Thursday, June 28, 2018

2 Indicted In Scheme To Defraud State Employees' Pharmacy Benefits Program

Hartford Courant · 2 hours ago

Statement from FDA Commissioner Scott Gottlieb, M.D., on FDA’s efforts to collaborate with internet stakeholders to stop the illegal sale of opioids online


Opioid addiction and abuse remains an immense public health crisis. We’re committed to continuing to take new steps to address these protracted dangers from every possible angle.

A crisis of this magnitude requires broad, collaborative and creative approaches. We’re especially aware that as we take more actions to curb the lawful prescribing of prescription opioids, our actions will inevitably push more and more people to obtaining opioids from illicit sources. And we know that digital drug dealers and other criminals are increasingly selling their illicit opioids through the internet, including social media and illegal online pharmacies. This activity is contributing to the public health emergency of opioid-related overdose deaths that have ripped apart families and communities. We aim to confront these new threats.

2018 National Health Care Fraud Takedown Acts on Opioid Crisis ...

https://energycommerce.house.gov/.../2018-national-health-care-fraud-takedown-acts-...
5 hours ago - WASHINGTON, DC – This morning, the Department of Justice (DOJ) announced the latest results of their National Health Care Fraud Takedown. According to ...
Department of Justice
U.S. Attorney’s Office
Eastern District of New York

FOR IMMEDIATE RELEASE
Thursday, June 28, 2018

Five Doctors and Eight Healthcare Professionals Charged as Part of National Healthcare Fraud Takedown

