Healthcare Fraud

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

USAO Seeking $17M in Money Judgments Against Defendants Convicted in Forest Park Trial The U.S. Attorney’s Office is seeking more than $17 million in money judgments against the seven defendants convicted in the Forest Park Medical Center bribery trial in April, announced U.S. Attorney for the Northern District of Texas Erin Nealy Cox. Each defendant played a role in the $200 million kickback scheme, designed to induce doctors to steer lucrative patients – particularly those with high-reimbursing, out-of-network private insurance – to the now defunct hospital. The majority of the kickbacks, which totaled more than $40 million, were disguised as ... Read more

Eight Therapists Arrested In Scheme to Defraud Program for Developmentally Disabled Children Defendants Allegedly Defrauded the New York State Early Intervention Program Out of More Than $600,000 through Fraudulent Billing for Therapy Sessions that Never Occurred A criminal complaint was unsealed today in federal court in Brooklyn charging Kaderrah Doyle, Cara Steinberg, Marina Golfo, Ego Onaga, Lyubov Beylina, Danielle Scopinich, Patricia Hakim and Enock Mensah with stealing more than $600,000 in funds from Medicaid and the New York City Department of Health and Mental Hygiene through fraudulent billing practices in connection with the New York State Early Intervention Program (EIP). ... Read more

Surgeon Pleads Guilty In Forest Park Medical Center Bribery Scam A Mesquite-based bariatric surgeon today formally admitted his role in the $200 million Forest Park Medical Center fraud, announced U.S. Attorney for the Northern District of Texas Erin Nealy Cox. 53-year-old Wade Neal Barker, one of Forest Park’s founding doctors, appeared in court this morning, where he pleaded guilty to conspiracy to pay and receive healthcare bribes and kickbacks as well as aiding and abetting commercial bribery. “Patients trust doctors to make healthcare recommendations based on their best interests,” said Nealy Cox. “Instead, Dr. Barker let his own financial considerations ... Read more

Beverly Hills Doctor Sentenced to 10 Years in Custody for Massive Workers’ Comp Scheme SAN DIEGO – Beverly Hills Radiologist Ronald Grusd and two of his corporations, California Imaging Network Medical Group and Willows Consulting Company, were sentenced in federal court today after a jury trial in December resulted in convictions on 39 felony fraud counts. U.S. District Judge Cynthia A. Bashant imposed a sentenced of 10 years in custody and a fine of $250,000, and remanded Dr. Grusd into custody. His companies, California Imaging Network and Willows Consulting Company, were each required to pay a $500,000 fine, and an ... Read more

Former General Counsel of Company That Operates Health Maintenance Organizations in Several States Sentenced to Prison for Role in $35 Million Health Care Fraud Scheme The former general counsel of a company that operates health maintenance organizations in several states was sentenced to six months in prison today for his role in a $35 million health care fraud scheme. Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney W. Steven Muldrow of the Middle District of Florida, Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services Office ... Read more

Four Area Hospitals to Pay Millions to Resolve Ambulance Swapping Allegations HOUSTON – Four Houston-area hospitals have agreed to pay $8.6 million to settle allegations they received kickbacks from various ambulance companies in exchange for rights to the hospitals’ more lucrative Medicare and Medicaid transport referrals. The hospitals are all affiliated with Hospital Corporation of America (HCA), which is based in Nashville, Tennessee, and include Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center and East Houston Regional Medical Center. Acting U.S. Attorney Abe Martinez made the announcement along with Chief Counsel Gregory Demske of the Department ... Read more

Owner of Durable Medical Equipment Company Pleads Guilty to Health Care Fraud Defendant Admits Billing D.C. Medicaid for Supplies That Were Not Provided WASHINGTON – Emeka H. Chijioke, 40, formerly of Atlanta, Ga., and Nigeria, pled guilty today to a federal charge of health care fraud stemming from a scheme in which he defrauded the District of Columbia’s Medicaid program out of more than $500,000. The guilty plea was announced by U.S. Attorney Channing D. Phillips, Andrew Vale, Assistant Director in Charge of the FBI’s Washington Field Office, and Nicholas DiGiulio, Special Agent in Charge of the U.S. Department of ... Read more

Novo Nordisk Agrees to Pay $58 Million For Failure to Comply With FDA-Mandated Risk Program Payments Resolve Allegations Highlighted in DOJ Civil Complaint And Recently Unsealed Whistleblower Actions WASHINGTON – Pharmaceutical Manufacturer Novo Nordisk Inc. will pay $58.65 million to resolve allegations that the company failed to comply with the FDA-mandated Risk Evaluation and Mitigation Strategy (REMS) for its Type II diabetes medication Victoza, the Justice Department announced today. The resolution includes disgorgement of $12.15 million for alleged violations of the Federal Food, Drug, and Cosmetic Act (FDCA) from 2010 to 2012 and a payment of $46.5 million for alleged ... Read more

Miami-Area Man Charged For Role in $63 Million Health Care Fraud Scheme A Miami-area man was charged in an indictment unsealed today for his alleged participation in a $63 million health care fraud scheme involving a now-defunct community mental health center located in Miami. Acting U.S. Attorney Benjamin G. Greenberg of the Southern District of Florida, Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office ... Read more

New York Doctor Pleads Guilty In Connection With Test-Referral Scheme With New Jersey Clinical Lab NEWARK, N.J. – An internal medicine doctor practicing in Yonkers, New York, today admitted taking bribes in connection with a long-running and elaborate test referral scheme operated by Biodiagnostic Laboratory Services LLC (BLS), of Parsippany, New Jersey, its president and numerous associates, Acting U.S. Attorney William E. Fitzpatrick announced. Ricky J. Sayegh, 44, of Scarsdale, New York, pleaded guilty before U.S. District Judge Stanley R. Chesler in Newark federal court to an information charging him with accepting cash bribes in violation of the Federal Travel ... Read more

