.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of pill mill defense. Criminal defense attorney Robert Malove represents the Florida Academy of Pain Medicine, Florida Academy of Physician Assistants, American Academy of Pain Management, and Florida Society of Neurology and has filed an amicus curiae brief in federal court challenging the constitutionality of the Florida statutes regulating the operation of pain clinics, i.e., pill mills.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement activity targeting pain clinics, i.e., pill mills, you need to make sure you hire a criminal defense attorney who is familiar with pill mill defense. For serious pill mill defense, throughout Miami-Dade, Broward and Palm Beach counties, call Florida pill mill defense lawyer Robert Malove immediately.

Continue reading "OPERATION SNAKE OIL - SOUTH FLORIDA PILL MILLS TARGETED - FIVE DOCTORS AMONG THOSE ARRESTED" »

MIAMI, FL - Federal agents took to the streets early this morning arrested and more than 30 suspects charged with Medicare fraud as part of a nationwide operation authorities are describing as the largest healthcare fraud take-down to date.

This morning’s arrests in Miami arrests coincided with other arrests in New York, Los Angeles and Detroit. In Miami, 32 defendants, including 2 doctors and 8 nurses, were charged for their participation in various fraud schemes involving a total of $55 million in false billings for home health care, durable medical equipment and prescription drugs.

Federal authorities charged more than 100 doctors, nurses and physical therapists in nine cities with Medicare fraud Thursday, part of a massive nationwide bust that snared more suspects than any other in history. Click here to watch ABC News anchor Diane Sawyer report on this historic bust.

More than 700 law enforcement agents fanned out to arrest 111 people accused of illegally billing Medicare more than $225 million. The arrests are the latest in a string of major busts in the past two years as authorities have struggled to pare the fraud that's believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare's budget from hemorrhaging that money will be key to paying for President Barack Obama's health care overhaul.

To watch Attorney General Eric Holder's press conference, click here.

Although the Indictments remain sealed, the defendants are charged with typical healthcare fraud schemes du jour, including physical therapy, mental health and home healthcare.

The defendants are accused of submitting false claims in excess of millions of dollars in to Medicare, the federal program for the elderly and disabled.

Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder partnered in 2009 to allocate more money and manpower in fraud hot spots. Thursday's indictments were for suspects in Miami, Florida; Los Angeles, California; Dallas and Houston, Texas; Detroit, Michigan; Chicago, Illinois; Brooklyn, New York; Tampa, Florida, and Baton Rouge, Louisiana. To read more about HEAT, Health Care Fraud Prevention and Enforcement Action Team, click here.

Ms. Sebelius has promised more decisive action on the front end, by vigorously screening providers and stopping payment to suspicious ones, under greater authority granted by the Affordable Care Act. Also announced today was the addition of Healthcare Fraud strike forces in Chicago and Dallas.

“Over the last two years our joint efforts have more than quadrupled the number of anti-fraud Strike Force teams operating in fraud hot spots around the country from two to nine -- with the latest additions Chicago and Dallas -- bringing hundreds of charges against criminals who had billed Medicare for hundreds of millions of dollars. Last year alone, our partnership recovered a record $4 billion on behalf of taxpayers. From 2008-2010, every dollar the Federal Government spent under its Health Care Fraud and Abuse Control programs averaged a return on investment of $6.80,” said HHS Secretary Sebelius.

When it comes to serious healthcare fraud defense, call Robert Malove. He wrote the book. If you or someone you know has been accused of committing healthcare fraud anywhere in the U.S., call Attorney Robert Malove.

The Associated Press reports that on August 12, Sushil Sheth, a suburban Chicago cardiologist was sentenced to five years in prison for bilking Medicare and insurance companies out of more than $13 million for care never provided.

The 5-year sentence falls short of the 94 - 121 month advisory sentence called for by the United States Sentencing Guidelines, for losses that exceed $7M but are less than $20M, by a perpetrator with a special skill who was a leader or organizer of a criminal enterprise.

U.S. attorney's office says used the proceeds to purchase a mansion, property in Arizona, luxury automobiles, and to invest in various venture capital opportunities.

