Friday, June 29, 2018

Medicare spent $2 billion for one drug as the manufacturer paid doctors millions
CNN
More than 80% of doctors who filed Medicare claims in 2016 for H.P. Acthar Gel — a drug best known for treating a rare infant seizure disorder — received money or other perks from the drugmakers. Read the full story

Must Read for Every American!! The American Chamber of Horrors


In the early 20th century, Americans were inundated with ineffective and dangerous drugs, as well as adulterated and deceptively packaged foods. 
A cosmetic eyelash and eyebrow dye called Lash Lure, for example, which promised women that it would help them “radiate personality,” in fact contained a poison that caused ulceration of the corneas and degeneration of the eyeballs. An elixir called Banbar claimed to cure diabetes as an alternative to insulin, but actually provided no real treatment and caused harm to those patients who substituted this for effective insulin therapy. Food producers short-changed consumers by substituting cheaper ingredients. Some products labeled as peanut butter, for instance, were filled with lard and contained just a trace of peanuts, and some products marketed as “jellies” had no fruit in them at all. Unscrupulous vendors even sold products to farmers, falsely promising they could treat sick animals – in at least one case, a product called Lee’s Gizzard Capsules killed an entire flock of turkeys instead of curing them. 
Although the FDA sought to remove these unsafe and misleading products from commerce, it was severely limited in its efforts by the 1906 Pure Food and Drugs Act. That law laid the cornerstone for the modern FDA and marked a monumental shift in the use of government powers to enhance consumer protection by requiring that foods and drugs bear truthful labeling statements and meet certain standards for purity and strength.
.....Continue reading

Doctors charged in overdose deaths of five patients

NewsOK.com-6 hours ago
Oklahoma City federal prosecutors announced the charge Thursday during a news ... Robison also is charged with 104 counts of health care fraud, accused of ...

Attorney General announces largest health care fraud takedown in ...

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The following are some of the recent health care fraud cases that have been ..... receive prescriptions from pharmacies in Florida and Oklahoma in exchange fo

Amazon purchase could disrupt the pharmacy business

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By Robert Langreth, Zachary Trace and Jared S. Hopkins | Bloomberg News. Amazon.com is buying its way into the pharmacy business. Now the question is, ...

Second Kim's Hometown Pharmacist indicted in federal court

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On June 26, Kim's Hometown Pharmacy owner and operator Kimberly Jones was ... count each of maintaining a drug involved premises and health care fraud.

6 medical professionals in Orlando included in health care fraud ...

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Ashraf Badr, a pharmacist and co-owner of Metro Pharmacy and Metro Rx PharmacyLLC: charged with one count of conspiracy to commit health care fraud ...

Federal authorities have charged two Pasadena pharmacy owners in a massive law enforcement action targeting health care fraud.

Two Pasadenans Indicted as Part of National $660 Million Healthcare ...

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Federal authorities have charged two Pasadena pharmacy owners in a massive law enforcement action targeting health care fraud. The United States Attorney ...

Four doctors among the 13 Tampa Bay residents charged in a ...

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Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” U.S. Attorney General Jeff Sessions said in a statement. “In many .

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A physician and her husband have been charged in a 17-count federal indictment alleging a fraud scheme involving controversial “compounded medicines” ...

Couple With New Canaan Ties Charged With Health Care Fraud: Feds

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Homer Zulaica: charged with conspiracy to offer and pay health care kickbacks stemming from his role as a sales representative for QMedRx, a compounding

Five NW Alabama Compounding Pharmacy Employeesincluding a district and an operations manager, of an Alabama-based compounding pharmacy Charged in Multi-Million Dollar Prescription Fraud Conspiracy during National Health Care Fraud Takedown

Department of Justice
U.S. Attorney’s Office
Northern District of Alabama

FOR IMMEDIATE RELEASE
Thursday, June 28, 2018

Five NW Alabama Compounding Pharmacy Employees Charged in Multi-Million Dollar Prescription Fraud Conspiracy during National Health Care Fraud Takedown

National Enforcement Action Brings Charges against 601 Individuals Responsible for Over $2 Billion in Fraud Losses and 84 Opioid Cases Involving 13 Million Illegal Dosages

