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Health Care Fraud Blog

Covers fraud in Medicare, Medicaid and insurance benefits.
By Robert David, Esq.

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Last Entry: November 17, 2009 at 14:01:34

CMS Efforts To Use Software to Detect Fraud

Posted on November 17, 2009
CMS uses contractors to process claims, but also to use sophisticated software to detect fraud patterns and make referrals for claims denials, audits and criminal investigations. At one time the system was somewhat fragmented, given that there are different contractors...

FBI, OIG, HEAT How About SFO - ?Serious Fraud Office??

Posted on November 16, 2009
We have done posts on the various monikers given to task forces, including the most recent in healthcare fraud, HEAT (Healthcare Fraud Prevention and Enforcement Team) and the agencies in involved in those investigations; the FBI (Federal Bureau of Investigation),...

Are Large Corporations Treated Differently? Pfizer $2 Billion False Claims Act Settlement Is Its Second In Six Years

Posted on November 13, 2009
Often, we hear that white collar crime is treated differently than other types of crime. However, it is often who commits white collar crime that brings about different treatment. I had a client indicted for fraud related to a DME....

Increased Penalties for Health Care Fraud Likely

Posted on November 10, 2009
Proposals to increase the criminal penalties for health care fraud are making their way into the Senate?s health care reform bill. The proposal, The Health Care Fraud Enforcement Act, involves significant increases in potential jail time through modifications of the...

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Medicare Fraud Bumps Workers Comp Fraud Off The Radar?

Posted on November 09, 2009
Budget priorities and redirection of investigations at the state level, has led to a drop off in investigations of workers compensation fraud at a time when such fraud is increasing, according to investigators. The focus on Medicare and Medicaid fraud...

Whistleblower Lawsuit Alleges Medicare Fraud by Fresenius North America

Posted on November 07, 2009
A Federal False Claims Act Case filed by an employee of a dialysis center owned by Fresenius North America, which has over 1500 clinics serving dialysis patients, alleges that a clinics in El Paso and elsewhere used unlicensed employees...

$60 Billion A Year In Medicare Fraud, Where Does That Number Come From?

Posted on November 06, 2009
In a Sixty Miutes piece on Medicare Fraud, reviewed by the HCFBlog here, Steve Kroft claimed the government loses $60 Billion to health care fraud. The piece, otherwise quite good, then goes on to describe some of what we...

West Publishing to Release White Collar Crime: Health Care Fraud Practice Guide

Posted on November 05, 2009
After 15 long months of hard word work, West Publishing is almost ready to release my book. The book is expected to be released before the end of the month. In the mean while, the publisher just sent me...

Health Care Fraud Heads North, But Miami Is Still Home

Posted on November 03, 2009
Part of the Health Care Fraud Task Force initiative in Miami, Houston, Detroit and Los Angeles has met with some success, and not so coincidently some of the cases have Miami roots. The FBI press release related to a plea...

Organized Crime and Medicare Fraud

Posted on October 28, 2009
The AP does an interesting story on the influence of organized crime on Medicare Fraud, including some violence associated with the schemes. Former drug dealers and mobsters are getting more involved in the fraud due to the lower criminal penalties...

60 Minutes Features South Florida in Medicare Fraud Expos�

Posted on October 27, 2009
This past Sunday night, 60 Minutes ran an excellent expos� on the $60 billion Medicare Fraud crime wave sweeping the country. 60 Minutes correspondent Steve Kroft spent some time in Miami this past August with FBI Special Agent Brian Waterman...

Upping the Ante in Pain Management Prosecutions: Orlando Area Doctor Charged With Drug Trafficking and Medicare Fraud

Posted on October 20, 2009
Dr. Jeffrey Freidlander of Lakeland , Florida was charged in the Middle District of Florida with trafficking in controlled substances including oxycontin, morphine and hydrocodone. The indictment alleges that the physician pre-signed prescriptions and allowed his staff of non-physicians to...

Patient Reactions to Fraud / Abuse Accusations

Posted on October 19, 2009
As a follow up to last week?s posting on pain management enforcement, we indicated that investigations concerning abuse in pain management focus on the treatment as opposed to a fraudulent claim. There is no crime of practicing bad medicine; physicians...

Fraud Crackdown Having Consequences For Licensees

Posted on October 19, 2009
The health care fraud bill past last year by the Florida Legislature had a number of ?get tough? provisions; including an extended list of disqualifying offenses for licensure, including some misdemeanors or other minor offenses. The law includes that a...

Prescription Drug Abuse Looks To Be A Focus of More Criminal Investigations

Posted on October 16, 2009
Pain Management, among other forms of drug related treatment, has been receiving substantial scrutiny lately. Unlike some other fraud or abuse investigations predicated upon whether services were provided or claims were fraudulent, the primary focus is the treatment, why the...