The U.S. attorney's office announced Wednesday that Sheth, who pleaded guilty a year ago to one count of health care fraud, was sentenced Tuesday by U.S. District Judge Rebecca Pallmeyer. He's to begin serving the prison term in two months.

Prosecutors alleged the 50-year-old Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursements.

In June 2007, federal agents seized more than 600 uncashed checks from insurers totaling more than $6.7 million.

As reported previously here, a central feature of the Obama administration’s health care reform has been the HEAT (Health Care Fraud Prevention and Enforcement Action Team) initiative is the use of Strike Force teams. Strike Forces are multi-agency units of Federal and State law enforcement personnel designed to identify, investigate, and prosecute Medicare fraud. Strike Forces are supported by a CMS data analysis team and CMS program experts.

Since May 2009, this Administration has expanded Strike Force cities from Miami and Los Angeles, when Strike Force teams were launched in Houston and Detroit in May 2009 and in Brooklyn, Baton Rouge, and Tampa in December 2009. (To read more, click: here).

Building on the momentum started last May, U.S. Department of Health and Human Services Deputy Secretary William Corr and U.S. Department of Justice Acting Deputy Attorney General Gary Grindler, testified earlier this month before the United States House of Representatives Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Committee on Appropriations and stated that the entire $250 million increase in the President’s Budget advances the goals of the HEAT initiative.

Strike Force defendants are also more likely to receive prison sentences and longer terms of imprisonment than more traditional criminal health care fraud defendants. Since the Strike Force’s inception, over 94% of all Strike Force defendants were convicted and sentenced to terms of imprisonment compared to 64% of all criminal health care fraud defendants. The average prison term for Strike Force defendants was 45 months, which was about 10% longer than the overall national average for federal health care fraud defendants over this same period.

New Strike Force locations are chosen based on thorough analysis of Medicare claims data, which helps identify hot spots of unexplained high-billing levels in concentrated areas, and a review of the most effective allocation of investigative and prosecutorial resources. The cost associated with Strike Forces expansion resulting in 20 locations by end-of-year FY 2011 is an estimated $46 million.

Florida and a number of states attempting to outlaw so called ambulance chasing in personal injury cases have employed several methods to limit access to records of patients. First, statutes prohibit access to police accident reports for 60-days. Second, statutes as well as professional rules regulating the professional conduct of lawyers and health care license holders prohibit the direct solicitation of patients for services.

Nevertheless, there have been some novel ways developed to get around those laws, including every once in a while someone starting a “newspaper” to use a media exception to the rule regarding access to accident reports. With restrictions on direct access to accident information, a black market for patient information has developed as well as intricate referral networks, including everyone involved in accidents, from tow truck drivers and auto body employees, to ambulance service employees, to hospital employees.

All these involve payments of one type or another, generally in cash, for access to that information and people who employ themselves gathering that information. In a recent case, a Miami man was indicted for a second time for bribing employees, first of an ambulance company, and then hospital employees to get patient information for personal injury attorneys.

To read more, click: here.

Whatever you do, don't harass the Medicare fraud investigators. A kind of simple rule, if you are committing a crime (no one I represent does that), don’t go out of your way to send harassing emails and phone calls to investigators, including death threats; it tends to incentivise them a bit to arrest you.

To read what happened to one defendant who couldn't get out of his own way, click here.

In an intriguing development in the war on pain, Palm Beach County, Florida, passed an ordinance designed to prevent new pain clinics from opening up and are intending to pass ordinances to curb the practices of existing pain clinics. This is a somewhat unusual development and may form the basis for legal challenges. The county commissioners, with some harsh words for pain clinics, are apparently attempting to regulate the medical profession through zoning regulations.

To read more, click: here.

Health and Human Services Office of Inspector General released an updated fraud alert “Telemarketing by Durable Medical Equipment Suppliers” originally published in March 2003.

