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Showing posts with label Medicare fraud. Show all posts
Showing posts with label Medicare fraud. Show all posts

Thursday, October 14, 2010

44 Charged in Huge Medicare Fraud Scheme

NY Times

 
An Armenian-American crime syndicate stole the identities of doctors and thousands of patients and used them and more than a hundred spurious clinics in 25 states to bill Medicare for more than $100 million for treatments no doctor ever performed and no patient ever received, the federal authorities announced on Wednesday.

Prosecutors said the case represented the largest Medicare fraud operation ever carried out by a single group that resulted in criminal charges. The group succeeded in stealing $35 million in Medicare reimbursements, officials said, before the charges were leveled and arrests were made on Wednesday.

The “highly organized massive scheme” is at the heart of a racketeering indictment and other charges unsealed in federal court against 44 people, including a number of members of the Armenian crime group, according to the F.B.I. and federal prosecutors in New York and Georgia.

“With 118 phantom clinics and over $100 million in bogus billings, this group of international gangsters allegedly ran a veritable fraud franchise,” Preet Bharara, the United States attorney in Manhattan, said in a statement announcing the charges. “As charged, they stole taxpayer dollars earmarked for the elderly and infirm and got away with it, until now.”

As of early Wednesday afternoon, 41 of the people accused had been arrested, 21 of them in the New York City area, and a number of others in Los Angeles and elsewhere, the authorities said. They included Armen Kazarian, whom the authorities identified as a “Vor,” a term that means “thief-in-law” and refers to a member of a select group of high-level criminals from Russia and the countries that had been part of the Soviet Union, including Armenia.

Prosecutors said that Mr. Kazarian’s arrest signified the first time a Vor has been charged in the United States with racketeering crime, and the first time since 1996 that a known Vor has been arrested on any federal charge.

The indictments (see also below) were announced at a Wednesday afternoon news conference by Mr. Bharara; Janice K. Fedarcyk, the assistant director in charge of the New York F.B.I. office; James T. Hayes Jr., the special agent in charge of the New York Office of Homeland Security Investigations; Police Commissioner Raymond W. Kelly; and other officials.

“The diabolical beauty of the Medicare fraud scheme — from the criminals’ standpoint — was that it was completely notional,” Ms. Fedarcyk said in a statement released in the early afternoon. “There were no real medical clinics behind the fraudulent billings, just stolen doctors’ identities. There were no runners or colluding patients showing up at clinics for unneeded or “upcoded” treatments, just stolen patient identities. The whole doctor-patient interaction was a mirage.”

Twenty-eight of 44 defendants were named in a racketeering indictment unsealed in New York. Additional indictments were unsealed on Wednesday in related cases by the United States attorneys in Los Angeles, Cleveland, Albuquerque, and Savannah, Ga.

The group used the stolen identities of the doctors and patients to bill Medicare for more than $100 million in nonexistent treatments over four years, according to a news release announcing the charge. And while the news release said Medicare would identify and shut down the bogus clinics after several months, in many cases “Medicare had already paid millions of dollars to the phony clinics — more than $35 million in total — and that money had already been withdrawn and sometimes transferred overseas.”

The group, official said, was aware that each clinic had a limited shelf life and would simply turn to another fraudulent clinic — they existed only on paper with an address that was usually a mail drop — operating at least 118 in 25 states including Michigan Medicare.

The racketeering indictment charges 28 defendants, including Mr. Kazarian, with crimes tied to the operation of the Armenian-American organized crime group, which it identifies as the Mirzoyan-Terdjanian Organization, a nationwide criminal operation with strong ties to Armenia. The group’s leadership is based in New York and Los Angeles, but its operations extend throughout the United States and overseas.

The indictment maintains that that the scheme operated with the assistance of, and under the protection of, Mr. Kazarian. The group’s members and associates are charged with numerous crimes, including racketeering, health care fraud, identity theft, money laundering and bank fraud. The indictment says members and associates of the organization are alleged to have used violence and threats of violence to ensure respect for and payments to its leadership.

Tuesday, June 9, 2009

The Nursing Home Abuse Center To Team With Law Firms In All 50 States
Story from PR Web

The Nursing Home Complaint Center Wants To Team Up With Personal Injury Law Firms To Stop Nursing Home Abuse & Medicare Fraud

medicare fraud lawyerThe Nursing Home Abuse Center intends to go after nursing homes, that abuse their patients, and wants to assist law firms that also have an interest in Medicare-Medicaid fraud, Class actions, and employee wage and hour issues. According to the group, "we want to align ourselves with larger personal injury law firms in specific cities, where we know nursing home abuse, Medicare or Medicaid fraud, and employee wage, and hour issues are wide spread, to stop these types of practices.."

