OWNER HEALTH CARE COMPANIES SENTENCED TO SERVE 120 MONTHS FOR ROLE IN FRAUD SCHEME

FROM:  U.S. JUSTICE DEPARTMENT 
Thursday, November 21, 2013
Owner of Home Health Companies Sentenced for Role in $20 Million Health Care Fraud Scheme

The owner and operator of several Miami health care agencies was sentenced today to serve 120 months in prison for his role in a health care fraud scheme involving defunct home health care company Trust Care Health Services Inc.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami Office; and Acting Special Agent in Charge Michael J. DePalma of the Internal Revenue Service—Criminal Investigation’s (IRS-CI) Miami Field Office made the announcement.

Roberto Marrero, 60, of Miami, was sentenced by U.S. District Judge K. Michael Moore in the Southern District of Florida.   In September 2013, Marrero pleaded guilty to conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks.

Marrero was an owner and operator of Trust Care, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.

Co-conspirators Sandra Fernandez Viera, 49, Patricia Morcate, 34, and Enrique Rodriguez, 59, all of Miami, have also pleaded guilty to related charges, including conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks.   On Nov. 13, 2013, Fernandez Viera was sentenced to serve 120 months in prison; Morcate was sentenced to serve 60 months; and Rodriguez was sentenced to serve 57 months.

Together with Marrero, Fernandez Viera was an owner and operator of Trust Care.   Morcate worked at and was an investor in Trust Care.  Rodriguez served as a patient recruiter on behalf of Trust Care.  

According to court documents, Marrero and his co-conspirators operated Trust Care for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

Marrero primarily controlled Trust Care and, in light of that role, oversaw the schemes operating out of the company.  Marrero was also responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims to the Medicare program.

Marrero and his co-conspirators paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Trust Care for home health and therapy services that were medically unnecessary and/or not provided.  Marrero and his co-conspirators at Trust Care also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation.  Marrero and his co-conspirators used these prescriptions, medical certifications and other documentation to fraudulently bill the Medicare program for home health care services, which Marrero knew was in violation of federal criminal laws.

From approximately March 2007 through at least October 2010, Trust Care submitted more than $20 million in claims for home health services.  Medicare paid Trust Care more than $15 million for these fraudulent claims.

Marrero and his co-conspirators have also acknowledged their involvement in similar fraudulent schemes at several other Miami health care agencies in addition to Trust Care with estimated total losses of approximately $50 million.   Those agencies include A&B Health Services Inc. , Centrum Home Health Care Inc., Global Nursing Home Health Inc., Lovable Home Health Services Corp., New Concepts In Health Inc., Nursemed Home Care Corp., R&M Health Care Inc., Ubieta Health System Inc., and Vital Care Home Health Services Inc.

The case was investigated by the FBI and HHS-OIG, with the assistance of IRS-CI, and was brought as part of the Medicare Fraud Strike Force initiative, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion.   In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

CDC SAYS 1 IN 6 BETWEEN THE AGES OF 2 AND 19 ARE OBESE

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

One in 6 obese

From the U.S. Department of Health and Human Services, I’m Ira Dreyfuss with HHS HealthBeat.

A study by the Centers for Disease Control and Prevention finds some signs that the weight gains of America’s young people are tapering off. The researchers saw this in data from 2008 to 2011 on almost 12 million low-income youngsters in 40 states.

But it doesn’t mean the weights are all healthy. The CDC says 1 in 6 people between the ages of 2 and 19 is obese. And researcher Ashleigh May says the excess weight produces a health burden:

“During childhood, things like high cholesterol, high blood sugar, asthma, and even mental health problems can occur. And children who are overweight or obese are more likely to become overweight or obese adults.’’

The study is in CDC’s Morbidity and Mortality Weekly Report.

Learn more at healthfinder.gov.

HHS HealthBeat is a production of the U.S. Department of Health and Human Services. I’m Ira Dreyfuss.

Last revised: October 24, 2013

MEDICAL COMPANY OFFICER AND A PHYSICIAN SENTENCED FOR ROLES IN $1.5 MILLION MEDICARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 
Tuesday, September 10, 2013
Medical Supply Company Officer and Southern California Physician Sentenced for $1.5 Million Medicare Fraud

A former officer of Fendih Medical Supply Inc. was sentenced to serve 51 months in prison yesterday in Los Angeles for his role in a fraud scheme that resulted in $1.5 million in fraudulent claims to Medicare.  In addition, a physician was sentenced to 27 months in prison for his role in the scheme.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney André Birotte Jr. of the Central District of California, Special Agent in Charge Glenn R. Ferry of the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and Assistant Director in Charge Bill L. Lewis of the FBI’s Los Angeles Field Office made the announcement.