Miami Herald Recommends More Resources to Combat Health Care Fraud

Posted on October 12, 2009
MIAMI, FL (October 12, 2009) Today the editorial board of the Miami Herald weighed in on the national health care reform debate by pointing out that the current health care system - Medicaid and Medicare - has insufficient front-end mechanisms...

Defendant Sentenced to 12+ Years in DME & Money Laundering Scam

Posted on October 02, 2009
MIAMI, FL (September 29, 2009) Defendant Daniel Martinez, of Davie, Florida, was sentenced for his participation in a $20 million health care fraud and money laundering scheme. U.S. District Judge Paul C. Huck sentenced Martinez to a total of a...

Miami Medical Equipment Supplier Sentenced to Eight Years

Posted on September 23, 2009
MIAMI, FL (September 22, 2009) Today the Miami Herald reported that ?A fugitive who claimed to be Mexican but was betrayed by his Cuban accent -- which led to his arrest in Spain -- was sentenced to eight years' imprisonment...

Three Arrested in Medicaid Fraud Conspiracy

Posted on September 16, 2009
TALLAHASSEE, FL (September 16, 2009) Attorney General Bill McCollum announced that three people have been arrested and accused of conspiring to defraud the Florida Medicaid program out of at least $112,000. Larry Hill is charged with Medicaid provider fraud and...

Pfizer to Pay U.S. $2.3 Billion

Posted on September 03, 2009
WASHINGTON, D.C.(September 2, 2009) The U.S. Department of Justice announced the largest health care fraud settlement in history. A landmark $2.3 billion health-care fraud settlement involving Pfizer Inc., has put the pharmaceutical industry on notice that promoting drugs for unauthorized...

If You Commit Fraud, Don?t Buy A Nice Car

Posted on August 25, 2009
From experience as criminal defense attorneys, nothing enrages agents and prosecutors more than extravagances by those accused. That is why good defense attorneys will make sure a client being accused of stealing vast or even minor sums of money...

Pharmaceutical Sales Reps Allege Kickbacks To Physicians

Posted on August 18, 2009
In a case originating in the 1990?s, former pharmaceutical sales representatives for Johnson and Johnson (J&J) alleged 80% of a medication they marketed, Procrit, was used to commit Medicare Fraud; an amount equal to $3 billion for the company as...

You?re Probably A Federal Criminal

Posted on August 03, 2009
Of general interest and with particular application in health care, the federal government has, over the course of several decades, criminalized an entire range of behavior that most people did not know or perceive to be criminal. This is not...

Legislative Wrap Up: Miami-Dade County as the Epicenter of Health Care Fraud

Posted on July 22, 2009
We have previously written about the federal government?s HEAT, a task force dedicated to rooting out health care fraud in several cities very prominently including Miami. In the last legislative session, the Sate of Florida also got into the Act....

Florida Gets Tough on DME Licensure, Operating Home Health Agencies & Clinics

Posted on July 21, 2009
Florida is among the few states that permit what is referred to as the ?corporate practice of medicine.? In many other states, medical and other health care entities are required to be owned by medical professionals individually or through professional...

Another Internet Pharmacy Trial Ends in Mistrial

Posted on July 15, 2009
By Robert David Malove, Esquire Exclusive to the Health Care Fraud Blog SAN DIEGO (July 15) In San Diego, on the 44th day of a trial highly touted ?Affpower enterprise? internet pharmacy prosecution by the Justice Department, seven defendants learned...

The HEAT is on!

Posted on July 14, 2009
A new moniker in the long list of federal task forces. Federal Agencies generally get the three letter moinker; FBI, IRS, CIA, OIG, DOD, etc. Task forces get more letters and try to do acronyms; HIDTA (DEA), FinCEN, OFAC (Treasury),...

Medicare Fraud and Cuba?

Posted on July 03, 2009
The recent arrests of by the DOJ-HHS health care fraud task force, HEAT, of 52 individuals related to Medicare Fraud in Detroit, and the allegation that the crimes were somewhat commuter crimes, brought to Detroit from Miami has also raised...

CEO of Insurer, WellCare, Resigns Following Fraud Settlement

Posted on July 02, 2009
The CEO of WellCare Health Plans, Inc., Health Schiesser, resigned after the insurer reached an agreement to settle claims with the federal government and Florida Medicaid for $80 million. The company is also keeping a reserve of $50 million to...

Miami Physician Sentenced to 97 Months in HIV Infusion Fraud

Posted on July 01, 2009
MIAMI, FL (June 29) In the ongoing prosecutions by the joint DOJ-HHS task force, another physician, Roberto Rodriguez was sentenced to 97 months in prison and ordered to pay over $9,000,000 in restitution in connection with $20,000,000 in fraudulent claims...

