Criminal and Civil Enforcement
February 2017
- February 9, 2017; U.S. Attorney; Western District of Texas
- El Paso Behavioral Health Facility Pays $860,000 to Resolve False Claims Act Allegations Under Civil Settlement with United States
Today, University Behavioral Health of El Paso, LLC ("UBH") paid $860,000 under a civil settlement with the Department of Justice to resolve allegations under the False Claims Act that the hospital paid unlawful remuneration under the Anti-Kickback Act and violated the Stark Law when it improperly paid a physician who made referrals to the hospital pursuant to a personal services agreement. - February 8, 2017; U.S. Attorney; District of Massachusetts
- Healthcare Sales Representative Sentenced for Obstructing Federal Investigation
BOSTON - A sales representative for multiple healthcare companies was sentenced today in U.S. District Court in Boston in connection with obstructing an investigation into kickbacks paid to medical professionals. - February 7, 2017; U.S. Attorney; Southern District of Florida
- Dr. Gary Marder and the United States Consent to a Final Judgement of Over $18 Million to Settle False Claims Act Allegations
Gary L. Marder, D.O., a physician residing in Palm Beach County and the owner and operator of the Allergy, Dermatology & Skin Cancer Centers in Port St. Lucie and Okeechobee, and the United States of America have stipulated to a consent final judgment of over $18 million to settle False Claims Act allegations against Dr. Marder. Co-defendant, Robert I. Kendall, M.D., a physician practicing in Coral Gables, has also agreed to pay the United States $250,000 to settle allegations that he violated the False Claims Act. - February 7, 2017; U.S. Attorney; Eastern District of Pennsylvania
- Delaware County Podiatrist Sentenced to 8 Years in Prison for Health Care Fraud
PHILADELPHIA - Today, a federal judge sentenced Stephen A. Monaco, a former podiatrist, to 97 months' imprisonment for defrauding Medicare, Medicaid and private victim insurance companies, announced Acting United States Attorney Louis D. Lappen. Defendant Monaco pleaded guilty to health care fraud on August 23, 2016, and surrendered his DEA license. - February 6, 2017; U.S. Department of Justice
- Healthcare Service Provider to Pay $60 Million to Settle Medicare and Medicaid False Claims Act Allegations
A major U.S. hospital service provider, TeamHealth Holdings, as successor in interest to IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc. (IPC), has agreed to resolve allegations that IPC violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed (a practice known as "up-coding"), the Department of Justice announced today. Under the settlement agreement, TeamHealth has agreed to pay $60 million, plus interest. - February 6, 2017; U.S. Attorney; Southern District of New York
- Clinic Manager Pleads Guilty In $70 Million Scheme To Defraud Medicare And Medicaid
Preet Bharara, the United States Attorney for the Southern District of New York, announced that EDUARD ZAVALUNOV, a manager of two health care clinics in Queens, New York, pled guilty today before U.S. District Judge Ronnie Abrams to conspiracy to commit wire fraud, mail fraud, and health care fraud, for his role in a massive health care fraud scheme through which three medical clinics in Brooklyn and Queens submitted over $70 million in fraudulent claims to Medicaid and Medicare. - February 1, 2017; U.S. Department of Justice
- Former Executive of Tenet Healthcare Corporation Charged for Alleged Role in $400 Million Scheme to Defraud
A former senior executive of Tenet Healthcare Corporation, was indicted for his alleged role in an over $400 million scheme to defraud. The indictment alleges that the scheme to defraud victimized the U.S. government, the Georgia and South Carolina Medicaid Programs, and prospective patients of Tenet hospitals. - February 1, 2017; U.S. Attorney; Middle District of Florida
- Fort Myers Urologist Agrees To Pay More Than $3.8 Million For Ordering Unnecessary Medical Tests
Fort Myers, FL - United States Attorney A. Lee Bentley, III announces that Meir Daller, M.D. has agreed to pay $3.81 million to the government to resolve allegations that he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary. - February 1, 2017; U.S. Attorney; Eastern District of Kentucky
- Pain Management Physician Resolves False Claims Act Allegations
LEXINGTON, Ky. - Pain management physician Dr. Robert Windsor has agreed to the entry of a $20 million consent judgment to resolve allegations that he violated the False Claims Act by billing federal health care programs for surgical monitoring services that he did not perform and for medically unnecessary diagnostic tests. Dr. Windsor owned pain management clinics in Georgia and Kentucky that operated under the umbrella of National Pain Care, Inc., including clinics in Lexington, London, Somerset, Hazard, Prestonsburg, and Pikeville, Kentucky. - February 1, 2017; U.S. Attorney; Northern District of Iowa
- Iowa Nursing Facility, Its Ownership, and Its Management Agree to Pay $100,000 to Resolve Allegations that Residents Received Worthless Care
The Abbey of Le Mars, Inc., and other individuals with financial interests in the Abbey's operations, agreed to pay $100,000 to settle allegations they violated the False Claims Act by submitting or causing claims to be submitted to Medicaid when the care provided to nursing facility residents was so grossly substandard that the care was worthless and effectively without value.
