DOJ: Physician Charged for Alleged Role in an Over $120 Million Health Care Fraud and Money Laundering Conspiracy Involving Sponsorship of Ultimate Fighting Championship Hall of Famers - I Want To Know If Detroit Land Bank Authority Was Involved

I want to know how many of his real estate investments were throgh the Detroit Land Bank Authority.

I also would like to know how many mortgages, TARP, did he take out.... get wiped out in quiet title back to the Detroit Land Bank Authority.... to be handed out back to a fake ass LLC, to mortgage, quiet title... blah, blah, blah.....

If you think this fake ass personea promulgating egregious societal schemes are bad, sit back and close your eyes to imagine this of but one, transposable model, to identify a sub network of blood curdling screams of children, under medical aegis of foreign entities, being used as lab rats, in the name of the tax exempt god, whose lives are in the hands of fake ass child welfare experts, who write curricula, to generate a reward system in the glorification of snatching and selling kids.

Foster care and adoption is fake, to cloak the residuals of the peculiar institution, more intuitively recognized as modern day human trafficking.

Like I said, children and real property are fungible, and they come with propaganda marketing schemes to maximize that revenue.

Happy Child Abuse Propaganda Month!

Praise the lord and show me his tiny human trust funds.

A physician who from 2016 to 2017 was the top prescriber of oxycodone 30 mg in Michigan was charged in a superseding indictment unsealed today with an over $120 million health care fraud and money laundering scheme that involved the alleged medically unnecessary distribution of over 2.2 million dosage units of controlled substances and the administration of medically unnecessary injections that resulted in patient harm. 

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Matthew Schneider of the Eastern District of Michigan, Special Agent in Charge Steven M. D’Antuono 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 made the announcement.

Francisco Patino, 65, of Wayne County, Michigan, was charged in the superseding indictment with one count of conspiracy to commit health care fraud and wire fraud, one count of conspiracy to commit money laundering and one count of money laundering.  These charges are in addition to the two counts of health care fraud and one count of conspiracy to defraud the United States and pay and receive health care kickbacks that was charged in the initial indictment.  The case is pending before U.S. District Judge Denise Page Hood of the Eastern District of Michigan.  Trial has been scheduled to begin on April 7 before Judge Hood.

The superseding indictment alleges the laundering of the proceeds of the health care fraud scheme to falsely portray the defendant as a legitimate doctor through the publication of a diet book and plan described as the “next Atkins,” paid-for appearances on a nationally syndicated television show, and the sponsorship of boxers, cagefighters and prominent Ultimate Fighting Championship (UFC) world champions and hall of famers.    

The superseding indictment alleges that Patino owned, controlled and operated numerous pain clinics and laboratories in Michigan – including Global Quality Inc., RenAMI, FDRS and Patino Laboratories – and was the top prescriber of Oxycodone 30 mg in Michigan from 2016 to 2017.  As alleged in the superseding indictment, from 2008 until his arrest in 2018, Patino induced patients to come to his clinics by offering unnecessary prescriptions for addictive opioids, of which he ultimately prescribed over 2.2 million dosage units of medically unnecessary controlled substances, including fentanyl, oxycodone and oxymorphone.  Patino prescribed these opioids to Medicare beneficiaries, some of whom were addicted to narcotics.  Some of these opioids were resold on the street, the superseding indictment alleges.  Fentanyl is one of the most potent opioids available for human use.

According the superseding indictment, Patino forced patients to submit to unnecessary and sometimes painful back injections and other procedures in exchange for the opioid prescriptions as part of a scheme to defraud Medicare of over $120 million.  The superseding indictment alleges that Patino persisted with these unlawful practices even after Medicare informed him that the injections violated Medicare’s rules and after Patino entered into a consent order with the State of Michigan that his prescription of opioids “constitute[d] a violation of the public health code.”

Patino also ordered unnecessary urine drug testing in exchange for illegal kickbacks, the superseding indictment alleges.  Patino was aware that his ownership structure and kickbacks were a violation of law and authored emails acknowledging that such ownership constituted  a “violation of the Stark and Anti-Kickback laws” and attempted to conceal and disguise the ownership structure and scheme in order to keep himself “out of Federal Prison & having all our assets seized to pay a 15 million dollar fine.”

The superseding indictment alleges that Patino conspired to commit money laundering and committed money laundering in connection with the creation and promotion of the “Patino Diet” plan, which Patino described to others as the “next Atkins diet.”  In order to conceal and disguise his illegal health care fraud scheme, Patino allegedly paid for the authorship and publication of a book touting the diet plan, entitled “The Age of Globesity,” and paid hundreds of thousands of dollars in order to promote the diet plan and appear as the exclusive medical expert on a nationally syndicated television show.

In addition to concealing the scheme by paying money to falsely portray himself as a media personality and a legitimate physician, the superseding indictment alleges, that Patino laundered the healthcare fraud and kickback money by entering into sham contracts or employment relationships to pay others on his behalf to sponsor boxers, mixed martial artists and Ultimate Fighting Championship (UFC) combatants, including UFC world champions and hall of famers.  The superseding indictment alleges that Patino also withdrew the proceeds derived from the conspiracy to live an extravagant lifestyle and spend money on luxury clothes, real estate and international travel, including multiple trips to the Cayman Islands.

The charges against Patino are related to a broader investigation into the Tri-County Network of pain clinics in Michigan and Ohio, which involves over $300 million in alleged Medicare fraud and the alleged distribution of over 6.6 million dosage units of controlled substances.  In connection with the investigation, 22 defendants, including 12 physicians, have previously pleaded guilty or been found guilty at trial.

An indictment is merely an allegation and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law. 

This case was investigated by the FBI and HHS-OIG.  Assistant Chief Jacob Foster and Trial Attorney Thomas Tynan of the Criminal Division’s Fraud Section are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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DOJ: Four Detroit-Area Physicians Found Guilty of Health Care Fraud Charges for Role in Over $150 Million Health Care Fraud Scheme

A federal jury found four Detroit-area physicians guilty today of health care fraud charges for their roles in a scheme to administer unnecessary back injections to patients in exchange for prescriptions of over 6.6 million doses of medically unnecessary opioids.  Patients were required to get the injections in order to get the prescriptions, some of which were resold on the street by drug dealers, the evidence at trial showed.

After a four-week trial, Spilios Pappas, 62, of Lucas County, Ohio, Joseph Betro, 59, of Oakland County, Michigan, Tariq Omar, 62, of Oakland County, Michigan, and Mohammed Zahoor, 53, of Oakland County, Michigan, were each found guilty of one count of conspiracy to commit health care fraud and wire fraud, and one count of health care fraud.  Sentencing has been scheduled for July 16 for Pappas, July 17 for Betro, July 24 for Zahoor and July 30 for Omar before Chief U.S. District Judge Denise Page Hood of the Eastern District of Michigan, who presided over the trial.  Seventeen other defendants, including eight other doctors, previously pled guilty in connection with the investigation. 

“These physicians subjected patients to medically unnecessary injections to reap millions in fraudulent billings.  Worse still, they incentivized those treatments by offering opioid prescriptions in sky-high dosages meant for the terminally ill,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division.  “Today’s verdict shows that the Department will root out physicians who let dollar signs rather than medical need drive their treatment of patients.” 

“These doctors sought to enrich themselves by performing unnecessary back injections in exchange for highly addictive opioids, violating their Hippocratic Oath to do no harm,” said U.S. Attorney Matthew Schneider of the Eastern District of Michigan.  “Our office will continue to prioritize the prosecution of doctors whose criminal behavior puts patients at risk.”

“Physicians take an oath that obligates them to do no harm to their patients.  These four men willingly broke that oath – by providing unnecessary drugs and conducting unnecessary procedures – solely to line their pockets,” said Special Agent in Charge Steven M. D’Antuono of the FBI’s Detroit Field Office.  “This guilty verdict sends a message to any doctor or healthcare professional who prioritizes profit or does harm to their patients under the guise of providing health care will be subject to the full investigative resources of the FBI and our law enforcement partners.”

“The public trusts that physicians will put patients’ health and safety first.  These defendants violated that trust in pursuit of their own financial gain,” said Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services, Office of Inspector General Chicago Region.  “The OIG takes matters of this nature very seriously and will continue to work with our law enforcement and prosecutorial partners to hold individuals who commit these kinds of criminal acts accountable.”

According to evidence presented at trial, from 2008 to 2016, Pappas, Betro, Omar and Zahoor worked at numerous medical clinics in Michigan and Ohio, which were operated under the name of the Tri-County Group (Tri-County) and owned by co-conspirator Mashiyat Rashid.  While the defendants worked at Tri-County, they engaged in a scheme to defraud Medicare of over $150 million by billing for medically unnecessary facet joint injections, unnecessary urinary drug screens, home health and a myriad of other unneeded ancillary services.  The evidence showed that patients, some of whom were suffering from legitimate pain and others of whom were drug dealers or opioid addicts, were offered prescriptions of oxycodone 30 mg by the defendants, but were forced to submit to unnecessary facet injections in exchange for the prescriptions. 

