Tag Health Care Fraud

Health Care Fraud: Group Of Individuals guilty For Implicated In The Forest Park Medical Center Bribery Scheme

Seven Guilty in Forest Park Healthcare Fraud Trial Following four days of deliberations, a federal jury returned guilty verdicts for seven individuals implicated in the Forest Park Medical Center bribery scheme Tuesday evening, announced U.S. Attorney Erin Nealy Cox. Wilton McPherson “Mac” Burt, Jackson Jacob, Douglas Sung Won, Michael Bassem Rimlawi, Shawn Mark Henry, Mrugeshkumar Shah, and Iris Kathleen Forrest were all convicted of conspiracy to pay or receive healthcare bribes. “The verdict in the Forest Park case is a reminder to healthcare practitioners across the District that patients – not payments – should guide decisions about how and where doctors administer treatment,” said U.S. Attorney Nealy Cox. “We are grateful to the Forest Park jury, 12 men and women who listened attentively through seven long weeks of trial. It’s obvious from the verdict that they deliberated each charge carefully, and we appreciate their service.” Ten other defendants had already pleaded guilty in the $200 million scheme, designed to induce doctors to steer lucrative patients – particularly those with high-reimbursing, out-of-network private insurance – to the now defunct hospital. Most of the kickbacks, which totaled more than $40 million, were disguised as consulting fees or “marketing money” doled as a percentage of surgeries each doctor referred to Forest Park. Instead of billing patients for out-of-network co-payments, instituted by insurers to de-incentivize the high costs associated with out-of-network treatment, Forest Park allegedly assured patients they would pay in-network prices. Because they knew insurers wouldn’t tolerate such practices, they concealed the patient discounts and wrote off the difference as uncollected “bad debt.” Hospital manager Alan Beauchamp, who testified for the government, admitted that Forest Park “bought surgeries,” and then “papered it up to make it look good.” The verdict was as follows: Mr. Burt, Forest Park’s managing partner, was found guilty on […]

Health Care Fraud: Mohamad Ali And Wansa Nabi Makki Charging With Multiple Health Care Fraud Offenses

Pharmacy Owner and Pharmacist Charged in a Scheme to Bill Insurance for Medications Not Dispensed An indictment was unsealed today charging Mohamad Ali Makki, R.Ph. and Wansa Nabi Makki with multiple health care fraud offenses, U.S. Attorney Matthew Schneider announced today. At the same time, related criminal complaints were unsealed charging Mamoud Makki and Hossam Tanana (husband of Wansa Makki) of laundering some of the proceeds of the health care fraud scheme. Schneider was joined in the announcement by Special Agent in Charge Timothy R. Slater of the FBI’s Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office. Charged in the indictment and criminal complaints are: Wansa Nabih Makki, 41, of Dearborn Mohamad Ali Makki, R.Ph., 43, of Dearborn Heights Mahmoud Makki., 36, of Dearborn Hossam Tanana, 53 of Dearborn According to the indictment, between January 2010 and January 2018, Wansa Makki owned and oversaw the operations of two local pharmacies, LifeCare Pharmacy in Livonia and LifeCare of Michigan in Farmington Hills. Mohamad Makki was the pharmacist-in-charge at both pharmacies. Both pharmacies were “closed door” pharmacies, meaning that they were not open to the public and only filled prescriptions for individuals associated with various care facilities. The indictment alleges that during the course of the conspiracy, Wansa Makki and Mohamad Makki billed Medicare, Medicaid and Blue Cross Blue Shield of Michigan for approximately $9.2 million dollars for medications that were never dispensed. The fraud scheme was detected by Medicare, in part, because of a huge deficit between each pharmacy’s recorded inventories and the claims that each submitted for insurance reimbursement. As part of the scheme to defraud, the defendants billed insurance companies for allegedly submitting claims for delivering over 500 medications to […]

Health Care Fraud: Three Pharmaceutical Companies Agree to Pay to Resolve Allegations That They Paid Kickbacks Through

Three Pharmaceutical Companies Agree to Pay a Total of Over $122 Million to Resolve Allegations That They Paid Kickbacks Through Co-Pay Assistance Foundations The Department of Justice today announced that three pharmaceutical companies – Jazz Pharmaceuticals plc (Jazz), Lundbeck LLC (Lundbeck), and Alexion Pharmaceuticals Inc. (Alexion) – have agreed to pay a total of $122.6 million to resolve allegations that they each violated the False Claims Act by illegally paying the Medicare or Civilian Health and Medical Program (ChampVA) copays for their own products, through purportedly independent foundations that the companies used as mere conduits. When a Medicare beneficiary obtains a prescription drug covered by Medicare, the beneficiary may be required to make a partial payment, which may take the form of a copayment, coinsurance, or a deductible (collectively “copays”). Similarly, under ChampVA, patients may be required to pay a copay for medications. Congress included copay requirements in the Medicare program, in part, to serve as a check on health care costs, including the prices that pharmaceutical manufacturers can demand for their drugs. The Anti-Kickback Statute prohibits a pharmaceutical company from offering or paying, directly or indirectly, any remuneration — which includes money or any other thing of value — to induce Medicare or ChampVA patients to purchase the company’s drugs. This prohibition extends to the payment of patients’ copay obligations. “Pharmaceutical companies undercut a key safeguard against rising drug costs when they create assistance funds to serve as conduits for the companies to subsidize the copays of their own drugs,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “These enforcement actions make clear that the government will hold accountable drug companies that directly or indirectly pay illegal kickbacks.” “We are committed to ensuring that pharmaceutical companies do not use third-party foundations to pay kickbacks […]