January 2017
- January 31, 2017; U.S. Attorney; Southern District of Texas
- Seven Sentenced in $6 Million Health Care Fraud Scheme
HOUSTON - The final seven of eight convicted in a $6 million fraudulent Medicare billing scheme have been ordered to federal prison, announced U.S. Attorney Kenneth Magidson. - January 31, 2017; U.S. Attorney; Southern District of Texas
- San Benito Man Heads to Prison for Posing as Licensed Vocational Nurse
McALLEN, Texas - A San Benito man has been ordered to federal prison following his conviction of aggravated identity theft, announced U.S. Attorney Kenneth Magidson. Juan Manuel Perez, 36, pleaded guilty Nov. 3, 2016. - January 27, 2017; U.S. Department of Justice
- Three Individuals Plead Guilty in $55 Million Health Care Fraud Scheme at Two Brooklyn Medical Clinics
Three individuals pleaded guilty this week in connection with a health care fraud scheme involving two Brooklyn, New York clinics that caused approximately $55 million in false and fraudulent claims to Medicare and Medicaid. - January 27, 2017; District of Idaho
- Fruitland Woman Pleads Guilty During Trial to Health Care Fraud and Aggravated Identity
BOISE - Cherie R. Dillon, 61, of Fruitland, Idaho, pleaded guilty today to 24 counts of health care fraud and 24 corresponding counts of aggravated identity theft for fraudulently billing dental services to health care benefit programs, U.S. Attorney Wendy J. Olson announced. Dillon was indicted on February 9, 2016, by a federal grand jury in Boise. Dillon's plea came at the close of the government's case after four days of trial in front of Chief U.S. District Court Judge B. Lynn Winmill. - January 25, 2017; U.S. Department of Justice
- Clinical Psychologist and Owner of Psychological Services Centers Convicted in $25 Million Psychological Testing Scheme Carried Out Through Eight Companies in Four Gulf Coast States
Two owners of psychological services companies, one of whom was a clinical psychologist, were convicted yesterday for their involvement in a $25.2 million Medicare fraud scheme carried out through eight companies at nursing homes in four states in the Southeastern United States. - January 25, 2017; U.S. Attorney; Central District of Illinois
- Co-owner of Chicago Medical Transport Company Sentenced to Five Years in Prison for Overbilling Illinois Medicaid $4.7 Million
SPRINGFIELD, Ill. - A Chicago man has been sentenced to five years in prison for fraudulent overbilling an estimated $4.7 million to Illinois' Medicaid program for non-emergency medical transport. Gregory D. Toran, 68, of Hazel Crest, Ill., was also ordered to pay $4.7 million in restitution. U.S. District Judge Sue E. Myerscough, who sentenced Toran on Jan. 23, allowed Toran to remain on bond until the federal Bureau of Prisons directs him to self-report to a prison facility to begin his prison sentence. - January 25, 2017; U.S. Attorney; Southern District of Texas
- Jury Convicts Local Doctor in $13 Million Health Care Fraud Scheme
HOUSTON - The final defendant charged in a $13 million Medicare and Medicaid health care fraud case has been found guilty on all eight counts as charged, announced U.S. Attorney Kenneth Magidson. A federal jury convicted Dr. Faiz Ahmed, 64, of Houston, today following a six-day trial and approximately five hours of deliberations. - January 23, 2017; U.S. Attorney; Northern District of Ohio
- Mother and son convicted of $7 million healthcare fraud scheme
A mother and son were convicted of crimes related to a $7 million home healthcare fraud conspiracy in which they provided forged documents and fraudulent forms to bill for services that were not provided. - January 23, 2017; U.S. Attorney; Eastern District of Texas
- U.S. Intervenes in East Texas False Claims Act Lawsuit Alleging Kickbacks for Ambulance Services
SHERMAN, Texas - The United States has filed a complaint intervening in an alleged kickback scheme in the Eastern District of Texas, announced Acting U.S. Attorney Brit Featherston today. - January 20, 2017; U.S. Attorney; District of Minnesota
- Twin Cities Child Care Provider Charged with Stealing Hundreds of Thousands from Low-Income Assistance Program
