Medicare Fraud

Posted: July 3, 2012 in Uncategorized
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McAllen TX – A federal grand jury indicted urologist Dr. Hossein Lahiji, 48, and his wife, attorney Najmeh Vahid Lahiji on three counts of healthcare fraud 31 MAY. The superseding indictment is the third set of charges returned in less than two years them. The latest indictment alleges a conspiracy to commit healthcare fraud and healthcare fraud against the government and private insurance providers over the course of about nine years. The Lahijis already had been indicted on charges of healthcare fraud in February 2011. And in December 2010, federal prosecutors in Portland, Ore., accused the Iranian-American couple of illegally funneling more than $1.8 million to Iran. The latest indictment accuses the Lahijis of conspiring to defraud federal healthcare programs Medicare and Medicaid, as well as private providers Aetna, Blue Cross Blue Shield, Humana and United Healthcare between January 2003 and February 2012. The indictment alleges they submitted false and fraudulent claims in connection with the use of unlicensed, unqualified medical personnel and billed for medical services not rendered. The Lahijis submitted fake claims to healthcare providers for urology services performed when he had traveled outside Texas and the United States. Those who actually performed the "urology services" were only licensed medical assistants who treated patients without supervision from any doctor or other qualified, licensed medical personnel, the indictment states. The scheme involved specific days where Dr. Lahiji claimed to treat between 65 and 117 patients in a single workday — between 7 a.m. and 6 p.m., prosecutors said. Dr. Lahiji also falsely claimed some patients required the taking of comprehensive medical history — an unnecessary task in many circumstances, while in others he did not even perform the exam. Such practices violate regulations established by Medicare, Medicaid, as well as state law and rules set by private insurance companies.
 Columbia MO – The University of Missouri's medical school dean is stepping down amid a federal investigation into potential Medicare billing fraud by two radiology professors. The university health system announced 1 JUN that Dr. Robert Churchill, a 25-year university employee and former radiology department chairman, will retire in October. The university also fired the two radiologists at the center of the federal probe. The moves come as the U.S. attorney's office in Kansas City continues a seven-month investigation the school said involves Medicare violations by Dr. Kenneth Rall and Dr. Michael Richards. Rall stepped down as radiology department chairman in December, but he remained a professor. An internal investigation by the school found that the two doctors falsely said they reviewed X-rays but instead relied solely on resident physicians, a violation of Medicare and hospital rules. It was emphasized that Churchill, who was hired as dean in October 2009 at a base salary of $480,000, was not involved in wrongdoing but will resign because he "does not want to allow distractions. School officials have yet to determine how much Medicare money was involved or how long the fraud lasted.
 Los Angeles CA – Physician assistant David James Garrison, 50, who worked at fraudulent medical clinics where he used the stolen identities of doctors to write prescriptions for medically unnecessary durable medical equipment (DME) and diagnostic tests has been convicted of conspiracy, health care fraud, and aggravated identity theft charges in connection with a $18.9 million Medicare fraud scheme. The evidence at trial showed that Garrison worked at fraudulent medical clinics that operated as prescriptions mills and trafficked in fraudulent prescriptions and orders for medically unnecessary DME, such as power wheelchairs, and diagnostic tests. The fraudulent prescriptions and orders were used by fraudulent DME supply companies and medical testing facilities to defraud Medicare. Garrison wrote the prescriptions and ordered the tests on behalf of some doctors he never met and who did not authorize him to write prescriptions and order tests on their behalf. The trial evidence showed that between March 2007 and September 2008, Garrison’s co-conspirator, Edward Aslanyan, and others owned and operated several Los Angeles medical clinics established for the sole purpose of defrauding Medicare. Aslanyan and others hired street-level recruiters to find Medicare beneficiaries willing to provide the recruiters with their Medicare billing information in exchange for high-end power wheelchairs and other DME, which the patient recruiters told the beneficiaries they would receive for free. Often, the Medicare beneficiaries did not have a legitimate medical need for the power wheelchairs and equipment. The patient recruiters provided the beneficiaries’ Medicare billing information to Aslanyan and others, or they brought the beneficiaries to the fraudulent medical clinics. In exchange for recruiting the Medicare beneficiaries, Aslanyan and others paid the recruiters cash kickbacks.
 St. Louis MO – A foreign exchange student from Kazakhstan has pleaded guilty to creating fake companies to defraud the Medicare program. Kamoliddin Akramov, 21, pled guilty to one felony count conspiracy to defraud the Medicare program. According to court documents, Akramov, a citizen of Kazakhstan, was in the United States on a J1 visa during the summer of 2010 and 2011 when he set up fake front companies in the St. Louis area, Tennessee and California. Officials said he rented mail boxes at UPS stores and other commercial mailbox companies and opened bank accounts for the false front companies. Authorities said Akramov used stolen identities of multiple medical doctors to submit thousands of reimbursement claims to the Medicare Program for non-rendered services. The doctors were not affiliated with the false front companies and did not know the companies existed, according to officials. Akramov's sentencing is set for August 7. He faces up to 10 years in prison and fines up to $250,000.
 Houston TX – Floyd Leslie Brooks, 45, entered a plea of guilty to conspiracy to violate the Anti-Kickback Statute for his role in the $45 million City Nursing Health Care scandal. This Statute prohibits solicitation or receipt of any type of remuneration, directly or indirectly, overtly or covertly, in cash or in kind, for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a federal health care program. The U.S. attorney’s office reported that the owner of City Nursing, Umawa Oke Imo, was convicted in May 2011 and sentenced to more than 27 years in federal prison for his role in the health care fraud conspiracy which included making cash payments to both beneficiaries and recruiters bringing Medicare beneficiaries to City Nursing. According to the plea agreement, Brooks received 32 checks totaling $13,700 for referring beneficiaries to Imo. In turn, City Nursing billed the Medicare numbers of those referred by Brooks for $1,196,230 worth of physical therapy services that were not provided and City Nursing received at least $790,461 in payment from Medicare and Medicaid for those services. Magidson said Brooks also admitted he referred another individual to Imo so that individual could also refer Medicare beneficiaries in return for payments. Brooks was permitted to remain on bond pending his sentencing hearing, which is scheduled for Sept. 20, 2012. At that time, he faces up to five years in prison and a $250,000 fine.
[Source: Fraud News Daily 1-14 Jun 2012 ++