Godwin Onyeabor, 49, of San Bernandino, Calif., was sentenced on Sept. 9, 2013, by U.S. District Judge Manuel L. Real in the Central District of California to 51 months in prison.  In addition to his prison term, Onyeabor was sentenced to three years of supervised release. Restitution will be determined at a later date.  Dr. Sri J. Wijegunaratne, 58, of Anaheim, Calif., was sentenced to 27 months in prison by Judge Real.  In addition to his prison term, Wijegunaratne was sentenced to three years of supervised release and ordered to pay restitution in the amount of $87,846.

On April 24, 2013, a jury in Los Angeles federal court found Wijegunaratne, Onyeabor and Heidi Morishita, 48, guilty of one count of conspiracy to pay and receive kickbacks.  In addition, Wijegunaratne and Onyeabor were found guilty of conspiracy to commit health care fraud.  Wijegunaratne was found guilty of seven counts of health care fraud, and Onyeabor was found guilty of eleven counts of health care fraud.

During trial, the evidence showed that Onyeabor, as the former officer of a durable medical equipment (DME) supply company, fraudulently billed more than $1 million to Medicare for DME that was either never provided to its Medicare beneficiaries or was not medically necessary.  Wijegunaratne provided Onyeabor and others with medically unnecessary power wheelchair prescriptions, and both Wijegunaratne and Morishita sold power wheelchair prescriptions to Onyeabor and others.  

The evidence showed that Onyeabor and others paid Wijegunaratne and Morishita cash kickbacks for fraudulent prescriptions for DME, and Onyeabor and others used these prescriptions to bill Medicare for the power wheelchairs and other DME.  Several Medicare beneficiaries testified that they were lured to medical clinics with the promise of free items such as vitamins and juice, only to receive power wheelchairs which they did not need and did not want, and were unsuccessful in their attempts to reject delivery of the power wheelchairs from Onyeabor’s supply company.

As a result of this fraud scheme, Onyeabor, Wijegunaratne and others submitted and caused the submission of approximately $1.5 million in false and fraudulent claims to Medicare and received almost $1 million on those claims.

Morishita’s sentencing is scheduled for Sept. 30, 2013.

The case is being investigated by the FBI and the Los Angeles Region of the HHS-Office of Inspector General (HHS-OIG) and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.  The case is being prosecuted by Assistant Chief Benton Curtis, Trial Attorneys Fred Medick and Alexander Porter of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

MULTI-INSTITUTIONAL CONSORTIA ESTABLISHED TO RESEARCH PTSD AND TBI

FROM:  U.S. DEPARTMENT OF DEFENSE 

DoD, VA Establish Two Multi-Institutional Consortia to Research PTSD and TBI

           In response to President Obama's Executive Order, the Departments of Defense (DoD) and Veterans Affairs (VA) highlighted today the establishment of two joint research consortia, at a combined investment of $107 million to research the diagnosis and treatment of post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) over a five-year period.

           "VA is proud to join with its partners in the federal government and the academic community to support the President's vision and invest in research that could lead to innovative, new treatments for TBI and PTSD," said Secretary of Veterans Affairs Eric K. Shinseki. "We must do all we can to deliver the high-quality care our Service members and Veterans have earned and deserve."

           The Consortium to Alleviate PTSD (CAP), a collaborative effort between the University of Texas Health Science Center – San Antonio, San Antonio Military Medical Center, and the Boston VA Medical Center will attempt to develop the most effective diagnostic, prognostic, novel treatment, and rehabilitative strategies to treat acute PTSD and prevent chronic PTSD.

           The Chronic Effects of Neurotrauma Consortium (CENC), a collaborative effort between Virginia Commonwealth University, the Uniformed Services University of the Health Sciences, and the Richmond VA Medical Center will examine the factors which influence the chronic effects of mTBI and common comorbidities in order to improve diagnostic and treatment options.  A key point will be to further the understanding of the relationship between mTBI and neurodegenerative disease.

           Since Sep. 11, 2001, more than 2.5 million American service members have been deployed to Iraq and Afghanistan. Military service exposes service members to a variety of stressors, including risk to life, exposure to death, injury, sustained threat of injury, and the day-to-day family stress inherent in all phases of the military life cycle.

