Why blaming undocumented immigrants for draining social services?.

TWO AREA PHYSICIANS AMONG FOUR DEFENDANTS CHARGED IN THREE SEPARATE FEDERAL HEALTH CARE FRAUD SCHEMES.


CHICAGO – Two Chicago area physicians are among four defendants who have been charged recently in three separate, unrelated federal healthcare fraud cases, federal law enforcement officials announced today. Each of the physicians, who were charged in separate cases, allegedly defrauded either Medicare and/or private health care insurers – in one case for more than $13 million – by either billing for services they never provided or inflating the services they did provide to patients. In the third case, the operator and manager of two former suburban Chicago durable medical equipment providers allegedly defrauded Medicare and Medicaid by providing power wheelchair or orthotic devices that were not prescribed or medically necessary and the recipients were not qualified to receive.

“Health care fraud remains an important priority of federal law enforcement. We will use all of our resources to ensure that dishonest physicians and other medical providers do not profit from cheating Medicare and private insurers,” said Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois.

Mr. Fitzgerald announced the cases, all three of which were charged or unsealed this week in U.S. District Court, with Robert D. Grant, Special Agent-in-Charge of the Chicago Office of Federal Bureau of Investigation; Lamont Pugh, Special Agent-in-Charge of the U.S. Department of Health and Human Services Office of Inspector General in Chicago; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor Office of Inspector General in Chicago. The Office of Personnel Management Office of Inspector General also participated in the investigations.

The defendants in all three cases were charged with one or more counts each of health care fraud. If convicted, each count carries a maximum penalty of 10 years in prison and a $250,000 fine.

The Court, however, would determine the appropriate sentence to be imposed under the advisory United States Sentencing Guidelines.

In each case, the public is reminded that charges are not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt. The details of each case follow:

United States v. Sushil Sheth

Dr. Sushil Sheth, a cardiologist with privileges at three unnamed Chicago area hospitals, was charged with health care fraud in a criminal information filed Wednesday in U.S. District Court.

Between January 2002 and July 2007, he allegedly received approximately $13.4 million – $8.3 million from Medicare and $5.1 million from other health care insurers – in fraudulent reimbursement for the highest level of cardiac care when those services were not performed, and then used the proceeds for his own benefit.

Sheth, 47, of Burr Ridge and whose business office is in Flossmoor, will be arraigned at a later date in U.S. District Court.

According to the charges, Sheth used his hospital privileges to access and obtain information about patients without their knowledge or consent. He then hired individuals to bill Medicare and other insurance providers for medical services that he purportedly rendered to patients whom he knew he never treated. Typically waiting almost a year after the treatment was purportedly provided, Sheth submitted false claims for reimbursement for providing the highest level of cardiac care – requiring hands-on treatment in an intensive care unit – on multiple days during patients’ hospital stays.

The charges seek forfeiture of approximately $13.4 million and two parcels of real estate in Scottsdale , Ariz. The Government has seized or restrained approximately $11.3 million in various bank and investment accounts held by Sheth and his wife.

The government is being represented by Assistant U.S. Attorney Steven J. Dollear. The case was investigated by the FBI and the Inspector General’s offices of the Department of Health and Human Services and the Labor Department.

United States v. Otto Garcia Montenegro

Dr. Otto Garcia Montenegro, a general practice physician who owned and operated a private medical clinic, Montenegro Clinic, Inc., in Elmwood Park, where he treated dozens of patients each week, was charged with health care fraud in a criminal information filed yesterday in U.S. District Court. Between early 2003 and May 2007, he allegedly submitted false health insurance claims totaling approximately $500,000 to Blue Cross Blue Shield of Illinois and other private medical insurance providers. The insurers paid Montenegro approximately $373,000 based on the false claims, the charges allege.

Montenegro , 47, of Elmwood Park , will be arraigned at a later date in U.S. District Court.

According to the charges, Montenegro did not collect deductibles and co-payments from patients and, instead, submitted hundreds of fraudulent insurance claims to insurers for services and treatments that he knew he did not actually provide in order to exhaust patients’ deductibles and copays and obtain money for himself. As part of the scheme, he allegedly created hundreds of bogus bills falsely identifying visits and treatments that never occurred.

The government is being represented by Assistant U.S. Attorney Jacqueline Stern. The case was investigated by the FBI and the Labor Department’s Office of Inspector General.

United States v. Stephen Anthony Pam and Shavon Keyona Williams

Stephen Anthony Pam, who controlled and operated two former durable medical equipment companies in suburban Chicago that supplied motorized wheelchairs, scooters, reclining lift chairs and orthotic devices, and Shavon Keyona Williams, who at various times worked as office manager or salesperson for both business, were each indicted on 34 counts of health care fraud for allegedly fraudulently billing millions of dollars to Medicare and Medicaid and other health care benefit programs.

Pam, 47, of Sugarland , Tex. , was arrested on January 23 in Houston after returning from a foreign trip. He remains in federal custody while being transferred to Chicago to face prosecution.

Williams, 30, of Chicago , will be arraigned at a later date in U.S. District Court. They were indicted by a federal grand jury on December 11 and the indictment was unsealed following Pam’s arrest.

Pam controlled and operated the former Alliance Healthcare Services & Medical Equipment, Inc., in Glen Ellyn , and the former Medlinc Concepts, Inc., in Oak Brook.

Between 2004 and 2008, the defendants allegedly falsely claimed to Medicare and Medicaid that power wheelchairs or orthotic devices were medically necessary for beneficiaries when they knew that physicians had not ordered or prescribed such equipment and that beneficiaries did not qualify to receive them under Medicare and Medicaid rules. As part of the fraud scheme, Pam and Williams allegedly submitted hundreds of claims for reimbursement to Medicare and Medicaid totaling more than $5 million, falsely stating that Alliance and Medlinc had delivered equipment to beneficiaries when they knew that either no equipment was actually delivered; beneficiaries received less expensive scooters or reclining lift chairs instead of more expensive power wheelchairs; or beneficiaries received orthotic devices that were less in quantity or Medicare-approved quality than what was billed.

In one aspect of the fraud scheme, the indictment alleges that between February 2005 and May 2006, approximately 99 percent of the Alliance claims submitted to Medicare and Medicaid were for power wheelchairs and accessories that were never supplied. These claims totaled approximately $4.7 million. Pam, through Alliance , allegedly received reimbursements from these claims totaling more than $1.8 million, and the indictment seeks forfeiture of that amount.

The government is being represented by Assistant U.S. Attorneys Felicia Manno Alesia and Ryan Hedges. The case was investigated by the Department of Health and Human Service’s Office of Inspector General and the FBI.

California will recover 112 million for Medi Cal Program fraud.

Attorney General Edmund G. Brown Jr. today announced that California will recover $112 million for its Medi-Cal program as part of a national settlement with Eli Lilly and Company for the unlawful off-label marketing of its anti-psychotic drug Zyprexa, which the company aggressively marketed for such unapproved uses such as treatment for depression, anxiety, irritability, disrupted sleep, nausea and gambling.

“This settlement means that Eli Lilly can no longer reap massive profits by aggressively marketing this drug for unapproved uses at the expense of state health care programs for seniors and the infirm,” Attorney General Brown said. “California’s Medi-Cal program will receive almost $112 million, which is more than welcome at a time when the state faces massive budget deficits.”

Eighteen percent of the $112 million recovered for the Medi-Cal program will go to relators (whistleblowers) – the remainder will be split between the State, which will receive $54 million and the federal government, which will receive $41 million.

Beginning in 2001, Eli Lilly launched a marketing campaign called “Viva Zyprexa!” which encouraged physicians to prescribe Zyprexa for children, adolescents, and dementia patients.

In October 2008, the California Attorney General entered a settlement with Eli Lilly over the Zyprexa marketing campaign. In his original complaint, Attorney General Brown alleged that Eli Lilly engaged in unfair and deceptive practices when it marketed Zyprexa for off-label uses and failed to adequately disclose the drug’s potential side effects (including diabetes and hyperglycemia) to healthcare providers.

Under this settlement, Eli Lilly agreed to change its marketing practices and to cease promotion of its off-label uses. Off-label uses are those not approved by the FDA when it approves the sale and use of a particular drug. Physicians are allowed to prescribe drugs for off-label uses, but federal law prohibits pharmaceutical manufacturers from marketing products for off-label uses.

The total settlement is $1.415 billion—the largest recovery in a health care fraud investigation in U.S. history. The settlement includes $800 million in civil damages to be paid to the States and $615 million as a result of criminal charges brought against the company for illegal marketing.

Although both California and the U.S. contribute 50% to the funding of the Medi-Cal program, California’s share is larger than the federal share due to the federal Deficit Reduction Act, which provides monetary incentives to states to use False Claims Acts to pursue Medicaid fraud.

