Virginia
Quick Reference: July 2, 2010 - Jury Convicts Office Manager of Ambulance Company on Health Care Fraud Charge – Read More July 2, 2010 - U.S. Attorney Names Health Care Fraud Coordinators – Read More June 23, 2010 - Chesterfield Mental Health Service Provider Convicted of Health Care Fraud – Read More April 6, 2010 - Chesterfield Mental Health Service Provider Indicted for Health Care Fraud - Read More March 17, 2010 - Virginia Beach Doctor Sentenced to 63 Months in Prison for Defrauding Medicare and Tricare - Read More March 2, 2010 - U.S. Files Complaint Against Virginia Medicaid Providers - Read More January 19, 2010 - Former Nursing Home Licensed Practical Nurse Sentenced to Two Years in Prison for Stealing Patients’ IDs - Read More November 17, 2009 - Virginia Beach Physician Found Guilty of Defrauding Medicare and Tricare - Read More October 24, 2009 - Former Nursing Home Licensed Practical Nurse Pleads Guilty to Stealing Patients’ IDs - Read More September 8, 2009 - D.C. Doctors’ Receptionist Pleads Guilty in $2 Million ID Theft Ring - Read More September 3, 2009 - Ohio Man Sentenced For Falsely Marketing Wheelchairs as Power Scooters - Read More July 26, 2009 - Prince George’s County Woman Pleads Guilty to Trafficking Pain Pills - Read More |  |
Jury Convicts Office Manager of Ambulance Company on Health Care Fraud Charge (U.S. Attorney for the Western District of Virginia)
Abingdon, Virginia - United States Attorney Timothy J. Heaphy announced on July 2, 2010, that Amy Joyell Hicks, 35, of Marion, Va. was found guilty of one count of devising a scheme to defraud a health care benefit program by a jury sitting in the United States District Court for the Western District of Virginia.
Hicks’ conduct centered around the operation of Angel Care Ambulance Company in Abingdon, Va. Hicks’ co-defendant, Darryl Jack Kiser, previously pleaded guilty to one count of health care fraud and one count of conspiracy to commit wire fraud.
“The investigation and prosecution of health care fraud is a top priority of the United States Attorney’s Office,” United States Attorney Timothy J. Heaphy said. “It is our duty to ensure that the Medicare program is devoid of fraud and the financial loss caused by fraud, so it can continue to serve those members of the community who rely on Medicare funding.”
According to evidence presented at trial by Assistant United States Attorney Zachary Lee and Special Assistant United States Attorney Janine Myatt, Kiser owned and operated Angel Care Ambulance Service in Abingdon, Va. between December 2004 and September 2007. Amy Joyell Hicks was employed as an Emergency Medical Technician and as the office manager for the business.
Angel Care Ambulance Service, a Medicare provider, provided transportation services to dialysis patients in the Abingdon area. During the Spring of 2007, information was provided to the Virginia Medicaid Fraud Control Unit and the United States Department of Health and Human Services Office of the Inspector General that Angel Care Ambulance Service was fraudulently billing Medicare for transporting some of these dialysis patients. The investigation by these agencies revealed that some patients did not fit Medicare guidelines and that Angel Care Ambulance Service was submitting false documentation regarding these transports in order to secure payment from Medicare and a private insurance company.
Pursuant to Medicare and the private insurance company’s guidelines, payment was only authorized for the ambulance transport of patients that were confined to a stretcher. The investigation determined that Angel Care Ambulance Service was transporting three patients who could walk unassisted and one patient that was confined to a wheelchair. Many times these patients would ride in the front passenger seat of the ambulance, instead of on a stretcher, or were transported in taxis and personal vehicles of Angel Care employees. To receive payment, Angel Care Ambulance Service would submit fraudulent “trip sheets” to a billing agency that described the patient being confined to a stretcher and unable to walk. The total amount of fraudulent billing to both Medicare and the private insurance company was determined to be $1,396,718.45, with a total of $387,111.31 actually being paid to Angel Care Ambulance Service.
Hicks faces a potential maximum sentence of up to ten years imprisonment and a fine of $250,000. She is scheduled to be sentenced in October 2010.