BIRMINGHAM – The U.S. Attorney’s Office for the Northern District of Alabama this week charged five employees, including a district and an operations manager, of an Alabama-based compounding pharmacy with participating in a conspiracy to generate prescriptions and defraud health care insurers and prescription drug administrators out of tens of millions of dollars.
U.S. Attorney Jay E. Town announced the charges against employees of Northside Pharmacy, based in Haleyville and doing business as Global Compounding Pharmacy, as part of a nationwide health care fraud takedown. Global’s compounding and shipping facility was in Haleyville, but the pharmacy did its prescription processing, billing and customer service at its “call center” in Clearwater, Florida.
Attorney General Jeff Sessions and Department of Health and Human Services Secretary Alex M. Azar III today announced the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units participated in today’s arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, FBi Deputy Director David L. Bowdich, Drug Enforcement Administration Assistant Administrator John Martin, HHS-Office of Inspector General Deputy Inspector General Gary Cantrell, IRS Criminal Investigation Deputy Chief Eric Hylton, Centers for Medicare and Medicaid Services Deputy Administrator and Director of the Center for Program Integrity Alec Alexander, and Defense Criminal Investigative Service Director Dermot F. O’Reilly.
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG.  In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE, a health insurance program for members and veterans of the armed forces and their families, and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.   
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation — and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
 U.S. Attorney Town said, “The defendants in the north Alabama case helped their employer, Global Compounding Pharmacy, defraud millions from Medicare, Blue Cross Blue Shield of Alabama and other insurance systems by pushing unnecessary medications and billing for reimbursement. The greed of these defendants, and this company, resulted in the distribution of medication when there was no need, with the primary focus on profit rather than the efficacy of care. The costs are not just monetary, but have social and health impacts on us all.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money – it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
According to court documents, defendants from the national sweep allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE for treatments that were medically unnecessary and often never provided. In many cases, the charges are that patient recruiters, beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of more than $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system. 
In the Global Compounding Pharmacy case in north Alabama, the defendants are charged with taking part in a multi-faceted, multi-million dollar scheme to defraud multiple insurance plans and their third-party pharmacy benefit managers by billing for fraudulent, often high-dollar prescriptions that Global would fill and bill for reimbursement. To maximize proceeds, Global engaged in additional fraudulent practices including automatically refilling and billing for prescriptions, regardless of patient need, and routinely waiving co-pays to incentivize patients to accept unnecessary medications and refills, according to charges and plea agreements in the case.
The U.S. Attorney’s Office, through separate informations filed in U.S. District Court, and all with associated plea agreements, charged Global Operations Manager JEFFREY SOUTH, District Manager ANGIE NELSON, sales representatives RODDRICK BOYKIN and DAWN WHITTEN, and biller STACEY CARDOZO. The informations charge each of the defendants with one count of conspiracy to commit wire fraud, mail fraud and health care fraud. South, Nelson, Boykin and Whitten also are charged with varying counts of health care fraud, and Whitten also faces a charge of aggravated identity theft.
The charges against South, 47, of Florence, Alabama, Nelson, 40, of Santa Rosa Beach, Florida, Boykin, 45, of San Antonio, Texas, Whitten, 55, of Columbus, Georgia, and Cardozo, 28, of Largo, Florida, add to eight Global sales representatives previously charged by the U.S. Attorney’s Office and who all have pled guilty to the conspiracy and scheme.
“These defendants, motivated by pure greed, helped conduct a complicated scheme to obtain unnecessary, high-priced medications, purely to gain the insurance reimbursement,” said Birmingham FBI Field Office Special Agent in Charge Johnnie Sharp Jr. “Rooting out health care fraud is central to the well-being of both our citizens and the overall economy. Health care fraud costs the country tens of billions of dollars a year, and the FBI seeks to identify and pursue investigations against the most egregious offenders involved in health care fraud through investigative partnerships with other federal agencies.”
According to court documents, Global hired sales representatives who were located in various states and were responsible for generating prescriptions from physicians and other prescribers. To generate a high volume of prescriptions, Global hired representatives who were married or related to doctors and other prescribers, and encouraged sales representatives to volunteer at doctors’ offices where they would review patient files and push Global’s products to patients, according to court documents.
The FBI, U.S. Postal Inspection Service, HHS-OIG, DCIS and IRS-CI, investigated the Global cases, which Assistant U.S. Attorneys Chinelo Dike-Minor, Don Long and Nicole Grosnoff are prosecuting.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in 10 locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who, collectively, have falsely billed the Medicare program for more than $14 billion.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Topic(s): 
Opioids
Prescription Drugs
Health Care Fraud
Component(s): 

Thursday, June 28, 2018

PILL SHARING: Claremore doctor indicted for drug distribution ...