Cardiologist Convicted of 51 counts of Healthcare Fraud. Ethic? Moral?

United States Attorney Donald W. Washington, along with Health & Human Services Office of Inspector General Special Agent in Charge, Mike Fields, and FBI, New Orleans Division, Special Agent in Charge, David Welker, announced the conviction of DR. MEHMOOD M. PATEL, 64, of Lafayette, by a federal jury of healthcare fraud After a three-month trial which began on October 1, 2008, and six days of deliberation, a jury returned a guilty verdict on 51 counts of healthcare fraud in United States District Court in Lafayette.

After the verdict Tuesday evening, Judge Tucker Melancon denied the government’s motion for detention before sentencing, but increased Patel’s release bond obligation to $500,000.00. The court also ordered the defendant to surrender all medical licenses, including those allowing him to practice medicine
in Louisiana, Canada, India and elsewhere by 9:00 a.m. on December 31, 2008. A date for sentencing is expected to be set soon.

PATEL was indicted in February 2006 stemming from a complaint made to the Department of Health & Human Services that the defendant was placing stents in people who did not need them. A search warrant was executed on Patel’s office in November 2003, at which time patient files were seized. Beginning on or about September 2003, Our Lady of Lourdes (OLOL) Hospital in Lafayette, LA conducted an internal investigation leading to the suspension of DR. PATEL’S privileges at OLOL. A similar process was undertaken by Lafayette General Medical Center (LGMC) in late 2003 and early 2004 which also led to DR. PATEL being suspended from practicing at LGMC. After the hospitals suspended the defendant’s privileges, the Louisiana State Medical Board restricted DR. PATEL’S license to practice interventional cardiology, leaving him the ability to practice internal medicine pending the results of the criminal trial.

Testimony at trial revealed that MEHMOOD M. PATEL, M.D., who has been practicing interventional cardiology in Lafayette, Louisiana and surrounding areas for more than 25 years, was falsifying patient symptoms in medical records, falsifying findings on medical tests, and performing unnecessary coronary procedures such as deploying angioplasty balloons and stents. Testimony from experts in cardiology specialties revealed that the defendant deployed stents, balloons and radiation in coronary arteries that had little or insignificant disease. Testifying medical experts included doctors from Emory University in Atlanta, GA, the University of Pennsylvania Medical School in Philadelphia, PA, Mt. Sinai Hospital in New York City, and the University of California at Los Angeles, CA, as well as cardiologists practicing in Louisiana. Each expert testified about only a small number of the thousands of procedures performed annually for many years by DR. PATEL. The indictment in the case contained 91 counts involving only 75 patients chosen by the government with the help of these experts.

Additionally, the jury heard testimony from dozens of other government witnesses including medical technicians, nurses, and patients who painted the defendant as one who lacked concern for patient care and safety. Many of the nurses and technicians indicated their concerns and made complaints to their supervisors after witnessing unnecessary angioplasty procedures performed by the defendant doctor. Testimony also revealed that DR. PATEL was performing unnecessary medical procedures and billing both Medicare and private insurance companies, which added up to millions of dollars paid to DR. PATEL and the hospitals where many of the procedures were performed. During the years 1999-2003, DR. PATEL was the number one biller in cardiology services for the State of Louisiana. During the approximately three-year period covered by the indictment, DR. PATEL billed Medicare and private insurance companies more than $3 million, of which he received $541,745.00 from this scheme. The indicted charges included less than $90,000.00 of the amount received by the defendant.

DR. PATEL performed procedures at both Our Lady of Lourdes Hospital and Lafayette General Medical Center, as well as a leased mobile catheterization lab located outside his practice, Acadiana Cardiology, before he opened his own catheterization lab in mid-2002 on the second floor of his office on St. Julien Street in Lafayette, Louisiana.

United States Attorney Donald W. Washington stated: “Patient care and safety are the primary duty of all healthcare providers. Doctors are never privileged to perform medically unnecessary procedures on any person for any reasons whatsoever. I hope that this matter sends a strong message to those good and honorable medical professionals to police their ranks and be faithful to their credo of doing no harm to any patient. Healthcare providers like Dr. Patel are not entitled to payment by federal and/or private health plans for medically unnecessary procedures. Physicians must be held accountable when they fail in their primary mission to care for their patients appropriately, ethically and respectfully. Healthcare fraud will continue to remain a priority for this office, and we will aggressively investigate and devote our full attention and resources to matters of this magnitude.”


Special Agent in Charge for Health & Human Services Office of Inspector General, Mike Fields, stated: “Yesterday, Dr. Patel heard from this jury what healthcare providers who defraud Medicare are hearing from juries all over America - you will be held accountable for your greed. HHS-OIG agents will
continue to work closely with our state and federal law enforcement partners to protect the Medicare Trust Fund.”

Special Agent in Charge of the FBI’s New Orleans Division, David Welker, stated: “It is reprehensible to think that a medial professional would put patients at significant risk and conduct medically unnecessary procedures simply to fill their personal coffers. Hopefully, as U.S. Attorney Donald Washington notes, this conviction should send a powerful message to healthcare providers of the perils of deviating from their oath. It should also send a message to patients to be personally involved in their own care. We will continue to aggressively investigate healthcare fraud to ensure the safety of the public.”
PATEL faces a maximum of ten years imprisonment, a fine not more than $250,000.00, and a term of not more than three years of supervised release following confinement.

Sentencing in federal court is determined by the discretion of federal judges and the governing statutes. Parole has been abolished in the federal system. This case was investigated by Special Agent Barbara Alleman of Health & Human Services and Special Agents Troy Chenevert and Greg Harbourt of the Federal Bureau of Investigation. The case was prosecuted by United States Attorney Donald W. Washington and Assistant United States Attorney Kelly
Uebinger

Undocumented Immigrants draining the Medicare.!!!!!!!

For Nativists and protectionists this is a must to see and read. Keep blaming your own ignorance.

MIAMI PHYSICIAN AND HIV CLINIC ADMINISTRATOR PLEAD GUILTY FOR THEIR ROLES IN A $37 MILLION MEDICARE FRAUD SCHEME

Doctor Wrote Prescriptions for Unnecessary HIV Infusion Treatments at Clinic;
Administrator Ran Related HIV Infusion Clinic

WASHINGTON - Miami physician Ronald Harris, M.D., and Miami resident Mariela Rodriguez each pleaded guilty today to defrauding the Medicare program in connection with a $37 million HIV infusion fraud scheme, Acting Assistant Attorney General Matthew Friedrich of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced.

Harris pleaded guilty to conspiracy to commit healthcare fraud and three counts of submitting false claims to the Medicare program before U.S. District Judge Cecilia M. Altonaga. In his plea, Harris admitted that he wrote false prescriptions for HIV infusion treatments while serving as the medical director for two medical clinics, Physicians Med-Care and Physicians Health. Both clinics purported to provide HIV infusion services to Medicare beneficiaries. Harris admitted that beginning in August 2002 and continuing through March 2004, he conspired with others to defraud the United States, to cause the submission of false claims to the Medicare program, to pay health care kickbacks and to commit health care fraud. Harris also admitted to submitting false claims.

According to information contained in plea documents, Harris admitted that between August 2002 and March 2004 he served as the medical director of Physicians Med-Care and Physicians Health, two Miami HIV infusion clinics that were owned and controlled by Carlos and Luis Benitez, and that were operated for the purpose of committing Medicare fraud. Prior to August 2002, Harris had no prior experience with infusion therapy for HIV patients. During his employment with Physicians Med-Care and Physicians Health, Harris admitted he approved approximately $26.2 million worth of fraudulent medical bills, signed documents containing false information about treatments purportedly provided to HIV patients and approved medically unnecessary treatments. According to information in the plea documents, the Medicare program paid approximately $17.5 million in fraudulent bills as a result of Harris' conduct.

Rodriguez pleaded guilty before U.S. District Judge Federico Moreno to conspiracy to commit health care fraud and one count of making false declarations to a federal grand jury. In her plea, Rodriguez admitted that she administered an HIV infusion clinic named Saint Jude Rehab Center, a Miami HIV infusion clinic that was owned and controlled by Carlos and Luis Benitez, and that was operated for the purpose of committing Medicare fraud. Similar to Physicians Med-Care and Physicians Health, Saint Jude purported to provide HIV infusion services to Medicare beneficiaries.