Testimony at trial established that the patients experienced more pain from the shots, in some case, than from the pain they had purportedly come to have treated, and that some patients developed adverse conditions, including open holes in their back.  Patients, including patients who were addicted to opioids, who told the doctors that they did not want, need or benefit from the injections, were denied medication by the defendants and their co-conspirators until they agreed to submit to the expensive and unnecessary injections. 

The evidence further established that the defendants repeatedly performed these unnecessary injections on patients, as Tri-County was paid more for facet joint injections than any other medical clinic in the United States.  The four defendants were all ranked in the top 25 doctors for dollars paid by Medicare for facet joint injections, even though they only worked a few hours a week.  The defendants practice was described during trial as an assembly line, where the four defendants earned anywhere from $1,100 to $3,500 an hour for performing the same injections on nearly every patient.

In addition to the unnecessary injections, the defendants signed a standing order for urine tests for each patient and for every visit to be sent to National Laboratories, also owned by Rashid, in exchange for tens of thousands of dollars in illegal kickbacks, the evidence showed.  The evidence further established that the physicians performed a quantitative test for 56 different drugs for every patient at every visit, regardless of whether the patients presented any reason for the test.

The evidence further established that the physicians provided prescriptions for narcotics, including opioids and benzodiazepines, as an incentive to patients who received the injections.  Moreover, the evidence established that the dosage of opioids being provided to patients was suitable only for terminally ill cancer patients.  Evidence from Michigan Automated Prescription System showed that the four defendants were among some of the top prescribers of oxycodone 30mg in the state of Michigan. 

In 2015, Pappas was the number seven prescriber of oxycodone 30mg in the state of Michigan; Betro 18; Omar 16; and Zahoor 38 the evidence showed.  At trial, oxycodone 30mg was described as the “gold standard” of drugs diverted to illegal purposes on the street.  Evidence showed that all four defendants were in the top 40 out of 50,000 Michigan prescribers even though they had conspired with Rashid to “stay under the radar” of the U.S. Drug Enforcement Administration by working only a few hours a week.  The doctors would see anywhere from 15-25 patients in a two to four hour shift, and then bill Medicare for office visits and procedure codes suggesting that they spent as much as two hours and 22 minutes with each patient.  Every piece of the fraud was consistently implemented and applied to over 94 percent of the patients in the clinic.

The FBI and HHS-OIG investigated this case.  Assistant Chief Jacob Foster and Trial Attorneys Tom Tynan and Anthony Burba of the Criminal Division’s Fraud Section are prosecuting the case. 

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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DOJ: Three Individuals, Including A Former Texas Mayor, CEO and Owner, Found Guilty in a $154 Million Money Laundering and Health Care Fraud Scheme

A federal jury found three individuals associated with dozens of hospice and home health companies guilty today for their roles in a $154 million health care fraud scheme, one of which was a mayor in Texas at the time.

After a three-week trial, the jury found Rodney Mesquias, 47, of San Antonio, Texas, Henry McInnis, 47, of Harlingen, Texas, and Francisco Pena, 82, of Laredo, Texas, guilty of one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. In addition, Mesquias and McInnis were found guilty of six counts of health care fraud and one count of conspiracy to obstruct justice. Pena was also convicted of one count of health care fraud, obstruction of health care investigations and one count of false statements, while Mesquias and Pena were each convicted of one count of conspiracy to pay and receive kickbacks.

U.S. District Judge Rolando Olvera presided over the trial and set sentencing for June 17, 2020.  

“Rodney Mesquias and his co-conspirators preyed on the most vulnerable population – those in need of hospice and home health care– to line their pockets with millions of dollars and engage in lavish spending,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “I thank our law enforcement partners for their hard work and dedication to bringing these health care fraudsters to justice. We look forward to continuing our partnership as we expand the Strike Force into the Rio Grande Valley.”

“It’s disgusting how these three made millions by lying about and manipulating people’s end of life care,” said U.S. Attorney Ryan K. Patrick of the Southern District of Texas. “These men won’t have season tickets or nice cars where they are headed.”

“Hospices should provide meaningful quality of life care for patients in the final stage of their disease. Rather than help these vulnerable patients, Mesquias and McInnis operating as the Merida Health Care Group along with Dr. Francisco Pena, exploited them and their families to steal millions of dollars from the American taxpayer,” said Special Agent in Charge Christopher Combs of the FBI’s San Antonio Field Office. “The FBI is committed to aggressively investigating and bringing to justice those who undermine our health care system.”

“The decision to provide hospice services should be based on a patient’s medical condition and desire for palliative care, not the selfish motives of hospice executives intending to line their own pockets,” said Special Agent in Charge C.J. Porter for the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region. “Our agency will continue to protect Medicare patients and Medicare itself from such unscrupulous individuals.”

According to evidence presented at trial, from 2009 to 2018, Mesquias, McInnis and Pena engaged in a scheme that involved over $150 million in false and fraudulent claims for hospice and other health care services. Mesquias owned and controlled the Merida Group, a large health care company that operated dozens of locations throughout Texas. McInnis was CEO. Pena, a licensed physician, was a medical director for the Merida Group and was at the time the mayor of Rio Bravo, Texas. According to evidence presented at trial, the Merida Group enrolled patients with long-term incurable diseases, such as Alzheimer’s and dementia, at group homes, nursing homes, and in housing projects by falsely telling them that they had less than six months to live, and sent chaplains to lie to the patients and discuss last rites and preparation for their imminent death. In fact, the patients were not suffering from a terminal illness that was expected to result in their death within six months, as is required to qualify for hospice services, and were in some instances walking, driving, working and even coaching athletic sporting events, the evidence at trial showed. However, the defendants kept the patients on services for multiple years in order to increase revenue. Mesquias also fired employees who refused to go along with the fraud, and directed them not to “[expletive] with his patients, or [expletive] with his money” by discharging patients from services, the evidence at trial showed.  Pena told a cooperating witness that, with respect to hospice patients, “the way you make money is by keeping them alive as long as possible,” according to trial testimony. 

The evidence further established that Pena gave a false statement to the FBI and directed others to obstruct the FBI’s investigation by covering up Pena’s involvement in accepting kickbacks for hospice patients from his mayoral office at Rio Bravo City Hall and elsewhere.  The evidence also established that Mesquias and McInnis obstructed justice by causing the creation of false and fictitious medical records and produced them to a federal grand jury in order to avoid Indictment.  The records added false diagnostic information making it appear that patients were dying when, in fact, they were not.

According to evidence presented at trial, the scheme involved laundering the proceeds of the fraud by, for example, placing a company in the name of the girlfriend of a co-conspirator physician to conceal the distribution of hundreds of thousands of dollars in illegal kickbacks that were provided to the physician in exchange for home health and hospice referrals. Mesquias and McInnis used proceeds derived from the scheme to purchase expensive vehicles such as a Porsche, expensive jewelry, luxury clothing from high-end retailers such as Louis Vuitton, exclusive real estate, season tickets for premium seating to see the San Antonio Spurs and a security detail and bottle service at high end Las Vegas nightclubs such as Hakkasan and Omnia, the evidence showed. Mesquias and McInnis treated physicians to lavish parties at these elite nightclubs, plying them with tens of thousands of dollars in alcohol and other perks in exchange for medically unnecessary patient referrals. 

Mesquias caused kickbacks and bribes to be paid to medical directors, including Pena, for the Merida Group’s affiliated entities in exchange for certifying that patients qualified for services when, in fact, they did not, and for referring patients for such services, the evidence showed. 

HHS-OIG’s McAllen Field Office; the FBI’s San Antonio Field Office, including the Laredo and McAllen Resident Agency Offices; and the Texas Health and Human Services Commission investigated the case with the assistance of the Texas Attorney General’s Medicaid Fraud Control Unit.  Trial Attorney Kevin Lowell and Assistant Chief Jacob Foster of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Andrew Swartz of the Southern District of Texas are prosecuting the case. 

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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DOJ: Assistant Attorney General Brian A. Benczkowski Delivers Remarks at the 20th Annual Pharmaceutical and Medical Device Compliance Congress

Remarks as Prepared for Delivery

Good afternoon, and thank you for inviting me to speak at the 20th anniversary of this important forum, which brings together compliance experts across the pharmaceutical and medical device industries.  It is truly a pleasure to be here on behalf of the Criminal Division of the Department of Justice.  

At the outset, I would like to commend you for the important work that you do.  The Department greatly values the role of the corporate compliance community.  Every day, you work hard to reinforce legal and regulatory compliance and ethical behavior in business organizations, work that benefits all of us. 

The role of the federal prosecutor is, of course, different from that of a corporate compliance professional, but in many ways our goals are aligned.  We both want to deter corporate criminal misconduct, and we both want to detect such misconduct when it does occur, holding wrongdoers to account in our respective ways. 