Claremore Daily Progress-2 hours ago
The largest health care fraud enforcement action in Department of Justice ... U.S. Attorney for the Northern District of Oklahoma, Trent Shores, announced the ..

Second Kim's Hometown Pharmacist indicted in federal court

The News Journal-3 hours ago
She is facing 26 counts of unlawful distribution of a controlled substance, and one count each of maintaining a drug involved premises and health care fraud.

Feds: Hamilton clinic gave pain drugs, 'Prescriptive Speedball' without ...

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Attorney General Jeff Sessions said it was the largest health care fraud operation in the country's history, with 76 doctors, 23 pharmacists and hundreds of others ...

Decatur company implicated in $2 billion Medicare fraud related to ...

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Federal officials on Thursday announced the largest-ever health care fraudenforcement action by the Medicare Fraud Strike Force, involving more than 590 ...

Mississippi couple pleads not guilty in $200M health fraud

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(AP) -- A Mississippi couple charged in a fraud case that prosecutors say ... two dozen counts including conspiracy, health care fraud and money laundering.

Major crackdown on 'drug dealers in lab coats' nets Louisville doctors

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The nation's largest crackdown on health care fraud netted 56 doctors — including a Louisville psychiatrist accused of prescribing a patient fentanyl, a drug ...

26 Baton Rouge-area residents charged in federal health care fraud ...

Cleveland 19 News-1 hour ago
Twenty-six people from the Baton Rouge-area are facing federal charges resulting from the nation's largest ever health care fraud investigation. U.S. Attorney .

Indictment involving Pop’s Pharmacy, LLC where Chalker worked as a pharmacist.

News Release - Massive Nationwide Health Care Fraud Takedown

www.myfloridalegal.com/newsrel.nsf/.../750F1F9E9C8DBE59852582BA005883DE
7 hours ago - The defendants allegedly submitted false and fraudulent claims to Medicare, TRICARE and Medicaid for compounded drugs and other prescription medications, ..
Department of Justice
U.S. Attorney’s Office
Central District of California

FOR IMMEDIATE RELEASE
Thursday, June 28, 2018

As Part of National Healthcare Fraud Sweep, Los Angeles-Based Prosecutors Filed 16 Cases Alleging $660 Million in Fraudulent Bills