Rodriguez admitted that she served as an administrator of Saint Jude between June 2003 and November 2003, during which time she submitted false claims to the Medicare program for HIV infusion treatments. Rodriguez further admitted that beginning in June 2003 and continuing through November 2003, she conspired with others to defraud the United States, to cause the submission of false claims to the Medicare program, to pay health care kickbacks and to commit health care fraud. Rodriguez also admitted to making false statements in her testimony before a federal grand jury. Between June 2003 and November 2003, Saint Jude submitted approximately $11.3 million worth of fraudulent bills to the Medicare program for HIV infusion services that were never provided and services that were medically unnecessary. As a result of this conduct, the Medicare program paid approximately $8.2 million in fraudulent bills. Sentencing for both Rodriguez and Harris has been scheduled for Nov. 4, 2008.

In a related case, Carlos and Luis Benitez, as well as their brother Jose Benitez, were indicted on June 11, 2008, for their role in a $110 million HIV infusion fraud and money laundering scheme. The indictment alleges that Carlos, Luis and Jose Benitez were the masterminds of a massive HIV infusion fraud operation throughout south Florida involving at least 11 clinics and that they laundered the proceeds of their crimes. Also according the indictment, Carlos and Luis Benitez were the true owners of Physicians Med-Care, Physicians Health and Saint Jude. All three Benitez brothers remain fugitives.

The cases were prosecuted by Hank Bond Walther, John K. Neal and Nathan Dimock of the Criminal Division's Fraud Section, and investigated by the FBI and the Department of Health and Human Services, Office of Inspector General. The cases were brought as part of the Medicare Fraud Strike Force, supervised by Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section and U.S. Attorney Acosta of the Southern District of Florida. Strike Force prosecutors have indicted 82 cases involving 142 defendants since Strike Force operations began in March 2007. Collectively, these defendants committed more than $492 million in Medicare fraud.

Undocumented Immigrants draining the Social Services? A lie or a lie.

I had seen more often the tip of the Iceberg when Hospitals, Corporations, Vendors and Suppliers has been the most abusives of the Medicare and Medicaid System were money is flying out the pocket of taxpayers as well as Legal and Undocumented Immigrants.

DME DEFENDANTS SENTENCED IN MULTI-MILLION DOLLAR MEDICARE FRAUD SCHEME

R. Alexander Acosta, United States Attorney for the Southern District of Florida, Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Miami Regional Office, and Bill McCollum, Attorney General, State of Florida, announced that defendants Mabel and Abner Diaz , of Miami Lakes, FL were each sentenced today to fourteen years’ incarceration for conspiracy to commit health care fraud and health care fraud. Defendant Suleidy Cano , of Hialeah, FL was sentenced to eleven years’ incarceration for conspiracy to commit health care fraud and aggravated identity theft.

According to the parties' joint factual statement in support of the plea, the fraud involved durable medical equipment (DME), which is equipment that can be used in the home on a repeated basis for a medical purpose. Where DME is prescribed or ordered by a physician, an authorized Medicare provider who supplies the equipment to a Medicare beneficiary may be eligible for reimbursement by Medicare.

Abner Diaz and Mabel Diaz co-owned and operated All-Med Billing Corp., a Miami medical billing company, where Cano worked as a biller. All-Med submitted claims to Medicare on behalf of suppliers who purportedly provided DME to Medicare beneficiaries. All-Med submitted $419,935,692.74 in fraudulent claims for DME purportedly provided to Medicare beneficiaries by 85 DME suppliers. These claims were for equipment that not been ordered by physicians or delivered to the beneficiaries as claimed. As a result of these claims, Medicare paid the suppliers approximately $148,586,919.99.

Mr. Acosta commended the investigative efforts of the Federal Bureau of Investigation, the U.S. Department of Health and Human Services, Office of Inspector General, and the Office of the Attorney General, Medicaid Fraud Control Unit. This case is being prosecuted by Assistant United States Attorneys Marc Osborne and Joseph Shumofsky

Illegals draining Social Services. A lie or a Lie?

Another case were I exposed the unethical and Illegal behavior from Companies. They thought they were going to get away with it and so they refused to change their illegal practices and kept alienating persons of conscience. Every hospital will be full of stories of heroism and mistakes blaming the other. And This is not about accidents, or complicated book keeping or reporting procedures. It is about white collar crime; crime at such a level that it has been difficult for low paid Federal employees to get their minds around the tens of millions of dollars involved and too complex for the news media to grasp. Finally, it is starting to unravel. Bring on the indictments not the Undocumented Immigrants.

CoxHealth has agreed to pay more than $60 million to settled a False Claims Act lawsuit in which the company was charged with overbilling Medicare. CoxHealth actually stole more money that they are being required to return to the U.S. Government because as federal agents began calculating the damages, it soon became clear Cox could not pay without going under

CoxHealth's $60 million settlement with the U.S. Justice Department will cost the health system an extra $3.07 million when the bill is paid in full with interest in five years.

That's according to a government document filed with the settlement agreement Tuesday.
The money will compensate the Medicare trust fund for a portion of the payments that Cox improperly claimed and received, the government said. The trust fund is the pool of taxpayer money from which the Medicare program pays hospitals, providers and beneficiaries.

Cox will pay $35 million immediately, then $5 million each year for five years with 4 percent interest on the deferred amounts. Cox officials say they already have the money in various reserve accounts.

The $60 million settlement "is considerably less than the alleged improper Medicare payments to Cox," U.S. Attorney John Wood said this week.

Federal officials agreed on that amount because that's what Cox could afford to pay without damaging its ability to provide medical care to the community, he said.

Officials won't divulge the estimated total amount of those alleged improper payments
But Assistant U.S. Attorney Joel May said it became clear as federal agents began calculating alleged claims, "There's no way Cox would ever be able to pay without going under."

She added, "That's when we switched gears to an 'ability-to-pay' posture."

The goal was to find a balance, May said.

"It is a priority for us to protect taxpayer dollars. Eventually it comes to practicality. You can't run a hospital out of business. That does not serve your community at all," she said. "It's the important art of weighing and balancing the need to protect the Medicare Trust Fund and the community's need for health care."

The U.S. Department of Justice alleges that Cox billed and received an undisclosed amount of Medicare payments it should not have gotten, and alleges it violated federal laws by providing kickbacks to physicians of the for-profit Ferrell-Duncan Clinic Inc.

The government is still negotiating a settlement with the physician-owned clinic, the government confirmed. Likewise, May said, its criminal investigation into alleged Medicare fraud at Cox continues.

How does a $60 million settlement compare with others?

According to Patrick Burns, spokesman with Washington, D.C.-based Taxpayers Against Fraud, the Cox settlement will be among the 20 largest settlements this year.

Burns' group is a nonprofit, public interest organization that aims to combat fraud against the federal government through the promotion and use of the Federal False Claims Act.

The settlement range is a low of about $10,000 up to one large system's cumulative $1.7 billion, he said. However, $900 million is the largest for a single defendant, he said.

The U.S. Department of Justice handles about 100 cases of the 300 to 400 false claims cases filed every year, Burns said. About 80 percent of those 100 are alleged health care fraud, he said.

Half of those 100 cases, he added, will be settled for less than $2 million

IMMIGRATION SYSTEM IS INHUMANE AND DYSFUNCTIONAL.!!!!!!!!

IMMIGRATION SYSTEM IS INHUMANE AND DYSFUNCTIONAL.!!!!!!!!!!!!!!



A PREGNANT CHINESE woman facing deportation lost her twin fetuses after immigration officials ignored her pleas for a doctor at Kennedy Airport, an elected city official and her lawyer charged. Zhen Xing Jiang, 34, of Philadelphia, who has been in the United States Undocumented for a decade, was being deported Tuesday when she complained of stomach and back pain, according to City Councilman John Liu (D-Queens). Customs officers denied her request for help, said Liu, who visited Jiang at Jamaica Hospital the next day. "This is cruel and it is atrocious what these officers did," Liu said. "What kind of law enforcement can just stand there as a pregnant woman is crying and in pain?" Jiang, who was discharged, could not be reached for comment. Federal Immigration and Customs Enforcement officials declined to discuss the circumstances involving Jiang's miscarriage, but released a statement saying her deportation was delayed for "medical reasons that were addressed immediately." "Once she is cleared medically, efforts to effectuate her repatriation will resume," the statement said. "She's traumatized by the experience," said her attorney, Michael Sommi

When Hospitals are going out of business.!!! Undocumented Immigrants Are always to be blame for. Hypocrisy is not a family value.!!!!!!!






THREE FORMER HOSPITAL EMPLOYEES PLEAD GUILTY TO MULTIMILLION DOLLAR FRAUD

R. Alexander Acosta, United States Attorney for the Southern District of Florida and Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, announced that defendants Joanna Delfel , Victor Garcia , and Sylvia Oramas, three former employees of Kendall Regional Medical Center (“KRMC”), a full-service hospital located in Miami-Dade County, Florida, pled guilty today to charges of conspiring to defraud KRMC of more than $5 million through a sophisticated purchase order scheme. Specifically, the defendants pled guilty to conspiracy to commit wire fraud, in violation of Title 18, United States Code, Section 1349. If convicted, each defendant faces a maximum term of imprisonment of twenty years. Sentencing is scheduled for January 8, 2009 at 8:30am before United States District Court Judge Patricia A. Seitz.

