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Quick Reference: February 8, 2012–Assistant Administrator of Houston Hospital Indicted for Alleged Role in $116 Million Medicare Fraud Scheme- Read More November 17, 2011– Houston Patient Recruiter Sentenced to 21 Months in Prison for Medicare Fraud Scheme Involving Claims of Hurricane Damage to Power Wheelchairs– Read More October 31, 2011– Owner of Houston Health Care Company Sentenced to 41 Months in Prison in Connection with $1.3 Million Medicare Fraud Scheme– Read More October 12, 2011– Owner of Houston Health Care Company Sentenced to 33 Months in Prison for Medicare Fraud– Read More August 31, 2011 –Houston Medicare Equipment Company Owner Lands in Federal Prison for Medicare Fraud – Read More August 23, 2011 –Government Recovers More Than $1.6 Million From Eleven Cities to Resolve Allegations They Caused Improper Medicare and Medicaid Ambulance Claims – Read More June 29, 2011 - Longview Medical Supplier Sentenced For Health Care Fraud Scheme – Read More June 22, 2011 - Owners of Houston Health Care Company Plead Guilty to Medicare Fraud – Read More June 22, 2011 - Owner of Houston Health Care Company Pleads Guilty in Connection with $1.3 Million Medicare Fraud Scheme – Read More June 20, 2011 –Owner of Houston Health Care Company Pleads Guilty to Defrauding Medicare – Read More June 7, 2011 – City of Dallas to Pay $2.47 Million to Resolve Allegations that it Caused Improper Medicare and Medicaid Ambulance Claims – Read More May 27, 2011 – Federal Jury Convicts Houston Doctor and Others in Medicare Fraud Scheme – Read More May 26, 2011 - Houston Federal Jury Convicts Patient Recruiter of Medicare Fraud Involving Claims of Hurricane Damage to Power Wheelchairs – Read More May 18, 2011 - Houston Medical Equipment Company Owner Sentenced to 84 Months in Prison for Health Care Fraud Scheme Involving More Than $2 Million in False Billings – Read More May 4, 2011 - Houston Federal Jury Convicts Four Defendants in Connection with $5.2 Million Medicare Fraud Scheme – Read More May 2, 2011 - DME Company Owner and Marketers Convicted of Defrauding Medicare of Millions – Read More April 8, 2011 - Houston Registered Nurse Pleads Guilty in Connection with an Alleged $5.2 Million Medicare Fraud Scheme – Read More March 11, 2011 - Houston-Area Resident Sentenced to 41 Months in Prison for Medicare Fraud Scheme Involving Claims of Hurricane Damage to Power Wheelchairs – Read More January 20, 2011 - Two Owners of Houston Health Care Company Plead Guilty to Alleged $5.2 Million Medicare Fraud Scheme – Read More January 4, 2011 - Houston Doctor Sentenced to 41 Months in Prison for Role in Medicare Fraud Scheme – Read More |  |
Assistant Administrator of Houston Hospital Indicted for Alleged Role in $116 Million Medicare Fraud Scheme
WASHINGTON – An assistant administrator of a Houston hospital was arrested today on charges related to his alleged participation in a $116 million Medicare fraud scheme involving false claims for mental health treatment, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
An indictment filed in the Southern District of Texas and unsealed today charges Mohammed Khan, 62, of Houston, with one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive illegal health care kickbacks and five counts of paying or offering to pay health care kickbacks. Khan is expected to make his initial appearance in federal court today in Houston.
“The indictment against Mr. Kahn alleges that he used his position as a hospital assistant administrator to submit millions in false claims to the Medicare program,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “According to the charges, he paid kickbacks to patient recruiters, owners of group homes and assisted living facilities, and beneficiaries so that he could fill his hospital with patients for whom he could bill the government for medically unnecessary services or services that were never provided. We will continue aggressively to pursue individuals who attempt to enrich themselves at the expense of the Medicare program.”
“The defendant charged in this indictment is accused of stealing precious Medicare resources by billing for services that were medically unnecessary or never provided," said Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office. “Our health care fraud efforts have never been more collaborative and aggressive. We will continue to work with our law enforcement partners to protect patients and fight against health care fraud.”
According to the indictment, Khan, as the assistant administrator of a Houston hospital, allegedly operated a scheme to defraud Medicare beginning in 2008 and continuing until his arrest today. Khan allegedly caused the submission of false and fraudulent claims for partial hospitalization program (PHP) services to Medicare through the hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.
The indictment alleges that Khan paid kickbacks to owners and operators of group care homes and assisted living facilities and to patient recruiters in exchange for delivering ineligible Medicare beneficiaries to the hospital’s PHPs. The indictment alleges that Khan also paid kickbacks to Medicare beneficiaries who attended the hospital’s PHPs. These kickbacks included cigarettes, food and coupons redeemable for items available at the hospital’s “country stores.” Khan and his co-conspirators submitted or caused to be submitted approximately $116 million in claims to Medicare for PHP services purportedly provided by the hospital to the recruited beneficiaries, when in fact, the PHP services were medically unnecessary or never provided.
Today’s charges were announced by Assistant Attorney General Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent in Charge Morris of the FBI’s Houston Field Office; Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG); the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU ); Special Agent in Charge Lucy R. Cruz of the Internal Revenue Service (IRS) Houston Field Office; Joseph J. Del Favero, Special Agent in Charge of the Chicago Field Office of the Railroad Retirement Board, Office of Inspector General (RRB-OIG); and Scott Rezendes, Special Agent in Charge of Field Operations of the Office of Personnel Management, Office of Inspector General (OPM-OIG).
The case is being prosecuted by Trial Attorney Laura M.K. Cordova, Attorney Allan Medina, Assistant Chief William Pericak and Deputy Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG, MFCU, IRS, RRB-OIG and OPM-OIG and 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 for the Southern District of Texas.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,190 defendants who collectively have falsely billed the Medicare program for more than $3.2 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
Houston Patient Recruiter Sentenced to 21 Months in Prison for Medicare Fraud Scheme Involving Claims of Hurricane Damage to Power Wheelchairs
WASHINGTON – A patient recruiter for a Houston durable medical equipment (DME) company was sentenced today to 21 months in prison for her role in a health care fraud scheme involving power wheelchairs, announced the Department of Justice, FBI and the Department of Health and Human Services (HHS).