Personal Injury Law Firms, class action law firms, or employment law firms that might have an interest in this are welcome to call the group at 866-714-6466, or visit their web site at Http://NursingHomeComplaintCenter.Com.

(PRWEB) June 8, 2009 -- The Nursing Home Complaint Center has been created to be the premier advocacy group in the nation, for senior citizens suffering wrongful death, abuse and neglect. At the same time the Nursing Home Complaint Center will focus on Medicare-Medicaid fraud, class actions, and wage and hour investigations in most major US cities. The Nursing Home Complaint Center wants to team up with law firms in each US state, that have a personal injury practice, with a focus on elder abuse, class actions, and/or employee wage and hour issues. This is a year-long project, and there will be a modest fee involved, for listing the participating law firms on the site. For more information, interested law firms can call Americas Watchdog's Nursing Home Complaint Center anytime at 866-714-6466, or contact the group via its web site at Http://NursingHomeComplaintCenter.Com.

So what types of issues is the group looking for? Americas Watchdog says, "once our legal team is in place, the Nursing Home Complaint Center will focus weekly press releases on elder abuse, Medicare or Medicaid fraud, Class Actions, or Wage and Hour investigations." As follow:

  • Nursing home neglect that involves wrongful death
  • Nursing homes not providing patients with minimum time per day.
  • Nursing homes over billing Medicare for testing that was never done.
  • Nursing homes not changing patients. (the patient then gets septic infections and then they often die)
  • Nursing-homes, or elder care firms that, instead of sending an actual nurse, or LPN, send a undocumented worker to spend the day with the patient.
  • Nursing homes not paying overtime to their employees, or abiding by FLSA.
  • Possible class issues related to standard of care, drug costs, testing schemes, etc.

The group says, "this is all about protecting our elderly, the taxpayer, and the employee, all at the same time."

According to the Nursing Home Complaint Center, "These are but a few of the issues that we intend to go after, and expose. The great thing for the personal injury law firm, class action firm, wage and hour firm, or Medicare fraud lawyer is we have experience doing every aspect of the investigation, we know exactly what we are looking for, and we have a great plan that should produce dramatic results for everyone involved."

According to the Nursing Home Complaint Center, "the ideal medium-to-large law firm would specialize in personal injury, with a practice emphasis on wrongful death, nursing home abuse, class action type issues, and/or wage and hour issues, etc. These types of lawyers will know exactly what we are talking about, they will understand the scope of the problem, and if they are in one of our target markets/states, they will understand exactly why we intend to have an insider campaign as part of this initiative."

These type of law firms are welcome to call Americas Watchdog anytime at 866-714-6466, or contact the group via their web site at Http://NursingHomeComplaintCenter.Com.

Thursday, October 2, 2008

Medicare Drug Premium on Rise

Medicare Drug Premium on RiseThe average premium that seniors will pay for Medicare drug coverage in 2009 will rise, with the average for the 10 most-popular plans increasing 31%, according to an analysis of new government data.

The average premium will increase 24% to $37 a month for all standalone drug plans, up from $30 this year, according to Avalere Health LLC, a Washington, D.C., consulting company that analyzed data from Medicare, the federal health-insurance program for seniors.

The average monthly premium for Humana Inc.'s basic plan, for example, will rise to $40.83 in 2009 from $25.52 this year and $9.51 in 2006, the cheapest plan that year. The plan is the second largest by enrollment, with 1.5 million participants, and overall, Humana has 3.4 million people enrolled in Medicare drug plans. Monthly premiums can vary from county to county.

The nation's most popular plan with 2.7 million participants, UnitedHealth Group Inc.'s AARP "preferred" plan, will raise its average monthly premium to $37, 15.5% more from 2008. Overall, UnitedHealth plans have 5.4 million enrollees.

UnitedHealth declined to comment on its Medicare premium increases for 2009. But the company had blamed high Medicare drug costs for part of its poor earnings performance this year. It also raised premiums across the board, in both its own branded plan and those under the AARP name.

Humana spokesman Tom Noland said the increases reflect rising costs. "If [premium] prices are increasing more on the midlevel plans, it's simply because our experience tells us that's where we need to be -- premium-wise -- to cover our actual costs plus a small margin," he said.

When the drug program began in 2006, Humana's premiums were among the cheapest. Humana, Mr. Noland said, has provided the most cumulative value for its drug-plan members, saving them an average of $4,900 on drug costs during that time and that the premiums are still in line with rivals.

The drug plans are heavily subsidized by the federal government and are offered through private insurance companies. Insurers will begin advertising their plans Oct. 1, and the six-week enrollment period starts in mid-November.

It's unclear how the price increases will affect the market. Medicare beneficiaries tend to select a plan and stay with it, and the market is highly concentrated.

