Owner of Los Angeles Medical Supply Company Sentenced to 60 Months in Prison for Multimillion-Dollar Medicare Fraud Scheme

A Los Angeles man who was the owner of a medical supply company was sentenced to 60 months in prison for his role in a scheme that fraudulently billed more than $4 million to Medicare.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Eileen M. Decker of the Central District of California, Assistant Director in Charge Deirdre L. Fike of the FBI’s Los Angeles Field Office and Special Agent in Charge Christian Schrank of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Los Angeles Region made the announcement.

Valery Bogomolny, 44, was convicted of six counts of health care fraud following a jury trial on Nov. 6, 2015, before U.S. District Court Judge S. James Otero of the Central District of California.  In addition to the prison sentence, Judge Otero ordered Bogomolny to pay $1,266,860.03 in restitution.

According to evidence presented at trial, between January 2006 and October 2009, Bogomolny used his company, Royal Medical Supply, to bill Medicare $4 million for power wheelchairs (PWCs), back braces and knee braces that were medically unnecessary, not provided to beneficiaries or both.  The evidence further showed that Bogomolny created false documentation to support his false billing claims, including creating fake reports of home assessments that never occurred.  PWCs were delivered to beneficiaries who were able to walk without assistance and Bogomolny signed documents stating that he had delivered equipment when, in fact, the equipment was not actually delivered.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Central District of California.  Fraud Section Trial Attorneys Ritesh Srivastava and Claire Yan are prosecuting the case.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged over 2,900 defendants who collectively have billed the Medicare program for over $10 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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Former Philadelphia Doctor Sentenced To 30 Years For Running Pill Mill And Distributing Oxycodone Resulting In Patient Death

PHILADELPHIA – Today, a federal judge sentenced William J. O’Brien III, a former doctor of osteopathic medicine, to 30 years in prison for illegal distribution of controlled substances resulting in death and additional charges arising from O’Brien’s operation of a pill mill.  United States District Court Judge Nitza I. Quiñones Alejandro also ordered the defendant to serve five years of supervised release upon release from prison; pay restitution of $342,504 to the bankruptcy trustee in connection with his conviction for conspiracy to commit bankruptcy fraud; and pay a special assessment of $12,300. The court also entered a judgment of forfeiture.

“We are pleased with the substantial sentence imposed on the defendant in this case,” said United States Attorney Zane David Memeger. “Those doctors who distribute dangerous prescription drugs for no legitimate medical purpose need to be held fully accountable when their irresponsible conduct leads to death and addiction among patients.”

On July 14, 2015, a grand jury in Philadelphia charged O’Brien and nine codefendants in a 139-count Second Superseding Indictment (‘the indictment”) with conspiring to distribute controlled substances and other crimes. O’Brien was also charged with 121 separate counts of distribution of controlled substances, and distribution resulting in death. In addition to O’Brien, the defendants charged in the indictment included members and associates of the Pagans Motorcycle Club (“Pagans”), an outlaw gang known for violence and drug dealing. O’Brien and his paramour Elizabeth Hibbs were charged with conspiracy to engage in money laundering, conspiracy to commit bankruptcy fraud, and making false statements under oath in bankruptcy proceedings.

On June 28, 2016, after a six-week trial, a jury found O’Brien guilty of all charges in the indictment except for four distribution counts. All codefendants in the case have pleaded guilty and are awaiting sentencing.

The evidence at trial showed that O’Brien worked together with Pagans and their associates to operate a “pill mill” out of O’Brien’s medical offices. O’Brien wrote fraudulent prescriptions for oxycodone and other drugs, while the Pagans and their associates recruited “pseudo-patients” to buy the fraudulent prescriptions. O’Brien charged $250 cash for the first appointment to obtain prescriptions for controlled substances and $200 cash for each subsequent visit. Oxycodone (30 mg) was in high demand by drug dealers who could sell each pill on the street for $25 to $30. O’Brien sold prescriptions for these dangerous and addictive drugs to hundreds of “pseudo-patients.” After filling the prescriptions, the Pagans and their associates resold the pills on the street. The trial evidence showed that from March 2012 to January 2015, more than 700,000 pills containing oxycodone and other Schedule II controlled substances were distributed by O’Brien in furtherance of the conspiracy.  O’Brien generated for himself an estimated $2 million in cash proceeds from the drug trafficking conspiracy.

In connection with his operation of the pill mill, and as proven at trial, O’Brien intentionally distributed, for no legitimate medical purpose, oxycodone, methadone, and cyclobenzaprine, a muscle relaxer, to Joseph Ennis, 38, of Bucks County. Mr. Ennis had initially sought treatment from O’Brien following a car accident. On December 17, 2013, O’Brien prescribed oxycodone and methadone without a legitimate medical purpose, which combined with the cyclobenzaprine, led to Mr. Ennis’ death. Mr. Ennis died five days later on December 22, 2013 from the combination of these substances. At sentencing, Mrs. Bridget Shaw, Mr. Ennis’ sister, asked the Court to consider “the countless victims [O’Brien] fooled who are not here to represent themselves. The patients he turned into addicts for his profit and their families who are now left swimming in hospital bills or worse, wondering how this hell came to be . . . Rather than save lives, according to the oath he took, he chose to ruin them.”