The Fraud Alert states in relevant part:

Section 1834(a)(17)(A) of the Social Security Act prohibits suppliers of durable medical equipment (DME) from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in three specific situations: (i) the beneficiary has given written permission to the supplier to make contact by telephone; (ii) the contact is regarding a covered item that the supplier has already furnished the beneficiary; or (iii) the supplier has furnished at least one covered item to the beneficiary during the preceding 15 months. Section 1834(a)(17)(B) specifically prohibits payment to a supplier that knowingly submits a claim generated pursuant to a prohibited telephone solicitation. Accordingly, such claims for payment are false and violators are potentially subject to criminal, civil, and administrative penalties, including exclusion from Federal health care programs.

The Office of Inspector General (OIG) has received credible information that some DME suppliers continue to use independent marketing firms to make unsolicited telephone calls to Medicare beneficiaries to market DME, notwithstanding the clear statutory prohibition. Suppliers cannot do indirectly that which they are prohibited from doing directly. OIG has also been made aware of instances when DME suppliers, notwithstanding the clear statutory prohibition, contact Medicare beneficiaries by telephone based solely on treating physicians’ preliminary written or verbal orders prescribing DME for the beneficiaries. A physician’s preliminary written or verbal order is not a substitute for the requisite written consent of a Medicare beneficiary.

To read the Fraud Alert: Click here.

All OIG Special Fraud Alerts are available on the OIG Web
site at: http://oig.hhs.gov/fraud/fraudalerts.asp

To read the Federal Register: Click here.

CMS uses contractors to process claims, but also to use sophisticated software to detect fraud patterns and make referrals for claims denials, audits and criminal investigations. At one time the system was somewhat fragmented, given that there are different contractors who process part A, B and D claims in given regions and a series of contractors were looking at data based upon particular types of claims or criteria. In addition, the flow of data prevented the contractors from analyzing and detecting fraud patterns until long after claims had been paid. Lately, CMS has moved to contractors who electronically review all claims for 7 regions searching for claims patterns that reflect fraud. The program, called ZPIC (Zone Program Integrity Contractors) has led, at least at the inception, to many providers receiving audit inquiries, chart reviews, and application renewals; and according to the program, the denial of $1.5 billion in claims in Florida alone since May.

Click here to read more.

We have done posts on the various monikers given to task forces, including the most recent in healthcare fraud, HEAT (Healthcare Fraud Prevention and Enforcement Team) and the agencies in involved in those investigations; the FBI (Federal Bureau of Investigation), OIG (Office of Inspector General), MFCU (Medicaid Fraud Control Unit); but the British, when they go to investigate large frauds have a more direct name, “Serious Fraud Office” which in England and Wales is a separate entity from the other governmental agencies and has specific criteria as to the amounts number of potential victims, and the general importance of the prosecution.

In the healthcare field, their most recent investigations have involved frauds on the British healthcare systems by drug manufacturers. The analogous agency in the United States would likely be the Department Of Justice or Main Justice and one of its individual units, but the names aren’t as cool. On the one hand, getting a visit from the Federal Bureau of Investigation is frightening, but it might be more so if you get an investigation from the Serious Fraud Office.

Click here to read more.

Often, we hear that white collar crime is treated differently than other types of crime. However, it is often who commits white collar crime that brings about different treatment. I had a client indicted for fraud related to a DME. Monthly, he would send me articles about large DME companies paying large fines and false claims settlements for the same conduct he was alleged to have engaged in and asked the simple question, “Why am I supposed to go to jail and they don’t?”

People arrested for crimes, and in particular health care fraud can find many rationales for conduct that objectively looks bad; some form the bases for defenses; some are to try to feel better. One reaction is generally the same for nearly all, whether it is speeding or a million dollar fraud, “everyone is doing it.” A variation on that theme, and a fair one is that often individuals and small companies are treated much differently than much larger companies.

In 2004, at the same time Pfizer was negotiating a resolution of a $460 million settlement with the United States for unlawful “off label” uses of its drugs, it also was planning and executing marketing campaigns for other drugs doing precisely the same conduct. The results, a huge fine and restitution, but no criminal charges for individuals. An individual that takes a million dollars in a Medicare fraud scheme is going to jail; as are employees and others most closely associated with that person and the scheme. The world’s largest drug company agreed it participated in a $1 billion in Medicare fraud and pays money. The company, or likely a subsidiary, also plead guilty to a crime, but no person goes to jail. $2 billion is not a small sum, but many sitting in prison wonder why the rules are different.

