Alabama
News Archive: 2009 Quick Reference: August 26, 2010 - Federal Judge Sentences Man To Three Years on Prescription Drug Fraud Conspiracy - Read More August 02, 2010 - Complaint Filed Against Robert M. Ritchea, M.D. for Submitting Over $2.2 Million in False Claims to Medicare – Read More July 20 2010 - Former Pharmacy Technician Pleads Guilty to Health Care Fraud - Read More March 10, 2010 - Federal Judge Sentences Former Simon-Williamson Clinic Employee to 30 Months in Prison for Fraud - Read More |  |
Federal Judge Sentences Man To Three Years On Prescription Drug Fraud Conspiracy (U.S. Attorney’s Office, the Northern District of Alabama)
Birmingham, AL – U.S. District Judge Virginia Emerson Hopkins sentenced a 30-year-old man to more than three years in prison for his role in a prescription drug fraud conspiracy, announced on August 25th, 2010, by U.S. Attorney Joyce White Vance.
The judge imposed the 39-month prison sentence that Byron Hope and federal prosecutors stipulated in Hope’s plea agreement with the government. Judge Hopkins also ordered HOPE to forfeit $72,746 as proceeds of illegal activity, and to pay the same amount in restitution to the Federal Employees Health Benefit Plan.
“The fraud perpetrated in this case was a double hit on society,” Vance said. “The criminals illegally obtained narcotics and stole money from insurance companies to pay for them,” she said. “We intend to be vigilant in detecting and prosecuting this type of crime.”
Hope pleaded guilty in April to one count of conspiracy to defraud a health care benefit program and to two counts of aggravated identity theft. The identity theft charges result from two prescriptions presented under stolen names, one at a Pell City pharmacy on Feb. 8, 2009, and another at a Calera pharmacy on Feb. 21, 2009.
HOPE acknowledged in his plea agreement that he conspired with others to defraud the Federal Employees Health Benefit Plan and United Health Care Inc. FEHBP provides health insurance benefits, including prescription drug coverage, to federal employees and their dependents. United Health Care administers a Flexible Spending Account for medical expenses, in which many members of the FEHBP program also were enrolled.
According to Hope’s plea agreement, the fraud was conducted as follows: From before September 2008 until June 2009, the names and identities of individuals covered by FEHBP’s prescription drug plan with Flexible spending accounts administered by United Health Care were used to create counterfeit and unauthorized prescriptions. HOPE and others in the conspiracy presented the counterfeit prescriptions to pharmacies in order to illegally obtain controlled substances, which were then distributed and sold. HOPE knew that the stolen identities used to forge prescriptions would cause a portion of the drug cost to be paid by health insurance.
The fraud cost FEHBP at least $72,746.
The United States Postal Inspection Service, the Food and Drug Administration, the United States Secret Service, the Office of Personnel Management, and the Montevallo Police Department investigated this matter. It was prosecuted by Assistant U.S. Attorney Lloyd Peeples.
Complaint Filed Against Robert M. Ritchea, M.D. for Submitting Over $2.2 Million in False Claims to Medicare (U.S. Attorney’s Office of Alabama)
Defendant Billed For Pain Injections Administered by Unlicensed Medical Assistant
Atlanta, GA - Robert M. Ritchea, M.D., 51, of Phoenix City, Alabama has been sued in a federal complaint on charges of submitting false or fraudulent claims to Medicare.
Sally Quillian Yates, United States Attorney for the Northern District of Georgia, said, “This lawsuit shows what happens when a doctor puts money before the health and safety of his patients. The complaint alleges not only that Dr. Ritchie allowed an unlicensed medical assistant to inject patients with pain medications, but also that he improperly billed Medicare for the treatments. We are committed to ending this kind of Medicare fraud.”
According to United States Attorney Yates and the complaint: Ritchea violated the False Claims Act by improperly billing Medicare for pain injections administered by an unlicensed medical assistant. The complaint alleges that an unlicensed medical assistant, acting at the direction of Ritchea, performed unnecessary pain injection procedures that were billed to Medicare as nerve blocks. The Alabama State Board of Medical Examiners does not permit medical assistants to perform the pain injection procedures for which Ritchea billed. Ritchea admitted to both the Alabama State Board of Medical Examiners and the Georgia Composite State Board of Medical Examiners that the procedures were not medically necessary and that they were over-prescribed and over-utilized. The complaint also alleges that Ritchea billed Medicare for more expensive procedures than were actually performed and that he billed Medicare for other services that are not reimbursable.
The complaint alleges Ritchea over-billed Medicare by more than $2.2 million in over 4300 separate claims. Pursuant to the False Claims Act, if Ritchea is found liable, the government is entitled to treble damages and civil monetary penalties ranging from $5,500-$11,000 per claim.
The United States’ complaint is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $3 billion nationwide since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in other types of False Claims Act cases have topped $4 billion since January 2009.
This case is being investigated by Special Agents of the Federal Bureau of Investigation. Assistant United States Attorneys Christopher J. Huber and Lena Amanti are litigating the case.