The case was investigated by the Federal Bureau of Investigation, the Food and Drug Administration Office of Criminal Investigations, and the Department of Health and Human Services Office of the Inspector General. It is being prosecuted by Assistant United States Attorneys Mary Beth Leahy and David E. Troyer.

Ambulance Company Owner Sentenced To 10 Months In Prison

Bassem Kuran, 23, of Philadelphia, PA, was sentenced today to ten months in prison for making false statements to Medicare through VIP Ambulance, Inc., an ambulance company that Kuran owned and which he served as President. The Honorable Gerald J. Pappert, United States District Judge, ordered that upon Kuran’s release from prison, he must serve three years of supervised release, and further ordered Kuran to pay restitution to Medicare in the total amount of $66,901.93.

At his guilty plea hearing, Kuran admitted that through his company, VIP, he submitted false billings for the purported transport of three patients that VIP did not actually transport. He also submitted billings for patients who were able to walk and could travel safely by means other than ambulance and who, therefore, were not eligible for ambulance transportation under Medicare requirements. As a result of the fraudulent scheme at VIP, the Medicare program paid nearly $67,000 for fraudulent claims from VIP for these three patients.

The case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation, and the U.S. Department of Labor Office of the Inspector General. It is being prosecuted by Assistant United States Attorneys Mary E. Crawley and Paul W. Kaufman.

09-19-2016 New Jersey Medical Biller Settles False and Fraudulent Claims Case and Agrees to 5-Year Exclusion

On September 19, 2016, Susan Toy, entered into a $100,000 settlement agreement with OIG and agreed to be excluded from participating in Federal health care programs for a minimum of five years. On July 1, 2016, OIG issued a letter to Toy, proposing to impose a civil money penalty and program exclusion on her, pursuant to the Civil Monetary Penalties Law. The settlement agreement resolves OIG’s allegations that Toy prepared and submitted claims for services that were never performed. Toy, through her health care billing company, prepared and submitted claims for an obstetrics and gynecology physician practice located in New Jersey. Toy was responsible for preparing and submitting claims based, in part, on superbills identifying the services purportedly performed during a patient encounter. OIG contended that Toy prepared and submitted claims for Current Procedural Terminology code 91122 (anorectal manometry) for patient encounters where the procedure was neither performed nor identified as performed on the superbill. Senior Counsels David Blank and Tamara Forys represented OIG with the assistance of Paralegal Specialist Mariel Filtz.

Doctor Sentenced To One Year In Prison For Accepting Thousands Of Dollars In Cash Bribes For Referrals

CAMDEN, N.J. – A doctor with offices in Toms River, New Jersey, was sentenced today to 12 months and one day in prison for accepting thousands of dollars in exchange for patient referrals to two lab companies that performed blood and DNA testing, U.S. Attorney Paul J. Fishman announced.

Vincent Destasio, 55, of Toms River, previously pleaded guilty before U.S. District Judge Joseph H. Rodriguez to an indictment charging him with one count of conspiracy to accept cash bribes. Judge Rodriguez imposed the sentence today in Camden federal court.

According to documents filed in this case and statements made in court:

Destasio, a doctor of osteopathic medicine, was paid cash kickbacks by two sales representatives – Daniel Gilman, 63, of Ocean Grove, New Jersey, and Kenneth Robberson, 47, of Wall, New Jersey – who were partners operating PROMED, a marketing and sales company specializing in blood testing laboratories and DNA laboratory testing companies.

From March 2014 through May 2015, Gilman and Robberson solicited Destasio by paying him cash bribes for referring patient lab work to two separate laboratories for which Gilman and Robberson provided marketing and sales. One company (Company 1) was a blood testing laboratory company and the other was a DNA laboratory testing company (Company 2). Neither Company 1 nor Company 2 had any knowledge of or involvement in the kickback scheme.

Gilman and Robberson received monthly commission checks from the two companies for referrals. After receiving the commission checks from the two companies, Gilman and Robberson would identify the number of patients Destasio had referred and pay him a cash kickback based on those patients. Destasio was paid thousands of dollars in cash bribes for his referrals.

In addition to the prison term, Judge Rodriguez sentenced Destasio to two years of supervised release, fined him $1,000 and entered a forfeiture judgment of $25,000.