With apologies for repeating a cliché -- the corporate compliance function is in some ways more important than the prosecution function. 

It can actually prevent misconduct in the first place through robust systems of controls, and by fostering a culture where compliance is valued and rewarded.  And while this aspect of corporate compliance is always important, it is especially important in the industries in which you operate, where the health and safety of patients often are at stake.

I came to my current role as the head of the Criminal Division from private practice, where I worked on investigations and compliance reviews for numerous life sciences clients. 

I know first-hand – both from that experience and my time with the Department – that the good corporate citizens within the pharmaceutical and medical device industries invest heavily in their compliance programs.  And they need to do so.  Most of you operate in a heavily regulated space, and the risks of non-compliance are high.

For at least the last two decades, the Department has made it clear that it expects companies to invest in effective compliance programs.  But I don’t think the Department has always been as clear about what that means – both in terms of what the Department would look for in an effective program, and with regard to how the Department’s prosecutors would factor compliance into resolving their corporate cases.

Over the last few years, including before I arrived, the Criminal Division has worked to be more transparent about how it approaches its evaluation of compliance programs, including developing new policies and guidance designed to help encourage responsible companies to fully invest in compliance, but also to invest wisely and efficiently.

Building on past efforts, in April of this year, the Criminal Division issued a newly expanded and refined guidance document for our white-collar prosecutors clarifying how to evaluate corporate compliance programs. 

This guidance promotes greater transparency in the specific factors we will use to evaluate the design and effectiveness of a compliance program.  It spells out numerous factors that the Criminal Division has frequently found relevant, but organizes them around three fundamental questions, which are always at the heart of our inquiry: 

1) Is the compliance program well designed?

2) Is the program being implemented effectively and in good faith?

3) And does the compliance program work in practice?

In setting forth these various factors, we were not seeking to be prescriptive.  We are not regulators, and we recognize that every company and industry is different. There is no such thing as a one-size-fits-all compliance program, nor should there be.  

We also know that no compliance program is 100% effective.  No system of controls is absolutely bulletproof.  

Corporations employ people, and not all of those people are going to be uniformly law-abiding and ethical.  Bad actors in a company will work to identify and exploit weak controls and compliance structures. 

The Criminal Division’s policies need to reflect that reality, especially because our prosecutors will invariably find themselves assessing a compliance program’s adequacy in hindsight, after a problematic event has already occurred. 

The policies and tools they bring to their analysis need to account for the fact that misconduct is sometimes going to happen, even within good organizations.  Our prosecution efforts need to differentiate between companies that are investing adequately in compliance and working hard to build a strong culture, and those that are not. 

Our written compliance guidance is crafted to avoid being overly rigid, allowing for each company’s program to be evaluated based on its unique risk profile. 

But the Division’s written guidance document is only part of what we’ve done to improve our prosecutors’ understanding of corporate compliance programs. 

In concert with our development of written compliance program guidance, we also trained all Criminal Division attorneys who work on corporate investigations to give them a range of perspectives on compliance program effectiveness. 

As part of that training, we brought in experts from inside the Department of Justice, as well as outside voices from industry and the accounting profession to share their views on various compliance challenges and how industry is confronting them. 

We looked at compliance challenges in high-risk markets and industries, as well as challenges that come with M&A due diligence and post-acquisition integration. We also focused on an area of growing attention in your industries, namely the evolution of compliance technology and data tools. 

All of this is part and parcel of a common effort in the Criminal Division to promote effective compliance regimes.  By training our prosecutors, we are making them better able to objectively assess the role of compliance in any corporate resolution, including whether to impose a monitor.  And by providing written guidance, our prosecutors should be working from a common understanding of how to do those assessments. 

But we also want you all to have a window into our thinking, so you can make wise, informed, and cost-effective decisions about whether and how to develop, grow, and enhance your compliance programs. 

This transparency hopefully will foster better alignment of the common goals I mentioned at the outset – deterrence of corporate crime on the front end, holding bad actors accountable on the back end, and doing so in a way that is fair and objective.     

We’ve made other policy changes as well that align with these goals.  Deterrence, of course, also is the objective behind applying the FCPA Corporate Enforcement Policy in all of our corporate criminal cases, including health care fraud cases.  Under this policy, a company receives the presumption of a declination if it voluntarily self-discloses the misconduct, fully cooperates with the Department, and engages in timely and appropriate remediation.   

Even if aggravating circumstances call for a criminal resolution, companies can get up to a 50% reduction off the bottom of the applicable fine range if the conditions of voluntarily self-disclosure, full cooperation, and timely and appropriately remediation are met. 

In a nutshell, the policy makes clear that when a company is serious about maintaining a culture of compliance, it can enjoy the peace of mind that the government will recognize that fact, and treat it fairly. 

Deterrence is also the objective behind the so-called “anti-piling on” policy.  That policy encourages enforcement components inside and outside of the Department of Justice to coordinate with one another when imposing penalties for the same conduct. 

Coordination includes crediting and allocating financial penalties and forfeitures to avoid disproportionate punishment.   

The “anti-piling on” policy is designed to encourage companies to aggressively root out perpetrators without fearing that they later will be subject to multiple penalties from multiple regulators. 

Deterrence is likewise the common thread behind our decision to be more transparent about corporate declinations under the enforcement policy. 

We now routinely publish corporate declinations on our website so that defense attorneys and corporate counsel can refer to these declination memoranda to understand the analysis behind our decision to not bring criminal charges.      

 All of these efforts have been geared toward enhancing transparency and fostering ethical corporate practices and behaviors so that companies will have the tools and information needed to invest fully in compliance, and so that criminal wrongdoing is deterred before it ever calls for the attention of the Department of Justice.

Enforcement

A few words about enforcement.  White-collar criminal enforcement and health care fraud continue to be a top priority for the Department of Justice and the Criminal Division.  

In 2018, our Fraud Section posted record numbers of white-collar prosecutions in a number of categories. 

In one year alone, we brought 10 corporate enforcement actions and recovered more than $1 billion in corporate U.S. criminal fines, penalties, restitution, and forfeiture, as part of resolutions that returned $3 billion globally. 

We also held individuals accountable for their criminal acts.  In 2018, the numbers of individuals charged increased by 33% from the prior year, and we convicted 40% more individuals at trial.

And as we near the end of 2019, we are on track to surpass many of those 2018 benchmarks.

In addition to general corporate enforcement, we have been laser-focused when it comes to combatting health care fraud and opioid fraud and abuse schemes that have destroyed so many lives across the United States. 

Health care fraud is a betrayal of the public trust -- it robs American taxpayers of billions of dollars every year and threatens our most vital federal programs, all while driving up the cost of health care and insurance. 

Illegal opioid schemes exploit the disease of addiction and corrupt the time-honored relationship between doctors and patients. 

During my tenure, we have brought the full power of the law to bear on the perpetrators of all these schemes.  

Over the last several months, we have announced indictments charging a variety of health care fraud, Anti-Kickback Statute, money laundering, and Controlled Substances Act violations in a number of regions of the country from Tennessee, Kentucky, West Virginia, and Ohio to Texas, California, New Jersey, and elsewhere. 

These indictments resulted from the successful work of our Strike Force model that combines seasoned prosecutors from the Criminal Division and U.S. Attorneys’ Offices, analysts, and law enforcement agents in federal districts across the country.

The Strike Force model has proven to be highly successful in combatting health care fraud and opioid abuse by combining data analytics and the use of traditional law enforcement investigative techniques.

It has allowed us to shine a bright light on dirty doctors, clinic owners, pharmacists, and others who long believed they could perpetrate their frauds and exploit their patients for personal financial gain without visibility. 

The data in our possession allows us to see them, however remote or rural their corner of the country.  With the overlay of traditional investigative techniques, we are able to use data analytics to track down the worst of the worst offenders and quickly build strong cases against them. 

In the past year, we expanded our Strike Force program to the Appalachian region to target opioid abuse related crimes and in the Rio Grande Valley and San Antonio, Texas.  We now have 15 total Strike Forces operating in 24 districts.

In just 2019 alone, the Criminal Division’s Health Care Fraud Strike Forces have brought charges against 354 individuals with a loss amount of over $4.1 billion. 

I’d like to highlight for you some of the schemes that we have uncovered and prosecuted which exploit new medical technology, like telemedicine, and use sophisticated money laundering to facilitate and disguise fraud. 

In April of this year, we announced the takedown of one of the largest health care fraud schemes ever investigated by the FBI and HHS-OIG, and prosecuted by the Criminal Division and U.S. Attorney’s Offices. 

The takedown resulted in charges against 24 defendants, including the CEOs, COOs, and others, associated with five telemedicine companies, the owners of dozens of durable medical equipment (DME) companies, and three licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $1.2 billion in loss. 

Significantly, as part of this operation, our partners at the Center for Medicare and Medicaid Services’ Center for Program Integrity took simultaneous adverse administrative action against 130 DME companies that had submitted over $1.7 billion in claims and were paid over $900 million.   These actions resulted in the immediate suspension of payments from the program and/or termination of the companies’ rights to bill the program at all.