           To improve prevention, diagnosis, and treatment of mental health conditions, the President released an Executive Order directing the Federal agencies to develop a coordinated National Research Action Plan. The Department of Defense (DoD), Department of Veterans Affairs (VA), the Department of Health and Human Services (HHS), and the Department of Education (ED) came forward with a wide-reaching plan to improve scientific understanding, effective treatment,  and reduce occurrences of Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), co-occurring conditions, and suicide.

NATIONAL ADVISORY COMMITTEE THAT LOOKS AT FOOD SAFETY RESTARTS WITH NEW MEMBERS

Credit:  HHS

FROM: U.S. DEPARTMENT OF AGRICULTURE
National Advisory Committee on Microbiological Criteria for Foods Restarts Critical Food Safety Work with 22 New Members, Renewed Charter
Congressional and Public Affairs
Richard J. McIntire

WASHINGTON, January 28, 2013–The U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) today announced the re-chartering of the National Advisory Committee on Microbiological Criteria for Foods (NACMCF) and welcomes the addition of new members.

The committee is charged with providing recommendations to the Secretaries of Agriculture and Health and Human Services (HHS) on microbiological criteria by which the safety and wholesomeness of food can be assessed. That work includes criteria for microorganisms that indicate whether foods have been adequately and appropriately processed.

"NACMCF's work provides FSIS and the Food and Drug Administration (FDA) with a valuable resource for obtaining external expert advice on scientific and technical food safety issues for our nation's food safety programs," said FSIS Administrator Al Almanza. "Re-chartering this committee benefits the public interest and fulfills statutory responsibilities."

The committee membership consists of scientists from academia, industry, other organizations, and federal and state government as well as one individual affiliated with a consumer group, who is serving in a representational capacity. NACMCF members are appointed by the USDA Secretary in consultation with the Secretary of HHS with advice on membership from the Department of Commerce's National Marine Fisheries Service, the Department of Defense's Defense Logistics Agency, and the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC).

NACMCF members serve a two-year renewable term. To ensure a balanced membership with diverse viewpoints, FSIS has employed a strong outreach effort to encourage nominations by minorities, women, persons with disabilities, and other under-represented populations.

Established in 1988, NACMCF formulates positions on the development of microbiological criteria, the review and evaluation of epidemiological and risk assessment data and methodologies for assessing microbiological hazards in foods. The committee's work also assists the CDC and the Departments of Commerce and Defense. The committee is the outcome of a 1985 report of the National Academy of Sciences Committee on Food Protection, Subcommittee on Microbiological Criteria.

The NACMCF meets approximately twice annually, while subcommittees meet more often as necessary. Background materials are available online at the previously noted address or by contacting Karen Thomas-Sharp at (202) 690-6620.

4 CHARGED IN DETROIT FOR ALLEGED $24.7 MILLION MEDICARE FRAUD SCHEME

Photo:  Detroit GM Building.  Credit:  Wikimedia.
FROM: U.S. DEPARTMENT OF JUSTICE
Thursday, September 20, 2012

Five Individuals Charged in Detroit for Alleged Roles in $24.7 Million Medicare Fraud Scheme

Four Additional Defendants Were Previously Charged for Their Roles in the Scheme

WASHINGTON – Five individuals were charged in court documents unsealed today in the Eastern District of Michigan for their participation in a Medicare fraud scheme involving purported home health and psychotherapy services, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

According to court documents, the scheme allegedly involved a total of more than $24.7 million in fraudulent claims submitted to Medicare for purported home health care and psychotherapy services that were medically unnecessary and/or never provided.

Court documents allege that the defendants are operators, employees and marketers associated with home health care and psychotherapy clinics operating in and around Detroit. Defendants charged in court documents unsealed today include: Mohammed Sadiq, 65, Troy, Mich.; Jamella Al-Jumail, 23, of Brownstown, Mich.; Firas Alky, 40, of Shelby Township, Mich.; Clarence Cooper, 53, of Detroit; and Beverly Cooper, 58, of Detroit.

Four defendants charged in the superseding indictment were previously charged and arrested in May 2012 for their roles in the scheme. Defendants previously charged include: Sachin Sharma, 36, of Shelby Township; Dana Sharma, 29, of Shelby Township; Abdul Malik Al-Jumail, aka Tony, 52, of Brownstown; Felicar Williams, 49, of Dearborn, Mich.

The superseding indictment charges all defendants with one count of conspiracy to commit health care fraud; Sachin Sharma with five counts of health care fraud; Sachin Sharma, Abdul Malik Al-Jumail, Williams, Sadiq, Alky and Clarence Cooper with one count of conspiracy to pay and receive health care kickbacks; and Jamella Al-Jumail with one count of destruction of records in a federal investigation. The superseding indictment also seeks forfeiture from all defendants.