Alleged Billings in the Eastern District of New York Exceeded $163 Million

Thirteen individuals, including five doctors, a chiropractor, three licensed physical and occupational therapists and two pharmacy owners have been charged for their participation in fraudulent schemes in connection with which Medicare and Medicaid programs were billed more than $163 million.  The charges filed in federal court in Brooklyn and Central Islip, New York, are part of a nationwide health care fraud takedown, led by the Medicare Fraud Strike Force, which resulted in criminal charges against 601 individuals for their alleged participation in health care fraud schemes involving approximately $2 billion in fraudulent claims.
The charges were announced by Richard P. Donoghue, United States Attorney for the Eastern District of New York; John P. Cronan, Acting Assistant Attorney General of the Justice Department’s Criminal Division; William F. Sweeney, Jr., Assistant Director-in-Charge, Federal Bureau of Investigation, New York Field Office (FBI); Scott J. Lampert, Special Agent-in-Charge, U.S. Department of Health and Human Services - Office of Inspector General, Office of Investigations, New York Regional Office (HHS-OIG); James D. Robnett, Special Agent-in-Charge, Internal Revenue Service-Criminal Investigation, New York (IRS-CI); and Dennis Rosen, Inspector General, New York State Office of the Medicaid Inspector General (OMIG).  The results of the nationwide takedown were announced today by Attorney General Jeff Sessions; Alex M. Azar II, Secretary, HHS; Christopher Wray, Director, FBI; Robert W. Patterson, Acting Administrator, Drug Enforcement Administration (DEA); Daniel Levinson, Inspector General, HHS-OIG; Don Fort, Chief, IRS-CI; Seema Verna, Administrator, Centers for Medicare and Medicaid Services.
“As alleged, the defendants charged throughout the Eastern District of New York as a part of the nationwide health care takedown abused their positions to enrich themselves, while bilking Medicare and Medicaid.  They did so without regard to the elderly and vulnerable citizens whose health depends upon these essential programs.  Licensed medical professionals and others who cheat the system will be investigated and prosecuted to the full extent of the law,” stated United States Attorney Donoghue.  Mr. Donoghue extended his grateful appreciation to the U.S. Office of Personnel Management, Office of Inspector General (OPM-OIG), U.S. Immigration and Customs Enforcement, Homeland Security Investigations (HSI), the New York City Police Department (NYPD), the New York Attorney General’s Medicaid Fraud Control Unit (MFCU), the New York City Human Resources Administration and the New York City Health and Hospitals Corporation, Office of Inspector General, for their assistance in the investigations in this district.
“Turning a blind eye to the needs of Medicare and Medicaid recipients,
these medical officials set their sights on personal gain,” stated FBI Assistant Director-in-Charge Sweeney.  “Our doctors and healthcare professionals are entrusted to serve those in need, but these individuals used their occupations as leverage to fulfill their fraudulent scheme. By allegedly billing Medicare and Medicaid more than $163 million, the defendants selfishly diverted funds allocated to our most vulnerable citizens.  Devoted to protecting the welfare of our citizens, we will continue to uproot those who blatantly take advantage these programs.”
“Health care fraud depletes funds intended to provide care for our most vulnerable citizens,” stated HHS-OIG Special Agent-in-Charge Lampert.  “This takedown sends a clear message that criminals who engage in health care fraud schemes will be caught and face consequences for their actions.”
“Medical doctors and medical professionals should be some of the most trusted people in our lives,” stated IRS-CI Special Agent-in-Charge James Robnett.  “The financial expertise of IRS-Special Agents is needed to not only decipher the tax violations, but is necessary to unravel the sophisticated widespread financial fraud perpetrated against the safety net millions of Americans rely upon on a daily basis.”
“Medicaid fraud is not a victimless crime.  Those engaged in schemes like this prey on the most vulnerable New Yorkers, rob the health care system of vital resources, and waste taxpayer dollars,” stated OMIG Inspector General Rosen.  “My office will continue to work closely with our federal partners to hold wrongdoers fully accountable.”
The schemes charged in the Eastern District of New York, detailed in eight indictments and one criminal information, are as follows:
