Health Care Fraud

VA Employee Found Guilty Of Corruption Charges And Defrauding VA Of Nearly $19 Million In A Year United States Attorney Jason R. Dunn announced that yesterday a jury sitting in U.S. District Court in Denver found former Veterans Affairs (VA) employee Joseph Prince, age 60, of Aurora, Colorado guilty of felony health care fraud, conspiracy, payment of illegal kickbacks and gratuities, money laundering charges and conflict of interest. The verdict is the result of an eight-day jury trial before U.S. District Court Judge Raymond P. Moore. Prince’s bond was continued and he was ordered to home incarceration pending his sentencing. ... Read more

Federal Jury finds Defendants Guilty of Submitting False Claims to Medicare under Civil False Claims Act Jury verdict results in recovery of more than $10.85 million to the Medicare program Gulfport, Miss. – Following a nine week trial, a federal jury in Gulfport returned a guilty verdict yesterday against Ted and Julie Cain of Ocean Springs, Ted Cain’s companies, Stone County Hospital (Wiggins) and Corporate Management, Inc. (Gulfport), and Tommy Kuluz, Chief Financial Officer of Corporate Management, Inc. for violating the Civil False Claims Act, announced U.S. Attorney Mike Hurst and Derrick Jackson, Special Agent in Charge of the Office ... Read more

Two Connecticut Physicians Pay over $4.9 Million to Settle False Claims Act Allegations U.S. Attorney John H. Durham, Special Agent in Charge Phillip Coyne of the U.S. Department of Health and Human Services, Office of Inspector General, Special Agent in Charge Brian C. Turner of the New Haven Division of the Federal Bureau of Investigation, and Connecticut Attorney General William Tong today announced that DR. CRISPIN ABARIENTOS and his wife, DR. ANTONIETA ABARIENTOS, have entered into a civil settlement agreement with the federal and state governments in which they will pay $4,927,903 to resolve allegations that they violated the federal ... Read more

Doctor and Sales Rep Charged in $12 Million Fraud Scheme Targeting Tricare and Extensive Cover Up Kickbacks Generate Expensive Compounded Drug Prescriptions LITTLE ROCK—A doctor and a medical sales representative have been charged in a scheme to pay and receive kickbacks to generate expensive prescriptions for compounded drugs. TRICARE, the military’s health insurer, paid over $12 million for the prescriptions, which the indictment alleges were rubber stamped without examining patients or regard to medical necessity. The 43-count indictment alleges the scheme also encompassed widespread efforts to obstruct the ensuing investigation. Cody Hiland, U.S. Attorney for the Eastern District of Arkansas, ... Read more

Pharmacy Owner Sentenced to 10 Years in Prison for Role in Largest Health Care Fraud Case Ever in Mississippi Nationwide Compound Pharmacy Fraud Scheme Involved Almost a Quarter of a Billion Dollars Hattiesburg, Miss. – Thomas Edward Spell, Jr., 51, a pharmacy owner in Ridgeland, Mississippi, was sentenced today to 10 years in federal prison for his involvement in a $243 million compounding pharmacy fraud scheme, announced U.S. Attorney Mike Hurst, Michelle A. Sutphin, Special Agent in Charge of the FBI in Mississippi, Thomas J. Holloman III, Special Agent in Charge of Internal Revenue Service Criminal Investigation’s (IRS CI) Atlanta ... Read more

25 Southern California Defendants Face Federal Charges Alleging Fraud Schemes that Cost Health Care Programs Millions of Dollars LOS ANGELES – A local health care fraud enforcement action has resulted in federal charges against of 25 Southern California defendants for their alleged involvement in healthcare fraud schemes that fraudulently sought over $150 million from the Medicare and Medicaid programs, as well as private insurers and union health benefit plans. Fourteen of those charged in federal court in Los Angeles and Santa Ana are doctors or medical professionals. The charges announced today target schemes billing Medicare, Medicaid and other health care ... Read more

South Florida Health Care Facility Owner Sentenced to 20 Years in Prison for Role in Largest Health Care Fraud Scheme Ever Charged by The Department of Justice A federal district judge sentenced a south Florida health care facility owner to 20 years in prison today after being found guilty in the largest health care fraud scheme charged by the U.S. Justice Department. The case involves a decades-long scheme of kickbacks and money laundering in connection with fraudulent claims to Medicare and Medicaid for services deemed medically unnecessary. Philip Esformes, 50, of Miami Beach, Florida, was sentenced by U.S. District Judge ... Read more

Owensboro Man Pleads Guilty to Health Care Fraud Conspiracy LEXINGTON, Ky. – Today, an Owensboro man admitted in federal court that he participated in a conspiracy to defraud health insurance programs of more than $1.3 million. Dinesh Goyal, 60, pleaded guilty to one count of conspiracy to commit an offense against the United States, before United States District Judge Joseph Hood. Goyal owned a toxicology laboratory in Owensboro, Kentucky called Tristate Medical Laboratory (“Tristate”). His co-conspirators, Mason Routt and Sam Ford, owned or were affiliated with a Nicholasville, Kentucky toxicology lab known as C.A.L. Laboratory Services (“CAL”). Among other things, ... Read more

Lakewood Man Charged In $10 Million Health Care Fraud Against Blue Cross Blue Shield NEWARK, N.J. – A Lakewood, New Jersey, insurance producer was charged today with conspiring to defraud several Blue Cross Blue Shield health care insurance affiliates of more than $10 million, U.S. Attorney Craig Carpenito announced today. Jonas Knopf, 63, of Lakewood, was charged by complaint with one count of conspiring to defraud three health care Blue Cross Blue Shield (BCBS) affiliates in Pennsylvania and the Washington, D.C., area. He is scheduled to appear today before U.S. Magistrate Judge Steven C. Mannion in Newark federal court. According ... Read more

Coordinated Health and CEO Pay $12.5 Million to Resolve False Claims Act Liability for Fraudulent Billing PHILADELPHIA, PA – United States Attorney William M. McSwain announced today that Coordinated Health Holding Company, LLC (“Coordinated Health”) and its founder, principal owner, and Chief Executive Officer, Emil DiIorio, M.D., agreed to settle allegations under the False Claims Act that they submitted false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health agreed to pay $11.25 million and DiIorio agreed personally to pay $1.25 million, for total settlement of $12.5 million. Coordinated Health has also entered into a ... Read more

Three Charged with Violating Federal Anti-Kickback Laws and Committing More Than $4.7 Million in Health Care Fraud TULSA, Okla.— A grand jury returned an indictment today charging three men, including two physicians, with violations of the federal anti-kickback statute as well as conspiring to commit health care fraud, announced U.S. Attorney Trent Shores. “Health care fraud is not a victimless crime. It has a costly effect on the taxpayer and beneficiaries enrolled in Medicare, TRICARE, and workers compensation coverage under the Federal Employees Compensation Act,” said U.S. Attorney Trent Shores. “The Justice Department will not stand idly by while physicians ... Read more

Livanova agrees to pay $1.87 Million to resolve False Claims Act allegations arising from improper kickback payments ATLANTA – LivaNova USA, Inc. (“LivaNova”), formerly known as Cyberonics, Inc., has agreed to pay the United States and the State of Georgia $1.87 million to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by knowingly paying kickbacks to Georgia physicians with the intent to cause referrals for implantation of LivaNova’s medical devices. “Healthcare providers must make recommendations about their patients’ health without respect to their own financial interests and medical device manufacturers cannot be ... Read more