Marion Beverly Metoyer, 57, of Dayton, Texas, was sentenced by U.S. District Judge Gray Miller in the Southern District of Texas. Metoyer was convicted by a jury on May 26, 2011, of one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiracy to defraud the United States and to receive health care kickbacks and two counts of receiving kickbacks.
Three co-conspirators were also sentenced today: Johnny Lee Andrews, 59, of Houston; Monica Renee Perry, 44, of Abbeville, La.; and Melvin Barnes, 61, of Humble, Texas. Andrews and Perry were each sentenced to 15 months in prison and Barnes was sentenced to one year of probation. Andrews, Perry and Barnes pleaded guilty on Sept. 23, 2010, to one count of conspiracy to commit health care fraud.
According to court documents, Helen Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies. Metoyer, Andrews, Perry and Barnes were patient recruiters for Luant and were paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare. In addition to recruiting patients, Barnes and Andrews were also delivery drivers for Luant. Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.
According to court documents, Luant billed Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008, based on representations from Metoyer, Andrews, Perry and Barnes. In fact, the hurricanes did not damage the wheelchairs. Certain beneficiaries did not even have a power wheelchair before receiving the ones provided to them by Luant. Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.
Metoyer, Andrews, Perry and Barnes visited the homes of beneficiaries in whose names claims were submitted to Medicare, and offered the beneficiaries free power wheelchairs in exchange for their Medicare information. The power wheelchairs were often billed to Medicare at more than $6,000 per chair. In total, Luant fraudulently billed Medicare approximately $3 million.
Etinfoh was convicted by a federal jury of health care fraud in April 2010, and was sentenced to 41 months in prison. Paula Whitfield, a patient recruiter for Luant, was also convicted by a federal jury in April 2010, and was sentenced to 21 months in prison.
Today’s sentences were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-In-Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG) and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
The case was prosecuted by Trial Attorney Laura M.K. Cordova and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Owner of Houston Health Care Company Sentenced to 41 Months in Prison in Connection with $1.3 Million Medicare Fraud Scheme
WASHINGTON – An owner and operator of a Houston durable medical equipment (DME) company was sentenced today in Houston federal court to 41 months in prison for his role in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Ekpedeme Obot, 35, of Houston, was sentenced by U.S. District Judge Lee Rosenthal in Houston. In addition to his prison term, Obot was sentenced to three years of supervised release and was ordered to pay $945,637 in restitution.
Obot pleaded guilty on June 22, 2011, to one count of making false statements relating to health care matters and one count of health care fraud. According to court documents, Obot was an owner and operator of Praise DME, a company that purported to provide orthotics and other DME to Medicare beneficiaries. According to court documents, Praise submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or not provided. Many of the orthotic devices were components of an “arthritis kit,” and were purported to be for the treatment of arthritis-related conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads. From March 2007 through August 2008, Obot submitted claims of more than $1.3 million to Medicare and was paid approximately $945,637.
In addition, according to court documents, Obot admitted that he made false statements to Medicare in his supplemental Medicare Enrollment Application when he failed to provide information about a prior felony conviction. Specifically, the Medicare Enrollment Application included a section entitled “Adverse Legal Actions/Convictions,” which required DME providers to list prior felony convictions. Obot was convicted on March 5, 2007, in Harris County, Texas, on a felony theft charge. In his application, he represented only that he had been subject to a recoupment action by Texas Medicaid in November 2006 that was resolved by entering into a payment plan.
Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-In-Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), Office of Investigations; Joseph J. Del Favero, Special Agent-in-Charge of the Chicago Field Office of the Railroad Retirement Board Office of Inspector General; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
This case was prosecuted by Special Assistant U.S. Attorney Justin Blan and Trial Attorney Laura M.K. Cordova of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
Owner of Houston Health Care Company Sentenced to 33 Months in Prison for Medicare Fraud
WASHINGTON – The owner and operator of a Houston durable medical equipment (DME) company was sentenced yesterday in Houston federal court to 33 months in prison for his role in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Bassey Monday Idiong, 32, of Humble, Texas, was sentenced by U.S. District Judge Vanessa D. Gilmore. In addition to his prison term, Idiong was sentenced to two years of supervised release and was ordered to pay $527,023 in restitution.
Idiong pleaded guilty on March 1, 2010, to one count of conspiracy to commit health care fraud and five counts of health care fraud. Idiong owned and operated B.I. Medical Supply LLC.
According to court documents, Idiong paid patient recruiters kickbacks in exchange for the names of beneficiaries for whom bills could be submitted to Medicare. B.I. Medical billed Medicare for expensive, rigid orthotics and braces that were packaged together and referred to as an “arthritis kit,” at a cost of approximately $4,000 per kit. B.I. Medical then supplied the beneficiaries with different, less expensive products that were not medically necessary. Court documents indicate that in one instance, B.I. Medical billed Medicare for an arthritis kit that included two knee braces for a beneficiary who had only one leg. In total, B.I. Medical submitted approximately $846,000 in fraudulent claims to Medicare.
The sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-In-Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), Office of Investigations; Joseph J. Del Favero, Special Agent-in-Charge of the Chicago Field Office of the Railroad Retirement Board Office of Inspector General; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
The case was prosecuted by Trial Attorneys Laura Cordova, Katherine Houston and Jennifer Saulino of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov .
Houston Medicare Equipment Company Owner Lands in Federal Prison for Medicare Fraud
HOUSTON - Sunny Robinson, the owner of Memorial Medical Supply - a Houston durable medical equipment business, has been sentenced to 97 months in prison for his role in a Medicare fraud scheme, United States Attorney José Angel Moreno announced today.
U.S. District Judge Ewing Werlein Jr. sentenced Robinson 42, of Houston, and three others convicted for their roles in Robinson’s fraud scheme yesterday, Aug. 30, 2011.
Robinson’s co-defendants - Manuel DeLuna, 50, Lisa Jones, 48, and Shirley Chavis, 44, all of Houston - pleaded guilty in advance of Robinson’s trial, to federal fraud charges. DeLuna, the general manager of Memorial Medical Supply convicted of conspiracy to commit health care fraud, was sentenced to 42 months. Jones and Chavis, both convicted of conspiring to receive kickbacks in exchange for patient information, were sentenced to 22 months in prison and five years probation, respectively.