As part of the plea, the defendants admitted that from January 2001 until May 2007, they defrauded KRMC by utilizing their knowledge of, and access to, HCA’s computerized supply management system. Specifically, the Defendants manipulated the computer system so that KRMC would issue payments to two outside medical supply vendors, The Pharmed Group, Inc. (“Pharmed”) and Allied Medical Products, Inc. (“Allied Medical”), for medical supplies that were fraudulently ordered, and never actually delivered. To execute the scheme, the Defendants used the computerized supply management system to generate phony purchase orders for medical supplies, and to falsely record that such supplies had been delivered-in-full to KRMC by Pharmed or Allied Medical. Based on these false and fraudulent computer entries, KRMC’s parent company, HCA, Inc. (“HCA”), paid Pharmed and AMP the full amount for the false supply orders, totalling more than $5 million. The fraud proceeds were funnelled back to the Defendants and other co-conspirators through a series of shell corporations, including Soho Marketing, Inc. (“SoHo Marketing”), and Gator Sports Collectibles, Inc. (“Gator Sports”), controlled by members of the conspiracy. Members of the conspiracy then issued checks from SoHo Marketing and Gator Sports to the defendants and other members of the conspiracy and created fraudulent documents to disguise these payments as employee compensation.

Mr. Acosta commended the investigative efforts of the Federal Bureau of Investigation. He also acknowledged the cooperative efforts of Kendall Regional Medical Center and its sister HCA affiliates for their assistance in this investigation. This case is being prosecuted by Assistant United States Attorney Ryan K. Stumphauzer

Another Charged in $110 Million Health Care Fraud Scheme. Isn't Just the Tip of the Iceberg and List going on and on.




WASHINGTON – Three Miami area brothers who allegedly financed 11 corrupt HIV infusion clinics and a physician’s assistant who worked at those clinics have been charged in a $110 million HIV infusion fraud scheme, the Department of Justice’s Criminal Division and the U.S. Attorney’s Office for the Southern District of Florida announced today.

The indictment alleges that between January 2001 and November 2004, Carlos and Luis Benitez conspired to submit approximately $110 million in false and fraudulent claims to the Medicare program for HIV infusion services allegedly provided at 11 corrupt HIV infusion clinics that they owned and controlled. As part of the scheme, Carlos and Luis Benitez referred Medicare beneficiaries to the clinics and directed the beneficiaries be paid kickbacks to induce them to claim they received legitimate services at the clinics when in fact the HIV infusion services were either not provided or were not medically necessary. The HIV infusion clinics that they owned and controlled were: AH Medical Office Inc.; Advanced Medical Rehabilitation Center Inc.; Best Medi Corp.; Physician’s Health Med-Care; Physician’s Med-Care Inc.; Saint Jude Rehab Center Inc.; Global Med-Care Corp.; CNC Medical Corp.; G&S Medical Centers Inc.; Karla Medical Services Inc.; and Best Medicare Inc.

The indictment alleges that Jose Benitez owned and operated one of the eleven clinics, Advanced Medical, and assisted in submitting approximately $10 million of the false and fraudulent claims to the Medicare program for HIV infusion services that were not provided and for services that were not medically necessary. Thomas McKenzie was a physician’s assistant at the HIV infusion clinics owned and operated by Carlos, Luis and Jose Benitez. The indictment alleges that, at the direction of Carlos, Luis and Jose Benitez, McKenzie was responsible for training physicians and providers in how to make it appear that legitimate and appropriate medical services were being provided as well as overseeing the preparation of documents to make it appear that the services were actually rendered and medically necessary.

After obtaining the proceeds from their crimes, the indictment alleges that Carlos, Luis, and Jose Benitez engaged in a scheme to launder those proceeds by, among other things, transferring millions of dollars in proceeds to sham "marketing" and "management" companies that they owned and controlled and by transferring proceeds among the corrupt HIV infusion clinics.

Carlos Benitez, Luis Benitez, Jose Benitez, and Thomas McKenzie were charged with conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; conspiracy to commit health care fraud; and submitting false claims to the Medicare program. Carlos, Luis and Jose Benitez were charged with conspiracy to launder the proceeds of their crimes, and Carlos and Luis Benitez were each charged with money laundering. The indictment also seeks forfeiture of assets held by all defendants. Carlos and Luis Benitez each face a maximum sentence of 155 years in prison, Jose Benitez faces a maximum of 40 years, and Thomas McKenzie faces a maximum of 50 years.

This case is being prosecuted by Trial Attorneys Hank Bond Walther and John K. Neal of the Criminal Division’s Fraud Section, as well as Laurel Loomis Rimon and Constantine Lizas of the Criminal Division’s Asset Forfeiture and Money Laundering Section, with the investigative assistance of the FBI and the Department of Health and Human Services Office of the Inspector General. The case was brought as part of the Medicare Fraud Strike Force that has been operating in Miami since March 2007. The Strike Force is led by Deputy Chief Kirk Ogrosky of the Criminal Division’s Fraud Section in Washington, D.C., and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida.

Nativists, and Anti Immigrants. What part of Ilegal you do not Understand.!!!!!!!!!!!!



Most of Nativists, Anti Immigrants found that Undocumented(Ilegal) Immigrants were mostly a drain. Well Just Ilegal Billing, Ilegal fraud, ilegal benefits entitled to, ilegal claim, ilegal Kickbacks, Ilegal charges for services do not rendered to patient,

But they found greater ambiguity on whether Undocumented immigrants are good or bad for American society because they do not see the real facts. They rather create waves of flames of Anti Immigrant sentiment to our Society to see Undocumented people as a bad people.

Undocumented Immigrants has been persecuted, scapegoated, dimished, criminalized and labeled as a problem on Social Services specially Healthcare Services like Medicare and Medicaid. Well lets see the real facts.!!!!!!!!!!!!!!!!!!.

False Claims Act Returns $2 Billion in FY 2007.

The Justice Department has announced that $2 billion has been recovered under the federal False Claims Act in Fiscal Year 2007, of which $1.45 billion came from whistleblower-filed cases. The total amount returned to the U.S. Government under the False Claims Act since 1986 is well over $20 billion. Department of Justice data is actually very conservative, as it does not include billions of dollars in civil recoveries returned to the states or criminal fines imposed as a direct consequence of False Claims Act filings and prosecutions.

The cases below represent a "running tally" of False Claims Act cases compiled by the Taxpayers Against Fraud Education Fund for Fiscal Year 2007.

Amount in Millions $ Date Nature of the fraud Medicare Medicaid.

Bristol-Myers Squibb 328 9/28/2007 A total $515 million settlement, with $328 million to be paid under the Federal False Claims Act, and the state's getting $187 million. Fraud charges included off-label marketing, kickbacks, AWP drug pricing violations and several other frauds involving 50 drugs and a total of seven qui tam cases.

Amerigroup 172 3//14/2007 Judgment for $334 million including penalties. Amerigroup cherry-picked patients in violation of its HMO Medicaid contract, purposely avoided women in their third trimester of pregnancy because they cost more to insure. Note that this judgment is on appeal and reflects a $190 million penalty on top of a $144 million jury verdict.

Combined settlement with four orthotics companies: Smith & Nephew, Biomet, Zimmer, DePuy (Johnson & Johnson) 310 9/27/2007 $310 million total settlement of broad practice of kickback in the orthotics industry. Zimmer to pay 169.5 million, DePuy to pay $84.7 million, Smith and Nephew to pay $28.9 million, Biomet to pay $26.9 million. Stryker agreed to be monitored, but has entered no civil settlement.

Aventis (sanofi-aventis) 180 9/17/2007 Medicaid Average Wholesale Price case involving the anti-nausea drug Anzemet. Total settlement was for $190 million

Medco 155 10/24/2006 Shorting prescriptions, canceling prescriptions to avoid paying non-performance penalties, soliciting and accepting kickbacks from pharmaceutical manufacturers to favor their drugs, and paying kickbacks to health plans to obtain business. X X

Purdue Pharma 140.5 5/10/2007 Company "mislabeled" the drug saying it was less addictive than it was. This is a $634.5 million settlement, with $276 million to be forfeited to the United States, $160 million allocated to federal and state government agencies to resolve false claims for government healthcare programs and $130 million will go to resolving private civil claims. Of the 160 million to go to State and Federal FCA claims, $19.5 million is to go to the states.