United States v. Wael Bakry, et al.:  The superseding indictment charges five health care professionals for their role in a wide-ranging health care fraud scheme in Brooklyn and Queens that billed the Medicare program for more than $116 million.  Wael Bakry, a physical therapist, Abraham Demoz, a physician, Victor Genkin, an occupational therapist, Mayura Kanekar, an occupational therapist, and Alexander Khavash, a chiropractor, were each charged with conspiracy to commit health care fraud, conspiracy to commit money laundering, conspiracy to pay health care kickbacks, conspiracy to defraud the United States by obstructing the lawful functions of the Internal Revenue Service, and subscribing to a false and fraudulent tax return.  Additionally, Bakry, Kanekar and Khavash were each separately charged with two false claims counts.  The charges stem from the defendants’ involvement in a scheme, run through multiple medical practices, in which the defendants paid illegal kickbacks for the referral of patients to their clinics.  These patients, in turn, subjected themselves to purported physical and occupational therapy and other services in return for kickbacks.  The superseding indictment was filed on June 20, 2018.  The case, which is pending before United States District Judge Sterling Johnson, Jr., is being prosecuted by Assistant Chief A. Brendan Stewart and Trial Attorney Andrew Estes of the Criminal Division’s Fraud Section. 
United States v. Artem Ashirov:  The indictment charges Artem Ashirov, a pharmacist and sole proprietor of ABO Pharmacy in Brooklyn, with five counts of violating the Anti-Kickback Statute.  The charges stem from a scheme in which Ashirov paid and offered to pay kickbacks for prescriptions filled at his pharmacy.  Between 2015 and 2018, Ashirov, through ABO Pharmacy, billed more than $14.9 million to Medicare and Medicaid.  Ashirov was arrested, and arraigned earlier today before United States Magistrate Judge Ramon E. Reyes, Jr., at the federal courthouse in Brooklyn.  The case is being prosecuted by Assistant United States Attorney Erin E. Argo of the U.S. Attorney’s Office for the Eastern District of New York. 
United States v. Gary Peresiper:  The indictment charges Gary Peresiper, a medical clinic business manager, with conspiracy to pay health care kickbacks.  The charge stems from Peresiper’s role at two Brooklyn clinics, Pulmonary Solutions, P.C., and Multi Care Medical NY PLLC.  Peresiper and co-conspirators submitted claims through these clinics for purported diagnostic testing and other services for beneficiaries who had been directed to the clinics in return for kickbacks.  From November 2010 to June 2013, the clinics billed Medicare approximately $10.2 million in claims, and were paid approximately $4.7 million on those claims.  Peresiper was arrested, and arraigned before United States Magistrate Judge Peggy Kuo at the federal courthouse in Brooklyn on June 4, 2018.  The case is being prosecuted by Trial Attorney Sarah Wilson Rocha of the Criminal Division’s Fraud Section.
United States v. Iouri Winogradov:  Iouri Winogradov, the operator of Brooklyn ambulette company Ambulette Star Trans, was charged with one count of conspiracy to violate the Anti-Kickback Statute and one count of conspiracy to commit money laundering.  The charges stem from Winogradov’s role in a kickback and money laundering scheme in which Winogradov and co-conspirators received and paid illegal kickbacks for the referral of patients to medical clinics.  The patients, who were transported to and from the clinics by Ambulette Star Trans, subjected themselves to purported physical and occupational therapy and other services.  Between 2010 and 2014, Ambulette Star Trans was paid approximately $7 million as a result of claims submitted to Medicaid.  The indictment was unsealed on June 27, 2018, and the defendant remains at large.  The case is being prosecuted by Andrew Estes of the Criminal Division’s Fraud Section.
United States v. Yuriy Barayev:  Yuriy Barayev, a pharmacy owner, was indicted on one count of health care fraud.  The charge stems from Barayev’s ownership of a Queens pharmacy, Woodhaven Rx Inc., through which he submitted claims for medications that were purportedly dispensed by his pharmacy, but in fact were never dispensed to beneficiaries.  From November 2013 to December 2015, Medicare reimbursed the pharmacy approximately $6.6 million for pharmaceutical claims.  Barayev was arrested, and arraigned before United States Magistrate Judge Steven L. Tiscione at the federal courthouse in Brooklyn on June 26, 2018.  The case is being prosecuted by Trial Attorney Sarah Wilson Rocha of the Criminal Division’s Fraud Section.