On March 7, 2011, Robinson was convicted at trial of all 19 counts of health care fraud and anti-kickback violations alleged against him for causing the submission of fraudulent medical claims to the Medicare Program in excess of $4.3 million from March 2005 through June 2009. During the five-day trial, the jury heard testimony and received evidence proving Robinson’s health care fraud scheme encompassed buying Medicare referrals, billing Medicare for durable medical equipment and getting paid. The names and Medicare numbers of doctors and Medicare beneficiaries were used to falsify medical records and on false and fraudulent claims to the Medicare and Medicaid programs for reimbursement.
Robinson illegally obtained protected Medicare beneficiary health information including names, dates, of birth, medical histories, Medicare and Social Security numbers from individuals and home health agencies. This health information was then used to submit false and fraudulent claims to Medicare for reimbursement for “Arthritis Kits,” power wheelchairs, diabetic supplies and incontinence supplies. The Medicare beneficiaries in many instances did not need or order the durable medical equipment nor did a physician prescribe the items. Many of the medical claims submitted were for durable medical equipment that wasn’t even provided. Memorial Medical Supply also falsely submitted claims for reimbursement to Medicare for equipment supposedly delivered to 34 deceased Medicare beneficiaries.
In connection with his guilty plea, DeLuna admitted that he and others illegally obtained protected Medicare beneficiary health information from individuals and home health agencies which was then used to submit false and fraudulent claims to Medicare for reimbursement for durable medical equipment. In connection with their guilty pleas, Jones and Chavis both admitted to receiving money in exchange for supplying patient information and billing numbers.
This case was investigated by agents of the Office of Inspector General – U.S. Department of Health and Human Services, Office of Inspector General – Officer of Personnel Management, the FBI and the Texas Attorney General’s Office – Medicaid Fraud Control Unit. These agencies are part of the Houston Medicare Strike Force which is a joint effort of the U.S. Attorney’s Office – Southern District of Texas and the Department of Justice – Fraud Section. Assistant United States Attorney Andrew Leuchtmann and Special Assistant United States Attorney Justin Blan prosecuted this case.
Government Recovers More Than $1.6 Million From Eleven Cities to Resolve Allegations They Caused Improper Medicare and Medicaid Ambulance Claims
DALLAS — The Texas cities of Plano, Frisco, Richardson, Mesquite, Celina, DeSoto, Corpus Christi, Cedar Hill, Rowlett, North Richland Hills and University Park (collectively “Cities”) have agreed to pay the U.S. and Texas the collective amount of $1.69 million to resolve allegations they violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney James T. Jacks of the Northern District of Texas. The U.S. and Texas contend all the Cities caused “upcoded” claims to be submitted to Medicare and Medicaid for city-dispatched 911 ambulance transports between 2006 and 2010. All the Cities fully cooperated with the investigation, and by settling, did not admit any wrongdoing or liability.
Ambulance services generally are coded either as basic life support level or advanced life support (ALS). ALS transports are reimbursed at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend the Cities’ billing contractor coded 911-dispatched transports at the ALS level, which indicates an ALS service was furnished and/or the patient’s condition necessitated an ALS intervention. The U.S. and Texas allege the Cities caused to be submitted for payment claims falsely representing to Medicare and Medicaid that such ALS services were appropriate and furnished by their personnel when in fact no ALS service was rendered and/or the patient did not require an ALS transport.
The U.S. and Texas initiated the investigation in response to a February 2010 whistleblower suit brought by Douglas Moore. Under the False Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the government and collect a share of any proceeds recovered by the suit. Mr. Moore can receive up to 30% of the recovery under the settlement.
U.S. Attorney Jacks praised the efforts of the Office of Inspector General of the U.S. Department of Health and Human Services and the FBI.
The case was handled by Assistant U.S. Attorney Sean McKenna, Assistant Texas Attorney General Sinty Chandy and OIG Senior Counsel Ellen Slavin. The case is captioned United States of America, et al. ex rel. Moore v. City of Cedar Hill, et al., Civil Action No. 3:10-cv-0233-O (N.D. Tex.). Investigations of other defendants remain ongoing.
Longview Medical Supplier Sentenced For Health Care Fraud Scheme
TYLER, Texas – A 50-year-old Henderson, Texas woman has been sentenced to federal prison for a health care fraud scheme in the Eastern District of Texas, announced U.S. Attorney John M. Bales today.
Sheena Shelton pleaded guilty on July 22, 2010, to health care fraud and wire fraud and was sentenced to 18 months in federal prison today by U.S. District Judge Leonard E. Davis. Shelton was also ordered to pay restitution in the amount of $125,000 to Medicare and Medicaid.
According to information presented in court, from 2003 to 2009, Shelton controlled and operated KC Medical Supplies, a durable medical equipment supplier in Longview, Texas. During that time, Shelton devised and carried out a scheme to defraud Medicare and Medicaid by submitting fraudulent claims for equipment and supplies which had not been prescribed or authorized by a physician. Shelton prepared documents that falsely represented that physicians had prescribed or ordered medical equipment for certain beneficiaries although they had not. Shelton forged the signatures of local physicians to fraudulent claim forms before submitting them to Medicare and Medicaid for payment.
Shelton was ordered to report to the U.S. Marshals Service on Aug. 31, 2011 to begin serving her prison sentence.
This case was investigated by the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG), the Texas Office of the Attorney General – Medicaid Fraud Control Unit (OAG-MFCU), and the FBI and prosecuted by Special Assistant U.S. Attorney Nathaniel C. Kummerfeld.
Owners of Houston Health Care Company Plead Guilty to Medicare Fraud
WASHINGTON – Two owners of a Houston health care company pleaded guilty for their roles in a scheme to defraud Medicare of more than $800,000, announced the Departments of Justice and Health and Human Services (HHS).
Kemmie Houston, 43, pleaded guilty today and Sharon Beal, 47, pleaded guilty yesterday in U.S. District Court in Houston. Houston and Beal both pleaded guilty before U.S. District Judge David Hittner to one count of conspiracy to commit health care fraud. In their pleas, Beal and Houston admitted that they defrauded Medicare of $851,212.
According to court documents, Beal and Houston owned and operated STK Consultants. STK maintained a Medicare provider number in order to submit Medicare claims for the costs of durable medical equipment (DME) and purported to provide orthotics, power wheelchairs, power wheelchair accessories and other DME to Medicare beneficiaries. According to court documents, STK submitted claims to Medicare for DME that was medically unnecessary and/or not provided. Many of the orthotic devices were components of what was referred to as an “arthritis kit,” and were purported to be for the treatment of arthritis-related conditions; in fact, however, they were not medically necessary or appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads. In total, from August 2005 through August 2010, STK submitted approximately $851,212 in fraudulent claims to Medicare.