As alleged in the indictments, DME companies paid illegal kickbacks and bribes in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for back, shoulder, wrist, and knee braces that were medically unnecessary.  

Additionally, an international telemarketing network lured hundreds of thousands of elderly and/or disabled patients into a criminal scheme that crossed borders, involving call centers in the Philippines and throughout Latin America. 

These defendants allegedly paid doctors to prescribe DME either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen. 

The proceeds of the fraudulent scheme were then allegedly laundered through international shell corporations and used to purchase exotic automobiles, yachts, and luxury real estate in the United States and abroad.

The Criminal Division coordinates closely with its law enforcement and agency partners to ensure that we are proactively identifying and addressing the most serious threats to the Medicare program.  And this forward-leaning approach has led us to tackle health care fraud in new frontiers of medicine. 

Within just months of announcing the DME indictments, the Criminal Division unveiled another significant enforcement action involving fraudulent genetic cancer testing, in partnership with the U.S. Attorney’s Offices for the Southern and Middle Districts of Florida, the Southern District of Georgia, and the Eastern and Middle Districts of Louisiana

As part of that operation, we charged 35 defendants associated with dozens of telemedicine companies and genetic testing laboratories for their alleged participation in one of the largest health care fraud schemes ever charged – a scheme involving more than $2.1 billion in fraudulent Medicare billings.

This investigation targeted an alleged scheme involving the payment of illegal kickbacks and bribes by genetic testing laboratories in exchange for referrals of Medicare beneficiaries.  The referrals were made by medical professionals working with fraudulent telemedicine companies.  And the referrals were for expensive cancer genetic tests that were medically unnecessary. 

Indeed, often times the diagnostic results were never even provided to the beneficiaries or were worthless to their actual doctors. 

In addition to our efforts to combat health care fraud and opioid fraud and abuse on the home front, I want to highlight a recent corporate resolution that demonstrates our efforts to hold providers accountable for paying bribes to foreign government officials to gain a competitive advantage in the medical services industry. 

In March, I announced that the Fraud Section had entered into a corporate resolution with Fresenius Medical Care, one of the leading providers of dialysis products and services in the world.

The company had agreed to pay $231 million to resolve investigations by the DOJ and the SEC into violations of the FCPA in connection with Fresenius’ participation in various corrupt schemes to obtain business in multiple foreign countries. 

Fresenius admitted that between 2007 and 2016, it paid bribes to publicly employed health and/or government officials to obtain or retain business in Angola and Saudi Arabia, as well as in Morocco, Spain, Turkey, and countries in West Africa.  Fresenius also admitted that it knowingly and willfully failed to implement reasonable accounting controls over financial transactions and failed to maintain books and records that accurately and fairly described the transactions.

This resolution, under which Fresenius agreed to retain an independent compliance monitor for two years, reflects the Department’s firm commitment to rooting out bribery and promoting the kind of effective compliance programs that will prevent misconduct going forward.

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It’s been a pleasure to speak here today.  As I hope you can tell, the Criminal Division will continue to aggressively investigate and prosecute health care and other frauds in the drug and device sectors.  I also hope my remarks give your industries some comfort that when we do investigate and prosecute, we will do so fairly, pursuant to clearly identified policies. There should be no mystery about how and why we bring and resolve enforcement actions.  And hopefully this transparency will help you prevent corporate crime, and help you make wise decisions about how to best deploy your compliance resources.  

Thank you very much, and I wish you the best for the remainder of the conference.

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PROCLAMATION: Presidential Proclamation on the Suspension of Entry of Immigrants Who Will Financially Burden the United States Healthcare System

This does not seem to apply to the Child Welfare System or the Medicaid Fraud schemes, within, but it does, with a smooth, legal finesse, document citizenship through contractual relationships under the responsibility of a corporation to approve health care coverage.

So, health insurance databases can be meshed within other immigration systems, where the health insurance company must maintain the genetic histories, expediting the naturalization process to a click of an app.

If the health insurance contracts are found violate its contracts, engaging in fraud, they can be stripped of their rights to bear the Arms of the United States, including asset forfeiture under the powers of the Treasury.

This is the Wall.

  Issued on: October 4, 2019

Healthcare providers and taxpayers bear substantial costs in paying for medical expenses incurred by people who lack health insurance or the ability to pay for their healthcare.  Hospitals and other providers often administer care to the uninsured without any hope of receiving reimbursement from them.  The costs associated with this care are passed on to the American people in the form of higher taxes, higher premiums, and higher fees for medical services.  In total, uncompensated care costs — the overall measure of unreimbursed services that hospitals give their patients — have exceeded $35 billion in each of the last 10 years.  These costs amount to approximately $7 million on average for each hospital in the United States, and can drive hospitals into insolvency.  Beyond uncompensated care costs, the uninsured strain Federal and State government budgets through their reliance on publicly funded programs, which ultimately are financed by taxpayers.

Beyond imposing higher costs on hospitals and other healthcare infrastructure, uninsured individuals often use emergency rooms to seek remedies for a variety of non-emergency conditions, causing overcrowding and delays for those who truly need emergency services.  This non-emergency usage places a large burden on taxpayers, who reimburse hospitals for a portion of their uncompensated emergency care costs.

While our healthcare system grapples with the challenges caused by uncompensated care, the United States Government is making the problem worse by admitting thousands of aliens who have not demonstrated any ability to pay for their healthcare costs.  Notably, data show that lawful immigrants are about three times more likely than United States citizens to lack health insurance.  Immigrants who enter this country should not further saddle our healthcare system, and subsequently American taxpayers, with higher costs.

The United States has a long history of welcoming immigrants who come lawfully in search of brighter futures.  We must continue that tradition while also addressing the challenges facing our healthcare system, including protecting both it and the American taxpayer from the burdens of uncompensated care.  Continuing to allow entry into the United States of certain immigrants who lack health insurance or the demonstrated ability to pay for their healthcare would be detrimental to these interests.

NOW, THEREFORE, I, DONALD J. TRUMP, by the authority vested in me by the Constitution and the laws of the United States of America, including sections 212(f) and 215(a) of the Immigration and Nationality Act (8 U.S.C. 1182(f) and 1185(a)) and section 301 of title 3, United States Code, hereby find that the unrestricted immigrant entry into the United States of persons described in section 1 of this proclamation would, except as provided for in section 2 of this proclamation, be detrimental to the interests of the United States, and that their entry should be subject to certain restrictions, limitations, and exceptions.  I therefore hereby proclaim the following:

Section 1.  Suspension and Limitation on Entry.  (a)  The entry into the United States as immigrants of aliens who will financially burden the United States healthcare system is hereby suspended and limited subject to section 2 of this proclamation.  An alien will financially burden the United States healthcare system unless the alien will be covered by approved health insurance, as defined in subsection (b) of this section, within 30 days of the alien’s entry into the United States, or unless the alien possesses the financial resources to pay for reasonably foreseeable medical costs.

(b)  Approved health insurance means coverage under any of the following plans or programs:

(i)     an employer-sponsored plan, including a retiree plan, association health plan, and coverage provided by the Consolidated Omnibus Budget Reconciliation Act of 1985;

(ii)    an unsubsidized health plan offered in the individual market within a State;

(iii)   a short-term limited duration health policy effective for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States;

(iv)    a catastrophic plan;

(v)     a family member’s plan;

(vi)    a medical plan under chapter 55 of title 10, United States Code, including coverage under the TRICARE program;

(vii)   a visitor health insurance plan that provides adequate coverage for medical care for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States;

(viii)  a medical plan under the Medicare program; or

(ix)    any other health plan that provides adequate coverage for medical care as determined by the Secretary of Health and Human Services or his designee.

(c)  For persons over the age of 18, approved health insurance does not include coverage under the Medicaid program.

Sec. 2.  Scope of Suspension and Limitation on Entry.  (a)  Section 1 of this proclamation shall apply only to aliens seeking to enter the United States pursuant to an immigrant visa.

(b)  Section 1 of this proclamation shall not apply to:

(i)     any alien holding a valid immigrant visa issued before the effective date of this proclamation;

(ii)    any alien seeking to enter the United States pursuant to a Special Immigrant Visa, in either the SI or SQ classification, who is also a national of Afghanistan or Iraq, or his or her spouse and children, if any;

(iii)   any alien who is the child of a United States citizen or who is seeking to enter the United States pursuant to an IR-2, IR-3, IR-4, IH-3, or IH-4 visa;

(iv)    any alien seeking to enter the United States pursuant to an IR-5 visa, provided that the alien or the alien’s sponsor demonstrates to the satisfaction of the consular officer that the alien’s healthcare will not impose a substantial burden on the United States healthcare system;

(v)     any alien seeking to enter the United States pursuant to a SB-1 visa;

(vi)    any alien under the age of 18, except for any alien accompanying a parent who is also immigrating to the United States and subject to this proclamation;

(vii)   any alien whose entry would further important United States law enforcement objectives, as determined by the Secretary of State or his designee based on a recommendation of the Attorney General or his designee; or

(viii)  any alien whose entry would be in the national interest, as determined by the Secretary of State or his designee on a case-by-case basis.