The investigation of this case was conducted by the Virginia Medicaid Fraud Control Unit, United States Department of Health and Human Services Office of the Inspector General, Virginia State Police, and the United States Marshals Service. Assistant United States Attorney Zachary T. Lee of the United States Attorney’s Office in Abingdon, and Janine Myatt, Special Assistant United States Attorney and Assistant Attorney General for the Commonwealth of Virginia, are prosecuting the case.
U.S. Attorney Names Health Care Fraud Coordinators (U.S. Attorney for the Eastern District of Virginia)
Alexandria, Virginia - Neil H. MacBride, United States Attorney for the Eastern District of Virginia, has named three prosecutors to lead the Office’s efforts to combat health care fraud in the District.
Every year, hundreds of billions of dollars are spent to provide health care for millions of Americans, and each year billions of these taxpayer dollars are stolen through fraudulent schemes. Combined federal and state spending on Medicaid and Medicare is projected to exceed $800 billion per year in 2010. While there is no official federal estimate of the level of fraud in Medicare, Medicaid or the healthcare sector more generally, estimates project the amount at three to ten percent of total spending, which could correlate to $27 to $80 billion in 2010 alone, if left unchecked.
“Health care fraud drives up the cost of health care, insurance premiums and taxes for everyone,” said U.S. Attorney MacBride. “The Department of Justice and my Office have made prosecuting these fraudsters a priority so that we not only hold them accountable but also deter other would-be criminals.”
U.S. Attorney MacBride selected Marla Tusk to oversee health care fraud prosecutions in the Alexandria Division. Tusk joined the U.S. Attorney’s Office in 2007, prosecuting narcotics and financial fraud cases, including a large mortgage fraud ring in Northern Virginia and a card-skimming conspiracy that targeted customers at high-end restaurants in Washington, D.C. Prior to joining the office, Tusk spent three years as a trial attorney with the Counterterrorism Section at the U.S. Department of Justice, where she was recognized for her prosecution of al-Qaeda conspirator Ahmed Omar Abu Ali. Tusk clerked for the Honorable Dennis Jacobs of the U.S. Court of Appeals for the Second Circuit and received her juris doctorate from Columbia Law School.
Jessica Aber Brumberg was selected as the health fraud coordinator for the Richmond Division. She joined the U.S. Attorney’s Office in 2009 and has prosecuted a wide range of cases, including fraud, child exploitation, narcotics and firearms. Before becoming a federal prosecutor, Brumberg practiced law at McGuireWoods, LLP, in Richmond, Va., largely focused on tort litigation in state and federal courts. She clerked for the Honorable M. Hannah Lauck of the U.S. District Court for the Eastern District of Virginia and received her juris doctorate from Williams & Mary Law School.
Katherine Lee Martin will coordinate health fraud prosecutions in the Tidewater region, covering both the Norfolk and Newport News Divisions. Martin joined the U.S. Attorney’s Office in 2008, prosecuting financial fraud and health care fraud cases, including an oncologist in Virginia Beach who fraudulently billed Medicare and Tricare for over $1.2 million. Before starting her legal career, Martin spent several years as a legislative aide on Capitol Hill. She clerked for the Honorable Tommy E. Miller of the U.S. District Court for the Eastern District of Virginia and received her juris doctorate from William & Mary Law School.
ChesterfieldMental Health Service Provider Convicted of Health Care Fraud (U.S. Attorney for the Eastern District of Virginia)
Richmond, Virginia - Denise C. McCreary, 43, of Chesterfield, Va., was convicted on June 23, 2010, by a federal jury for submitting false and fraudulent claims for reimbursement to the Virginia Medicaid program. Neil H. MacBride, United States Attorney for the Eastern District of Virginia; Kenneth T. Cuccinelli, Attorney General of Virginia; and Michael F.A. Morehart, Special Agent- in-Charge of the FBI’s Richmond Field Office, made the announcement after the verdict was returned.
After a two day trial in Richmond, Virginia, a jury convicted McCreary of nine counts of health care fraud. Trial evidence established that McCreary owned and operated Camp Hope Youth Services, a Medicaid contracted provider of Intensive In-home Therapy Services for children and adolescents. Intensive In-home Therapy Services, one of the many mental health services offered by Medicaid in Virginia, are designed to assist youth and adolescents who are at risk of being removed from their homes, or are being returned to their homes after removal, because of significant mental health, behavioral, or emotional issues. Medicaid requires that Intensive In-home Therapy providers employ qualified metal health workers to provide a medically necessary service to at-risk children and adolescents.