Beal is scheduled to be sentenced on Sept. 14, 2011, and Houston is scheduled to be sentenced on Sept. 15, 2011. Beal and Houston each face a maximum sentence of 10 years in prison.
The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Texas Attorney General Greg Abbott; Acting Special Agent-in-Charge Russell D. Robinson of the FBI’s Houston Field Office; and Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations.
This case is being prosecuted by Trial Attorney Laura M.K. Cordova and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov
Owner of Houston Health Care Company Pleads Guilty in Connection with $1.3 Million Medicare Fraud Scheme
WASHINGTON – An owner of a Houston health care company pleaded guilty today to committing health care fraud and making false statements relating to health care matters, announced the Departments of Justice and Health and Human Services (HHS).
Ekpedeme Obot, 34, pleaded guilty before U.S. District Court Judge Lee Rosenthal in Houston to one count of making false statements relating to health care matters and one count of health care fraud.
According to court documents, Obot was an owner and operator of Praise DME. Praise maintained a Medicare provider number in order to submit Medicare claims for the costs of durable medical equipment (DME) and purported to provide orthotics and other DME to Medicare beneficiaries. According to court documents, Praise submitted claims to Medicare for DME, including orthotic devices that were medically unnecessary and/or not provided. Many of the orthotic devices were components of an “arthritis kit,” and were purported to be for the treatment of arthritis-related conditions; in fact, however, they were not medically necessary or appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads. From March 2007 through August 2008, Obot submitted claims of more than $1.3 million to Medicare and was paid approximately $945,637.
In addition, according to the plea agreement, Obot admitted that he made false statements to Medicare in his supplemental Medicare Enrollment Application when he failed to provide information about a prior felony conviction. Specifically, the Medicare Enrollment Application included a section entitled “Adverse Legal Actions/Convictions,” which required DME providers to list prior felony convictions. Obot was convicted on March 5, 2007, in Harris County, Texas, on a felony theft charge, but in his application, he represented only that he had been subject to a recoupment action by Texas Medicaid in November 2006 that was resolved by entering into a payment plan.
At sentencing, Obot faces a maximum penalty of 10 years in prison on the health care fraud charge and five years in prison on the false statements charge. Sentencing is scheduled for Oct. 12, 2011, at 9:00 a.m., CDT before Judge Rosenthal.
Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Texas Attorney General Greg Abbott; Joseph J. Del Favero, Special Agent -in-Charge of the Chicago Field Office of the Railroad Retirement Board Office of Inspector General; Acting Special Agent-in-Charge Russell D. Robinson of the FBI’s Houston Field Office; and Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations.
This case is being prosecuted by Special Assistant U.S. Attorney Justin Blan and Trial Attorney Laura M.K. Cordova of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine districts have obtained indictments of more than 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov
Owner of Houston Health Care Company Pleads Guilty to Defrauding Medicare
WASHINGTON – An owner of a Houston health care company pleaded guilty today in connection with a $654,227 Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Simone Ball, 24, pleaded guilty before U.S. District Judge Lee Rosenthal in Houston to one count of conspiracy to commit health care fraud. In her plea, Ball admitted that she defrauded Medicare of $654,227.
According to court documents, Ball was an owner and operator of Preferred Plus Medical Supply. Preferred Plus maintained a valid Medicare provider number in order to submit Medicare claims for the costs of durable medical equipment (DME) and purported to provide orthotics and other DME to Medicare beneficiaries. According to court documents, Preferred Plus submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/or not provided. Many of the orthotic devices were components of “arthritis kits,” and purported to be for the treatment of arthritis-related conditions, although they were neither medically necessary nor appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads. In total, from August through December 2008, Preferred Plus submitted approximately $654,227 in fraudulent claims to Medicare.
At sentencing, scheduled for Oct. 12, 2011, Ball faces a maximum sentence of 10 years in prison.
Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; the Texas Attorney General Greg Abbott; Acting Special Agent-in-Charge Russell D. Robinson of the FBI’s Houston Field Office; and Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations.
This case is being prosecuted by Trial Attorneys Laura M.K. Cordova and Benjamin O’Neil, and Deputy Chief Charles La Bella of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine districts have obtained indictments of more than 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov
City of Dallas to Pay $2.47 Million to Resolve Allegations that it Caused Improper Medicare and Medicaid Ambulance Claims
DALLAS — The City of Dallas has agreed to pay the U.S. and Texas $2.47 million and enter into certain compliance obligations to resolve allegations that it violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney James T. Jacks of the Northern District of Texas. The U.S. and Texas contend Dallas caused “upcoded” claims to be submitted to Medicare and Medicaid for city-dispatched 911 ambulance transports between 2006 and 2010. Dallas fully cooperated with the investigation, and by settling did not admit any wrong-doing or liability.
Ambulance services generally are coded either as basic life support level or advanced life support (ALS). ALS transports are reimbursed at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend Dallas directed its billing contractor to code every 911-dispatched transport at the ALS level, which indicates an ALS service was furnished and/or the patient’s condition necessitated an ALS intervention. The U.S. and Texas believe Dallas caused to be submitted for payment claims falsely representing to Medicare and Medicaid that such ALS services were appropriate and furnished by Dallas personnel when in fact no ALS-service was rendered and/or the patient did not require an ALS transport.
The U.S. and Texas initiated the investigation in response to an August 2009 whistleblower suit brought by Douglas Moore, a former employee of Dallas’ auditing department. Under the False Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the U.S. and Texas and collect a share of any proceeds recovered by the suit. Mr. Moore can receive up to 30% of the recovery under the settlement.
U.S. Attorney Jacks praised the efforts of the Office of Inspector General of the U.S. Department of Health and Human Services and FBI. “Any time false claims are submitted for payment, the nation's health insurance programs suffer,” said Special Agent in Charge Mike Fields of the OIG’s Dallas Regional Office. “Our HHS OIG investigators will continue to work closely with our law enforcement partners to identify providers who improperly receive crucial Medicare and Medicaid dollars.”