United States v. Yong Jun Kim:  The indictment charges Yong Jun Kim, a medical doctor who operated My Health Wellness Center in Flushing, New York, with one count of conspiracy to commit health care fraud and one count of violating the Anti-Kickback Statute.  The charges stem from Dr. Kim’s role in a scheme in which claims were submitted to Medicare for physical therapy services that were not medically necessary, not provided, or otherwise did not qualify for reimbursement.  Between 2012 and 2015, Dr. Kim billed Medicare approximately $5.6 million and was paid approximately $3.5 million on those claims.  Dr. Kim was arrested, and arraigned before United States Magistrate Judge Steven L. Tiscione at the federal courthouse in Brooklyn on June 27, 2018.  The case is being prosecuted by Senior Litigation Counsel Patricia Notopoulos of the U.S. Attorney’s Office for the Eastern District of New York.
United States v. Yekaterina Kleydman:  The indictment charges Yekaterina Kleydman, a medical doctor, with one count of health care fraud and three counts of making false claims.  The charges stem from a scheme in which Dr. Kleydman fraudulently billed Medicare and Medicaid for cosmetic dermatological procedures that did not qualify for reimbursement.  Between January 2015 and March 2018, Dr. Kleydman billed Medicare and Medicaid approximately $2.5 million and was paid approximately $700,000 on those claims.  Dr. Kleydman was arrested, and arraigned before United States Magistrate Judge Steven L. Tiscione at the federal courthouse in Brooklyn on June 25, 2018.  The case is being handled by Trial Attorney Debra Jaroslawicz of the Criminal Division’s Fraud Section.
United States v. Harold Bendelstein:  The indictment charges Harold Bendelstein, a medical doctor, with one count of health care fraud and two counts of making false claims.  The charges stem from a scheme in which Dr. Bendelstein billed Medicare and Medicaid for incision procedures to patients’ ears, when, in fact, Dr. Bendelstein either did not perform the procedure specified or performed no procedure at all.  Between January 2014 and February 2018, Dr. Bendelstein billed Medicare and Medicaid approximately $585,000 and was paid approximately $200,000 on those claims.  Dr. Bendelstein was arrested, and arraigned before United States Magistrate Judge Steven L. Tiscione at the federal courthouse in Brooklyn on June 27, 2018.  The case is being prosecuted by Trial Attorney Debra Jaroslawicz of the Criminal Division’s Fraud Section.
United States v. Hal Abrahamson:  The information charges Hal Abrahamson, a licensed podiatrist, with one count of health care fraud.  The charges stem from a scheme in which Dr. Abrahamson submitted claims to Medicare and private insurance companies for procedures he did not perform, including skin grafts and wound packing, among other false billings.  Between 2013 and 2017, Dr. Abrahamson caused a loss of approximately $869,000 to the Medicare program and other insurers.  Dr. Abrahamson was arraigned and pleaded guilty before United States District Judge Denis R. Hurley at the federal courthouse in Central Islip on June 26, 2018.  The case is being prosecuted by Assistant United States Attorney Charles Kelly of the U.S. Attorney’s Office for the Eastern District of New York. 
The charges are merely allegations, and the defendants are presumed innocent unless and until proven guilty.
The Defendants:
WAEL BAKRY
Age:  46
Staten Island, New York
E.D.N.Y. Docket No. 17-CR-0353 (SJ)
Dr. Abraham Demoz
Age: 58
Oceanside, New York
E.D.N.Y. Docket No. 17-CR-0353 (SJ)
Victor Genkin
Age: 49
Brooklyn, New York
E.D.N.Y. Docket No. 17-CR-0353 (SJ)
Mayura Kanekar
Age: 43
Bayside, New York
E.D.N.Y. Docket No. 17-CR-0353 (SJ)
Alexander Khavash
Age: 41
Parkland, Florida
E.D.N.Y. Docket No. 17-CR-0353 (SJ)
Artem Ashirov
Age:  42
Rego Park, New York
E.D.N.Y. Docket No. 18-CR-0321 (WFK)
Gary Peresiper
Age:  52
East Rockaway, New York
E.D.N.Y. Docket No. 18-CR-0280 (SJ)
Iouri Winogradov
Age:  51
Brooklyn, New York
E.D.N.Y. Docket No. 18-CR-0317 (JBW)
Yuriy Barayev
Age:  43
Briarwood, New York
E.D.N.Y. Docket No. 18-CR-0318 (FB)
Dr. Yong Jun Kim
Age:  48
Roslyn, New York
E.D.N.Y. Docket No. 18-CR-0320 (ARR)
Dr. Yekaterina Kleydman
Age:  35
Staten Island, New York
E.D.N.Y. Docket No. 18-CR-0310 (NGG)
Dr. Harold Bendelstein
Age:  57
Far Rockaway, New York
E.D.N.Y. Docket No. 18-CR-0309 (SJ)
Dr. Hal Abrahamson
Age:  55
Melville, New York
E.D.N.Y. Docket No. 18-CR-0314 (DRH)