United States Attorney Andrew M. Luger today announced an indictment charging FOZIA SHEIK ALI, 50, for fraudulently obtaining at least hundreds of thousands of dollars for child care services that had not been provided. ALI is charged with wire fraud and theft of public money. The indictment was unsealed late yesterday in U.S. District Court in Minneapolis, Minn. - January 20, 2017; U.S. Attorney; Southern District of Texas
- Rio Grande Valley Area Doctor Charged in Illegal Kickback Scheme
McALLEN, Texas - A Rio Grande Valley area doctor has been taken into custody for his scheme to solicit and obtain illegal kickbacks in exchange for Medicare patient referrals, announced U.S. Attorney Kenneth Magidson. - January 19, 2017; U.S. Attorney; Eastern District of Pennsylvania
- University Of Pennsylvania Health System Agrees To Settle Voluntary Disclosure Of Improper Medicare Billing For Unnecessary Stent Procedures
The United States announces that it has settled allegations under the False Claims Act with the University of Pennsylvania Health System ("UPHS") for improperly billing Medicare for stent procedures two interventional cardiologists performed at Pennsylvania Hospital between 2008 and 2012. UPHS voluntarily disclosed the allegations to the U.S. Attorney's Office and has agreed to pay $845,000 to resolve the matter. The cardiologists no longer work at Pennsylvania Hospital. - January 19, 2017; U.S. Attorney; Southern District of New York
- Manhattan U.S. Attorney Announces $50 Million Settlement With Walgreens For Paying Kickbacks To Induce Beneficiaries Of Government Healthcare Programs To Fill Their Prescriptions At Walgreens' Pharmacies
Preet Bharara, the United States Attorney for the Southern District of New York, Scott J. Lampert, Special Agent in Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General ("HHS-OIG"), and Craig Rupert, Special Agent in Charge of the Northeast Field Office of the Defense Criminal Investigative Service, Department of Defense, Office of Inspector General ("DoD-OIG"), announced today a $50 million settlement in a civil fraud lawsuit against WALGREEN CO. ("WALGREENS"), a nationwide retail pharmacy chain that owns and operates thousands of retail pharmacies throughout the United States. The settlement resolves claims that WALGREENS violated the federal Anti-Kickback Statute ("AKS") and False Claims Act ("FCA") by enrolling hundreds of thousands of beneficiaries of government healthcare programs ("government beneficiaries") in its Prescription Savings Club program ("PSC program"). - January 19, 2017; U.S. Attorney; Southern District of Texas
- Another RGV Durable Medical Equipment Company Owner Indicted for Health Care Fraud
McALLEN, Texas - The owner of a Rio Grande Valley area durable medical equipment (DME) company has been arrested for her scheme to defraud Texas Medicaid through fraudulent billings, announced U.S. Attorney Kenneth Magidson. - January 18, 2017; U.S. Attorney; District of New Jersey
- Salesman For New Jersey Clinical Lab Sentenced To 20 Months In Prison For Bribing A Doctor In Test-Referral Scheme
NEWARK, N.J. - A Berkeley Heights, New Jersey, man was sentenced today to 20 months in prison for bribing a doctor in exchange for test referrals as part of a long-running and elaborate scheme operated by Biodiagnostic Laboratory Services LLC (BLS), of Parsippany, New Jersey, its president and numerous associates, U.S. Attorney Paul J. Fishman announced. - January 17, 2017; U.S. Attorney; Western District of Missouri
- Former Physician Pleads Guilty to Health Care Fraud Scheme
KANSAS CITY, Mo. - Tammy Dickinson, United States Attorney for the Western District of Missouri, announced that a former Kansas City, Mo., physician who lost his medical license due to an earlier fraud scheme, pleaded guilty in federal court today to his role in a fraud scheme that involved disability examinations of veterans. - January 13, 2017; U.S. Attorney; District of Kansas
- Medical Imaging Provider Sentenced for Federal Health Care Fraud