The case was handled by Assistant U.S. Attorney Sean McKenna, Assistant Texas Attorney General Sinty Chandy, and OIG Senior Counsel Ellen Slavin. The case is captioned United States of America, et al. ex rel. Moore v. City of Dallas, et al. Civil Action No. 3:09-cv-1452-O (N.D. Tex.). Investigations of other ambulance providers remain ongoing.
Federal Jury Convicts Houston Doctor and Others in Medicare Fraud Scheme
HOUSTON - After approximately 12 hours of deliberation, a Houston jury has convicted Umawa Imo, 57, a citizen of the Federal Republic of Nigeria, Kenneth Anokam, 56, a naturalized citizen, and Houston physician Dr. Christina Clardy, 61, United States Attorney Angel José Moreno announced today. Clardy, previously released on bond, was taken into custody after the verdict was returned. Imo and Anokam, already in federal custody since 2009, were ordered to remain in custody. Dr. Thaddeus Hume, 63, another Houston area physician, was acquitted of all charges.
Today's verdict found Imo guilty of conspiracy to commit health care fraud, 39 counts of health care fraud, three counts of mail fraud and five counts of money laundering; Anokam was found guilty of conspiracy, 27 counts of health care fraud and four counts of structuring, while Clardy was found guilty of conspiracy, 14 counts of health care fraud and three counts of mail fraud.
The second superseding indictment, returned on March 25, 2010, charged Imo, Anokam, Clardy, Hume and two others - who are believed to have fled the United States - with various federal crimes including one count of conspiracy to commit health care fraud and 39 substantive health care fraud counts. Three counts of mail fraud were also charged which related to paper checks valued at approximately $180,448 that were mailed by the Medicaid contract administrator, Texas Medicaid and Healthcare Partnership, to City Nursing Services of Texas Inc., a business owned by Imo, in lieu of electronic fund deposits. The charged also included five counts of money laundering related to five transactions totaling $2,805,195 from a City Nursing bank account for referrals, the purchase and shipping of tankers to Lagos, Nigeria, as well as a check for more than $1 million payable to Imo himself and four counts of structuring financial transactions to avoid reporting requirements related to a series of bank withdrawals over a two-week period by Anokam. Another co-defendant, Joann White, pleaded guilty to conspiracy to commit health care fraud on Feb. 12, 2010 and was called to testify at the trial by the United States.
During the 13-day trial beginning May 9, 2011, the jury learned that City Nursing Services of Texas Inc., a clinic located on the 9800 block of Bissonnet Street in Houston, billed Medicare and Medicaid for approximately $45 million worth of physical therapy services they did not provide over a two and a half year period. By March 2009, Medicare and Medicaid had paid approximately $30 million dollars on the physical therapy claims. Between March 2009 and June 2009, approximately $4 million in payments were withheld by Medicare due to lack of documentation of services rendered.
Jurors heard testimony from numerous Medicare and Medicaid beneficiaries about how they were paid for coming to the clinic and signing undated blank treatment forms. One beneficiary testified that when she asked for physical therapy she was told the clinic did not provide that type of services and was instructed to go to her primary care physician for a referral. Another beneficiary described the clinic as looking like an unemployment office with people just hanging out and referred to a day when he saw an employee direct a patient to make a pot of coffee. There was no licensed physical therapist working at the clinic and "treatments" were predominantly limited to short massages and hot packs. Beneficiaries could use the treadmills and other exercise equipment at their own will. Three former employees of the clinic testified about how they handed out cash given to them by Imo and Anokam to beneficiaries and to "recruiters" or "marketers" who brought beneficiaries to the clinic. Beneficiaries were paid once a month when they came to see the doctor; however, those beneficiaries who took Medicare Explanation of Benefit statements into the office to complain about the fraudulent billing were given extra payments, sometimes $200 - $300, to "settle" matters. The employees also testified about how the clinic billed Medicare for treatment that was not provided, including treatment for numerous individuals who were deceased. According to the employees, Imo and Anokam enlisted their help to create false and fraudulent patient file documents to reflect physical services that had not been provided.
Medicare and Medicaid experts explained to the jury that when physical therapy services are billed under a physician's Medicare provider number, as was the case here, the physician must be qualified to provide physical therapy and either personally provide the services, or be present in the office directly supervising the provision of the services.
Clardy took the stand and testified that she did not sign certain Medicare and Medicaid documents; however, she was unable to recall whether or not she had authorized anyone else to sign the documents. The United States introduced a letter sent by Clardy to the owner of the clinic, Imo, in July of 2007 - a year before she left the clinic. The letter showed her knowledge of the fraudulent activities at the clinic and requesting that Imo immediately cease billing Medicare under her physician provider number. In it, Clardy also threatened to notify Medicare of the fraud. The United States also introduced evidence showing that not long after the July 2007 letter, Clardy began receiving substantial monthly payments from Imo along with evidence that Clardy allowed Imo to fraudulently bill an additional $21 million under her number between August 2007 and August 2008. A total of $29 million was billed under Clardy's Medicare number by City Nursing.
United States District Court Judge Melinda Harmon, who presided over the case has scheduled sentencing for Sept. 9, 2011, for the defendants. The possible punishment for health care fraud, conspiracy to commit health care fraud and money laundering is a maximum 10 years in prison and a $250,000 fine while mail fraud carries a possible punishment of up to 20 years in prison. Structuring carries a possible punishment of up to 10 years in prison and a $500,000 fine.
The investigation into Imo, Anokam, White, Hume, Clardy and City Nursing was the result of a joint investigation by agents of the FBI, Internal Revenue Service-Criminal Investigations, the Department of Health and Human Services-Office of Inspector General and the Texas Attorney General's Office-Medicare Fraud Control Unit. Assistant United States Attorneys Julie Redlinger and Mark Donnelly are prosecuting the case.
Houston Federal Jury Convicts Patient Recruiter of Medicare Fraud Involving Claims of Hurricane Damage to Power Wheelchairs
To Date, Six Individuals Guilty of Federal Crimes for Roles in Scheme
WASHINGTON – Marion Beverly Metoyer, a patient recruiter for a Houston durable medical equipment (DME) company, was convicted today by a Houston federal jury of health care fraud related to a power wheelchair fraud scheme, the Departments of Justice, Health and Human Services (HHS) and the FBI announced.
After a four-day trial, Metoyer, 57, of Dayton, Texas, was convicted on 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 referring Medicare beneficiaries.