          LOS ANGELES – In another massive law enforcement action targeting health care fraud, federal authorities here announced today criminal cases naming a total of 33 defendants – including doctors, pharmacists and an attorney – who have been charged in a wide-range of schemes that collectively attempted to bilk public and private insurance programs out of more than $660 million.
          The defendants charged locally are among hundreds of people charged across the United States in cases that cumulatively allege approximately $2 billion in false billings. The nationwide sweep includes charges against 165 doctors, nurses and other licensed medical professionals who allegedly participated in health care fraud schemes
          In the Central District of California, most of the defendants were charged for their roles in schemes to defraud health insurance programs such as Medicare. The cases allege health care fraud and kickback schemes involving surgeries, compounded drugs, home health services, Medicare Part D prescription drugs and hospice care.
          “Health care fraud schemes cost Americans billions of dollars every year through higher premiums and tax money stolen from public programs, such as Medicare,” said First Assistant United States Attorney Tracy L. Wilkison. “There is an incredible array of scams, some of which involve services that are simply never provided, and some of which use complicated and sophisticated ruses to conceal illegal acts, such as bribes. Today’s announcement of the far-reaching law enforcement actions targeting a wide range of schemes and a large number of defendants demonstrates the excellent work by our law enforcement partners. Together, we will continue the hard work necessary to identify and hold accountable corrupt health care professionals and fraudsters seeking to line their pockets with your hard-earned money.”
          "Health care fraud occurs quietly and behind the scenes on a regular basis in Southern California, which makes detecting it very challenging," said Paul Delacourt, the Assistant Director in Charge of the FBI's Los Angeles Field Office. "The charges we've brought in Los Angeles against physicians and pharmacists are particularly disturbing since these individuals are placed in a position of trust by victims simply trying to navigate a complicated insurance system. A great deal of investigative ability went into each one of these cases, and I'm proud that the work of our agents and law enforcement partners will ebb the flow of the destructive fraud that plagues Southern California.”
9 new defendants charged in Operation “Spinal Cap”
          This week, prosecutors unsealed charges against nine new defendants being charged as part of Operation “Spinal Cap,” which targets a long-running health care fraud scheme that generated nearly $1 billion in fraudulent claims to federal government, California state, and private insurers. The scheme – which was spearheaded by Michael Drobot, the former owner of Pacific Hospital in Long Beach – involved more than $40 million in illegal kickbacks paid to doctors and other medical professionals in exchange for referring thousands of patients who received surgeries and other services at Pacific Hospital.
          In the cases announced today in Operation Spinal Cap:
  • Daniel Capen, 68, of Manhattan Beach, an orthopedic surgeon, has agreed to plead guilty to conspiracy and illegal kickback charges. Capen accounted for approximately $142 million of Pacific Hospital’s claims to insurers, on which the hospital was paid approximately $56 million.
  • Timothy Hunt, 53, of Palos Verdes Estates, another orthopedic surgeon who referred spinal surgery patients to Capen and other doctors, has agreed to plead guilty to a conspiracy charge involving his receipt of illegal kickbacks stemming from various financial relationships with Pacific Hospital and related entities.
  • George William Hammer, 65, of Palm Desert, the former chief financial officer of the physician management arm of Pacific Hospital, has agreed to plead guilty to tax charges based on the fraudulent classification of illegal kickbacks in hospital-related corporate tax filings.
  • Lauren Papa, 52, of Tarzana, a chiropractor, has agreed to plead guilty to a conspiracy charge involving her receipt of illegal kickbacks to refer patients to a neurosurgeon with the understanding that the neurosurgeon would perform the surgeries at Pacific Hospital.
  • Tiffany Rogers, 53, of Palos Verdes Estates, an orthopedic surgeon, was named in an indictment unsealed Wednesday in connection with receiving illegal kickbacks to refer patients for spinal surgeries at Pacific Hospital.
  • Brian Carrico, 64, of Redondo Beach, a chiropractor – along with Performance Medical & Rehab Center, Inc., which was partially owned by Carrico; and One Accord Management, Inc., which Carrico wholly owned – were charged in connection with the receipt of illegal kickbacks to influence the referral of patients to Pacific Hospital. An indictment unsealed Wednesday alleges that these defendants and other co-conspirators were responsible for approximately $80 million in claims submitted to the federal workers’ compensation program and were paid approximately $56 million in connection with patients that Performance Medical referred to Pacific Hospital.
  • William Parker, 64, of Redondo Beach, was charged in a separate indictment unsealed on Wednesday in connection with the same kickback scheme involving Carrico and his companies.
