December 11: Week That Was in Healthcare Fraud and Malpractice
"Countless everyday people suffering from illnesses [had] no idea their medicine had been diverted from the legitimate stream of commerce and could be dangerous to consume.”
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 (OIG). The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
Owner charged in $100M black market medicine fraud scheme
Randy Crowell – aka “Roger” – the owner of a Utah-based pharmaceutical company, was arrested this week at his home in Nevada and indicted on charges for fraudulently distributing over $100 million of black market prescription drugs.
“This scheme was not only profitable for Crowell, but also dangerous to the thousands of patients who ultimately took these black market medications not knowing that they had been previously prescribed to others and then resold and trafficked, often in unsafe conditions,” wrote the Department of Justice.
“As alleged, Randy Crowell perverted the system designed to ensure patients receive safe and effective medication, making millions in the process,” stated Manhattan US Attorney, Preet Bharara.
“Crowell’s alleged crime victimized not only benefit programs like Medicaid, but also countless everyday people suffering from illnesses who had no idea their medicine had been diverted from the legitimate stream of commerce and could be dangerous to consume.”
“Targeting the most vulnerable sources of supply, namely Medicaid patients and others with subsidized benefits, scheme participants encouraged sick people with serious illnesses to forego medical treatment in exchange for profit,” asserted Diego Rodriguez, FBI Assistant Director-in-Charge.
“This put others at risk of unknowingly purchasing mishandled medication. While many social benefit programs are subject to fraud, estimates of fraudulent billings to public health care programs are in the tens of billions.”
California ambulance managers sentenced to jail
Several individuals associated with a Southern California ambulance company were sentenced to jail this week for their involvement in a $1.5 million Medicare fraud scheme.
According to last Tuesday’s announcement from the Department of Justice, Yaroslav Proshak (aka Steven Proshak) of Village Valley, CA was sentenced to 108 months. Emilia Zverev of Van Nuys, CA was sentenced to 36 months. And Sharetta Michelle Wallace of Inglewood, CA was sentenced to 24.
Zverev and Wallace were ordered by a judge to pay restitution of over $800,000, collectively and separately with Proshak, reported the Department of Justice.
ProMed Medical Transportation (ProMed), an ambulance transportation company near Los Angeles owned and operated by Proshak, employed both Zverev, a billing manager, and Wallace, who supervised EMTs. ProMed provided non-emergency services to Medicare beneficiaries, many who were dialysis patients.
According to trial evidence, between 2008 and 2010, the defendants plotted to bill Medicare for ambulance transportation services when they were not actually needed. They also attempted to hide patients’ medical conditions by making changes to paperwork and creating fraudulent documentation.
ProMed submitted a minimum of $1.5 million in false and fraudulent Medicare claims, confirms the Department of Justice. Medicare paid over $800,000 for these claims.
Guilty plea in Illinois healthcare fraud case
Terry L. Stinnett of Marion, Illinois is in hot legal water this week involving a healthcare fraud scheme. Stinnett pled guilty on Tuesday and faces the possibility of a decade in prison, a $250,000 fine, and 3 years of supervised release.
Stinnet admitted he had submitted false and fraudulent claims. He also admitted to false acts of billing when he had actually not been caring for customers.
Stinnet performed work with the Home Services Program, a Medicaid Waiver Program that helped individuals stay in their home as opposed to a nursing home.
This prosecution is part of the "Operation Home Alone" initiative which began last year by the United States Department of Health and Human Services - Office of Inspector General, the Illinois State Police - Medicaid Fraud Control Bureau, and the Federal Bureau of Investigation.