THOMPSON-WEST SELECTS FORT LAUDERDALE LAWYERS WEINTRAUB & MALOVE TO WRITE HEALTH CARE FRAUD PRACTICE GUIDE

Posted on June 30, 2009
FOR IMMEDIATE RELEASE FORT LAUDERDALE, FL (June 29) After conducting a nationwide search, Thompson-West, the leader in legal information solutions, has selected Fort Lauderdale lawyers, Benson Weintraub and Robert David Malove to develop a guide and treatise in the area...

EIGHT MORE MIAMI-AREA RESIDENTS CHARGED IN $22 MILLION MEDICARE FRAUD SCHEME INVOLVING HOME HEALTH CARE

Posted on June 28, 2009
MIAMI, FL (June 26) - Gladys Zambrana, Javier Zambrana, Enrique Perez, Alejandro Hernandez Quiros aka Alex Hernandez, Vanessa Estrada, Vicenta Tellechea, Modesto Hidalgo and Carlos Castaneda were indicted in connection with an alleged $22 million Medicare fraud scheme operated out...

Medicare Fraud Strike Force Operations Lead to Charges Against 53 Doctors, Health Care Executives and Beneficiaries for More Than $50 Million in Alleged False Billing in Detroit Early Morning Takedown Leads to Arrests in Detroit, Miami and Denver

Posted on June 25, 2009
WASHINGTON (June 24, 2009) ? According to a joint press release issued by the Department of Justice Press U.S. Department of Health and Human Services, fifty-three people have been indicted for schemes to submit more than $50 million in...

Pharmaceutical Company Manager Sentenced for Off-Label Marketing

Posted on June 19, 2009
A Branchburg, NJ, woman, Mary Holloway, age 47, was sentenced in U. S District Court in Massachusetts for violating the Food, Drug and Cosmetic Act for marketing the drug Bextra for uses and dosages that were not approved by the...

OWNER OF AGING CARE HOME HEALTH CARE SENTENCED IN FEDERAL COURT FOR FALSIFYING HEALTH CARE RECORDS

Posted on June 16, 2009
On June 15th, JANICE DAVIS, age 62, of West Monroe, was sentenced in United States District Court for the Western District of Lousianna for healthcare fraud. DAVIS was sentences to spend 15 months in federal prison and a term of...

Maimi Herald Reporter Wins Award for Medicare Fraud Expos�

Posted on June 01, 2009
The Miami Herald received 17 Sunshine State Awards Saturday, including top honors for coverage of deadly storms in Haiti, Medicare scandals, failed transit projects and rogue mortgage brokers. The South Florida chapter of the Society of Professional Journalists awarded The...

ACHA Conducts ?Sweep? Of Entire County Of Providers

Posted on May 28, 2009
?Sweeps? among law enforcement are generally used in high drug crime areas to literally sweep in and arrest as many people as possible to clear out the drug dealing in that area. In a modification of the theme, the State...

The HEAT is on as Feds Launch Crackdown on Healthcare Fraud

Posted on May 21, 2009
According to a press release, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder launched an interagency high-level task force to help detect and prevent health-care fraud, which robs the nation's coffers of billions of dollars each year...

Wyeth Gets Agita From Whistleblower Law Suit Seeking Hundreds Of Millions For Stomach Acid Medication Rebates

Posted on May 20, 2009
The Justice Department and 16 Attorneys General joined a whistleblower lawsuit alleging that Wyeth Labs offered lower prices on two prescription drugs that were not offered to the Medicaid Programs of the various states avoiding hundreds of millions of dollars...

Number of Medicare Fraud Fugitives Leads To Stricter Supervision Of Charged Defendants

Posted on May 20, 2009
Some 60 defendants charged with Medicare Fraud in the Southern District of Florida have fled pending trial since 2004. Many who have fled are of Cuban origin, leading authorities to conclude that they have returned to Cuba, which is generally...

Medicare Errors Account For $2.8 Billion A Year

Posted on May 17, 2009
One study by CMS found that up to 70% of payments for some medical equipment should not have been due to a failure to document the medical necessity for the equipment provided under CMS guidelines. In 2008, the errors resulted...

Citing Savings, OIG to Increase Fraud Enforcement

Posted on May 12, 2009
Newly appinted Secretary of HHS, Kathleen Sebelius, has stressed health care fraud enforcement, citing that for every dollar spent on fraud and abuse detection and enforcement, the government receives $1.55 in savings. $1.7 billion over the next ten years has...

Pharmaceutical Wholesaler Agrees To $500,000 Settlement On Diverted Drugs

Posted on May 08, 2009
An Ohio pharmaceutical wholesaler, Masters Pharmaceutical, Inc, agreed to pay $500,000 and entered into a consent decree pertaining to compliance with DEA regulations in settlement of claims that the distributor unlawfully supplied controlled substances to unlawful internet pharmacies and failed...