Bill L. Harbert-owned construction companies 102 5/15/2007 Bid rigging for US AID paid for water and sewer systems installed in Egypt in the 1980s as part of the Camp David peace accords.

Oracle / PeopleSoft 98.5 10/10/2006 Provided false pricing information to GSA to obtain a federal contract.

ConocoPhillips 97.5 8/15/2007 Underpaid royalties owed on natural gas produced from federal and Indian leases

Omnicare / Specialized Pharmacy Services (Michigan) 52.5 10/5/2006 Improper billing, failure to credit Medicare for returned drugs, billing drugs for dead patients. X
Omnicare 49.5 11/14/2006 Illegal switching of generic pill to capsule forms of Zantac (ranitidine) in nursing homes and other facilities.

InterMune, Inc. 36.8 10/27/2006 Illegal off-label promotion of Actimmune. X X

Lourdes Perez, Provident Home Health Care Services Inc. and Tri-Regional Home Health
Care Inc. 33.8 10/11/2006 Medicare "bill mill" in which Medicare was billed for patients who were not homebound and for services her companies did not perform, creating false medical records to support the claims. X

Maximus Inc. 30.5 7/24/2007 Maximus billed DC Medicaid for targeted case management services that it either did not provide or had no records for.

Kerr-McGee Oil 30 1/25/2007 Jury verdict on case involving Kerr-McGee cheating the government out of millions of dollars in royalties on oil it produced in publicly owned coastal waters.

Robert I. Bourseau, Dr. Rudra Sabaratnam, and their two single-employee corporations, RIB Medical Management Services, Inc., and Navatkuda, Inc., 23.8 10/2/2006 Used false cost reports to bill Medicare for unreimbursable services at the Chula Vista psychiatric hospital formerly known as Bayview Hospital & Mental Health Systems. X

Akal Security Inc 18 7/13/2007 Akal violated terms of its contract to provide trained civilian guards at eight U.S. Army bases.

Harris County Hospital District 15.5 3/28/2007 Medicare Secondary Payer violations plus billing Medicaid for patients under custody of law enforcement.

Larkin Community Hospital in Miami and its current and former owners, Dr. Jack Michel, Dr. James Desnick, Morris Esformes and Philip Esformes 15.4 11/30/2006 Kickbacks X X

Aggregate Industries 15 7/27/2007 Total settlement of $50 million, of which $27 million will go into a special fund to be used to pay for future maintenance and repair of the Big Dig highway project, and an additional $8 million will be paid in criminal fines.

Jackson Memorial Health System 14.25 12/20/2006 Jackson Memorial was deliberately making use of unallowable or reopened cost reports, getting wrongful overpayments as a result. X

Ajax Paving Industries Inc. and Dan's Excavating Inc. 11.75 3/16/2007 Knowingly violated Disadvantaged Business

Enterprise (DBE) contracting requirements for federally funded construction
projects at Detroit Wayne County Metropolitan Airport

Cell Therapeutics 10.5 4/18/2007 Off-label marketing of Trisenox billed to Medicare.

Intergris Baptist Medical Center 10 11/28/2006 Inflated costs for organ transplants

Emory Worldwide 10 11/14/2006 Inflated bills for handling priority mail for USPS

Medicis Pharmaceutical 9.8 5/8/2007 Off-label marketing: Company promoted the use of a topical anti-fungal, Loprox, for diaper rash on children under the age of 10, without approval by the Food & Drug Administration.

American Medical Response Inc. 9 10/5/2006 Ambulance services fraud. X

KBR Inc. 8 11/29/2006 Overcharged the U.S. Army for logistical support in the Balkans during 1999 and 2000
Crane Co.
7.6 8/14/2007 Substandard valves sold to the U.S.

SCCI Health Services Corporation, and its subsidiary, SCCI Hospital Ventures Inc 7.5 1/7/2007 Kickback and self-referral (Stark violations) X

Raritan Bay Medical Center 7.5 3/16/2007 Purposefully inflated outlier charges for inpatient and outpatient care to make these cases appear more costly than they actually were.

PBSJ 6.4 1/25/2007 PBSJ submitted claims to the overstated overhead rates in its Government contracts.

Atlanta's Northside Hospital 5.75 10/20/2006 Kickbacks

Oakland City University 5.3 7/31/2007 University paid incentives to admissions recruiters contrary to federal regulations.

IBM & PriceWaterhouseCoopers 5.2 8/16/2007 Companies solicited and provided improper payments and other things of value on technology contracts with government agencies

Keystone Mercy Health Plan 5 10/27/2006 Medicaid HMO Kept Medicaid overpayments X
Cook County, Illinois 5 12/20/2006 County mismanaged a federally funded study involving pregnant drug addicts.

AIT Worldwide Logistics of Itasca, Ill. 4.2 10/20/2006 Kickbacks and bill padding.

St. Elizabeth Regional Medical Center (NE) 4 10/31/2006 Used false cost reports to overbill l Medicare for neonatal and burn units.

Scooter Stores 4 5/14/2007 Settlement includes $4 million in cash and $13 million in foregone Medicare payments to settle charges the company billed Medicare medically unnecessary power wheelchairs.

HealthSouth Corporation 4 11/3/2006 HealthSouth submitted fraudulent Medicare claims for prosthetic and orthotic devices - such as artificial limbs and braces - used to treat HealthSouth hospital inpatients X

Our Lady of Lourdes Regional Medical Center 3.8 5/9/2007 Billing Medicare, Medicaid and private insurance providers $2.5 million for unnecessary cardiac procedures, such as angiograms and angioplasties, on more than 70 patients.

Orphan Medical/ Jazz Pharmaceuticals Inc 3.75 7/13/2007 Aggressive marketing of Xyrem (GBH, the "date rape" drug) for unapproved use. Part of a total settlement of $20 million, including criminal.

Cabrini Medical Center 3.4 3/29/2007 Kickbacks billed as administrative services for referral of patients.

Korrect Optical 3.25 1/25/2007 Korrect Optical submitted false claims to the

Department of Veteran Affairs ( VA )through ophthalmic prescriptions for eyewear for veterans.

Dr. Daniel Nixon and other board members of the Institute for Cancer Prevention, Tatum, LLC and Weiser, LLP 3.2 1/17/2007 Unlawful receipt and use of federal grant money.

Electronic Data Systems Inc. and Travelers Casualty 2.85 1/23/2007 EDS was processing National Flood Insurance Program claims based on backdated policies written by Travelers.
Dey 2.8 4/26/2007 Settle charges of price inflation and defrauding Mass. Medicaid program (AWP).

Rural/Metro Corporation 2.5 6/11/2007 Kickback for referrals

David Rommel 2.48 11/13/2006 Dental practice fraud. Won by summary judgment.

Danbury Hospital (CN) 2.4 10/27/2006 Self-reported upcoding for septicemia, respiratory failure, respiratory infections and inflammations. X

Affiliated Computer Services, Inc 2.3 7/2/2007 ACS allegedly Submitted inflated claims for programs run by and through the U.S. Department of Agriculture (USDA), the U.S. Department of Labor (DOL), and the Administration for Children and Families of the U.S. Department of Health and Human Services. Self reported.

APAC Atlantic 2.25 10/3/2006 False asphalt testing

University of Miami Medical School 2.2 12/27/2006 UM sometimes billed for critical care services when patients were not critically ill or where critical services were not rendered. X X

Loma Linda Behavioral Medicine Center (Loma Linda BMC) in Redlands 2 4/26/2007 Fraudulently overbilled federal health insurance programs by manipulating cost reports.

O'Hara Regional Center for Rehabilitation, Health Care Management Partners, ORCR Inc., Solomon Health Management, Solomon Health Services 1.9 10/5/2006 Abuse and neglect and substandard nursing home services. X

Emeritus Corp 1.86 8/30/2007 False and inaccurate billing to the Texas Medicaid program.

COSMOS Corp 1.5 1/23/2007 COSMOS improperly charged government contracts for costs that dealt with the company's operations, and also shifted labor costs from private contracts to government contracts.

Crawford and Company 1.36 10/11/2006 Billing the government for health care services to federal employees at rates set by Crawford managers, rather than billing the actual time spent performing that service.

Ciena Healthcare Management 1.25 8/20/2007 Improperly billed Medicaid and Medicare for inadequate care of and services to residents at four metro Detroit nursing homes.

Bli Farms, Richard Bli and the estate of James E. Bli 1.229 11/29/2006 False crop insurance claims.

Lancaster Community Hospital 1.2 6/8/2007 Knowingly overbilled Medicare for physical therapy costs.

Lakewood Cheder School 1.2 10/31/2006 False information to obtain funds for preschool lunch program.