According to evidence presented at trial, Helen Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies. Metoyer was a recruiter for Luant who was paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare. Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.
Evidence at trial showed that, based on representations from Metoyer and other recruiters, Luant would bill Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008. In fact, the hurricanes did not damage the wheelchairs. Certain beneficiaries testified that they did not even have a power wheelchair before receiving the ones provided to them by Luant. Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.
At trial, beneficiaries in whose names claims were submitted to Medicare testified that recruiters whom they had never met, including Metoyer, came to their homes and offered them free power wheelchairs in exchange for their Medicare information. The power wheelchairs were often billed to Medicare at more than $6,000 per chair.
Etinfoh was previously convicted by a federal jury of health care fraud in April 2010, and was sentenced to 41 months in prison. Paula Whitfield, a patient recruiter for Luant, was also convicted by a federal jury in April 2010, and was sentenced to 21 months in prison. Melvin Barnes, Johnnie Lee Andrews and Monica Rene Perry, each a patient recruiter for Luant, pleaded guilty to conspiracy to commit health care fraud and await sentencing.
At sentencing, Metoyer faces maximum penalties of 10 years in prison for the health care fraud conspiracy; 10 years in prison for committing health care fraud; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary. A sentencing date has not been set.
Today’s guilty jury verdict was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Acting Special Agent-In-Charge Russell D. Robinson of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), Office of Investigations; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
The case was tried by Trial Attorney Laura Cordova and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Strike Force operations in nine locations have obtained indictments of 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
Houston Medical Equipment Company Owner Sentenced to 84 Months in Prison for Health Care Fraud Scheme Involving More Than $2 Million in False Billings
WASHINGTON – The owner of a Houston-area durable medical equipment (DME) company was sentenced to 84 months in prison for her role in a Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Doris Vinitski, a Houston-area resident, was sentenced yesterday by U.S. District Court Judge Nancy F. Atlas in the Southern District of Texas. Vinitski pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud.
According to court documents, Vinitski, 46, was the owner of Onward Medical Supply, a Houston-area DME company. Onward began billing Medicare for fraudulent DME in 2003. In pleading guilty, Vinitski admitted she paid kickbacks, sometimes $1,000 per patient, to recruiters who brought patients to Onward. Vinitski and her co-conspirator and estranged husband, John Lachman, then billed Medicare for DME that these patients either did not need or never received, including power wheelchairs and orthotic devices. Lachman also pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud and was sentenced to 26 months in prison. According to court documents, the fraud scheme at Onward resulted in more than $2 million in fraudulent billing to Medicare.
Nine additional defendants involved in the Onward fraud scheme are currently serving prison sentences. One remaining defendant is awaiting sentencing in the Eastern District of Texas.
The sentence was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Russell D. Robinson, Acting Special Agent-in-Charge of the FBI’s Houston Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of the HHS Office of Inspector General (OIG), Office of Investigations; and Texas Attorney General Greg Abbott on behalf of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
The cases were prosecuted by Trial Attorney Jennifer L. Saulino and Acting Assistant Chief O. Benton Curtis III of the Criminal Division’s Fraud Section. The cases were investigated by the FBI, HHS-OIG and MFCU.
The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section. Since March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants who collectively have billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
Houston Federal Jury Convicts Four Defendants in Connection with $5.2 Million Medicare Fraud Scheme
To Date, 11 Individuals Guilty of Federal Crimes for Roles in Scheme
WASHINGTON – A federal jury in Houston convicted four defendants today in connection with a $5.2 million Medicare fraud scheme that operated from April 2006 to August 2009, announced the Departments of Justice and Health and Human Services (HHS), the FBI and the Texas Attorney General.
Ezinne Ubani, 46, of Houston, and Mary Ellis, 55, of Missouri City, Texas, were each convicted of one count of conspiring to commit health care fraud, and two counts of making false statements for use in determining rights for benefit and payment by Medicare. Ellis was also convicted of one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries, and three counts of receiving illegal kickbacks for referring Medicare beneficiaries.
Caroline Njoku, 45, of Houston, was convicted of one count of conspiring to commit health care fraud and one count of conspiring to receive kickbacks for referring a Medicare beneficiary. Njoku was found not guilty of one count of receiving illegal kickbacks for referring a Medicare beneficiary. Terrie Porter, 47, of Houston, was convicted of one count of conspiring to receive illegal kickbacks for referring a Medicare beneficiary and one count of illegally receiving a kickback for referring a Medicare beneficiary. Estella Joseph, 62, of Houston, was found not guilty of one count of conspiring to receive kickbacks for referring a Medicare beneficiary, and not guilty of one count of receiving an illegal kickback for referring a Medicare beneficiary.
The four defendants were convicted after a 15-day trial before U.S. District Court Judge Nancy Atlas in Houston. According to the evidence presented at trial, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries. Family Healthcare Group hired Njoku, Ellis, Porter and other co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. After the Medicare beneficiaries were recruited, Ubani, a registered nurse, and other co-conspirators fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact they knew the beneficiaries were not home-bound and not in need of skilled nursing.
Ubani’s husband, Clifford, and Njoku’s husband, Princewill, were co-owners of Family Healthcare Group and they both previously pleaded guilty to conspiring to commit healthcare fraud and conspiring to paying illegal kickbacks for referring Medicare beneficiaries. Additionally, Adelma Casas-Sevilla, a registered nurse employed by Family Healthcare Group, previously pleaded guilty to conspiring to commit healthcare fraud. Sammie Wilson and Cynthia Garza-Williams, both patient recruiters for Family Healthcare Group, also pleaded guilty to conspiring to commit healthcare fraud. Erica Walker and Florida Holiday Island, both patient recruiters for Family Healthcare Group, pleaded guilty to conspiring to receive illegal kickbacks for referring a Medicare beneficiary and illegally receiving a kickback for referring a Medicare beneficiary. Family Healthcare Group is no longer in business.
At sentencing, scheduled for July 20 and 21, 2011, the defendants face maximum penalties of 10 years in prison for the health care fraud conspiracy count; five years in prison for making false statements for use in determining rights for benefit and payment by Medicare; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary.
Today’s guilty verdicts were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Special Agent-in-Charge Richard C. Powers of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations; and Texas Attorney General Greg Abbott.