          With the new cases being filed in Operation Spinal Cap, the fraudulent claims related to this scheme now span a 15-year period and cumulatively total more than $950 million.
          The investigation into the spinal surgery kickback scheme is being conducted by the Federal Bureau of Investigation; IRS Criminal Investigation; the California Department of Insurance; and the United States Postal Service, Office of Inspector General.
          “Public health insurance programs – whether a workers’ compensation program or Medicare – are not a personal pocketbook for criminals seeking to exploit government programs designed to help those who need these plans the most,” stated R. Damon Rowe, Special Agent in Charge of IRS Criminal Investigation’s Los Angeles Field Office. “Taxpayers rightly expect individuals working in the healthcare industry that receive payments from taxpayer-funded programs to scrupulously follow the rules. IRS Criminal Investigation will continue to protect the integrity of public health insurance programs and ensure that doctors, pharmacists and medical service providers who profit from these illicit schemes are held accountable.”
          The new cases were filed by Assistant United States Attorney Ashwin Janakiram of the Major Frauds Section, and will be prosecuted by AUSA Janakiram and Assistant United States Attorneys Joseph T. McNally and Scott D. Tenley of the Santa Ana Branch Office.
          The nine new defendants charged in this investigation will be summoned to appear for arraignments in United States District Court in Santa Ana next month.
Investigation into compound prescription kickback scheme at TYY Consulting
          An indictment unsealed on Wednesday outlines a wide-ranging conspiracy that was responsible for more than $250 million in fraudulent claims for prescriptions that were filled by compounding pharmacies in Nevada and Southern California. The indictment charges Irena Shut, 41, an attorney who resides in Hidden Hills, with paying kickbacks to two podiatrists to authorize prescriptions written on pre-printed prescription pads designed to maximize insurance payments, regardless of the medical need for an expensive compounded formulary for each “patient.”
          The scheme was operated through TYY Consulting, a Las Vegas, Nevada-based outfit that used a nationwide network of marketers to refer prescriptions to TYY-affiliated pharmacies in exchange for kickbacks. As a result of the fraudulent claims, the victim health care plans paid out nearly $175 million. Shut, who worked as a marketer for TYY, received approximately $6.8 million in kickbacks, some of which was, in turn, given to the charged podiatrists.
          The charged podiatrists, Domenic Signorelli, 51, of Irvine, and Robert Joseph, 51, of Huntington Beach, along with several other unnamed co-conspirator doctors, allegedly received kickbacks for “writing” the prescriptions. Once the prescriptions were filled, members of the conspiracy submitted fraudulent claims to federal, state and private insurers for the compounded drugs.
          The victims of the scheme include the Department of Defense’s TRICARE program – which provides civilian health benefits for U.S Armed Forces military personnel, military retirees, and their dependents – as well as federal and state workers’ compensation programs.
          In addition to paying kickbacks to the charged podiatrists and other medical professionals, TYY induced other doctors to participate in the scheme by offering prostitutes, fancy meals, and expensive event tickets, according to the indictment.
          This case is being investigated by the FBI and the United State Postal Service, Office of Inspector General (USPS-OIG).
          USPS-OIG Special Agent in Charge Brian Washington stated, “Today’s indictments should send a clear message to all health care providers that health care fraud is a federal crime that carries serious consequences and will not be tolerated. The USPS-OIG, along with our law enforcement partners, will continue to aggressively investigate those who engage in fraudulent activities intended to defraud federal benefit programs and the Postal Service.”
          This case is being prosecuted by Assistant United States Attorney Ashwin Janakiram of the Major Frauds Section.
          Shut, Signorelli and Joseph will be directed to appear for arraignments next month in federal court in Los Angeles.
Distribution of prescription opioids
          Angela Gillespie-Shelton, 48, of Houston, was arrested Wednesday in her hometown after being indicted last week in Los Angeles on federal drug trafficking and money laundering charges. The six-count indictment alleges that Gillespie-Shelton was one of the leaders of a narcotics trafficking ring based in Los Angeles that sold illegal prescriptions for cash and obtained opioids and other drugs that were shipped from Los Angeles to Texas for sale on the black market.
          Gillespie-Shelton allegedly laundered over $1 million of the black market cash proceeds through numerous accounts both to conceal the proceeds and to further the narcotics trafficking conspiracy, including by paying rent for the clinic where the illegal prescriptions were written. The indictment further alleges that Gillespie-Shelton paid more than $200,000 to one of the doctors who wrote the illegal prescriptions.