WellCare to pay $80 million to Florida Medicaid, Healthy Kids

Posted on May 06, 2009
WellCare Health Plans, Inc., Florida ?s largest managed care provider, has agreed to pay $80 million in forfeiture and restitution to Florida?s Medicaid program. WellCare also entered into an agreement for compliance and monitoring in a deferred prosecution agreement with...

Scam Artists Hawk Fraudulent Medicare Kit

Posted on May 05, 2009
Telemarketers in Houston are pushing ?Medicare approved arthritis kits? that are really an assortment of DME and prosthetic devices billed to Medicare individually. Barbara McGinity with the Better Business Bureau explains that the scam artists have taken something Medicare will...

New Mortgage Fraud Law May Expand False Claims Act

Posted on May 01, 2009
The Senate recently approved the Fraud Enforcement and Recovery Act of 2009, originally designed to combat mortgage fraud, however the Act also expands the Federal False Claims Act, generally brought by whistleblowers against health care providers. Pursuant to the...

The Rise & Fall of a Home Health Care Company

Posted on May 01, 2009
HealthEssentials was a Louisville, KY company providing nurse practitioner services to geriatric patients at assisted living facilities and nursing homes. The company, which started in 1998, grew quickly and at one point had operations in 18 states with revenues of...

Medicaid Fraud With a Twist

Posted on April 30, 2009
A garden variety Medicaid fraud case with a twist. A pharmacist in the Pittsburgh area was arrested for false claims to Medicaid and a private insurer for medications not ordered or provided. However, the pharmacist is also accused of submitting...

Medicaid Fraud Enforcement Doubles In NY

Posted on April 30, 2009
Attorney General Andrew Cuomo announced that the State of New York has recovered $263 million in Medicaid funds in 2008, the most in any year and up from $114 million in 2007. $35 million came from one managed care provider,...

What is Medical Necessity?

Posted on April 28, 2009
The term ?medically necessary? in the context of Medicare and Medicaid reimbursement has been under some scrutiny lately. Medicare defines "medical necessity" as services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to...

Florida Passes Tougher Anti-Medicaid Fraud Law

Posted on April 28, 2009
In a move targeted to increase health care fraud enforcement by the State of Florida, the Florida legislature has recently passed legislation containing a number of new fraud provisions, including: * elevating Medicaid fraud from a third degree felony to...

Physicians, Fraud & COPD

Posted on April 23, 2009
There has been a substantial crackdown by federal and state authorities in Florida over the last several years with regard to Medicare and Medicaid payments related to respiratory conditions such as COPD. The enforcement has typically focused on the....

Florida Legislators Move to Prevent Doctor Shopping

Posted on April 23, 2009
Legislation before the Florida House and Senate would require a controlled substances reporting database containing all prescribing and dispensing information related to certain controlled substances. The purpose and intent of the statute is to prevent drug abuse and profit making...

Whistleblower to Collect $45M

Posted on April 16, 2009
As the results of a whistleblower lawsuit under the federal False Claims Act, a division of Quest labs of New Jersey entered a guilty plea in federal court to a felony charge of misbranding in Wednesday and agreed to pay...

Ryan Haight Online Pharmacy Consumer Protection Act of 2008

Posted on April 13, 2009
One significant development in the area of medical and pharmacy practice was the passage last year of The Ryan Haight Online Pharmacy Consumer Protection Act of 2008. This Act modifies the Controlled Substances Act to address the facilitation of the....

Cutting Edge Medicare Fraud

Posted on April 10, 2009
Florida, New York and California are generally on the cutting edge of Medicare fraud, and many hours of law enforcement time is taken to uncover the next wave of perceived schemes. However, fresh from Georgia: hyperbaric oxygen therapy fraud....

Pharmacy Fraud, Past Present and Future

Posted on April 08, 2009
Many in the healthcare industry and the attorneys who represent them in South Florida notice trends in law enforcement and criminal prosecutions that are logically preceded by increased audit activity. There are generally surges in prosecutions following increased outlays in...

FEDS DISMISS INDICTMENT AGAINST 10 IN FORT LAUDERDALE INTERNET PHARMACY CASE

Posted on April 06, 2009
By Robert David Malove, Esquire Exclusive to the Health Care Fraud Blog FORT LAUDERDALE, FL (April 6, 2008) In a stunning development with implications in two large prosecutions, the United States dismissed with prejudice an Indictment against 10 individuals today...

Four Indicted in Puerto Rico on Medicare Fraud Charges

Posted on March 08, 2009
Reprinted from Caribbean Net News caribbeannetnews.com Federal grand jury in Puerto Rico hands down indictments in Medicaid fraud Published on Thursday, March 5, 2009 By Mar�a Miranda Sierra Caribbean Net News Puerto Rico Correspondent Email: miranda@caribbeannetnews...