Currently, the highest dollar “amount of loss” category for sentencing purposes involving fraud is for a loss figure of $400,000,000 or more, garnering a 30 level sentencing enhancement; whereas $1,000,000 or more will get a 16 level enhancement. If someone participated in a scheme with a resulting loss of $1million dollars, they are likely to go to prison for a minimum (without other adjustments) of 41 months. This sentence could be applicable to the person who masterminded the scheme as well as some low level employee who merely assisted. A person who participates in a scheme with a resulting loss of $1 billion would be subject to prison for a minimum of 188 months; however in this case, no one goes to jail. Clients complain, "the rich (corporate defendants) get richer, while the poor (individual defendant) gets prison."

Click here to read more.

Part of the Health Care Fraud Task Force initiative in Miami, Houston, Detroit and Los Angeles has met with some success, and not so coincidently some of the cases have Miami roots. The FBI press release related to a plea in a in a $10 million infusion fraud case which mirrors frauds extensively prosecuted in Miami, a Miami resident plead guilty with regard to the fraud in Detroit.

MIAMI, FL (October 12, 2009) Today the editorial board of the Miami Herald weighed in on the national health care reform debate by pointing out that the current health care system - Medicaid and Medicare - has insufficient front-end mechanisms in place to detect fraud, waste and abuse and by calling for stiffer sentences saying, “unless penalties for fraudsters who steal millions of dollars are toughened so that the prison sentence is more than a legal slap, they'll keep scamming.”

The Herald offered up some eye opening statistics. Since 2005, federal prosecutors in South Florida have charged more than 900 Medicare offenders in cases totaling more than $2 billion in fraudulent claims. Across the U.S., taxpayers are hit with $60 billion in healthcare fraud each year.

In an effort to shape national healthcare policy, the editorial urged called on the President to press for more investigators to catch abuses when claims are first filed -- not down the road when government investigators and auditors eventually detect that millions have been erroneously paid out to crooks, some of whom have flown the coop.

According to The Herald, “health care reform bills [must] include more accountability, but unless there's sufficient money to enforce the rules and nab the scammers it won't get done right.” To read the editorial, click here.

Of general interest and with particular application in health care, the federal government has, over the course of several decades, criminalized an entire range of behavior that most people did not know or perceive to be criminal. This is not lost on the people who practice in the medical field; one client recently surmised “If it is a good idea in healthcare, it is probably a misdemeanor, if it is a great idea, it's a a felony.”

One other client, after being acquitted of federal criminal charges predicated upon the application of a vague regulation, asked “What did I do wrong?” The only answer I could come up with was “You made money in health care.”

The intricate and ever expanding number of regulations, national and local coverage determinations, and transmittals from Medicare and Medicaid often carry with them potential criminal penalties for fraudulent claims. Fox News has an interesting article about hearings being conducted by Congress on the issue of the over criminalization of federal law.

To read the Fox News article, click here.

A new moniker in the long list of federal task forces. Federal Agencies generally get the three letter moinker; FBI, IRS, CIA, OIG, DOD, etc. Task forces get more letters and try to do acronyms; HIDTA (DEA), FinCEN, OFAC (Treasury), OCDETF (DOJ).

Now we finally have a task force with a cool name: HEAT (Health Care Fraud Prevention and Enforcement Action Team). And they have been busy between Miami, Detroit and Huston. In one week, six indictments and allegations of $282 million in fraud from DME, to Pain Management, to therapy.

For more, click here.

FOR IMMEDIATE RELEASE

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.

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.

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.

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.

On June 15th, JANICE DAVIS, age 62, of West Monroe, was sentenced in United States District Court for the Western District of Lousianna for healthcare fraud. DAVIS was sentences to spend 15 months in federal prison and a term of three years of supervised release following confinement.

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.

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.