Administrators of Centers for Medicare and Medicaid Services, the federal agency that manages Medicare, say beneficiaries should shop around to avoid premium increases and Medicare fraud.

By: Jane Zhang and Vanessa Fuhrmans
Wall Street Journal; September 26, 2008

Tuesday, September 23, 2008

Guilty Plea in Fraud at Hilfiger Licensee

The former chief financial officer of Tommy Hilfiger Group's handbag licensee pleaded guilty to fraud charges in the theft of more than $19 million over a seven-year period.

The U.S. Attorney for the Southern District of New York said Tuesday that Martin S. Bodner, former chief financial officer of Tommy Hilfiger Handbags & Small Leather Goods Inc., an independently owned licensee of Tommy Hilfiger Group, pleaded guilty to mail fraud and wire fraud charges. According to court papers, the theft occurred while Mr. Bodner was employed by the handbag licensee from the middle of 2000 to the end of December 2007.

Mr. Bodner, 60 years old, agreed to repay the licensee an amount no less than $19.6 million minus the $2.5 million Mr. Bodner has already returned to the company. He also agreed to forfeit a home in Sands Point, N.Y., a Manhattan apartment, three cars and various other property. Mr. Bodner is scheduled to be sentenced on Nov. 5. The sentencing guidelines in the plea agreement said a prison sentence within "the range of 63 to 78 months is reasonable." The court may also impose a fine ranging from $12,500 to $125,000, the plea agreement says.

Mr. Bodner's attorney, Matthew Menchel had no comment. Ludo Onnink, chief financial officer of Tommy Hilfiger Group, said in an email message that Tommy Hilfiger Handbags & Small Leather Goods -- which changed its name from Dickson North America in 2000 -- has been a licensee to Hilfiger Group for nine years. "We are not involved in the fraud of this guy and have no ownership or interest in Tommy Hilfiger Handbags & Small Leather Goods," Mr. Onnink said.

Mr. Bodner was first arrested in connection with the fraud on Dec. 21, 2007, by the Federal Bureau of Investigation. According to court papers, Mr. Bodner supervised the handbag licensee's payroll, which gave him control over the amounts the company paid to its employees through a third-party payroll service.

Court documents state that Mr. Bodner began stealing money from the licensee by secretly increasing his salary and bonus as well as getting reimbursed for phony business expenses. Court papers state Mr. Bodner directed the firm's payroll service to increase his compensation by $14,712,000 during his six-and-a-half-year tenure.

Mr. Bodner also put one of his sons on the payroll during 2004 and 2005, with a salary of $225,500, "when in truth and in fact (Mr.) Bodner's son did not work," for the licensee, according to court papers. Mr. Bodner "caused hundreds of checks to be issued to various payees for the purpose of paying off (his) personal credit card bills, purchasing a luxury automobile for himself, paying for insurance for a home, apartments, and automobiles owned by Mr. Bodner, and paying for decorating services," court papers said.

By: Teri Agins
Wall Street Journal; September 17, 2008

Friday, September 12, 2008

Senators Protest Whistleblower Policy

Two U.S. senators accused the Department of Labor of violating the "spirit and goals" of a federal law aimed at protecting employees who report corporate wrongdoing and Medicare fraud, and called on the agency to stop rejecting claims from workers at subsidiary companies.

In a letter to Secretary of Labor Elaine Chao, Sen. Patrick Leahy, a Vermont Democrat who is chairman of the Judiciary Committee, and Sen. Charles Grassley, an Iowa Republican who also is on the committee, wrote that they were dismayed that the "administration -- the Department of Labor in particular -- has been using overly restrictive interpretation of this law to dismiss a majority of the complaints" filed under the whistleblower-protection provisions of the 2002 Sarbanes-Oxley Act.

Sen. Leahy and Sen. Grassley, who wrote those provisions, said that "there is simply no basis to assert" that employees of the subsidiaries of publicly traded companies aren't covered under the act, as the department has asserted in numerous recent cases.

The letter cited an article in The Wall Street Journal last week that reported on the department's stance. Department records show the government has ruled in favor of corporate whistleblowers 17 times out of 1,273 complaints filed since 2002. An additional 841 cases have been dismissed, the records show, with many of the dismissals made on subsidiary-exclusion grounds. The rest of the cases are either pending, withdrawn, or were settled.

In a statement, the Labor Department said it would respond fully to the concerns of the senators. But the agency said, "We are confident we are correctly enforcing the statute, and do not believe the text of Sarbanes-Oxley as written supports the broader reading that employees of subsidiaries are automatically covered."

Tom Devine, legal director of the Government Accountability Project, a nonprofit group that promotes whistleblower rights, called the department's stance "dysfunctional," saying: "This one is a no-brainer. There is nothing in the law that allows for that type of loophole."