Members of the public are reminded that the complaint contains only allegations. It will be the government’s burden to prove a defendant's liability by the preponderance of the evidence at trial.
For further information please contact Sally Q. Yates, United States Attorney, or John Horn, First Assistant United States Attorney, through Yvette Comer at (404) 581-6335. The Internet address for the Homepage for the U.S. Attorney's Office for the Northern District of Georgia is www.justice.gov/usao/gan.
Former Pharmacy Technician Pleads Guilty to Health Care Fraud (U.S. Attorney for the Northern District of Alabama)
Huntsville - A Rainbow City woman pleaded guilty on July 20, 2010, to health care fraud totaling more than $330,000 for illegal prescription reimbursements she received while working as a pharmacy technician at a discount department store in East Gadsden, U.S. Attorney Joyce White Vance and FBI Special Agent in Charge Patrick Maley announced.
Charlotte Turley, 52, pleaded guilty before U.S. District Judge C. Lynwood Smith Jr. to four counts of health care fraud and agreed to forfeit at least $331,118 to the government as proceeds of illegal activity. A federal grand jury indicted Turley on the fraud charges in April.
“When someone steals money intended to pay legitimate claims, it results in higher overall health insurance costs to everyone,” Vance said. “We intend to be vigilant in detecting and prosecuting this type of crime. Would-be health care criminals are not welcome in Alabama.”
According to Turley’s plea agreement, she schemed to defraud Blue Cross and Blue Shield of Alabama between June 2005 and July 2008 while she worked at an East Gadsden K-Mart store. As a pharmacy technician, Turley entered insurance claim information for prescription drugs into the store’s computer system. Turley acknowledged in her plea agreement that she entered false information to reflect she received prescriptions that were never prescribed, and that she received reimbursements from Blue Cross and Blue Shield for the fake prescriptions.
The defendant faces maximum sentences of 10 years in prison and fines of up to $250,000 on each count. Sentencing is scheduled Nov. 18 at 11 a.m.
The FBI investigated the case. It is being prosecuted by Assistant U.S. Attorneys Lloyd Peeples and Henry Cornelius.
Federal Judge Sentences Former Simon-Williamson Clinic Employee to 30 Months in Prison for Fraud (U.S. Attorney for the Northern District of Alabama)
Birmingham, AL - A federal judge on March 10, 2010, sentenced a Hoover woman to 30 months in prison for health care, wire and tax fraud involving nearly $1.2 million embezzled from a Birmingham health care provider, United States Attorney Joyce White Vance announced in conjunction with U.S. Postal Inspection Service, FBI and IRS officials.
Kimberly Perrin, 41, worked as comptroller for the Simon-Williamson Clinic in Birmingham. She embezzled $1,197,074 from the clinic between July 2005 and February 2009.
U.S. District Judge Karon O. Bowdre ordered Perrin to pay combined restitution of $1,553,419 to the clinic and to the Internal Revenue Service. Perrin is repay the clinic $1,197,074 and the IRS $356,345 in unpaid taxes. Perrin also must forfeit $1,197,074 to the government as proceeds of illegal activity.
Judge Bowdre ordered Perrin to serve three years supervised release after completing her prison term, and to perform 40 hours of community service.
“Over the course of several years, Perrin wrote numerous checks totaling more than $1.1 million from her employer’s business account to enhance her own personal lifestyle,” Vance said. “In so doing, Perrin not only stole from her employer, she defrauded the IRS out of more than $356,000 in unpaid income taxes. Such criminal conduct must be punished in order to discourage others who might be tempted by their own greed,” Vance said.
Perrin carried out her embezzlement scheme by causing the clinic to issue and mail checks both to her, personally, and to third parties to pay for her personal expenses. In order to conceal her conduct, Perrin did not make appropriate entries on the clinic’s books and records. Perrin also did not report receiving the income on her tax returns for the 2005, 2006, 2007 and 2008 tax years.
“Stealing from a health care provider hurts that business and the doctors who work there, but it also affects the cost of health care and, therefore, harms us all,” said FBI Special Agent in Charge Patrick Maley. “That is why the FBI takes seriously its responsibility to investigate and hold accountable individuals who perpetrate this, and all white-collar crime,” he said.
“The IRS enforces the nation's tax laws, but also takes particular interest in cases where someone, for their own personal benefit, has taken what belonged to others,” said IRS Criminal Investigation Special Agent Reginael D. McDaniel. “We are pleased with the successful resolution of this investigation due to the cooperative efforts of the U.S. Attorney's Office, the U.S. Postal Inspection Service and the FBI," McDaniel said.
“It is repulsive that during a time when many Americans are concerned over health care costs, Ms. Perrin defrauded a health care system of well over a million dollars,” said U.S. Postal Inspector in Charge, Atlanta Division, Martin D. Phanco. “I am proud to say, as in this case, postal inspectors stand vigilant to track such detrimental fraud and assist in prosecution whenever the scheme involves U.S. mail.”
Assistant U.S. Attorney Lloyd Peeples prosecuted the government’s case.