(c)  Consistent with subsection (a) of this section, this proclamation does not affect the entry of aliens entering the United States through means other than immigrant visas, including lawful permanent residents.  Further, nothing in this proclamation shall be construed to affect any individual’s eligibility for asylum, refugee status, withholding of removal, or protection under the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, consistent with the laws and regulations of the United States.

Sec. 3.  Implementation and Enforcement.  (a)  An alien subject to this proclamation must establish that he or she meets its requirements, to the satisfaction of a consular officer, before the adjudication and issuance of an immigrant visa.  The Secretary of State may establish standards and procedures governing such determinations.

(b)  The review required by subsection (a) of this section is separate and independent from the review and determination required by other statutes, regulations, or proclamations in determining the admissibility of an alien.

(c)  An alien who circumvents the application of this proclamation through fraud, willful misrepresentation of a material fact, or illegal entry shall be a priority for removal by the Department of Homeland Security.

Sec. 4.  Reports on the Financial Burdens Imposed by Immigrants on the Healthcare System.  (a)  The Secretary of State, in consultation with the Secretary of Health and Human Services, the Secretary of Homeland Security, and the heads of other appropriate agencies, shall submit to the President a report regarding:

(i)   the continued necessity of and any adjustments that may be warranted to the suspension and limitation on entry in section 1 of this proclamation; and

(ii)  other measures that may be warranted to protect the integrity of the United States healthcare system.

(b)  The report required by subsection (a) of this section shall be submitted within 180 days of the effective date of this proclamation, with subsequent reports submitted annually thereafter throughout the effective duration of the suspension and limitation on entry set forth in section 1 of this proclamation.  If the Secretary of State, in consultation with the heads of other appropriate executive departments and agencies, determines that circumstances no longer warrant the continued effectiveness of the suspension or limitation on entry set forth in section 1 of this proclamation or that circumstances warrant additional measures, the Secretary shall immediately so advise the President.

(c)  The Secretary of State and Secretary of Health and Human Services shall coordinate any policy recommendations associated with the reports described in subsection (a) of this section.

Sec. 5.  Severability.  It is the policy of the United States to enforce this proclamation to the maximum extent possible to advance the interests of the United States.  Accordingly:

(a)  if any provision of this proclamation, or the application of any provision to any person or circumstance, is held to be invalid, the remainder of the proclamation and the application of its other provisions to any other persons or circumstances shall not be affected thereby; and

(b)  if any provision of this proclamation, or the application of any provision to any person or circumstance, is held to be invalid because of the failure to follow certain procedures, the relevant executive branch officials shall implement those procedural requirements to conform with existing law and with any applicable court orders.

Sec. 6.  General Provisions.  (a)  Nothing in this proclamation shall be construed to impair or otherwise affect:

(i)    United States Government obligations under applicable international agreements;

(ii)   the authority granted by law to an executive department or agency, or the head thereof; or

(iii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b)  This proclamation shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c)  This proclamation is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

Sec. 7.  Effective Date.  This proclamation is effective at 12:01 a.m. eastern daylight time on November 3, 2019.

IN WITNESS WHEREOF, I have hereunto set my hand this fourth day of October, in the year of our Lord two thousand nineteen, and of the Independence of the United States of America the two hundred and forty-fourth.

DONALD J. TRUMP

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DOJ: Midwest Health Care Fraud Law Enforcement Action Results in Charges Against 53 Individuals Alleging $250 Million in Loss - Michigan

How come no one mentioned that Michigan Medicaid Fraud Control Unit?

Awwwww.....

I wonder why?

Not really.

Get 'em.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division announced today a health care fraud law enforcement action in Detroit, Chicago and Minnesota.  Charges were filed against 20 individuals in the Eastern District of Michigan for their alleged involvement in Medicare fraud schemes resulting in $144.8 million in illegitimate billings.  In the Northern District of Illinois, charges were filed against 12 individuals for their alleged involvement in Medicare fraud schemes resulting in over $103 million in illegitimate billings. Of those charged in the two federal districts, seven were doctors or licensed medical professionals.  In addition, in the state of Minnesota, 21 defendants, including two licensed medical professionals, have been charged with defrauding Medicaid for almost $3 million. Minnesota’s Medicaid Fraud Control Unit (MFCU) investigated these cases.  

Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI and U.S. Health and Human Services-Office of Inspector General (HHS-OIG). 

The charges announced today aggressively target schemes billing Medicare, Medicaid and private insurance companies for medically unnecessary procedures, medical procedures that were never provided and prescription medications that often were never purchased and/or distributed to beneficiaries.

“Health care fraud robs taxpaying Americans and corrupts the relationship between doctors and patients,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division.  “Today’s actions in the Midwest are further proof of the Department’s steadfast commitment to investigating and prosecuting those who put their personal greed above the public good.” 

“I applaud the actions taken by our law enforcement partners to seek out and hold accountable those who choose to defraud our health care programs,” said U.S. Attorney Matthew Schneider of the Eastern District of Michigan.  “These charges should send a strong message to health care professionals that theft from these vital programs will be met with serious consequences.”

“The abuse of our healthcare programs affects all taxpayers, who foot the bill to make coverage available,” said Special Agent in Charge Steven M. D’Antuono of the FBI’s Detroit Field Office.  “These offenders stole American taxpayers' hard-earned money to line their own pockets. We thank our federal and state partners for their collaborative efforts to stop this systemic fraud.”

“As we pursue these cases, our focus is always on the beneficiaries and taxpayers who rely on us to protect the integrity of Medicare programs,” said Special Agent in Charge Lamont Pugh III of the HHS-OIG Chicago Region.  “We will continue to work with our law enforcement partners to hold accountable anyone who steals taxpayer dollars and threatens the integrity of this vital benefit.”

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Among those charged in cases handled by Strike Force attorneys in the Eastern District of Michigan are the following:

James Letko, 46, of Pittstown, New Jersey; Steven King, 41, of Pembroke Pines, Florida; Patricia Flannery, 40, of Hellertown, Pennsylvania; Katherine Peterson, 33, of Millford, New Jersey; and Rami Lazeki, 40, of Plymouth, Michigan, were charged in an indictment filed Sept. 26 with one count of conspiracy to commit health care fraud and five counts of health care fraud.  The charges stem from an alleged $80 million, multi-prong health care fraud scheme run by Letko, the CEO of A1C Holdings; King, its chief compliance officer; Flannery and Peterson, members of its management team; and Lazeki, pharmacist in charge at All American Medical Pharmacy.  All five allegedly conspired to direct employees of multiple subsidiary pharmacies under A1C Holdings to conceal Letko’s ownership in the subsidiary pharmacies; falsify contracts with pharmacy benefit managers to conceal Letko’s ownership interest; classify subsidiary pharmacies as mail order when in fact they were retail pharmacies; authorize refills without patient consent and fail to collect co-pays to induce patients to accept refills of medically unnecessary medications and diabetic testing supplies.  The FBI and HHS-OIG investigated the case.  Assistant Chief Malisa Dubal of the Criminal Division’s Fraud Section is prosecuting the case.

Regina Black, 50, of Shelby Township, Michigan, owner of Rehabilitative Counseling and Behavior Services of America of Clinton Township, Michigan, was charged in an indictment filed Sept. 17 and unsealed today with five counts of health care fraud and three counts of wire fraud.  The charges stem from Black’s alleged role in a $4.9 million health care fraud scheme, in which she advertised and offered services, such as dancing, field trips and other social activities for Medicare enrollees at senior residential buildings.  Using the enrollees’ Medicare numbers, Black allegedly caused Medicare to be billed for individual and group psychotherapy services that were not medically necessary, not rendered and/or not otherwise eligible for reimbursement through Medicare.  The FBI and HHS-OIG investigated the case.  Trial Attorneys Steven Scott and Claire Sobczak of the Fraud Section are prosecuting the case.

Robert Cornfield, D.P.M., 55, of Rochester, Michigan, a podiatrist and owner of Robert H. Cornfield, DPM PC of Rochester, Michigan, was charged in an indictment filed Sept. 17 and unsealed today with five counts of health care fraud.  The charges stem from Cornfield’s alleged role in a $1.7 million health care fraud scheme in which Cornfield submitted or caused the submission of claims to Medicare for podiatric services he never provided.  Specifically, Cornfield allegedly defrauded Medicare by submitting claims for nail avulsions without actually performing the service.  From January 2010 through July 2019, Cornfield allegedly billed Medicare for more than 17,000 nail avulsion procedures, ranking him among the highest in the country for that procedure.  The FBI and HHS-OIG investigated the case.  Trial Attorneys Steven Scott and Jay McCormack of the Fraud Section are prosecuting the case.