McCreary billed Medicaid for services that were not reimbursable because the services did not address a child’s specific mental health issues, were not provided by qualified mental health workers, and were not provided to children who were in actual need of the offered services. McCreary also billed Medicaid for services that were never provided. The indictment alleges that Medicaid paid McCreary at least $601,580 that she was not entitled to receive.
At sentencing, scheduled before United States District Court Judge Henry E. Hudson for September 17, 2010, McCreary faces a maximum sentence of ten years’ incarceration and a $250,000.00 fine on each health care fraud count.
“We view health care fraud as a very serious crime and an office priority,” said United States Attorney Neil H. MacBride. “We will aggressively investigate and prosecute health care providers who attempt to take advantage of the system.”
Kenneth T. Cuccinelli, Attorney General of Virginia, added, “My office will not tolerate health care providers who commit fraud against the Medicaid program – the very program that the taxpayers of the commonwealth fund for some of our most vulnerable citizens. I want to personally thank the men and women of my Medicaid Fraud Control Unit, the United States Attorney’s Office for the Eastern District of Virginia, the FBI, and Virginia’s Department of Medical Assistance Services for their outstanding collaboration to bring Denise McCreary to justice.”
The case was investigated by the Federal Bureau of Investigation and the Virginia Attorney General’s Medicaid Fraud Control Unit. It is being prosecuted by Assistant United States Attorney Michael C. Moore and Special Assistant United States Attorney Joseph E.H. Atkinson.
A copy of this press release may be found on the website of the United States Attorney's Office for the Eastern District of Virginia at http://www.usdoj.gov/usao/vae. Related court documents and information may be found on the website of the District Court for the Eastern District of Virginia at http://www.vaed.uscourts.gov or on http://pacer.uspci.uscourts.gov.
Chesterfield Mental Health Service Provider Indicted for Health Care Fraud (U.S. Attorney for the Eastern District of Virginia)
Richmond, Virginia - Denise C. McCreary, 43, of Chesterfield, Va., has been indicted by a federal grand jury for submitting false and fraudulent claims for reimbursement to the Virginia Medicaid program.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia; and Kenneth T. Cuccinelli, Attorney General of Virginia, made the announcement after the indictment was returned.
McCreary owned and operated Camp Hope Youth Services, a Medicaid contracted provider of Intensive In-home Therapy Services for children and adolescents. Intensive In-home Therapy Services, one of the many mental health services offered by Medicaid in Virginia, are designed to assist youth and adolescents who are at risk of being removed from their homes, or are being returned to their homes after removal, because of significant mental health, behavioral, or emotional issues. Medicaid requires that Intensive In-home Therapy providers employ qualified metal health workers to provide a medically necessary service to at-risk children and adolescents.
According to the indictment, McCreary billed Medicaid for services that were not reimbursable because the services did not address a child’s specific mental health issues, were not provided by qualified mental health workers, and were not provided to children who were in actual need of the offered service. McCreary also billed Medicaid for services that were never provided. The indictment alleges that Medicaid paid McCreary at least $601,580.00 that she was not entitled to receive.
The case is being investigated by the Federal Bureau of Investigation and the Virginia Attorney General’s Medicaid Fraud Control Unit. It is being prosecuted by Assistant United States Attorney Michael C. Moore and Special Assistant United States Attorney Joseph E.H. Atkinson.
Criminal indictments are only charges and not evidence of guilt. A defendant is presumed to be innocent until and unless proven guilty.
A copy of this press release may be found on the website of the United States Attorney's Office for the Eastern District of Virginia at http://www.usdoj.gov/usao/vae. Related court documents and information may be found on the website of the District Court for the Eastern District of Virginia at http://www.vaed.uscourts.gov or on http://pacer.uspci.uscourts.gov.
Virginia Beach Doctor Sentenced to 63 Months in Prison for Defrauding Medicare and Tricare (United States Attorney’s Office for The Eastern District of Virginia)
Norfolk, Virginia - Ronald Poulin, 61, of Virginia Beach, VA, was sentenced on March 15, 2010 in United States District Court to 63 months in prison for health care fraud, making false statements relating to health care matters, and altering records to obstruct an investigation. A Norfolk federal jury found Poulin guilty of those offenses last November following a two week trial. Neil H. MacBride, United States Attorney for the Eastern District of Virginia, made the announcement after Poulin was sentenced by United States District Judge Mark S. Davis, who also ordered Poulin to pay restitution in the total amount of $790,641.87.
