August 28: Week That Was in Healthcare Fraud and Malpractice
By - Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
4 convicted in $63M FL healthcare fraud scheme
Roger Rousseau, former Medical Director of the currently non-operational Health Care Solutions Network Inc, (HCSN), and three HCSN therapists – Doris Crabtree, Angela Salafia, and Liliana Marks – were all found guilty this week of conspiracy to commit healthcare fraud. HCSN claimed to provide intensive care for the mentally ill.
Over an approximate period of seven years, HCSN billed Medicare and Medicaid for medically unnecessary health services and paid kickbacks to assisted living facility owners and operators in exchange for beneficiary referrals, according to trial evidence.
Rousseau regularly signed what he understood as erroneously amended medical records, as trial evidence additionally confirms. He rarely met with patients and did not review the records, confirmed other trial information.
HCSN submitted over $63 million in false and fraudulent claims to both Medicare and Medicaid, $28 million of which was paid for by Medicare and Medicaid.
Says the Department of Justice, “HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.” The Medicare Fraud Strike Force, the organization maintains, has charged over 2,300 defendants who have billed Medicare for over $7 billion.
87 month sentence in $30M NYC Medicare fraud scheme
Last Tuesday, Oscar Huachillo, the former owner and operator of several HIV/AIDs clinics was sentenced to 87 months in prison for coordinating a $31 million Medicare fraud scheme. Huachillo will simultaneously serve a 60-month sentence for millions in tax evasion.
Huachillo, who had already pled guilty for healthcare fraud and tax evasion, submitted bills to Medicare for costly treatments involving excessively diluted doses or treatment that was either medically unnecessary or simply never administered.
According to United States Attorney Preet Bharara, “Oscar Huachillo defrauded Medicare out of tens of millions of dollars and evaded millions of dollars in taxes on his illegal windfall. His schemes put patients at risk, undermined and exploited the Medicare program, and cheated honest taxpayers.”
According to multiple forms of documentation and statements from court proceedings, Huachillo essentially operated healthcare “fraud mills.” Included in the detailed fraud scheme details were findings such as patients were offered $50 for each referred patient.
Stated United States District Judge Katherine Polk Failla during the sentence announcement, “[I]n the cases I’ve had as a judge, this is the worst fraud I’ve had. $31 million in losses; that’s terrible.” She additionally added, “The conduct is simply reprehensible.”
