Wednesday, February 26, 2014

Pharmacist Sentenced to Seven Years in Prison for Obtaining $1.7 Million from Health Insurers for Drug He Never Dispensed


U.S. Attorney’s Office February 25, 2014
  • Northern District of Illinois (312) 353-5300
CHICAGO—A Chicago pharmacist was sentenced to seven years in federal prison after being convicted at trial of collecting more than $1.7 million through false claims he submitted to insurance companies for a drug that he never dispensed and stealing the identities of unsuspecting pharmacy customers to make that money, which he used to finance a lavish lifestyle. The defendant, Ronald Kielar, also created fake documents to make his false insurance claims appear legitimate.
Kielar, 76, of Mundelein, was a pharmacist at the former Cartagena Pharmacy, located in the 1500 block of West Devon Avenue, which was owned by his ex-wife. He was sentenced to five years in prison on six counts of health care fraud and one count of obstruction of justice and received a mandatory consecutive sentence of two years on three counts of aggravated identity theft. Kielar, who was convicted on all 10 counts he was charged with at a trial last fall, was ordered to begin serving the 84-month sentence on June 10.
U.S. District Judge Robert M. Dow, Jr., who imposed the sentence on Friday, also ordered Kielar to pay more than $1.725 million in restitution and to forfeit nearly $78,000 in proceeds from the sale of property he owned in Florida.
According to court documents, Kielar used patients’ insurance information, including their names and dates of birth, to bill for the drug Procrit, which stimulates the production of red blood cells. These patients, however, were never prescribed Procrit, Kielar never provided them with the medication, and the patients never authorized the use of their insurance information to submit claims for payment. After he was indicted, Kielar forged prescriptions, patient receipts, and false invoices to make the insurance claims look legitimate. Between November 2004 and August 2010, Kielar submitted 603 false claims and received more than $1.7 million from Blue Cross and Blue Shield of Illinois and the United Food and Commercial Workers Unions and Employers Midwest Health Benefit Fund.
“Each time [Kielar] hit the submit button on the pharmacy’s computer for a Procrit claim, he made a calculated choice: to lie to the victim insurance company who received, processed, and paid on the claim,” Assistant U.S. Attorney Heather McShain wrote in a sentencing memo. Kielar also betrayed a physician who had been his friend for 40 years and whose name and DEA registration number Kielar used without permission, as well as unsuspecting patients whose personal information he used.
Evidence showed that Kielar used proceeds from the fraud scheme to pay salaries to himself and his ex-wife and then used those funds to pay mortgages on his home in Illinois, as well as properties in Florida and Arizona.
The sentence was announced today by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Robert J. Holley, Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation; James Vanderberg, Special Agent in Charge of the U.S. Department of Labor Office of Inspector General in Chicago; and John Redmond, Special Agent in Charge of the Chicago Office of the U.S. Food and Drug Administration Office of Criminal Investigations.
The government was represented by Assistant U.S. Attorneys Heather McShain and Steven J. Dollear.

Around Iowa: Pharmacist's health care fraud trial starts--Allegations are that Michael Stein billed Wellmark for expensive drugs when his pharmacy actually did little work and only acted as a pass through entity for Florida compaines

IOWA CITY

A trial is starting for an Iowa pharmacist accused of fraudulently billing an insurance company for life-saving drugs sent to hemophilia patients.
Michael Stein, the owner of Pharmacy Matters in Iowa City, has pleaded not guilty to 15 counts of health care fraud. Jury selection began Monday in federal court in Des Moines.
Prosecutors contend Stein billed Wellmark for expensive drugs to treat hemophilia, when his pharmacy actually did little work in dispensing those drugs. They say his pharmacy acted as a “pass-through entity” for Florida companies, giving them access to the Blue Cross and Blue Shield network.
Stein’s attorneys say the case is a contract dispute between a pharmacist and an insurer.
quoted from here

Feds make Medicare fraud a top priority

By
Published:   |   Updated: February 23, 2014 at 08:51 AM
TAMPA — Four men set up four bogus medical clinics in Tampa.
They pay Medicare clients who allow the clinics to bill Medicare HMO insurance providers in their names for vein procedures they never undergo. Each clinic submits a separate bill for each patient, submitting multiple claims for the same procedures on the same individuals at the same time.
The scam went on for more than three years. Collectively, the men were able to steal more than $2.5 million from federal taxpayers.

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Warning Letters Usv Limited 2/6/14

Warning Letters Usv Limited 2/6/14