Newly appinted Secretary of HHS, Kathleen Sebelius, has stressed health care fraud enforcement, citing that for every dollar spent on fraud and abuse detection and enforcement, the government receives $1.55 in savings. $1.7 billion over the next ten years has been set aside for such enforcement.

For more info click here.

Legislation before the Florida House and Senate would require a controlled substances reporting database containing all prescribing and dispensing information related to certain controlled substances.

The purpose and intent of the statute is to prevent drug abuse and profit making by the over prescribing of controlled substances. The database would be accessible by pharmacists and practitioners dispensing medications to patients to make sure a patient has not received multiple prescriptions for controlled substances. However, somewhat disconcerting from a civil liberties perspective is that the database would also be accessible to law enforcement as part of an “active investigation.” This includes State Boards, Medicaid fraud investigations or any investigation concerning fraud, prescribing, or dispensing controlled substances which seems to include any time law enforcement wants the information. Active investigation is defined as “an investigation that is being conducted with a reasonable, good faith belief that it could lead to the filing of administrative, civil, or criminal proceedings, or that is ongoing and continuing and for which there is a reasonable, good faith anticipation of securing an arrest or prosecution in the foreseeable future.”

Th read the legislation click here and here.

There has been a substantial crackdown by federal and state authorities in Florida over the last several years with regard to Medicare and Medicaid payments related to respiratory conditions such as COPD. The enforcement has typically focused on the durable medical equipment (DME) providers. However, after a large number of indictments related to DME companies and with Medicare moving toward a bidding process for DME suppliers, the focus has been turning to the physicians who prescribe DME and the often expensive medications associated with respiratory illness. According to a recent report by Medicare (via the Miami Herald), there was some cause for concern.

“Although South Florida is home to 2 percent of the nation's Medicare beneficiaries, the region accounts for 17 percent of the government program's total spending on inhalation drugs because of potential fraud, a new federal study says. In 2007, Medicare spent $143 million on claims for drugs to treat respiratory ailments in Miami-Dade County, according to the report by the Department of Health and Human Services released Tuesday. That's 20 times more than the amount Medicare spent in the Chicago area, which has twice as many beneficiaries.”

And this: “''In Florida alone, approximately 60 percent of the top 100 ordering physicians are the subject of administrative actions by [Medicare] or its contractors or are the subject of law enforcement investigations,'' acting administrator Charlene Frizzera wrote Inspector General Daniel R. Levinson in March.

The Miami Herald has been doing a fantastic job in recent months reporting the recent health care fraud enforcement efforts. Click here for the full report.

On January 7, 2009, defendants Carlos De Cespedes and Jorge De Cespedes, brothers and majority shareholders of The Pharmed Group, Corp. (Pharmed), were sentenced by U.S. District Court Judge Patricia Seitz to 108 months’ imprisonment as a result of their plea to two separate Informations. The Informations charged them with conspiracy to commit health care-related wire fraud and tax evasion, respectively.

For more: http://www.usdoj.gov/usao/fls/PressReleases/090107-01.html

Since the inception of Medicare Fraud Strike Force (MFSF) operations in 2007, federal prosecutors in Washington, D.C., have indicted 104 cases with 184 defendants in Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars.

The MFSF is a multi-agency team of federal, state and local prosecutors and agents designed specifically to combat Medicare fraud. Strike force operations began in the Miami area on March 1, 2007.

The strike force teams are led by a federal prosecutor supervised by both the Criminal Division’s Fraud Section in Washington and the local office of U.S. Attorney. Each team has four to six agents, at least one agent from the FBI and HHS Office of Inspector General, as well as representatives of local law enforcement. The Florida MFSF teams operate out of the federal Health Care Fraud Facility in Miramar, Fla. Kirk Ogrosky is Deputy Chief of the U.S. Department of Justice Criminal Division’s Fraud Section

The Medicare Fraud Strike Force was conceived and implemented by the Section to combat Medicare fraud through aggressive use of “real time” law enforcement techniques. Between March and September 2007, MFSF prosecutors charged 117 individuals in 74 cases, including company owners, pharmacists, physicians and corrupt patients, and convicted 61.