Essential Read!! Statement from FDA Commissioner Scott Gottlieb, M.D., on agency’s continued efforts relating to compounded drugs for patients who cannot use an FDA-approved drug

As a physician, I understand how important it can be for health care providers to treat patients with compounded drugs when a patient’s needs cannot be met by FDA-approved drugs. But because compounded drugs are not FDA-approved, it’s important for patients and the medical community to have access to information about the quality of these products. I’m also committed to developing policies and conducting oversight in a manner that seeks to promote use of FDA-approved drugs and minimize the risks to patients who are prescribed a compounded drug. 
In achieving all of these goals, we’re committed to striking the balance Congress intended between access and safety. That means taking actions to protect patients and enforce the existing laws that govern compounding.
Today, the United States Department of Justice announced numerous health care fraud enforcement actions targeting schemes billing reimbursors for medically unnecessary compounded drugs, including compounded pain and scar creams. Compounding pharmacies allegedly included specific combinations of ingredients in compounded creams to increase the billing amount. 
The FDA is aware of many pharmacies that compound topical pain creams comprised of multiple ingredients. Oftentimes, at least one of the ingredients is an active ingredient in an FDA-approved topical pain cream, such as lidocaine. The remaining ingredients may be active ingredients in drugs approved by the FDA for non-topical administration to treat non-pain related indications, such as antidepressants, anticonvulsants, antivirals and narcotics.
Clinicians and patients may not be aware of potential safety risks, or the potential lack of effectiveness, associated with certain ingredients and combinations of ingredients in their compounded topical pain creams. In the coming months, the FDA intends to announce its plan to improve the information available about compounded topical pain creams, which will help inform reimbursors’ and the medical community’s decisions about these products.
The FDA is also taking steps to ensure that outsourcing facilities, a new type of compounder created by federal legislation enacted in 2013, are compounding drugs from bulk drug substances for which there is a clinical need. In March of this year, the agency issued a draft guidance that describes how the FDA proposes to evaluate clinical need. Soon, the FDA will be announcing its plan to secure input from medical professionals about clinical need for the nominated substances. 
In addition, the FDA is inspecting compounding facilities to assess whether drugs that are essentially copies of FDA-approved drugs are being compounded for patients who could use an FDA-approved drug. As we described in our January 2018 communication, such a practice creates significant public health risks because patients are unnecessarily exposed to drugs that have not been shown to be safe and effective, and it undermines the integrity of the premarket approval processes that Congress put in place to protect patients from unsafe, ineffective, or poor quality drugs.
Furthermore, the FDA is inspecting compounding facilities not registered as outsourcing facilities to confirm that they are distributing compounded drugs pursuant to valid patient-specific prescriptions. The prescription requirement helps to ensure that drugs compounded in these facilities, which are not FDA-approved, are provided to patients based on individual patient needs.
Through these endeavors and others, the FDA is taking actions to help ensure that compounding remains a practice of customizing medications for individual patients whose needs cannot be met by FDA-approved drugs. 
We applaud efforts from our federal law enforcement partners that work with our own Office of Criminal Investigations to protect patients.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
###

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Page Last Updated: 06/28/2018 
In the Northern and Southern Districts of Alabama, 15 defendants were charged for their roles in eight health care fraud schemes involving compounding pharmacy fraud and unlawful distribution of controlled substances.

source
In the District of Connecticut, three defendants, including two medical professionals, were charged for their roles in two schemes involving compounding drugs and unlawful distribution of Schedule II and IV controlled substances. 

source 

MUST READ!! "For example, one indictment in a compounding pharmacy fraud case alleges an attorney/marketer paid kickbacks and offered incentives such as prostitutes and expensive meals to two podiatrists in exchange for prescriptions written on pre-printed prescription pads, regardless of the medical need for the prescriptions. Once the prescriptions were filled, members of the conspiracy submitted approximately $250 million in fraudulent claims to federal, state, and private insurers for the compounded drugs. "

Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Thursday, June 28, 2018

National Health Care Fraud Takedown Results in Charges Against 601 Individuals Responsible for Over $2 Billion in Fraud Losses

Largest Health Care Fraud Enforcement Action in Department of Justice History Resulted in 76 Doctors Charged and 84 Opioid Cases Involving More Than 13 Million Illegal Dosages of Opioids