          The doctor, Madhu Garg and numerous other co-conspirators have already been convicted in this matter.
          The case against Gillespie-Shelton is being investigated by the Drug Enforcement Administration, IRS Criminal Investigation, the Los Angeles Police Department, the Los Angeles County Sheriff’s Department, the California Department of Justice, and the Texas Department of Public Safety.
          The prosecution of Gillespie-Shelton is being handled by Assistant United States Attorney Michael G. Freedman of the Organized Crime Drug Enforcement Task Force.
SoCal residents charged in compound drug scheme
          A group of pharmacists, doctors and marketers worked together to defraud the TRICARE program by submitting more than $40 million in claims for medically unnecessary compounded medications prescriptions, according to an indictment unsealed Wednesday that also alleges AMPLAN, the Amtrak employee health benefit plan, was victimized.
          Marketers that participated in the scheme solicited beneficiaries of the health plans through misleading cold calls that promised free compounded medications, as well as through “wellness” programs that included gym memberships, fitness tracking devices and supplements. The marketers used sensitive personal and insurance information gathered from the beneficiaries to generate fraudulent prescriptions for compounded medications.
          The marketers paid doctors to authorize prescriptions by misleading the doctors into believing that the marketers operated legitimate telemedicine businesses or by paying the doctors to write the prescriptions.
          The six defendants charged in this case are:
  • Thu Van Le, aka Tony Le, 40, of Yorba Linda, a licensed pharmacist and owner of TC Medical Pharmacy (TCMP) in Pomona and a silent owner of Mars Hill Pharmacy (MHP) in North Carolina;
  • Chau Nguyen, aka Cindy Le, 36, of Yorba Linda, a licensed pharmacist and co-operator of TCMP;
  • Truong Giang Le, 31, of Pomona, a co-operator of MHP;
  • Chan Van Le, aka Kevin Le, 39, of Chino, the manager of MHP;
  • Nha Le Tuan Truong, 36, of Fountain Valley, a pharmacist who laundered fraudulently obtained proceeds through a charity; and
  • Jeffery Lawrence, 55, of Los Angeles, the owner of Wellytics Inc., an entity through which he fraudulently solicited insurance information from beneficiaries of AMPLAN.
          Through TCMP, the defendants submitted approximately $13 million in claims, and TRICARE paid reimbursements of more than $10 million, according to the indictment. Through MHP, the defendants submitted approximately $28 million in claims, and TRICARE paid more than $21 million. Nha Le Tuan Truong allegedly laundered more than $1 million in Tricare reimbursements through a charitable foundation.
          Lawrence allegedly solicited Amtrak employees to participate in a wellness program that Lawrence claimed would be reimbursement by AMPLAN. Several employees gave Lawrence their AMPLAN beneficiary information, which he then used to procure compounded medications prescriptions submitted to TCMP in exchange for more than $600,000 in kickbacks.
          “These cases reinforce our commitment and determination to pursue those who would defraud Amtrak’s health care programs and target such vulnerable populations,” said Amtrak Inspector General Tom Howard. “Our agents will continue to hold perpetrators accountable and to protect Amtrak, its employees and their dependents.”
          This case is being investigated by the Defense Criminal Investigative Service, the FBI, IRS Criminal Investigation, Amtrak’s Office of Inspector General, the Office of Personnel Management’s Office of Inspector General, the Department of Labor’s Office of Inspector General, and the California Department of Insurance.
          This case is being prosecuted by Assistant United States Attorneys Mark Aveis, Paul G. Stern and Cassie Palmer of the Major Frauds Section.
          The six defendants charged in this case were arrested on Tuesday and each pleaded not guilty at their arraignments in United States District Court. A trial in this case was scheduled for August 21 in Santa Ana.
Medicare Fraud Strike Force Cases
          Seven of the cases announced this week were filed by DOJ trial attorneys working in Los Angeles under the aegis of the Medicare Fraud Strike Force in conjunction with the United States Attorney’s Office. Strike Force operations are part of a joint initiative between the Department of Justice and the U.S. Department of Health & Human Services to prevent and deter fraud and enforce current anti-fraud laws around the country.
          “We will not tolerate criminals stealing precious dollars from our federal health care programs,” said Christian J. Schrank, Special Agent in Charge for the U.S. Department of Health & Human Services Office of Inspector General (HHS-OIG). “Today’s announcement shows our commitment to working with our state and federal law enforcement partners to swiftly investigate these fraud schemes and bring criminals to justice.”
Strike Force prosecutors unsealed seven criminal cases this week.
  • Seven people were named in an indictment that alleges multiple health care fraud conspiracies in which the owner of two pharmacies submitted claims to Medicare and Medi-Cal for expensive, brand-name prescription drugs that were never dispensed to patients. Rather, the drugs were provided to co-conspirators to sell to third parties, thereby generating a profit from each prescription drug twice – first from the reimbursement from Medicare or Medi-Cal, and second from the sale of the prescription drugs diverted to the black market.