This case is being prosecuted by Trial Attorneys Charles D. Reed and Sarah Hall, and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
DME Company Owner and Marketers Convicted of Defrauding Medicare of Millions
HOUSTON – A federal jury has convicted a durable medical equipment (DME) company owner and two marketers of defrauding both federal health care programs - Medicare and Medicaid, United States Attorney José Angel Moreno announced today.
Lia St. Junius, 25, the owner of The Mobility Store - a Houston area DME company, and Devon Spicer, 48, and Martha Ramos, 57,all of Houston, were found guilty late Friday afternoon by a jury following a two-week trial. Medicare and Medicaid are health care benefit programs funded by the federal government which pay for health care services provided to the elderly, the blind and disabled.
The indictment, returned in October 2010, charged St. Junuis, Spicer and Ramos along with James Claude Reese Jr., Brenda Lopez and Lily Johnson with the commission of various federal crimes including conspiracy to commit health care fraud, health care fraud, paying or receiving kickbacks, money laundering and tax evasion. Today’s verdicts found St. Junius guilty of conspiracy to commit health care fraud and paying kickbacks for the referral of Medicare beneficiaries and Medicaid recipients, health care fraud and conspiracy to commit money laundering. Ramos and Spicer were convicted of receiving kickbacks for referring Medicare beneficiaries and Medicaid recipients to The Mobility Store.
St. Junius was convicted of conspiracy to commit health care fraud, counts 10 through 16 of substantive health care fraud and conspiracy to commit money laundering, but acquitted on substantive health care fraud counts 2 through 9. Through their verdicts, the jury found that St. Junius conspired to defraud Medicare and Medicaid by billing Medicare and Medicaid for orthotic braces and devices, referred to as “The Artho Kit” that were different than equipment that was provided to Medicare beneficiaries or not ordered by a physician. During the trial, several witnesses testified that in May 2004, St. Junius had submitted an application with Medicare to become enrolled as a DME company called “The Mobility Store.” Although the application requested the name of all persons who had an ownership interest in the company, St. Junius failed to reveal that co-defendant James Reese was involved in the company. Reese, who pleaded guilty to health care fraud and tax evasion before trial, had previously operated a DME that had been suspended for submitting fraudulent claims. Between 2005 and 2008, St. Junius submitted fraudulent documents to Medicare indicating that Reese was not involved in the operation of The Mobility Store and that marketers were not soliciting Medicare beneficiaries. The jury also heard testimony that St. Junius paid marketers 10% of the amount received from Medicare for each orthotic brace or device billed.
Spicer was convicted on all substantive counts of receiving kickbacks based upon evidence presented that showed her referral of Medicare beneficiaries in 2005 to The Mobility Store resulted in $750,000 being paid by Medicare. Spicer received approximately $75,000 during 2005. The jury acquitted Spicer of conspiracy to commit health care fraud. Ramos was also acquitted of the conspiracy charge but found guilty on all substantive counts of receiving kickbacks based upon evidence that as a result of referrals by her, The Mobility Store was paid $40,000 and Ramos received approximately $4,000.
In 2008, Medicare revoked The Mobility Store’s provider number because of its failure to provide accurate information about its operation procedures. As a result of the fraudulent scheme, The Mobility Store billed Medicare and Medicaid more than $10 million and was paid more than $5 million. Through testimony, the jury heard that St. Junius purchased several expensive cars and a home valued at more than $650,000 with proceeds from the fraudulent scheme.
Immediately following the return of the verdicts, United States District Judge David Hittner, who presided over the trial, revoked each defendant’s bond and ordered that each be remanded into the custody of the U.S. Marshals Service.
St. Junius faces a maximum of 20 years in prison and a fine of up to $500,000 for his convictions. Spicer and Ramos each face up to a five-year maximum prison term and a $250,000 fine for their convictions. A sentencing date has not been set. The three others charged for their involvement in this health care fraud scheme, Reece, Lopez and Johnson, pleaded guilty to conspiring to commit health care fraud in advance of trial. A sentencing date for these three defendants has yet been set. .
This case was investigated by the FBI, the U. S. Department of Health and Human Services Office of Inspector General, Internal Revenue Service Criminal Investigations and the Medicaid Fraud Control Unit of the Texas Attorney General’s Office. Assistant United States Attorney Samuel Louis and Special Assistant United States Attorney Suzanne Bradley tried the case before the jury.
Houston Registered Nurse Pleads Guilty in Connection with an Alleged $5.2 Million Medicare Fraud Scheme
WASHINGTON – A registered nurse employed by a Houston health care company pleaded guilty today in connection with an alleged $5.2 million Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Adelma Casas Sevilla, 54, pleaded guilty before U.S. District Court Judge Nancy Atlas in Houston to one count of conspiracy to commit health care fraud. According to court documents, Family Healthcare Group, a home health care company, purported to provide skilled nursing to Medicare beneficiaries. According to court documents, Family Group hired co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. After the Medicare beneficiaries were recruited, Casas Sevilla, in her capacity as a registered nurse, fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact she knew the beneficiaries were not home-bound and not in need of skilled nursing.
At sentencing, scheduled for July 21, 2011, Casas Sevilla faces a maximum sentence of 10 years in prison for the health care fraud conspiracy count.
Today’s guilty plea was announced by Assistant Attorney General of the Criminal Division Lanny A. Breuer; U.S. Attorney José Angel Moreno of the Southern District of Texas; Special Agent-in-Charge Richard C. Powers of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations; and Texas Attorney General Greg Abbott.
This case is being prosecuted by Trial Attorneys Charles D. Reed and Laura Cordova, and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:www.stopmedicarefraud.gov.
Houston-Area Resident Sentenced to 41 Months in Prison for Medicare Fraud Scheme Involving Claims of Hurricane Damage to Power Wheelchairs
WASHINGTON – Helen Etinfoh, the former owner and operator of a Houston durable medical equipment (DME) company was sentenced today to 41 months in prison in connection with a $3 million power wheelchair fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.
Etinfoh, 50, was also ordered by U.S. District Judge Ewing Werlein Jr. of the Southern District of Texas to pay $851,228 in restitution jointly and several with her co-defendant. In addition, Etinfoh was sentenced to three years of supervised release following her prison term. Eitnfoh was remanded to custody after sentencing.