Sentences imposed in Strike Force cases averaged nearly five years, including one of 151 months, and included payment of millions of dollars in restitution.

FORT LAUDERDALE, FL (September 17, 2008) Health care fraud blog publisher, attorney Robert David Malove, will be attending the 2008 Fraud & Compliance Forum in Baltimore next month.

The AHLA/HCCA Fraud & Compliance Forum will provide practical guidance on the pressing legal and compliance issues that have arisen in the last twelve months. For health lawyers, the program will highlight the most important legal developments in areas such as Stark, the False Claims Act, and the Anti-Kickback Statute. For compliance officers, the conference will cover important issues such as Part D compliance plans, compliance effectiveness, and fraud and abuse. The program’s uniqueness stems not only from the important content for health lawyers and compliance officers but also from the additional value of bringing together legal counsel and compliance officers in one educational arena. The networking opportunities and synergistic advances in fraud and abuse compliance make this program an essential educational forum for both health lawyers and compliance officers.

Continue reading "Healthcare Fraud Blog Publisher to Attend AHLA/HCCA Fraud and Compliance Forum" »

Exclusive COVERAGE BY Health CareFraud Blog

DALLAS, TX (August 27, 2008) - The federal government’s largest health fraud case involving online pharmacies was scheduled to conclude today with the sentencing of Ryokesh Johar Saran (Joe Saran) before US District Judge Jorge A. Solis in the Northern District of Texas. Saran as well and the 30 corporations he controlled were scheduled for sentencing. Sentencing for the corporate and individual defendants was indefinitely postponed due to the apparent heart attack Saran suffered en route to court.

Benson Weintraub, the nationally renown federal sentencing expert and a former full-time professor of law along with publisher of the Health Care Fraud Blog, Robert Malove, both of Fort Lauderdale have represented Saran and the corporate defendants for more than two-years and have been mounting a virtually unprecedented course of complex presentece litigation. The defense has challenged the criminalization of Group Purchasing Organizations (GPO), comparing it to “pharmaceutical arbitrage” according to recent defense pleadings.

Though the government’s theory of “intended loss” reflects a gross exaggeration of loss, artificially inflating the sentencing range called for by the advisory United States Sentencing Guidelines. The amount of restitution, $69,000, better reflects the relative severity of the offense behavior caused by Saran and 30 individual codefendants,

The case was launched by the US Attorney General’s office with much fanfare, but Saran, the lead defendant and virtually only one not yet sentenced, has challenged the methodology by which the government arrived at its loss calculations, particularly in view of the “actual loss” associated with the Mandatory Victim Restitution Act (MVRA).

Defense lawyers and US Attorneys are tracking the Saran case as a benchmark in health care fraud sentencing litigation based on the novel issues presented by his counsel. Similar theories of “loss” asserted by the DOJ Trial Attorneys from Washington were recently rejected by two federal judges in Miami before whom Weintraub and Malove recently prevailed at sentencing.

The defense issued subpoenas for agents of the FBI and FDA as part of it’s reaction to the prosecution’ failure to abide by its earlier commitment to turn over all Brady material in mitigation of punishment. The government moved to quash the subpoenas and that litigation, too, is still in progress. The defense preemptively filed a motion to enforce the government’s promise made one-year ago of an incremental turnover of Brady materials and the defendant’s statements. Parenthetically, Chad Meacham, lead counsel for the Dallas US Attorneys office, repudiated the discovery stipulation reached between the defense and his predecessor, Bill McMurrey, now a partner at the Dallas office of Bracewell and Giuliani.

According to the L.A. Times, the owner of a Los Angeles-area hospital and a man who acted as a recruiter were arrested August 6 on federal charges of defrauding Medicare and Medi-Cal by providing unnecessary health services to homeless people who were recruited from “Skid Row” with promises of payments.

Rudra Sabaratnam, 64, of Brentwood, an owner and top executive of a hospital; and Estill Mitts, 64, who resides near the Miracle Mile section of Los Angeles, the operator of a Skid Row “Assessment Center,” were arrested without incident.