TOPEKA, KAN. B A man who owned a medical imaging business was sentenced Thursday to 18 months in federal prison for health care fraud, U.S. Attorney Tom Beall said. In addition, the defendant was ordered to pay more than $1.5 million in restitution to Medicare and Medicaid. - January 13, 2017; U.S. Department of Justice
- Medstar Ambulance to Pay $12.7 Million to Resolve False Claims Act Allegations Involving Medically Unnecessary Transport Services and Inflated Claims to Medicare
Medstar Ambulance Inc., including four subsidiary companies and its two owners, Nicholas and Gregory Melehov, have agreed to pay $12.7 million to resolve allegations that the Massachusetts-based ambulance company knowingly submitted false claims to Medicare, the Department of Justice announced today. - January 12, 2017; U.S. Attorney; Eastern District of Washington
- Confederated Tribes of the Colville Reservation Enter Into False Claims Act and Voluntary Compliance Agreements Regarding Challenged Youth Counseling Services
Spokane, WA - Today, the Confederated Tribes of the Colville Reservation (CCT) and the United States of America, acting through the U.S. Department of Justice (DOJ) and on behalf of the Office of Inspector General of the Department of Health and Human Services (OIG-HHS), announced a voluntary settlement agreement reached by the parties relative to allegations that the Colville Tribes submitted false claims to Medicaid seeking the reimbursement of mental health counseling services that was purportedly provided by the Tribe's Behavioral Health Unit - Youth Counseling services. - January 12, 2017; U.S. Department of Justice
- Home Health Agency Administrator Pleads Guilty in $7.8 Million Medicaid Fraud
The administrator of five Houston-area home health agencies pleaded guilty today to conspiring to defraud the State of Texas' Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. These programs provide qualified individuals with in-home attendant and community-based services that are known commonly as "provider attendant services" (PAS), and this case marks the largest PAS fraud case charged in Texas history. - January 12, 2017; U.S. Attorney; District of Connecticut
- Connecticut Home Health Agency and its Owners Pay $5.25 Million to Settle False Claims Act Violations
United States Attorney Deirdre M. Daly and Connecticut Attorney General George Jepsen today announced that Family Care Visiting Nurse and Home Care Agency, LLC (Family Care VNA), and David A. Krett and Rita C. Krett, R.N., B.S.N., owners of Family Care VNA, have entered into a civil settlement with the federal and state governments in which they will pay approximately $5.25 million to resolve allegations that they violated the federal and state False Claims Acts. Family Care VNA has offices in Stratford, Woodbridge, Norwalk and Meriden, and provides home health services in Fairfield, New Haven, Hartford and Middlesex Counties. - January 12, 2017; U.S. Attorney; Western District of Missouri
- KC Daycare Center owner, Director Indicted for $556,000 Fraud Scheme
KANSAS CITY, Mo. - Tammy Dickinson, United States Attorney for the Western District of Missouri, announced that the owner and the director of a Kansas City, Mo., day care center were indicted by a federal grand jury today for their roles in a conspiracy to file false attendance reports in order to fraudulently receive as much as $556,000 in federal benefits. - January 12, 2017; U.S. Attorney; Western District of Missouri
- Additional Charges Against Nigerian immigrant for Day Care Fraud Linked to International Scheme
KANSAS CITY, Mo. - Tammy Dickinson, United States Attorney for the Western District of Missouri, announced that additional charges have been filed against the Nigerian owner of a day care center in Kansas City, Mo., who was indicted last summer for engaging in a fraud scheme. - January 11, 2017; U.S. Department of Justice
- Shire PLC Subsidiaries to Pay $350 Million to Settle False Claims Act Allegations