The senators asked the department to supply documentation and a response supporting the agency's position -- and until that time, to suspend its interpretation that exempts employees of subsidiaries.

The department's Occupational Safety and Health Administration enforces the whistleblowers' provisions, which prohibit publicly traded companies or "any other officer, employee, contractor, subcontractor, or agent of such company" from retaliating against employees who provide information or assist in investigations related to alleged fraud.

In their letter, the legislators wrote that the whistleblower provision was a direct response to fraud perpetrated by Enron Corp., "through the misuse and abuse of its shell corporations and subsidiaries."

Cases dismissed on the subsidiary-exclusion rule include whistleblower complaints against the German manufacturing conglomerate Siemens AG, London media titan WPP Group PLC; ING Groep NV of the Netherlands; Alabama insurer Torchmark Corp.; and Florida investment firm Raymond James Financial Inc. The companies have declined to comment on the cases.

Another pending case involves UBS AG, the Swiss bank. An attorney says the Labor Department has asked him to show that the UBS unit that employed his client is covered under the act. UBS declined to comment.

By: Jennifer Levitz
Wall Street Journal; September 10, 2008

Thursday, September 11, 2008

Humana to Lose Some Medicare Enrollees

Humana Inc. said it expects to lose nearly 10% of its Medicare drug-plan enrollees at the start of 2009 because it bid premiums too high to win an allotment of low-income, government-assigned members.

Although some analysts suggested this might be positive for Humana's bottom line, since higher prices could bolster earnings and these members yield little profit, the Louisville, Ky., health insurer's stock took a hit Tuesday. Humana shares fell nearly 5% to $41.75 in after-hours trading after it announced it would lose all of its 308,000 "dual-eligible" Medicare members, a source of instant market share for many of the companies that sell and administer the benefit.

This group comprises more than six million Medicare beneficiaries who are so poor that they also qualify for the joint state-federal Medicaid program. To ensure they still get drug coverage and to avoid Medicare fraud, the government provides a fully subsidized benefit and automatically allocates them among those private drug-plan providers that end up submitting bids below the average of those received.

UnitedHealth Group Inc., with 5.4 million drug-plan members, is the biggest provider. Humana has 3.1 million enrollees.

Wall Street Journal; September 10, 2008

Thursday, September 4, 2008

Two Charged in Medical-Care Billing Scam

A top hospital official and the operator of a homeless facility face federal Medicare fraud charges for their alleged involvement in an elaborate plan to recruit homeless individuals for unnecessary health-care treatment and then bill the government for it.

Federal Bureau of Investigation agents on Wednesday arrested Rudra Sabaratnam, chief executive of City of Angels hospital, and Estill Mitts, operator of a homeless assessment center in Los Angeles's downtown "Skid Row," for conspiring to persuade homeless people to act as patients in an attempt to fill beds, according to the U.S. attorney's office here.

"Individuals who saw a great deal of money were trying to line their pockets illegally with millions of dollars that were intended to go to the elderly and the sick," said U.S. Attorney Thomas P. O'Brien. Mr. O'Brien said the investigation was ongoing and he expects other defendants to be indicted in the near future.

Lawyers for Messrs. Sabaratnam and Mitts couldn't be reached for comment.

At the same time, Medicare fraud whistleblowers have filed civil charges against three Southern California hospitals where search warrants were served Wednesday as well as against their chief executive officers and other alleged co-schemers, including an ambulance company.

Lured by the promise of money -- about $30 -- homeless individuals checked into hospitals, where they often received unnecessary and even potentially harmful diagnoses or treatments, according to the civil complaint. One homeless patient was given a nitroglycerin patch, which dropped her blood pressure to such levels that her life was imperiled, said Los Angeles City Attorney Rocky Delgadillo. As a result, Medicare and Medi-Cal, a joint federal and state program, were billed for the false services and provided the hospitals with compensation.

Los Angeles's sizable homeless population has been the subject of controversy in recent years, as some hospitals have been charged with dumping their discharged patients onto the streets of Skid Row. A new city ordinance, believed to be the first of its kind in the nation, makes it a misdemeanor for health facilities to transport a patient to a place other than his or her residence without written consent.

This investigation began as a result of a videotape by Los Angeles Police Department officers who noticed an ambulance dropping off five homeless people in downtown Los Angeles. One of those homeless individuals later came forth to reveal information about the alleged recruitment scheme.

"This is a shameless exploitation of the homeless population," said Mr. Delgadillo. "Skid Row has served as a cloak of chaos. But we're peeling back the onion and sending the message to these charlatans that the city and our residents do care about those who are in the most vulnerable situation in L.A."

By: Amy Kaufman
Wall Street Journal; August 7, 2008