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today 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 also 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, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director of the Center for Program Integrity Alec Alexander and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
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 (MFSF) 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 and/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.”
“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.”c
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly 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 over $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.
“Healthcare fraud touches every corner of the United States and not only costs taxpayers money, but also can have deadly consequences,” said FBI Deputy Director Bowdich.  “Through investigations across the country, we have seen medical professionals putting greed above their patients’ well-being and trusted doctors fanning the flames of the opioid crisis.  I want to thank the agents, analysts and our law enforcement partners in every field office who work each and every day to stop these criminals and hold them accountable for their actions.”
“DEA is committed to ending the opioid crisis occurring in our communities and preventing prescription drug misuse,” said DEA Assistant Administrator Martin.  “DEA will continue to work with our partners every day to protect our citizens while ensuring that patients have adequate access to these critical medications.”
“This year’s operations, focusing on opioid-related schemes, spotlight the far-reaching impact of health care fraud,” said HHS Deputy Inspector General Cantrell.  “Such crimes threaten the vitally important Medicare and Medicaid programs and the beneficiaries they serve.  Though we have made significant progress in our fight against health care fraud; our efforts are not complete.  We will continue to work with our partners to protect the health and safety of millions of Americans.”
“It takes a special kind of person to prey on the sick and vulnerable as happened in many of these health care fraud schemes,” said Deputy Chief Hylton.  “Medical professionals and others callously placed individuals and vital healthcare services in harm’s way simply because of greed.  IRS-CI special agents continue to work side-by-side with other federal, state and local law enforcement officers to uncover these schemes and hold these criminals accountable for their actions.”
“CMS makes it a top priority to protect the health and safety of millions of beneficiaries who depend on vital federal healthcare programs,” said Alec Alexander, deputy administrator and director of the Center for Program Integrity.  “CMS’ Center for Program Integrity collaborates closely with our law enforcement partners to safeguard precious taxpayer dollars. Under Administrator Seema Verma, we will continue to strengthen this partnership with law enforcement in order to ensure the integrity and sustainability of these essential programs that serve millions of Americans.”
“Heath care fraud wounds our service members and veterans alike, as they rely upon and rightfully expect uncompromised care through the Department of Defense’s TRICARE Program,” said DCIS Director O’Reilly.  “Investigations that culminated in enforcement actions over the past several days underscore the steadfast commitment of the Defense Criminal Investigative Service and our investigative partners to vigorously investigate fraud impacting TRICARE.  We remain vigilant in our efforts to ensure the high standards of care our service members, military retirees, and their dependents deserve while safeguarding American taxpayer dollars.” 
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 over $14 billion.
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For the Strike Force locations, in the Southern District of Florida, 124 defendants were charged with offenses relating to their participation in various fraud schemes involving over $337 million in false billings for services including home health care and pharmacy fraud.  In one case, an owner, medical director, and two employees of a sober living facility were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, and substantive counts of money laundering.  The indictment alleges a scheme that illegally recruited patients, paid kickbacks, and defrauded health care benefit programs for widespread fraudulent urine testing.  During the course of the fraudulent scheme, the facility submitted more than $106 million in claims for substance abuse treatment services. 
In the Central District of California, 33 defendants were charged for their roles in schemes to defraud insurance programs out of more than $660 million.  For example, one indictment in a compounding pharmacy fraud case alleges an attorney/marketer paid kickbacks and offered incentives such as prostitutes and expensive meals to two podiatrists in exchange for prescriptions written on pre-printed prescription pads, regardless of the medical need for the prescriptions.  Once the prescriptions were filled, members of the conspiracy submitted approximately $250 million in fraudulent claims to federal, state, and private insurers for the compounded drugs. 