Sabaratnam and Mitts were indicted under seal by a federal grand jury last week. The 21-count indictment, which was unsealed this morning following their arrests, alleges that Sabaratnam and Mills conspired to recruit homeless people to receive unnecessary health services for the purpose of committing health care fraud.

Sabaratnam and Mitts are jointly charged with conspiring to receive and pay kickbacks for patient referrals and to commit health care fraud. Sabaratnam is charged with eight counts of paying kickbacks for patient referrals. Mitts is charged with four counts of receiving kickbacks for patient referrals. Mitts is additionally charged with six counts of money laundering and two counts of tax evasion for allegedly failing to report more than $479,000 in income in 2005 and more than $620,000 in income in 2006.

If convicted of all counts, Sabaratnam faces a statutory maximum penalty of 50 years in federal prison, and Mitts faces a maximum possible sentence of 140 years in prison. Click here to read the complete text of the US Attorney's press release.

BENSON WEINTRAUB, the nationally renown federal sentencing expert and ANTHONY C. VITALE of the Health Law Offices of Anthony C. Vitale, PA presented a novel issue in health care fraud during a 5-day sentencing proceeding against Rodolpho Ramirez, a DME operator sentenced by US District Judge Adalberto Jordan (S.D.Fl.) to 24-months imprisonment for making fraudulent claims to Medicare and paying kickbacks to a local physician.

Weintraub and Vitale were successful in persuading Judge Jordan to assume, without deciding the issue, that an obscure provision of “Special Rules” in the calculation of loss under the Federal Sentencing Guidelines is instructive and resulted in a significant exclusion of “relevant conduct” claimed by the government and a Guideline range approximately half of that requested by John Cunningam and Jay Darden, DOJ Trial Attorneys from the Fraud Section in Washington.

The case attracted considerable attention in the legal profession with both criminal defense lawyers and a Deputy Attorney General observing portions of the extraordinarily lengthy hearing characterized by expert medical testimony about medical necessity, Medicare billing procedures, and medical economics.

The prosecutors argued that for the past year, they consistently employed another loss methodology in 70-100 other cases in the Southern District of Florida, a hotbed of Medicare Fraud, and every Judge accepted it, to which Judge Jordan replied, “Did anyone raise the issue asserted by Mr. Weintraub?” to which the government responded “No.”

Continue reading "DEFENSE LAWYERS PREVAIL IN HEALTH CARE FRAUD CASE" »

On April 2, the same day that seven co-defendants were indicted (click here) for their roles in an $11 million Medicare fraud scheme involving HIV infusion clinics, Rita Campos Ramirez who had pleaded guilty in August 2007 to a $170 million conspiracy to commit health care fraud was sentenced to 10 years in prison. According to the U.S. Department of Justice and local federal prosecutors, the scheme represents the largest known individual case of Medicare fraud in the history of the program.

Continue reading "Miami Woman Sentenced to 10-years for Role in $170M Healthcare Fraud Consiracy" »

Yeleiny Guerrero was the co-owner of Denis Medical Services, Inc. She was charged in a 6 count indictment with conspiracy to defraud the United States by causing the filing of false Medicare claims, conspiracy to commit health care fraud and 4 counts of health care fraud. Her codefendants were Ramon Oscar Soto, Araelia Nieto and Rafael Moreno. Soto was the leader of the charged conspiracy which involved three separate DME companies: P & A Medical, ROS Medical and Denis Medical Services. Nieto and Moreno were co-owners of the other two DME companies. All three of them pleaded guilty and were sentenced to time in the federal pokey: Moreno 18 months, Nieto 24 months and Soto 37 months.

The evidence at trial demonstrated that Guerrero established the corporation in her name, opened a bank account as the sole signatory, applied for all state and federal licenses and signed the Medicare Supplier Application so as to obtain a provider number. She worked at the office in a warehouse district daily from 8 am to 12 noon.

Continue reading "Defendant Acquitted of Healthcare Fraud " »

Healthcare Fraud Blog publisher, Robert David Malove, will attend the ACFE Healthcare Fraud Seminar Orlando March 24-25, 2008.