Home Care Investigated in Florida

Posted on March 05, 2009
On March 5, 2009 the Miami Herald reported that ?State investigators began sweeps this week targeting fraud and abuse in the home healthcare industry in Miami-Dade, aiming to potentially save millions of dollars in questionable payments by Medicaid. ?They launched...

Owners of Two Miami Medical Clinics Plead Guilty

Posted on January 17, 2009
On January 14, 2009, the owners and operators of two Miami medical clinics, along with a phlebotomist at one of the clinics, have pleaded guilty to defrauding the Medicare program in connection with a $5.3 million HIV and cancer infusion...

Two Pharmed Directors Sentenced

Posted on January 07, 2009
On January 7, 2009, defendants Carlos De Cespedes and Jorge De Cespedes, brothers and majority shareholders of The Pharmed Group, Corp. (Pharmed), were sentenced by U.S. District Court Judge Patricia Seitz to 108 months? imprisonment as a result of their...

THOMPSON-WEST SELECTS FORT LAUDERDALE LAWYERS WEINTRAUB & MALOVE TO WRITE HEALTH CARE FRAUD PRACTICE GUIDE

Posted on November 02, 2008
FOR IMMEDIATE RELEASE FORT LAUDERDALE, FL (November 3) After conducting a nation-wide search, Thompson-West, the leader in legal information solutions, has selected Fort Lauderdale lawyers, Benson Weintraub and Robert David Malove to create the leading print authority and Westlaw resource...

ATTORNEY GENERAL HONORS MEDICARE STRIKE FORCE AT THE DEPARTMENT OF JUSTICE?S ANNUAL AWARDS CEREMONY

Posted on October 28, 2008
Today in Washington, D.C., the Attorney General?s Award for Distinguished Service was also awarded to employees from the Fraud Section of the Criminal Division of the Department of Justice, Deputy Chief Kirk Ogrosky; Trial Attorneys John S. Darden and Harold...

Healthcare in America: Guns or Butter?

Posted on October 25, 2008
By Benson Weintraub, Esq. FORT LAUDERDALE, FL (October 25, 2008) My interest in health care fraud originated as a white collar criminal defense lawyer in the federal courts with an abiding commitment to academic excellence, particularly in the criminal justice...

Collapse of Financial Markets and Its Impact Upon National Health Care Priorities

Posted on October 19, 2008
By Benson Weintraub, Esq. FORT LAUDERDALE, FL (October 19, 2008) Economic prognosticators theorized a maximization of wealth through a combination of largely unregulated commercial notes and instruments including sub-prime mortgages secured or subject to credit default swaps or government backed securities; irrespective, the taxpayers were ultimately left holding the billion dollar bag while the investment banks and financial institutions profited by a billion-dollar is the federal government?s subsidies and bailout...

MEDICARE FRAUD STRIKE FORCE INDICTS EIGHT MIAMI-DADE RESIDENTS FOR AIDS/HIV INFUSION FRAUD

Posted on October 07, 2008
Eight Miami-Dade County residents have been charged in a 16-count indictment for their alleged roles in a Medicare fraud scheme involving fake HIV infusion treatments. After the arrests, the Sept. 24, 2008, indictment was unsealed charging one count of health...

Medicare Fraud Strike Force Prosecutions Top $500M

Posted on September 25, 2008
Since the inception of Medicare Fraud Strike Force (MFSF) operations in 2007, federal prosecutors in Washington, D.C., have indicted 104 cases with 184 defendants in Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than...

PHYSICIAN?S ASSISTANT PLEADS GUILTY TO ROLE IN $119 MILLION FRAUDULENT HIV INFUSION SCHEME

Posted on September 19, 2008
MIAMI, FL (September 18, 2008) - Thomas McKenzie, 53, a Miami physician?s assistant pleaded guilty today to defrauding the Medicare program in connection with a $119 million HIV infusion fraud scheme. McKenzie, pleaded guilty in Miami to one count of...

Healthcare Fraud Blog Publisher to Attend AHLA/HCCA Fraud and Compliance Forum

Posted on September 17, 2008
FORT LAUDERDALE, FL (September 17, 2008) Health care fraud blog publisher, attorney Robert David Malove, will be attending the 2008 Fraud & Compliance Forum in Baltimore next month. The AHLA/HCCA Fraud & Compliance Forum will provide practical guidance on the...

A COMPLIANCE OFFICER?S MUSE?

Posted on September 15, 2008
By Benson Weintraub, Esq. FORT LAUDERDALE, FL (September 15, 2008) In post-Depression era history, the federal government has yielded to systemic extensions of credit through extortionate means, most recently in bailing out Fannie and Freddie, the first of many economic...