Gilman and Robberson have both pleaded guilty to an information charging them with conspiracy to bribe a physician. Gilman was sentenced Sept. 28, 2016, to 12 months and one day in prison. Robberson is scheduled to be sentenced Oct. 5, 2016.

U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Timothy Gallagher in Newark, and special agents of the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Scott J. Lampert, with the investigation leading to today’s sentencing.

The government is represented by Assistant U.S. Attorney R. David Walk Jr. of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Camden.

U.S. Attorney Fishman reorganized the health care fraud practice shortly after taking office, creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $1.29 billion in health care fraud and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act, the Food, Drug and Cosmetic Act and other statutes.

California Made Incorrect Medicaid Electronic Health Record Incentive Payments to Hospitals

Although the California Department of Health Care Services (State agency) made Medicaid electronic health record (EHR) incentive program payments to eligible hospitals, it did not always make these payments in accordance with Federal requirements. Specifically, from October 1, 2011, through December 31, 2015, the State agency made incorrect Medicaid EHR incentive payments to 61 of the 64 hospitals reviewed, totaling $23.2 million. These incorrect payments included both overpayments and underpayments, resulting in a net overpayment of $22 million. Because the incentive payment is calculated once and then paid out over 4 years, payments made after December 31, 2015, will also be incorrect. The adjustments to these payments total $6.3 million.

The Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009, established Medicare and Medicaid EHR incentive programs to promote the adoption of EHRs. As an incentive for using EHRs, the Federal Government is making payments to providers that attest to the “meaningful use” of EHRs. The State agency made approximately $971 million in Medicaid EHR incentive program payments from October 1, 2011, through December 31, 2014. Of this amount, $601 million was paid to 263 hospitals.

We recommended that the State agency (1) refund to the Federal Government $22 million in net overpayments made to the 61 hospitals, (2) adjust the 61 hospitals’ remaining incentive payments to account for the incorrect calculations (which will result in cost savings of $6.3 million after December 31, 2015), (3) review the calculations for the hospitals not included in the 64 we reviewed to determine whether payment adjustments are needed and refund to the Federal Government any overpayments identified, and (4) review supporting documentation from all hospitals to help identify any errors in incentive payment calculations.

In written comments on our draft report, the State agency disagreed with our first recommendation and agreed with our remaining recommendations.

United States Settles Health Care Fraud Action Involving Doctor Who Prescribed Unnecessary Opioid Prescriptions

A doctor who practiced in Warren, Michigan, agreed to pay $200,000 to resolve allegations that he violated the False Claims Act by writing prescriptions for oxycodone and other controlled medications without medical justification, and for billing for medical services without medical justification, announced U.S. Attorney Barbara L. McQuade.

From 2010 through early 2012, Hussein Awada, 46, conspired with patient “marketers” to write prescriptions for tens of thousands of dosages of oxycodone and other controlled medications for no medical purpose. Awada then used the patient data for the patients brought to him by the marketers to submit bills to Medicare for services that were either never performed or were medically unjustified. Awada caused these same patients to receive medically unnecessary monthly x-rays, and other invasive tests, to help conceal his fraud.

In a related criminal action, Awada previously pled guilty to prescribing 80,000 dosages of oxycodone and Roxicodone for no legitimate medical reason, and he admitted to defrauding Medicare, Medicaid, and Blue Cross Blue Shield of about $2.3 million. Awada was sentenced to 84 months in prison and was ordered to pay $2.3 million in restitution. To help pay the restitution, Awada was ordered to forfeit assets. To settle his civil liability under the False Claims Act, Awada agreed to pay an additional $200,000.

The allegations in the civil False Claims Act suit were brought to the government by a whistleblower, known as a relator, under the qui tam provisions of the False Claims Act. The relator, Heather Henson, worked as a receptionist for Awada at his medical practice Midwest Family Practice, PLC during a six-month period from 2010 to 2011. Henson will receive $36,000 out of the $200,000 settlement, as well as a portion of the assets Awada forfeits, for her role in filing the qui tam action.

“Prescription pain pills like oxycodone are controlled substances because their abuse can lead to addiction, illness and death,” McQuade said. “This settlement demonstrates that doctors pay a substantial price when they seek to profit by prescribing medically unnecessary prescription drugs and services that may harm their patients.”

This case was investigated jointly by the U.S. Attorney’s Office for the Eastern District of Michigan and the Department of Health and Human Services, Office of Inspector General.

The case is captioned as United States ex rel. Henson v. Midwest Family Practice, PLC et al., Case No. 2:13-cv-14579 (E.D. Mich.). The related criminal action is captioned as United States v. Awada, Case No. 2:12-cr-20595 (E.D. Mich.).