 Oklahoma City OK – An Oklahoma City counselor has received a 3-year suspended sentence and ordersto pay more than $15,000 in restitution after pleading guilty to two counts of Medicaid fraud. Vickie Yearwood entered the plea 30 MAY in Oklahoma County District Court. The multicounty grand jury indicted Yearwood, a licensed professional counselor through Beacon Pointe LLC, last month for Medicaid fraud. The 53-year-old Yearwood was accused of presenting false claims for reimbursement to the Oklahoma Health Care Authority for more than $5,000 in services between October and December. The indictment also alleged Yearwood created false documentation for counseling sessions that didn't occur. Yearwood previously pleaded no contest to one count of Medicaid fraud in April 2011.
 Montgomery AL – A Clarke County dentist has pleaded guilty to charges that he attempted to file a claim with Medicaid for a dental procedure that was not performed. Alabama Attorney General Luther Strange said 61-year-old Victor Clarence Hawkins of Grove Hill pleaded guilty before Montgomery County District Judge Jimmy Pool to one count of attempting to file a false claim with the Alabama Medicaid Agency. That's a Class A misdemeanor. The Attorney General's Medicaid Fraud Control Unit had accused Hawkins of billing Medicaid for a root canal for a child. Strange said a review of an x-ray revealed the procedure had not been performed. Pool placed Hawkins on probation for a year and the dentist was permanently barred from being an Alabama Medicaid provider

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