Miami Physicians Plead Guilty and Admit Ordering $6.8M Worth of Unnecessary HIV Infusion Treatments

Posted on September 12, 2008
MIAMI, FL (September 11, 2008) - Miami physicians, Carlos Contreras, M.D., and Ramon Pichardo, M.D., each pleaded guilty today to defrauding the Medicare program in connection with a $6.8 million HIV infusion fraud scheme. To read the indictment in its...

Miami Still a Hotbed for Medicare Fraud - HIV Clinic Administrator Pleads Guilty for Role in a $14 Million Medicare Fraud Scheme

Posted on September 09, 2008
MIAMI, FL (September 9, 2008) ? Dilcia Marinez, 57, pleaded guilty today in U.S. District Court to her role in defrauding the Medicare program and laundering the proceeds of the crimes in connection with a $14 million HIV infusion fraud...

DME DEFENDANTS SENTENCED IN $148M MEDICARE FRAUD SCHEME

Posted on August 28, 2008
MIAMI, FL (August 28, 2008) - Defendants Mabel and Abner Diaz, of Miami Lakes, FL were each sentenced today to fourteen years? incarceration for conspiracy to commit health care fraud and health care fraud. Defendant Suleidy Cano, of Hialeah,...

MIAMI DME OWNER SENTENCED FOR MEDICARE FRAUD

Posted on August 28, 2008
Yesterday, U.S. District Court Judge Patricia A. Seitz sentenced Ariel Delgado, a Miami DME owner, to 30 months in prison, to be followed by three years of supervised release. The defendant was also ordered to forfeit $474,609 and pay restitution...

$211,000,000 INTERNET PHARMACY CASE

Posted on August 27, 2008
Exclusive COVERAGE BY Health CareFraud Blog DALLAS, TX (August 27, 2008) - The federal government?s largest health fraud case involving online pharmacies was scheduled to conclude today with the sentencing of Ryokesh Johar Saran (Joe Saran) before US District Judge...

Inspector General's Draft Report Says Medicare's Claims of Reduced Imroper Payments Misleading

Posted on August 20, 2008
Today, The New York Times reported that ?Medicare?s top officials said in 2006 that they had reduced the number of fraudulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to...

Inspector General's Draft Report Says Medicare's Claims of Reduced Improper Payments Misleading

ACFE Healthcare Fraud Seminar

Posted on August 19, 2008
CEO Magazine reports that healthcare costs are within the top three business concerns, and for good reason: U.S. healthcare spending has increased from a mere $27 billion in 1960 to $2 trillion in 2005. That is a 7,100 percent...

Hospital Owner and "Skid Row" Assessment Center Operator Arrested in Healthcare Fraud Scheme That Recruited Homeless and Fraudulently Billed Government for Unnecessary Services

Posted on August 14, 2008
According to the L.A. Times, the owner of a Los Angeles-area hospital and a man who acted as a recruiter were arrested August 6 on federal charges of defrauding Medicare and Medi-Cal by providing unnecessary health services to homeless people...

New CMS Stark Regulations Tighten Referral Rules

Posted on August 07, 2008
New Stark Law regulations posted on July 31, 2008 by the Centers for Medicare and Medicaid Services (CMS) revise and expand the prohibition on physician referrals for designated health services (DHS) to entities with which they have financial relationships...

MEDICAL SUPPLY EXECUTIVE IMPRISONED FOR DEFRAUDING MEDICARE

Posted on August 04, 2008
On August 4, 2008, U.S. Attorney for the District of Northern Georgia David Nahmias announced that Angela D. Isley, , 44, of Atlanta, Georgia, was sentenced by United States District Judge Charles A. Pannell, Jr. to serve more than 5...

U.S. Eleventh Circuit Court of Appeals Reverses and Orders Re-Sentencing

Posted on July 31, 2008
The United States Circuit Court of Appeals for the Eleventh Circuit in Atlanta reversed one of my cases on July 31, 2008, and remanded it back to the district court for re-sentencing due to the sentencing judge's failure to specifically...

DEFENSE PREVAILS, AGAIN, IN PHYSICIAN SENTENCING

Posted on July 11, 2008
MIAMI (July 11, 2008). Yesterday the Bureau of National Affairs first reported another case rejecting the government?s methodology of computing ?loss? in health fraud cases under the federal sentencing guidelines in the Southern District of Florida. BENSON WEINTRAUB, the nationally...

Miami Pharmacy Owner of Convicted of Medicare Fraud, Co-defendant Acquitted

Posted on July 07, 2008
After a six day trial in Miami, a federal jury in Miami convicted Gustavo Smith, 43, the owner of a Miami pharmacy for his role in a $3 million Medicare fraud scheme and for money laundering of all 17 counts...