On April 16, 2010, after a week-long trial, a federal jury convicted Etinfoh of one count of conspiracy to commit health care fraud and four counts of health care fraud. The jury also convicted Paula Whitfield, a patient recruiter for the DME company, of one count of conspiracy to commit health care fraud and one count of health care fraud. Whitfield was previously sentenced to 21 months in prison.
According to evidence presented at trial, Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies. Whitfield was a recruiter for Luant who was paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare. Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.
Evidence at trial showed that, based on representations from Whitfield and other recruiters, Luant would bill Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008. In fact, the hurricanes did not damage the wheelchairs. Certain beneficiaries testified that they did not even have a power wheelchair before receiving the ones provided to them by Luant. Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.
At trial, beneficiaries in whose names claims were submitted to Medicare testified that recruiters whom they had never met, including Whitfield, came to their homes and offered them free power wheelchairs in exchange for their Medicare information. The beneficiaries, all of whom could walk, testified that they neither needed nor used the power wheelchairs delivered to them by Luant, which were often billed to Medicare at more than $6,000 per chair.
Today’s sentences were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Special Agent-in-charge Richard C. Powers of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of the Inspector General (HHS-OIG), Office of Investigations; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
The case was tried by Assistant Chief Sam S. Sheldon and Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Strike Force operations in nine locations have obtained indictments of 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
Two Owners of Houston Health Care Company Plead Guilty to Alleged $5.2 Million Medicare Fraud Scheme
WASHINGTON -- Two owners of a Houston health care company pleaded guilty today in connection with an alleged $5.2 million Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Clifford Ubani, 52, and Princewill Njoku, 51, each pleaded guilty before U.S. District Court Judge Nancy Atlas in Houston to one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks and 16 counts of payment of kickbacks to Medicare beneficiary recruiters.
According to court documents, Ubani and Njoku were owners and operators of Family Healthcare Group (Family Group), a home health care company. Family Group purported to provide skilled nursing to Medicare beneficiaries. According to court documents, Ubani and Njoku hired co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. Ubani and Njoku admitted that they paid kickbacks to the recruiters for their referrals.
Ubani and Njoku previously pleaded guilty to conspiracy to commit health care fraud related to their ownership of another Houston health care company, Family Healthcare Services (Family Services). Family Services submitted approximately $1.1 million in fraudulent claims to Medicare for the costs of durable medical equipment.
At sentencing, scheduled for July 19, 2011, Ubani and Njoku each face a maximum sentence of 10 years in prison for each health care fraud conspiracy count, five years in prison for each kickback conspiracy count and five years in prison for each kickback count.
Today’s guilty pleas were announced by Assistant Attorney General of the Criminal Division Lanny A. Breuer; U.S. Attorney José Angel Moreno of the Southern District of Texas; Special Agent-in-Charge Richard C. Powers of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations; and Texas Attorney General Greg Abbott.
This case is being prosecuted by Trial Attorneys Charles D. Reed and Laura Cordova, and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:www.stopmedicarefraud.gov.
Houston Doctor Sentenced to 41 Months in Prison for Role in Medicare Fraud Scheme Medical Equipment Company Manager and Delivery Driver Also Sentenced to Prison for Roles in Fraud Scheme
WASHINGTON – Houston-area residents Dr. Howard Grant, Obisike Nwankwo and John Lachman were sentenced today to 41 months in prison, 21 months in prison, and 26 months in prison, respectively, for their roles in a multi-million dollar durable medical equipment (DME) Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced today.
In addition to the prison terms, U.S. District Court Judge Nancy Atlas in the Southern District of Texas sentenced Grant, Nwankwo and Lachman each to three years of supervised release. Grant was ordered to pay $121,742 in restitution jointly and severally with co-defendants. Nwankwo was ordered to pay $29,052 in restitution jointly and severally with co-defendants. Lachman was ordered to pay $1.14 million in restitution jointly and severally with co-defendants.
Grant and Nwankwo were both convicted by a federal jury after a two-week trial in the Southern District of Texas in May and June 2010. Grant was convicted of two counts of health care fraud and one count of conspiracy to commit health care fraud and Nwankwo was convicted of one count of conspiracy to commit health care fraud . Lachman pleaded guilty prior to the trial to one count of conspiracy to commit health care fraud.
Evidence at trial established that Onward Medical Supply, a Houston-area DME company, billed Medicare for fraudulent DME, including power wheelchairs and orthotic devices, beginning in 2003 and continuing until late 2009. In addition to the three co-conspirators sentenced today, one additional individual was convicted at trial, and seven individuals have pleaded guilty for their participation in various parts of Onward’s Medicare fraud scheme, including Onward’s owner, Doris Vinitski.
According to evidence presented at trial, Vinitski worked with Medicare biller and co-defendant John Nasky Okonkwo and others in late 2008 and early 2009 to submit fraudulent claims to Medicare identifying Dr. Howard Grant as the prescribing physician for the DME. The claims were submitted in several groups in November 2008. Evidence presented at trial showed that Grant learned about the fraudulent prescriptions prior to Onward’s submission of the claims to Medicare. Evidence at trial also showed that, upon learning of the prescriptions, Grant asked Vinitski for $10,000 in exchange for allowing the fraud scheme to continue. Okonkwo agreed to plead guilty for his participation in the scheme. Following the verdict, U.S. District Court Judge Nancy Atlas ordered Grant to surrender his medical license and his Drug Enforcement Administration (DEA) number and to stop all billing to Medicare and Medicaid.
Evidence at trial established that Nwankwo acted as a delivery driver for Onward and several other DME companies and that he delivered DME such as power wheelchairs and orthotics for Onward to beneficiaries who did not want or need the equipment. One beneficiary testified at trial that when Nwankwo tried to deliver a power wheelchair to her, she told him to get off her front step or she would call the police.
Lachman managed the Onward fraud scheme in the early years, until the end of 2006. During that time, he created fraudulent patient files, managed payments of kickbacks to recruiters and delivery drivers, and operated the day-to-day business of Onward.
The sentences were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Richard C. Powers, Special Agent-in-Charge of the FBI’s Houston office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of the HHS Office of Inspector General (OIG), Office of Investigations; and Texas Attorney General Greg Abbott on behalf of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
The cases were prosecuted by Trial Attorneys Jennifer L. Saulino, O. Benton Curtis III and Nicola J. Mrazek of the Criminal Division’s Fraud Section. The cases were investigated by the FBI, HHS-OIG and MFCU.
The cases were brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section. Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