According to the superseding indictment, from January 2007 through April 2012, the defendants operated a large network of purported home health care and psychotherapy companies in the Detroit area through which they conspired to defraud Medicare.

According to court documents, Sachin Sharma, Dana Sharma, Abdul Malik Al-Jumail, Williams, Jamella Al-Jumail, Sadiq, Alky and other alleged co-conspirators incorporated home health care, psychotherapy and other medical service companies to carry out the scheme, including Reliance Home Care, LLC; First Choice Home Health Care Services Inc.; Associates in Home Care Inc.; Haven Adult Day Care Center LLC; Swift Home Care LLC; ABC Home Care Inc.; Accessible Home Care Inc.; and Be Well Home Care LLC. The defendants, along with co-conspirators, allegedly submitted Medicare enrollment applications to permit these companies to bill Medicare. Sachin Sharma, Abdul Malik-Al-Jumail, Sadiq, Alky and others allegedly paid kickbacks and bribes to recruiters, including Williams and Clarence Cooper, to obtain Medicare beneficiaries’ information, which could be used to fraudulently bill Medicare for purported services provided by the companies they operated and controlled. The defendants then allegedly caused these companies to bill Medicare for home health and psychotherapy services, even though these services were not medically necessary and were often not provided.

According to the superseding indictment, the defendants caused Reliance, First Choice, Associates, Haven, Swift, ABC, Accessible and other home health, psychotherapy and medical services companies to submit approximately $24.7 million in claims to Medicare for services that were medically unnecessary and/or not provided. In addition, Jamella Al-Jumail is charged with destroying records relating to Accessible’s Medicare billings upon learning of the May 2012 arrest of Abdul Malik Al-Jumail, her co-conspirator and father.

Clarence and Beverly Cooper, Sadiq and Jamella Al-Jumail were arrested yesterday.

The case is being prosecuted by Fraud Section Assistant Chief Gejaa T. Gobena and Trial Attorney William G. Kanellis. The investigations were conducted jointly by the FBI and HHS-OIG, as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney's Office for the Eastern District of Michigan and the Criminal Division's Fraud Section.

MEDICARE FRAUDSTER GOES TO PRISON FOR CRIMES IN MICHIGAN

U.S. DEPARTMENT OF JUSTICE

Tuesday, July 24, 2012
Detroit-Area Health Care Clinic Owner Sentenced to Serve 60 Months in Prison for Role in $8.5 Million Diagnostic Testing Fraud Scheme

WASHINGTON – The owner of a Detroit-area health care clinic was sentenced today to serve 60 months in prison for his leading role in an $8.5 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

Miami-area resident Emilio Haber, 53, was sentenced by U.S. District Judge Patrick Duggan in the Eastern District of Michigan in Detroit. In addition to his prison term, Haber was sentenced to serve three years of supervised release and was ordered to pay $6,341,000 in restitution, joint and several with his co-defendants, and was ordered to forfeit approximately $99,000 seized from bank accounts he controlled.

On Oct. 26, 2012, Haber pleaded guilty to one count of conspiracy to commit health care fraud. According to plea documents, Haber conceived and oversaw fraud schemes at two clinics, Ritecare LLC and CompleteHealth LLC. Haber incorporated and opened Ritecare and CompleteHealth in the state of Michigan in 2007. CompleteHealth merged into Ritecare in July 2008.

According to court documents, while operating CompleteHealth and Ritecare, Haber and his co-conspirators billed Medicare for medically unnecessary tests and services, including, but not limited to, nerve conduction studies. Haber obtained patients for the clinics through the payment of kickbacks to Medicare beneficiaries and patient recruiters. Haber admitted that he and other co-conspirators paid patient recruiters $100-$150 per patient obtained, with $50-$75 to go to the patient in exchange for visiting Ritecare and subjecting themselves to medically unnecessary tests.

To justify the medically unnecessary tests, Haber admitted that he and other co-conspirators told patient recruiters to instruct the patients to feign certain symptoms. Haber and other co-conspirators also directly instructed patients to feign symptoms. The kickbacks paid to the recruiters and the patients were contingent upon the Medicare beneficiaries identifying the symptoms necessary to justify medically unnecessary tests. Consequently, the patients’ medical records contained false or fabricated symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.

The department said that between approximately August 2007 and approximately October 2009, Haber and his co-conspirators at CompleteHealth and Ritecare submitted and/or caused to be submitted approximately $8.5 million in fraudulent claims to the Medicare program for medical and testing services that were medically unnecessary and procured through the payment of kickbacks. Medicare paid approximately $6.3 million of those claims.