In the Southern District of Texas, 48 individuals were charged in cases involving more than $291 million in alleged fraud.  Among these defendants are a pharmacy chain owner, managing partner, and lead pharmacist charged with a drug and money laundering conspiracy. According to the indictment, the coconspirators used fraudulent prescriptions to fill bulk orders for over one million pills of hydrocodone and oxycodone, which the pharmacy, in turn, sold to drug couriers for millions of dollars.  In the Northern District of Texas, a home health agency owner was arrested on a criminal complaint for a $2.6 million health care fraud scheme.
In the Eastern District of Michigan, 35 defendants face charges for their alleged roles in fraud, kickback, money laundering and drug diversion schemes involving approximately $197 million in false claims for services that were medically unnecessary or never rendered.  In one case, a physician was charged in separate kickback conspiracies with two home health agency owners, which resulted in more than $12 million in fraudulent insurance billings.
In the Northern District of Illinois, 21 individuals were charged for various fraud schemes involving home health and dental services.  These schemes involved allegedly over $54 million in fraudulent billing.  One case alleges a home health fraud and kickback conspiracy, which resulted in more than $6.2 million paid by Medicare based on the fraudulent billings.
In the Eastern District of New York, 13 individuals were charged with participating in a variety of schemes including kickbacks, services not rendered, identity theft and money laundering involving over $38 million in fraudulent billings.  For example, the owner of a Brooklyn ambulette company was charged in a $7 million conspiracy stemming from the alleged payment of kickbacks for the referral of patients, who subjected themselves to purported physical and occupational therapy and other services, and were transported by the ambulette company.
In the Middle District of Florida, 21 individuals were charged with participating in a variety of schemes involving more than $21 million in fraudulent billings.  In one case, a physician and clinic owner were charged with a conspiracy to defraud Medicare of more than $2.8 million for fraudulent home health billings.
In the Southern Louisiana Strike Force, operating in the Middle and Eastern Districts of Louisiana as well as the Southern District of Mississippi, 42 defendants were charged in connection with health care fraud, drug diversion, and money laundering schemes involving more than $16 million in fraudulent billings.  One case alleges that three pharmacy owners and a nurse practitioner conspired to unlawfully dispense controlled substances and defraud TRICARE and private insurance companies out of $12 million.
In the Corporate Strike Force, five defendants were charged in the Middle District of Tennessee with a kickback conspiracy at a durable medical equipment company, which allegedly resulted in more than $1 million in kickbacks and over $2.5 million in fraudulent billings to Medicare.
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In addition to the Strike Force locations, today’s enforcement actions include cases and investigations brought by an additional 46 U.S. Attorney’s Offices, including the execution of  search warrants in various investigations conducted by the Central and Northern Districts of California, Middle District of Florida, Southern District of Georgia, Western District of Kentucky, Eastern District of Michigan, Western District of North Carolina, Eastern and Western Districts of Texas, Eastern and Western Districts of Virginia, and Western District of Washington.
In the Northern and Southern Districts of Alabama, 15 defendants were charged for their roles in eight health care fraud schemes involving compounding pharmacy fraud and unlawful distribution of controlled substances.
In the Eastern District of California, four defendants were charged for their roles in two health care fraud schemes, one of which included forged prescriptions.
In the Southern District of California, seven defendants, including a physician, were charged for their roles in three health care fraud schemes and one scheme involving identity theft and services that were not rendered. 
In the District of Colorado, a defendant was charged with health care fraud related to billings to Medicaid and Medicare.
In the District of Connecticut, three defendants, including two medical professionals, were charged for their roles in two schemes involving compounding drugs and unlawful distribution of Schedule II and IV controlled substances. 
In the District of Delaware, a physician/owner of a pain management clinic was charged with unlawfully prescribing more than two million dosage units of Oxycodone products.
In the District of Columbia, a durable medical equipment company owner was charged with defrauding Medicaid of $9.8 million.
In the Northern District of Florida, four defendants were charged in a scheme to defraud TRICARE and other private insurance companies out of over $8 million for medically unnecessary compounded creams and pills. 
In the Northern, Middle, and Southern Districts of Georgia, 12 defendants, including two physicians, were charged in nine health care fraud, drug diversion, or compounding pharmacy schemes involving over $13.5 million in fraudulent billings. 
In the District of Idaho, three defendants, all of who are medical professionals, were charged for their roles in three separate fraud schemes involving controlled substances.
In the Central and Southern Districts of Illinois, seven defendants were charged in six separate schemes to defraud the Medicaid program.