Robert E. Eberhart and Jonathan Holzaepfel, orthopedic surgeons and partners in
Seacoast Trust, and Thomas King 1 3/8/2007 HealthSouth paid higher than normal rent equivalent to income from referrals made by the doctors

Parkway Hospital, Inc 1 8/14/2007 Inflated hospital costs reports.

Environmental Management Inc. 1 4/2/2007 Overbilling and illegal disposal of chemicals in methamphetamine lab cleanups for DEA.

Dey 1 4/4/2007 Settlement of Hawaii FCA marketing the spread cases

Julio C. Melo, M.D., 0.984 7/23/2007 Billed Medicare for Evaluation and Management services that exceeded the number of hours there were in a day.

RightCHOICE Managed Care Inc. 0.975 1/31/2007 RightCHOICE paid higher fees to physicians serving government0insured patients than for other plans.

Comprehensive Cancer Centers 0.9 11/8/2006 Upcoding led to overbilling of Medicare for CCC services at Desert Regional Medical Center (owned by Tenet) X

Iftakhar Khan and Amjad Khan 0.825 1/9/2007 Owners of Livonia-based Michigan

Rehabilitation and Pain Management fraudulently billed Medicare. X

Green Valley Pavilion, LLC 0.55 5/14/2007 Forging and altering patient charts to maximize reimbursement from Delaware's Medicaid Program

Oregon Imaging Center 0.51 12/12/2006 Tests not ordered by doctor.

Moritz Embroidery Works 0.5 7/10/2007 False "Buy American Act" certification to the United States government for military and police emblems and patches.

John Dempsey Hospital 0.475 6/27/2007 Overbilled Medicare for chemotherapy treatment.

Colquitt Regional Medical Center 0.475 3/5/2007 Overcharged the government for services through CRMC's Home Health Office in Sylvester, GA X X

Hillsboro Area Hospital, in Hillsboro, Ill. 0.3 2/7/2007 Over billing for the treatment of Medicare beneficiaries who were diagnosed with pneumonia, sepsis, and renal failure. X

Beacon Ambulance Company. 0.219 3/29/2007 Use of one basic technician and a single Paramedic on ambulance run, and billing for two Paramedics.

Promark, Inc. 0.2 11/14/2006 Overstating warranty on epoxy paint to DoT

Riverview Cancer Center 0.165 10/5/2006 Upcoding and services not provided

LS Technologies 0.145 3/16/07 Submitted duplicate claims for two different subcontracts and was paid $50,000 based on these false claims.

Madison County, Alabama 0.11 2/19/2007 Diversion of money from "Working Connection," a welfare-to-work program.

Kansas City, Missouri School District 0.066 5/18/200 66,000 paid in money and over $13.6 in claims relinquished in E-Rate fraud case.

Armstrong Williams 0.035 10/22/2006 Failing to do contracted work for Dept. of Education

Dr. Roberto Ramirez 0.03 12/21/2007 False dental billing X X

Clark's Trading Company (Clark's 0.012 10/18/2006 Product substitution (meat) at Federal Bureau of Prisons.
Link: http://www.taf.org/total2007.htm

Why nobody exposed the root of the problem on Medicare and Medicaid? Rather than just blamed the people who's do not have a voice either a vote? Nativists, Anti Immigrants ranting by Ignorance rather than facts.!!!!!!!!!!




CoxHealth anticipates Medicare fraud settlement of about $60 million


SPRINGFIELD -- CoxHealth Systems says it is closer to ending a Medicare fraud investigation that the FBI and the U.S. attorney’s office have been conducting for more than three years. CoxHealth may be close to reaching a settlement that could cost it $60 million.

The federal government's investigation into CoxHealth Systems focuses on billing practices at one of its clinics but also delved into other areas. Investigators have been trying to prove, or force an admission, that Medicare was overcharged for certain procedures, and was billed for services that some physicians didn’t perform.

CoxHealth has been putting money away for fines, penalties or repayments since it learned about the investigation in late 2004. A settlement is in the works between Cox and the federal government in the neighborhood of 60 million dollars.

In a statement posted on a Web site for investors and stock analysts, CoxHealth says $60 million "is in the range where CoxHealth anticipates we may finally settle. CoxHealth accrued this amount in its financial statements over the last three years."

Financial records for 2005 and 2006 show CoxHealth put away $13 million both years for possible payments related to the case. That would mean, in 2007, CoxHealth had to have put the remaining $34 million aside for legal funds.

The U.S. Attorney's office says general protocol requires, in cases alleging Medicare's fund has been defrauded, settlement money would return to the Medicare fund.

CoxHealth says the negotiations are far from over. No one has publicly said when the two sides might agree on the final amount of a settlement

Walgreens Pays $35 Million, Settles Medicaid Fraud Allegations.


Walgreens shoppers Statement. Thank you for trusting Walgreens with your more valuable asset: Your Health. Failed to compliance with.

By paying $35 million, Walgreens, the self-proclaimed "Pharmacy America Trusts®" settled allegations by a pharmacist whistleblower that it unlawfully defrauded Medicaid by switching prescriptions for ranitidine, the generic form of the brand-name drug Zantac®, and fluoxetine, the generic form of Prozac®.

The United States, Puerto Rico, 42 states, and qui tam Relator Bernard Lisitza claimed that Walgreens improperly caused its pharmacies to switch Medicaid patients' prescriptions from ranitidine tablets to ranitidine capsules, and from fluoxetine capsules to fluoxetine tablets.

The alleged Medicaid fraud covered by the settlement lasted for more than four years, from July 16, 2001 through at least December 31, 2005. The Complaint was brought by the Relator in 2003, under "qui tam" provisions of federal and state False Claims Acts, after he uncovered the conduct and reported the problem to the government. The investigation and prosecution was led by the Attorneys General offices in Florida, Illinois, Ohio, Texas and several other states, and by the United States Attorney's Office in Chicago. Relator Lisitza pursued the case with the assistance of his attorneys, Michael I. Behn and Linda Wyetzner, of Behn & Wyetzner, Chartered, in Chicago.

According to the government, Walgreens switched drugs because the United States and various individual states had imposed price limits for the amounts that Medicaid would pay for the tablet form of ranitidine, and for the capsule form of fluoxetine. By substituting a drug dosage form with a Medicaid price ceiling for another form with no ceiling, Walgreens received substantially higher reimbursement amounts from various state Medicaid programs. For example, the Complaint states that the switches resulted in the government paying Walgreens as much as four times more for ranitidine capsules than for tablets.

Ranitidine tablets were the standard form of the medication. Capsules were rarely prescribed. Likewise, fluoxetine capsules were the standard forms of the drug. Legally, tablets and capsules are different drugs, and state pharmacy laws generally prohibit substituting tablets for capsules or capsules for tablets.

As different drugs, tablets and capsules also have different prices. State Medicaid regulations determine how much a pharmacy is paid for a particular prescription. States follow federal Medicaid reimbursement limits when they are set by the federal government for certain popular generic drugs. The United States, through the Centers for Medicare & Medicaid Services ("CMS") sets a Federal Upper Limit price for ranitidine tablets and fluoxetine capsules. State Medicaid programs followed these federal price limits. There were no price limits for ranitidine capsules or fluoxetine tablets, as they were virtually never prescribed.

The case alleges that Walgreens' ranitidine drug switching violated federal and state False Claims Acts. False Claims Acts prohibit submitting false or fraudulent claims to the government. Here, the United States, individual states and Relator Lisitza alleged that Walgreens violated federal and state False Claims Acts by claiming Medicaid reimbursements for the form of the drug with the higher price when the lower-priced ranitidine tablets should have been provided.

False Claims Acts are designed to deter fraud against the government and provide substantial remedies against those who lie, cheat and steal from the public treasury. The government can collect up to three times the amount it was defrauded in addition to civil penalties of $5,500 to $11,000 per false claim.