          The defendants named in the indictment are:
  • Irina Sadovsky, 48, of Woodland Hills, the owner and pharmacist-in-charge of Five Star and Ultimate pharmacies;
  • Yigal Keren, 36, of Los Angeles, who owns and operates transitional housing centers;
  • Mikhail Khanukhov, 38, of Sherman Oaks, the manager at Five Star and Ultimate pharmacies;
  • Shahriar “Michael” Kalantari, 51, of Los Angeles, who was a marketer;
  • Andrei Sotnikov, 47, of Northridge, a marketer;
  • Nida Rosales, 62, of Bellflower, a marketer; and
  • Juan Carlos Enriquez, 31, of Van Nuys, a pharmacy technician and marketer
          The indictment alleges that Sadovsky paid kickbacks to marketers in exchange for patient referrals from facilities that treated Medicare and/or Medi-Cal patients. Sadovsky also paid kickbacks directly to Medicare beneficiaries in exchange for filling their prescriptions at Five Star Pharmacy.
          Five Star and Ultimate Pharmacies were collectively paid more than $54 million by Medicare and Medi-Cal between January 2014 and September 2017.
          This matter is being investigated by the FBI and HHS-OIG, and the case is being prosecuted by DOJ Trial Attorney Alexis Gregorian.
  • Armen Pogossian, 69, of Pasadena, the owner of L.A. Nova Pharmacy, was indicted for his role in the submission of $2.9 million in claims to Medicare Part D sponsors for prescription drugs that were never dispensed to Medicare beneficiaries; indeed, they were never even ordered from a wholesaler. The five-count indictment alleges that Pogossian attempted to conceal the fraudulent claims from auditors through the use of fake invoices that purported to show the drugs had been obtained from wholesalers and thus were in the pharmacy’s inventory. This case is being investigated by the FBI and HHS-OIG and is being prosecuted by DOJ Trial Attorney Alexis Gregorian.
  • Tamar Tatarian, 37, of Pasadena, the owner of Akhtamar Pharmacy, was named in a three-count indictment that alleges she participated in a scheme that submitted $1.3 million in claims to Medicare Part D sponsors for prescription drugs that were never ordered from wholesalers, and thus never dispensed to Medicare beneficiaries, which Tatarian attempted to conceal from auditors through the use of fake invoices. This case is being investigated by the FBI and HHS-OIG and is being prosecuted by DOJ Trial Attorney Alexis Gregorian.
  • Ruben Filian, 33, of Glendale, a physician’s assistant, was indicted for allegedly participating in a $58 million scheme to certify patients to home health care in exchange for illegal kickbacks. Filian is charged with one count of conspiracy to commit health care fraud, four counts of health care fraud, one count of conspiracy to pay and receive kickbacks, five counts of paying and receiving kickbacks, and three counts of money laundering. This case is being investigated by the FBI and HHS-OIG and is being prosecuted by DOJ Trial Attorney Emily Culbertson.
  • Dr. Stephen Levine, 74, of North Hollywood, a referring physician to home health agencies, was named in a criminal information for his role in the $58 million fraud scheme that also involved Filian. Levine allegedly certified numerous beneficiaries for home health services, without regard to whether the beneficiaries were homebound or whether the services were medically necessary. Levine was paid cash kickbacks for his referrals. Using Levine’s referrals as support, owners and operators at multiple home health agencies billed Medicare for home health services, and Medicare suffered losses of at least $6.5 million. This case is being investigated by the FBI and HHS-OIG and is being prosecuted by DOJ Trial Attorney Emily Culbertson.
  • Sarkis Manukyan, 76, of Panorama City, and Eduard Terosipyan, 67, of Montebello, both of whom are managers of medical clinics in Los Angeles and Burbank, were indicted in a $1.9 million Medicare fraud involving kickbacks and outpatient physician services not rendered or not medically necessary. This matter is being investigated by the FBI, the California Department of Justice and the Los Angeles Sheriff’s Department. This case is being prosecuted by DOJ Trial Attorney Niall O’Donnell.
  • Lucille Lam, 54, of Burbank, co-owner and managing employee of Bliss Hospice, was charged in a criminal information for allegedly participating in a scheme to pay kickbacks in exchange for Medicare beneficiaries referred to Bliss for hospice services. As part of the scheme, Lam and the co-owners of the hospice falsely categorized the illegal kickbacks as payroll expenses. Based on the referrals that Lam and her co-conspirators obtained through illegal kickbacks, Bliss submitted claims to Medicare and was paid approximately $2.4 million. This matter is being investigated by the FBI, HHS-OIG, and the California Department of Justice. This case is being prosecuted by DOJ Trial Attorney Claire Yan.
          Indictments and criminal informations contain allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court.
Component(s): 
Contact: 
Thom Mrozek Spokesperson/Public Affairs Officer United States Attorney’s Office Central District of California (Los Angeles) 213-894-6947
Press Release Number: 
18-103