Today’s sentencing was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Acting Special Agent in Charge of the FBI’s Detroit Field Office Edward J. Hanko; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

This case was prosecuted by Assistant Chief Gejaa T. Gobena of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Philip A. Ross of the Eastern District of Michigan. It was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,330 defendants who have collectively billed the Medicare program for more than $4 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

HSS SAYS AFFORDABLE CARE ACT HELPS MILLIONS WITH FREE PREVENTATIVE CARE

More than 16 million people with Medicare get free preventive services in 2012

"Millions of Americans are getting cancer screenings, mammograms and other preventive services for free thanks to the health care law," said Secretary Sebelius. "These new benefits, made possible through the health care law, are helping people stay healthy by giving them the tools they need to prevent health problems before they happen."

Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits such as cancer screenings. Through the Affordable Care Act, preventive benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.

The law also added an important new service for people with Medicare — an Annual Wellness Visit with the doctor of their choice— at no cost to beneficiaries.

For more information on Medicare-covered preventive services, please visit: http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html

THE HIDDEN CRIME OF ELDER ABUSE

FROM:  U.S. DEPARTMENT OF JUSTICE 
Deputy Attorney General James M. Cole Speaks at the White House World Elder Abuse Awareness Day EventWashington, D.C. ~ Thursday, June 14, 2012
Thank you for that kind introduction.

The Attorney General very much wanted to be here, but is headed to Canada, where he will be meeting with his foreign counterparts.   It is therefore my privilege to join my colleagues, Secretary Sebelius and Director Cordray, and all of you today to commemorate World Elder Abuse Awareness Day.

At the outset, I want to commend Secretary Sebelius for forming the Elder Justice Coordinating Council.   This critical first step firmly demonstrates this Administration’s commitment to protecting our older Americans and we look forward to working with our federal partners on the Council.

It’s worth noting that in anticipation of the Coordinating Council, the Department of Justice, with support from HHS, began working earlier this year on developing an Elder Justice Roadmap.  The Elder Justice Roadmap project has already sought input from hundreds of stakeholders from around the country in order to help identify potential policy, practice, and research priorities in the field of elder abuse, neglect and financial exploitation.  We expect the results of this Roadmap to help inform the Coordinating Council as it moves ahead in developing its strategic agenda.

I also want to thank Kathy Greenlee and her staff at the Administration on Aging for their tireless efforts to protect our older Americans and for organizing today’s event.

Elder abuse is a hidden epidemic that annually impacts the health and well-being of six million older people, as well as their families and caretakers.   It includes physical, sexual and emotional abuse; neglect; and what we’re here to talk about today -- financial exploitation.   Victims come from all ethnic, racial and socioeconomic backgrounds.   And sadly, perpetrators of financial exploitation are more likely to be family members than strangers.

This type of elder abuse depletes the resources of individuals, families, businesses, and public programs including Medicare and Medicaid, by billions each year, placing enormous burdens on our health care, financial, and judicial systems.

For me, and for today’s Department of Justice, protecting older Americans is a top priority that we advance on multiple fronts.

For example, in order to protect the financial integrity of the Medicare program, upon which so many of our older Americans rely, both the Department of Justice and the Department of Health and Human Services decided early on to make combating healthcare fraud an enforcement priority and created the Health Care Fraud Prevention and Enforcement Action Team, or HEAT.

Since HEAT began in May 2009, we’ve recovered over $8 billion dollars in cases involving fraud against the Medicare program and other federal health care programs.   We believe this has sent a strong and clear message that Medicare fraud will not be tolerated and that DOJ and HHS will act swiftly to where it does occur.          

Just as important as protecting the fiscal integrity of the Medicare program, is our commitment to ensuring that our nation’s nursing homes and other health care providers are actually providing the care and services to which our Medicare beneficiaries are entitled, rather than exploiting those beneficiaries (and the Medicare program) for their own profit.   Tony West, the Department’s Acting Associate Attorney General, has taken a particularly active role in supporting these cases and will discuss a particularly egregious example of financial exploitation this afternoon.  

Protecting older Americans from consumer scams and fraud is also a top priority of the Department.   Just this past March, the Department hosted an historic consumer protection summit that brought together federal and state law enforcement and regulators with consumer advocates to harness our collective experiences, to discuss strategies for enhancing our civil and criminal enforcement of consumer fraud crimes, and to increase public awareness about common schemes so that ordinary citizens can fight back themselves.  