Poulin is an oncologist and hematologist with a medical practice located in Virginia Beach, Virginia. The evidence presented at trial showed that between January 2006 and August 2008, Poulin filed several hundred false and fraudulent claims totaling approximately $1.3 million with the federally funded health care benefit programs Medicare and TRICARE. The billing scheme involved three components: Poulin billed for a greater amount of chemotherapy drugs than patients actually received; split single-dose 40,000 unit vials of the anemia drug Procrit between two patients and billed as if each patient had received a full vial; and billed for patient office visits which never occurred.
In addition, after being served with administrative subpoenas by the Department of Health and Human Services, Office of Inspector General and the Department of Defense, Office of Inspector General, directing him to produce certain patient and billing records as part of an investigation of his billing practices, Poulin altered the records to obstruct and influence the investigation.
“The federal government spends billions on health care, and it’s our responsibility to root out those who corrupt the system and steal from the taxpayers,” said U.S. Attorney MacBride. “Ronald Poulin lied to get more money for his services than he deserved, and now he is going to spend 63 months in prison as a result of that greed.”
The case was investigated by the Federal Bureau of Investigation, the Department of Health and Human Services, Office of Inspector General, and the Department of Defense, Office of Inspector General. Assistant United States Attorneys Katherine Lee Martin and Alan M. Salsbury prosecuted the case for the United States.
A copy of this press release may be found on the website of the United States Attorney's Office for the Eastern District of Virginia at http://www.usdoj.gov/usao/vae. Related court documents and information may be found on the website of the District Court for the Eastern District of Virginia at http://www.vaed.uscourts.gov or on http://pacer.uspci.uscourts.gov.
U.S. Files Complaint Against Virginia Medicaid Providers (Civil Division)
WASHINGTON – The United States and the Commonwealth of Virginia have filed a False Claims Act complaint in the Western District of Virginia against Medicaid providers Universal Health Services Inc., Keystone Marion LLC and Keystone Education and Youth Services LLC, the Justice Department announced on March 2, 2010. These entities did business as the Keystone Marion Youth Center, a residential facility in Marion, Va., which receives Medicaid funds to provide psychiatric counseling and treatment for boys ages 11-17. The United States’ and the Commonwealth of Virginia’s complaint alleges that the defendants billed Medicaid for inpatient psychiatric care that was not provided, in violation of federal and state Medicaid requirements, and falsified records to cover up their serious violations.
According to the complaint, the defendants’ actions violated the False Claims Act. Under the act, a health care provider that submits false or fraudulent claims to a federal health care program is liable for three times the government’s damages, plus a civil penalty for each false claim. The United States and the Commonwealth of Virginia earlier intervened in this whistleblower suit filed by several former therapists who worked at the Marion residential facility.
“The Justice Department is committed to ensuring that scarce Medicaid resources are devoted to their intended use – the appropriate care and treatment of some of our nation’s neediest and most vulnerable patients,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “We must protect Medicaid from fraudulent practices that deprive beneficiaries of the quality health care they deserve.”
Assistant Attorney General West acknowledged the collaborative efforts made by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Western District of Virginia, the Virginia Attorney General’s Office, the Department of Health and Human Services’ Office of Inspector General and the Commonwealth of Virginia’s Medicaid Fraud Control Unit.
“We intend to prove that these defendants billed Medicaid for providing troubled children with much needed psychiatric medical care when, in fact, they provided no such service,” said Timothy J. Heaphy, United States Attorney for the Western District of Virginia. “We will not sit idly by and allow healthcare providers to take advantage of troubled children in order to feed their own desire for wealth. The Medicaid system was designed to help the most vulnerable among us, not to line the pockets of fraudsters.”
“The Office of Inspector General has an obligation not only to protect Medicaid from fraudulent billing but also to protect mentally ill children from substandard care,” said Nick DiGiulio, Special Agent in Charge for the Philadelphia Region of the Office of Inspector General of the Department of Health of Human Services.
The United States’ and the Commonwealth of Virginia’s 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 $2.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion.