In the Northern District of Indiana, eight defendants were charged in various health care fraud schemes to defraud both the Medicare and Medicaid programs. 
In the Northern District of Iowa, two defendants – both medical professionals – were charged for their roles in two opioid-related schemes.
In the Districts of Kansas and the Northern and Western Districts of Oklahoma, 12 defendants, including four physicians, were charged in various unlawful distribution of controlled substances schemes.  In the Western District of Oklahoma, one case marks the district’s first time charging unlawful distribution of controlled substances resulting in a death.
In the Eastern and Western Districts of Kentucky, 12 defendants, including five medical professionals, were charged in various schemes involving health care fraud, unlawful distribution of controlled substances, aggravated identity theft, and money laundering.  One case involved the operation of two false-front medical clinics.
In the Districts of Maine and Vermont, two defendants were charged for their roles in two schemes to defraud various government programs including Medicare, Medicaid, and ones run by the HHS’ Administration for Children and Families.
In the District of Nebraska, seven defendants, including one physician, were charged in five separate schemes to defraud Medicare, Medicaid, and various HHS programs.
In the District of Nevada, four defendants, including three medical professionals were charged with conspiracies to commit health care fraud and distribute controlled substances. 
In the District of New Jersey, eight defendants, including a New York doctor, an anesthesiology technologist for a Philadelphia hospital, and the owner of a medical billing company, were charged for their roles in five schemes to defraud private insurance companies of over $16 million. 
In the Southern District of New York, two defendants were charged in schemes involving health care fraud or drug diversion.
In the Middle District of North Carolina, two defendants were charged with a conspiracy to defraud Medicare out of over $4 million.
In the Southern District of Ohio, three defendants – all medical professionals – were charged for their roles in two health care fraud schemes, one of which involved illegal drug distribution and kickbacks.
In the Eastern and Middle Districts of Pennsylvania, 12 defendants were charged for their roles in three drug diversion schemes.
In the Western District of Pennsylvania, four defendants – all physicians – were charged in various health care fraud and drug diversion schemes. One scheme involved 32,000 dosage units of buprenorphine.
In the District of Rhode Island, one defendant was charged for participating in a theft and aggravated identity theft scheme.
In the District of South Carolina, three defendants were charged for their separate roles in a conspiracy to possess with the intent to distribute fentanyl.
In the District of South Dakota, two defendants were charged in separate cases, one of which involved a scheme to defraud the Indian Health Service.
In the Middle District of Tennessee, 10 defendants were charged in two separate schemes, including a conspiracy to fraudulently obtain oxycodone.
In the Eastern District of Texas, two defendants were charged for their role in health care fraud schemes to defraud the Medicare and Medicaid programs.
In the District of Utah, two defendants were charged in two cases, one of which involved a $31 million scheme to defraud Medicare and Medicaid.
In the Western District of Virginia, eight defendants were charged for their alleged roles in health care fraud schemes.  One $45 million scheme to defraud Medicaid involved falsification of documents in patient files.
In the Eastern District of Washington, a dentist and another individual were indicted for distributing and conspiring to distribute hydrocodone and tramadol without a legitimate medical purpose. 
In the Eastern District of Wisconsin, three defendants were charged in a scheme involving the unlawful distribution of controlled substances and aggravated identity theft.
In addition, in the states of Arizona, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maine, Michigan, Missouri, Mississippi, Nevada, New York, Oklahoma, Pennsylvania, Texas, Vermont, and Washington, 97 defendants have been charged with defrauding the Medicaid program out of over $27 million.  These cases were investigated by each state’s respective Medicaid Fraud Control Units.  In addition, the Medicaid Fraud Control Units of the states of California, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Nevada, North Carolina, Ohio, Texas, Tennessee, and Virginia participated in the investigation of many of the federal cases discussed above. 
The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section and from the U.S. Attorney’s Offices in the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois, Middle District of Louisiana, and the Middle District of Florida; and agents from the FBI, HHS-OIG, DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and state Medicaid Fraud Control Units.
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.
Additional documents related to this announcement will shortly be available here: 
This operation also highlights the great work being done by the Department of Justice’s Civil Division.  In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2 billion in judgements and settlements related to matters alleging health care fraud. 
Topic(s): 
Bankruptcy
Health Care Fraud
Press Release Number: 
18-866

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