Likewise, the Department’s Consumer Protection Branch has done terrific work combating fraud on the elderly as part of a broader emphasis on fraud targeting vulnerable populations.   We have had successful prosecutions of a number of fraudsters targeting the elderly through reverse mortgage fraud scams and lottery scams. And we have enhanced public awareness about these schemes through collaboration with others such as AARP.

Our health care fraud and consumer protection efforts are just some of the ways that the Department protects our nation’s older Americans from financial exploitation.   But while we have made strides to address this form of elder abuse, enforcement alone is not a complete strategy.   We can’t simply prosecute our way out of this problem.

Everyone here today knows that the way we can be most effective in protecting older Americans from financial exploitation is by combining our resources and expertise, and by collectively deploying the myriad tools at our disposal.

We need the federal agencies represented on this stage, Adult Protective Services workers, long term care ombudsmen, domestic violence advocates, geriatric specialists, the financial services industry, health care providers, advocates, state and local law enforcement and prosecutors, and – what has been a “missing link” in this area – civil legal aid lawyers.

Legal services programs have a unique opportunity to prevent and remedy elder abuse, especially the scourge of financial exploitation.   For example, they can  help prevent mortgage foreclosures resulting from a family member’s theft of a senior’s life savings; they can counsel worried older clients about legal options for responding to debt brought on by a financial scam, or better yet counsel them on how to avoid the scam in the first place; they can advise clients on how to revoke a power of attorney that is being used by someone unscrupulous to exploit them; and they can offer elders a safer future by representing abused clients in obtaining a protective order.

While this expertise can be critical to preventing or addressing abuse, legal services program staff too often don’t have the specialized training on how to identify and support older victims, and how to harness their existing expertise to respond to older victims’ special needs.

That’s why, with the essential cooperation of Legal Services Corporation President Jim Sandman, who is with us here today, I’m delighted to announce the “Missing Link Project,” a new collaborative effort by the Department’s Elder Justice Initiative, our Office for Victims of Crime, and our Access to Justice Initiative to develop such training materials for legal services providers.   President Sandman has pledged that when the training has been developed, it will be made available to all LSC programs, which together provide critically needed services to every county in this country.   We are hopeful that the trained legal aid lawyers’ efforts will be further leveraged by private lawyer pro bono volunteers, thus increasing the overall capacity to serve elderly victims.   Jim, we thank you for your commitment.   And I also want to thank Acting Assistant Attorney General Mary Lou Leary and the staff of the various offices involved for their strong support of this effort.

Too many elderly Americans are suffering alone.   Together we can change that.

We know the importance of your work on the front lines of the battle against elder abuse and financial exploitation.   What you do every day makes an extraordinary difference in ordinary lives.   I want you to know that the U.S. Department of Justice is honored to be your partner.

Thank you.

HOUSTON NURSE GETS 97 MONTHS IN PRISON FOR PART IN $5.2 MILLION MEDICARE FRAUD

FROM:  U.S. DEPARTMENT OF JUSTICE
Wednesday, May 16, 2012
Houston-Area Nurse Sentenced to 97 Months in Prison for Role in $5.2 Million Medicare Fraud Scheme
WASHINGTON – A Houston-area nurse was sentenced today in Houston for her participation in a $5.2 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Service (HHS).
Ezinne Ubani, the former director of nursing at Family Healthcare Group, a Houston home health care company, was sentenced by U.S. District Judge Nancy Atlas in the Southern District of Texas to 97 months in prison, followed by three years supervised release.  Ubani was ordered to pay $2.5 million in restitution jointly and severally with her codefendants.  Ubani was convicted of one count of conspiracy to commit health care fraud and two counts of making false statements following a May 2011 trial.

According to the evidence presented at trial and in court documents, Family Healthcare Group purported to provide skilled nursing to Medicare beneficiaries.  Family Healthcare Group paid co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided.  The evidence showed that Ezinne Ubani falsified documents to support the fraudulent payments.  After the Medicare beneficiaries were recruited, other co-conspirators fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact they knew the beneficiaries were not home-bound and not in need of skilled nursing.

Ubani is the seventh defendant sentenced in connection with this scheme.  Three other defendants, Clifford Ubani, Princewill Njoku and Cynthia Garza Williams, await sentencing in the Southern District of Texas.

The sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-In-Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG); and the Texas Attorney General’s Medicaid Fraud Control Unit (OAG-MFCU).