Final Group Of Physicians And Owner Of Medical Practice Plead Guilty In Medical Kickback Scheme Pam Gardner, 55, of Springfield, Tennessee, pleaded guilty yesterday, to conspiracy to solicit and receive cash kickbacks in exchange for making patient referrals, announced Jack Smith, Acting United States Attorney for the Middle District of Tennessee. During a hearing before U.S. District Court Judge Sean Cox, sitting by designation, Gardner admitted that, as the owner and operator of Medical Necessities, Inc., a medical practice located in Springfield, Tenn., she agreed to receive cash kickbacks in exchange for causing patients to be referred to Air Affiliates, ... Read more

Poplar Healthcare to Pay Nearly $900,000 to Resolve A False Claims Act Allegations PROVIDENCE, RI – Acting United States Attorney Stephen G. Dambruch and Philip Coyne, Special Agent-in-Charge of the Boston Office of Inspector General for the Department of Health and Human Services (HHS-OIG), today announced that Poplar Healthcare PLLC, and Poplar Healthcare Management, LLC (“Poplar”), of Memphis, TN, have entered into a civil settlement agreement with the United States, under which Poplar will pay $897,640 to resolve allegations under the federal False Claims Act. The government alleges that Poplar, directly and through a subsidiary known as GI Pathology, promoted ... Read more

Louisville Based Physician Settles Federal False Claims Act And State Civil Claims Pays $751,681.16 to settle allegations LOUISVILLE, KY – Forrest S. Kuhn, Jr., M.D., a physician specializing in allergy, asthma and immunology with medical offices in Louisville, Danville, and Glasgow, Kentucky, has agreed to pay $751,681.16 to resolve allegations that he violated the federal False Claims Act by submitting false claims to Medicare, Medicaid, and other government health care programs, announced United States Attorney John E. Kuhn, Jr., who is no relation to the defendant. “Unfortunately, the strength of our healthcare system is eroded by a minority of providers ... Read more

Detroit-Area Neurosurgeon Sentenced to 235 Months in Prison for Role in $2.8 Million Health Care Fraud Scheme A Detroit-area neurosurgeon was sentenced today to 235 months in prison for his role in $2.8 million health care fraud scheme in which he caused serious bodily harm to patients by performing unnecessary invasive spinal surgeries. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge David P. Gelios of the FBI’s Detroit Division, Assistant Director in Charge Deirdre Fike of the FBI’s Los Angeles Division, ... Read more

Forest Laboratories and Forest Pharmaceuticals to Pay $38 million to Resolve Kickback Allegations Under the False Claims Act Forest Laboratories LLC, located in New York, New York, and its subsidiary, Forest Pharmaceuticals Inc., have agreed to pay $38 million to resolve allegations that they violated the False Claims Act by paying kickbacks to induce physicians to prescribe the drugs Bystolic®, Savella®, and Namenda®, the Department of Justice announced today. “Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s ... Read more

Pharmaceutical Executives Charged in Racketeering Scheme BOSTON – Several pharmaceutical executives and managers, formerly employed by Insys Therapeutics, Inc., were arrested today on charges that they led a nationwide conspiracy to bribe medical practitioners to unnecessarily prescribe a fentanyl-based pain medication and defraud healthcare insurers. The indictment alleges that Michael L. Babich, 40, of Scottsdale, Ariz., the former CEO and President of the company; Alec Burlakoff, 42, of Charlotte, N.C., former Vice President of Sales; Richard M. Simon, 46, of Seal Beach, Calif., former National Director of Sales; former Regional Sales Directors, Sunrise Lee, 36, of Bryant City, Mich. and ... Read more

Two Defendants Indicted For Healthcare Fraud And Money Laundering SAN JUAN, P.R. – On November 29, 2016, a federal grand jury returned an indictment charging defendants Pedro Van Rhyn Soler and Edgardo Van Rhyn Soler with one count of health care fraud and two counts of money laundering for their participation in a scheme to defraud Multinational Life Insurance Company (“MLIC”), formerly known as National Life Insurance Company (“NALIC”),” announced Rosa Emilia Rodríguez-Vélez, United States Attorney for the District of Puerto Rico. According to court documents, between 2006 and 2011, Edgardo Van Rhyn Soler was the Vice President and then ... Read more

Former Owner of Miami Based Pharmacy Convicted at Trial of $700,000 Medicare Fraud Scheme The former owner of a Miami based retail pharmacy was convicted, following a three-day trial, for his participation in a scheme that involved the fraudulent submission of approximately $700,000 dollars in false billing to Medicare. Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, and Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), made the announcement. Andres Alfonso, 54, of Miami, was convicted of three substantive counts of health care fraud.  Alfonso ... Read more

Anchorage Man Sentenced to 10 Months in Federal Prison for Medicaid and Social Security Fraud Schemes Anchorage, Alaska – U.S. Attorney Karen L. Loeffler announced that Julio De La Cruz, 53, of Anchorage was sentenced yesterday by Chief U.S. District Judge Timothy M. Burgess to serve 10 months in federal prison for his part in a scheme to defraud the State of Alaska Medicaid Program out of approximately $64,000.  In a separate case, Judge Burgess also sentenced De La Cruz to serve 10 months for defrauding the United States Social Security Administration out of approximately $37,000.  De La Cruz was ... Read more