Chiropratic Clinics Face Change in Ownership Law

Posted on June 19, 2008
Effective July 1, 2008 there is a significant change in the law in Florida concerning the employment of chiropractic physicians, and the law carries felony level criminal penalties. Under the statute, F.S. 760.4167, any entity, including licensed health care...

DEFENSE LAWYERS PREVAIL IN HEALTH CARE FRAUD CASE

Posted on May 30, 2008
BENSON WEINTRAUB, the nationally renown federal sentencing expert and ANTHONY C. VITALE of the Health Law Offices of Anthony C. Vitale, PA presented a novel issue in health care fraud during a 5-day sentencing proceeding against Rodolpho Ramirez, a DME...

New Florida Law Requires Physician Medical Directors for Health Care Clinics Employing Chiropractors

Posted on May 14, 2008
Effective July 1, 2008, pursuant to Florida Statutes � 460.4167, no chiropractor may be employed by a health care clinic unless the clinic has a medical director that is an MD or DO. Specifically, the provision is intended to...

Miami Pharmacy Owner of Convicted of Medicare Fraud, Co-defendant Acquitted

Posted on May 07, 2008
After a six day trial in Miami, a federal jury in Miami convicted Gustavo Smith, 43, the owner of a Miami pharmacy for his role in a $3 million Medicare fraud scheme and for money laundering of all 17 counts...

Psychiatrist ordered imprisoned for Medicare fraud

Posted on April 17, 2008
Check this out. Usually you would think of a psychiatrist as being someone who treats patients who suffer from auditory or visual hallucinations. However, an Illinois psychiatrist is headed to federal prison for two and a half years for defrauding...

Miami Woman Sentenced to 10-years for Role in $170M Healthcare Fraud Consiracy

Posted on April 11, 2008
On April 2, the same day that seven co-defendants were indicted (click here) for their roles in an $11 million Medicare fraud scheme involving HIV infusion clinics, Rita Campos Ramirez who had pleaded guilty in August 2007 to a $170...

Feds Charge Seven in $11 Million Medicare Fraud Scheme

Posted on April 08, 2008
Seven Miami-area residents were indicted on April 2, 2008, in connection with an $11 million Medicare fraud scheme involving HIV infusion clinics. The defendants were all charged with: conspiracy to defraud the United States, to cause the submission of false...

Two More Florida Men Sentenced for Healthcare Fraud & Money Laundering

Posted on April 04, 2008
Medicare billing fraud scheme

Symposium on Healthcare Fraud Investigations

Posted on March 18, 2008
This is a one-of-a-kind event you won?t want to miss. The Symposium will be held Monday, March 31, 2008 to Tuesday, April 1, 2008 at The Latham Hotel Georgetown, Washington, DC. Reserve your space today by calling 888-224-2480 or...

Feds Suffer Defeat in Healthcare Fraud Prosecution

Posted on March 11, 2008
Yeleiny Guerrero was the co-owner of Denis Medical Services, Inc. She was charged in a 6 count indictment with conspiracy to defraud the United States by causing the filing of false Medicare claims, conspiracy to commit health care fraud...

ACFE Healthcare Fraud Seminar Orlando March 24-25, 2008

Posted on March 01, 2008
CEO Magazine reports that healthcare costs are within the top three business concerns, and for good reason: U.S. healthcare spending has increased from a mere $27 billion in 1960 to $2 trillion in 2005. That is a 7,100 percent increase...

Ben Kuehne Had No Motive Or Financial Incentive To Launder Money For Ochoa?s Attorney?s And Exclusive Beneficiaries, Especially Roy Black

Posted on February 14, 2008
By Benson Weintraub, Esquire, Fort Lauderdale February 14, 2008

Anti-Kickback Statute

Posted on February 01, 2008
This federal statute prohibits the solicitation, receiving, offering or paying of any remuneration, directly or indirectly, in cash or in kind, in exchange for a healthcare program referral.

Prof. Benson Weintraub to Present "Defense of a Criminal Healthcare Fraud Case" at Health Care Compliance Association's 12th Annual Compliance Institute

Posted on January 28, 2008
Professor Benson Weintraub, Esquire, a Ft. Lauderdale-based global health care attorney and counselor with an international practice and clientele, and a distinguished academic authority on the Federal sentencing of corporations and individuals, has been invited to present "Defense of a Criminal Healthcare Fraud Case" at Health Care Compliance Association's (HCCA) 12th Annual Compliance Institute to be held in New Orleans April 13-16, 2008...

Medicare Fraud Defendant Sentenced in Florida

Posted on January 23, 2008
On January 10, Cesar Romero was sentenced by U.S. District Court Judge Patricia A. Seitz to forty-six months in jail and remanded into immediate custody for his role in a multi-million dollar Medicare billing fraud scheme on which Romero previously had pled guilty...