This case is being prosecuted by Trial Attorney Charles D. Reed and Deputy Chief Sam S. Sheldon of the Fraud Section in the Justice Department’s Criminal Division.  The case was investigated by the FBI, HHS-OIG, Texas OAG-MFCU and the Federal Railroad Retirement Board-Office of Inspector General.  The case was brought as part of the Medicare Fraud Strike Force, supervised by the Fraud Section in the Justice Department’s Criminal Division and the U.S. Attorney’s Office for the Southern District of Texas.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

ATTITUDES TOWARD DRINKING CHANGE OVER TIME

FROM:  HHS HealthBeat (May 3, 2012)
The Peter Pan drinker
Getting really drunk at college age is bad for you, but some college-agers think it’s normal. Continuing to get really drunk when you’re older, though, seems to be different.

At the University of Missouri, Rachel Winograd looked at interview data on more than 400 people. She found heavy drinkers at age 25 didn’t feel immature. But at 29 and at 35, attitudes changed:

“By age 29 or 30, when most of your peers have settled down and you’re still drinking heavily, you may start to view yourself as a sort of Peter Pan of partying, who never fully matured.”

Winograd says cutting back on drinking might make the person feel more mature.
The study in the Journal Alcoholism: Clinical and Experimental Research was supported by the National Institutes of Health.

HHS AND HEALTHCARE COMPANY SETTLE OVER PATIENT INFORMATION SAFEGUARDS

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HHS settles case with Phoenix Cardiac Surgery for lack of HIPAA safeguards

Phoenix Cardiac Surgery, P.C., of Phoenix and Prescott, Arizona, has agreed to pay the U.S. Department of Health and Human Services (HHS) a $100,000 settlement and take corrective action to implement policies and procedures to safeguard the protected health information of its patients. 

The settlement with the physician practice follows an extensive investigation by the HHS Office for Civil Rights (OCR) for potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.

The incident giving rise to OCR’s investigation was a report that the physician practice was posting clinical and surgical appointments for its patients on an Internet-based calendar that was publicly accessible.   On further investigation, OCR found that Phoenix Cardiac Surgery had implemented few policies and procedures to comply with the HIPAA Privacy and Security Rules, and had limited safeguards in place to protect patients’ electronic protected health information (ePHI). 

“This case is significant because it highlights a multi-year, continuing failure on the part of this provider to comply with the requirements of the Privacy and Security Rules,” said Leon Rodriguez, director of OCR.  “We hope that health care providers pay careful attention to this resolution agreement and understand that the HIPAA Privacy and Security Rules have been in place for many years, and OCR expects full compliance no matter the size of a covered entity.”

OCR’s investigation also revealed the following issues:

• Phoenix Cardiac Surgery failed to implement adequate policies and procedures to appropriately safeguard patient information; 
• Phoenix Cardiac Surgery failed to document that it trained any employees on its policies and procedures on the Privacy and Security Rules;
• Phoenix Cardiac Surgery failed to identify a security official and conduct a risk analysis; and
• Phoenix Cardiac Surgery failed to obtain business associate agreements with Internet-based email and calendar services where the provision of the service included storage of and access to its ePHI.

Under the HHS resolution agreement, Phoenix Cardiac Surgery has agreed to pay a $100,000 settlement amount and a corrective action plan that includes a review of recently developed policies and other actions taken to come into full compliance with the Privacy and Security Rules.

HHS SECRETARY SPEECH ON MEDICARE FRAUD

FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICE
SECRETARY KATHLEEN SEBELIUS
Chicago Fraud Prevention Summit
April 4, 2012
Chicago, IL
Thank you.
As you know, the work we’re doing together here today – sharing best practices and developing new strategies – is part of a national conversation that began in January 2010 at the first Health Care Fraud Prevention Summit and has continued across the nation.
It was President Obama who asked us to come together. When he came into office, we were, frankly, falling behind. Scams were getting bigger and more sophisticated. Criminals were being more creative and going after larger sums. They were evolving, and we needed to catch up.

So over the last three years that is exactly what we’ve done.
Attorney General Holder just spoke about law enforcement’s strong commitment to stamping out fraud. More boots on the ground has meant more criminals locked up, more schemes taken down, and a stronger health care system for the rest of us.
But we're not just prosecuting fraud. We're also taking steps to prevent it.
In the past, nearly anyone could fill out a form and become a Medicare provider. In a matter of weeks, criminals could set up false clinics, enlist willing accomplices and vulnerable seniors to submit false claims and begin collecting payments. For industrious criminals, this approach was a ripe target.
But that‘s no longer the case. Over the last three years we have made our health care system dramatically less appealing to those who once had thought of stealing from Medicare and Medicaid as easy money.
Today, I want describe how this transformation took place.
To begin, it’s now a lot more difficult for bad actors to get their foot in the door.
Today, before you can become a Medicare provider, you have to go through a rigorous third-party review process that will make sure you meet all the requirements to bill Medicare.
We have a comprehensive database that allows us to systematically screen all current and prospective providers against other key sources like provider licensing and criminal records. If you get banned from one Medicaid program or Medicare, you get banned from all Medicaid programs.