Major recoveries have been achieved through incentives and protections in the laws designed to encourage whistleblowers to come forward with information about fraud against the government. Whistleblowers can receive a substantial percentage of the recovery, ranging from 15 to 25 percent when the government pursues the case with the whistleblower. Pharmacists like the Relator in this case have brought numerous successful actions, resulting in taxpayers recovering hundreds of millions of dollars in improper government payments

WOMAN ARRESTED ON FEDERAL FRAUD CHARGES FOR DEFRAUDING MEDICARE OUT OF $12 MILLION




This morning, special agents with the FBI and IRS-Criminal Investigation arrested the operator of Wescove Home Health Services at her home in Covina on health care fraud and money laundering charges stemming from her participation in a scheme that defrauded Medicare out of more than $12 million.
Felcoranenda “Nenda” Estudillo, 50, a registered nurse, ran Wescove, which was based in the city of West Covina. Estudillo was Wescove’s administrator, responsible for the home health agency’s day-to-day operations and Medicare billing activity. In a 36-count indictment returned earlier this week and unsealed today, Estudillo is charged with conspiracy, health care fraud, money laundering, the structuring of cash transactions and falsifying records to maintain Wescove’s participation in the Medicare program.
According to the indictment, Estudillo paid marketers to recruit Medicare beneficiaries to receive benefits they were not eligible to receive. The marketers recruited and referred Medicare patients to Wescove, even though the beneficiaries were not confined to the home and did not need skilled nursing or therapy services. According to the indictment, Wescove billed Medicare for home health services provided to beneficiaries who were not confined to their homes, did not qualify for or need those types of services, or never received any services.
Estudillo allegedly paid marketers fees ranging from $300 to $4,800, based upon the amount that Wescove was able to fraudulently bill to Medicare. Estudillo would pay marketers higher fees for patient referrals that resulted in increased Medicare billings. She also allegedly paid referral fees that she booked as “skilled nursing” payments to conceal the payment of kickbacks.
According to the indictment, some Medicare beneficiaries were paid cash to sign up for home health services after being recruited by the marketers to receive services they did not need or did not receive. Estudillo allegedly paid more than $3.1 million to at least six marketers for the referral of Medicare beneficiaries.
The indictment charges Estudillo with 11 money laundering counts and 12 cash-structuring violations. These result from allegations that Estudillo laundered the proceeds of her Medicare billing scheme to promote the scheme, conceal the source of payments made to marketers and to herself, and avoid the payment of taxes . According to the indictment, Estudillo paid cash to some of the marketers who referred patients. To facilitate this, Estudillo devised a check-cashing scheme involving the marketers and Wescover employees in which they negotiated Wescove checks, obtained cash, and Estudillo used some of the cash to pay the marketers and patients. Estudillo allegedly wrote checks to marketers and employees in amounts less than $10,000 in an effort to avoid the currency transaction reporting requirements that banks are required to follow.
Estudillo is expected to make her initial court appearance this afternoon in United States District Court in Los Angeles.
If convicted of all counts in the indictment, Estudillo faces a statutory maximum penalty of 430 years in federal prison.
The investigation of Estudillo was conducted by IRS-Criminal Investigation and the Federal Bureau of Investigation

Why Nativists and protectionists poisoned the Immigration debate rather than a constructive solution to the problem?






For years Undocumented Immigrants has been accused that they are drained the Social Services like Medi care and Medi Caid but the big part of the equation that no one said anything is Health Care fraud.!!!!!!!!!! Why?.

I had been exposed several of Health care frauds ending up in Billions of dollars in taxpayers pocket expenses and scapegoating the Undocumented Immigrants.

The undocumented people are denied almost all benefits but, yet they are a huge contribution to the economy. The point is that Corporate America Is treating immigrants like slaves. Therefore segregation is not over.

So is not the right to live anywhere one wishes as long as one is peaceful human; right? Who is it to say those in power, those more bigoted or wealthy can tell another human where they are allowed to pursue happiness and peace. Deny welfare or medical benefits but work hard, paid taxes, get lower wages, then being persecuted, scapegoated, diminished and demonized.!!!!!!! Those are our Human Values?.

It's pretty clear that we need immigrants from a macroeconomic level, but we need a Humane comprehensive Immigration reform..


A billion here, a billion there, and pretty soon you're talking real money," the late Senator Everett Dirksen is supposed to have said.*

And so it is today with health care fraud, a burgeoning crime plague that's adding up in a big way, big-ticket scheme after big-ticket scheme, essentially costing you money every time you walk into a hospital or doctor's office or fill a prescription, whether you know it or not. The National Health Care Anti-Fraud Association estimates that this fraud collectively costs Americans between $60 billion and $100 billion a year. Ouchhhhhhhhhhh.

We're the primary investigative agency, with jurisdiction over federal programs like Medicare and Medicaid (both big targets) and private insurance programs, all the while working hand-in-hand with plenty of public and private sector partners.
Locally, our agents team up with their investigative counterparts on health care fraud working groups, task forces, and strike teams to tackle the biggest scams. Nationally, we have a Health Care Fraud unit at FBI Headquarters that helps support and coordinate field investigations and leads field-wide initiatives.

An anniversary, of sorts. It was 15 years ago, actually, that we ran our first major health care fraud investigation—"Operation Gold Pill." It involved about a thousand "professional patients" getting prescriptions for medicine they didn't need and having them filled at pharmacies that billed Medicare for much more than the cost.
The patients then sold the medication at a discount to dealers, who turned around and hawked it on the street or repackaged it and sold it back to the pharmacies—a full circle of crime.

Fifteen years ago this month, as the investigation came to a head, hundreds of FBI agents and other law enforcement professionals fanned out across the nation, making more than a 100 arrests and seizing more than $30 million in cash and assets.
By today's standards, that's pocket change. But soon, more resources came our way, and we were in the business of busting health care fraud full-time.

A million ways.... Today, the schemes are more complex, more time-consuming, and more costly than ever. "There's literally millions of ways to defraud health care," our Associate Deputy Director Joseph L. Ford told reporters this week. "They come up with new ways every day." Just a very few examples of what we see:

Hospitals, doctors, pharmacists, and other care providers submitting fake bills for services never rendered—or overcharge;

Service providers charging insurance for unnecessary and costly procedures;

Doctors selling prescriptions to patients for cash;

Companies billing insurance for expensive equipment but providing poor substitutes;
Crooked docs enticing patients to visit their offices for "free services" or gifts, then stealing their personal information and using it to file fake claims

BILLIONS OF DOLLARS ARE STOLEN FROM MEDICARE AND ULTIMATELY FROM U.S. TAXPAYERS BUT THEY ARE NOT UNDOCUMENTED IMMIGRANTS !!!!!!!






TWO MEN SENTENCED IN MILLIONAIRE MEDICARE FRAUD SCHEME. WHRN THE ANTI IMMIGRANTS WILL START TO ACTING MORE RATIONAL AND USED A COMMON SENSE RATHER THAN BEING BIGOTRY, IGNORANCE AND LACK OF KNOWLEDGE.


R. Alexander Acosta, United States Attorney for the Southern District of Florida, and Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, announced today that on April 2, 2008 the Honorable Adalberto Jordan sentenced defendant Michael Labrada, 27, of Miami to a 97 month prison term and Miguel Castillo, 42, of Miami, to a 57 month prison term for their participation in a multi-million dollar health care fraud and money laundering scheme.

Labrada was sentenced in connection with two criminal cases. In the first case, Labrada was convicted of conspiring with Angel Castillo, Jr. to commit health care fraud by serving as a straw owner of a medical equipment company known as JJ & D Medical Equipment, Inc. The company submitted more than $6.8 million dollars in bogus claims and received approximately $1.6 million in payments. In the second case, Labrada was convicted of money laundering charges in connection with a $2.3 million laundering scheme orchestrated by his co-defendant, Angel Castillo, Jr.

Miguel Castillo was also convicted of related health care fraud and money laundering conspiracy charges. In addition to serving as a straw owner of a medical equipment company, Miguel Castillo collected hundreds of thousands of dollars in fraud proceeds from check cashers at the direction of his cousin and co-conspirator, Angel Castillo, Jr.

Last month, Angel Castillo, Jr. was sentenced to a 235 month term in connection with his ownership of more than eight durable medical equipment companies in Miami during 2005 and 2006. The companies collectively submitted in excess of $48,000,000 in false claims by way of two Miami based medical billing companies. In reality, the companies never provided any Medicare patients with any type of equipment or service. Angel Castillo Jr. used a series of straw owners to conduct banking transactions and conceal his ownership of the companies.

After receiving more than $7,000,000 from the Medicare program, Angel Castillo, Jr. then laundered the proceeds of the scheme by using friends, family and other associates, including various bank employees, to cash hundreds of checks. In some cases, Castillo’s associates needed duffel bags to carry the cash out of local banks.

Co-conspirators, Giovanni Guerrero, Javier Roberto More, Angel Hernandez, Juan A. Zaragoza have all pled guilty to related health care fraud and money laundering offenses in the past months. The case is being prosecuted by Special Assistant United States Attorney William J. Parente Jr. of the Federal Bureau of Investigation

How many immigrants, legal and Undocumented, get how much health coverage from where and what does it cost?

In response to that. This should be no surprise since 45 million AMERICANS are currently uninsured which restricts their access to fundamental preventative health care services. This has lead to the inefficient and expensive use of other services (i.e. ED) and has negatively impacted public health (regardless of immigration status). This is one of their assumptions that Many Undocumented immigrants are overwhelming the healthcare system and driving up the cost. is not true. "Vulnerable populations" such as "infants, youth, women, indigenous people, the very poor, the elderly and disabled do not have health care as well and are a part of the equation. In a recent poll that expressed that the majority thought that Undocumented immigrants were 50 percent responsible or more for the uninsured treated in hospitals leaves one with the question of its validity and wonder which portion of the population did this statistic come from.