Washington State Made Incorrect Medicaid Electronic Health Record Incentive Payments to Hospitals

Although the Washington State Health Care Authority (State agency) made Medicaid electronic health record (EHR) incentive program payments to eligible hospitals, it did not always make these payments in accordance with Federal requirements. Specifically, from October 1, 2011, through December 31, 2015, the State agency made incorrect Medicaid EHR incentive payments to 19 of the 20 hospitals reviewed, totaling $11.3 million. These incorrect payments included both overpayments and underpayments, resulting in a net overpayment of $9.2 million. Because the incentive payment is calculated once and then paid out over 4 years, payments made after December 31, 2015, will also be incorrect. The adjustments to these payments total $2.5 million.

The Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009, established Medicare and Medicaid EHR incentive programs to promote the adoption of EHRs. As an incentive for using EHRs, the Federal Government is making payments to providers that attest to the “meaningful use” of EHRs. The State agency made approximately $250 million in Medicaid EHR incentive program payments from October 1, 2011, through December 31, 2014. Of this amount, $120 million was paid to 87 hospitals.

We recommended that the State agency (1) refund to the Federal Government $9.2 million in net overpayments made to the 19 hospitals, (2) adjust the 19 hospitals’ remaining incentive payments to account for the incorrect calculations (which will result in cost savings of $2.5 million after December 31, 2015), (3) review the calculations for the hospitals not included in the 20 we reviewed to determine whether payment adjustments are needed and refund to the Federal Government any overpayments identified, and (4) review supporting documentation from all hospitals to help identify any errors in incentive payment calculations.

In written comments on our draft report, the State agency partially concurred with our recommendations and provided information on actions that it planned to take to address our recommendations.

09-19-2016 New Jersey Medical Biller Settles False and Fraudulent Claims Case and Agrees to 5-Year Exclusion

On September 19, 2016, Susan Toy, entered into a $100,000 settlement agreement with OIG and agreed to be excluded from participating in Federal health care programs for a minimum of five years. On July 1, 2016, OIG issued a letter to Toy, proposing to impose a civil money penalty and program exclusion on her, pursuant to the Civil Monetary Penalties Law. The settlement agreement resolves OIG’s allegations that Toy prepared and submitted claims for services that were never performed. Toy, through her health care billing company, prepared and submitted claims for an obstetrics and gynecology physician practice located in New Jersey. Toy was responsible for preparing and submitting claims based, in part, on superbills identifying the services purportedly performed during a patient encounter. OIG contended that Toy prepared and submitted claims for Current Procedural Terminology code 91122 (anorectal manometry) for patient encounters where the procedure was neither performed nor identified as performed on the superbill. Senior Counsels David Blank and Tamara Forys represented OIG with the assistance of Paralegal Specialist Mariel Filtz.

HHS’s Office of Inspector General Levies Largest Penalty Under a Corporate Integrity Agreement Against Nation’s Biggest Provider of Post-Acute Care

September 20, 2016

For More Information Contact:
Don White
415/437-7982

Kindred Health Care, Inc., the nation’s largest provider of post-acute care, including hospice and home health services, has paid a penalty of more than $3 million for failing to comply with a corporate integrity agreement (CIA) with the Federal Government, Department of Health and Human Services’ Inspector General Daniel R. Levinson announced today.

It is the largest penalty for violations of a CIA to date, the Office of Inspector General (OIG) said.

The record penalty resulted from Kindred’s failure to correct improper billing practices in the fourth year of the five-year agreement. OIG made several unannounced site visits to Kindred facilities and found ongoing violations.

“This penalty should send a signal to providers that failure to implement these requirements will have serious consequences,” Mr. Levinson said. “We will continue to closely monitor Kindred’s compliance with the CIA.”

OIG negotiates CIAs with Medicare providers who have settled allegations of violating the False Claims Act. Providers agree to a number of corrective actions, including outside scrutiny of billing practices. In exchange, OIG agrees not to seek to exclude providers from participating in Medicare, Medicaid, or other Federal health care programs. CIAs typically last five years.

In this case, CIA-required audits performed by Kindred’s internal auditors in 2013, 2014, and 2015 found that the company and its predecessors had failed to implement policies and procedures required by the CIA and that poor claims submission practices had led to significant error rates and overpayments by Medicare.

Kindred was billing Medicare for hospice care for patients who were ineligible for hospice services or who were not eligible for the highest level and most highly paid category of service, OIG said.

The Medicare hospice benefit covers services for beneficiaries with terminal illnesses who have life expectancies of six months or less. When patients elect hospice, they agree to stop receiving curative treatment and in its place receive palliative care. Benefits are largely for pain relief, respite care and grief and loss counseling for the patient and the family. Benefits can be provided in a person’s home or an inpatient hospice facility.

As a result of the findings of CIA-required audits of its claims, Kindred decided to close 18 sites that it characterized as “underperforming” since March 2015. The company has paid a penalty of $3,073,961.98.

OIG also found that in 2016 the company took significant corrective actions, including upgrading internal audits and investigations and tracking resolutions of identified issues.