Former St. Elizabeths Hospital Chief Pharmacist Pleads Guilty

Posted on January 14, 2008
On January 9, 2008, U.S. Attorney for the District of Columbia Jeffrey A. Taylor announced that Raymond Jackson, former Chief Pharmacist at St. Elizabeths Hospital, pleaded guilty to stealing $95,000 of medication from the hospital. Taylor waived his right to be be indicted by a federal grand jury and instead entered a plea agreement a one count information charging him with theft or embezzlement in connection with health care in violation of Title 18, U...

Healthcare Fraud Blog Publisher Successfully Completes Certified in Healthcare Compliance (CHC) Examination

Posted on December 24, 2007
The Compliance Certification Board (CCB) announced that Board Certified Criminal Trial Lawyer Robert David Malove, has successfully completed the Certified in Healthcare Compliance Examination, thus earning the "CHC" designation. Healthcare compliance is a relatively new industry, born out of the government's crackdown on Medicare fraud...

Medicare Fraud Strike Force Cases Result in Long Prison Terms for Five Health Care Company Owners

Posted on December 15, 2007
On December 13, 2007, the owners of five separate Miami-based health care corporations have were sentenced to prison. Collectively, the five defendants filed fraudulent claims with Medicare for over $28.6 million worth of unnecessary durable medical equipment (DME) and infusion therapy...

Healthcare Fraud Blog Publisher Successfully Completes Healthcare Corporate Compliance Graduate Certificate Program at GWU

Posted on November 15, 2007
Today, the person most essential to your healthcare organization's long term success may not be a doctor, nurse, or technician. Increasingly, the most vital person in your company may be the one who helps you navigate a tangled web of regulations, certifications, and liability...

Last of 21 Defendants Sentenced in Private Insurance Health Care Fraud Conspiracy

Posted on October 18, 2007
On October 10, 2007 Dmitry Rakovsky was sentenced by United States District Judge Marcia G. Cooke in Miami, Florida. Rakovsky was sentenced to a term of 59 months in prison, to be followed by a term of three years of supervised release. He was also ordered to forfeit property and pay restitution in the amount of $900,000...

South Florida bills billions for HIV

Posted on September 21, 2007
September 21, 2007 From The Washington Times By Jim McElhatton - Doctors and clinics in three Southern Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show...

Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering

Posted on September 18, 2007
On September 6, 2007, Gianni Suarez Vazquez, a participant in a massive Medicare fraud scheme, pled guilty in federal court in West palm Beach, Florida, to mail fraud and money laundering charges. He is scheduled to be sentenced before U.S. District Judge Donald M...

Miami Defendants Sentenced on Health Care Fraud

Posted on September 16, 2007
On August 31, 2007, defendants Maricel Li and Marta Perez, both residents of Miami, were sentenced by United States District Court Judge James I. Cohn in Fort Lauderdale, Florida. Li was sentenced to twenty-four (24) months' imprisonment, followed by three (3) years of supervised release...

Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam

Posted on September 07, 2007
On August 28, 2007, a federal grand jury indicted the former operations director of A-Care EMS Inc. on charges that he sent fraudulent claims to the Centers for Medicare and Medicaid Services to pull in more money. The indictment, filed Tuesday in the U...

Florida Durable Medical Equipment Owner Convicted of Medicare Fraud

Posted on September 07, 2007
On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida...

Political Commutations: Scooter Libby, Jimmy Hoffa & Sentencing Disparity

Posted on July 12, 2007
By Benson Weintraub [Benson Weintraub is a sentencing lawyer is Of-Counsel to the Law Offices of Robert David Malove, P.A.,in Fort Lauderdale and former Visiting Professor of Law at Hofstra University. While in law school, he worked on the Hoffa litigation under the direction of civil rights lawyer, Leonard Boudin...

Medicare Fraud Defendant Gets 10-Year Prison Term

Posted on May 25, 2007
On May 18, 2007, the US Attorney's Office reported that Jafet Garcia, a defendant in a massive South Florida Medicare fraud scheme, was sentenced in West Palm Beach Federal court to ten (10) years? imprisonment. According to the court file, the defendant and his partners purchased four medical equipment companies located in Miami-Dade and Palm Beach Counties, between February 2004 and December 2004...

11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions

Posted on May 24, 2007
On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations. The scheme involved transporting patients to the defendants? pharmacies in exchange for illegal kickbacks for patients and doctors...

Feds Add More Resourses to Fight Healthcare Fraud

Posted on May 22, 2007
The Centers for Medicare & Medicaid Services Program Integrity Group at recently opened a field office in Santa Ana, California, aimed at preventing and prosecuting health care fraud. "In the two years since the office has been up and running, we have been able to stop almost $2billion in inappropriate or improper payments from going out the door," program director Kimberly Brandt said...