Anthony Weinert, D.P.M., 48, of Oakland, Michigan, owner of Anthony Weinert DPM P.C. in Warren, Michigan, and Troy Surgicare in Troy, Michigan, was charged in an indictment filed Sept. 24 and unsealed yesterday with eight counts of health care fraud.  The charges stem from Weinert’s alleged role in a $1.7 million health care fraud scheme, in which Weinert submitted or caused the submission of claims to Medicare for podiatric services he did not provide.  Specifically, Weinert allegedly defrauded Medicare by submitting claims for nail avulsions, capsulotomies and mass removals without actually providing the services.  The FBI and HHS-OIG investigated the case.  Trial Attorneys Jay McCormack and Steven Scott of the Fraud Section are prosecuting the case.

Christopher Fratine, 52, of West Branch, Michigan, owner of Unity Home Health Care LLC of West Branch, Michigan, was charged in an indictment filed Sept. 26 with nine counts of health care fraud and three counts of wire fraud.  The charges stem from Fratine’s alleged role in an $18.2 million home health care fraud scheme in which he submitted or caused the submission of claims for home health episodes that were not provided.  The FBI, HHS-OIG, and Michigan State Police investigated the case.  Trial Attorney Steven Scott of the Fraud Section is prosecuting the case.  

Sharon King, 66, of Bloomfield Hills, Michigan, was charged in a superseding indictment filed Sept. 19 and unsealed today with three counts of conspiracy to pay and receive health care kickbacks.  One of the counts alleges that King engaged in these acts while on supervised release.  These charges come in addition to her original charge for conspiracy to commit health care fraud, which was originally filed in June 2018 and which remains pending.  The charges stem from King’s alleged role in a scheme to fraudulently bill Medicare in excess of $2.5 million for physician and home health services that were medically unnecessary, never provided and induced by kickbacks.  As part of the scheme, King allegedly provided kickbacks, including prescriptions for controlled substances, to Medicare beneficiaries who agreed to accept physician services from Thomas Mays, M.D. and referrals for home health services provided by Personal Touch, Inij Home Healthcare and other home health agencies.  These purported home health and physician services were allegedly often medically unnecessary, not actually provided and/or induced by health care kickbacks.  The FBI and HHS-OIG investigated the case.  Trial Attorney Jay McCormack is prosecuting the case, which Trial Attorney Tom Tynan of the Fraud Section initially handled.  

Farzana Haris, 59, of Canton, Michigan, owner and operator of Inij Home Health Care, was charged in an information filed Sept. 26 with one count of conspiracy to commit health care fraud. The charge stems from Haris’ alleged role in a scheme with co-conspirators Sharon King and Dr. Thomas Mays, M.D. to fraudulently bill Medicare approximately $1.1 million for home health services that were medically unnecessary, never provided and induced by kickbacks.  The FBI and HHS-OIG investigated the case.  Trial Attorney Jay McCormack is prosecuting the case, which Trial Attorney Tom Tynan initially handled.  

Charles Hobson Sr., 78 of Southfield, Michigan, co-owner and operator of Personal Touch Home Health Care, and Charles Hobson, Jr., 50, of Lathrup Village, Michigan, co-owner and operator of Personal Touch Home Health Care were charged in an information filed Aug. 23 with one count of conspiracy to pay and receive kickbacks and bribes in connection with a federal health care program. The charge stems from the Hobsons’ alleged role in a scheme with co-conspirator Sharon King, in which the Hobsons paid kickbacks to King and other patient recruiters in exchange for recruiting Medicare beneficiaries to Personal Touch. The FBI and HHS-OIG investigated the case.  Trial Attorney Jay McCormack is prosecuting the case, which Trial Attorney Tom Tynan initially handled.  

Mohamed Gomaa, 28, of Dearborn Heights, Michigan, a licensed pharmacist and owner of MedlifeRx Pharmacy of Auburn Hills, Michigan, was charged in an indictment filed Sept. 26 with four counts of mail fraud.  The charges stem from Gomaa’s alleged role in a $3.48 million scheme that dispensed expensive and medically unnecessary medications, using forged or fraudulent prescriptions, and sent them by mail to Medicare, Medicaid, BCBS and other private insurance beneficiaries who did not want or need them.  Gomaa then allegedly billed Medicare and the other various insurance programs and insurers for the high-cost drugs.  The FBI and HHS-OIG investigated the case.  Trial Attorney Patrick Suter of the Fraud Section is prosecuting the case.

Yogesh Pancholi, 40, of Northville, Michigan, owner of Shring Home Health Care (Shring) of Livonia, Michigan, was charged in an indictment filed Sept. 24 and unsealed yesterday with one count of conspiracy to commit health care fraud and wire fraud, two counts of health care fraud and two counts of money laundering.  The charges stem from Pancholi’s alleged role in a $2.8 million home health “bust out” scheme for the submission of request for advance payments or RAPs.  Pancholi allegedly submitted RAP claims through Shring for services not prescribed or rendered to Medicare.  The FBI and HHS-OIG investigated the case.  Trial Attorney Patrick Suter is prosecuting the case.

Kenneth Mitchell, D.P.M., 57, of Southfield, Michigan, a licensed podiatrist and minority owner of Urban Health Care Group LLC of Southfield, Michigan, was charged in a superseding indictment filed Sept. 17 and unsealed yesterday with one count of falsification of records in a federal investigation.  These charges come in addition to Mitchell’s original charges filed Sept. 17 consisting of one count of conspiracy to commit health care fraud and wire fraud and three counts of health care fraud.  The charges stem from Mitchell’s alleged role in a $1.8 million scheme by which he and co-conspirators submitted false and fraudulent claims for medically unnecessary podiatry and other services on behalf of Urban Health Care Group LLC.  HHS-OIG investigated the case.  Trial Attorney Patrick Suter of the Fraud Section is prosecuting the case.

Among those charged in cases handled by Strike Force attorneys in the Northern District of Illinois are the following:

Mark Sorensen, 50, of Chicago, Illinois, and Paulina Goncharova, 30, of Minneapolis, Minnesota, were indicted on Sept. 24 on one count of conspiracy to pay kickbacks and three counts of kickbacks.  Sorensen was the owner and Goncharova was the Vice President of Finance for Symed, a Medicare-enrolled durable medical equipment (DME) pharmacy in Chicago, Illinois.  The charges stem from Sorensen and Goncharova’s roles in a scheme to fraudulently obtain money from Medicare for braces including paying kickbacks to purchase signed doctors’ prescriptions and falsification of business records.  Between April 2015 and April 2018, Symed billed Medicare approximately $87 million, and was paid $25 million for DME claims.  Trial Attorney Leslie S. Garthwaite of the Fraud Section is prosecuting the case.

Altamash Mir, 43, formerly of Oak Brook, Illinois and Palos Hills, Illinois, owner of a home health “consulting” business and concealed owner of home health agencies; Muhammad Ateeq, 31, of Rawalpindi, Pakistan, a biller and concealed owner of home health agencies; Nadir Mir, 31, of Las Vegas, Nevada, manager of a home health agency; Tasneem Jamal, 66, formerly of Oak Brook, Illinois and Palos Hills, Illinois, administrator and nominee owner of a home health agency; Hamdeh Chatat, 37 of Highland, Indiana, administrator of a home health agency and a home health “consultant”; Bilal Malik, 41, of Palos Hills, Illinois, Las Vegas, Nevada, and San Bernadino, California, nominee owner of a home health agency; Kendria Cochran, 28, Chicago, Illinois, manager of multiple home health agencies; and Luis Ramos, 28, of Chicago Heights, Illinois, manager of multiple home health agencies, were charged on Sept. 26, 2019, in a 35-count indictment that alleges health care fraud, conspiracy to commit money laundering, concealment of money laundering, false statements relating to health care matters, and engaging in monetary transactions in criminally derived property of greater than $10,000 in value.  The charges stem from the defendants’ alleged roles in at least approximately a $40 million fraud scheme in which home health agencies were acquired using fake aliases and/or nominee owners and used to submit fraudulent claims for home health services that were never rendered.  Trial Attorney Patrick Mott and Assistant U.S. Attorney Jeremy Daniel are prosecuting the case.

Renato Duarte, Psy.D., 60, of Chicago, Illinois, was charged in an indictment filed Sept. 19 and unsealed today with six counts of health care fraud.  The charges stem from Duarte’s billing for providing psychological counseling services to patients who he did not see, including while he was traveling outside of the Chicago area.  This caused at least approximately $1.07 million in loss between June 2016 and April 2019.  Trial Attorney Leslie S. Garthwaite of the Fraud Section is prosecuting the case.   

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The charges and allegations contained in the indictments are merely accusations.  The defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

The Fraud Section leads the Medicare Fraud Strike Force (MFSF), which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  Since its inception in March 2007, MFSF maintains 15 strike forces operating in 24 districts and has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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DOJ: Federal Law Enforcement Action Involving Fraudulent Genetic Testing Results in Charges Against 35 Individuals Responsible for Over $2.1 Billion in Losses in One of the Largest Health Care Fraud Schemes Ever Charged

T'is but a drop in the bucket.