And if a doctor retires, dies, or becomes ineligible, we know about it and can remove his information from our system. In the past, out-of-date and invalid provider numbers would remain on the rolls -- like a forgotten backdoor entrance allowing criminals to sneak in and start billing bogus claims. But no longer.

I am proud to announce today that we have already removed 3,000 ineligible providers from the Medicare program identified in just the first month of these new screening procedures.

But that’s just our first line of defense. We’re also working to make sure that even if criminals do find their way into the system, it’s a lot harder to get away with taxpayer dollars.
In the past, government was often two or three steps behind perpetrators, quickly paying out nearly every properly submitted claim -- then later trying to track down the bad guys after we got a tip. That meant we were often showing up after criminals had already skipped town, taking all of their fraudulent billings with them.
But new data analysis tools allow us to analyze claims in real time, taking away criminals’ head start. Instead of the old ‘pay-and-chase’ model, we’re getting proactive by using a technology similar to the one credit card companies use to identify and stop suspicious payments before they go out. So now, just as Visa can put your card on hold when it is used to buy ten flat screen TVs, we have the ability to freeze questionable payments until we can investigate.

Since this system was put in place, we have stopped, prevented, or identified $30 million in payments that should never have been made. And because the system is designed to get smarter over time, it’s only going to be more effective in the future.
We’re also making it easier for law enforcement officials from the FBI, the Inspector General Office’s and local jurisdictions to share data and access claims information as soon as they are submitted to Medicare.

Under the old system, it was as if police officers in one town weren’t talking to the officers in the next town. Now, we’re all beginning to plug into the same system in real time, so we can respond with the same speed and agility as the criminals.
This new fraud prevention system has changed the equation for any criminal. But we also know that neither law enforcement, nor federal officials are going to stop fraud alone. And no law or technology is as effective at preventing fraud as consumers who are educated and informed.

So with the support of partner organizations across the country, thousands of Senior Medicare Patrol volunteers are giving their friends and neighbors the tools to recognize, resist, and report fraud.

Millions of beneficiaries have taken advantage of the program’s one-on-one or group counseling sessions and over 25 million people have received fraud prevention information through SMP community outreach events.
And it’s clear that this kind of outreach pays off.
In 2010, a home health agency set up an office in the lobby of a Chicago-area affordable senior housing building and offered free blood pressure checks. In the process, they collected seniors’ Medicare numbers.

One of those seniors later noticed something wasn’t right when she reviewed her Medicare Summary Notice. The home health agency had billed Medicare for more than $1,400 in skilled nursing services that she believed she never received. So she contacted the Illinois SMP and they helped her file a complaint.

The complaint triggered an investigation. And the investigation uncovered far more than a single isolated incident, leading Medicare to recoup more than $62,000 in inappropriate payments. Just as importantly, it ended a scheme that, if allowed to continue, could have drained thousands if not millions more from Medicare’s coffers.

And it all started with one cautious citizen who – thanks to the outreach and education of the local Senior Medicare Patrol -- knew to speak up when something wasn’t right.
From 2010 to 2011 the number of calls to the Illinois SMP rose 64 percent and the trend has continued into 2012. And as these numbers increase, the good news is that more and more of them are coming from seniors who are already putting into practice what they have learned from their neighbors, a local presentation, or ‘Fraud Alert’ emails. When someone calls on the phone or knocks on the door asking for their Medicare number, they know to refuse, and then to report it immediately.
This also serves to remind us that no one group, agency, or business owns all of the resources or expertise we need to keep criminals out of our health care system.
Because we all have a stake in preventing health care fraud, we’re all doing our part.
For someone thinking about committing fraud, this means the health care landscape looks a lot less friendly today:

It’s harder than ever to get into the system as a bad actor. Get in and it’s harder still to submit a fraudulent claim. Find a way to submit a claim and you are more likely to get caught. And when you get caught, you’re going to face a tougher punishment.
There is no responsibility that this Administration takes more seriously than safeguarding taxpayer dollars. I am proud of how far we have come. And I look forward to working with all of you in the days and months ahead to build on that progress and protect our health care system for this generation and the next.