March 20: 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. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
Thirteen Indicted in $50 Million Medicare Fraud Scheme
Owner and operator of the New Orleans-based medical clinic Medical Specialists of New Orleans, Paige Okpalobi, 58, and her accountant, Christopher White, 48, pleaded guilty to one count of conspiracy to commit healthcare fraud and one count of conspiracy to falsify records in a federal investigation.
Out of thirteen others who were indicted with this scheme, including two doctors from Okpalobi’s medical clinic, eight have pleaded guilty thus far.
Between 2007 and 2014, Okpalobi submitted almost $50 million in claims to Medicare for home health services that were performed but deemed medically unnecessary or for services that were simply not delivered.
The medical clinic Okpalobi owned employed doctors to falsely certify Medicare beneficiaries were qualified to receive home healthcare. Medicare was fraudulently billed with these false certifications through home healthcare companies jointly operated by Okpalobi.
White admitted to coordinating the payment of patient recruiters who sold information illegally. Additionally, Okpalobi and White fabricated tax and employment records in response to a federal grand jury subpoena to try and hide accepted illegal kickbacks and essentially mislead a grand jury.
Fake Patient Files Created in $12 Million Medicare Scheme
Mohammed Sadiq, 67, pleaded guilty to one count of healthcare fraud and one count of filing a false tax return.
Sadiq fraudulently billed Medicare for $12.6 million in home health services not provided or for services obtained via illegal kickbacks. Substantial funds for personal use were withdrawn and were not reported on his individual 2008 federal tax return.
Sadiq owes $1.5 million in taxes, interest, and penalties.
Ten others were either convicted at trial or pleaded guilty.
Sadiq created fake patient files to fool a Medicare auditor and make home health services appear to have been tangibly provided and medically necessary when neither was the case.
Pharmacist Receives Kickbacks for Unfilled Prescriptions
Rouzbeh Javaherian, 34, of Beverly Grove, California, pleaded guilty to healthcare fraud involving a scheme defrauding the Medicare Part D program through the Los Angeles-based Emoonah Inc./Westaid Pharmancy and Medical Supply (Westaid).
Javaherian, a licensed pharmacist and owner of Westaid, paid illegal kickbacks to Medicare beneficiaries so Westaid could receive and fill prescriptions. Javaherian submitted false and fraudulent claims to Medicare Part D plan sponsors for prescriptions that went completely unfilled.
Javaherian received $644,000 in Medicare overpayments.
$27 Billion Returned to Medicare Trust Fund
Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell announced $27.8 billion was returned to the Medicare Trust Fund since the start of the Health Care Fraud and Abuse Control (HCFAC) Program.
$3.3 billion in taxpayer dollars were recovered by the government’s healthcare fraud and prevention and enforcement efforts in 2014. This amount includes monies collected from individuals, companies, programs serving senior citizens, and programs serving the disabled or economically disadvantaged attempting to defraud federal health programs.
For every $1 spent on investigations within the last three years related to healthcare fraud and abuse, the administration recovered over $7.
“As the innovative and collaborative work of the Health Care Fraud and Abuse Control Program proceeds, more taxpayer money is being recovered, more criminals are facing justice, and more fraud is being punished, prevented, and deterred,” said Holder.
“These impressive recoveries for the American taxpayer demonstrate our continued commitment to this goal and highlight our efforts to prosecute the most egregious instances of health care fraud and prevent future fraud and abuse,” said Burwell. “With the continued support of Congress and our partners at the Department of Justice, we’ve cracked down on tens of thousands of health care providers suspected of Medicare fraud – all of which are helping to extend the life of the Medicare Trust Fund.”