Health Care Fraud: Ademola O. Adebayo Convicted For One Count Of Conspiracy To Commit Health Care Fraud And Wire Fraud

Florida Pharmacist Sentenced to 10 Years in Prison for $100 Million Compounding Pharmacy Fraud Scheme Eight Others Previously Sentenced A Florida pharmacist was sentenced to 120 months in prison today followed by three years supervised release. He was also orderd to pay $3.2 million in restitution and $1.4 million in forfeiture for his role in a massive compounding pharmacy fraud scheme, which impacted private insurance companies, Medicare and TRICARE. Eight other individuals have previously been sentenced in connection with the scheme. Various real properties, cars and a 50-foot boat have been forfeited as part of the sentencings. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, Special Agent in Charge George Piro of the FBI’s Miami Field Office, Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office and Special Agent in Charge John F. Khin of the U.S. Defense Criminal Investigative Service’s (DCIS) Southeast Field Office made the announcement. Ademola O. Adebayo, 55, of Odessa, Florida, was convicted on Jan. 11 after a four-day trial of one count of conspiracy to commit health care fraud and wire fraud, three counts of health care fraud, and one count of conspiracy to commit money laundering. He was sentenced before U.S. District Judge Federico A. Moreno of the Southern District of Florida, who presided over the trial. According to evidence presented at trial, from 2012 to 2015, Adebayo and his co-conspirators engaged in a scheme to defraud private insurance companies, Medicare and TRICARE out of $121 million by submitting false and fraudulent claims for compounded drugs, primarily pain and scar creams, and other prescription medications that were not medically necessary, never provided, or both. The […]

Financial Fraud: Covidien LP Has Agreed To Pay To Resolve Allegations That It Violated The False Claims Act

Covidien To Pay Over $17 Million To The United States For Allegedly Providing Illegal Remuneration In The Form Of Practice And Market Development Support To Physicians SAN FRANCISCO – Covidien LP has agreed to pay $17,477,947 to resolve allegations that it violated the False Claims Act by providing free or discounted practice development and market development support to physicians located in California and Florida to induce purchases of Covidien’s vein ablation products, the Department of Justice announced today. “Patients in federal health care programs deserve medical care that is free from improper financial incentives,” said U.S. Attorney David L. Anderson for the Northern District of California. “As this case makes clear, companies must steer clear of violating the Anti-Kickback Statute or risk being pursued.” “Today’s settlement serves as an important reminder to those in the health care community that unlawful kickbacks come in many forms and are not limited to monetary payments to providers,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “Providing free or discounted services to health care providers to induce the use of certain items or services can lead to excessive and unnecessary treatments, and drive up health care costs for everyone.” The United States alleged that Covidien violated the Anti-Kickback Statute and, correspondingly, the False Claims Act by providing practice development and market development support to health care providers located in California and Florida from Jan. 1, 2011, through Sept. 30, 2014, to induce those providers to purchase ClosureFASTTM radiofrequency ablation catheters that were billed to Medicare and to the California and Florida Medicaid programs. ClosureFastTM catheters are used in procedures that treat venous reflux disease, a disease often marked by the presence of varicose veins. The practice and market development support Covidien provided included customized marketing plans for specific vein […]

Health Care Fraud: Howard Randall Thomley pled guilty To Defraud Health Care Benefit Programs