The Justice Department announced today that Shire Pharmaceuticals LLC and other subsidiaries of Shire plc (Shire) will pay $350 million to settle federal and state False Claims Act allegations that Shire and the company it acquired in 2011, Advanced BioHealing (ABH), employed kickbacks and other unlawful methods to induce clinics and physicians to use or overuse its product "Dermagraft," a bioengineered human skin substitute approved by the FDA for the treatment of diabetic foot ulcers. Shire plc is a multinational pharmaceutical firm headquartered in Ireland, with its United States operational headquarters in Lexington, Massachusetts. Shire sold the assets associated with Dermagraft in early 2014. - January 10, 2017; U.S. Attorney; Central District of California
- Brea Man Who Operated Physical Therapy Clinics Sentenced to Over 10 Years in Federal Prison in $3 Million Medicare Fraud Scheme
SANTA ANA, California - A Brea man who operated rehabilitation clinics in Walnut, Torrance and Los Angeles and defrauded Medicare out of approximately $3 million by billing for unneeded or unnecessary services has been sentenced to 121 months in federal prison. - January 10, 2017; U.S. Attorney; District of New Jersey
- Passaic County, New Jersey, Doctor Charged With Taking Bribes In Test-Referral Scheme With New Jersey Clinical Lab
NEWARK, N.J. - A doctor practicing in Passaic County, New Jersey, was charged today with accepting bribes in exchange for test referrals as part of a long-running and elaborate scheme operated by Biodiagnostic Laboratory Services LLC (BLS), of Parsippany, New Jersey, its president and numerous associates, U.S. Attorney Paul J. Fishman announced. - January 9, 2017; U.S. Department of Justice
- Detroit-Area Neurosurgeon Sentenced to 235 Months in Prison for Role in $2.8 Million Health Care Fraud Scheme
A Detroit-area neurosurgeon was sentenced yesterday to 235 months in prison for his role in $2.8 million health care fraud scheme in which he caused serious bodily harm to patients by performing unnecessary invasive spinal surgeries. - January 9, 2016; U.S. Attorney; Northern District of Texas
- Texas Dental Management Firm, 21 Affiliated Dental Practices, and Their Owners and Marketing Chief Agree to Pay $8.45 Million to Resolve Allegations of False Medicaid Claims for Pediatric Dental Services
DALLAS - Texas-based MB2 Dental Solutions (MB2) and 21 pediatric dental practices affiliated with MB2, along with their owners and marketing chief, have agreed to pay the United States and the State of Texas Medicaid program $8.45 million to resolve allegations that they violated the False Claims Act by knowingly submitting, or causing the submission of, claims for pediatric dental services that were not rendered, were tainted by kickbacks, or falsely identified the person who performed the service, announced U.S. Attorney John Parker of the Northern District of Texas. - January 6, 2017; U.S. Attorney; Southern District of New York
- Owner Of Utah-Based Pharmaceutical Distributer Pleads Guilty To $100 Million Health Care Fraud Scheme
Preet Bharara, the United States Attorney for the Southern District of New York, announced that RANDY CROWELL, a/k/a "Roger," pled guilty today before United States District Judge Edgardo Ramos to fraudulently distributing more than $100 million worth of prescription drugs obtained on a nationwide black market. CROWELL used a Utah-based wholesale distribution company to sell illicitly procured drugs to pharmacies, which in turn dispensed them to unsuspecting customers. As part of his guilty plea, CROWELL agreed to forfeit more than $13 million in personal profits from the scheme. - January 5, 2017; U.S. Attorney; Northern District of Georgia
- Sandy Springs Podiatrist and Office Manager charged with Illegal Distribution of Fentanyl, Oxycodone, and Other Drugs
ATLANTA - Dr. Arnita Avery-Kelly, a licensed podiatrist, and Brenda Lewis, Avery-Kelly's office manager, have been arraigned on federal charges of illegal distribution of opioid pain killers and other drugs at clinic locations purporting to provide podiatric care in Sandy Springs, and Lithonia, Georgia. Dr. Avery-Kelly and Ms. Lewis were indicted by a federal grand jury on December 21, 2016.
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