Policy & Regulation News

March 13: Week That Was in Healthcare Fraud and Malpractice

By Jacqueline DiChiara

- 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.

Hoax Medical Clinic Steals Physicians’ Identities

Karo Gotti Blkhoyan was sentenced to 57 months of imprisonment after being arrested this week in California.

Blkhoyan was formerly charged for conspiracy to commit healthcare fraud and money laundering.

  • Healthcare Merger and Acquisition Activity Up 14.4% in 2018
  • Safety-Net Hospital Profitability Sinks as Demand Rises
  • AMGA Urges CMS to Release Claims Reimbursement Plan for CPC+
  • Blkhoyan and co-conspirators, who owned and operated South Carolina-based Pinnacle Group Services (PGS) from October 2009 to August 2010, were paid over $300,000 and billed Medicaid for $1.1 million in claims and services that had not been rendered.

    No patients ever actually went to PGS.

    Physicians’ identities were stolen so Medicare could be billed for false services.

    Arrests have been made and they await the judicial process.

    Registered Nurse Commits $5 million in Medicare Fraud

    James Ademiju, a licensed registered nurse in Illinois and operator of Adonis Inc. and BestMed-Care Services, Ltd., is charged with healthcare fraud after investigation of Suburban Home Physicians.

    Ademiju allegedly billed skilled-nursing services that did not qualify for Medicare and performed services that were deemed unnecessary.

    Although patients were not confined to their home, as Medicare requires, nursing assessments falsely stated homebound patients required help with daily activities, such as bathing and dressing.

    Patients were also referred although they already had primary-care physicians.

    Ademiju was charged with one count of health care fraud and faces a maximum prison penalty of ten years and a $250,000 fine, or a fine totaling twice the gain or loss. Ademiju additionally faces mandatory restitution.

    Florida Physicians Overcompensated Thousands per Month

    Recovery Home Care and National Home Care Holdings LLC will pay $1.1 million for violating the False Claims Act.

    Doctors were unlawfully paid for referrals of Medicare patients’ health care services.

    Recovery Home Care allegedly overcompensated dozens of physicians in violation of the Anti-Kickback Statute and Stark Law. 

    Clinical Social Worker Sentenced to 21 Months for Fraud

    Carla Clark, a Louisiana-based licensed clinical social worker, was sentenced to imprisonment and two years of supervised release. Clark will pay over $400,000 in restitution for involvement in a health care fraud scheme with Fusion Services, LLC and Grace Social Services, LLC.

    Clark created fabricated medical records stating Medicare beneficiaries had received face-to-face psychotherapy when such services had not been provided.

    Clark additionally created false claims with assistance from Sonya Williams, Owner of Fusion Services, LLC and Grace Social Services, LLC, and submitted them to Medicare for reimbursement.

    Medicare payments of approximately $350,000 were deposited directly into personal bank accounts.

    Clark was ordered to pay over $413,000 in restitution to the Department of Health and Human Services and Centers for Medicare and Medicaid Services.