Mississippi Man Pleads Guilty To Health Care Fraud For His Role in $200 Million Compounding Pharmacy Scheme Hattiesburg, Miss – Howard Randall Thomley, 60, of Hattiesburg, pled guilty yesterday before U.S. District Judge Keith Starrett to a Criminal Information charging him with health care fraud for his role in a $200 million scheme to defraud health care benefit programs, including TRICARE, announced U.S. Attorney Mike Hurst, Special Agent in Charge Christopher Freeze with the Federal Bureau of Investigation, Special Agent in Charge Thomas J. Holloman III of IRS Criminal Investigation’s Atlanta Field Office and Special Agent in Charge John F. Khin of the Defense Criminal Investigative Service’s Southeast Field Office. Thomley will be sentenced by Judge Starrett on July 2, 2019 and faces a maximum penalty of 10 years in federal prison. During his guilty plea, Thomley admitted that, from approximately August 2012 through January 2016, he conspired with others to carry out a scheme to defraud TRICARE, which is a federally funded health care benefit program that serves United States military personnel and their families. Thomley owned and operated a company called Advantage Marketing Professionals, which marketed medications for Advantage Pharmacy, a compounding pharmacy in Hattiesburg. For each prescription submitted by Thomley, Advantage Marketing Professionals and Thomley would receive a percentage of the revenue that Advantage Pharmacy obtained from TRICARE. Thomley and others associated with Advantage Marketing Professionals recruited beneficiaries of TRICARE and paid them a percentage of the revenue from each prescription – including refills – that they and their families accepted, in order to induce the beneficiaries to accept millions of dollars of expensive compounded medications that were not medically necessary. In order to obtain prescriptions, Thomley and his co-conspirators filled out pre-printed prescription forms with the beneficiaries’ names, and obtained prescriber signatures, knowing that the medical […]

Heath Care Fraud: Walgreen Co. Pay For Settle Allegations Under the False Claims Act

Walgreen Co. Agrees to Pay $3.5 Million to Settle Allegations Under the False Claims Act United States Attorney Matthew D. Krueger announced today that Walgreen Co. (“Walgreens”) has agreed to pay $3.5 million to the United States and the State of Wisconsin to settle allegations that Walgreens violated the False Claims Act by submitting claims to Medicaid for stimulant medications without complying with Medicaid rules designed to ensure that stimulants are dispensed for appropriate medical treatment.  Walgreens operates retail pharmacies throughout Wisconsin.  The Wisconsin Medicaid program will reimburse a pharmacy for dispensing certain stimulant medications only if the pharmacy first verifies with the prescribing physician that the physician prescribed the stimulant for medically appropriate treatment, such as treatment for attention deficient disorder.  The False Claims Act prohibits a pharmacy from knowingly submitting claims for payment for medications in violation of Medicaid’s rules.  The United States and the State of Wisconsin allege that, from 2011 through 2014, Walgreens violated Wisconsin Medicaid rules by dispensing routinely stimulant medications to Wisconsin Medicaid beneficiaries without first verifying that the prescribing physician ordered the medication for medically appropriate treatment.  The United States and the State of Wisconsin further allege that, by failing to verify that medications were prescribed for appropriate treatment, Walgreens dispensed and billed Wisconsin Medicaid for medically unnecessary medications.  “Pharmacies play an important gate-keeping role in the Medicaid program to ensure that the millions of dollars spent each year on prescription medications buy drugs that are medically necessary,” stated United States Attorney Krueger.  “This settlement demonstrates that the Department of Justice will hold pharmacies accountable.” “The dispensing of medications of any kind needs to be done following all protocols and with proper verification to ensure the medical necessity of the treatment,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health […]

Health Care Fraud: WALGREENS BOOTS ALLIANCE Pay For Two Civil Healthcare Fraud Settlements

Manhattan U.S. Attorney Announces $269.2 Million Recovery From Walgreens In Two Civil Healthcare Fraud Settlements Geoffrey S. Berman, the United States Attorney for the Southern District of New York, Gregory E. Demske, Chief Counsel to the Inspector General of the U.S. Department of Health and Human Services (“HHS-OIG”), Scott J. Lampert, Special Agent in Charge of HHS-OIG’s New York Regional Office, William F. Sweeney Jr., the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation (“FBI”), Leigh-Alistair Barzey, Special Agent-in-Charge of the Defense Criminal Investigative Service (“DCIS”) Northeast Field Office, Michael C. Mikulka, Special Agent-in-Charge, New York Region, U.S. Department of Labor Office of Inspector General (“DOL-OIG”), Matthew Modafferi, Special Agent in Charge, U.S. Postal Service, Office of Inspector General, Northeast Area Field Office (“USPS-OIG”), and Thomas W. South, Deputy Assistant Inspector General for Investigations, U.S. Office of Personnel Management, Office of the Inspector General (“OPM-OIG”), announced today that the United States filed and settled two healthcare fraud lawsuits against national pharmacy chain WALGREENS BOOTS ALLIANCE, INC. (“WALGREENS”), pursuant to which WALGREENS must pay the United States and state governments a total of $269.2 million. The first settlement, approved on January 16, 2019, by U.S. District Judge Paul A. Crotty and unsealed today, requires WALGREENS to pay $209.2 million to resolve allegations that it improperly billed Medicare, Medicaid, and other federal healthcare programs for hundreds of thousands of insulin pens it knowingly dispensed to program beneficiaries who did not need them. The second settlement, approved on January 15, 2019, by U.S. District Judge J. Paul Oetken and unsealed today, requires WALGREENS to pay $60 million to resolve allegations that it overbilled Medicaid by failing to disclose to and charge Medicaid the lower drug prices that WALGREENS offered the public through a discount program. In both settlements, […]
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