Wait for Medicaid Fraud in Child Welfare.

Much love to my #Superfans, for there exists an entire industry of human asset management databases, where they like to do incredibly crafty revenue maximization schemes, like SACWIS.

This is modern day human trafficking and the battle of parental rights.

Elderly Patients Nationwide Lured into Criminal Scheme; Centers for Program Integrity & Medicare Services Takes Administrative Action against Providers that Submitted Over $1.7 Billion in Claims

A federal law enforcement action involving fraudulent genetic cancer testing has resulted  in charges in five federal districts against 35 defendants associated with dozens of telemedicine companies and cancer genetic testing laboratories (CGx) for their alleged participation in one of the largest health care fraud schemes ever charged. According to the charges, these defendants fraudulently billed Medicare more than $2.1 billion for these CGx tests.  Among those charged today are 10 medical professionals, including nine doctors.

The Department of Justice, Criminal Division, together with the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and FBI spearheaded today’s landmark investigation  and prosecution that resulted in charges against CEOs, CFOs and others.

In addition, the Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI), announced today that it took adverse administrative action against cancer genetic  testing companies and medical professionals who submitted more than $1.7 billion in claims to the Medicare program.

Today’s announcement is a culmination of coordinated law enforcement activities over the past month that were led by the Criminal Division’s Health Care Fraud Unit, resulting in charges against over 380 individuals who allegedly billed federal health care programs for more than $3 billion and allegedly prescribed/dispensed approximately 50 million controlled substance pills in Houston, across Texas, the West Coast, the Gulf Coast, the Northeast, Florida and Georgia, and the Midwest.  These include charges against 105 defendants for opioid-related offenses, and charges against 178 medical professionals. 

Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF), as well as the U.S. Attorney’s Offices for the Southern District of Florida, Middle District of Florida, Southern District of Georgia, Eastern District of Louisiana, and Middle District of Louisiana.  The MFSF is a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI, DEA and HHS-OIG.  In addition, the operation included the participation of various other federal, state and local law enforcement agencies, including the Louisiana Medicaid Fraud Control Unit.

The coordinated federal investigation targeted an alleged scheme involving the payment of illegal kickbacks and bribes by CGx laboratories in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for expensive cancer genetic tests that were medically unnecessary.

Often, the test results were not provided to the beneficiaries or were worthless to their actual doctors.  Some of the defendants allegedly controlled a telemarketing network that lured hundreds of thousands of elderly and/or disabled patients into a criminal scheme that affected victims nationwide.  The defendants allegedly paid doctors to prescribe CGx testing, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen. 

“These defendants allegedly duped Medicare beneficiaries into signing up for unnecessary genetic tests, costing Medicare billions of dollars,” Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division.  “Together with our law enforcement partners, the Department will continue to protect the public fisc and prosecute those who steal our taxpayer dollars.”

“The scope and sophistication of the health care fraud detected in Operation Double Helix and the related Operation Brace Yourself is nearly unprecedented.  But the citizens of the Southern District of Georgia should know that we put together an unprecedented response,” said U.S. Attorney Bobby L. Christine of the Southern District of Georgia.  “Our office charged more defendants, responsible for more health care fraud losses, than ever before in this office’s history. While these charges might be some of the first, they won’t be the last.” 

“The defendants allegedly targeted elderly, disabled and other vulnerable consumers, luring them into this fraudulent scheme that affected victims nationwide and generated losses in excess of one billion dollars which spanned multiple jurisdictions,”  said U.S. Attorney Peter G. Strasser for the Eastern District of Louisiana.  “Schemes such as these have a profound effect on our nation, not only by the monies lost in the scheme, but also by stoking public distrust in some medical institutions.  It is imperative to preserve taxpayer confidence whenever and wherever possible.  Our office, along with our investigative partners, reminds seniors and their caregivers to be vigilant for fraudulent schemes.  If you are aware of or believe you are the victim of a health care fraud scheme, please contact law enforcement.”

“The defendants are alleged to have capitalized on the fears of elderly Americans in order to induce them to sign up for unnecessary or non-existent cancer screening tests,” said U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida.   “The genetic testing fraud schemes put personal greed above the preservation of the American health care system.  The U.S. Attorney’s Office in South Florida, alongside our law enforcement and USAO partners, remains committed to protecting taxpayer dollars and the Medicare program from abuse.”

“We are honored to work every day alongside our law enforcement partners to stop the exploitation of vulnerable patients and misuse of taxpayer dollars,” said CMS Administrator Seema Verma. “In order to prevent additional financial losses, CMS has taken swift action to protect the Medicare Trust Funds from the providers who allegedly have fraudulently billed over $1.7 billion. CMS continues to use a comprehensive and aggressive program integrity approach that includes fraud prevention, claims review, beneficiary education, and targeting high-risk areas of the federal healthcare programs with new tools and innovative demonstrations.”   

“Healthcare fraud and related illegal kickbacks and bribes impact the entire nation," said Assistant Director Terry Wade of the FBI’s Criminal Investigative Division.  “Fraudulently using genetic testing laboratories for unnecessary tests erodes the confidence of patients and costs taxpayers millions of dollars.  These investigations revealed some medical professionals placing their greed before the needs of the patients and communities they serve.  Today's law enforcement actions reinforce that the FBI, along with its partners, will continue to pursue and stop this type of illegal activity.”

“Unfortunately, audacious schemes such as those alleged in the indictments are pervasive and exploit the promise of new medical technologies such as genetic testing and telemedicine for financial gain, not patient care,” said Deputy Inspector General for Investigations Gary L. Cantrell of HHS-OIG.  “Instead of receiving quality care, Medicare beneficiaries may be victimized in the form of scare tactics, identity theft, and in some cases, left to pay out of pocket.  We will continue working with our law enforcement partners to investigate those who steal from federal healthcare programs and protect the millions of Americans who rely on them.”

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In the Southern District of Florida, the following defendants were charged: 

Richard Garipoli, 42, of Loxahatchee, Florida, the owner of a telemedicine company Lotus Health LLC (Lotus Health), located in Loxahatchee, is charged with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, and substantive counts of health care fraud and receiving kickbacks.  The indictment charges that from January 2017 through September 2019, Garipoli, and unnamed co-conspirators, billed Medicare and Medicare Advantage plans over $326 million, for which Medicare paid over $84 million, for false and fraudulent Cancer Genomic tests (CGx Tests) that were not medically necessary, and not eligible for Medicare reimbursement.  Doctors contracted with Lotus Health allegedly authorized bogus doctors’ orders that the CGx Tests were medically necessary when the doctors did not engage in treatment of the beneficiaries, had no physician-patient relationship with them, and often did not even speak with the beneficiaries for whom they ordered tests.  The Indictment alleges that various companies paid kickbacks to Lotus Health in exchange for ordering and arranging for the ordering of CGx tests for Medicare beneficiaries, without regard to whether the CGx tests were medically necessary or eligible for Medicare reimbursement, and without regard for the fact that the tests were prescribed without any physician-patient relationship.  Various laboratories including Clio Laboratories in Lawrenceville, Georgia and LabSolutions in Atlanta, Georgia and Easton, Pennsylvania then allegedly submitted false and fraudulent claims to Medicare and Medicare Advantage plans for the false and fraudulent CGx tests that were not medically necessary and not eligible for Medicare reimbursement.  Garipoli and others allegedly concealed the submission of these false and fraudulent claims to Medicare and Medicare Advantage plans; and diverted fraud proceeds for their personal use and benefit, the use and benefit of others and to further the fraud.  The case is being prosecuted by Trial Attorneys James Hayes and Tim Loper of the Criminal Division’s Fraud Section

Jamie Simmons, 62, a resident of South Carolina, and the owner of telemedicine companies MedSymphony LLC (MedSymphony) and Meetmydocc LLC (Meetmydoc) in Ft. Lauderdale Florida, is charged with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, and substantive counts of health care fraud and receiving kickbacks.  The indictment alleges that from January 2018 through September 2019, Simmons, and unnamed co-conspirators, billed Medicare and Medicare Advantage plans over $56 million, for which Medicare paid over $17 million, for false and fraudulent Cancer Genomic tests (CGx Tests) that were not medically necessary, and not eligible for Medicare reimbursement.  Doctors contracted with MedSymphony authorized bogus doctors’ orders that the CGx Tests were medically necessary when the doctors did not engage in treatment of the beneficiaries, had no physician-patient relationship with them, and often did not even speak with the beneficiaries for whom they ordered tests.  The Indictment alleges that various companies paid kickbacks to MedSymphony through Meetmydoc in exchange for ordering and arranging for the ordering of CGx tests for Medicare beneficiaries, without regard to whether the CGx tests were medically necessary or eligible for Medicare reimbursement, and without regard for the fact that the tests were prescribed without any physician-patient relationship.  Various laboratories then submitted false and fraudulent claims to Medicare and Medicare Advantage plans for the false and fraudulent CGx tests that were not medically necessary and not eligible for Medicare reimbursement.  Simmons and others allegedly concealed the submission of these false and fraudulent claims to Medicare and Medicare Advantage plans; and diverted fraud proceeds for their personal use and benefit, the use and benefit of others and to further the fraud.  The case is being prosecuted by Trial Attorneys James Hayes and Tim Loper.

