Guilty plea for $32 million Medicare fraud
Felix Gonzalez, the owner of Miami-based home health care company AA Advanced Care Inc., pled guilty to leading a Medicare fraud scheme that netted $22 million of the $32 million in false claims that were submitted. The company provides home health and therapy services to Medicare beneficiaries, but was allegedly billing the Medicare program for expensive physical therapy and home healthcare service that were either not medically needed or not provided at all.
Gonzalez also admitted to negotiating and paying kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary services that could be billed.
Podiatrist plead guilty to $999,170 fraud
Dr. Lawrence Iken plead guilty to one count of healthcare fraud for submitting false claims for services that were submitted over an eight year period. Through his own company and acting as an independent contractor, Iken overbilled Medicare, Medicaid and private insurance companies for services that were never rendered. This includes billing for draining abscesses and hematomes when he only clipped patients’ toenails.
Dr. Iken agreed that over the time frame, he overbilled $999,170. He faces a maximum of 10 years in prison, personal fines up to $250,000 and a company fine of up to $500,000.
Orchestrators of $97 million Medicare scheme sentenced
The two owners of a Houston-area mental health clinic were sentenced to 148 months and 120 months respectively for orchestrating a $97 million Medicare fraud scheme. Mansour Sanjar and Cyrus Sajadi were found guilty of using their community mental health clinic from 2006 through 2011 to provide partial hospitalization program (PHP) services, which include outpatient treatment for severe mental illness, and billing for them, even if the beneficiaries did not qualify for the services. They also billed for services when residents were watching movies, coloring and playing games, which are not billable activities.
It was also discovered that the pair paid kickbacks to group home operators and patient recruiters for delivering ineligible patients.
“Doctors are not only bound by oath to serve the health of their patients, they are bound by duty to serve as gatekeepers for Medicare spending,” said Assistant Attorney General Caldwell. “In this case, without the criminal participation of Drs. Sanjar and Sajadi, this fraud simply could not have happened.”
Clinic owner sentenced to 30 months
Ronnie Lorenzo Robinson, the former owner of Peaceful Alternative Resources, was sentenced to 30 months in prison for his role in a $3.4 million Medicaid fraud scheme. The company provided mental health and mentoring services from two offices in North Carolina. The company submitted fraudulent reimbursement claims for fake mental health services which were either provided by unlicensed, non-Medicaid approved individuals, if they were provided at all.
Michigan physician gets 15 months for $2.1 million in fraud
Dr. Paula Williamson has been sentenced to prison for 15 months for her role in a $2.1 million Medicare fraud scheme. Between August 2009 and October 2012, Williamson and others committed healthcare fraud by referring Medicare beneficiaries for home health services that were medically unnecessary or never provided. Williamson also falsified documents to support the fake claims.
Settlement reached in $1 million fraud case
Nason Medical and two of its doctors have reached a $1,021,778.26 settlement. It was alleged that the provider submitted claims to Medicare that should have been provided by physicians, but were actually provided by physician assistants, some tests were not medically indicated and some radiological services were handled by technicians that were not licensed.
“Being a health care provider in Federal healthcare programs such as Medicare and Medicaid is a privilege, not a right. When health care providers order medically unnecessary procedures such as CT scans and submit other improper claims just to boost profits, they threaten both the health of their patients and the financial integrity of the Medicare and Medicaid programs,” said Derrick Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General (OIG).
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