Thursday, April 12, 2018

Pharmacy Owner And Pharmacist Sentenced To 160 Months In Prison For $4.3 Million Pain And Scar Compounding Creams Where Referral Payments Received When TRICARE Insurance Billed

The compounding cream cases where pharmacies engaged in marketing to obtain patients and where there were billings to TRICARE insurance continue. 

In a recent case, after a five-day trial of one count of conspiracy to pay health care kickbacks and paying and receiving kickbacks, a long sentence was handed out by a federal district court judge to a pharmacy owner and pharmacist.  

On March 30, 2018, the owner of a Florida pharmacy, Larry B. Howard, also a licensed pharmacist, was sentenced by U.S. District Judge Paul G. Byron to serve 160 months in prison and ordered to pay $4.3 million in restitution for his role in this case.

Sunday, April 8, 2018

Two Los Angeles Executives of Provider of Substance Abuse Treatments Billed to Drug Medi-Cal Indicted by Grand Jury

The Drug Medi-Cal program has been under a lot of scrutiny since 2013 when it was the subject of investigative reporting. In 2014, significant changes and audits were made.  Many facilities were closed. However, it seems that there are still criminal filings coming out of those past audits.

On March 29, 2018, two executives at a South Los Angeles company that offered alcohol and drug abuse treatment services were indicted on federal charges that allege they defrauded the Medi-Cal program from 2009 to 2015 by submitting bills seeking more than $2 million for services that did not qualify for reimbursement or simply were never provided. An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proven guilty in court. 

Saturday, March 31, 2018

Michigan Home Health Agency Assistant Director of Nursing Sentenced to Three Years for Role in Paying Kickbacks With $1.6 Million in Billings to Medicare

The assistant director of nursing of a Michigan home health agency, Juan Yrorita, age 63, was sentenced to 36 months in prison on March 29, 2018 by U.S. District Judge Drain for his role in a case involving approximately $1.6 million in Medicare claims for home health services that were procured through the payment of kickbacks, and that were also allegedly medically unnecessary and not provided.

Mr. Yrorita plead guilty after four days of trial to one count of conspiracy to commit health care fraud and wire fraud. As part of his guilty plea, Mr. Yrorita admitted that his co-conspirators at Anointed Care Services (Anointed), a Detroit-area home health agency, paid kickbacks to recruit Medicare beneficiaries.  Mr. Yrorita further admitted that as Anointed’s assistant director of nursing, he falsified medical records to support Anointed’s fraudulent claims to Medicare for services that were medically unnecessary and never provided. According to the evidence at trial, Anointed submitted approximately $1.6 million in false and fraudulent claims to Medicare. 

Tuesday, March 20, 2018

United States Resolves Civil Claims That Philadelphia Cardiologist Billed Medicare For Unnecessary Stent Procedures After Voluntary Self-Disclosure

Vidya Banka, M.D., a cardiologist and former director of Pennsylvania Hospital’s cardiac catheterization lab, has entered into a civil settlement agreement with the United States to resolve allegations that he improperly submitted Medicare claims for unnecessary cardiac stent procedures.  Here is the U.S. Attorney's Office press release about this case.

The University of Pennsylvania Health System (“UPHS”), which owns Pennsylvania Hospital, brought the matter to the United States’ attention through a voluntary self-disclosure relating to conduct from 2010 to 2012. In January 2017, UPHS reached a separate settlement with the United States. The United States then continued to investigate Dr. Banka and it resulted in this settlement where he pays $126,617 and agrees to a 5 year OIG exclusion.  

Voluntary self-disclosures are obviously not a free pass for the individuals involved and the hospital's self-disclosure did not protect the provider from exclusion.  The exclusion for a cardiologist is a tough consequence given that it will make it impossible for him to perform any procedures at any hospital that accepts Medicare or government funding.

Thursday, March 15, 2018

Los Angeles Dentist Charged in Federal Health Care Fraud Case

On March 12, 2018, a Los Angeles dentist was charged in federal court with six counts of health care fraud and two counts of aggravated identity theft. The identity theft counts are usually added in these cases since they add additional and potentially mandatory prison time which increases the pressure on those charged to plea. An Indictment is not evidence and the dentist is presumed innocent. Here is the link to the U.S. Attorney's Office Press Release.

San Diego Doctor and Seven Others Arrested for Allegedly Prescribing Opioids to Homeless, Dead and Incarcerated People With Medications Then Sold On the Street

The United State's Attorney's Office in San Diego has recently charged a physician and seven others in a case involving a clinic where pain medication prescriptions were then diverted.  Here is the press release from the U.S. Attorney's Office on the case. An Indictment is not evidence and the doctor and others are presumed innocent.


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