Minal Patel, 40, of Atlanta, Georgia was charged based on his role in an alleged scheme to solicit medically unnecessary CGx tests from Medicare beneficiaries through telemarketing and “health fairs.”  The tests were then approved by telemedicine doctors who allegedly did not engage in treatment of the beneficiaries, and often did not even speak with the beneficiaries for whom they ordered tests.  Patel, the owner of LabSolutions in Georgia and Pennsylvania, then paid the telemarketers illegal kickbacks and bribes in exchange for the doctor’s orders and medically unnecessary tests.  LabSolutions billed Medicare for more than $494 million.  In addition, the government seized approximately $30 million in bank accounts from Patel, as well as luxury vehicles, including a Ferrari and a Range Rover.  The case is being prosecuted by Trial Attorneys Tim Loper and James Hayes.

In the Eastern District of Louisiana, the following defendant was charged:

Khalid Satary, 47, of Suwanee, Georgia was charged based on his role in an alleged scheme to solicit medically unnecessary cancer genetic (CGx) tests from Medicare beneficiaries through telemarketing and “health fairs.”  The tests were then approved by telemedicine doctors who did not engage in treatment of the beneficiaries, and often did not even speak with the beneficiaries for whom they ordered tests.  Satary, the owner of several labs in Georgia, Oklahoma and Louisiana, and his co-conspirators, through companies they controlled, then paid the telemarketers illegal kickbacks and bribes in exchange for the doctor’s orders and medically unnecessary tests.  The labs included Performance Laboratories in Oklahoma, Lazarus Services in Louisiana, and Clio Labs in Georgia, where Elmore was CEO.  Performance Labs, Clio Labs and Lazarus Services collectively billed Medicare for more than $547 million.  In addition, the government  seized 16 bank accounts and restrained real estate from Satary.  The case is being prosecuted by Trial Attorneys Timothy Loper and Jared Hasten.

In the Southern District of Georgia, 19 defendants were charged:

Anthony T. Securo, 56, of Columbus, Georgia, was indicted by a federal grand jury in Savannah, Georgia, for his role in a scheme to bill Medicare and other health benefit programs for medically unnecessary durable medical equipment. According to the indictment, Securo, a medical doctor, signed thousands of orders for durable medical equipment for Medicare beneficiaries he claimed to be “treating,” but in fact never even met. These thousands of items were billed to Medicare for more than $23 million. According to the indictment, Securo ordered these medically unnecessary items after having short telephone conversations with the patients, but then signed medical records stating that Securo had performed examinations or physical tests of the patients that were never actually performed.

In addition, 18 other defendants were charged in the Southern District of Georgia by way of criminal information.  The 18 other defendants include two “telemedicine” physician recruiters, seven physicians, two nurse practitioners, two individuals who brokered the sale of physician orders, one company that brokered the sale of physician orders, and four durable medical equipment companies.  In total, the 19 defendants charged in the Southern District of Georgia were responsible for over $400 million in genetic testing, durable medical equipment, and pain cream billing to Medicare, according to court documents. The cases are being prosecuted by Assistant U.S. Attorneys J. Thomas Clarkson Jonathan A. Porter of the Southern District of Georgia

In the Northern District of Texas, the following defendant was charged:  

Daniel R. Canchola, M.D., 49, Flower Mound Texas, a physician, was charged for his alleged referral of Medicare beneficiaries for medically unnecessary “cancer screening,” or “CGx,” genetic tests.  Canchola received illegal kickbacks and bribes for the CGx orders he signed, and he did so without examining or speaking to patients and in the absence of any physician-patient relationship.  Oftentimes the beneficiaries for whom Canchola ordered CGx tests never received their test results.  From in or about January 2018 through in or about March 2019, Canchola caused the submission of over $69 million in false and fraudulent claims to Medicare.  The case is being prosecuted by Trial Attorney Brynn Schiess of the Fraud Section.

Sekhar Rao, M.D., 48 of Austin, Texas, and Vinay Parameswara, M.D., 46, of Austin, Texas, were charged for their role in alleged referrals of TRICARE beneficiaries for medically unnecessary “cancer screening” genetic tests and toxicology tests.  Rao and Parameswara did not examine or speak with the beneficiaries they signed testing orders for and there was no physician-patient relationship between the physicians and these beneficiaries.  Tests were repeated many times and beneficiaries often did not receive the results of their tests. From in or about May 2014 and until in or about June 2016, Rao, Parameswara and others caused the submission of over $36 million in false and fraudulent claims to TRICARE. The case is being prosecuted by Assistant Chief Adrienne Frazior of the Fraud Section.

In the Middle District of Florida, the following defendant was charged:

Ivan Andre Scott, 34, Kissimmee, Florida, a marketer, was charged for his role in an alleged $2.8 million scheme to provide Medicare beneficiary information to doctors and telemedicine companies, that could then be billed for medically unnecessary genetic testing.  The case is being prosecuted by Trial Attorney Alejandro J. Salicrup of the Fraud Section.

In the Middle District of Louisiana, the following defendants were charged:

Mark Allen, 51, of Greer, South Carolina, and Kevin Hanley, 42, of Prairieville, Louisiana, were charged for their roles in an alleged scheme to solicit medically unnecessary cancer genetic (CGx) tests from Medicare beneficiaries, have the tests approved by telemedicine doctors who did not engage in treatment of the beneficiaries, and submit claims through clinical testing laboratories that paid kickbacks in exchange for the referrals.  Allen and his co-conspirators, through companies they controlled, solicited the tests and arranged for approvals by telemedicine providers.  They then transmitted the test samples and orders to labs in Louisiana, including Acadian Diagnostic Laboratories LLC, where Hanley was the CFO, and elsewhere.  Acadian, through Hanley and others, paid kickbacks to companies controlled by Allen and others to obtain the referrals, and submitted claims to Medicare for the tests.  Acadian and other labs billed Medicare for more than $240 million.  The case is being prosecuted by Trial Attorneys Tim Loper, Justin Woodard and Gary Winters of the Fraud Section and Assistant U.S. Attorney Kristen Craig of the Middle District of Louisiana.

In addition, as part of the Northeast Regional Takedown announced on Sept. 26, the District of New Jersey announced charges against the following:

Matthew S. Ellis, MD, 53, of Gainesville, Florida; Edward B. Kostishion, 59, of Lakeland, Florida; Kyle D. Mclean, 36, of Arlington Heights, Illinois; Kacey C. Plaisance, 38, of Altamonte Springs, Florida; Jeremy Richey, 39, of Mars, Pennsylvania; and Jeffrey Tamulski, 46, of Tampa, Florida. Kostishion, Plaisance, and Richey operated Ark Laboratory Network LLC (Ark), a company that purported to operate a network of laboratories that facilitated genetic testing.  Ark partnered with Privy Health, Inc., a company that McLean operated, and another company to acquire DNA samples and Medicare information from hundreds of patients through various methods, including offering $75 gift cards to patients, all without the involvement of a treating health care professional.  Ellis, a physician based in Gainesville, served as the ordering physician who authorized genetic testing for hundreds of patients across the country that he never saw, examined, or treated.  These included patients from New Jersey and various other states where Ellis was not licensed to practice medicine.  Through this process, Ellis, Kostishion, Plaisance, and McLean submitted and caused to be submitted fraudulent orders for genetic tests to numerous clinical laboratories.  These orders falsely certified that Ellis was the patients’ treating physician and, in many cases, contained false information indicating that a patient had a personal or family history of cancer, when, in fact, the patient had no cancer history whatsoever.  In 2018 alone, Medicare paid clinical laboratories at least approximately $4.6 million for genetic tests that Ellis ordered in this manner.  In addition, Kostishion, Plaisance, Richey, and Tamulski entered into kickback agreements with certain clinical laboratories under which the laboratories would pay Ark a bribe in exchange for delivering DNA samples and orders for genetic tests.  The bribe payments were based on the percentage of Medicare revenue that the laboratories received in connection with the tests.  Among other things, Kostishion, Plaisance, Richey, and Tamulski concealed these kickback arrangements through issuing sham invoices to laboratories that purportedly reflected services provided at an hourly rate even though the parties had already agreed upon the bribe amount, which was based on the revenue the laboratories received.  In 2018, the clinical laboratories paid Ark at least approximately $1.8 million in bribes.  The case is being prosecuted by Assistant U.S. Attorney Bernard Cooney of the District of New Jersey.

A complaint, information or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $16 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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