CEO Magazine reports that healthcare costs are within the top three business concerns, and for good reason: U.S. healthcare spending has increased from a mere $27 billion in 1960 to $2 trillion in 2005. That is a 7,100 percent increase in spending! Employers today face many unique regulations, systems, procedures and records, with the potential for fraudulent activity at a heightened level. Fraud fighters need an improved understanding of these staggering numbers and the types of healthcare fraud that may occur. This two-day, instructor-led course is designed for anti-fraud and audit professionals who work in the payer, provider, vendor and employer benefit areas or advise clients who operate within the healthcare continuum. Get the targeted training you need to keep up with the latest fraud schemes and related laws affecting this highly complex profession.

For more info, please visit http://www.ACFE.com

Professor Benson Weintraub, Esquire, a Ft. Lauderdale-based global health care attorney and counselor with an international practice and clientele, and a distinguished academic authority on the Federal sentencing of corporations and individuals, has been invited to present "Defense of a Criminal Healthcare Fraud Case" at Health Care Compliance Association's (HCCA) 12th Annual Compliance Institute to be held in New Orleans April 13-16, 2008.

Weintraub has served as a full-time Professor of Law. During his legal career, Porf. Weintraub has successfully represented complex white collar targets, corporations, business entities, executives, defendants, and witnesses as a tenacious, exclusively federal white collar criminal defense lawyer for more than 25 years.

Among his credits has defended more than 60 Physicians, Health Care Delivery Corporations & Organizations, DME Distributors, Internet Pharmacies, Pharmacists, Pharmaceutical Manufacturers, and public officials on hospital regulatory boards throughout the nation.

He also represented David Paul in the failed CenTrust Bank case as well as reputed drug lords, Willie Falcon and Salvador Magluta.

Weintraub recently represented Arne Soreide, a high profile telecom executive convicted after trial (by other counsel) in Fort Lauderdale of a $22m fraud, successfully convincing the U.S. Court of Appeals for the Eleventh Circuit in Atlanta that his 25 year sentence of imprisonment must be reversed, which the appellate court conceded was improper.

Weintraub was appointed by the first Chairman of the US Sentencing Commission to assist the fledgling agency in drafting its initial sentencing guidelines for organizations and individuals.

His extensive academic writing has been widely published or cited in Yale L.J., Harvard Law Review, Federal Sentencing Reporter, Stanford Journal of Law & Policy, Notre Dame Law Review, Federal Probation (US Courts), etc., and health care blogs.

Florida Board Certified Criminal Trial Lawyer Robert David Malove is Of Counsel to Benson Weintraub, LLC, upon whom a Masters Degree in Forensic Science, was conferred on Malove by the distinguished George Washington University in Washington DC. Malove received his JD from Pepperdine University School of Law. He has completed the Graduate Certificate Program in Healthcare Corporate Compliance at George Washington University and is Certified in Healthcare Compliance (CHC) by the Compliance Certification Board of HCCA. For more information visit www.healthcarefraudblog.com.

On January 9, 2008, U.S. Attorney for the District of Columbia Jeffrey A. Taylor announced that Raymond Jackson, former Chief Pharmacist at St. Elizabeths Hospital, pleaded guilty to stealing $95,000 of medication from the hospital. Taylor waived his right to be be indicted by a federal grand jury and instead entered a plea agreement a one count information charging him with theft or embezzlement in connection with health care in violation of Title 18, U.S. Code, Section 669.

Jackson, 48, of Ashford Drive, Waldorf, Maryland, will face up to ten years of incarceration when he is sentenced by the Honorable Emmet G. Sullivan on May 2, 2008. Under the federal sentencing guidelines, the advisory sentence Jackson faces is between 24 and 30 months in prison. The guidelines' recommended sentence sentence takes into consideration specific offense characteristics including a loss in excess of $200,000 and abuse of position of trust. Jackson will be ordered to pay restitution of $95,000 to St. Elizabeths and $140,882 to Kaiser Foundation Health Care Plan.

Continue reading " Former St. Elizabeths Hospital Chief Pharmacist Pleads Guilty" »