The fact of the matter is that the most predictive factors in defining access to quality health care are income, zip code and race. White America for the most part have been the main part of the population who have lived in the better areas where health care has thrived at its peak. Depending on where you live will have a strong influence of the type of health services you will receive, anyway. When looking at the history of the United State concerning the availability of health care, it needs to be pointed out that undocumented immigrants have truly not been the first in line for anything. Income is a factor as well on the determination of who will receive health care, the statistics reveal blacks have the lowest median household income at 31.905, compared to the median for Latinos at 33,820, Asians at 47,631 and whites at 53,975. Although these household figures are not impressive the availability leans toward white America in being able to receive and have access to heath and all of its added benefits. The country with the most developed knowledge base is the US, and with all the advanced technology racial hidden biases exist influencing the choices made by scientist and industry as well. This has a trickle down affect to the front line of provided health care, lets look at some examples of this fact. On the front lines Whites are three times as likely to undergo bypass surgery that non-whites. Non-White patients seeking admission to nursing homes experience greater delays before placement that White patients. Doctors are less likely to do breast cancer screening for Hispanic women that for White women. Non-White pneumonia patients are seen less in hospitals that Whites, and finally, poor urban blacks and Hispanic neighborhoods have about 24 physicians per 100.000 compared to 69 physicians per 100.000 for poor white communities (Vernellia R.Randall, pg 1-8). It would appear that the cost of health care insurance is being driven up by the ones who are in line first and can afford it. The portion of the population that don't have access to adequate health care that provides the use of the most advanced technology in the world can't possibly be the cost drivers.

let's focus on the true problem at hand. Sadly the state of our failing healthcare system will place the blame on a minority with little to no political voice, despite their immense contributions to our economy. More concerning is the accusation that Undocumented immigrants are placing an undue burden on the U.S. health care system as a whole. An accusation that is largely unconfirmed, according to Mohanty, Assistant Professor of Medicine at UCLA. Cody so far has been the only one to solely address the issue of our failing health care system for what it is FAILING. Why is this? Employers, consumers and governments at every level are straining under the burden of a health care bill that is growing at a pace five or six times the rate of inflation. As the price tag for insurance increases employers pass the additional cost burden on to their employees; forcing workers to dig deeper into their pockets. The outcome is deleterious. Millions who can't continue to dig forgo coverage altogether and chance that their families will stay healthy.

the US spends nearly $5,000 per person on health care -- more than twice the amount of some other industrialized countries. But our life expectancies are horrible. Canada, for example, spends about 60 percent less per person than the United States but has longer life expectancies. Where is the return on investment? Why is the system failing us and our health? New medical technologies may be responsible for as much as 50 percent of U.S. medical cost growth. In addition, prescription drugs represent the fastest growing part of the health care bill, with Americans paying the world's highest prices for medication. While the industry says it needs to charge high prices to finance research and development, the largest pharmaceutical companies in 2002 spent 14 percent of their revenues on research and development while devoting 31 percent to marketing and administration.

The contributions of undocumented immigrants and the benefits they provide to the U.S. economy more than balance the health care resources they consume. In fact, the Social Security Administration has reported $56 billion in annual earnings from this population that help to generate almost $7 billion annually in Social Security tax revenue and an additional $1.5 billion annually in Medicare taxes. Also, undocumented immigrants contribute at least $300 billion to the U.S. gross national product annually.

ANOTHER MILLIONAIRE MEDICARE FRAUD AFFECTING TAXPAYER POCKETS. WHY WE CONTINUE TO BLAMING UNDOCUMENTED IMMIGRANTS?

MIAMI DME OPERATORS CHARGED IN $11 MILLION MEDICARE FRAUD CASE
December 04, 2007

R. Alexander Acosta, United States Attorney for the Southern District of Florida, Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, and Melody Jackson, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General, Atlanta Region, announced that defendants Alicia Rodriguez and Juan Viera were held without bond in connection with an Indictment unsealed last week charging them with Medicare fraud and money laundering. Defendants Rodriguez and Viera are both charged with five counts of mail fraud and four counts of money laundering. Defendant Rodriguez is also charged with one count of obstruction of a criminal health care fraud investigation. The charges stem from a multi-million dollar Medicare fraud case involving two Miami medical equipment companies, R&N (“R&N”) Medical Supplies, Inc. and A&S (“A&S”) Medical Services, Inc.

According to the Indictment and evidence proffered at the pretrial detention hearing, in early 2006, defendants Rodriguez and Viera purchased R&N and A&S for the purpose of submitting fraudulent Medicare claims. To conceal their ownership and control of these companies, they used a nominee owner on the corporate, Medicare, and banking documents for the two companies. Over the 5-week period between March 7, 2006 and April 13, 2006, the defendants used these two companies to submit more than $11 million in fraudulent Medicare claims. These claims sought reimbursement for medical equipment that had not been ordered by a physician, was not medically necessary, and was not delivered as claimed.

This fraud was uncovered when large cash withdrawals from the R&N bank account caught the attention of law enforcement in April 2006. Specifically, on April 7, 2006, $110,000 in cash was withdrawn from the R&N account. When the agents tracked down the purported owner and corporate officer of R&N, the individual was living in a small efficiency apartment without air conditioning or running water. When served with a subpoena requiring the production of R&N’s business records, the individual admitted that she was not the true owner of R&N. She explained that she had been recruited by defendant Alicia Rodriguez to pose as the owner of both R&N and A&S. In return for her services, she received occasional cash payments from defendant Rodriguez.
Thereafter, the individual agreed to cooperate and arranged a meeting with defendant Rodriguez to discuss the subpoena. This meeting was recorded. During this meeting, defendant Rodriguez directed the individual to provide false information to the federal agent and the grand jury concerning R&N. Defendant Rodriguez repeatedly warned the individual not to mention her name or “Juan’s” name to the government. At the conclusion of the meeting, defendant Rodriguez handed the individual an envelope containing $4600 in cash and suggested a trip to Puerto Rico.
Mr. Acosta commended the Federal Bureau of Investigation and the Department of Health and Human Services for their investigation of this matter. This case was prosecuted by Assistant United States Attorney Adrienne Rabinowitz.
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov

http://miami.fbi.gov/dojpressrel/pressrel07/mm20071204a.htm

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AMBULANCE COMPANY AND OWNER SENTENCED FOR HEALTH CARE FRAUD ABUSING TAXPAYERS POCKETS.

TYLER, TX -- United States Attorney John L. Ratcliffe announced today that a 47-year-old Forney man has been sentenced to 97 months in federal prison for health care fraud in the Eastern District of Texas.

ANURA ANDRADI and his ambulance company, Doctor's Ambulance Service, LLC, aka Doctor's Ambulance Service Corp. were sentenced by United States District Judge Michael Schneider today after previously being found guilty by a jury of 40 counts of health care fraud.

According to information presented in court, from March 2004 to December 2005, Andradi and Doctor's Ambulance Service defrauded Medicare and the Texas Medicaid program by certifying that dialysis patients met the Medicare and Medicaid guidelines for ambulance transports, when in fact, they did not.

The jury also found that Andradi and Doctor's Ambulance Service obtained $750,000 from the fraudulent scheme and that five ambulances and over $220,000 seized from various bank accounts were derived from the proceeds fraudulently obtained by the defendants. Andradi was sentenced to 97 months in federal prison and ordered to pay restitution in the amount of $2,710,015. Doctor’s Ambulance Service was placed on probation for 5 years and ordered to pay restitution of $2,710,015.

MAULIE HAPPAWANA, 46, of Plano, and RON PYATT, 39, of Grand Prairie, were also sentenced for their roles in the health care fraud scheme. Happawana and Pyatt previously pleaded guilty in federal court to conspiracy to commit health care fraud. From March 2004 to December 2005, Happawana and Pyatt defrauded Medicare and the Texas Medicaid program by certifying that dialysis patients met the Medicare and Medicaid guidelines for ambulance transports, and, in fact, they did not. Happawana was placed on probation for 5 years and ordered to pay restitution of $54,808.57. Pyatt was placed on probation for 3 years, with 180 days of home confinement, and ordered to pay restitution of $12,553.74.

Special Agents from the Federal Bureau of Investigation, the Internal Revenue Service, Criminal Investigation, United States Department of Health and Human Services, Office of the Inspector General, and the Texas Attorney General's Medicaid Fraud Control Unit investigated this case. Assistant United States Attorneys Terri L. Hagan and Kevin McClendon prosecuted the case.